November 5, 2010
NIH Podcast Episode #0121
Balintfy: Welcome to the 121st episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy, and coming up in this episode, November is National Diabetes Awareness Month; we’ll hear about treatment options, as well as resources for screening and prevention of breast cancer; we’ll hear from leaders in research on women’s health; and we’ll wrap up our series on the History of Medicine. But first, this news update. Here’s Craig Fritz.
Fritz: Researchers funded by the National Institute of Mental Health have found that digital images can be manipulated with the mind. In the study, scientists found that research subjects, whose brains were connected to a computer displaying two merged images, could force the computer to display one of the images and discard the other. The signals transmitted from each subject's brain to the computer were derived from just a handful of brain cells. The study involved patients with epilepsy who had fine wires implanted in their brains to record seizure activity. In this instance, the wires were inserted in a brain region important for memory and the ability to recognize complex images, including faces. While the recordings from their brains were transmitted to a computer, the research subjects viewed two pictures superimposed on a computer screen, each picture showing a familiar object, place, animal or person. They were told to select one image as a target and to focus their thoughts on it until that image was fully visible and the other image faded away. This work reflects progress in the development of brain-computer interfaces, which allow people to control computers or other devices with their thoughts. These interfaces hold promise for helping paralyzed individuals to communicate or control prosthetic limbs. In this study they were used as a tool to understand how the brain processes information, and especially to understand how thoughts and decisions are shaped by the collective activity of single brain cells.
The Eunice Kennedy Shriver National Institute of Child Health And Human Development is cautioning parents and caregivers to be alert for an increased risk of SIDS during cold weather. SIDS, or sudden infant death syndrome, is the sudden and unexpected death of an infant under 1 year of age, which cannot be explained. As cold weather arrives, parents and caregivers often place extra blankets or clothes on infants to keep them warm. However over bundling may cause infants to dangerously overheat. Infants are sensitive to extremes in temperature and cannot regulate their body temperatures well. Studies have shown that multiple layers or heavy clothing, heavy blankets, and warm room temperatures increase SIDS risk. Infants who are in danger of overheating feel hot to the touch. Scientists say parents and caregivers should dress infants in light clothing for sleep and keep rooms at a temperature comfortable for adults. Other tips to reduce the risk of SIDS include: placing the infant on his or her back to sleep; placing infants to sleep on a firm, safety approved mattress; keeping toys, blankets, and other loose objects out of the crib, and never smoking around an infant.
For this NIH news update - I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Later in the program, breast cancer, research on women’s health and rare books and manuscripts. Coming up next family health history and type 2 diabetes.
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National Diabetes Awareness Month
Balintfy: During National Diabetes Awareness Month, the National Diabetes Education Program, or N-D-E-P, an initiative of the NIH and Centers for Disease Control and Prevention, is raising awareness about the importance of preventing or delaying type 2 diabetes.
Rodgers: NDEP is focusing on family health history and gestational diabetes as important risk factors for developing diabetes.
Balintfy: Dr. Griffin Rodgers is the Director of the National Institute of Diabetes and Digestive and Kidney Diseases and a leader of the National Diabetes Education Program.
Rodgers: Many people with type 2 diabetes have one or more family members with the disease. NDEP is encouraging families to talk about their family’s history of diabetes. Knowing your family health history is important because it provides people and their health care team with information about their risk for type 2 diabetes.
Balintfy: Risk for type 2 diabetes is also higher for women who have been diagnosed with diabetes during pregnancy, called gestational diabetes. Dr. Rodgers says those women also need to understand their risk.
Rodgers: Unfortunately, too many women think that once the baby is born, they are no longer at risk for developing diabetes. That’s not the case.
Balintfy: Dr. Rodgers adds that for women who have had gestational diabetes their children are also at risk for future obesity and type 2 diabetes.
Rodgers: Therefore it’s important to tell the child’s doctor about your history of gestational diabetes and take steps now to work with the entire family to maintain a healthy lifestyle that includes being more physically active and maintaining a healthy weight.
