Commentary in 2000

Stem cell research, xenotransplantation and somatic and germ line gene therapy are examples of emerging technologies that, if successful, will forever change the way we live. But how well does the public understand the benefits and risks of these technologies, and whose responsibility is it to communicate them? Here, Erik Millstone and Patrick van Zwanenberg of the University of Sussex, UK, discuss whether science is suffering because of a lack of transparency in presenting scientific information to its main consumer group—the general public.

The development of clinical investigators remains a thorny national problem. The National Institutes of Health has instituted new granting programs to support clinical research that have already stimulated 450 new applications for support; private foundations have also joined the effort.

The discovery of coregulators and other recent advances in our understanding of the molecular biology of nuclear receptor action have generated expectations that these exciting basic advances will be translated into new diagnostic and therapeutic approaches for endocrine diseases such as breast cancer.

Whereas federal expenditure in the United States on the development of an HIV/AIDS vaccine is approximately $250 million, only $25 million is spent on research and development for a malaria vaccine. It is not malaria but tuberculosis (TB) that is the poor relation. Government funds for a vaccine to fight this disease are in single figure millions. Stefan Kaufmann of the Max Planck Institute for Infection Biology examines obstacles in addition to funding that hinder the development of a new TB vaccine.

Using recent advances in biological and medical sciences, a new candidate human immunodeficiency virus (HIV) vaccine has been developed and tailor-designed for a phase III clinical trial in Kenya. It has two components, DNA and MVA (an attenuated poxvirus), used in a prime-boost vaccination protocol. Both of these vaccine vehicles express a common ‘chimeric’ protein derived from small parts of the HIV genome. The vaccine focuses on the induction of cell-mediated immune responses.

Malaria kills over one million people, mainly children, in the tropics each year, and DDT remains one of the few affordable, effective tools against the mosquitoes that transmit the disease. Attaran et al. explain that the scientific literature on the need to withdraw DDT is unpersuasive, and the benefits of DDT in saving lives from malaria are well worth the risks.

In an attempt to broaden the current debate over proposed revisions to the Declaration of Helsinki, we define vulnerable subjects as those lacking basic rights, and examine the ethical risks inherent in research on such subjects. We then propose special ethical criteria for the conduct and publication of research on vulnerable subjects.

Global health problems require global solutions, and public–private partnerships are increasingly called on to provide these solutions. But although such partnerships may be able to produce the desired outcome, they also bring their own problems. A first-of-its kind workshop in April, hosted by the Harvard School of Public Health and the Global Health Council, examined the organizational and ethical challenges of partnerships, and ways to address them.

Based on early studies, it was hypothesized that expression of Fas ligand (FasL) by tumor cells enabled them to counterattack the immune system, and that transplant rejection could be prevented by expressing FasL on transplanted organs. More recent studies have indicated that the notion of FasL as a mediator of immune privilege needed to be reconsidered, and taught a valuable lesson about making broad conclusions based on small amounts of data.

The most exciting recently developed therapeutic approaches for glioma and other types of nervous system tumors involve combinations of immuno-therapy and neural stem cells. But we must bear in mind that the human brain differs greatly from the mouse brain, and that approaches that are effective in animal models may not always be safe for humans.

Malaria is a disease of poor countries. The development of malaria vaccines requires considerable investment, for which there is little commercial interest, particularly for transmission-blocking vaccines that have the public health objective of protecting communities from the spread of malaria rather than protecting individuals from the disease. Here, Carter et al. summarize the report of a committee of experts on the relevance and prospects for these vaccines.