Health Agency

Millions of Dutch people will not benefit from the biomedical knowledge which is being acquired.

'The revolution of personalised e-health and personalised medicine will pass them by', says Jos van den Broek, lecturer in science communication at the Faculty of Mathematics and Natural Sciences of Leiden University and Professor by Special Appointment in Biomedical Science Communication at the Leiden University Medical Center.

A gsm which measures your heartbeat and blood pressure using simple sensors is not a distant possibility; it is just a small innovation away from our present gsm which can already count footsteps and calories. Professor Van den Broek: 'Our complete personal environment is becoming governed by electronics.' He delivered his inaugural lecture on 26 October on the consequences of this development for biomedical science communication.

He has many examples to demonstrate his point. 'It will shortly be possible to study complete material flows in our bodies, using small implants. Our health will be measurable anywhere and everywhere via the electromagnetic waves of the worldwide web. The technological possibilities are incredible; it is simply not possible to hold back this trend. As science communicators, we have to give this serious consideration. What is the future of the communication of biomedical sciences?'

In Van den Broek's definition this is more than simply communication on science for journalists. 'I am referring here to all communication on illness and health, between doctor and patient, but also among laymen.' New media such as the PC and internet have in fact brought the medical world into the homes of consumers; the boundaries between the producer and the consumer of health information have become blurred. There are millions of weblogs on health; just searching for 'Blog + Health' in Google will give you 400 million hits.'

A doctor can hardly compete with all the knowledge available in the thousands of patient forums. 'But they don't need to,' Van den Broek asserts. 'Communicating about science isn't merely a matter of those who know communicating to those who don't know. I call this 'feeding the geese'. A knowledge dialogue should be instigated with people who know together with people who know something else. The point of departure should not be 'equality' but 'evenly matched'. This will be far more constructive as we all have a certain amount of knowledge. This is my lecture in a nutshell.'

Van den Broek expects that within ten years it will be possible to measure our health continuously wherever we are. 'The consequences of this ambient intelligence may be far-reaching. For example, who will have access to this knowledge? Insurance companies? Employers? Privacy issues will become an important concern.'

But this is not his only concern. 'If we don't watch out, these developments will lead to inequality. A large group of people have access to the knowledge and benefit from its acquisition. They are able to follow, read and discuss such biomedical knowledge. They benefit from personalised medicine and personalised e-health. But there are too many people who will not be able to benefit from sharing this knowledge. Take, for example, the one and a half million functionally illiterate people in the Netherlands as well as the group who are in socio-economic terms weaker and the elderly. Within the framework of my professorship, I want to contribute to combatting this social inequality.'

Jos van den Broek (1951) studied biochemistry and acquired his PhD in Pharmacology. In order to share the knowledge contained in his dissertation with his fellows who had not studied chemistry, he published a lay version. After obtaining his PhD, Van den Broek worked as a journalist and chief editor for many years with such scientific publications as the Chemisch Weekblad, Bionieuws and Natuur & Techniek. He now teaches science communication at the Faculty of Mathematics and Natural Sciences. He is also author and co-author of several popular scientific books such as: Strandvondsten. Over de natuur van zee, strand en duin (2006) and Oud? De duvel is oud! De wetenschap achter gezond oud worden (2007).

Van den Broek calls himself an 'inquisitive inquirer' who always wants to know everything. He favours an active transfer of knowledge by participatory means: people must join in. 'I want to show people that science is often easier than they assume; it's more fun and closer than people think. Science permeates our lives.'

Inaugural lecture Prof. Dr J.M. van den Broek Leiden University, The Netherlands
Title: Nice to know - Need to know - Sharing to know. Biomedical science communication in transition Friday 26 October

http://www.ics.leidenuniv.nl

Healthcare providers have observed it for years -- patients who appear to have a better quality of life while battling their cancer live longer.

