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THE iN FORMER FELLOWS NEWSLETTER NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

The views and opinions of authors expressed in this newsletter do not necessarily state or reflect those of NIDDK or the U.S.

Government, and they may not be used for advertising or product endorsement purposes.

VOLUME 8, ISSUE 2 – APRIL 2015

In this issue • Free Smartphone

Apps to Help With Your Day-to-Day Work

• A Primer on Personalized Medicine: The Imminent Systemic Shift

• The Science and Policy of Marijuana

• A Hypothetical NIH Equipment/ Instrument Library

• A Syringe Full of Trust

• Recent Publications by NIDDK Fellows

• New Fellows

EDiTORS ~•~

Kavya Devarakonda kavya.devarakonda@nih.gov

Christine Krieger christine.krieger@nih.gov

Joseph Tiano joseph.tiano@nih.gov

The iNFORMER is

published by the

Fellows Advisory

Board (FAB) in

collaboration with the

NIDDK Fellowship

Office

10th Annual NIDDK Scientific Conference

April 20-21, 2015

9:00 AM – 5:00 PM

Natcher Conference Center, Building 45

Compete for one of the seven travel awards

Have lunch with a keynote speaker

Join the networking lunch with career panelists

This year’s event will feature three keynote speakers:

Dr. Charles Rice, Rockefeller University

Dr. Tom Muir, Princeton University

Dr. Thomas Boyer, University of Arizona

A schedule of events is included

at the end of the newsletter.

All NIDDK fellows and scientific staff

are encouraged to attend.

Announcements

APRIL 2015 VOLUME 8, ISSUE 2 Page 2

THE iNFORMER

Free Smartphone Apps to Help With Your

Day-to-Day Work

Way back in 2012, Manhattan Research

conducted a survey on physician usage of apps.

Based on that survey, clinicians were identified as first

adopters of mobile devices and the medical apps that

run on them. As app users, physicians tend to

download fewer apps than the average consumer, but

they tend to use those apps more often.

Back then, iPads began to be used by

physicians a lot. Today, smartphones are the go-to for

information. The value of smartphone apps is

catching on in medicine. iPhone and Android

smartphone platforms have created a market in

medical applications because they can run more

complex medical apps at point-of-care than the older

text-based apps used on personal digital assistants

(PDAs).

Here is a look at some free smartphone apps

that may help you in your day-to-day work. All iPhone

and Android apps can be downloaded from iTunes

and Google Play.

Dropbox (iOS, Android)

A cloud-based app allows you to store, access, and share

medical literature, project work, and other information.

Prognosis (iOS)

This app is designed for physicians and is a fun game that

presents an engaging series of clinical case scenarios that

assess the decision making skills of the player.

Doctor's Dilemma® (iOS)

You can test your knowledge in a variety of disciplines.

Doctor's Dilemma is simple to play (earn points with correct

answers, lose them with incorrect answers), but the questions

will challenge you.

Calculate by QxMD (iOS, Android)

This tool offers the ability to search for easy-to-use

calculators by specialty.

MedPage Today; Medscape (iOS, Android)

These apps gives you access to breaking medical news

and includes CMEs.

PubMed on Tap (iOS)

Search PubMed and PubMed Central while on the go.

Evernote (iOS, Android)

An app that allows you to take notes, capture photos, create

‘to-do’ lists, and record voice reminders that are accessible

across all the devices you use.

Cloud Storage and

File Sharing

Games

Medical News

Medical Articles

Note-Taking and

Organization

Medical Calculator

APRIL 2015 VOLUME 8, ISSUE 2 Page 3

THE iNFORMER

A Primer on Personalized Medicine:

The Imminent Systemic Shift

Imagine a hypothetical scenario from a not-so-distant future: You get sick. Prior to this, you have been disappointed with how slowly your physician adopts new technologies. Therefore, you decide to find a new physician. At the new clinic, an administrator asks if you brought your electronic genome (e-genome) with you. You answer that you have not had a chance to get your genome sequenced yet, but you would like to do so. At that point in time, you begin a set of routine procedures. Enough of a biological sample is collected for the sequencing of your entire genome via a simple cheek swab or a finger prick test.

