"Our Grandchildren Will Not Live as Long as We Do"

Question: What are the biggest health risks facing America?

Francis Collins: If you look at health in the United States, you could point to some really significant achievements and you could also point to the role that NIH has played in making those things happen; cardiovascular disease has dropped by more than 60% in mortality over the course of the last 30 to 40 years, much of it from insights derived from groups like the Framingham Study which pointed out what the risk factors were and what we could do about them.  Cancer is dropping in its frequency, finally, after many years of going up.  

But there are clouds on the horizon of public heath, obesity and it’s related disease, diabetes, probably is the one that causes the greatest concern when you see the way in which our population is growing more overweight almost year by year with no sign that we’ve managed to turn this around.  And that could, if not somehow addressed, result in an outcome where our grandchildren will not live as long as we do and we would therefore turn down what has been upward curve in longevity over many decades.  A critical need there through research, research that involves nutrition, research that involves understanding exercise, then understand the built environment and how to motivate health behaviors to try to turn around this obesity epidemic.  

Certainly other areas of concern... Alzheimer’s Disease comes to mind as a condition which as our population is aging and as the Boomers are coming into this phase of potentially higher risk of Alzheimer’s, that we are gong to see very large numbers of people affected by this heartbreaking disease with terrible consequences for themselves and their families and for our medical economics because of the cost of caring for them.  So this has to be a very high priority for our high intensity efforts to come up with new solutions about prevention and treatment.

Question:
How much of research should be focused on prevention, as opposed to treatments and cures?


Francis Collins: NIH is intensely interested in prevention.  I think everybody would agree that we haven’t paid enough attention to this approach to maintaining health, that we’ve not had a health care system in terms of medical care—we’ve had a "sick care" system where if you get sick there might be some help for you, but there’s been relatively little invested in terms of helping people stay well.  And maybe as a part of that we’ve had modest efforts, really, to try to invest in research on prevention.  That’s all changing.  Some of that’s coming about because of a better understanding of the environment and things that people should be careful about as far as bad influences on their future health, whether it’s smoking or diet or exercise.  We’re learning a lot about that.  

And some of it is the ability through personalized medicine to begin to identify individual risks for a future illness to get us beyond the one-size fits all approach to prevention, which has been not that effective.  People haven’t necessarily warmed to these recommendations about what you should do about diet, exercise, colonoscopies, mammograms and so on because it all sounds very much generic.  

But if you could provide people with information about their personal risks and allow them therefore to come up with a personalized plan for maintaining health that seems to inspire a lot more interest.  Genomics is moving us in the direction of being able to do that and I think that’s one of the more exciting developments in the prevention arena even though it’s early days yet, to see how that’s going to play out.

Recorded September 13, 2010
Interviewed by David Hirschman

We must confront our national obesity crisis, warns NIH director Francis Collins, or face a decrease in life expectancy.

To boost your self-esteem, write about chapters of your life

If you're lacking confidence and feel like you could benefit from an ego boost, try writing your life story.

Personal Growth

In truth, so much of what happens to us in life is random – we are pawns at the mercy of Lady Luck. To take ownership of our experiences and exert a feeling of control over our future, we tell stories about ourselves that weave meaning and continuity into our personal identity.

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

Ashes of cat named Pikachu to be launched into space

A space memorial company plans to launch the ashes of "Pikachu," a well-loved Tabby, into space.

GoFundMe/Steve Munt
Culture & Religion
  • Steve Munt, Pikachu's owner, created a GoFundMe page to raise money for the mission.
  • If all goes according to plan, Pikachu will be the second cat to enter space, the first being a French feline named Felicette.
  • It might seem frivolous, but the cat-lovers commenting on Munt's GoFundMe page would likely disagree.
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