Many U.S. companies take pride in being more “sustainable” by reducing environmental impacts and engaging constructively with the communities in which they operate and the customers they serve. Corporate sustainability reporting is replete with examples of resource conservation efforts and sustained initiatives to reduce greenhouse gas footprints. Non-governmental evaluative frameworks like the Global Reporting Initiative and CDP provide powerful templates for demonstrating environmental progress.
With regard to the social justice pillar of sustainability, however, we are only beginning to understand the potential for progress.
Considered from this perspective, EPA’s Draft EJ 2020 Action Agenda outlines a framework for a fairer and more sustainable future. EPA characterizes the sustainable elements of its plan in terms of opportunity to use a community-based approach to make “a visible difference in environmentally overburdened, underserved, and economically distressed communities.” Moreover, the EJ 2020 draft framework highlights a number of practical approaches to shaping more sustainable and socially just environmental programs.
EJSCREEN provides the data to make discussions about overburdened and underserved communities concrete and factual. With data from this tool, it becomes much easier to see whether public or private efforts to improve the environment, provide jobs, or fund new amenities align with social justice or thwart it by giving more to those who already have a great deal. The tool is powerful because instead of relying on assumptions and impressions, it simply relays the facts in formats that are easy to see. For example, with EJSCREEN it will be easy to see whether a new educational grant program is benefiting communities which, because of income or language barriers, need that supplement, or whether lead paint removal funding is going to communities least able to do the work on their own.
Tools like EJSCREEN also inform EPA’s efforts to align regulatory programs with environmental justice goals by incorporating considerations of environmental justice into permit issuance. When environmental justice is part of the permitting discussion rather than a consideration after the fact, the “rules of the road” are clearer for all parties. EPA’s emphasis on constructive engagement and collaboration throughout its draft EJ 2020 framework forecasts an intent to make permitting engagement constructive and focused on problem-solving. It’s far easier to re-route traffic, refine a monitoring program, or address operational concerns in project design and permitting than to do so as a contentious afterthought. EPA’s facilitation of this kind of collaborative engagement can save all parties time and grief because community perspectives are known, considered, and addressed. The process itself builds familiarity and, in time, trust.
The most basic building block for environmental justice is its incorporation within environmental programs as crafted, not just as implemented by permit. In recent rules, EPA has employed the power of tools like EJSCREEN to understand and address geographic distributional effects. Through its Environmental Justice Research Roadmap, there will be opportunities to address the more difficult issue of how to understand and address inequities that are population-based rather than place-based – for example, how environmental and social factors can contribute to health disparities.
Regulations and permits are only as good as the assurance that they are followed. EPA’s continuing commitment to focus enforcement efforts in overburdened communities has long been applauded by the business community. It’s a key means to assure a level playing field and consistent community protection.
Finally, the strength of the 2020 Action Agenda is that it is a Framework — a consistent approach across EPA programs and authorities. If EPA engages across the agency, with the partners it identifies and in the open and communicative manner it embraces, 2020 should be replete with success stories from all stakeholders’ perspectives.
About the author: Sue Briggum is Vice President of State and Federal Public Policy, Waste Management, and a former member of the National Environmental Justice Advisory Council (NEJAC), a federal advisory committee providing advice to the EPA. Sue also co-chaired the NEJAC work group on EJ Screening, as well as served as a member of the Science Advisory Board’s (SAB) work group on EJ in Rulemaking.
from The EPA Blog http://ift.tt/1dxGfu0
By Sue Briggum
Many U.S. companies take pride in being more “sustainable” by reducing environmental impacts and engaging constructively with the communities in which they operate and the customers they serve. Corporate sustainability reporting is replete with examples of resource conservation efforts and sustained initiatives to reduce greenhouse gas footprints. Non-governmental evaluative frameworks like the Global Reporting Initiative and CDP provide powerful templates for demonstrating environmental progress.
With regard to the social justice pillar of sustainability, however, we are only beginning to understand the potential for progress.
Considered from this perspective, EPA’s Draft EJ 2020 Action Agenda outlines a framework for a fairer and more sustainable future. EPA characterizes the sustainable elements of its plan in terms of opportunity to use a community-based approach to make “a visible difference in environmentally overburdened, underserved, and economically distressed communities.” Moreover, the EJ 2020 draft framework highlights a number of practical approaches to shaping more sustainable and socially just environmental programs.
EJSCREEN provides the data to make discussions about overburdened and underserved communities concrete and factual. With data from this tool, it becomes much easier to see whether public or private efforts to improve the environment, provide jobs, or fund new amenities align with social justice or thwart it by giving more to those who already have a great deal. The tool is powerful because instead of relying on assumptions and impressions, it simply relays the facts in formats that are easy to see. For example, with EJSCREEN it will be easy to see whether a new educational grant program is benefiting communities which, because of income or language barriers, need that supplement, or whether lead paint removal funding is going to communities least able to do the work on their own.
Tools like EJSCREEN also inform EPA’s efforts to align regulatory programs with environmental justice goals by incorporating considerations of environmental justice into permit issuance. When environmental justice is part of the permitting discussion rather than a consideration after the fact, the “rules of the road” are clearer for all parties. EPA’s emphasis on constructive engagement and collaboration throughout its draft EJ 2020 framework forecasts an intent to make permitting engagement constructive and focused on problem-solving. It’s far easier to re-route traffic, refine a monitoring program, or address operational concerns in project design and permitting than to do so as a contentious afterthought. EPA’s facilitation of this kind of collaborative engagement can save all parties time and grief because community perspectives are known, considered, and addressed. The process itself builds familiarity and, in time, trust.
The most basic building block for environmental justice is its incorporation within environmental programs as crafted, not just as implemented by permit. In recent rules, EPA has employed the power of tools like EJSCREEN to understand and address geographic distributional effects. Through its Environmental Justice Research Roadmap, there will be opportunities to address the more difficult issue of how to understand and address inequities that are population-based rather than place-based – for example, how environmental and social factors can contribute to health disparities.
Regulations and permits are only as good as the assurance that they are followed. EPA’s continuing commitment to focus enforcement efforts in overburdened communities has long been applauded by the business community. It’s a key means to assure a level playing field and consistent community protection.
Finally, the strength of the 2020 Action Agenda is that it is a Framework — a consistent approach across EPA programs and authorities. If EPA engages across the agency, with the partners it identifies and in the open and communicative manner it embraces, 2020 should be replete with success stories from all stakeholders’ perspectives.
About the author: Sue Briggum is Vice President of State and Federal Public Policy, Waste Management, and a former member of the National Environmental Justice Advisory Council (NEJAC), a federal advisory committee providing advice to the EPA. Sue also co-chaired the NEJAC work group on EJ Screening, as well as served as a member of the Science Advisory Board’s (SAB) work group on EJ in Rulemaking.
My original intention was to write about something entirely different today, but, really, how could I, given that SB277 has become law in California and non-medical exemptions to school vaccine mandates are a thing of the past? The topic I had in mind for today can easily keep for a day or two anyway. Besides, what I want to contemplate now is how SB277 will work in practice. Sure, it’s fun to watch the antivaccine fringe completely lose it as SB 277 got closer and closer to passing. Indeed, if you want to experience a combination of amusement and revulsion, just peruse the comments of this post on the antivaccine crank blog Age of Autism announcing that Governor Jerry Brown had signed the bill. It’s full of outraged antivaccine activists shouting about how Gov. Brown “has blood on his hands,” how his entire legacy will be defined by this single act of signing SB 277 (really, they do have a vastly inflated view of their own importance), and rants about medical tyranny. The #SB277 hashtag on Twitter is similarly depressing and entertaining.
