In Vivo #7 EN by IN VIVO

Think health

No. 7 – DECEMBER 2015

TEENAGERS:

TOWARD CUSTOMISED MEDICINE / TARGETED RESEARCH / FIGHTING STEREOTYPES / NEW FREEDOM

TRANSSEXUALS The long road to recognition IN UTERO Surgery before birth DRONES Medication from the sky Published by the CHUV www.invivomagazine.com IN EXTENSO 24 HOURS INSIDE THE HUMAN BRAIN

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IN VIVO / NUMBER 7 / DECEMBER 2015

CONTENTS

FOCUS

19 / RESEARCH Teen health Hospitals take action to improve care for young people. BY CÉLINE BILARDO AND MELINDA MARCHESE

MENS SANA

30 / INTERVIEW Carl Hart: “Swiss policy on drugs is inspiring” BY CLÉMENT BÜRGE

34 / INNOVATION Medicine falling right out of the sky BY JULIE ZAUGG

37 / TRENDS The generous donors of the Internet community BY CATHERINE COCHARD

40 /DECODING Should we be scared of vaccines? BY JULIE ZAUGG

44 / IN THE LENS Biohacking: science off the beaten path

British photographer David Stewart has released a book on adolescents called “Teenage Pre-occupation” (Browns, 2013). He believes that young people, in their attitude and appearance, reflect the very essence of the society in which they live.

DAVID STEWART

BY ERIK FREUDENREICH

CONTENTS

44 34

66 CORPORE SANO

IN SITU

50 / TRENDS

08 / HEALTH VALLEY

Music settles in at the hospital

Technology helping seniors

BY CATHERINE COCHARD

Surgery before birth BY BERTRAND TAPPY

56 / TABOO A pill named desire BY ANDRÉE-MARIE DUSSAULT

60 / INSIGHT Philosophy in therapy

CURSUS

70 / COMMENTARY Data shortage

72 / PORTRAIT

62 / DECODING

Barbara Balmelli, a physiotherapist who treats the human hand

BY CLÉMENT BÜRGE

74 / TANDEM

66 / PROSPECTING

Preventing pressure ulcers through remote training

Viruses, those tireless globetrotters BY BERTRAND TAPPY

A sponge to diagnose cancer

BY CAMILLE ANDRES

Transsexuals: you’ve come a long way

14 / AROUND THE WORLD

THIERRY PAREL, TU DELFT, DR

53 / INNOVATION

Editorial

I TREAT, THEREFORE I AM

PATRICK DUTOIT

BÉATRICE SCHAAD Chief editor

Is philosophy only for the healthy (or, in other words, functionally unhealthy)? Or, can it be used to help patients and even the hospital that is treating them? The Service of Liaison Psychiatry at Lausanne University Hospital (CHUV) came up with the original idea of bringing in a philosopher, Hubert Wykretowicz, to work alongside its team (see p. 60). The Service of Plastic Surgery at the CHUV has launched a similar initiative. They aim to challenge acquired knowledge, but first and foremost our understanding of disease and patients and our relationships with them. With medicine attempting to transform the body into “treatment areas”, philosophy reminds us that – as pointed out by Friedrich Stiefel, the psychiatrist who initiated working with the philosopher – the body is also experienced by the patient, not just as an accumulation of symptoms, but existentially: the body I am, the body that is changed by the disease, that is looked at and that is treated medically. In some way, philosophy also reminds us that we’re definitely dealing with a subject and not an object on the operating table. These reflections give doctors and nurses the chance to review their role. As medicine develops ever higher technical standards, it risks dehumanising their work and their relationship with the patient. Philosophy reintroduces – as with Descartes’ “I think, therefore I am” – doubt and subjectivity. These questions are even more necessary in these times, when we can supposedly sequence our genome on the kitchen table and create sperm in vitro. Given these spectacular developments and the advances and promises of personalised medicine, philosophers – joined by other experts from human sciences such as linguists, sociologists and political scientists – are contributing to designing medical progress. Just what the doctor ordered. Because how much longer can we believe that medicine cannot solve every problem? How much longer can we go on believing that medicine is powerless without suspecting failure on the part of medical professionals? Medicine is advancing at break-neck speed, but do we realise what it could be turning us into? Demanding, impatient and stubborn beings when our questions go unanswered. Philosophy no doubt offers a set of antidotes to remedy the situation. ⁄

POST-SCRIPTUM UPDATES ON PREVIOUS “IN VIVO” ARTICLES YOU CAN SUBSCRIBE TO “IN VIVO” OR REQUEST BACK ISSUES ON OUR WEBSITE WWW.INVIVOMAGAZINE.COM

3D PRINTING IV n° 1

QUANTIFIED SELF

PERCEPTION p. 62

IV n° 3

p. 24

First drug approved

The benefits of hypnosis

Will 3 August 2015 remain a key date for the pharmaceu tical industry? That is the day that the U.S. Food and Drug Administration announced that it had approved Spritam, an epilepsy drug produced using a 3D printer. Aprecia Pharmaceutical, the company that developed Spritam, believes that 3D printing can be used to measure out individual doses adapted specifically to the patient and to create a more porous formulation, making the drug easier to absorb. /

Hypnosis can be used to reduce the consumption of painkillers and sedatives following a surgical procedure. Using this technique in anaesthesia also shortens hospital stays. These findings are drawn from a report published by the French Institute of Health and Medical Research in September 2015. This report notes, however, that the current data on the use of hypnosis to quit smoking are “inadequate – disappointing even”. /

IV n° 1

Connected objects increase stress Connected bracelets allow people to keep an eye on their physical condition. However, a study conducted by the Eindhoven University of Technology in the Netherlands showed that constant self-tracking can increase stress. Researchers studied 74 participants during a battery of tests where half of the subjects were able to check their heart rates. When asked to assess their level of stress, they reported feeling more pressure than the control group. /

MEDICAL TOURISM

GIVING BLOOD IV n° 2

p. 38

IV n° 5

GARO / PHANIE

In September 2015, the Argentine Ministry of Health announced that it would lift the ban on blood donations from homosexuals “to end a long history of institutional discrimination against the LGBT community”. The restriction is still in effect in many countries, including the United States, France and Switzerland. /

p. 35

A booming market

A win for the homosexual community

p. 66

According to a report published by France Stratégie, the French Prime Minister’s think tank for strategy, the number of medical tourists more than doubled between 2007 and 2012, jumping from 7.5 million to 16 million. Estimated at $60 billion, the medical tourism market is comprised of a complex mosaic of people flows, with the Dutch going to Belgium to flee endless waiting lists, while Americans seek affordable dental care in Mexico. /

POST-SCRIPTUM

LESS IS MORE IV n° 6

p. 19

Unnecessary screening

OFER PERL

Screening for cervical cancer is done too often, says a survey by the Swiss Federal Office of Public Health (FOPH). Nearly two-thirds of women between the ages of 25 and 49 have a Pap smear every year. Gynaecologists recommend this type of screening every two years between ages 21 and 29, then once every three years until age 70. Based on that information, the Swiss newspaper Tages-Anzeiger estimates that one million unnecessary Pap smears are being performed every year, costing an extra 70 million Swiss francs. /

DIGITAL GIANTS IV n° 6

p. 34

Google takes on diabetes The digital giants are moving further into health care by teaming up with companies specialised in the sector. In August 2015, the French pharmaceutical group Sanofi announced an agreement with Google’s Life Sciences division. The goal of the partnership is to combine Sanofi’s expertise in diabetes treatments and devices used to treat the disease with Google’s data analytics in the hope of improving care. /

AUTISM IV n° 6

p. 60

Testing the sense of smell Israeli scientists from the Weizmann Institute of Science in Tel Aviv used the sense of smell to diagnose autism in children under the age of 2. In their article published in the journal Current Biology, the researchers explained that the breathing of autistic children only showed minimal changes in response to good and bad odours. By contrast, children without the disorder adjusted their breathing in less than a second (305 milliseconds). This study offers a first step towards an alternative method of diagnosing autism, but the findings of the experiment have yet to be repeated and verified. /

Thanks to its university hospitals, research centres and numerous start-ups specialising in healthcare, the Lake Geneva region is a leader in the field of medical innovation. Because of this unique know-how, it has been given the nickname “Health Valley”. In each “In Vivo” issue, this section starts with a depiction of the region. The accompanying map was created by the model maker Adrien Pochon (see p. 78) and the graphic designer Sébastien Fourtouill.

IN SITU

HEALTH VALLEY Panorama of the latest innovations.

TOLOCHENAZ

P. 09

Medtronic’s pacemaker, with no case or electrodes, was successfully implanted.

GENEVA

P. 11

MODEL: ADRIEN POCHON AND SÉBASTIEN FOURTOUILL, PHOTOGRAPH: THIERRY PAREL

Two Asian pharmaceutical companies, Tasly and Santen, have opened offices at the tip of the lake.

IN SITU

HEALTH VALLEY

NEUCHĂ&#x201A;TEL

P. 11

The portable medical laboratory by 1Drop Diagnostics will be launched in 2016.

MONTHEY

P. 11

The start-up Karmagenes develops personality tests based on DNA analysis.

LAUSANNE

P. 09

Quadriplegics remotely control robots by thought.

IN SITU

HEALTH VALLEY

Technology helping seniors Gerontechnology is designed to improve living conditions for the elderly. Several companies in French-speaking Switzerland are active in this field. GERIATRICS The Swiss are getting older. The number of Swiss people aged 65 and older will nearly double to more than 2.5 million people between now and 2060. The Swiss Federal Statistical Office estimates that they will represent 28.3% of the population, compared with 17.1% in 2010. The ageing population is creating needs in leisure activities, in-home services and health care. Several companies in French-speaking Switzerland now specialise in this sector. Gait Up, a spin-off from the Swiss Federal Institute of Technology in Lausanne (EFPL) and the Lausanne University Hospital (CHUV), has developed an algorithm that can detect certain disorders based on movement and send notifications if the person falls. In 2015, another EPFL start-up, Domosafety, launched a home alert system for the elderly that warns loved ones or medical professionals in the event of an accident or loss of autonomy. Sensors installed in the home detect any abnormal behavioural change, such as a lack of movement for an extended period due to a fall.

Maintaining independence Domosafety wants to keep seniors independent and living at home. But with Big Brother watching? “The system isn’t intrusive,” says Edouard Goupy, co-founder and CEO of Domosafety. “There is no camera, no microphone and no direct observation. The point isn’t to find out if someone spends 20% of their time in the dining room. If everything is all right, nothing happens,” he says. “The indicators are very accurate and were developed with the help of home care doctors and nurses. And the individual doesn’t wear any sensors. The user approves all the settings.” Domosafety has 14 employees and 150 customers in Switzerland, with plans to develop abroad. The company could soon join CHUV to work on its mobile health assessment platform (NeuroTech), initiated by Professor Philippe Ryvlin, Department Chair of the Department of Clinical Neuroscience. 8

TEXT BENJAMIN KELLER

ABOVE: THE SENSOR DESIGNED BY THE START-UP GAIT UP, WHICH DETECTS DISORDERS BY ANALYSING MOVEMENT, AND EDOUARD GOUPY, CEO OF DOMOSAFETY.

“The idea is to use Domosafety’s systems to generate clinical data on patients with neurological diseases, in order to store and analyse that data,” says Stanislas Veuthey, operations manager of the project at CHUV. “We could be able to predict an epileptic seizure a few hours before it happens and notify the patient so that he may administer the appropriate treatment.” PersonalCare Systems is developing a similar system, with plans for commercial use by early 2016. The Geneva-based company, founded in 2012, addresses home care facilities and foundations. In May 2015, the start-up won the Prix Graines de Boss, an award given to promising young companies. Meeting real needs Despite its proliferation, the gerontechnology developed at present does not always meet the needs of the elderly, says Henk Verloo, professor at the Institut et Haute École de la Santé La Source in Lausanne. “There is a huge potential. Everyone is convinced of it, inclu ding seniors. But there is a gap between what engineers design and what users want,” he says. “For example, many people are reluctant to wear alarm systems because they don’t want it to be visible. Installing sensors in their home is also hard for them to accept.” Henk Verloo is taking part in a study to identify the perception and usefulness of innovative technology for seniors to be used at home. The project is a team effort between the Universities of Applied Sciences and Arts in Geneva, canton of Vaud and La Source, and the home care services of the cantons of Geneva and Vaud. Research extends beyond the elderly and their loved ones to look at the perception of health care professionals and how engineers, manufacturers and scientists view these technologies. Ethical issues between health care providers and patients also need to be considered. “With the alert and monitoring systems, nurses feel as though they’re watching their patients. And that’s the reality.” ⁄

IN SITU

HEALTH VALLEY

3 QUESTIONS FOR

JOSÉ DEL R. MILLÁN BBP / EPFL

HIS BRAIN-CONTROLLED TELEPRESENCE ROBOT BRINGS NEW INDEPENDENCE TO PARALYSED PEOPLE

EPFL moves closer towards creating a digital brain

NEUROSCIENCES For the first time ever, a team from EPFL’s Blue Brain Project (BBP) has reconstructed part of a brain on a computer. Scientists focused on building about a third of a cubic millimetre of the neocortex of young rats. The fragment is made up of some 30,000 neurons connected by 40 million synapses. The electrical behaviour of this virtual tissue was simulated using supercomputers. Even though the reconstitution only covers a tiny portion of the brain, this is ground-breaking work. “The brain is a well-ordered structure, so once you begin to understand the order at the microscopic level, you can start to predict much of the missing data,” says Henry Markram, founder of the Human Brain Project, the large-scale scientific programme which includes the BBP.

THE DEVICE

MICRA TPS Extremely lightweight at 1.75g and 25.9mm long, the tiny new pacemaker designed by the U.S. firm Medtronic is revolutionary. The device has no case or leads and can be implanted directly in the heart using a catheter. This pacemaker, produced in Tolochenaz, was implanted in five patients at the Geneva University Hospitals (HUG) and the Cantonal Hospital of Fribourg on 1 June 2015. A first in Switzerland. 9

WHAT ARE YOUR LABORATORY’S LATEST ACHIEVEMENTS?

Quadriplegics were able to remotely control our robot at EPFL by thought, from home, hundreds of kilometres away. And they did that as successfully as non-disabled people. Our goal was to develop mindcontrolled technology – through brain-machine interface – so that it could be used by those who really need it, i.e., people with a serious motor disability.

HOW DOES THE ROBOT WORK?

WHAT ARE THE APPLICATIONS OF THIS TECHNOLOGY?

Our robot on wheels is equipped with a webcam that films its surroundings and a screen that displays the user’s face. It is commanded by thought, and brain activity is measured by electrodes placed on the head. Users learn how to control their brain activity to give instructions. To make it easier to control, the pilot is assisted by our intelligent robot, which can learn to detect his intentions and help him avoid obstacles, for example.

Our telepresence robot can be used by people with reduced mobility to go out and interact with the world. We have demonstrated that this technology is safe and ready to be applied in real-life conditions. But there are many potential applications for brain interfaces. For example, we are developing an interface that improves the driving experience by predicting the driver’s intentions. / José del R. Millán leads the Defitech Foundation Chair in Brain-Machine Interface at EPFL

IN SITU

HEALTH VALLEY

DEAD HEART

ORGAN DONATION One hundred people die every year in Switzerland because they cannot get a transplant. Nearly 1,400 patients are currently on the waiting list, but recent measures and initiatives are expected to reduce these numbers.

In late 2015, Geneva University Hospitals and CHUV will begin so-called “dead heart” transplants. Most organs are currently taken from people who are only clinically brain dead following a brain injury. A dead heart, however, can be taken following an irreversible cardiac arrest, which mainly involves deaths due to a decision to switch off life-support systems. This measure could increase the number of donors by 10% to 20%.

NETWORK

APP

The world’s first electronic donor card in the form of a smartphone app is the culmination of the work between Jocelyn Corniche, an anaesthetist at CHUV and the Swisstransplant foundation. The card has been available since autumn of 2014 and can be consulted by emergency services even if the smartphone is locked. More than 80,000 donors have registered.

Improving communication and co-ordination networks worldwide is one of the priorities to increase the number of donations. A native of French-speaking Switzerland will play a key role in doing that. Thierry Berney, chief physician of the Transplantation Service at the Geneva University Hospitals, has taken up the position of president of the European Society for Organ Transplantation for two years. His main goals are to develop exchange programmes between Europe and the American Society of Transplant Surgeons and to help Eastern European countries to expand their own transplant programmes.

“We must invent new economic models for health care.” THIERRY MAUVERNAY IN AN INTERVIEW WITH THE SWISS NEWSPAPER “LE TEMPS” IN SEPTEMBER 2015, THE HEAD OF THE LAUSANNE-BASED BIOTECH FIRM DEBIOPHARM ENCOURAGED THE SWISS GOVERNMENT TO PROVIDE MORE SUPPORT FOR RESEARCH AND DEVELOPMENT. HE BELIEVES THAT SWITZERLAND’S COMPETITIVE ADVANTAGE IS SLIPPING AND THAT PUBLIC SUPPORT FOR INNOVATION IS INADEQUATE.

