IN VIVO #3 ENG by IN VIVO

perception www.invivomagazine.com

Think health

No. 3 – JULY 2014

five SENSes / illusions / Brain

MIND YOUR perceptions

IN EXTENSO The birth of a human In Vivo No. 3 – July 2014

Infographic supplement

PAULA JOHNSON Men and women unequal in the face of medicine FAT TAX Fighting obesity by taxing calories TABOO Sex in phsychiatric hospitals Published by the CHUV www.invivomagazine.com IN EXTENSO The birth of a human

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IN VIVO / No. 3 / july 2014

contents

FOCUS

19 / perception Mind your perceptions Overview of the research on the senses By serge maillard, melinda marchese and benjamin keller

MENS SANA

30 / Interview Paula Johnson recommends a more individualised medicine by julie zaugg

34 / taboo Death: thinking about living it by béatrice schaad

36 / trends High potential? Parents want to know by marie-adèle copin

39 / prospecting Clinical trials: “The law is not in favour of patients” by benjamin keller

42 / decoding Taxing calories

Nirwan Malla

by julie zaugg

CONTENTS

61 21 CORPORE SANO

IN SITU

47 / Innovation

09 / health valley

The promise of electricity

ObeSense: an “intelligent” T-shirt to fight obesity

by jean-christophe piot

50 / taboo

The quest for immortality

CURSUS

by Clément bürge

70 / commentary

58 / trends

“Innovation is our greatest value”

What yours tears can say about you by jean-christophe piot

61 /

in the lens

The leech, a tiny creature that wishes you well by Melinda Marchese and erik freudenreich

3D printed blood vessels

by Julie Zaugg

54 / prospecting

14 / around the world

72 / portrait Daniela Dunker Scheuner teaches meditation to treat addictions

74 / tandem Ornithologist Alexandre Roulin and biochemist Stefan Kunz

oram dannreuther, eric deroze, heidi diaz

Sex and psychiatry, a volatile combination?

Editorial

Seeing with your ears

Patrick dutoit

Béatrice Schaad Chief editor

“Ceci n’est pas une pipe.” (“This is not a pipe.”) In writing those words, Magritte was playing on a universally shared doubt: is what we see truly reality or a mental construction that we alone perceive? In other words, the world is not the world; it is the view we have of it, which transforms it. Perception is wonderfully complex, as shown by the work that has enabled blind people to “see” with their ears (see p. 19). It is the combination of one’s own sensitivity, background, culture, senses and the moment it takes place. Though an infinitely personal experience, perception can also be shared – and this is perhaps its most miraculous feature. Aristotle hit the mark when he added a sixth sense to the first five, one that is very different from hearing, smell, or taste but that brings them all together: common sense. It’s a sort of guarantee that we’ll agree with others about what is beautiful or what hurts. It’s a consensus, a wall to protect us from solitude. But will this consensus endure? Over the past decade, incredible neuroscientific developments have continued to shake up the very idea of common sense. As studies into the mechanisms of perception have become more advanced, medical imaging has revealed how personal these mechanisms are and how widely they can vary from one individual to another. It is striking to note that, as our society increasingly caters to individuality, encouraging everyone to stand out and constantly perform (the “me” society), medical technology is now following suit and focusing more on the individual. Crick and Watson’s first discovery about the structure of DNA 60 years ago sparked the development of personalised medicine and the ethical issues that go along with it. Genomics and the potential to develop a given pathology change the approach to treatment. When faced with a risk, both patient and doctor are more often inclined to agree that prevention is better than treatment. How affordable is this medicine that promises treatment tailored to one’s genetic make-up? Can we refuse it for patients who are paying increasingly high premiums? This dilemma between focusing on an individual’s specific needs and the necessity to apply scientific discoveries to the population as a whole is as old as the history of science itself. Except that, today, the pressure is certainly higher. Research will have to strike a delicate balance to maintain its efforts in studying both the individual and the group simultaneously while developing therapeutic responses that can be applied to as many people as possible. ⁄

post-scriptum updates on previous “in vivo” articles You can subscribe to “in vivo” or request back issues on our website www.invivomagazine.com

Alzheimer’s IV n° 1

p. 9

Success on a fish

Mario Anzuoni / Reuters

New advances in research on Alzheimer’s disease were made by a team of biologists from Inserm. The French team was successful in correcting a behavioural disorder in a fish with Alzheimer’s by injecting it with FKB52, a protein naturally present in healthy humans. Researchers had already demonstrated the protective qualities of FKB52 in humans in 2010. This success is the first step towards a treatment that can be applied to humans. /

3D PRINTING IV n° 1

p. 62

Cancerous tumours in 3D 3D printing is now being used to help research to fight cancer. Teams of researchers from China and the United States have created models of cancerous tumours using the technique. Until now, only two-dimensional cell culture models have been used. This breakthrough will provide a more realistic image and therefore results. These tumours built in vitro are designed to study the growth and spread of the cancer and the development of new treatments. /

E-Cigarettes IV n° 1

p. 14

As harmful as tobacco A US study has shown that electronic cigarettes could be just as carcinogenic as tobacco. To analyse the toxicity of liquid nicotine, researchers from universities in Boston, Dallas and Los Angeles exposed healthy lung cells to the nicotine steam for four hours. By comparing the effects of the steam to those from traditional tobacco smoke, they noted that the cells showed the mutations associated with the development of cancer in both cases. /

post-scriptum

Artificial blood IV n° 2

p. 39

Soon to be running through our veins?

Artificial heart IV n° 2

Transparency IV n° 2

p. 14

Carmat wants to resume testing

Clinical trials under fire A report from the Cochrane Collaboration, a not-for-profit organisation, has recently pointed to the ineffectiveness of the drug Tamiflu in fighting certain flu complications. This conclusion was based on the analysis of data provided by its manufacturer Roche, obtained after a long struggle. This small step perfectly illustrates the increased need for transparency in clinical trials for researchers and doctors as well as for patients. /

BBlood cell culture from stem cells is progressing. Professor Marc Turner from the University of Edinburgh used the process to manufacture type O artificial blood that can be transfused to patients. A clinical trial is planned for 2016. In 2011, Professor Luc Douay led a similar clinical trial at Pierre-and-Marie-Curie University in Paris but for self-transfusion. /

IV n° 2

carmat

neuroprosthetics p. 50

A cerebral implant to boost the memory Brain implants, which are mainly used by paralysis or amputee patients to control neuroprosthetics by thought, may be able to stimulate the memory one day. A research agency of the Pentagon is working on a brain implant to restore the lost memory of wounded soldiers. Wake Forest University neurologist Robert Hamspon conducted an initial experiment in which he was able to introduce an image into the memory of a monkey that the animal had never seen before. /

The French company Carmat, which developed the first artificial heart, stated in April that it wanted to continue its implant trials. On 2 March, Claude Dany, 76, died 75 days after becoming the first patient in the clinical trials to be implanted with the artificial organ. The company nevertheless sees this first attempt as conclusive, since it aimed to reach a 30-day survival goal in patients in acute life-threatening cases. /

p. 26

Telemedicine IV n° 2

p. 34

Remote stroke response In the Nord-Pas-de-Calais region in France, hospitals have set up a telemedicine solution to act as quickly as possible in the event of a stroke. Patients experiencing a stroke can now be evaluated remotely by a neurologist if one is not available at the hospital where they are located. This measure is expected to save lives, as every minute counts to reduce the risk of death and damage when a stroke occurs. /

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 João Lauro Fonte, a Brazilian illustrator and graphic designer based in London.

in situ

Health Valley An overview of medical innovation in Western Switzerland.

NEUCHATEL

p. 09

The CSEM (Swiss Centre for Electronics and Microengineering) is developing a T-shirt equipped with physiological sensors.

RENENS

p. 11

UniverCité, dedicated to biology and design, is the largest community laboratory in Europe.

LAUSANNE

p. 12

MONTHEY

p. 08

The Nestlé Research Centre studies the relationship between health and diet.

The test developed by the SME Augurix is used to detect a gluten intolerance in 10 minutes.

João Lauro Fonte

GENEVA

p. 11

The City of Calvin will host a convention devoted to clinical trials this November.

in situ

HEALTH VALLEY

in SITU

HEALTH VALLEY

Start-up DETECTION

The Lausanne-based start-up Lunaphore boasts a new technology used to detect cancer biomarkers. Microfluidic chips have been developed to analyse a tumour in less than five minutes. Launched by researchers from the Swiss Federal Institute of Technology in Lausanne, the young company won the PERL (Lausanne entrepreneur award) in May 2014.

AUTO-IMMUNITY

Anokion, a start-up from the Swiss Federal Institute of Technology in Lausanne, has developed a technology used to re-train white blood cells. This method offers promise in fighting auto-immune diseases such as multiple sclerosis. Private investors have injected more than 33 million Swiss francs into the young company.

GLUTEN

Simtomax is a gluten intolerance test developed by the young SME from Monthey, Augurix. Recently approved by the Australian Therapeutics Goods Administration (TGA), the product could be commercialised in Australia. In ten minutes, Simtomax can detect Coeliac disease (gluten intolerance), which affects around 250,000 people in Australia.

