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Science Policy Around the Web – December 11, 2018

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By: Sarah Hayes, Ph.D.

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Guns kill more U.S. kids than cancer. This emergency room physician aims to prevent those firearm deaths

 

Emergency room physician Rebecca Cunningham responded to an NIH call for public heath proposals with a plan to build infrastructure for studying firearms injury in children. After one round of revisions, Cunningham has been awarded a five year, 4.9 million grant from NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) – the largest NIH award for firearms research in over 30 years.

This large award heralds a new beginning for research which had slowed under the weight of a 20-year-old policy restricting federal research purview. The 1996 Dickey Amendment banned the CDC from funding anything leading to gun-control advocacy. This policy indirectlysuppressed federal spending on firearms-related research across all agencies. In 2013, a mass shooting in a Connecticut elementary school spurred a presidential memorandum leading to a 300% bump in NIH funding for research related to firearms.

Progress on Cunningham’s grant will lay a foundation for firearms research in public health going forward. Almost 30 scientists from diverse institutions will work together to build capacity for firearms study beyond the five-year term of the grant. Advice will be actively sought from gun-owning stakeholders, and key research questions will be identified. Existing data bases will be organized to facilitate use in research, pilot studies will be carried out to address ways to make firearms safer, and a new wave of scientists will be trained to continue the work.

Cunningham leads with the conviction that her research is and should remain staunchly apolitical. She respects the American right to own firearms, understands that guns may be acquired for safety, and say her research is not at odds with gun ownership. Rather, she likens her work to the evidence-based progression toward mandating seat-belts in cars – a policy which reduced automobile fatalities even as the number of cars grew. Cunningham says “the person, the gun, the home environment—all are modifiable in some way or another;” and these are some of the variables we will ultimately need to understand more fully in order to reduce the number of gun fatalities in children.

 

(Meredith Wadman, Science)

 

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December 11, 2018 at 3:44 pm

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The Impact of Research Funding on Minority Health and Health Disparities

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By: Nancy Chiles Shaffer, Ph.D.

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Federal agencies have attempted to improve minority health and reduce health disparities since the 1980s, and these efforts have continued through today. To briefly highlight some of the progress that has been made, the Department of Health and Human Services (HHS) initially released a report in 1985, “The Secretary’s Task Force Report on Black and Minority Health (Heckler Report)”, that discussed the state of racial health disparities in the United States1. This report led to the creation of the Office of Minority Health in 19861. Subsequently, the Office of the Director of the National Institutes of Health (NIH) created the Office of Minority Programs2. This began the efforts of NIH to address minority health and health disparities. Additionally, in 1993, HHS founded the Office of Research on Minority Health, which was later reauthorized in 20101,2. The Agency for Healthcare Research and Quality (AHRQ), under the Healthcare Research and Quality Act, was directed in 1999 to monitor racial disparities in health care3.  The National Center on Minority Health and Health Disparities was founded in 2000 and later became an NIH institute in 20102. More recently, in 2011, the HHS Action Plan to End Health Disparities as well as the National Stakeholder Strategy for Achieving Health Equity were created to further reduce health disparities1. Over these 33 years, funding also has been explicitly designated to improve minority health in the United States. While only 427 grants addressing minority health and health disparities were funded in 1985, there are currently 7,958 active grants4. How have health outcomes and health care been impacted by funding for minority health and for addressing health disparities?

One of the markers of national health that can be used to examine the success of these efforts so far is life expectancy. In 1990, life expectancy at birth was 71.8 years for men and 78.8 years for women5. Race-specific life expectancy was 72.7 years and 64.5 years for White and Black men, respectively, and 79.4 years and 73.6 years for White and Black women, respectively5. These data reflect 8.2 years shorter life expectancy for Black men and 5.8 years shorter life expectancy for Black women compared to their White counterparts.  Efforts to increase life expectancy led to a 6% (4.5 years) and 3% (2.3 years) increase in life expectancy by 2015 in men and women, respectively. Additionally, the difference in life expectancy between Black and White individuals decreased by 46% (3.8 years) in men and 52% (3 years) in women.

