Dr. Thomas R. Frieden.


The New York Times, GoogleNews.com, May 15, 2009  —  WASHINGTON – President Obama will announce on Friday that he has chosen Dr. Thomas R. Frieden, the New York City health commissioner, as the next director of the Centers for Disease Control and Prevention, administration officials said Thursday.

Dr. Frieden, a 48-year-old infectious disease specialist, has cut a high and sometimes contentious profile in his seven years as New York’s top health official under Mayor Michael R. Bloomberg. He led the crusade to ban smoking in restaurants and bars, pushed to make H.I.V. testing a routine part of medical exams, and defended a program that passes out more than 35 million condoms a year.

As an Epidemic Intelligence Service Officer for the Centers for Disease Control and Prevention (CDC) from 1990 to 1992, Tom Frieden documented a large outbreak of tuberculosis with drug resistance in New York City.1 His work fostered public awareness and helped improve public funding (city, state and federal) for tuberculosis control.  In 1992, he was appointed assistant commissioner and director of the Health Department’s Bureau of Tuberculosis Control, where he faced a large and fast-growing epidemic of tuberculosis, including HIV-related and drug-resistant tuberculosis.1,4 New York City rapidly controlled the epidemic, reducing overall incidence by nearly half and cutting multidrug-resistant tuberculosis by 80%.5 The city’s program became a model for tuberculosis control.

Frieden graduated from Oberlin College (BA), Columbia University College of Physicians and Surgeons (MD) and Columbia University’s Mailman School of Public Health (MPH). He completed training in internal medicine at Columbia-Presbyterian Medical Center and sub-specialty training in infectious diseases at Yale University.

At the C.D.C., he will inherit a host of immediate and long-term problems, including a looming decision about whether and how to produce a swine flu vaccine. Health experts say the agency must resolve serious morale and organizational issues even as the administration struggles to overhaul the nation’s health care system.

“I think the administration selected Tom Frieden because he can take public health to a new place,” said Jeffrey Levi, executive director of Trust for America’s Health, a nonprofit public health advocacy organization. “He’s a transformational leader.”

Dr. Frieden is expected to take office next month. With his appointment, which does not require Senate confirmation, New York City will have former commissioners in two of the nation’s most visible health positions; Dr. Margaret A. Hamburg, who held the job in the 1990s, is nearing confirmation as commissioner of the Food and Drug Administration.

Confronted with a growing epidemic of diabetes in New York City, Frieden has worked to raise awareness, particularly among pregnant women, and has established a hemoglobin A1C diabetes registry that tracks patients’ blood sugar control over several months and reports that information to treating physicians to help them provide better care. The New York City Board of Health’s decision to require laboratories to report A1C test results has generated a heated debate among civil libertarians, who view it as a violation of medical privacy and an intrusion into the doctor-patient relationship,although patients can choose not to receive information from the program. The New York City Health Department asserts that the A1C registry can help reduce the risk of blindness, kidney failure, leg amputations and early death among people with diabetes.

To combat cardiovascular disease, New York City has adopted regulations since 2006 to eliminate artificial trans fat from all restaurants.The restaurant industry and its political allies condemned the trans-fat measure as an assault on liberty by an overzealous “nanny state, but compliance has exceeded 90% among New York City restaurants, and the measure has inspired similar laws in several US cities and the state of California.The Health Department also required chain restaurants to post calorie information in order to raise consumer awareness of fast food‘s caloric impact. The measure requires chains with 15 or more outlets to post calorie counts on menus and menu boards. It has prompted two lawsuits by the New York State Restaurant Association. In the first, a U.S. District Court judge ruled that federal law pre-empted New York City’s action and overturned it.The NYC Board of Health then repealed and re-enacted the measure,which took effect in May 2008. Most chains now post calorie information in their New York City outlets, despite a pending legal challenge, and customers have experienced widespread “sticker shock.”

During Frieden’s tenure, the New York City Health Department has greatly expanded the collection and use of epidemiological data, launching an annual Community Health Survey56 and the nation’s first community-based Health and Nutrition Examination Survey.

To improve quality and efficiency of medical care, the agency also launched the nation’s largest community-based electronic health records project to improve preventive care for more than one million at-risk New Yorkers.

Life expectancy has reached record highs in New York City since 2002, and the city is now considered a national model for emergency preparedness.

