Photo Credit: Pizza Luce - Seward
Whenever I go to local restaurants, I always try to strike up a conversation with the server. Here in Minneapolis, many servers are students at our numerous colleges and universities. Having worked at a restaurant while in college, I have a lot of empathy for these folks.
Sometimes I get a big surprise. This happened recently with a server who attended MCAD—the Minneapolis College of Art and Design. When he learned that I did some polymer chemistry, he asked if I knew about the male contraceptive system, being developed in India, that was polymer based. Never heard of it. One of my colleagues, the medicinal chemist Gunda Georg, has been working in this area for some time, so I try to follow the topic. Of course, it is a very important one.
So what’s this about? A quick check revealed a very interesting story. A maverick Indian scientist, S.K. Guha is finally getting attention. He even scored a $100,00 grant from the Gates Foundation. This injectable polymeric system—styrene/maleic anhydride—is referred to by the acronym RISUG, short for Reversible Inhibition of Sperm Under Guidance. The polymer coats the interior of the vas deferens and inactivates sperm as they pass by. The method seems to work for ten years and a reversal procedure is available. According to malecontraceptives.org: “Our research has convinced us that RISUG is the most promising of the potential male contraceptives.”
So what’s the problem here? Do the clinical trials, make sure the method is safe and Bob’s your uncle? Not so fast there, pardner.
“We had no support from industry,” said Guha. As Elaine Lisser, a San Francisco activist for male contraception put it: “To men, an ideal method would be cheap and long-lasting. To company shareholders, an ideal method would be expensive and temporary.”
Now I’m not trying to push some great conspiracy theory about Big Pharm. We’ve heard it all before. They HAVE a cure for x, or y, or z, but they are not revealing it because they can make more money from selling drugs to treat the disease.
But in some public health matters there is no economic incentive for pharma to step in because they cannot make the kind of money they need to operate from something like RISUG. Another recent example of a rather simple approach to a serious problem that will probably not be too popular with pharma is the diagnosis of pre-cancerous cervical lesions with vinegar. See the New York Times article: Fighting Cervical Cancer with Vinegar and Ingenuity.
When vinegar is applied to the cervix, white spots may become visible. These resemble warts and may be removed by cryotherapy—freezing—using a metal probe cooled by a tank of carbon dioxide. Where there’s Coke, there’s CO2. This method has the potential to do for underdeveloped countries what the PAP smear has done for countries like the U.S. The death rate for cervical cancer worldwide is about 250,000. The vast majority occurring where PAP smears are not readily available to a poor population.
Intelligent use of foreign aid, Gates money, and public health research may yield more benefit than higher-tech approaches that pharma necessarily pursues.
I thank Guy Wagner, server at Pizza Luce, for calling this topic to my attention.
People who work with crystals have received an inordinate number of Nobel Prizes. Some of them receive the prize because of the importance of the compounds they have worked on. Protein crystallographers have helped to unravel the mysteries of such things as photosynthesis and how hemoglobin transports oxygen. The Protein Data Bank (PDB) is a treasure trove of interesting and useful results from crystallographic experiments. The prize has also been awarded to people who have invented new methods for the determination of structures from crystallographic data.
Usually, like most scientists, I read the news reports of the science prizes and try to understand what the winners did and why it is important. In this particular case, I saw most of the action as it developed.
Shechtman obtained experimental evidence – a diffraction pattern – for five-fold symmetry in what later came to be known as quasi-crystals. This is not supposed to happen. He realized the importance of this observation and proceeded to publish and defend it. According to a detailed scientific description of the work released by the Nobel folks: “The achievement of Daniel Shechtman is clearly not only the discovery of quasicrystals, but the realization of the importance of this result and the determination to communicate it to a skeptical scientific community.”
His jaw-dropping discovery was initially greeted with skepticism, for example:
“When Shechtman told scientists about his discovery, he was faced with complete opposition, and some colleagues even resorted to ridicule. Many claimed that what he had observed was in fact a twin crystal. The head of the laboratory gave him a textbook of crystallography and suggested he should read it … All the commotion finally led his boss to ask him to leave the research group, as Shechtman himself recalled later.”
