|Doctor Peter Rhee answers media questions about the condition of US Representative Gabrielle Giffords at University Medical Center in Tuscon, Arizona|
This is the VOA Special English Health Report.
On Saturday in Tucson, Arizona, a gunman opened fire on a small crowd meeting outdoors with a congresswoman. Six people were killed and fourteen were wounded, including the representative, Gabrielle Giffords.
The bullet traveled along the left side of her brain as it went in one side of her head and came out the other.
Doctor Leigh Vinocur is a nationally known expert in emergency medicine. She says the path that the bullet took was lucky for the forty-year-old congresswoman.
LEIGH VINOCUR: “And then when the neurosurgeon described that it appeared the nerves to her eye were OK, I just think it could have been worse. You know, if it’s any lower, it hits your respiratory center and you die immediately. You worry about motor function, and it appears that she’s moving her extremities. We don’t know how her speech will be, because the temporal lobe does affect speech. She certainly is following commands.”
On Tuesday doctors said Representative Giffords was breathing without the aid of a machine. But she remained in critical condition.
Doctor Vinocur praised the college intern who gave the congresswoman first aid. Daniel Hernandez had trained in high school as a nurse’s assistant.
|Emergency workers treat a shooting victim near the shopping center where the attack took place|
But Doctor Vinocur says people have to be extra careful about putting pressure on bleeding head wounds.
LEIGH VINOCUR: “So you can put pressure on the scalp, which does bleed a lot, to sort of stem that bleeding. But you want to be careful to make sure you’re not pushing brain tissue back in through the hole, you’re not pushing fragments of bone. Or if there were metal bullet fragments that were left in the entrance or exit wound, you don’t want to push those back into the brain.”
Doctor Peter Rhee, trauma chief at the University Medical Center in Tucson, says he expects Representative Giffords to survive. She has been following simple commands, like moving her toes, squeezing a hand and giving the thumbs-up sign. But no one knows yet how well she might recover.
Doctors have temporarily removed about half of her skull to ease pressure.
Doctor Rhee operated on the congresswoman and also treated other victims of the shooting attack. He says his work as a Navy surgeon in the wars in Iraq and Afghanistan prepared him well.
In fact, emergency medicine specialist Leigh Vinocur says that specialty grew out of military medicine dating back to World War One.
LEIGH VINOCUR: “The lessons that we learn on the battlefield are the things that have translated. And we have made such great strides, even within this last war, of saving people.”
Doctor Vinocur teaches at the University of Maryland medical school and speaks for the American College of Emergency Medicine.
The young suspect charged in the shooting had been acting strangely. Last year he was suspended from a community college because of his behavior. But he was legally able to buy the handgun used in the shooting.
- The most common form of diabetes, type 2, occurs when the pancreas doesn’t produce enough insulin, which regulates sugar in the blood. The excess sugar can affect the heart and blood vessels, eyes and other organs.
Scientists in California have developed a new approach to treating diabeteswhich might be able to reverse the disease and not just treat the symptoms.
The World Health Organization estimates that more than one-third of a billion people worldwide have diabetes. The most common form of the disease, type 2 diabetes, is on the rise. It’s usually the result of excess weight and lack of physical exercise.
The pancreas doesn’t produce enough insulin, which regulates sugar in the blood. The excess sugar can affect the heart and blood vessels, eyes, and other organs.
Treatment includes losing weight and exercising. Some patients take insulin or other medicines.
At the California biotechnology company Genentech, researchers have been investigating a growth factor protein called FGF21, which is involved in controlling blood sugar.
Junichiro Sonoda says previous studies have shown that when FGF21 is injected into laboratory mice and monkeys, it has a variety of beneficial effects. “Well, the animals lose weight, and cholesterol, which increases cardiovascular risk, now goes down. And there’s a good cholesterol called HDL, which level goes up with FGF21 treatment.”
Efforts to get the same effect in humans have been stymied by the fact that the effect lasts only a few hours. “So that means, to get the beneficial effect you have to inject a lot of it and many times during the day.”
So the Japanese-born researcher and his colleagues tried a different approach. They developed antibodies that mimic FGF21 by attaching to the same receptors in the pancreas and elsewhere, and they tested it on mice.
“The blood glucose level got normalized. And we kept monitoring blood glucose after a single injection of this antibody, and it took almost 40 days for the blood glucose level to come back to a ‘normal’ diabetic level,” Sonoda said.
That kind of long-lasting effect is one of the things that drug developers look for. “This could become the very first class of drug that could reverse the disease instead of just treat the symptoms of disease. That would be a huge benefit for patients.”