Dr. Frieden has long been expected to be Mr. Obama’s choice, and although he is widely admired in the public health community, some C.D.C. veterans began lobbying in recent weeks on behalf of the agency’s acting director, Dr. Richard E. Besser.

Dr. Besser has been the government’s chief scientific spokesman during the swine flu epidemic, winning rave reviews for his confident performance. He will return to his post as head of the agency’s coordinating office for terrorism preparedness and emergency response.

Dr. Frieden has won positive reviews himself for his televised swine flu updates, and he will take some of his own advantages to his new role, including his long and close relationship with Dr. Hamburg.

The two worked together for years in New York City and were critical players in an effective campaign to stop a growing epidemic of drug-resistant tuberculosis infections. Dr. Frieden and Dr. Hamburg will play important roles in how the government decides to fight swine flu next fall if the virus returns with a vengeance.

Their relationship will also be tested in the effort to improve the safety of the nation’s food supply, in which both agencies play crucial parts. Mr. Obama has made food safety a top health priority; a government working group that includes the food and drug agency, the Department of Agriculture and other agencies is already at work on the problem; and Congress has proposed a variety of legislative fixes.

Any changes are likely to affect the disease centers, which play a central role in monitoring and solving outbreaks of food-related illnesses.

Also facing Dr. Frieden will be a set of decisions about how to organize the agency. Dr. Julie L. Gerberding, who left in January as the agency’s director, undertook a reorganization that lasted years and has been widely criticized as overly bureaucratic and the cause of a raft of top staff departures. But still another administrative overhaul would create its own set of headaches.

“Morale is the weakest thing at the agency right now,” said Dr. James M. Hughes, former director of the C.D.C.’s National Center for Infectious Diseases. “He has to really listen to people, and I think there are too many bureaucratic layers.”

Like other federal agencies, the disease centers added thousands of contract employees during the Bush administration. Deciding which functions are best fulfilled by contractors and which should be brought back inside the agency is another delicate problem for Dr. Frieden.

Health care reform also needs to be on his plate,” said Dr. Jeffrey P. Koplan, who served as the centers’ director from 1998 to 2002. “There is a huge opportunity there to improve public health, and it’s one in which any C.D.C. director will want to be a player.”

However he decides these questions, Dr. Frieden is bound to kick up controversy, say those who know him.

“I found he’s willing to challenge the status quo in an effort to make a difference,” said Dennis deLeon, president of the Latino Commission on AIDS in New York City.

Dr. Frieden has a history of focusing on health threats that endanger large numbers of people, sometimes at the expense of more popular causes. This put him in marked opposition to the Bush administration, which spent more than $50 billion on bioterrorism initiatives and paid far less attention to problems like smoking.

Dr. Alfred Sommer, emeritus dean of the Johns Hopkins Bloomberg School of Public Health, who was on the team that recommended Dr. Frieden as New York’s health chief in 2002, recalled interviewing him shortly after the Sept. 11 attacks. Dr. Frieden had flown to New York from India, where he was living and working on tuberculosis control.

Before he left India, he was asked about his top priority, Dr. Sommer said. “Oh, well, that’s easy, Al,” Dr. Sommer recalled him replying. “Tobacco. Tobacco is killing more people, and that’s my top priority.”

“Tom, I don’t disagree that tobacco is a real scourge, but have you heard of 9/11?” Dr. Sommer said he countered.

“Of course I know about that, but bioterrorists are not going to kill more New Yorkers than tobacco is,” Dr. Frieden said.

By Henry Goldman

May 15, 2009, BloombergNews.com   —   An assistant principal was hospitalized in critical condition and three New York City public schools shut in a renewed outbreak of swine flu that first sickened hundreds of residents about three weeks ago.

“Unusually high levels” of flu-like illness in the schools triggered the closures, Mayor Michael Bloomberg said last evening at a City Hall news conference. The male assistant principal at Intermediate School 238 in Jamaica, in the city borough of Queens, where more than 50 students have been sent home sick, may have had a pre-existing condition that worsened his illness, Bloomberg said.

New York City was the first area in the U.S. last month to report more than a dozen cases of swine flu that has now reached 34 countries and sickened more than 6,500 people worldwide, according to the World Health Organization. City health authorities said May 1 they would test only those New Yorkers seriously ill with flu-like symptoms because most local cases of the new influenza, known as H1N1, were no more severe than seasonal flu. At the time, Bloomberg said more than 1,000 people in the city may have been infected with the virus.

