Category: Featured Articles

Both genetic and environmental factors affect people’s risk of developing post-traumatic stress, according to new research that illustrates how nature and nurture combine to shape health and behaviour.

A particular genetic variant makes people much more susceptible to post-traumatic stress disorder (PTSD) after harrowing experiences, but only if they have also had an abusive childhood, scientists in the United States have discovered.

The findings add to a growing consensus that the debate about whether mental health, personality and behaviour are driven by nature or nurture is founded on a misconception.

They indicate strongly that genes and the environment are not mutually exculsive forces, but rather work together to influence human development.

PTSD is a serious anxiety disorder that develops among people who witness or experience unpleasant events, such as war, murders, terrorist attacks or natural disasters. It commonly leads to nightmares, insomnia, flashbacks, mood swings and depression, and can severly impair people’s ability to live a normal life.

Not everybody who experiences severe trauma develops PTSD, and the risk is known to be influenced by genetics. Studies of twins who served in Vietnam showed that identical pairs, who share all their genes, are more likely both to suffer than are fraternal sets.

Genes, however, do not explain all the variability in people’s risk, and the precise genes and environmental factors that are involved have remained obscure.

A study led by Kerry Ressler, of Emory University in Atlanta, examined the effects of a gene called FKBP5, which is known to be involved in the way the human body responds to stress.

The DNA code of this gene varies at four points, which allowed the scientists to investigate whether any particular genetic profiles would either raise the risk of PTSD or protect against it.

As PTSD develops only when people have lived through traumatic events, Dr Ressler decided to study a group of 900 adults who lived in deprived urban communities, who were more likely to have had violent experiences of the sort that can provoke the disorder.

The participants, most of whom are black, were also asked to complete a questionnaire about their childhood experiences, which recorded whether they had suffered physical or sexual abuse at a young age.

When variations in the FKBP5 gene were examined on their own, the researchers found no effect on PTSD risk. A history of child abuse also made no difference when considered in isolation.

When the two factors were considered together, however, they were found to interact to raise or reduce risk. People with certain variants of FKBP5 were much more likely to develop PTSD after trauma if they had also been abused as children.

“These results are early and will need to be replicated, but they support the hypothesis that combinations of genes and environmental factors affect the risk for stress-related disorders like PTSD,” Dr Ressler said.

“Understanding how gene-environment interactions affect mental health can help us to understand the neurobiology of these illnesses.”

The results, which are published in the Journal of the American Medical Association, follow several other studies that have shown how genetic variants interact with environmental factors to affect behaviour or mental health.

A team led by Avshalom Caspi and Terrie Moffitt, of the Institute of Psychiatry in London, has found that a particular variant of a gene called MAOA predisposes to antisocial behaviour when accompanied by child abuse.

Evidence from the same research group also indicates that variation in a gene called 5HTT can influence whether people develop depression after stressful life events such as bereavement, and whether they develop psychosis after smoking cannabis.

Dr Caspi said the Emory research was exciting. “It is part of an emerging body of research that documents not so much that genes cause disease, but rather that genetic differences between people shape how people respond differently to the same experiences."

Dr Moffitt said: “This is an important insight, because it offers clues for unraveling the biology of psychiatric disorders, which will lead to new and better treatments.”

Dr Ressler said the social aspects of the research are as important as its genetic aspects, showing how important it is to understand how social deprivation contributes to PTSD.

“This finding helps us to understand the neurobiology of PTSD,” he said. “It’s equally important to understand how to decrease the high rates of childhood and adult trauma that inner-city populations suffer. PTSD rates in US inner cities are as high as among war veterans.”

By Judith Graham

Although the two reports might seem contradictory, some experts suggest they are in fact complementary. The take-home message is that "a very comprehensive, aggressive MRSA screening program can significantly reduce the number of infections," said Dr. Lance Peterson, founder of Evanston Northwestern's MRSA screening program.

(WebMD) When it comes to education, does having more mean you live longer? A new study shows that highly educated Americans are expected to live longer than those with fewer years of schooling.

Researchers from Harvard Medical School looked at data from the National Health Interview Study from 1966 to 2003. From the 1980s to 2000, the findings show that those who lived the longest were the most highly educated.