As an aside, at this point I can’t resist pointing out briefly that perhaps the most hilariously unhinged reaction to the passage of SB 277 comes from Jon Rappaport, where the derp is so strong that it’s hard to believe that a human being can be so ignorant about science. Let’s just say the title of his rant is Mandatory vaccination: California is ordering genetic alteration. His argument? Epigenetics man. As I like to say: Epigenetics. You keep using that word. I do not think it means what you think it means. Rappaport’s rant is so unhinged that it’s basically self-refuting, which is why I didn’t construct an entire post around it. True, it’s not as utterly vile as Kent Heckenlively’s post yesterday likening SB 277 to the Fugitive Slave Act of 1850, because, apparently, vaccine mandates are the equivalent of making slaves of parents, but it is a masterpiece of quackery.
There. I’ve gotten that out of my system. Now what about SB 277 in practice? SB 277 is a major improvement in the law regulating vaccination and vaccine exemptions in California that protects children from infectious disease. However, it is not perfect. For example, a question came up for me reading Gov. Brown’s signing message:
The Legislature, after considerable debate, specifically amended SB 277 to exempt a child from immunizations whenever the child’s physician concludes that there are “circumstances, including but not limited to, family medical history, for which the physician does not recommend vaccination.”
Thus, SB 277, while requiring that school children be vaccinated, explicitly provides an exception when a physician believes that circumstances — in the judgment and sound discretion of the physician — so warrant.
What does this mean? I went and took a look at the text of the bill as passed, specifically, Section 5:
SEC. 5. Section 120370 of the Health and Safety Code is amended to read:
120370. (a) If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.
What does that mean? It’s hard not to suggest that it means that antivaccine pediatricians in California, like Dr. Bob Sears and Dr. Jay Gordon, are already putting money down on a new Lamborghini. No, that’s not my joke; I saw it on Twitter:
That might be going too far, but it does bring up a point. The biggest weakness in SB 277 is that it appears to leave it pretty much up to a child’s pediatrician regarding whether a medical exemption to the school vaccine mandate is medically indicated. In that, it is similar to the Mississippi law. In contrast, in West Virginia, it isn’t just the word of the child’s physician that matters; all requests for medical exemptions are reviewed by an Immunization Officer, who determines if they are appropriate “based upon the most recent guidance from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) with respect to medical contraindications or precautions for each vaccine.”
On the surface, it would indeed seem to be a godsend to antivaccine pediatricians, who will likely see their business boom in the wake of SB 277, as parents, no longer able to get nonmedical exemptions, start looking for medical exemptions, much the way parents in states that allow religious exemptions but not personal belief exemptions, suddenly found religion and used it as a justification for not vaccinating. Resistance will flow wherever it can. I’m just happy that, in this case at least, only letters from a physician will be valid for obtaining a medical exemption; one could only imagine what would happen if letters from naturopaths and chiropractors, who, unfortunately, are licensed “health care professionals” in the state of California, were permitted.
Governor Brown signed this law because of the strong medical exemption provisions. He recognized that parents with reasonable medical objections—as opposed to personal or religious objections—must still have access to exemptions for their children.
Consult with a physician who knows your child and your family.
No one should scare you into or out of vaccinating.
This is the sort of thing that irritates me about Dr. Jay. He knows damned well that the parents of some of his patients are antivaccine activists. Heck, he was the pediatrician who took care of Jenny McCarthy’s son Evan back when she was emerging as America’s foremost (if you can call it that) antivaccine celebrity activist. Does he ever, in the privacy of his office, suggest to them that maybe—just maybe—it’s not such a good idea to spread misinformation demonizing vaccines as toxin-laden poison causing autism, autoimmune diseases, neurodevelopmental disorders, SIDS, and even shaken baby syndrome? Only he and his patients’ parents know for sure, but I doubt it. Certainly, he rarely, if ever, publicly calls out people on “his side” for promoting such misinformation. Instead, he falls back on a vague false equivalency that paints pro- and anti-vaccine activists both as irrationally trying to frighten people to their position. Of course, even if that were true, there would still be a big difference. What pro-vaccine activists say about the dangers of vaccine-preventable diseases is true. What antivaccine activists say about the dangers of vaccine is almost always untrue. In fact, Dr. Jay himself engages in such fear mongering just a few months ago when he declared that The MMR is not controversial because of Wakefield.
His protestations otherwise (which, to be fair, I really think he believes, thanks to massive cognitive dissonance), we know what side Dr. Jay is on.
But back to Twitter. There was an exchange yesterday in which Dr. Jay asserted:
@unhealthytruth Medical exemptions will be solely at the discretion of doctors. #SB277 Families unable to choose their MDs will have issues
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
Dr. Jay replied about “family history” in SB 277 and was asked:
.@jaygordonmdfaap Tell me how YOU as a PEDIATRICIAN would apply that. Be specific. #SB277
He was therefore asked how he, as a pediatrician, would decide whether to recommend a medical exemption to school vaccine mandates, now that SB 277 basically gives him the power to do that. At first, he said, simply, “Nope”:
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
After some prodding, he did get one thing right:
“@geekpharm: @gorskon@JayGordonMDFAAP if I say I'm worried the mercury will cause autism, would you give my kids a medical exemption?”__No
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
Which is a relief.
However, elsewhere, he remained maddeningly vague, going on about “family history” of reactions to vaccines, even though he admits that the AAP does not consider this a contraindication. He sparred with a couple of doctors, who asked him what specific medical conditions he’d consider a contraindication to vaccination. Oddly enough, he didn’t mention any of the contraindications that no one disagrees about, such as the accepted contrindication that children with severe immunosuppression (such as due to chemotherapy or illnesses that compromise the immune system) should not receive attenuated live virus vaccines. It would have been so easy to say that, because such a contraindication is on firm medical ground. But instead, Dr. Jay went here:
-2-
Just the usual health care situation: If your doctor talks with you and respects your judgement your child will get needed exemptions
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
And:
-3-
If not, some families w very reasonable requests for medical exemption will be turned down. "No shots, no school."
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
And:
@davidjuurlink@gorskon An adverse reaction to previous vaccine in patient or sibling is one good example.
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
So what does this mean? The cynic in me thinks it might mean this:
Certainly, for some physicians, that will be the main criterion. The question will come when it is parents who have a perfectly healthy child with no accepted contraindications to vaccination (such as immunosuppression) or even typical “contraindications” promoted by the antivaccine movement, such as a sibling who had an adverse reaction to vaccination, a sibling with autism, the child having autism himself, and the like. How far will pediatricians like Dr. Jay go to give their patients’ parents what they want? It will be a fascinating question, something to keep an eye on as SB 277 is implemented. One thing that I expect to happen is for dubious laboratories, like Doctors Data, to come up with more (and ever more bogus) panels of laboratory tests purported to predict “sensitivity” to adverse reactions from vaccines. Just you watch.
One comforting observation is that there doesn’t seem to be much of a problem with pediatricians writing up dubious recommendations for medical exemptions in Mississippi, whose law doesn’t require review of doctors’ requests for medical exemptions for their patients by an Immunization Officer. But Mississippi is not California, and the law has been in place there for many years. People are used to it. Also, California is one of the great paradises for the many “alternative” practitioners there, including physicians who have gone to the dark side, making the supply of physicians willing—shall we say?—to stretch the boundaries of indications for a medical exemption to vaccines likely much greater in California than it is in Mississippi.