And the most influential twin proponent at that time was Nobel laureate Linus Pauling. I consider the late chemist to be one of the greatest scientists alive then. The twin theory or model explains the experimental data by “twinning” or the interpenetration of two – at least – separate crystals. It is a well known phenomenon that can lead to very strange diffraction patterns. I heard Pauling give a talk on his twinning theory that I found absolutely convincing. But then, I was a fan. Pauling later had to amend his initial twinning model, but by that time the evidence had mounted – from all over the world – that the quasi-crystal phenomenon could not be explained simply by twinning.
Upon first making his observation, Shechtman reports saying to himself: “Eyn chaya kazo” (Hebrew for: “There can be no such creature”). No doubt he realized the heat he would take for reporting this discovery.
מזל טוב, Professor Shechtman.
This piece was originally posted on the Chronicle of HIgher Education Brainstorm Blog and is used with permission.
Figure used with permission of the University of Minnesota Bioethics Center.
I didn’t want to attend this conference because I knew that it would be difficult and painful. Like having your wisdom teeth pulled without anesthesia.
As my colleague, bioethicist Carl Elliot, put it: “Only 16 percent of academic health centers in this country will pay the medical bills for research subjects who are injured in clinical trials. None will pay for lost wages and suffering. And an ethicist is arguing that we all have a duty to sign up for these trials? Give me a break.”
But Carl was not able to attend this conference and I knew that Mary Weiss, the mother of Dan Markingson, would be there. Her son died in connection with a clinical trial at the University of Minnesota that has become notorious. I wanted to offer moral support. I met her – for the first time – before the start of the conference. She seemed in control, and we had a pleasant conversation, but I was concerned. After the first talk, on the pro side, she had to leave. I could understand why.
My original intention was to try to present a dispassionate description here of the pros/cons of the question outlining the case made by each side. But I can’t. At first I was offended that my university would put on such a conference given our terrible record with clinical trials in the past. It seemed hypocritical. But in retrospect, I thank the Center for Bioethics for broaching the subject. During the conference most of the points that needed to be made came out. Professor Joan Liashenko did the heavy lifting of organizing and running the conference.
I was particularly impressed by two African-American women who persistently questioned the claim that treating research participation as a moral obligation would actually help the minority community. Henrietta Lacks came up during the discussion. I later learned that one of these women is a bioethicist and the other the president of the Minnesota Black Nurse’s Association.
Which brings me to the first problem I have with the title proposition. Cui bono? And I maintain that the answer is overwhelmingly the pharmaceutical industry. This proposition finds support in the Lysaught presentation cited below.
But what really frosted me was the “moral obligation” business. Thou shalt not steal, thou shalt not kill, thou shalt not covet thy neighbor’s wife, thou shalt participate in clinical research?
The argument that it’s just like paying taxes or giving to charity seems absurd to me. As one of the participants put it, the consequences of paying taxes are not nearly as great as losing one’s life, or being blinded. And for what? Mostly to justify supposedly new clinical therapies for pharma?
And as for charity… Most of us believe, even if we don’t believe in a God, that we are our brother’s and sister’s keepers. When we give to charity, if we are so inclined, we can do a little investigation. We can find, if we wish, something about the percent of money that actually goes to use in a charity and how much goes to administration.
Most patients are not capable of making scientific judgments about whether a clinical trial is worthwhile. Many doctors and people who sit on institutional review boards are not. To claim that people should risk themselves, out of beneficence, to participate in a clinical trial is unreasonable. Certainly to declare it to be a moral obligation is wrong.
I was upset by the use of the term “moral obligation” because I think this means something far beyond “this would be a good idea.” I don’t think there is support for the proposition in the works of, for example, Kant or John Stuart Mill. But these arguments are dense and not easily capsulized for this forum.
