Recently, I saw a portrait-like, three-dimensional ultrasound image of an unborn baby’s face. It was amazing. The parents loved it, and will no doubt frame it for life. But with a national discussion about healthcare continuing, does such an image make any medical sense?

Before I could think long about that question, I came across the 2009 Comparative Price Report on Medical and Hospital Fees by Country from the International Federation of Health Plans. In that large collection of data, one comparison—the cost of a well-baby visit—made me think back about the 3D ultrasound image.

Sure, such a well-baby visit probably varies from one country to another. But does the high-end cost of $148 in the U.S. really provide a nearly 10 times better visit than the $15 charge in Germany? Or do the parents in the U.S. just get ultrasound portraits and other extras? Moreover, do those extras lead to healthier babies?

This issue reminds me that changing the value of healthcare depends on the providers and the customers. The providers might charge more than necessary, but the customers might also request more than is necessary. Like good health, good healthcare requires balance.

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To treat cancer with radiation, oncologists have battled competing problems: killing cancer cells without harming healthy ones. In Radioprotection in Normal Tissue and Delayed Tumor Growth by Blockade of CD47 Signaling in Science Translational Medicine, researchers from the University of Pittsburgh School of Medicine and the National Cancer Institute described a surprising finding, which can be best described in an image and caption:

Tumors have elevated expression of CD47 which serves as a “don’t eat me signal,” bypassing the action of phagocytic cells. Also as a consequence of ionizing radiation, phagocytic cells such as macrophages undergo cell death reducing the number of these cells in the tumor microenvironment, reducing the phagocytosis of tumor cells. Under CD47 suppression phagocytic cells are protected from ionizing radiation, and tumor cells are exposed to engulfment by phagocytic cells which reduces tumor growth. [Image © Science/AAAS]

In these experiments on mice, these scientists found, in particular, that CD47 can be suppressed by blocking it from getting bond by a molecule called thrombospondin-1. So if the binding between thrombospondin-1 and CD47 gets blocked, radiation kills cancer cells but not protective phagocytes, which can attack the tumor cells. Although no one knows how this works, these scientists showed similar results in a range of tissues, including bone-marrows cells, muscle and skin.

This finding could lead to treatments that hit cancer harder and produce fewer side effects.

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Last week, I visited The Houston Museum of Natural Science. I wandered through exhibits of dinosaurs and gems, and I even rode thousands of feet—virtually, that is—below ground in an oil-drilling bit. Perhaps best of all, I lingered for some time in The Cockrell Butterfly Center. It made for a magical day.

What is your favorite science museum?

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To learn something new about food—be it the sensation and perception behind eating or the business thinking of food makers—take a tour of science, sociology, and commercialization with David A. Kessler, former commissioner of the U.S. Food and Drug Administration in his recent book:

Early in this book, Kessler describes asking an unnamed food-industry executive if food is designed to be highly hedonic, as Kessler describes the reply:

“Oh, absolutely,” [the food executive] replied without a moment’s hesitation. “We try to bring as much of that into the equation as possible.”

That surely explains some of today’s epidemic obesity.

In addition to assessing the intent of the food industry, Kessler takes readers through a journey of the neurophysiology and psychology of eating. It is well worth the read.

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If you want to catch up on stem-cell research, the following videos will bring you up to speed on some of the basics.

Everything You Wanted To Know About Stem Cells… But…

• useful review
• good information
• mediocre production

Johns Hopkins Medicine: A Century of Stem Cells

• nice, quick history

Life-Saving Research in to Stem Cells – Horizon – Lifeblood

• BBC production
• stem cell from cord blood

Mapping Stem Cell Research: Terra Incognita

• PBS production
• long but good story
• ethics mixed with science

SIRA: Could Stem Cell Therapy Renew Your Body Cells?