Balintfy: To find out if you are at risk for diabetes, and things you can do to prevent or delay type 2 diabetes, contact the National Diabetes Education Program. Visit the website www.YourDiabetesInfo.org, or call 1-888-693-NDEP; that’s 1-888-693-6337.
Breast cancer awareness
Balintfy: This year, there will be an estimated 207,000 new cases of breast cancer for women, and roughly 40,000 will die from the disease. But researchers emphasize that we are in a better position now to treat women and to advise them of their risk of recurrence and their overall survival of their disease.
McCaskill-Stevens: Today, we understand that breast cancer is no longer just one disease.
Balintfy: Dr. Worta McCaskill-Stevens is a medical oncologist in the Division of Cancer Prevention at the National Cancer Institute.
McCaskill-Stevens: It is a disease now that is divided into many subtypes, and these subtypes have been defined by new technology that we have.
Balintfy: Early detection is still key – when breast cancer starts, it is too small to feel and does not cause signs and symptoms. Dr. McCaskill-Stevens recommends women age 40 and older should have mammograms every 1 to 2 years.
McCaskill-Stevens: It’s important that women discuss with their physicians their risk of developing breast cancer. If they are at higher risk of developing disease -- and this is a discussion that should be about mammography, as to whether they are higher enough risk that they should receive more frequent mammograms or they should be receiving another imaging modality.
Balintfy: Risk factors for breast cancer include a personal or family history of breast cancer, certain breast changes, and being overweight or obese after menopause. The most important risk factor for breast cancer is age, and the risk is not the same for all women of a given age group. Dr. McCaskill-Stevens also points out there are disparities among races.
McCaskill-Stevens: In the disparities that have been observed between African-Americans and white women, one must also consider the fact of access and being vigilant about discussing this with your family members and with your physicians, and that when there are noted symptoms that may be suggestive of breast cancer, that they be addressed in an—in a very expedient manner.
Balintfy: She emphasizes that breast cancer awareness is a lifelong commitment.
McCaskill-Stevens: Breast cancer risk is not something that stands still. It increases with age, and so that just because you have determined what your risk status is, it is important that you continue to do so over time.
Balintfy: To better understand risk factors, screening recommendations and treatment options for breast cancer, Dr. McCaskill-Stevens recommends contacting the National Cancer Institute. Call 1-800-4-CANCER, or visit www.cancer.gov.
NIH Women's Health Research Office celebrates 20 years, announces vision for 2020
Balintfy: A recent scientific symposium has highlighted some of the advances that have increased understanding of women’s health, differences between females and males, and implications for gender-appropriate clinical care and personalized medicine.
Pinn: It was a celebration of science, it was a celebration of advancing.
Balintfy: Dr. Vivian Pinn is the director of the Office of Research on Women’s Health.
Pinn: But most of all, it was exciting to me that so many were willing to come from across the country to celebrate with us because they thought women’s health research was important.
Griffith: So, I’m an engineer, and we’re trying to develop new tools to study women’s health, particularly gynecology diseases that are under study, diseases like endometriosis.
Balintfy: That’s Dr. Linda Griffith; she’s professor and chair of MIT’s Biological and Mechanical Engineering Department. She points out that endometriosis, which is when tissues that usually grow inside the uterus instead grow on the outside, can’t be diagnosed easily and doesn’t have great therapies. Dr. Griffith, also the scientific keynote speaker, says of the symposium:
Griffith: It covered everything from ways that women respond to drugs differently than men, to diseases that are specific for women, to issues with translation, to basic science—it was a fantastic day.
Balintfy: The symposium, which also celebrated the 20th anniversary of the Office of Research on Women’s Health, gave an opportunity to look back. Former NIH Director Dr. Bernadine Healy, who launched the Women’s Health Initiative, that was a $625-million effort to study the causes, prevention and cures of diseases that affect women at midlife and beyond, explains that research on women’s health had to come at the right time.
Healy: It would not have happened without, not just a team, but an army of people supporting it. And, you know, we were all privileged to come together at that magical moment and I’m just thrilled to be back here 20 years later, almost, and know that the many things that people said we couldn’t do, we were able to do.
