Archive for March 2012
By: Danielle Daee
In 2006, the independent, non-profit Institute of Medicine (IOM) Committee on Gulf War and Health published their findings based on a literature review of Gulf War veterans’ health. This committee, consisting of scientists and health professionals, was charged by the US Department of Veterans Affairs (VA) to examine available data from studies (largely those funded by the VA) to (1) reveal any consensus conclusions and (2) make recommendations for future studies. In their report, the committee revealed many shortfalls by the VA and the Department of Defense (DoD) in recording medical and combat histories of veterans. In addition, the committee described that Gulf War veterans generally report more overall symptoms compared to controls. Several multiple symptom disorders (e.g. fibromyalgia, chronic fatigue syndrome) also were diagnosed more often in Gulf War veterans. Despite this increase in symptoms, the committee could not identify a unique set of symptoms that could be defined as a specific Gulf War Syndrome.
The inability to define a syndrome has generated a public controversy among some veterans, scientists, and physicians who feel that a syndrome designation could aid in diagnosis, treatment, and benefit procurement. As a result the congressionally appointed Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC), staffed by independent scientists and veterans, undertook their own investigation. Their report, published in 2008, contradicts the IOM findings and asserts that there is sufficient evidence to suggest the existence of a multisymptom Gulf War Illness caused by neurotoxic exposures. The disparate findings triggered congressional hearings in an attempt to establish a clear consensus.
According to the IOM committee chair Dr. Lynn Goldman, the two studies fundamentally differed in their treatment of the available data. Goldman asserted that the IOM’s rigorous review of published studies revealed errors in many study designs that undermined the conclusions of the authors. As a result, the IOM could not conclude that a unique subset of symptoms comprised a Gulf War Syndrome. Goldman also contended that the results of some studies and the poor quality of veteran exposure data could not allow the committee to conclude that a specific exposure triggered the increased symptoms reported in veterans. Goldman held fast to the reality that Gulf War veterans are sicker and report more symptoms than non-deployed veterans. Consequently, she fully supported the congressional provision for “undiagnosed illnesses” to be compensated for veterans. In addition, Goldman highlighted the IOM’s recommendation to the VA to standardize the criteria for veterans to receive healthcare and benefits. This measure was intended to alleviate the bureaucratic obstacles that often hindered a veteran’s benefit procurement.
From an outsider’s perspective, it seems clear that much of this debate could have been avoided if the VA and DoD kept better records of veterans’ health prior to deployment (including vaccinations), health post-deployment, deployment locations, and field exposures. With this information, perhaps a consensus conclusion would have been likely between the two committees. Additionally, a clear picture of every veteran’s health prior to and after deployment would ease the burden on the VA to validate service-related illnesses. Moving forward, these records may improve provided that the IOM’s recommendations to the VA and DoD are implemented.
RAC report: http://www1.va.gov/RAC-GWVI/
By Adele Blackler
H5N1, the highly pathogenic and deadly avian flu, has been causing panic since it first appeared in Hong Kong in 1997. Though the flu has a high mortality rate, it is very rarely transmissible between humans, and thus there has been no widespread epidemic or pandemic resulting from H5N1[i].
However, the announcement last year by two research groups, from the U.S. and the Netherlands, that they had identified key mutations that made the flu highly transmissible among ferrets, caused an outcry among the public and the scientific community. The U.S. National Science Advisory Board for Biosecurity, NSABB, raised concerns that full publication of the research methods could give potential bioterrorists a new weapon and asked that only redacted methods be published, to make it difficult to duplicate the results[ii].
Recently, a special World Health Organization (WHO) panel convened to discuss the flu research and, after discussion with the research authors and leading scientists in the field, recommended that the current voluntary halt to research should continue until a more thorough analysis of laboratory biosafety could be completed[iii]. However, in the interest of aiding public health efforts and scientific research, the WHO panel recommended that both papers be published with complete methods, meaning that the published methods will be complete enough to be replicated by other labs around the world with access to the starting material. In response, the NSABB has requested a second look at the manuscripts and research and Congressional Representative Jim Sensenbrenner (R-WI) has questioned why this research was funded by the National Institutes of Health (NIH) in the first place[iv].
