The Nature Debate: Enhancing the Body

This evening I attended The Nature Debate: Enhancing the Body at King’s Place in King’s Cross, north London.

Today’s discussion is the second of two panel events on “the risks, benefits and extent of how far research can extend our mental and physical abilities”. Chaired by Kerri Smith, Nature Podcast Editor and presenter of Nature Neuroscience’s NeuroPod, the panel comprised:

Kevin Warwick, Professor of Cybernetics at the University of Reading and wannabe cyborg.
Andy Miah, Reader in New Media & Bioethics at the University of the West of Scotland, Fellow of the Foundation for Art and Creative Technology and dapper dresser.
Aubrey de Grey, Chairman of The Methuselah Foundation, an organization committed to accelerating progress toward a cure for age-related disease, and owner of a magnificent beard.

After a brief introduction and tongue in cheek incitement to “get physical” from Nature Managing Editor Nick Campbell, the panel members lay down their views on the subject of physical enhancement.

Aubrey de Grey begins by pointing out that all three panel members are advocates for physical enhancement and questions whether the discussion will really be a debate at all, then lays down his case, arguing that being against the concept of physical enhancement is “incoherent”. Citing examples such as the beneficial effects of antibiotics and vaccines on the immune system, he illustrates that we humans have already taken measures to enhance ourselves physically.

Next up is Kevin Warwick, who compares humans to computers in order to demonstrate the limitations of our mental capacities. He cites a professor at MIT who claimed that all the memories of a 100-year-old person could fit on a single CD and states that machines can sense spectra like ultraviolet and X-rays, finally suggesting that by harnessing the power of computers in these areas we can enhance mental powers such as memory capacity and sensory perception. Warwick’s most famous experiments represent the first steps along this path – in 1998 he implanted a chip under his skin and was able to open and shut doors via a computer, then in 2002 a new chip that interfaced directly onto his median nerve permitted him to move a robot arm in synchrony with his own actions.

The third panel member, Andy Miah, spoke about the value of human enhancement in elite sports. An asthmatic, he only recently began regularly using his inhaler and feels that his running capability has increased tremendously – where do these kind of measures fall in the debate about physical enhancement? Miah also discusses the case of the South African runner Oscar Pistorius, who is a double amputee and the proud owner of very high-tech carbon fibre transtibial artificial limbs. Pistorius successfully campaigned to compete with able-bodied athletes in the 2008 Beijing Olympics. His case raises interesting questions about the perception of disability and the purpose of enhancements.

Chair Kerri Smith picks up on this theme and asks the panel whether there is a difference between enhancing the physical capabilities of a disabled person in order to bring them up to the the capacity of a ‘normal’ individual, and physically enhancing a healthy person to give them abilities above the norm. Harking back to the case of Oscar Pistorius, Andy Miah opines that the definition of a ‘normal’ human and, therefore, what constitutes a physical enhancement is particularly difficult, especially in the paralympics. This issue then leads into a discussion of what constitutes an acceptable physical enhancement, with Aubrey de Grey suggesting that elite sport is ‘the canary in the coalmine’ of physical enhancement and may well prove to be the litmus test of what society considers acceptable.

Finally, the panel are asked what sort of physical enhancements are possible at this moment in time and how long it will be before one of their pet projects comes to fruition. Aubrey de Grey says that the aim in his field is “to solve the problem of aging faster than it catches up with us” and that he hopes the discipline of regenerative medicine will reach this point in 25-30 years. Andy Miah thinks that the first genetically enhanced athletes might appear in the 2012 Olympic Games, and acknowledges that genetic modification is already possible in animals and it is only ethical and safety concerns that prevent such techniques being used in humans today. Kevin Warwick cites his most recent experiments – in which rat neurons are interfaced with robot ‘bodies’ – as examples that enhancing physical capabilities through computers is technologically possible at the moment, and purports that it could only be 12-18 months before scientists start doing similar experiments with the human nervous system. On the other hand, there are many concerns relating to surgery, infection, and the ethics of such undertakings, meaning that linking human brains to robot bodies – Steve Martin brain-in-a-jar style – might not happen for up to 10 years.

So what of Nature’s original question – “How should we respond to enhancement technologies?” The answer from the panel seems to be: “enthusiastically”. The last word goes to Aubrey de Grey, who states “It is intellectually bankrupt to say that any enhancement per se is wrong”.

