Dr. Colman was the Director of the Montreal Neurological Institute.

Last June I sat in David Colman’s office – having accepted his invitation for a private tour of  “the Neuro”.

Had I known he had less than a year to live, how much longer I would have lingered!

There was so much more I had hoped to learn from him, so much more he had to give – not just to the world of science and medicine – that loss is inestimable – but also to the world of writing and philosophy.

Dr. Colman’s unexpected death this month has left a surprising emptiness in me – I only ever met the man once. But his monthly blog musings (Director’s Corner, which he called his “monthly opportunity to vent”), and our occasional e-mail exchanges gave me insight and inspiration, as I’m sure they did for many.

A busy agenda had been arranged for me that day at the Neuro – yet our conversation was unhurried, drifting easily from current affairs, to the new iPad, to multiple sclerosis and myelin. He scribbled diagrams on my notepad, explaining the complexities of his research on cancer metastasis, and finally, as I moved reluctantly towards the door, photos of his daughters, one of them the same age as my own, turned our conversation to parenting.

Our “friendship”, if I can call it that, first started when he contacted me about an Op-ed piece I had published in the Montreal Gazette. We seemed to see eye-to-eye on the subject and I think we both recognized in each other a certain daring.

A month or so later, in consulting him about a brain tumor story I was researching, he humbly confessed to aggressively working on “halting cancer cell metastasis”. The research, he said, had produced great results “that are apparently unpublishable because they are highly anti-current dogma and therefore threatening”. “The data are incontrovertible,” he told me. “We have a means to arrest the migration of tumor cells.”

Intrigued, I asked him to send me a version of his until-then rejected paper – which he did, complete with deliciously sarcastic comments to the reviewers!

I struggled over what to say to him – it was a brilliant paper – “Perhaps a little too long?” I ventured meekly.  “Problem is of course, the more the bastards suggested, the more we wrote!” he retorted.

Last November he emailed to say that the paper had finally been accepted  – it was his penultimate publication (Neoplasia. 2010 Dec;12(12):1066-80).

In reading Dr. Colman’s blogs and listening to his lectures it is hard to miss the fact that one of his favorite words was “serendipity”. He delighted in the seemingly chance discovery, the detour that produced a Eureka moment. He had the stories to illustrate such miracles: how messing with colours of petunias had led to research on gene quieting, or how observations of butterfly wings led to the development of Rhogam (an injectable antibody for Rh disease).

He quoted Louis Pasteur: “Chance favors the prepared mind”, and wrote “we must also teach how to prepare the mind to accept the unexpected discovery, because most often, serendipity provides the real breakthroughs”.

He believed that important discoveries and insightful observations could be around any corner – especially when you weren’t looking for them – which is why, I believe, his blogs were refreshingly sprinkled with odds and ends from every spectrum of science and art, from astronomy, to Greek mythology, to plant biology or literature or cetaceans.

And his stories are so endearing, and enduring, because he served them up with such a generous portion of his own experiences. There’s the one about that “blistering August day in 1959, the kind of day when New York City asphalt turns to taffy and the air is Africa hot..” – a 10-year-old David Colman takes refuge with his buddies in an air-conditioned movie theatre. Although “Monsters from Outer Space” was the feature that day, it was the opening newsreel of Dr. Wilder Penfield, the first director of the Montreal Neurological Institute, that captured his imagination with an account of one of his first epilepsy surgeries:

“For the only time that day in the darkened Alpine Theatre, I felt shivers travel along my spine –             not from the air conditioning nor from the monsters from outer space, but from that short                         newsreel segment about the cheerful doctor and his grateful patient. I never forgot it.

And at least for one impressionable ten-year-old boy, it started mental wheels spinning in the                   sudden realization that real science – and especially uncovering the mysteries of how the brain                 works – was so much more thrilling than science fiction.”

How fitting that Dr. Colman eventually became the Wilder Penfield Professor of Neuroscience at the Neuro, bringing along with his scientific expertise, his gift for story-telling and communication. This distinguished professor believed in communicating science to non-scientists. He wrote that “the jargon that scientists use so as to precisely communicate with each other, puts a wall between us and the public…With a little effort, it can be ‘translated’ so that all of us can comprehend the value of what we as neuroscientists study.”

