Showing posts with label bioethics. Show all posts
Showing posts with label bioethics. Show all posts

The anthrax vaccine boondoggle

The anthrax vaccine is a truly bad idea. The U.S. has wasted billions of dollars on it, and it just seems to go from bad to worse. Now a government panel has recommended that we test the vaccine on children, which raises a whole new array of ethical questions.

Don't get me wrong: vaccines are the greatest boon to public health of the last 200 years. We eradicated smallpox, we're close to eradicating polio, and childhood deaths from infectious diseases are far, far lower thanks to the vaccines we give our children. These are truly wondrous advances.

But the anthrax vaccine is different, from start to finish.
For starters, anthrax is not infectious. This might come as a surprise to those who've only heard about this through the media. An anthrax "outbreak" is impossible, because the B. anthracis bacterium cannot spread from person to person. Vaccines against diseases such as measles, mumps, and influenza protect millions of people each year, because these are common infectious diseases that spread easily between people.

Anthrax was never a public health threat, and it isn't one now. We don't need an anthrax vaccine. And by developing and then promoting one, the government is abusing the good will that the public has towards vaccines, possibly endangering the public health further by playing into the hands of the anti-vaccine movement.

The Centers for Disease Control (CDC) does not recommend that children be vaccinated against anthrax. In fact, it doesn't recommend that anyone get routine vaccinations against anthrax:
"Vaccination is recommended only for those at high risk, such as workers in research laboratories that handle anthrax bacteria routinely."
The CDC recommendation makes sense. Therefore I was stunned to learn this week that the National Biodefense Science Board (NBSB) recommended that we launch an anthrax vaccine testing program in children (see page 37 of their report).

The NBSB report admits that
"Currently, U.S. children are not at immediate risk from anthrax and would not benefit directly from pre-event AVA [anthrax vaccine] administration."
It also states that
"There is no known benefit to vaccinating children in the absence of an imminent threat from exposure to B. anthracis other than potential future benefit."
Case closed, right? We can't conduct vaccine trials in children if there's no benefit.

Somehow, though, even after these statements in their own report, the NBSB managed to recommend testing the vaccine in children. As justification, they present this claim:
"Preparation for a national and potentially global threat from the use of B. anthracis spores by terrorists is a major priority for U.S. national security."
This is a massive overstatement. A national and global threat? Anthrax is not infectious, as the NBSB knows. The only people affected in an attack would be those directly exposed to the bacterium, likely only a handful of people. We don't vaccinate millions of people just to protect a hypothetical few: this is an abuse of the public trust in vaccines.

So why are we wasting billions of dollars to develop, test, and administer a vaccine against something that hardly infects anyone? The anthrax vaccine development project was on its way to being cancelled by the U.S. before the 2001 anthrax attacks. In an ironic twist, the likely perpetrator of the attacks, Bruce Ivins, was allegedly motivated by his interest in reviving the anthrax vaccine program. If so, then he succeeded in a big way: in 2004, the government announced Project Bioshield, which dedicated $5.6 billion to biodefense, much of that going to anthrax vaccine research.

I'm not surprised that if the government dedicates billions of dollars to biodefense, and distributes it to companies and universities who then become dependent on these funds, then advisory panels such as the NBSB will recommend an ever-increasing number of security measures. After all, some of the members of that committee are funded by biodefense dollars, and if we cut the funding, their own livelihoods might suffer.

Speaking to the Washington Post, panel member Ruth Berkelman said:
“We need to know more about the safety and immunogenicity of the vaccine as we develop plans to use the vaccine on a large number of children in the event of a bioterrorist’s attack.”
No, we don't. We don't need to know about the safety of the vaccine in children because it would be unethical to test it on them. And if there is an attack, we shouldn't respond by vaccinating "a large number of children," because anthrax doesn't spread from person to person. This is one vaccine we can do without.


[Note: I was a member of the research group that sequenced the DNA of the B. anthracis used in the 2001 attacks. We published our findings in two papers, one in 2002 and the second, after the investigation concluded, in 2011.]

Test your kids' genes for sports ability: hype or reality?

A company called Sports X Factor recently announced that it's selling a genetic test that will reveal your potential to be a sports star. They're marketing it as a way to predict what sports your kid will excel at. Is this real, or just another over-hyped attempt to cash in on parents' aspirations for their children?

Sports X Factor, which sells the test for $180, stated in a press release a few weeks ago that the test
"can make workouts more effective, children’s sports choices more appropriate and trainers’ awareness of potential risk factors more precise. It can even save a life."
Wow, sounds impressive. But is it true?

In some ways, this is nothing new. Another company, Atlas Sports Genetics, started offering a similar test in 2008. They make similar promises, claiming that their test
"Gives parents and coaches early information on their child’s genetic predisposition for success in team or individual speed/power or endurance sports."
Unlike some of the rank pseudoscience I often blog about, this claim actually has some real science behind it. Back in 2003, Kathryn North and colleagues at the University of Sydney published a paper in a leading genetics journal about a gene called ACTN3. They found that mutations in this gene were associated with elite sprinters, both male and female. Superficially, it's easy to take this association and turn it into a "speed gene," but it's not.

The science is much more nuanced. (Isn't it annoying when things aren't so simple?) ACTN3, which affects muscle fibers, has three common genotypes. Let's call them Red, White, and Blue.* Elite-level sprinters are usually Red or White: 92% of male sprinters and 100% of female sprinters in the original study were one of these. In the general population, 30% of people are Red and 52% are White. For elite endurance athletes, there tendency is the opposite: slightly more of them are Blue, but the difference isn't significant.

The advice from Atlas Sports Genetics is a gross over-generalization of the science. Here's how they interpret the test results:
Blue: Predisposition to endurance events
White: Equally suited for both endurance and sprint/power events
Red: Predisposition to sprint/power events
The science simply isn't this clear. The only thing you might say is that Blue genotypes are not likely to be Olympic sprinters. But that's true of 99.999% of us anyway. There's no "predisposition" to particular sports.

The newer test from Sports X Factor looks at 9 genes, not just ACTN3. Although a broader test might sound superior, the genes they test include ApoE4, which is associated with a slightly higher risk of Alzheimer's disease. This raises serious ethical questions. Do you really want your child to know that he/she might be pre-disposed to Alzheimer's? As Hank Greely, a Stanford lawyer and bioethicist, said in the Washington Post, “I think this company is a good advertisement for the need for more regulation of genomic testing,”

I suggest that parents save their money, and instead take a test that I'm offering right here, for free, to determine your child's sports potential. Just follow these two easy steps:
  1. Ask your child, "do you want to play soccer?"
  2. If the answer is yes, sign your child up for a kids' soccer team.
Wasn't that easy? And it works for almost any sport! Just replace "soccer" by your kid's favorite sport. Oh, and then you have to go to the games. That's the hard part.

*For science geeks only: the genotypes Red, White and Blue are RR, RX, and XX respectively. The mutation is R577X, where the X is mutation that introduces a premature stop codon at position 577 that shortens the ACTN3 protein. RR means that both copies of the protein are full-length. RX means one copy is shortened, and XX means both are. About 18% of the population is XX ("Blue").