In Vivo #4 ENG

NUTRITION www.invivomagazine.com

Think health

No. 4 – DECEMBER 2014

10 PAGES OF NUTRITIONAL ADVICE

STAYING FIT THROUGH HEALTHY EATING

IN EXTENSO

Infographic supplement

IN VIVO No. 4 – December 2014

The microbes within us

CÉLINE LAFONTAINE "The human body is now sold by pieces" BRAIN The science of optimism SURGERY Botox for chronic migraines Published by the CHUV www.invivomagazine.com IN EXTENSO THE MICROBES WITHIN US

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IN VIVO / N° 4 / DECEMBER 2014

CONTENTS

FOCUS

19 / PREVENTION Staying fit through healthy eating 10 pages of nutritional advice

BY CAMILLE ANDRES, ERIK FREUDENREICH AND WILLIAM TÜRLER

MENS SANA

30 / INTERVIEW Céline Lafontaine condemns the excesses of bioeconomics

BY JULIE ZAUGG

34 / DECODING The science of optimism

BY BERTRAND TAPPY

38 / INNOVATION The end of the cuckoo’s nests

BY SARA BANDELIER

40 / TRENDS The boom in geomedicine

BY CLÉMENT BÜRGE

44 / INNOVATION Remote-controlled medicine

BY MARGAUX FRITSCHY

CONTENTS

64

34

21 IN SITU

48 / PROSPECTING

08 / HEALTH VALLEY

Botox: new relief for migraine sufferers

Lessons learned

BY JEAN-CHRISTOPHE PIOT

14 / AROUND THE WORLD

52 /TRENDS

36

Amateur athletes, beware!

You may be taking drugs.

BY MARGAUX FRITSCHY

54 / DECODING The challenges of old age

BY JEAN-CHRISTOPHE PIOT

57 / IN THE LENS Protons versus cancer

BY ERIK FREUDENREICH

64 / PROSPECTING DNA does not tell everything

BY PAULE GOUMAZ

FOLLOW US ON TWITTER: INVIVO_CHUV

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Hand-held doctor

CURSUS

68 / COMMENTARY Physiotherapy, the great unknown

70 / PORTRAIT Claudia Mazzocato, helping patients with serious illnesses

72 / TANDEM Immunotherapy specialist Lana Kandalaft and her right-hand, Kim Ellefsen

PHILIPPE GETAZ, MICHAEL LIONSTAR, CAS OORTHUYS/NFA, COLLECTIE NEDERLANDS FOTOMUSEUM

57

CORPORE SANO

Editorial

PLEASURE COMES SLOW-COOKED

PATRICK DUTOIT

BÉATRICE SCHAAD Chief editor

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You might call it progress. A shake that contains the exact nutrients you need for perfect nutrition. You are guaranteed to take in just the right amounts of Omega-3, carbohydrates and proteins required by our modern-day temples (p. 21). Mouth-watering Simmental prime rib? That crispy fresh courgette you’ve just bought at the corner market? Who needs all that? Everything is contained in a single beverage. The company that came up with the idea touts the slogan, “What if you never had to worry about food again?” The surrounding picture shows a young man wearing a sleeveless shirt and standing in a high-tech kitchen. He will never experience the joy of grease stains from splattering butter.

Our special report (p. 19 to 29) looks at how science is fuelling huge advances in nutrition. But what kind of world is it whipping up for us? Is it even appetising? Developments like these wipe our tables completely clean of many other benefits reaped from the pleasures of dining. What about savouring the taste and texture of different foods in your mouth?

What about the conversation around how delicious the food is and choosing just the right words to describe it? What about simply enjoying the experience of sharing a meal? Having a gluttonous meal with friends must certainly count for something in terms of health benefits. Perhaps they just haven’t yet been quantified by science. Even when imperfections join our table, voices are raised or omega-3s lack here and there.

Trying to maintain a perfect diet has a name: orthorexia. The eating disorder was defined for the first time by a doctor in 1997 to refer to the obsession with healthy eating. It may offer the body some benefits, but it weakens the soul, the first symptom being social isolation.

That’s what could happen when scientific progress interferes with our eating habits. How are we supposed to tell the difference between eating well and obsessing over it until it makes us sick? Resisting that temptation will be made even more complex as food is gradually personalised, a phenomenon emerging in numerous other medical fields. Isn’t a meal something that is not supposed to be individualised and focused on yourself?

Breathe in that perfectly nutritious drink. Compare it to the aroma wafting from the stove. The conclusion draws itself. Give up that all-in-one smoothie and other products dressed in lab coats. Making that choice means you still want a world where pleasure remains a slow-cooked art. ⁄

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

iKNIFE IV n° 1

p. 12

Acquired technology

BERNHARD KRISTINN INGIMUNDARSON

Waters Corporation, a leading analytical instrument manufacturer, has bought the iKnife technology developed by the Imperial College London. This intelligent scalpel was designed based on a complex mass spectrometry process used to determine whether the tissue it cuts is healthy or cancerous.

Waters plans to continue developing this technology to provide surgeons with real-time diagnostic information about the tissue where they make their incision. /

EUTHANASIA IV n° 1

p. 26

Wave of requests in Belgium

BARCODES

Fifteen Belgian prisoners have IV n° 1 p. 34 requested euthanasia rather Putting an end to medication errors than go on suffering in prison.

This spate of requests has come Massachusetts Institute of Technology has developed a scanning device to prevent patients from receiving the wrong medication. Nursing staff shortly after a Belgian appeals use the bedside machine to scan the barcode on the patient’s electronic court approved the right to wristband, then place the medication on the tray and insert it into assisted suicide for a 52-year old the device. In a few seconds, the scanner identifies the size, shape, colour man convicted of murder and and any markings on the pills to check whether they correspond to rape, who has been in prison the patient’s records. / for 30 years. This surge in early death candidates has spurred a controversy, even among advocates of euthanasia. /

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POST-SCRIPTUM

QUANTIFIED SELF p. 66

A website for the obsessed Self-measurement fanatics will soon have a haven where they can track all the data on themselves captured by various applications in real time, such as their pulse, distance covered or the number of burritos eaten. The website dubbed Gyroscope was developed by the American designer Anand Sharma. Frustrated at not being able to centralise his personal metrics, Sharma created his own online dashboard called April Zero. Its success has encouraged him to develop a platform that everyone can use. /

IV n° 2

BRAIN p. 53

Helping Marines stay calm and collected

STEM CELLS IV n° 2

p. 64

First worldwide A 70-year old Japanese woman with age-related macular degeneration received the world’s first ever transplant of artificial stem cells. These “next-generation” stem cells are adult cells harvested from the patient and reprogrammed to a quasiembryonic state to be turned into retina cells. The purpose of the operation was to make sure that the technique would not cause side effects, such as cancers, while improving the patient’s condition. /

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IV n° 3

Meditation could become an integral part of training for US Marines. An experiment conducted by University of California researchers in collaboration with the US military showed that soldiers trained in mindfulness meditation techniques were better able to control their emotions in combat simulation than their counterparts who had not received the training. This technique could be an effective way of preventing post-traumatic stress disorder. /

p. 19

Combining the senses to improve memory

LOGAN WALLACE / AP

IV n° 1

MEDITATION

A team of scientists from Lausanne University Hospital (CHUV) and the University of Lausanne (UNIL) have demonstrated that combining both visual and auditory information helps form a more accurate memory of a given event.

However, the improvement in memory depends on one’s natural ability to integrate multi-sensory information, which varies from one individual to another. This discovery opens up a whole new field of exploration for improving the current methods of teaching, training and rehabilitation. /

PERSONALISED MEDICINE IV n° 3

p. 30

Digital health record Apple’s new Health app can be used to create your own health dashboard online. Health centralises all health-related data (cholesterol levels, BMI, sleep quality, etc.) collected from different iPhone apps. Although Health could save lives, for example, by notifying the hospital in the event of abnormal heart rhythms, the app also raises issues about data protection. /

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. This third map was created by Sébastien Fasel, co-founder of Emphase, a visual communication agency based in Lausanne.

IN SITU

HEALTH VALLEY Latest news about medical research and innovation in western Switzerland.

GENEVA P. 08 The Geneva University Hospitals are drawing on the experience of Swiss airlines in order to prevent accidents.

HEALTH VALLEY’S PLAYERS ARE:

Medtech – 436 companies

Biotech – 83 companies

Pharma – 90 companies

Universities/Hospitals 16 institutions

BERN P. 09 Calcisco wins a prize for its tests to detect signs of blood calcification.

LAUSANNE P. 09 Detecting glaucoma using a smart contact lens is the project of Lausanne based company Tissot Medical Research.

FRIBOURG P. 11 The start-up EmedSwiss is developping an electronic medical record.

IN SITU

HEALTH VALLEY

Lessons learned For the past twenty years, airlines have been steadily improving safety by enhancing communication between crew members. Now this expertise is being passed on to Swiss healthcare workers.

SAFETY Shaken by a spate of disasters in the 1990s, the airline industry had to rethink the way it did things, mainly focusing on the communication mechanisms of its crew members. “The human factor is behind 75% of all in-flight problems,” says Frédéric Macheret, an Airbus A320 captain and trainer for Swiss International Air Lines. “At the time, we noted that many incidents were related to a lack of coordination and leadership within crews.” Oddly, this was a period when the technical resources available to the airline industry were actually advancing. “But the more complex the technology, the more the human aspect has to be improved. No one can go off and work in a corner. Sharing information is vital.”

Frédéric Macheret believes that hospitals, which are subject to growing stress and constant technological innovation, currently face the same challenges that aviation grappled with twenty years ago. Mistakes happen, either due to inadvertence or poorly managed incidents. But to better prevent them, Pierre Hoffmeyer, physician in chief at the Orthopaedic Surgery Service of Geneva University Hospitals (HUG), brought the experience of SWISS on board four years ago. The training programme brings together doctors, anaesthesiologists, technicians, nurses and airline pilots to come up with new group strategies for handling incidents and stress.

In a one-day workshop, participants cover techniques used by airlines, such as a checklist. This before take-off procedure is used to make sure that all participants understand the flight duration and other key information. It unites the crew towards achieving a common goal. And ensures that everyone is in position in the event of an emergency.

Another highlight is the completely confidential dialogue about problem situations.

“This provides the unique opportunity to discuss stress management, teamwork or the impact of a lack of communication, outside 8

TEXT: CAMILLE ANDRES

ABOVE: FOR SERGE GALLANT, USING TECHNIQUES FROM THE AERONAUTICAL INDUSTRY HAS HELPED IMPROVE TEAMWORK AT CHUV. THE LAUSANNE UNIVERSITY HOSPITAL HAS BEEN USING A SAFETY CHECKLIST SINCE 2012 TO PROVIDE BETTER PATIENT CARE BEFORE AND DURING SURGERY. THESE CHECKLISTS HAVE HELPED IMPROVE PROCESSES IN ALL THE SERVICES WHERE THEY ARE USED.

of the purely professional environment,” says trainer Domizio Suva, senior visiting physician and head of the Septic Orthopaedic Unit at HUG. “They don’t have this time to debrief in a normal work day.”

Lausanne University Hospital (CHUV) has joined the movement. Although it has not developed a formal partnership with airlines, for the past two years the Vaudbased facility has been applying certain approaches used in aviation to its training programmes. “These methods mainly involve crew resource management techniques, such as those practised in Geneva in partnership with SWISS,” says Pierre Gallant, head of the CHUV training centre.“The purpose of these procedures is to develop leadership and relational skills, which were analysed as having frequently been the cause of accidents.”

The airline model can obviously not be transposed into the medical environment in all respects, but the training programme is gradually being polished as it develops. And it has met with incredible success among healthcare staff. At the HUG, it is impossible to quantify the drop in incidents, but several studies have shown that all participants have gained new knowledge, which varies depending on their profession. A culture of safety has emerged, based on anticipating problems before they occur. The social skills of surgeons, who were once used to working alone like pilots, have been developed.

And the experiment has not stopped with French-speaking Switzerland. Since 2010, Zurich University Hospital along with its Cardiovascular Surgery and Neurosurgery Clinics has set up similar training programmes. The private hospital GZO in the Zurich Oberland has also enlisted SWISS to train its healthcare staff. This programme differs in that it focuses on the parallels between patients and passengers. A way of better understanding the notion of patients as customers. ⁄

IN SITU

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HEALTH VALLEY

In millions of Swiss francs, the funds raised by Biocartis, a spin off from the Swiss Federal Institute of Technology in Lausanne (EPFL) in a new round of financing. The biotech firm now employs nearly 200 people, about 30 of whom are based in Lausanne.

Biocartis recently launched its automated molecular diagnostics system, Idylla, in Europe.

9.7

In percentage, the expected growth rate for the Swiss medical technology industry in 2014, according to a recent study published in the “Swiss Medical Technology Industry Report”. Revenue for the sector now totals a record 14 billion Swiss francs – that’s 2.3% of Swiss GDP! Medtech SMEs also turned in an outstanding performance, bringing in 12.8 billion Swiss francs in exports (5.2% of total Swiss exports) over the period surveyed. Their growth is expected to continue into next year, despite fears of giants Apple, Google and Samsung trampling the health market.

THE OBJECT

ARKIMED Designed by Swiss neurosurgeon Duccio Boscherini and computer engineer Sacha R. Droz, the Arkimed system is used by surgeons to control – by movement – the images that could prove essential during an operation.

Although Arkimed is not yet ready for market release, about twenty neurosurgical procedures have been performed by Duccio Boscherini using this technology, which itself seems straight out of the sci-fi thriller “Minority Report”.

“We’re convinced that a revolution is on its way” MARC THURNER 3D PRINTING REPRESENTS A TURNING POINT IN MEDICAL TECHNOLOGY, SAYS MARC THURNER, DIRECTOR OF THE FRIBOURGBASED COMPANY REGENHU IN AN INTERVIEW WITH “PME MAGAZINE”.

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START-UP HEART VALVES

Vaud-based Symetis has completed an important step in its development, earning its second compliance accreditation in Europe (CE marking) for its “ACURATE neo” heart valve. The certification could help to boost the start-up into third position on this market worldwide, just behind heavyweights Medtronic and Edwards Lifesciences.

CALCIFICATION

Calcisco, a start-up based in Bern, was recently awarded by the W.A. de Vigier Foundation for its test used to measure calcification propensity in blood. This medical advance will help save lives.

Conditions triggered by calcification are the leading cause of death in patients with chronic kidney disease.

MOVEMENT

Analysing a patient’s gait can determine the effectiveness of a therapy. That’s the idea behind the wearable movement sensor developed by the young company Gait Up. The package includes proprietary software, and the system is designed to be used by geriatric services, rehabilitation clinics and gait analysis laboratories.

HIGH-TECH LENSES The start-up Tissot Medical Research in Lausanne has come out with a smart contact lens that can detect glaucoma. The lens was designed by researchers at the Swiss Federal Institute of Technology in Lausanne (EPFL) and at the Haute Ecole Arc engineering school in Neuchâtel.

It’s the first ever lens to continuously measure intra-ocular pressure! Its market launch is set for late 2015.

IN SITU

NEODE NEUCHÂTEL

The Neode platform for technology transfer supports nearly thirty budding companies between its La Chaux-de-Fond and Neuchâtel sites. Personalised medicine, diagnostics (One Drop Diagnostics) and laser technology are just some of the medtech projects underway at the science park.

HEALTH VALLEY

BIOARK MONTHEY

Bioark specialises in backing diagnostics and biotech start-ups.

Its technology park is home to Augurix, Cordsavings and the SME BioKaizen, which is developing a system for the early detection of certain types of cancer using a simple blood test.

LE VIVIER VILLAZ-ST-PIERRE

In the Glâne district of Switzerland, the Vivier tech park sprawls over almost 20,000 square meters, and some 20 companies are currently present on the site. The Vivier is also home to Venturi, a “start-up accelerator” whose portfolio includes Myotest and Osmotex, two specialist medical companies.

TECHNOLOGICAL PARKS BIOPÔLE EPALINGES

Twenty-two companies have set up operations at the Biopôle site, open since 2009. One recent addition to the Vaud-based complex is the US firm Ariad, which specialises in cancer research. Biopôle hopes to develop a start-up incubator in 2015.

