Synopsis: 5. medicine & health:


Nature 02916.txt

Through a blend of clever politicking and sheer fatigue, the deal was thrashed out in impromptu huddles that formed in the main conference hall during the small hours of 11 Â December,


Nature 02978.txt

and examines how different levels of greenhouse-gas emissions could affect sectors such as agriculture, health and infrastructure over the twenty-first century.

Without an effective plan,"the country may sleepwalk into disaster. The study was mandated by the 2008 Climate Change Act,

owing to heat-related illness. But the most pressing risks laid out by the study concern water,

Public health, business, agriculture and forestry, urban infrastructure and natural ecosystems are identified all as priority areas for early action.


Nature 02984.txt

Caution urged for mutant flu workwhy would scientists deliberately create a form of the H5n1 avian influenza virus that is probably highly transmissible in humans?

whether the public-health benefits of the work outweigh the risks of a potential pandemic if the virus escaped from the lab. For the scientists who have created the mutated strains of the H5n1 virus,

the justifications are clear. Surveillance of flu viruses could, they argue, allow health organizations to monitor birds

and other animals for the mutations that would provide an early warning of a pandemic

and enable authorities to act quickly to contain the virus. That claim is meeting with scepticism,

however. More than a dozen flu experts contacted By nature say they believe that the work opens up important vistas in basic research,

and that it sends a valuable warning about the potential for the virus to spark a human pandemic.

But they caution that virus surveillance systems are ill-equipped to detect such mutations arising in flu viruses.

As such, work on the viruses is unlikely to offer significant, immediate public-health benefits, they say. That tips the balance of risk-benefit assessment in favour of a cautious approach, says Michael Osterholm,

who heads the University of Minnesota s Center for Infectious disease Research and Policy in Minneapolis,

and who is a member of the US National Science Advisory board for Biosecurity (NSABB. In a paper submitted to Science, Ron Fouchier s team at Erasmus Medical center in Rotterdam, The netherlands,

found that just five mutations allowed avian H5n1 to spread easily among ferrets, which are a good proxy for how flu behaves in other mammals,

including humans. All five mutations have been spotted individually although not together in wild viruses. Yoshihiro Kawaoka of the University of Wisconsin-Madison and his colleagues have submitted similar work to Nature,

provided that a mechanism is established to disseminate the data to flu researchers and public-health officials on a need-to-know basis. The US government,

the World health organization (WHO) and other bodies are now trying to put this mechanism together, along with a framework for inter  national oversight of such research.

39 flu researchers declared a 60-day pause in the creation of lab mutant strains of the H5n1 avian flu virus. The hiatus,

Scientists contacted By nature say that basic research on such mutated strains may eventually yield insight relevant to developing pandemic countermeasures such as drugs and vaccines.

says Ilaria Capua, an animal-flu expert at the Experimental Animal health Care Institute of Venice in Legnaro, Italy."

and so give the virus fewer opportunities to evolve into a human pathogen, she says. Other scientists add that it should force governments to rethink existing vaccine technologies,

which are only capable of supplying vaccine six months after a pandemic starts, and of producing enough vaccine for a small fraction of the world population.

But the notion that the research offers a guide to dangerous variants that could be stamped out before they spread is unrealistic

say Osterholm and other researchers.""In order to even consider the possibility of reducing the animal reservoir of an emerging pandemic virus,

one would need rapid and complete detection of virus in all geographical areas, Osterholm says. Yet surveillance of H5n1 in poultry worldwide is patchy, particularly in poorer countries,

or years after they are collected hardly the swift turnaround of a pandemic alert system.""Could we pick up a mutation in real time

and stop a pandemic? asks Capua.""Not with the surveillance we have now. Source: Genbankmoreover, if H5n1 surveillance in poultry is poor,

H5n1 infections in pigs are uncommon and cause only mild illness, creating little economic incentive to monitor them4.

Genbank contains partial sequences from just 24 pig H5n1 isolates. Yet pigs are a likely source of a human pandemic H5n1 virus

because they are susceptible to both human and avian viruses, creating opportunities for genetic reassortment in co-infected animals.

But even if a candidate pandemic H5n1 virus was detected in poultry, culling flocks to eliminate it would be no mean feat.

says Jeremy Farrar, director of the Oxford university Clinical Research Unit in Ho chi minh city, Vietnam. Molecular technologies need to be made more easily available and affordable to countries at risk,

says Marc Lipsitch, an epidemiologist at the Harvard School of Public health in Boston, Massachusetts.""There are many, many,

H5n1 is far from being the only flu virus that poses a pandemic threat. But he believes that more extensive genetic surveillance could eventually pay off."

which the mutant flu research could provide immediate public-health benefits, Anthony Fauci, director of the US National Institute of Allergy and Infectious diseases, replies:"


Nature 03012.txt

In each of these cases, simple steps to curb air pollution would promote public health; scaled up, they may offer the only realistic way to tame global warming over the next few decades.

