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Category: Science and Research

Killing Zika Virus Carrying Mosquitoes with Gene Drives?

Genetically engineering out the lives of pests is not a new idea. The idea of leveraging sexual reproduction to pass specific gene changes (mutations or alterations) through entire populations to control pests has been proposed as far back as the 1940s, for example, A Strain of the Mosquito Aedes aegypti Selected for Susceptibility to the Avian Malaria Parasite Plasmodium lophurae.

Evolutionary geneticist Austin Burt was credited with the method of cutting DNA to reduce populations of disease-spreading species and the associated idea of “Gene drives”. The central idea behind a gene drive is to ensure that the engineered module stands a high probability of being passed onto offspring, such that the genetic module can be spread through the population. We can “drive” a genetic mutation into an entire population.

“How do we do this?”

Imagine if we can genetically engineer the virulence out of mosquito bites — nay, let’s engineer the future lives out of an entire species of the worst offenders (these would be the aegypti mosquitoes) — and free our communities of chemical pesticides! Kill the pests but spare our environment!

That is what Oxitec is working on. The company is harnessing a pathway that has been explored for killing cancer cells to genetically engineer male aegypti mosquitoes. Male aegypti mosquitoes live long enough to mate with female aegypti mosquitoes in the wild. Males pass along what amounts to a ticking time bomb genetic sequence to their female partners. Their offspring will then carry these gene sequences that produce death-causing proteins.

Female aegypti mosquitoes are the ones that bite and deposit diseases in hosts. Thus rather than working on fatality-causing mutations where an aegypti mosquito embryo won’t even see the light of day, Oxitec wants the males mosquitoes to mate with the existing biting wild female population. Offsprings will die before adulthood due to the inherited vulnerability or will be too weak to survive the normal assaults of nature.

“Should we do this? How far should we do this?”

Along with questions of possibility and feasibility comes questions of ethics and responsibility.

What are the ethics of genetically extinguishing entire species, even if we’re talking about a loathed species like the aegypti mosquitoes? You will hear bioethicists talk about the impact on the natural food web and the ripple effect of employing such technology (i.e. “Today, mosquitoes. Tomorrow, other species maybe even certain humans?”)

Additionally, one can argue that the very situations fertile for cultivating diseases are not fixed by genetically fixing pests. How does genetically engineering mosquitoes fix the slums and ghettos in which pests and disease carrying insects establish and thrive? How do we know that another species won’t take the place of one that we genetically extinguished, because the very conditions of poverty remain?

Questions about genetically engineering away virulence and pestilence are complex, and reach beyond what is merely scientifically possible.

We need to consider the law of unintended consequences, and these are complex questions of consequences that are difficult for us to imagine, until we’ve done it.

Then, do we do it? Should we do it?

Transgender, Cisgender: Where does gender identity come from?

“What causes a person to be transgender”? You might as well ask the question, “What causes a person to be (a) gender?” These questions ask the exact same thing.

If you are a cisgender person wanting to understand what causes a person to be transgender, then ask yourself, “What causes me to identify as the gender I am?” The answer goes to the heart of the gender “identity” — what makes a person know “the gender” that person is and what makes a person cisgender or transgender, comes from the same “root”.

For a cisgender person, the answer may be easy: look down and you have your answer. But this answer does not tell the whole story. We look down because this is the easiest way for cisgender people to get an answer, and since our self-identification is congruent with our observation, we don’t further question. But what if our self-identification is not congruent with our observation?

Then let’s examine this “root” or “roots”. In other words, What is the origin of gender identity?

We know from empirical evidence that “biology” with its “male” and “female” hormones, do not dictate gender identity. There are biological males and females who identify with the other gender. Along with biology, is the genetics and epigenetics consideration: perhaps a set of genes contribute in whole or in part a “gender identity”. Genetics determine gender from a biochemical perspective, but I don’t know of any evidence that suggests genetics determine “gender identity”.

Biology and attendant hormones do not “cause” gender identity, even though hormones certainly shape the gender experience.

Cordelia Fine’s book, Delusions of Gender describes copious evidence that gender identity is socially reinforced. The book shows how even the most conscientious parents who want to raise their children “gender neutral” are not immune to reinforcing gender biases. Delusions of Gender is persuasive in arguing that society drives the parameters of gender conformity but does not examine the origin of “gender identity”.