CALENDAR LAB/LIFE 25 September 2014 to 22 February 2015 Lausanne The Musée de la Main UNIL-CHUV addresses the issues faced by modern biological and medical research in a two-part exhibition with a special focus on stem cells. This event has been made possible thanks to the collaboration with the Faculty of Biology and Medicine at the University of Lausanne (UNIL), UNIL Science-Society Interface, and PNR 63.

CHILD PROTECTION 11 December 2014 Lausanne To mark its 20th anniversary, Lausanne University Hospital’s CAN Team (Child Abuse and Neglect Team) is organising an event to present its research on child protection services.

The event will take place in the César-Roux auditorium at Lausanne University Hospital (CHUV).

PROMOTING HEALTH 29 January 2015 Lucerne The Swiss Health Promotion Foundation has announced that it will hold the 16th National Health Promotion Conference on 29 January in Lucerne. The theme will focus on lifestyle and its impact on health promotion.

WWW.PROMOTIONSANTE.CH

PULMONARY ONCOLOGY 15 to 18 April 2015 Geneva Next spring, the City of Calvin will host the European Lung Cancer Conference. The event, organised by the European Society for Medical Oncology, aims to develop cooperation between lung cancer specialists while driving research, education and the Europe-wide fight against lung cancer.

WWW.ESMO.ORG

WWW.MUSEEDELAMAIN.CH

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IN SITU

HEALTH VALLEY

3 QUESTIONS

DIDIER PITTET

THE HEAD OF THE “SAVE LIVES: CLEAN YOUR HANDS” PROGRAMME, LAUNCHED BY THE W.H.O, BELIEVES THAT WE’RE STILL A LONG WAY FROM PREVENTING EPIDEMICS.

In millions of Swiss francs, the cash raised by the start-up EmedSwiss to develop an electronic medical record using internet technologies. Founded by Dr Lubos Tkatch, the Fribourgbased company has recently begun marketing its software solution developed over the past eight years.

WITH THE SYSTEMATIC USE OF HYDROALCOHOLIC GEL, DO YOU THINK THAT HOSPITAL-ACQUIRED INFECTIONS WILL SOON BE A THING OF THE PAST?

1

We’ve made a major step forward. Depending on the resources implemented, infections have been reduced by 20% to 80%. Our programme has been rolled out in 173 of the 194 Member States of the United Nations.

Hand hygiene is clearly improving in all collective areas. In addition, the formula in the product that we supply to the WHO makes it possible to manufacture the gel at low cost. For example, in Uganda and Mali it is made using alcohol produced from locally grown sugar cane.

CAN THE GEL BE USEFUL IN FIGHTING PANDEMICS SUCH AS EBOLA?

Ebola requires special precautions to avoid contact with any biological fluid carrying the virus. In Africa, however, healthcare staff often lack both supplies and training. To improve the situation, it is vital to develop a culture of institutional safety. We have to do more than just go and offer them gel. Hand hygiene has to be adopted at every level, from the hospital director to the cleaning staff.

HOW CAN WE DEVELOP THIS CULTURE OF SAFETY? The WHO has implemented multi-modal strategies with field representatives and some hospitals acting as reference facilities. We’re also learning a lot about hospitals in the south. For example, Kenya has developed a mobile phone surveillance system used to monitor how patients’ surgical wounds are healing for up to thirty days following their release from hospital. /

3

Didier Pittet is a professor of medicine at Geneva University Hospital. Working with British chemist William Griffith, he invented the hydroalcoholic solution used to disinfect hands.

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NEONATOLOGY

SCIENCE PHOTO LIBRARY

2

PREEMIES ON EPO A doping hormone used to enhance athletes’ performances, Erythropoietin, or EPO, could help to reduce brain damage in highly premature babies. Researchers from the University of Geneva (UNIGE) and Geneva University Hospitals (HUG) presented the findings of their study in August in the highly reputed Journal of American Medical Association (JAMA). Every year in Europe, about 40,000 children are born before the 32nd week of pregnancy, including 80 at the HUG. Some of these new-borns suffer from brain damage which can lead to serious complications as adults.

IN SITU

HEALTH VALLEY

FOURTH STOP

YVERDON-LES-BAINS SYMBIOS

ON THE ROAD

In each issue, “In Vivo” travels to meet with companies based in the Health Valley.

Rendez-vous in Yverdon-lesBains.

Custom implants The Vaud-based company Symbios exports its prosthetics expertise throughout Europe.

TEXT: CAMILLE ANDRES

Nearly one million new hip and knee prostheses are implanted every year in the United States and Europe. One of the leaders in this sector is Symbios Orthopédie SA, based in Yverdon-les-Bains. The SME designs and manufactures cutting-edge artificial hip and knee replacements. “Our customers are orthopaedic surgeons from the old continent,” says Jean Plé, director of Symbios. “Focusing on the European market is a strategic decision. It’s currently the biggest in terms of units.”

Symbios employs 120 people, 80 of which are in Yverdon, and enjoys the synergies from being located in Health Valley. “A company never works alone. It feeds off the expertise and experience of its surroundings,” he says. “Today, the region is home to a number of companies specialised in medical fields and watchmaking, a clear advantage for finding qualified personnel.”

Hip and knee implants have changed drastically since Symbios was first set up in 1989. The Vaud-based company now does more than design prosthetics, as it also 12

develops proprietary 3D software used for personalised pre-operative planning. But more progress can be made. “The main challenge in our field is achieving total patient satisfaction,” says Jean Plé. Post-operative pain and changing patient profiles are some of the obstacles standing before this objective. “The people receiving implants are increasingly younger. They want to live as they did before, without pain.

It’s up to us to find solutions to meet that need.”

The SImOS project focuses on reaching that goal. Launched in collaboration with the Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne University Hospital (CHUV) and the Swiss scientific programme Nano-Tera, SImOS aims to develop a “smart” implant featuring force and temperature sensors along with an accelerometer. /

IN SITU

HEALTH VALLEY

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

Developing the ecosystem… grounding our companies How can we change that mindset, which boils a company down to a “financial asset” managed according to the “optimal allocation of resources”? By enriching the fertile soil that will feed these companies’ growth.

Shire’s highly publicised decision to move from Eysins to Zug reminded us of the importance of “roots” and an “ecosystem” for a company. We had almost begun to wonder if those notions still had any meaning in today’s world of globalisation and “borderless” capitalism.

Rootless companies?

With multinationals, company headquarters, research and development centres and other major projects coming to the region, we have a right to celebrate the successes that strengthen our positioning on the global map of life sciences. But in our giddiness, we must not forget to remain watchful and proactive, as these newcomers have not yet firmly established their roots. “Landless” activities – based on the analogy of greenhouse farming – are illusions. At a stretch, they may be useful to statisticians in search of rankings or the fantasy of technocratic managers who dream of dealing with purely fluid and mobile “assets”, rather than men and women attached to their environment because they have developed ties and grounded their life there, drawing from it their energy, life force, references and dreams...

Regional roots Managers who treat their company like a set of Lego-brick “factors of production” will integrate the components of our region, boost their value and draw on them to help lastingly drive company performance. They will establish roots for their company and drive away the spectre of relocation. In doing so, these firms will join the regional fabric of companies which, like vines gaining their nourishment from a particular parcel of land to produce quality wines, benefit from the history, culture, expertise, support, and networks unique to the plot where they were created and have grown.

We are aware of everything that our local business environment has to offer: jobs, wealth creation, tax resources, reputation and contribution to academic and entrepreneurial strength to name a few. But companies must also be aware of the wealth their region brings them: outstanding framework conditions and political stability, an attractive work and living environment, the experience of generations of men and women who dedicate their drive, talent, creativity and trust to contribute to company growth, prosperity, image and in many ways to its long-term success.

Community of people and projects As such, some cases unfortunately result in a relocation. We then realise that some managers We highlight these advantages to strengthen the ties have a virtual or ideal view of their company, between all regional actors – be they academic, reducing it to a malleable entity to be deformed at industrial, governmental or innovation-driven. ⁄ will. It becomes “relocatable” in the click of a mouse to any other place offering a higher return FOR MORE INFORMATION on capital invested. www.bioalps.org the life science cluster of Western Switzerland

TO READ

DR

“Number One: Tome 3 - Next, Les Clefs du savoir, 2014”

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IN SITU

WORLD

IN SITU

AROUND THE WORLD

CBS

Because research knows no borders, In Vivo provides information on the latest medical innovations around the world.

HAND-HELD DOCTOR TECHNOLOGY The Qualcomm Tricorder X PRIZE contest promises to hand over a total of $10 million to the best portable diagnostic device, similar to the one used by Mr. Spock in “Star Trek”.Contestants have come up with a profusion of fantastic ideas: analysis of a drop of blood on a miniature laboratory the size of a credit card, medical history performed by an artificial intelligence algorithm or diagnostics based on the analysis of video images of the throat. Ten finalists have been selected by the X PRIZE Foundation in charge of the competition.

They have to present a device that can function on humans by 2015.

800,000

The number of annual suicide deaths worldwide, for a rate of one person every 40 seconds. The World Health Organization has called for action to improve prevention programmes focusing on this problem that remains taboo in many countries.

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RESEARCH

NEW HOPE FOR ANAEMIA PATIENTS Two teams overseen by Professor Olivier Hermine from Necker Hospital in Paris have recently uncovered the mechanisms at work in beta-thalassemia. This genetic blood disease causes severe anaemia and affects 100,000 newborns across the world every year. Their research published in two prestigious journals, Nature and Nature Medicine, offers a new treatment option involving sotatercept, a drug currently undergoing clinical trials.

IN SITU

WORLD

S VO ICK I V P IN EST Ces médicaments qui ontB Genetic testing that can

“You can form and erase memories” PIERRE-MARIE LLEDO FRENCH NEUROBIOLOGIST PIERRE-MARIE LLEDO IS ONE OF THE FIRST EUROPEAN RESEARCHERS TO USE OPTOGENETICS, A TECHNIQUE USED TO CONTROL NEURON ACTIVITY BY COMBINING OPTICS AND GENETICS.

changé nos vies

destroy families

JACQUES BEAULIEU, MULTIMONDES, 2014

“GEORGE DOE”, VOX.COM

Jacques Beaulieu takes us through the history of forty ground-breaking drugs and how their development has impacted our health.

And he notes that their use is growing. The Quebecois physician has authored nearly twenty educational books on medicine, teaming up with different doctors and health specialists. In this book, Jacques Beaulieu also warns about increasingly efficient medical research, which helps us live even longer lives.

In an article published

by Vox magazine, an American biologist anonymously shared how his use of 23andme, a direct consumer genetic testing service, ended in his parents’ divorce. How did that happen? He found out that he had a half brother and decided to tell his family about it. They never got over the shock.

At a time when the Swiss National Council wants to regulate commercial testing in Switzerland, this fascinating account shows the unexpected fallout from new medical technology.

BELMONTE / BSIP / NEWSCOM

Doctors turning to vampires for inspiration

CLINICAL STUDY Injecting blood from young healthy people into older patients with Alzheimer’s disease is the subject of an experiment set to launch in October at Stanford University in California. Previous testing on mice has shown that transplants of fresh young blood can rejuvenate certain organs and improve cognitive performance in the rodents. The protein found in plasma thought to be responsible for the phenomenon is called “growth differentiation factor 11 or GDF11.”

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The Body keeps the score

Breaking the Wall of Cardiovascular Diseases

BESSEL VAN DER KOLK, VIKING ADULT, 2014

FALLING WALLS LAB PAR KATERINA SPRANGER

Drawing on his experience with different cases of trauma over the course of his career, the American psychiatrist Bessel van der Kolk has released a book that can also serve as a survival guide for victims of post-traumatic stress disorder. The author provides an overview of the effects of trauma and suggests new therapeutic paths to healing, including activities such as yoga, theatre and exercise to find a healthy balance in patients’ lives.

Every year, the Falling Walls Foundation invites young scientists to present their breakthrough research. Its international Falling Walls Labs are organised throughout the world. Each participant is given three minutes to convince a panel of experts of the quality of their research. The German/ Ukrainian researcher Katerina Spranger presented her VIVa project, software she developed that is used to better plan stent implantation in a given patient.

S ON VIDEO E.COM LINKS TO AGAZIN NVIVOM .I W W W

IN SITU

EBOLA AND AIR TRANSPORT The Ebola epidemic which has raged across West Africa for several months is creating huge challenges in the field. The virus is also raising questions about air travel. Despite reassurance from the World Health Organisation on the risk of contracting Ebola during a flight, many countries have taken measures to check people arriving from risk zones.

As the incubation period for Ebola can take from 2 to 21 days, it is possible that an infected person could travel by plane without presenting symptoms of the illness.

Moroccan medical staff are taking passengers’ temperatures when they arrive at Casablanca Mohammed V airport from the most affected countries, including Guinea, Liberia and Sierra Leone.

The USA has also announced the introduction of temperature checks at its five main airports.

ABDELJALIL BOUNHAR / AP THE CANADIAN PRESS

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WORLD

IN SITU

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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

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FOCUS

NUTRITION

PREVENTION

STAYING FIT THROUGH HEALTHY EATING /

A balanced diet boosts the immune system.

By asking themselves a few simple questions, anyone can control their appetite, avoid gaining excessive weight and stay healthy.

A look at the 21st century diet: a mix of personalised nutrition and futuristic powder.

/ BY CAMILLE ANDRES, ERIK FREUDENREICH AND WILLIAM TĂœRLER

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NUTRITION

P

ersonalised daily nutrients served in the form of capsules – that’s the futuristic programme launched a few months ago by fifteen researchers from the Nestlé Institute of Health Sciences (NIHS) in Lausanne. Code name: Iron Man. The idea is to create a machine that can analyse a person’s nutritional deficiencies and then concoct a custom blend of essential vitamins and minerals tailored to the individual. Inspired by the food replicator that featured in the Star Trek series, this future Nespresso-like nutrient dispenser is one of the many examples of research aimed at developing personalised nutrition.

To each his own diet. We are not all created equal when it comes to food. Some nutrients are recommended based on an individual’s profile (healthy, obese, diabetic, etc.), age or gender.

“We metabolise a given food differently depending on our genetic make-up,” says François Pralong, chief of the Endocrinology Service at Lausanne University Hospital (CHUV) and professor at the Faculty of Biology and Medicine at the University of Lausanne.

Some individuals are more sensitive than others to a given amount of salt. And that sensitivity can apply to all types of micro-nutrients (vitamins, minerals, trace elements, etc.) and even macro-nutrients (proteins, carbohydrates, lipids).

Both children and the elderly are among the individuals who need vitamin and mineral supplements the most.

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AGE AND GENDER DIFFERENCES

Children need more vitamins, minerals and calcium. The elderly should generally reduce their salt intake and consume more vitamin D, calcium and enough proteins. Their tendency to lose their appetite and sense of taste leads them to eat less and lose weight and muscle mass (cachexia).

Healthy adults need smaller amounts of vitamins and minerals and less calcium, because they have

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already built up adequate stores of these nutrients.

Due to their menstrual cycle, women need more iron than men and, at menopause, more calcium to offset the higher risk of osteoporosis. But these are general guidelines. The food pyramid (by order of importance: fluids, fruit & vegetables, cereals, dairy products, meat, fish, fats and, last, sweets, snacks and alcohol) still holds true. Eating high-fat foods, such as fast-food, delays the feeling of satiety, meaning you tend to eat more.

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NUTRITION

SOYLENT, THE MAGIC POTION OF THE 21ST CENTURY

JOSH EDELSON / AFP

Would you be willing to replace all your meals for the same nutritional drink? That’s the outlandish idea from an American entrepreneur that has gained quite a hefty online following.

S

wapping prime rib, fries and crispy vegetables for an odourless shake made of some 30 vital ingredients (proteins, fibres, vitamins, carbohydrates, etc.). This is the strange idea pushed by American Rob

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Rhinehart, founder of the start-up Soylent. Launched as a Kickstarter project a year ago, the miracle blend has since garnered thousands of internet fans who now share their own recipes on forums. The beverage is not only “practical”, it also provides cheap nourishment. A week’s supply of

Soylent costs about 65 Swiss francs, coming out at 3 Swiss francs per meal. For the most part, users say they are satisfied with the product and in good health after weeks or months of use.

Rob Rhinehart has even announced that he now plans to live off a Soylent-only diet…

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NUTRITION

The nutrition pyramid: foods placed at the bottom can be eaten more frequently and in greater quantities.