The National Center for Health Statistics (NCHS), a division of HHS’ Centers for Disease Control and Prevention, produced two data briefs examining racial differences in life expectancy. The first report explored the causes of death related to racial differences in life expectancy in 20106. It was found that there was a Black disadvantage in death rates due to heart disease, cancer, homicide, diabetes, and perinatal conditions. The Office of Minority Health stated in a 2011 press release that the Affordable Care Act provided opportunities for “bringing down health care costs, investing in prevention and wellness, supporting improvements in primary care, and creating linkages between the traditional realm of health and social services”7. The second NCHS brief assessed how decreases in racial disparities in life expectancy in 2013 are attributable to decreases in death rates for conditions among Black people, including heart disease, cancer, HIV, unintentional injuries, and perinatal conditions8. Despite these decreases, AHRQ’s “National Healthcare Quality and Disparities Report” in 2016 stated that most racial disparities in health care still exist9.

Beyond federal funding, private organizations and philanthropic organizations have also committed to reducing health disparities. A 2009 workshop that aimed to determine factors associated with health disparities was funded by the California Endowment, Missouri Foundation for Health, Connecticut Health Foundation, United Health Foundation, and Kaiser Permanente, and the CDC7. The Merck Company Foundation in 2009 provided $15 million to fund their Alliance to Reduce Disparities in Diabetes, focusing on reducing disparities in type 2 diabetes in low-income adults, Blacks, Hispanics/Latinos, and Native Americans7. Aetna Foundation, through their Racial and Ethnic Health Care Equity program, funded a report in 2012 addressing how the Affordable Care Act could be used to “advance health equity for racial and ethnic minorities”7. A brief funded by the California Endowment, California Wellness Foundation, and the San Francisco Foundation concluded that language barriers in California inhibited enrollment in the California Health Benefit Exchange7,10. As a result, funding was provided to increase cultural and linguistic competence for health care providers. The Cigna Foundation funded a $200,000 grant in 2015 for the Health Advocates In-Reach and Research (HAIR) program at the University of Maryland School of Public Health’s Center for Healthy equity to train barbers and hair stylists on health education11.

While funding has resulted in improvements in minority health, there is still more work to be done. The Office of Minority Health states that racial and ethnic minorities “…are less likely to get the preventive care they need to stay healthy, more likely to suffer from serious illnesses such as diabetes or heart disease, and when they do get sick, are less likely to have access to quality health care”12. Many of the areas that require additional attention are the focus of several current funding initiatives. The Office of Minority Health currently has grants to address uninsured men, HIV/AIDS, Lupus, and cultural and linguistic competency13. In addition, AHRQ is currently funding research addressing health disparities among the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community, as well as mobile technology to improve self-care for HIV/AIDS patients9. Given the improvements that have been observed thus far over the past 33 years, the ongoing continuation of funding to address minority health and health disparities has the potential to help the United States achieve health equity for all.

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December 7, 2018 at 2:41 pm

Science Policy Around the Web – December 6, 2018

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By: Neetu M. Gulati, Ph.D.

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The CRISPR Baby Scandal Gets Worse by the Day

Ethical concerns and controversy came to the forefront last week when news broke that Chinese scientist He Jiankui had supposedly created genetically edited babies using CRISPR technology: a first in the world. CRISPR/Cas9 technology, or CRISPR as it is more commonly known, is a scientific tool that allows researchers to edit (add, subtract, or change) the expression of genes quickly and precisely. This technology could be used to fix mutations that cause human disease. However, there are also risks, using CRISPR for gene editing may have disastrous side effects such as potentially leading to cancer.

He Jiankui claimed that he used the technology to alter a gene called CCR5 to reduce the risk of of HIV infection in embryos before implanting them in a woman, who then gave birth to twin girls. He claimed another CRISPR baby may be on the way from another pregnant woman. It is unclear if He has actually done what he claimed, and he has not yet published his results in a peer-reviewed journal. Nevertheless, the response to He’s claims have been strongly negative. Many people are concerned that He violated ethical norms by editing human embryos, especially because the overall consensus among scientistsin the field of gene-editing was that “there is a need for caution” and to only use the technology after “much more research to meet appropriate risk/benefit standards.”

Since the public has learned about He’s experiments, numerous scientists, including pioneers in the CRISPR field, have spoken out against He’s actions and have called for a temporary moratorium on similar experiments. Southern University of Science and Technology in China, where He has been on unpaid leave since February, has opened an investigation into He after finding out about his research. China’s National Health Commission is also investigating He.