ALPINE PLANTS

Pharmalp has recently signed a partnership agreement with PlanetSolar. The Alpine plantbased products created by the start-up from Conthey will be used as supplies for the crew of the solar-powered boat on its next journeys. They will include a soothing gel to relieve skin irritation and burns and a probiotic to reduce digestive problems.

the device

The endoscope of the future SamanTree Technologies is developing a digital microscope used to detect and measure cancer tissue in endoscopic surgery. The Lausanne-based start-up has recently come in second in the “venture” 2014 competition for its extremely promising technology.

The number of kilos of a malignant liver tumour removed from a 30-year old woman at the Geneva University Hospitals in April. The patient is recovering and has been doing well since the operation.

30,000 The number of hours it took a team from the University of Lausanne, in collaboration with Australian researchers, to determine when the Y chromosome appeared 180 million years ago.

“We want to attract private sector investment to Health Valley” Patrick Aebischer In an interview published in May 2014 in the “Neue Zürcher Zeitung”, Patrick Aebischer, president of the Swiss Federal Institute of Technology in Lausanne, encourages collaboration between companies and universities.

in situ

HEALTH VALLEY

ObeSense: an “intelligent” T-shirt to fight obesity Swiss engineers have designed clothing used to monitor the consequences of excess weight. The T-shirt is equipped with a number of sensors, including an electrocardiogram. Intelligent textiles “Metabolic syndrome”, the medical term used to describe the harmful effects of excess weight, is a condition affecting nearly 40% of Swiss people. Overweight people face a higher risk of cardiovascular incidents and sleep apnea. Concern over obesity is growing in the medical community. One of the most original solutions proposed to remedy the situation is unquestionably the ObeSense project, led by the Swiss Centre for Electronics and Microengineering (Centre Suisse d’Electronique et de Microtechnique or CSEM) in Neuchâtel. It is designing “intelligent” garments to anticipate these types of complications. “We have already developed systems featuring sensor-equipped T-shirts which can be used to assess physical performance or a patient’s state of health,” says Mattia Bertschi, section director of the CSEM. “But this new medical application will require more data to establish a diagnosis.” The research centre is working with other laboratories throughout the country, including the Lausanne University Hospital (CHUV), Swiss Federal Institute of Technology in Lausanne (EPFL), University Hospital Zurich (UZH) and the Swiss Rehabilitation Centre (Centre romand de rééducation or CRR). Each establishment focuses on developing a specific application for this high-tech clothing. The CSEM is responsible for the physical activity indicator, determined with an accelerometer, and cardiac performance using an electrocardiogram embedded in the T-shirt. The UZH calculates cardiac output by the oxy gen concentration in skin capillaries, while the CRR measures energy consumption based on lung ventilation. “By combining all these parameters, we can develop a more detailed analysis of our observations and more effectively prescribe an appropriate treatment for obese people,” says Etienne Pruvot, a doctor at the Cardiology Service at the CHUV. 9

Text: Jade Albasini

C. above: The “intelligent T-shirt” developed by the Swiss Centre for Electronics and Microengineering contains an electrocardiogram and an accelerometer. The data it records includes cardiac and energy consumption.

Initial testing This “smart textile” is not only used to prevent the risks of obesity but is also a relatively non-invasive way of monitoring patients. “The traditional methods of measuring calories generally require the use of a face mask or take place in a special room. The T-shirt would make certain costly laboratory analyses obsolete,” says Olivier Dériaz, doctor and research director at the CRR. This innovative solution would also simultaneously record a range of indicators, saving healthcare workers a considerable amount of time. A simplified prototype has already been tested on 15 volunteers in Valais, Switzerland. “We first experimented with it on healthy people with different body masses, including some slightly overweight individuals,” he says. The findings are currently being analysed at the EPFL and will be available within the next few months. And for seniors too The T-shirt has proved its success and is gaining popularity, but it could also revolutionise how general practitioners work. “Our goal is to transfer our innovations to Swiss industry,” says Mattia Bertschi. “But before a product can be launched on the market, the initial results must be validated and clinical trials conducted once approval is granted by the competent authorities.” If these steps are completed, this intelligent garment could be extended to other applications. “It would be the ideal tool for monitoring older patients. The clothing could be hooked up to a smartphone and send an alert if no activity is detected,” says Etienne Pruvot. The cardiologist is already envisaging an expertise centre to handle “alert” data and determine whether emergency intervention is needed or whether the attending physician should simply be notified. ⁄

in SITU

HEALTH VALLEY

3 questions

David Vernez

His laboratory is the only one in Switzerland that tests the effects of hazardous chemicals on samples of viable human skin. What is the focus of your research?

We study products used in workplaces that could be hazardous to employees’ health. Our work forms the basis for defining prevention strategies and fostering the implementation of regulations. Knowledge remains very limited on the risks of chemicals being absorbed through the skin, especially due to their vast diversity.

Why is it essential to conduct tests on viable human skin?

The skin of pigs features similarities with human skin, but its surface and hair growth are different, so the results are less representative. Similarly, we could miss certain effects by testing on frozen human skin. By working with the service of plastic and reconstructive surgery and the service of dermatology to provide us with samples, we can conduct our trials on viable skin. The findings of our study on phthalates, plasticisers found in vinyl gloves for example, showed that they pass through the skin barrier, contrary to the claims of theoretical models.

Which fields does this affect the most?

The risk of chemical absorption through the skin concerns any sector where chemicals are used in large quantities, e.g. the chemicals industry, construction or farming. And if we factor in local effects such as skin irritations, the risk extends considerably to a wider range of fields that includes professional cleaners or hairdressers, who are in contact with a broad spectrum of chemicals. / David Vernez is the interim director of the Swiss Institute for Work and Health

Alain Herzog / EPFL

INNOVATION

A Swiss park Boost global visibility for Switzerland’s scientific research centres. That is the goal of the National Innovation Park (PNI) backed by the Swiss Confederation. In March, the French-speaking cantons and sites – including Microcity in Neuchâtel, Energypolis in Sion, Bluefactory in Fribourg and the Campus Biotech in Geneva, along with the Swiss Federal Institutes of Technology in Lausanne (EPFL) and Zurich (EPFZ) – filed a joint agreement to create a decentralised EPFL hub in Western Switzerland. This collaboration network will be ratified by Parliament in 2015.

In millions of US dollars, the amount of money raised by Advanced Accelerator Applications (AAA), a spin-off company of the CERN, to expand in the United States. The company specialises in molecular imaging.

in situ

HEALTH VALLEY

UniverCité Renens

The largest community laboratory in Europe recently opened in Renens. This 1,000 sq. m space welcomes, free of charge, anyone who wants to conduct research in biology or design. The purpose of UniverCité is to promote innovation outside the traditional academic or entrepreneurial environments.

inaugurations Hackuarium Lausanne

A PostDoc in biochemistry at the Swiss Federal Institute of Technology, Luc Henry has recently inaugurated the first biohacking centre in Switzerland. Inspired by open-source software, this movement aims to become a third alternative alongside university research and the corporate world. Biohackers strive to make biotech advances available to all.

SwissTech Conference Center Ecublens

After the Rolex Learning Center, the Lausanne Campus of the Swiss Federal Institute of Technology (EPFL) opened the SwissTech Conference Center in April. The new building is located in the EPFL’s northern district and features a futuristic architectural design. The centre is totally versatile, with a conference room that can be transformed into an exhibition room or banquet room within a number of minutes. More than 500 housing units were built nearby, along with shops and an underground car park. Microcity Neuchâtel

The new Microcity building inaugurated in early May is an innovation complex set up in Neuchâtel near the academic institutions. Ten chairs of the Swiss Federal Institute of Technology in Lausanne (EPFL), representing more than 180 staff members, have already settled in, joining Neode, the Neuchâtel-based scientific and technological park. The new building will eventually have the capacity for 12 EPFL chairs. Owned by the canton of Neuchâtel, the seven-floor micro tech campus had a budget of 71.4 million Swiss francs.

calendar Nano Engineering 22 to 26 September 2014, Lausanne The 40th International Conference on Micro and Nano Engineering will be held this year at the EPFL’s new SwissTech Convention Center. The engineers and experts speaking at the event will outline the new trends in these fields before an expected audience of 500 to 800 people.

Treating rare diseases 7 October 2014, Yverdon-les-Bains

The organisation Swiss Biotech is bringing together business leaders from Swiss biotechnology industries at the Y-Parc in Yverdon-lesBains for the second edition of “Swiss Biotech Fall Day”. The programme for the event will focus on the development of drugs to treat rare diseases.

www.mne2014.org

www.swissbiotech.org

Focus on clinical trials 11 and 12 November 2014, Geneva Entrepreneurs from small and medium-sized companies, business leaders, investors and manufacturers from the pharmaceutical industry will meet at the Starling Hotel and Convention Center in Geneva for two days of networking and exchange on the latest clinical trials and future developments in the area. www.terrapinn.com www.swissbiotech.org

Health Fair 13 to 16 November 2014, Lausanne

The SwissTech Convention Center will host the Planète Santé Health Fair in November. Visitors of all ages can enjoy games and tests on health or attend a number of talks and debates at this event which brings together the leaders of the Swiss medical community. www.planetesante.ch

in SITU

HEALTH VALLEY

third stop

ON THE ROAD

Lausanne

In each issue, “In Vivo” travels to meet with companies based in the Health Valley. Rendez-vous in the heights of Lausanne.