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AVOID FRUSTRATION

A proper diet also boosts the immune system. “For a healthy subject, the best immunity comes from a balanced and varied diet with more fruit and vegetables, vegetable fats, fish, poultry and white meat,” says Pauline Coti Bertrand, head of clinical nutrition at the CHUV. “However, other foods should not be excluded. This is called ‘relative frequency’.

Supplements can be an option for sick patients, depending on the needs that arise as a result of the illness. The most important thing is to maintain your weight as close as possible to your healthy weight, and to exercise.”

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People with a disorder such as obesity face different issues. “Nowadays, we no longer use diets at all,” says François Pralong. “We noted that the restrictions cause frustration, which invariably leads to relapse.” The yo-yo effect of losing and regaining weight is extremely unhealthy because it reduces lean body mass (muscle) and leads to gradual gains in fat. Three or four weight swings in ten years can have devastating effects on metabolism and open the pathway to insulin resistance, diabetes or hypercholesterolaemia.

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YES OR NO?

NUTRITION

A WEIGHT GENE

IS SPINACH RICH IN IRON? NO Like many green vegetables, spinach contains iron. But it needs to be absorbed in large amounts to reach the daily intake of 14 mg recommended by dietitians. Iron is an essential mineral for our organism, playing a role in the transport of oxygen to our cells through haemoglobin and in mechanisms involving neurotransmitters. One hundred grams of fresh spinach leaves only contain 2.7 mg of the precious mineral, significantly less than lentils, eggs, seafood and especially meat.

CAN ADULTS DIGEST MILK? YES and NO Milk contains lactose, a carbohydrate that requires a special enzyme (lactase) to be broken down properly.

The human body was not originally designed to digest lactose after nursing during infancy. But since neolithic times, as populations became more sedentary, people of European descent have developed the ability to assimilate lactose into adulthood.

Conversely, most people from Asia and Africa lack the enzyme lactase as adults and are often lactose intolerant.

IS EATING FISH GOOD FOR YOUR NEURONS? YES The iodine and omega-3 in fish do in fact contribute to keeping certain neurological functions in good condition. So-called “oily” fish is recommended, such as salmon, mackerel and sardines (which actually contain no more fat than a semi-lean meat), rich in precious essential fatty acids.

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Luc Pellerin has long been interested in brain energy metabolism. In his research, the associate professor with the Department of Physiology at the University of Lausanne (UNIL) has focused his attention on nutrient transporters located within the brain, and other tissues and organs such as the liver and heart.

That is how he discovered the MCT1 gene. By disrupting it in mice, he and his team realised that it plays an important role in the regulation of body weight.

The genetically modified rodents displayed less obesity after being subjected to a high-fat and high-sugar diet, without experiencing hypoglycaemia or an increase in adipose tissue.

What would happen if the gene were to be disrupted in humans?

“There are two main challenges,” says Luc Pellerin. “First, it’s technically difficult. The gene is found in different tissues and organs, which would have to be targeted one by one. And the gene also has useful functions.

As a transporter, it contributes to

the exchange of energy substrates. The gene is responsible for supplying some tissues with essential nutrients.”

One option could involve developing a pharmaceutical drug that partially inhibits the effects of the gene. In short, some of its activity would need to be reduced and some maintained. “Of course, we’re not saying that we can eat an unhealthy diet,” the scientist says. “What is interesting is that we were able to demonstrate that the development of obesity is not linked to a series of genetic mutations but to a change in environment, which is now saturated in high-fat foods.”

MCT1 is actually a “normal” gene. It is there to promote the accumulation of fat, and has served this purpose since the time when human beings did not have abundant food and had to move more to get it. Bottom line: Instead of waiting for some miracle drug, we ought to watch what we ingest and get some exercise.

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NUTRITION

Why do we eat? Out of hunger, desire, boredom, stress? This awareness can help us control our eating and avoid gaining excessive weight.

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CONTROLLING YOUR APPETITE

Over the past few years, scientists have discovered a whole slew of hormones that regulate the appetite. This does not refer to the hormonal treatments used to reduce hunger. That is why taking a psychological approach is so important. Marion Linda, assistant psychologist with the Obesity Prevention and Treatment Consultations Unit at the CHUV, believes that healthy eating means, from a psychological point of view, “clearly identifying body sensations” and, in general, handling one’s emotions well.

“People need to develop their understanding of the mechanisms of food intake,” says François Pralong.

In other words, why do we eat? We eat out of hunger, desire, compensation, spite, boredom, stress, etc. Eating habits should be slightly altered while bearing in mind a few dieting tips about what a healthy plate 24

should look like in terms of quality (food pyramid) and quantity: do not take a second helping, chew and eat slowly so that you don’t outpace the feeling of satiety (see interview p. 26).

Patients’ weight needs to stabilise over the first six to ten months before they can hope to lose about 10% of their weight over a one- to two-year period. This can sometimes be disappointing, especially for highly overweight people. And of course, physical activity is just as important – or even more so. “Ideally, everyday people should do twenty to thirty minutes of enough physical activity to break a sweat, regardless of the physical effort or time of day,” says François Pralong.

“Even ten minutes is enough to limit cardiovascular risks.” ⁄

FOCUS

IS GARLIC GOOD FOR BLOOD CIRCULATION? YES This aromatic plant rich in antioxidants helps reduce the absorption of fat and cholesterol.

It also prevents atherosclerosis, which is caused by fatty deposits on the artery lining. Garlic therefore acts as a serious weapon in preventing cardiovascular diseases.

IS WHOLEMEAL BREAD MORE NOURISHING THAN WHITE BREAD? YES As its name indicates, wholemeal bread is made from whole wheat grains. This means it contains more fibre, mineral salts and vitamins.

Eating wholemeal versus white bread also increases the feeling of satiety.

NUTRITION

“CONFOODERATIO HELVETICA”

F

BY WILLIAM TÜRLER

ood and nutrition are the chosen theme for the universal exposition Expo 2015 to be held in Milan from 1 May to 31 October 2015.

Switzerland’s contribution will be the pavilion entitled “Confooderatio Helvetica”. The display will be easy to spot with its four towers full of typical Swiss specialities to which visitors are free to come and help themselves. How will it work? The platforms in the towers lower as the food depletes, changing the structure of the pavilion. The experiment will be tracked in real time on social media. The aim is to make visitors think about their own consumer behaviour and the interdependence of the food sector. After the Expo, the towers will be disassembled and reused as greenhouses for urban gardening.

IS WINE A GOOD ANTIOXIDANT? YES and NO Some studies show that moderate alcohol consumption can contribute to postponing the onset of atherosclerosis. The tannins contained in wine, like those in tea or cocoa, also play a preventive role in cardiovascular diseases.

However, the people in some studies who were shown to have benefited from one glass of wine per day belong to a Mediterranean population – a group with a particularly healthy diet.

The pavilion, developed by the government communications agency Presence Switzerland, is designed to illustrate the country’s positioning on sustainable development through its

NETWERCH / PRÉSENCE SUISSE

IS CHOCOLATE AN ANTI-DEPRESSANT? YES and NO Chocolate contains theobromine, a substance that increases serotonin levels in the body. Serotonin is a “feelgood” neurotransmitter and can have a positive effect on a person’s mood.

As long as it’s dark. But its texture and sugar/ fat combination, already present in breast milk, are more of what makes chocolate a “comfort” food.

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agriculture services. The Expo theme will stress the importance of healthy nutrition, supported by evidence and contributions from researchers, consumers and private companies. One of the pavilion towers will be filled with salt samples to raise visitors’ awareness about the strategy backed by Switzerland’s Federal Food Safety and Veterinary Office to reduce salt consumption.

According to a study recently published in the New England Journal of Medicine, excessive salt intake actually kills more than 1.6 million people worldwide every year. The study confirms that high sodium diets significantly increase blood pressure and the risk of cardiovascular diseases and strokes. Researchers say that the world’s daily salt intake averaged 3.95 grams per person in 2010, nearly double the amount – 2 grams – recommended by the World Health Organisation (WHO). Eating less salt would benefit many adults. Salt takes the worst toll on older people, people of African descent and anyone susceptible to hypertension.

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NUTRITION

“YOU HAVE TO BE AWARE OF YOUR SENSATIONS.”

PHILIPPE GETAZ

INTERVIEW BY WILLIAM TÜRLER

To truly enjoy a meal, people need to focus on the present moment and tune out all other interference.

That’s what is recommended by Véronique Di Vetta, dietitian with the Obesity Prevention and Treatment Consultations Unit at the CHUV. Interview.

What recommendations would you give to someone who wants to control their appetite?

IV

They should ask themselves four main questions. Am I hungry when I eat? Am I aware that I’m eating?

Do I know how to recognise when I’ve eaten enough? Does my meal satisfy me? This is a key point in distinguishing between hunger and the urge to eat. Hunger is a physiological sensation that is generally felt every four hours. It arises with a slight drop in blood sugar level resulting in a hollow feeling in the stomach, weakness or VDV

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even irritability. The urge to eat more often leads to overeating, but these cravings can also be triggered by wanting to compensate for emotions such as sadness or anger.

How do we know when we’re full?

IV

VDV You

have to be aware of your sensations. The feeling of satiety comes after twenty minutes or so.

That’s why it’s essential to eat more slowly and chew thoroughly.

Putting off meal times makes it more difficult to perceive your sensations.

Hunger will be stronger, so you risk eating faster and therefore overeating.

Stevia is a sugar substitute currently on everyone’s lips. What are its nutritional properties?

IV

Extracts from the Stevia rebaudiana plant are used to produce this no-calorie sweetener VDV

that has gained popularity due to its reputation for being “natural”. The problem is that this type of product maintains people’s sweet tooth, which is not what we want. I would instead suggest consuming regular sugar, but in smaller amounts. That said, stevia can temporarily help someone who wants to reduce their caloric intake. And the other advantage is that it doesn’t cause cavities.

In short, how can we maximise satisfaction from a meal?

IV

It is important to make your meal time a full experience, to focus on the taste, texture and smell of food, without doing anything else at the same time (computer, TV, reading). Eating should be a time of pleasure, a break. Meals should be taken seated at a table, in a calm environment, so that you can savour the food.

VDV

FOCUS

CAN PINEAPPLES HELP YOU LOSE WEIGHT? NO The pineapple’s reputation for being a “fat burner” comes from its content in bromelain, an enzyme that can break proteins down into small particles. But bromelain actually has no effect on fat reserves. They will only melt if energy output is higher than calorie intake.

ARE SLOW CARBS BETTER FOR YOU THAN FAST CARBS? YES These days, we more often refer to complex or simple carbohydrates.

Complex carbohydrates are found in grains and their derivatives (bread, toasts, rice, pasta, potatoes, etc.) and in legumes. They lead to lower glycemic levels, increase the feeling of satiety and are a prime source of fibre in non-refined foods. That’s why dietitians recommend a 50% portion of complex carbohydrates in a normal daily diet, provided they are not combined with butter or with oil when cooked. Simple carbohydrates such as sucrose (extracted from sugar beets), glucose and fructose (found in fruits) should not exceed 10% to 15% of the total daily energy intake.

But everything depends on how you eat them. Eating bread on an empty stomach leads to nearly the same glycemic index as a dessert eaten after a meal.

These informations were compiled with the help of Marie-Pascale Oppliger, a qualified dietitian from the Biel Nutrition Centre and a member of the Swiss Association of Registered Dietitians (ASDD).

NUTRITION

“I was desperate” INTERVIEW BY WILLIAM TÜRLER

OO.* is currently about age 50. She is a former patient from the Obesity Centre at the CHUV and agreed to meet with In Vivo to share her experience of stabilising at a weight of about 90 kilos, down from 120 kilos.

“I never exercised again after finishing school. I kept gaining weight until I reached 120 kilos, at 1.68 metres tall. I knew that I was moving in the wrong direction.

In 2009, I realised that I couldn’t stand anything sweet.

I would break into a sweat, get headaches and felt incredibly tired. So I decided to change my eating habits, by eating less and avoiding sweet foods. But I still felt sharp hunger pangs.

“And I wasn’t losing any weight. Two years later, I got very sick with a bad cold. For seven days, I could only drink smoothies and mineral water. For the rest of the month, I ate perhaps one-fifth of what I would normally eat. And again, I hardly lost any weight, barely 2 kilos.

That wasn’t normal. I was desperate.

“I was having trouble walking, suffered from tachycardia and felt intense pain in my hips. I decided to make an appointment at the Obesity Centre at the CHUV because I really wanted all that to change. We planned on doing a gastric bypass. This surgical procedure reduces the size of the stomach and reconstructs the gastro-intestinal tract, but the operation requires extremely restrictive, lifelong commitments. Plus, you are supposed to eat more proteins and starches rather than vegetables. I love vegetables!

“For me, it wasn’t the natural choice. We finally opted for another solution. I was prescribed metformin, a drug used to reduce glucose intolerance and regulate metabolic processes. It was very effective on me.

I quickly felt less hungry and lost about 20 kilos in a few months. By the end of 2012, my weight had stabilised at about 90 kilos. Today, I still take metformin every morning and evening, for a total of 2 grams per day. I try to eat vegetables as much as possible and avoid eating too much in the evening. I also avoid soft drinks, instead drinking fruit juice. I don’t feel any side effects, and my weight has remained stable.” *Name given to the reporting staff

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FOCUS

NUTRITION

INTERVIEW “DIETARY SUPPLEMENTS ADDRESS A GIVEN SUB-POPULATION”

INTERVIEW BY

WILLIAM TÜRLER

Vitamins, Omega-3, caffeine... These substances are supposed to be good for us. How can we use them wisely?

Answers from an expert.

What makes a dietary supplement different from a drug? in vivo

drugs, either boosting or cancelling out their effects.

The differences vary from country to country. Basically, dietary supplements are iv What forms can supplements take? designed to make up for an actual or presumed lc The list of authorised forms is a long one. They deficiency. They have three defining criteria. In are available in capsules, powder, tablets, bars or Europe, they must be on a positive list. In other drops. For most people, this adds to the confusion words, anything that is not legal is banned. In the between medicine and supplement, as the line United States, it’s the other way around. Anything between the two can be rather hazy. that is not banned is legal, which is obviously not the same thing. Then, there is dosage, which iv Can natural foods have the same effects as cannot be higher than the recommended amount, supplements? i.e. in line with normal requirements. For example, lc Of course. That would be a functional food. the recommended daily amount of vitamin C is For example, tomatoes contain lycopene and other 120 milligrams. Lastly, there are active constituents, some of A nutrition specialist the nutritional, functional and which have not yet been health aspects. The thinking is as Luc Cynober, educated as a identified. Other examples follows: a given product is rich in pharmacist and biologist, is a include salmon and sardines, professor of nutrition at the Faculty calcium, calcium increases bone which are rich in fatty acids. of Pharmaceutical Sciences at density, calcium intake can Paris Descartes University. He is also therefore prevent osteoporosis. iv Isn’t it better then to use the coordinator of the authoritative luc cynober

Are dietary supplements recommended to stay healthy? iv

book on amino acids and co-author of The Truth About Dietary Supplements (La vérité sur les compléments alimentaires) published by Odile Jacob in 2010.

There is no universal answer. In essence, supplements address a given sub-population. Typically, folic acid is recommended for pregnant women and women who want to have a baby because folate deficiency can cause neural tube defects in the foetus. Omega-3 fatty acids are useful for the development of the brain and nervous system in children. Then in the elderly, vitamin D helps prevent hip fractures in the event of a fall. lc

Are there substances that promote sleep, improve memory or boost intellectual capacity? iv

Any cerebral stimulant, such as caffeine or especially B vitamins contained in certain grains and types of meat, is good for the brain. Some supplements can promote sleep or help fight depression, but they can also interact with other lc

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foods directly?

It is. But it’s also important to remember that the concentration is lower in food. Plus, the ripeness of fruit and how it’s prepared also need to be factored in. For example, the highest bioavailability of lycopene is not in tomatoes, but in ketchup.

However, that doesn’t necessarily mean that ketchup is a healthy and well-balanced food. There is also the issue of taste and price. Not everyone likes fish, for example, and it’s relatively expensive. lc

Which encourages people to consume more and more dietary supplements… iv

Fundamentally, many people also take them to feel better about not eating structured, well-balanced meals. This is particularly true in the United States, where more than half of the population takes dietary supplements, of which 10% to 20% take more than ten or even twenty per day. lc

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In Europe, the figure varies between 20% and 30% of the population.

Is growth comparable to that in the United States? iv

NUTRITION

Professor Luc Cynober takes a close look at the effects of dietary supplements.