Social and cultural rules do not dictate gender identity, even though society and culture drive conformity of gender behaviors.

What about psychological and neurological factors? Cisgender people do not deal with psychological or neurological issues around their gender identity, because “gender identity” is not even a thought — it is a knowing that is reinforced by and congruent with their biological and social/cultural experiences. Psychological and neurological considerations arise primarily when a person’s gender identity do not align with biological sex, and even then, are considerations imposed by others (people who decide that “something is wrong”).

I don’t view psychology and neurology as determinants of gender identity, even though both are used as factors when society impose “rights and wrongs” about gender identity.

Now I am left with a phenomenological dimension as the origin of gender identity. The very origin of your conscious knowing that “you” are “you” is also the origin of your gender identity.

In other words, strip away physical properties (Homo sapiens) and social conditioning (gender) and cultural constructs (role) of what and who you are.

How do you still know “who” you are?

That which creates the conscious quality you self-identity as “Me”, gives rise to your “gender identity”.

This conscious quality, within which gender identity resides, emerges independently of biology, society, and culture.

Just as this conscious quality that lets you self-identify as “Me”, emerges independently of biology, society, and culture.

What we are seeing as “gender identity” are really products of biology, society, and culture ACTING UPON the original conscious quality, and assigning a moral value to a phenomenon.

When there is agreement between gender identity and biological/social/culture influences, we don’t think twice about “gender identity” even as we may debate on the frameworks that society and culture have on “gender roles/rules”.

When there is disagreement between gender identity and biological/social/culture influences, we have heated arguments about the “right or wrong” about gender identity, when the real “rights or wrongs” remain with the frameworks that society and culture have on “gender roles/rules”.

Gender Identity is part of Consciousness.

Antibiotic Resistance: Cultural Issue not Medical Science

We must tackle a cultural problem around overuse of antibiotics.

It doesn’t matter whether we keep coming up with antibiotics: we simply breed for the most drug resistant pathogens by increasing the selective pressure in bacteria. We do this by over-prescribing antibiotics.

But wait. This isn’t necessarily about getting doctors to stop over-prescribing antibiotics. If it were that simple….

When a patient comes in complaining of what a physician judge to be “a cold”, the physician may very well tell the patient, “Go home, sip lots of hot tea and chicken soup, get plenty of rest, and take some decongestant for the symptoms.”

Then that patient says, “But I waited in your damn office for 45 minutes! You’d better get me SOMETHING.”

In other words, the patient EXPECTS the doctor to write a prescription for what the patient perceives to be “more than just” a cold.

If that doctor tries to educate the patient on the broader consequences of antibiotic overuse, the patient may very well continue to demand (DEMAND!) that the doctor write a prescription for an antibiotic (yes, here in the U.S. many patients aren’t afraid to tell doctor what they want prescriptions for). If that doctor refuses, the patient simply goes to another doctor, who is willing to write the prescription.

So I don’t care if we come up with nth generation macrolide / cephalosporin or we engineer a quinolone that won’t cause such serious adverse events that half of the drugs in that class has been pulled off the shelf…

I don’t care if we start ‘designing’ antibiotics that overcome a microbe’s awesome drug-effluxing receptors…

it is only a matter of time that we create enough selective pressure for a bug to breed and mutate into a superbug that not only will clip whatever enzyme an antibiotic uses to disable the superbug’s replication system but will pump and dump that antibiotic faster than you can say “vancomycin”.

The most important thing we can do is to curb society’s demand for antibiotics for conditions that does not warrant antibiotics, and hope that pharmaceutical sciences can catch up with the superbugs.

Ever the Sluggish $BMY

Bristol Myers Squibb was hot commodity during ASCO and while remains at historically high prices, this stock is trading sideways around the $46-47 range as investors wonder whether they were intoxicated by all the hype around the BMS pipeline.
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Sibling Aggression is Bullying and not Benign

A new study that will be published in the July 2012 issue of Pediatrics suggest that bullying is bullying, no matter whether it came from a brother or sister – versus another peer.

I’d be interested to see the actual data on this (I don’t get this without an expensive subscription) — I wonder if the distress may be even more when the bullying behavior comes from a sibling because a child would trust that his own brother or sister would not hurt him as he may expect a stranger.

This study is making headlines all over Google this week.