Perhaps the most effective means of making sure that doctors sympathetic to antivaccine parents don’t come up with excessively creative rationales for recommending medical exemptions is vigilance by the state medical board, the federal government, and insurance companies. For instance, one quality metric that is being increasingly examined among pediatricians is the percentage of children who are up-to-date on the recommended vaccines. Pediatricians who fall short on that measure because they issue way more medical exemptions than average could well come under scrutiny. At the very least, they might be risk losing pay-for-performance bonuses. (Not all antivaccine-sympathetic pediatricians are in concierge practices like Dr. Jay and Dr. Bob.) Unfortunately, state medical boards tend to be toothless; so I have little hope that complaints about a physician to the Medical Board of California will have much of an impact.
Don’t get me wrong. The passage of SB 277 is a major victory in the struggle to protect children from the ravages of infectious disease and a major defeat for the antivaccine movement, which marshaled pretty much everything it had to defeat it and still came up short. The California legislature and Governor Jerry Brown are to be commended, as are the innumerable advocates for children “on the ground” who worked tirelessly for its passage. But it is not perfect. It’s politics. Compromises had to be made. SB 277 makes the situation in California much better than it was before with respect to child health and should serve as a model for the remaining 47 states that allow religious and personal belief exemptions. It is a beginning, not an end, and part of what needs to be done now is to keep an eye on its implementation. While I suspect that there will be some doctors who profit as a result of the law, fortunately I also suspect that the number of doctors who will be willing to go much beyond the CDC/AAP guidelines for medical contraindications to vaccination is and will remain small.
from ScienceBlogs http://ift.tt/1KsE2yH
My original intention was to write about something entirely different today, but, really, how could I, given that SB277 has become law in California and non-medical exemptions to school vaccine mandates are a thing of the past? The topic I had in mind for today can easily keep for a day or two anyway. Besides, what I want to contemplate now is how SB277 will work in practice. Sure, it’s fun to watch the antivaccine fringe completely lose it as SB 277 got closer and closer to passing. Indeed, if you want to experience a combination of amusement and revulsion, just peruse the comments of this post on the antivaccine crank blog Age of Autism announcing that Governor Jerry Brown had signed the bill. It’s full of outraged antivaccine activists shouting about how Gov. Brown “has blood on his hands,” how his entire legacy will be defined by this single act of signing SB 277 (really, they do have a vastly inflated view of their own importance), and rants about medical tyranny. The #SB277 hashtag on Twitter is similarly depressing and entertaining.
As an aside, at this point I can’t resist pointing out briefly that perhaps the most hilariously unhinged reaction to the passage of SB 277 comes from Jon Rappaport, where the derp is so strong that it’s hard to believe that a human being can be so ignorant about science. Let’s just say the title of his rant is Mandatory vaccination: California is ordering genetic alteration. His argument? Epigenetics man. As I like to say: Epigenetics. You keep using that word. I do not think it means what you think it means. Rappaport’s rant is so unhinged that it’s basically self-refuting, which is why I didn’t construct an entire post around it. True, it’s not as utterly vile as Kent Heckenlively’s post yesterday likening SB 277 to the Fugitive Slave Act of 1850, because, apparently, vaccine mandates are the equivalent of making slaves of parents, but it is a masterpiece of quackery.
There. I’ve gotten that out of my system. Now what about SB 277 in practice? SB 277 is a major improvement in the law regulating vaccination and vaccine exemptions in California that protects children from infectious disease. However, it is not perfect. For example, a question came up for me reading Gov. Brown’s signing message:
The Legislature, after considerable debate, specifically amended SB 277 to exempt a child from immunizations whenever the child’s physician concludes that there are “circumstances, including but not limited to, family medical history, for which the physician does not recommend vaccination.”
Thus, SB 277, while requiring that school children be vaccinated, explicitly provides an exception when a physician believes that circumstances — in the judgment and sound discretion of the physician — so warrant.
What does this mean? I went and took a look at the text of the bill as passed, specifically, Section 5:
SEC. 5. Section 120370 of the Health and Safety Code is amended to read:
120370. (a) If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.
What does that mean? It’s hard not to suggest that it means that antivaccine pediatricians in California, like Dr. Bob Sears and Dr. Jay Gordon, are already putting money down on a new Lamborghini. No, that’s not my joke; I saw it on Twitter:
That might be going too far, but it does bring up a point. The biggest weakness in SB 277 is that it appears to leave it pretty much up to a child’s pediatrician regarding whether a medical exemption to the school vaccine mandate is medically indicated. In that, it is similar to the Mississippi law. In contrast, in West Virginia, it isn’t just the word of the child’s physician that matters; all requests for medical exemptions are reviewed by an Immunization Officer, who determines if they are appropriate “based upon the most recent guidance from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) with respect to medical contraindications or precautions for each vaccine.”
On the surface, it would indeed seem to be a godsend to antivaccine pediatricians, who will likely see their business boom in the wake of SB 277, as parents, no longer able to get nonmedical exemptions, start looking for medical exemptions, much the way parents in states that allow religious exemptions but not personal belief exemptions, suddenly found religion and used it as a justification for not vaccinating. Resistance will flow wherever it can. I’m just happy that, in this case at least, only letters from a physician will be valid for obtaining a medical exemption; one could only imagine what would happen if letters from naturopaths and chiropractors, who, unfortunately, are licensed “health care professionals” in the state of California, were permitted.
Governor Brown signed this law because of the strong medical exemption provisions. He recognized that parents with reasonable medical objections—as opposed to personal or religious objections—must still have access to exemptions for their children.
Consult with a physician who knows your child and your family.
No one should scare you into or out of vaccinating.
This is the sort of thing that irritates me about Dr. Jay. He knows damned well that the parents of some of his patients are antivaccine activists. Heck, he was the pediatrician who took care of Jenny McCarthy’s son Evan back when she was emerging as America’s foremost (if you can call it that) antivaccine celebrity activist. Does he ever, in the privacy of his office, suggest to them that maybe—just maybe—it’s not such a good idea to spread misinformation demonizing vaccines as toxin-laden poison causing autism, autoimmune diseases, neurodevelopmental disorders, SIDS, and even shaken baby syndrome? Only he and his patients’ parents know for sure, but I doubt it. Certainly, he rarely, if ever, publicly calls out people on “his side” for promoting such misinformation. Instead, he falls back on a vague false equivalency that paints pro- and anti-vaccine activists both as irrationally trying to frighten people to their position. Of course, even if that were true, there would still be a big difference. What pro-vaccine activists say about the dangers of vaccine-preventable diseases is true. What antivaccine activists say about the dangers of vaccine is almost always untrue. In fact, Dr. Jay himself engages in such fear mongering just a few months ago when he declared that The MMR is not controversial because of Wakefield.
His protestations otherwise (which, to be fair, I really think he believes, thanks to massive cognitive dissonance), we know what side Dr. Jay is on.
But back to Twitter. There was an exchange yesterday in which Dr. Jay asserted:
@unhealthytruth Medical exemptions will be solely at the discretion of doctors. #SB277 Families unable to choose their MDs will have issues
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
Dr. Jay replied about “family history” in SB 277 and was asked:
.@jaygordonmdfaap Tell me how YOU as a PEDIATRICIAN would apply that. Be specific. #SB277
He was therefore asked how he, as a pediatrician, would decide whether to recommend a medical exemption to school vaccine mandates, now that SB 277 basically gives him the power to do that. At first, he said, simply, “Nope”:
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
After some prodding, he did get one thing right:
“@geekpharm: @gorskon@JayGordonMDFAAP if I say I'm worried the mercury will cause autism, would you give my kids a medical exemption?”__No
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
Which is a relief.