Nestlé

Promoting healthy eating The Nestlé Research Centre leads a number of research projects to improve the quality of the food we eat. text: Jade Albasini

Vers-chez-les-Blanc, in upper Lausanne. With a population of some 1,100, this small community became home to the Nestlé Research Centre (CRN) in 1987. The institute, which conducts research on the food we eat, has since opened three branches, located in Shanghai (China), St. Louis (USA) and Tokyo (Japan). Its managers highlight the importance of maintaining the main centre in Health Valley. “The concentration of qualified engineers and noted scientists in the Lake Geneva region is unique,” says Thomas Beck, director of the CRN since 2012. “Our geographical location means that we can work closely with a number of establishments on the cutting edge of the latest technologies, such as ETH Zurich or the Swiss Federal Institute of Technology in Lausanne (EPFL). Being close to leading pharmaceutical companies brings another added value for us.” The CRN’s 600 employees across its four sites worldwide work towards 12

improving the quality of products while reducing their sugar or salt content without compromising taste. They also try to grasp the complex relations between food and well-being. “Our health is directly related to the ingredients we eat,” says Thomas Beck. “That’s why we conduct numerous studies to better understand the impact of food on the organism.” Every year, more than 200 scientific studies conducted by the CRN are published in medical journals. For example, in 2014 Nestlé researchers discovered that coffee considerably reduces insulin resistance in healthy people. They also revealed that children who cook develop better eating habits, with 76% of them eating more green vegetables. And the probiotic bacteria Lactobacillus rhamnosus appears to promote weight loss in female subjects. Another aim of the CRN is to anticipate future human dietary needs in order to extend life expectancy while remaining healthy. /

in SITU

HEALTH VALLEY

benoît dubuis Director of the Campus Biotech site and Chairman of BioAlps

The history of Switzerland is a story of successful integration. We need to carry on that tradition. Nestlé was founded by German-born chemist Henri Nestlé. Xavier Givaudan was French. Charles Eugene Lancelot Brown, who was half English and half Swiss, teamed up with Bamberg, Germany native Walter Boveri to found the company Brown, Boveri & Cie. More recently, a number of industrial groups, such as the Bertarelli and Mauvernay families, have come to our country to set up and develop their company.

Integration and diffusion of wisdom In the 16th century, leading researchers in medicine such as Paracelsus, André Vésale and Erasmus of Rotterdam came to Basel to print their theses and treaties. The city played a role in the humanist movement during the Renaissance and in its scientific progress. And continuing into modern times, a key to Switzerland’s success has been its ability to innovate. To bring about this innovation, our higher education establishments work to attract the best talent, both Swiss and foreign, in a globalised environment. This diversity is a precious asset that can be measured by our country’s competitiveness in the international academic arena.

Integration of knowledge In the Preliminary Discourse of his famous Encyclopaedia, Diderot wrote that there are two means of developing the Sciences: “by our own discoveries and by the investigations of other men.” It was a fact in the 18th century. It is now a necessity in the 21st. An interdisciplinary approach, although less visible to the general public, is what truly drives change. It is our most valuable asset in upholding our leading position in a number of industrial sectors.

Integration and valorization of know-how Our industrial development has been built on generations of entrepreneurs who have come from beyond our borders. Some of the Integration of new trajectories of innovation most important contributions include those of Innovation could never survive on internal the Huguenots, who brought us chemistry and resources alone. And the line between an organisawatchmaking. Fleeing their home country after tion and its ecosystem is fading. Open innovation the Edict of Nantes was revoked, silk weavers is currently the road to take. This means seeking and merchants made Basel a hub for silk ribbon. knowledge and resources outside the organisation. The need for dyes attracted the chemical industry, which diversified into fine chemicals In short, we would not survive without our ecosysand then pharmaceuticals. The history of tem. Collaborating and sharing bring constant value. watchmaking followed a similar path, with skilful Switzerland understood this before everyone else by artisans bringing their watchmaking know-how to favouring integration and openness. We need to hold Switzerland as well as the capital needed to on to those values and continue developing them. ⁄ develop this new industry. Integration of entrepreneurs and values FOR MORE INFORMATION Behind any great innovation are people. Here www.bioalps.org again, the examples are legion. The platform for life sciences in Western Switzerland

TO READ DR

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

in SITU

world

in situ

around the world

Khademhosseini lab

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

3D printed blood vessels technology People in need of a transplant could soon benefit from a new advance in artificial organs. Researchers at the Khademhosseini Lab in Boston have recently created the first synthetic blood vessels designed using a 3D printer. “In the near future, we’ll be able to develop tissue customised specifically for a patient or for the testing of new drugs,” says Ali Khademhosseini, director of the laboratory leading the project.

study

The hormone that makes you smarter Scientists have known for several years that a hormone called klotho, when present in high levels, increases longevity in humans and animals. Researchers at the University of California, San Francisco recently tested 700 people aged 52 to 85 to see if klotho could also prevent the brain from ageing. Although the results of their hypothesis came up negative, they did note a better cognitive performance in people with high levels of the hormone. In other words, klotho apparently makes you smarter.

This is the percent reduction in the number of dengue cases thanks to a new vaccine developed by Sanofi Pasteur. The vaccine still needs in-depth study before it can be launched on the market. But these results – the culmination of more than 20 years of work – offer true hope in fighting this viral infection. Dengue, also called “tropical flu”, affects more than 100 million people throughout the world every year.

in situ

world

jeff chiu / associated press

A pill that protects against AIDS

DRUG Truvada is a pill which, if taken daily, helps prevent infection by the AIDS virus with a success rate of more than 90%. The drug has been available in the United States since 2012 and is expected to hit the market soon in Canada and some European countries. Yet, to date, very few US doctors have prescribed Truvada to their patients, mainly due to the lack of information about the product, but also due to controversy surrounding the treatment, especially on social media. The pill is criticised for promoting unprotected sex.

s vo ick i v p in est Face au risque Promoting gender b épidémique equality for lab rats Didier Houssin, Odile Jacob, 2014

In his latest book, Didier Houssin, professor of surgery at Paris Descartes University and advisor to the World Health Organization, looks at how major epidemics have been managed in recent decades. He describes the increasingly global responses against AIDS in the 1980s, mad cow disease in the 1990s, SARS and bioterrorist attacks in the early 2000s, then chikungunya and the flu pandemic in 2009. The book aims to teach us about the future safety of the world’s population.

Never too old to be studied Article by Donna Zulman and Keith Humphreys, “New York Times”

“Non-communicable disesase prevention should get more attention.” Margaret Chan, Margaret Chan, Director-General of the World Health Organization said in a speech on 19 May, highlighting that non-communicable diseases are now the “biggest killers” worldwide. To address the problem, the WHO chief calls for a change in paradigm.

A US study showed that 40% of clinical research excluded people over the age of 65. Many researchers expressed concerns about age-related health issues that could distort results. The authors of this article disagree and argue that clinical researchers should select candidates based on criteria other than age. They believe that doctors do not know some drugs’ effects on older patients, because, for example, organ function changes with age. According to them, medicine must adapt to an aging US population, since more than 13% of people are 65 and older. s on video .COM Links to AGAZINE VIVOM .IN WWW

Article by Janine A. Clayton and Francis Collins, Nature

Francis Collins, the director of the National Institutes of Health who co-authored the article published in May, calls for more balanced gender representation in lab rats, which are mostly male. Why this disparity? One theory claims that hormonal fluctuations in female rats could skew results. The authors claim that this is unfounded and that the gender bias could have dire consequences on women’s health. Women suffer from more side effects and need drug doses better suited to their bodies.

The sore problem of prosthetic limbs “TED Talk” by David Sengeh

A researcher from MIT Media Lab in Boston, David Sengeh grew up in Sierra Leone, where a civil war left more than 8,000 amputee victims. He wondered why many amputees would not use their prosthetic limbs. Learning that prosthetics were often uncomfortable, he decided to help by developing a better adapted prosthetic model. With technology based on magnetic resonance imaging, he uses 3D printingto create made-to-measure prosthetic limbs quickly and cheaply. The first trials conducted a few months ago on US army veterans proved successful.

in SITU

The zebra fish in medical research Captured using an electronic microscope, this image shows the embryo of a zebra fish on the fourth day of development. To create this portrait, the zebra fish was attached to a sample holder by the tail and set at a 65-degree angle. As zebra fish embryos are about 1 cm long, much too large to be captured in a single shot, three photos were combined using digital technology. The black and white photo was then colourised to show how reflective the fish’s scales are. The “Danio rerio“, or zebra fish, is a tropical freshwater fish found in eastern Asia, and plays an important role as a model organism to study the biological development of neurodegenerative diseases in vertebrates. Annie Cavanagh and David McCarthy / Wellcome Images

world

in situ

world

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

D republic-of-innovation.ch

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

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

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ThIERRy MAUvERNAy Delegate of the Board Debiopharm Group

REPUBLIC OF INNOVATION

focus

PERCEPTION

brain

mind your perceptions /

Recent research has seriously challenged preconceived notions about our five senses. Blind people can â&#x20AC;&#x153;seeâ&#x20AC;? with their ears, and teenagers can improve their visual acuity through video games. An in-depth look into the largely uncharted territory of perception.

