March 15, 2006

  • Biotech Implants, Pregnancy,













    Biotech Implants












    The maker of the VeriChip implant, about the size of a grain of rice, is targeting hospitals in the D.C. area. (Verichip Corp. – Verichip Corp.)

    Use of Implanted Patient-Data Chips Stirs Debate on Medicine vs. Privacy

    By Rob Stein
    Washington Post Staff Writer
    Wednesday, March 15, 2006; A01

    When Daniel Hickey’s doctor suggested he have a microchip implanted under his skin to provide instant access to his computerized medical record, the 77-year-old retired naval officer immediately agreed.

    “If you’re unconscious and end up in the emergency room, they won’t know anything about you,” Hickey said. “With this, they can find out everything they need to know right away and treat you better.”

    Roxanne Fischer felt the same way, and she had one of the devices injected into the arm of her 83-year-old mother, who has Alzheimer’s disease. “I may not be available if she ends up in the emergency room. This gives me tremendous peace of mind,” Fischer said.

    The two D.C. residents are among just a handful of Americans who have had the tiny electronic VeriChip inserted since the government approved it two years ago. But the chip is being aggressively marketed by its manufacturer, which is targeting Washington to be the first metropolitan area with multiple hospitals equipped to read the device, a persuasive factor for Fischer and Hickey. Within weeks, the first hospital is expected to announce plans to start routinely scanning all emergency-room patients.

    Some doctors are welcoming the technology as an exciting innovation that will speed care and prevent errors. But the concept alarms privacy advocates. They worry the devices could make it easier for unauthorized snoops to invade medical records. They also fear that the technology marks a dangerous step toward an Orwellian future in which people will be monitored using the chips or will be required to have them inserted for surveillance.

    “It may seem innocuous, but the government and private corporations could use these devices to track people’s movements,” said Liz McIntyre, who co-wrote a book warning about the dangers of such radio-frequency identification (RFID) technology. “It may sound paranoid, but this is bound to be abused.”

    The devices, originally developed to track livestock, have been implanted in more than 6 million cats and dogs to trace lost or stolen pets. For medical identification, the device — a microchip and a copper antenna encased in a glass capsule about the size of a grain of rice — is inserted, usually under the skin on the back of a patient’s arm, in a quick, relatively painless procedure. Each unit, which lasts indefinitely, transmits a unique 16-digit number that can be read by a handheld scanner. The number is used to locate a medical record previously stored on a secure Web site.

    Using the system, emergency-room doctors could scan unconscious or incoherent patients to quickly check their blood type and find out if they are taking any medications or have allergies or other medical conditions. Nurses could identify family members and determine whether patients are organ donors or have living wills. Surgeons could scan patients on the operating table to make sure they are working on the right person.

    VeriChip Corp. of Delray Beach, Fla., is selling kits containing scanners and the large-bore needles used to insert the chips, and recommending that doctors charge patients about $200 each. The company has sold about 2,500 chips worldwide for use in people, and several hundred have been implanted, including about 100 in the United States, spokesman John Procter said. So far in the United States, however, most of the chips have been implanted into the company’s own employees. Suspecting that many people are hesitant to get the chips until more emergency rooms are able to scan them, the company has begun giving scanners to hospitals for free, Procter said.

    Hackensack University Medical Center in New Jersey became the first hospital to begin routinely scanning emergency-room patients last summer, and about a dozen people in that area have now been “chipped,” Procter said. About 80 other hospitals nationwide have agreed to follow, a number the company hopes will reach 200 by the end of the year.

    Many of the hospitals, including three in the Washington area, have received scanners and started training their emergency-room staffs in their use, he said. Procter declined to name the hospitals until they formally announce their plans.

    One area doctor has begun implanting the chips.

    “I thought this would be important to offer to many of my patients,” said Jonathan Musher, a Chevy Chase physician the company hired to help recruit hospitals and assemble a nationwide network of doctors offering the chips. “With this, a quick scan back and forth across their arm could make all the difference in critical life-and-death situations where seconds count.”

    Privacy advocates, however, worry that the devices are prone to invasion because they can be surreptitiously scanned from a distance.

    “As far as I can tell, there are no security measures taken with the chip. It’s not a secure chip,” said Richard M. Smith, an Internet and privacy consultant in Boston. “There’s nothing to stop someone from accessing the code and cloning the chip” to access records, he said.