“I know that many will find this information troubling, but information I’ve always thought is the best antidote to anxiety and we will continue to provide New Yorkers with clear, accurate and timely information as we have it,” Bloomberg said last night. “By taking common sense precautions and not by overreacting we will get through this together.”

In addition to IS 238, or the Susan B. Anthony School, the shut schools are Public School 16Q in Corona, Queens, where 29 students were documented with flu-like symptoms, and IS 5Q, the Walter Crowley Intermediate School in Elmhurst, Queens, where 241 students were reported absent.

‘Unusually High’

“We have been carefully monitoring the H1N1 virus, and we’re taking this action today because there are unusually high levels of flu-like illnesses at three public schools,” Bloomberg said at City Hall, where he was joined by Governor David Paterson and city schools Chancellor Joel Klein.

“This is the best procedure: to close these three schools for public safety and for the continued safety of the families involved,” Paterson said.

A total of 4,500 students attend the three schools. The earliest date the schools may reopen is May 22 under the order put in place after health officials discovered the influenza symptoms. Bloomberg said H1N1 has been documented in the assistant principal and four students.

Flu Symptoms

Symptoms of H1N1 include fever, cough, body aches, headaches, chills, fatigue, sore throat and sometimes diarrhea and nausea. Bloomberg advised New Yorkers to go to the doctor if they have trouble breathing but stay home if it’s not severe for at least 24 hours, and to cover mouths when coughing or sneezing.

“While the symptoms of H1N1 flu seem to resemble those of seasonal flu, the H1N1 virus appears to spread rapidly so we’re closing these schools in order to slow transmission,” Bloomberg said.

Deputy Mayor Linda Gibbs, who supervises the Health Department, said the city’s surveillance system, which monitors local hospitals, detected the flu outbreak within the last day.

The two middle schools each reported about 17 percent absent with illness. The elementary school had 29 ill students of about 1,500, “but all 29 reported with flu-symptoms in the nurse’s office,” Gibbs said.

Swine flu is confirmed in 4,298 cases in the U.S., including three deaths, the Centers for Disease Control and Prevention in Atlanta reported yesterday.

AP Photo/Aaron Favila, Source GoogleNews.com

GoogleNews.com, May 15, 2009  —  by MARIA CHENG and FRANK JORDANSGENEVA (AP) – As swine flu cases topped 6,600 worldwide, vaccine makers and other experts met Thursday at the World Health Organization to discuss the tough decisions that must be made quickly to fight the evolving virus.

Pharmaceutical companies are ready to begin making a swine flu vaccine – but as the virus may mutate, questions abound: How much should be produced? How will it be distributed? Who should get it?

The expert group’s recommendations will be passed to WHO Director-General Margaret Chan, who is expected to issue advice to vaccine manufacturers and the World Health Assembly next week.

WHO’s flu chief said the meeting of industry representatives and independent experts sought to answer questions including when to recommend to manufacturers that they switch from a seasonal vaccine to one that works against the pandemic strain.

“No big decisions, no announcements,” Keiji Fukuda told reporters after the meeting. “These are enormously complicated questions, and they are not something that anyone can make in a single meeting.”

But some feel the main decision has already been made.

“It’s a foregone conclusion,” said David Fedson, a vaccines expert and former professor of medicine at the University of Virginia. “If we don’t invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing.”

Most flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake.

Vaccine makers can make limited amounts of both seasonal flu vaccine and pandemic vaccine – though not at the same time – but they cannot make massive quantities of both because that exceeds manufacturing capacity.

“What is really going to be wrestled with is that seasonal influenza itself has a significant impact on people,” said Fukuda. “This is an infection which is estimated to kill some hundreds of thousands of people each year around the world, so there is a real trade-off if you just say we’re going to stop making that vaccine.”

At the moment, health officials aren’t sure how deadly swine flu is, and whether they will need more seasonal flu vaccine or swine flu vaccine. And if the swine flu mutates, scientists aren’t sure how effective a vaccine made now from the current strain will remain.

WHO estimates that up to 2 billion doses of swine flu vaccine could be produced every year, though the first batches wouldn’t be available for four to six months.

The U.S. Centers for Disease Control and Prevention is currently working on a “seed stock” to make the vaccine, which should be ready in the next couple of weeks. That will be distributed to manufacturers worldwide so they can start producing the vaccine.