Then, while you are having a medical

examination with your new physician, your genome gets sequenced by the “lab on a chip” portable equipment and the data are electronically fed into the physician’s iPad. Your physician punches in some additional phenotypic characteristics into an app to help her determine whether your genotype is homozygous or heterozygous for the gene(s) known to be metabolically linked to the sickness you are experiencing. Then, minutes later, your physician picks a drug “z” over “x” or “y,” which has the highest chances of addressing your sickness with the lowest likelihood of side effects, given your unique set of genomic and phenotypic characteristics.

Though a captivating and exciting glimpse

of a possible future, the personalized medicine scenario above is certainly oversimplified, and its detailed script is still being written. Before such medical practices can become a widely accepted reality, not only applicable to a narrow group of specific genetic disorders, some major changes to the current status quo need to happen.

Firstly, the research efforts of several

players in the health and science ecosystem must be refocused. According to Charles R. Scriver, a key player in the Human Genome Project (HGP), “Since genomes speak biochemistry, not phenotype, for genomics to penetrate medicine, biochemistry and biology must be allies.” [1] Analogous to the HGP and its goal of sequencing and mapping a complete set of genes for humans,

the Human Phenome Project (HPP) aims to elucidate the phenome, a complete phenotypic characterization of human species. More specifically, the goal of the HPP is to determine in practical terms what exactly a phenotype is and to assemble all of the phenotypic components, including morphologic, biochemical, physiological, and even behavioral characteristics of the human species into a complete set.

Even though the HPP idea is now at least

12 years old, this project is so complex that as of 2012, scientists across have the world are still “getting ready for the HPP” [2]. A lot more scientific work will have to be completed before the HPP can be started. The good news is important developments have already started. In 2006, after the completion of the HGP, a new global effort, the Human Variome Project (HVP), was launched to share information about genetic variation in clinical practice. According to Casimiro Vizzini, an expert at the International Basic Sciences Programme of the United Nations Education, Scientific and Cultural Organization, “The term variome refers to the sum of all the genetic variations found in different populations of the same species.” [3]

As a global organization, the HVP has

been working to develop and maintain standards, systems and infrastructure to enable sharing of information on genetic variation generated during diagnostic and predictive testing as part of routine clinical practices. The ultimate goal is to link genetic variation to the patient body and disease development phenotypes to help doctors with diagnosis and drug selection for effective treatments.

Another change that must occur is that

personnel and organizations within the health care ecosystem will have to figure out, re-align and sometimes even shift their roles completely per the requirements coming from future personalized medicine mandates. Large players have already realized that the personalized medicine future is fast approaching and have decided to start changing.

APRIL 2015 VOLUME 8, ISSUE 2 Page 4

THE iNFORMER

In his 2015 State of the Union Address,

President Obama announced the launch of the

new Precision Medicine Initiative, which was

promptly followed by a press release from the

White House unveiling details. The National

Institutes of Health (NIH), the Food and Drug

Administration (FDA), and the Office of the

National Coordinator for Health Information

Technology (ONC) will together receive a $215

million investment in 2016 to start executing this

initiative. Main objectives of the initiative are:

Creation of a voluntary national patient-

powered research cohort of at least 1 million Americans in order to involve and

encourage patients to contribute their

medical records and data on gene profiles,

metabolites, body microorganisms,

environmental and lifestyle data, personal

device and sensor data — all with under

rigorous protection of patients’ privacy

Discovery acceleration of effective and

tailored treatments for cancer via

expanding genetically based clinical cancer

trials, elucidating fundamental aspects of

cancer biology and establishing a national

“cancer knowledge network” to identify

genomic drivers in cancer

Ensuring patients’ health data privacy and

security within the precision medicine model

Modernization of the regulatory landscape

to adequately support the new precision

medicine innovation, research and health

care model via development of high quality

curated databases and interoperability

standards to enable secure exchange of data

across systems.

These objectives will be achieved via the

establishment of public-private partnerships with

the private sector, existing research cohorts and

patient groups, in order to develop the required

precision medicine infrastructure and frameworks,

and provide consumers with secure access to their

own health data as well as to the applications and

services that can analyze it.