It depends on the segment.

Slimming products are stable or even falling. But products for the elderly or those affecting the memory are rising. People commonly take supplements to stay younger and stronger, boost their intellectual performance and remain healthy as long as possible. lc

iv

What about sick people?

If it involves illness, we move into the clinical realm. For example, supplements have nearly no effect in preventing obesity. Due to its genetic and environmental traits, this disorder requires medical treatment. If someone is sick, supplements won’t be as effective as the appropriate treatment. Many people want effectiveness without side effects.

It can be even dangerous for cancer patients, especially with the interaction between antioxidant supplements and chemotherapy. Many forms of chemotherapy require a pro-oxidant environment to be effective.

What side effects can arise if someone takes too much of a supplement? iv

Depending on the person, there may be neurological problems or bleeding. There have also been a number of cases of tainted products, which is true of 30% of supplements in the United States. That’s why you should never buy them online from unidentified companies. lc

Experts have only recently begun looking into the the differences in how men and women react to medicine. Does that also apply to dietary supplements? iv

Similar differences certainly exist. The regulation of muscle mass varies between the two genders, lc

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MARTIN COLOMBET

lc

simply due to the differences in anabolic hormones. But there is not a lot of data on the subject.

The problem is that there is only a very limited possibility of patenting results. Manufacturers don’t want to finance studies on a concept that could be immediately copied by others.

Do you have other examples of foods that have positive effects on health? iv

In France, studies have shown that cranberry is recommended for preventing urinary infections in women. We also know that intestinal problems can affect the skin or hair. Interesting studies show that some probiotics can have positive effects in this area. ⁄ lc

“The organ donation ideology hides the notion of capitalist appropriation that comes with it.”

CÉLINE LAFONTAINE

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CHRISTOPHE DELORY

MENS SANA

MENS SANA

INTERVIEW

CÉLINE LAFONTAINE The body has become a piece of merchandise like any other, sold off in parts to the highest bidder. Bioeconomics specialist Céline Lafontaine shares her insight into the “body market”.

INTERVIEW: JULIE ZAUGG

“Eggs from a European woman with blue eyes go for more than eggs from an Asian woman” The development of biotechnology and in vitro conservathis issue. The US government has begun tion techniques has set the stage over the past few decades investing massively in biotechnology and for a worldwide market for human body parts, which can GMOs, in the hopes of making living ornow be sold off to the highest bidder. In her compelling ganisms a new source of productivity. book The Body-Market, Céline Lafontaine, professor of sociology at the University of Montreal, condemns some IV You refer to organ transplants as an exof the shady dealings currently plaguing the biomediample of how the body has been turned into cal industry. Here, she breaks down the ethical and a commodity. How did this trade develop? political issues involved in the development of bioCL It involves selling off the body in parts. The economics. spread of organ transplants in the 1970s created a shortage, which led to the emergence of IN VIVO Bioeconomics is a new concept. What is a black market. Kidneys are the primary organs it? CÉLINE LAFONTAINE The human body has always concerned in trafficking, as people can survive with been the subject of economic models, whether in only one. Left with nothing else to sell but their prostitution, slavery or factory workers during the body, the poor in India and Bangladesh now turn industrial revolution. But it was always sold as a their kidneys for a profit. Doing so often weakens unit in a work force. Bioeconomics is at the opthem to the point where they can no longer work posite end of the spectrum, dividing the body and become even more destitute. In China, organs into biological elements – cells, molecules, are harvested from prisoners on death row. A test is bones, etc. – and using them as a source of sometimes even run upstream to determine compatibileconomic productivity. The oil crises in the ity with the recipient before choosing which prisoner to 1970s brought people to realise that there execute. In South Africa, medical tourism has developed are limited reserves of natural resources. for transplants. You can have a new kidney and take a Bioeconomics emerged as a response to safari on the same trip.

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MENS SANA

INTERVIEW

Participants in clinical trials are also paid. So is it really one day be used to cure the child if he or exploitation? CL Clinical tests are essential to the pharmaceu- she develops leukaemia. tical industry in developing new drugs. Trials started being outsourced in the 1990s, following the trend in manufactur- IV Medically assisted procreation has ing. In the trail of Novartis, a growing number of pharma- given rise to a whole new industry. How ceutical companies went to India and China to conduct their did that market begin? CL It’s the very ideal clinical trials. But the main problem is that the effects of the of bioeconomics. The industrial productivity drugs tested are often unknown. And the bodies being used model developed for the bovine industry was in the experiments, and on which data are based that will transposed to women. Medically assisted prolater be marketed, are often not the ones that will benefit creation causes women to produce dozens of from them most. eggs instead of just one, while minimising the impact on their body, the dangers and even the risk of mortality related to ovarian stimulation.

The technology to freeze eggs has created a market for this living material. Women, particularly in India, now take tremendous risks to sell their oocytes. This market grew even larger in the early 2000s after the discovery that stem cells could be generated from embryos. New York recently became the first place in the world to authorise egg donation strictly for the purposes of stem cell research. Surrogate mothers represent another facet of the industry. Their role is similar to that of a slave or prostitute, who sells her body 24 hours a day, seven days a week for nine months.

IV

“THE MARKET FOR LIVING MATERIAL CREATES A DUAL STANDARD IN MEDICINE.”

IV Does the body contain even more parts that could be sold off in the future? CL Biobanks have reIV Do our cells also have a financial value? CL Now cently sprung up that store a person’s genotype. Perthat cells can be kept alive outside the human body sonalised medicine requires large databases to identify and multiply in vitro, they can be given a producthe biomarkers that cause certain diseases. It’s a pertive value. Just look at the case of Henrietta Lacks version of the notion of informed consent. If you sign [editor’s note: a young African-American woman off on the use of your biological material, it’s usually for who died of a tumour in 1951 and whose cancer a very specific goal. But in this case, no one knows what cells were multiplied in a laboratory and used they’re consenting to. We don’t know what diseases it to develop vaccines and perform other experiwill be used to study. Instead of donating a piece of your ments]. As stem cell research advances, this livbody to another individual, you donate it to the general ing material now even plays a key role in treatpurpose of research. ment. Cells are no longer for research alone.

They are now being used to heal other bodies.

IV Who sets the prices on this market for biological maBroadly speaking, most products from the huterial? CL Organ trafficking, for example, is regulated by man body (menstrual blood, umbilical cords, supply and demand, like drugs. You also have the traditional foreskin, aborted foetuses, sperm) now have intermediaries who take their cut along the way. But even value. This human waste can be recycled when reduced to being treated as a mere object, body tissue and sold. For example, umbilical cord blood remains symbolically tied to the person. Prices on the egg and banks are based on the (scientifically controsperm market are set based on the social value associated with versial) concept that those frozen cells could the donor’s features. Eggs from a European woman with blue

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MENS SANA

INTERVIEW

eyes go for more than eggs from an Asian woman. A Californian sperm bank has even specialised in high value-added donors, who look like basketball champions or film stars.

“WITH MEDICALLY ASSISTED PROCREATION, IV And when no financial transaction takes THE INDUSTRIAL place, who benefits from the rewards genPRODUCTIVITY MODEL erated by the living material? CL The blood banks that emerged after World War II creDEVELOPED FOR THE ated the notion of donating body tissue. You donate your corpse, you give your blood, you BOVINE INDUSTRY WAS get an organ donor card as a good deed to society, to help advance medical science or help oth- TRANSPOSED TO WOMEN.”

ers. But that donation ideology hides the notion of capitalist appropriation that goes with it. The IV Are these inequities strictly a North-South pheliving material will be used for research. But the nomenon? CL No, bioeconomics contributes to disparfinancial rewards from this research will not go to ities even within wealthy societies. Private umbilical the donor, but to the scientist. This principle was cord blood banks are only open to those who can pay passed into law with the Bayh-Dole Act adopted in for them. And the cells stored there sidestep the pubthe United States in 1980, making it legal to patlic banks. They are no longer available for other sick ent living material. More recently, biobanks and the children who might need them. In the age of bioecogenetic material they contain have made it possible nomics, not all bodies are equal. Some are exploited for private entities to develop and market drugs for for the benefit of others. / which they alone will receive the financial benefits.

Fundamentally, why the concern about the development of this market for living material if everyone is supposed to be free to choose whether or not to participate?

CL It creates a dual standard in medicine, amplifying the social inequality that already exists. First, you have the citizens of Southern countries, who sell their bodies, and women, who are more vulnerable to commercial exploitation because their bodies, by their very biological make-up, generate a number of potential stem cells such as eggs, menstrual blood, umbilical cords and embryos. Then, you have people from rich countries, who view health as a right. This propels them into a consumer-driven quest for perfect health, which now goes beyond a mere lack of illness. It means having control over one’s body. They try to push limits and stop the ageing process, especially through regenerative medicine. It’s a form of neocolonialism.

IV

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BIOGRAPHY

Céline Lafontaine is a professor of sociology at the University of Montreal and a member of the research team “Medications as social objects”.

Following her books L’Empire cybernétique (2004) and La Société postmortelle (2008), she has recently published Le Corps-marché, la marchandisation de la vie humaine à l’ère de la bioéconomie.

Céline Lafontaine studies the social issues involved in regenerative medicine. She is also a member of the Research Centre for Techniques, Knowledge and Practices at Paris University 1.

MENS SANA

DECODING

THE SCIENCE OF OPTIMISM Recent research using magnetic resonance imaging shows that our brain is naturally programmed to see the glass as half full.

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conomic crisis, political tensions, the poor performance of our national football team... World news floods us with current events that give us little to be happy TEXT: about. However, Tali Sharot, BERTRAND director of the Affective TAPPY Brain Lab at University College London, says our brain is wired to see life through rose-coloured glasses, regardless of what happens.

For several years now, the British researcher has been studying why our brain obsessively tends to remember good news over bad. That is the “optimism bias”, and about 8 out of 10 of us suffer from it.

Chances are you’re a serial optimist without even realising it. You don’t think so? To prove it, Tali Sharot often uses a very simple exercise. Try to imagine yourself one year from now, then five years, then ten. Take a minute to imagine yourself in this hypothetical future.

thinking of a pleasant time – a holiday, a day with your children (who have grown), a degree, a promotion and so on. Like 8 people out of 10, you have just tipped the scales in favour of happy events over bad ones (illness, war, divorce, etc.).

LOS ANGELES LAKERS When the Los Angeles Lakers won the NBA championship in 1987, coach Pat Riley announced that his team would surely win the championship the following year. Many viewed his prediction as a taunt, as no team had ever succeeded in garnering two titles back to back. But that is exactly what the Lakers did. Obviously it is not enough just to want it to happen. However, believing in a bright future increases the chances of that outcome actually coming true, wrote Robert Merton, the father of the “self-fulfilling prophecy”. Optimism drives people into the mindset of pursuing that distortion of reality. Subjective reality is therefore more likely to become objective reality. By telling themselves that they would be champions a second year in a row, Pat Riley’s players probably trained harder than if they had believed it to be a hopeless endeavour.

BOB GALBRAITH / AP

Unless you’re cheating (because you’re very smart readers and you know what we’re getting at), you are probably

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DAVID COOPER / GETTYIMAGES

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The researcher Tali Sharot has used magnetic resonance imaging to shed light on the mystery of the “optimism bias” of the human brain. Visit www.invivomagazine.com to view her TED conference on this subject.

OPTIMISM AND LIFE EXPECTANCY In her book, Tali Sharot tells the story of a study conducted on 238 cancer patients. Those who were more pessimistic about their chances of survival were more likely to die within seven months than their more optimistic counterparts. In this case, the tendency to look on the bright side of life has a genuine positive impact.

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“Optimism has a huge influence on our lives, especially regarding our ability to make choices, whether it’s choosing a profession, getting married or even deciding what to have for lunch,” says Tali Sharot. “For example, when a couple gets married, the young husband and wife can’t imagine divorcing one day. But statistics show that 40% of them will.” What this means is that people know bad things will happen, but think they mostly happen to other people. That attitude can either cost us our life, or save it.

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THINKING POSITIVE STARTS IN OUR The findings were conclusive. When the AMYGDALA brain imagined something positive, When it comes to health, our optimism the amygdala (located deep within the bias can work in two ways, with a very brain and responsible for our emotions) different impact. The first involves and the rostral anterior cingulate cortex the strong warning labels found, for (which modulates the activation of areas example, on cigarette packaging. With of the brain linked with motivation) the “optimism bias”, all that warning were actively involved. These results line is in vain. The brain does up with other older research indeed record the that demonstrated that FRIDAY information and the fear it these same areas did not We generally prefer the causes, but the message it function properly in people weekend to the work week. retains is that if cigarettes suffering from depression.

But if you ask someone if kill, they’ll probably kill they like Friday or Sunday our neighbour. UnfortuAnother study, also better, you’re probably in for nately, this illogical conducted using imaging, a surprise. Friday wins out.

Why? Tali Sharot believes reasoning can result in tried to confront subjects that the majority of human devastating consequences. with good or bad news to beings favour something the question, “What do you they have to look forward In her book loaded with think is the percentage risk to, rather than a reward they examples that connect that you’ll develop cancer?”. can have immediately but behavioural studies with The answers could vary that will soon be over. brain function, Tali Sharot widely. But when particialso discusses a study by pants were given the Professor Richard Schulz from the Universtatistical figure – 30% average risk of sity of Pittsburgh published in the Journal of developing the disease – those who had Personality and Social Psychology. The overestimated the risk easily brought survey of 238 cancer patients revealed that, their first estimate down, while those after factoring in age and state of health, who had predicted a risk significantly those who were more pessimistic about their lower than the average found it much chances of survival had a greater likelihood harder to raise their estimate to the of dying within the next seven months than objective figure. their more optimistic counterparts. In this case, the tendency to look on the bright side The culprit? The right inferior frontal of life has a genuine positive impact. gyrus, responsible for processing bad news, wasn’t doing its job, especially with Optimism does affect our judgement, but the optimists. “Of course, this is nothing the main question remains: where does this revolutionary,” says Tali Sharot. “Now process of distorting reality come from? we’re sure that we have isolated the exact To find out, Tali Sharot used magnetic part of the brain implicated. And the field resonance imaging. With her team, she of study remains so vast that we still have asked her volunteer subjects to think of a plenty to discover!” Pretty optimistic, eh? ⁄ number of positive experiences (promotion, romantic encounter, etc.) and then negative ones (break-up, losing their wallet) while undergoing an MRI.

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“YOU HAVE TO BE CAREFUL NOT TO PROMISE THE IMPOSSIBLE.” INTERVIEW Stéphanie Clarke heads the Neuropsychology and Neurorehabilitation Service at Lausanne University Hospital.

Have you observed a “geolocation” of optimism? sc Yes. If you look at the facts in a very simplified manner, we have noticed that patients who have had a lateralised stroke on the left side of their brain lost hope more easily and retained negative information more quickly about the consequences of that event. Conversely, victims of a stroke on the right side of their brain were more positive, as their “optimism” hadn’t been damaged.

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care for patients whose recovery can sometimes be extremely long. How can their attitude towards their condition impact the outcome of their treatment? sc In neurorehabilitation, we give great importance to the patient’s environment. Of course, that won’t influence everything, but having family support and positive goals (like being able to return home) can only have positive effects. In fact, with some people we often note that life after illness is perceived as better than before!

Why is that?

An increasing number of studies prove that if the patient and those around them find the right balance between their expectations and what they can actually achieve, everything becomes a source of happiness, even a simple conversation.

However, you have to be careful not to promise the impossible. Our role is to provide the patient and their loved ones with all the information they need to instil them with just the right amount of optimism!⁄ iv

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INNOVATION

Plans are to rebuild the complex entirely between now and 2019.

THE END OF THE CUCKOO’S NESTS TEXT: SARA BANDELIER

ROUNDED WALLS, OPEN SPACES, PRIVATE GARDENS. PSYCHIATRIC INSTITUTIONS ARE REDESIGNING THEIR STRUCTURE AND FACILITIES. WHY? TO TRANSFORM A SOULLESS PLACE INTO A SOOTHING ENVIRONMENT.

he wind rustles the dead leaves lying along the alleyway. In the park, a man in a straightjacket is surrounded by doctors. And in the background looms the dark, sinister asylum where patients receive shock treatment. This cliché of the psychiatric hospital is definitely a thing of the past. Doctors and architects now work together to design a welcoming environment open to the outside world.