Until vaccine manufacturers get the seed stock, they won’t know how many doses of vaccine they can make or how long that would take. Sanofi Pasteur, the world’s biggest vaccine producer, said Thursday it is waiting for the green light from WHO before it starts making swine flu vaccine.

WHO is also negotiating with vaccine producers like GlaxoSmithKline PLC to save some of their swine flu vaccine for poorer nations. Many rich nations like Britain, Canada, Denmark, France, Switzerland and the United States signed deals with vaccine makers years ago to guarantee them pandemic vaccines as soon as they’re available.

As of Thursday, at least 33 countries reported more than 6,600 cases of swine flu worldwide, with 70 deaths. The figures are based on tallies provided by national governments and WHO. According to the global body’s pandemic alert level, the world is at phase 5 – out of a possible 6 – meaning that a global outbreak is “imminent.”

“It’s a no-brainer,” Fedson said of the decision to make swine flu vaccine. “All that’s being discussed now is the details of how to make sure you have enough seasonal flu vaccine and the logistics of making the switch to H1N1 vaccine production.”

While the vaccine question hangs in the air, WHO has given Indian pharmaceuticals giant Cipla the medical go-ahead to produce a generic version of the anti-viral medication Tamiflu. The drug, also known as oseltamivir, is one of two anti-virals shown to work against swine flu.

WHO said Cipla’s generic version was as effective as the original made by Swiss firm Roche Holding AG and would hopefully make the drug more accessible to poor countries.

North America has been the hardest-hit continent. The United States has reported 3,352 laboratory-confirmed cases of swine flu, including four deaths. Arizona officials reported Thursday the latest case, a woman in her late 40s who died last week from what appeared to be complications from the illness.

On Thursday, New York City closed three schools in response to a swine flu outbreak that has left an assistant principal in critical condition and sent hundreds of kids home with flu symptoms, in a flare-up of the virus that sent shock waves through the world last month.

Mayor Michael Bloomberg said that four students and the assistant principal have documented cases of swine flu at a Queens middle school.

Mexico has 2,656 cases and 64 deaths, while Canada has 389 cases with one death, according to WHO figures.

Mexico confirmed 374 more cases Thursday including four more deaths, but Health Secretary Jose Angel Cordova said the new cases show the virus is appearing less deadly. Mexico’s swine flu deaths now represent 2.4 percent of its confirmed cases, he said.

Spain and Britain have the most cases in Europe, at 100 and 78 respectively.

In Central America, Costa Rica has eight cases and one death and Panama has 29 cases.

Novel H1N1 Flu a Naturally Circulating Virus, Not From a Laboratory


Medscape.com, May 14, 2009, by Emma Hitt PhD   –  The World Health Organization (WHO) is refuting claims made by an eminent virologist that the novel H1N1 strain that is circulating is derived from a laboratory.

Keiji Fukuda, MD, MPH, assistant director-general ad. interim for health security and environment at the WHO, spoke at a press conference today.

According to Dr. Fukuda, on Saturday, May 9, the WHO was contacted by Dr. Adrian Gibbs, who Dr. Fukuda referred to as a “credible” virologist. After looking at the gene sequence of H1N1, Dr. Gibbs speculated that the virus circulating may have been from a laboratory-derived virus.

Dr. Gibbs, an emeritus professor at the Australian National University in Canberra, said that all 8 of the genes from the novel H1N1 strain seemed to have evolved at a faster rate than would have been expected if the virus had just emerged naturally from pigs.

Dr. Fukuda stated that the WHO discussed the hypothesis provided by the scientist and they contacted the UN Food and Agriculture Organization (FAO) and the World Animal Health Organization (OIE). WHO asked their virologists to “look at the evidence and then provide their opinion to us – was this a credible hypothesis or not?” he said.

“Based on that evaluation by all of the laboratories, the conclusion is that this group of scientists feels that the hypothesis does not really stand up to scrutiny,” Dr. Fukuda said. “The evidence suggests that this is a naturally occurring virus and not a laboratory-derived virus.”

Dr. Fukuda also used the press conference to clarify some confusion evident in certain media reports. “WHO is not making any changes in its recommendation about antiviral use,” he said. He also emphasized that they have not seen any evidence of increased resistance to antivirals, although they will continue to monitor for any evidence of resistance.

