The sunshine cure

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I wrote this feature for Nature Medicine after receiving a poorly-written email extolling vitamin D’s benefits. The writer was so impassioned, though, that I was intrigued. This ran in the April 2007 issue. You can view a pdf version of the article here.

Could ten minutes of sunlight a day be all that’s needed to fight multiple sclerosis, cancer and tuberculosis? Apoorva Mandavilli discovers the growing interest in vitamin D’s many virtues.

Long before antibiotics turned tuberculosis (TB) into a curable disease, a Danish scientist found an unusual way to treat it. In 1895 Niels Ryberg Finsen, then just 35, discovered that light from an electric arc lamp cured most people with TB of the skin. Over the following six years, he successfully treated 804 patients.

Nobody understood how the treatment worked, and the condition, lupus vulgaris, was relatively rare. But TB was such a fearsome scourge at the time that Finsen’s discovery won him the 1903 Nobel Prize in Physiology or Medicine. It also began the trend of sending those sick with TB to recover in sanatoriums housed in sunny locales.

It’s only now, more than a century later, that scientists are beginning to understand why Finsen’s method worked.

“It had to be through vitamin D,” says Barry Bloom, dean of the Harvard School of Public Health.

Last year, Bloom and his colleagues published evidence suggesting that vitamin D, made in response to sunlight, stimulates the production of a compound in the body called cathelicidin, which can kill various viruses and bacteria, including the TB microbe (Science 311, 1770– 1773; 2006).

It’s not often that you hear scientists of Bloom’s caliber extolling the virtues of a vitamin; that’s more commonly associated with over-anxious parents or ardent fans of alternative medicine.

Vitamin D may be best known for its role in harnessing calcium from the diet to build strong bones. But Bloom’s report is one of several in the past few years published in top journals— including the New England Journal of Medicine, Journal of the American Medical Association and Nature Immunology—that suggest a far meatier role for the vitamin in the body’s defense against diseases such as tuberculosis, multiple sclerosis (MS) and cancer.

“I think there’s an emerging mainstream acceptance of vitamin D as an immune- regulating factor,” says Eugene Butcher, professor of pathology at Stanford University. “The only people who are going to be skeptical of it are people who haven’t bothered to read the literature in the last five years.”

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Held to ransom

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(This Opinion column ran on Nature’s news site on March 26, 2007. You can download a pdf of the original post.)

A pharma giant’s decision to withhold new drugs from Thailand will only hurt patients, says Apoorva Mandavilli.

Is there ever a good enough reason to deny life-saving medicines to an entire country’s citizens? I say no. But it seems pharmaceutical giant Abbott begs to differ.

The Chicago-based company decided on 14 March not to introduce in Thailand any of its seven new drugs — including an antibiotic, an important AIDS drug called Kaletra and medicines to treat blood clots, kidney disease and high blood pressure. Without this crucial registration, the drugs cannot be imported to or sold in that country.

It seems to me that Abbott is, in effect, holding millions of Thais’ lives hostage to force their government to respect its patents. This is good business?

The price of drugs varies from place to place.

What’s shocking to me is that the company is making no bones about the fact that its decision is retaliation against Thailand’s decision in January to issue ‘compulsary licenses’ allowing some locals to import or make cheap copies of Abbott’s new version of Kaletra. “This matter is about intellectual property and the integrity of the patent system,” Abbott spokeswoman Melissa Brotz said in a statement.

Lofty words, but I’m reminded more of a schoolyard fight.

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India’s watchdog: A breath of fresh air

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(I met Sunita Narain, the charismatic leader of the Center for Science and Environment, while on a reporting trip to Delhi about Indian science. She’s extremely press-savvy, so I was certainly being shown what she wanted me to see, but after several disheartening interviews with government officials about AIDS and other pressing issues, I couldn’t help but be impressed with her efficient and single-minded approach. Nothing is simple in India, as even this article, which began as a straightforward profile of this organization, shows. The feature appeared in Nature in February 2007. You can download a pdf of this article.)

How often does independent research change laws as well as minds? A lobby group in Delhi is forcing the Indian government into new regulations. Apoorva Mandavilli meets its leader.

Sunita Narain

A decade ago the city of Delhi was choking. Fumes from the growing traffic rendered the air thick and foul with toxic chemicals, earning India’s capital city the dubious distinction of being the fourth most polluted city in the world. Levels of fine particles in the air were nearly 17 times higher than the permissible maximum. You could almost feel them as you breathed.

Visit Delhi today, and the difference is palpable. Green-striped buses and auto rickshaws rush past powered by compressed natural gas. Levels of sulphur in diesel have been brought down from 2,500 parts per million to 500 parts per million. Concentrations of particles in the air are still three times the national standard, but more bearable — the air feels unmistakably cleaner.