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Consumption of caffeine during pregnancy increases the risk of having an underweight baby

Caffeine has been proposed to have all sorts of effects on health, both good and bad. Just in the last few months, it has been reported that caffeine can help repair damaged blood vessels, protect against cataract formation, and even shrink women’s breasts.

Now new research published in the British Medical Journal has found that consuming caffeine during pregnancy can increase the risk of giving birth to low-birth-weight baby. Underweight babies are more likely to be delivered early or by cesarean section, and are at a higher risk of having neurological disabilities.

The authors of this study devised a questionnaire on habitual caffeine intake that was administered before conception and twice during pregnancy in 2,635 women. They then looked at information on pregnancy complications and delivery details in the electronic databases of the two large UK maternity hospitals in which the study was conducted.

The mean caffeine intake during pregnancy in these women was 159mg a day – equivalent to approximately a cup and a half of filter coffee, three cups of tea, or about three cans of cola drink. Approximately 62% of the total caffeine ingested was in the form of tea, 14% was in coffee, 12% in cola drinks and 8% in chocolate.

Compared with women who consumed less than 100mg of caffeine a day, the risk of having a low-birth-weight baby was 20% higher in those who consumed 100-199mg per day and 50% higher in those who consumed 200-299mg per day. The size of the reduction in birth weight increased as caffeine intake increased.

Importantly, the magnitude of the association between caffeine consumption and baby size was similar to that seen between alcohol consumption and birth weight, i.e. caffeine consumption increased the risk of having a low-birth weight baby as much as alcohol consumption did.

The Food Standards Agency in the UK has now changed it’s recommendations on caffeine intake during pregnancy on the basis of this research, lowing the limit from 300mg a day to 200mg a day.
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CARE Study Group (2008). Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study BMJ, 337 DOI: 10.1136/bmj.a2332

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The sexual health of Great Britain

This week the Office for National Statistics released the results of their 2007/08 contraception and sexual health survey, which was undertaken as part of the National Statistics Omnibus Survey.

Over four months, 1,164 women aged 16-49 and 1,543 men aged 16-69 completed a questionnaire on contraception use, sexual health, and knowledge of sexually transmitted infections (STIs). The survey found that the majority of Brits are monogamous. Men still claim to have had more sexual partners than women but at least are mostly using condoms while they’re playing the field. Women, on the other hand, prefer the pill to any other form of contraception. We’re not too hot on emergency contraception but know our STIs better than we used to, gleaning most of our info from the TV.

As many as 75% of men and 78% of women reported having had only one sexual partner in the previous year. Within all age groups, a higher proportion of men than women reported multiple sexual partners and more women than men reported having had just one partner.

The pill was the most popular form of contraception, used by 28% of women employing such measures, and the condom was the second most popular method (24%). In total, 43% men and 50% of women had used a condom in the past year, with those who had had more than one sexual partner more likely to have used a condom than those who had only had one partner. More specifically, 80% of men and 82% of women who had multiple partners had used a condom in the past year.

Almost all women (91%) had heard of the morning after pill, but awareness of the emergency intrauterine device (IUD) had dropped from 49% in 2000/01 to 37% in 2007/08. Less than half (49%) of the women who had heard of emergency contraception knew that the morning after pill is effective up to 72 hours after intercourse, while less than 10% were aware that the emergency IUD was effective if inserted up to five days after sex. Only 6% thought that the morning after pill protected against pregnancy until the next period and less than 1% believed that it protected against sexually transmitted infections.

Nearly all respondents correctly identified that chlamydia is an STI (85% of men and 93% of women), far more than in 2000/01 (35% and 65%, respectively), and nearly all men and women knew that gonorrhoea is an STI (92% and 91%, respectively).

Alarmingly, half of all respondents reported making no changes to their behaviour as a result of what they had heard about HIV/AIDS and other STIs, but thankfully more than a third of men and women said they had increased their use of condoms.

Most respondents got their information on STIs from television programmes (31%), followed by TV adverts (22%), and newspapers, magazines or books (20%). On the other hand, the internet was rarely used as a source of information about STIs, even by young people (3% of those aged 16-24).

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The Lancet website relaunch

Today medical journal The Lancet relaunched a sleek and efficient new version of their website TheLancet.com.

The team at The Lancet consulted 100 authors, readers, doctors and clinicians – or ‘development partners’ – to find out what users wanted, and the result is a much cleaner and easier to use website. In the new design, The Lancet journals The Lancet, The Lancet Infectious Diseases, The Lancet Oncology, and The Lancet Neurology are now all accessible and searchable from a single website.