Balintfy: Former Surgeon General, Dr. Antonia Novello also emphasizes the importance of women—like Drs. Healy and Pinn, and others—in leadership roles.
Novello: When you come here and you see 20 years after, the women who created it, and now you see 20 years after the women that are going to continue it who realize this field is here forever and the one generation of the year 2020, and -40, and -60 will be thankful that there were some women in the 1980s, when it was not even important to mention it, that they thought about you as a generation to be able to shine with what they did in obscurity… And so when you come 20 years now, and not only do you learn of the studies that were not putting off at the forefront, then and now, you cannot introduce research at the NIH unless you give me the idea that you are going to benefit the other half of the United States as well, then you realize that we’ve come a long way.
Balintfy: Current NIH institute directors who also attended the symposium, emphasize that the research continues to move forward.
Katz: I’m director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Balintfy: That’s Dr. Stephen Katz.
Katz: And of course, another name for us is the National Institute on Women’s Health. We have so many issues that correspond to women’s health that, just to name a few, osteoarthritis, osteoporosis, many of the autoimmune diseases that afflict women to a much greater extent than men. And then there are other diseases which used to affect men to a much greater extent, like gout, used to be almost unheard of in women, but now is seen in an increased proportion of women.
Balintfy: Dr. Susan Shurin, Acting Director of the National Heart Lung and Blood Institute also highlights current women’s health priorities at her institute:
Shurin: Probably the most important ones right now are the differences in the ways that heart attacks manifest in women compared to men and the increasing incidents of Chronic Obstructive Pulmonary Disease in women, which follows the increase in smoking after the Second World War. It turns out that COPD is as common now – is now more common, actually, in women as it in men, and it manifests a little bit differently. The good news is that if women are able to stop smoking, the lung disease doesn’t seem to progress as much as it does in men. There may be actually more benefit to stopping smoking in women than there is in men.
Balintfy: And Dr. Griffin Rodgers, who we heard at the beginning of the program, again emphasizes the importance of gestational diabetes awareness.
Rodgers: This is particularly important because it affects 5 percent of all pregnancies in this country. Women who develop gestational diabetes are at high risk of going on to develop diabetes themselves, and the infant that is born during that pregnancy, that infant is also of high risk.
Balintfy: Dr. Rodgers adds that his institute, NIDDK is partnering with the Office of Research on Women’s Health to increase awareness of gestational diabetes. Dr. Pinn adds that these kinds of efforts, and the symposium itself, help.
Pinn: I really think the way we promote women’s health and women’s health research is through this interdisciplinary approach, which means a collegial approach, working together.
Balintfy: For more information on the symposium and research on women’s health, visit the website orwh.od.nih.gov. Coming up next, the conclusion of our series on the History of Medicine.
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The History of Medicine series – part 3 of 3
Balintfy: We’re wrapping up our series on the National Library of Medicine’s History of Medicine Division today with Michael North. He’s the Head of the Rare Books and Early Manuscripts Section. So let’s start with a little perspective on the section.
North: You’re probably aware that the National Library of Medicine is the largest medical library in the world. And, in the Rare Books and Early Manuscripts Section in the History of Medicine Division, we have the largest rare medical book collection in the world. That includes over 60 thousand medical and scientific books dating before 1800.
Balintfy: What would you say are some highlights of the Rare Books and Early Manuscripts Section?
North: In our collection we have really most of the important high points in medical publishing over the last five hundred years including a copy of Vesalius’s “De Fabrica” printed in Boswell in 1543 which is considered the first modern anatomical atlas. We have a copy of William Harvey’s “De Motu Cordis” which was published in 1628. It was the first book to lay out the—to prove the circulation of the blood through the body. And Edward Jenner’s—we have a copy of Edward Jenner’s “An Inquiry Into the Causes and Effects of the Variolae Vaccinae” in which he proved that by vaccinated people with cow pox, it would cause immunity to small pox and basically has allowed us to eliminate small pox from the world today.
We also have a large collection of natural history which even includes things like astronomy. The further back you go in science and medicine, all the sciences and philosophy and that sort of thing were mixed together. The same people were really doing the same kinds of investigations and experiments and writing and that sort of thing. So, you know, you had physicians studying botany and astronomy because they thought that movements of the stars could cause or end epidemics and that sort of thing.