To this end, he reached out to the public and to the media, and selected a skilled team of writer scientists for his communications department. He used popular language and familiar references. He quoted Joni Mitchell in explaining astronomy and supernovae; he quoted Sherlock Holmes in explaining the logic of evolution; and he quoted the Bible in describing a government grant to the Neuro as “manna from heaven”. To the latter he included the gift of his great humour: “There are limits to the analogy, and I have not lost my perspective – I do know that there are still some differences between Heaven and the government of Canada,” he wrote.

Though he wasn’t a medical doctor, Dr. Colman, like Dr. Penfield before him, believed strongly that medical research and clinical care should remain inseparably intertwined. His work in the lab did not distance him from the human story. “Somehow the most poignant deaths of my friends have been from very aggressive brain tumours,” he wrote. He empathized with impatient, frustrated patients who turn desperately to unproven, potentially dangerous measures for  “miracle” cures. “Who are we to kill new hopes by being thuddingly, dispassionately rational while they are suffering so?” he asked.

In his opening remarks at the Neuro’s 75^th anniversary symposium in 2009 Dr. Colman spoke of the legacy left by the institution’s previous leaders without realizing he would soon be among them.

“What has happened so far over these 75 years is only our beginning, the simple prologue to what-is-now-the-unimaginable, the amazing, the astounding progress that will undoubtedly emerge as a result of The Neuro’s efforts over the course of this century.”

He had a vision that “we will finally learn how to harness the healing potential of the nervous system to prevent and cure neurological disease by the end of his century”.

Energy never dies. That energy that David Colman generated in his lifetime will continue to fuel his vision. Like the supernova he once wrote so passionately about. A supernova is the death of a massive star, generating brilliant energy that feeds future generations of stars and planets:

In a fraction of a second, the star’s core collapsed, generating an immeasurable amount of                         unsustainable heat and pressure. A massive explosion followed, heralded first by a very short-                 lived searing X-ray flash (termed the “shock breakout”), before giving way to brilliant light in the             visible range that waxed and then waned over the next several days…The explosion blew stellar                 debris outward at tens of thousands of kilometers a second, hurling the contents of the core across           NGC 2770, scattering the atoms synthesized inside the star during it’s lifetime, and importantly,               the heavy elements that can be created only in the enormous heat and pressure following the                     shock breakout.

“We are stardust, we are golden, we are billion year old carbon,” according to Joni Mitchell. “And I feel to be a cog in something turning”.

The continuity is comforting.

But what about Director’s Corner – posted faithfully every month for the past seven-and-a-half years? The June 2011 entry never went up, and I feel sure that would bother him. So, here it is. Maybe someone else could write July’s?

By Kate Johnson

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has a chance to redeem itself and make good on its controversial new contraceptive guidelines.

As I wrote in my last post, the guidelines are tainted with undisclosed conflicts of interest, calling their recommendations into question.

Now, two new studies in the British Medical Journal have made the guidelines redundant – presenting the SOGC with a rare opportunity to correct its mistakes (BMJ 2011;340:d2151 and BMJ 2011;340:d2139).

If it rises to this challenge, the SOGC will get a much-needed second chance to fulfill its role in furnishing Canadian physicians and their patients with some solid recommendations about safe, reliable oral contraceptive options.

For months the SOGC has been warning its members and the public about the potential for a “pill scare”, a mass abandonment of the top-selling drospirenone-containing oral contraceptives Yaz and Yasmin, due to fears of blood clots, or venous thromboembolisms (VTEs).

Mounting lawsuits against Bayer, the manufacturer of the pills, claim the products carry a higher risk of VTEs than older levonorgestrel-containing pills.

The SOGC, concerned about the bad press, says it fears a repeat of the 1995 British pill scare, which was triggered by similar VTE concerns in levonorgestrel-containing pills. The scare prompted mass discontinuations of the pills, a surge in unplanned pregnancies and abortions, and a 25% increase in the national birth rate (Human Repro 1997; 12 (12): 2595-2598).

Dismissing current concerns about Yaz and Yasmin as “stimulated reporting” – “the phenomena whereby media attention stimulates physicians and patients to report adverse events”,  the SOGC issued guidelines and a statement insisting the  Bayer products are just as safe as other oral contraceptives and even “offer additional benefits to women with acne and hirsutism”.