However, elsewhere, he remained maddeningly vague, going on about “family history” of reactions to vaccines, even though he admits that the AAP does not consider this a contraindication. He sparred with a couple of doctors, who asked him what specific medical conditions he’d consider a contraindication to vaccination. Oddly enough, he didn’t mention any of the contraindications that no one disagrees about, such as the accepted contrindication that children with severe immunosuppression (such as due to chemotherapy or illnesses that compromise the immune system) should not receive attenuated live virus vaccines. It would have been so easy to say that, because such a contraindication is on firm medical ground. But instead, Dr. Jay went here:
-2-
Just the usual health care situation: If your doctor talks with you and respects your judgement your child will get needed exemptions
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
And:
-3-
If not, some families w very reasonable requests for medical exemption will be turned down. "No shots, no school."
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
And:
@davidjuurlink@gorskon An adverse reaction to previous vaccine in patient or sibling is one good example.
— Jay Gordon, MD, FAAP (@JayGordonMDFAAP) June 30, 2015
So what does this mean? The cynic in me thinks it might mean this:
Certainly, for some physicians, that will be the main criterion. The question will come when it is parents who have a perfectly healthy child with no accepted contraindications to vaccination (such as immunosuppression) or even typical “contraindications” promoted by the antivaccine movement, such as a sibling who had an adverse reaction to vaccination, a sibling with autism, the child having autism himself, and the like. How far will pediatricians like Dr. Jay go to give their patients’ parents what they want? It will be a fascinating question, something to keep an eye on as SB 277 is implemented. One thing that I expect to happen is for dubious laboratories, like Doctors Data, to come up with more (and ever more bogus) panels of laboratory tests purported to predict “sensitivity” to adverse reactions from vaccines. Just you watch.
One comforting observation is that there doesn’t seem to be much of a problem with pediatricians writing up dubious recommendations for medical exemptions in Mississippi, whose law doesn’t require review of doctors’ requests for medical exemptions for their patients by an Immunization Officer. But Mississippi is not California, and the law has been in place there for many years. People are used to it. Also, California is one of the great paradises for the many “alternative” practitioners there, including physicians who have gone to the dark side, making the supply of physicians willing—shall we say?—to stretch the boundaries of indications for a medical exemption to vaccines likely much greater in California than it is in Mississippi.
Perhaps the most effective means of making sure that doctors sympathetic to antivaccine parents don’t come up with excessively creative rationales for recommending medical exemptions is vigilance by the state medical board, the federal government, and insurance companies. For instance, one quality metric that is being increasingly examined among pediatricians is the percentage of children who are up-to-date on the recommended vaccines. Pediatricians who fall short on that measure because they issue way more medical exemptions than average could well come under scrutiny. At the very least, they might be risk losing pay-for-performance bonuses. (Not all antivaccine-sympathetic pediatricians are in concierge practices like Dr. Jay and Dr. Bob.) Unfortunately, state medical boards tend to be toothless; so I have little hope that complaints about a physician to the Medical Board of California will have much of an impact.
Don’t get me wrong. The passage of SB 277 is a major victory in the struggle to protect children from the ravages of infectious disease and a major defeat for the antivaccine movement, which marshaled pretty much everything it had to defeat it and still came up short. The California legislature and Governor Jerry Brown are to be commended, as are the innumerable advocates for children “on the ground” who worked tirelessly for its passage. But it is not perfect. It’s politics. Compromises had to be made. SB 277 makes the situation in California much better than it was before with respect to child health and should serve as a model for the remaining 47 states that allow religious and personal belief exemptions. It is a beginning, not an end, and part of what needs to be done now is to keep an eye on its implementation. While I suspect that there will be some doctors who profit as a result of the law, fortunately I also suspect that the number of doctors who will be willing to go much beyond the CDC/AAP guidelines for medical contraindications to vaccination is and will remain small.
“I remember as a kid having a balloon and accidentally letting the string go and watching it just float off and into the sky until it disappeared. And there’s something about that, even, that feels very much like what life is, you know, that it’s fleeting, and it’s temporal.” –Pete Docter
So, you want to colonize another world, do you? Want to send humans to go live somewhere new, on a habitable planet beyond Earth? Well you’re not alone. But which planet will you choose? Will it be Mars, a smaller, colder, farther-out world than our own? Where perhaps you add a magnetic field, a thicker atmosphere, and hope to get the increased pressures and temperatures we need for liquid water and life?
Image credit: Wikimedia Commons user Daein Ballard.
Or is there not only another option, but a better option? Could we, perhaps, take advantage of the hottest planet in our Solar System — Venus — and its thick, energy-rich atmosphere?
Image credit: Cloud City fan art, via http://ift.tt/1dxa7Xw.
“I remember as a kid having a balloon and accidentally letting the string go and watching it just float off and into the sky until it disappeared. And there’s something about that, even, that feels very much like what life is, you know, that it’s fleeting, and it’s temporal.” –Pete Docter
So, you want to colonize another world, do you? Want to send humans to go live somewhere new, on a habitable planet beyond Earth? Well you’re not alone. But which planet will you choose? Will it be Mars, a smaller, colder, farther-out world than our own? Where perhaps you add a magnetic field, a thicker atmosphere, and hope to get the increased pressures and temperatures we need for liquid water and life?
Image credit: Wikimedia Commons user Daein Ballard.
Or is there not only another option, but a better option? Could we, perhaps, take advantage of the hottest planet in our Solar System — Venus — and its thick, energy-rich atmosphere?
Image credit: Cloud City fan art, via http://ift.tt/1dxa7Xw.
The ruby, birthstone for July, is among the most highly prized of gemstones. Large rubies are harder to find than large diamonds, emeralds and sapphires. As a result, rubies’ value increases with size more than any other gemstone.
Photo credit: Shutterstock
Along with its close relative, the sapphire, the ruby is a form of the mineral corundum, which is normally drab and grey in color. Red gemstone corundum is called ruby. All other gemstone corundum colors – orange, yellow, brown, green, blue, purple, violet, black, and colorless – are called sapphires.
The Mogok valley of Upper Burma is famous as the source for the finest and rarest rubies of all, know as “pigeon’s blood” for the stones’ intense red color. Another major source of rubies is Thailand, well-known for dark, brownish-red rubies. Both Thailand and Burma regard the ruby as their national stone.
In the Orient, rubies were once believed to contain the spark of life – “a deep drop of the heart’s blood of Mother Earth,” according to ancient Eastern legends. Ancient Asian stories tell that the ruby was self-luminous. They called it “glowing stone” or “lamp stone.” It’s said that an Emperor of China once used a large ruby to light his chamber, where it glowed as bright as day. Brahmins – Hindu priests of the highest caste – believed that the homes of the gods were lit by enormous emeralds and rubies. Later, Greek legends told the story of a female stork, who repaid the kindness of Heraclea by bringing her a brilliant ruby – a ruby so bright that it illuminated Heraclea’s room at night.
Ancient Hindus, Burmese, and Ceylonese regarded sapphires as unripe rubies, believing that if they buried the sapphire in the ground, it would mature to a rich red ruby.
In the Middle Ages, rubies were thought to bring good health, as well as guard against wicked thoughts, amorous desires, and disputes. Rubies, along with other types of red stones, were said to cure bleeding. And it was believed that the ruby held the power to warn its owner of coming misfortunes, illness, or death, by turning darker in color. It is said that Catherine of Aragon, first wife of King Henry VIII, predicted her downfall in seeing the darkening of her ruby.
Because of their rarity, there are very few famous large rubies. In his 13th-century books of his travels, Marco Polo relates the tale of a magnificent gemstone – believed to be a ruby nine inches long and as thick as a man’s arm – belonging to the King of Ceylon. Kublai Khan, the Emperor of China, offered an entire city in exchange for the enormous stone, to which the King of Ceylon replied that he would never part with his prize for all the treasures of the world.