    Even though the medical information is stored in a protected computer, anyone with a password could obtain the information.

    “Once the identification number is obtained, who gets to decide who gets access to the Web site?” asked Janlori Goldman of the Columbia College of Physicians and Surgeons, who heads the Health Privacy Project, a Washington-based research and advocacy group. “Can law enforcement have access? Can public health workers have access? Can employers have access? Given the recent efforts by law enforcement and data monitoring by the government, this is exactly the kind of technology that would be attractive.”

    And, like any computerized database, it could be vulnerable to hackers.

    “We know from many other examples that there are lots of security breaches that occur across the country,” said Marc Rotenberg of the Electronic Privacy Information Center, another Washington research and advocacy group. “There’s no reason to think this will be any different.”

    Company officials and other proponents say the device and accompanying system are carefully designed to protect recipients.

    “The privacy of VeriChip’s customers is our highest priority,” said Scott Silverman, the chief executive of Applied Digital Solutions Inc., the firm’s parent company. “Both the amount of information and who has authorized access to that information is determined by the user.”

    Others worry about how the devices will be used in the future.

    “This device is intended to uniquely number humans. It’s embedded in the flesh, and it’s permanent. It can be read without someone’s knowledge and consent,” McIntyre said. “Scanners can be installed in doorways or ceiling tiles to track people’s comings and goings without people even being aware it’s happening. That’s not so far off.”

    Company officials scoff at those fears.

    “Some people say, ‘Oh, my God. It’s “1984.” It’s George Orwell,’ ” Musher said. “But this is a passive device. It’s not controlling or tracking anyone.”

    The company is, however, marketing the devices to limit entry to secure facilities. The Mexican government is using the implants like key cards for high-security offices. And CityWatcher.com of Cincinnati, which stores surveillance-camera footage from around the country, recently started using the chips to control access to tapes. Bars in Spain and Amsterdam, meanwhile, are offering the chips to patrons who want quick entry and to run electronic tabs.

    “We’re just waiting for the first case where a convicted sex offender on condition of release is required to have a VeriChip implanted,” Rotenberg said.

    For their part, Fischer and Hickey hope the devices catch on.

    “This is the wave of the future,” Fischer said. “I’m looking at this from the positive side. To obtain optimal care, I think we have to take advantage of the best technology available.”

    © 2006 The Washington Post Company


     







     


     







    Pregnancy




    Rick Friedman for The New York Times
    THE THEORIST Dr. David Haig sees pregnancy as a tug of war between mother and fetus over nutrients.


     


    March 14, 2006


    Silent Struggle: A New Theory of Pregnancy




    Pregnancy can be the most wonderful experience life has to offer. But it can also be dangerous. Around the world, an estimated 529,000 women a year die during pregnancy or childbirth. Ten million suffer injuries, infection or disability.


    To David Haig, an evolutionary biologist at Harvard, these grim statistics raise a profound puzzle about pregnancy.


    “Pregnancy is absolutely central to reproduction, and yet pregnancy doesn’t seem to work very well,” he said. “If you think about the heart or the kidney, they’re wonderful bits of engineering that work day in and day out for years and years. But pregnancy is associated with all sorts of medical problems. What’s the difference?”


    The difference is that the heart and the kidney belong to a single individual, while pregnancy is a two-person operation. And this operation does not run in perfect harmony. Instead, Dr. Haig argues, a mother and her unborn child engage in an unconscious struggle over the nutrients she will provide it.


    Dr. Haig’s theory has been gaining support in recent years, as scientists examine the various ways pregnancy can go wrong.


    His theory also explains a baffling feature of developing fetuses: the copies of some genes are shut down, depending on which parent they come from. Dr. Haig has also argued that the same evolutionary conflicts can linger on after birth and even influence the adult brain. New research has offered support to this idea as well. By understanding these hidden struggles, scientists may be able to better understand psychological disorders like depression and autism.


    As a biologist fresh out of graduate school in the late 1980′s, Dr. Haig decided to look at pregnancy from an evolutionary point of view. As his guide, he used the work of Robert Trivers, an evolutionary biologist at Rutgers University.


