Commentary in 2004

This special supplement of Nature Medicine, directed at the topic of emerging infectious diseases, is very timely. Recent high-profile outbreaks have highlighted the global risk that infectious agents, both new and old, represent for society. The experience of severe acute respiratory syndrome (SARS) shows the risk posed by emerging infectious diseases, but also the power of strongly coordinated global surveillance and public health measures, coupled with scientific research, to keep infection under control^1,2. Diseases such as drug-resistant malaria continue to be threats. There is a need to enhance global resources to investigate, detect and respond to emerging infections, and to appropriately coordinate and direct research efforts to meet the challenges presented by these diseases.

Much progress has been made in recent years to strengthen local, state, national and international capacities to detect and respond to bioterrorism events and naturally occurring outbreaks of disease. New tools and systems are available to estimate the potential impact of a biological event and predict resource needs for effective response, enable earlier detection of an attack or outbreak, enhance diagnostic capacity and facilitate rapid intervention to mitigate the impact of an event on a community. These advances have required new approaches to preparedness, planning and surveillance, as well as new partnerships and collaborations across a range of disciplines. We examine some of these developments, discuss potential uses and limitations of these approaches, and identify priorities for the future.

Successful translation of modern molecular immunology into effective cancer immunotherapy is threatened by regulatory barriers and challenges to the development of novel agents and combinatorial strategies through effective public-private partnerships. For its promise to be fully realized, both the National Cancer Institute and Food and Drug Administration must take active steps to help academic investigators and companies jointly navigate the pathways from laboratory to clinic.

Research groups worldwide are trying to make immunogens intended to elicit neutralizing antibody responses as part of a prophylactic vaccine to counter the spread of HIV-1. The relative merits of different designs can only be gauged properly through comparative studies, and particularly by evaluating human or animal antisera under identical, or comparable, conditions. Hence there is a need for assay standardization and for the creation of a centralized testing facility that could distribute consensus protocols and reagents.

Biobanks will have a crucial role in the identification of genes associated with disease — a prerequisite to designing adequate diagnostic and therapeutic tools. To maximize their impact and chances of success, collaboration at a global scale is highly desirable.

The question “When are research risks reasonable in relation to anticipated benefits?” is at the heart of disputes in the ethics of clinical research. Institutional review boards are often criticized for inconsistent decision-making, a problem that is compounded by a number of contemporary controversies, including the ethics of research involving placebo controls, developing countries, incapable adults and emergency rooms. If this pressing ethical question is to be addressed in a principled way, then a systematic approach to the ethics of risk in research is required. Component analysis provides such a systematic approach.

Obese people, who are already subject to adverse health effects, are additionally victimized by a social stigma predicated on the Hippocratic nostrum that weight can be controlled by 'deciding' to eat less and exercise more. This simplistic notion is at odds with substantial scientific evidence illuminating a precise and powerful biologic system that maintains body weight within a relatively narrow range. Voluntary efforts to reduce weight are resisted by potent compensatory biologic responses. This article will review some of this evidence, together with promising avenues of research. Further progress in understanding and treating obesity will come not from repetition of anachronistic preconceptions but rather from the rigorous scientific approach that has driven advances in so many other areas of medicine.

Human/nonhuman stem cell chimeras will be increasingly applied to study human cells in developing nonhuman animals. Such experiments raise a number of issues that may create further controversy in the stem cell field. Here we outline the scientific value and ethical ramifications of such studies, and suggest how such experiments may be conducted ethically.

Several lines of evidence indicate that development of an effective vaccine for HIV-1 is going to be, at best, extremely difficult. The inability to solve fundamental scientific questions is the root cause for why a successful vaccine is not currently within our grasp. A renewed, organized, focused effort is needed to overcome these scientific obstacles.

Using stem cells to generate new neurons and replace those lost in diseases such as Parkinson and amyotrophic lateral sclerosis would be a major breakthrough, but significant hurdles remain before this goal can be realized. Instead, a more practical short-term approach may be to use stem cells to protect neurons dying in these diseases.