The improvement is largely due to the efforts of one small non-governmental organization, the Centre for Science and Environment (CSE). Founded by the science journalist Anil Agarwal in 1980, the Delhi-based group launched a relentless campaign in 1996 to replace diesel in Delhi’s public transport with a cleaner fuel: compressed natural gas. Its headline-grabbing tactics were what you might expect from a group founded by a science journalist: at one point it hired a booth at a Delhi car show and offered attendees lung tests. In April 2002, after years of legal battles, India’s Supreme Court forced Delhi’s public vehicles to switch to compressed natural gas. “It’s undoubtedly one of the most influential organizations in the country,” says Mahesh Rangarajan, a former Rhodes scholar and commentator on Indian politics based in Delhi.

So how did a small band of campaigning journalists evolve into a respected environmental pressure-group powerful enough to change laws and send multinational companies running for cover?

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DDT is back

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(This article was #29 in Discover Magazine’s top 100 stories of 2006.)

More than 30 years after the use of DDT was abandoned in many countries, the much-maligned pesticide is making a comeback. In September the World Health Organization openly endorsed indoor spraying of DDT, saying it is not only the best weapon against malaria, it is also cheaper and more effective than other insecticides. The announcement followed a similar move in May by the United States Agency for International Development (USAID).

One of the reasons for the more aggressive stance is President Bush’s Malaria Initiative, launched in 2005 after Congress reproved USAID for spending the lion’s share of its budget on operational costs—and less than 8 percent on the insecticides, bed nets, and medicines that would actually save lives. In 2007, USAID plans to spend more than $20 million on indoor spraying—up from less than $1 million spent in 2005.

Many environmental groups support the use of DDT for malaria—but only in the short term. Meanwhile, USAID representatives say that, when used properly, the chemical poses little risk to the environment or to human health. “Until we find that it is hazardous,” says Admiral Tim Ziemer, coordinator of the President’s Malaria Initiative, “it’s unconscionable not to use something that can save lives.”

Polio’s return traced to lapses in India

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(This article was #60 in Discover Magazine’s top 100 stories of 2006.)

In May a 39-year-old man in Namibia tested positive for poliovirus, marking the country’s first case in 10 years. Since then, the outbreak there has reached 20 confirmed cases.

This year 10 other formerly polio-free countries are once again battling the disease. Genetic sequencing has traced cases in five of the countries, including Namibia, to a polio strain in India, where the virus remains endemic. As of October 2006, a total of 358 cases have occurred in the poor, densely populated north Indian state of Uttar Pradesh alone, up from 29 in 2005.

The World Health Organization has taken India to task, saying its outbreak is endangering efforts worldwide to keep the disease at bay. To protect a high-risk community from polio, at least 95 percent of the children must be vaccinated; but in late 2005 and early 2006 the vaccination rates in Uttar Pradesh dipped to between 85 and 90 percent.

The Indian government, vowing to eliminate polio by 2007, has discussed a pilot project using an injectable vaccine in addition to oral drops. The injectable vaccine is thought to offer better protection against polio infection in children with diarrhea, which is common in the area.

Premature medication

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(This Opinion column ran on Nature’s news site on December 22, 2006. You can see the original post here.)

Handing out experimental drugs to desperate patients is not a good idea, says Apoorva Mandavilli.

At first glance it seems only kind and right to let people with serious illnesses take whatever medicines they want. Some have campaigned so hard for this that the US Food and Drug Administration agreed on 11 December to let patients buy experimental drugs direct from the manufacturer when there are no other options available.

But this could have some terrible consequences.

Yes, the humanitarian argument for giving access is compelling. And yes, on an individual basis, it seems cruel to deny a medicine to someone who is suffering. But if the drug hasn’t been properly tested, how do we know it won’t aggravate the illness or, worse still, prove fatal to the people who take it? It may even actively discourage companies from investing in proper trials for those drugs where the only customers are desperate patients.

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Your first dose…

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(This is the post I wrote launching Spoonful of Medicine, Nature Medicine’s blog. You can see the original post here.)

Hello everyone!

Welcome to ‘Spoonful of medicine’, where we hope to enlighten, entertain and occasionally exasperate you with our comments on biomedical research and public health.

We hope you’ll be active participants as well, letting us know when we’ve made sense and, of course, when you think we’re stark, raving mad. We hope the proportion is at least slightly more of the former.

Initially, at least, most entries will be posted either by me, Apoorva Mandavilli, or by my colleague, Charlotte Schubert. I am the news editor and am responsible for pretty much everything you read in our news section. You can read more about me here.

Charlotte edits the News & Views section, which involves much editing of copy written by scientists. She’ll say hello soon… you can read more about her here.

Let the games begin…

Save me from myself!

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(This Opinion column ran on Nature’s news site on December 5, 2006. You can see the original here.)