Amid the backlash, He defended himself and his actions at the Human Genome Editing Summit in Hong Kong, claiming to be “proud” of his work. Dr. He has not been seen since the summit, however, and there are now concerns that he may be missing.

(Ed Yong, the Atlantic)

 

Trump emphasizes workforce training in new vision for STEM education

The White House released a new five-year strategic plan for science, technology, engineering, and mathematics (STEM) education this week, with a vision that “all Americans will have lifelong access to high-quality STEM education and the United States will be the global leader in STEM literacy, innovation and employment.” The report emphasizes workforce training in STEM, focusing primarily on opportunities outside of traditional classroom settings, such as apprenticeships. The plan also highlights the need for more diversity in STEM, such as minorities and women.

Overall the strategic plan focuses on four pathways to success: developing and enriching partnerships between educators, employers, and the community; engaging students in trans-disciplinary learning, including advancing innovation and entrepreneurship education; building computational literacy; and operating with transparency and accountability. The plan put forth by the Trump administration diverges from some of the key priorities of the former administration, including efforts focused on traditional academic environments such as training more teachers, and improving STEM instruction in colleges and universities. Instead, this plan appears more focused on how STEM education prepares students for the years after schooling is completed. “STEM education is absolutely critical to supporting the American worker, and this plan brings together a number of programs that are part of our emphasis on the American worker,” said Michael Kratsios, deputy assistant to the president at OSTP.

(Jeffrey Mervis, Science)

 

NASA’s InSight Mars explorer lands safely on the Red Planet

For only the eighth time in human history, a spacecraft has been landed on Mars. The InSight lander touched down on Martian soil on November 26, 2018 after over six months of space travel.

NASA’s InSight mission aims to gather information about Mars, and is part of the NASA Discovery program for focused solar science missions. InSight will study the crust, mantle, and core of Mars, to allow scientists to learn more about the formation of rocky planets in the solar system.

InSight has already begun taking photos of the surface of Mars, which have been posted on social media accounts such as Twitter. The lander has also set up solar panels, which allows InSight to power its cutting edge instruments. In doing so, the lander set an ‘off-world record,’ generating more electrical power than any previous vehicle on the planet’s surface. InSight project manager Tom Hoffman spoke on the importance of this achievement, “The 4,588 watt-hours we produced during sol 1 means we currently have more than enough juice to perform these tasks and move forward with our science mission.” This almost doubles the energy produced in a Martian day produced by NASA’s Curiosity rover, which previously held the record.

InSight will continue taking pictures of the surface of Mars to study its new surroundings and use its robotic arm to set up instruments to place them on the surface of Mars for the next few weeks. It will take two to three months before the lander begins conducting science on the Red Planet.

 

(Sarah Kaplan, Washington Post)

 

 

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December 6, 2018 at 5:23 pm

Science Policy Around the Web – December 4, 2018

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By: Caroline Duncombe, B.S.

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Why tear gas, lobbed at migrants on the southern border, is banned in warfare

On November 25th, U.S. Border Protection agents released tear gas into a crowd of migrants as they attempted to cross the border from Tijuana, Mexico into the United States. This brought an international standard on chemical weapons to question and subsequent controversy: the legality of using CS gas, a riot-control agent, on civilians.

Fifteen years ago, the US joined 192 other countries in signing the 1993 Chemical Weapons Convention. This international agreement banned both the production, stockpiling, and use of chemical weapons for war. Included on this list of chemical weapons to be banned in warfare is 2-chlorobenzalmalononitrile, the tear gas utilized by the U.S Border Protection agents. Yet, what occurred on the U.S./Mexico is not legally considered warfare, and the Chemical Weapons Convention does not prohibit the use of riot-control agents by governments on their own soil.

There is little to no international oversight on the use of tear gas for purposes beyond warfare. This may be in part that if CS gas is used properly, the effects are non-lethal. CS gas is not actually a gas, but a fine powder that will disperse throughout the air upon burning. Upon contact with any unsuspecting humans, the particulates activate the pain receptor TRPA1 resulting in a painful and persistent burning sensation on the body. If used improperly, like within a small space or directly into a crowd, CS gas can be lethal. For instance, in 2013, Egyptian police sprayed tear gas into a vehicle of protesters, killing 37 people mostly by asphyxiation. The long-term physiological impact of CS gas is largely unknown, although exposure to CS is noted to have caused long-term emotional trauma to some of its recipients.