As of 2:30 am EDT today, the WHO is reporting a total of 6497 laboratory-confirmed cases, including 65 deaths, in 33 countries. Today’s number represents an increase of 769 cases from yesterday. The US Centers for Disease Control and Prevention is reporting 4298 confirmed and probable cases in 46 states and the District of Columbia and a total of 3 deaths in the United States.

For now, daily WHO press briefings will be discontinued, according to Dr. Fukuda. The decision is more because of upcoming WHO meetings and a desire not to spread the staff “too thin” than because of any abatement of the H1N1 epidemic, he pointed out.

“This is an event which is serious; this is something which requires close monitoring, but most of the cases at this time continue to be mild cases…although there are some people who do get fatalities and serious illnesses,” he said.

No “big decisions” have been made yet about H1N1 vaccine production, although the initial steps for producing are under way, he said.

FDA Safety Changes: Zithromax, Frova, Lexiscan

Medscape.com, May 14, 2009, by Yael Waknine   –   The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise that concomitant use of azithromycin may potentiate the effects of oral anticoagulants, frovatriptan succinate is linked to a risk for serotonin syndrome that is increased by coadministration of antidepressants, and regadenoson injection may cause heart block and hypotension in some patients.

Azithromycin May Potentiate the Effects of Oral Anticoagulants

The FDA approved class labeling changes for azithromycin tablets and oral suspension to advise of a potential drug interaction with warfarin. On February 27, the label for Zithromax (Pfizer, Inc) was updated.

Although data from a pharmacokinetic study of 22 healthy men taking a 5-day course of azithromycin did not support an interaction with subsequently administered warfarin, postmarketing reports suggest that azithromycin may potentiate the effects of oral anticoagulants.

The FDA advises careful monitoring of prothrombin time in warfarin-treated patients receiving a course of azithromycin.

Azithromycin is a macrolide antibiotic indicated for the treatment of nongonococcal urethritis and cervicitis as a result of Chlamydia trachomatis and for the prophylaxis and treatment of disseminated Mycobacterium avium complex disease.

Warfarin is an oral anticoagulant indicated for the prophylaxis and/or treatment of venous thromboembolism and pulmonary embolism and for thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement and to reduce the risk for death, recurrent myocardial infarction, and thromboembolic events after myocardial infarction.

Triptans Such as Frovatriptan Succinate (Frova) Linked to Risk for Serotonin Syndrome

The FDA approved class labeling changes for frovatriptan succinate tablets to provide updated information regarding the risk for potentially life-threatening serotonin syndrome in patients receiving treatment with 5-hydroxytryptamine receptor agonists (triptans). On March 3, the label for Frova (Endo Pharmaceuticals, Inc) was updated.

Although this reaction has occurred in patients receiving triptans alone, the risk for its occurrence is significantly increased by concomitant use of selective serotonin reuptake inhibitors (SSRIs; eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and escitalopram) or serotonin-norepinephrine reuptake inhibitors (SNRIs; eg, venlafaxine and duloxetine).

Symptoms of serotonin syndrome may include mental status changes (eg, agitation, hallucinations, and coma), autonomic instability (eg, tachycardia, labile blood pressure, and hyperthermia), neuromuscular aberrations (eg, hyperreflexia and incoordination), and/or gastrointestinal tract symptoms (eg, nausea, vomiting, and diarrhea).

The FDA advises close monitoring of SSRI- or SNRI-treated patients receiving triptans, particularly during initiation of therapy and dose increases.

Frovatriptan is indicated for the acute treatment of migraine with or without aura in adults.

Regadenoson (Lexiscan) Linked to Risks for Nodal Block and Hypotension in Some Patients

On March 17, the FDA approved safety labeling revisions for regadenoson injection (Lexiscan; Astellas Pharma US, Inc) to provide additional postmarketing information regarding the risks for sinoatrial (SA) and atrioventricular (AV) nodal block and hypotension.

Adenosine receptor agonists, including regadenoson, can depress SA and AV nodal function potentially leading to first-, second-, or third-degree AV block or sinus bradycardia requiring intervention, the FDA warned.

In clinical trials, the risk appeared to be low: 2015 patients (3%) had first-degree AV block (PR prolongation > 220 milliseconds) within 2 hours of regadenoson administration, and 1 patient (0.05%) had transient second-degree AV block with 1 dropped beat. However, the FDA has since received postmarketing reports of third-degree heart block and asystole within minutes of regadenoson use.

