Commentary in 1998

The self-organization of cells into complex interacting systems can be described using a branch of mathematics called nonlinear dynamics, which includes the study of chaos. Here, Donald Coffey explains how analysis of complex biological systems using nonlinear dynamics sheds light on the events leading to disorders as varied as epilepsy, heart disease and cancer

The Office of AIDS Research, a relatively small but Influential unit within the US National Institutes of Health, is responsible for “coordinating the scientific, budgetary, legislative, and policy elements of the NIH AIDS research program”. Here the new director, Neal Nathanson, presents his vision of how the nations $1 .7 billion AIDS research effort should be used to respond to the challenge of AIDS

Several neurodegenerative disorders are characterized by intracellular protein accumulations or inclusions, such as the Lewy bodies of Parkinson's disease. Although little is know about the origin of these accumulations and their specific affect on neurons, it seems likely that as they grow they prove fatal to the cell. Here Michael Brownstein and colleagues speculate on a broad role for alpha synuclein in the development of Lewy bodies and the other protein inclusions associated with neurodegeneration.

With the identification of several Alzheimer disease (AD)-associated genes, genetic testing for AD is possible. However, as for some other-late onset disorders, the ethical and social implications of such tests are considerable. In response to the commercial availability and the likely increased use of AD genetic tests, The Stanford Program in Genomics, Ethics, and Society formed a broad-based working group to examine the pros and cons of testing. Here they present their recommendations.

Despite exciting progress in the biology underlying a variety of proposed molecular medicines, an unmet challenge Remains—delivery. This problem, how to better target the new generation of therapeutics, cuts across all diseases. The solution offers unprecedented opportunities for multidisciplinary teams of bioengineers to work with biological and medical scientists to realize the fruits of our nation's investment in molecular and cellular medicine.

The Brockham Group was convened to investigate the growing problem of antibiotic resistance and to develop a strategy to improve our understanding and management of this phenomenon. Here they present their recommendations.

Barry Bloom (a Howard Hughes Investigator at the Albert Einstein College of Medicine) and Roy Widdus (Coordinator of the Children's Vaccine Initiative) describe their vision of global implementation of vaccines, highlighting what has already been achieved and, perhaps more importantly, what remains to be done. They also call for further efforts to develop the broad collaborations required to achieve a new vision for global vaccine use.

Ronald Saldarini (President, Wyeth-Lederle Vaccines & Pediatrics) discusses the factors that can hinder or encourage greater industrial investment in vaccine research and development. Saldarini argues that the commercial sector's commitment to vaccines has never been higher and that appropriate national and international policies on pricing and purchasing will ensure better implementation and continuing research.

Amie Batson (formerly with the WHO's Global Programme for Vaccines and Immunization and currently a World Bank Health Specialist) explains the relationship between public sector agencies and industry—each at the mercy of the other's strategic policies and both able to benefit from collaboration. Batson explores how a greater understanding and collaboration can lead to better strategies to assure global vaccine supply.

Anthony Fauci and Gregory Folkers (National Institute of Allergy and Infectious Diseases) discusses the role of US government agencies and the NIAID in particular, in the fight against infectious diseases and the part that vaccine research plays in this fight. From long term strategic decisions to specific research projects, Fauci illustrates the federal commitment to vaccine development and how it has and can impact both national and international health.

Last year, President Clinton made clear the urgent need for an effective HIV vaccine, and suggested that it should be possible to create one within ten years. The authors agree. Although recent progress should not be underestimated, many obstacles remain some technical, others not. Here, Dennis Burton (Scripps Research Institute) and John Moore (Aaron Diamond AIDS Research Center) outline their views on the state of development of an HIV vaccine and the areas in which more effort should be focused.