October 8, 2010
NIH Podcast Episode #0119
Balintfy: Welcome to the 119th 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 episode news for African Americans with chronic kidney disease, what everyone should know about H1N1 and this year’s flu season, plus an interview with an historical perspective: "the history of medicine helps to humanize medicine." But first, this news update, here’s Craig Fritz.
Fritz: A recent study by a consortium supported by the National Cancer Institute has found that adding immunotherapy to standard treatment significantly improved outcomes in children with a nervous system cancer known as neuroblastoma. The percentage of children surviving without cancer after two years rose from 46 percent to 66 percent utilizing the new treatment. Immunotherapy stimulates the body to fight disease by introducing specific antibodies that attack the cancer cells. The previous standard for treatment was aggressive chemotherapy that killed many cancer cells but also harmed healthy cells. Neuroblastoma is responsible for 12 percent of all cancer deaths in children under age 15 and is the most common non-brain solid tumor in children. Nearly 50 percent of patients with neuroblastoma have a high-risk form of the disease and have poor long-term survival, despite intensive treatment. Scientists note that while the addition of immunotherapy sets a new standard of treatment for neuroblastoma, there is still much work to be done to manage side-effects and toxicity.
The National Heart, Lung And Blood Institute plans to add about 1,750 participants over the age of 75 to its upcoming systolic blood pressure intervention trial, or SPRINT. The study seeks to determine whether a lower blood pressure range in older adults will reduce cardiovascular and kidney diseases, age-related cognitive decline, and dementia. Systolic blood pressure is the top number in a blood pressure reading. Researchers hope that the study expansion, known as SPRINT-Senior, will provide useful scientific and public health information on a large and growing segment of the population. Smaller, previous studies have shown that lowering systolic blood pressure in older participants reduced stroke, heart failure, and overall cardiovascular events by more than 30 percent. SPRINT-Senior will evaluate the safety and potential benefits or risks of maintaining systolic blood pressure at an even lower target than currently recommended or studied previously. Announced in 2009, SPRINT is a nine-year study to be conducted in over 70 clinical sites across the United States. Including the 1,750 new SPRINT-Senior participants, approximately 9,250 people age 55 years or older are expected to be enrolled.
For this NIH news update, I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up next, what the latest research is telling about personalized medicine for chronic kidney disease, then later exhibits that highlight the history of medicine.
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Lower blood pressure goal benefits African-Americans with chronic kidney disease, protein in the urine
Balintfy: The largest and longest study of chronic kidney diseases in African Americas adds new information about which patients benefit from lowering blood pressure. Wally Akinso reports on how this information may help doctors practice personalized medicine, the tailoring of each treatment regimen to each patient's unique characteristics.
Akinso: A lower blood pressure goal was no better than the standard blood pressure goal at slowing progression of kidney disease among African Americans who had chronic kidney disease resulting from high blood pressure. However, the blood pressure goal did benefit people who also had protein in the urine, which is a sign of kidney damage. Dr. Griffin Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases, explains that high blood pressure causes about one third of new cases of kidney failure.
Rodgers: The risk of kidney and heart disease—conditions that are often associated with longstanding hypertension—are far higher among people of African-American heritage than those of other racial or ethnic groups.
Akinso: Dr. Rodgers stresses the importance of long term studies like the African American Study of Kidney Disease and Hypertension, which is the largest and longest study of chronic kidney disease in African Americans.
Rodgers: The African American Study of Kidney Disease and Hypertension which is abbreviated AASK or A-A-S-K is an important long-term study that among other treatment modalities, compared standard with intensive therapy for hypertension close to 1100 African American patients with chronic kidney disease presumed to be due to hypertension.
Akinso: The AASK study, funded by the NIDDK, found that among people with protein in their urine, keeping blood pressure at the level reduced the likelihood of kidney disease progression, kidney failure, or death by 27 percent compared to standard blood pressure level, a statistically significant difference. Dr. Rodgers explains that the study was conducted in two phases.