In a special podcast to accompany the launch, the Editor-in-Chief Richard Horton outlines his favourite features:

“The most exciting things about The Lancet’s new site for me are first, we have the possibility for internet television … in the YouTube would that we live in I think that’s immensely important for communication, especially in health when you’ve got some pretty difficult concepts sometimes. And secondly, I think we’re also able to convey the personality of The Lancet in ways that we’ve never been able to before: the idea that we’re publishing research, educational material, and also opinion.”

The new video functionality is showcast TheLancet.com Story, a very flashy and professional-looking production in which members of the journal staff and Dr Anne Szarewski, clinical consultant at Cancer Research UK and one of the development partners, discuss what the new website means to them. The Lancet hopes that in the future users will be able to submit their own medical videos to the site.

Richard Horton boasts that the website has “the best search engine in medicine”, and certainly it’s an awful lot faster than the search on the previous incarnation. Importantly, the search results include not only results from The Lancet family of journals, but also all relevant results in Medline, a life sciences and biomedical publication database run by the US National Library of Medicine.

Articles now include links to related material as well as social bookmarking tools, including parent company Elsevier’s 2Collab social networking tool. In addition, online community features are planned, including social networking, debates, wikis and discussion boards.

On the editorial side of things, original research articles now include drop-down Editors’ Notes within the table of contents – 2 or 3 sentences that summarize what is important about the research – while journal homepages feature three articles that represent the Editor’s choice. The news aspect of the website has been expanded with the inclusion of ‘This Week in Medicine’, short paragraph-long summaries of what has been going on in medicine worldwide. Specialty-based online collections comprising content from across The Lancet family of journals will launch in the near future, one mooted project being a cardiology portal.

I think the new version of TheLancet.com is a vast improvement on the previous website, not least because it is so much easier to navigate and doesn’t trip you up with sign-ins every 5 minutes. The site also looks far crisper, in stark contrast to it’s cluttered forebear. I’m more into text than multimedia so I’m not fussed about using the new video content, but it’s certainly very impressive and a new direction for The Lancet.

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New Scientist cancer special

The latest issue of New Scientist is a cancer special titled ‘Old killer, new hope‘.

The main focus of the issue is a large article on genomics – ‘Living with the enemy‘. Instead of classifying tumors according to where in the body they appear, for example the prostate or the lung, scientists are now starting to groups cancers according to which molecular pathway the cancer uses in order to grow and spread.

New targeted therapies can act specifically on a particular molecular pathway, sparing the normal dividing cells that are often killed off in conventional forms of cancer therapy. For example, breast cancer patients with mutations that cause overproduction of the protein HER2 can be treated specifically with with an antibody called trastuzumab, better known as Herceptin, whereas those with receptors to the hormone estrogen can be treated with a drug called tamoxifen. An interactive graphic shows how these modern therapies work.

Patients doing it for themselves‘ describes how powerful, well-funded patient groups are setting the agenda for cancer research. The article cites the example of the Multiple Myeloma Research Foundation, which amazingly donates as much money to research on multiple myeloma as the US National Cancer Institute.

The capacity of the immune system to hold tumors dormant is discussed in ‘Tumors under lock and key‘. Apparently about a third of breast cancer survivors still have tumor cells circulating in their blood after successful treatment, in cases up to 22 years after therapy. Finding out how the immune system keeps microtumors, which are thought to be responsible for these circulating tumor cells, from running amok could provide new strategies for fighting cancer.

The special issue also contains a list of expert tips for evading cancer and an editorial lamenting how patients and healthcare providers are ever going to be able to afford these fancy new treatments.

All these articles are currently available online for free, so go check them out.

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Attitude has no effect on survival in women with breast cancer

Many patients with cancer feel that their attitude towards the ‘fight’ is an important part of beating the disease, but maintaining a positive perspective is pretty tough in the face of a life-threatening malignancy.

A large, population-based study published in the Journal of Clinical Oncology has now found that psychosocial factors such as fighting spirit and fatalism have no effect on survival in patients with breast cancer. The authors Phillips et al. emphasize that their results could allay the concerns of anxious women who believe that their mental attitude towards breast cancer will affect their likelihood of survival, and could in fact lift the burden of responsibility such women may feel.

Phillips et al. studied 708 Australian women diagnosed with nonmetastatic breast cancer before the age of 60 (average age 40 years old). At study entry approximately 11 months after diagnosis, all women completed an array of psychosocial tests that were designed to assess factors such as anxiety and depression, coping style, and social support. These women were then followed up for an average of 8.2 years.

