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The Obama effect and the year in medicine

Italian doctor Paolo Zamboni made world news with his experimental treatment for MS, which immediately prompted calls for studies.

Alessandro Vincenzi/Alessandro Vincenzi/The Globe and Mail

When Barack Obama was sworn in as U.S. President in January, many top Canadian scientists feared they would soon be hearing a great sucking sound as research resources and talent were drawn back to the United States.

After all, Canada had indirectly benefited from some of the restrictive science policies of the George W. Bush administration, such as federal funding curbs on stem-cell research. Canada, by contrast, seemed like a friendlier place to do science. Better still, many Canadian scientists had enjoyed hefty increases in their research grants in the early part of the decade.

Now the tables have turned. Mr. Obama declared that science is "essential" for America's continued health, security and prosperity. His economic-stimulus package included $10-billion (U.S.) for medical research.

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At about the same time, Prime Minister Stephen Harper's government trimmed the budgets of three granting agencies that fund university-based research - the type of work that can potentially generate major discoveries and groundbreaking innovations. A lot of researchers are skeptical of the Canadian government's commitment to science, even though Ottawa has pledged more money for university infrastructure and equipment. The money, some researchers argue, should be going to "brains not bricks."

The government's credibility took another hit when Gary Goodyear, the federal minister responsible for science and technology, declined to answer a question about whether he believes in evolution, during an interview with The Globe and Mail's science reporter Anne McIlroy. Mr. Goodyear, a chiropractor by training, later said he did believe in evolution but the remarks he made to clarify his position were so ambiguous that experts in developmental biology wondered whether he understood the concept.

Some high-profile scientists - including one of Canada's leading AIDS researchers, Rafick-Pierre Sékaly of the University of Montreal - have already begun to shift their research operations south of the border.

But it's far from an exodus, and Canada continues to attract U.S. investment. Californian and Canadian officials recently announced a $40-million joint venture in stem-cell research.

As this year draws to a close, it's not yet clear that the United States has regained its competitive edge.

"Obama is certainly pro-research and pro-science," said Gordon Keller, a stem-cell biologist and director of Toronto's McEwen Centre for Regenerative Medicine.

"But he is facing trillion-plus-dollar deficits and trying to get health care off the ground. I am not sure how much money there will be for … increased long-term funding for National Institutes of Health," which finances a substantial chunk of medical research in the United States.

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Another factor in Canada's continued favour is government funding for the health-care system and universities, which provides many researchers with their core salaries, said John Dick, a senior scientist at the University Health Network in Toronto. "It's not a life and death situation if you lose your grant - you're are not out of a job the next month," he explained. And that's not necessarily the case in the United States.

The following is a wrap-up of some of the year's medical highlights, low points and emerging trends to watch in 2010.

Lessons from a pandemic

The H1N1 influenza pandemic turned out to be not as bad as some were expecting.

It's impossible to calculate the severity of the outbreak, because the vast majority of cases never come to the attention of public health officials. But using the best available evidence from the United States, researchers at Harvard's School of Public Health and the U.K.'s Medical Research Council, have come up with two estimates.

Under one set of data and assumptions, they concluded 1.44 per cent of people with H1N1 symptoms were hospitalized and 0.048 per cent died. Under another set, 0.16 per cent were hospitalized and 0.007 per cent died, according to their study published earlier this month in the online journal PLoS Medicine.

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That works out to a potential range of 7,800 to 29,000 deaths in the United States from H1N1, compared to the annual flu, which kills 36,000 in that country.

Using the same approach, that would mean between 780 and 2,900 H1N1 deaths in Canada. That's significantly fewer than the roughly 4,000 or more Canadians who die in a "normal" flu season. (The estimate from the Public Health Agency of Canada stood at 336 in mid-December - but this figure represents only confirmed deaths directly linked to H1N1.)

"Our work shows that the severity of H1N1 may be less than initially feared," said Marc Lipsitch, who led the research team at Harvard.

Does that mean public health officials over-reacted to the perceived threat? No, says Dr. Lipsitch. "It's a sign of good judgment in public health to prepare for something worse than actually happens, because you can't know until it happens how bad it's going to be."

He also noted that H1N1 hit some younger people especially hard, while the seasonal flu tends to take its biggest toll among the elderly.

"It's still bad. It's still putting people in hospital and it's killing more children than normal seasonal flu," said Dr. Lipsitch. "So it's not harmless, but it's milder than other pandemics have been."

While public health officials may have acted prudently, there were some snags and lessons to be learned for the next pandemic. H1N1 infections started to peak in Canada well before ample supplies of the vaccine could be produced and distributed across the country. Some experts say Canada may be better served by using multiple vaccine suppliers, rather than relying on just one company.