And because ozone is toxic to plants, such measures could boost global crop production by 1-4%.The United nations Environment Programme explored the potential gains in a detailed assessmentlast June (see go. nature. com/4wcwxf).


Nature 03029.txt

and says that it will stop accepting new applications for clinical trials using stem-cell products until July.

The 10 january announcement by the government's health ministry was viewed as an effort to crack down on a flourishing trade in unproven stem-cell therapies,

Antibiotic ban The US Food and Drug Administration is restricting some uses of a major class of antibiotic in farm animals,

which microbes acquire resistance to the drugs. On 4 january, the agency banned unapproved uses of cephalosporins in cattle, pigs,

chickens and turkeys a ban that it had ordered already in 2008, but revoked after protests from farmers,

People MMR lawsuit Disgraced medical researcher Andrew Wakefield is suing The british Medical Journal (BMJ), its editor Fiona Godlee,

) Wakefield's work posited a now-discredited link between autism and the combined measles, mumps and rubella (MMR) vaccine;

and he was struck off the UK medical register for serious professional misconduct. Wakefield filed the suit on 3 january in a district court in Texas, where he now lives.

Hepatitis C hopefuls Pharmaceutical giant Bristol-myers squibb of New york city has become the latest company to spend billions on the promise of hepatitis C treatments.

New jersey, which has three treatments for hepatitis C in clinical trials. See go. nature. com/qjoqfn for more on hepatitis C drugs.

Teva rethink Israeli pharmaceutical firm Teva, the world's largest maker of generic drugs, may shift its focus towards branded medicines after it announced a new chief executive.

Jeremy Levin, former head of strategy and alliances at Bristol-myers squibb in New york city, has a reputation for making external partnerships

and acquisitions and is expected to continue his approach at Teva, which is headquartered near Tel aviv.""Medicines are told medicines,

he investors in a conference call on 3 january.""It doesn't matter if they are branded or generic.

Coming up 12 january The british Medical Journal and Britain's Committee on Publication Ethics host a London meeting on how best to manage research misconduct in the United kingdom. 13 january India may have gone a year without reporting a case of polio a milestone

that could see it removed from the list of countries where the disease is still endemic. 14-16 january Russia's failed Mars mission,


Nature 03037.txt

Rules tighten on use of antibiotics on farmsthe US Food and Drug Administration (FDA) is now moving to protect key antibiotics known as cephalosporins,

which are used in humans to treat a range of infections, including pneumonia. On 4 Â January, the agency said that it would prohibit certain uses of cephalosporins in farm animals including cattle, pigs, chickens and turkeys,

because overuse of the drugs is"likely to contribute to cephalosporin-resistant strains of certain bacterial pathogens.

If cephalosporins become ineffective in treating human diseases, the FDA said, "doctors may have to use drugs that are not as effective,

or that have greater side effects. Source: National Antimicrobial Resistance Monitoring System/FDATHE new rules, to come into effect on 5 Â April,

restrict veterinary surgeons to using the two cephalosporin drugs specifically approved for food-producing animals ceftiofur and cephapirin and ban prophylactic use.

In animals not listed in the FDA order, such as ducks or rabbits, vets will have more discretion to use the drugs.

Most antibiotic classes are used both in animals and in humans, so the FDA is also considering tightening controls on all classes of antimicrobials used on farms.

It is reviewing comments on rules that would prohibit the use of any antimicrobial drug to promote animal growth

a move that would be welcomed by many vets.""We would support greater veterinary oversight of antimicrobial drugs,

says Christine Hoang, assistant director of scientific activities at the American Veterinary Medical Association in Schaumburg, Illinois. The European union (EU),

which already forbids the use of antimicrobials to promote growth, plans to strengthen its own rules.

Its new antibiotic-resistance strategy, published in November  2011, calls on EU countries to ensure that antibiotics are only available on prescription,

and to strengthen surveillance systems to track and report cases of resistance (see Nature http://doi. org/cshmhv;

2011). ) Although it is accepted widely that overusing antibiotics can be a major driver of resistance in microbes,

the evidence linking antibiotic use in farm animals with resistance in humans is still controversial (A e. Mather et al.

