From pigs, the possibility of replacement tissue

With donor organs unavailable for most of the 80,000 people awaiting transplants in the United States, scientists are working to overcome the two biggest hurdles to xenotransplantation—immune rejection and infection. A Massachusetts company, Immerge BioTherapeutics, in collaboration with researchers around the country, has eliminated a gene in a cloned “knockout” pig that produces a key enzyme in the rejection process. The company has also identified swine that do not produce porcine endogenous retrovirus, which has been found to infect human cells in vitro.

“The waiting list for transplants continues to grow,” Julia L. Greenstein, Ph.D., president and CEO of Immerge, said in a January talk sponsored by the Interdepartmental Program in Vascular Biology and Transplantation. “For the most part the donor list has remained incredibly static. We need to be able to do something else to address the patients who are on the waiting list and are never going to get organ transplants.”

—John Curtis

An advocate for access, for all

As a child Tomas Lagerwall paid a visit to a “cripple center” in his native Sweden. “I remember seeing all those people sitting in wheelchairs doing nothing,” said Lagerwall, secretary general of Rehabilitation International, a network of more than 230 organizations in 90 countries devoted to promoting the rights of the disabled.

But over the years attitudes toward people with disabilities have changed, Lagerwall said at a talk at the School of Public Health in January. The 19th-century notion of institutionalizing them fell by the wayside as people with disabilities became more independent and capable of negotiating the outside world. “Today we talk about disability rights and an inclusive society,” Lagerwall said.

To that end Rehabilitation International is promoting a UN Convention on the Rights of People with Disabilities as well as community-based rehabilitation (CBR), which provides cost-effective programs in developing countries where at least three-quarters of those with disabilities live. “The CBR concept is that two-thirds of the rehabilitation work can be done at the local level, with local staff. It does not have to be very costly.

—John Curtis

In medicine, a spiritual crisis

Medical science has, in the last century and a half, permitted miracles unimaginable in the day of Hippocrates, says Daniel P. Sulmasy, M.D., Ph.D., a Franciscan friar and director of the Bioethics Institute of New York Medical College. Yet, he says, physicians are among the most dissatisfied of professionals. The science and economics of healing, he told an audience at the Program for Humanities in Medicine Lecture Series in January, have dehumanized medicine. “I believe people are reaching a point which is very close to crisis,” he said. “I believe the crisis is primarily a spiritual one.”

Illness, he said, is a disruption of relationships within the body. Healing is the art of restoring “right relationships.” That requires more than a seven-minute office visit, with referrals to unknown specialists or prescriptions for medications limited to those on an HMO’s approved list. It requires a strong relationship between physician and patient. “What is the meaning of medicine? What is its value? What are right and good healing relationships about?” he asked. “Those are spiritual questions.”

—John Curtis

Giving names to the dead in the wake of 9/11

As the Office of the Chief Medical Examiner in New York City began processing the victims of 9/11, a fundamental decision about the massive operation was made. “No autopsies were going to be done,” said Amy Zelson Mundorff, M.A., a forensic anthropologist with the city. “The cause and manner of death were not at issue.”

Instead, Mundorff said at a pathology grand rounds in February, identification was the main concern. A “rule of thumb” quickly emerged: any human fragment bigger than a thumbnail would be DNA tested. DNA testing determined the identities of more than 5,000 of the 20,000 fragments found. The medical examiners also used dental records, clothing, personal effects, tattoos and prostheses to identify 1,480 of the 2,792 victims. They still have hopes of someday identifying all the victims.

“Our chief has promised the families it will never be over,” Mundorff said. “Even though we have done all the identification that we can from the information that we have, if new technologies come up in the future we can exhume and retest the unidentified pieces, if requested.”

—John Curtis