But, as I wrote previously, the group’s opinion seems largely influenced by the manufacturer.

Medical authorities have been less definitive than the SOGC on this issue. Prior to this new evidence, the U.S. Food and Drug Administration leaned, somewhat obscurely, towards the safety of the products, while the European Medicines Agency (EMA) and the British Medicines and Healthcare products Regulatory Agency (MHRA) concluded that the risks may have been “slightly higher than previously estimated”.

Prescrire, an independent European journal concluded that compared to older pills, those containing drospirenone conferred a “high risk of thrombosis” and were “not the best choice”.  (Rev Prescrire 2011; 113 p.43-45).

But now, the two new studies add fuel to those safety concerns – showing drospirenone-containing pills carry a 2.7-fold and 3-fold increased risk of VTE compared to levonorgestrel-containing pills.

Although “the data are inconclusive”, due to some weaknesses such as small numbers and missing information, “it seems sensible to prescribe an oral contraceptive with a  well known favourable safety profile (one that contains levonorgestrel) unless there is persistent reason to use another type,” concluded Nick Dunn, MD, senior lecturer at the University of Southampton School of Medicine, in England, in an accompanying editorial (BMJ2011;342:d2519).

In a predictable response to the new evidence, Bayer has issued a statement saying the new studies are flawed – an echo of its similar criticisms about previous studies. It says the safety of its products is based on solid evidence from two self-sponsored studies (Contraception. 2007 May;75(5):344-54 and Obstet Gynecol. 2007 Sep;110(3):587-93), and that two earlier studies which first suggested an increased VTE risk were also flawed (BMJ 2009;339:b2890 and BMJ 2009;339:b292).

To date, SOGC’s  statements and guidelines have mirrored Bayer’s analysis – which is not surprising given the society’s reliance on the company for scientific analysis and interpretation.

With it’s second chance to avert a pill scare, let’s hope the SOGC will venture beyond its industry reference points, subject the new studies to unbiased analysis, acknowledge that there may possibly be as much as a 3-fold increased risk with drospirenone-containing pills, but that in absolute terms that risk still remains small.

If the new evidence is confirmed, a 2.7-fold to 3-fold increased risk is still small –  meaning out of 100,000 women taking drospirenone-containing contraceptives in one year,  23 to 30 would have an VTE, compared to between 9 and 12.5 among those taking levonorgestrel-containing pills.

By Kate Johnson

If it wasn’t for “the Bayer facts”, the new contraceptive guidelines from the Canadian Society of Obstetricians and Gynaecologists (SOGC) would be rather underwhelming.

But stripped down they are alarmingly revealing: “an egregious example of the extreme,” according to Dr. Allan Sniderman, a McGill University cardiology professor who has called for widespread medical guideline reform.

The guidelines, which focus on Bayer’s controversial contraceptives Yaz and Yasmin (drospirenone and ethinyl estradiol ), are an almost identical copy of a consensus statement from a Bayer workshop – which, not surprisingly, endorses the pills’ safety.

But since Yaz and Yasmin are at the center of almost 5-thousand individual and 13 class-action lawsuits in Canada and the U.S. it is hard to believe that the SOGC would not reach beyond a company workshop to furnish Canadian doctors and patients with the facts about the pills’ alleged link to venous thromboembolisms (VTE).

The SOGC guidelines, and the statement from Bayer’s workshop – both written by Dr. Robert Reid, professor of obstetrics and gynecology at Queen’s University, Kingston, Ontario – are identical, aside from the cover page and a few stray paragraphs.

This itself is a concern, since the consensus statement was published months earlier and clearly states it was crafted by an international panel that was hand-picked by Bayer – the majority of whom “will, at one time or another, have received sponsorship and/or funding from one or more manufacturers of contraceptive drugs or products”. A quick Google search confirms a handful of them are in fact Bayer consultants, including the author, Dr. Reid.

While the guidelines are a virtual reproduction of the workshop document, all the Bayer facts are left out – a revealing omission – even though Dr. Reid insists the company had no influence on the manuscript. Dr. Reid’s conflict of interest as a company consultant is also not disclosed, and neither is the fact that the SOGC receives funding from Bayer – a fact which is documented on the SOGC website.

