Healthcare, medicine & pharmaceuticals

The germ of a new idea

The history of germs has been a troubled one. Early in life, we learn that germs are bad for you and they must be eradicated. Schoolchildren learn about the development of penicillin in medicine, as if killing bacteria makes one healthy. One US scientist, Martin J Blaser, has long studied helicobacter pylori, a sturdy microbe that lives in the gut and is implicated in peptic ulcers and cancer. He asked if an organism that had endured 200,000 years could survive if it only caused harm.

Blaser started the Foundation for Bacteriology to focus on the positive role that bacteria play in human evolution. He found that, without most of them, we could not even survive. Just as mapping the human genome has uncovered the importance of genes in human health, bacteria may play a more central role. We carry 10,000 bacterial species, which together form our microbiome. After mapping the human genome, the National Institutes of Health began to map the human biome in 2007.

Passengers in our microbiome carry at least 4 million genes that patrol our guts to prevent infection, manufacture vitamins, digest food and even change brain chemistry. If bacteria are so crucial, then what happens if we destroy them with antibiotics? Research suggests Crohn’s disease, obesity, and asthma arise from lack of certain bacteria. Disturbing the delicate balance of bacteria in the human body can cause excesses of one type, which then appears to be the culprit in the disease, rather than a symptom of imbalance.

The average American has received 10-20 courses of antiobiotics by the age of 18. Blaser says, “Whenever they are used, though, there is collateral damage”. But so-called ‘germophobia’ sells a lot of antiobiotics and even more anti-bacterial products in the home. About 75% of antiobiotics consumed in the US are not even for illness – they are fed to poultry, cows and pigs to make them grow more quickly.

Blaser and Stanley Falkow found that babies born naturally receive a huge range of bacteria from the mother; babies born by casearian section lack many of them. The US delivers nearly a third of children by section and the Chinese closer to one half. It means that women at the turn of the 20th century had far more species of bacteria than women do today. At the same time, there has been a massive rise in obesity, celiac disease, asthma, allergies and Type 1 diabetes.

What is the answer? We can rebuild our human ecosystems with probiotics, the opposite of antibiotics. This is more than the commonly sold ‘probiotic’ health foods, such as yoghurt drinks, which contain Lactobacillus GG. It is a hugely complex business because the body needs so many bacteria and in different amounts. As one scientist said, “We are an endlessly variable stew of essential microbes”. Antibiotics have a lot to answer for when used liberally. They are, literally “anti-life”.

How to electrify your brainpower

How would you like to be as clever as your friend/tutor/boss? New technology suggests all you need is a ‘zap cap’, a hat that provides an electromagnetic pulse into your brain. However, researchers into the topic of electrical stimulation want their work to be taken seriously for treating depression, OCD, tinnitus, Alzheimer’s and Parkinson’s, where drugs can only go so far.

Since 2008, deep brain therapy (DBT) has been used in Parkinson's disease, where a small group of neurons buried deep inside the brain starts to die and the electrodes take over their job.

Another effective therapy may be transcranial magnetic simulation (TMS) for disorders of the brain and mind. It changes how often the brain cells fire. This is not the same as electroconvulsive therapy (ECT) where an electric current is passed through the brain long enough to create a seizure. This therapy is rarely used today.

Another more gentle treatment (with no direct effect on neurons) is transcranial direct current simulation (tDCS), which is used to treat speech problems caused by strokes. Stroke patients receive 8-12 hours speech therapy on the NHS (UK) when they leave hospital. In a small study of 24 patients, when combined with tDCS, they became 92% better at learning words than the training program alone (55% better).

In another experiment, a group of people had to learn a set of numbers and the half that received tDCS responded much more quickly - for up to six months. It is not known whether improvement in one area of cognitive ability could comprise another area. Playing with the brain is dangerous, and it is still early days before science can turn you into a genius.

A new kind of ‘pharming’

Medicine has long used plants for their drug properties but now companies are looking to take a step further – grow plants that naturally contain antibodies. This is called pharmaceutical farming or ‘pharming’. There are currently two shortcuts to growing drugs – genetic modification or transient expression.

For plants to make foreign proteins, such as antibodies, they can be genetically engineered but this is a slow and expensive process, as well as being politically unpopular in open fields. Bacteria are added to some plant cells, the plant regenerates from a few cells, and the plants then breed and generate enough seeds for commercial production.

The only company currently pharming in open fields is Ventria Bioscience, in California. It grows rice that produces lactoferrin, which is found in milk, tears and saliva. Lactoferrin helps protect against infections and can be used in formula milk for children. Its rice fields are still kept well away from normal rice fields.

Growing large quantities of plant cells, rather than whole plants, is a faster process and means they can be grown in large vats rather than open fields. Companies do not need the kind of approvals needed for using open fields. Pfizer has licensed the technology of Protalix, which produces a synthetic version of taliglucerase alfa in modified carrot cells. It was the first genetically engineered protein produced by protein to be approved by the FDA.

An alternative is transient expression. Bacteria are added to a leaf and the DNA is added to some cells, which begin producing the desired protein. Next, plants are grown for a week or so, the leaves harvested, and the protein extracted – all automated for mass production.