IN SITU

HEALTH VALLEY

START-UP DIAGNOSTICS

Mice regain hearing

GENE THERAPY Hearing was restored in deaf mice with a new treatment developed by American scientists working with a team from EPFL. The mice suffered from genetic deafness due to a mutation in the gene TMC1. The researchers used gene therapy to inject a functional version of the gene affected in cells in the animals’ inner ear. These cells regained their function and the mice their hearing. Patrick Aebischer, President of EPFL, believes that this method could be tested on humans with genetic forms of deafness within the next five to ten years.

The Neuchâtel-based start-up 1Drop Diagnostics has deve loped a portable medical lab which, in about 10 minutes, can detect markers for hundreds of diseases – including cardiovascular disease, infectious disease and certain forms of cancer – from a single drop of blood. The system planned for launch in 2016 earned the company the Vigier Foundation award of 100,000 Swiss francs.

FIREFLIES

NEW OPERATIONS

Asian pharmaceutical companies Two new Asian companies have chosen to open offices in Geneva. The first, Tasly, is China’s third largest pharmaceutical group. From its new European headquarters, the company plans to commercialise health care products based on traditional Chinese medicine. Worldwide, the Tasly group generates annual revenue of $4 billion and employs 10,000 people. The second newcomer is the Japanese firm Santen, which specialises in eye conditions. The multinational company hopes to triple its sales on the old continent to reach the €300 million mark by 2020.

Scientific communication

Med Communications International, a leader in scientific and medical information, has opened its European headquarters in Geneva. In a press release, the U.S. firm stated that it would “continue to expand its services throughout Europe from this central location” and that opening this new office “reinforces Med Communications’ commitment to being the best-in-class global provider of scientific services for the pharmaceutical, biotech, food, cosmetics and medical device industries.” 11

In millions of dollars, the amount of money recently raised by the start-up ADC Therapeutics, which operates in Epalinges. Specialising in oncology, the company develops several products used to treat diseases such as leukaemia and lymphomas.

1.9

In millions of Swiss francs, the amount given to Geneva University Hospitals, the University of Geneva and the University of Bern by the Swiss National Science Foundation. The funding will be used to finance the development of a new scanner for brain imaging by adapting technology designed for the Large Hadron Collider, or LHC, the most powerful particle accelerator at the European Organization for Nuclear Research (CERN).

The EPFL start-up Lucentix is using fireflies to revolutionise the way biomolecules are detected. The enzyme that makes fireflies glow has been modified to light up in the presence of a given target molecule. This method is fast and cheap, with numerous potential applications in biology and medical diagnostics.

BLOOD SAMPLING

A device the size of a credit card was developed by DBS System to run analyses from just one drop of blood. The start-up based in the city of Gland has recently raised 600,000 Swiss francs and is set to launch its system for commercial use. Its first customers are Swiss hospitals.

PERSONALITY

The Valais-based start-up Karmagenes is commercialising a personality test that analyses DNA to identify 14 character traits, such as a tendency to be innovative, optimistic or sociable. The company estimates its test to be 80% accurate and believes it will interest individuals, dating sites and potentially human resources departments.

IN SITU

HEALTH VALLEY

SEVENTH STEP

LAUSANNE KB MEDICAL

ON THE ROAD

In every issue, “In Vivo” meets with the leaders of Health Valley. Lausanne is the focus of this edition.

Using a robot in spinal surgery KB Medical has developed technology to make minimally invasive spine surgery more widely available. LEÏLA HUSSEIN

Since its foundation in 2012, KB Medical has focused exclusively on developing its AQrate robotic system. The technology assists surgeons in performing minimally invasive spine surgery, meaning that the procedure involves a tiny incision. “Only 20% of spine surgery is minimally invasive, compared with 80% for gastric surgery,” says Jean-Marc Wismer, CEO of KB Medical since 2014. “There was a clear demand from professionals for technology designed for these operations, which are performed to treat herniated discs, scoliosis and other back deformities.” And rightly so. These procedures require extreme precision as they involve high risks. An injury to the arteries or spinal cord can lead directly to patient paralysis or death. “When we began designing the product, we had to keep in mind regulatory and clinical requirements. We asked surgeons what they needed, so that we could work on 12

real issues.” And the result? In addition to its hardware platform and navigation and 3D imaging system, AQrate is intuitive, stays out of the way of surgeons and offers them precision down to the millimetre. The robot is currently being tested, but Jean-Marc Wismer is already planning the next phase. “We hope to launch the system in early 2016. We are in discussions with major distribution groups, especially in Germany and the United States.” This EPFL spin-off, founded by two students, has come a long way since its beginnings. With more than fifteen innovations patented, the ten-person team has recently moved to larger offices in the centre of Lausanne, where they are developing new functions. “The mediumterm goal is for minimally invasive spine surgery to become more common, and for procedures to be shortened to limit trauma to the patient.” /

IN SITU

HEALTH VALLEY

BENOÎT DUBUIS Director of the Campus Biotech site and Chairman of BioAlps

For those who see the falling tree, I say support the growing forest.

If you want people to listen, spread bad news! People will read you. People will praise you for your visionary mind. And people will respect you. Worry, and people will think you’re cautious. Because caution is a cardinal virtue, and therefore you are wise or at least on the path to wisdom. So I’m going to worry. I’m going to worry about people who believe that the grass is always greener on the other side of the fence. That wise proverb reflects how we are rarely satisfied with what we have. The grass on the other side always looks greener, nicer, fresher. Probably because we don’t know it. And probably because we focus on the problems at home and delude ourselves about what everyone else has.

Maturity means understanding that if we were to go to the other side of the fence, we would also lose certain things by gaining others. The wise man finds happiness in what he has, you’d say. I would simply add, don’t be influenced by those who don’t know where to go, but guide those who cross the border into your world. Immerse yourself with the intelligence deployed in other lands. They can then go back to enrich their own field with determination and enthusiasm. See in your field a land of opportunity, nurture it, let it live and reveal its potential before harvesting it. And by helping your field, you help yourself. The intelligence that you put into cultivating it will be the seed of your success. Now, it is in that spirit that I encourage you to mark your calendar on 16 March 2016. It will be the unique opportunity to immerse yourself in the future of life sciences in your country. Switzerland produces many winners in the Life Sciences race. From passion to action, we are good at turning ideas into successful businesses. Yet the question arises as to how to sustain this success, even improve upon it? To address this question, the “Life Sciences Nation” report is proposing a truly insightful study.

Some things may indeed be better, but let’s not Many “gardeners” work in that field. They will be forget that a field is made up of more than grass. there at the opening on 16 March at the Hotel It is the stream that irrigates it and brings it Allegro in the Bern Casino. Mark the date and join water. It is also the growing forest, and not just them. Register at www.republic-of-innovation.org. ⁄ the falling tree. It is the others that have been put in the same field.

FOR MORE INFORMATION

www.bioalps.org the platform for life sciences in Western Switzerland

IN SITU

WORLD

IN SITU

AROUND THE GLOBE Research doesn’t stop at borders. In Vivo covers the latest medical innovations worldwide.

The price, in dollars, of a dose of DDD107498. This drug has the potential to treat malaria in a single dose and prevent the spread of the disease, according to Professor Ian Gilbert, a member of the research team from the University of Dundee (Scotland) that published the discovery in the journal “Nature”. The compound is now being developed by the German pharmaceutical giant Merck Serono. Ian Gilbert estimates that the drug will be available within five to six years.

THE DEVICE

A SPONGE TO DIAGNOSE CANCER As with many diseases, early detection of oesophageal cancer strongly increases the chance of remission. Professor Rebecca Fitzgerald from the University of Cambridge and her team have developed the “cytosponge”. This capsule, once swallowed, releases a sponge that harvests cells along the oesophagus lining. The Irish firm Covidien plans to commercialise the medical sponge, which offers a cheaper and less invasive way of removing tissue than a traditional biopsy.

The end of cataract surgery RESEARCH The partial or total clouding of the lens in the eye – i.e., a cataract – may soon be cleared up by using eye drops containing lanosterol, a substance naturally produced by the eyes. A Chinese-American research team from the University of San Diego published their discovery in the journal Nature. Cataracts affect 20% of people over 65 and two-thirds of those 85 and older. The only treatment currently available involves replacing the lens with an implant in a relatively harmless surgical procedure. But that technique isn’t available everywhere. Treatment with lanesterol eye drops showed positive results during tests, increasing lens clarity in the dogs and rabbits involved in the experiment. This innovative approach means that the use of surgery could be cut in half in the years to come.

“We are on the way to a generation free of AIDS” BAN KI-MOON SECRETARY-GENERAL OF THE UNITED NATIONS, AT THE THIRD INTERNATIONAL CONFERENCE ON FINANCING FOR DEVELOPMENT IN ADDIS ABABA ON 14 JULY 2015. HE BELIEVES THAT WE CAN END THE EPIDEMIC BY 2030 BY BOOSTING INVESTMENT TO $32 BILLION PER YEAR UNTIL 2020.

HEALTH WORLD VALLEY

PR NEWSWIRE / NEWSCOM

IN SITU

AN 8-YEAR OLD BOY RECEIVES A DOUBLE-HAND TRANSPLANT INNOVATION At age 8, Zion Harvey has become the youngest child to get a bilateral hand transplant. A team of 40 medical professionals from the Children’s Hospital of Philadelphia performed the operation, which lasted more than ten hours. Scott Levin, who led the hand transplant team at the hospital, said “This surgery was the result of years of training, followed by months of planning and preparation by a remarkable team.” Zion Harvey lost both his hands and feet to a gangrene infection. The boy had already had a kidney transplant, which made the hand transplant easier as he was already taking anti-rejection medicine.

IVO ICKS V IN ST P BE Furiously Happy: A Funny Book About Horrible Things JENNY LAWSON, FLATIRON BOOKS, 2015

The American journalist Jenny Lawson discusses her battles with mental health. In her inimitable, funny and irreverent style, she fills her book with outrageous stories. Like that time when she invi ted a herd of kangaroos to her house but failed to warn her husband about it. Jenny Lawson says that for her, “furiously happy” is about taking those unique moments in our lives “into battle with us when our brains declare war on our very existence”. It’s a guide to accepting who we are, with all our qualities and our flaws.

Le bonheur plus fort que l’oubli COLETTE ROUMANOFF, MICHEL LAFON, 2015

The writer and theatre troupe director Colette Roumanoff found out that her husband had Alzheimer’s disease in 2005. Ten years later, she tells her moving story about living with the illness, which she has renamed “confusionitis”. Despite the gradual deterioration of Pierre’s cognitive abilities, Colette insists that her marriage is a happy one. What’s her secret? Understanding how the disease works to better interpret her husband’s reactions and adapt her behaviour accordingly.

Parents’ denial fuels the childhood obesity epidemic JAN HOFFMAN, NEW YORK TIMES, JUNE 2015

In her article published in The New York Times, the journalist Jan Hoffman tells the story of a mother offended by the recommendations from her son’s dietitian, “I can’t believe you’re telling me I can’t buy Chips Ahoy! cookies”. American researchers report that 70% of parents see their obese children as being “about the right weight”. This denial may be due to the fact that parents feel guilty of being overweight, too.

VIDEO N S AN D COLUM OM .C NKS TO E LI N R ZI FO AGA NVIVOM WWW.I

S SEE

The amazing story of the man who gave us modern pain relief LATIF NASSER, TED, MARS 2015

In his most recent TED talk, Latif Nasser, the director of research at Radiolab, tells the story of a relatively unknown hero, John J. Bonica. He was a professional wrestler and doctor who is today considered to be the founding father of pain relief. The Sicilian immigrant, who went from the ring to the bedside of World War II veterans in the United States, authored The Management of Pain in 1951, a seminal work hailed as a classic in pain relief literature.

IN SITU

3D MICROSCOPY WITHOUT DYE A new microscopy technique was used to create this image of human sperm. Using a quick and easy process that requires no chemicals to show the structure of cells, the instrument developed by the start-up Nanolive in Ecublens can take photos of living cells and build a 3D model of them. By combining holography, rotational scanning and a powerful image reconstruction algorithm, the 3D Cell Explorer can measure subtle changes in the way light spreads through the sample depending on the composition of the different structures present within the cell. NANOLIVE.CH

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WORLD

UP-TO-DATE INFORMATION All you need to know about life sciences and innovation in the region. Sections that are designed for you: What’s on, Innovation, People, Science. It’s a one-stop site for news about companies, higher education, and sponsors of innovation.

D republic-of-innovation.ch

“The joys of discovery are made all the richer when shared. Learn about innovation and experience that goes beyond everyday lives.” BENOIT DUBUIs Founder BioAlps, Eclosion, Inartis

“The Republic of Innovation website is informative, smart, open, and easy to read. It’s a true delight and a real help.”

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ThIERRy MAUvERNAy Delegate of the Board Debiopharm Group

INVIVO4_6_18_EN.indd 18

REPUBLIC OF INNOVATION

23.10.2014 16:08:56

FOCUS

TEENAGERS

RESEARCH

TEENAGERS: TOWARD CUSTOMISED MEDICINE

Teenagers, with all the physical, psychological and social changes going on in their minds and bodies, have specific needs and require specific care. Now hospitals are taking action.

/ BY

CĂ&#x2030;LINE BILARDO AND MELINDA MARCHESE

FOCUS

TEENAGERS

ost of the time it starts with a few blemishes, growth of body hair and a new body odour. Then come noticeable physical changes and mood swings. Puberty, a critical stage in adolescence, needs to be taken seriously. “That’s where it all begins,” says Anne-Emmanuelle Ambresin, Physician-inChief at the Interdisciplinary Division for Adolescent Health (DISA) at the Lausanne University Hospital (CHUV). “It’s a hormonal roller coaster combined with cognitive, biological and behavioural changes.” This transformation is what leads young adolescents – who are no longer children, but not yet adults – towards independence and finding their sexual, personal and professional identity.

tential excesses. “Adolescents with problems require special attention and a specific medical approach,” says Susan Sawyer, director of the Chair of Adolescent Health at the University of Melbourne in Australia. This eminent expert in adolescent health feels that teenagers “have long been overlooked in studies on health.” Anne-Emmanuelle Ambresin agrees. “Scientists began talking about issues specific to adolescents 30 years ago, but their health care has only become a priority in the past few years.”

Medical centres and hospitals specialised in adolescent health first began to open in Canada, Australia, the United States and then in Europe. The physicianin-chief at DISA refers to a study led by the AustralNot everyone experiences this transition in the same ian epidemiologist George Patton in 2011 that gained way. The majority of adolescents go through a phase international attention and shed light on the need to rich in learning, creativity and study adolescents and their health self-affirmation. But experts estimore closely. “ This research mate that 10% to 20% of teenagshowed that child mortality had WHAT IS ers endure a period of extreme dropped in the past few years, but ADOLESCENCE? vulnerability and risk-taking. the death rate for young people age 14 to 19 hadn’t changed one The United Nations defines Dropping out of school, alcohol bit. That’s when people realised an adolescent as age 10 to 19. But not everyone agrees. abuse, violent attitudes and suimore efforts had to be made to adIs adolescence only defined cide attempts are some of the podress adolescents’ needs.” based on age? Today, experts commonly define adolescence as a period of life between childhood and adulthood, which begins at puberty, i.e. around age 12. Opinions vary as to when it ends, but it’s generally when the individual is independent and has a job, estimated between age 24 and 25.

A GROWING BRAIN One of the main discoveries that helped experts better understand adolescents and their development concerns their brain. The advances in medical imaging over the past ten years have shown that teenagers sometimes act impulsively and emotionally because their brain has not yet matured. Laurent Holzer, child psychiatrist and director of different adolescent health units at CHUV, explains that brain maturation is not yet complete at this stage of 20

life. The part that matures last (around age 30!), the prefrontal cortex, is involved in planning actions, managing feelings and controlling reactions. “The biological changes and mechanisms taking place during puberty drive adolescents to take risks, to simply test where they are and where they can go. Their social environment can also help them to overcome these new challenges,” he says. “Socialisation in younger children occurs at an explicit level, while for teenagers, everything is implicit. They have to understand things at another level, why they’re blushing, what the signs of interaction related to sexuality are, etc. Adolescents must be stimulated and supported by their peers throughout this period, which is critical for socialisation.”

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TEENAGERS

“DOCTORS ARE AFRAID OF ADOLESCENTS” Anne-Emmanuelle Ambresin* emphasises the importance of training all primary care physicians in adolescent care. INTERVIEW BY

CÉLINE BILARDO

a young individual who needs help.

Their physical and mental problems often require a multidisciplinary approach, with health care providers for different degrees of treatment who must be able to work as a team. All the doctors should understand how to deal with adolescents so that they will open up and develop ties with the medical staff.