New York is cutting trans-fats from restaurant menus to cut down on heart disease — what a good idea.

I’m so lucky I live in a city that, with or without my consent, seems determined to save me from killing myself.

First, New York banned smoking in public places. And now, as of today, trans-fats have been banned from restaurant menus. That’s right. By law, the city’s 24,000 restaurants will soon have to switch to healthy cooking.

Guilty pleasures: getting rid of trans-fats would save about 500 lives in New York each year.

As you can imagine, some fast-food chains — and advocates for personal liberties — are practically foaming at the mouth at this move. Where will it all end? Visions of daily alcohol rations and obligatory morning jogs fill the imagination. How dare the government interfere. But before we get carried away by the invasion of liberties argument, let’s consider the facts.

Trans-fats are undoubtedly the vilest thing to hit food since monosodium glutamate (MSG). According to the best science, they raise the levels of bad cholesterol, lower the levels of good cholesterol and generally mess with your body, contributing to obesity, heart disease and diabetes. They have absolutely no known benefits and yet are intentionally added to foods — they’re made when manufacturers add hydrogen to vegetable oil to increase its shelf life and make it taste less greasy. “It’s as if somebody were adding arsenic to hamburger mix,” says Walter Willett, trans-fat guru and professor of epidemiology and nutrition at Harvard School of Public Health.

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Finally: hints of HIV turnaround in South Africa

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(This Opinion column ran on Nature’s news site on November 3, 2006. You can see the original post here.)

It’s about time that this country hard-hit by AIDS promised help for the afflicted, says Apoorva Mandavilli.

HIV causes AIDS. That’s not news to you or me, but shockingly it has taken years for the government in South Africa — where about 1,000 people die of AIDS every day — to acknowledge that fact and pledge to provide medicines.

In the past few weeks, the country’s deputy president Phumzile Mlambo-Ngcuka has publicly promised to expand access to AIDS tests, antiretroviral drugs and prevention programmes to those who most need them.

That sounds sensible — if a rather obvious thing for a politician to say — but it’s a far cry from what South Africans had heard until recently.

Health minister Manto Tshabalala-Msimang has extolled the virtues of beetroot, lemon juice and garlic in fighting AIDS. At the international AIDS conference in Toronto this August, her booth prominently featured those items. Six years earlier, at the same conference in Durban, President Thabo Mbeki said he didn’t know anyone with AIDS and questioned its link to HIV.

It’s about time the government changed its tune. As the richest country in Africa, South Africa is in a much better position to combat AIDS than its poorer neighbours. But thanks to the government’s appalling neglect, it hasn’t seen any decline in the rate of new infections.

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Health agency backs use of DDT against malaria

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(Nature asked me to write this article after the editor saw my feature in Nature Medicine on DDT’s return. The feature came two months ahead of the announcement that the WHO would back DDT. This article appeared the week after the announcement, in the 21 September 2006 issue.)

After decades of being shunned  as an environmentally damaging chemical, the pesticide DDT is once again being touted as the most effective way to fight malaria.

The World Health Organization (WHO) announced on 15 September that it will support the indoor spraying of pesticides generally, and DDT specifically, to control mosquitoes in countries with high rates of malaria. The US Agency for International Development signalled a similar shift in policy back in May.

Although these agencies never formally opposed DDT, they did not fund countries to purchase it, and instead actively promoted the use of insecticide-treated bednets. Malaria rates have continued to rise in the meantime, claiming more than a million lives a year, mostly in sub-Saharan Africa. The agencies now advocate combining the two approaches.

“I have to pinch myself a little to believe that they’ve done this, but I’m really, really happy they have,” says Amir Attaran, professor of law and medicine at the University of Ottawa, Canada, who has long criticized the agencies for their malaria policies.

In sharp contrast to its previous stance, the WHO also admitted for the first time that it stopped supporting DDT despite evidence of its effectiveness. “There are  lots of data there, but people are  so emotional about the issues,” says Arata Kochi, director of the WHO’s Global Malaria Programme. “Science comes first and we must take a position based on the science and the data.”

DDT, or dichlorodiphenyl-trichloroethane, is an organochlorine that is more effective, cheaper and longer-lasting than the alternatives. Fears about its use date back to the 1960s when Rachel Carson’s book, Silent Spring, famously chronicled its devastating effects on the environment. In the years that followed, the United States and many European countries banned DDT.

These countries once used thousands of tonnes of the pesticide for agricultural purposes. But the use of DDT for malaria control is very different: small quantities are sprayed once or twice a year on the inside walls and ceilings of houses.

Following widely publicized success with DDT in some countries such as India and South Africa, others began clamouring for the pesticide. “A lot of countries, especially in southern Africa, have become bullish about the use of DDT,” says Richard Tren of the non-profit group Africa Fighting Malaria.

PDF: Health agency backs use of DDT against malaria