Now, a prospective, multi-institutional study examining the quality of life of patients with locally advanced non-small cell lung backs that observation. In fact, quality of life is so important, it out-weighs other classic predictors of survival.

"In the past, we've consider the stage of disease or tumor size along with other empirical data to predict how long a patient will survive, but now we know quality of life is a critical factor in determining survival," said Nicos Nicolaou, M.D., an attending physician in the radiation oncology department at Fox Chase Cancer Center in Philadelphia and lead author of the abstract.

The study included patients with locally advanced non-small cell lung cancer enrolled in a treatment trial (Radiation Therapy Oncology Group 9801 assessing the addition of amifostine to induction chemotherapy followed by concurrent chemoradiation). In addition to quality of life surveys, factors used to predict overall survival, included stage of disease, gender, age, race, marital status, type of tumor, tumor location in the lung, blood oxygen level, and type of treatment.

"Our study shows that what matters most is what patients themselves are telling us about their quality of life", said Benjamin Movsas, M.D., principal investigator of the RTOG study and senior author of the abstract. Movsas is chairman of the Radiation Oncology Department at Henry Ford Hospital in Detroit.

Of the 239 patients analyzed, 91 percent completed a pre-treatment quality of life questionnaire. Patients with a quality of life score less than the median (66.7) had a 69% higher rate of death than patients with a quality of life score greater than 66.7 (p=0.002).

"We conducted two different statistical analysis including all the usual prognostic factors and either way, quality of life remained the strongest predictor of overall survival. What's more, if a patient's quality of life increased over time, we saw a corresponding increase in survival," Movsas said.

Married patients or those with a partner had the highest quality of life score.

"We found a significantly lower quality of life score for single, divorced and widowed patients which deserves further study," Nicolaou said. "These findings underscore the importance of helping our patients improve the quality of life where we can in order to help them live longer better."

"Quality of life measures should be incorporated into treatment decision making and clinical trials," Movsas concluded.

http://www.fccc.edu/

The clinical threshold for undertaking elective surgery to remove part or all of the colon (colectomy) for people with inflammatory bowel disease (IBD) may be too high, warn researchers in a study published on bmj.com.

IBD is a general term for chronic inflammation of the intestine and includes ulcerative colitis and Crohn's disease. Around a quarter of a million people in the UK are affected and many people will require colectomy at some stage. Currently there are about 2,000 total or partial colectomies performed each year in England for IBD.

Death rates following elective colectomy are typically quite low, at least in the short term, while delaying surgery carries increased risks. It is thought, increasingly, that the thresholds for elective colectomy may be too high. However, there is a lack of strong evidence about this.

So researchers from Swansea and Oxford used routinely collected hospital data throughout England to investigate mortality after colectomy for IBD, comparing those who underwent elective colectomy, emergency colectomy, or who were hospitalised for IBD but had no colectomy. The study included 23, 464 people who were hospitalised for more than three days for IBD, 5,480 of whom underwent colectomy, and traced all deaths up to three years after hospital admission.

They found improved long term survival for elective colectomy compared with emergency colectomy or no colectomy. The findings also confirmed a substantially increased risk of dying shortly after emergency colectomy.

At three years, the increased of risk of death in people who did not undergo colectomy was almost as high as that in people who underwent emergency colectomy. In contrast, survival among people who underwent elective colectomy was very similar to that in the general population.

Our study findings suggest that the threshold for elective colectomy for IBD in England is too high, say the authors.

It also illustrates that, whenever indicated and possible, it is preferable for colectomy to be undertaken electively, rather than risk the need for emergency surgery when it has a much poorer prognosis.

They believe that further research is now required to establish the threshold criteria and optimal timing for colectomy in people with poorly controlled IBD.

The idea that surgery for IBD should be the last resort is flawed, adds an accompanying editorial. These findings, even allowing for interpretation, should be a word of caution to those who promote it.

http://www.bmj.com

Iowa State University researchers have developed a technology that detects a single molecule of the virus associated with cervical cancer in women.

