Embryonic stem cells: can we really restore vision to the blind?

Restoring sight to the blind is, literally, a miracle.  For centuries, men have told stories of miracles in which a blind person suddenly was able to see again.

In modern times, there have been cases of vision restored thanks to corneal transplants and cataract surgery.  These are amazing treatments themselves, and they have become almost routine in the developed world.  But when the cells inside the eye are damaged, there is nothing we can do.

Until now.  In an amazing advance, scientists at Advanced Cell Technology reported this week in The Lancet that they used embryonic stem cells to restore partial vision to 2 patients who were legally blind.  One patient had macular degeneration, a very common but incurable eye disease, and the second had Stargardt disease.  Both diseases are progressive and usually lead to blindness.

Both diseases also affect internal eye cells known as retinal pigment epithelium (RPE) cells.  The research team, led by Robert Lanza, took human embryonic stem cells and coaxed them into becoming RPE cells.  They tested the RPE cells extensively for any signs of contamination by viruses or bacteria, and once they confirmed that the cell cultures were pure, they injected them into the eyes of these first two patients.  (Earlier studies were done in mice and rats before trying the therapy on humans.)

After four months, both patients showed improvements in vision.  This is an amazing result for macular degeneration, which has been, until now, irreversible.  The cells appeared to "take" in both patients, attaching to other cells in the eye and replacing damaged areas.  As Rob Stein and David Brown reported in the Washington Post

"One of them no longer needs a large magnifying glass to read and can reportedly thread a needle. The other has begun to go shopping on her own."

According to the study, neither patient has shown any signs of rejecting the cells.

The Lancet study, which you can read here, was funded entirely by private funds due to U.S. government restrictions on embryonic stem cell research.

This is only an early result from a very small study, but coming on the heels of reports just a few months ago, in which adult stem cells restored heart function to patients with advanced heart failure, the promise of stem cells again got just a bit brighter.

So yes, maybe we really can make the blind see again.

A surprising triumph in the fight against polio

Source: polioeradication.org

The last case of polio in India occurred exactly one year ago, on January 13, 2011.  In the decades-long battle against this devastating disease, this is one of the best pieces of news in a long time.  Just two years ago, health officials counted 741 polio infections in India, and it seemed that the battle was far from over.  It may yet be, but in 2010 the cases dropped dramatically, to just 42, and last year there was only one, on January 13.


As recently as the 1950s, polio was a dreaded, incurable disease that killed or paralyzed millions of children each year.  The U.S. alone had 58,000 cases in 1952. Then came the invention of a vaccine by Jonas Salk, one of the great medical breakthroughs of the 20th century.  By the 1960s, widespread vaccination campaigns had virtually eliminated polio from Europe and the U.S.  Polio lingered in the U.S., mainly in the Amish population who refused to accept vaccinations, but it finally disappeared in 1979.

The worldwide campaign to eliminate polio started in 1988, when 350,000 infections were recorded.  Polio is extremely difficult to control, because a large majority of infected people show no symptoms, but they can still spread the virus.  Vaccination campaigns need to treat everyone who comes in contact with an infected individual in order to break the cycle of transmission.  This is especially hard to do in remote areas of poor countries, especially when the populace is suspicious and uncooperative.

The greatest challenge in India came in the desperately poor, crowded regions of the north, where health care, hygiene, and education are all very poor.  The vaccination efforts were made even more difficult by conspiracy theories among the Muslim population.  As Simon Denyer wrote in the Washington Post this week:

"Rumors spread among the region's numerous Muslims that the polio vaccination campaign was an American conspiracy to wipe them out, by making their sons impotent and their daughters infertile.... Vaccinators were stoned as they approached Muslim neighborhoods. 'The general mind-set was that the immunization campaign was aimed at ending our lineage,' said Anwar Ahmad, the head of a madrassa in a Muslim neighborhood in the city of Meerut."

The campaign turned around after UNICEF and Rotary international launched a major education effort that first convinced Muslim leaders, and then everyone else, that the vaccine would benefit their communities.  With this success in India, polio is now endemic in only three countries in the world: Afghanistan, Pakistan, and Nigeria.  The same rumors and conspiracy theories that plagued India have spread within Muslim populations in these countries as well, but India shows that the misinformation - and polio - can be defeated.