Proc. R. Soc. B http://doi. org/hj8; 2011). ) A research programme coordinated by Europe s Innovative Medicines Initiative could provide some answers:

in the next few months it will call for proposals for  350 million (US$445 million) in grants to understand how resistance arises,

and to develop new antimicrobial drugs. Antimicrobial resistance is also this year s top priority for the intergovernmental World organisation for Animal health (OIE),

based in Paris. Bernard Vallat, director-general of the OIE, says that it is working with the FDA

and the World health organization to help developing countries to improve their legislation covering the control, distribution and use of veterinary antimicrobials.

The three organizations plan to urge governments to put vets in charge of allocating the drugs

and to ban preventative use.""There are over 100 countries worldwide without legislation. Antibiotics are sold like sweets,

Vallat told Nature.""There is no control and this is a major risk to animal and human health


Nature 03064.txt

Canadian oil sands: defusing the carbon bombenvironmentalists and many politicians have called the oil sands a planetary-scale threat as they fight to prevent further development of the resource.

Andrew Weaver and Neil Swart, both climate scientists at the University of Victoria in British columbia, listened to the rhetoric and decided to run some calculations.

Because of the energy-intensive process for producing oil from this region, it is true that greenhouse gas emissions are higher than average.

But their work underscores evidence that the environmental impacts of producing the oil sands are primarily local rather than global."

In situ production, by contrast, uses steam injection to liberate the oil underground, which reduces surface disturbance but actually increases greenhouse-gas emissions as a result of higher energy consumption.


Nature 03070.txt

Bossart, a microbiologist at Boston University in Massachusetts, works on treatments and vaccines for the Nipah and Hendra viruses,

"If we want to protect large animals from these infections, then we have to test vaccines in them,

says Bossart. The US Department of Homeland Security (DHS) has broken ground for a facility that would have allowed researchers such as Bossart to work closer to home.

and reviewers considering fears about whether it could keep pathogens safely contained in the middle of prime US cattle country.

Beef producers have been alarmed particularly that the 2010 assessment put the cumulative risk of foot-and-mouth disease escaping from the NBAF over the facility s projected 50-year lifespan at 70%(see Fear factor.

The virus that causes the disease spreads quickly and would have a devastating effect on the US cattle industry

whether current disease threats justify the facility, which could cost up to $1 Â billion to build."

The site is adjacent to the KSU Biosecurity Research Institute, a BSL-3 facility that studies animal and plant pathogens.

The DHS says that the NBAF is needed to develop countermeasures against bioterrorism a threat that resonates less now than it did immediately after the anthrax attacks on the United states in 2001.

A second is the risk of animal-borne diseases spreading to humans as population growth and dispersal puts people into greater contact with wild animals.

The third is the potential for global warming to expand the range of insect-borne diseases."

"We have the capabilities to build a facility that will better prepare us in the event of some pathogen coming in.

although many of the diseases studied in Winnipeg, including the Nipah Virus, are not currently found in North america, preparedness matters."


Nature 03115.txt

The country's largest research agency, the National institutes of health, saw its budget held level. NASA, meanwhile, looks set to lose out,

BUSINESS Biosimilars rules Drug-makers keen to sell generic forms of branded biological drugs such as enzymes and antibodies were excited to finally see draft guidance on the matter emerge from the US Food and Drug

so it is much harder to copy drugs based on them than small-molecule drugs (see Nature 449,274-276;

has rejected, as expected a US$5. 7-billion takeover bid by drug giant Roche, based in Basel, Switzerland.

Roche replied that its bid was"full and fair. The firm is expected now to start wooing Illumina's major investors to accept a takeover

even though Illumina's share price is currently well above Roche's bid. Synbio troubles US synthetic biology firm Amyris which engineers microbes to process plant sugars into useful chemicals saw its share price plunge by 28%on 10 february,

See page 289 for more on the flu-virus debate. go. nature. com/pf7bwv20-24 february Marine scientists'responses to the Gulf of mexico oil spill in 2010 are discussed among topics at the Ocean Sciences Meeting in Salt lake city, Utah


Nature 03175.txt

Flu surveillance lackingin addition, the surveillance is sustained typically not, but instead is ad hoc and reactive,

and is largely in response to disease outbreaks or temporary research projects. But a flu virus that emerges anywhere,

at any time, can threaten the entire planet. The Nature analysis"highlights a global problem:

lack of data, says Ian Brown, head of avian virology and mammalian influenza at the Animal health and Veterinary Laboratories Agency lab in Weybridge, UK.