Adenosine receptor agonists also induce arterial vasodilation and hypotension. In clinical trials of regadenoson, 7% and 4% of patients experienced decreased systolic (> 35 mm Hg) and diastolic (> 25 mm Hg) blood pressure, respectively, within 45 minutes of regadenoson administration.

The FDA notes that the risk for serious hypotension may be increased for patients with autonomic dysfunction, hypovolemia, left main coronary artery stenosis, stenotic valvular heart disease, pericarditis or pericardial effusions, or stenotic carotid artery disease with cerebrovascular insufficiency. In postmarketing experience, syncope and transient ischemic attacks have been observed.

Regadenoson is a pharmacologic stress agent indicated for radionucleotide myocardial perfusion imaging in patients unable to undergo an adequate exercise stress test.

Zithromax Prescribing Information

Frova Prescribing Information

Lexiscan Prescribing Information

Clinical Implications

  • Postmarketing reports suggest that azithromycin may potentiate the effects of oral anticoagulants. Prothrombin time should be carefully monitored in warfarin-treated patients receiving a course of azithromycin.
  • Potentially life-threatening serotonin syndrome can occur in patients receiving triptans alone but, more particularly, with concomitant use of antidepressants. Patients receiving combination therapy should be observed closely for symptoms of serotonin syndrome, particularly during dose increases. Symptoms may include mental status changes, autonomic instability, neuromuscular aberrations, and/or gastrointestinal tract symptoms.

Clinical trials have demonstrated a low risk for atrioventricular block and sinus bradycardia requiring intervention in patients receiving regadenoson for myocardial perfusion imaging; postmarketing reports have included third-degree heart block and asystole within minutes of drug administration.

Journal of Translational Medicine

Medscape.com, May 14, 2009, by Allison Gandey   –   A new study is testing the usefulness of stem cells derived from a patient’s own fat tissue to treat multiple sclerosis (MS). Preliminary results, published online April 24 in the Journal of Translational Medicine, are promising and could have implications for a range of inflammatory illnesses.

The researchers, led by Boris Minev, MD, from the University of California, San Diego, point out that none of the currently available treatments for MS selectively inhibit the immune attack against the nervous system, and they do not stimulate regeneration of previously damaged tissue. “We’ve shown that stromal vascular fraction cells may fill this therapeutic gap.”

During an interview, study coauthor Thomas Ichim, PhD, chief executive officer of Medistem, in San Diego, California, said, “As people gain weight, their bodies make inflammatory compounds that attract stem cells. Liposuction is a common procedure, and it is easy to do and might prove to be a rich source of stem cells that could be used to treat a variety of inflammatory diseases.”

The stromal vascular fraction of adipose tissue is said to contain mesenchymal stem cells, T regulatory cells, endothelial precursor cells, and preadipocytes, as well as anti-inflammatory M2 macrophages.

As a result, fat tissue has attracted interest as a possible alternative source of stem cells. Enticing characteristics of adipose-derived cells include:

  • Ease of extraction.
  • Higher mesenchymal stem-cell content.
  • Expandability of the cells (approximately equivalent, if not superior, to bone marrow).

Asked by Medscape Neurology & Neurosurgery to comment on the work, American Academy of Neurology spokesperson Lily Jung, MD, said, “The fact that we can get stem cells from fat is very interesting, and it’s easy to obtain. I think there are a lot of people who would be willing to donate their fat,” she laughed. Dr. Jung is a clinical associate professor of neurology at the University of Washington Medical School, in Seattle.

Fat Tissue Rich Source of Stem Cells

The researchers report 3 case studies supporting further evaluation of stromal vascular fraction cells. Patients were part of a physician-initiated compassionate-use evaluation. The first MS patient had suffered frequent painful seizures for 3 years. After receiving treatment, he reported that the seizures stopped and he experienced significant cognitive improvements and less spasticity in his arms and legs.

The second patient reported improvements in his sense of balance and coordination as well as increases in energy and better mood.

The final patient had been diagnosed with MS 15 years prior to receiving stromal vascular fraction. After treatment, his gait, balance, and coordination improved dramatically over a period of several weeks.

“His condition continued to improve over the next few months, and he is currently reporting a continuing improvement and ability to jog, run, and even bicycle,” Dr. Minev said.

