By Lisa Brown
A collaborative research team led by GSDM Professor of Molecular & Cell Biology and Associate Dean for Research Dr. Maria Kukuruzinska has identified a molecular explanation for at least a subset of cases of the disabling autoimmune disease Sjogren’s Syndrome. The team’s findings are published in the journal Laboratory Investigation.
Sjogren’s Syndrome (SS) is a complex autoimmune disease manifested by defective salivary and lacrimal gland function. The most common symptoms of SS are dry mouth and dry eyes, which can lead to dental cavities, vision problems, and thrush. SS also carries an increased risk for developing B cell lymphoma.
While the cause of SS has remained controversial, the prevailing dogma has been that immune system pathology drives the disease. The manuscript now provides evidence that defects in cell polarity, or cell structure, are the likely culprits in at least some cases of SS.
The collective expertise of the international multidisciplinary team of investigators—which included oral & maxillofacial surgeons, oral & maxillofacial pathologists, immunologists, as well as developmental, molecular, and cell biologists—facilitated the application of studies with models to human SS patients.
The authors showed that structural abnormalities acquired during embryonic development of the model salivary submandibular gland (SMG) mimic defects observed in embryonic SMGs from non-obese diabetic models predisposed to develop SS after birth. Furthermore, the authors provide a molecular explanation for SS by identifying dysregulation of the Hippo signaling pathway, a central pathway regulating the organ size, cell proliferation, and differentiation, as an underlying basis of this disease, which they validate in human labial biopsy specimens from SS patients.
The authors postulate that defects in embryonic salivary cell polarity may have a role later in adult tissue homeostasis and be exacerbated by hormonal conditions and/or environmental insults, potentially explaining the frequently observed late onset of this disease.
Submitted by GSDM Communications.
SPH Bicknell lecturer: what’s wrong with approach to obesity epidemic
This summer there was much rejoicing in the public health community over the recently announced falling obesity rate among preschoolers in many states, the first time in decades the rate has gone down.
“Although obesity remains epidemic, the tide has begun to turn for some kids in some states,” said Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), which had released the data. “While the changes are small, for the first time in a generation, they are going in the right direction.”
But for Paul Campos, a University of Colorado at Boulder law professor, concerns about obesity have been headed in the wrong direction for generations.
Campos, the author of the controversial 2004 book The Obesity Myth: Why America’s Obsession with Weight Is Hazardous to Your Health, has been a vocal critic of what he considers a self-defeating war on fat that has no basis in science and can have devastating consequences for women.
Campos argues that the health risks of obesity have been exaggerated by medical and public health professionals and the $50 billion a year weight-loss industry. Against a cacophony of voices calling attention to weight—from the CDC to First Lady Michelle Obama—he concludes that the health risks associated with body fat have been overblown, save for a small minority of people who are at the extremes of body weight.
Studies support the idea, says Campos, that a moderately active, moderately overweight person is likely to be healthier than someone who is thin but sedentary. He sees cardiovascular and metabolic fitness as more significant keys to health than a person’s body mass index (BMI).
Even if obesity carries risks, Campos argues, the solution is not to try to make fat people thin. In his view, the cycle of short-term weight loss, usually followed by weight regain, poses potentially serious health risks.
On Thursday, Campos will bring his critique of America’s obsession with weight to the School of Public Health, where he will deliver the 2013 William J. Bicknell Lecture. The lecture, titled The Obesity Epidemic: Is Focusing on Weight Hazardous to the Public’s Health? is free and open to the public and will be followed by a panel discussion on obesity that includes Frank Hu, a Harvard School of Public Health professor of nutrition and epidemiology, and Abigail Saguy, a UCLA associate professor of sociology and gender studies and author of What’s Wrong with Fat?
BU Today spoke with Campos about the hazards of fighting the war on weight.
BU Today: What was your reaction to the CDC’s childhood obesity findings?
Campos: Like most of these reports that come out about weight, I think it’s important to contextualize. Obesity among preschoolers, as an indicator, was just invented a few years ago by the CDC—not based in science, but just an arbitrary definition. Basically, they took the 95th percentile of the height-weight chart from the 1960s and 1970s and treated that as a definition of childhood obesity. So it’s kind of a made-up definition. And I have trouble seeing a decline in a made-up definition as a big deal.