    In the 1970′s, Dr. Trivers argued that families create an evolutionary conflict. Natural selection should favor parents who can successfully raise the most offspring. For that strategy to work, they can’t put too many resources into any one child. But the child’s chances for reproductive success will increase as its care and feeding increase. Theoretically, Dr. Trivers argued, natural selection could favor genes that help children get more resources from their parents than the parents want to give.


    As Dr. Haig considered the case of pregnancy, it seemed like the perfect arena for this sort of conflict. A child develops in intimate contact with its mother. Its development in the womb is crucial to its long-term health. So it was plausible that nature would favor genes that allowed fetuses to draw more resources from their mothers.


    A fetus does not sit passively in its mother’s womb and wait to be fed. Its placenta aggressively sprouts blood vessels that invade its mother’s tissues to extract nutrients.


    Meanwhile, Dr. Haig argued, natural selection should favor mothers who could restrain these incursions, and manage to have several surviving offspring carrying on their genes. He envisioned pregnancy as a tug of war. Each side pulls hard, and yet a flag tied to the middle of the rope barely moves.


    “We tend to think of genes as parts of a machine working together,” Dr. Haig said. “But in the realm of genetic conflict, the cooperation breaks down.”


    In a 1993 paper, Dr. Haig first predicted that many complications of pregnancy would turn out to be produced by this conflict. One of the most common complications is pre-eclampsia, in which women experience dangerously high blood pressure late in pregnancy. For decades scientists have puzzled over pre-eclampsia, which occurs in about 6 percent of pregnancies.


    Dr. Haig proposed that pre-eclampsia was just an extreme form of a strategy used by all fetuses. The fetuses somehow raised the blood pressure of their mothers so as to drive more blood into the relatively low-pressure placenta. Dr. Haig suggested that pre-eclampsia would be associated with some substance that fetuses injected into their mothers’ bloodstreams. Pre-eclampsia happened when fetuses injected too much of the stuff, perhaps if they were having trouble getting enough nourishment.


    In the past few years, Ananth Karumanchi of Harvard Medical School and his colleagues have gathered evidence that suggests Dr. Haig was right. They have found that women with pre-eclampsia had unusually high levels of a protein called soluble fms-like tyrosine kinase 1, or sFlt1 for short.


    Other labs have replicated their results. Dr. Karumanchi’s group has done additional work that indicates that this protein interferes with the mother’s ability to repair minor damage to her blood vessels. As that damage builds up, so does her blood pressure. And as Dr. Haig predicted, the protein is produced by the fetus, not the mother.


    “When I first came across David Haig’s hypothesis, it was absolutely cool,” said Dr. Karumanchi. “And it made me feel like I might be on the right track.”


    Dr. Haig is now collaborating with Dr. Karumanchi and his Harvard Medical School colleagues to understand more about how exactly sFlt1 may cause pre-eclampsia. They describe their research in the latest issue of Current Topics in Developmental Biology.


    Dr. Haig also made some predictions about the sorts of maternal defenses that have evolved. One of the most intriguing strategies he proposed was for mothers to shut down some of the genes in their own children.


    This strategy takes advantage of the fact that most of the genes we carry come in pairs. We inherit one copy from our mother and one from our father. In most cases, these pairs of genes behave identically. But in the past 15 years, scientists have identified more than 70 pairs of genes in which the copy from one parent never makes a protein. In some cases, a parent’s gene is silenced only in one organ.


    Scientists do not fully understand this process, known as genomic imprinting. They suspect that it is made possible by chemical handles called methyl groups that are attached to units of DNA. Some handles may turn off genes in sperm and egg cells. The genes then remain shut off after a sperm fertilizes an egg.


    Only a few of these genes have been carefully studied to understand how they work. But the evidence so far is consistent with Dr. Haig’s theory. One of the most striking examples is a gene called insulin growth factor 2 (Igf2). Produced only in fetal cells, it stimulates rapid growth. Normally, only the father’s copy is active. To understand the gene’s function, scientists disabled the father’s copy in the placenta of fetal mice. The mice were born weighing 40 percent below average. Perhaps the mother’s copy of Igf2 is silent because turning it off helps slow the growth of a fetus.