• primarily neural stem-cell information

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In pharmaceutical development, adding dose-response techniques to earlier steps could improve efficiency. In PLoS Computational Biology, Rui-Ru Ji of Bristol-Myers Squibb and colleagues published Transcriptional Profiling of the Dose Response: A More Powerful Approach for Characterizing Drug Activities. This article describes how to use 12 arrays per compound to study the dose response—in this case, based on responses of kinase inhibitors. As the authors write:

We developed analytical methods that identify transcripts responsive to dose, calculate classical pharmacological parameters such as the EC50, and enable an in-depth analysis of coordinated dose-dependent treatment effects.

This technology could be applied to a range of steps in drug development. Moreover, it could help to reveal dose-related molecular mechanisms.

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Given the wide range of available diagnostics and therapies, a physician cannot prescribe one over another without comparative data. According to Controlling Health Care Costs While Promoting The Best Possible Health Outcomes from the American College of Physicians (ACP):

U.S. pharmaceutical and biotechnology research companies spent $58.8 billion in 2007 on research and development. Much industry R&D was for Phase 3 and 4 clinical trials, but relatively little of this was for comparative studies of clinical effectiveness. National expenditures on comparable effectiveness research are miniscule compared with total health care spending.

That means that physicians have little data to use to make decisions. As a result, it’s no surprise that unnecessary things get done. As the ACP report continues:

The Congressional Budget Office estimates that 5% of the nation’s Gross Domestic Product—$700 billion per year—is spent on tests and procedures that do not actually improve health outcomes.

As the United States thinks about healthcare reform, we should find ways to fund comparative studies.

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Fierce Pharma recently posted the Top 15 Bestselling Drugs of 2008. Graphically, here’s the results:

The 2008 sales go from 7.77 billion for Lipitor—a cholesterol-lowering drug—to 2.9 billion for Lexapro, which is an anti-depressant.

By putting these drugs in categories based on what they treat, here’s the breakdown:

Cardiovascular medications make up the largest chunk—or 32 percent of the total sales of the top 15 sellers. That’s no surprise when that category includes Lipitor, Plavix (an anti-clotting medication), Neulasta (which can increase the count of white blood cells after chemotherapy), and Epogen (which treats anemia).

To me, it was a bigger surprise that asthma medications in the top 15—Advair and Singulair—bring in a combined $7.82 billion a year in sales.

For an era that is supposedly beyond the blockbusters, 2008 saw many billion-dollar-a-year drugs.

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In Adding Experience to Science Education, I discussed the value of bringing hands-on tasks to science education, and more scientists than I knew already do just that. For example, Rachel D. Fink of Mount Holyoke College wrote recently in PLoS Biology about her “Science Buddies” program in It’s Elementary: Science Buddies Bring Biology to Life. After bringing hands-on biology to local elementary students, Fink also got undergraduates going into the schools to provide demonstrations and just expand the science-education opportunities in general.

In Finks’ program, she found that it helped every student involved—the elementary students, as well as Fink and her undergraduates. As Fink writes about “Science Buddies:”

Conceived as a way to help enrich the local science curriculum, the program has served as a training ground for young science educators, opening the eyes of college students to the joys and challenges of primary school teaching.

Do other scientists have similar experiences to share?

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Instead of seeing the future of pharmaceuticals as the end of blockbusters, maybe it is more like the beginning of precision drug discovery. In BMC Bioinformatics, Nobuyoshi Sugaya and Kazuyoshi Ikeda of PharmaDesign in Tokyo describe one higher-precision approach in “Assessing the druggability of protein-protein interactions by a supervised machine-learning method.” Here, the authors describe a supervised machine-learning method that searches for protein-protein interactions that could make good targets for small molecules.

Such an approach can look at lots of potential targets quickly—potentially reducing breadth of the protein space to explore. As the authors write:

… there is both need and opportunity for development of a methodology that can efficiently select drug target PPIs [protein-protein interactions] by holistic assessment of the druggability of PPIs with the omics data.

Moreover, in the best cases, Sugaya and Ikeda’s technique found known examples of good targets in protein-protein interactions from others with an accuracy of 81 percent.

So technologies such as this one, could enhance the precision of drug discovery by going after the targets with the most potential.

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