Why would the SOGC choose to omit these facts, when transparency about such industry ties is so strongly recommended by groups like the Institute of Medicine (here), and the Council of Medical Specialty Societies (here)?

As I’ve written in an article for the Canadian Medical Association Journal – the SOGC’s lack of transparency is clearly bucking the trend.

In a five page response to my questions the group’s executive vice-president Dr. André B. Lalonde could give me no clear answers, insisting simply that the guidelines “did not come from the international meeting.”

But, according to Dr. Reid they definitely do.  “The reason the SOGC asked me to write the guidelines is that they knew I had been to this meeting,” he said in an interview. “That’s really where I got my information.”

So, with that fact firmly established, yet omitted from the SOGC guidelines, can we trust what the guidelines say?

That’s a thorny question which I have explored in many interviews over the past few months.

Dr. Reid defends the guidelines, saying they reflect the best evidence, “in my opinion and that of the other experts who were attending”  the consultant-stacked workshop.

He says any independent epidemiologist would agree.

But he admits he didn’t ask one.

I did.

Dr. Susan Jick, DSc, Director of the Boston Collaborative Drug Surveillance Program, and professor of epidemiology and biostatistics at Boston University School of Public Health, says the SOGC’s interpretation of the evidence “demonstrates naiveté about the epidemiology and smacks of consultation.”

The guidelines unfairly emphasize the safety data on Yaz and Yasmin and too easily dismiss the evidence for increased risk, she says.

Indeed, the workshop panel did “scoff at” the risk data, and accepted that safety data as “gold standard”, according to my interview with Dr. Reid.

But Dr. Jick says the safety studies have major methodological flaws such as the inclusion of non-idiopathic cases, and the use of a high-risk reference group. “When you do that you dilute the effect. Anyone who is a good epidemiologist and trained in this area understands that.”

Perhaps if Dr. Jick’s analysis was included in the guidelines, along with a disclosure of the Bayer facts, the SOGC would be helping physicians and patients make informed decisions.

Omitting these details makes the SOGC look like “industry’s puppet”, says Dr. Adriane Fugh-Berman, director of PharmedOut, a Georgetown University organization that  examines industry influence on prescribing.

Meanwhile public concern over the safety of these blockbuster contraceptives is mounting.

Between February 15 and October 15, 2010, the number of U.S. lawsuits pending against the company more than quadrupled – from 1,100 to 4,800,  and the number of Canadian class-action suits rose from two to 13, according to company records. The FDA has also disciplined the company for misleading advertising.

In light of the ongoing debate, some experts suggest it would be appropriate for guidelines to err on the side of caution until the evidence is clear.

“I would argue that if there’s concern about the safety of these products, even if that hasn’t been proven, there are other products where there isn’t that kind of argument. So I think that doctors should choose those products rather than the ones where there is still controversy,” said  Dr. Joel Lexchin professor at  York University’s School of Health Policy and Management and research associate at the Canadian Center for Policy Alternatives.

That argument is only valid if the controversy is based on good science, said Dr. Reid.

“When a doubt is based on poor science it should not influence medical practice. The people who have to deal with the fallout of that are obstetrician-gynecologists who start to see women coming in wanting abortions because they stopped the pill after some scary story in the paper,” he said.

Dr. Reid has publicly cautioned Canadian physicians about a potential “pill scare” like the one which occurred in the UK in 1995. That incident, triggered by an official warning about similar risks in the previous third generation oral contraceptives, was followed by mass discontinuations of the pills, a surge in unplanned pregnancies and abortions, and a 25% increase in the national birth rate.

But as journalist Jim Edwards wrote in his blog entitled “This Birth Control ‘Pill Scare’ Warning is Brought To You by Bayer”, “the SOGC’s credibility is undermined when its guidelines fail to mention its conflict of interest or alternatives to the products of its sponsors”.

This week, an editorial by Dr. Steven Nissen in the Archives of Internal Medicine even goes so far as to suggest that authors such as Dr. Reid, who are industry consultants, “essentially become temporary employees of industry, whose duty is the promotion of the company’s products.” According to Dr. Nissen “no conceivable logic can defend the practice of including promotional speakers” on clinical practice guideline committees.

It’s past time for doctors “to recognize the corrosive influence of industry money on the practice of medicine,” writes journalist Alison Bass in a blog about the commentary.

