August 21, 2009
NIH Podcast Episode #0091
Balintfy: Welcome to the 91st episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this podcast, a couple reports on genes: one shows the success of mapping breast cancer genes, the other how a so-called “depression risk gene” may not really add to depression risk. Also, we’ll have an interview about why doctors wear white lab coats, and how that might be changing. But first, important information about testing well water. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Well Water Should be Tested Annually to Reduce Health Risks to Children
Balintfy: According to new guidance offered by the American Academy of Pediatrics, private well water needs to be tested yearly, and in some cases more often. Researchers at the National Institute of Environmental Health Sciences, took a lead role in helping develop recommendations, and draft a new American Academy of Pediatrics policy-statement. It covers the things parents should do if their children drink well water. Wally Akinso brings us this report.
Akinso: Private well water should be tested yearly to reduce health risks to children.
Rogan: We hope that people will be aware that they have responsibility for their own drinking water when they are on a well.
Akinso: Dr. Walter Rogan is an epidemiologist at the National Institute of Environmental Health Sciences and the lead author of a policy statement on private well water that appears in the journal Pediatrics.
Rogan: This one is about drinking water in private wells and children. It outlined some background information background water in wells and makes recommendations about what families should do if they have kids and are getting their water from a private well.
Akinso: The new policy statement, "Drinking Water from Private Wells and Risks to Children" points out that water contamination is inherently local, and that families with wells need to keep in contact with state and local health experts to determine what should be tested in their community.
Rogan: All authorities recommend that you test once a year for coliform bacteria, which is an indication of sewage contamination of the water and for nitrate contamination, which is an indication of both sewage and fertilizer. These are both common occurrences in wells and are important in terms of the possibility of illness occurring in the families.
Akinso: The presence of nitrates can be a problem particularly for infants under three months who can not metabolize nitrate. Water with a nitrate concentration of more than 10 milligrams per liter should not be used to prepare infant formula or given to a child younger than one year according to Dr. Rogan. He says the policy statement suggests using bottled water for infants when nitrate contamination is detected, or when the source of drinking water is unknown.
Rogan: The health department should be able to provide you with a list of certified testers or may even provide you with containers that you can turn water to them and they’ll test it for you. Commercial kits are available. You can go to Home Depot or Lowes and buy kits but we couldn’t find much published information that said they were accurate. So until that information exist people are better off checking with the health department.
Akinso: Dr. Rogan adds that some parts of the country may have arsenic, radon, salt intrusion or agricultural runoff that may get into the water supply. For more information, including viewing the policy statement, visit www.niehs.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Mapping Breast Cancer Genes
Balintfy: Now we turn to genes, the building blocks of inheritance. As scientists learn more about the genetic mutations that can lead to diseases, the hopes are that they can use genetic information to tailor patient therapy. They can also target people who are at high risk, so they can benefit from preventative treatments and lifestyles. Breast cancer has been a major focus of cancer genetics and prevention efforts. Kristine Crane files this story about the genetics of breast cancer.
Crane: Over a decade ago, scientists discovered that mutations of the BRCA 1 and 2 genes cause a higher risk of breast cancer.
Olopade: We started thinking about clinical cancer genetics about fifteen years ago, just as BRCA1 was being identified as the first major breast cancer susceptibility gene.
Crane: Dr. Olufunmilayo Olopade is an internationally renowned leader in the field of clinical cancer genetics. She has led efforts to educate oncologists about how genetics could be used for both treatment and prevention. In 1997, Dr. Olopade served as Chair of the American Society of Clinical Oncologists Task Force on Genetics Education.
Olopade: When we started in 1997, we had no idea that in fact within a short period of time that we would actually find genes and that those genes can be tested in individuals, and that those individuals can avail themselves of prevention strategies.
Crane: The BRCA 1 and 2 mutations gave way to the discovery of other breast cancer genes. Some drugs were then designed specifically for people with those genetic mutations.
Olopade: Now we’re not talking about one size fits all, you know, everybody go get your mammogram; we’re talking about individualizing risk assessment, that we’re talking about personalizing treatment for breast cancer patients. And so, it really has implications for molecular diagnostics, for a lot of things.
Crane: Dr. Olopade has been especially interested in risk factors for women of African origin. She led a study of women in her native Nigeria that showed 73 percent of women with breast cancer had aggressive tumors characterized by the BRCA mutations. That type of cancer does not respond to the hormone therapy that is often used as first-line treatment in the West. Women of Ashkenazi Jewish origin are prone to the same type of cancer. Dr. Olopade says discovering these common threads has prompted a more global approach to cancer research.
Olopade: We began to ask ancestry instead of black white. We went back to Africa, we learned a lot about some of the reasons why young women get breast cancer. And we learned about things that we totally did not expect and which the Africans had not been able to study because they didn’t have the technology. And by bringing that to the United States we opened up a whole new area of research, for everybody.
Crane: Dr. Olopade says more international research projects should address the development of new therapies.
Olopade: Because after all we are all an immigrant population, right. And so a number of things that we have to think about in the different countries in fact or in our country may originate in different countries.
Crane: And Dr. Olopade emphasizes that cancer genetics could benefit people everywhere.
Olopade: It’s leading to greater therapeutic discovery. It’s leading to people feeling empowered to do something with their risk instead of feeling paralyzed by it. And we’ve learned that we have to touch on a lot of different things in order to get there. But it’s been rewarding to see how far we’ve come, and what I hope we would do is that we don’t rest on our laurels, but get out there and make these advances accessible to people all over the world.
Crane: Dr. Olopade is director of the Cancer Risk Clinic at the University of Chicago, where she evaluates risk factors and designs individualized prevention plans. She recently spoke at the National Cancer Institute’s Cancer Prevention Fellowship Research Program. This is Kristine Crane at the National Institutes of Health, Bethesda, Maryland.