The "highly educated" were defined as anyone who had had at least one year of college. The researchers defined "low level" of education as having at most graduated from high school.

More Findings

At age 25, life expectancy went up 1.5 years for the highly educated. During that same time, life expectancy for people with fewer years of schooling rose by just six months.

Across the board, life expectancy is on the rise, but just barely for those who have had at most a high school diploma.

Overall, the researchers found that African-Americans still die five years earlier than whites. An exception is that young African-American men narrowed the gap between education and life expectancy.

Why the Higher-Educated Are Expected to Live Longer

Researchers say one big factor is quitting smoking . More and more people have quit smoking , but the quitters have been among the highly educated groups.

Obesity is more common among the less educated. According to the study, recent research suggests that obesity might contribute to as many deaths as does smoking.

The study's authors urge creating a wider net of health-awareness programs in less-educated groups. The study appears in the March/April issue of Health Affairs.

The research team was led by Ellen Meara, PhD, at Harvard Medical School.

Former Eli Lilly Rep Says He Wined and Dined Doctors to Make a Sale

To sell their drugs, pharmaceutical companies hire former cheerleaders and ex-models to wine and dine doctors, exaggerate the drug's benefits and underplay their side-effects, a former sales rep told a Congressional committee this morning.

Shahram Ahari, who spent two years selling Prozac and Zypraxa for Eli Lily, told a Senate Aging Committee chaired by Sen. Herb Kohl, D-Wisc., that his job involved "rewarding physicians with gifts and attention for their allegiance to your product and company despite what may be ethically appropriate."

Ahari claims that drug companies like hiring former cheerleaders and ex-models, as well as former athletes and members of the military, many of whom have no background in science.

"On my first day of sales class, among 21 trainees and two instructors, I was the only one with any level of college-level science education," Ahari told ABCNews.com on Tuesday.

During their five-week training class, Ahari claims that instructors teach sales tactics, including how to exceed spending limits for important clients, being generous with free samples to leverage sales, using friendships and personal gifts to foster a "quid pro quo" relationship, and how to exploit sexual tension.

"The nature of this business is gift-giving," says Ahari. He claims that he's heard stories about sales reps helping to pay the cost of a doctor's swimming pool and another doctor who was routinely taken to a nightclub where a hostess was paid to keep him company.

Drug reps develop a positive view of their drug and a negative view of the competitors, according to Ahari. "You drink the Kool-Aid. We were taught to minimize the side effects and how to use conversational ploys to minimize it or to change the topic."

According to Ahari, the benefits could be lucrative for sales reps, who tended to earn more than researchers. On top of a base salary for starting reps of $50,000, "there were four quarterly bonuses, an annual bonus, stock options, a car, 401K, great health benefits, and a $60,000 expense account."

Included in his prepared remarks, Ahari cites a quote from a senior marketing executive at Parke-Davis: "I want you out there every day selling Neurotonin. Neurotonin is more profitable than Accupril, so we need to focus on Neurotonin. Pain management, now that's money…. I don't want to see a single patient coming off Neurotonin before they've been up to at least 4,800 milligrams a day. I don't want to hear that safety crap, either."

A spokesman for Parke-Davis did not immediately respond to ABC News' request for comment.

A spokesman for Eli-Lilly emphasized that Ahari's testimony didn't allege any specific product misconduct on the part of the company but rather focused on industry practice.

"We think his examples are exaggerated. We have policies in place that allow us to engage in interactions with health care professionals at an appropriate level and they are intended to provide information about our products so that they will be able to make appropriate medical decisions for their patients," the spokesman said.

One doctor who says he has resisted the pitches of sales reps is Dr. Jerome P. Kassirer, a professor at Tufts University School of Medicine.

"I don't see drug reps and haven't seen them for probably 35 years," he tells ABCNews.com's Audrey Grayson. "One important question: why would the drug industry spend so much money on advertising if they didn't think they were influencing physicians? The notion that this is all for physician education is nonsense."

Democrats in Congress are pushing for a bill to counter the pharmaceutical companies' sales campaigns by paying nurses, pharmacists and other health professionals to present objective academic literature on prescription drugs to doctors.

A drug industry group, Coalition for Healthcare Communication, is not opposed to the measure but questioned the role of politicians and the federal government.