“All 3 patients in our study showed dramatic improvement in their condition after the course of stromal vascular fraction therapy. While obviously no conclusions in terms of therapeutic efficacy can be drawn from these reports, this first clinical use of fat stem cells for treatment of multiple sclerosis supports further investigations into this very simple and easily-implementable treatment methodology,” he said.

Dr. Jung said she would have liked to see more changes on magnetic resonance imaging (MRI). “The fact that there were no clear changes for 2 of the patients does raise questions about whether this improvement is objective and quantifiable.” Still, she said, “The bottom line is that at least 1 patient is responding nicely, so this does warrant further study.”

Steven Goldman, MD, from the University of Rochester Medical Center, in New York, was also cautious in his assessment of the work. “It reports only 3 cases, though each with relatively stable long-standing disease, and offers little detail as to the neurological exams or detailed MRI of these patients before and after treatment. So while the overall approach may have some promise, this report provides no real basis for evaluating its potential efficacy.”

Adult Stem Cells Safer

Dr. Ichim agreed that the work is preliminary, but he says that adult stem cells hold great promise for future research. “Adult stem cells are often overlooked in favor of embryonic cells,” he said. “Celebrities such as Christopher Reeve and Michael J. Fox have really helped draw public attention to embryonic stem-cell research, and this is a shame, because there are many advantages to using a patient’s own cells.” He points to less risk for infection, cancer, and immune rejection.

Dr. Jung said she agrees that adult stem cells present less risk for patients.

“Embryonic stem-cell research is only just beginning, whereas adult stem cells are already a clinical reality,” Dr. Ichim added, citing stem-cell therapy for heart failure as an example. “We are learning how to revitalize and regenerate the human body.”

Study authors Dr. Ichim and Neil Riordan, PhD, manage and are shareholders of Medistem, a company that has filed intellectual property on the use of adipose stromal vascular fraction cells for immune modulation.

J Transl Med. Published online April 24, 2009.

The Sarpa salpa fish is a potentially hallucinogenic form of Bream normally found in off the coast of Africa Photo: BNPS  

A species of bream, sarpa salpa, which can trigger hallucinations when eaten, has been been discovered in British waters due to global warming.

Telegraph.co.uk, May 14, 2009  —  The species of bream is normally found in the balmier waters of the Mediterranean and South Africa, was found by fisherman Andy Giles in his nets in the English Channel.

Mr Giles, 38, caught the fish, which is instantly recognised by its gold stripes running along its body, six miles south of Polperro, Cornwall.

“We were trawling for lemon sole and hauled up the net at the end of the day and almost immediately saw this striped fish, we didn’t have a clue what it was,” he said.

“I had never seen one before and after taking a photograph of it I tried to look it up on the internet and called some friends to see if they knew what it was.

“I put it in the fish box and brought it back for experts to have a look at it.

“Now I realise what it was and the effects it can have, perhaps I should have taken it into town to sell to some clubbers!”

There have only been three previous recordings of sarpa salpa in British waters before, with one of them being off the Channel Islands in 1983.

James Wright, a senior biologist at the National Marine Aquarium in Plymouth, said: “These are a fairly common fish off Tenerife, Malta and Cyprus but it is very rare to get them this far north.

“It could be a single fish that was shoaling with a different species but it could be that there are more of them in our waters.”

Sarpa salpa are a popular dish in many Mediterranean restaurants.

But according to marine experts, certain species of plankton-eating fish, like the sarpa salpa, can give off hallucinogenic fish poisoning if the heads or other body parts are consumed.

The effects include vivid hallucinations within minutes of eating it which can last for days.

In 2006 two men, one aged 90, were hospitalised in the south of France after eating sarpa salpa.

The elderly man suffered from auditory hallucinations a couple of hours after eating the fish followed by a series of nightmares over the next two nights.

The younger man, aged 40, endured similar effects which took 36 hours to disappear.


The secretary of energy talks with Technology Review about the future of nuclear power post Yucca Mountain and why fuel-cell cars have no future.  

MIT Technology Review, by Kevin Bullis, May 14, 2009  —  In his first 112 days as the U.S. Energy Secretary, Steven Chu has presided over unprecedented changes at the Department of Energy (DOE). The stimulus bill signed into law in February provided $39 billion to the agency–a sum that Chu acknowledges is straining the agency as it attempts to sort through proposals for distributing this money. The money is in addition to the agency’s yearly budget of about $25 billion. Most recently, President Obama’s proposed 2010 budget upped DOE’s budget by $400 million and called for increased spending on climate science and nuclear security, as well as support for many alternative-energy projects.

