It’s happening right in our back yard. At Brown University, at major local hospitals, in business and academic labs, and in private medical practices, cutting-edge research is being conducted that promises to prevent and cure cancer, protect millions from HIV infection, make paraplegics walk again, and much more.
At Brown alone, the growth in this field has been daunting – a 75-percent increase in life-science lab space in three years, including the new Sidney E. Frank Hall for Life Sciences; a slew of new faculty members in biology, medicine and public health; and a $100 million gift from the Warren Alpert Foundation, which Brown has called “transformational.”
Total external funding for Brown’s Division of Biology and Medicine (including the medical school) and its teaching-hospital partners has grown to $200 million per year, doubling in the past five years alone.
The school has become home to three National Institutes of Health Center of Biomedical Research Excellence (COBRE) facilities, in genetics and genomics; heart and lung development in fetuses and babies; and cancer biology. Plus it has an NIH-funded Center for AIDS Research; a $7.2 million grant for limb-loss research involving war veterans; and a federally designated Center of Excellence in Women’s Health.
The breakthroughs being made by these scientists range from a potential microbicide to prevent the spread of HIV – based on genetic modifications to bacteria found in yogurt – to brain sensors connected to computers that allow paraplegics to move objects by thinking.
New insights on the nature of a substance found in human joints promise to help prevent and better treat arthritis. Research on the toxicity of nanomaterials – funded by a $1.8 million National Science Foundation grant – will help ensure these groundbreaking new materials are safe for medical uses and their full potential can be realized.
And on the public-policy and public-health front, local researchers are making a national impact in geriatrics, drug and alcoholism treatment, HIV prevention and much more.
But that’s all big-picture research – basic and applied science and large-scale policy work that may make national headlines and help transform medicine, but doesn’t really apply to local residents’ lives today.
That said, there are dozens of other projects at Brown, local hospitals and other facilities that do have an immediate impact. What follows is a sampling:
Small changes
Rena R. Wing, director of the Weight Control and Diabetes Research Center at Brown Medical School and The Miriam Hospital, has been studying obesity and its links to diabetes for many years, publishing more than 200 articles on these topics.
Now she’s turned her attention to young adults, for whom being overweight can be a prelude to a lifetime of obesity-related health problems. As it is, young adults typically gain about a pound per year as they age, Wing said in an interview, and if they already have a problem, they are less likely than older adults to join a weight-loss program.
It’s not surprising that young adults – ages 18 to 35 – don’t join such programs, Wing said, because the people they’d encounter there are likelier to be in the 45- to 50-year-old range, not their peers. They have different issues in their lives; they can’t relate to one another.
So Wing has developed programs to try to prevent weight gain in young adults, studying different strategies tailored specifically to their needs. And she’s looking at one theory: that small changes might make a bigger difference in the long haul than a single major effort.
For example, is it more helpful to dramatically change your diet to cut back to, say, 1,500 calories a day, and join a gym? Or would you do better to wear a pedometer and make a point of walking an extra mile a day, or cutting back to one soda per day, or switching from whole milk to skim milk?
“One of the nice things about our research projects is everybody gets a weight loss program and [it’s] free,” Wing said. So by agreeing to fill out questionnaires at the beginning, the middle and the end, and being part of the project, she noted, you get a lot of benefits.
Wing is actively recruiting young adults now. For more information, call 793-8000.
Smoking cessation + fitness = success?
It’s a well-known problem: When people quit smoking, they often gain weight – an average of 10 to 13 pounds for women, according to Lynn Bucknam, project director of Commit to Quit, an initiative at The Miriam Hospital.
Bess H. Marcus, a professor of psychiatry and human behavior at the Warren Alpert Medical School at Brown University and director of the Centers for Behavioral and Preventive Medicine at Miriam, has spent more than 20 years studying ways to prevent cardiovascular disease and promote health among women, and smoking cessation and its connection to exercise became a key interest for her.
Working with women in a hospital environment, Marcus discovered that they quit smoking faster and avoided smoking for a longer time if they exercised.
In 2003, aiming to reach women in the community, Marcus did a pilot study with about 40 women in conjunction with local YMCAs. She wanted to find out if adding exercise to a smoking cessation program helped, and it did, cutting cigarette intake in half.
Now, working with the East Side / Mount Hope YMCA in Providence, the Kent County YMCA in Warwick and the Newman YMCA in Seekonk, Marcus is taking her Commit To Quit program to a broader audience. She’s recruiting female smokers ages 18 to 65 who are in general good health but not regular exercisers, and offering them free three-month YMCA memberships as part of their involvement in a 12-week group program to quit smoking.
In this particular study, the women are being divided into two groups: an exercise group, which gets a regimented exercise program to follow during the 12 weeks, and a health and wellness group that will be taught about lifestyle changes, healthy eating strategies, and stress management; both strategies have proven to be effective in helping with smoking cessation.