"The First Amendment provides everyone with a right to speak, including Uncle Sam," John Kamp, CHC director told the Associated Press. "But I question whether the federal government needs to be in the business of countering pharmaceutical sales."

WASHINGTON — A federal appeals court Tuesday temporarily blocked a lower court's order requiring a former USA TODAY reporter to pay thousands of dollars in fines.

Top federal health authorities Thursday reiterated that vaccines do not cause autism after government health officials acknowledged that a vaccine, by worsening an underlying genetic condition, may have triggered autismlike symptoms in one girl.

The case is viewed as an important milestone by autism groups that maintain that vaccinations are connected to autism.

But Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, emphasized that the concession should not be interpreted to mean that vaccines cause autism.

"The government has made absolutely no statement about indicating that vaccines are the cause of autism, as this would be a complete mischaracterization of any of the science that we have at our disposal today," Gerberding said during a Thursday news conference. "I think we need to set the record straight on that."

And some vaccination experts said the legal rulings were an example of the courts taking action ahead of the evidence needed to justify such a move.

Still, on the steps of a U.S Federal Court in Atlanta Thursday morning, Athens, Ga., neurologist Dr. Jon Poling and his wife, Terry Poling, made it clear that they believed vaccines triggered the encephalitis that led to their 9-year-old daughter Hannah's autismlike symptoms.

"I wanted to know why my daughter, who had been completely normal until she received [five vaccines for nine different diseases], in one day was no longer there … no longer responding," Terry Poling told the crowd of reporters present.

The Polings said Hannah received the battery of vaccines in 2000, when she was 19 months old. Shortly after these shots, they said she suffered from a fever that left her screaming and arching her back. Following this, they said, Hannah began showing classic signs of autism — staring at lights, running in circles and staring at fans.

"When my husband saw this, his heart just broke," Terry Poling said.

But doctors overwhelmingly maintained that the case will have no effect on guidelines that urge parents to have their children vaccinated against disease. And they said that the fears spurred by this case could end up doing more harm than good to the nation's children.

They added that there is as yet no evidence providing a reliable link between vaccination and the worsening of underlying mitochondrial diseases such as the one suffered by Hannah Poling.

Dr. Pauline Filipek, associate professor of clinical pediatrics and neurology at the University of California Irvine School of Medicine, and her colleagues conduct research into a possible connection.

"Mercury has long been known to be a mitochondrial toxin, and could potentially interact with underlying genetic vulnerability of deficient mitochondria," she said. "That said, there remains no epidemiological data that we are aware of that implicates vaccination in autism or in mitochondrial disorders."

And vaccine experts said the victory for the Polings may represent a defeat for an important public health measure. Dr. William Schaffner, professor and chairman of preventive medicine at Vanderbilt University, said he believes the concession should not have been made until more evidence suggesting exactly how the vaccines may have contributed to Hannah's condition come to light.

"It appears that the judges in this case have not only made a legal decision but also a medical and scientific decision," he said. "I don't believe the court's role is to make these decisions."

"Legal action does not equate with proof," agreed Dr. Ira Rubin of Naperville Pediatrics in Naperville, Ill. "How many times have defendants in cases been found guilty and later found innocent when DNA testing is done?"

Does Compensation Mean a Connection?

This case, as well as other cases involving possible injury brought about by a vaccine, are handled under the National Childhood Vaccine Injury Act of 1986. The act created a no-fault system in which people with grievances, such as the Polings, would file injury claims against the federal government rather than sue the companies that made the vaccine or the health care providers who administered it.

A "special master" appointed by the U.S. Court of Federal Claims reviews these cases to determine whether vaccines were more likely the cause of the injury at hand. If the government chooses not to rebut the claim by showing that the vaccine probably was not responsible for the injury, the claim is approved and an award is made.

"But any subset of this theory is a hypothesis, and you don't draw conclusions from a hypothesis."

Dr. Gary Mirkin, CEO of Allied Pediatrics of New York in Great Neck, agreed.

"This case … looks like a child who had a very rare pre-existing, underlying condition that may or may not have been aggravated by the administration of multiple vaccines to result in a regressive form of autism or something that appeared to be autism," Mirkin said. "If this child had never had a vaccine, it is not inconceivable that the same scenario may have developed if the child was confronted with a serious infection or even a series of multiple infections."

