The New England Journal of Medicine is unusual among the biggie journals: Assuming the post office doesn’t screw up, doctors actually get their copies a day or two before the stated embargo date on the cover. So in theory they have a chance to scan the hard data before reading about the study in the newspaper. By contrast, Nature and Science arrive in scientists’ mailboxes the week after the cover date, which means that the only way a scientist can see the study in question ahead of time is if a reporter faxes it to the person. Thus, scientists often learn of the latest studies the way everybody else does, over coffee and a Danish.
NEJM, then, is a little better about tying its embargo policy to its stated intention that the news should be kept under wraps until experts see it first. But, Atul, by writing about the gene-therapy paper here, on a popular news outlet like Slate, the morning before the NEJM cover date, you have BROKEN THE EMBARGO. I’m surprised they’re even letting you into the operating room now!
By the way, journalists do get previews of the upcoming NEJM issue, in the form of the table of contents and smooth, press-friendly synopses, as well as an early copy of the journal proper.
I’m delighted, though not surprised, that the results of the “bubble boy” study are so positive. The indications all along were that the approach could work for this disease if the patients were treated in infancy. Gene therapy seems ideal for certain single-gene immune disorders, don’t you think? It’s much easier to monkey around with blood cells than to manipulate, say, liver or brain cells. And it’s much more straightforward to replace an inoperative gene—the cause of severe combined immunodeficiency disorder—than to correct a “bad” gene, like the one that prompts blood cells to twist up in sickle-cell anemia. What remains to be demonstrated is that gene therapy can have wider utility, not only for rare and devastating single-gene disorders, but against chronic diseases, or common killers like heart disease or cancer.
Speaking of heart disease, what do you think of today’s news that angioplasty is so superior to clot-buster drugs in the treatment of heart attacks that patients who’ve had a cardiac arrest should be taken to a place where a trained team can go in there and ream out the clogged arteries, rather than to the nearest hospital? I’m curious: Just how hard is it to do angioplasty? Do you do it regularly, or is this strictly the purview of your cardiac specialists? And I can’t help but wonder whether you’re planning to specialize in a particular type of surgery, or if you’re going to be a much-needed general surgeon—a species that apparently is on the medical endangered list?
The thought of endangered species brings me to my final concern of the morning: the future of frogs. A new study in my fave journal, Proceedings of the National Academy of Sciences, shows that male frogs exposed to the tiniest quantities of the weedkiller atrazine developed deformed, partly feminized sex organs. Atrazine, the most widely used weedkiller in this country, apparently spurs cells to turn the male-making hormone, testosterone, into the so-called female hormone, estrogen; and male frogs exposed to doses of atrazine as small as one-thirtieth the amount permitted in our drinking water show signs of hermaphroditism. Granted, we have no idea yet what this portends for humans—who don’t, as one researcher pointed out, spend as much time in the water as frogs do—but the finding nonetheless underscores one of those fundamental, irritating bits of reality: A compound that kills one thing is not likely to be good for other things. We’re all descended from common stock. Cells are cells, DNA is DNA. If you want to kill mosquitoes, are you willing to accept a certain modest level of neurotoxicity in your environment? If you want a green, clean lawn, will you mind that the rate of some hermaphroditic, or intersexual, conditions might rise slightly in the general population? Conditions like hypospadias, in which the urinary opening is on the underside of the penis, rather than at the tip? Statistics on the incidence of genital abnormalities are notoriously difficult to pin down; I’ve tried for a number of stories. But there are indications that things like hypospadias may be slightly on the rise.
Now, here’s a question. Is that necessarily terrible? I’m not discounting the medical difficulties that accompany some intersexual conditions. But I must say that the many people in the “intersex community” that I have interviewed over the years are some of the smartest and most interesting people I’ve ever met. Is it possible that the same odd mixture of testosterone and estrogen during fetal development that ends up giving a child unusual genitalia is in fact the ideal ratio for optimal brain development?