Timely global surveillance of animal flu viruses is crucial not just for identifying pandemic threats,

and keeping animal vaccines and diagnostics up to date. To assess trends in global genetic surveillance, Nature analysed the records of nonidentical sequences from all subtypes of avian

and pig flu deposited in the US National Center for Biotechnology Information s Influenza Virus Sequence Database between 2003 and 2011.

and several large flu sequencing projects, including the Influenza Genome Sequencing Project a major initiative run by the National Institute of Allergy

and Infectious diseases (NIAID) to boost the sequencing of existing isolates. The analysis covered all subtypes of flu virus, not just H5n1.

That s important, says Malik Peiris, a flu virologist and surveillance expert at the University of Hong kong,

because"H5n1 is not the sole pandemic candidate, and low pathogenic viruses are just as likely, if not more likely,

to become pandemic. The number of avian flu sequences deposited in the database skyrocketed between 2003 and 2010,

before dropping off in 2011. The number of pig sequences deposited remained relatively flat from 2003 to 2010

before jumping dramatically in 2011. However, few contemporary data are available. The number of avian flu sequences from isolates collected in each year peaks in 2007

and plummets thereafter. The jump in the number of pig sequences also disappears (see Delayed sequencing.

Roughly 30%of the sequences are from isolates collected before 2003. The 2007 peak in avian viral sampling was largely the result of surveys of more than 100,000 wild birds to monitor for the arrival of H5n1 in the Americas1,

such as spotting changes that might herald dangerous strains. Many years can pass between the collection

head of the Molecular genetics of RNA VIRUSES lab at the Pasteur institute in Paris. One reason is that many of the virus samples are sequenced in retrospective research studies.

The Influenza Genome Sequencing Project is also helping by generating vast quantities of sequences it now accounts for half of all avian

An exception is the Centers of Excellence for Influenza Research and Surveillance a network created by the NIAID in 2007 to boost flu surveillance

which has a policy of releasing all sequence data within 45 days of its collection.

The two agencies responsible for monitoring disease outbreaks in animals the Food and agriculture organization (FAO) of the United nations and the World organisation for Animal health (OIE) stipulate that sequences of potentially zoonotic viruses should be deposited in public databases within 3 months

says Ilaria Capua an avian-flu researcher at the Veterinary Public health Institute in Legnaro, Italy, who champions greater availability of sequences5.

Just 7 of the 39 countries with more than 100 million poultry in 2010 collected more than 1, 000 avian flu samples between 2003 and 2011.

Surveillance of avian flu viruses is bad, but that of pig viruses is worse. Yet pigs are a serious pandemic risk:

they can be infected co with both human and avian flu strains, which means that they provide ample opportunity for gene swapping and, thereby,

the emergence of pandemic strains such as the 2009 H1n1 pandemic virus. The world is home to some 1 billion domestic pigs, almost half

of which are in China, yet only 7, 679 pig flu sequences were collected between 2003 and 2011.

Just three countries the United states, China and Hong kong  collected more than 1, 000 swine flu sequences each,

and around 200 countries collected none at all. Five of those countries-Russia Poland, the Philippines, Denmark and The netherlands are each home to more than 10 million pigs.

In pigs, flu tends to be mild, so there is little economic incentive for surveillance. Moreover, the pork industry often doesn t want the negative image of having swine flu detected in its farms.

Research teams at Hong kong University, including one led by virologist Malik Peiris, are compiling one of the world's single largest sources of pig sequences.

The pandemic risk posed by pigs has risen also since 2009. The 2009 pandemic H1n1 virus,

which is now endemic in pigs, is unusual in that it contains the triple reassortant internal gene (TRIG) cassette,

a highly conserved set of six genes that allows the virus to swap genes with flu viruses from other species much more freely than the seasonal H1n1 that circulated before 2009 (see Pandemic 2009 H1n1 virus gives wings to avian flu).

but"we are noting lots of reassortment between the pandemic virus and endemic swine viruses, says Peiris.

globally changing the swine influenza virus landscape, says Peiris.""This certainly is a source of concern for public health.

The size of a country s poultry population is no predictor of how many samples that country will generate (see Many birds, few samples.

and a well-structured and hygienic farming industry inevitably have fewer flu sequences to report,

as disease levels tend to be low, says Brown. However, many of the countries that have contributed few

or no sequences have poor veterinary systems and flu-prone farming systems, such as backyard farms and mixed poultry and pig farms,

which are often close to wild ducks and other flu reservoirs.""Proper geographic representation is lacking, says van der Werf,

or report, outbreaks so that they can claim they are free of infection and so avoid trade problems.