In terms of context, rates of obesity and overweight have flattened out or declined all over the world. Much of the alarmism about obesity is based on projections that people were just going to get fatter and fatter, and it appears from the data over the last 10 to 12 years that this has just stopped. The alarmism in many ways has never been based on a sound scientific analysis, but on classic moral panic, in the sociological sense.
Where is that moral panic coming from?
There are several factors. One is a very straightforward economic one—there’s an enormous weight-loss industry in the United States. I don’t think most of this is really conscious at all—people’s economic interests just dovetail with beliefs. We have a very strong aesthetic preference for thinness in this society, and this gets medicalized. It becomes a sign of moral quality, essentially.
Another factor is that we have, in many ways, an eating-disordered culture in this country. Anorexia nervosa is rampant. If you look at the normal representation of a female body, it’s in the second percentile. That just feeds into this tremendous anxiety about weight.
There’s also a generalized anxiety about overconsumption, especially among the upper classes. Look at the popularity of the TV shows about hoarding—there’s a fascination with people consuming too much.
So there’s a social class element to this?
Absolutely. Obesity in our culture has become a marker for lower class status. This is something that makes people in higher economic status nervous. We think—who are these overweight people? Well, they’re people of color who are shopping at Walmart—and since we have a culture with a lot of downward mobility at present, that anxiety gets fueled by weight. It’s tied up with a lot of discriminatory beliefs and actions.
With women particularly, you have to get to extreme emaciation before you evoke a similar kind of revulsion from mainstream culture. Fatness is considered a respectable reason for scorn. We have this very stigmatizing culture surrounding weight.
If it’s so ingrained in our thinking, how do we fix it?
Well, first we have to give up on this phony notion that we somehow know how to make fat people thin. We don’t. Every discussion of this subject should start with an acknowledgment that we don’t know how to turn fat people into thin people.
I’m all for encouraging people of all sizes to be active and avoid eating-disordered behavior. Physical activity and nutrition are good things. What I’m not for is stigmatizing people and haranguing them about their weight. It doesn’t make them thinner, and it doesn’t make them healthier.
It’s like that old aphorism that defines insanity: Doing the same thing over and over again and expecting different results. That’s where we are with weight in this culture.
You are by training a law professor, not a health expert. What do you say to critics arguing that you lack the expertise to weigh in on weight?
I think what we’re talking about, when we talk about obesity, is a cultural phenomenon. That is, to refer to it as a health issue is already to engage in a kind of question-begging.
What academics from a whole bunch of disciplines have been criticizing is the idea of obesity and overweight, as it’s being defined, as a health issue. There’s a kind of language issue at the core of this. Obesity is a word that, by its very definition, pathologizes higher weight. Higher-than-average weight is being framed as a disease state. If the people who were authorized to speak on this are pathologizing weight to begin with, we have to ask: Should this be framed that way? I think it’s valuable to have people from a variety of disciplines talking about this issue. This is something that has many facets, health being one of them.
Health experts have criticized you for downplaying a serious public health problem. Why hasn’t your point of view gotten more traction?
Actually, there’s quite a vigorous debate within the health community on the question of how much is weight a causal factor in terms of health risk.
There are people who have criticized my work, but others who have been supportive of it. I think people mischaracterize what I say about the issue. I’m not saying obesity can’t pose a health risk for some people; it certainly can. I’m saying the cures that are being proposed are sometimes worse than the disease.
If the problem is that overweight people are more prone to disease than thin people, it does not mean the solution is to make people thinner. That can make the health consequences worse. There’s a debate right now because some people in the health community are beginning to grapple with the sort of crude and overly simplistic model that says, “If A has bad effects, then what we should be doing is getting rid of A.” It’s so much more complicated than that.
The 2013 William J. Bicknell Lecture in Public Health is Thursday, October 24, from 10 a.m. to noon at the School of Public Health Bakst Auditorium, 72 East Concord St. It is free and open to the public. The lectureship is named in honor of the late William J. Bicknell, founder and chair emeritus of the SPH international health department.