How do you get the message across? aea On the initiative of Professor Pierre-André Michaud, a pioneer in adolescent health in Lausanne, we have introduced more than 16 hours of classes on adolescent care in the university medical school programme at Lausanne. We also offer an optional threeday training course for interested primary care physicians (general practitioners, paediatricians, gynaecologists). They will all end up treating an adolescent at some point in their career. And they are the first filter who can identify iv

*ANNE-EMMANUELLE AMBRESIN IS CHIEF PHYSICIAN AT THE INTERDISCIPLINARY DIVISION FOR ADOLESCENT HEALTH (DISA) AT CHUV.

ERIC DÉROZE

dolescents are no longer children but are not yet adults. They deserve care, communication and treatment adapted to their age. Medical professionals need to learn more about these issues.

How is a medical approach to adolescent care different? aea Young adolescents take more time than patients coming in for adult consultation. The issue of confidentiality and forms of address, formal versus informal, should always be discussed with a teen.

How do doctors react during these training courses? aea Health care providers are most often relieved when they finish these classes! I think that adolescents suffer from terrible prejudice, and doctors are often afraid of seeing them at their office. They say they’re not ready and can’t get adolescents to talk. The point of the training is to let health care professionals experiment with how they should behave with an adolescent. Teenagers just want to be listened to by someone they trust and respect, who is competent in their field and knows how to talk to them. Medical professionals learn how to ask simple but key questions to spot an adolescent in difficulty and be able to meet their needs. Or in more complex cases, refer them to a centre like DISA, where they can benefit from an interdisciplinary approach. iv

TEENAGERS

JOHANN PELICHET

FOCUS

“TEENS NEED RECOGNITION” LUNA, 18, LAUSANNE

Luna* began having problems in primary school, especially with her classmates. “The other kids would often tease me, and the teachers wouldn’t do anything. They gave me no support and didn’t listen. I felt as though they were even annoyed by the situation, which brought them out of their comfort zone. I was alone most of the time and could only rely on myself to get through the school year.” The young girl managed to improve her marks and eventually completed secondary school. “I came out of that period exhausted, and that did not help to boost my confidence. It was hard to imagine gaining any self-assurance. In 2010, when I was only 13, that awkwardness developed into eating disorders. I lost 20 kg in a few months.” That’s when Luna was taken in at the Interdisciplinary Division for Adolescent Health (DISA) at CHUV. “It was the only place where I felt comfortable, understood and heard. Teens need recognition, but

also need to be listened to without being judged. Lots of adults tend to overreact, but I don’t think that’s the right way to handle a problem with a teenager. It’s just the opposite. They should teach young people how to put things into perspective and approach problems calmly.”

Luna also wanted to talk privately about her situation with the medical staff. “In paediatric hospitals, the doctors addressed my mother, right in front of me. But I’d been completely aware of the dangers and the consequences ever since my health problems started. I wanted to have my say.”

But the young woman still had to seek medical care at facilities designed for children. “I distinctly remember one situation when I was 16. I went to a paediatric hospital, initially for a simple potassium infusion. The health care staff decided I had to stay there. I’d tried to explain repeatedly the instructions from my family doctor, but no one would listen to me. Nothing I said mattered. I wanted to be treated like an adult, not like a child. Being hospitalised next to babies made me uncomfortable. The nurses referred to me as “the big girl”, addressed me informally and talked to me the way they talked to the other children. I didn’t like that.”

Today, Luna is on the road to recovery. “My wounds are slowly healing. They were deep.” Despite her health problems, she has continued going to school. “I found support from some teachers but also from hypnosis. Being able to express myself through art and especially music has helped me move on.” Now 18, she continues her treatment at DISA. “I’m very close to my doctor, who has monitored and understood me throughout my adolescence.”

*NAME HAS BEEN CHANGED

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UNDERSTANDING TEENS BETTER Adolescence is when many severe adult disorders begin. “Eighty per cent of adult psychiatric diseases emerge during the teen years,” says Olivier Halfon, child psychiatrist and director of the University Department of Child and Adolescent Psychiatry (SUPEA). “Schizophrenia, addictive behaviours, bipolar and eating disorders often develop in adolescence. And the consequences continue into adulthood. A child can be fine and gradually show symptoms of a disease when he or she hits puberty.” The expert says that neurobiological research has completely changed his view about the development of the adolescent brain. “We can now better understand the psychiatric disorders that surface during this stage of life.” Research has shown that young people respond to a hormonal change taking place. Puberty affects their body and their brain. And that causes them to experiment in ways that can put them in danger and trigger mental disorders.

Pre-adolescence

10 TO 14

The first physical signs of puberty emerge, including body hair growth, oil production in skin and increased perspiration. In girls, breasts develop, and menstruation begins. In boys, testicles enlarge, and their voice changes. Both sexes develop a greater ability to reason, with more focus on the present than on the future, and become capable of deeper moral thinking. Identity crises begin, along with feelings of awkwardness about their body. Pre-adolescents experience moodiness, begin to want more independence and struggle with their identity.

DIFFERENT NEEDS Some say they are violent, rebelling against authority and society, “but adolescents are not against everything and are not constantly angry,” says Françoise Narring. The head of the youth clinic (Unité Santé Jeune) at Geneva University Hospitals (HUG) stresses the complexity of dealing with adolescents and communicating with them to understand them properly. “Teens don’t let on much about themselves. They often come in for a physical problem, like a headache or stomach ache that hides a deeper problem. We must know how to talk to them, ask the right questions and spot an adolescent that is in

Adolescence

15 TO 19

Physical growth stabilises in girls but continues in boys. Their ability to reason develops further and they can set targets. Existential doubts arise about the meaning of life. Adolescents gradually build a new relationship with their body and physical appearance. During this period, they can sometimes feel very high self-esteem, but that feeling can totally change direction at other times. Adolescents begin to distance themselves from their parents. Experts also note that interest in sex begins to emerge during this stage.

Young adults 20 TO 24

At about age 20, young women have normally stopped growing, while boys continue to gain weight and muscle mass. They develop the cognitive ability to express ideas clearly during these years. Young adults can put their experiences into perspective and feel less of a need for recognition. They gain firmer sexual identity, self-confidence, independence and sense of altruism. Greater emotional stability generally develops during this stage.

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ADOLESCENTS AND THEIR RIGHTS Medically speaking, adolescents are minors and are governed by laws pertaining to children’s rights. Since the beginning of the 20th century, legal authorities have continually considered relaxing some of the rules concerning them. HOW IS THE CAPACITY OF DISCERNMENT ASSESSED? The capacity of discernment is evaluated for each new concrete case. The doctor assesses the patient’s capacity of discernment, a key concept in making medical decisions. This capacity is determined based on:

MINOR ADOLESCENT

INCAPABLE OF DISCERNMENT

INFOGRAPHIC DESIGNED WITH THE HELP OF JEANNE-PASCALE SIMON, LEGAL EXPERT FROM THE LEGAL AFFAIRS UNIT AT CHUV.

CAPABLE OF DISCERNMENT Adolescents deemed “capable of discernment”, even when subject to parental consent, can choose to accept or refuse treatment. They are entitled to control confidential medical information.

Intellectual criterion The child understands the consequences of his or her decision Criterion of volition The child takes decisions on his or her own free will and maintains the decision

EMERGENCIES

Adolescents who do not demonstrate their capacity of discernment are represented by their legal guardian. The legal guardian makes the decisions, but informs and consults the child first.

When an emergency procedure must be performed, and no legal guardian can be reached, medical professionals are authorised to act without consent in the interest of the patient.

CAPABLE OF DISCERNMENT Adult adolescents are presumed to be capable of discernment.

ADULT ADOLESCENT

INCAPABLE OF DISCERNMENT Adolescents are deemed incapable of discernment in cases of psychiatric illness or addiction.

PARENTS PARENTS Parents are children’s legal guardians. In cases of divorced parents, joint parental consent is required.

LEGAL ISSUES If the two parents do not agree, or if they are deemed incapable of representing their child, the child is placed under the care of a legal guardian.

Their therapy representative or one or both of their parents take decisions on their behalf.

Medical professionals can administer the necessary care when they receive consent from the adolescent or any authorised guardian.

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TEENAGERS

worse condition than he or she lets on, so that we can initiate further care.” Parents, school staff and primary care physicians (paediatricians and family doctors) play a key role in early detection. Adolescence experts are working to inform and train them in caring for young people (read interview p. 21).

Children with a chronic disease must come to terms with their disorder and their difference, sometimes becoming aware of additional consequences of their disease (e.g. not being able to have children because of fertility problems) once they reach adolescence. They have much more to cope with than normal teenagers. And their disease can even worsen at this stage, with the onset of new symptoms or complications. “When they are not adequately prepared to handle their treatment independently, these people frequently stop taking their medication and seeing their paediatric endocrinologist,” says Franziska Phan-Hug. Medical experts agree on a need for “coconsultations”, in which the adolescent is seen by both a paediatrician and doctor specialised in adult care, with personalised follow-up, encouraging the individual to seek care voluntarily. 25

JOHANN PELICHET

SPECIAL CONSULTATIONS The development of specialised hospital units, such as DISA in Lausanne, the Unité Santé Jeune in Geneva and the Chair of Adolescent Health at the University of Melbourne, reflect the growing awareness and action taken to provide adolescents with health care organizations and treatments designed for them. These facilities play an important role. “A teenager will not feel comfortable in the waiting room at their paediatrician’s office, but neither might he be ready to seek treatment from an adult doctor,” says Franziska Phan-Hug, paediatric endocrinologist and head physician of the Centre for Endocrinology and Metabolism in Young Adults (CEMjA) at CHUV. This centre, launched in 2013, is developing as a transition facility, bringing together doctors for children and for adults, specialised in chronic and rare diseases – more specifically in endocrine disorders (growth disorders, Turner syndrome, sexual differentiation disorders) and conditions linked to diabetes. “You might think that a child who’s been taking on a treatment since they were young would be better behaved when they go through adolescence, but the opposite is true. An adolescent with a chronic disease will rebel and test limits even more than others.”

“I’M READY TO LIVE MY ADULT LIFE” SARAH, 22, LAUSANNE

Sarah* is currently going through a transition period. “I’m about to leave the Interdisciplinary Division for Adolescent Health (DISA) at CHUV, where I’ve been going for more than seven years.” At age 22, the young woman says she is now ready to move into adult care. “It’s a gradual, gentle transition, which suits me just fine. I even think the transfer is necessary. So far, I’ve been very happy to get treatment from experts in adolescence. It has really helped me to overcome the challenges I’ve faced in the past few years.” Sarah was placed in a children’s home far from her family in 2008 and rapidly began gaining weight. “I went from 56kg to 130kg. I developed diabetes and sleep apnoea.” She spent some time at the psychiatric hospital unit for adolescents (UHPA) at CHUV. “The staff is trained in how to communicate with young people. I really liked talking to the nurses. But it wasn’t easy dealing with me! I was a rebellious teen, a leader. Sometimes I just didn’t want to talk. And they respected that. If I needed to talk, an adult would be there for us. I could talk freely, without pressure. That wouldn’t have been possible with one of my parents. I would’ve been too scared of their reaction, of disappointing them.” Thanks to this specialised care, Sarah feels she has had a “normal” adolescence. “We did lots of things with the staff. They would take us bowling, to the sports pitch… and even out for drinks. They filled the emotional hole left by the absence of my family.” Sarah has been living alone for a few months and enjoys her independence. “I’m ready to live my adult life. Now I just have to find a restaurant training programme. I had the opportunity to cook at the different homes where I’ve lived, and I love it!” *NAME HAS BEEN CHANGED

TEENAGERS

JOHANN PELICHET

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“NOT ALL TEENS SHOULD BE TREATED THE SAME WAY” LEILA, 18, LAUSANNE

What does adolescence mean for Leila? “It’s a transition period between childhood and adulthood, when individuals gradually have to gain freedom and independence.” And Leila feels she was stripped of that freedom. “I’ve been independent since I was a young girl. I’ve managed on my own since I was little. When I was about 14, my mother tried to get closer to me, communicate more, but it didn’t work. I was always on the defensive. Our relationship began to deteriorate and become conflictual. Sometimes, it was explosive! When I was 15, I left to live with a friend, then with my boyfriend.” After a big fight, her parents contacted a child psychiatrist to help the young woman

communicate and manage her emotions. To no avail. She spent a few weeks at the psychiatric hospital for adolescents (UHPA) at CHUV. “I was with young people of all ages and all sorts of problems. We had to do the same activities, but interests and tastes in films, for example, are not the same at 12 and at 16. Some teens had eating disorders, so we weren’t allowed to have food in our rooms. Others had suicidal tendencies, so some products, such as nail varnish remover, were forbidden. Personally, I had all sorts of unnecessary, even frustrating restrictions. Being deprived of that freedom was very hard for me. Not all teens going through a difficult period should be treated the same way.”

Leila explains that she really just needed someone to listen to her. “I think we should let teens express themselves, and then give them advice, without telling them what they have to do, what’s ’good’ or ’bad’. Teens need to feel free to make choices, while feeling the support of an adult.” Now 18, the young woman has decided to stop school temporarily to devote herself to her passion, dance, while working to pay her way. “I feel like a ’young adult’. I’m happy to be able to make my own choices, but I still feel the need to get advice, to express myself without being judged. I haven’t yet found anyone I feel comfortable talking with.”

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CONTINUING EFFORTS CEMjA recorded 400 consultations the year it opened at CHUV. Today, the centre records more than 1,500. This figure confirms that these specialised centres meet a real demand. But is adolescents’ health getting worse? “Young people are in no way ’worse’ than they used to be,” says the child psychiatrist Laurent Holzer. “Medical professionals and the public are now simply more sensitive to their problems. These issues were not believed to have any impact on their future. Now, our duty is to continue identifying those adolescents who show early signs of mental disorders and monitor them more closely.” Ten years ago, “mobile” teams at CHUV were set up to do just that. The Adolescent Mobile Team (EMA) works with teenagers (age 13 to 18) in the Canton of Vaud who refuse treatment or avoid outpatient care. EMA offers them support in their day-to-day life (e.g. at home or in children’s homes). Recently released figures have also broken the stereotype. Their consumption of psychoactive substances such as cannabis has dropped significantly in the past ten years. Sonia Lucia, a scientist from the University Institute of Social and Preventive Medicine, has recently led her team in a population survey on the victimisation and delinquency of young people in the Canton of Vaud (2014). The findings, published in 2015, speak for themselves. The percentage of teens aged 14 to 16 who, on a weekly basis, drink alcohol has fallen from 18% to 7% in ten years, those who smoke tobacco cigarettes are down from 18% to 14% and those who use marijuana from 9% to 5%. “We still have a lot of work to do to improve this medical care for adolescents,” says Susan Sawyer from the University of Melbourne. “We need to continue our research on adolescents, our efforts in developing appropriate structures, set care models and develop expertise among health care providers in the approach to adolescents.” / 27

Puberty comes earlier and earlier “Scientists have noted a drastic decline in the average age of puberty, down from age 17 to 12 in less than two centuries,” says Susan Sawyer, director of the Chair of Adolescent Health at the University of Melbourne. Today, the age of puberty has stabilised. Early onset is more typically seen in girls with the beginning of menstruation, despite the first sign of puberty generally being the development of breasts. In boys, the testicles enlarge. Why is this happening? “First, positive factors show that we now have better hygiene and nutrition,” says Susan Sawyer. “One negative cause is the influence of the environment, especially our increased exposure to endocrine disruptors in cosmetics, cleaning products and food packaging.” These chemicals interfere directly with our hormone system.

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INTERVIEW BY

CÉLINE BILARDO

in vivo

TEENAGERS

INTERVIEW “ADOLESCENCE IS NOT AN ILLNESS”

Philippe Jeammet is a Professor Emeritus of child and adolescent psychiatry at Paris Descartes University. Here, he analyses the key role that parents play in their children’s development.

How do you define adolescence?

It’s society’s response to the physiological phenomenon of puberty. Adolescence is not new, but the way we respond to it is new. It’s nothing like the rites of passage in traditional societies that we ourselves had in our childhood, where there was a marker, like in religious tradition, going from the end of primary school to secondary school, standards about going out, what boys or girls were allowed. The structure has totally changed. philippe jeammet

The notion of freedom comes up a lot in your different books, especially the freedom allowed by parents today. Why is that? iv

I think it’s absolutely fundamental, and maybe even more in the parents’ mind than in the adolescents’ mind. You have to understand that freedom does not mean the absence of rules. Freedom involves other rules, and these rules are expressed differently than they used to be. I believe Biography Philippe Jeammet is a that we’ve replaced the Professor Emeritus of vertical authority of child and adolescent mid-20th century society, psychiatry at Paris when adults had much Descartes University. more authority. Today, The French child psy teens can get away with chiatrist and psycho talking to adults in ways analyst is also president that they never would of the organisation have done before. But École des Parents et des Éducateurs d’Ile-dethat doesn’t reflect a lack France (EPE-IDF), which of respect. It’s simply provides guidance to that the relationship to parents and educators. hierarchical authority He has been seeing, has changed. pj

Many parents feel overwhelmed and say that if it’s not what they experienced, then it’s not 28

advising and listening to adolescent patients since 1968. Philippe Jeammet is the author of several books on adolescents.

right. But it’s another form of authority that is more horizontal and more taxing for parents. Because they have to defend their decisions. Why are they exercising authority? They can no longer force it on children and say, that’s the way it is and that’s how it has to be done. Adults now have to say, “This is why I don’t agree.” They have to explain themselves, but sometimes parents don’t know what to say. These days, problems arise because the parents themselves are at a loss. iv

What impact does that have on adolescents?