Flu experts say that the dire state of surveillance could be turned rapidly around by, for example, creating a network of sentinel sites,

says Jeremy Farrar, director of the Oxford university Clinical Research Unit in Ho chi minh city, Vietnam (see page 534).

The problem is that no global body has overall responsibility for flu surveillance. The World health organization (WHO) runs a global network of labs for human flu surveillance

and selects human strains to be included in vaccines for seasonal flu. Monitoring animals falls to the FAO,

which tends to focus on food security, and the OIE, which looks mostly at animal health and trade.


Nature 03292.txt

The team resorted to tempting the creatures with blood-filled condoms warmed under a heat-lamp, and putting the leeches into syringes attached to blood-filled test tubes sealed by a thin film.

After killing the leeches over the course of several months, the team identified goat DNA in every one of them.

Meanwhile, Australian scientists have found DNA from critically endangered species and potentially toxic plants in traditional Chinese medicines6.


Nature 03322.txt

Screen uncovers hidden ingredients of Chinese medicineyang Liu/Corbismany traditional Chinese medicines contain species not listed in the ingredients.

Traditional Chinese medicines rack up billions of dollars in worldwide  sales each year, and exports to Western countries are on the rise.

However, most of the medicines have not been proved to be effective, and industry regulation is scant.

 When the medicines have been ground up, it is very difficult to tell what they are made of.

In the past, researchers have examined herbal medicines by running assays for toxic compounds and using DNA tests to determine

Bunce s team sequenced DNA from 15 traditional Chinese medicine preparations that had been seized by Australian customs

including a poisonous herb called Ephedra and the woody vine Aristolochia. Sometimes known as birthwort, Aristolochia  contains aristolochic acid,

which can cause kidney and liver damage and bladder cancer. Medicinal use of the herb probably explains high rates of bladder cancer in Taiwan,

according to a paper published this week in Proceedings of the National Academy of Sciences2. At least one of the four medicines that contained Aristolochia DNA also contained aristolochic acid.

Other medicines contained DNA from plants in the same family as ginseng the root of which is illegal to trade internationally as well as soya and nut-bearing plants,

which can cause severe allergic reactions. But many PLANT DNA sequences could not be pinned to individual species,

because plant genetic databases are incomplete. The researchers also found DNA from eight genera of vertebrate animals.

Nearly half of the medicine samples tested for animal DNA contained genetic material from multiple animals,

"Many of those traditional Chinese medicine supplements are such adventurous mixtures of multiple ingredients that, quite frankly,

says Edzard Ernst, chair in complementary medicine at Peninsula Medical school in Exeter, UK. Bunce thinks that food

and drug regulatory agencies should consider adopting deep-sequencing techniques to screen herbal medicines; his team has applied for a grant to test its methods on supplements that are on the market in Australia.

among these thousands of ingredients, there were not a few that have the potential to do more good than harm.

However, my impression is that we are a very long way from instilling proper science into this area such that patients are not at risk of either direct harm

or the indirect harm of treating serious conditions with useless supplements


Nature 03332.txt

Monkey genetics track social statusimagebroker/FLPAGROOMING is one way in which rhesus macaques show deference and curry favour.

which meant that its social stress increased, as it experienced more bullying and found it harder to get resources.

potentially heightening susceptibility to disease, says Tung.""That heightened state is more damaging to be in,

although the study did not look at the monkeys'health. The changes did not seem permanent.

Research has shown also the health consequences of low social status on both animals and humans. One investigation, known as the Whitehall study2, found that low-ranking British civil servants suffer higher rates of illness and death than their superiors.

The results of the macaque study are"potentially highly relevant to humans because they confirm that health depends on social status,

and not vice versa, says Michael Marmot, an epidemiologist at University college London, who led the Whitehall study."

"Clearly, changing ranks leads to changes in gene expression and not the other way around, he says. The macaque study suggests potential mechanisms for the Whitehall study's findings,

Marmot adds. The link between genes and social status may be more difficult to tease out in humans than in monkeys,

says Tung, owing to the greater complexity of our society. The monkey experiment is an"important study,

and is hoping to examine how social rank affects the macaques'susceptibility to infection


Nature 03351.txt

Million-year-old ash hints at origins of cookinggreatstock Photographic Library/Alamythe plant and animal ash was found thirty metres inside the Wonderwerk Cave beyond the reach of a lightning strike.


Nature 03361.txt

They also hope it will help in the development of tomatoes that can survive pests, pathogens and even climate change,

UK,"is to link this genome sequence to traits that are useful and important, especially for food security and human health


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