/ BY

SERGE MAILLARD, Melinda Marchese and benjamin keller

focus

PERCEPTION

he mechanism of perception long remained a pure mystery. How do we perceive sensory input? How is that “outside” information sent to the brain? And how does the brain process these data? Is sensation the same as perception? For millennia, these complex questions stood within the confines of philosophical debate.

magnetic resonance imaging (MRI), electroencephalograms (EEG) and transcranial magnetic stimulation (TMS), have uncovered some of the mystery surrounding the mechanisms of perception and related disorders, including schizophrenia, autism, anorexia nervosa, dyslexia and even dyschromatopsia (disorder of colour perception).

In his treatise On the Soul, Aristotle developed the Some surprising discoveries have been made. “For first genuine theory on sense-perception, a concept example, we have noted that the brain processes which he differentiated from simple sensation. The information much faster than we thought,” says Greek thinker “studies each of the five external Professor Micah Murray, a neuroscientist specialised senses – sight, hearing, smell, taste and touch – be- in perception at the CHUV and the University of fore introducing a unique and original notion of Lausanne (UNIL). “Sensory stimuli can be followed down to the millisecond.” Unlike common sense, distinct from the an MRI, which provides a static external senses but inherent to What does image, an EEG shows dynamic their function,” says Michel Nodéperception brain activity. “As a result, we can Langlois, professor of philosophy mean? trace the information that reaches at the Fermat School in Toulouse, the brain in real time and deterin the review Philopsis. Aristotle Everything we sense, through mine, for example, what area of believed that this common sense the eyes, ears, mouth, skin or the brain perceives which inforincluded perception that went benose, is perception. But this perception is not an “objective” mation first.” Transcranial magyond external sensory functions. reality. It goes beyond the senses ne tic s timulation is used to It encompasses the awareness of and is closely tied to our cognition. “activate” or “deactivate” brain this perception, and of the differThe outside information that functions and sensory abilities. ent senses. reaches our senses is “processed” Nowadays, Aristotle and other philosophers no longer have the monopoly over the notion of perception. Researchers have invaded this area of study and have gained extensive experience in it. Neuroscientific techniques, such as

by mechanisms that give it meaning. Technically, the process involves sensory information that is translated into neural responses. For instance, light is transformed by the photoreceptors in the eye and sound by the hair cells in the ear. And it is the neural responses from our sense organs that form the basis of perception. Disorders, such as hallucinations, can occur that widen the gap between “reality” and perception.

Seeing with your ears hope for the vision-impaired In March 2014, scientists from the Hebrew University in Jerusalem announced a surprising innovation. They have developed “sensory substitution devices” that allow blind people to perceive space and make out shapes. This is achieved with an algorithm that converts a camera image scanned from right to left into music. This new tool 20

These are not the only technologies used to repair or improve our perception capabilities. Today, innovative webcams and video games can also play a part. It is an entirely new field of research waiting to be explored.

gives the blind the possibility to “see”, or at least better perceive their environment. How can they do that? The blind adjust their perception. Without sight, one’s sense of hearing is highly stimulated. The device converts the image into sound. The pixels are represented by the volume, while the positioning is represented by the duration of the sound. MRI studies have shown that the areas of the brain typically used to process vision can now be activated by sound. “Even those who have been blind since birth can perceive their environment,” says Mi-

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“I see music” French-born Vincent Mignerot is a synaesthete. His brain spontaneously associates several sensory perceptions. Research on this mysterious neurological mechanism aims to better understand how the brain manages information. by melinda

A oram dannreuther

marchese

s a child, Vincent Mignerot sensed the delicious taste of plum every time he pronounced or heard the word “building”. When he was sick, he would visualise his symptoms. For example, his fever resembled a hot, white ball. In other words, he would spontaneously and subconsciously associate several sensory perceptions – taste with a sound or pain with a shape and colour. It was not until he was 20 years old that this Lyon, France native, now 36, realised by chance that not all humans experience these mental associations. “When I was a psychology student, I read an article that described a phenomenon that I didn’t even know existed but had always lived with myself, synaesthesia,” he says. This neurological ability was first described medically in the early 18th century and affects 4% to 5% of the population worldwide.

Synaesthesia can take on several forms. Some synaesthetes see music, while others associate numbers with colours or perceive sound when they smell an odour. Vincent Mignerot experiences six of these forms. “Today, I have lost the lexical-gustatory capacity (associating a word with a taste), but still experience nociception (associating a colour with pain),” he says. “I also experience an intense form of cognitive synaesthesia. All my thoughts occur in the form of colours and

shapes that move about in space, in 3D.” Now passionate about the phenomenon, Vincent Mignerot set up a website dedicated to the subject three years ago (http:// synestheorie.fr), which covers the latest scientific research in the area. With the help of a graphic designer, he develops tools that site visitors can use to “test” their everyday perception. “It’s definitely not a super power or even a disability,” he says. “I can easily not pay attention to it. It has never been a problem.” In addition to the philosophical and artistic nature of his project, Vincent Mignerot also hopes that research on synaesthesia will result in scientific progress. “Magnetic resonance imaging (MRI) has already shown that specific neural connections occur in synaesthetes, and the human brain is capable of multimodal sensory integration. All that contributes to a better general understanding of the brain and how it functions.”

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gabriel numbers

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synesthetic art

This drawing shows the days of the week as visualized by artist and synesthete Gabriel Numbers. His depiction of the week is not chronological, because he visualizes the days of the week as a non-linear time frame.

mental maps of numbers

The number forms shown here were compiled in the 1880s by Englishman Francis Galton using drawings made by his patients. A cousin of Charles Darwin, he was the first scientist to notice certain persons could associate numbers to visual representations. Thus, the concept of synaethesia took form.

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cah Murray. “Based on the criteria set out by the WHO, they’re no longer legally blind!” In an article in the French newspaper Le Figaro, one of the study’s co-authors, Dr. Ella Striem-Amit, said, “dividing the brain into areas defined by the type of sensory information processed – visual cortex, auditory cortex – is imprecise. The organ actually appears to be organised into areas based on the tasks accomplished rather than the senses typically used for that task.” Micah Murray suggests that these conclusions can also apply to healthy people. “All of our senses interact, and the information coming from the different senses is not processed separately” he adds. “These ‘multi-sensory’ processes are reshaping our understanding of perception and, as a result, of the disorders that can arise.” To be able to perceive surrounding shapes, the blind must first learn how the device works. During the experiments led by the Israeli scientists, participants’ perception of the shapes around them gradually improved each time they listened. Understanding this new language takes dozens of hours of practice. Also in March, a British artist with “achromatopsia” (only seeing in black and white) announced that he had a chip implanted in his brain that is connected to a camera. His “auditory prosthesis” analyses colour frequencies and converts them into sound vibrations. Neil Harbisson confirms that he can again perceive colours. And, with his “eyeborg”, he even claims to be the world’s first cyborg!

The power of video games... to optimise visual acuity What if video games, loathed by so many parents, weren’t so bad for their kids? Recent studies show that, in certain conditions, they can even improve the perception abilities of gamers. “In our studies, we noted the positive effects on visual acuity and contrast sensitivity in subjects who play video games regularly, i.e. more than five hours per week,” says Daphné Bavelier from the University of Geneva. But the games available on the market do not all produce these effects. “We observed them in first-person or third-person shooter games in which the player has to shoot at and destroy their enemies while keeping an eye on everything happening around them,” says the expert. “In this type of game, the player has to make quick decisions while assessing future actions. Attentional control is augmented.” The scientist says that perception is also enhanced by dividing one’s attention on the screen and constantly re-evaluating what is important to better anticipate situations. “Playing 20 to 40 minutes per day over several weeks is enough to gain the initial positive effects on perception abilities.” Video game training can be used in correcting vision problems and could even help patients with disorders such as schizophrenia, depression or attention deficit

Glossary Schizophrenia The main symptoms of schizophrenia, often confused with multiple personality disorder, include social withdrawal and a loss of contact with reality. The acute phase of this psychosis leads to auditory hallucinations that can be very disturbing for the individual. Factors associated with the onset of schizophrenia vary from social to psychological or genetic. Its causes remain for the most part unknown.

AchromatopsiA This rare vision disorder affects the ability to distinguish colours. The achromat only sees shades of grey. Achromatopsia can either be congenital or acquired due to brain damage and is characterised by the absence of the retinal photoreceptors used to see colour. The symptoms include reduced visual acuity, uncontrolled oscillatory movement of the eyeball and aversion to bright light.

Autism The disorders along the autism spectrum are characterised by abnormal social interaction and communication. The patient shows a range of restricted and repetitive behaviour. The symptoms are generally noticed by the parents in the first two years of the child’s life. The basis of autistic disorders may either be genetic or environmental, but its exact cause remains subject to controversy.

Anorexia nervosa This mental disorder, not to be confused with the loss of appetite caused by another pathology, manifests itself by an exaggerated preoccupation towards physical appearance, inducing a restrictive diet that can prove to be fatal. Anorexia nervosa mainly affects women in their teens, which can perceive themselves as being overweight even though it is not the case.

