Extremes In Medicine

Saturday, February 2, 2013
By Wolfgang K Piller MD

Medicine, or let’s say the functioning and malfunctioning of human bodies and minds still remains fascinating for me. There is more to it than cholesterol, blood pressure, PSA and mammography; it’s like an old chest in the attic. Each time you open it, something will draw your attention and occupy your mind. This month, science surprised me with the marvels of two extremes:

It is good news that we are a step closer to an AIDS vaccine! For the last 30 years, science has failed repeatedly to produce a sufficiently effective vaccine, because the virus keeps changing its appearance, in a way that the vaccine can’t discover it any longer. Now three virus particles were found to be stable enough that a vaccine seems to be very effective. This was proven in mice. Well, mice you say. Well, you don’t know the NOG-mouse as the NOD/Shi-scid/lL-2Rynull-mouse lovingly is called! The NOG-mouse suffers from eight different immune deficiencies or modulations, it basically has no immune system whatsoever and would not last a single day in a normal environment. Thus it readily accepts human bone marrow or stem cells as its own, letting the living tissue of man act in the body of a mouse. These mice are called humanized mice and they help in the research of cancer, leukemia, regeneration of damaged tissues and infectious diseases like AIDS. (Strictly speaking, it would also be correct to speak about zombie mice, infested with human tissues, although that does not sound very scientific.) It’s incredible what the human brain can produce, this time a pet for Frankenstein and hopefully the end of AIDS.

The second marvel of study is about the “re-use of explanted, resterilized implantable cardioverter-defibrillators”. These devices are similar to pacemakers, but they give an electric shock to the heart, when a life threatening rhythm occurs. Patients requiring such a device would die very soon, if they did not have one, so they are life saving, jus like a vaccine for AIDS would be.

The study describes how 81 used devices were implanted in Indian patients, too poor to afford one – thus doomed to die. The patients were then followed up for complications, basically for the occurrence of infections due to their second hand devices. No infections occurred. For me it is not quite clear why this study was necessary. It is already well known that second hand pacemakers have not caused problems in the past. They had been implanted a second time, because greedy physicians passed the devices as new and kept the money for themselves. (However neither the study, nor the scandal, address the theoretical problem of transmitting prion diseases, like mad cow disease.) They neither address an ethical problem, because in the industrialized world this study would never have been permitted. Implants are deemed for single use only and any complication would have been a medical mistake and open to compensation claims. It certainly is commendable, that those people received a secondhand lifesaving device for charity but not within the setting of a study, which did not even give special medical care to the participants. We transplant organs, which by nature are contaminated, thus we also should be honest enough not to outsource research to people who are vulnerable. Very soon we will have to address our healthcare costs and it may be the re-use of implants is within this context.

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