Medicago of Canada uses sealed greenhouses full of tobacco plants with the DNA for making flu vaccines. Usually it takes a few months to create a flu vaccine from chicken eggs, but Medicago can do it in three weeks. In fact this company is being supported by the US military to develop and test vaccines in case of an epidemic of, say, bird flu.

Building greenhouses is more expensive than pharming in open fields, so only the rich countries can afford it. For cheaper drugs, such as HIV drugs for sub-Saharan Africa, more antibodies can be created in open fields, for less money. Once again, it depends on who’s paying.

Making the best of ourselves

Human enhancement is not unusual – we’ve been doing it for centuries. Our methods for enhancing ourselves have just become more sophisticated, whether it is plastic surgery, Botox, or a hearing aid. It is also a matter of opinion whether a form of enhancement has improved the body or not. A recent exhibition confirms the idea of enhancement as a mixed blessing indeed.

People with disabilities use prosthetics to replace the parts that are missing or do not work. New prosthetic designers now create parts that are better than the normal human ones. For example, Oscar Pistorius’s ‘Cheetah’ legs were seen to give him an unfair advantage in the Paralympics. A similar controversy happened when Ian Thorpe, the Australian swimmer, wore a high-tech swimsuit.

The pressure to be beautiful in a narrow, mainstream way has sent many people to the plastic surgeon. One exhibit shows a plastic surgeon who draws all over the naked body of an artist until almost no empty space is left, showing there is no end to the possibilities for enhancement. Another shows a fictitious game show, based on Extreme Makeovers, in which a person has a series of operations to turn him into a superhero with a bionic eye and arm, and his heart wired with electrodes to make it stronger.

Nobody can fail to be moved by the audacity of human enhancement nor the promise it holds for future generations to be healthier or more beautiful than those today. The question is whether it is interfering with what is natural. But when Icarus tried to fly too close to the sun, he was only attempting to enhance his human ability – and now flying is almost passe.

Slim chance of losing weight

Shocking rates of obesity in the rich countries have prompted a concerted effort to find drugs that help people lose weight. But diet pills were on sale even in the 1800s, containing such dubious substances as lard and arsenic. It seems ironic that most of our history has been spent searching for sufficient food to survive, but now obesity affects 1 in 3 adults in the US, with similar rates in Australia and UK.

The simple answer is to eat less or exercise more. But the body is designed to gain weight to survive famines – not to lose weight to look and feel beautiful. Common diet drugs, on the whole, are expensive and offer a fat chance of losing weight.

One group of drugs, amphetamines, curb appetite and boost activity but they can cause heart problems and be addictive. One example is phentermine, which must only be taken for a few weeks. Orlistat blocks fat absorption in the gut and can be taken long term – but it causes flatulence and incontinence.

Qnexa, by Vivus, combines phentermine with topiramate, a drug used to treat epilepsy that also curbs appetite. But even this has side effects, such as memory loss (perhaps you forget how fat you were?). In a year-long trial, people lost 9.3% body weight (about 11 kilos) and only 5% loss is needed for FDA approval. It was approved this year.

Another group of drugs mimics gut hormones, incretins, which regulate how much we eat. GLP-1 mimics, a type of incretin, have to be injected and often cause nausea at first and may inflame the pancreas. But they also lose weight. Since obesity and diabetes are intertwined, sales of GLP-1 mimics have soared to diabetics and non-diabetics. One drug, liraglutide, has been linked with weight loss of 6% over a year but will not be licensed for another year or two.

A third group boosts metabolic rate, one of which is beloranib, originally used for cancer, because it raids fat stores.

The question is whether it is better to treat obesity with drugs or lifestyle changes, although most doctors will encourage both. Patients will have to decide if they are willing to wear the side effects to be slim.

Print your own drugs

The idea of 3D printing is not new, but imagine if you could print your own drugs, detergents, or beauty products. This is the idea of a chemist, Lee Cronin, at University of Glasgow who has fabricated chemicals using a digital blueprint and a 3D printer. While it is currently intended for chemists, there is no reason why it can’t be used by anybody, as long as the software protects them from making unsafe or illegal drugs. It is “democratising chemistry”.

The 3D printer was used as part of the Fab@Home project, which aims to bring self-fabrication into the home (no lies, please). The team used a common bathroom sealant to print reaction chambers and connection tubes of different lengths. The printer’s nozzles then squirted in the chemical inks, or reactants. In future, you could download an app to your 3D printer and order a standard set of chemical inks; no need for test tubes, beakers or flasks. But ratios and speed of reaction are crucial, which means the size of the chambers and the tubes need to be changed too.

This kind of printed ‘labware’ can be used in the discovery of proteins, to provide a heat source like a Bunsen burner, and even to print a window into the vessel so you can see the reaction. To reduce the frequency of explosions, the flask material will be changed from bathroom sealant to a fabric like Teflon.

The team is working on a kit to produce Ibuprofen so the developing world has access to it via their mobile phones. It sounds outrageous, but most drugs and detergents are just combinations of carbon, hydrogen and oxygen or corn syrup, glycerol and paraffin. There could also be opportunities for chemists to share or trade recipes for substances not yet commercialised.

What next, we wonder – printable beer?