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syndrome. For now, the most concrete effects are limited to vision. “Some patients have already corrected their amblyopia by playing video games. This disorder, also called ‘lazy eye’, is detected during childhood and results in poor depth perception.” As such, video games refute a theory that has been dominant since the 1970s, which claims that vision develops over a “sensitive” period during childhood, after which development stops. “Actually, we can regain these abilities later by stimulating the visual cortex

appropriately,” says Daphné Bavelier. But video game training extends well beyond helping people with perception disorders. “There is also a whole educational side to our project. With video games, we can each enhance the precision of our visual system and our ability to detect objects within our field of vision. All that information is more rapidly integrated.” Daphné Bavelier works with video game makers to conduct her research. But creating a video game

Changing one’s perception of pain BY marie-adèle copin

their phobias, free themselves from an addiction or treat an allergy. The Lausanne University Hospital (CHUV) uses hypnosis to relieve acute pain, such as from severe burns or in transplant patients. “At one point I had a young patient with burns on both legs,” says Maryse Davadant, an intensive care nurse at the CHUV specialised in hypnosis. “I asked him to explain his pain in detail. He told me that it felt as though he was being burnt with flames from a blowlamp. I told him to lower the intensity of those flames in his mind,” she says. “That didn’t work, but he spontaneously imagined blocks of ice on the blowlamps, which gave him some relief.” Hypnosis can help relieve acute pain. Explanation by Maryse Davadant, intensive care nurse.

philippe gétaz

A 71-year old man underwent open heart surgery without general anaesthesia. As incredible as it may seem, he had only a local anaesthetic and endured the operation while wide awake. He was under hypnosis. The events took place in 2007 at the Sacré-Cœur de Roulers Clinic in Belgium. Despite popular belief, scientists have made it clear that there is nothing esoteric about hypnosis. It is an effective therapeutic technique to help patients face

The nurse says that this initial analysis is absolutely essential. “When the person feels intense pain, you can’t ask them to take a mental journey because their suffering is too great.” In fact, the patient is already under hypnosis, overcome with their physical sensations. By playing on metaphors, Maryse Davadant manages to relieve their pain. Metaphors are used throughout their care. “It is very unpleasant for severe burn patients to have their bandages changed and wounds cleaned. Their flesh is completely exposed.” The person is mentally transported to a place where they

feel safe in order to focus their attention. The nurse offers suggestions so that the patient can experience something other than the present situation. “I know what step in the process will be difficult,” she explains. “I integrate the pain into images. If the patient chooses to be in a river, I tell him, for example, that he slightly scratched himself on some rocks.” Contrary to common misconception, people under hypnosis are in complete control of their body. They are even extremely focused. “It’s an altered state of consciousness.” Neuroscience has proved that certain parts of the brain are activated under hypnosis. “When patients imagine themselves in a forest and smell mushrooms, medical imaging shows that the olfactory region of the brain is stimulated. That means that the patient is having the experience of being in the woods.” This state of consciousness changes what the patient feels and their perception of pain to help them feel it in an acceptable way. Hypnosis also increases the patient’s independence. “The goal is to learn self-hypnosis,” says Maryse Davadant. “The patient understands that they’re acting for themselves. They are no longer being subjected to treatment, but instead playing an active role in their care.”

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adapted to patients is a long, expensive process. “Most of our work involves creating easy levels. Some of our patients are 85 years old!”

A better diagnosis for schizophrenia

By also looking into the condition of patients’ vision or hearing, schizophrenia can more easily be diagnosed. The illness affects about one in one hundred people, with symptoms generally appearing in early adulthood. “Until now, the diagnosis of schizophrenia has been mostly based on subjective criteria. Psychiatrists have to rely on what they are told by patients and those close to them,” says Micah Murray. “After all, the disorder can’t be diagnosed with a blood test!”

In the American television series Perception, the main character is a talented neuropsychiatrist who is also a paranoid schizophrenic. However, he has turned his pathology into an asset, being enlisted by the FBI as a consultant who uses his hallucinations to help him solve cases. Although the series in itself offers little scientific value, it does shed some light on this complex illness.

The specialist believes that MRIs and EEGs now show an additional “risk factor” that links sensory disorders with schizophrenia, providing a more sound diagnosis. But this has not yet taken root in clinical practice. “The use of an EEG and MRI to diagnose schizophrenia will spread in hospitals over the next five years,” predicts Micah Murray. “These tools can also improve the treatment of the illness. The success of a given therapy becomes easier to gauge by evaluating its effects on sensory abilities.”

“People think that schizophrenia is a purely cognitive disorder,” says Micah Murray. “Thanks to the support of the Swiss National Fund and National Centre for Competence in Research – Synapsy, we have in fact discovered that the pathology also leads to vision and hearing disorders. But it is difficult to determine the cause and effect relationship,” he says. “Do the hallucinations occur because of the vision problems? Or do the hallucinations lead to the vision problems? In other words, where is the problem located? In the eye or in the brain?”

The increased use of EEG testing is also expected to improve the diagnosis and treatment of other pathologies. Micah Murray gives the example of the language disorder dysphasia. “Tests to measure how fast the brain processes information can be used to determine whether or not language is impaired or, for example, whether a child’s perception can be enhanced through a given therapy,” he says. “For dysphasia, we assess the child’s ability to differentiate between the sounds /ba/ and /ga/ in order to predict whether he or she has the disorder.” /

Glossary Amblyopia From the ancient Greek amblus (“obtuse”) and opsis (“sight”), amblyopia refers to reduced visual acuity that impairs depth perception. The disorder can affect one or both eyes and may either be functional (caused by problems in perceptual learning) or organic (due to either curable or non-curable damage).

Dyslexia The disorder may occur as a developmental learning disability in childhood or as a result of brain damage. Different languages affect the disorder differently. Slowness in reading occurs primarily in those with clear letter-sound correspondence, or transparent languages, such as Italian or Spanish. In “opaque” languages such as French or English, dyslexia affects both reading accuracy and speed.

Colour blindness This congenital disorder is the inability to see certain colours, in particular red and green. English chemist John Dalton, who was colour blind himself, described the condition for the first time in 1798. Colour blindness affects between 2% and 8% of the population and is significantly more common in men than in women.

Dysphasia Etymologically, the word dysphasia means “poor language” or “difficult speech”. It indicates a disturbance in the learning and development of spoken language. Dysphasia can affect expression, comprehension, or both. The disorder is characterised by poorly structured oral expression and limited vocabulary, causing difficulty in school and disabilities in everyday life.

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When our senses play tricks on us Some phenomena completely disrupt our perception of what we see, hear or feel. Here are some examples to test well-known optical, auditory and gustatory illusions.

Hermann Grid

Café wall illusion

This optical illusion makes straight parallel lines look like curves. The columns of dark and light squares are slightly staggered in each row, forming a curve. For the illusion to work, each “brick” needs to be surrounded by “mortar”, that is, an intermediate shade between the light and dark colours. This phenomenon was first described by Dr. Richard Gregory after he observed it on a wall outside a café in Bristol, United Kingdom.

Discovered more than one century ago, the Hermann grid illusion causes the viewer to see grey patches between the black squares. The effect is the result of an optical process called retinal lateral inhibition, which increases the contrast between the light and dark areas.

McGurk effect

Phi Phenomenon

Colours and food

This phenomenon occurs when our eyes tell our ears what they should hear. If you see a person whispering the syllable “va”, but a recording pronounces “ba”, you will probably hear “va”. This is one of the first examples of sensory interaction described by British psychologist Harry McGurk in 1976.

The phi phenomenon takes place every time you watch a film. Images are projected one after the other, but you do not perceive them as fixed, separate images. This is explained by a brain mechanism. When the retina sees an image, an “afterimage” persists in the brain for a fraction of a second. During this time, all it takes is for the eye to see a second, slightly different image for the brain to automatically link the first image, which is retained in the memory. That is how motion is perceived in film.

Oxford University researchers have found that red cutlery tends to limit food intake. “Red could, for example, be used to serve food to people who need to reduce their food intake, but should certainly not be used for those who are underweight,” says the study published in the journal Flavour in June 2013.

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Troxler effect

Fixate on the central point in the image. After a few seconds, the circle around it seems to fade away. This is the Troxler effect, or Troxler’s fading, named after the Swiss physician Ignaz Paul Vital Troxler, who was born in the 18th century. The explanation for this optical illusion can be found in the retina. This nervous tissue at the back of the eye captures light stimuli that strike its photoreceptor cells (rods and cones) and sends them to the optic nerve, which in turn transmits them to the visual cortex. The brain then interprets sensory input to

perception

“build” vision. Photoreceptors always signal a change. To stimulate them, the eye is constantly but imperceptibly moving, with sometimes extremely rapid oscillatory movements. “If the receptors are no longer stimulated, and the image is stabilised on the retina, it disappears completely,” indicates Daniel Kiper, a researcher at the Institute of Neuroinformatics at the University and ETH Zurich. The neurons in peripheral area of the retina require larger movement to be stimulated than those in the centre, which produces the Troxler effect. “When fixating on

a stimulus, eye movements become smaller and are no longer large enough to stimulate the peripheral receptors and send the image of the circle to the brain.” Daniel Kiper points out that the cortex is involved when the circle is replaced by the background colour. “As the brain no longer receives information from the retina, it fills in the space with what that it finds in the rest of the image.” How does that work? “We don’t know. It’s very mysterious.” The thinner, fainter, blurrier the surrounding circle is, or the further from the fixation point, the stronger the Troxler effect.