 

(Alex Horton, Washington Post)

 

 

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December 4, 2018 at 4:54 pm

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Science Policy Around the Web – November 30, 2018

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By: Allison Cross, PhD

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Fire, drought, flood: Climate challenges laid bare in US government report

On Black Friday, and amid the news of deadly wildfires in California, the federal government released the Fourth National Climate Assessment (NCA4).  This report, detailing global warming and climate change, is mandated every four years as part of The Global Change Research Act of 1990.  The report was released by the U.S. Global Change Research Program which includes scientist and policy experts from 13 federal agencies.  It affirms that the effects of climate change are already being felt across the country, and that current global efforts to combat it, as well as regional efforts to adapt to it, do not reach the levels needed to avert substantial damage to the US economy, environment, and public health.

The NCA4 describes the latest in climate-change science and examines how global warming is likely to differentially effect regions across the country and the economy.  The report explains how higher temperatures and drier conditions will result in more large fires across the west coast.  The southwest and midwest can expect persistent droughts to continue, while the east coast will suffer from increased flood risks. These conditions will disrupt agricultural productivity.  The US National Oceanic and Atmospheric Administration estimated that the 2017 economic loss in the US from major storms, floods and droughts was $290 billion, and the NCA4 declares that storms are expected to become even more powerful as global warming continues.

The report states that if the current trends in global greenhouse-house emissions continue, some US economic sectors can expect to experience annual losses of hundreds of billions of dollars by the end of the century.

Though the report was intended to inform policy-makers, it makes no specific policy recommendations to address the issues outlined in the report.  With President Trump having removed the US from the Paris climate change agreement after he took office, and repeatedly blaming the deadly California wildfires on poor forest management, many scientists are concerned that the government will not take action to address the grave findings outlined in the report.

This report released by the  U.S. Global Change Research Program  comes after, and is in agreement with, a report released in October by the Intergovernmental Panel on Climate Change (IPCC) stating that major and costly changes would be needed to avert the disastrous effects to come from climate change.

 

(Jeff Tollefson,  Nature Briefing)

 

FDA plans overhaul of decades-old medical device system

Just 24 hours after a global investigation into medical device safety was published, the Food and Drug Administration announced they will be overhauling the medical device approval process.  The FDA says the changes were planned before the new stories broke, referring to the Medical Device Safety Action Plan: Protecting Patients, Promoting Public Health issued by the FDA back in April. The investigation into medical device safety that made the headlines was led by the International Consortium of Investigative Journalists and found that, over a 10-year period, the FDA received reports of more than 1.7 million injuries and close to 83,000 deaths suspected of being linked to medical devices.

Under current regulations, most medical devices can undergo an expedited approval process if the manufacturers can prove the devices are similar to those already on the market.  This approval process was implemented by the FDA in 1976 and is known as the 510(k)clearance process.  This process means that extensive clinical safety and efficacy testing is only required for a handful of new devices. It has been reported that under this clearance process almost 20% of products are approved based on similarity to devices that are more than 10 years old.  Critics of the expedited clearance process point out that this system has allowed defective devices to be cleared included hip replacements that failed prematurely, and surgical mesh linked to pain and bleeding.

The FDA has said that under the modernized 510(k) clearance process, medical devices that come to the market “should either account for advances in technology or demonstrate that they meet more modern safety and performance criteria.”  The proposed changes to the approval process include pushing companies to compare their devices to more up-to-date technology.  The FDA also plans to pursue actions to allow them to retire outdated base-products when safer, more effective technology emerges.

The FDA has set a deadline of early 2019 to finalize its guidance on establishing an alternative accelerated pathway for medical device approval but the reforms being proposed may take years to implement.

 

(Matthew Perrone, Associated Press, Stat News)

 

 

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November 30, 2018 at 3:46 pm

Publications and Patents: Laying the foundation for future innovation and economic growth

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By: Xavier Bofill de Ros, Ph.D.