Only days after the president’s State of the

Union Address, the House Energy and Commerce

Committee released a nearly 400-page discussion

document of the 21st Century Cures Act. Briefly,

the core ideas of this legislative initiative are:

Putting patients first, by creating a

regulatory environment that is conducive to

incorporating their perspectives and

addressing their unmet medical needs,

including biomarker quantification, antibiotic,

drug and dormant therapies development,

and innovative device review pathways

Building the foundation for 21st century

medicine, including the creation of the next

generation of patient-centered solutions,

stimulating innovation in health information

technologies and helping young scientists have successful careers

Modernizing and streamlining clinical

trials to allow broader utilization of flexible

and more cost efficient trial designs, while

reducing regulatory overlap and

administrative burden to cut costs and speed

up the assessment of new treatments

Accelerating and supporting the

innovation cycle at federal public health

agencies, including NIH

Modernizing medical product and device

regulation by taking into account novel

manufacturing technologies

All interested stakeholders have been

encouraged to participate in the discourse on how

to improve this legislation.

In turn, miscellaneous players such as

biopharmaceutical companies, patients groups,

health insurers, pharmacy benefit managers,

physicians, and scientists have actively started

figure out whether they are poised to gain or lose

from these initiatives. Some interest groups and foundations have started information campaigns to

sway the legislators and the general public, and

are prompting constituents to act and shape the

future of personalized medicine in the United

States.

One example is the EveryLife Foundation

for Rare Diseases, which, in partnership with Rare

Disease Legislative Advocates and with a

sponsorship from almost 30 large pharmaceutical

and smaller biotechnology companies, led a Rare

Disease Week, a legislative conference on Capitol

Hill last February.

APRIL 2015 VOLUME 8, ISSUE 2 Page 5

THE iNFORMER

The conference provided an overview of the 21st

Century Cures Initiative, lobbied the members of

congress and gave a detailed training on being an

effective advocate, including ways of using modern

social media platforms such as Facebook and

Twitter. Constituents were asked to help ensure

the 21st Century Cures legislation improves access

to experimental drugs for patients with rare

diseases. Other suggestions for constituent

advocates were to encourage support for the

development of lifesaving therapies deemed not

profitable by drug companies and investment in

medical innovation for diseases that have few or no

treatment options.

The NIH, as one of the largest players

within both the science and health care

ecosystems in the United States, will be directly

affected by this imminent systemic shift. It is likely

the NIH will not only execute the initiatives but also

actively participate in influencing the public

discourse on both personalized medicine

initiatives. The NIH has already started to

showcase information about the precision medicine

initiative on its websites, and in the beginning of

February, held a workshop on Building a Precision

Medicine Research Cohort, which is one of the

main objectives of the president’s initiative. The

workshop gathered leading experts in health care,

mobile health, patient advocacy, genomics,

epidemiology, privacy, computer science and

information technology to identify the challenges

and explore the opportunities associated with

building such a cohort of patients.

Additionally, on March 30 the NIH

announced the formation of team of experts in

precision medicine and large clinical studies to

chart the course for the initiative and to define, with

input from all interested stakeholders within

ecosystem, the vision for building the national

participant group and to formulate what will be

considered “success” 5 and 10 years after the

launch of the initiative. A preliminary report from

the team of experts is expected in September

2015.

Overall, the advent of personalized

medicine practices in the United States will be a

fascinating story to watch as it develops in years to

come. In the future, humans may be getting their e-

genomes assembled at birth, like they are currently

getting their vitamin K shots. Then, e-genomes

may be compared to the standardized human

“default genome” template to determine the

individual’s e-variome. By adulthood, all of the

unique phenotypic characteristics, including

environment influences and lifestyle risk factors an

individual has experienced, may be added and

integrated with the e-genome/e-variome data

stored on the cloud to produce a data set that is

unique for that person.

Let us conditionally call this data set the “e-

OME.” So, in the hypothetical scenario about a visit

to a new physician, you would only have to walk

into a clinic with a password to grant your doctor

access to download your private e-OME data set

into her iPad. Your doctor would then run some

sophisticated algorithms via an app to connect to

the “holy grail” of personalized medicine — the

global medical bioinformatics database. Her goal

would be to determine how well your e-OME

interfaces with the current list of all known disease

phenotypes previously determined for your ethnic

subgroup with a specific intent to probe for the

specific disease she suspects based on your

clinical symptoms.

Then, your doctor will evaluate the side

effects of all known drugs against that particular

disease in the cohort of patients having the closest

cumulative e-OME to yours. In the end, a selection

of the drug tailored “specifically for you” will be

made and a prescription written. Oh, what a

wonderful future lies ahead of us! Meanwhile, there

is a plenty of work to do for scientists around the

nation.

