Biomedicine

Margaret McCartney

To be a “guinea pig” in a clinical trial is not an experience people volunteer for lightly. We need only think of the dramatic side-effects of the so-called Elephant Man drug trial at Northwick Park in 2006 to be reminded that volunteers can end up worse off. In that case, there was financial reward for the unfortunate guinea pigs, though most trials do not offer cash incentives. Either way, the prospect of being given drugs or operated on is daunting when we suspect a lack of emotional care and consultation.

Even the term guinea pig has outmoded and unethical connotations. People taking part in clinical experiments should not be seen as unknowing animals. Indeed, a number of recent experiences have convinced me that we need to redefine the term human guinea pig to mean an active, able and knowledgeable person, who agrees to participate in research. In order to make this happen, patients need to be involved as much as medical experts.

Not long ago I attended the launch of a new service on healthtalkonline, the website of the research charity Dipex. Founded by GP Ann McPherson, who at the time had breast cancer, and Andrew Herxheimer, who had undergone a knee replacement, the website provides an archive of videos in which people talk about their medical experiences.

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Clive Cookson

Traumatic head injury, which my Hong Kong colleague Justine Lau describes so graphically in Saturday’s FT Magazine: An accident victim’s journey back to health is all too common.

In most industrialised countries the number of people admitted to hospital with a brain injury is similar to the number who suffer a stroke: around 135,000 a year in the UK. Around half a million Britons are living with long-term disabilities from head injuries, according to the charity Headway. Again, the number is similar to those disabled by stroke, except that most injury victims are much younger; half of all deaths in adults under 40 are due to traumatic brain damage.

Justine Lau

Justine Lau

The brain contains about 1.3kg of white matter, with a texture similar to soft blancmange, held together in the skull by several layers of membrane. The effect of a traffic accident such as Justine’s is like vigorously shaking a plate of blancmange. The brain shears and tears, disrupting the connections between neurons (nerve cells), while bony ridges underneath the skull can lacerate the front of the brain. At the same time blood vessels tear and bleed, leading to a dangerous build-up of pressure as clots form within the brain.

While a stroke tends to affect a specific area of the brain, accidental impact usually causes more general damage. Symptoms and outcome vary greatly, of course. The death of actress Natasha Richardson in March, after initially refusing treatment following a skiing accident in Canada, showed that what seems at first to be a relatively minor blow to the head can trigger fatal bleeding. Conversely, some people recover almost completely from horrific initial injuries.

However many patients suffer from a common range of distressing symptoms and Justine’s account illustrates several of them. One is post-traumatic amnesia, the period after the patient emerges from unconsciousness following the accident and appears to be conscious and awake – but is behaving or talking in a bizarre or uncharacteristic manner, and cannot remember what happened a few hours or even a few minutes ago. Justine’s talking and acting like a child is typical of this phase.

Another symptom, which often occurs during the period after the patient has emerged from post-traumatic amnesia and is coming to terms with the accident’s long-term consequences, is severe depression, including suicidal thoughts and actual suicide attempts.

On the positive side, the brain shows remarkable adaptability – plasticity in scientific parlance. Gradually, the neurons re-form broken connections or make new ones to bypass areas that have been permanently damaged.

The best sign of recovery is returning to work. A rule of thumb is that if someone does not get back to work within two years, he or she is unlikely ever to do so. Justine’s return to the FT Hong Kong bureau 10 months after the accident is an excellent sign for her long-term future.

This time last week no one outside a small group of public health experts had heard that the world faced an imminent flu pandemic. But virologists at the US Centers for Disease Control and Prevention (CDC) in Atlanta were already working feverishly to crack the genetic code of virus isolated a few days earlier from two patients – in California and Texas – suffering from flu apparently linked to a mysterious outbreak in Mexico.

Over the weekend, as pandemic scare stories hit the media, the CDC researchers had completed the RNA sequences of the virus, using the latest tools of molecular biology. (Flu virus has a genome composed of RNA rather than the related DNA that makes up the genes of almost all other organisms.) The achievement is a real testimony to the powers of 21st-century science in an emergency.

Clive Cookson

The flu strain that is spreading from Mexico and causing alarm about a possible pandemic has generally been called “swine flu” by health authorities, including the World Health Organisation.

But pig producers and animal health experts understandably dislike that term. Not only does it give pigs a bad name (and incidentally damage consumer demand for pork products) but also, they say, it is inaccurate.

In fact the H1N1 virus responsible for the outbreak has not been linked directly to pigs, in Mexico or anywhere else. The virus has not been isolated from any animal apart from humans, though virologists surmise that it may have originated in a pig.

Like birds and people, pigs can act as a “mixing vessels” in which different viruses swap genes and produce a new strain. The Mexican virus appears to contain porcine, avian and human genetic components.

The Paris-based animal health organisation OIE proposes calling it “North American flu”, to reflect its geographical origins. After all, the last pandemic, in 1968, was caused by “Hong Kong flu” – and the great 1918-19 pandemic was “Spanish flu”.

For me, North American flu is too much of a mouthful. I’d prefer “Mexican flu”.

Read an FT special report on the world’s best chance to tackle malaria

Watch video interviews with six experts at the “Malaria: getting to zero” conference on April 15 – 17 2009

View an interactive world map showing malaria prevalence and conditions in individual countries

Clive Cookson

A potential treatment for Alzheimer’s, which is designed to tackle the underlying causes of disease, has given promising results in its first clinical trial. Scientists at University College London gave a new drug called CPHPC to five patients for three months. They found that it removed a blood protein called SAP, which is believed to be involved in the formation of damaging “plaques” in the brain of Alzheimer’s patients.

Embryonic stem cells get all the publicity in stem cell research, good and bad. Their supporters see them as the future of regenerative medicine, producing all manner of new human tissues to treat degenerative diseases. Opponents – mainly from religious groups – hate the fact that they originate with the destruction of an embryo.

No treatment based on human embryonic stem cells has yet been tested on patients, though the US Food and Drug Administration recently told Geron that it could begin a clinical trial of embryonic stem cells to treat spinal injury. Meanwhile, as the UK national stem cell conference in Oxford heard today, universities are making good progress using adult stem cells, derived from the patients themselves, to repair bone and cartilage.

Scientists at Sheffield university have taken an important step towards using stem cells to restore hearing to deaf people.

Their research shows for the first time how embryonic stem cells can be converted into the specialist cells we rely on for hearing. These sensory hair cells and auditory neurons, as they are known, cannot be regenerated in adults using existing medical technology; once they are damaged, hearing loss is permanent.

The long-term aim is to treat deafness by transplanting new auditory cells, generated from stem cells, into people who have lost their own.

The controversial all-in-one polypill – a cocktail of drugs to fight heart disease – has come through its biggest clinical trial so far with flying colours.

Two thousand middle-aged and elderly people in India took part in the trial. The results, published online by the Lancet, show that a polypill with five active ingredients works almost as well as the sum of its individual components. And the combination causes no unexpected side-effects.

Salim Yusuf of McMaster University in Canada and his Indian colleagues, who organised the trial, estimate that middle-aged people could roughly halve the chance of suffering a “cardiovascular event” – heart attack or stroke – by taking polypills regularly. For those at high risk, the benefits would be greater.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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