Immune System Pioneers Share America's Largest Prize in Medicine in Albany Today

I have to admit, I've been quiet on the blogging front even since explaining why the first few months of this year, I was effectively unable to do much d-blogging (I was in the process of moving). To some extent, my decision to be quiet on the blogging front since then has been driven by the fact that #1) my goal has always been to raise awareness of issues that others weren't aware of or communicating and #2) with the advent of social media sites like TuDiabetes and the proliferation of diabetes bloggers (referred to herein as d-bloggers). When I began blogging in the Fall of 2005, there were only a handful of us out there, including Scott Johnson, Amy Tenderich, Kerri Morrone-Sparling, Allison Blass, Allie Beatty, Gina Capone, Bernard Farrell and a few others.

Today, there are hundreds of d-bloggers, which has proven the viability of an informal group of people blogging about a common interest, in this case, type 1 diabetes. I am proud to be among the original members of the Diabetes OC (online community) and still remain a blogger (a few of the earlier diabetes bloggers have since stopped blogging).

Anyway, in keeping with my personal blogging mission of communicating truly "breaking" diabetes news, today's posting originates from Albany, NY (the capital of the state I now live in, and a place I generally feel makes news mostly for government waste, inefficiency, bureaucracy and all the things I despise about government, but generally NOT for its contributions to society). Today's news, however, marks a recognition of some great progress for autoimmune disease research which has taken place in a remarkably short period of time (in the medical profession, anyway).

The news: Today, the nation's richest prize in medicine and biomedical research was awarded to three immune system researchers for work in the field of immunology. The prize, known as the Albany Medical Center Prize, is the largest medicine/science award in the United States, and ranks second only to the $1.4 million Nobel Prize among medical prizes. The Albany prize was established in 2000 with a $50 million gift from the late Morris "Marty" Silverman, a New York City businessman who wanted to encourage health and biomedical research.

This year, the $500,000 Albany Medical Center Prize is being shared by Dr. Ralph Steinman of Rockefeller University, Dr. Charles Dinarello, of the University of Colorado, and Dr. Bruce Beutler, of The Scripps Research Institute in La Jolla, CA. The co-recipients of the Prize, who will share the award, were honored at a news conference and luncheon held today at the Hilton Garden Inn at Albany Medical Center.

So what's the Albany Medical Center Prize being awarded for?

Well, all three of this year's recipients have effectively transformed the emerging field of immunology with groundbreaking discoveries that led to a better understanding of how the human immune system senses and responds to infectious agents. The shared prize represents decades of work in three labs. Their scientific research has led to trials on new therapies for people with infections, autoimmune disorders, and other immune system-related diseases. Autoimmune diseases (and there are more than 80 such diseases) are among the most challenging for medicine to address. For most autoimmune diseases, patients are usually told there is no known cure for their diseases, and they're given palliative (meaning a remedy that alleviates symptoms without actually curing) medications intended to reduce the impact of their diseases, without actually changing the outcome of the diseases. But with new knowledge on how the immune system functions, more breakthroughs (and perhaps disease treatments or, dare I say it, cures) are likely to emerge in the future.

"Collectively, the work of these scientists has led to a dramatically better understanding of the human immune system, in health and in disease," said James J. Barba, president and chief executive officer of Albany Medical Center, who served as chairman of the National Selection Committee. "That knowledge has already directly resulted in new therapies for people with conditions including rheumatoid arthritis, diabetes, Crohn's disease and cancer. And, the discoveries they have made about how the body senses and responds to infection remain the basis of active research that holds the promise of new and improved vaccines and innovative ways to harness the power of the immune system to better fight viruses and bacterial illness. Their achievements are nothing short of astounding."

All three pioneers have extensively published research and have been cited by countless medical and scientific journals including the Lancet, Nature, The New England Journal of Medicine and the Journal of the American Medical Association. They have received numerous other prestigious national and international awards and honors as well as a number of honorary degrees.