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These changes are made to improve care. “The idea that architecture could heal, calm, welcome and surround the patient came about in the 19th century,” says Jean-Michel Kaision, director of the Department of Psychiatry at the Lausanne University Hospital. But it took some countries longer to integrate those principles. “Psychiatric hospitals are still often thought of as a prison, a place for punishment,” says his colleague Jacques Gasser. “We want to create an environment for treatment that is both aesthetic and organic, with colours and non-cubic shapes.”

As chair of the Department of Psychiatry, Jacques Gasser is leading the project to redesign the Hospital of Cery in Lausanne.

Individual bedrooms, rounded structures, smaller units, shared spaces, open access to private gardens, atriums and personalised areas are now an integral part of new psychiatric treatment facilities. Östra Hospital in Sweden has already embarked on a similar programme. Its architecture reflects the design of Scandinavian homes, with their paintings depicting nature scenes, their wooden furniture and their colourful curtains. Roger Ulrich, professor of architecture at Chalmers University of Technology in Gothenburg, Sweden, conducted a study in which he noted the benefits of these redesign projects. “The physical setting plays a key role in reducing stress and aggression in patients,” he says. “Our research shows continued increases in the use of physical restraints and sedation at traditional psychiatric facilities in Sweden, while Östra has observed a considerable drop in aggressive behaviour.”

Roger Ulrich has identified a number of factors that are believed to reduce stress and aggression.

The patient’s privacy and dignity are guaranteed with individual bedrooms and WCs. Their space can be adapted to their needs for isolation. Free access to the garden offers a sense of control and calm.

Silence is also important. Units are smaller in size to reduce the stress caused by crowding and noise.

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In Lausanne, the Alcôves project launched by Pieter Versteegh and Catherine Versteegh-Cellier aims to transform the intensive care unit at the Hospital of Prangins (Vaud). “It’s the most problematic area, where staff work on therapeutic isolation for the most serious cases,” says architect Pieter Versteegh. Catherine Versteegh-Cellier’s objective is to “reduce the number of situations that can make the patient’s condition worse when they are taken to intensive care and during their stay in the room, while still guaranteeing their safety.” She goes on to explain, “Patients are meant to start responding to the stimuli from the outside world again, through the architectural design

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that awakens their body and their senses and gradually bring them back into contact with others.”

“When patients are placed in this room, they always experience it in the pain of their symptoms rather than as a treatment,” says Catherine Versteegh-Cellier, head of the Clinical Unit at the Neuchâtel Psychiatric Centre.

Patients are overcome with a feeling of seclusion, exclusion and oppression. They are lonely, unable to see the rest of the unit around them and sometimes unable to open the shutters on the window… if there is one. Intensive care units have also been reinvented at Cery. The facility will feature two to three bed-

rooms surrounding a community area. “There are environments that affect patients with dementia differently, like a setting from their youth,” says Jean-Michel Kaision. “We’re going to try to recreate environments where they feel comfortable.”

Swedish architect Roger Ulrich believes that revamping psychiatric facilities is a step in the right direction. “Modern facilities now have individual rooms, more natural light and perhaps improvements in design,” he says. “But most of them still have long corridors and centralised desks where staff can easily observe the patients, sometimes intrusively. Progress is still needed.” ⁄

1 The soft architectural shapes planned for the Hospital of Cery are aimed at creating a peaceful environment.

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VEGAR MOEN, CCL

Designed by JDS, Helsingør Hospital in Denmark has set a benchmark in psychiatric architecture.

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TEXT: CLÉMENT BÜRGE

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THE BOOM IN GEOMEDICINE

Geographical data can reveal a lot about a patient’s state of health.

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That realisation turned his life upside down. “Would I have chosen to live in those places if I’d known previously that I was increasing my chances of developing a heart condition? Definitely not.”

hen Bill Davenhall turned 55, he began to suffer from heart problems. Even though he knew he was genetically predisposed to develop the condition, he wanted to know what had triggered the onset of the disease.

“I decided to analyse the places where I’d lived,” he says. He spent the first nineteen years of his youth in a rural area in Pennsylvania, where natural gas extraction was common. “There, I breathed high concentrations of carbon dioxide and methane gas.” Then he moved to Louisiana, settling in a city next to a plastic plant. “I spent twenty-five years there breathing chloride and benzene.”

A few years later, he moved to Los Angeles. “It’s an area with high doses of ozone and carbon dioxide,” he says. When you look at the geographical breakdown of people with cardiovascular problems, “if I wanted to have a heart attack, I’ve been to the right places.”

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Today, Bill Davenhall devotes himself to promoting the use of geographical data in medicine, which is called geomedicine. “This information is just as important as my genetic predisposition or my lifestyle,” he says. “But no doctor has ever asked me questions about where I live.”

My Place History The My Place History smartphone app, presented at a TEDMED conference in 2009, can be used by Americans to enter the different places they have lived in their life. They can then cross their “itinerary” with government databases such as the “Toxics Release Inventory”, which lists the toxic chemicals that they could have, or can, come into contact with in those areas.

He advocates including information on place history into patients’ health records. “The doctor could then know whether a person has been exposed to chemicals or toxic gases,” he says. “And the diagnosis would be more accurate.”

OBESITY IN GENEVA

A growing number of people are turning to geomedicine today in 2014, even though the field of study has been around for some time. Back in 1853, epidemiologist John Snow used a map of cholera cases and water wells in London’s Soho district to track down the source of an outbreak.

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Idris Guessous has highlighted a link between where people live and obesity in Geneva.

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TECHNOLOGICAL BOOM

Idris Guessous, an epidemiologist who works for Lausanne University Hospital and Geneva University Hospitals, applies the same method. He published a report in March 2014 on obesity in the canton of Geneva.

The recent development of geomedicine is mainly a result of new technologies.

“It’s much easier than it used to be to collect data,” says Idris Guessous. “There is more of it, and we have software to process data rapidly. We can send a helicopter over the Geneva area to collect hundreds of thousands of data.

We can also calculate the pollution rate down to the minute, which used to be unimaginable.”

“We observed where overweight people are located in the canton to check whether there was any spatial clustering,” the physician says. He came to some interesting conclusions. The researcher discovered a clustering of people with the same weight on the left bank. People on that side were thinner than those on the right bank.

The miniaturisation of electronic devices (GPS, drones, etc.) and development of smartphones have transformed the field.

Marcel Salathé, a Swiss researcher at Penn State University in the United States, has created crowdbreaks.com, a website that tracks disease trends.

“We take our information from Twitter to detect where certain conditions are developing in real time,” he says. “The system helps us to locate them geographically.” Google has also developed Google Flu, which aggregates online search data to identify regions with flu activity.

When the words “headache” or “cold” are frequently entered in the search engine, it indicates a household with a case of flu.

Idris Guessous offers three explanations for this pattern. First, there is more fast food on the right bank in the canton, providing easier access to fattening food. However, sport facilities are more developed on the left bank. It is therefore easier to exercise. “The third reason is sociological,” the researcher says. “We discovered a group effect.

When people live together, they tend to adopt similar behavioural patterns, which drives them to have the same weight.” He is currently studying the exact reasons for this phenomenon.

His discoveries are highly valuable and could be used to develop new strategies in the fight against obesity. “The maps we have designed can be used by the government to determine where to build sport facilities and launch prevention campaigns,” the expert says. Eventually, once the mechanism is established that drives the population living in certain areas to stay thinner, it will be a question of “transposing the healthy habits of these areas to others,” he concludes.

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John Snow The British physician John Snow (1813-1858) is considered the founder of epidemiology. He studied the cholera epidemic that swept through London in 1854.

By mapping out the mortality rate in different areas of the city, the epidemiologist concluded that the source of the Soho outbreak was sewagepolluted water coming from the Broad Street pump.

These new technologies have also given rise to gadgets used to improve treatment based on geomedicine. Bill Davenhall has developed a smartphone app called My Place History. Users enter their home location to assess the health risks associated with that area. David Van Sickle, anthropologist and founder of the start-up Propeller Health, has come out with an asthma inhaler embedded with a GPS tracker to indicate where his patients are using the device.

“This shows us which environments bring about asthma attacks,” he says.

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“We can then tell our patients to avoid going places where they know that the atmosphere will give them problems.”

Or simply understand how the disease works. “We discovered in a study conducted in Wisconsin that people in rural areas used their inhalers more often than people in the city, which contradicts current studies.” The prevailing hypothesis is that asthma is caused by pollution.

But this geographical information also poses a serious threat to personal data protection. What will happen if companies get their hands on our geomedical record? Could an insurance company charge a customer higher premiums based on their geographical history?

“We have to be very careful with the use of this type of data,” says David van Sickle. “Patients have to be able to check the information that they disclose. It’s crucial.” Bill Davenhall is more optimistic: “Geomedicine will considerably improve our treatment.

It’s worth taking that risk.” ⁄

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INTERVIEW “WE’RE SURROUNDED

BY MILLIONS OF TOXIC SUBSTANCES” A recent report from a Harvard University research team warned that new chemicals that can affect our nervous system have been identified. Analysis from Nathalie Chèvre, ecotoxicologist at the University of Lausanne (UNIL).

INTERVIEW BY CÉLINE BILARDO

What new findings are in this report for neurotoxin product research?

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Interest in pollutants dates back to the 1920s, and they were already discussed in reports by the 1950s. However, this study says that the substances listed have been proved and recognised to affect the human nervous system. Research estimates that nearly 100,000 chemicals on the market can be found in our environment. And each one can create other compounds, which break down once released in the environment and create other potentially toxic molecules.

Nathalie Chèvre

How much exposure do we have to these substances?

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The study named manganese, fluoride, the pesticide chlorpyrifos, lead and polybrominated diphenyl ethers [or PBDEs, used as flame retardants]. And they’re all over the place! In dust, sediment, food, textiles, etc.

These chemicals could affect health after long-term exposure to low doses.

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What is their impact on children?

Of the chemicals listed, the effects of chlorpyrifos are well known. This molecule over-stimulates the nervous system and disrupts behaviour in both adults and children.

In fact, children are the most susceptible as their nervous system is still being formed.

They can develop serious neurological disorders such as hyperactivity. There is no miracle solution to protect yourself against chemicals, but washing clothes before wearing them for the first time and eating organic or locallygrown food are first steps. Comparatively, we are rather lucky in Switzerland was we have many relevant standards and regulations that are already in force.

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REMOTE CONTROLLED MEDICINE A new generation of electronic chips, when placed under the skin, are designed to release hormones or drugs by remote control.

Technological and medical revolution, or just another gadget? ontraceptive microchips implanted under the skin, which can be switched on and off using a wireless connection, could hit the market soon. The US start-up behind the project, MicroCHIPS, has recently completed a series of tests on its implant.

seven Danish women suffering from osteoporosis. It delivers daily doses of teriparatide, a molecule used to stimulate bone growth. “It’s highly successful,” says Robert Farra, President & Chief Operating Officer of MicroCHIPS.

“If we can adapt it to different treatments, it would represent a real breakthrough for people who need to take medication regularly, which often presents a burden, especially for the chronically ill”, says Pierre Voirol, head pharmacist at the Pharmaceutical Assistance and Clinical Pharmacology Unit at the CHUV.

Founded by researchers from the Massachusetts Institute of Technology (MIT), MicroCHIPS has received $4.6 million in funding from the Bill & Melinda Gates Foundation.

Microsoft’s founder is looking for ways to provide women in the poorest countries with contraception that would last longer than the implants currently available and that could be deactivated if the user wished to conceive.

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An initial version of the chip is currently being used to treat

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TEXT: MARGAUX FRITSCHY

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TECHNOLOGICAL TREND

INGESTIBLE SENSORS: HOW DO THEY WORK? The digital feedback system developed by Proteus uses ingestible sensors to monitor its user’s health.

Explanations.

The Proteus sensor is activated when swallowed and records that the patient has taken their medication.

The device is powered by stomach fluids, and transmits the data collected to a skin patch.

Using a Bluetooth connection, the patient can use the application provided with the sensor to check and analyse their data.

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Although the contraceptive microchip is not yet available on pharmacy shelves, this type of high-tech device is already used in sensors placed inside and outside the body to monitor a patient’s condition. An example is the Helius sensor designed by the US company Proteus Digital Health. The Helius ingestible sensor is swallowed with medication and communicates with a patch worn on the skin.

The information collected can then be transmitted to a smartphone, tablet or computer.

The internal sensor is activated by gastric fluids. The system checks whether the patient is truly taking their medication and determines whether or not the treatment is effective.

The whole procedure is more accurate and efficient than doctor visits, as data is collected constantly.

Meanwhile, Novartis has recently signed a partnership deal with Google to develop smart contact lenses. The technology would be used by diabetics to track their blood glucose levels by measuring tear fluid in the eye. This offers them a simple and non-invasive way of keeping closer tabs on their disease.

In ingestible tablets, skin patches or in clothes or shoes (smart fabrics), these digital devices are designed to monitor a person’s condition and understand their reaction so

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that they can receive better treatment. The market research firm IDTechEx forecasts that this type of technology will develop into a market representing $70 billion by 2024, up from $14 billion today.

IDTechEx also believes that companies specialised in these technologies will eventually become as big as pharmaceutical groups. Companies like Google will also play a key role in gathering medical data. The US giant has recently launched an ambitious experimental project to present a standard of what a healthy human being should look like.

Google’s “Baseline Study” will be harvesting genetic and molecular information provided by anonymous volunteers over the next few years.

The company MicroCHIPS plans to launch its digital pill by 2018. As of now, the microchip has not been rejected by the human immune system once implanted under local anaesthesia. MicroCHIPS hopes to be granted approval by the US Food and Drug Administration to launch clinical tests on its medicine in the months to come. ⁄

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inside the chip. I can only think of hormonal treatments being compatible with the technology, such as for contraception, thyroid imbalances, osteoporosis or delicate treatments using growth hormones.

A third party could use the microchips because they’re remote-controlled. Isn’t that dangerous? tb Insulin pumps used by diabetics are Bluetoothenabled. Cardiac pacemakers are also controlled through the skin. So these devices would also present a potential danger. The truth is, this type of technology always raises fears about hacking risks, but I don’t know if they’re founded. iv

“I’M CONCERNED ABOUT THE PRICE” INTERVIEW Spectacular progress or science gone out of control? Thierry Buclin, physician-in-chief of the Clinical Pharmacology Division at the CHUV shares his opinion.

Couldn’t the governments of countries with high birth rates want to control these microchips to reduce the number of births? tb Governments don’t need this technology to control their country’s birth rates. For example, in South Africa the government offers financial compensation or nutritional supplements to women from underprivileged groups who choose to use implants or have contraceptive injections every three months.

Ethically, it’s not black and white. They have to be able to advise the right contraception method. ⁄ iv

Do you think that these chip treatments can be useful? tb Honestly, I’m more concerned about the price. Technology like that is expensive. Unless the healthcare system wants to come on board, I don’t think that these contraceptive microchips will be affordable for everyone. The costs aside, we’ll also have to see whether these devices can be adapted to other treatments. That’s not really what we’re seeing. The dose of medication has to be very small to be contained iv

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JOÃO MEDEIROS Science Editor for “Wired” UK

Peek, an eye-opening innovation.

Find out how a British scientist turned a smartphone into a system for performing complete eye exams.

Andrew Bastawrous started working as an eye surgeon in 2005. He went into medicine to work in poor environments, where he could have an impact. He trained in the UK, a period interspersed with frequent trips to countries in Africa and South America. “The biggest causes of blindness in those regions are cataracts, when the natural lens inside your eye becomes cloudy, and not having access to glasses, says Bastawrous. They are the same diseases that people in the developed world suffer, the only difference is that we can easily fix it.”

Peek is a smartphone clip-on adapter and app that allows healthcare worker with minimal training, a bike and a solar-powered rucksack to do a quick eye exam. The exam is as accurate as the one using standard hospital equipment. “The phone is not going to treat anybody but will identify the people who need treatment”, says Bastawrous.

The story of Andrew Bastawrous and Peek is a tale of unorthodox innovation. Peek was first born in a context of necessity and frugality. When faced with the impossible task of using expensive equipment in a low-tech environment, Bastawrous simply asked: what if it’s possible to do the same with less? Now helped with Zooniverse, a project that uses crowdsourcing to analyse scientific images, he’s using inexpensive and effective scientific methods initially developed to analyse galaxies do the data analysis of eye disease and, potentially, save lives.