The word ruby is derived from the Latin “ruber,” meaning red. This name was once used to describe all red stones, including red spinel, red tourmaline, and red garnet. Many famous rubies in history turned out not to be rubies after all. For example, the famed Timur ruby – given to Queen Victoria in 1851 – was later found to be ruby spinel.
from EarthSky http://ift.tt/1i0DZGV
The ruby, birthstone for July, is among the most highly prized of gemstones. Large rubies are harder to find than large diamonds, emeralds and sapphires. As a result, rubies’ value increases with size more than any other gemstone.
Photo credit: Shutterstock
Along with its close relative, the sapphire, the ruby is a form of the mineral corundum, which is normally drab and grey in color. Red gemstone corundum is called ruby. All other gemstone corundum colors – orange, yellow, brown, green, blue, purple, violet, black, and colorless – are called sapphires.
The Mogok valley of Upper Burma is famous as the source for the finest and rarest rubies of all, know as “pigeon’s blood” for the stones’ intense red color. Another major source of rubies is Thailand, well-known for dark, brownish-red rubies. Both Thailand and Burma regard the ruby as their national stone.
In the Orient, rubies were once believed to contain the spark of life – “a deep drop of the heart’s blood of Mother Earth,” according to ancient Eastern legends. Ancient Asian stories tell that the ruby was self-luminous. They called it “glowing stone” or “lamp stone.” It’s said that an Emperor of China once used a large ruby to light his chamber, where it glowed as bright as day. Brahmins – Hindu priests of the highest caste – believed that the homes of the gods were lit by enormous emeralds and rubies. Later, Greek legends told the story of a female stork, who repaid the kindness of Heraclea by bringing her a brilliant ruby – a ruby so bright that it illuminated Heraclea’s room at night.
Ancient Hindus, Burmese, and Ceylonese regarded sapphires as unripe rubies, believing that if they buried the sapphire in the ground, it would mature to a rich red ruby.
In the Middle Ages, rubies were thought to bring good health, as well as guard against wicked thoughts, amorous desires, and disputes. Rubies, along with other types of red stones, were said to cure bleeding. And it was believed that the ruby held the power to warn its owner of coming misfortunes, illness, or death, by turning darker in color. It is said that Catherine of Aragon, first wife of King Henry VIII, predicted her downfall in seeing the darkening of her ruby.
Because of their rarity, there are very few famous large rubies. In his 13th-century books of his travels, Marco Polo relates the tale of a magnificent gemstone – believed to be a ruby nine inches long and as thick as a man’s arm – belonging to the King of Ceylon. Kublai Khan, the Emperor of China, offered an entire city in exchange for the enormous stone, to which the King of Ceylon replied that he would never part with his prize for all the treasures of the world.
The word ruby is derived from the Latin “ruber,” meaning red. This name was once used to describe all red stones, including red spinel, red tourmaline, and red garnet. Many famous rubies in history turned out not to be rubies after all. For example, the famed Timur ruby – given to Queen Victoria in 1851 – was later found to be ruby spinel.
Modern-day warfighters face heavy odds on the battlefield, as they often carry more than 100 pounds of gear, including body armor, weapons, and night-vision technology. These loads can slow them down, reduce agility and result in fatigue, joint sprains or long-term ailments like arthritis or chronic back problems.
To remedy this, the Office of Naval Research (ONR) has presented the Marine Corps with a 3-D computer simulation program that measures equipment weight, distribution and effects on body mechanics and individual warfighter performance.
A Marine tests the ETOWL, a 3-D computer simulation program geared toward lightening warfighter equipment loads. (Photo: University of Iowa/Released)
The program —called Enhanced Technologies for Optimization of Warfighter Load, or ETOWL— and its companion software is being delivered to the Gruntworks Marine Expeditionary Rifle Squad, which focuses on individual mobility. Gruntworks serves as a “workshop” to test existing and emerging equipment that would help infantry Marines. Once given to the Marine Corps, ETOWL will be renamed GruntSim.
“ETOWL fits perfectly within ONR’s mission to develop groundbreaking technologies that enhance the resilience, physical superiority and overall warfighting performance of U.S. Marines,” said Vice Chief of Naval Research Brig. Gen. Kevin Killea.
ETOWL calls to mind popular combat-themed video games such as “Call of Duty.” Users can create a Marine avatar, load it with as much or as little equipment as desired and run it through a virtual obstacle course featuring different warfighting scenarios.
Using a color-coded system, ETOWL measures the stress placed on each avatar’s joints as well as its balance, flexibility and center of gravity. Green is good and red is dangerous. The 3-D simulation program features seven different male and female Marine Corps body types.
The benefits of ETOWL are numerous, said ONR Program Manager Dr. Peter Squire. For example, the Marine Corps can use data from the virtual tests to quickly design real-world prototypes for testing by live Marines. Squire believes this will prevent future injuries and reduce the time and financial cost of unnecessary field trials. In addition, military vehicle manufacturers can improve their product designs to enable Marines to fit better in seats and through escape hatches.
“It’s very exciting to see ETOWL transition from ONR prototype to a technology that will enhance human load and performance for the Marine Corps,” said Squire, who works in ONR’s Expeditionary Maneuver Warfare and Combating Terrorism department. “This is the kind of research that’s very rewarding because it provides a direct benefit to our nation’s warfighters.”
The ETOWL program was developed by the Center for Computer Aided Design at the University of Iowa. Once the future GruntSim is handed off to the Marine Corps, its design software (called the SANTOS human simulation environment) will be made available to the academic community to access free of charge from the center’s website.
“This will allow for further research and potential improvement of ETOWL and future programs like it,” said Squire. “ETOWL has been an important part of ONR’s mission because we now have a system to better understand human performance. This is a burgeoning research area that will only become more critical in the future.”
Squire’s work aligns with the recently released Naval S&T Strategy, which emphasizes mobility and adaptability within irregular warfare as key components of warfighter performance.
Disclaimer: Re-published content may have been edited for length and clarity. The appearance of hyperlinks does not constitute endorsement by the Department of Defense. For other than authorized activities, such as, military exchanges and Morale, Welfare and Recreation sites, the Department of Defense does not exercise any editorial control over the information you may find at these locations. Such links are provided consistent with the stated purpose of this DoD website.
from Armed with Science http://ift.tt/1GMzFHG
By Warren Duffie
Office of Naval Research
Modern-day warfighters face heavy odds on the battlefield, as they often carry more than 100 pounds of gear, including body armor, weapons, and night-vision technology. These loads can slow them down, reduce agility and result in fatigue, joint sprains or long-term ailments like arthritis or chronic back problems.
To remedy this, the Office of Naval Research (ONR) has presented the Marine Corps with a 3-D computer simulation program that measures equipment weight, distribution and effects on body mechanics and individual warfighter performance.
A Marine tests the ETOWL, a 3-D computer simulation program geared toward lightening warfighter equipment loads. (Photo: University of Iowa/Released)
The program —called Enhanced Technologies for Optimization of Warfighter Load, or ETOWL— and its companion software is being delivered to the Gruntworks Marine Expeditionary Rifle Squad, which focuses on individual mobility. Gruntworks serves as a “workshop” to test existing and emerging equipment that would help infantry Marines. Once given to the Marine Corps, ETOWL will be renamed GruntSim.
“ETOWL fits perfectly within ONR’s mission to develop groundbreaking technologies that enhance the resilience, physical superiority and overall warfighting performance of U.S. Marines,” said Vice Chief of Naval Research Brig. Gen. Kevin Killea.