If adults are confused, it can lead to anxiety in young people. And nothing is more contagious than anxiety. pj

Many mental illnesses start developing during adolescence. Why? iv

Mental illnesses that often start during adolescence, such as schizophrenia, mood disorders and anorexia, all have something in common. Victims focus inward in response to fear, which is typical during this stage of life. pj

But adolescence is not an illness. It’s normal! The majority are fine. However, adolescence reveals our own lack of confidence and uncertainty, because during this period, that transformation of the body and of access to adult sexuality drives adolescents to take some distance from their parents and try to understand who they are inside, in their gut, in their minds and draw on their own resources. Through the most fragile individuals, we can see how, over a few years, someone who had an easy childhood – now faced with the task of putting to work what they’ve received from their parents, acting in their own name, enduring a feeling of solitude – can panic and develop powerful fears that will force them, biologically, to react actively to protect themselves and protect their mental balance.

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When fear dominates, all senses and logic are distorted.

For more than 40 years, the child psychiatrist Philippe Jeammet has been studying feelings, such as fear and solitude, which can have devastating effects on adolescents.

What does the adolescent risk? iv

All of these psychiatric disorders will lock the individual down into one of the three areas that are needed for the personality to develop properly: taking care of their body, developing academic skills and developing sociability. The impaired adolescent will wall themselves in one of these three relationships, sometimes all three. By walling themselves in, they gain control. And that feels safe. “I’m not interested in school. Social life doesn’t interest me. I’m a rebel.” At the time, that protects them because they regain purpose and control. But it cuts them off from worthwhile, healthy relationships. They become prisoners of their own behaviour. The more they’re prisoners, the harder it is for them to open up to others and the further inward they go. It’s a vicious, pathogenic circle.

What role should parents play in the medical care of an adolescent?

THOMAS LOUAPRE

To read “Grandir en temps de crise”, Bayard Jeunesse, 2014 “Adolescences”, La Découverte, 2012 “Anorexie, Boulimie: Les paradoxes de l’adolescence”, Fayard, 2011

Sometimes it’s better to leave the parents out of it for a while, not because the parents are bad, but because the relationship is too emotionally charged. For example, with anorexia nervosa, the parent feels relieved when the child eats, but the child still feels anxiety. Or when the child loses weight, the parent stresses, and the child feels guilty. The parents should stay out of this relationship of tension and mutual control for a while. Parents need to understand that this behaviour is not a choice. They don’t do it to annoy, push or rebel against them. They do it for a sense of control when they feel lost. People’s entire understanding of mental illness needs to change. It’s not a weakness or an illness in the traditional sense, but an emotional pj

deficiency that makes it difficult to build mutual relationships with those around them.

What would the best attitude for parents to have with an adolescent who seems lost? iv

For them to say, “Wait, don’t clam up, we should talk about it.” Potentially bring in someone from outside and ask “What do we want, what for, so that we can remain attentive to and considerate of each other’s needs.” Take a step back and figure out how to move forward in this relationship with the child. But they have to talk about it and learn how to use their emotions to avoid building that wall. That’s the message that they should have. Illness occurs when misunderstanding solidifies, but it could develop in a completely different direction. ⁄ pj

PETER ASH LEE / ART + COMMERCE

MENS SANA

“When a drug user has no other source of pleasure in his or her life, he or she continues shooting up because he or she can’t do anything else. However, if a person has attractive alternatives, like working and making money, earning respect from their peers in one way or another, that person will stay clean.” CARL HART

MENS SANA

INTERVIEW

CARL HART American scientist Carl Hart has gained recognition

by challenging common beliefs about drug addiction. From his temporary home in Geneva, he is currently preparing his second book. INTERVIEW: CLÉMENT BÜRGE

“Swiss policy on drugs is inspiring” Carl Hart, 49 years old, is not a typical researcher. He grew Carl Hart is now temporarily living in Geneup in a poor area of Miami, where he used and dealt drugs. va. He is working on his next book, which will “I’m the opposite of the cliché white researcher from a partly be inspired by Switzerland’s drug policy. wealthy family,” he says, laughing. Carl is the first tenured African-American professor of sciences at Columbia UniIV Discussing your problems as a youth in versity, where he leads research projects on how drug your book could have hurt your career. Why abuse impacts human behaviour. did you talk about it? CARL HART I wanted people to know that I’m not the cliché rich, white scienHis story, told in his book High Price*, has sparked the tist. But, more importantly – and that’s one of the ire of conservative politicians, who think his theory is purposes of my book – I wanted to inspire African unfounded and overly provocative. Members of the American youths and give them hope. Even if we scientific community have reacted by expressing their make mistakes, we’re not doomed to make nothing support for his work and pointing out that his opinof our lives. We can always succeed and get a good ions are based on relevant research and solid data. job. Everyone should be allowed to get into trouble “Carl’s overall argument is persuasive,” Craig R. and make up for it later. That’s what my life shows. Rush, a University of Kentucky psychologist specialised in behaviour related to drug use, said in an IV Tell us about the famous Rat Park experiment article in The New York Times. “I have a great deal conducted in the 1970s, which you describe in your of sympathy with Carl’s views,” says David Nutt, book. CH During that experiment, some rats lived in a a professor of neuropsychopharmacology at Imrich and exciting social environment, while others had to perial College London. “Addiction always has a live isolated in cages with nothing to do. And both groups social element, and this is magnified in socieof rats could choose to self-administer morphine. What ties with little in the way of work or other happened? The rats that lived in the attractive environment ways to find fulfilment.” took much less morphine than their poor caged counterparts.

MENS SANA

INTERVIEW

You reconstituted this experiment with humans. Can IV Which is false? CH Eighty to ninety peryou describe what you did and how? CH We brought in cent of people who use illegal drugs are addicted users and gave them crack in the morning. Then, not addicts. Most are responsible memduring the day, we offered them either to take more crack bers of our society. They have a job, pay or make five dollars. And we would adjust the doses of their taxes, take care of their family. crack we were offering. Sometimes it was more, sometimes less. IV

IV What did you find? CH We

“HUMAN BEINGS WILL ALWAYS USE DRUGS, NO MATTER WHAT LAWS OR BANS ARE IN PLACE.”

saw that the decision to take drugs was totally rational and wasn’t only driven by the addiction. When offered a small dose of crack, the individual would choose money instead. When the dose was large, they took the crack. When drug addicts are provided with attractive alternatives, they make rational decisions.

Your research goes against what we’ve always heard about drugs. Where does that difference come from? CH The main problem involves perception, which has contaminated the entire scientific community. When we, as researchers, start a research project, we tend to perceive drugs as something negative, almost evil. Only the harmful impacts of drugs have been studied and described. But as scientists, we should have a more in-depth unIV You also refute the idea that people who take derstanding of a subject and approach it from drugs are more likely to become criminals. CH several angles. People confuse drug use and crime. But it’s been shown that the pharmacological effects of drugs do IV What would the positive aspects of not push people to become criminals. We drugs be? CH There are many positive can compare the impact of hard drugs effects. For some people, drugs make it BIOGRAPHY with that of alcohol. We all know that a easier to interact socially or can improve Carl Hart is a drunk person can be aggressive, but most sexual performance and cognitive abili- leading research- aren’t. We’ve given thousands of doses of er on the impact ties. Human beings will always use drugs, of drugs on hucrack to laboratory subjects, and it’s never no matter what laws or bans are in place. man behaviour. once caused any violent behaviour. So the We should be analysing the various Born in 1966 in fact that a person can become aggressive aspects of the impact of drugs on the hu- an impoverished or commit a crime has nothing to do with area of Miami, man body. the drug itself. he joined the IV

Which ideas do you think are false about addiction? CH There are so many ideas that have been fed to us. Most people think crack is so addictive that you can become dependent after only taking it once. The same with heroin. Just one injection, and boom, you have a drug problem. IV

United States Air Force at age 18. Four years later, he started doing scientific research at the University of Maryland. In 2013, he published the book High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.

IV We

often hear that drugs make people lazy. What do you think? CH The myth says that drugs have an impact on an individual’s cognitive performance, that drugs keep people from becoming productive members of society and destroy families. But using drugs alone cannot be the source

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INTERVIEW

of these evils. These problems are caused humans wouldn’t be ethical either. All our treatments and more by an individual’s personal situation. our laws would only be based on empirical evidence and Are they poor? Do they live in a dangerous observations made on rats. neighbourhood? Do they go to school? Do they work? A whole set of factors needs to IV But drugs do cause harm. If it’s not due to the nature of be taken into account. the substance itself, how do you explain it? CH Public policies on drugs have done a lot of damage. The crimiIV You say that it’s the environment and nalisation of drugs is a huge mistake. There are so many not the drugs that affect a person’s path. examples of how toxic these policies are. For example, CH The equation is simple. Drugs trigger a today, when we arrest someone who uses drugs, a trace euphoric effect, which is a positive reinforcewill remain on their criminal record for years. That keeps ment. When a drug user has no other source them from getting a job and back on the right track. of pleasure in their life, why not take drugs? They’ ll continue shooting up because they IV What can we do to improve the situation? CH We can’t do anything else. However, if a should decriminalise drugs and stop arperson has attractive alternatives, like READ resting and imprisoning drug users. Inworking and making money, earning *“High Price: A Neuroscistead of tracking down users, the police entist’s Journey of Selfrespect from their peers in one way or Discovery That Challenges should make sure that the drugs sold are Everything You Know another, that person will stay clean. not toxic or laced with dangerous chemAbout Drugs and Society”, icals. We should also better educate Harper, 2013. young people, as we do with alcohol. “Is Cognitive Functioning

“THE CRIMINALISATION OF DRUGS IS A HUGE MISTAKE.”

Impaired in Methamphetamine Users? A Critical Review”, 2011, Nature.

What do you think of Switzerland’s policy on drugs? CH Switzerland is ad“Acute Physiological and mirable at several levels. I’m mostly Behavioral Effects of Intranasal Methamphetamine impressed with the tone of the debate. in Humans”, 2007, Nature. Drug-related issues are discussed pragmatically, and the support programmes WATCH “Let’s quit abusing for heroin addicts are amazing. Giving drug users”, drugs to addicts as a form of treatment TED Talk, 2014. is an intelligent approach that works. Link to the articles In the United States, we’d never even and video on www.invivomagazine.com IV You inject drugs into your particimention that idea. Any issue related to pants in your experiments, which is drugs passes through an ideological unusual. Why not just work with rats? CH It was my prism that demonises drugs. And that prementor Marian Fischman who began doing this type of vents us from thinking clearly. experiment at Columbia University in the 1980s. She wanted to know how humans react when given drugs, IV You’re now in Geneva, where you’re workwhich had never been done before in a laboratory seting on your next book. Why did you choose ting. The huge advantage of working with humans is Switzerland to start this new project? CH that you can ask them questions. So you can understand Switzerland has an interesting approach to the complexity of their decisions and reactions. drugs. That helps me remove the blinkers that I’m forced to wear in the United IV But is that method ethical? CH Of course, it’s a sensitive States. My new book will try to tackle the issue. We make sure we don’t give drugs to people who’ve drug issue differently. Being in Geneva never taken any. At the same time, not doing research on helps free my spirit. ⁄

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INNOVATION

Doctors, scientists and humanitarian workers are all looking into the potential of drones to help patients and victims of natural disasters. But the technical, legislative and privacy hurdles remain. Lausanne-based company and offshoot of the National Centre of Competence in Research in Robotics at EPFL, which was recently ranked by Venturelab as one of the top three Swiss start-ups. “And the result is an incredibly flexible and agile drone that can make its way through the most hostile and treacherous environments.” rones look like big metal insects surrounded by a spherical cage. The cage acts as a protective shell during take-off, meaning that the drone can hit objects without being damaged. “We have spent hundreds of hours watching insects to understand how they remain stable after crashing into something,” says Patrick Thévoz. The entrepreneur co-founded Flyability, a

That makes drones the ideal partner for rescue teams that have to find victims stuck under a collapsed building after an earthquake, trapped in a burning building or caught in a storm at high altitude. “The robots on wheels that are currently used often get stuck in debris on the ground,” Patrick Thévoz says. “We saw that in Fukushima,

TEXT: JULIE ZAUGG

where they did not manage to enter the damaged power plant.” Matternet, a Californian start-up, has developed drones to bring food, water and drugs to victims of natural disasters. The company tested its machines in Haiti following the earthquake in 2010 and in Bhutan, a country chosen for the poor condition of its roads, making it the ideal place for experimenting with drones. Terre des Hommes also used drones in Haiti in the aftermath of hurricane Sandy in 2012. “Some houses were swept 15 kilometres away by a river,” says Frédéric Moine, information systems advisor at the NGO. “A drone equipped with a camera helped us to assess the damage.”

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INNOVATION

TUCKED INSIDE ITS CARBON CAGE, THE DRONE DEVELOPED BY THE LAUSANNE-BASED START-UP FLYABILITY CAN TAKE OFF AGAIN AFTER HITTING A WALL OR OBSTACLE.

THE “AMBULANCE-DRONE” DESIGNED BY THE DUTCH RESEARCHER ALEC MOMONT BRINGS FIRST-AID ESSENTIALS TO CARDIAC ARREST VICTIMS. WATCH THE VIDEO ON WWW.INVIVOMAGAZINE.COM.

The drone’s images were compared with those taken before the disaster by OpenStreetMap – a participatory community mapping initiative aimed at creating a free-access world map – to guide reconstruction efforts.

which devastated the Philippines in 2013. Other NGOs apply drones to monitoring refugee flows or determining if anti-personnel mines have moved after a landslide.

Medair, a humanitarian organisation, used drones in its relief efforts following typhoon Haiyan

Humanitarian aid is not the only potential application for drones. Alec Momont, a researcher from

FLYABILITY, JP5\ZOB/WENN.COM / NEWSCOM

FLYING AMBULANCE

the Delft University of Technology in the Netherlands, has designed a drone to be used as a flying ambulance. The drone can bring a defibrillator, a tourniquet and other first-aid essentials (venom kit, epinephrine auto-injector, splint, asthma inhaler) to patients within a radius of 12 km2 in under one minute, compared with an average response time

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of ten minutes for a traditional ambulance. Guided by GPS to the signal from the mobile phone used to make the emergency call, the drone can find its way to the site of the accident. Once there, a medical practitioner can diagnose the emergency remotely and instruct helpers on site via the camera mounted on the device. “That increases a patient’s chances of surviving a cardiac arrest from 8% to 80%,” says Alex Momont. Cornelius Thiels, a doctor and researcher at the Mayo Clinic in Minnesota in the United States, has other ideas. He feels that many hospitals, especially smaller ones, do not stock enough blood products, including red cells, plasma and platelets. “A single patient with massive bleeding can easily deplete the blood supply.” They end up having to transfer the person to another hospital or have blood delivered by road or air. Cost aside, this can be risky for the medical staff. Every year, 40 health care providers die during these emergency transfers. The vehicle can get stuck in traffic, putting the patient’s life in danger. The doctor believes that “using drones could help save time and lives.” These unmanned flying machines could also be used to transport laboratory samples or drugs to patients in remote

INNOVATION

areas. “Narcotic painkillers could be shipped with a daily dose, rather than giving patients a monthly supply, thus minimising the risk of addiction,” Cornelius Thiels says. And eventually, drones might even transport organs. “Supply and demand could be coordinated more flexibly and reduce waiting times for patients who need a transplant.”

bean island of Grenada. Despite their potential, drones still have progress to make. The average vehicle can carry no more than 2 to 3kg and only fly for up to one hour. That restricts its range of action to 90 km2 at most. “If we use them to transport drugs or lab samples, we have to make sure they’re not exposed to heat or moisture during flight,” says Cornelius Thiels.

DRONES FOR RESEARCH

Many countries have laws restricting the use of their air space by drones. For example, the United States bans civil or recreational unmanned aircraft operations above certain altitudes, while conflict zones only allow military planes to fly. “Every country has its own rules,” says Patrick Thévoz of Flyability. “In Switzerland, drones cannot fly within five kilometres of an airport, above certain altitudes or above a crowd.” In France, flight plans must be submitted to the authorities for approval. “But a European law is being drafted to standardise all that,” he says.