Rodgers: First, in a clinical trial that ran between 1995 and 1998, participants were randomly assigned to standard blood pressure goal of roughly 140/90 or a lower goal and therefore a more intensive treatment with a blood pressure goal of 130/80. After the clinical trial was completed, most of the remaining participants were enrolled in a follow up study or the second phase of the study which began in 1998 and ended in 2010—current year. In which everyone had a blood pressure goal of less than 130/80.
Akinso: Dr. Rodgers explains the importance of the follow up study.
Rodgers: The phase two study was performed and in this follow-up study the recommended blood pressure therapy started with an angiotensin converting enzyme inhibitor, these are known as ACE inhibitors. This medication works by blocking the action of protein angiotensin, which raises blood pressure. And if blood pressure was not controlled, additional drugs were added. On average, patients required about 3.5 medications for blood pressure every day.
Akinso: Dr. Rodgers says for some patients, more intensive control of blood pressure may slow progression for chronic kidney disease.
Rodgers: The AASK study adds new information about chronic kidney disease patient's benefit from lowering their blood pressure. And this information may help doctors practice evidence-based personalized medicine, and the tailoring of treatment regimens for patients who have unique characteristics.
Akinso: Dr. Rodgers adds that people who participate in studies like AASK provide important information on how to protect the kidneys and preserve overall health. For information, visit www.niddk.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
NIH scientists consider fate of pandemic H1N1 flu virus
Balintfy: Scientist estimate that at least 183 million Americans – that’s about 59 percent of the total U.S. population – have some immunity to the 2009 pandemic H1N1 flu virus. Dr. Anthony Fauci, Director at the National Institute of Allergy and Infectious Diseases explains, this is because they were exposed to related viruses or vaccines prior to 2009, were immunized against the virus, or developed immunity following infection with the virus.
Fauci: One of the things people wonder now, as we come through next cycle the year after, what is going to happen with H1N1? Is it going to come back in a pandemic form? Is it going to change? Is it going to completely disappear? Or is it going to assume the recycling that we’ve seen historically that some pandemic viruses do?
Balintfy: To stay in circulation in the face of such high levels of population immunity, the virus must adapt either through abrupt or gradual changes.
Fauci: It is unlikely that H1N1 will return in a pandemic form unless it actually drifts and changes. So, that, in many respects, is good news.
Balintfy: But Dr. Fauci cautions against complacency. He explains that many gaps remain in understanding how a given pandemic flu virus adapts to increased immunity in humans. For that reason, flu vaccination for everyone older than six months is a wise public health measure to maintain high levels of population-wide immunity.
Fauci: Well, that’s the overwhelming message. In fact, we’re seeing that there is now some data that’s getting stronger and stronger that prior exposures to various influenzas and prior vaccination to various influenzas does protect you to some extent against the emergence of new strains of influenza, even though they’re different from the ones that you were infected with or vaccinated with. So, the new recommendation from the CDC is, unless you have some contraindication, that everyone from six months of age onward should be vaccinated.
Balintfy: Immunization with 2010-2011 seasonal flu vaccine is particularly urged for babies older than six months, children, teens and young adults as the best way to protect individuals in those potentially more susceptible age groups. And Dr. Fauci adds, that this year’s seasonal flu vaccine will include three virus strains.
Fauci: The 2009 H1N1 pandemic flu is one of the three components of this year’s seasonal influenza trivalent vaccine. It’s a 2009 H1N1, a Perth H3N2, and a Brisbane/B, so we have it there. And vaccinations are available right now, so we encourage people, even now, to go and get vaccinated when it becomes available in your community.
Balintfy: Dr. Fauci and colleagues recently commented on the possible fate of the 2009 H1N1 pandemic virus in an online publication. For more information on the commentary and season flu vaccination, visit the website, www.niaid.nih.gov.
NIH Genomic Mapping Study Finds Largest Set of Genes Related to Major Risk Factor for Heart Disease
Balintfy: After scanning the DNA of people from all over the world, scientists have discovered genes related to major risk factors for coronary heart disease, the nation’s number one killer. Wally Akinso is back with a report on how gene variants explain between a quarter and a third of the inherited portions of risk factors that can be measured in the blood.