- In clinical trials at Johns Hopkins Cancer Center in Baltimore, Maryland, doctors report they successfully pumped cancer-fighting medicine directly into a breast tumor.
There’s some promising news about breast cancer treatment. In clinical trials at Johns Hopkins Cancer Center in Baltimore, Maryland, doctors report they successfully pumped cancer-fighting medicine directly into a breast tumor. Early results show the treatment not only kills the tumor, but spares the patients disfiguring surgery and the side effects of more radical treatments.
The earliest stages of breast cancer are usually discovered during a mammogram. Right now, the standard treatment when tumors are found is surgery, followed by radiation therapy and then hormone treatment. Some women who have a high risk of getting breast cancer even opt to have mastectomies – the surgical removal of one or both breasts – just to reduce their risk.
At Johns Hopkins Cancer Center in Baltimore, one oncologist has been studying a less radical approach.
“Since most cancers originate within the breasts and the cells that line the milk ducts within the breasts, can we possibly eliminate those dangerous cells, and by doing so, eliminate breast cancer?” asks Dr. Vared Sterns.
The idea is simple. Give a small concentration of a chemotherapy drug directly through the patient’s nipple and into the milk ducts where cancer cells or even pre-cancerous cells are forming. The entire procedure takes about 30 minutes. In clinical trials, researchers found this technique was more effective and less toxic than the conventional practice of administering chemotherapy through the vein.
“What we found was that the concentration of the drug within the breast was very, very high, while the concentration of the drug within the blood system was very low,” said Sterns.
With conventional chemotherapy, the opposite was true: Drugs administered through the vein concentrated in the blood system and but were less concentrated where they were most needed – in the breast. The clinical trials have been so promising that this type of treatment might eventually become the standard for patients with very early stages of breast cancer or those who are at risk of developing it.
“It is my hope that the treatment can be delivered in just your usual mammogram suite. This has been done in our study quite easily on an outpatient basis. It doesn’t take very long. It’s not painful,” said Sterns.
She likens this procedure to a colonoscopy. If there’s a polyp, the doctor removes it before it can become cancerous.
Dr. Sterns said researchers need to find out how much of the drug is needed and how often it should be administered to rid the breast of cancer. She estimates that work will take another 10 years. Then, if this procedure is as promising as it seems, it may become standard treatment for patients with early stage breast cancer.
Malaria control efforts currently depend on things like chemically treated bed nets and spraying against mosquitoes. But scientists keep trying to find other ways to prevent the disease.
A number of vaccines remain under development. Most contain genetically engineered versions of a few proteins from the Plasmodium parasite. Plasmodium is the organism that causes malaria. Those modified proteins are designed to get the body’s defenses to launch an immune response against the Plasmodium. But the parasite contains thousands of proteins.
Another experimental vaccine includes a deactivated version of the entire parasite. Robert Seder is a researcher at the National Institute of Allergy and Infectious Diseases, near Washington.
ROBERT SEDER: “So instead of picking out one or two or three genes, you have the potential for what we call breadth — generating an immune response that would be broad rather than narrower. And so that would be a good thing.”
Radiation is used to weaken the parasite so it cannot make people sick or get spread by a mosquito. To make the vaccine, scientists use the parasite at a time in its growth when the organism is called a sporozoite
This idea has been known since the nineteen sixties. But Mr. Seder says a discovery by a researcher at a vaccine company cleared the way for progress.
ROBERT SEDER: “The major breakthrough here was that my collaborator, Stephen Hoffman at Sanaria, developed a method where he could isolate the sporozoites and purify them so that they could administer it as a vaccine to humans. And no one thought that that was possible.”
But no one knew either if the weakened sporozoites would activate the immune system to protect against malaria. So researchers tested it on volunteers and found that it was safe — there were only minor side effects. But it was not very effective. Only two out of forty-four volunteers were protected when bitten by malaria-infected mosquitoes.
To find out why, the researchers tested the vaccine on laboratory animals. They decided that the problem was the way the vaccine had been given to the volunteers. It was injected into the skin, to simulate the bite of a mosquito. Mr. Seder says it would have been more effective if it had been given directly into the blood.
However, vaccines are generally given by mouth or injected into the skin or muscle. Having to inject it into the blood could make vaccination programs more difficult if the vaccine is approved for general use. Mr. Seder says it is also too soon to know how much the vaccine would cost.