ETOWL calls to mind popular combat-themed video games such as “Call of Duty.” Users can create a Marine avatar, load it with as much or as little equipment as desired and run it through a virtual obstacle course featuring different warfighting scenarios.
Using a color-coded system, ETOWL measures the stress placed on each avatar’s joints as well as its balance, flexibility and center of gravity. Green is good and red is dangerous. The 3-D simulation program features seven different male and female Marine Corps body types.
The benefits of ETOWL are numerous, said ONR Program Manager Dr. Peter Squire. For example, the Marine Corps can use data from the virtual tests to quickly design real-world prototypes for testing by live Marines. Squire believes this will prevent future injuries and reduce the time and financial cost of unnecessary field trials. In addition, military vehicle manufacturers can improve their product designs to enable Marines to fit better in seats and through escape hatches.
“It’s very exciting to see ETOWL transition from ONR prototype to a technology that will enhance human load and performance for the Marine Corps,” said Squire, who works in ONR’s Expeditionary Maneuver Warfare and Combating Terrorism department. “This is the kind of research that’s very rewarding because it provides a direct benefit to our nation’s warfighters.”
The ETOWL program was developed by the Center for Computer Aided Design at the University of Iowa. Once the future GruntSim is handed off to the Marine Corps, its design software (called the SANTOS human simulation environment) will be made available to the academic community to access free of charge from the center’s website.
“This will allow for further research and potential improvement of ETOWL and future programs like it,” said Squire. “ETOWL has been an important part of ONR’s mission because we now have a system to better understand human performance. This is a burgeoning research area that will only become more critical in the future.”
Squire’s work aligns with the recently released Naval S&T Strategy, which emphasizes mobility and adaptability within irregular warfare as key components of warfighter performance.
Disclaimer: Re-published content may have been edited for length and clarity. The appearance of hyperlinks does not constitute endorsement by the Department of Defense. For other than authorized activities, such as, military exchanges and Morale, Welfare and Recreation sites, the Department of Defense does not exercise any editorial control over the information you may find at these locations. Such links are provided consistent with the stated purpose of this DoD website.
It takes just three minutes for a precious 10 millilitre blood sample to be carried from the specialist cancer wards of the Christie Hospital in Manchester, down a corridor, and into a lab housing several large, white machines.
But before arriving in the fluorescent light of the Cancer Research UK Manchester Institute, the blood was on a different journey: flowing around a cancer patient’s body – and potentially collecting some unwelcome passengers along the way.
The stowaways are cancer cells that have broken away from a tumour and escaped into the blood. They’re wily and difficult to target, and can lodge in nooks and crannies in the patients’ body, and spawning the secondary tumours that sadly claim so many lives.
Yet, Professor Caroline Dive and her team – along with colleagues from the Cancer Research UK Lung Cancer Centre of Excellence – believe these rogue cells could hold the key to stopping this process in its tracks.
The team’s work is part of a fast-flowing area of research, moving away from a need for invasive tissue samples, called biopsies, to gather precious research material.
Instead, they’re turning to blood-based ‘liquid biopsies’ – searching for crucial information floating in a patient’s blood.
It’s in the blood
Caroline’s team is focussing on lung cancer, the world’s biggest cancer killer.
“One of the problems is we detect very few lung cancers early enough,” she tells us from her office just down the corridor from the lab. “And once the cancer has spread around the body, it becomes very difficult to treat.”
This means lung cancer survival remains stubbornly low: for every 100 people diagnosed in England and Wales, just five are alive 10 years later.
‘With circulating tumour cells, we can begin to study drug resistance’ – Prof Dive
“We need to understand the biology far better, so we can develop drugs to treat the disease more effectively,” Caroline explains.
But to compile this more comprehensive picture, the team need samples. And gathering these has, until now, proved difficult.
“Biopsying patients with lung cancer can be problematic, and really very challenging,” Caroline stresses.
“And often when a biopsy is produced, it’s quite small. By the time it’s gone to the pathology team for a diagnosis there’s not much left for researchers like me to study.”
But the team believe they’ve found a way around this.
The ‘American fridge’
Over in the lab, Caroline’s team – one of the world’s best at tracking down circulating cancer cells – is hard at work, preparing the latest round of blood samples for an elaborate cellular fishing trip.
Their lab is littered with pristine white machines, each exquisitely engineered to hook out circulating cells using different features that tell them apart from healthy blood cells.
For example, circulating tumour cells are often bigger, allowing different filtering devices to catch them. They’re also less ‘squidgy’ than healthy blood cells, so the researchers can trap them in small networks of tubes.
But one particular machine – CellSearch – has been the lab’s dominant focus for some time.
CellSearch – a futuristic sounding name for what’s essentially yet another plain white box – relies on magnets to catch rogue cancer cells in a patient’s blood sample.
But these lung cancer cells are rare in the blood.
A recent study by Caroline’s team found only around 200 of these tumour cells in 1 millilitre of patient blood – and this was the highest number they saw across six patients with small cell lung cancer. Compared to the estimated five billion red blood cells in that same volume of blood and you start to get an idea of how challenging they are to find.
So to catch them, the team need to use some specialised bait.
Circulating cancer cells carry a particular molecular on their surface, called EPCAM. And when the team prepares a blood sample, they use antibodies to attach microscopic metal beads to the EPCAM molecules on the cancer cells’ surface. This allows the magnets to fish for these cells, pulling them away from others in the sample. But it’s not perfect – some blood cells also get trapped among the cancer cells.
“You’ve enriched the circulating tumour cells, you haven’t purified them,” Caroline explains. “There are still way too many blood cells to do any molecular testing.”
So, as the video below shows – and as Caroline’s team will demonstrate at this year’s Royal Society Summer Science Exhibition – the samples are placed into a second big white box called the DEPArray (or the ‘American fridge’, as the team call it) that will painstakingly pick out the cancer cells, one by one, for analysis.
With the cells isolated, the team are now using them to solve one of the biggest challenges in cancer: how cancers become resistant to drugs.
Irresistible force
Progress in understanding drug resistance has been slow, chiefly because the tissue samples used to study lung cancer tend to be taken before a patient starts treatment.
“Getting a biopsy when a patient is first diagnosed is doable, but challenging. Getting multiple biopsies, as the patient’s cancer goes from being drug sensitive to drug resistant, is really much more difficult,” says Caroline.
“So I think the real challenge has been that we can’t look at drug-resistant disease,” she explains. “And now with these blood samples we can. That’s the step-change, that’s the game changer.”
Caroline believes that isolating and studying the rogue cancer cells in a patient’s blood could give crucial new information to help monitor and understand how drug resistance develops.
“What we can do now is just ask for a small volume of the patient’s blood to tackle those important questions about the biology of drug resistant disease.”
And the team is already using this technique to explore more uncharted territory. They have been able to grow lung cancer cells taken from patient’s blood in laboratory animals, and have shown they respond to treatment in the same way the patient they came from did. And the team has also found a way to grow the circulating cells in the lab.
This is a big deal, particularly for research on lung cancer.
“Now we can grow a patient’s circulating tumour cells in the lab we can test a variety of combinations of drugs, to see which are the best at killing the cells,” says Caroline.
And by doing this – alongside other ground-breaking research projects like the Cancer Research UK-funded TRACERx study – Caroline and her colleagues hope to map the genetic twists and turns a tumour takes as it develops, becomes resistant to treatment and, in some cases, spreads around the body. There are years of work ahead to piece together this complex picture, but it’s a crucial part of finding new ways to stop it.
It will also involve cracking open these single circulating cells, reading their entire genetic code, and comparing this to other cells to see what’s different. This research holds great promise, but it isn’t easy, and it isn’t cheap.