This BU Today story was written by Lisa Chedekel. She can be reached at email@example.com.
D.C. brawl touches Boston
Alan Jette has been trying to save the government a little money. The School of Public Health professor has been researching cost-effective ways to assess applicants claiming work disabilities so that they can receive Social Security benefits.
But his research has been has been halted by, um, a putative attempt to save the feds money.
“We have been asked to stop that work” as a result of the government shutdown, says Jette, a professor of health policy and management and director of the Health & Disabilities Research Institute, who had been collaborating with both the Social Security Administration and the National Institutes of Health. “We meet on a regular basis with our collaborators. But they’re all gone…furloughed, and they’ve been told they can’t use their emails. It has set back our work. It’s absolutely delayed everything.”
The shutdown, resulting from a standoff between President Obama and some congressional Republicans who have demanded he kill or delay his health reform law, has prompted full or partial stop-work orders on about seven BU research projects, including Jette’s, says Andrew Horner, vice president for research finance and operations. Among the affected efforts is the famous Framingham Heart Study (FHS), already reeling from the automatic spending cuts known as the sequester and federal policy changes. The study, begun in 1948 and run by BU since 1971, is the nation’s oldest large-scale study of cardiovascular disease.
The FHS is in the final weeks of studying offspring of the original participants, as well as minority participants. “Dozens of scheduled appointments for subjects from out of town have had to be canceled since the shutdown began” two weeks ago, says principal investigator Philip Wolf, a School of Medicine professor of neurology and a School of Public Health professor of public health. “This has created a significant hardship, since these subjects include participants who are the least likely to attend and the most difficult to encourage, as they are typically elderly and less well.”
Robert Kennedy got a full stop-work order for his work through the US Geological Survey capturing space-based views of Earth’s landscapes and studying how humans and nature change them. Projects with other agencies are continuing, but like Jette’s, Kennedy’s research is hampered by the unavailability of federal collaborators and data, says the College of Arts & Sciences assistant professor of earth and environment.
With deadlines approaching, “Each day of continued closure causes increasingly detrimental effects,” Kennedy says.
At least one affected researcher says the hit to his work has been minimal. Daniel Miller, a School of Social Work assistant professor, is part of a multi-institution project studying how the involvement of fathers who don’t live with their children can affect food insecurity for those children.
His project analyzes existing data, Miller says, obviating the need to pay for subjects or additional materials. Also, the project is scheduled to end in December, and he is spending less time on it. The one outstanding question, he says, is whether he and his collaborators will have federal money to travel to a conference next month to present their results.
Most non–University-funded research at BU is through grants, and those are proceeding, although some routine work has had to stop because the shutdown has idled federal personnel and administrative systems, Provost Jean Morrison wrote in an email last week to the BU community. But the University also has research that’s funded through 25 to 30 contracts with various agencies, representing “not a small dollar amount,” Horner says. Of those, “we have approximately seven contracts that received partial or full stop-work orders.”
Student recipients of federal financial aid would not be affected by the shutdown, according to Morrison. Active duty military personnel and veterans who have been approved for tuition assistance will receive the money, but the government closure has stalled applications for new benefits, she wrote.
Gloria Waters, vice president and associate provost for research, emailed researchers earlier this month with advice on what they could and could not do, depending on their government funding source–a tricky task, she wrote, as agencies’ information kept changing, and “each agency has provided separate guidance related to ongoing activities during the shutdown.”
Senators Monday scrambled to approve a deal that would reopen the government until January 15 and lift the debt ceiling—another battle between Tea Party Republicans in Congress and Democrats there and in the White House—until February. House Republicans meanwhile were stymied yesterday in coming up with their own plan.
Even temporary funding “would be preferable to the shutdown,” Wolf says, but the FHS “requires a clear path for research project planning and execution, and stopping and starting is a major problem.”
Congress has agreed to pay furloughed federal workers retroactively to October 1, the start of Uncle Sam’s fiscal year. “However, it’s unclear if that legislation will carry over to contracts,” says Horner. Once the shutdown ends, “we have some expectation that the government will make us whole, retroactive to October 1, but I wouldn’t take any money to the bank” on that.