References

1. Scriver CR. “Translating knowledge into practice in

the "post-genome" era.” Acta Paediatr. 2004

Mar;93(3):294-300.

2. Oetting WS et al. “Getting ready for the Human

Phenome Project: The 2012 forum of the Human

Variome Project.” Hum Mutat. 2013 Apr;34(4):661-6.

3. Casimiro Vizzini. “The Human Variome Project:

Global Coordination in Data Sharing,” Science &

Diplomacy. 2015 Mar;4(1):1-8. A quarterly publication

from the AAAS Center for Science Diplomacy.

APRIL 2015 VOLUME 8, ISSUE 2 Page 6

THE iNFORMER

The Science and Policy of Marijuana

The increased discussion of marijuana in

the news lately has been hard to ignore. Four

states (Washington, Oregon, Alaska, Colorado),

and now the nation’s capital, have completely

legalized the drug, whereas several other states

may be moving in that direction through

decriminalization and/or the addition of laws

legalizing medicinal use [1]. Although marijuana

laws have significantly changed in the last few

years, several questions remain. How are state

and federal agencies coordinating the differences

in federal and state laws? How are science and

policy influencing each other to govern marijuana

laws now and in the future?

Medicinal marijuana and drug classification

To date marijuana is classified as a

schedule I drug. According to the Controlled

Substance Act (CSA) and the Drug Enforcement

Administration (DEA), this classification is assigned

to drugs that currently do not have accepted medial

uses, and pose a high potential for abuse as well

as physical dependence. Other drugs that fall into

this category include heroin, LSD, ecstasy,

methanqualone, and peyote [2]. The classification

of marijuana as a schedule I drug may seem at

odds with the growing discussion about “medicinal

marijuana”; however marijuana remains a schedule

I drug because the U.S. Food and Drug

Administration (FDA) have approved neither the

unprocessed plant nor plant extracts as medicine.

Although marijuana as a whole is not yet approved

for medicinal purposes, the cannabinoids found in

marijuana have led to the development of two

FDA-approved medications. One of the approved

cannabinoids, delta-9-tetrahydrocannabinol (THC),

has been shown to stimulate appetite and reduce

nausea. The second cannabinoid, cannabidiol

(CBD), may be effective for decreasing pain,

inflammation, controlling seizures, and possibly for

treating psychosis and addiction [3].

Current cannabinoid-based drugs in clinical

trials or approved by the FDA for medical use:

Dronabinol (Marinol®) contains THC and is

used to treat nausea caused by

chemotherapy and extreme weight loss

resulting from AIDS.

Nabilone (Cesamet®) contains a synthetic

cannabinoid similar to THC and is used for

the same purposes as described above

Sativex®, contains approximately equal

parts THC and CBD, is currently approved in

the United Kingdom and other European

countries to treat spasticity caused by

multiple sclerosis (MS), and is currently in

Phase III clinical trials in the United States to

establish its effectiveness and safety in

treating cancer pain.

Epidiolex™ is a CBD-based drug recently

created to treat certain forms of childhood

epilepsy. Epidiolex has not been approved by

the FDA yet as it still has to undergo clinical

trials for safety and efficacy.

What is the state versus federal perspective?

As mentioned above, at the federal level

marijuana remains a schedule I drug and therefore

the possession of the drug is illegal. In order to

help define the role that federal and state law

enforcement agencies play in the regulation of

marijuana laws in each state, James M. Cole, the

deputy attorney general, released the Cole Memo

in August 2013. This memo instructed U.S.

Department of Justice attorneys and law

enforcement to focus on eight priorities in enforcing

the CSA against marijuana conduct. Issues not

pointed out in the memo were to remain under the

states’ jurisdiction. These eight points in which

federal agencies should regulate marijuana-related

issues include [4]:

Preventing the distribution of marijuana to

minors

Preventing revenue from the sale of

marijuana from going to criminal enterprises,

gangs, and cartels

Preventing the diversion of marijuana from

states where it is legal under state law in

some form to other states

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THE iNFORMER

Preventing violence and the use of firearms in the cultivation and distribution of marijuana

Preventing drugged driving and the exacerbation of other adverse public health consequences associated with marijuana use

Preventing the growing of marijuana on public lands and the attendant public safety and environmental dangers posed by marijuana production on public lands

Preventing marijuana possession or use on federal property

More recently, a bipartisan group of senators introduced a marijuana reform bill on March 10 (S.683). The bill is sponsored by Rand Paul (R-KY), Cory Booker (R-NJ) and Kirsten Gillibrand (D-NY) and aims to make it easier for states to allow medicinal marijuana. Measures in the bill include (1) downgrading marijuana from a schedule I drug to a schedule II drug, (2) loosening restrictions on the transportation of marijuana between states, (3) allowing banks to provide services to marijuana businesses, (4) encouraging the National Institute on Drug Abuse (NIDA) to broaden access of marijuana for research, and (5) allowing doctors with the Department of Veteran’s Affairs to recommend marijuana in states that already allow it [1]. What are the current concerns regarding marijuana legalization?