Caroline is quick to caution that the technique is still in its early stages. “There are lots of reasons why information from circulating tumour cells is going to be really important in the future. But is it a quick, easy test right now? Not yet,” she says.
But looking for entire, intact cancer cells isn’t the only way of fishing for cancer clues in the blood.
The floating code
Researchers are also studying blood-borne fragments of cancer’s DNA
When cancer cells die – which they do constantly as a tumour grows and multiplies – they release fragments of DNA code into a patient’s blood. And Professor Jacqui Shaw, from the University of Leicester, is trying to work out if cracking this code can help patients.
“We’re looking at circulating DNA from several different types of tumour, including breast and pancreatic cancers,” Jacqui tells us. “And we’re also handling the circulating DNA analysis for the TRACERx study in lung cancer.”
Her team is scouring these circulating DNA fragments for faults linked to the rapid growth of the cancer cells.
And they believe that analysing these chunks of DNA could potentially offer a real-time ’snap-shot‘ of these faults, as well as a way of monitoring how the disease changes over time.
This could help researchers and doctors get a handle on something called ‘tumour heterogeneity’ – a complex phenomenon mirroring Darwin’s own theory of evolution. Groups of cells within the same tumour can be genetically very different from each other. And when the disease spreads around the body these cells can become more different still.
This means that relying on a single tissue biopsy gives an incomplete picture of a patient’s disease.
Jacqui believes that circulating DNA could help track tumour heterogeneity, “identifying genetic faults that might be missed by analysing a single tumour biopsy”. And this could one day help doctors make more informed decisions about which treatments to offer their patients.
But just as with Caroline’s circulating cell studies, the field of circulating tumour DNA is still in its relative infancy.
“We don’t yet know which tumours are the most ‘leaky’,” explains Jacqui. Understanding why these chunks of DNA end up in the blood – and what useful information they hold – are a big focus of the team’s research.
And they are combining this with work on circulating tumour cells to help find out more. “Circulating DNA and tumour cells can be analysed from the same blood sample,” says Jacqui. “So we need to do more studies to better understand the relationship between both of these ‘liquid biopsies’.”
One journey starts, another begins
Although it’s easy to talk of a ‘simple blood test’ for cancer, the reality is a lot more complex – and a long way off.
But through research on rogue tumour cells and circulating DNA, the secrets held in a patient’s blood are beginning to come into focus.
And researchers like Caroline, Jacqui and their colleagues are revealing a never-before-seen level of complexity within different tumours.
The promise is a kinder way to gather this information, and use it to make crucial decisions about how a patient’s disease should be treated. But that’s a long journey we’re only just beginning to tread.
For now this means a regular three-minute walk for our scientists collecting blood samples from one the busiest lung cancer wards in the country.
But in time this could become the three minutes a patient and their family might spend walking to the hospital car park or waiting for the next bus across the road. For them that short walk could mark the start of a different journey free from cancer.
Let’s hope that just 10 millilitres of blood could one day help them get there.
Nick
The Royal Society Summer Exhibition features 22 exhibits from across the scientific spectrum. It the runs all week in London, and is free to enter. Find out more here.
from Cancer Research UK - Science blog http://ift.tt/1NwuOiH
It takes just three minutes for a precious 10 millilitre blood sample to be carried from the specialist cancer wards of the Christie Hospital in Manchester, down a corridor, and into a lab housing several large, white machines.
But before arriving in the fluorescent light of the Cancer Research UK Manchester Institute, the blood was on a different journey: flowing around a cancer patient’s body – and potentially collecting some unwelcome passengers along the way.
The stowaways are cancer cells that have broken away from a tumour and escaped into the blood. They’re wily and difficult to target, and can lodge in nooks and crannies in the patients’ body, and spawning the secondary tumours that sadly claim so many lives.
Yet, Professor Caroline Dive and her team – along with colleagues from the Cancer Research UK Lung Cancer Centre of Excellence – believe these rogue cells could hold the key to stopping this process in its tracks.
The team’s work is part of a fast-flowing area of research, moving away from a need for invasive tissue samples, called biopsies, to gather precious research material.
Instead, they’re turning to blood-based ‘liquid biopsies’ – searching for crucial information floating in a patient’s blood.
It’s in the blood
Caroline’s team is focussing on lung cancer, the world’s biggest cancer killer.
“One of the problems is we detect very few lung cancers early enough,” she tells us from her office just down the corridor from the lab. “And once the cancer has spread around the body, it becomes very difficult to treat.”
This means lung cancer survival remains stubbornly low: for every 100 people diagnosed in England and Wales, just five are alive 10 years later.
‘With circulating tumour cells, we can begin to study drug resistance’ – Prof Dive
“We need to understand the biology far better, so we can develop drugs to treat the disease more effectively,” Caroline explains.
But to compile this more comprehensive picture, the team need samples. And gathering these has, until now, proved difficult.
“Biopsying patients with lung cancer can be problematic, and really very challenging,” Caroline stresses.
“And often when a biopsy is produced, it’s quite small. By the time it’s gone to the pathology team for a diagnosis there’s not much left for researchers like me to study.”
But the team believe they’ve found a way around this.
The ‘American fridge’
Over in the lab, Caroline’s team – one of the world’s best at tracking down circulating cancer cells – is hard at work, preparing the latest round of blood samples for an elaborate cellular fishing trip.
Their lab is littered with pristine white machines, each exquisitely engineered to hook out circulating cells using different features that tell them apart from healthy blood cells.
For example, circulating tumour cells are often bigger, allowing different filtering devices to catch them. They’re also less ‘squidgy’ than healthy blood cells, so the researchers can trap them in small networks of tubes.
But one particular machine – CellSearch – has been the lab’s dominant focus for some time.
CellSearch – a futuristic sounding name for what’s essentially yet another plain white box – relies on magnets to catch rogue cancer cells in a patient’s blood sample.
But these lung cancer cells are rare in the blood.
A recent study by Caroline’s team found only around 200 of these tumour cells in 1 millilitre of patient blood – and this was the highest number they saw across six patients with small cell lung cancer. Compared to the estimated five billion red blood cells in that same volume of blood and you start to get an idea of how challenging they are to find.
So to catch them, the team need to use some specialised bait.
Circulating cancer cells carry a particular molecular on their surface, called EPCAM. And when the team prepares a blood sample, they use antibodies to attach microscopic metal beads to the EPCAM molecules on the cancer cells’ surface. This allows the magnets to fish for these cells, pulling them away from others in the sample. But it’s not perfect – some blood cells also get trapped among the cancer cells.
“You’ve enriched the circulating tumour cells, you haven’t purified them,” Caroline explains. “There are still way too many blood cells to do any molecular testing.”
So, as the video below shows – and as Caroline’s team will demonstrate at this year’s Royal Society Summer Science Exhibition – the samples are placed into a second big white box called the DEPArray (or the ‘American fridge’, as the team call it) that will painstakingly pick out the cancer cells, one by one, for analysis.
With the cells isolated, the team are now using them to solve one of the biggest challenges in cancer: how cancers become resistant to drugs.
Irresistible force
Progress in understanding drug resistance has been slow, chiefly because the tissue samples used to study lung cancer tend to be taken before a patient starts treatment.
“Getting a biopsy when a patient is first diagnosed is doable, but challenging. Getting multiple biopsies, as the patient’s cancer goes from being drug sensitive to drug resistant, is really much more difficult,” says Caroline.
“So I think the real challenge has been that we can’t look at drug-resistant disease,” she explains. “And now with these blood samples we can. That’s the step-change, that’s the game changer.”