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INTERVIEW “We should pay more attention to how patients perceive their environment”

Erik Freudenreich

Professor Daniel Javitt has been studying how the brain functions for many years. The unit that he oversees at Columbia University in New York studies the effects of glycine in treating certain disorders of perception.

Is it accurate to say that perception is one of the main focuses of your research?

in vivo

daniel javitt I’m especially interested in perception from the point of view of schizophrenia. My work is based on what are called N-methyl-Daspartate (NMDA) receptors, which can be found in the visual and auditory cortex. Our studies have revealed a link between NMDA dysfunction and perception disorders such as schizophrenia. Schizophrenia patients often explain that the world feels like it’s been shattered into a thousand pieces, that things go too fast.

Scientists, such as psychiatrists, long ignored these remarks, because they believed that the schizophrenia psychosis only involved the frontal cortex and dopamine receptors. But once we establish the relationship between the pathology and NMDA receptors, the patients’

description sounds more logical. We generally don’t pay enough attention to the way mentally ill patients perceive their environment. iv

Why did you decide to study schizophrenia?

When I was finishing medical school, the United States had a serious problem with PCP, a synthetic drug that became the subject of my dissertation. Curiously, people under the influence of PCP display the same symptoms as patients with schizophrenia. The fact that the effects of the disease could be reproduced by taking a chemical substance meant that there was a very basic problem behind the illness. We were then able to identify a dysfunction in the NMDA receptors, which are essential for memory and neural connections. That’s where the idea came up that we could stimulate these receptors with glycine to treat schizophrenia. dj

Patients with schizophrenia can suffer from auditory hallucinations. What causes them?

Specialising in schizophrenia With degrees in neuroscience and psychiatry, American scientist Daniel C. Javitt is at the forefront of global research on new treatments for serious mental disorders. He is the director of the Division of Experimental Therapeutics in the Department of Psychiatry at Columbia University in New York and the director of schizophrenia research at the Nathan Kline Institute, also based in New York. 28

dj You should turn that question around. Why don’t healthy people normally have hallucinations? If you take a subject who do not have schizophrenia and place them in an airtight container that cuts out all sound, they too will begin hearing things. Actually, it’s the constant flow of information from the outside world that keeps us from going deep into our thoughts and hearing those voices. Interestingly, if you analyse the brain images while someone with schizophrenia is experiencing an auditory hallucination, you can see that the areas of the brain that process language are activated. It’s not merely a cognitive problem, but also a sensory one. The patient’s brain reacts as if it’s truly perceiving the voices.

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What about optical illusions?

We’ve been studying the phenomenon for a long time. These illusions cause different reactions in the brain. Some of our patients react normally, while others are extremely sensitive to certain optical effects. The Hermann grid illusion is one that causes them the most problems (see p. 26). You are normally supposed to see grey patches at the intersections of the lines on the grid because your brain is trying to stick the pieces of the puzzle back together. That’s not what happens in schizophrenia, as the neural interconnections used to see these patches are not operational. In fact, you could say that their perception of the grid corresponds to reality. dj

How many years until we have a good understanding of our brain?

dj We will never be able to completely understand how it works. But today we have many tools that we can use to analyse and measure a number of major functions. Take my work or that of my colleague Daniel Javitt is at the in Lausanne, Micah Murray, forefront of global on what is called mismatch research on new negativity. This phenomenon treatments for serious occurs when the brain processes mental disorders. an infrequent change in a repetitive sequence of stimuli in the brain. For example, if you live in the country, you automatically notice when the birds suddenly stop singing. It’s a very important function encoded in our brain for survival in a hostile environment. We’ve been able to ling taking in visual information and in sounding show that this function is produced by the NMDA out complex words. These are important process receptors in the auditory cortex. What we try to that involves NMDA receptors. If we manage to do is help patients to activate the reflexes that repair this dysfunction, for example with the they don’t currently have. Schizophrenia patients glycine-based treatments that we are currently often lose the ability to read passages of informastudying, we will make a huge leap forward in tion fluently, both because of difficulty in controlrebuilding patients’ social and professional lives. ⁄ 29

â&#x20AC;&#x153;We live in a male-dominated world. A greater diversity in profiles, especially more women, in the medical profession and among researchers will certainly make a difference.â&#x20AC;? PAULA JOHNSON

Boston Globe via Getty Images

mens sana

MENS SANA

INTERVIEW

Paula Johnson “Women are not included enough in clinical

trials.” Paula Johnson, an internationally renowned women’s health specialist, believes that this negatively affects their care.

interview: Julie Zaugg

“We need a better understanding of the differences between the sexes” rience shortness of breath or discomfort in Disease does not affect men and women in the same way. Some the upper abdomen. Since this disease has diseases are even “women-only”. Paula Johnson, Professor of been less studied in women, the latter sympMedicine at Harvard Medical School (USA) and Executive tom is often confused with gallbladder pain, Director of the Connors Center for Women’s Health and which can lead to misdiagnosis. Gender Biology, explains why women’s health can’t wait. Why are men and women not equal when it IV Apart from genetic differences, do men and comes to disease? PAULA JOHNSON Gender is a genetic women also react differently to their environment? PJ Of course. Stress affects women much construction. There are fundamental differences between men and women in their genes. When these more than men. There is a condition called the differences are combined with the influence of our “broken heart” syndrome. It can be triggered by hormones, environment and gender – i.e. the roles, a traumatic event, like the sudden loss of a loved behaviour and attitudes that society attributes to one or a major change in one’s physical environment each sex – the disease is experienced differently in following an earthquake. It can cause the heart dysmen and women. function. The vast majority of patients afflicted by the syndrome are middle-aged women, whereas men are almost unaffected. IV Can you give us an example of a disease that affects the two sexes differently? PJ Women Nor are the two sexes equal in terms of obesity. The arwith diabetes have a higher risk than men with eas of the brain associated with regulating the desire for the same condition of developing high blood food are not the same in men and women. A study recently pressure. Cardiovascular disease has the same showed that when women live in a violent situation, their symptom of chest pain in both sexes, but risk of obesity increases. This is not the case in men. women are significantly more likely to expeIN VIVO

MENS SANA

INTERVIEW

vessels. But then again, it has to occur to IV Are there actually “women-only” diseases? PJ Yes, lymdoctors to use these methods. They have phangioleiomyomatosis (LAM) is a rare disease that causes to remember that there are differences beabnormal growth in lung cells and ends up destroying the tween the sexes. organ. It only affects women. It is often diagnosed very late, once it’s already too late, because doctors don’t think of testing their female patients for the condition. SimilarIV And when a doctor is treating a patient, ly, most of the auto-immune disorders, such as multiple do they have to think of prescribing a difsclerosis, lupus and rheumatoid arthritis, are much more ferent treatment depending on the sex? PJ prevalent in women. However, the rate of mortality for It’s worth considering. Remember the study men with these diseases is far higher. that came out in the early 1990s that recommended taking one aspirin per day to prevent heart attacks. Well, it was based on a group of exclusively male patients. When the hypothesis was finally tested on women just over eight years ago, the findings showed that aspirin only had the effect on patients over age 55. It helped prevent strokes, but not heart attacks.

“Including different factors in research allows for personalised healthcare.”

Another example came a few years ago during tests on a new lung cancer therapy involving genetic mutations found on the surface of cancer cells. The initial findings looked promising. But by taking a closer look, they found that the treatIV If they’re so different, should there be distinct ment was more successful in women (82%). In fact, methods used to diagnose men and women? the genetic mutations targeted by the drug occurred PJ For certain diseases, yes. The standard test used almost exclusively in women. It was a crucial disin cardiac catheterisation to detect a heart concovery, which encourages a more personalised treatdition in women often comes out negative. The ment approach based on the sex of the patient. procedure involves inserting a tube (catheter) into a vessel and injecting dye into the bloodstream. By measuring pressure and blood flow IV What can we do to make sure that this type of in the heart and vessels, doctors can detect any success does not remain an isolated case? PJ We blockage in the arteries. This is often easily visneed to improve the understanding of the differences ible in men, but in women this method does between men and women. We had to wait for a law to not always show the plaque because it is lies be passed in 1993 to include women in clinical studmore evenly along the blood vessels. Women ies in the United States. The oldest data that we have are even frequently told that they’re in good on women’s reactions to disease only date back about health and sent home, while they’re actually 20 years. We know that women often experience illness suffering from a heart condition. differently, for example in heart conditions, but we don’t know why. We have to make sure that women are systematically included in clinical trials – and the same for IV So what can we do about it? PJ We have female animals in pre-clinical testing – and that gender is solutions that are better suited to diagnosfactored in when results are reported. This is not always ing heart conditions in women. An intrathe case. Still today, only 33% of participants in studies vascular ultrasound or FFR (fractional flow on cardiovascular diseases are women. Similarly, in neureserve), used to measure blood flow in roscience, 66% of pre-clinical studies are conducted only arteries, is better at detecting a less conon male animals or do not report the gender. spicuous build-up of plaques in the blood

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INTERVIEW

How do you explain these shortcomings? PJ Following tragic scandals such as Thalidomide (Editor’s note: a drug used in the 1950s and 1960s to prevent morning sickness in pregnant women which caused serious congenital defects), clinical testing wanted to avoid including people who might be pregnant. But that’s not the only reason. We live in a male-dominated world. A greater diversity in profiles, especially more women, in the medical profession and among researchers would certainly make a difference. IV

“Doctors have to remember that there are differences between the sexes.”