But stories such as this one are complex, well-camouflaged, and thorny to handle – which means the public often remains in the dark.

UPDATE – April 12,2011: See Jim Edwards’ latest piece about my blog “Money Talks: Ob/Gyn Society Allowed Bayer to Write Its Birth Control Guidelines”.

As published April 4, 2011 in the Canadian Medical Association Journal - full story

By Kate Johnson

How ironic that people like Neil Cameron blame the vaccine-autism mess on journalism, when it was actually a journalist who first blew the whistle on Andrew Wakefield’s fraudulent study.

At a time when science journalists are struggling to retain their foothold let’s not forget the conclusion of the autism-vaccine debacle.

Medicine is a highly specialized field that calls for specialized journalists who can critically assess and examine scientific studies. Such journalists are a dying breed as media outlets downsize and health sections dwindle. New York Times science reporter Natalie Angier recently said science coverage is “basically going out of business” – which means the public must rely on non-specialized journalists to navigate the medical literature. While they do their best, how can such journalists know the intricacies of a field that science journalists spend an entire career learning?

A year ago I wrote that Dr. Richard Horton, editor of The Lancet described the autism-vaccine mess as a “system failure”. “We failed, I think the media failed, I think government failed, I think the scientific community failed,” he said. Yet, despite this failure, a science journalist succeeded in exposing the flaws which eventually led to the study’s retraction.

As I’ve written for the American Medical Writers Association, journalists who are specifically trained to critique scientific analysis, place it in context, and “translate” it into more digestible forms are an essential link in the chain of communication between the research lab and the public.

Many scientists recognize this fact, and their collaboration with journalists can enlighten the public still further. Indeed, Dr. Amir Raz from Montreal’s Institute for Community and Family Psychiatry and Lady Davis Institute for Medical Research at the Jewish General Hospital has told me science writers are “the mouthpiece of the field”.

Neil Cameron correctly states that “famous, prestigious, refereed and long-established scientific journals” are increasingly publishing questionable studies. All the more reason to protect and support science journalism and the insight it can offer.

I would say that in the end, the autism-vaccine story is a science journalism triumph and should be a wake-up call to journalistic organizations and society in general that science journalism is worth paying for.

Kate Johnson is a freelance medical journalist living in Montreal. She is a member of the Association of Health Care Journalists and the American Medical Writers Association.

By Kate Johnson

The Patients’ Association of Canada is gearing up for its official launch next month and I’ll be watching with interest to see what kind of spin they put on their message. Without a doubt, a group that aims to add the patient voice to healthcare policy debate is filling a gaping void. The question is whether PAC’s voice will simply join the throng or whether it will trigger change.

At the helm of the group is Sholom Glouberman, Ph.D., a soft-spoken, articulate health-policy philosopher with an impressive array of positions at McGill University, the University of Toronto and the Baycrest Center for Geriatric Care in Toronto. He told me the group aims to present the patient’s perspective to Canada’s health policy decision-makers.

“The patient perspective is interestingly, and sometimes quite significantly different from the perspective of others,” he explained, giving the example of government-funded physiotherapy in Ontario.

Under current policy, physiotherapists must be able to document physical improvement in their patients or else drop them from the publicly-funded program. Yet, for many patients at Dr. Glouberman’s geriatric center, physical improvement is not the sole outcome they are looking for.

“For a large number of these patients physiotherapy is their hold on the possibility of change,” he said. “Going to the physiotherapist itself is useful even though they’re not becoming more limber. And the physiotherapist very often has little sense of that.” If this patient perspective had been considered it might have helped shape a different policy that could have allowed patients to continue with some form of therapy despite lack of physical improvement, he said.

Strategic positioning will be very important for PAC in the healthcare discussion. Patients are sometimes pitted against doctors over certain issues, but Dr. Glouberman doesn’t regard the group’s role in that light. “To a certain extent the best allies of physicians would be patients, if patients had a stronger voice,” he said. “Our closest partner has so far been the Ontario Medical Association, so we’re working with doctors -  and bringing the patient into the mix is, I think, going to protect doctors. We’re not talking about arguing merely for the patient, we’re talking about arguing for a better healthcare system – just like everybody else,” he pointed out.