To date, little research has been conducted to examine the health and safety of marijuana. Because of the increased acceptance of marijuana use and the push for legalization, a greater emphasis has been placed on understanding the science behind marijuana addiction liability, effects of long-term use, and the effects of marijuana on the developing brain, among other issues. A complete list of studies supported by NIDA examining the health and safety of marijuana can be found on their website [5].

In addition to concerns regarding the

impact of marijuana on health, other concerns arise in regards to the presence of marijuana in society. For example, what is the most appropriate test for determining if a vehicle driver is under the influence of marijuana? What is a reasonable limit for drivers of vehicles? How should the concentration of marijuana in edible products be regulated, and what should be the limits? Research investigating the most accurate detection methods

for marijuana in the body, reasonable limits levels of marijuana in the body that do not impair one’s ability to operate a vehicle, and drug metabolism could all provide insight into policy regarding these questions. How might science inform marijuana policy in the future?

One way in which NIDA plans on

contributing to the understanding of the health risks and benefits of marijuana use is though the funding of a longitudinal study that will track a large sample of young Americans from late childhood, prior to first exposure to drugs, to early adulthood. Neuroimaging of these individuals is proposed to help clarify how and to what extent drugs of abuse, including marijuana, affect adolescent brain development.

However, much more must be

accomplished to fully comprehend the health and safety issues resulting from widespread marijuana legalization. Whether smoking or consuming marijuana has therapeutic benefits that outweigh its health risks is still an open question that science has not yet reconciled. Additionally, the ability to isolate plant extracts and/or develop synthetic drugs may completely eliminate the need for legalization of the marijuana plant. Regardless, as science involving marijuana health and safety continues to advance, laws regarding medicinal marijuana and other marijuana-derived compounds will continue to evolve. It will be crucial these scientific developments guide policy laws regarding marijuana use in the future.

References

1. Ingraham, Christopher. “The senate marijuana

reform bill would bring federal policy in line with

medical research.” The Washington Post. 10 March

2015.

2. “Drug Scheduling.” Drug Enforcement Agency.

2012.

3. “Drug Facts: Is Marijuana Medicine?” National

Institute on Drug Abuse. December 2014.

4. Cole, James M. “Memorandum for all United States

attorneys.” U.S. Department of Justice. 14 February

2014.

5. “NIDA research on the therapeutic benefits of

cannabis and cannabinoids.” National Institute on

Drug Abuse. March 2014.

APRIL 2015 VOLUME 8, ISSUE 2 Page 8

THE iNFORMER

A Hypothetical NIH Equipment/Instrument

Library

When it comes to the issues a

postdoctoral fellow might care about, I believe

each one would be able to list a few right away.

Aside from landing a permanent position, and

enjoying work and life, getting a nice publication

is surely on the top of most fellows’ wish lists.

Just as Galileo’s telescope launched modern

astronomy, employing a novel method in

research typically leads to a nice paper in a

relatively short period of time. Unless one

develops a new technology by him- or herself,

most of the time new technology requires

acquiring a new instrument. Life science

instruments are usually very expensive,

particularly the new ones – they often cost much

more than our annual salary/stipend.

It is also worth noting that instruments are

often only used for a brief period of time before

they are relegated to a corner to collect dust.

This is not uncommon given the nature of

scientific projects: After a paper is out the whole

project might be closed. Therefore, sharing

instrument and equipment is a good option. It

can save funds for the institute, and save

researchers the trouble and time of purchasing a

new instrument.

Core facilities are a great example of the

benefits of sharing expensive instruments.