In a statement cosigned by various education leaders, the Association of American Universities, a research consortium that admitted BU last year, decried the shutdown and looming debt default for their economic and human toll. “This stalemate threatens to exacerbate the cynicism Americans already feel about the function and importance of their government,” the statement says.
This BU Today story was written by Rich Barlow. He can be reached at firstname.lastname@example.org.
James Pokines, PhD, DABFA, assistant professor in the Forensic Anthropology Program at Boston University School of Medicine, recently co-edited a groundbreaking reference book, Manual of Forensic Taphonomy. The word ‘taphonomy’ derives from ancient Greek, ‘tapho’ referring to ‘burial’ and ‘nomos’ to ‘laws.’ The book presents the first update in the entire field in more than a decade.
The field of taphonomy examines postmortem changes in bodies, for both recent forensic cases and archaeological/palaeontological research on more ancient remains. The work examines changes to bones caused by multiple forces, including the effects of marine and freshwater environments, scavenging, thermal alteration, and human ritual and cemetery practices. The inherent variations in bone structure and morphology affecting their differential survival and the survivability of DNA in varying environments are also examined.
Dr. Pokines has over a decade of experience as a forensic anthropologist and forensic archaeologist. He holds an undergraduate degree in anthropology and archaeology from Cornell University, advanced degrees in anthropology from the University of Chicago and ABFA board certification in forensic anthropology. His research includes vertebrate osteology, zooarchaeology, taphonomy and paleoecology, and he has ongoing archaeological projects in the Bolivian Andes (Tiwanaku and related sites), the Nile Delta (Tell Timai) and the Paleolithic of northern Jordan. He is also the forensic anthropologist for the Commonwealth of Massachusetts, Office of the Chief Medical Examiner, Boston.
Researchers from Boston University School of Medicine (BUSM) and several other institutions including the National Center for PSTD, VA Boston Healthcare System, Suffolk University, Massachusetts General Hospital and Harvard University, have determined that psychophysiologic reactivity to trauma-related, script-driven imagery procedures is a promising biological predictor of a post-traumatic stress disorder (PTSD) diagnosis. These findings appear online in the Journal of Abnormal Psychology.
Approximately seven to12 percent of the general adult population in the U.S. suffers with PTSD. This disease develops after an inciting trauma. PTSD commonly affects military personnel who have faced combat, victims of sexual assault, people from conflict-ridden areas of the world, and patients who have survived intensive care unit admissions.
The researchers analyzed data from five prior studies with 150 study participants: 78 diagnosed with PTSD and 72 who had experienced trauma but did not develop PTSD. Researchers studied four main predictor classes including the measurement of psychophysiologic reactivity to trauma-related scripts; psychophysiologic reactivity to other stressful but non-trauma related scripts; self-reported distress in response to trauma-related scripts; and self-reported distress to other stressful but non-trauma-related scripts. Of the four indices examined, psychophysiologic reactivity to trauma-related cues appeared to be the most robust predictor of PTSD.
The researchers believe that these findings have significant implications for the field of psychiatry. “Psychophysiologic reactivity to script-driven imagery is a potential experimental paradigm that could be used to index an individual’s fear response,” explained principal investigator Suzanne Pineles, PhD, assistant professor of psychiatry at BUSM and clinical psychologist at the National Center for PTSD at the VA Boston Healthcare System. “Future research may extend the use of this paradigm to other populations. For example, it is possible that individuals with other fear-based disorders, such as phobias or panic disorder, would exhibit similar patterns of reactivity to scripts describing their fear.”
Funding for this work was provided by a VA Career Development Award from the Clinical Sciences R&D Service, Department of Veterans Affairs.
Beginning Sept. 1, BU Henry M. Goldman School of Dental Medicine (GSDM) student Matthew Green DMD 15 began a one year term as the New England Regional Representative for the American Association for Dental Research (AADR) National Student Research Group (NSRG).
AADR NSRG is a student-run organization motivated by a mission to cultivate a rich environment for research in dental education. The organization comprises a network of self-governing Student Research Group (SRG) chapters at individual US dental schools. Nationally, the NSRG is led by elected officers.