But within this delicate balance, perhaps one of the biggest challenges for PAC will be to seize the opportunity to push change rather than simply comment on the status quo. This may require treading very carefully to preserve what might initially be a rather fragile alliance with healthcare workers. An example reported by CTV and featured on the group’s website is the issue of surgeon fatigue. The debate was sparked by a commentary in last month’s New England Journal of Medicine (N Engl J Med 2010; 363:2577 – 2579) in which Michael Nurok, MD, an anesthesiologist and intensive care doctor at Hospital for Special Surgery in New York City questioned whether surgeons scheduled for elective procedures should inform patients when they are working under conditions of sleep deprivation.

In addition to recommending institutional policies to facilitate rescheduling surgeries in such circumstances, the authors also suggest that “patients should be empowered to inquire about the amount of sleep their clinicians have had the night before such procedures.” If I were a surgeon I’d be offended by such a question. It goes without saying that I wouldn’t  show up for a procedure if I thought I was impaired.  If I was a patient I wouldn’t want to risk offending my surgeon with such a question right before going under the knife.

This seems like the perfect entry point for a patient advocacy group like PAC to take a collaborative position rather than an adversarial one – and not simply to state the obvious about an undesirable situation but rather to push for practical solutions. Rather than taking a stand against sleep-deprived surgeons the group could align itself with them – pushing for their protection against the pressure to perform under such conditions and advocating for flexibility to allow for surgery rescheduling.

I welcome the prospect of a fresh perspective in the healthcare arena and I’ve got my fingers crossed that PAC can mix some smart strategy with its thought-provoking philosophy. Hopefully that will add momentum to the healthcare discussion and make my job more interesting!

By Kate Johnson

I always love to see a journalist speaking into a microphone rather than holding one – especially in the context of a scientific meeting. That’s why science journalist Steve Silberman fuelled my delight earlier this week with his address to the very cool-sounding “Raz Lab” workshop.

The Raz Lab, run by Dr. Amir (– you-guessed it) Raz, is part of the Institute for Community and Family Psychiatry and Lady Davis Institute for Medical Research at the Jewish General Hospital in Montreal. I didn’t attend the workshop – which was intended for international researchers with expertise in the placebo effect – but Silberman’s address was open to the public and it’s been on my calendar for weeks.

Silberman made a splash last fall with an article about the placebo effect that he wrote for Wired. That alone would have been enough to get me out, despite the Montreal heatwave. But what really piqued my curiosity was that he had been chosen to speak to a caste of scientists, AND in addition to talking about his research on placebos he was also going to tell them about the importance of science writing.

“Science writers are the mouthpiece of the field,” proclaimed Dr. Raz in his introduction – confessing a soft spot for science journalism, which he had once considered as a career. That attitude is a light on the horizon in my field of work.

Silberman’s placebo article caught Dr. Raz’s eye because it is “by far one of the better” popular accounts of an intricate scientific subject, he said. Indeed, as Silberman told us, the article took four months of research during which he estimates he read about 400 journal articles. You just don’t find that depth and thoroughness much in science writing these days – there are no resources for it – and many editors feel there is no public appetite. In fact, facing the flak for what the magazine’s managing editor felt was a bad choice, Silberman lost his fulltime job and was relegated to freelance status, and his editor was fired.

That was before any of them knew that the article would generate such interest. Yet Silberman remains on the freelance list, fighting to retain good science and thorough research in his articles.

Such journalism is deeply threatened, Silberman told the audience. Newspapers and magazines are dropping their science sections, or folding completely. The public’s reading habits are changing. Introducing nuanced, subtle, multi-layered scientific information is getting harder to do – and, as a freelancer myself I know that getting paid for that kind of writing is even harder.

That’s why Dr. Raz’s comment about science journalists being the mouthpiece of the medical field was so heartening – because I do think he is right.

I’ve blogged before about how scientists, despite their brilliance, may not always have the gift of good communication skills. Lab-work may be their forte but writing might not. As I wrote for the American Medical Writers Association, journalists who are specifically trained to understand scientific language, place it in context, and “translate” it into more digestible forms are an essential link in the chain of communication.

And as science becomes more “arcane” – as Silberman put it – such translation will become even more important.

