31 March 2006

A perfect storm of dots: Health, disease, transplants, and "the century of biology"

Today in SciDevNet: 'Disappointing' results from US Bird flu trial: Flu experts unanimously agree that the global capacity to produce vaccines is already insufficient.

10 March, on the Australian Broadcasting Corporation's News in Science: Diabetics fly far for pig cell transplants

People with diabetes are flying to a clinic in Mexico for an injection of pig cells, hoping this xenotransplant will cure them. But experts are worried about the risks involved with this so-called xenotourism or xenotravel, both to the patient and to the rest of the community .... Normally if you bring live animal material into Australia it has to go through quarantine. But when the animal material is inside someone, it's not exactly obvious."There is no quarantine status that says you must declare that you've had a porcine transplant," says Anthony d'Apice, whose research involves genetically modifying pigs to stop rejection of their pancreas and kidney cells when they are transplanted into non-human primates."

On 6 March 2006, Alexander G. Higgins (Associated Press) reported from Geneva:

The lethal strain of bird flu poses a greater challenge to the world than any infectious disease, including AIDS . . . the World Health Organization said Monday. Scientists also are increasingly worried that the H5N1 strain could mutate into a form easily passed between humans, triggering a global pandemic. It already is unprecedented as an animal illness in its rapid expansion. (WHO's Dr Margaret) Chan told more than 30 experts in Geneva that the agency's top priority was to keep the deadly H5N1 strain of bird flu from mutating.

"Should this effort fail, we want to ensure that measures are in place to mitigate the high levels of morbidity, mortality and social and economic disruption that a pandemic can bring to this world," she said ....

"In a globalized economy, with high volume of international travel, vulnerability to new disease threats is universal," she said. "It is the same for the rich and for the poor."

Yet The Next Generation of Diseases are in Hiding, Somewhere warned the New York Times, back in 2003. All the diseases mentioned in the article — SARS, monkeypox, new forms of flu — are zoonoses; diseases/pathogens that were no problem in the originating species, but are deadly in the new host. Hence the threat posed to humans by bird flu.

Any time a disease breaks a species barrier, it becomes virulent in the new species. Strangely, this fact is rarely noted when thinking about animal-to-human transplants. Animal organ donation has moved beyond science fiction to be talked of as a solution to shortages and the exploitation of the poor. Xenotransplantation is the jargon term for it, but animal-to-human transplantation is what it means. And that can mean whole organs or just cells, although there still are no legally binding global definitions.

For some commentators, animals are the new black to cure our ills, keeping us — or those with money, at least — alive and youthful. As the March 2005 article in Wired explained:

Transplant surgeons have long dreamed of using animals to make up the chronic organ shortfall in hospitals, but have been hindered by all sorts of problems. The most serious is that the human body’s immune system rejects foreign tissue after transplantation. The new method has the potential to avoid the immune-rejection problem and make xenotransplants a reality. And according to the scientist in charge, using pigs is morally preferable to using human stem cells. ‘Pig tissue avoids the ethical problems associated with human embryonic tissue’, said Yair Reisner, the head of the Gabrielle Rich Center for Transplantation Biology Research at the Weizmann Institute of Science in Israel.

Not a word about disease. No mention of the species barrier being torn down. Yet animal-to-human transplantation (xenotransplantation) and the making of chimera (mixed-species animals and even humans when we put other species into our bodies) deliberately tears down the species barrier, with what should be obvious consequences.

Wired is not alone. The New York Times/International Herald Tribune editorialised in May 2005 with It's science, not a chimera:

We are already partly down the path of mixing human and animal cells or organs. Although it once seemed odd and unsettling, no one worries much anymore about transplanting pig valves into human hearts or human fetal tissue into mice. The key reason may be that these manipulations don't visibly change the fundamental nature of either the human or the animal. People become much more concerned when they think a transplant may alter the mind or appearance of the recipient…

Again, no mention of disease.

WHO's watching?

Even the World Health Organisation promotes xenotransplantation, through its ‘partnerships and collaborators’ such as the International Xenotransplantation Association (the home page of which carries ads from ‘corporate sponsors’ include Genzyme Transplant, Wyeth, Roche, and Novartis) instead of acting to encourage responsible science in the public interest, such as stem cells that don't need to be cultured on another species. Singapore is successfully doing that today.