Bucknam said the goal is to enroll 400 women over the next year and a half; the study is funded by the National Institutes of Health.
“The fear of weight gain is a significant obstacle for women in quitting smoking,” Bucknam said, adding that women who quit are also likelier to relapse than men. “Even today, one in five American women is a smoker.”
What’s great about this study, Bucknam said, is that it could make an impact on countless women right away, especially if the collaboration with the YMCAs proves successful.
“A lot of studies are out there that are successful. Few studies that are out there are then accessible,” she said. “The goal is that YMCAs across the country will be a place for women to go quit smoking.”
For more information, call Commit To Quit at 793-8210.
Exercise as alternative
Millions of Americans suffer from what scientists call peripheral arterial diseases (PADs) – clogging of non-coronary arteries such as the carotid, the renal and lower-extremity arteries – and their quality of life suffers substantially for it.
When you don’t have good blood flow to your legs, you can have a difficult time walking. It’s “a very common disease,” said Dr. Timothy Murphy, a professor and medical director of the Vascular Disease Research Center at Brown Medical School and an interventional radiologist at Rhode Island Hospital, and “it can be very disabling.”
Murphy has led multiple federally funded clinical trials in this field, and now he’s leading the largest National Institutes of Health/National Heart, Lung and Blood Institute-funded multi-center clinical trial of treatments for this disease, known as intermittent claudication.
Here’s the key question Murphy wants to answer: Are stents that are helpings patients walk really better than a cheaper known alternative — exercise and a healthy lifestyle?
Supervised exercise, Murphy said, “is associated with big improvement” in patients with claudication, but stents are “very popular” and fit better with the current culture in medicine.
“The message that the health care system sends is, ‘Do the best you can. If you get sick, come to the hospital and we’ll give you an expensive procedure and medication,’ ” Murphy said. “But is leading a healthier lifestyle fundamentally better for people with this condition?”
For his study, which lasts for two and a half to three years and will report its findings in about four years, Murphy is recruiting people with arterial blockages to the legs but not other common accompanying problems, such as lung disease or arthritis.
Along with looking at how well the subjects walk on a treadmill, Murphy said, the study will look at how well they walk in the community, how long they can walk, and how their lipids, glucose levels, body mass index and other indicators look.
In addition, the study will look at the subjects’ perceived quality of life and at the cost-effectiveness of each approach. Participants get free medication, risk factor management and reimbursement for their time and travel.
The study has been going on for 18 months already, and Murphy said he has seen patients complete it on both sides. “It turns out both groups get better, and both groups are very satisfied with the results,” he said.
For more information, call the Vascular Disease Research Center at 444-6105.
Mapping brains
This study might not yield immediate insights. But if a child fits the criteria for this project, families will be helping to conduct cutting-edge research and walk out, at the very least, with an amazing new view of a brain at work.
Dr. Dan Dickstein, director of Bradley Hospital’s Pediatric Mood, Imaging and Neurodevelopment Program, is using MRI and other technology to understand the biology of psychiatric illness in children, including bipolar disorder, anxiety and attention deficit hyperactivity disorder, in a new project called Pedi-MIND.
The ultimate goal of Pedi-MIND, which is part of the Bradley Hasbro Children’s Research Center, is to be able to look at a child’s brain MRI and say, “This child has bipolar disorder” – not in isolation, but in the context of a broader diagnostic effort.
Dickstein, a pediatrician and child psychiatrist, only joined Bradley last summer, after working at the National Institute of Mental Health in Washington, D.C. He has a particular interest in bipolar disorder, he said, because it’s “a huge health issue across the world,” the sixth-leading cause of disability worldwide, costing more than $40 billion per year.
For a long time, it was thought children couldn’t have bipolar disorder, Dickstein said, but that view has changed, and in the last decade alone, there’s been a 40-fold increase in the number of children diagnosed with the disease.
“The question is, is this better awareness of a serious problem, or is this potentially overdiagnosis?” he said. One of the best ways to answer that question, he said, is to base mental-health diagnoses in children on more than what’s currently available – direct evaluation and interviews with parents, teachers, etc.
If you could add neurobiological markers, Dickstein said, you could be far more confident in the diagnosis, and you could treat children more quickly and better.
Of course, it’s not that simple. It’s not like the brain of a child with bipolar disorder looks obviously different. But Dickstein is testing children by having them play games while inside MRI machines to see how their brains light up as they play, when they win or lose, when the rules of the game change surprisingly.
Dickstein is recruiting children in four categories: those diagnosed with bipolar disorder, those diagnosed with generalized anxiety disorder, those diagnosed with ADHD, and healthy children. He’s only scanned a handful of children so far, but he’s aiming for 20 in each group.
The entire study takes about six hours, including a psychiatric study, the MRI and a computer analysis, Dickstein said.
For more information, go to pedimind.lifespan.org or call 793-8200. •