That’s not to say all scientists are incapable of translating their work for the general public. Far from it. In fact, more and more they are being urged to consider this communication as one of their essential roles. People like Dr. David Colman, head of the Montreal Neurological Institute, do it profoundly well, which is evident when you read his monthly musings – yet Dr. Colman also recognizes the value of science/journalism collaborations, as I discovered when he invited me to spend a day with him and his colleagues at the Neuro last month.

Silberman’s invitation to speak at the Raz Lab workshop is another good example of such collaboration – and just last month The American Academy of Arts and Sciences published a report in the same vein. Written by science journalist Chris Mooney, the report entitled “Do Scientists Understand the Public?”discusses four workshops organized by the academy which examined “ways to improve engagement between the scientific and public communities.”

Chris Mooney was an excellent choice to write this account – he also wrote a great piece about it in the Washington Post. I’ve blogged before about Unscientific America, the book he wrote with Sheril Kirshenbaum about “How Scientific Illiteracy Threatens Our Future.”

Mooney and Kirshenbaum examine “the science-media divide” – the clash in which scientists criticize journalists for bad reporting and journalists criticize scientists for poor communication. It’s a great book that ultimately offers insight into how science journalists and scientists can work together.

And that’s what is desperately needed right now.

On a bitterly cold day this past January I came home from a ski on Mount Royal and wrote about the blind instinct that takes over when you hurtle down the slope with icy crystals in your eyes.

It made me think of what I, and many other journalists are doing every day. Steve Silberman spoke about “the perfect storm” that science journalists are weathering right now, but later he told me that he does have hope: “Evolution required”, he told me on Twitter. Scientists like Dr. Amir Raz are part of that evolution.

By Kate Johnson

Bench to Bedside to Breakfast News

June 3, 2010

By Kate Johnson

For a gastroenterologist, Nicholas Talley takes an unusual interest in his patients’ respiratory symptoms. He also considers their dermatologic history a vital part of his work-up. As professor and chair of internal medicine at Jacksonville’s Mayo Clinic College of Medicine Dr. Talley is refreshingly willing to step outside of his field of specialty to gather clues and gain insight into the roots of gastrointestinal dysfunction.

In a recent issue of Nature Reviews Gastroenterology & Hepatology, he and his colleagues shared their observations about the common co-occurrence of certain gut and lung disorders, suggesting complaints from both ends might share the same cause and perhaps, in the future, might also share one treatment.

In fact, now that spring has sprung, if you suspect that asthma and allergies may also upsetting your stomach, Dr. Talley believes you may be right.

He, along with some other respiratory and gastrointestinal researchers suspect that the same things which make noses itch and asthmatic lungs flare may also be causing similar inflammation in the digestive tract.

In other words, allergic symptoms may run from one end of the gut to the other.

The good news is, while asthma and hayfever therapies have not yet been designed for the gut, researchers are looking into it. In the meantime there are other suggestions to minimize stomach complaints during allergy season.

The link that Dr. Talley sees between the gut and the lungs, may be due to an influx of cells called eosinophils.

In his recent paper (Nat. Rev. Gastroenterol. Hepatol. 7, 146–156 (2010), he  and his colleagues describe how patients with asthma and allergic rhinitis have abnormally high levels of eosinophils in both their airways and their intestines.

Eosinophils are important immune system cells that are made in the bone marrow and normally line the mucous membrane in the stomach, small intestine and colon.

In health, these cells are not normally found in the airway at all – their main purpose is defend against bugs and toxins and prevent them from being absorbed into the body.

But in some people with asthma and allergies, the eosinophilic response is exaggerated, and exposure to allergens can trigger an excess of these cells – in both the gut and the lungs.

As a result, in addition to wheezing and sneezing, patients may also be bloated and gassy.

“I don’t think respiratory researchers have been terribly excited about gut problems, but I bet a lot of their asthma patients have gut problems if they ask them,” said Dr. Talley in an interview.

“I most certainly have seen patients with severe forms of asthma that have a pretty profound gastrointestinal (GI) component,” said Dr. Sally E. Wenzel Professor of Medicine, and Director of the University of Pittsburgh Asthma Institute. “A history of diarrhea and GI distress is not that uncommon [in asthma] and it’s not inconceivable that there is a relationship with eosinophils,” she said, adding that among the different types of asthma, some are considered to be linked to eosinophils while others are not.