However, at some point, we inevitably encounter

a situation where a piece of equipment is

unavailable. If you are lucky, you might find that

the instrument you want is in the laboratory next

door. More than often, you are not that lucky,

and you have to persuade your advisor to agree

to purchase it. This follows writing an equipment

application without a guarantee that it will be

approved. Then, if it is approved, the instrument

arrives at your door a few months later, at which

point, you might not need it anymore because

you have already taken a painful alternative

method to answer your question or you have

simply moved on to another seemingly more

promising project.

So, what can be done to solve some of

these problems, and make fellows’ lives less

miserable? One way is to establish a NIH

Equipment/Instrument Library. Similar to a

regular library, equipment could be checked out,

and after the project is completed, returned to

the library. As the first step, information about all

of the instruments at the NIH should be

deposited into the library, so that researchers

can know if a particular instrument is available

on campus. This database would also provide

fellows with access to an expert on the

instrument should they have any questions.

Creating this list should be easy given that all of

the expensive instruments on campus have a

decal number.

There would be many benefits to

establishing an NIH Equipment/Instrument

Library. Such a system would allow easy tracking

of how frequently instruments are used. Creating

such a library would also clear out more

laboratory space, as individual labs can store the

unused equipment in the library and locate it

later on if needed. This is in contrast to the

current surplus program, where you cannot get

an instrument back after it is surplused. The NIH

Equipment/Instrument Library could save the NIH

a lot of money, which might be used on other

projects or to compensate fellows better.

In the mean time, what a fellow can do

when he or she needs equipment but doesn’t

want to purchase it? (1) One can send out an

email to the many NIDDK fellows email lists,

which are unfortunately not easily combined. (2)

One can make a phone call to the manufacturer

and ask for a sales representative who can tell

you if a group on campus purchased the

instrument. (3) One can find a company that can

help analyze samples for you.

If you have other options, please contact

me and I might include it in a future issue of our

newsletter.

APRIL 2015 VOLUME 8, ISSUE 2 Page 9

THE iNFORMER

A Syringe Full of Trust

In 2014, the United States saw a significant increase in measles infections according to the Centers for Disease Control and Prevention (644). For comparison, in the last 12 years there were never more than 250 confirmed cases per year and as of this writing there are 173 confirmed cases in 2015 [1]. This is both alarming and confusing because measles was declared eliminated in the United States in 2001. Refusing to vaccinate has allowed this highly contagious virus to gain a foothold in the United States once again. Even worse, vaccine refusal rates continue to rise despite overwhelming evidence for the safety and efficacy of the measles, mumps, and rubella (MMR) vaccine [2-4].

The measles virus belongs to the family

Paramyxoviridae, which contains single-stranded RNA viruses. Measles is highly contagious and is spread via aerosolized droplets from sneezing or coughing. Just to highlight the highly contagious nature, it is estimated that 9 out of 10 people living together will contract the virus from a single infected individual [5]. Symptoms typically include fever, cough, runny nose, and several days later, a flat red rash. The majority of complications arise in children as secondary infections such as pneumonia can occur in about 1 out of 20 cases [5]. The measles vaccine has led to a 75 percent decrease in in deaths from measles since 2001 [5]. So the question is why is there a refusal to vaccinate against this highly contagious virus? As it turns out there is no correct answer, but let us attempt to understand the various reasons and what can be done to gain the publics trust in vaccines. Victims of our own success

As illustrated above, the measles vaccine is highly effective in preventing the spread of the virus and for several years the total number of cases in the United States never exceeded 100. A successful vaccine campaign has made this disease very rare and consequently many Americans no longer perceive it as a threat. However, outside the United States the disease is still highly prevalent and was responsible for approximately 145,700 deaths worldwide in 2013 [6]. This is sad news considering the preventable nature of this disease and provides a compelling

picture of what can happen in the absence of the vaccine.

Unfortunately, the nation received a wake-up call when an outbreak occurred at a Disney theme park late last year. According to the CDC, among the 110 California patients about half were confirmed to be unvaccinated [7]. The virus has spread to several states and now many foreign countries are dealing with similar outbreaks. Sadly an 18-month child has now died in Germany as a result of a measles outbreak. It is important for Americans to realize that this is a very real threat across the globe as Europe alone noted 32,818 cases in 2013 [8]. With international travel now commonplace the massive distance is no longer a protective barrier against this highly contagious virus. Preying on fears

Without a doubt, one of the most common reasons for vaccine refusal is a concern that vaccines will harm the child. These concerns also tend to cluster in small areas of like-minded individuals and create hotspots for a potential outbreak. These worries can lead to outright refusal, delayed vaccination, or selective inoculation with certain vaccines that are deemed safe by the individual. This refusal is strongly associated with fear and emotion, which can cloud logical and rational thinking. This has been documented by several experts and has been coined as “probability neglect” [9]. American legal scholar Cass R. Sunstein explains it as an outcome that is so terrifying that one will equate the level of terror with the likelihood that it will occur.