Akinso: By scanning the genomes of more than 100,000 people all over the world, scientists have found the largest set of genes related to a major risk factor for heart disease according to a NIH study.
O'Donnell: Scientist reported the largest set of genes discovered to date that underlie high cholesterol and triglycerides, which are major risk for heart attacks and strokes.
Akinso: Dr. Christopher O'Donnell is the associate director of the Framingham Heart Study and senior advisor for Genomics to the National Heart, Lung, and Blood Institute's Acting Director.
O’Donnell: The research team found approximately 95 genetic variants or sign post in the DNA—so-called miss spellings in the DNA code, which contributes to changes in blood cholesterol and triglyceride levels in men and women of many ethnic backgrounds. And abnormal levels of blood cholesterol and triglycerides are powerful risk factors for heart disease. Of these genetic variants 59 have not been known previously and thus provide new clues for developing effective treatments to combat heart disease.
Akinso: The Genome-wide association studies or GWAS, analyze DNA across populations to pinpoint hard-to-find genetic hotspots for common diseases that are thought to have many causes, both genetic and environmental. Dr. O'Donnell says the findings of GWAS provide clues to better understand causes for heart disease and stroke.
O'Donnell: The findings of this study point us to specific genetic signposts that allow us to understand more fully why many people from all walks of life have abnormal levels of cholesterol and other blood lipids that lead to heart disease. What's really exciting about this work is that we are moving now from discovery to understanding brand new information about how genes alter the lipids that contribute to heart disease.
Akinso: Dr. O’Donnell adds that these results help refine their course for preventing and treating heart disease. For more information, visit, www.nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: Coming up, the history of medicine plus current and upcoming exhibits, that’s next on NIH Research Radio.
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The History of Medicine series - part 1 of 3
Balintfy: In the past couple episodes of NIH Research Radio, we were learning about the latest, cutting edge technology nanotechnology. Now, we’re kicking off a series looking back – sort of. While the medical research done by the various institutes and centers here at NIH is obviously striving for advances and new discoveries, there is a division that’s helping researchers – and the public – keep a perspective. I’m talking with Dr. Jeffery Reznick, deputy chief of the History of Medicine Division at the National Library of Medicine. First, why is it important that we have a division like this?
Reznick: So, having a History of Medicine Division in the National Library of Medicine here at NIH is particularly important because the history of medicine helps to humanize medicine. It helps to make more informed our decisions about health science, health care, and the scientific advancement of health care. And studying the history of medicine helps to reveal, in essence, the implications of the science, the implications of disease and health, not only for the pursuit of science in and of itself, but also for the individuals and the communities, the populations that are impacted by the science both here in the United States and around the world.
Balintfy: Can you tell me more about the History of Medicine Division today, what kind of programs you offer?
Reznick: Sure. So, the History of Medicine Division is home to an award-winning exhibition program, which my colleague, Dr. Maron Parry, will be speaking about. It’s home to one of the world’s finest rare book collections, under the stewardship of my colleague, Michael North, and, an images and archives collection under the stewardship of my colleague, Dr. Paul Theerman. We also are home to a team of technology professionals who are dedicated uniquely to creating websites, which feature our collections and our exhibitions.
Balintfy: And we will be speaking to all of these colleagues, Dr. Parry shortly, but what in particular would you emphasize about the division Dr. Reznick?
Reznick: Well, Joe, I appreciate the opportunity to speak with you today. And one thing I’d like to mention is that the History of Medicine Division has something, really, for everybody, whether you’re a student or teacher, a scholar, a health professional who’d like to learn more about the history of your field, if you’re an artist or filmmaker, or, in fact, a journalist looking to explore the history of medicine perhaps in the context of nanotechnology as we talked about at the outset of our interview. So, I encourage you, no matter who you are, and whoever our listeners might be, to look at the History of Medicine website, explore our resources. And if you have a particular question or resource you’re looking for in the history of medicine, don’t hesitate to contact us, and we’d be happy to be of service.