In total, 33% of women experienced distant recurrence of their cancer and 24% died during follow-up. Once the patient data had been adjusted to take into account other factors that affect chances of recovery, such as tumour size, no associations could be found between psychosocial factors and either distant disease-free survival or overall survival.

The authors conclude that their study does not support the controversial theory that psychosocial factors influence survival after breast cancer. They state, “This should be reassuring for women, particularly those who experience substantial levels of psychosocial distress after their diagnosis.”

It is important to note, however, that therapies that aim to reduce psychosocial stress in women with breast cancer should not be discounted, as such interventions do seem to improve quality of life.

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K.-A. Phillips, R. H. Osborne, G. G. Giles, G. S. Dite, C. Apicella, J. L. Hopper, R. L. Milne (2008). Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study. Journal of Clinical Oncology 26 (28): 4666-4671 DOI: 10.1200/JCO.2007.14.8718

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Would you like a defibrillator with your coke sir?

Authorities in Japan have taken an interesting approach to improving the dire survival rates after out-of-hospital sudden cardiac arrest (SCA), i.e. heart attack in the home or in a public place rather than in a ward on a hospital.

Nature Clinical Practice Cardiovascular Medicine
reports that automated external defibrillator devices (AEDs) are being placed in vending machines and advertising hoardings in public spaces in Japan. Members of the public can then use these devices to provide defibrillation at the scene of a SCA, saving precious minutes before emergency services arrive.

The American Heart Association estimates that 166,200 people die in the United States each year from out-of-hospital SCA and only 6.4% of patients who are admitted to hospital for SCA survive until discharge.

Early medical response is crucial for people who suffer an out-of-hospital SCA. For every minute that passes between collapse and defibrillation, survival from witnessed SCA falls by 7-10%. In most cases it is the emergency services who provide defibrillation, but time is lost waiting for paramedics to arrive at the scene.

An obvious way to shorten the time between SCA and defibrillation is for lay witnesses to perform the procedure. In fact, studies have found that defibrillation by members of the public considerably improves survival after SCA.

The Japanese government authorized the lay use of AEDs in July 2004. Subsequently, a study by the Japanese Fire and Disaster Management Agency in 2006 found that 32.1% of the 140 SCA victims who were defibrillated by a member of the public were still alive at 1 month, compared with 8.3% of the 18,180 people who did not receive defibrillation from a lay person.

In most countries public-access AEDs can only be used by trained individuals, be they members of the public, first aiders, paramedics and so on; however, what is interesting in Japan is that no training is necessary in order to use these devices. In addition, the Japanese government has formally declared that the liability of an individual who uses an AED is limited, irrespective of the outcome of resuscitative efforts.

Another interesting point about public-access AEDs in Japan is that rather than being directed by the government, the positioning of AEDs in public places is being spearheaded by commercial companies. As Nature Clinical Practice Cardiovascular Medicine reports:

“The cost of keeping an AED in a vending machine is primarily covered by the revenue from drink purchases and is shared by the manufacturer of the drink, the provider of the machine, the distributor of the AED, and the proprietor who provides the space and electricity. Allowing paid advertising on a display panel above a box housing an AED is another method of funding public access AEDs. Again, the proprietor has only to provide the space and electricity. These creative efforts are surely effective in keeping down AED dissemination costs.”

Although Japan was a little behind other countries when it came to introducing public-access AEDs, the creative approaches to accessibility undertaken by the Japanese are in a class of their own.

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Last night the Bee Gees saved my life

The Bee Gees’ disco smash ‘Stayin’ Alive’ is more appropriately titled than anyone could have realized – the 1977 hit is the ideal speed at which to perform chest compressions in heart attack victims. Having practiced cardiopulmonary resuscitation (CPR) with the song, participants in a recent study could maintain the ideal rhythm weeks later by simply thinking of the tune as they performed the procedure.

Dr David Matlock, an author of the study, said many people were put off performing CPR as they were not sure about keeping the correct rhythm. CPR can more than double the chance of survival after cardiac arrest, if performed properly.

The research from the University of Illinois, which will be presented during the American College of Emergency Physicians’ scientific assembly in Chicago this month, found that at 103 beats per minute, Stayin’ Alive is almost the same pace as the American Heart Association’s recommendation of 100 compressions per minute for CPR.

In this study, 15 students and doctors first performed chest compressions on mannequins to the beat of Stayin’ Alive. Five weeks later, they performed the same procedure without the music but were told to think of the song while doing compressions. The average number of compressions the first time was 109 per minute; the second time it was 113.