This distinction in asthma – between eosinophilic versus non-eosinophilic disease – suggests exciting diagnostic and treatment possibilities for the field of gastroenterology, which is hampered by vague symptoms and imprecise therapies.

“Just as there are different types of asthma, there are probably different types of gut diseases that may or may not be related to eosiniphils  – even though they may look similar clinically,” said Dr. Talley.

“Perhaps if we have modes of identifying people with eosinophil-related problems, for example by histological tissue examination, we might have a better chance at making precise diagnoses and prescribing targeted treatment,” he said. “It’s a totally different way of thinking about this, which is why we’re excited about it.”

Early support for this notion can be seen in asthma patients who quite commonly suffer from gastroesophageal reflux disease (GERD), or a more severe condition known as eosinophilic esophagitis (EE). While the precise cause of these overlapping lung-gut conditions is still being debated –  eosinophilic excess is present in both, though much more profoundly in the latter.

“We thought wow, hang on, we can distinguish these things not by symptoms but by looking at what’s going on with their eosinophils,” he said. Perhaps the same could be done in irritable bowel syndrome, which is also linked to asthma.

“By looking for these subtle inflammatory changes (through biopsy) and by profiling and categorizing people based on these results, we think then you might be able to say this person has a particular  profile, and we would treat them in one way, whereas this other person who has similar symptoms does not have that profile and we will have to find a different treatment approach,” he said. “We strongly suspect that this is the approach that will lead to significant benefits for subsets of patients in the future – rather than treating everyone with the same symptom profile in the same way and hoping they get better. In other words, we’d like to target treatment at pathology, rather than symptoms.”

Although eosinophils are normally protective in the gut, in allergy, a glut in the lungs and gastrointestinal tract reverses their function, causing damage to the mucous membranes. When this happens, the protective barrier in the gut is broken, allowing toxins to leak into the circulation.  This increased intestinal permeability, or “leaky gut” has been documented in asthma sufferers.

“If you’re experiencing feelings of fullness, bloating, can’t finish your meal, or have pain in your stomach – it’s more likely to be associated with eosinophils,” said Dr. Talley. “With lower gut symptoms – constipation, diarrhea, and lower abdominal pain –  we found these people don’t have excess eosinophils.”

Although inhaled asthma and nasal allergy treatments can alleviate respiratory symptoms, they have little chance of relieving gut complaints. Systemic asthma treatments aimed specifically at reducing eosinophils could offer gastrointestinal promise, but this approach still needs to be explored.

And while respiratory symptoms may wax and wane with the seasons, gastrointestinal symptoms may wind up becoming chronic, requiring a more permanent solution.

“You can continue to have the gut inflammation and to be symptomatic longterm even though perhaps the allergens are not always there,” says Dr. Talley.

So, what can be done right now for the allergically-challenged gut?

“Clearly diet is going to be the big key here,” says Dr. Talley.

If part of the problem is intestinal permeability, what about repairing the protective barrier and avoiding foods that irritate the fragile gut?

Food is rarely the cause of asthma or other respiratory symptoms, says Dr. Wenzel – so the initial trigger for eosinophil overgrowth is most likely inhaled allergens. But once the gut is inflamed, and intestinal permeability becomes compromised, certain foods might present a daily dose of irritation. Sometimes foods that are managed fine in a healthy gut can stir up trouble, or even allergy in an inflamed one.

In fact, avoidance of the six most common food allergens (cow’s milk protein (casein), soy, wheat, egg, peanut/tree nuts, and seafood) has been shown to significantly improve symptoms in patients with eosinophilic esophagitis.

What about repairing the leaky gut, so that toxins can’t pass through the intestinal lining?

A recent study in celiac disease, an intestinal disorder marked by intestinal permeability, showed that probiotic treatment with bifidobacteria had an anti-inflammatory effect (J Leuk Biol. 2010 87: 765) on intestinal cells. And there is promising data for the same probiotic in irritable bowel disease, though no data looking at upper gut syndromes, says Dr. Talley.

Finally, there is some evidence that a low-fat diet may calm inflammatory processes. A brand new study comparing high and low-fat diets showed the latter significantly reduced airway inflammation and improved response to asthma medications.

Perhaps this diet might have similar anti-inflammatory effects in the gut.

At the very least, it’s another hint that what’s happening at the intestinal interface may have may have far-reaching percussions throughout the body.