Balintfy: Is that actually the best way to visit the National Library of Medicine, maybe through the website?
Reznick: Well, that’s one important way to visit us, but, of course, we are open to the public. We are a federal entity like all entities here at NIH. And if anyone would wish to visit us physically, they can do so here on the NIH campus in Bethesda.
Balintfy: Thank you Dr. Reznick.
Reznick: Thank you Joe.Balintfy: Now we’re continuing the conversation about the NLM’s History of Medicine Division with Dr. Manon Parry who is a curator in the exhibition program. Now when I think of curator I think of museums. Is the National Library of Medicine in a way a museum?
Parry: Absolutely. We actually have a four thousand square foot exhibition space where we have our permanent exhibitions on display for about two years. We also have a range of traveling exhibitions and online web versions. So people can get access to all of the projects that we develop all around the world.
Balintfy: Dr. Parry, so your division creates, manages and displays exhibits?
Parry: Yeah, the exhibition program specializes in projects on topics in the history of medicine. We have a wide range of projects drawing on the collections of the National Library of Medicine, but also borrowing from museums and archives all around the world.
Balintfy: Can you give some examples of them?
Parry: Our current project is called "Against the Odds" and that’s on display on the campus of the National Institutes of Health and that is an exploration of global health and human rights. It’s also accessible online at nlm.nih.gov/againsttheodds. We also have very populated exhibitions traveling the country at the moment including one on Harry Potter and the history of medicine used in that series of novels and Frankenstein, and the history of medicine and how it relates to that story.
Balintfy: Who then are the audiences that you think are going to find these interesting? It’s not just for researchers. But it sounds like these would have appeal to anyone.
Parry: Absolutely. Our exhibitions are designed for a really broad audience. Everything from school groups to scientists. We also include educational resources for high school and undergraduate students, career resources for people interested in careers in medicine, but it’s also tailored to members of the general public who just have an interest and questions about science and society.
Balintfy: Do you have a favorite exhibit Dr. Parry?
Parry: My current favorite is one that I recently completed actually. It’s called "The Literature of Prescription." That’s available online at nlm.nih.gov/literatureofprescription. It’s also traveling the country. And that’s about Charlotte Perkins Gilman and The Yellow Wallpaper, a short story that she wrote in the late nineteenth century questioning the medical profession’s attitude towards women at a time when women were campaigning for a greater role in public life.
Balintfy: Can you tell me some more about it? What’s interesting about it? What will people learn about it?
Parry: I think it’s really exciting because it shows how science is shaped by things that are going on in society and culture at the time. So the story follows Gilman’s attempts to campaign for a broader role for women in society and the backlash amongst the medical community when they were arguing at the time that women had a limited intellectual capacity and would be strained by too much education and made ill. She was actually suffering from depression herself and was subject to a very strict cure that involved giving up her artistic activities including writing which she loved. She found that that treatment was actually making her worse so she threw off the recommended prescription and instead, wrote a terrifying tale about what happens when women are forced to give up the activities that they enjoy. That is the publication of The Yellow Wallpaper. You can read the full story on the exhibition website.
Balintfy: Neat. Any other highlights that you think would be worth sharing whether they be here at the campus in Bethesda or traveling around the country?
Parry: I think the only thing I would like to talk about next is—or at least to mention is that we have a steady stream of new projects coming out all the time so it’s always worth visiting the website, taking a look at what’s coming up. We have a series of exhibitions coming in the next few months as part of the 150th anniversary of the Civil War and each will focus on a different aspect of Civil War medicine so we’re expecting that to be very popular. And again, they’ll be available for and accessible to a wide range of audiences. They’ll be on tour at public libraries and university campuses around the country. They’ll be educational resources for high schoolers and undergraduates and we really hope that people get a chance to enjoy them.
Balintfy: Thank you very much Dr. Manon Parry. We’ll hear more from Dr. Jeff Reznick and more of his colleagues next time. For now, that’s it for this episode of NIH Research Radio. Please join us again on Friday, October 22nd when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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