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NEWS & VIEWS

SCIENTISTS MAKE PROGRESS ON WEST NILE VIRUS VACCINE

In March, scientists from the National Institute of Allergy and Infectious Diseases (NIAID) and the Walter Reed Army Institute of Research announced the discovery of a vaccine that prevents West Nile Virus (WNV) in mice. The vaccine, created from the genes of two similar viruses, protected immunized mice from the strain of WNV found in New York.

WNV was first identified in the United States in 1999 in New York, but has subsequently spread as far as the mid-west. It is a type of flavivirus, which is generally spread by parasites such as mosquitos, and often causes inflammation in the central nervous system. WNV is particularly dangerous because its symptoms are mild and easily overlooked, but it can cause deadly encephalitis. In the United States, almost 90 people have become seriously ill from the virus. Seven of those have died.

Scientists created the vaccine by replacing certain genes in a dengue virus – a type of flavivirus that does not attack the brain – with genes from WNV. The hybrid virus creates a strong immune response to the WNV portion of the virus, but does not cause encephalitis. Scientists observed a significant reaction in the immune systems of the mice from even single doses of the vaccine.

The researchers, who began working on the vaccine shortly after WNV was identified in New York, will soon begin testing the vaccine in monkeys, and hope to begin human trials by the end of the year. They expect to be able to move to human trials quickly because one of the dengue viruses used is already considered safe for use in humans.

JOHN M. EISENBERG, HEAD OF AHRQ, DIES

John M. Eisenberg, MD, who was Director of the federal Agency for Healthcare Research and Quality (AHRQ), died of a brain tumor in March at the age of 55. Dr. Eisenberg had served as the AHRQ Director since 1997, when it was known as the Agency for Health Care Policy and Research. AHRQ conducts and sponsors research on the quality, appropriateness, and effectiveness of health care services.

Prior to his appointment at AHRQ, Dr. Eisenberg was Chairman of the Department of Medicine and Physician-in-Chief at Georgetown University. He also served as a founding Commissioner of the Congressional Physician Payment Review Commission, and was the first physician to be elected to the Association for Health Services Research. Dr. Eisenberg was also a member of the Institute of Medicine of the National Academy of Sciences.

Jacque Bieber, Director of the AAN Center for Research, said Dr. Eisenberg's death was a great loss for health care. “Dr. Eisenberg has been a pace setter and champion for research and quality,” she said. “He invited the AAN to submit research questions to AHRQ so that neurology would be represented. Two of the AAN guidelines now in development – on stroke and Parkinson disease – started when the AAN submitted questions to AHRQ.”

NEW PAIN AND LAW WEB SITE

In response to the increasing focus on the adequate and timely treatment of pain – and the mounting legal repercussions of not doing so – the Center for Health Law Studies at Saint Louis University and the American Society of Law, Medicine, & Ethics created a new Web site on pain and the law.

Launched in March, the site, www.painandthelaw.org, features timely updates on news related to pain management, including federal and state legislation, court decisions, expert commentary, and professional resources.

The site includes links to articles about some of the controversial aspects of pain management – for example, the need to balance use of opioids and other pain medications against their potential for abuse and addiction.

The Web site also features subscription links to an e-mail newsletter that offers periodic updates on current news and pain legislation.

STUDY CLAIMS THAT HMO INCENTIVE PLANS DO NOT REDUCE PATIENT TRUST

One of the issues in the growing number of class-action lawsuits against health maintenance organizations (HMOs) is the practice of undisclosed incentive plans. These suits claim that physician incentives hurt patients and information about them should have been provided to patients. Although HMOs may have been secretive about their incentive plans for fear of damaging physician and HMO relations to patients, a new study claims that such fears are unfounded.

The study, published in the March 2002 issue of Health Affairs, polled 1,918 HMO members to determine their level of trust in their HMO and doctor before and after disclosing the HMO physician incentive policy. The trial subjects were then randomized into two groups; one was given the details about their HMO's physician payment plan, and the other was not. After a month, the questionnaire was given again to determine what change – if any – there had been to patient trust levels.

“We found that learning about cost containment incentives did not reduce people's trust either in their doctor or in the HMO,” said Mark Hall, Professor of Law and Public Health at Wake Forest University, who headed the research team.

The study's results showed that patient trust did not fall as a result of explaining the HMO's incentive plan. In fact, the trust of patients in the HMO that used a capitation plan actually rose a statistically significant 1.4 percent. Trust in the fee for service group rose, but not a statistically significant level. However, researchers point out, the total increase in trust of the subjects who learned more about physician incentives through this trial was three percent.

The HMOs studied were similar in that they both offered physicians financial bonuses for keeping patient satisfaction high, encouraging patients to use preventative services, and keeping within budget, but one HMO paid physicians on a capitation basis and the other paid them on a fee for service basis.

While the study's results seem to advocate disclosure of physician incentive plans, researchers caution that the study does have limitations. The incentive plans of the HMOs studied are more positive than those used by many HMOs, which could have had a significant impact on patient trust. Explanations of the HMO incentive plans also presented both the positive and negative aspects of physician incentives.

ADULT STEM CELLS RESTORE FUNCTION IN RATS

A study in the March issue of Experimental Neurology claimed that stem cells taken from the bone marrow of adult humans restored limb function in rats that had suffered ischemic stroke injuries. The study's principal investigator, Walter Low, PhD, of the University of Minnesota's Stem Cell Institute, said “The ability of bone marrow stem cells to…restore function in laboratory animals with stroke holds promise for people who have experienced a stroke.”

For the study, researchers extracted and expanded stem cells from human bone marrow and implanted them in the brains of rats seven days after the stroke. Before the transplant, the rats were not able to fully use any of their limbs, but several weeks following the transplant, the rats could again properly use their limbs. Furthermore, the transplanted stem cells developed into cells resembling the major cells of the brain: neurons, astrocytes, and oligodendroglia.

Previous research at the Stem Cell Institute had differentiated adult bone marrow stem cells into different types of cells when grown in a culture. The versatility and differentiation capabilities of these cells, called multipotent adult progenitor cells, could make them useful as a way to restore function after stroke.

According to Dr. Low, “There are many additional studies on these stem cells that need to be conducted before we can consider initiating any clinical trial.” Some of the questions that the researchers hope to answer are how long after stroke can cells be transplanted to restore function and whether the neural phenotype of the bone marrow stem cells will remain stable over time.