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Many hours on the laboratory bench made me wonder: What is the real impact of our science? How do the thousands of publications appearing in scientific magazines every month and the funds poured into research benefit our society? We all know history; Fleming’s research on mold resulted in the discovery of penicillin and saved millions of lives ever since, and GPS systems rely heavily on basic trigonometry. These examples embody the power of science as a driver of technological progress and motivates – public policies to support scientific research. For example, NIH receives $37 billion  annually to fund intramural and extramural biomedical research[1]. Some of this investment in research generates intellectual property, bringing back to the system private money derived from license agreements. For instance, the NIH Technology Transfer Office had an income of $138 million from royalties in 2015[2]. However, many critics are quick to point out that basic research rarely pays off in practical R&D.

To understand where we are we need to know where we are coming from. A big part of the current legislation that governs the intellectual property derived from publicly-funded research is inspired from the Patent and Trademark Law Amendments Act, also known as the Bayh–Dole Act passed in 1980. This act established that the ownership of inventions made with federally-funded research projects by universities, small business and non-profit institutions is entitled to them in preference to the government. Prior to that act, the government accumulated ownership to large numbers of patents derived from the $75 billion per year of funding dispersed through different agencies, however fewer than 5% of those patents were licensed[3]. In exchange for this new source of revenue, public money receiving institutions  are required to educate the research community about the patenting procedures and to protect the government’s interests on funded inventions among other requirements. Despite the criticisms for forcing consumers to “pay twice” for patented products, the economic impact of the Bayh-Dole Act has been important. Recent reports suggest that academic licenses to industry contributed between $148 to $591 billion per year to US gross domestic product (GDP)[4].

Besides economic performance, other approaches to assess the impact of scientific publications on intellectual property come from the bibliometric analysis of the prior art on issued patents. A recent study from Kellogg School of Management analyzed the content of 4.8 million patents and 32 million research articles to find out how research is connected to inventions[5]. By analyzing the prior art references of patents, and the references of these references, the authors revealed that 80% of research articles linked to a future patent. This connection is often indirect, since direct citations of research articles in patents only account for about 10%, but it quickly accumulates to 42% and 74% when second degree and third degree citations are included. This indicates that the vast majority of the publication corpus ends up in the pool of knowledge where inventions arise. The analysis of the distance between research articles and patents also revealed differences between fields of research. Areas such as “Computer science”, “Nanotechnology” and “Biochemistry and Molecular Biology” depict a more immediate impact on patents compared to others less easily applicable. The authors of the study also went on to address which institutions yield research articles with a more significant impact on patents. To this aim, they compared the publications from universities, government laboratories and publicly traded firms. Consistent with previous studies, firms’ scientific production is the most directly linked to patent production. However, universities and government publications follow at a very close distance, despite generally engaging with more long-term research goals.

Other less tangible contributions from academic research and industry take place through the open access of data, reagents or knowledge[6]. Examples of these are The Cancer Genome Atlas (TCGA) with genomic data from more than 11,000 patients, the Jackson Laboratory (JAX) collection and distribution of mouse strains of human diseases, or the Addgene repository, with a collection of more than 67.000 plasmids. Similarly, collaboration agreements like CRADAs (Cooperative Research and Development Agreements) allow industry to partner with academic labs[7]. Under such agreements, which can last years, researchers from academic labs and companies can engage with joint ventures by providing each other with resources, skills and funds. In these partnerships the ownership of any coming intellectual property is discussed upfront as well as first option rights for licensing. Such collaboration formulas have a positive impact on the market readiness of the technologies developed, when not directly shortening the pathway to market through the same industrial partner. Similarly, there’s also specific agreements allowing for to joint clinical trials, specifically for rare diseases, or to transfer research materials.

Overall, this illustrates that public investment can be used to generate innovation and economic growth through the right policy measures. Contrary to the belief that technological and scientific advances move independently, there’s a well-connected flow of ideas that permeate between patented inventions and scientific articles. There are already good incentives to the research communities to facilitate the collaboration between academia and industry. However, there’s still room for novel policies to further leverage what can be achieved through the public investment on research.

[1]https://www.nih.gov/about-nih/what-we-do/budget

[2]https://www.ott.nih.gov/sites/default/files/documents/pdfs/AR2016.pdf

[3]GAO/RCED-98-126 Transferring Federal Technology. Page 3.