Medical Recommendations Remain Unchanged

Schaffner said holding back on kids' vaccinations could expose them to risk of sickness or death from other conditions, including measles and polio.

"These diseases that affected childhood are now not known by this generation of parents, so there's no balancing of concern," he said.

"Without vaccination, these disease will return, and they will spread."
The legal standard set by this system is therefore a much lower bar than the demands of medical validity, which would require a much greater magnitude of evidence to draw the conclusion that vaccines were in any way responsible for an injury.

Regardless, the case has brought attention to the nearly 5,000 other families that lawyers have chosen in an effort to seek this compensation from the government, claiming that a mercury-based preservative in vaccines known as thimerosal brought about autism and other developmental disorders in their children. Since 2001, the ingredient has been absent from most vaccines, save for certain influenza shots.

Past studies in Denmark, and more recently California, have suggested that thimerosal was not to blame, as reported cases of autism have continued to increase after the removal of thimerosal from most vaccines. Boyd Haley, a chemist at the University of Kentucky and vocal proponent of a vaccine-autism link, believes these studies are flawed. And he said that he believes this case, as well as most other cases of autism, are indeed the result of an underlying genetic vulnerability being triggered by the mercury that used to be present in vaccines.

"I am very pro-vaccine," Haley said. "I strongly believe in vaccination. I just believe that they ought to be safe and they ought to be tested."

Specifically, Haley said certain genetic conditions may make some children unable to effectively manufacture glutathione, a protein he says would allow them to clear substances such as mercury from their systems. Autism, he said, could be the result.

But Schaffner countered that this opinion demonstrates one of many hypotheses behind the development of autism in some children. Some of these hypotheses, he said, are being investigated. But none so far, he noted, have the weight of scientific proof.

"The theory, that there may be underlying genetic defect that results in or can be somehow activated by some environmental process or insult, and that this in turn leads by some biological mechanism to autism is a valid theory, and it is a theory being pursued by the autism research community," Schaffner said.

Science experiments are nothing new for Andy Ylitalo. The Oak-Land Junior High School seventh-grader does a science project each school year during winter break. It’s been a tradition in his family for years and he and his younger brother both are encouraged by their scientist parents to come up with project ideas on their own.

In years past, the projects may have been for presentation at a school science fair, but this year, Andy’s sights were set a little higher.

This was the first year that the Stillwater Area Schools district pushed back its science fairs so that winners could enter into the regional science fair, the winners of which may enter their projects in the state science fair.

In past years the school-based science fairs were too late in the school year to allow winners to continue competing at higher levels — ultimately culminating in a competition at the Minnesota Academy of Science state science fair.

The local science fair now is sponsored by the Partnership Plan in conjunction with the school district. It started in 2007 as a districtwide event and was called the Science Expo.

After the fair in 2007, there was some interest from students to be able to compete further in science fairs, up to the state level.

This year’s science fair was combined with the Partnership Plan’s Art to Heart event and renamed Da Vinci Fest.

The Twin Cities Regional Science Fair was in February and Andy qualified for entry in the state competition by earning a blue ribbon, an award designated for the top 5 percent of projects entered at the regional level.

His project, Disinfecting Drinking Water: What Works Best? was his own brainchild, he said. As he was brainstorming ideas for his winter break project, Andy said, he developed the idea to see what types of products that can be used to disinfect bacteria-laden drinking water were most effective.

Refining and planning how the project would run started around Thanksgiving and the experiments were underway by the school’s winter break.

“I put a lot of hours into it during the two weeks at Christmas break,” Andy said Tuesday from his West Lakeland home.

Andy contaminated well water from his home tap with small amount of saliva to create his stock of water for testing. After that was determined, he set out to test the effectiveness of chlorine bleach, iodine tablets and colloidal silver in reducing the bacteria load in the water.

Ultimately the experiment showed that colloidal silver was the most effective method to make water more bacteria free.

“Silver works really well and it’s actually very safe,” Andy said. “The problem with it is it’s pretty expensive.”