In 2007, Bastawrous did the first ever cohort study of eye disease in Africa on a population of 5000 throughout the Rift Valley in Kenya.

Bastawrous went back later, to re-examine the same population, setting up 100 different clinics with expensive equipment in places with poor access and no electricity. “I thought there had to be a better way of doing this instead of Perhaps more importantly, Bastawrous’ story carrying all this equipment and having all these is also a lesson about what it takes to innovate. expensively trained personnel. That’s when When he had the idea for Peek, his colleagues I had the idea of converting all of it into a tried to dissuade him. “People would tell me: smarthphone.” ‘Sounds like a nice idea but you have too much work. Concentrate on your PhD’,” Bastawrous recalls. “But the idea kept on growing and I just thought, I’ll try to do it myself.” ⁄ PROFILE

João Medeiros heads the “science” section of the British edition of “Wired” magazine. He often covers stories relating to health and organises the annual “Wired Health” event.

IMAGETRUST

FIND OUT MORE

http://www.wired.co.uk/

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TEXT: JEAN-CHRISTOPHE PIOT

BOTOX: NEW RELIEF FOR MIGRAINE SUFFERERS SOME FORMS OF HEADACHES RESIST PHARMACOLOGICAL TREATMENT. SURGICAL DECOMPRESSION OF THE PERIPHERAL SENSORY NERVES OFFERS GENUINE HOPE. HOW DOES IT WORK?

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everal times a month, my head would be stuck in a vice for three, sometimes four days,” says Alain Beutler, second on the list of some fifty migraine patients treated at Lausanne University Hospital (CHUV). “It was taking an immense toll on my personal and professional life,” recalls the mechanic, who had suffered from migraines since childhood. Florence Lavanchy can commiserate. At age 38, the medical assistant had been having headaches for about twenty years. “Either the painkillers no longer brought any relief or they would knock me out,” she says. “On a scale of 1 to 10, my pain was a 7 or 8.”

Migraines and headaches are infinitely debilitating and can cause great distress. Despite significant progress in pain management, some patients do not respond to traditional therapies. Most of these treatments address only the intenCORPORE SANO

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These frontal thermograms of the head of a patient show the different phases of a migraine attack. The hot spots (red, yellow and white patches) start to form at the base of the neck ( 1 ) before rising towards the head ( 2 ).

At the peak of the attack ( 3 ), the pain is mainly around the eyes and brain.

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DR. G. RAVILY / SCIENCE PHOTO LIBRARY

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sity of attacks but provide no cure and can have serious side effects. Wassim Raffoul, chief of the Plastic and Reconstructive Surgery Service at the CHUV, and clinic heads Giorgio Pietramaggiori and Sandra Scherer now offer solutions aimed at this category of drug-resistant patients.

The technique used at the CHUV since 2013 is the fruit of pure chance. Dr Bahman Guyuron, based in Cleveland, developed the procedure following observations by plastic surgeons. Patients who had previously suffered from migraines reported a significant reduction in the frequency and severity of their pain after receiving Botox injections in the forehead. Clinical studies have confirmed that the paralysis of these facial muscles has the side effect of decompressing certain peripheral sensory nerves that can trigger migraine attacks.

CAREFUL SCREENING “This type of surgery is not for all patients,” says Giorgio Pietramaggiori. “To treat migraines and other types of headaches, we consult neurologists to rule out all identifiable causes, including hormonal imbalance, poor blood flow and cervical herniations. If no traditional therapy can provide relief or prevent pain, we carry out further screening before considering surgery.”

Florence Lavanchy and Alain Beutler are two of the first patients at the CHUV to benefit from surgery to treat their migraines.

The team uses two complementary techniques. When potential patients are suffering from a headache during their visit, they inject a short-term local anaesthetic into the areas causing the pain (forehead, temples, zygomatic arches, back of the neck or nose) to pinpoint the nerve endings. If the paCORPORE SANO

tient is not having an attack, the doctors inject botulinum toxin and ask patients to monitor their pain for one month. This step is used to observe how decompression affects one or more nerves. If pain intensity is reduced by at least 50%, surgery offers a viable solution.

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The procedure performed by the CHUV surgeons involves the decompression of the nerves by removing a portion of the adjacent anatomical structures, such as the small muscle located between the eyebrows that is responsible for the notorious “lion’s wrinkle”. The operation releases the trigger

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SUCCESSFUL RESULTS Like in the United States, the success rate is high, with 85% of patients declaring significant relief. “Not only are my headaches less frequent, but they are two to three times less severe,” says Florence Lavanchy.

Alain Beutler reports similar results: “The relief was immediate and spectacular. I can now work again without dreading a potential attack. I can finally spend my free time doing something other than lying down in the dark.” Benefiting from postoperative follow-up at the CHUV and occupational therapy, Alain Beutler makes progress every day. And it seems to be permanent. Fifteen years after the first surgical procedures performed in the United States, there have been no reports of the headaches coming back.

Wassim Raffoul, chief of the Plastic and Reconstructive Surgery Service at the CHUV, believes that the surgical decompression of peripheral nerves is a procedure that will become more common.

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point that can cause a migraine attack. This relatively short outpatient surgery can sometimes last longer than expected. “I was supposed to be on the operating table for 3 hours and 40 minutes. The operation ended up taking nearly 8 hours,” says Alain Beutler. “This patient is unusual,” says Wassim Raffoul. “He had trigger points located all around his skull and the back of his head. This case helped us hone the technique.”

Now the operation rarely lasts more than two hours.

says Sandra Scherer. “There are no visible side effects on the face, and patients don’t lose any feeling.” An important point. After a short convalescence, the operation leaves just a few undetectable scars, most of which are hidden on the scalp. Wassim Raffoul and his team expect this type of surgery to become more common in the future. /

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PROSPECTING

A DEBILITATING DISEASE Do you suffer from severe, chronic, throbbing headaches?

Nausea? Sensitivity to light or sound? Like Hippocrates and Lewis Carroll, you may be suffering from migraines, a condition that affects 20% of women and 8% of men. This chronic neurological disorder, resulting from blood flow problems in the brain, has various causes. Some are genetic, with 60% to 70% of patients reporting a family history of the condition. Everyday things – stress, fatigue, physical effort, smells – can trigger attacks lasting anywhere from a few hours to several days.

TEXT: MARGAUX FRITSCHY

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AMATEUR ATHLETES, BEWARE! YOU MAY BE TAKING DRUGS. Dietary supplements sometimes contain performanceenhancing substances and can endanger your health.

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early 15% of amateur athletes use doping products. That is what physicians Stéphane Borloz and Gérald Gremion announced last year in the journal from the Swiss Society of Sports Medicine (SSMS). Three main factors explain the phenomenon: 1) lack of awareness about the danger of using these products, 2) desire to boost performance and 3) body worship. “Specialised websites sell all sorts of dietary supplements, and it’s often impossible to check their ingredients,” says Stéphane Borloz. “Some of these products can contain illegal substances, others are just plain adulterated.”

With each test costing between 500 and 1,000 Swiss francs, sporting event organisers most often cannot afford to set up effective drug testing infrastructure. “We already lack the resources to combat drug use among professionals,” notes Stéphane Borloz. “The situation in amateur sports is even more complicated.”

The rare anti-doping tests organised at amateur competitions are available on CORPORE SANO

Dietary supplements A concentrated source of nutrients or other substances with a nutritional or physiological effect. These supplements sometimes contain certain ingredients, such as stimulants, without any mention of them on the packaging.

Stimulants Amphetamines, cocaine, caffeine, ephedrine and their derivatives are the most commonly used.

Stimulants boost concentration and focus, reduce the feeling of tiredness, increase aggressiveness and promote weight loss.

TRENDS

a voluntary basis. Users are therefore at liberty to decline. In 2006, former professional cyclist Christian Charrière, who came in fifth place at Sierre-Zinal, had refused to cooperate for testing. A few days before him at another competition, mountain biker Daniel Paradis also said no. Their obstinance caused the organisers to start wondering and raised suspicions about the two racers.

“Most athletes are healthy, want nutritional advice and do things right. Then there are the others, who get out of hand,” says Olivier Baldacchino, a running coach in Geneva. In his fifteen years in the business, no one has ever approached him directly about doping, but he remembers a former client who was later arrested after buying performance enhancers online.

BODY WORSHIP Doping also pervades the world of fitness, where body worship is prevalent. Gym lovers sometimes add stimulants – including amphetamines or anabolic steroids like nandrolone and growth hormones – into their cocktail of dietary supplements.

These products can cause serious health problems such as heart conditions, liver or kidney damage or fertility issues. Combin-

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ing a number of these stimulants can also cause significant side effects, not to mention the risk of infection from needles.

Substance abuse is also found among amateur thrill-seekers. Gérald Gremion, head doctor at the CHUV and head of the Swiss Olympic Medical Centre, points to snowboarding and BMX racing as disciplines typically vulnerable to doping.

“Those who practise these sports want to find ways of losing their inhibitions. They take cocaine, cannabis or similar stimulants to push themselves to take risks.”

Anabolic steroids (nandrolone, growth hormones) A category of steroid hormones related to a natural human hormone, testosterone, anabolic steroids are used to build muscle mass.

SALVATORE DI NOLFI / KEYSTONE

Although doping only seems to concern a minority of amateur athletes, sports

Fat burners Athletes are fond of the caffeine in energising, antioxidant drinks, as it helps the organism better consume or burn its fat. In high doses, it can have performance-enhancing effects.

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TRENDS

physicians believe that it is crucial to act upstream by emphasising prevention.

“Nowadays, people tend to over-medicate themselves,” says Gérald Gremion. “Sport should be practised in the healthiest state possible.” Medicine already has side effects, and these are only exacerbated by physical activity.

“Performance has become the top priority in all areas of our society,” says Martial Saugy, director of the Swiss Laboratory for Doping Analyses (LAD). But if you aim too high, you end up realising that you’ll never be perfect or as good as you want.

“And then, you risk depression.” /

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the challenges of

old age There are more and more people age 80 and over and, due to their frailty, they have special medical needs.

t’s a relatively quiet midweek morning in the emergency room at Lausanne University Hospital (CHUV), when the ambulance pulls up to bring in an older patient, the victim of a fall. The elderly lady is rapidly tended to by the geriatrics specialist on duty, undergoing an initial set of tests to evaluate her condition: questioning, blood test, X-rays.

i

“This initial assessment is essential in measuring the patient’s overall state of health and bringing her an immediate medical response if necessary,” says Andreina D’Onofrio, a specialised clinical nurse with the Geriatrics Unit at the CHUV. “The next step is to determine what her condition was before her accident.” Annie is 81 and has been alone since the death of her husband. She still lives at home. While climbing onto a stool, she lost her balance and fell hard on her side. She came to the hospital on the advice of her cleaning lady, who provides additional information for the healthcare staff. They want to know if this fall is the first, if Annie was able to CORPORE SANO

get back up on her own and if she has had any recent problems keeping her balance.

As her condition does not require immediate medical care, Annie is sent to the Geriatrics and Geriatric Rehabilitation Unit. The process is a well-established one, a series of steps designed to produce an objective assessment of Annie’s situation based on indicators specifically

DECODING

who are the elderly?

Old age is a form of inequality in terms of health and death.

There is a higher proportion of women as the population ages.

Over age 80, there are nearly twice as many women (64%) as men (36%). Although men enjoy slightly better health than women, they decline and die sooner.

OLIVIER VOGELSANG / TAMEDIA PUBLICATIONS

TEXT: JEAN-CHRISTOPHE PIOT

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spotlight on care givers and healthcare providers

For both healthcare staff and doctors, caring for the elderly can be an exhausting enterprise. Patients can get confused, anxious and sometimes upset or even aggressive. They rip out IVs, pinch and bite.

Treating them requires extraordinary patience and perseverance.

designed for the patients who come into the unit. “We try to retrace the exact circumstances of the fall and assess Annie’s physical and psychological condition to provide the geriatric physicians with objective information for formulating their diagnosis,” says Andreina D’Onofrio.

Annie is then recommended care that is suited to her situation.

Over the next few days, Andreina D’Onofrio and her colleagues will gradually assess Annie’s condition based on eight scales used to measure a number of criteria: hyperactivity or atony, nutritional problems, dehydration, signs of depression, etc. This methodical approach helps determine which strategy is best adapted and where Annie will go next: back home or to a long-term care facility. Having recovered well, she can go home, bringing with her the cane recommended by her doctors.

Jeanne Matti, a one hundred-year-old woman from Geneva, still enjoys going to antique markets.

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DÉCRYPTAGE DECODING

THE CHALLENGE OF LOSING INDEPENDENCE Annie’s case is actually quite common among people entering their later years.

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a psychiatric conundrum Retirement age may be a time when people are prone to depression, but psychiatric care for the elderly faces challenges of its own. Practitioners are often required to reduce medical treatments, as the side effects of certain molecules can aggravate the physical condition of elderly patients.

According to Christophe Trivalle, geriatrics physician at Paul-Brousse Hospital in Villejuif and author of “Vieux et malade: la double peine!” (L’Harmattan, 2010), this is a complex notion. “The definition of old age is not reduced to a mere number, especially with biological decline occurring later than before. Often it comes when a dramatic deterioration suddenly deprives them of their independence.” What we refer to as “old age” is when physical restrictions severely limit normal day-to-day activities: getting up, eating, going to bed, going to the toilet, shopping, preparing food.

Daily life becomes increasingly difficult to handle, frequently compromising the quality of their social life. The turning point occurs around age 83. That is the average age when most Swiss people grow vulnerable. The main focus during Annie’s stay at the CHUV was precisely to assess her degree of frailty and her ability to regain the daily life she had had before.

of handling the explosion in patients over age 85. In Switzerland, 20% of healthcare costs go to sick people age 80 and over, but this age group only represents 5% of the Swiss population.

These elderly patients, along with the Americans and Norwegians, rank among the top three most protected groups in the world according to the OECD, but their growing number will only make problems increasingly worse. Although “ageing is not a disease,” as Christophe Trivalle points out, old age tends to be a time of “polypathology”. “The elderly are characterised by having multiple diseases simultaneously, which increase in frequency as they get older.” They couple diabetes or high blood pressure with neurodegenerative conditions, and the frequency keeps rising with age.

Thirty percent of people over age 90 suffer from Alzheimer’s disease.

Patients and healthcare providers agree on one point. Leaving their home must happen as late as possible. “Avoiding or reducing the period of dependency is essential from a human point of view, not to mention the economic aspect,” says Christophe Trivalle. “The elderly need to regain a feeling of well-being despite the physical decline, even if that means adapting their lifestyles and reinventing a balance with their environment.” This is closely related to the position of the elderly in our society and our view of them. ⁄

This is a poignant social and medical issue, as communities currently struggle with the economic challenge CORPORE SANO

DECODING

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PROTONS VERSUS CANCER TEXT: ERIK FREUDENREICH IMAGES: PHILIPPE GÉTAZ

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IN THE LENS

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Proton therapy A proton beam that destroys tumours. That’s what proton therapy is.

This cutting-edge technology has successfully treated certain forms of eye and brain cancer.

Special report from the Paul Scherrer Institute.

Many specialists consider it the technology of the future in the fight against cancer. Proton therapy is a form of radiotherapy that more accurately attacks cancer cells using positively charged particles called protons. The precision of the beam is incomparably superior to conventional radiotherapy treatments, as the protons scatter significantly less and remain closer to the beam’s trajectory.

Another advantage is the phenomenon called the “Bragg peak”, named after the British physicist William Bragg (1862-1942) who discovered it. It refers to proton behaviour.

The particles pass through tissue, deliver their energy at a given depth range, then stop completely. This means that the protons destroy the tumour with minimal damage to the surrounding tissue.

This technique is most effective in treating cancers near sensitive organs such as the brain or eye. Proton therapy also produces excellent results in treating children and young adults, due to its low toxicity.

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IN THE LENS

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1/

THE CENTRE FOR PROTON THERAPY AT THE PAUL SCHERRER INSTITUTE

The Paul Scherrer Institute (PSI) in Villigen (AG), the largest research centre for natural and engineering sciences in Switzerland, has been using proton therapy to treat patients since 1984. Half of the people treated at the PSI are from Switzerland, but its Centre for Proton Therapy also receives patients from neighbouring European countries, Russia and even the United States.