[4]The Economic Contribution of  University/Nonprofit  Inventions in the United  States: 1996-2015. Biotechnology Innovation Organization and the Association of University Technology Managers

[5]Ahmadpoor M, Jones BF. “The dual frontier: Patented inventions and prior scientific advance”. Science. 2017 Aug 11;357(6351):583-587.

[6]Bubela T, FitzGerald GA, Gold ER. Recalibrating intellectual property rights to enhance translational research collaborations. Sci Transl Med. 2012 Feb 22;4(122).

[7]Ben-Menachem G, Ferguson SM, Balakrishnan K. Beyond Patents and Royalties: Perception and Reality of Doing Business with the NIH. J Biolaw Bus. 2006 Jan 1;24(1):17-20.

 

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November 28, 2018 at 10:41 am

Science Policy Around the Web – November 27, 2018

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By: Allison Dennis, B.S.

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California’s Wildfires Could Mean A Generation Of Lung Problems

The acute dangers of uncontrolled wildfires are undeniable, yet chronic dangers remain poorly understood. Changes in air quality due to wildfire smoke may have long-term and widespread health effects that researchers are only beginning to decipher. In 2017, nature provided the near perfect conditions for a much needed experiment. As the Mendocino Complex Fire raged, its smoke drifted over 200 miles to blanket the living space of an outdoor colony of primates bred for research for 10 days. 500 infant rhesus macaques, a commonly used model of human disease, were exposed, allowing respiratory immunologist Lisa Miller to begin an experiment looking for long-term respiratory damage in a pediatric population. Her previous studies of a smaller group of monkeys exposed in 2008 revealed monkeys born in wildfire conditions grew up to have a reduced lung capacity and compromised immune system . Ten years after the fire, monkeys who were infants at the time of the fire have a high incidence of idiopathic pulmonary fibrosis, a fatal human disease associated with environmental pollutants and cigarette smoking. By carefully recreating her impromptu 2008 experiment, Miller is hoping to gain deeper insights into what damage can occur in the developing lung tissue that will lead to possible interventions.

Miller’s research already suggests that a brief exposure to smoke early in life can have a lifetime of consequences. Smoke inhalation is much more widespread than the immediate dangers of fire, and will need to be incorporated into disaster preparedness plans. Financial assistance may be needed to help families temporarily relocate following fires not only due to burned homes, but also to homes blanketed in smoke. Currently, websites like airnow.gov provide up to date measures of air quality and can be used to decide when to limit children’s time outdoors. Parents with other options may need to weigh the potential risks of raising a family in places where wildfires are an annual occurrence.

(Maggie Koerth-Baker, FiveThirtyEight)

 

Genome-edited baby claim provokes international outcry

 

The announcement of the first genome-edited babies is shocking ethicists, scientists, and spectators around the world. He Jiankui of the Southern University of Science and Technology of China in Shenzhen claims to have altered the embryonic DNA of two twin girls born in November 2018 by using CRISPR-cas9 to disable the protein CCR5, known to provide HIV access to human cells. The study has not yet been submitted for publication and will likely undergo extensive peer review for verification. He recruited couples looking to conceive, where the male partner had HIV. The risk of transmission of HIV between father and offspring is very low, and removing semen from sperm before fertilization is commonly used to further mitigate the small risk. However, He thought these would-be parents would especially value the benefits of conferring their child with a lifetime protection against HIV through altered genetics.

Since its first demonstration as a gene-editing technique nearly ten years ago, ethicists have debated the potential application of CRISPR-cas9 to alter human DNA. Because reproductive tissues develop from the edited zygotic cells, it is likely that the twins will pass these changes on to their offspring along with any other possible off-target changes to the genome. While lacking the CCR5 gene has been shown to confer protection against HIV infection, it may subsequently increase the risk of other viral infections. Many still feel that not enough is known about the long-term and generational effects of altering a person’s germ-line using these proteins to justify the risks they could pose over an unborn person’s lifespan. To what extent the institutions that facilitated the experiment were consulted or informed of the true nature of the search remains unclear. The trial was only registered on November 8th, well after the work had begun. However in the race to be first, He appears to understand that any harm to the children arising from the experiment stating these risks are “going to be my own responsibility.”

 

(David Cyranoski, Nature News)

 

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November 27, 2018 at 10:24 am