Green is currently Secretary of the GSDM SRG chapter. In his new national role as NSRG New England Regional Representative, Green will network with local SRG chapters to encourage excellent and abundant student research in the region. Institutions that Green will work with include Tufts University, Harvard University School of Medicine, University of Connecticut, Dalhousie University, the Forsyth Institute, McGill University, University of Laval, University of Montreal, and the University of New England.
Green said, “As modern dental medicine evolves rapidly, it is critical to have a solid core of young dental researchers. As a regional representative, it is important for me to gather support and people willing to tackle the most pressing issues facing dentistry.”
Green continued, “My role as a regional representative is critical in keeping an open line of communication between the national and local levels. I am excited for my role, ensuring my fellow dental researchers have proper guidance, support, and funding for the research of oral and craniofacial sciences.”
Dean Jeffrey W. Hutter said, “Congratulations to Matthew on his appointment as NSRG New England Regional Representative. I am proud to have a student from our School take this important role of communicating on a national level on behalf of the entire New England region.”
This story was submitted by GSDM Communications.
Professor and Chairman of the Department of Urology at BU School of Medicine Richard K. Babayan, MD, has received the Joseph B. Dowd, MD, New England Section Lifetime Achievement Award. Dr. Babayan also serves as the Chief of Urology at Boston Medical Center.
In recognizing Dr. Babayan, New England Section President, Dr. Mark Plante stated that “he has always cared not only about the Section, but in mentoring young urologists both at his own institution and throughout all of New England. He never tires of sharing his time, his insight, and his passion for urology and service. We are grateful and fortunate to have Dr. Babayan as a part of our Section.”
Since its inception in 1999, the Dowd Award has only been given to three other urologists who have been recognized for their exceptional service and dedication to the New England Section. The award criteria states “Upon the unanimous consent of the Board of Directors, this honor shall be bestowed to a deserving individual who aspires to the many ideals set forth by the late Dr. Dowd – dedication to the practice of urology and longstanding service to the New England Section.” The award was presented at the NEAUA annual meeting in Hartford, Conn. in September.
Chronic Hepatitis C Virus Infection Associated with All-cause and Liver-related Mortality in HIV-infected Patients with Alcohol Problems
Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center(BMC) have found that chronic hepatitis C virus (HCV) infection is associated with all-cause and liver-related mortality in a group of human immunodeficiency virus (HIV)-infected patients with alcohol problems. The findings appear online/in the current issue of Addiction.
HCV is a known cause of cirrhosis and liver cancer. Prior studies have confirmed that liver disease is a major cause of death among patients with HIV infection. Persons with HCV are more likely to use alcohol and other drugs compared to those who are uninfected. Prior studies that have examined the association between chronic HCV infection and mortality have often lacked person-level data on alcohol and other drug use.
The researchers analyzed data from a cohort of HIV-infected adults with current or past alcohol problems enrolled between 2001 and 2003, searching for causes of death using the National Death Index.
A total of 397 adults (50 percent HCV-infected) were included in the study. As of December 31, 2009, 83 cohort participants had died (60 HCV-infected, 23 HCV negatives), and 26 of those deaths were liver-related (21 HCV-infected, 5 HCV negatives). “HCV infection was independently associated with all-cause and liver-related mortality, even when adjusting for alcohol and other drug use,” explained lead author Daniel Fuster, MD, a postdoctoral scholar from the Clinical Addiction Research and Education Unit at BMC and BUSM.
According to Fuster says “these results underscore that HCV is a risk-factor for all-cause mortality, and not just liver-related death, among patients with HIV with alcohol problems even with adjustment for potential confounders such as alcohol, smoking and other drug use.”
This study was supported by funding from the NIAAA R01-AA13216 and K24-AA015674, and from the NIDA R25-DA13582.
On the sunny and crisp fall day in September, volunteers representing the Boston University Henry M. Goldman School of Dental Medicine (GSDM) participated in the Bay Cove Human Services annual wellness fair at the Gill Wellness Center in Jamaica Plain.