At a lecture at MIT on Tuesday, Chu, who won the 1997 Nobel Prize in Physics and is the former director of the Lawrence Berkeley National Laboratory, outlined his plans for reducing carbon dioxide emissions. In the near term, Chu said, the answer is improving energy efficiency. Better buildings could cut energy use in the United States by roughly one-third, he said. That would save more energy than is produced by all of the country’s nuclear-power plants, solar-power plants, and wind farms. The simple step of fine-tuning a building after it’s built–to ensure that things such as the heating, ventilation, and air-condition systems are working properly–could cut energy use in those buildings by 10 percent, according to Chu.

In the longer term, alternative energies can be a big part of the solution. But Chu noted that solar power, for one, is still far too expensive to compete with conventional power plants (except on hot summer days in some places, and with subsidies). Making solar cheap will require “transformative technologies,” equivalent to the discovery of the transistor, he said.

But Chu’s first months in office weren’t all about handing out money for new technologies. Technology Review‘s energy editor, Kevin Bullis, sat down to talk with Chu about two of the most controversial decisions of the first hundred days. In an abrupt break with previous administrations, President Obama’s proposed 2010 budget eliminates funding for the controversial plan to store the nation’s nuclear waste at Yucca Mountain. The proposed 2010 budget also cuts funding for research into hydrogen fuel cells–a multibillion dollar initiative that was the focus of President Bush’s plan to develop future low-carbon-emissions vehicles. A researcher at heart, Chu discussed some of the technical solutions to storing nuclear waste and applications for fuel cells that might be more practical than using them to power cars.

Technology Review: There’s some 50,000 metric tons of nuclear waste scattered among 130 sites across the country. What are you going to do with that waste now?

Steven Chu: Yucca Mountain as a repository is off the table. What we’re going to be doing is saying, let’s step back. We realize that we know a lot more today than we did 25 or 30 years ago. The NRC [Nuclear Regulatory Commission] is saying that the dry cask storage at current sites would be safe for many decades, so that gives us time to figure out what we should do for a long-term strategy. We will be assembling a blue-ribbon panel to look at the issue.

[We’re] looking at reactors that have a high-energy neutron spectrum that can actually allow you to burn down the long-lived actinide waste. [Editor’s note: Actinides include plutonium, which can be dangerous for 100,000 years.] These are fast neutron reactors. There’s others: a resurgence of hybrid solutions of fusion fission where the fusion would impart not only energy, but again creates high-energy neutrons that can burn down the long-lived actinides.

TR: Is this to burn up existing waste? Or to deal with waste in future reactors?

SC: It could be for existing, but mostly for future waste. So we’re looking at, instead of the way we do it today, where you’re using 10 percent or less of the energy content of fuel, can you actually reduce the amount of waste and the lifetime of the waste.

TR: What about the existing waste?

SC: Some of the waste is already vitrified. There is, in my mind, no economical reason why you would ever think of pulling it back into a potential fuel cycle. So one could well imagine–again, it depends on what the blue-ribbon panel says–one could well imagine that for a certain classification for a certain type of waste, you don’t want to have access to it anymore, so that means you could use different sites than Yucca Mountain, [such as] salt domes. Once you put it in there, the [salt] oozes around it. These are geologically stable for a 50 to 100 million year time scale. The trouble with those type of places for repositories is you don’t have access to it anymore. But say for certain types of waste you don’t want to have access to it anymore–that’s good. It’s a very natural containment.

TR: Waste you know you don’t want to reprocess.

SC: Yes, whereas there would be other waste where you say it has some inherent value, let’s keep it around for a hundred years, two hundred years, because there’s a high likelihood we’ll come back to it and want to recover that.

So the real thing is, let’s get some really wise heads together and figure out how you want to deal with the interim and long-term storage. Yucca was supposed to be everything to everybody, and I think, knowing what we know today, there’s going to have to be several regional areas.

TR: That will deal with some of the transportation problems.

SC: Right. It makes it less of a problem.

TR: I know you’ve come out in favor of nuclear power. It’s been decades since any new plants have been constructed. What progress has been made so far in getting some new plants built?

SC: We’re now going to a two-step licensing. You license the generic plant, and then there’s a separate license for the site. And this helps speed along the process. Before, the way we did it is every plant was a new one.

A lot of this depends on some loan guarantee money, which will help.