This is so even though the OECD/WHO 2001 Consultation on Xenotransplantation Surveillance Summary stated, in part:

With xenotransplantation, there is a potential risk of transmitting known zoonotic infections as well as new or unknown infectious agents of animal origin into human recipients and into the wider human population. The latter is an unquantifiable hazard…

Other views simply aren’t reported; views like those of Professor Peter Collignon, Director of Infectious Diseases & Microbiology, Canberra Clinical School, ANU and University of Sydney, who wrote, in Microbes and Infections 3, 2001, Éditions Scientifiques et Médicales Elsevier SAS:

What if we were trying to design the ideal experiment in which a new virus that would infect humans would be cross-transmitted from pigs to humans? We would be hard pressed to come up with a better experiment than what is planned to be done with xenografts (and on a massive scale). Once established into a new human host, human to human transmission has occurred for many of these agents (HIV, influenza, hepatitis B, SV40).

Yet today this is the hottest trend in biotech, the new panacea. Take 21 February 2006, for example. On that day alone here are a few of the stories:

The University of Michigan announced a "milestone" in type 1 diabetes research using pig islet cells. "The goal is to have suitable donor pigs available by the time the University has refined the immunosuppressive treatment to a point that makes it safe for clinical trials to begin." (That same day , Australian scientists announced a milestone for the same type 1 diabetes research , using notpigs, but seaweed.)

Massachusetts a leader in pig-human hybrids, ran the headline of the Lowell Sun, reporting that "Newborn piglets have had human blood, sheep have lived with human livers, and human cells have been introduced into mice brains."

And the Saturday Evening Post, in Saluting American Innovation announced, "Researchers are on the verge of overcoming the organ donor shortage through xenotransplantation--or pig to human organ transplant."

It isn’t as if the information isn’t available. It's just not an issue in the media, and discounted when policy is made. Now, while programs about historical plagues are hot, the plaguemakers of the future, acting in greater secrecy than in the past, act unchecked. The dots exist. Who's going to connect them?

What is happening around the world should be your right to know, particularly as this is one of the most secretive, and well-connected industries in the world. We need xenotransplantation to be a major issue. And for that, the public needs to know what the implications of this technology truly are. For that, media and reporters must finally work in the public interest. For that, patient confidentiality is a danger to the world, but it is the practice as it exists.

Even where chickens are concerned, the necessaries to stop the spread of disease are not being carried out: monitoring, notification, quarantine, culling. Too expensive! As one Nigerian government worker said when asked why they are doing almost nothing to monitor, quarantine, and cull: "It's suicide," he said.

What is needed is a global strategy to fight disease, and for that, we need to promote safe science, not push action plans, as the US does, for an interim technology with a permanent legacy. To paraphrase the New York Times, chimeras and xenotechnology isn’t just science. Mixing species in the name of health is like scattering landmines in the name of peace. The difference, though, is that with landmines, you can sometimes dig them out before they kill, but once a disease or pathogen finds a new host, it's impossible to dig it out.

As the New York Times said, back in that doom 'n gloom article in 2003:

But for many diseases, the world does not put the clues together in time . . . We have been warned. But must epidemics always catch humanity by surprise?

But hell, this might sound like another doom 'n gloomsayer rant. Perhaps it's just a matter of perspective, when you look at the picture that the dots make when you connect them. Just as war can be fun, biology could be so much fun that it's a children's game.

Here's an excerpt from Make me a Hipporoo by physicist and futurist Freeman Dyson, New Scientist, 11 February 2006

When children start to play with real genes, evolution as we know it will change forever .

It has become part of the accepted wisdom to say that the 20th century was the century of physics and the 21st century will be the century of biology . . . . Domesticated biotechnology, once it gets into everyone's hands, will give us an explosion of diversity of new living creatures . . . Designing genomes will be a personal thing, a new art form as creative as painting or sculpture. Few of the new creations will be masterpieces, but all will bring joy to their creators and variety to our fauna and flora.

The final step in the domestication of biotechnology will be biotech games, designed like computer games for children down to kindergarten age, but played with real eggs and seeds rather than with images on a screen.

Australian scientists didn't even breed the cane toad to be lethal. They just transported it from one place to another, and now, as with new diseases that we don't even understand, we cannot expunge the cane toad from Australia. It just spreads, adapts, and kills.

Adaptation acts as if it possesses intelligence. Will we?

1 comment:

Anonymous said...

Geez, just the post to read while recovering from a chest cold! I'm too paranoid hypochondriac to read much past the headlines on health news, let alone watch doctor shows on TV, but this kind of looming horror should be fertile ground for near-future SF writers (and not just the disaster-epic Crichton types). Puts an entirely new spin on Animal Farm as well. --Faren