Unfortunately, a single scare can cause

lasting terror. In 1998, Andrew Wakefield published a paper linking autism and inflammatory bowel disease to the MMR vaccine. It was quickly discovered that Wakefied falsified the data and was setting up an elaborate scheme to profit from new medical tests and subsequent litigation [10]. However several years following this false report, vaccine rates in England and Wales fell dramatically [11]. Unfortunately, anti-vaccine advocates continue to keep this myth alive and attempt to link autism to other vaccines as a grand governmental conspiracy.

APRIL 2015 VOLUME 8, ISSUE 2 Page 10

THE iNFORMER

In addition, many question the vaccine components, claiming that they contain toxic levels of chemicals such as aluminum and formaldehyde.

The truth is that vaccines undergo extensive and continuous surveillance by the CDC. The Vaccine Safety Datalink collects and organizes data from nine U.S. health care institutions encompassing over 9 million individuals. The VSD can rapidly monitor vaccine associated adverse events and the system can be updated weekly. In fact, the VSD was instrumental in identifying real adverse events such as the 197 children in a cohort of 1.8 million that developed thrombocytopenic purpura after receiving the MMR vaccine [12].

Despite this strong oversight and safety

protocols, fear continues to motivate the anti-vaccine movement. Politics have now entered the arena and further complicate the issues. Recently, statements from Sen. Rand Paul (R-KY) and Gov. Chris Christie both suggested that individuals and parents “should have some measure of choice” when it comes to vaccinations. Even the ongoing debate to make vaccines mandatory has grown ugly, with the anti-vaccine movement calling such measures a violation of basic human rights. On the other hand, many public figures have taken to the airwaves to persuade the public to get vaccinated, including a hilarious but convincing monologue by talk show host Jimmy Kimmel. As health experts we need keep the public focused solely on the facts about vaccination.

Let’s just talk…

In a perfect world, health officials could

effectively address worries while preserving public trust. Unfortunately, this is a difficult balancing act and controversy continues to linger. One of the hardest things to do is to effectively communicate uncertainty. Meteorologists deal with this everyday and the solution they have come up with is called the “wet bias.” Nobody gets angry when meteorologists predict rain and it turns out to be a sunny day, but people go crazy if it rains when it was not predicted. Unfortunately, in medicine you cannot continually overstate the risk of adverse events because this can cause more harm than good.

There are always inherent risks involved in

medicine, whether it is a delicate surgical procedure or simply prescribing a drug. It is vital to

build trust around the issue of vaccines by candidly discussing the real risks alongside the dangers of the disease. But is also important to empathize and listen to the parents’ concerns. Much of this debate has caused scientists and health care experts to go on the defensive, which can widen the gap even further. We need thoughtful, rational conversations – not angry yelling matches. A good example is the Vax Northwest partnership with the University of Washington, which is recruiting parents to act as peer-educators to increase vaccine adoption within the state. The goals for this program are to support health care providers and develop relationships focused on productive conversations with hesitant parents.

It may be impossible to convince everyone

that vaccines are necessary and safe. But we need to approach hesitant individuals without anger or judgment. After all, scientists are trained to be skeptical and critical even in the face of compelling data. So perhaps we should have patience with individuals that are exercising critical and skeptical thinking. Trust is not built rapidly. We must be diligent in delivering the facts either good or bad while maintaining respect, and avoiding being pulled into the controversy.

References 1. Centers for Disease Control. Measles Cases and

Outbreaks: January 1 to March 13, 2015. 2. Smith M and Woods C, Pediatrics. 2010; 125(6):

1134-41 3. DeStefano F, Price CS, Weintraub ES. Journal of

Pediatrics. 2013 4. Klein N, et al., Pediatrics. 2011; 129(5): 809-14 5. Centers for Disease Control. The Pink Book:

Course Textbook. May 2012. 6. World Health Organization. Measles Factsheet

No. 286. February 2015. 7. Zipprich, et al., MMWR. 2015 8. World Health Organization. WHO Epidata. 16

December 2014. 9. Sunstein, C. (2002). “Probability Neglect:

Emotions, Worst Cases, and Law,” Yale Law Journal 112, 61-107.