Unfortunately, even here in the U.S. we have our own conspiracy theorists: the anti-vaccination zealots over at Age of Autism, where Dan Olmsted and Mark Blaxill recently posted a series of articles claiming that polio is "a harmless intestinal bug" that only causes disease when triggered by pesticides or by arsenic.  Never mind that there is no evidence to back this truly wacky assertion; these two anti-vaxxers seem happy to invent facts to support their single-minded campaign against all vaccines, even when the vaccines are demonstrably saving tens of thousands of lives.

Polio is still with us, and it could return.  Besides the 3 countries with endemic polio, 9 other countries continue to suffer polio cases that were imported from endemic countries.  Without widespread vaccination in those countries, polio could re-establish itself in any of them.

If polio stays out of India, we can thank the thousands of health care workers who traveled to remote villages, in extremely difficult conditions, to dispense lifesaving vaccines.  Their heroic efforts have paid off for everyone.  We should also thank the combined efforts of the WHO, UNICEF, Rotary International, the Gates Foundation, and the CDC, all of whom are backing the worldwide effort to eradicate polio.  Let's root for humanity to win this one.

The worst quackery of 2011: battlefield acupuncture

Pseudoscience continued to thrive in 2011, making my choice for the worst quackery of the year a difficult one.  So much nonsense!  Promoters of both new age and old-time hocus pocus continued to sell their unscientific therapies, as they have for decades (or centuries), including homeopathy, Ayurveda, acupuncture, qigong, reiki, magnet therapy, and a cornucopia of special "super foods", all guaranteed to cure whatever ails you.  These various alternatives to medicine are just as ridiculous today as when they were invented, decades or centuries ago.

How can anyone choose the worst practice among so many false claims?  Well, those that cause real harm to patients are worse than those that are merely useless.  I also decided to give extra weight to newer forms of mumbo jumbo.  But I could have chosen differently, and I encourage readers to nominate their own favorites in the Comments section.

And the 2011 winner of the worst quackery award is: battlefield acupuncture.  This particular bizarre medical practice offers a trifecta of ills:

1. It offers no medical benefit and carries a real risk of harm for some patients.
2. The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year.
3. The patients are wounded combat veterans who have no choice about where to get treatment.

Battlefield acupuncture has a growing number of supporters in the U.S. Defense Department (especially Richard Niemtzow, its proud inventor), who are determined to see it delivered to as many troops as possible.  I've written about this before, but it's in the news again this month, in Wired magazine.  In battlefield acupuncture, the "doctor" (no competent doctor would do this) sticks needles into the patient's ear to relieve pain.  Yes, that's right: needles in the ear.

Battlefield acupuncture was invented out of whole cloth by military doctor Richard Niemtzow, who runs an acupuncture clinic out of Andrews Air Force Base in Maryland.  Niemtzow appears to be the leading advocate for the use of acupuncture on wounded soldiers, and he has been disturbingly effective.  The military publication Stars and Stripes reported in August that the Air Force has

"launched a program to train more than 30 military doctors to use acupuncture in the war zone and at their base clinics. The program will be expanded next year with the Air Force, Army and Navy combining funds for two courses to certify 60 active-duty physicians as medical acupuncturists."

Multiple scientific studies have shown clearly that acupuncture doesn't work. The benefit is the same no matter where you place the needles, or even if you use toothpicks that don't pierce the skin.  (See a summary here, with multiple references.)  Acupuncture points and "meridians" - the pathways that acupuncturists claim to manipulate with their needles - don't even exist.

Acupuncture carries a real risk of harm, too, primarily from infection.  Acupuncturists don't practice sterile procedure, as I've pointed out before.  They claim that they do, because they think that using sterilized needles is sufficient.  Wrong again.  Sterile procedure requires that every site of needle insertion be properly sterilized, because most infections are caused by bacteria already present on the skin.  As reported last year in BMJ:

"Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure."  

Pretty serious harm from a procedure with no real benefit.

The evidence for "auricular acupuncture" - sticking needles in the ear - is less than zero.  This shouldn't be surprising, since Neimtzow just pulled this wacky theory out of thin air - but he and his converts have repeatedly asserted that it works, although they offer nothing more than anecdotes.  Niemtzow has even claimed that 18th-century pirates pierced their ears to improve their night vision.  Yes, really.  Now he's piercing the ears of wounded soldiers.