IV Does this inequality exist in terms of funding? PJ Yes. Research on women’s diseases or those that affect more women are often under-funded. Lung cancer gets very little money, but kills more women in the United States than breast cancer, ovarian cancer, and uterine cancer combined. Women who are non-smokers are also three times more likely to develop the disease than men who are non-smokers. IV What concrete steps can we take to things? PJ Scientific journals, which have huge power in the academic world, could require researchers to systematically mention gender when reporting their findings. We could also develop labels, similar to the nutritional labels on food packaging, that would clearly say whether a medical drug or device has been adequately tested on both men and women. Lastly, we must teach doctors what we know so far. That will help break the cycle.

Can patients do something about it? Female patients must always ask their doctor about how things affect their gender. When they’re prescribed a treatment, they should ask, “Will it affect me differently because I’m a woman?” or “Has it been tested on women?”. This will require practitioners to examine the issue and seek out answers, which can move things in the right direction. IV PJ

Is this disregard limited to women? PJ No, we see the same thing with racial minorities. They are also affected differently by disease and often excluded from clinical trials. For example, we know that African-American smokers develop lung cancer more quickly than whites, but we don’t know change why. There is also a cumulative effect. African-American women are the population group with the highest risk of developing BIOGRAPHy A pioneer in a cardiovascular disease and dying from it women’s health, young. There are social and environmental particularly in explanations. They are often poorer, more cardiovascular diseases, Paula obese and have less access to healthcare. Johnson has But there are also biological factors that many strings we do not yet understand. IV

to her bow. She teaches medicine at Harvard, heads the Connors Center for Women’s Health and Gender Biology and is Chief of the Division of Women’s Health at Brigham and the Women’s Hospital in Boston. The 54-year old researcher has spent 25 years working in a number of different departments at the hospital, such as the heart transplant and quality control departments.

Isn’t this driving us towards increasingly personalised medicine? PJ Definitely. The more these different parameters, such as sex and ethnicity, are factored into medical research, the more we can develop diagnosis solutions, therapies and prevention methods that are adapted to a patient’s individual characteristics. This would not only benefit women and minorities. Men would also benefit from medical care based more on their biological features. /

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Death: thinking about living it Gian Domenico Borasio’s book,“Dying”, serves as a clear and surprising pain-reliever. He makes an interesting point: thinking about your death could help you live a better life.

text Béatrice Schaad

here are three golden rules to dying: talk, talk and talk. Discussing death with your loved ones, and especially with yourself, is the unconventional wisdom from Gian Domenico Borasio, professor and chair in Palliative Medicine at the University of Lausanne and chief of the Palliative Care Service at the Lausanne University Hospital. His book, Dying, has recently been translated into French after topping book sales in Germany, where nearly 150,000 people took an interest in the seemingly paradoxical advice of considering their own death while still alive. Understandably, it is something one might want to put off with multiple avoidance techniques. Gian Domenico Borasio writes how life’s end remains largely unexplored territory despite the gains in knowledge about how life begins, but. If you look up the “death” section in a physiology manual, you will find information only about the death of individual cells, parts of tissue or maybe organs.

The author has built his book on questions that are simple only in appearance. “Why do we die?”, he asks, going through the typical stages in pulmonary death or brain death. Or: where do we die? In a nursing home? At the hospital? In our own home? And more importantly: what do we need when we die? He describes the “lubricant” that is the communication between doctor and patient, “essential to any successful guidance” at the end of one’s life. Gian Domenico Borasio takes a spirited tone as he points out how, unfortunately, doctors quite often prove that it is easier to communicate badly than to overcome fears and difficulties about bringing up the subject.

He is an active supporter of teaching medicine differently. The specialist advocates an approach that is less strictly focused on technological development in favour of one that focuses on the more sensitive aspects, such as the emotions stirred by guiding patients in the last stage of their life. He studies communication in the broad sense, within the family or between specialists. In

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no way does he spare his own profession, always elegant but direct, and seasoned with a dash of humour – yet another lubricant. “Have you worked in a team? Show me your scars,” he says, referring to the sometimes turbulent collaboration between professionals at the bedside of a dying patient. For Gian Domenico Borasio, death – especially the death of others – is the essential subject of study in his life. The expert describes a number of other needs of the patient and their loved ones when dealing with such finiteness. In a style that reflects his uncommon intelligence and strength of conviction, he lays poignant and sometimes provocative arguments on the table, especially in the chapters on “pitfalls”. The first is believing that patients should be treated at all costs right up until the very last breath. But the facts are stubborn, he says.

The benefits and undesirable effects from artificially feeding and hydrating patients at the end of their life has been documented in scientific studies. The book is ideally structured by alternating between analyses and testimonies from patients and their loved ones. Then he supports his demonstrations by telling real-life stories, often with great sensitivity.

Question one’s practices, the fine line between the conviction to treat people and the risk of uselessly prolonging life. These are the issues that define the area of specialisation in which Gian Domenico Borasio has gained his international renown. But he laments that many people simply don’t know what palliative medicine entails. Quoting a survey by the Federal Office of Public Health, he writes that barely one-third of German-speaking Swiss can offer a definition. The French-speaking Swiss are the best informed (78%). Gian Domenico Borasio has undoubtedly dealt with this high score in practice as the first chair in palliative medicine in Frenchspeaking Switzerland since 2011 who also promotes it with various federal bodies. So what’s his philosophy? He believes that, ideally, palliative medicine could lastingly bring modern medicine closer to the patient, as it covers multiple disciplines and is more focused on dialogue with a certain awareness of its limitations. It will not be easy, though. There is considerable resistance within the medical community. And Gian Domenico Borasio has already overcome a number of these hurdles. The first is the reader. His appeal coaxes even the hardest-headed audience into thinking about their own death. His book, Dying, could just as well be entitled “Living”. By taking a pragmatic approach to the various steps preceding death, he invites readers into a form of deep introspection about the meaning of their own life – introspection that is neither imposed nor even suggested, but that flows naturally. His words teach us not only how to die, but also how to live, here and now, echoing the writings of Seneca as he fittingly warns, Read “While we are “Mourir, Ce que l’on postponing, life sait, ce que l’on peut faire, comment s’y speeds by.” /

préparer.” Presses polytechniques et universitaires romandes, Le Savoir Suisse Collection. This book is available at bookshops or from the publisher: www.ppur.org

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Text Marie-Adèle Copin

High potential? Parents want to know

Psychological examinations are increasingly common to identify gifted children. It’s a trend that hides a complex reality, as gifted children can also be prone to failure.

néa gets good marks. But she disturbs the class, talks a lot and complains often. This situation surprises her mother, Stéphanie Laurent. At home, this seven-year old schoolgirl from Lausanne is quiet, responsible and not the type to bother others. What’s wrong? School. Enéa is bored. A teacher friend advised Stéphanie Laurent to enter her daughter for tests to determine whether she was “high potential”. And the result came back positive. High potential (HP) children are referred to as gifted or precocious. They are sometimes compared with child prodigies, which is one reason for the increase in requests for psychological examinations. “Interest in these tests is growing,” states Pierre Fumeaux, a child psychiatrist at Lausanne University Hospital who is currently conducting a study on the subject. “A few years ago when parents or teachers had to deal with a difficult student, they would ask the doctor if the

Figures inset

Percentage of HP children within the population, according to the World Health Organization.

55% Percentage of HP children with a depressive disorder, according to the Swiss Association for Gifted Children.

33% Percentage of HP children who succeed in school, according to the French Association for Gifted Children.

child was hyperactive. Now the term ‘high potential’ has taken centre stage in the media.” Contrary to popular belief, gifted is not always synonymous with success. High potential children can also be prone to failure. A different brain

To be diagnosed as “HP”, an individual has to obtain a score of at least 130 on IQ tests. “But the score isn’t enough,” explains Claudia Jankech, a psychotherapist in Lausanne specialised in child and teenager psychology. “We also need to understand their family and social context and their personality.” Surprisingly, a high number of HP children have trouble in school. “When it’s too easy for them, they get used to being on autopilot,” says the psychologist. “They’ve never learnt how to learn.” These difficulties are partly due to what specialists call arborescent thinking. “Normal people develop logical reasoning through linear, sequential thinking. However, the thought process in HP children is like

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fireworks exploding with ideas and impressive intuition. They can solve complex equations but will have difficulty explaining how they came up with the answer,” explains Pierre Fumeaux.

enéa 10 years old A model child at home, Enéa talks a lot in class and disturbs her classmates.

Mathys 8 years old Mathys went through a period of irrational anxiety because he knew the earth’s core was on fire.