10. Godlee F, Smith J, Marcovitch H: Wakefield's article linking MMR vaccine and autism was fraudulent. BMJ 2011, 342:c7452.

11. World Health Organization. Immune surveillance, assessment and monitoring. 2014

12. O'Leary ST, Glanz JM, McClure DL, Akhtar A, Daley MF, Nakasato C, Baxter R, Davis RL, Izurieta HS, Lieu TA, et al.: The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. Pediatrics 2012, 129:248-255.

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Adler-Wailes DC, Alberobello AT, Ma X, Hugendubler L, Stern EA, Mou Z, Han

JC, Kim PW, Sumner AE, Yanovski JA, and Mueller E. Analysis of variants and

mutations in the human winged helix FOXA3 gene and associations with

metabolic traits. Int J Obes (Lond). 2015 Feb 12. doi: 10.1038/ijo.2015.17. [Epub

ahead of print]

Francis TC, Chandra R, Friend DM, Finkel E, Dayrit G, Miranda J, Brooks JM,

Iñiguez SD, O'Donnell P, Kravitz A, and Lobo MK. Nucleus accumbens medium

spiny neuron subtypes mediate depression-related outcomes to social defeat

stress. Biol Psychiatry. 2015 Feb 1. 77(3): 212-22. doi:

10.1016/j.biopsych.2014.07.021

Huang CJ, Kraft C, Moy N, Ng L, and Forrest D. A novel population of inner

cortical cells in the adrenal gland that displays sexually dimorphic expression of

thyroid hormone receptor β1. Endocrinology. 2015 Mar 12. doi:

http://dx.doi.org/10.1210/en.2015-1118 [Epub ahead of print]

Kravitz AV, Tomasi D, LeBlanc KH, Baler R, Volkow ND, Bonci A, and Ferre S.

Cortico-striatal circuits: Novel therapeutic targets for substance use disorders.

Brain Res. 2015 April 8. doi: 10.1016/j.brainres.2015.03.048. [Epub ahead of

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Ma X, Xu L, and Mueller E. Calorie hoarding and thrifting: Foxa3 finds a way.

Adipocyte (2015, In press)

APRIL 2015 VOLUME 8, ISSUE 2 Page 12

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Welcome New Fellows

Fabian Bolte Alberto Cecoon Dahong Chen

Visiting Fellow, Germany Visiting Fellow, Italy Visiting Fellow, China

PhD, University of

Muenster PhD, University of Verona

PhD, University of

Oklahoma

Liver Diseases Branch

(Rehermann) Bldg 10

Laboratory of Chemical

Physics (Clore) Bldg 5

Laboratory of Cellular and

Developmental Biology

(Lei) Bldg 50

Sucharitha Iyer Muthukumar Kannan Shailesh Kumar

IRTA Visiting Fellow, India Visiting Fellow, India

PhD, Thomas Jefferson

University, PA PhD

PhD, Institute of Microbial

Technology, Chandigarh

Metabolic Disease

Branch (Agarwal) Bldg 10

Laboratory of Cellular and

Molecular Biology (Prinz)

Bldg 8

Laboratory of

Biochemistry and

Genetics (Maisson) Bldg

8

APRIL 2015 VOLUME 8, ISSUE 2 Page 13

THE iNFORMER

Welcome New Fellows

Virginia Meyer Marisa Rubio Mrinmoy Saha

IRTA IRTA Visiting Fellow, India

PhD, University of Denver PhD, Yale University PhD, Oregon State

University

Laboratory of Chemical

Physics (Clore) Bldg 5

Laboratory of Cellular and

Molecular Branch, Bldg 8

(Hinshaw)

Laboratory of Bioorganic

Chemistry, Bldg 8 (Appella)

Birong Shen Pengfei Tian

Visiting Fellow, China Visiting Fellow, China

PhD, Peking University PhD, University of

Copenhagen

Laboratory of Cellular and

Molecular Biology (Furano)

Bldg 8

Labor Laboratory of

Chemical Physics (Best)

Bldg 5

Not Pictured:

Adrienne Greenough

IRTA

PhD, Duke University

Genetics of

Development and

Disease Branch (Proia)

Bldg 10