Folic acid folly?

For more than a decade, food manufacturers in Canada and the United States have been required by law to add folic acid to bread, pasta, flour and other grain products. The fortification effort is meant to ensure that women receive adequate levels of folic acid in case they become pregnant. The B vitamin is critical in the early stages of fetal development.

And, by all accounts, the mandatory program has been highly successful in reducing certain birth defects such as spina bifida, which has plunged by 50 per cent to about 110 cases a year in Canada.

However, other research has hinted that there might be a dark side to fortification - fuelling cancers in the general population.

Two studies, published earlier this year, suggested folic acid supplements may boost the odds of getting prostate and colon cancers.

Then, in November, yet another study showed an overall increase in cancer cases and deaths among Norwegians taking folic acid pills.

Although these findings are worrisome, experts generally agree there's not enough evidence to justify pulling the plug on folic acid fortification.

Still, it's certainly a research field worth watching. Policy makers may eventually be compelled to revisit a program that essentially treats everyone the same way - rather than targeting just those who are supposed to benefit from it.

New hope for MS?

An Italian doctor has captured international attention with a new theory - and possible treatment - for multiple sclerosis.

Paolo Zamboni, a professor of medicine at the University of Ferrara, has published a series of papers suggesting that a narrowing of blood vessels in the neck could contribute to the development of MS. According to Dr. Zamboni, veins draining blood from the brain are malformed, or become blocked, leading to a buildup of iron in the brain which, he thinks, causes the neurological symptoms of MS.

By increasing blood flow, through a relatively simple operation, he believes symptoms can be reversed or minimized. The procedure has been performed on 65 MS patients, including Dr. Zamboni's wife, with mixed results.

The medical community looks upon Dr. Zamboni's work with some degree of skepticism. "We have seen similar claims of potential causes and cures in the past," the University of British Columbia MS Clinic said in a recent statement.

Most previous research has indicated that MS is an autoimmune disease in which the body's own immune system attacks the protective myelin coating on nerves. The disease can affect balance, mobility, vision, hearing and memory. Dr. Zamboni acknowledges his findings are preliminary and need to be confirmed by other research teams. And even if the treatment works in some patients, MS may still be an autoimmune disorder. Poor blood drainage could simply be a trigger that sets the disease in motion, according to Dr. Zamboni.

The MS Society of Canada, with an annual research budget of about $10-million, has urged scientists to submit proposals to investigate the theory. UBC has requested funds to begin a study involving 100 patients.

Perplexing rise of celiac disease

Celiac disease was once considered to be a fairly rare disorder. But an increasing number of people are being stricken with the digestive ailment. And there is good reason to be concerned - it can lead to an early death.

A study by researchers at the Mayo Clinic in Rochester, Minn., revealed the disease is 4.5 times more common today than it was about 50 years ago. "It now affects about one in 100 people," said Joseph Murray, lead author of the study published in the journal Gastroenterology.

Celiac disease is an autoimmune disorder that damages the small intestine, interfering with the absorption of nutrients. It is triggered by gluten, a protein found in wheat, barley and rye.

Dr. Murray says something must have changed in the environment to make the condition more common. He speculated that modern food production and processing could be to blame. But, he readily acknowledges, "it could be something entirely different."

Faux journals

Pharmaceutical companies will often use favourable studies and review articles published in peer-reviewed journals as part of their sale pitches to doctors.

"See, look how well our drug works," the drug reps will say as they hand physicians reprints of the seemingly objective reports.

But what if there is a lack of published material? Or, more to the point, no articles with a positive spin?

Well, if you're especially audacious, it seems you just create a journal out of thin air.

Pharmaceutical giant Merck paid an undisclosed sum to publishing firm Elsevier to produce several editions of what looked like peer-reviewed medical journals, The Scientist magazine revealed earlier this year.

The pseudo-publications, part of a Merck marketing effort to raise the profile of the company's drugs among Australian physicians, came to light during court proceedings.

One of the publications was titled The Australasian Journal of Bone and Joint Medicine and included glowing reviews of Merck's osteoporosis drug Fosamax and painkiller Vioxx, which has since been pulled from the market.

Rush to judgment

If there is a lesson to be learned from 2009 it's this: Don't jump to conclusions.

Take the case of a British schoolgirl who died within hours of receiving a vaccination that provides protection against cervical cancer.

Many parents - including some in Canada - began to question the safety of the shots.

However, an autopsy later revealed that Natalie Morton's chest cavity was filled with cancer.

It now appears the timing of her death, so close to getting the vaccine jab, was just a coincidence. The multiple tumours were so advanced, "death could have arisen at any point," pathologist Alexander Kolar told an inquest.

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