Medical research has also joined the drone movement. Project Premonition, an American initiative aimed at detecting new viruses by decoding their genome, uses them to capture mosquitoes and analyse the blood from the animals and humans they’ve bitten. “I’ve been hunting mosquitoes for twenty years. Until now, that meant laying traps out in nature on foot or by truck,” says Douglas Norris, a microbiologist from John Hopkins University, which is involved in the project. A team of scientists can lay 8 to 12 traps per day at most.” Project Premonition now wants to outsource that task to drones. “They can fly in a straight line, without having to fly around obstacles, and can work day and night,” the scientist says. Douglas Norris believes that just one of these devices can replace an entire team of trappers. And they can zip through dense jungle-covered areas that humans can’t reach. In March, researchers conducted a feasibility study on the Carib-

The use of these flying machines also raises privacy issues. If they’re deployed to monitor refugees with a ground resolution of 4 centimetres, the people’s faces become completely recognisable. Or, if drugs sent to a patient’s home are intercepted by a neighbour, that person would then have confidential health information. In essence, drones still face several hurdles before they can take off. ⁄

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TRENDS

THE GENEROUS DONORS OF THE INTERNET COMMUNITY Crowdfunding has raised money to publish books, produce albums and create artistic works. Now the health sector is joining in.

TEXT: CATHERINE COCHARD ILLUSTRATION: TANG YAU HOONG

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TRENDS

hese days, there’s no escaping crowdfunding requests. Incentives are everywhere, asking people to contribute financially to projects that support films, books or music albums. In June, a young British man even launched a bid to raise €1.5 billion to bail out Greece and help repay its debt to the International Monetary Fund. Although that particular campaign did not reach its target, several scientific research projects have been carried out successfully. Some platforms, such as Wellfundr and FutSci, are even dedicated to health projects.

LEGISLATION ON CROWDFUNDING In Switzerland, the only legal restrictions that apply to this form of fundraising are based on existing legislation for financial markets. These restrictions apply either to the companies that receive the funds or to crowdfunding platform operators. “For example, Switzerland has what is called the 10/20 rule. This rule states that any Swiss company granted loans by more than 20 non-bank lenders is considered a bank subject to withholding tax,” says Damien Conus, a lawyer specialised in crowdfunding who teaches at the Haute École de Gestion management school in Geneva. Another scenario: crowdfunding platform operators must comply with the due diligence legislation applicable to financial intermediaries concerning money laundering (especially checking the origin of the funds). They must also obtain a licence under the legislation applicable to banks, depending on the control they have over the funds.

The numerous medical studies that have been crowdfunded include the campaign launched by David Hawkes of the Florey Institute of Neuroscience and Mental Health in Australia. The researcher collected some A$12,000 on www.pozible. com to support his project on the use of viral vectors to treat neurological disorders. Michael Pollastri from Northeastern University in the United States raised $25,000 to launch his project on neglected tropical diseases using the platform Experiment. In May 2015, Grenoble-based Ecrins Therapeutics rounded up 555,000 Swiss francs on Crowd Avenue to develop a new cancer drug. Among the most successful campaigns is Embrace, the connected bracelet developed for epilepsy patients by the Italian start-up Empatica. This device alerts loved ones in the event of a seizure.

“THE FUTURE OF MEDICAL RESEARCH IS IN PRIVATE FUNDING.” PHILIPPE RYVLIN, NEUROLOGIST

The concept of raising money online, in small amounts donated by a large number of people, dates back to the late 1990s when the first crowdfunding sites were created. The model for these platforms remains the same. The project initiator sets the target amount in advance and only receives the money if the total amount is collected. Crowdfunding has grown swiftly over the past few years. A study by the Judge

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TRENDS

Business School at the University of Cambridge reported that in 2014 nearly €3 billion was raised across the entire alternative finance market in Europe. That’s a 144% jump in one year (€1.21 billion in 2013). The Cambridge Judge experts believe that European alternative finance could exceed €7 billion in 2015. Goldman Sachs published a study in April 2015 purporting that crowdfunding has become so successful that the leading American banks could lose €11 billion in annual profits over the next five years, as those funds will instead be invested in platforms like Kickstarter and Indiegogo. Researchers rely on this type of financing because it is becoming increasingly difficult to raise funds for scientific research. “The future of medical research is in private funding,” says Philippe Ryvlin, chief of the Department of Clinical Neuroscience at Lausanne University Hospital (CHUV). And the professor knows what he’s talking about. He worked for years to round up several million Swiss francs from large and small private donors to set up the Institute for Epilepsy in Lyon. The facility is set to open between now and the end of the year. This intense fundraising effort convinced him that the research field needs to adjust the way it thinks about financing. “In addressing a broad audience, crowdfunding is in line with the changes in society. We can strike a better balance between what users want from medical research and the amount of money they are prepared to put into it.” Philippe Ryvlin admits that until only recently, medical researchers were not necessarily concerned about what the public thought of their work. “Today,

USING CROWDFUNDING TO PAY FOR TREATMENT Research is not the only area in medicine to use crowdfunding. In countries where medical treatment is not covered by a national health care system, some patients appeal to the solidarity of the Internet community to pay for their medical care through crowdfunding. GoFundMe is one of the popular platforms used to try to raise the money necessary to pay for treatment. In the “Success Stories” section of the website, visitors can get an overview of the most inspiring crowdfunding campaigns. On that page is the face of Alex Haas, a third-degree burn victim who was able to get the care he needed thanks to the campaign led by his family and friends. There’s also the face of young Kiersten Yow, who was attacked by a shark and sustained injuries to her left leg and arm. The 12-year-old was able to get treatment thanks to crowdfunding efforts. She is now in rehabilitation and is expected to regain the use of her lower limb.

we have to work more closely with the general public and understand what they expect from medical research, an area they are often passionate about! We must be held accountable to taxpayers, whose taxes finance some of the research, and engage with society in general to explain why we do things the way we do.” It’s not just about raising money but, more importantly, about convincing people of the importance of research. In North America, some naysayers fear that crowdfunding applied to scientific research only works for the “sexiest” projects. Americans call this “panda bear science” in reference to that cute and cuddly black and white mammal. “Any change can have potentially perverse effects,” says Philippe Ryvlin. “It’s the risk we have to take. We have no choice! And in Switzerland, a country that strongly believes in voting, it would seem unnatural to doubt public opinion about funding for scientific research. Crowdfunding is a form of the democratic process.” ⁄

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DECODING

SHOULD WE BE SCARED OF VACCINES? TEXT JULIE ZAUGG

Parents, and some medical professionals, are worried about the effects of vaccines used on their children to immunise them against disease. Specialists offer reassurance. t began with an She was quickly joined by another user, innocent question who posted a link to a support march for posted on the Stacy, a Belgian baby who died of online medical meningococcal meningitis ten days after forum Doctisbeing vaccinated. On Youtube, the activist simo: “Hello, I’m Alvin Jackson passionately rants about looking for info vaccination requirements for children, about vaccinacomparing them to genocide. tions for babies. I have a four-month “The huge majority of parents support old girl who I haven’t had vaccinated yet immunisations, but a small minority, because I’ve read lots of very active in the media articles and books about and online, is opposed THE MOST the damaging effects of to it,” says Pierre-Alex CONTROVERSIAL vaccines (cancers in the Crisinel, staff physician VACCINES long term, neurological with the Paediatric problems, etc.).” But the Infectious Diseases author of the post, and Vaccinology Unit Lunaya78, rapidly at the Lausanne HEPATITIS B shifted into attack University Hospital At the end of the 1990s, mode, criticising the (CHUV). The oppoan organisation of hepapower of pharmas, nents mainly cite the titis B vaccine victims sparked a controversy in doctors’ lack of dangers of vaccines, France, saying that they transparency and the which have been had developed multiple serious side effects denounced as the sclerosis. The French experienced by cause of a string of Minister of Health at the vaccinated children. diseases from autism time, Bernard Kouchner, suspended the use of the vaccine. In the 2000s, the French government and UK pharmaceutical laboratory GlaxoSmithKline had to pay damages to some patients. Several studies have since exonerated the vaccine.

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MEASLES, MUMPS AND

DECODING

to multiple sclerosis, allergies, diabetes and epilepsy.

RUBELLA (MMR)

Controversy broke out in the UK in 1998 following the publication of a paper by the physician Andrew Wakefield in the medical journal “The Lancet”, establishing a link between the MMR vaccine and autism. Further investigation revealed that Andrew Wakefield had received money from litigants suing the vaccine manufacturer. “The Lancet” fully retracted the article in 2010.

Some parents, especially in the United States and United Kingdom, believe that we should let children develop these childhood diseases to boost their immune system. “There has been a deep change in the perception of risks,” says Claire-Anne Siegrist, Director of the Centre for

Vaccinology at the Geneva University Hospitals (HUG) and senior physician of General Paediatrics. “People are no longer afraid of the diseases that the vaccines prevent, and so they wonder if they’re of any use at all.” Some people oppose vaccinations for religious reasons, while others claim the right to choose freely which medicines they give to their children, decrying the immunisation requirements in France and the United States. “Laws are less strict in Switzerland,” says Pierre-Alex Crisinel. “Only the cantons of Geneva and

LIBRARY OF CONGRESS PRINTS AND PHOTOGRAPHS DIVISION WASHINGTON, D.C. 20540 USA

A country doctor administers a typhoid fever vaccination at a Texas school in 1943. This scene is immortalised by the American photographer John Vachon.

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DECODING

Neuchâtel impose mandatory vaccination against diphtheria. And the new law on epidemics will do away with that requirement in 2016.” It’s not just parents who mistrust vaccines. Pierre Verger, an epidemiologist at the French National Institute of Health and Medical Research (Inserm), studied the attitude of 1,712 French general practitioners towards vaccines. “Between 15% and 40% never or only rarely recommend some vaccines,” the scientist says. In fact, one quarter of them feel that we immunise our children too much. “They are the most suspicious of the vaccines that have caused public controversy, such as hepatitis B and papillomavirus.”

do are only recommended if the serious consequences are extremely rare.” That means about 1 in 100,000 to 1 in a million cases. Dozens of studies have

Vaccines with significant harmful side effects never reach the market.

VACCINE COCKTAILS

Newborns often get a combined vaccine that immunises them against several diseases at once. “Some parents fear that the shots overload their immune system and make them more vulnerable to infections,” says David Goldblatt, professor of vaccinology and immunology at University College London. He disagrees: “Every day we deal with millions of bacteria in our intestines, and our immune system does just fine. And thanks to the progress in medicine, the number of antigens contained in vaccines has been reduced in recent years.”

Pierre Verger also noted in some practitioners, especially older ones, “a form furthermore disproved of defiance” against recommendations anti-vaccine fears. from the authorities. For example, the meningococcal C vaccination is consid“As vaccines are adminisered unnecessary due to the rarity of tered on a large scale, the disease. Homeopaths, chiropractors people tend to accuse them and naturopaths are of triggering all the even more reluctant diseases that this vast ALUMINIUM and sometimes hostile group of patients Aluminium is used as towards any practice would have developed an adjuvant in various that contradicts their anyway,” says Bernard vaccines. It has been asown doctrine of Vaudaux, former head sociated with a series of treating people with of the Paediatric problems. “We noted that plants Infectious Diseases aluminium particles can or back exercises. and Vaccinology Unit persist at the injection site for an abnormally long at CHUV. UNFOUNDED FEARS

This backlash is for the most part unfounded, according to ClaireAnne Siegrist from HUG. “Vaccines with significant harmful side effects never reach the market, and those that

period,” says Romain Gherardi, a neuropathologist at Paris Est-Creteil University in France. “These particles are responsible for microlesions in the deltoid muscle [one of the shoulder muscles] and can migrate to the brain.” He claims to have seen more than 600 patients with this problem. The French National Assembly ordered a report for further study. The report, released in 2013, established no link between the adjuvant and these conditions.

The frequent changes in the recommended immunisation schedule also lead to confusion. “Some vaccines, such as smallpox and tuberculosis, were dropped because those

DECODING

CENTRE FOR INFECTIONS/PUBLIC HEALTH ENGLAND/SCIENCE PHOTO LIBRARY

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diseases have disappeared from the indigenous Swiss population,” Bernard Vaudaux says. Other vaccines have been replaced with a new, more effective version, including the vaccine against pneumococcal infections. Certain immunisations are now administered less PAPILLOMAVIRUS frequently. For example, Papillomavirus is a virus tetanus and diphtheria that can cause cervical booster shots protect cancer. The vaccine people for longer than was brought to market expected, so fewer in 2006 and is now administered to most inoculations are necessary teenagers. A group of between the ages of 25 complainants claims that and 45.

the vaccine has caused various diseases from multiple sclerosis to hidradenitis suppurativa and lupus. “Some believe that there’s no point vaccinating against a cancer when screening can detect it in its early stages,” says Pierre-Alex Crisinel, staff physician with the Paediatric Infectious Diseases and Vaccinology Unit at CHUV. The debate is not over.

Some caution should nevertheless be taken with vaccines. They can be fatal for people with a deficient immune system – especially the elderly, newborns that cannot be immunised before the age of 1, and

HIV patients with poor protection from antibodies. However, in theory, these people benefit from the “herd effect”, which is to say the invisible wall that is created between them and the disease, because they live within an immunised population. Several European countries, including the United Kingdom, Ireland and the Netherlands, suffered measles outbreaks in the early 2000s, resulting from a drop in the vaccinated population following the MMR vaccine scare (see p. 41). The United States recorded nearly 1,000 measles cases between 2013 and 2015. More serious yet, Nigeria and Pakistan have recently faced a resurgence of polio, a disease that had been virtually eradicated, due to the religious authorities’ mistrust of the vaccine. They wrongly accused it of containing pork, which is forbidden in Islam, or of causing sterility as part of a western conspiracy to make Muslim women infertile. ⁄

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IN THE LENS

SCIENCE OFF THE BEATEN PATH TEXT: ERIK FREUDENREICH IMAGES: THIERRY PAREL

BIOHACKING Science lovers across the world are developing an alternative approach to biology research. A journey into the heart of Hackuarium, the community laboratory in Lausanne. A new category of researchers has emerged over the past few years on the fringe of scientific progress. Biohackers conduct their experiments in do-it-yourself labs, well outside the traditional academic environment, promoting their open source approach to science. Spaces devoted to this new alternative to research have cropped up across the globe, from New York to London to Paris, and now in Renens, where the not-for-profit Hackuarium laboratory opened just over a year ago. Set up in what used to be IRL’s printing workshop, the lab brings together researchers, students and pensioners who come to spend some of their free time trying to move science forward based on an open, community ideology.

DETECTING ARSENIC

Sachiko Hirosue (pictured) is a biohacker. With Robin Scheibler, she leads a project called “Biodesign for the real world”, which addresses problems of water quality. “We’re currently focusing on a specific aspect of this issue,” the scientists say, “arsenic contamination.” Arsenic has been used as a poison since ancient times. High amounts of this metalloid chemical element seep into the soil due to industrial pollution such as from mines, metallurgical processes and pesticides. “In certain regions of Asia, high concentrations of arsenic are found regularly in groundwater. Arsenic can disrupt the endocrine system and cause skin problems and cancers.”

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IN THE LENS

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IN THE LENS

NETWORKING

The Hackuarium laboratory currently has about half a dozen projects under way, ranging from sequencing the genome of beer to building a robot that will be used to conduct scientific experiments at the South Pole. “As students regularly come to contribute to the project, having space and equipment at Hackuarium helps advance our work considerably,” says Robin Scheibler. “We can also have discussions with the rest of the community, which has been very valuable.”

GENETIC MODIFICATION

“Concretely, we use a bacterium that we’ve genetically modified to detect the presence of arsenic in water,” says Sachiko Hirosue. The microorganism was developed by Professor Jan Roelof van der Meer, director of Fundamental Microbiology at the University of Lausanne. The entire system was used by the Biodesign team in August 2015 to test the water in Lake Ottans, located in the Canton of Valais near an old gold and arsenic mine.

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IN THE LENS

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IN THE LENS

BIG DATA

“In the near future, we’d like to set up a computer platform to exchange the data we’ve collected,” says Robin Scheibler, “because the main point of our project is to share our knowledge. We plan to organise events and meetings to get people thinking about issues involving water and what it contains.”

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COMMENTARY

ANNE-CAROLINE PAUCOT Founder of the websites Lasantedemain.com and Dicodufutur.org

“Neckinitis”, “click-mania” and “tech zombiism”: the symptoms of these diseases of the future can be felt today. Our attachment to an electronic device can also turn us into “tech zombies”. This disorder affects a number of adolescents, referring to their physical presence and mental absence in their environment. These individuals are unable to communicate with the people around them, but can carry on remote conversations.

Plague, cholera… Although they rarely disappear forever, diseases take part in writing history. Meanwhile, other illnesses develop. And our binary, virtual, connected world has brought its share of health issues.

