Mosaic Science

Visually distinguishing cancer from non-cancer can be the most difficult part of brain surgery. Alex O’Brien writes about how scorpions, Amazon.com and the legacy of a dying girl are helping provide new tools.

Hepatitis C—often called the “silent killer” because it can progress unnoticed and diagnosed for decades—has a cure. The problem is finding those who need it.

There is a drug that can reverse an otherwise fatal heroin overdose within minutes. So why has it been such a struggle to get it into the hands of addicts?

A look at the donors, patients, doctors and scientists involved in the complex global network of rare—and very rare— blood.

A story about a handful of girls who have “syndrome X,” a rare disease that keeps their bodies in what seems to be a permanent state of infancy:

Brooke was born a few weeks premature at just over 4 pounds. She had many birth defects, including moderate hearing loss, dislocated hips and dysmorphic facial features. Her brain had abnormally large chambers of fluid and lacked a corpus callosum, the bundle of nerve fibres that connects the right and left hemispheres. She had trouble swallowing, and by six months was eating through a feeding tube in her stomach. She always coughed and wheezed. Her paediatrician labelled her with “syndrome X”, not knowing what else to call it.

By age three, Brooke had reached 12 pounds, and she hovered around that weight until age 12, when she appeared on Dateline. After watching the show, Walker tracked down Howard Greenberg’s address and sent him a letter about his scientific background and his interest in Brooke’s case. Two weeks went by before Walker heard back, and after much discussion he was allowed to test Brooke. He was sent Brooke’s medical records as well as blood samples for genetic testing. In 2009, his team published a brief report describing her case.

On the scientists working to bring consciousness back to patients in vegetative states or comas:

Kate Bainbridge, a 26-year-old schoolteacher, lapsed into a coma three days after she came down with a flu-like illness. Her brain became inflamed, including the primitive region atop the spinal cord, the brain stem, which rules the sleep cycle. A few weeks after her infection had cleared, Kate awoke from the coma but was diagnosed as being in a vegetative state. Luckily, the intensive care doctor responsible for her, David Menon, was also a Principal Investigator at the newly opened Wolfson Brain Imaging Centre in Cambridge, where one Adrian Owen then worked.

Menon wondered if elements of cognitive processing might be retained in patients in a vegetative state and discussed with Owen how to use a brain scanner to detect them. In 1997, four months after she had been diagnosed as vegetative, Kate became the first patient in a vegetative state to be studied by the Cambridge group. The results, published in 1998, were unexpected and extraordinary. Not only did Kate react to faces: her brain responses were indistinguishable from those of healthy volunteers. Her scans revealed a splash of red, marking brain activity at the back of her brain, in a part called the fusiform gyrus, which helps recognise faces. Kate became the first such patient in whom sophisticated brain imaging (in this case PET) revealed ‘covert cognition’. Of course, whether that response was a reflex or a signal of consciousness was, at the time, a matter of debate.

Anti-malarial drugs are quickly becoming ineffective as Plasmodium parasites from western Cambodia evolve resistance to them. The writer travels to the Thai-Burmese border to interview a French researcher named François Nosten who is working to eliminate malaria before the resistant parasites spread to other countries:

Nosten thinks that without radical measures, resistance will spread to India and Bangladesh. Once that happens, it will be too late. Those countries are too big, too populous, too uneven in their health services to even dream about containing the resistant parasites. Once there, they will inevitably spread further. He thinks it will happen in three years, maybe four. “Look at the speed of change on this border. It’s exponential. It’s not going to take 10 or 15 years to reach Bangladesh. It’ll take just a few. We have to do something before it’s too late.”

Hundreds of scientists are developing innovative new ways of dealing with malaria, from potential vaccines to new drugs, genetically modified mosquitoes to lethal fungi. As Nosten sees it, none of these will be ready in time. The only way of stopping artemisinin resistance, he says, is to completely remove malaria from its cradle of resistance. “If you want to eliminate artemisinin resistance, you have to eliminate malaria,” says Nosten. Not control it, not contain it. Eliminate it.