Their work began with Steinman in 1973, when he discovered a white blood cell he named the dendritic cell. Dinarello then built upon Steinman's work to develop therapies to block the immune system's inflammatory reaction when it's harmful. Dinarello identified the molecule in the body that produces inflammation. Since discovering that molecule, later named Interleukin-1, he's focused his work on blocking it to relieve inflammation. This, and discoveries of different Interleukins, has resulted in treatment for several immune disorders (namely, autoimmune responses that cause diseases). Beutler then defined what another type of protein produced by the dendritic cells does for immune systems. It's called Tumor Necrosis Factor, or TNF. Beutler isolated TNF and explained that it also played a role in responding to inflammation. (For those of you following the Dr. Faustman/Nathan trial at Massachusetts General Hospital, just remember that her work builds upon the foundation of research discovered by Steinman and Dinarello). More recently, Beutler created a medication that blocks TNF when it goes haywire. The medication - brand name Enbrel - has been used to treat rheumatoid arthritis and psoriasis. Although Enbrel does not address the immune response which causes type 1 diabetes, it has lead to more research and trials, further expanding the medical profession's understanding of how the immune system works and ways to mitigate an immune response that causes disease.

For more in-depth biographies of the 2009 winners, and information on previous winners of the Albany Medical Center Prize in Medicine and Biomedical Research, go to: www.amc.edu/Academic/AlbanyPrize.

Their groundbreaking discoveries are best described in the press release at the following link:
http://www.amc.edu/PR/PressRelease/04_24_09_A.html

Another story from the Albany Times-Union can be found at
http://www.timesunion.com/AspStories/story.asp?storyID=793590

AP/Seattle Times
http://seattletimes.nwsource.com/html/health/2009115566_apusmedmedicalprize.html

If you recall, I documented some of the groundbreaking research into type 1 diabetes now in various stages of development. I would simply close by reminding everyone of the Boston Consulting Group chart (which has been widely-cited by the drug industry, anyway) on the various stages in drug industry development. In essence, treatments for autoimmune diseases are expected to emerge in the coming years:



Note that in red are events I've added to the chart to show some of the key developments (there aren't that many) relative to type 1 diabetes treatments. According to this observation (as you can see, most of it is retrospective), we stand on the edge of a new era in medicine and pharmaceutical development, and top on that list are treatments to address the core issue of autoimmunity, a group of some 80+ diseases (including type 1 diabetes) which have been pretty poorly addressed by the medical profession. You can see that around 2010 (less than a year away!), the next "wave" of drug development is expected to emerge.

For more on the pending trials for various type 1 autoimmunity trials, see my October 22, 2008 posting at http://sstrumello.blogspot.com/2008/10/not-hype-evidence-of-hope.html. Thanks to the researchers being awarded in Albany today, these trials are possible!

The 'Joy' of Misinformation

The mainstream media like to depict obesity, and too often make the mistaken claim that obesity shares a causal relationship with type 2 diabetes (the most common form), even though the validated scientific evidence on that is anything but conclusive. At best, there is a correlation, but as anyone who works with statistics can tell you (including me and my work with marketing research), it's a very big mistake to say that obesity causes the disease (see here for some critique of the routine confusion between these terms). Obesity is certainly not healthy, but it annoys me when the media routinely state things as facts when they aren't facts.

Correlation does not equal cause.

Too often, the media concludes a causal relationship among correlated observances when causality was not even considered by the study itself. Without clear reasons to accept causality, we should only accept correlation. Two events occurring in close proximity does not imply that one caused the other, even if it seems to makes perfect sense.

Anyway, statistics aside, the other day, Jenny Ruhl (Diabetes Update Blog) featured an interesting post about how the rise in toddler obesity pointed to genetic damage from pollutants. I am inclined to agree with her thesis. Indeed, I agree with her, but the larger obesity issue is often oversimplified to be the cause of type 2 diabetes and it isn't. Her posting made me think about the larger obesity problem and how the popular press seem to imply causal relationships where they don't exist.

High fructose corn syrup, a product of genetic engineering, overproduction of a crop the world doesn't really need more of, and let's not forget chemical production, may also contribute, but is it THE reason? Highly unlikely. There are many factors at work, and we can certainly point to changes in the American diet as another factor. Again, the mainstream press like to claim that junk food is the cause of this problem. While higher consumption of higher-calorie foods found at fast-food establishments can lead to obesity, even in the poorest neighborhoods, few residents eat every meal at the Golden Arches, even if it IS the only restaurant around.