Much Touted "Depression Risk Gene" May Not Add to Risk After All
Balintfy: While the genetics of breast cancer is showing promise, progress in genetics research in general is not always smooth. A range of factors led to the wide acclaim of a 2003 study suggesting a possible gene-environment interaction contributing to depression risk. This study had far-reaching influence on the field, including proposals by some researchers to market a gene test to the public, claiming to be able to predict a person’s risk for depression. However, despite considerable resources being invested in research building upon the 2003 study, attempts to replicate its findings—which is a key step in the scientific process—has had inconsistent results. Wally Akinso is back with this report on how a “depression risk gene” may not add to depression risk after all.
Akinso: A certain gene long thought to increase a person’s risk for major depression actually may have no effect according to a study funded by the National Institute of Mental Health. NIMH senior investigator Dr. Kathleen Merikangas, says the study, published in a recent issue of the Journal of the American Medical Association, challenges a widely accepted approach to studying risk factors for depression.
Merikangas: When we put together the gene, serotonin gene, with stressful life events we did not find that people who had this particular gene were at increase risk for depression in the presents of life events.
Akinso: Serotonin is one of several chemical messengers in the brain, which help brains cells communicate with one another. Among, other functions, serotonin is involved with regulating mood. In the study, which included re-analyzing data on 14,250 participants in 14 studies, the presumed high-risk version of the serotonin transporter gene did not show a relationship to increased risk for major depression, alone or in interaction with stressful life events. Dr. Merikangas explains that researchers are still in the early stages of understanding how genes and environment interact to increase the risk for depression.
Merikangas: When we're trying to study the effective genes on complex human disorders such as depression that it's not going to be easy to simplify the way that we conceive of environmental exposure and these genes and producing these disorders then it's unlikely that there’s going to be one single gene that is going to either elevate or protect against certain disorders in the presents of environmental exposures. We need to understand more about both the genetic architecture of complex diseases as well as how environmental factors are related to the risk of particular diseases.
Akinso: Most mental disorders are thought to be caused by a combination of many genetic risk factors interacting with environment triggers. However the exact combinations continue to present significant challenges to research. For more information about this study, visit www.nimh.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: Coming up after this break, we’re all used to seeing doctors in white lab coats. What’s the history on that, and will it end. Stay tuned.
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White Lab Coats in Medicine
Balintfy: Recently there’s been talk in the medical industry about the use of the white lab coat. Some are suggesting that the white lab coat go away. To get some perspective on this discussion, I talked to Dr. Stephen Greenberg; he works in the History of Medicine Division at the National Library of Medicine here at NIH. We started with the question, when were white lab coats first used by doctors, and why.
Dr. Greenberg: It has been kind of a uniform thing for a while. In the 19th century, you find when laboratory medicine really gets going in France under Pasteur, in Germany under Koch, that there’s an attempt to make the art of medicine more into the science of medicine, and since those are the big years of the rise of microbiology, the rise of biochemistry, the idea of making yourself appear more scientific became very attractive. But I think it’s always been as much for the status of having a uniform thing, what you are and what you do, as any concerns about sterility and cleanliness.
Balintfy: Has that changed in the years?
Dr. Greenberg: I think it has because people, first of all, are much more aware of how diseases are spread. At the same time, they kind of assume that doctors know best and that hospitals know best, and the idea that if you go to a doctor’s office, if you go to a clinic or a hospital, you have an expectation of cleanliness and professionalism that certainly someone going to visit a doctor in the 1830s and ’40s would never have had that expectation.
Balintfy: What would the uniform have been like in those days, and how would it be different from what we see today when we go to the doctor’s office?
Dr. Greenberg: It would have been a business suit. And, of course, since we’re talking in the 19th century, we’re talking a long frock coat, dark, probably black, a high stiff collar, and some sort of a tie. And you see many pictures and paintings representations the 19th century that look as though the doctor has gone basically from the street into the clinic, into the operating room, into the anatomy lab without a change of clothes. There were even pictures of anatomy classes standing by a cadaver where they’re not only wearing street clothes, they’re also wearing hats. There seems to be some sort of macho business involved there.
Balintfy: But the white lab coat now is more a sociological symbol?
Dr. Greenberg: I think so, because nowadays, if you’re going to a sterile surgical procedure, people won’t be wearing white. They’ll be wearing scrubs and the scrubs are likely to be colors. Blues and greens are very popular, but as anyone who’s watched the TV show “Scrubs” can tell you, you can get them in any color you want.
Balintfy: Is there anything else particularly interesting about scrubs, the white lab coat, or its history or future?
Dr. Greenberg: Well, the one thing that I like to point out to people are two paintings done by the painter Thomas Eakins in Philadelphia in a matter of a few years. The earlier one, The Gross Clinic, which was painted in 1875, Samuel Gross’ clinic, you see Dr. Gross and his students standing around doing a procedure and they’re all dressed for street. They could have walked right out, no gloves, no masks, street clothes. Eakins was asked to do another painting of a similar scene a few years later, in 1889, The Agnew Clinic, and just in that period they’d gone from street clothes to whites, and it’s almost the same painting. I mean, the pose is the same, the angle is the same, but suddenly everyone is in whites.
Balintfy: So it changed that quickly.
Dr. Greenberg: It did.
Balintfy: And it might go away that quickly?
Dr. Greenberg: Sociology? Well, there’s a famous line by a historian from the 19th century who says, “Things change, but they change slowly. They change slowly, but they do change.” I don’t think that senior doctors in their offices are about to give up their white coats, because there’s still the prestige of, “I’m a doctor, and you’re not.”
Balintfy: Thank you very much Dr. Greenberg.
Dr. Greenberg: My pleasure.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, September 4th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.