As if tech zombies weren’t unbearable It only takes a few seconds in a public enough, parents break into full panic mode place to realise why “neckinitis” is becoming when their kids suffer from “virtualism”, such a common modern-day ailment. This a sort of reality deficit disorder. Constantly tendonitis of the neck comes from continually absorbed in video games and virtual worlds, looking at screens. American surgeon patients can no longer tell the difference Kenneth Hansraj estimates that we can exert between the physical and virtual world. up to 22kg of pressure on our neck from They think they’re avatars with super powers. tilting our head down to look at a smartphone! And this illness can result in tragedy, with That phone is also causing “nomophobia”, the patients even jumping out the window fear of being out of contact with our mobile thinking they can fly! device. No signal, dead battery and similar situations lead addicted users to feel intense With technology palpably taking over lives, anxiety. When technology gods are with screen other objects can provoke pathological reacaficionados, they can be victims of “click-mania”, tions. Individuals can develop “robophobia”, a or attacks of restlessness brought on by the delusional fear that robots will steal their work absence of notifications and alerts. We’ve or their spouse. “Metalism” refers to reactions to become addicted to endlessly clicking our way implants and prosthetics. Introducing metal into through the Internet. When we stop clicking for the body can trigger allergies, inflammation, pain, a while, we feel that click anxiety coming on. short-circuiting, intoxication and other problems. And as any good thing can also be a bad thing, our increased longevity can result in an “eternity” depression caused by the boredom felt from living PROFILE for too long. Anne-Caroline Paucot is a journalist and author of several books on the impact of new technology on our societies. In 2014, she launched Editions Propulseurs, which publishes books to make forward thinking accessible for all.

These disorders have not yet been labelled but have been announced. Like any other disease, prevention is better than a cure. Once our amusement dies down, we should give these health issues a closer look. ⁄

TO READ

“La Santé demain”, Ed. Les Propulseurs

TEXT: CATHERINE COCHARD

MUSIC SETTLES IN AT THE HOSPITAL Health care specialists increasingly believe in the therapeutic benefits of the art of music. Used for pain management, anxiety, concentration or even neuro-rehabilitation, sounds act directly on the brain.

EVEN IN THE OPERATING ROOM A study published in August 2015 in the British medical journal The Lancet reported the benefits of music in the operating room. It showed that listening to music before, during or after an operation reduced patients’ pain and anxiety. Catherine Meads of Brunel University, who conducted the research, believes that anyone undergoing surgery should be offered the option of listening to music. Even better, patients should be allowed to choose what music they would like to hear to optimise its positive effect.

n Nashville, Tennessee, researchers have developed special soothers for premature infants born at 34 to 35 weeks. When the newborns coordinate their breathing and sucking correctly, the dummy activates a recording of their mother singing a lullaby. The findings of this experiment published in “Pediatrics”, the journal of the American Academy of Pediatrics, show how newborns rewarded by the soothing sound learnt how to eat faster and therefore left the hospital earlier. Using music as therapy in medicine is nothing new. In ancient Egypt, chants were prescribed for patients to treat sterility, rheumatic pain and insect bites. The virtues attributed to sound are of course different today. Most of the time, CORPORE SANO

sound is perceived as a “mediator” that promotes communication between the patient and therapist. “Music therapy is used to treat patients with psychological, social, behavioural or relational problems and emotional, sensorial or neurological disorders,” says David Suchet, a music therapist in Lausanne. Swiss hospitals have been using it for years. “The use of artistic mediation therapies is the result of a long process that began in the 1960s,” says Sarah Flores Delacrausaz, a music therapist who has been working at the Cery psychiatric hospital for 17 years. Music therapy has gained greater awareness thanks to the special training programmes introduced in Switzerland. Its use is gaining ground, spreading to different areas of treatment. “The appeal of this type of therapy is clear. It opens up unique and original ways towards understanding and treating psychological diseases.” BOOSTING MORALE

A strong relationship between the patient and music therapist is vital, but even the music on its own has a positive effect. The Centre de psychiatrie du Nord Vaudois, a psychiatric hospital in

MARIA ZARNAYOVA / EPA

In the maternity ward at Kosice-Saca in Slovakia, newborns listen to music through headphones.

CORPORE SANO

TRENDS

Yverdon, conducted an experiment called Amenhotep. In the study, the doors to the isolation chambers became an interface where the patient could choose to play music by simply brushing against them, like a touch screen. “Even though subjects are going through a particularly chaotic period, this system gives them some control over their environment,” says Alexia Stantzos, a specialised clinical nurse at Lausanne University Hospital (CHUV) and assistant scientist at the University of Health Sciences (Haute École de la Santé) in Lausanne, which led the study. “Patients are also free to choose which song they want to listen to and adjust the volume. From a cognitive standpoint, they feel more independent, while emotionally, listening to music helps meet their individual needs.” Between now and this autumn, four of the centre’s intensive care rooms will be equipped with these music therapy doors. Music therapy also benefits somatic disorders. “In cases of neuro-rehabilitation (e.g. stroke patients), listening to or practising music helps reduce concentration problems, improve hemiplegia and assist gait through rhythmic auditory stimulation. Music therapy also promotes speech by using a repertory that the patient is familiar with or by soothing negative emotions,” says David Suchet. INDIVIDUAL SOUND IDENTITIES

“The effect of music on the brain can be read in an MRI (read note opposite). There is no way of associating a melody with a given benefit because every person has their individual sound identity. “Any individual is made up of different elements – such as culture, birth place, the sounds they experienced CORPORE SANO

A POSITIVE IMPACT ON THE BRAIN Playing the piano, flute or violin changes an area in the brain involved in concentration, aggression and even anxiety. That finding was reported in a recent study published by the University of Vermont, United States, in the Journal of the American Academy of Child & Adolescent Psychiatry. “Playing an instrument is associated with faster cortical thickness maturation in areas of the brain used in motor planning and coordination, visuospatial ability and emotion and impulse regulation,” the authors say. The research by Nadine Gaab at Boston Children’s Hospital has established a connection between music skills and language development. “The musicians have higher speeds of spontaneous speech when asked to describe an image and a larger working memory.”

TRENDS

during childhood – that will shape their own musical tastes,” says Serge Ventura, director of École Romande de Musicothérapie (music therapy school in French-speaking Switzerland). “We have to figure out the sound identity of each of them before we can act effectively with music. It’s not just the music alone that treats, but the relationship that forms between the therapist and the patient through the sounds, which respond to the patient’s specific experience and identity.” In the future, we will undoubtedly be able to measure everyone’s individual sound identity more accurately. Sync Project is a Boston-based company developing ways to align user music with biometrics collected from wearable technology, such as smartwatches and other bracelets like those made by Jawbone. Sync Project tries to establish patterns by correlating data and music. For example, the subject runs faster while listening to U2 or relaxes better with Marvin Gaye. Then the most appropriate music can be suggested for their activity and state of health. All that’s left is for everyone to create their playlist. /

SURGERY BEFORE BIRTH Today, surgical procedures can be performed on foetuses without opening the mother’s stomach. In this article, we look at foetal laser surgery, as impressive as it is revolutionary.

CÉCILE GUENOT

TEXT: BERTRAND TAPPY

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INNOVATION

Other laser applications in foetal surgery

The laser can be used to coagulate the blood vessels that feed tumours.

he eyes of everyone in the room are transfixed on a small screen. For the novice, what appears on the monitor looks like underwater diving in a hostile environment. We can hardly see anything or tell up from down in the strange cavity stretching before our eyes. As if the sight itself were not odd enough, at the bottom of the screen we can see a small rod moving about. It seems to be erasing a network of faint blood vessels along the edges of the mysterious cavern.

SACROCOCCYGEAL TERATOMA Tumours that grow at the bottom tip of the spine. LUNG TUMOURS These tumours compress the lung of the foetus and prevent healthy lung development. CHORIOANGIOMA This tumour that develops in the placenta “robs” the foetus of blood.

performs operations like this one just over twenty times a year. Most often, he teams up with Switzerland’s second specialist in the field, Luigi Raio, from the Bern University Hospital.

The first operations have been performed to treat tumours in utero or correct urinary and cardiac � blockages in foetuses. Suddenly, a hand appears. A tiny, fragile hand, still covered in the soft, downy hair that only humans have before they leave their mother’s womb. And a bit further, a head, then another, as if floating amid the surreal setting. Then we finally realise, while watching this amazing scene take place before CORPORE SANO

those closed eyes, what we’re marvelling at. It’s the inside of a uterus and two lives that are slowly taking shape in the placenta. This field is called in utero laser surgery, a speciality unlike any other. David Baud, a physician at the Department of Obstetric Gynaecology at the Lausanne University Hospital (CHUV), INNOVATION

The two hospitals have been working together closely in this cutting-edge surgical procedure to treat tiny patients from all over Switzerland and other European countries. “More than 90% of the time, we treat cases of twin-to-twin transfusion syndrome (see inset),” says David Baud. “These are most often emergency procedures, once the syndrome has been diagnosed by a gynaecologist. We can operate as early as the 14th week of pregnancy, but it’s not easy because the foetuses are tiny,” the expert says. “But later in the pregnancy, the amniotic fluid becomes naturally cloudy, and that seriously complicates our work.”

Once the diagnosis has been made, there is no alternative to surgery. Twin-to-twin transfusion syndrome has a risk of mortality of more than 90% for both babies. Until the 2000s, that meant certain death. At best, one twin would survive, but with the risk of serious neurological damage. Things significantly improved with the development of fetoscopic surgery. Today, the outcome is favourable for both foetuses 70% of the time and for at least one of the babies 90% of the time. “Once the operation is over, there’s always a risk of the water breaking or the uterus contracting and causing premature labour.” Thanks to technological advances in the 2000s, an efficient and lightweight device was developed combining the laser beam, camera, light source and water injection all within a diameter of barely two millimetres.

Twin-to-twin transfusion syndrome

But this is only the beginning of foetal surgery. The first operations have been performed to treat tumours in utero or correct urinary and cardiac blockages in foetuses. These initial trials – in which David Baud’s team participated – suggest a whole spectrum of new possibilities to improve, or save, the lives of those who have not yet been born. ⁄

“The effects are dramatic. One of the babies becomes ’obese’ with an over-developed bladder for its age and an under-developed heart, while the second baby becomes small, shoved into a corner of the mother’s stomach by the amniotic membrane.” The procedure involves burning the vessels responsible for the flow imbalance to restore normal blood supply between the foetuses and the placenta. “The main difficulty is choosing the best point of entry using imaging and based on our experience,” says David Baud. “If you’re successful, you easily find the blood vessels around the umbilical cord, and the babies are not subject to too much strain. However, if you miss your entry, prepare yourself for a long and laborious procedure.”

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Twin-to-twin transfusion syndrome occurs in monozygotic twins – identical twins who share the same placenta – at any time during the development of the two foetuses. “The condition develops when most of the blood supply flows from one baby to the other and is caused by an abnormality in the placental blood vessels,” says David Baud.

INNOVATION

A PILL NAMED DESIRE TEXT: ANDRÉE-MARIE DUSSAULT

A drug designed to enhance women’s sexual desire has recently been given the green light for sale in the United States. But is it anything to get excited about?

“M

that question at Sandra Fornage, chief of the Obstetric Gynaecology and Sexual Medicine Clinic at Lausanne University Hospital. “Lots of them explicitly ask for a drug,” the specialist says. “They are upset that things are not what they ‘used to be’ and would like to feel more desire for their partner.” The little blue pill for erectile dysfunction – which does not affect sexual desire – has been on the market for nearly 20 years, but until now no drug addressed women’s sexuality. But the situation has changed. Last August, the U.S. Food and Drug Administration (FDA) approved Flibanserin after rejecting it twice, in 2010 and 2013, for its limited effectiveness and side effects.

y husband has Viagra, but is there anything out there for me?” Many women direct

The new drug – sold under the brand name Addyi – should allow all women to boost their sexual drive, says its manufacturer, the American laboratory Sprout Pharmaceuticals. For now, Addyi is only available in the United States with a prescription. The drug is aimed at pre-menopausal women suffering from a decline in libido. Sandra Fornage believes the release of the little pink pill is a positive step. “We really have very little to offer women,” she says. While

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TABOO

research to find treatments that solve men’s sexual issues has been around for a long time, women’s desire was not studied until recently. “Women’s sexual pleasure is taboo,” wrote Odile Buisson in the French newspaper “Libération”. The gynaecologist authored the book “Qui a peur du point G? Le plaisir féminin, une angoisse masculine” (Who’s afraid of the G-spot? Women’s pleasure, men’s fear) published in 2011. Since the 1970s, the scientific community has acknowledged that women can also experience pleasure and have orgasms, says Sandra Fornage. “These days, espe-

“WHILE RESEARCH TO FIND TREATMENTS THAT SOLVE MEN’S SEXUAL ISSUES HAS BEEN AROUND FOR A LONG TIME, WOMEN’S DESIRE WAS NOT STUDIED UNTIL RECENTLY.” SANDRA FORNAGE, GYNAECOLOGIST

AN INAPPROPRIATE COMPARISON Addyi, the first drug to boost women’s sex drive, is often dubbed the “female Viagra”, likening it to the famous little blue pill for men. Yes, both drugs are designed to improve one’s sex life, but they do not act in the same way. Viagra affects the vascular system by inducing the relaxation of blood vessels in the penis during sexual stimulation. Blood therefore flows more easily to the penis, causing an erection naturally. The effect is short-lived, beginning about 30 minutes after the pill is taken and lasting nearly four hours. Flibanserin, which is sold under the trade name Addyi, is a psychotropic drug similar to an anti-depressant. It does not act “mechanically” for sexual events to occur, but rather on the patient’s brain by lowering levels of serotonin, the hormone that causes certain sleep disorders, aggressiveness and even depression. Addyi must be taken daily. CORPORE SANO

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cially since the phenomenal success of Viagra, pharmaceutical companies are competing in a mad dash to find a ‘miracle’ product for women.” “SIGNIFICANT” EFFECT

The supposed aphrodisiac properties of Flibanserin were discovered accidentally while the drug was being tested as an anti-depressant. The pill acts on the brain, by increasing dopamine and norepinephrine – two neurotransmitters that affect pleasure (the shiver that we sometimes feel when we listen to music is caused by dopamine), addiction, arousal and attention, to mention just a few of their capabilities – and by lowering levels of serotonin, which influences several physiological functions such as sleep and mood. The findings from the most recent clinical trials, led over a period of two years on more than 1,300 women in Canada and the United States, showed that, for the majority of them, taking Flibanserin daily had a “significant” effect on their desire, and they experienced more satis-

fying sexual events. “Interestingly, nearly all the participants who took a placebo also experienced increased desire and sexual satisfaction,” says Francesco Bianchi-Demicheli, sexologist and physician at the Department of Obstetrics and Gynaecology at Geneva University Hospitals (HUG), highlighting how much psychology can play a role in sexuality.

“SEXUAL DESIRE INVOLVES RELATIONAL, SOCIAL, CULTURAL, BIOLOGICAL, GENETIC, CHEMICAL AND OVERALL HEALTH FACTORS.” FRANCESCO BIANCHI-DEMICHELI, SEXOLOGIST

And not just psychology. Sexual desire is the result of multiple and complex interactions. “It involves relational, social, cultural, biological, genetic, chemical and overall health factors,” says Francesco Bianchi-Demicheli. “We can’t act on all those aspects with a single drug.” But that doesn’t mean that chemistry is at a complete loss. “A growing number of neurobiological studies on animals

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show that sexual behaviour can be controlled by a pharmacological substance.” The physician believes that Flibanserin, along with the proper monitoring, can be useful for women experiencing a lack of sex drive, or “hypoactive sexual desire disorder”, which affects nearly 35% of women. However, only 10% of women are believed to truly suffer from this problem of sexual appetite. “They can feel frustrated, disappointed or diminished in their identity as women, or maybe had to end one or more relationships because of the situation,” says Francesco Bianchi-Demicheli. “ We will assess patients’ level of satisfaction over time,” says the sexologist Sandra Fornage. “We are only at the very beginning of the process.” CRITICISM

Rina Nissim, a nurse specialised in gynaecology in Geneva who has written several books on women’s sexual health, feels that nothing good will come of the release of Flibanserin on the market, especially due to the drug’s side effects. “Today, we hear about low blood pressure, fainting and nervous depression, but it’ll take years before we know everything.” Rina Nissim is co-founder of the former Women’s Dispensary in Geneva, a health centre that encourages women to take control of their health. She laments that “we live in an oversexed society where women – and girls – are constantly pressured to be ‘sex CORPORE SANO

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bombs’.” The nurse believes that a lack of desire cannot be treated. “Their relationship simply has to be worth it - women have to get something out of it - and men have to learn how to satisfy their partner.” That is clearly not the opinion of the pharmaceutical industry. Several companies are developing their own chemicals to compete with Flibanserin, following the example of Emotional Brain. This Dutch company hopes to bring two drugs to market, Lybrido and Lybridos, in 2017. Lybrido is aimed at women who only lack sexual drive, while Lybridos addresses women with inhibitions due to anxiety or complexes. Lorexys, another remedy developed by the U.S. firm S1 Biopharma, completed its second phase of clinical trials in the United States this year. /

PHILOSOPHY IN THERAPY Philosophical counselling, a recent development in Switzerland, looks at life’s existential questions and gives health care providers insight into dealing with patients. TEXT: CAMILLE ANDRES

t was the sudden death of her husband that pushed Françoise* to seek the help of a philosopher in 2013. At the time, she was full of questions, about death, loss, the meaning of life. For one hour a month over the course of a year, she met with the philosophical counsellor Jean-Eudes Arnoux, based in Lausanne. “I wasn’t looking for a solution,” says Françoise, “but for a way to go on living”.