“The cases referred to us by different hospitals are first analysed by our ‘Tumour Board’ based on a complete medical record, says Damien Weber, director of the Centre for Proton Therapy and member of the PSI directorate. At this meeting, we closely examine each case with the physicists, radiation oncologists and technicians to be sure of the advantages of treatment for the case under review.”

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IN THE LENS

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IN THE LENS

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2/

ASSESSMENT

Once a case has been accepted for treatment, the patient is invited for an initial consultation at the Centre for Proton Therapy. “We explain how the treatment works, the results and associated risks, says Damien Weber. The team then defines a plan of attack against the tumour, which is simulated on a computer. One point that sets us apart is the weekly meeting devoted to delineation [editor’s note: drawing the contour of tumours]. The beam has to be very accurate, but we also need to determine the exact volume of the tumour being treated, to be sure that we don’t miss the target.”

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IN THE LENS

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3/

THE GANTRY

A few weeks after the first visit, the patient comes back to the centre to begin treatment.

Like conventional radiotherapy, proton therapy is delivered in several sessions spaced out over time. The PSI uses three machines: OPTIS 2 (for ocular melanomas) and Gantry 1 and 2 (opposite), used to treat brain and ENT cancers as well as some chondrosarcomas (malignant tumours in the cartilage).

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IN THE LENS

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CONTROL ROOM

/4

After being positioned in the Gantry, the patient can communicate by microphone with the technicians in the control room. They then launch the treatment. The proton beam is delivered by the COMET cyclotron.

In use since 2007, this circular particle accelerator was specially built for the Centre for Proton Therapy at the PSI.

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IN THE LENS

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TEXT: PAULE GOUMAZ

DNA DOES NOT TELL EVERYTHING EPIGENETICS SUGGESTS THAT OUR ENVIRONMENT INFLUENCES THE HERITABLE TRAITS THAT WE PASS ON TO OUR CHILDREN AND GRANDCHILDREN. TODAY, THIS FIELD HAS OPENED UP NEW POSSIBILITIES IN TREATING A NUMBER OF DISEASES.

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owards the end of World War II, Nazi Germany enforced a blockade that left the populations of several Dutch provinces starving. The babies born to women who were pregnant during that “Hunger winter” were smaller than normal and in poor health. But surprisingly, their daughters and granddaughters also gave birth to sickly newborns who were more susceptible to developing Type 2 diabetes. In 2005, American researchers identified an epigenetic modification caused by DNA methylation in people exposed to the famine while in their mother’s womb.

This change was then passed on to the following generation.

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The sequencing of the first human genome in 2001 fuelled unprecedented progress but raised a number of questions.

These issues can be summed up in the point made by geneticist Thomas Hunt Morgan (way) back in 1935: if an individual’s character is determined by genes, why aren’t all the cells in an organism identical?

Our cells carry the same genes, but there is no resemblance whatsoever between muscle cells, liver cells or neurons.

Researchers only recently began digging more deeply into the field. “Epigenetics is the study of gene expression in the organism,” says Winship Herr, who teaches epigenetics at the Center for Integrative Genomics (CIG) at the University of Lausanne. “It addresses the idea that not everything is programmed in our DNA.” The cells of our organism PROSPECTING

contain all our genes in their nucleus. But each individual cell only reads the genes it needs to build the proteins required for its function. In other words, some genes are activated and “expressed”, while others are silenced.

Whether or not genes are activated is determined by different chemical changes, which do not affect the DNA sequence.

Epigenetics first looks into embryonic development and cellular differentiation. “A wellknown example is X chromosome inactivation in female mammals,” says Winship Herr.

“This process, which occurs randomly in each cell, is normal in their development.”

But the phenomenon is associated with a number of diseases, especially metabolism disorders such as diabetes

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GLOSSARY 1. Epigenetics

and obesity, auto-immune diseases and cancers. “Gene mutations and deregulation in gene expression are at work in all cancers,” says Winship Herr. “We really hope to develop therapies that target these alterations and reprogramme cancer cells, i.e. initiate their differentiation and stop their uncontrolled growth.”

Researchers believe that a number of environmental factors can cause epigenetic modifications, including nutrition – as shown in the study

In 1942, British biologist Conrad Waddington coined the term “epigenetic” to explain embryonic development.

By epigenetic landscape, he referred to the processes whereby genes produce an individual’s observable characteristics (phenotype).

Today, epigenetics refers to the study of changes affecting gene expression but that do not cause mutations in the DNA sequence.

on the Dutch famine – the mother’s behaviour, stress and exposure to pollution.

“A growing number of diseases are influenced by these variations,” says Winship Herr.

“But what about the transmission of this genetic information? Some changes will have to be passed on through several generations to be verified. Not even scientists agree completely on the very definition of epigenetics!” /

2. Phenotype

All of the observable characteristics (anatomical, morphological, molecular and physiological) of a living organism, determined by genes and the environment.

For example, hydrangea of the same genetic variety can have a colour (phenotype) ranging from pink to blue depending on soil acidity.

Visit www.invivomagazine.com to learn more about epigenetics.

CAS OORTHUYS/NFA, COLLECTIE NEDERLANDS FOTOMUSEUM

3. Methylation

Amsterdam during the “Hunger Winter” (1944-1945).

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PROSPECTING

One of the best known biochemical modifications in gene expression. In this process, methyl groups (made up of carbon and hydrogen atoms) are added to the DNA and either activate or suppress the function of certain genes.

4. Chromatin The structure likened to “beads-on-a-string”, whose main function was long believed to be to compact DNA – which is two metres long! – into the cell nucleus.

Chromatin also plays an essential role as it promotes gene accessibility and expression, depending on whether the genes are “turned on” or “turned off”.

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Vitamin C C 6H 8O 6

C6H 8O6 EVERY MOLECULE TELLS A STORY TEXT: BERTRAND TAPPY

The story of vitamin C begins on a boat. James Lind, physician with the British Royal Navy, was looking for an effective remedy for scurvy. This disease was the sailors’ curse during long oceanic crossings, causing symptoms such as despondency, loosening of teeth, haemorrhaging and death.

Lind decided to conduct a clinical trial – supposedly the first ever. In his systematic experiment on scorbutic sailors, he compared the effects of a number of empirical remedies used to treat the disease at the time. The most effective turned out to be a blend of citrus fruit juices, whose benefits he described in a book published in 1753...

It took the navy many years before applying his recom-

Said to prevent just about any illness, Vitamin C becomes a bestseller every year as winter approaches. But what exactly is Vitamin C? mendations. And medicine needed more time yet to understand the biological mechanism at work in Lind’s discovery. Vitamin C had just made its debut into the scientific community.

Today it is sold as a medicine, despite being available in ample quantities in many fruits and vegetables.

Since the days of James Lind, the list of its supposed virtues has continued to stretch. Vitamin C is thought to be the most effective therapy for fighting colds and flus and is also attributed with being able to boost mental capacity, counteract the effects of

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nicotine in smokers and prevent cancer.

Interestingly, humans, unlike most mammals, are one of the rare species that cannot produce vitamin C. Perhaps that is why so many parents make their children load up on it!

This last assertion, fervently upheld by two-time Nobel Prize winner Linus Pauling in the 1970s, caused a stir in the scientific community.

And it was never confirmed.

“This example perfectly illustrates how vitamin C eventually came to be thought of as a cure-all,” says Thierry Buclin, chief of the Clinical Pharmacology Service at Lausanne University Hospital. “Between miracle food and effective medicine, vitamin C is a well of hope into which people pour all the benefits of Mother Nature.”

And no proof has ever been given that it can truly prevent or treat the common cold or flu. “We know that the lack of vitamin C makes the mucous membranes more susceptible to infection,” says Thierry Buclin, “and that taking it as a supplement can correct the problem. But that does not mean that a regular dose will prevent us from getting sick if we already take in enough from the food we eat!” So, food or medicine?

Whichever, vitamin C looks determined to continue riding the wave of success. /

ZOOM

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PATRICK LEMOINE

MD, PhD, International Medical Director of the Orpea Clinea group, psychiatry division.

Magic or sham, the placebo effect has intrigued both doctors and patients for centuries. to a given therapy. If the difference is negative, it is referred to as a nocebo effect (I will harm).

The history of the placebo dates The placebo effect concerns all specialiback to 382, with the commissionties. According to medical authors like ing of the Vulgate – Latin transHenry K. Beecher, placebos work an averlation of the Bible. The Vulgate age of one-third of the time. In treating contains the Vespers for the Dead, angina pectoris, they can be effective in up which begin, “Placebo Domino” (I to 85% of cases. Placebos can also work in shall please the Lord). In the 13th centreating infection, hypertension tury, mourning families would hand or insomnia. out ample food and drink at funerals.

This attracted people with little or no Of all the explanations provided, psychorelation to the deceased who would sing neuroimmunology has provided the most this verse in the hopes of a meal. They biological insight. An example: rats are were mockingly named placebos. As anaesthetised, and an incision is made in the society grew more secular, the lord lost skin on their head using a dirty lancet. A visits upper case letter and Placebo came to ible bandage is applied to the wound before refer to a sycophant, or a flatterer. Later, they are awoken. A few days later, leukocytes in the 16th century, a first placebo was used develop to fight the infection. The entire during the Inquisition. To avoid excessive operation is repeated two more times, but the exorcisms, suspects with debatable signs fourth time, there is no incision, just the bandof possession were presented with false, age. The number of white blood cells increases placebo relics. If they reacted as if the relas if the infectious operation had taken place. ics were authentic, their convulsions were The conclusion? A false external stimulus can thought to be a figment of their imagination even cause white blood cells to react. and not from Evil. The idea came about to verify questionable clinical results by admin- In fact, placebos seem to act by encouraging istering an ineffectual product. the organism to produce its own endogenous medicines, such as endorphins for pain, dopamine An example of a pure placebo is the sugar for Parkinson’s disease, serotonin for depression pill. An impure placebo is an available treat- and probably natural antibiotics for infection. Our ment that clearly has not demonstrated its body can actually develop any drug in the world – effectiveness, but has a “placebo effect”. This and even better than the pharmaceutical industry refers to the positive difference between the – because it will produce anything to protect itself expected reaction and the observed reaction and survive. ⁄ FIND OUT MORE

DR

Le Mystère du nocebo. Odile Jacob, 2011

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COMMENTARY

cursus

commentary

to help them work around their limitations and obstacles to movement or function (as a result of an illness, accident or Roland Paillex ill-adapted behaviour) Head Physiotherapist at the and overcome the chalLausanne University Hospital lenges they face. In its approach, physiotherapy promotes “health” as defined by the World Health Organization hen you ask people what they think phys- (WHO): “Health is a state of complete physical, mental and social well-being iotherapy involves, and not merely the absence of disease the first answer that or infirmity.” comes up is masFor example, a stroke victim can sage. If you dig a bit deeper, you hear that practise walking with a physiotherapist.

A patient who has had a heart attack can physiotherapists help people who have had accidents, such as sprains or fractures, be trained to regain endurance. Those suffering from respiratory failure will be get back on their feet. But these answers taught how to improve their pulmonary represent only a small part of what physifunction by repeating the appropriate otherapists actually do. exercises. An elderly person who falls Physiotherapy is one of the three regularly will be stimulated to get back pillars of traditional medicine, alongside up on their own and develop strength the work of doctors and nurses. For the in their legs and their balance. patients we care for, physiotherapy offers Physiotherapists deal with issues new possibilities, improves their quality involving pulmonology, cardiology, of life and increases their well-being lymphatic circulation, the pelvic floor, regardless of their age. It identifies and rheumatology, orthopaedics, traumatolomaximises their potential for mobility. gy, sports medicine, psychiatry, paediatric It can also treat pain. Physiotherapy hanneurology, geriatrics and ergonomics. dles both acute and chronic problems and It is important for the Swiss to better applies to health prevention and promounderstand all aspects of physiotherapy tion, treatment, rehabilitation in order to be able to discuss it with their and palliative care. doctor if they feel that a physiotherapist Physiotherapy offers solutions for could improve their well-being. ⁄ children, teenagers, adults and the elderly

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Philippe GETAZ

curSUS

career at the chuv

Physiotherapy, the great unknown

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Giving your brain a good workout Researchers at the University of Montreal and Professor Demonet, director of Leenaards Memory Centre (CLM) at the CHUV, have published a study aimed at analysing the real effects of the different brain training programmes available on the market, especially online.

Their findings were based on clinical tests and MRI imaging, and were published in the journal Plosone. BT

neurones

Power corrupts people. And so does testosterone.

A joint study led by the Faculty of Business and Economics at the University of Lausanne and the Endocrinology and Diabetology Service at the Lausanne University Hospital (CHUV) has revealed that managers’ testosterone levels could influence their behaviour and cause them to make decisions for the sole purpose of increasing their profits. BT

study

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news

Switzerland becomes the first country to create an electronic organ donor card

LAURENT GILLIERON / Keystone

cursus

Developed by an anaesthesiologist from the CHUV with the support of Swisstransplant, the organ donor card is automatically displayed on the user’s smartphone upon arrival at hospital. The system is available via the app Echo112, which already has 350,000 users in Switzerland. The initiative could significantly increase the number of potential donors. e-health

Dr Jocelyn Corniche, an anaesthesiologist with the CHUV and REGA (the Swiss air-rescue

organisation), designed the app.

Echo112 contacts the local emergency services and notifies them of the user’s exact position in Switzerland or abroad. “In seeing those dozens of patients arriving at the emergency unit every day, I thought that their smartphone screen would also be the best way of communicating whether they’re a potential organ donor.”

This revolutionary process has made Switzerland the first country to have an electronic donor card. BT

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portrait

“S

career at the chuv

Claudia Mazzocato created the first palliative care unit at Lausanne University Hospital (CHUV). Now she is head physician.

Text: Julien Calligaro

ome doctors say that, to do this job, you can’t be afraid of death. I think they’re wrong.”

Claudia Mazzocato is serene, but not without emotion, when she talks about her job. As head physician at the Palliative Care Service at the CHUV, she has her work cut out for her. Both at the clinic and in her research, the doctor is confronted with death on a daily basis. She chose that path early in her professional career.

During her post-grad year, Claudia Mazzocato noticed that her patients who were at the end of their life were in pain, and often alone. That was when she knew what her speciality would be. With a certain degree of apprehension, she left for three years to work at the Geneva University Hospitals, the only institution in Switzerland with a palliative care service at

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the time. “I had no idea how I would react to dealing with death,” she confesses. “After one month in Geneva, I loved my work. I really got into it.”

Claudia Mazzocato then headed to Paris to complete her studies, spending two six-month periods in the French capital. “That’s when the CHUV administration asked me to lead a focus group to develop a palliative care service at the facility. I suggested forming a mobile team that would work with the different hospital services and go to patients’ homes.” One year later, her proposal was accepted.

The phone rings. One of her patients is on the line. “They can call me any time,” the specialist says. “Having a doctor available is essential for people suffering from a serious illness. Pain doesn’t wait.” These days, most

of her time is devoted to consultations at the out-patient oncology service.

On top of her consultations at the oncology service, Claudia Mazzocato also draws up advance directives. “People at the end of their life use these ‘living wills’ to indicate any treatments they would not want, should they lack the mental capacity to take that decision when the time comes,” she explains. “They talk about themselves, their life and their values, both physical and spiritual. We develop a very strong bond. And that’s very rewarding,” she says. “Once during a patient interview, I told a man that I should be paying for the consultation, not him.

Patients and their loved ones bring me so much.”

This powerful relationship and the medical challenge are what shapes Claudia Mazzocato’s speciality. But isn’t she afraid of the tables turning one day, i.e. being in the position of the patient?

“Of course, I think about it every day. I still have fears about death. That’s also why I do this job.” ⁄

career at the chuv

Eric DĂŠroze

cursus

Understanding and availability are the watchwords for efficiently meeting the needs of patients with serious illnesses. To this end, Claudia Mazzocato regularly travels with her colleagues to the different hospital wards, providing the patients with more preventive care.