A few months ago, the Los Angeles Times had a very interesting article entitled 'The Joy of Obesity' in which researchers examined the classic American cookbook and the most recent edition. Their finding:

In the classic American cookbook, which has been published since 1931, changes in ingredients and serving sizes have led to a 63% increase in calories per serving in many recipes featured in the book, according to a fairly recent study.

There are many reasons for the increase in the nation's obesity, and it may even deserve to be called an epidemic. But the press isn't doing us any favors by claiming some things as fact, when they aren't. If we are to have an honest discussion about how to address the nation's healthcare problems, our citizens cannot be relying on inaccurate information.

It's that simple.

Joy of Cooking' or 'Joy of Obesity'?
By Jeannine Stein, Los Angeles Times
February 17, 2009

Restaurants get a bad rap for serving gargantuan portions of food and contributing to Americans' expanding waistlines. But what if something in your home were equally guilty? Something as innocent as ... "Joy of Cooking"?

The classic "cookbook, first published in 1931, has done some girth-expanding of its own, a new study has found.

Published as a letter Tuesday in the Annals of Internal Medicine, the report examined 18 classic recipes found in seven editions of the book from 1936 to 2006. It found that calorie counts for 14 of the recipes have ballooned by an average of 928 calories, or 44%, per recipe. And serving sizes have grown as well.

Take beef stroganoff: In the 1997 edition, the recipe called for three tablespoons of sour cream. The 2006 edition calls for one cup.

Then there's waffles: In 1997, the basic recipe made 12 six-inch waffles; in 2006, the same ingredients made about six waffles.

Overall, the scientists found, changes in ingredients and serving sizes led to a 63% increase in calories per serving in 17 of the recipes between 1936 and 2006.

"When we talk about obesity, people like to plant the source of the issue on away-from-home dining," said Brian Wansink, the study's co-author and director of Cornell University's Food and Brand Lab. "But that raised the thought in my mind: Is that really the source of things?. ... What has happened in what we've been doing in our own homes over the years?"

Wansink and co-author Collin Payne, assistant professor of marketing at New Mexico State University in Las Cruces, said they wanted to quantify how home cooking had changed, but knew that doing it anecdotally wasn't scientific. So they turned to cookbooks, settling on "Joy of Cooking" because of its history and the fact that it had enough recipes carried through all editions.

In addition to beef stroganoff and waffles, recipes chosen for analysis included macaroni and cheese, goulash, Spanish rice, brownies, sugar cookies and apple pie.

Wansink said similar calorie increases were found in other enduring recipe books such as the "Better Homes and Gardens Cook Book."

The study found that some of the added calories in the dishes came from a substitution of ingredients -- extra meat instead of vegetables, for example. Back in the day, meat was expensive, so less of it was used, he said.

In other recipes, Wansink said, sauces were added, or more butter or sugar, or extras such as nuts and raisins. "They're now there for a little more excitement," he said.

Cultural shifts may have also had an effect on recipe ingredients and portion sizes, Wansink added. Families have gotten smaller, so a dish that once was consumed by eight people is now consumed by four.

And because sizes of dinner plates have grown over the years, a standard 2-ounce portion of pasta can now look diminutive.

Jeannie Gazzaniga-Moloo, a Roseville, Calif.-based registered dietitian and spokesperson for the American Dietetic Assn., said she was surprised by the findings.

"I would have expected that with the increasing awareness of nutrition, the calories would have been lower or stayed the same," she said.

Beth Wareham, editor of the 2006 edition, is not losing sleep over the study.

"It's such a tiny number of recipes. It's really a non-event," she said.

She said that the book has become more healthful overall, booting out many processed foods in favor of fresh ingredients. The 2006 edition has a chapter on nutrition written by Dr. Walter Willett, chairman of the nutrition department at the Harvard School of Public Health.

In putting together the latest edition, writers and recipe-testers used their common sense in terms of ingredients and serving sizes, Wareham said -- and they figured readers have some common sense of their own.

"We give Americans credit," she added, "for knowing that eating a brownie is not as good as eating a plate of whole grains and vegetables."

jeannine.stein@latimes.com

URL for this article:
http://www.latimes.com/news/science/la-sci-joy17-2009feb17,0,320694.story