A big part of the Wired story is how the billionaire founders of the Samueli Institute, an institute dedicated to pseudoscience, have used their political muscle to obtain millions of dollars in Defense Department earmarks to support acupuncture research.  ($7.6 million in 2010, for example.)  Make no mistake, there's plenty of money in acupuncture, as in the rest of the alt-med industry.

But the real harm is in treating wounded soldiers by sticking needles in their ears, instead of offering real treatments.  To their credit, some soldiers are not fooled by Niemtzow's claims.  As a veteran over at Military.com said,

"In civilian medicine, this [battlefield acupuncture] would be called malpractice. This smacks of using military personnel in the field as guinea pigs. That's a dangerous game. If the pain of severe trauma isn't treated effectively in a timely manner, shock and even death can follow."

That discussion appeared in 2008, but three years later, Andrews Air Force Base has a full-time acupuncture clinic, and the military is training more doctors in this dangerous, ineffective, and highly unethical practice.  For this, battlefield acupuncture gets my award for the worst quackery of 2011.

(For further reading, see David Gorski's excellent takedown of battlefield acupuncture from 2008.)

The Skeptical Optimist

Some readers of this blog may be surprised to learn that I'm very optimistic about the future of science and medicine.  Over the past few years, I've criticized many different frauds, fakes, bad scientists, bogus claims, quack medical practices, and scam artists.  I will continue to do so.

But deep down, I'm an optimist.  Science has transformed our lives over the past century, thanks to a list of discoveries far too long to write down, including cures and vaccines for many childhood diseases, better ways to heat and light our homes, and faster ways to travel and communicate. I'm confident science will continue to make progress on all sorts of problems affecting our species. One reason I focus my criticism on pseudoscience is that every minute spent on bad science is a minute that could have been spent on real science, moving us closer to genuine treatments or real scientific discoveries.

I also write on occasion about true breakthroughs, such as the recent success using stem cells to treat damaged hearts, or last year's development of a vaccine against the Ebola virus.  It's good to remind ourselves that good stuff is happening despite all the nonsense being pushed by quacks out there.

But I'm a skeptical optimist.  All real scientists must be skeptics: we know that initially exciting results often turn out to be statistical flukes, experimental errors, or just plain randomness.  We have to check and double-check our results before publishing, and even then we sometimes make mistakes.  Our training makes us skeptical whenever we hear about some amazing new breakthrough, even when we are hopeful that the results are true.

But we can't let pseudoscience take precious resources away from real work.  So it's back to the front lines in the ongoing battle against the anti-science forces: watch this space tomorrow for my choice for the worst quackery of 2011.

Kill the tigers

Here's a choice: save the last remaining tigers on the planet, or kill them, chop them into pieces, and eat them in the mistaken belief that tiger parts can be used as medicine.

Sounds like an easy choice, no? Unfortunately, humans have already decided to kill the tigers rather than saving them. Fewer than 4,000 wild tigers survive on the planet. As journalist Caroline Alexander wrote in a compelling article in the December issue of National Geographic, "tigers in the wild face the black abyss of annihilation." And their greatest threat, she writes, is "the brutal Chinese black market for tiger parts."

Traditional Chinese Medicine (TCM) practitioners claim that tiger parts can be used to treat a wide variety of ailments, including malaria, bacterial infections, bad skin, ulcers, leprosy, and impotence. There is not a whit of scientific evidence to support any of these claims; they are nothing more than folk medicine, based on primitive beliefs dating from a pre-scientific era, when it was believed you could acquire the properties of an animal by eating it. Unfortunately, these beliefs have driven the mightiest of the big cats to the brink of extinction.

The World Federation of Chinese Medicine Societies asked its members to stop using tiger bones last year, but their action is far too little, too late. The New York Times reported around the same time that tiger-based "medicines" are widely available in China.

Proponents of Traditional Chinese Medicine claim that it is beneficial, but they have no science to back them up. NIH's National Center for Complementary and Alternative Medicine (NCCAM), an apologist for all sorts of quack medical practices, explains that

"In the TCM view, a vital energy or life force called qi circulates in the body through a system of pathways called meridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi."