Association of Sibling Aggression With Child and Adolescent Mental Health

Corinna Jenkins Tucker, PhDa,
David Finkelhor, PhDb,
Heather Turner, PhDb, and
Anne Shattuck, MAb

+ Author Affiliations

aDepartment of Family Studies, and
bSociology Department, University of New Hampshire, Durham, New Hampshire

Abstract

OBJECTIVE: Sibling aggression is common but often dismissed as benign. We examine whether being a victim of various forms of sibling aggression is associated with children’s and adolescents’ mental health distress. We also contrast the consequences of sibling versus peer aggression for children’s and adolescents’ mental health.

METHODS: We analyzed a national probability sample (n = 3599) that included telephone interviews about past year victimizations conducted with youth aged 10 to 17 or an adult caregiver concerning children aged 0 to 9.

RESULTS: Children ages 0 to 9 and youth ages 10 to 17 who experienced sibling aggression in the past year (ie, psychological, property, mild or severe physical assault), reported greater mental health distress. Children ages 0 to 9 showed greater mental health distress than did youth aged 10 to 17 in the case of mild physical assault, but they did not differ for the other types of sibling aggression. Comparison of sibling versus peer aggression generally showed that sibling and peer aggression independently and uniquely predicted worsened mental health.

CONCLUSIONS: The possible importance of sibling aggression for children’s and adolescents’ mental health should not be dismissed. The mobilization to prevent and stop peer victimization and bullying should expand to encompass sibling aggression as well.

GSK Trading Sluggish on Avandia Saga

2013-06-10 11.31 AM105 Around ASCO time GSK was a promising stock being touted by life science investors as one of those undervalued stock that you can go both long and short. Even with the Avandia scandal going on, you’d think that GSK is almost invincible.

Except it isn’t.

Headlines around Avandia still dominates investor consciousness and even though GSK is more than Avandia, this goes to show that a little bit of bad news that lingers on too long can hurt investor confidence and such ambivalence has been playing out in GSK stock price these past couple of weeks.

$GSK needs to get close to $52.50 and break past this to regain investor confidence. The stock price seems tentative about it, teasing that $52 threshold.

The Bigger the Marketing Machine The Smaller the Cause Relevance

I saw this post from my friend Casey Quinlan about the Susan G. Komen foundation canceling various events across the U.S. due to public backlash of what the public perceives as the foundation’s foray into political stances:

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I don’t know what’s happened with Komen but the corporate good will seems to have declined the bigger it’s gotten. Maybe Susan G. Komen foundation needed to stay more a corpus supporting grass roots level chapters as opposed to this major corporation painting everything pink.

What was ironic was that the pink ribbon concept was created by the late Ms. Lauder of Breast Cancer Research Foundation. I did not know that BCRF was the originator of the pink ribbon concept! I thought it came from Komen because this organization pops up *everywhere* I see breast cancer. What a pity that BCRF isn’t getting more recognition and activity about its work — but this also speaks to the formation of public consciousness: the better marketing machines gets the credit even when they may not have come up with the innovation.

Large “cause-based” organizations that consume 80%+ funds for overhead will run into this type of PR problem. Instead of funding research, education, outreach, even scholarships (think: children whose parents have passed due to cancer) — the infrastructure gobbles up the raised funds. This is also what causes frustration and resentment in consumers.

How marketers over-leverage Neuro-Bunk to sell you stuff.

I worked in the cancer field and around this time (ASCO conference) I’d start seeing attention grabbing headlines like, “ginger kills cancer cells!” and then I start seeing ginger candies popping out all over supermarkets — not just in Asian markets where I used to find them, but everywhere. This is one of those “cancer bunks” where the preclinical researcher observed that high doses of an ingredient in ginger kills cancer cells on a petri dish. And suddenly… ginger kills cancer cells. I was furious why this scientist let the flames be fueled by gross extrapolation of science that hasn’t been tested in humans.

My favorite part is when she calls herself Dr. Strangelove in juxtaposition to Dr. Love, who has been on TED selling Oxytocin as the moral molecule. Crockett says there are scientific studies that have shown Oxytocin increasing envy, gloating, selective assocation with one’s own group (clique behavior, exclusionary behavior) — so she can easily say that Oxytocin is the immoral molecule.

People may say, oh this type of bunk can’t harm anyone — but then you are talking about vulnerable population (patients who suffer from conditions that may be labeled “incurable” “irreversible” “terminal” — and they are willing to try anything and everything at their own expense (non approved treatments aren’t paid for by insurance companies).