That's a significant improvement over the current test for the human papillomavirus, said Edward Yeung, an Iowa State Distinguished Professor and the Robert Allen Wright Chair in Chemistry who led the research team that developed the new test. The current test, the Nobel Prize-winning polymerase chain reaction technique, requires 10 to 50 virus molecules for detection.

"We are always interested in detecting smaller and smaller amounts of material at lower and lower concentrations," Yeung said. "Detecting lower levels means earlier diagnosis."

The discovery by Yeung, who's also a senior chemist and deputy program director for the U.S. Department of Energy's Ames Laboratory at Iowa State; Jiangwei Li, an Iowa State doctoral student; and Ji-Young Lee, a former Iowa State doctoral student; will be published in the Nov. 1 issue of the journal Analytical Chemistry .

Their work was funded by a five-year, $950,000 grant from the National Institutes of Health with additional support from The Robert Allen Wright Endowment for Excellence at Iowa State.

The project advanced just as human papillomavirus made national headlines. In June of 2006, the U.S. Food and Drug Administration approved a vaccine developed to prevent cervical cancer, precancerous lesions and genital warts caused by four types of the virus. The vaccine has been approved for females ages 9 to 26.

The Centers for Disease Control and Prevention reports the human papillomavirus is the most common sexually transmitted infection in the U.S. The agency estimates about 6.2 million Americans are infected every year and over half of all sexually active Americans are infected at some time in their lives.

Yeung said single molecule detection of the virus could help women and families decide to get vaccinated. He said vaccines administered after such early detection could still have time to stop the virus.

The new detection technology improves current technology by eliminating a step to amplify DNA samples for testing. Although the current test is efficient and well understood, the amplification can cause small contaminants to create test errors.

Yeung's single molecule spectroscopy technique involves creating chemical reagents that recognize and fluorescently tag the genetic sequence of the human papillomavirus. Test samples pass through a laser beam that lights the tags. Cameras capture the images for computer analysis.

The research team tested the technique using samples from normal Pap smears. They also spiked some of those samples with the virus to make sure the tests picked up known amounts of the virus.

Although this test concentrated on detecting the human papillomavirus, Yeung said it should detect HIV, avian flu and other viruses as well.

Will the technology make it to medical labs?

Yeung -- who helped start CombiSep Inc. in 1999 to develop and market chemical separation instruments for pharmaceutical and life sciences research (the company merged with Advanced Analytical Technologies Inc. of Ames late last year) -- said he won't be directly involved in taking the detection technology to market. But he said companies have expressed some interest in licensing and developing the technology.

As that project moves on, Yeung will continue looking for ways to detect chemical targets at the smallest limits. He said the next challenge is to figure out how to detect single molecules of proteins.

http://www.iastate.edu

An exciting discovery via ScienceDaily: researchers "have discovered the key brain chemical that causes Parkinson's disease ... Parkinson's disease occurs when some nerve cells in a part of the brain called the substantia nigra die or become impaired. Normally, these cells produce dopamine - a vital chemical that allows smooth, coordinated function of the body's muscles and movements. Scientists have long known that a key protein called alpha-synuclein plays a role in the development of Parkinson's disease. Alpha-synuclein is found throughout the brain - but in some people, the protein clumps together. This causes the death of the dopamine-producing cells, which in turn causes Parkinson's to develop. ... researchers discovered that dopamine itself actually plays a role in destroying the cells that produce it. In the process that leads to Parkinson's disease, dopamine is converted into a highly toxic chemical called DOPAL. Using test-tube, cell-culture and animal models, the researchers found that it is DOPAL that causes alpha-synuclein protein in the brain to clump together, which in turn triggers the death of dopamine-producing cells and leads to Parkinson's." It should go without saying that finding a key mechanism in this day and age will quickly lead into the design of therapies.

View the Article Under Discussion: http://www.sciencedaily.com/releases/2007/10/071030153020.htm
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