Andy’s love of science and math may come a lot from his parents’ influence. His mother Caroline Ylitalo holds a Ph.D. in science and is a researcher-inventor in labs at 3M while his father, also a Ph.D. in science, is a laboratory manager for 3M.

Caroline Ylitalo has worked for years with aspiring scientists to instill in them a love of science and affection for curiosity and problem solving.

“Science is fun. That’s what we’re focused on here,” said Caroline Ylitalo, who also is a visiting science “wizard” at Andersen Elementary School and a Destination Imagination coach.

“I think kids come up with the best ideas,” Caroline Ylitalo said. “They don’t look at it like adults who say what’s doable. They have a broader perspective.”

While Andy enjoys science, what he really loves is mathematics. He is enrolled in the five-year Talented Youth Math Program at the University of Minnesota this year.

He also plays soccer in the Valley Athletic Association and plays saxophone and piano.

He likes to get together with his friends every now and then and go to a movie, go bowling or take a skiing trip.

Andy said he hasn’t thought too much about what he will study in college or what kind of job he wants when he gets older — he is only 12 right now — but he was firm about one thing that’s sure to be in his future: “I don’t know what it will be,” Andy said of his future job, “but I know it will have math in it somewhere.”

Caroline Ylitalo said she hopes the immediate future will bring a change in the approaches to teaching science in Stillwater district schools.

“We’re hoping Andy’s success and interest in the science projects will motivate the schools to consider allowing kids in school to work on science projects as part of the curriculum,” she said.

Joining Andy at the state science fair at the Crown Plaza Hotel in St. Paul March 30 to April 1 is Stillwater Area High School senior Abigail Williams whose project about trout stream water quality also qualified for entry.

Scientists believe they have uncovered a key reason why flu viruses tend to strike in cold weather.

They found the viruses coat themselves in fatty material that hardens to a gel, protecting them in the cold.

This coating melts in the higher temperatures of the respiratory tract, allowing the virus to infect cells.

The US National Institutes of Health team hope their study, which features in the journal Nature Chemical Biology, could lead to new treatments.

    
"The study results open new avenues of research for thwarting winter flu outbreaks"
Dr Duane Alexander
National Institute of Child Health and Human Development

However, a UK expert said the discovery did not explain why some flu viruses also thrived in tropical climates.

The hard rubbery coating around the virus which forms in colder temperatures gives it the protection it needs to pass from person to person. The coating is so robust it can even resist to certain detergents.

However, once inside a host the virus can only infect a target cell once the coating has melted.

But this liquid phase is not tough enough to protect the virus against the elements, and so if the protective coating melts when the virus is outside the host, it dies.

Detailed fingerprint

Dr Duane Alexander, director of the National Institute of Child Health and Human Development, said: "The study results open new avenues of research for thwarting winter flu outbreaks.

"Now that we understand how the flu virus protects itself so that it can spread from person to person, we can work on ways to interfere with that protective mechanism."

The researchers used a sophisticated magnetic resonance technique to create a detailed fingerprint of how the flu virus's outer membranes responded to variations in temperature.

    
"I don't think this study provides anything like a definitive answer on the spread of the virus"
Professor John Oxford
Queen Mary College School of Medicine

The virus's outer membrane is composed chiefly of molecules known as lipids, such as oils, fats and cholesterol.

The researchers found that at temperatures slightly above freezing, this lipid covering solidified into a gel.

However, as temperatures approached 15.6C (60F) , the covering gradually thawed, eventually melting to a soupy mix.

The researchers concluded that temperatures in the spring and summer were too high to allow the viral membrane to enter its gel state.

As a result, at these temperatures the individual flu viruses would dry out and weaken – accounting for the end of the flu season.

Professor John Oxford, an expert in virology at Queen Mary College School of Medicine, London, said the paper was interesting, but it might be premature to draw firm conclusions.

He said: "If this is the case why do we get flu in tropical areas, where the temperature is 35C (95F) all the time?

"Places like Vietnam and Indonesia are predicted to the epicentre of a new outbreak of pandemic flu."

Professor Oxford said researchers had tried to link flu infection definitively to cold weather since the great Russian outbreak of 1890, but had failed to come up with conclusive proof of a link.

"I don't think this study provides anything like a definitive answer on the spread of the virus – there must be some other factors that come into play," he said.