Dr Matlock acknowledged that the pace kept in the second round was a little fast, but stated that when it comes to trying to revive a stopped heart, a few extra compressions per minute is better than too few. “It drove them and motivated them to keep up the rate, which is the most important thing,” he told the Associated Press.

According to the BBC, a spokesman for the American Heart Association said that the organization had been using Stayin’ Alive as a training tip for CPR instructors for about two years.

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Diabetes gonna get you

About 10 days ago Diabetes UK launched their biggest ever UK public awareness campaign – Beware the silent assassin. I first got wind of the campaign when I spotted this arresting poster at Old Street tube station in east London.

The campaign has been launched on the back of research by Mori showing that people tend to underestimate the severity of the complications associated with diabetes; for example, only 29% of adults are aware of the link between diabetes and heart disease, and only 46% appreciate that diabetes shortens life expectancy. Diabetes UK says, “This research tells us that the public see diabetes as rather mild and easily managed – something of an inconvenience rather than the serious condition it can be.”

In addition, an estimated 500,000 people in the UK have the condition but are not aware of it, so are at risk of being diagnosed too late to prevent the complications of diabetes. “Dealing with the diabetes time-bomb is a matter of urgency if we want to prevent millions of people from facing a grim future of ill-health,” said Douglas Smallwood, Chief Executive of Diabetes UK.

The ‘hard-hitting campaign’ launched by the charity aims to spook the public into realizing that diabetes is serious condition that can potentially cause heart disease, stroke, amputations, kidney failure and blindness.

The images, which will appear on outdoor posters as well as in newspapers and magazines, feature an ominous ghostly figure – the specter of undiagnosed diabetes presumably – pouncing on unsuspecting members of the public. The ads also include secondary warning messages such as:
– Diabetes causes more deaths than breast and prostate cancer combined.
– The death certificate will say heart attack. It was really diabetes.
– Diabetes causes heart disease, stroke, amputations, kidney failure and blindness.
So far so portentous.

The campaign also encourages people at risk of developing type 2 diabetes, i.e. the overweight, to make changes in their lifestyle to avoid a future of chronic disease. As the blurb states, “With early diagnosis and by leading a healthier lifestyle and improving diabetes control, the risk of developing these serious complications can be minimised. “

The adverts refer readers to a microsite developed especially for the campaign, which has quizzes to help users establish their risk of developing diabetes and gives information and support on managing the condition.

I personally feel that these adverts suggest that diabetes could to strike you dead on the spot – assassinate you – the way heart disease might, but is this really the case? On the other hand, a campaign educating our increasingly overweight population that diabetes is a serious and mostly preventable disease is certainly needed, and it is quite likely that striking adverts such as these will get people thinking more seriously about their health.

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Herbal remedies and acute kidney disease

Nature Clinical Practice Nephrology has recently published a review by Luyckx and Naicker highlighting the link between traditional medicines and kidney injury.

Traditional and herbal remedies are widely used worldwide, with as many as 80% of people in some populations using such treatments. The use of herbal remedies becoming increasing common in Western countries, as shown by a 2002 survey that found that 36% of people in the US use alternative or complementary medicines.

Herbal therapies all pass through the kidney on their way out of the body; consequently, many have been associated with acute kidney disease. Luyckx and Naicker report that “folk remedies account for up to 35% of cases of acute kidney injury and mortality rates for acute kidney injury range from 24% to 75%.”

The herbal remedies most commonly used in the US include echinacea, which is used as an immunostimulant, and St John’s wort, which is used to treat depression among other things. Echinacea, however, has been associated with acute kidney injury and St John’s Wort with kidney transplant rejection.

Various factors besides direct toxicity of the agent can contribute to kidney injury, such as contamination of the preparation or incorrect administration. In addition, the type of nephrotoxicity experienced by an individual taking a herbal remedy is dependent on which part of the kidney is affected, and the authors discuss these factors in more detail in their review.

Luyckx and Naicker do point out that the effects of herbal remedies are something of an unknown quantity; for example, some studies have shown that cranberry decreases the risk of kidney stones, whereas other studies find that cranberry increases this risk.

The review concludes by saying “The incidence and prevalence of acute kidney injury associated with the use of traditional remedies is unknown and probably varies greatly from place to place. Since the use of traditional remedies is common worldwide, it is probably safe to assume that the incidence of acute kidney injury is not high. Individual morbidity, however, can be considerable.”

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