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Lana Kandalaft

tandem

Kim ellefsen

cursus cursus

career at the chuv

B

ringing together immune system to Immunotherapy specialist Lana researchers, defend itself against Kandalaft and her right-hand doctors and the cancer. The Kim Ellefsen work together to set up patient’s cells can also patients right in heart of the hospital sometimes be the new Centre for Experimental complex to develop genetically modified Therapies to fight cancer. personalised cancerto make them more Text: Camille Andres, photos: eric déroze fighting treatments: effective in fighting That’s the concept the disease. “This behind the Swiss Cancer Center, in Lausanne technique has produced excellent results in the (SCCL). The Centre for Experimental Therapies United States,” says Lana Kandalaft. Other (CTE), a unit of the oncology department at analyses, developed in collaboration with Eric Lausanne University Hospital (CHUV) and key Raymond, chief of the Medical Oncology Service part of the SCCL, will be one of the largest at the CHUV (see “In Vivo” n°1) can indicate which immunotherapy centres in Europe when it drugs would be best suited to treat the type of goes fully operational in 2016. cancer and patient involved.

“Each patient is different. Sometimes the solution used for A does not at all have the same effect on B,” explains Lana Kandalaft, director of the CTE. Doctors are easily overwhelmed by the countless treatments available on the market. How should they choose the best adapted therapy or offer additional care on top of the current standard treatments? Professors George Coukos, chief of the oncology department, and Lana Kandalaft, who came to the CHUV in 2012 from the University of Pennsylvania, have been exploring this very issue.

The CTE will make George Coukos’ original vision a reality, by developing various immunotherapies to offer personalized therapies. They all involve analysing the tumour, after it has been removed from the patient’s body, and keeping it alive in a sterile environment. One method involves creating therapeutic vaccines using cells harvested from the patient. Once reinjected, the vaccine teaches the

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What about getting the centre up and running?

“The technology exists. Setting it up here is a huge challenge,” says Kim Ellefsen, the CTE’s head of operations and right arm to Lana Kandalaft. While Ms. Kandalaft handles the strategic decisions and oversees the communication on the project, Kim Ellefsen manages the day-to-day operations between the people involved. The contributions to the project by Lana Kandalaft, with her expertise in cancer and immunotherapy, come from her experience in creating a similar structure at the University of Pennsylvania. Kim Ellefsen brings her operational background from the CHUV and her tenacity in dealing with challenges. Together, they form somewhat of a “power duo”. And this will become an increasingly valuable asset as the centre continues to grow. The CTE team will expand from 45 to 80 staff members by 2017 in order to prepare between 200 and 400 cellular therapies for all types of cancers. ⁄

nominations

Walking again after paralysis

Researchers at the Swiss Federal Institute of Technology in Lausanne (EPFL) succeeded in helping completely paralysed rats to walk again by electrically stimulating the cut section of their spinal cord. A new laboratory set up at Lausanne University Hospital (CHUV) will test the technol­ogy on human patients using a brand new gait analysis platform starting in the summer of 2015. Find out more at invivomagazine.com. BT

Chabane Nadia position Head of the Cantonal Centre for Autism last name

first name

RESEARCH

7th Challenges in Viral Hepatitis The next minisymposium will be held on 22 January 2015 at the Alexandre Yersin auditorium. The many renowned national and international experts scheduled to speak include Prof. Geoffrey M. Dusheiko from the University College London and Dr. Harry R. Dalton from the University of Exeter. This year’s talks will focus on hepatitis C and E. For further information, please contact: malika.binggeli@ chuv.ch. BT EVENT

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Mazzolai Lucia position Chief of the Angiology Service last name

first name

The Management Board of University of Lausanne-Lausanne University Hospital (UNIL-CHUV) has appointed Dr Nadia Chabane to the position of Full Professor and the head of the Hoffmann Chair of Excellence for autism spectrum disorders and the Cantonal Centre for Autism.

This is the first centre of its kind in Switzerland, the fruit of the partnership between the UNIL and the CHUV and supported by the Hoffmann Foundation.

Professor Lucia Mazzolai was appointed as a member of the European Society of Cardiology’s working nominations group “Peripheral Circulation”. The European Society last name Lehn of Cardiology (ESC) has 18 working first name Isabelle groups which collectively aim to position Director of Healthcare stimulate and disseminate scientific knowledge in different fields of Isabelle Lehn, currently director cardiology. Collaboration is highly of healthcare at the department encouraged between the working of medicine, will replace Hélène groups and different organisations Brioschi Levi as director of of the ESC. healthcare at the CHUV as of 1 December 2014.

Ms. Lehn herself says that she “grew professionally at the CHUV”, and her work history proves it. She joined the hospital in 1989 and only left the CHUV for a short five-year period.

ERIC.DEROZE, Philippe Getaz, Margaux ZEENDER

cursus

cursus

career at the chuv

migration

Christel Tran left for Canada to specialise in the study and treatment of genetic metabolic disorders.

What is your professional background?

I initially received training in internal medicine, but very quickly developed an interest in metabolism, that huge and complex set of chemical transformations that takes place in the body. After meeting different people, including Michel Roulet from the Clinical Nutrition Unit and Luisa Bonafé at the Molecular Paediatrics Division, I decided to study inborn errors of metabolism.

What are those?

They are genetic diseases in which one or more enzymes does not function properly in the meta­­bolic process. They are rare, since in most cases the “defective” gene must be inherited from both parents for the disease to develop. Each case is different, but disorders break down into three main types: those affecting energy metabolism, the metabolism of small molecules such as proteins found in food and the metabolism of macromolecules.

Gilles Weber

And where did that training lead you?

First to Geneva, where I took the programme specialised in Endocrinology-Diabetology with Professor Jacques Philippe, then to Toronto at the Hospital for Sick Children. This centre has the dual advantage of a strong reputation and a lot of patients. I stayed there for two years. The experience quickly became both a professional and personal challenge, as I

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last name Tran first name Christel with the chuv since 2005 TITlE Head of Consultation

for Adults with Inborn Errors of Metabolism Affiliated with: Centre for Molecular Diseases (CMM) and Endocrinology, Diabetology and Metabolism Service (EDM) since 2013

hadn’t examined children since medical school, not to mention the language barrier and cultural differences. But today I can reap all the benefits of what I learnt there.

Why did adult consultations only open last year?

Because until recently, the outcome was often fatal for children suffering from these diseases. But thanks to scientific advances and the outstanding collaboration between the different units – especially paediatrics and the adult endocrinology-diabetology service – what used to be purely paediatric care for these patients has now evolved into a Centre for Molecular Diseases to treat both children and adults. We take care of about 50 adult patients, most of whom lead completely normal lives, with jobs and families. ⁄ BT

GILLES WEBER

CONTRIBUTORS

ERIK FREUDENREICH Erik Freudenreich headed the production of this issue of “In Vivo” at the agency LargeNetwork. He is a journalist who regularly writes articles on health and science for magazines such as L’Hebdo, Technologist, and Hémisphères.

For this issue, he wrote the report on proton therapy (p.57).

PHILIPPE GÉTAZ Philippe Gétaz is a photographer with the Medical Teaching and Audiovisual Communication Centre (CEMCAV) at the Lausanne University Hospital (CHUV). For “In Vivo”, he went to the Paul Scherrer Institute in Villigen in the canton of Aargau to illustrate the report on proton therapy (p.57) and produced the portrait on dietitian Véronique Di Vetta (p. 26).

IN EXTENSO WINS SUVA JURY’S CHOICE AWARD AWA RD

We are pleased to announce that our illustrated supplement “In Extenso” on the science of running earned a prize at the SUVA Media Awards event organised by the Swiss Accident Insurance Fund.

Our colleague Benjamin Bollmann took home the Jury’s Choice Award (Prix Coup de cœur) specially created this year to celebrate the twentieth anniversary of the SUVA Media Awards. This honour recognises highly innovative and/or surprising journalistic work in terms of theme, form and/or media.

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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

PUBLICATIONS MANAGERS

Gabriel Sigrist and Pierre Grosjean

PROJECT MANAGER

Alexandre Armand, Aline Hiroz, Anne-Renee Leyvraz, Anne- Melinda Marchese Marie Barres, Anne-Marie Vuillaume, Bertrand Hirschi, Erik Freudenreich (ad interim) Brigitte Morel, Cannelle Keller, Celine Vicario, Christian Sinobas, Christine Geldhof, Deborah GRAPHIC DESIGN MANAGERS Gonzales, Dagmar Baroke, Damien Weber, Denis Sandro Bacco and Diana Bogsch Orsat, Diane de Saab, Elise Mean, Emilie Jendly, Enrico Ferrari, Fernando Mendes, Fiona Amitrano, Gilles Bovay, Idris Guessous, Jeanne-Pascale Simon, EDITORIAL STAFF Jocelyne Bouton, Katarzyna Gornik-Verselle, LargeNetwork (Camille Andres, Sara Bandelier, Céline Bilardo, Benjamin Bollmann, Laure Espie, Laurent Meier, Lauriane Bridel, Martine Brocard, Clément Bürge, Julien Calligaro, Erik Freudenreich, Margaux Fritschy, Lydia Lederer, Manuela Palma, Marie-Cecile Olivier Gschwend, Jean-Christophe Piot, Daniel Saraga, Julie Zaugg), Paule Goumaz, Monin, Marite Sauser, Massimo Sandri, Muriel Bertrand Tappy Cuendet-Teurbane, Muriel Faienza, Nathalie Jacquemont, Nicolas Jayet, Odile Pelletier, Pauline Horquin, Philippe Coste, Philippe ICONOGRAPHIC RESEARCH Dosne, Serge Gallant, Sonia Ratel, Sabrine Elias Ducret Stephan Studer, Stephane Coendoz, Stephanie Dartevelle, Thuy IMAGES Oettli, Ulrike Kliebsch, Virginie Bovet, CEMCAV (Eric Déroze, Heidi Diaz, Philippe Gétaz, Gilles Weber, Margaux Zeender), Valerie Blanc, Veronique Sechet Martin Colombet, Christophe Delory, Sébastien Fasel et le Service de communication du CHUV. LAYOUT

DISTRIBUTION PARTNER

BioAlps

Ilina Catana, Sébastien Fourtouill, Romain Guerini and Yan Rubin TRANSLATION

Technicis PRINTING

PCL Presses Centrales SA 17’000 copies in French 3’000 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 the views of the publisher.

FOLLOW US ON TWITTER: INVIVO_CHUV

SPARKLING INNOVATION

These pages present a selection of the people speaking during TEDxCHUV 2014. The full programme is available online at www.chuv.ch/tedx and #tedxchuv (Twitter).

TEDXCHUV 2014

Thursday, 13 November 2014 from 2:00 to 6:00 at the Swiss Tech Convention Center Campus of the Swiss Federal Institute of Technology (EPFL) – Lausanne

“AND IN THE MIDDLE BEATS THE HEART” PROF. RENÉ PRÊTRE Chief of Cardiovascular Surgery, Lausanne University Hospital (CHUV) For the scientist, the heart is a pump that makes blood circulate in the body. The cardiologist’s and the surgeon’s action is meant to preserve this fantastic source of energy and to optimize the circuit. For the poet, the heart has a lyrical dimension: it is the symbol of love and life, our two most precious possessions. This talk is aimed to get an insight on the central position of the heart in our body… and in our life.

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“IT’S NOT ABOUT DYING” PROF. GIAN-DOMENICO BORASIO Chief of Palliative Care, CHUV Palliative care is about living, not dying. The fact that we will die is the only certainty that we have in life.

Looking back on their lives, dying patients share their insights with us and thus teach us how to live.

All we need to do is to listen.

“A TALE ABOUT BLOOD” PROF. JEAN-DANIEL TISSOT Head of the Vaud Regional Blood Transfusion Service My life, your blood. Blood is multi-faceted and full of mystery, flowing through the crossroads between myth and symbol.

To explore it is to embark on an extraordinary journey through biological horizons, led by the red blood cell – that enigmatic stardust we all need to breathe and to stay alive.

“BRINGING BRAIN CELLS BACK HOME”

“I AM NOT ONLY A DIAGNOSTIC MACHINE”

“SAVING LIVES, ONE APP AT A TIME”

DR JOCELYNE BLOCH

DR VALÉRIE D’ACREMONT

DR JOCELYN CORNICHE

Associate Physician with the Neurosurgery Service, CHUV Could you imagine that our brain cells are able, after a journey in the lab, to come back home with a precise mission: To help our brain recover after stroke.

Assistant Physician, Lausanne University Medical Polyclinic (PMU) What could this febrile child be suffering from? Health workers in Africa face such questions every day.

To have in hand an electronic device with sensors could revolutionize their practice, enhancing their clinical cleverness while still working under the tree.

Head of the Clinic of the Anaesthesiology Service, CHUV People die every day because of the lack of organ donors. Find out how your Smartphone can help solve the problem.

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WHAT’S A TED TALK? TED presentations bring talent together

to share and discuss ideas that will shape our future. Speakers are faced with a tremendous challenge, that of presenting their subject in a MAXIMUM OF 18 MINUTES.

This year, TEDxCHUV gives the floor to researchers and clinicians driving medical innovation. The talks will be in French and in English.

MINUTES MAXIMUM PAR ORATEURS POUR PRÉSENTER LEUR SUJET

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SWISSTECH CONVENTION CENT E PLANETESANTE.CH/SALON

A new kind of health fair open to the general public

Why hold a health fair in 2014? To meet people’s new needs in a s. Planète Santé Live is an innovative, interactive fair where the individual t event to bring together the major French Swiss health institutions side by side with a number of private organisations.

Original and unexpected activities, fun for everyone!

Planète Santé Live has more to offer than just a regular exhibition.

Visitors can choose from a number of experiences and activities, such as taking a narrated journey along the path of a drop of blood, visiting giant organs, exploring a camera obscura or photographing their own iris. A multitude of health tests will be available to gauge loads of factors from blood pressure to the memory, physical condition or the quality of wakefulness. And children will have aining and science workshops.

100 talks and debates

Throughout the fair, more than 100 talks and round table discussions will take place with reputed specialists from French-speaking Switzerland. Topics include sleep disorders, electronic cigarettes

VOUCHER

and sugar addiction. Other featured talks will discuss the future of medicine, health innovation, the “Human Brain Project” and personalised medicine.

Participants and sponsors

Participants in the Planète Santé Live trade fair include: Switzerland’s ), Swiss Health Promotion (Promotion Santé Suisse), Vaud Public Health Service (Service de santé publique du canton de Vaud), the Universities of Applied Sciences and Arts Western Switzerland (HES-SO), the Faculties of Medicine and universities of Lausanne and Geneva, Lausanne University Hospital (CHUV), Geneva University Hospitals (HUG), Swiss Federal Institute of Technology in Lausanne (EPFL), the Valais, Neuchâtel and Fribourg hospitals, Swiss Leagues against Cancer of French-speaking Switzerland (ligues contre le cancer de Suisse romande), Medical Society of French-speaking Switzerland (Société Médicale de la Suisse Romande), Swiss Lung League (Ligue pulmonaire), Swiss federation of Health Leagues (Ligues de la santé), Lausanne University Medical Polyclinic (Policlinique médicale universitaire), Emergency Medical Foundation (Urgences Santé) and Jules Gonin Eye Hospital.

Information: planetesante.ch/salon

VOUCHER

FOR A FREE INVITATION, COMPLIMENTS OF :

FOR A FREE INVITATION, COMPLIMENTS OF : ENTRY CODE

SwissTech Convention Center (EPFL) 13 to 16 November 2014 Thursday, Friday and Saturday: 10.00 a.m. – 7.00 p.m.

Sunday: 10.00 a.m. – 6.00 p.m.

TO BE PRESENTED AT THE FAIR ENTRANCE

Full name Email

planetesante.ch/salon

ENTRY CODE

SwissTech Convention Center (EPFL) 13 to 16 November 2014 Thursday, Friday and Saturday: 10.00 a.m. – 7.00 p.m.

Sunday: 10.00 a.m. – 6.00 p.m.

Full name Email

planetesante.ch/salon

Address Valid for a 20% reduction on train travel and transfer Information: cff.ch/planete santé

À PRÉSENTER À L’ENTRÉE DU SALON

Post code and city

Address Valid for a 20% reduction on train travel and transfer Information: cff.ch/planete santé

Post code and city

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NUTRITION www.invivomagazine.com

Think health

No. 4 – DECEMBER 2014

10 PAGES OF NUTRITIONAL ADVICE

STAYING FIT THROUGH HEALTHY EATING

IN EXTENSO

Infographic supplement

IN VIVO No. 4 – December 2014

The microbes within us

CÉLINE LAFONTAINE "The human body is now sold by pieces" BRAIN The science of optimism SURGERY Botox for chronic migraines Published by the CHUV www.invivomagazine.com IN EXTENSO THE MICROBES WITHIN US