Sound Medicine -- November 30, 2002

Hosts Barbara Lewis & Dr. David Crabb talk to experts about:

Insulin signaling, a key to diabetes

Treating AIDS in Kenya

Vaccine for cervical cancer

Insulin signaling, a key to diabetes

Dr. C. Ronald Kahn, a researcher who has performed groundbreaking studies on insulin action and diabetes, joins us to talk about why type II diabetes had been ranked a top health threat among Americans. He is the Mary K. Iacocca Professor of Medicine at Harvard Medical School and president and director of the Joslin Diabetes Center in Boston.

Dr. Kahn reports that in the 1990s, diabetes increased 40% in the U.S. Many cases are type II diabetes (non-insulin dependent), and result from obesity. Currently in the U.S. there are 17 million people diagnosed with the disease, 5 million undiagnosed, and as many as 20 million with pre-diabetic conditions.

Dr. Kahn explains how insulin works in our bodies and why studying insulin signaling is key to future treatment of diabetes. Basically, in people with type II diabetes, tissues don't respond normally to insulin. His research seeks to understand insulin responses in the brain which control appetite, as well as reproductive functions. Dr. Kahn says we should address environmental causes before worrying about genetic therapy. He says studying insulin signaling reveals how tissues, such as fat, store insulin. His studies with mice show that it's possible to block insulin in fat, keeping animals lean and preventing them from developing diabetes.

Resources:

Read overviews of Dr. Kahn's research into insulin signaling and the brain from the Joslin Diabetes Center and the Harvard Medical School.

Treating AIDS in Kenya

In 2000, when Dr. Joe Mamlin arrived in Eldoret, Kenya, to assume the post of IU team leader for the IU School of Medicine-Moi University faculty/student exchange program, he was overwhelmed by what he saw at Moi Hospital. AIDS was slowly but surely wiping out the population of Kenya. Today, however, there is hope for some Kenyans, thanks to the vision of Dr. Mamlin and the IU School of Medicine. Dr. Mamlin, professor emeritus of the IU School of Medicine, joins us to discuss the situation in Eldoret and the efforts aimed at AIDS prevention and treatment there.

Dr. Mamlin says the profile of AIDS has changed since his first visit to Kenya in 1988. The disease now claims many more, and much younger, victims. He explains that in Kenyan society, individuals are promiscuous but do not openly discuss sex; nor do they use condoms. With virtually no treatment available, people refuse to test and remain sexually active. Dr. Mamlin's recent work began with testing a few pregnant women to prevent their babies from contracting AIDS. He then began a larger program that helps Kenyan physicians prevent and treat HIV. The two Moi clinics in Eldoret now treat 370 patients, more than any other in Kenya. Dr. Mamlin's latest efforts have resulted in a large grant from the Gates Foundation for patient education and funding from other charitable groups to provide drugs for treating entire families afflicted with the disease.

Resources

Read more about Dr. Mamlin's (and others') work in new ground, a magazine published by the IU Foundation. Includes a Flash-based photo essay on the Eldoret program.

An article in the Journal of American Medicine describes the mother-to-child transmission grant (MCTC-Plus) that Moi University has received to treat pregnant women and their families.

Get an overview of IU-Moi partnership from the IU Department of Medicine.

Vaccine for cervical cancer

In the news this month is a national study of a new cervical cancer vaccine that proved to be 100 percent effective. The results are published in the November 21 2002, issue of the New England Journal of Medicine. The vaccine is for type 16, one of the human papilloma virus (HPV), one of the forms of HPV that can trigger cervical cancer. One study author is Darron Brown, MD, professor of medicine, microbiology and immunology at the IU School of Medicine. He joins us to discuss HPV and the future of this promising vaccine.

There are about 100 types of papilloma viruses, says Dr. Brown. They infect different parts of the skin, and include plantar warts. Some 40 types infect the the genital tract, and they are usually asymptomatic. But, Dr. Brown explains, some genital warts become precancerous or cancerous growths on the cervix. For women in the U.S., cervical cancer is less prevalent due to PAP smear screening, but it is common in third world countries.

Because the papilloma virus is simple, a vaccine is possible. Dr. Brown explains how the vaccine was developed and how it works. (He emphasizes it is not a live virus.) He says it should be offered it to all sexually active individuals, or better yet, to all 8-10 year olds. Evidence shows the vaccine works and is safe, but more testing is necessary. The drug will ready by end of decade, maybe sooner, he reports.

Resources

The National Institutes of Health provides a good fact sheet on the human papilloma virus (HPV) and genital warts.

Read a description of the cervical cancer vaccine study at the online New England Journal of Medicine.

National Public Radio (NPR) recently reported on the cervical cancer vaccine. Listen to the November 20 and November 22 stories online.

Upcoming programs:
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• The first incident of AIDS in the United States was recorded in June 1981.
• After a peak in 1993, the number of new diagnoses of AIDS each year has declined and leveled off at around 40,000.
• Since the implementation of HAART (highly active retroviral therapy) in 1996, deaths related to HIV/AIDS have declined, leading to an increase in the number of people living with the virus.
• HAART uses a specific combination of medications in a specific sequence, to combat the virus at different stages during its life cycle, and has proved effective for many, but not all, AIDS patients.
• As of 2001, it is estimated that approximately 800,000 to 900,000 people are living with HIV/AIDS; 338,978 of these individuals have full-blown AIDS.
• Blood tests to screen the nation's blood supply and donor self-deferral measures have dramatically reduced the incidence of transfusion-associated HIV infections.
• Education, early diagnosis, and effective treatment services remain as the ultimate weapons to combat the HIV and AIDS epidemic.

Source: Centers for Disease Control and Prevention