This is little more than fantasy. Too bad NCCAM's leaders seem to have forgotten whatever they knew about human physiology. They might just as well explain that midi-chlorians circulating in the blood are the source of the Force. (Actually, there are midichlorians in nature now, in a species of tick.  Really.)

Some forms of "alternative medicine" are ineffective but mostly harmless (think homeopathy, which is just water and sugar pills), while others can be harmful to the patients who use them (think acupuncture, with its risk of infection, or ayurveda, which uses toxic chemicals). TCM is doubly harmful: it doesn't benefit patients, and it is the single greatest threat to the world's tigers. I hope people come to their senses before the last tiger is gone.

Stem cell hopes for damaged hearts

As the holiday season begins, I decided to discuss some good news about real science.

The promise of stem cell research just got a lot brighter.

There was some very good news from the world of medicine just a couple of weeks ago. For the first time, stem cells were injected into the hearts of humans who had suffered serious heart damage, and patients improved dramatically. It appears that, as everyone hoped, the stem cells grew into new heart cells to replaced the damaged tissue. This is the promise of all stem cell research: to repair or replace damaged organs that otherwise would never recover. In principle, we can someday use the same technique to replace damaged livers, kidneys, spinal cords, cartilege, and virtually all other tissues in the human body.

In the new study, just published in The Lancet, a group of researchers led by Robert Bolli grew stem cells from patients' own hearts, after the patients had suffered serious heart attacks, leaving their hearts permanently damaged. Bolli explained to CNN reporter Caleb Hellerman:

"Once you reach this stage of heart disease, you don't get better. You can go down slowly, or go down quickly, but you're going to go down."

In an effort to repair the patients' hearts, Bolli and colleagues collected a small amount of tissue from each patient's own heart, and purified stem cells from that tissue. By using the patient's own cells, there is no danger of rejection as there would be with cells from an unrelated donor.

They measured the patients' heart function by how much blood was being pumpled through the left ventricle. The patients had an average Left Ventricular Ejection Fraction (LVEF) of 30.3% at the beginning of the study, an indication of very severe heart disease. Four months later, the 16 patients who received the stem cells had an average LVEF of 38.5%, while patients in the control group (who didn't get the stem cells) showed no change. Even more dramatically, after one year the patients LVEF had improved further, to 42.5%.

Thus, remarkably, the cardiac stem cells seem to have "taken" in these patients, growing back into healthy cardiac cells in these severely ill patients. The researchers used MRI to measure the damaged heart tissue in 7 of their patients, and found that it had actually decreased by 30% after one year. In a companion trial at Cedars-Sinai Heart Institute in Los Angeles, Dr. Eduardo Marbán reported similarly positive results. Marbán told CNN that the patients grew approximately 600 million new heart cells after the procedure, comparable to the number of cells that die in a serious heart attack.

One reason these findings are especially dramatic is that they show convincingly that the human heart contains stem cells that can re-grow into new heart cells. It is entirely possible that heart damage that has always been thought to be irreversible can be completely repaired - someday.

The results are very preliminary, and only a few patients have been treated so far, but this is a major triumph for stem cell research. The research in question used adult stem cells, but embryonic stem cells may prove even more effective, and may be easier to obtain because they don't have to come directly from someone's heart.* Heart disease is the leading cause of death in the U.S., and we need to pursue every possibility for new treatments. Those who oppose stem cell research - including embryonic stem cell research - should wake up and take notice: many lives are at stake.

*Disclaimer: Until June 2011, I was a member of the Maryland Stem Cell Research Commission, a state commission established by the legislature and the governor to promote human stem cell research through state-funded grants. The views expressed here, as always, are my own, and do not represent the Commission.

Football has corrupted America's universities

(In which I take on the football-industrial complex again.)

Big-time college football is no longer a sport. It's a very expensive entertainment industry with commercial sponsors, big-money television contracts, and highly paid executives. Its proponents have corrupted the mission of almost every university with a large football program, especially those in the NCAA's top division. It's time to acknowledge that this large, expensive entertainment business should be expelled from campus.