looks at them in terms of living conditions, i.e., from an existential point of view.” BROADER

PHILOSOPHICAL COUNSELLOR went to consult REFLECTION Developing since the 1980s, the the philosopher While psy practice has been in existence Georges Savoy chotherapy for about half a dozen years in in Fribourg, “for generally uses Switzerland and, for the time being, is not regulated. Counselhis listening skills drugs and ling sessions are not covered by and his way of science, the health care system. expressing certain philosophical things. Going to counselling is see a professional based on a helped me gain some perspecbroader reflection: humanity’s tive in a trying situation.” place in history, on the planet, the role of feelings and lthough the process emotions in people’s lives, seems akin to seeing etc. The most common issues a psychologist, it’s dealt with are happiness, death, Alice*, suffering from depression not quite the same, love, romantic relationships and after a stressful redundancy, as Jean-Eudes Arnoux, a work. “I see both young people pioneer in who are having trouble philosophical adapting and heads of compaCOUNSELLING counselling with nies,” says Georges Savoy. In ancient times, humans were defined by their an office practice nature, a rational being made of flesh. The first phiin French-speakEach philosopher has his or her losophers, such as Plato and Seneca, were masters of both thought and living. Philosophy is meant to be a ing Switzerland, way of doing things, resulting form of counselling – from the Latin consilium meanpoints out: from their own background, ing “consultation”, “advice” – to help people live in “Psychotherapy convictions and intellectual th harmony with their body and soul. In the 20 century, approaches preferences, and adapts it to humans were primarily defined by their condition and emotions, by phenomenology, a philosophical school problems in his client. “I don’t have just of thought that aims to explore the transcendental terms of illness, one method, but for me, structures of consciousness. The function of philosoi.e., a medical psychoanalysis is important,” phy was therefore reduced to thinking about existpoint of view, says Georges Savoy. “I help ence. Medicine was considered the only legitimate science for studying the disorders of the body. while philosophy people develop their own ideas, CORPORE SANO

INSIGHT

FRIEDRICH STIEFEL

SOCRATES

CEMCAV, DR

WHY INVOLVE PHILOSOPHERS IN MEDICINE? Friedrich Stiefel, head of the Liaison Psychiatry Service at the Lausanne University Hospital (CHUV), has been working with the philosopher Hubert Wykretowicz for two years. Their aim is to assess acquired knowledge that seems natural and logical and to question it. They look at ways of understanding disease, the patient, patient relations and practices. “A sick person is not just a biological body that envelops a mind. That individual is a figure that changes with time and point of view,” the psychiatrist says. The purpose of his work with the philosopher is not to find a specific treatment. If there’s any “treatment” at all, it should be for the health care providers, to raise their awareness and expand their perspective. “If we take the example of a patient suffering from Parkinson’s disease, that person’s history is not simply the accumulation of neurological symptoms and the potential mental distress that goes with it,” says Friedrich Stiefel. “The patient also feels his or her body in its existential dimension: the body I have, the body I am, the body that connects me with others, the body that looks, the body that is looked at, etc. There is also the slowdown of motor functions and impairment caused by muscle stiffness that change their relationship with time and space. These changes in perception are not discussed in medical training. Studying the dimension of experience – at the heart of what patients are going through day to day – would help medical professionals develop their knowledge and understanding of the sick person.” Other fields of study that are not typically associated with medicine, such as linguistics, anthropology and sociology, are joining this initiative to question and understand human beings in this changing world, including patients and the people who provide their care.

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INSIGHT

desires and fears. To become themselves, actually. That’s the Socratic tradition.”

E SOCRATES Considered to be the founder of philosophy, this Greek thinker (4th century BC) practised maieutics, i.e., a term which refers to using rational interrogation and reasoning to reach a truth.

mmanuelle Métrailler, a philosopher in Valais, works with Platonism. She helps her patients reconnect with all the power of their soul and the dimensions of their personality to “regain harmony and integrity between what they say and what they do.” This approach is close to that of Jean-Eudes Arnoux, who focuses his thinking on the relationship with truth. “I don’t know if philosophical counselling makes people happy, but it makes them more lucid. The clearer our minds, the more capable we are of accepting ourselves and living an authentic life.” ⁄ * NAMES HAVE BEEN CHANGED.

Transsexuals: you’ve come a long way

TEXT CLÉMENT BÜRGE

Once shunned by society, transsexuals are gaining more and more rights. This is the story of one woman, born a man, who has lived through this social transformation.

hroughout her childhood, Michelle Biolley hid the truth from everyone. No one knew her secret. Not her friends, not her teachers, especially not her family. She was suffering. Although born a boy, she knew that she was a woman. “I had this thing between my legs, and I didn’t know what to do with it,” she says. The problem was that Michelle Biolley grew up in the wrong place, a small village near Winterthur. And at the wrong time. “It was the 1980s, and I couldn’t say anything,” she says. “In the rural community where I was raised, we didn’t talk about that kind of thing.”

documents the sex change process. “We’ve come a long way,” says Michelle Biolley, relieved. Official discrimination of this segment of the population began in the second half of the 19th century, says Susan Stryker, a University of Arizona professor and author of the book “Transgender History”. The expert explains that for the first time, doctors considered people with gender dysphoria (the contemporary medical term) as “sick”, and you could be sent to an asylum or prison! That’s when the first political groups emerged to de fend transgender rights, mainly in New York and Berlin. DR

But today, the situation is It was not until shortly Michelle Biolley, born radically different for all after World War II that a man and now a transsexuals. The Amerithe transsexual issue was woman, campaigns can star Caitlyn Jenner again seen in a positive for transgender rights. made the cover of Vanity light. The case of the Fair. The singer Conchita American Christine Wurst has turned the concept of gender Jorgensen revealed the phenomenon to upside down. Amazon even produced the general public. In 1952, the former GI a television series, “Transparent”, which became the first person to talk publicly CORPORE SANO

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Christine Jorgensen

THE PIONEER

MAURICE SEYMOUR

Christine Jorgensen, born George William Jorgensen Jr. on 30 May 1926 in New York, is the first person known to have undergone sex reassignment surgery. Her story is being told all over the world as the young woman appears on magazine covers across the globe. A Hollywood film was also made that was inspired by her life. She chose the name ’Christine’ in honour of Christian Hamburger, the Danish surgeon who performed the operation.

about her gender reassignment surgery. People from all over the world heard her story, as the young woman appeared on the cover of every magazine on the planet. A Hollywood film was even made about her life. At about the same time, the medical field also started seriously looking into the subject. The term “transsexual” was coined in 1949. Specialised medical centres began to open. In 1966, the American endocrinologist Harry Benjamin published the first standard work on the transgender issue called “The Transsexual Phenomenon”.

Xxxxxxx

But the trend was reversed in the 1970s. The feminist and gay movements highly criticised transsexuals, says Susan Stryker. CORPORE SANO

DECODING

Being trans was once again perceived as an illness, she notes. Clinics and hospitals specialised in transsexual cases closed. That negative climate lasted for several decades. And it was tough on Michelle Biolley until the early 1990s. As a young teenager, she would secretly go and read books on transsexuals in Zurich. One day she went to Berlin, where she met the first trans groups in her life. When she returned to Switzerland, she finally decided to talk to a doctor. He sent her to see experts at a specialised medical centre in Basel. “The staff there humiliated me,” she says. “They came out with such nonsense.” They advised her to wear mini-skirts, high heels and too much make-up “to gain acceptance from the community.” She was asked if “she wanted large

breasts, because transsexual women like large breasts.” A therapist told her that she was such a good-looking guy that she didn’t understand why she would want to become a woman. “After four years of therapy, psychiatrists were still recommending that I should change my mind,” Michelle Biolley says, “so I decided to take charge of my transition myself.” In 1995, she ordered hormones online. And she transformed her body without help from anyone.

Caitlyn Jenner

THE SYMBOL

Chaz Bono

THE ACTIVIST The daughter of Cher and Sonny Bono is unique in that she grew up in the public eye. Chaz Bono, a former lesbian, began a short career as a musician before becoming an activist for LGBT rights. He began his transition in 2008.

Henry Hohmann, president of Transgender Network Switzerland, the umbrella organisation that defends the rights of Swiss transsexuals.

But everything changed in the 1990s. Transgender activism intensified, and the social conception of transsexuals shifted. Susan Stryker talks of a new notion of the “future”, how people were again enthusiastic about the technology. Transsexuals became a symbol of progress, she says, as if it were a futuristic body, altered by science.

The winner of the 1976 Olympic decathlon, Bruce Jenner was the cliché of the American alpha male. He later married Kris Kardashian and featured in the television reality show “Keeping Up with the Kardashians”. In April 2015, Bruce Jenner confessed that he considered himself a woman. Revealing her new identity on the cover of the American magazine “Vanity Fair”, beckoning “Call me Caitlyn”, she became a transsexual icon.

PHILIPPE GÉTAZ

In Switzerland, basic health insurance is now required to cover the costs of a transition. The conditions are now more flexible to obtain authorisation for a name or gender change on a passport. “Over the past five years, a lot of things have changed,” says Friedrich Stiefel, In the 2000s, generation head of the Liaison Y – more tolerant towards Psychiatry Service at gender issues – reached the Lausanne University adulthood, the professor Hospital (CHUV). “People explains. As a result, transused to have to be at least Surgeon Olivier sexuals were increasingly 25 before having gender Bauquis performs one present in the media. reassignment surgery, sex change procedure Films and television series which is no longer the per week. touched on the topic. case. And they had to Transsexual celebrities see a psychiatrist for two went public. “The media exposure did years,” he says. “Today, things are more our community a world of good and flexible. Decisions are made on a casebrought visibility to our cause,” says by-case basis.” Young transsexuals are no CORPORE SANO

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Andreja Pejic

THE SUPERMODEL

longer afraid to talk about it and ask for a transition. “I have more and more patients, and they are increasingly young,” says Olivier Bauquis, a surgeon specialised in gender reassignment at CHUV.

But things are far from perfect. “Trans people should The haute-couture be able to change their phenomenon Andrej name and gender on their Pejic worked as a male passport without having model for years, walking for both men’s and to see a psychiatrist,” says women’s collections. Henry Hohmann. Some She was noted for her people still suffer from androgynous features, discrimination. “People are and in 2014 officially still getting insulted in the became a transstreet,” he says. “Hatred sexual woman named and lack of understanding Andreja. haven’t disappeared.” And that can impact the careers of people who change their gender. “In 2014 and 2015, 20% of people who had a transition lost their job because of that decision,” Henry Hohmann says. He also complains of the shortage of care involved in a transition. “Not enough hospitals do the operation in Switzerland,” Hohmann says. And those that do perform it too rarely, so the staff doesn’t have the necessary expertise.” Olivier Bauquis, who has been performing gender reassignment surgery at CHUV since 2007, agrees. “As only a small number of hospitals perform the operation correctly, we have too many patient applications at CHUV,” he says. “We do at least one sex change procedure per week. That’s too much for our small team.” The treatment is looked down on in the medical community. CORPORE SANO

DECODING

“Some health care providers and doctors think it’s against nature to do that kind of operation,” says the surgeon. “That pressure is hard to take.” But life is much easier for people who have undergone the transition. Today, Michelle Biolley is comfortable with who she is. She has become a film-maker and an activist for the transgender cause. She is happy. ⁄

Lana Wachowski

THE GENIUS FILM-MAKER Lana Wachowski and her brother Andy are the creators behind the “Matrix” trilogy. Lana Wachowksi secretly began her transition in 2002 and revealed her new identity in 2012.

TEXT BERTRAND TAPPY

VIRUSES, THOSE TIRELESS GLOBETROTTERS FROM THE FLU TO HIV, A VIRUS THAT CAUSES THE SAME ILLNESS IS NEVER PERFECTLY IDENTICAL EVERYWHERE ON THE PLANET. RESEARCHER SÉVERINE VUILLEUMIER DEVOTES HER TIME TO STUDYING THE VIRUS POPULATIONS ROAMING AROUND THE GLOBE AND WHAT THEY CAN TELL US.

espite all the media attention, human immunodeficiency virus (HIV) still holds many secrets for scientists and the general public. For example, did you know that there are several sub-types of the virus, which can mix with one another to form yet more strains? In fact, 72 “recombinant” forms of HIV are at the root of pandemics. Until 1996, only two recom binant versions had been identified. And scientists were convinced that they never combined with each other. “We now know that’s false,” says Séverine Vuilleumier, a scientist from the Institute of CORPORE SANO

Microbiology at the Lausanne University Hospital. “When the viruses meet, they engage in battles, and science can learn a lot from them.” Our knowledge about this behaviour has grown so fast thanks to the development of genomics, which can be used to map out the precise genetic code of living organisms, including viruses. “Today, we know about a wide catalogue of forms of the AIDS virus,” Séverine Vuilleumier says. “What interests my team more specifically is studying the migratory movements of these virus types and sub-types to determine their history, origin and strength. If a given form A meets another form B, who wins? What will come of that encounter? The answers to PROSPECTING

these questions will provide precious information, for example in searching for a vaccine.” Séverine Vuilleumier has been studying these complex migration patterns for many years. Early in her career, the biologist studied extinctions and emergences of animal species. She believed that their migration patterns could explain why some of them disappeared. Later, the scientist began looking at viruses, which she thinks are “interesting because they evolve much faster and are easier to observe.” This research eventually caught the attention of the Faculty of Biology and Medicine at the University of Lausanne (UNIL) and the Swiss National Science

N H

J K

G F

VARIOUS FORMS OF HIV THROUGHOUT THE WORLD HIV features high genetic diversity. Two major types of the virus have been identified: HIV-1, the most common strain in the world, and the less contagious HIV-2. Each type is made up of several groups, which can further be divided into sub-types.

VIH-1

D C

P A Group M of HIV-1 is the most common type of the virus in the world. It is responsible for the AIDS pandemic and has infected nearly 40 million people. New recombinant forms of HIV Group M still emerge today.

Foundation, which financed the next phase of her work. In addition to predicting the evolution of HIV around the world, this study of the migratory behaviour of viruses has already pinpointed the type of virus that was first transferred from animals to humans, and therefore the place. “Animals are rarely sick after contracting SIV [simian immunodeficiency virus, the animal form of HIV],” Séverine Vuilleumier says. “And the same goes for other viruses like Ebola, another pandemic that drove the scientific commuCORPORE SANO

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nity to look into the subject. The mechanisms behind the emergence of a given version of the virus over another have yet to be discovered,” she continues. “These recombinations generally weaken the virus, but unfortunately the microorganism can also become much, much stronger. Ironically, that’s not always good news. If the virus becomes too powerful, it can kill its host and therefore bring about its own demise.” Many of our old certainties about HIV have already been challenged by the discoveries PROSPECTING

The AIDS virus originated in primates in the Congo Basin at the beginning of the 20th century. It is believed to have spread to humans around the 1950s. HIV began to migrate in its different genetic variations to other regions of the world in the 1960s. The microbiologist Séverine Vuilleumier specialises in studying the consequences of these migratory movements of the virus.

made by these new “genomic cartographers”, including Séverine Vuilleumier and her team. The next step is to develop strategies to control or even slow the evolution of the virus and the pandemic. “I started out studying animals and ended up focusing on viruses. It’s an excellent way of moving back up from the microscopic to the human scale,” Séverine Vuilleumier says mischievously. And she seems more motivated than ever to yo-yo back and forth between the immense and the immensely small. ⁄

Methylphenidate C 14H 19NO 2

C 14H 19 NO 2 EVERY MOLECULE TELLS A STORY TEXT: BERTRAND TAPPY

It all began in 1944, when the chemist Leandro Panizzon synthesised methylphenidate at Ciba’s laboratories in Basel. Like the vast majority of chemists of the day, he decided to test his discovery on the first person he could find, his wife Marguerite (nicknamed “Rita”). And she rapidly noticed the effects. Rita felt the most significant changes while playing tennis, as her game improved after taking the drug. The molecule acts quickly on the nervous system and improves concentration. A patent was filed, and methylphenidate was marketed to combat fatigue and confusion. This was in the heyday of post-war Europe.

Ritalin is over sixty years old but is inextricably linked to children and teenagers.