I did find a wonderful talk by Professor Susan Wolf of the University of North Carolina, who gave the Frumke lecture at NYU entitled: “Moral Obligations and Social Commands.” This talk examines the concept of what a moral obligation is and gives examples. To claim that participation in research is a moral obligation does not seem to pass the Wolf Test. This outstanding lecture is available in hard copy here and even, mirabile dictu, on YouTube.
It was an exhausting day. Certainly caused a Brainstorm. I drove one of the speakers to the airport and came home. Took three beers to return to earth.
This piece originally appeared in the Chronicle of Higher Education. For those interested in more details, that version includes some references and links to the slides used by the conference speakers.
What Have We Learned From Bachmann’s Recent Gardasil/HPV Eruption?
Being a scientist makes spontaneous blogging on some topics problematic. A couple of weeks ago, Michele Bachmann made the unsupported claim that HPV vaccination led to “mental retardation.”
At the time two bioethicists— professors Steve Miles at the University of Minnesota and Art Caplan at the University of Pennsylvania—called out Bachmann and challenged her to provide evidence in support of her claim. Miles was first and offered to contribute $1,000 to a charity of her choice. Caplan upped the ante by $10,000. The offer expired with no response from Bachmann. Some right-wing luminaries, including Rush Limbaugh and Ed Morrissey, also came down hard on Bachmann for this claim.
1. Bachmann is not fit to be president.
Since I am interested in biological structure, I wanted to look a little more into the science of the HPV vaccines. Fascinating. Proteins from a variety of human papilloma viruses are produced by genetic engineering. The menu includes viruses that lead to cervical cancer as well as genital warts and other baddies. Such vaccines are a scientific tour de force. I also learned that the adjuvant used to make the vaccine contains aluminum. An adjuvant makes a vaccine more effective for reasons that are not crystal clear. It is possible that this adjuvant is responsible for the pain of injection experienced by those vaccinated.
2. A lot of good and nontrivial science has gone into this vaccine. Producing it is expensive.
Which leads into the final lesson. Or at least into a discussion of what makes the HPV/Gardasil controversy not simply a soundbite matter.
I need to give all credit to Alison Bass for calling this fact to my attention in her excellent essay “Coverage of Rick Perry’s vaccine misadventure misses the point.”
The problem is that the public health benefits of providing HPV vaccines to relatively affluent children may not make a lot of financial sense. Merrill Goozner has explored this idea in his post: “The Gardasil Hustle.”
As Bass points out: “Merck itself estimated it would cost $1.4- to $1.6-billion to immunize young girls from the disease, which can be picked up fairly easily (and much more cheaply) with regular pap smears.”
The distribution of cervical cancer is loaded heavily against the poor. The highest incidences may be found in African-American women and in white women living in Appalachia (see Cancer Health Disparities).
The poor are either uninsured or cannot afford Pap smears.
It may make more sense to use the money spent on HPV vaccinations for Pap smears for poor women who cannot afford them.
There is a lot of money on the table here. The Web is a nightmare for a truth seeker. You can find people claiming that HPV is more cancer causing than cigarettes or that the HPV vaccine is contaminated with HPV DNA. And it is sometimes difficult to know what to make of some of these Web sites. They look plausible. Some are even written by medical doctors, and some doctors put links to them in their tweets. What is the average parent in search of information to do? I’ll post some thoughts on this in the future.
Endnote: Thanks to Alison Bass for her always thought-provoking work.
Picture Credit: Tracy Singleton
(This post originally appeared in the Chronicle of Higher Education on the day after the Ames straw poll.)
Dombey and Son
“As the last straw breaks the laden camel’s back”
Mr. Keillor frequents the Side Track Tap, but there is another place in town, the Birchwood Cafe. It is inhabited by a bunch of lefties, elderly hippies like me, vegans, people with nose-rings and purple hair. You know, that type. They buy food locally and hate Monsanto.