No, I'm not talking about Penn State. (Not this week, that is. I wrote about Penn State's scandal in a New York Times forum last week.) This week we have another scandal, which illustrates all too well how football will crush any forces that might try to rein it in, including university presidents. Here's the scenario:

1. Pay $2 million to buy out the old coach and hire a more exciting one, even though the team is having its best season in years.
2. Hire that new coach for another $2 million, who has now produced a losing season (2 wins, 10 losses), leaving games with even lower attendance than last year.
3. Because football is still losing money, get rid of 8 other varsity sports.

This is a bad joke, right? No! This is exactly what the University of Maryland just did. Last week, U. Maryland (where I was a professor until this past summer) announced it was eliminating 8 varsity sports teams to make up for the fact that football was losing too much money. I kid you not. Here's what they are cutting: men’s cross-country, indoor track, outdoor track, men’s swimming and diving, men’s tennis, women’s acrobatics and tumbling, women’s swimming and diving, and women’s water polo.

The president of U. Maryland, Wallace Loh, issued a report that he sent to all students and faculty, describing the tortured reasoning that led to this sorry state of affairs. In it, he illustrates how he and his administration have completely lost sight of their real mission. Poor Dr. Loh: he came into the job only a year ago, with good qualifications to run a major educational institution, but no qualifications to run a football program. After all, why should he?

It's not because football is good for the university, despite the claims of some fans. Just to check, I compared the rankings of the top 25 football teams to the academic rankings of their universities. This graph shows the result.

As you can see, there is no correlation at all - the football team's ranking gives you no indication of the overall academic quality of a school.

So why cut eight other teams when football is failing? Dr. Loh explains:

"In a time of constrained resources, we have to choose: should we have fewer programs so that they can be better supported and, hence, more likely to be successful at the highest level? Or, should we keep the large number of programs that are undersupported compared to their conference peers?"

There you have it. We can't keep all these programs around if they're not winning! "Successful at the highest level" - such broken logic, such nonsense from the president of a major university, is almost enough to make me cry. Obviously, Dr. Loh thinks that "successful" means we beat the other schools' teams. But his own report says that a university's core mission is "education, research, and the arts." Did he evaluate these sports teams based on how well the students are educated? No: what matters is whether a team wins.

And of course there's money: if the football team wins, then the university can make money from oh-so-lucrative television contracts! Dr. Loh acknowledges this:

"If we believe—as I do—that intercollegiate athletics is an integral part of the college educational experience and not only commercialized mass entertainment, then we must come together to reform this financial model …. We have to reset the balance between academics and big-time athletics."

I'll say. But despite these nice-sounding phrases, Dr. Loh's "reform" consists of eliminating eight other varsity teams. Nothing about reigning in football's costs, and certainly nothing about making sure the players themselves get a good education and have a future after college. This is the essence of how big-time football has corrupted America's universities. We pay the players nothing, we give them a lousy education (many of them don't even graduate), and then the university spits them out and moves on.

I've heard the cries of protest from football supporters: football makes money! It subsidizes all the other sports! Oddly, even Dr. Loh makes this claim in his report, despite admitting that football at Maryland is losing millions of dollars per year. To this I have two responses:

1. Fine, let's suppose that football makes money. Then it will do just fine as an independent business. Get it out of the universities, and let each team pay fees use of the university's name, the stadium, practice fields, and parking on game days. Then the football club can pay its coaches whatever it wants, and it can pay the athletes, who are disgracefully paid nothing right now. And the university will still have its team, but without the corrupting influence of money.
2. So what if football does make money? Since when did universities run an entertainment business? Should they open casinos next?

So get football off our campuses. If athletes want to train for the NFL, let the NFL pay for a minor league, the way baseball does. Universities can have a team if they must, but make it independent, and let's stop the farce of having university presidents try to manage large, commercial sports programs. Let them get back to focusing on research and education, topics on which they actually have some expertise.

As for the athletes: let them play. They can play football if their studies leave them enough time. If they just want the exercise, they can go out for other sports that provide great physical training and far lower risks of injuries. They can try the track team, or maybe the swim team. Oh, wait….

[Note: for those who will criticize me as a football-hating weenie, I'll have to disappoint you. I grew up watching and loving college ball, before it become so commercialized. My father played varsity football all through college, and he taught me the game in our backyard.]