“Medical discoveries exploded after World War II, offering hope that science would find a remedy for any somatic or psychological condition,” says Thierry Buclin, chief of the Clinical Pharmacology Division at the Lausanne University Hospital (CHUV). “But in the latter case, most drugs do not treat the problem. At best, they alter the disorder or bring relief. We know now that they can also aggravate it.” A few years after its launch, Ritalin was discovered to improve the day-to-day behaviour of children suffering from attention

CORPORE SANO

deficit disorder with or without hyperactivity (ADHD). At first, prescriptions were reserved for the most serious cases. And the results were sometimes spectacular. Over the years, the number of children taking the medication increased at an equally astonishing rate. Some parts of the United States reached startling proportions, with nearly 20% of school children on Ritalin. “An anti-Ritalin movement emerged in the late 1990s, with people accusing the drug of all sorts of things,” Thierry Buclin says, “stunted growth, heart problems,

ZOOM

addiction, drug abuse, suicidal thoughts, etc.” At the same time, stimulants have in recent years been found effective in treating some adult forms of ADHD. The controversy rages on and new studies on ADHD surface. But more than anything, the use of Ritalin reflects the disagreement between regions, social groups, institutions, doctors and families on the fundamental issues about standardising behaviour and influencing it chemically. Whether our children are viewed as misbehaved, uncontrollable, rebellious, high-potential or hyperactive, they continue to wonder what we expect of the next generation. Can the answers to those questions come in the form of a tiny pill? ⁄

SERGE GALLANT Director of the CHUV Training Centre

Can educational innovation build expertise? Beware of the risks of “illusory” education!

Switzerland has a particularly well developed system of professional training throughout one’s career. This system is extensively supported by the government, professional organisations and employers. The Lausanne University Hospital has 10,000 employees who each do a different job. CHUV therefore devotes a large portion of its budget to the development of its staff. As health care expertise progresses at record speed, ongoing professional training has become crucial to rapidly offset the inevitable holes in the staff’s education. The current environment requires highly specialised medicine and treatments to meet the needs of a vulnerable, ageing population with serious health problems.

Must we remind people that, between the energy invested by the clinical and education experts, the production costs represent an average of 300 hours of work for one hour of training in an interactive e-learning programme like the one presented in the “Tandem” section of this magazine? The idea here is not to condemn educational innovation and campaign for the return of the good old blackboard and white chalk. Quite the opposite! These technological developments have proved effective in certain conditions, both in terms of learning and cost management. However, it is only an educational strategy. The significant investment it requires should push us to ask what the point of education truly is. At hospitals, and especially universities, the purpose of professional training must not only be to increase the knowledge of the staff. It also implies developing their expertise – that perfect balance of scientific, technical, ethical and collaborative knowledge, all equally important and necessary – of all professionals to better serve patients and their loved ones.

PHILIPPE GÉTAZ

It is therefore no surprise that new educational information and communication technologies, especially e-learning, appear But we can easily forget that goal and be blinded as miracle solutions to those who want to by technological innovation, which risks leaving believe that all we have to do is pass trainees starry-eyed instead of better educated! ⁄ knowledge down on one side for learning to take place on the other.

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COMMENTARY

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COMMENTARY

We realise that over-specialisation in medicine and the development of the biomedical Jean-Daniel Tissot industry are making it Dean of the Faculty harder to define what a of Biology and Medicine at “doctor” is. These days we the University of Lausanne have general practitioners, specialists and medical he shortage of doctors researchers. The medical field has never is more than ever a been so multi-faceted. pressing issue. The Swiss But we need to understand what’s Federal Council wants really happening, restructure contradictory to pour 100 million messages and prioritise opposing interests Swiss francs into to bring an appropriate response. Otherboosting capacity at wise emergency measures will be taken undergraduate medical schools. This that are disconnected from reality. cash injection is attracting takers, as the And the role of a Faculty of Biology and Swiss Federal Institute of Technology in Medicine is to bring order to this chaos. We Zurich (EPFZ) is now preparing its own should lift the “fog of war” that reigns in the Bachelor’s degree in medicine. medical profession. To do that, we want to Parliamentary pressure, the frenzy set up a group of doctors and follow their resulting from these announcements and career path from the first year of medical our own concerns have forced us to act. school. The Faculty of Biology and Medicine But they also create a smoke screen, has the complex mission of guaranteeing masking the fundamental problem that is basic medical training focused on clinical our relatively poor knowledge of medical aspects, while training new categories of demographics. We hear as much about the doctors, such as laboratory pathologists shortage of doctors as its antithesis, the and medical engineers. We also face the surplus of specialists. The Swiss Academy challenge of communication. Our objective of Medical Sciences estimates that 20% is to bring about a shift in the professions of doctors change jobs ten years after and not just create elitist crossovers finishing school. This figure reflects the between medicine and other fields. And fact that more women are joining the most importantly, we must encourage medical profession, and how poorly our doctors once they have their degree and structures have adapted to this shift. So support them to prevent disillusionment the issue is not about training. and the demographic haemorrhage. ⁄

CEMCAV

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Data shortage

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NEWS

Beads to fight cancer

Health care hotel

The team led by Professor Alban Denys, chief physician of the Service of diagnostic radiology and interventional radiology at CHUV, was honoured at the European Conference on Interventional Oncology. This award comes in recognition of their work to design beads that release angiogenesis inhibitors that can be used to treat liver cancers. The licence has been sold to a UK company to develop the drug. MB

Switzerland’s first “patient hotel” will open on the CHUV grounds in the autumn of 2016 to provide accommodation for independent patients and their family. The establishment will be run by the Vaud native, Stéphanie Abel.

ONCOLOGY

New Dean’s Office at the FBM Five new people joined the Dean’s Office at the Faculty of Biology and Medicine in August. Professor Jean-Daniel Tissot holds the position of dean, and four new associate deans assist him in his duties. They are Isabelle Décosterd for education and training, Nicolas Fasel for research and innovation, Manuel Pascual for strategic programmes, external relations and communication and François Pralong for succession and career planning. MB APPOINTMENTS

RESEARCH

A hotel designed for patients, the first of its kind in Switzerland, will begin operations on the CHUV campus in the autumn of 2016. Accommodation will include 114 rooms with facilities and services to cover the dayto-day needs of independent patients who come for acute care or exams. This medical care can even be organised or provided at the Hôtel des Patients. Stéphanie Abel, a graduate of the Lausanne Hotel School, has been named to run the establishment. Originally from Moudon, she gained experience in health care as a student while working at a social medical care living facility. She went on to hold positions as hotel director in Lausanne and Geneva for 17 years. This Vaud native will begin at the helm of

the new Hôtel des Patients in January 2016 to oversee the hotel’s pre-opening. Stéphanie Abel will be working with Jérôme de Torrenté, who will oversee the health care staff from CHUV. This unique establishment will work closely with CHUV, as the hospital doctors will be administering care for hotel guests. Patients will enjoy the comfort of a hotel while receiving the same medical attention provided by the same health care staff as at an acute care hospital. The patient hotel can also accommodate patients’ families or anyone accompanying them. Similar projects are currently being reviewed at other Swiss hospital campuses. MB

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Barbara Balmelli, a physiotherapist, devotes her days to treating the most wonderful tool of all, the human hand. TEXT: BERTRAND TAPPY, PHOTOS: HEIDI DIAZ

or starters, let’s do a little exercise. Stretch your hand out in front of you. Then slowly move each finger while turning your wrist. Nothing extraordinary, right? Now, try to imagine all the parts and wiring it would take to reproduce those movements faithfully. Are you getting dizzy? That’s understandable. The human hand is an amazing and as yet unparalleled piece of work. It continues to fascinate all sorts of medical professionals, from doctors and health care providers to engineers. They have not yet managed to pierce the mystery of its 27 bones, some thirty muscles and countless nerve endings. Unfortunately, the number of conditions and injuries that can affect our hands is equally impressive, including fracture, ligament tears, arthritis and tendinitis, to name just a few.

Even if the appropriate treatment comes in time, recovery is key. Our brain has the annoying habit of quickly neglecting an injured hand. This phenomenon, called “exclusion”, often complicates rehabilitation (loss of sensitivity, stiffness) and as a result the return to normal life. That’s why mobilisation should be started as early as possible. And that’s where the team of specialised physiotherapists from the Department of the Musculoskeletal System at the Lausanne University Hospital (CHUV) comes in. Barbara Balmelli is part of that team. And this Ticino-born physiotherapist continues to be captivated by the hand. Yet, her career direction came about by coincidence after taking a training programme in Grenoble with a colleague four years ago. “What I liked

first of all was the incredible passion that I felt from the teachers,” she says. “Not many professions focus that much attention to the subject, and we can’t settle for minimum service. The hand is an essential tool in our daily lives and a work tool for the vast majority of our patients. When it’s not working, it can rapidly compromise our independence,” she says. “Treating someone’s hand also creates a very special, almost intimate relationship, which I think is very precious.” Barbara’s patients all have different objectives (playing sports again after an accident, going back to work after an inflammation or simply holding a pencil), but they all have to accept going to their sessions, which can last several weeks or even months. “What’s most important is regaining spontaneous movement and function,” Barbara Balmelli says. “That’s why we focus on the fun aspect, so that our patients no longer think about their movements. And we make sure that they can talk to each other and share their experiences. For someone like me who dislikes stillness, it’s the perfect environment!” ⁄

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In the recovery process, the physiotherapist does not make decisions alone. Talking with the patient is vital for setting objectives, and the programme is determined jointly with the medical and support teams.

To regain strength, mobility and co-ordination, stimulation and exercises can vary widely from one patient to another.

LUCIE CHARBONNEAU

TANDEM

RAUL PRIETO

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n 2009, 19.2% of Charbonneau has Lucie Charbonneau and Raul Prieto patients at the been working with have developed a remote training CHUV developed Raul Prieto since late programme to address a sensitive pressure ulcers, skin 2011 on that very issue. sores primarily Raul Prieto, the head subject: preventing pressure ulcers. resulting from a lack of educational TEXT: CAMILLE ANDRES, PHOTOS: HEIDI DIAZ of movement. Every technology and year, about 1,000 communication at the patients are at risk of developing the condition. CHUV Training Centre, specialised in e-learning in “Pressure ulcers – collateral damage caused by 2008 and boasts both educational and IT expertise. hospitalisation – affect the patient’s quality of life and can extend their hospital stay,” says Lucie Together, Lucie Charbonneau and Raul Prieto are Charbonneau, a nurse at the CHUV. developing a four-hour training programme for young hospital staff members newly hired at the Following her training in Quebec, Lucie CharbonCHUV. “Lucie has brought her expertise on the neau came to the CHUV in 1994 and became subject, while I’ve contributed to learning methods,” specialised in wounds and healing in 2005. She says Raul Prieto. What’s on the programme? Quizzes, was appointed to head the “Zero pressure ulcer” interactive exercises, videos and simulations. programme launched at the CHUV in 2009. The wound care specialist quickly singled out one Newly hired nurses complete a questionnaire, major need: training for health care personnel, which is used to assess their knowledge about especially new employees. “Pressure ulcers require pressure ulcers. If less than 65% of their answers medical treatment, but preventing them is the role are correct, the nurses are asked to take the of nurses and auxiliaries. It’s complicated, because training programme developed by Lucie Charbonpatients need to be cared for in a specific way that neau and Raul Prieto during their three-month trial is not always taught in school,” she says. “What’s period. The course is available on the CHUV’s most difficult is for auxiliaries to intervene when a remote training platform. potential problem could occur. Caring for patients is complex, and other important medical aspects Their training programme is bringing results. Since often take priority.” its launch in 2014, 300 staff members have taken the course. Nearly 80% of them pass the final exam. The challenge at hand is an educational one. But, Trainees who fail are asked to repeat the module or from a practical standpoint, how can such a large take a traditional training course. In December 2014, number of employees be trained? Should the occurrence of pressure ulcers at the CHUV stood classroom courses be provided? Too complicated, at 10.3%, only half the previous number! Starting too costly and too long. Could remote training, or this autumn, the training is expected to be available e-learning, offer an efficient alternative? Lucie for all the hospital’s medical staff.

TO KNOW MORE

eformation.chuv.ch CHUV’s training platform

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Award goes to a myrmecologist Professor Laurent Keller, director of the Department of Ecology and Evolution at the University of Lausanne, won the Marcel Benoist Prize in 2015. The panel of judges praised his disruptive research in evolutionary biology specialised in ants, which has led to a better understanding of the natural selection and social organisation of living organisms. His qualities as a mentor and ability to popularise science were also highlighted. MB HONOUR

Woman-motherchild merger CHUV will open a new division in 2016. The Woman-MotherChild Department will merge the Department of Paediatric Care and Surgery and the Department of Gynaecology, Obstetrics and Medical Genetics. The new unit will be headed by Jean-François Tolsa, full professor from the Faculty of Biology and Medicine. After a year of transition in 2016 to settle the financial and organisational aspects, the department will be fully operational in 2017. MB

Relation between education and a Mediterranean diet Individuals with a high level of education have eating habits that most closely resemble the Mediterranean diet, which is considered one of the best forms of preventive action against cardiovascular diseases, diabetes and obesity. This finding comes from a study which examined what more than 4,000 Lausanne residents were eating, led by the research team of Professor Pedro Marques-Vidal of the Service of internal medicine at CHUV. This research is part of the larger CoLaus study, which looks into the causes of cardiovascular diseases.

STUDY

Professor Philippe Ryvlin named “Ambassador for Epilepsy” The internationally renowned expert in epilepsy, Philippe Ryvlin, chair of the Department of Clinical Neuroscience at CHUV, has recently been honoured with the title of ambassador for epilepsy by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). This award is given every two years by the Joint Executive Committees of the ILAE and IBE to leading figures who stand out for their exceptional achievement in the international fight against epilepsy. BT

DISTINCTION

ERIC DÉROZE

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MIGRATION

After finishing medical school at age 21, Clara Podmore left for Cambridge to do her PhD in epidemiology. Can you tell us about your research, in a few words? My PhD aims to determine whether there is a causal relationship between iron overload and type 2 diabetes. We know that most patients with haemochromatosis, a hereditary disease known as iron overload disorder, also have type 2 diabetes. But we want to identify modifiable risk factors for type 2 diabetes on top of the non-modifiable factors that we’re already aware of (age, gender, genetic background, etc.). That will help us better prevent and treat this disease. To do so, we have to analyse the genetic information of tens of thousands of people and identify the genes responsible for iron metabolism. Then, we’ll have to see if they have an effect on the development of diabetes to confirm our hypothesis.

Was studying in Cambridge, in an internationally renowned laboratory, a dream come true? I’d say that it’s a plan that developed over the course of my career. Fortunately, not all the top research groups are located in the United States. And I must admit that I have a certain fondness for English culture and lifestyle, which has a better balance between people’s professional and personal lives. It’s not always easy to stay motivated when doing research, so it’s important to be in an environment where you feel happy. That helps keep you going!

LAST NAME Podmore FIRST NAME Clara TITLE Resident with the Service of Internal Medicine (2011)

Your work requires you spend lots of time in front of a computer analysing data, a so-called “dry lab”. How do you handle these more tedious periods far from the clinic? It’s true that my main job is very different from the day-to-day work at the clinic. However, I’ve made sure that I wouldn’t totally lose contact by continuing to see patients, going to conferences and especially, discussing cases encountered by my colleagues, who do lots of clinical work. Not to mention that it gave me the opportunity to experience another health care system, with its advantages and disadvantages. And to appreciate even more the Swiss health care system, which really is excellent. ⁄ BT

BACKSTAGE HEALTH VALLEY MAP The 3D model of French-speaking Switzerland was created by young model maker Adrien Pochon using paper and cardboard (p. 06).

DR, GILLES WEBER

TEENAGERS Johann Pelichet, apprentice photographer at CEMCAV, took the portraits of the three young women who shared their story in the report on adolescents (p. 19 to 29). He also shot the cover photo.

CONTRIBUTORS

TANG YAU HOONG Tang Yau Hoong is a self-taught illustrator based in Kuala Lumpur, Malaysia. He works with LargeNetwork on a regular basis and, for this issue of “In Vivo”, designed the metaphorical image featured with the article on crowdfunding in medical research (p. 37).

CATHERINE COCHARD

Catherine Cochard is a freelance journalist and independent film-maker who is passionate about the human side to the subjects she touches on. For this issue of “In Vivo”, she delved into the benefits of music on patients (p. 50) and on crowdfunding in medical research (p. 37).

ANDRÉE-MARIE DUSSAULT Andrée-Marie Dussault has been a freelance journalist since 2004. Formerly the editor-in-chief at the feminist magazine l’“Emilie” in Geneva between 1998 and 2003, she wrote the article in this issue of “In Vivo” on the pill that enhances women’s sexual desire (p. 56).

IN VIVO

Magazine published by the Lausanne University Hospital (CHUV) and the news agency LargeNetwork www.invivomagazine.com

PUBLISHER

CHUV, rue du Bugnon 46 1011 Lausanne, Switzerland T. + 41 21 314 11 11, www.chuv.ch redaction@invivomagazine.com EDITORIAL AND GRAPHIC PRODUCTION LargeNetwork, rue Abraham-Gevray 6 1201 Geneva, Switzerland CHIEF EDITORS T. + 41 22 919 19 19, www.LargeNetwork.com Béatrice Schaad and Pierre-François Leyvraz PROJECT MANAGER AND ONLINE EDITION

Bertrand Tappy THANKS TO

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PCL Presses Centrales SA 18,000 copies in French 2,000 copies in English The views expressed in “In Vivo” and “In Extenso” are solely those of the contributors and do not in any way represent those of the publisher.

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