Caroline believes that isolating and studying the rogue cancer cells in a patient’s blood could give crucial new information to help monitor and understand how drug resistance develops.
“What we can do now is just ask for a small volume of the patient’s blood to tackle those important questions about the biology of drug resistant disease.”
And the team is already using this technique to explore more uncharted territory. They have been able to grow lung cancer cells taken from patient’s blood in laboratory animals, and have shown they respond to treatment in the same way the patient they came from did. And the team has also found a way to grow the circulating cells in the lab.
This is a big deal, particularly for research on lung cancer.
“Now we can grow a patient’s circulating tumour cells in the lab we can test a variety of combinations of drugs, to see which are the best at killing the cells,” says Caroline.
And by doing this – alongside other ground-breaking research projects like the Cancer Research UK-funded TRACERx study – Caroline and her colleagues hope to map the genetic twists and turns a tumour takes as it develops, becomes resistant to treatment and, in some cases, spreads around the body. There are years of work ahead to piece together this complex picture, but it’s a crucial part of finding new ways to stop it.
It will also involve cracking open these single circulating cells, reading their entire genetic code, and comparing this to other cells to see what’s different. This research holds great promise, but it isn’t easy, and it isn’t cheap.
Caroline is quick to caution that the technique is still in its early stages. “There are lots of reasons why information from circulating tumour cells is going to be really important in the future. But is it a quick, easy test right now? Not yet,” she says.
But looking for entire, intact cancer cells isn’t the only way of fishing for cancer clues in the blood.
The floating code
Researchers are also studying blood-borne fragments of cancer’s DNA
When cancer cells die – which they do constantly as a tumour grows and multiplies – they release fragments of DNA code into a patient’s blood. And Professor Jacqui Shaw, from the University of Leicester, is trying to work out if cracking this code can help patients.
“We’re looking at circulating DNA from several different types of tumour, including breast and pancreatic cancers,” Jacqui tells us. “And we’re also handling the circulating DNA analysis for the TRACERx study in lung cancer.”
Her team is scouring these circulating DNA fragments for faults linked to the rapid growth of the cancer cells.
And they believe that analysing these chunks of DNA could potentially offer a real-time ’snap-shot‘ of these faults, as well as a way of monitoring how the disease changes over time.
This could help researchers and doctors get a handle on something called ‘tumour heterogeneity’ – a complex phenomenon mirroring Darwin’s own theory of evolution. Groups of cells within the same tumour can be genetically very different from each other. And when the disease spreads around the body these cells can become more different still.
This means that relying on a single tissue biopsy gives an incomplete picture of a patient’s disease.
Jacqui believes that circulating DNA could help track tumour heterogeneity, “identifying genetic faults that might be missed by analysing a single tumour biopsy”. And this could one day help doctors make more informed decisions about which treatments to offer their patients.
But just as with Caroline’s circulating cell studies, the field of circulating tumour DNA is still in its relative infancy.
“We don’t yet know which tumours are the most ‘leaky’,” explains Jacqui. Understanding why these chunks of DNA end up in the blood – and what useful information they hold – are a big focus of the team’s research.
And they are combining this with work on circulating tumour cells to help find out more. “Circulating DNA and tumour cells can be analysed from the same blood sample,” says Jacqui. “So we need to do more studies to better understand the relationship between both of these ‘liquid biopsies’.”
One journey starts, another begins
Although it’s easy to talk of a ‘simple blood test’ for cancer, the reality is a lot more complex – and a long way off.
But through research on rogue tumour cells and circulating DNA, the secrets held in a patient’s blood are beginning to come into focus.
And researchers like Caroline, Jacqui and their colleagues are revealing a never-before-seen level of complexity within different tumours.
The promise is a kinder way to gather this information, and use it to make crucial decisions about how a patient’s disease should be treated. But that’s a long journey we’re only just beginning to tread.
For now this means a regular three-minute walk for our scientists collecting blood samples from one the busiest lung cancer wards in the country.
But in time this could become the three minutes a patient and their family might spend walking to the hospital car park or waiting for the next bus across the road. For them that short walk could mark the start of a different journey free from cancer.
Let’s hope that just 10 millilitres of blood could one day help them get there.
Nick
The Royal Society Summer Exhibition features 22 exhibits from across the scientific spectrum. It the runs all week in London, and is free to enter. Find out more here.
from Cancer Research UK - Science blog http://ift.tt/1NwuOiH
A full-size working model of Gaia’s internal systems arrived in Germany this week. The Avionics Model is mounted in a circular set-up representing the systems on the actual satellite, now orbiting the Sun–Earth L2 point about 500 000 km from Earth.
With the model at ESA’s European Space Operations Centre, ESOC, in Darmstadt, Germany, the ESA flight control specialists responsible for Gaia now have access to a fully functional test bench of the inner workings of the billion-star surveyor.
The model will remain at ESOC for the rest of the mission, with the team trained to use and maintain it with the support of Airbus Defence and Space, Toulouse, the prime contractor during Gaia’s development.
The model was a whopping 4x4 m at its base, and could only be moved at night owing to its size.
We asked ESA's Dave Milligan, the Gaia spacecraft operations manager at ESOC, for the back-story on why the AVM is being transferred now.
Dave replied:
We're coming up to one year of operations after the commissioning period, which lasted 6 months. The first 18 months have been packed with activities not foreseen before launch for which the avionics test bench has been heavily used for validation purposes at Toulouse (e.g. changing how the spacecraft's safe mode software works, creating new software for the 7 payload computers to deal with some issues on the telescope performance, reproducing then solving various anomalies, etc).
So, we're moving it now for several reasons:
During the move, it is not available for some two months and Gaia operations are now rather stable, so we can afford to have it unavailable for a period
The AirbusDS team that built Gaia are dispersing onto new projects, so it makes sense to maintain the expertise/experience in Gaia avionics here at ESOC
The until-now intense operational workload at ESOC seems to be dropping now, so we can dedicate time to receiving, maintaining and operating the test bench
from Rocket Science » Rocket Science http://ift.tt/1LCzVzx
v
A full-size working model of Gaia’s internal systems arrived in Germany this week. The Avionics Model is mounted in a circular set-up representing the systems on the actual satellite, now orbiting the Sun–Earth L2 point about 500 000 km from Earth.
With the model at ESA’s European Space Operations Centre, ESOC, in Darmstadt, Germany, the ESA flight control specialists responsible for Gaia now have access to a fully functional test bench of the inner workings of the billion-star surveyor.
The model will remain at ESOC for the rest of the mission, with the team trained to use and maintain it with the support of Airbus Defence and Space, Toulouse, the prime contractor during Gaia’s development.
The model was a whopping 4x4 m at its base, and could only be moved at night owing to its size.
We asked ESA's Dave Milligan, the Gaia spacecraft operations manager at ESOC, for the back-story on why the AVM is being transferred now.
Dave replied:
We're coming up to one year of operations after the commissioning period, which lasted 6 months. The first 18 months have been packed with activities not foreseen before launch for which the avionics test bench has been heavily used for validation purposes at Toulouse (e.g. changing how the spacecraft's safe mode software works, creating new software for the 7 payload computers to deal with some issues on the telescope performance, reproducing then solving various anomalies, etc).
So, we're moving it now for several reasons:
During the move, it is not available for some two months and Gaia operations are now rather stable, so we can afford to have it unavailable for a period
The AirbusDS team that built Gaia are dispersing onto new projects, so it makes sense to maintain the expertise/experience in Gaia avionics here at ESOC
The until-now intense operational workload at ESOC seems to be dropping now, so we can dedicate time to receiving, maintaining and operating the test bench
from Rocket Science » Rocket Science http://ift.tt/1LCzVzx
v