    On the other hand, mice carry another gene called Igf2r that interferes with the growth-spurring activity of Igf2. This may be another maternal defense gene. In the case of Igf2r, it is the father’s gene that is silent, perhaps as a way for fathers to speed up the growth of their offspring. If the mother’s copy of this second gene is disabled, mouse pups are born 125 percent heavier than average.


    A number of other imprinted genes speed and slow the growth of fetuses in a similar fashion, providing more support for Dr. Haig’s theory. And in recent years, some medical disorders in humans have been tied to these imprinted genes. Beckwith-Wiedemann syndrome, for example, causes children to grow oversize organs that are prone to developing tumors. Some cases of the disorder have been tied to a mutation that replaces a mother’s silent copy of Igf2 with an extra copy of the father’s.


    “Both of the copies come from the father, and you get double the amount of Igf2, ” said Dr. Haig. The extra Igf2 appeared to cause a fetus to grow too quickly, leading to the syndrome.


    Dr. Haig’s work is now widely hailed for making sense of imprinted genes. “Molecular biologists had it worked out in exquisite detail, but they had no idea why it existed,” said Kyle Summers, a biologist at East Carolina State University. “Haig just comes in and says, ‘I know why this is happening,’ and explained it.”


    Dr. Haig has recently been exploring his theory’s implications for life after birth. “I think it can influence all sorts of social behaviors,” he said.


    Scientists have found that some genes are imprinted in the brain after birth, and in some cases even in adulthood. “Imprinted genes and behavior are the new frontier,” said Dr. Lawrence Wilkinson of the University of Cambridge. In a paper to be published in The Philosophical Transactions of the Royal Society of London, Dr. Wilkinson and his colleagues argue that the evidence on imprinted brain genes — preliminary as it is — fits with Dr. Haig’s theory. They call it “the most robust evolutionary hypothesis for genomic imprinting.”


    One major source of conflict after birth is how much a mother will feed any individual offspring. A baby mammal is more likely to thrive if it can get more milk from its mother. But nursing demands a lot of energy from mothers that could be used for other things, like bearing and nursing more offspring.


    It turns out that a number of imprinted genes are active in the brain, where they might influence how babies behaved toward their mothers. One strong candidate for that role in mice is a gene known as GnasXI. Normally the mother’s copy of the gene is silent. If the father’s copy is not working, mouse pups are weak sucklers. They draw so little milk that by 9 days old, they are a quarter of the weight of normal mice. Switching off the father’s copy of GnasXI may be putting a brake on the aggressive nursing of their pups.


    Some genes continue to be imprinted in the brain even in healthy adults. Dr. Haig has proposed that the evolution of these genes has been shaped by the groups in which mammals live.


    In many mammal species, females tend to stay in the groups where they are born and males leave. As a result, females tend to share more genes with other members of their group than males. A conflict may emerge between maternal and paternal genes over how the members of the group should act. Maternal genes may favor behavior that benefits the group. Paternal genes may favor behavior that benefits the individual.


    “You have to think about resources in a different way,” Dr. Wilkinson said. “Instead of thinking about foodstuffs, you have to think about social resources. Your mom and dad want different things from your behavior.”


    Dr. Wilkinson and his colleagues are beginning to identify genes that may play this role. One, known as Nesp55, is active in mouse brains. The father’s copy of the gene is silent. Dr. Wilkinson and his colleagues found that disabling the mother’s Nesp55 gene makes mice less likely to explore a new environment. Normally, the mother’s copy of Nesp55 may encourage the mice to take more risks on behalf of the group, whether that risk involves looking for food or defending the group. “It’s a possibility, but it needs to be proved,” said Dr. Wilkinson.


    Dr. Wilkinson suspects that conflict between imprinted brain genes may add to the risk for mental disorders, from autism to depression. Because one copy of each of these genes is silenced, they may be more vulnerable. “If you ask me, do I think that imprinted genes are likely in the next 10 years to crop up as mechanisms in mental disorders, I’d say yes,” he said.


    Dr. Haig has enjoyed watching his theory mature and inspire other scientists. But he has also had to cope with a fair amount of hate mail. It comes from across the political spectrum, from abortion opponents to feminists who accuse him of trying to force patriarchy into biology.


    “People seem to think, ‘He must have a political agenda,’ ” Dr. Haig said. “But I’m not talking at all about conscious behaviors. I’m just interested in these mechanisms and why they evolved.”





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