Bay Cove Human Services is a private, non-profit corporation that provides a wide range of services to individuals and their families with developmental disabilities, aging, mental illness, and drug and alcohol addiction. The organization holds the wellness fair to improve health awareness through education and prevention.
Some of the offerings to attendees of the fair were health screenings, blood pressure and glucose checks, and information on community-based health services. Attendees were treated to music and food and also participated in wellness activities, such as yoga.
Led by Oral Health Promotion Director Kathy Lituri, the GSDM volunteers offered oral health care education, screenings, and referrals to the fairgoers. The volunteers were Clinical Instructor of Health Policy & Health Services Research Martin Ugarte-Chavez, Peter Meaney DMD 14, and pre-dental students Rohit Gupte, Albert Song, and Arina Sorokina (GMS).
This story was submitted by GSDM Communications.
Garden, recreation space offers students welcome respite
Just over a year ago, Karen Antman was strolling past the newly opened Medical Student Residence on Albany Street when she spotted students tossing a football in the small courtyard abutting the building. The tight space called for some creative, and potentially dangerous, catches.
“They kept careening into the benches and rose bushes,” says Antman, dean of the School of Medicine and Medical Campus provost. “Clearly they needed a field.”
Coincidentally, there was a wide-open space behind the building, where two additional residences will be built once funding and city approval are secured. Realizing that students needed recreation space immediately, Antman approached John Barton, Medical Campus executive director of facilities, with the idea of transforming the site into a green space that could be used for sports and other activities. Working together, they developed a plan and a budget. Antman says that Barton was the one who dubbed the space the “Field of Dreams.”
“The name stuck,” says Antman, MED’s John Sandson Professor of Health Sciences. “I presented a plan at our Dean’s Advisory Board this spring, and volunteers had funded it by the end of the meeting.”
The donors, who prefer to remain anonymous, covered the $90,000 construction cost, and work was completed in August. The field now boasts an NBA-sized basketball court, a sand volleyball court, and a grass field for sports like soccer, Ultimate Frisbee, and football as well as nine raised vegetable beds, where students can help themselves to fresh produce.
The Field of Dreams offers an essential respite to the stress of medical school. “No matter how wonderful a student you were before, medical school is difficult,” says Angela Jackson, a MED associate professor of medicine and associate dean for student affairs. “It’s more demanding, more anxiety-producing, and just being able to balance life is impossible.” And while extracurricular activities are available for MED students, Jackson says, “there is something about just getting your hands in the dirt and eating the product of your work.”
On a recent autumn afternoon, Barton swipes his BU identification card to enter the gated field. Any BU student with a valid ID has access to the area. So far, Barton says, the University has had no problems with trespassing or vandalism, despite the high-traffic area.
There’s still some work to do on the field. Barton points to the volleyball court, which he’d like to expand in the coming months, and the grass that’s been reluctant to take hold. Still, the field is already popular. On a recent weeknight, students were playing a pickup basketball game on the new court. And the garden, although tired and wilting after a long growing season, produced a nice crop of eggplants, kale, Brussels sprouts, tomatoes, and a wide variety of herbs.
Claire Wang (MED’16) comes to the garden occasionally to pick bell peppers and chilies to mix into stir fries, and she sees people playing basketball nearly every night. Without the field, most students would have to go to a gym, the Charles River Campus, or the South End to play sports, she says. “It definitely allows students to have access to their hobbies.”
Jackson recruited students via email to participate in the garden. Those interested compiled a wish list of fruits, vegetables, and herbs. Some even solicited suggestions from parents knowledgeable about gardening. After pruning their choices, the students presented a list to Jackson, Antman, and Barton, and Barton’s team planted them in early summer.
“This year was trial and error,” says Barton, who envisions planting fruit trees and blueberry bushes in the future.
Although the field is enhancing the quality of life for current MED students, it will eventually be replaced by two buildings that will provide critically needed additional housing. The first will eliminate the raised beds and sand volleyball court; the second will occupy the remainder of the field.
“Given the fundraising required for either building,” Antman says, “I believe we will have most of the field for some time.”
This BU Today story was written by Leslie Friday. She can be reached at email@example.com.