Not all cheaters are creative. But apparently enough creative people cheat to interest researchers like Francesca Gino. Professor Gino is a behavioral economist at the Harvard Business School in Massachusetts. Behavioral economists use ideas from psychology to study how people make economic choices.
FRANCESCA GINO: “Interestingly, there are actually a lot of examples in the literature, novels, movies, comic books about this idea of the evil genius, but really no empirical evidence for this relationship.”
BATMAN (ADAM WEST): “He’s terrorized Gotham City, he’s baffled the police department and he’s held us up to public ridicule.”
Fans of old TV shows might recognize Batman and Robin, struggling to catch one of those evil geniuses — the Joker.
BATMAN: “Gloating on his own success, he may be planning some super crime and stumble on his own pride.”
ROBIN (BURT WARD): “And how do we go about stopping him?”
BATMAN: “Just go about our normal routine and let the venomous viper trap himself.”
ROBIN: “And when he does.”
ROBIN: “Caught in a bat trap!”
Professor Gino was less interested in catching cheaters than understanding them. She tested volunteers to see how creative they were. Then she tested them in situations involving small amounts of money, where they could earn extra by cheating.
For example, they took a test and had to copy their answers onto another paper. But on that other paper the correct answers were already lightly marked, supposedly by mistake. The test-takers knew they would earn more for correct answers. They were led to believe they could cheat without getting caught.
The results showed that the more creative people were more likely to cheat. By comparison, people who were more intelligent but less creative were not more likely to cheat. Professor Gino says creative people are better at creating excuses to justify their actions to themselves.
FRANCESCA GINO: “What we find is that that creativity leads people to be more morally flexible, so they are much more able to come up with justification for the behavior that they’re about to engage in and as a result, they are more likely to cheat.”
She says workplaces that value creativity also create openings for that moral flexibility. Original thinkers may be less likely to follow all the rules.
FRANCESCA GINO: “We think that creativity really helps people resolve this conflict between something that is more longer term –which is the idea of being good and moral — and then something that is more short term, and is the idea of advancing your own self-interest. And that does not necessarily mean getting money out of cheating, but it could also be getting other types of pleasures or utilities.”
The study shows the “dark side” of creativity, she says.
FRANCESCA GINO: “So it’s not that we are trying to say that people shouldn’t be creative, we are trying to say that they should be creative but they should be thinking about the fact that their creativity can be used for the wrong reasons.”
Malaria is caused by a parasite spread through the bite of infected mosquitoes. The World Health Organization, in its latest estimate, says the disease caused seven hundred eighty-one thousand deaths in two thousand nine. Most of those deaths were in children in Africa. Worldwide there were two hundred twenty-five million cases of malaria.
Both of these numbers represent improvements. In two thousand there were an estimated two hundred thirty-three million cases of malaria and almost a million deaths.
Malaria remains a major problem in Africa, but there have been some successes. Deaths in Rwanda, for example, have been reduced by sixty percent.
There are still no vaccines to prevent malaria. The main way for communities to control the disease is by controlling mosquitoes.
In a recent study, researchers in West Africa have shown that spraying insecticide indoors can greatly reduce malaria transmission.
The fight against malaria has two main targets: the parasite itself and the mosquito that carries the parasite. Insecticides target the mosquito. But over time the insects develop resistance to the chemicals. This has been happening with current mosquito killers, including chemicals known as pyrethroids.
Gil Germain Padonou and other researchers at the Center de Recherche Entomologique de Cotonou in Benin tested another insecticide. This one is called bendiocarb. They tested it with indoor spraying at sites throughout Benin.
There were fewer mosquito bites in homes sprayed with bendiocarb. More importantly, none of the three hundred fifty-thousand people who lived there got malaria-infected mosquito bites during the test.
Peter Hotez heads the American Society of Tropical Medicine and Hygiene, which published the research.
PETER HOTEZ: “And this is what this bendiocarb is all about, showing that it’s efficacious — at least in this setting in Benin, in a real, live field setting. So it provides a potentially good alternative where there’s been high development of resistance to pyrethroids.”
Dr. Hotez says the effectiveness in the test does not mean all malaria programs should use bendiocarb, or that indoor spraying should be the only method used.
PETER HOTEZ: “When we think about a large-scale goal to take on malaria, it’s not an either/or situation. We’re going to have to throw multiple things out there in order to see what the optimal combination is to achieve control.”
Bendiocarb is widely used against a number of different insects. The insecticide is considered relatively safe when used as directed. It has not been shown to cause cancer, and it passes quickly out of the bodies of humans and other mammals.