Balintfy: Michael North, what’s your favorite collection or project?
North: Let’s see. I guess one of my favorite projects is something called Turning the Pages where we’ve scanned important parts of important rare medical books and put them up on the web as a virtual book where people can turn the pages online, it’s animated. We include exhibition text with the material to put the material in context.
And so one of the most recent books that we put up is a Japanese manuscript by a famous physician named Hanaoka Seishu who was a surgeon in Japan in the late eighteenth, early nineteenth century and he invented a form of anesthesia in the 1820’s before anesthesia was invented in the west. He was particularly interested in cancer and being able to perform surgical operations on cancer patients to remove tumors and that sort of thing. And we were lucky enough to have a beautifully illustrated manuscript of his in the collection. It features many of his patients who came from all over Japan in the early nineteenth century to receive treatment. So people can now go on our website and look at this manuscript, turn the pages, and read some text that one of our exhibition curators wrote that sort of explains what is going on and who Hanaoka Seishu was.
Balintfy: Who is most likely to use the collections in the Rare Books and Early Manuscripts Section?
North: Well primarily the collection is used by historians of medicine and this includes people who are professors at universities, graduate students, and undergraduates. We also have cultural historians, art historians, publishers, image researchers, genealogists. We also have people studying the history of the book and calligraphy, paleography and that sort of thing. But we also have clinicians and epidemiologists using the collection.
Balintfy: Say I’m not a researcher, say I’m a high school or college student or just a member of the general public, visiting out of curiosity, what do you think out of these collections would be most interesting?
North: Well, often people ask us what is the oldest item in the collection and it happens to be an Arabic manuscript that was written by Rhazes, who was one of the famous Islamic physicians of his time. He lived in the ninth century. He was one of the first people to write about things like alcohol and distillation and small pox inoculation and that sort of thing. He wrote a huge corpus that was circulated throughout the Middle East, considered very important and also influenced medieval European physicians.
Balintfy: Speaking of medieval European physicians, in those days, medicine was kind of grotesque compared to what we know today. Is that something that you can see in these materials?
North: Well, it’s hard to say. Really, fortunately, or unfortunately a lot of these early manuscripts are not illustrated so you really have to be somebody who can read the text often to figure out what’s going on in them. But -- and I will say that we look at some of these medieval and ancient texts, often their theories about the body and disease and that sort of thing, are so completely foreign to us that we would hardly believe that they are talking about the same animal. For instance, the humoral theory where they believed that the body needed to be kept in balance between the four humors: Blood, bile, black bile and phlegm. And Hippocrates and Galen back in the ancient world wrote a lot about these and they were the basis of their theories of disease and health. And they were carried through the Middle Ages and all the way up to really to almost modern times until the nineteenth century which is why bloodletting was taking place and purging and that sort of thing.
Balintfy: And, these collections are all open to the public?
North: Yes, that’s correct. Really anyone can come in and use this material. We’re open Monday through Friday from 8:30 to 5:00. All you have to do is get a library card. We do have a special reading room with increased security where we watch over people who are using the materials, but we still welcome anybody to come in and take a look at the things they are interested in. We do carry out interlibrary loan of reproductions of the materials. We’ve actually microfilmed a huge percentage of the collection. And I encourage people to visit our website where we have a huge number of images from the collection and exhibitions on various historical topics that hopefully sort of elucidate a lot of what’s going on in the library.Balintfy: Is there any way to quantify how much this collection is worth? I guess it’s basically priceless.
North: That’s right. Monetarily there is almost no way that this material could be replaced. Really I think a lot of its value is more cultural. And it is valued more as a collection as a group of things put together often rather than the individual items’ value.
Balintfy: Thank you Michael North. To see collections from the Rare Books and Early Manuscripts Section, visit the History of Medicine Division at the National Library of Medicine here in Bethesda, Maryland, or check out the website at www.nlm.nih.gov/hmd. That’s it for this episode of NIH Research Radio. Please join us again on Friday, November 19 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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