As for Dr. Love’s Oxytocin-love, Tell “oh this can’t harm anyone” to the children whose parents are trying to purchase oxytocin to dose their “ills”.

Danger of Safety Deafness to Pharma DTC Ads

Pharma ads are a relatively “new” phenomenon. In the late 1990s, the FDA allowed pharma companies to advertise directly to consumers (DTC). These DTC campaigns were reviled by physicians who believe that the ads would create pressure on them from the patients and disrupt that physician patient relationship.

Pharma companies do not have “free speech” because they operate under “commercial speech”. They are therefore dictated by the Food and Drug Administration (FDA) on what they are allowed to say and they are required to provide the information about the safety of the drug as part of “fair-balance”.

This is why you will see the disclaimers built into the ad, as the narrator smoothly go from talking about how the drug works and to ask your doctor about the drug to the standard —

“…WonderDrug is not for everyone. Women who are pregnant or nursing should not take WonderDrug. Your doctor may do routine liver testing when you are on WonderDrug. Do not take WonderDrug if you are also taking IncrediblePill. Patients who experience big toe palpitations should stop WonderDrug immediately and call their doctor….”

From an industry perspective, one of the arguments *for* DTC is that diseases and conditions become educational opportunities.

For example, depression is a stigmatized condition — then Pfizers happy little marshmallow cartoon (or pill? or cloud? I don’t know what that Zoloft character was meant to be) showed up on screen and it was a way to encourage consumers to talk to their doctors about conditions they may otherwise not discuss. For erectile dysfunction, it used to be an uncomfortable topic, but it is one of the side effects of diabetes and patients care about sexual function (compliance on meds) — so you have ads that break the ice of conversation that patients need to have so that doctors can work with them on adhering with medication regimen for best outcomes.

So there are definitely positives as a result of DTC.

On the other hand, when a DTC for restless leg syndrome came out, I didn’t like that campaign very much. I felt this was such a specialized population of patients, that having a DTC campaign may cause patients to start diagnosing themselves, erroneously, based on seconds of soundbite.

In the past when pharma companies have been sued for not disclosing safety risks and full side effect profile, their DTC ads have usually been part of the lawsuit where the charges would be that patients have not been properly informed of the full risks of the drug and that the time spent on effectiveness tips the fair balance to make the drug appear “safer than it should appear”.

Image by http://www.sxc.hu/profile/StillSearcOne of the concerns I have is that over time, patients may begin to ignore those safety statements. This can be a real danger.

It’s not unlike how many of us have grown “blind” to online ads. We go to the website and our eyes are hit by ads all over the place, but we’ve trained ourselves to selectively ignore them. Ad-blindness is a real phenomenon and internet marketers talk about this and how to bypass or overcome them.

In pharma DTC, we may become so used to those safety disclaimers that we may become selectively deaf to those statements. Many of those statements are also repetitive and similar — such that we may begin to downplay the real risks that “need for liver monitoring” may pose.

Here’s an example from real life:

We’ve all seen various statin drug commercials — these are widely used blockbuster drugs. There are always safety statements about muscle weakness — sign of serious adverse event that can result in death.

One of my relatives was on a statin drug and he watches a lot of TV, he no doubt has seen ads for these statin drug commercials including the one he was taking. One afternoon when he visited and we were sitting at a picnic table he casually mentioned that he had trouble walking very far because he seems to have very low energy.

I knew he must be on a statin drug but he’s been on several drugs for several years: this person is a chronic smoker who still wouldn’t give up smoking or horrible fat-laden diet after multiple surgeries including a quadruple bypass (I am not kidding! Quadruple bypass! One of the most serious heart surgeries you can get). He’s always complaining of aches and pains — but still:

I asked him if he had switched meds recently and sure enough, he had been taken off an old statin in favor of “a newer” statin. I told him that he needed to call his doctor immediately and make sure that his “weakness” isn’t due to a serious adverse event like rhabdomyolysis, which can cause fatalities because of kidney over-burden.

He called his doctor and was taken off that statin to another statin and his “weakness” improved dramatically.

In other words, patients who are watching these commercials may grow deaf to these statements that sound very clinical but they don’t know what this looks like in real life. We aren’t thinking “oh I’m feeling this way because the drug is causing my muscle fibers to massively break down” — we think “I’m feeling really weak.”

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