So this morning there was much discussion at the ‘Birch over Mrs. Bachmann’s disembowelment of Mr. Pawlenty, our beloved former governor. Some even felt sorry for TeaPaw but there was a great deal of Schadenfreude. It was the coffee special of the morning.
Yuh see, TeaPaw was the victim of really bad timing. He had cultivated his garden in Iowa for the last two years much to the annoyance of people who wanted him to show some leadership in fixing our budgetary problems in Minnesota. He left us about six billion dollars in the hole. Mrs. Bachmann pointed out some of his other shortcomings in the swordfight, er debate, prior to the so-called straw poll.
Another mistake that Pawlenty made – hindsight being 20/20 – was making such a fuss about Iowa. The Ames straw poll is basically a farce. It costs thirty bucks to vote. Talk about a poll tax. The Ron Paul web site generously offered a free ride from anywhere in Iowa as well as a free ticket. Of course someone had to pay for the ticket, didn’t they?
Intelligent folks—like Romney—didn’t participate. Except Romney was smart enough to show up for the debate and the nation-wide publicity. He didn’t do very well in the straw poll, but no one is asking him to step aside. And of course Rick Perry waited for the day of the straw poll to toss in his Stetson.
The timing thing with Bachmann was remarkable. Pawlenty and Bachmann have never been friends. She did a quick conversion to Iowaism. Everything I need to know I learned in Iowa. Probably kindergarten. That sort of stuff. Pawlenty was also in a bad spot because of his previous encounter with Romney where he wussed out. So when Bachmann put the pin in his balloon, he unwisely struck back. Bachmann is absolutely a master at making critics look bad.
So we’ve basically been spared of both Pawlenty and Bachmann in Minnesota politics for the foreseeable future. Wow, does that feel good.
So now it is on to Perry vs. Romney. Can’t wait. The ‘Birchers think that Perry will do to Bachmann what she did to Pawlenty. Wouldn’t doubt it.
Could I have another cuppa that Schadenfreude, please? (The ‘Birch has wifi.)
PS: I see that Paul Krugman is unhappy that he is losing his whipping boy. He had previously described our beloved governor as an “embarrassing ignoramus.” Krugman had this to say earlier today: “What made Pawlenty fun was that he was supposed to be the smart, capable candidate, someone who actually knew stuff; and yet every time he opened his mouth on policy issues, he revealed that he didn’t know a blessed thing.”
Wikimedia: Adam and Eve
Lucas Cranach The Elder (1528)
(Originally posted on Brainstorm at The Chronicle of Higher Education.)
Those ethically challenged folks at the University of Minnesota are at it again… A couple of years ago we had a dean who served on the Pepsi board even though it seemed a little incongruous for a med school dean to be involved with a company that made products that rotted children’s teeth. But of course we were assured by the Vice President of the Academic Health Center that this conflict had been declared manageable. Then we had the spectacle of a different dean pointing out that after all what was happening with respect to conflict of interest policies was not illegal: “We’re not violating a legal statute.”
And then there have been a number of bimbo eruptions at the Carlson school. An older one involved a faculty member who said of a potential speaker “It’s one thing if you’re bringing in a criminal to speak. But if someone’s under investigation, that’s fair game.” To what should be no one’s surprise given such an environment a student group has recently demonstrated what seems to be, at least, unethical behavior. A Missouri start-up is accusing students in a University of Minnesota class of copying its idea for a business.
So now what? The University of Minnesota has just announced a sizable donation from an outfit called Adam and Eve, purveyors of among other things, porn and hard-core DVDs. The press release announcing this happy marriage contains a link to the Adam and Eve site where wares may be inspected (probably NSFW and must be 18 to log on).
When asked about hardcore porn – something that’s believed to distort a person’s view of sexuality, Eli Coleman, director of the university program on human sexuality replied:
“If this was a company that was into child pornography or something like that, that was illegal, I don’t think we could morally accept something from people who are involved in illegal activities. But this is a company that’s responsible and is law-abiding…”
It is a sad day at a university when the ethical standard is: “If it is not illegal, we can do it.”