In an influenza pandemic, early detection and tracking is essential to being able to slow the spread of the virus and mitigate damage by quickly developing a vaccine. Understanding what mutations can make the H5N1 flu transmissible could help with early detection of emerging pandemic-causing strains and could make tracking the flu easier. This research could play a key role in understanding how the avian flu can become transmissible among humans, and that could help with early detection. Ultimately, if the H5N1 flu becomes highly transmissible among humans and turns into a pandemic-causing strain, early detection could save a countless number of lives.
Is the possibility of great public benefit enough to allow the H5N1 research to continue? Supporters of continuing this line of research point to the 1970s, when a new type of experiments involving altering DNA made headlines. Recombinant DNA research was also temporarily halted due to safety concerns, yet today DNA recombination experiments are routinely performed with no risk to health and safety[v].
Or is the risk that the deadly virus could escape the lab simply too great to justify continuation of the research? If research continues, what security measures should be in place? Further complicating the current debate is that many scientists in favor of H5N1 research are disagreeing about the biosafety level (BSL) a lab should have in place while working with the virus. Currently, most infectious disease labs work with the second highest level of biocontainment, BSL3. This is the same biocontainment level that was used for the current H5N1 research. Individuals in favor of raising the required BSL to the highest possible level (BSL4) argue that it is the safest way to work with the virus and minimize exposure. However, few labs in the nation are equipped for BSL4, and requiring such a high level of security might unduly restrict who can perform research on H5N1, effectively putting an end to most of the research on the virus[vi].
Currently, it looks like research on the engineered flu strain will resume at the end of the voluntary moratorium, and the results will most likely be published with full, not redacted, methods. However, the debate on whether or not this research should continue, and if the proposed benefits outweigh the possible risks, will continue for quite some time.
By: Danielle Daee
Human papillomavirus (HPV) is an important health issue because it is the most common and recurrent sexually transmitted infection worldwide and it can cause genital warts and cancer (including cervical, anal, oral, and penile cancers). While many of these cancers are rare, cervical cancer remains one of the leading causes of cancer mortality in women worldwide. Current screening procedures for cervical cancer are very successful in identifying precancerous lesions in women; however, regular screenings remain rare in impoverished populations. As a result, there has been a push for the development of an HPV vaccine to combat the challenges of HPV infections.
Merck recently developed an efficacious, quadrivalent vaccine (Gardasil) that prevents infection by HPV strains 16 and 18 (which cause ~70% of cervical and anal cancers) and HPV strains 6 and 11 (which cause 90% of genital warts) in both men and women. Although universal vaccination would have clear benefits for both sexes and would help achieve herd immunity, the development of vaccination programs has been stymied by costs. Currently, to be effective a three-dose regimen ($120 per dose) is required. This is particularly cost-prohibitive for target, impoverished populations worldwide. Furthermore, the vaccine will only prevent ~70% of cancers so additional screening procedures will still be necessary for effective cancer detection, driving preventative costs even higher.
Although HPV vaccines are clearly effective and important, it is evident that current costs will prevent the widespread use of the vaccines. Moving forward, it is necessary to develop a more cost-effective vaccine by reducing dosage and increasing efficacy. Research efforts should be focused on identifying common peptide targets that could enhance the cross-reactivity of HPV vaccines so numerous variants could be simultaneously targeted. Additionally, it is imperative that scientists and physicians vociferously support the preventative value of an HPV vaccination program. Strong support is essential to persuade international health organizations and local insurance companies that the value (in terms of both cost and human life) is worth the effort to provide affordable and convenient prevention for at-risk individuals.