Studies suggest that HP children’s brains function differently. Information moves better between the two cerebral hemispheres. “We assume that they use both their left and right brains easily and have excellent abilities in both logic and creativity,” says the child psychiatrist. “Other work has shown that HP children can more easily juggle with concepts and think in the abstract, such as performing mental calculations. “In a functional MRI, a dye is injected to highlight the areas of the brain with the highest blood flow. Using a scanner, we can then see which areas are activated,” Pierre Fumeaux explains. “A stimulus or given task will activate certain areas of the brain in normal individuals. In HP children, sometimes several larger areas are activated at the same time,” he adds. These indicators help doctors understand how an HP mind works. “But our knowledge in neuroscience remains limited,” the researcher admits. “Being high potential is not an illness, but a special cognitive ability. And that’s not a priority for researchers.” Hyper-sensitivity

HP children also typically have emotional characteristics featuring high sensitivity or a high level of empathy. Stéphanie Laurent’s two other children, boys, have also been diagnosed as high potential. “Nathael, age six, cries at Christmas because poor people are cold and have nothing to eat.” His hyper-sensitivity distresses him. “It can take on huge Nathael

eric déroze

6 years old Nathael cries at Christmas because poor people are cold and have nothing to eat. 37

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proportions. At one point, Mathys, age eight, felt unreasonable fear because he knew that there was a core on fire at the centre of the earth.” Myriam Bickle Graz, a developmental paediatrician at Lausanne University Hospital who wrote a thesis on the subject, says, “The children seen at consultations were often overwhelmed by their emotions. For some, it was incredibly difficult; they have no filter,” she explains. “The fear of death, for example, comes very early.” They develop symptoms such as anxiety, sleep disorders, strained relationships with other children and aggression. As in the Laurent family, there are often several gifted siblings. “Not all siblings are necessarily going to be HP, but there is a certain degree of genetic heritage. However, that hasn’t been proven scientifically,” explains Myriam Bickle Graz. “It remains a clinical observation.” Although some high potential children suffer, the majority of them lead normal lives. As summed up by Pierre Fumeaux, “the happiest HP children are those who are not identified as such and manage to adapt.” ⁄

INTERVIEW “The methods of diagnosis are debatable” In a survey conducted on gifted children, the French sociologist Wilfried Lignier noted that specialists do not agree about the tests designed to diagnose giftedness. You observe that most gifted children don’t have difficulty in school or psychological problems. Why then do parents have them take tests? WL These parents are very concerned that their children will face difficulties, whereas they actually have every chance of success. They think that the school’s assessment is not enough. Psychology offers greater legitimacy for their concerns. IV

You approach giftedness as a “debated and debatable” issue. Why? WL Many psychologists don’t recognise giftedness mainly because they doubt the credibility of IQ tests. These tests are meant to assess something other than academic skills, but in form they are quite similar to the exercises performed in school. Furthermore, children also have this impression. After the test is over, some say that they did well in the “maths” section, referring to the logical reasoning, or the “language” section, referring to the vocabulary. Being so similar to exercises done in school, these tests contradict the idea that intelligence isn’t the same as academic performance. Yet most of the social repercussions expected from test results are based on the idea that they tell a truth that school does not. IV

You show that the diagnosis swings in favour of one gender. How do you explain that high potential is more often diagnosed in boys? WL Parents tend to express greater concern about their future, as it more readily carries their hopes of upward social mobility. The fact that boys have greater chances of having “symptoms”, such as openly expressing their boredom or not being able to stay still, also plays a role. IV

FIND OUT MORE

“The Little Nobility of Intelligence – A Sociology of Gifted Children” (La petite noblesse de l’intelligence: Une sociologie des enfants surdoués), Wilfried Lignier, publisher: La Découverte, 2012. 38

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clinical trials: is n

“Th

w a l e

r in favou

s” t n ie t a p The framework for clinical trials has been strengthened by new legislation ragarding research on humans. But it’s not enough. Text: Benjamin Keller

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experience serious negative side effects, says the Swiss Patient Organisation (SPO).

ast year, 205 clinical drug trials were authorised in Switzerland, each including hundreds or even thousands of participants. These tests are not without risk. Swissmedic, the Swiss authority responsible for the authorisation and supervision of therapeutic products, has reported 78 cases of “unexpected serious adverse events” (see glossary). The people who take part in studies are not adequately protected when they

Switzerland’s new Human Research Act passed on 1 January 2014 has improved the framework for clinical drug trials by setting up a national registry to record clinical trials and by improving the classification of research procedures according to the risk involved. However, the legislation did not introduce the SPO’s primary demand to reverse the burden of proof if the participant is harmed. “The new law is not in favour of patients,” claims the SPO delegate for French-speaking Switzerland, Anne-Marie Bollier. “In the event of complications,

it is the injured party who has to prove the relationship with the drug administered under the trials.” That is what is explicitly written in the Explanatory Report on the Ordinances to the Human Research Act. She criticises this requirement as “absurd”. “The balance is unfairly tipped in favour of industry and insurance companies. Patients don’t have 35 lawyers paid year round to defend them.” The SPO demands that it should be the responsibility of the research organisation and its insurance company to discredit any causal relationship, not for the participants to demonstrate it. Legal battles

The SPO President Margrit Kessler does not provide any

Gaetan Bally / Keystone

“It seems absurd that in the event of complications, the injured party has to prove the relationship with the drug administered under the trials”, says Anne-Marie Bollier, the French Swiss delegate of the Swiss Patient Organisation.

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specific figures but mentions “several cases” where subjects in clinical trials were victims of complications and did not receive financial compensation or had to fight to receive any. In addition to the inflexibility of insurance companies and sponsors of clinical studies, the SPO criticises the denial of medical investigators. The organisation provides concrete examples on its website, such as the case of a man suffering from advanced melanoma. He did not want to be treated using chemotherapy, so he participated in a research project based on an alternative treatment. Nine days after testing began, he experienced partial paralysis in the face, a side effect that had never been mentioned previously. The medical community first denied any relationship with the treatment. It was the patient’s wife, a nurse, who managed to prove it after a long battle. Now, after the intervention of the Ethics Committee, facial paresis is included in the initial analysis report. Health professionals, however, believe that patients benefit from adequate guarantees. “I don’t see how participants could be better protected, given the number of rules and clinical best practice guidelines that have to be followed,” says Bernard Waeber, director of the Clinical Research Centre at Lausanne University Hospital. “Before deciding on any changes to reverse the burden of proof, we should first

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draw from the teachings of the Human Research Act’s first year of application,” says Maximiliano Wepfer, deputy head of communication at the Swiss Medical Association (FMH). Tighter control over individual studies

The fate of subjects in clinical drug studies is not the SPO’s only concern. This umbrella organisation also demands greater protection for individual testing. The practice is legal, as long as patients provide their “informed consent” and are indeed properly informed. “But it doesn’t always work that way,” Anne-Marie Bollier of the SPO points out. “Patients with a life-threatening illness will try anything, and information is not always entirely clear,” she notes. The SPO requested, in vain, that individual testing be covered in the Human Research Act. “We want the law to require a written record of what the patient knew at the time testing began,” says Anne-Marie Bollier. The organisation won a halfvictory. Thanks to her efforts, the Swiss Academy of Medical Sciences began reviewing the directives on the distinction between a standard treatment and an experimental treatment, including specific rules governing the information that must be provided for patients. The SPO delegate applauds this progress but remains cautious: “At least it provides a legal reference in the event of a dispute in court.” ⁄

Glossary 1. Clinical trial A study conducted on human beings to test the safety, efficacy and other properties of a treatment (e.g. a drug).

2. Sponsor

Person or organisation that initiates a clinical trial.

3. Investigator

Person responsible for conducting a clinical trial (e.g. a doctor).

4. Unexpected serious adverse effects

Any unexpected serious adverse effect (that causes death, is life-threatening or requires extended hospitalisation) related to the use of an experimental drug during a clinical trial.

5. Individual testing

Experimentation on a non-standard treatment (e.g. an unauthorised drug) as part of an individual consultation.

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Taxing calories Should fattening and sweetened foods be taxed to discourage consumers? Several countries have tried it. Their experience says a lot. effective are these measures? A 10% tax on n Switzerland, 41% of the soft drinks would lead to a 7% reduction population is overweight, in soft-drink calorie consumption, as and one-tenth is obese. calculated by a study published in Elsewhere, the situation is Archives of Internal Medicine. The study worse. Nearly 70% of the also found that an 18% tax on unhealthy population in the United foods would result in weight loss of only States is overweight, and 2 kg per year in overweight one-third is people aged 18 to 30. obese. In response “The tax has to be high to this Denmark: In October 2011, enough if we want to epidemic, Denmark introduced change consumer beha which can Text a tax on foods that Julie Zaugg viour,” says Oliver Mytton, lead to contained more than researcher at the Centre diabetes, 2.3% trans-fat, which for Diet and Activity heart disease and even the upped these prodResearch at the University reappearance of forgotten ucts’ prices by about 10%. The measure of Cambridge (UK), who diseases such as gout, a was scrapped at analysed 30 international number of countries have the end of 2012 due studies conducted on this decided to tax sugary and to pressure from type of tax. “Otherwise, fattening foods. But how industry and unions, as was a sugar tax planned for 2013.

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people wouldn’t even notice it, or it would be absorbed by retailers.” He says it would have to be at least 20% for it to really have an impact on consumers. Mytton recommends taxing sweetened drinks as a priority. “They aren’t necessary for our diet,” he says. “They contain only ‘empty’ calories and provide low satiety. It’s perfectly justified to pick them out as a target.” The rare examples of taxes enforced offer valuable lessons.

KEYSTONE / SCIENCE PHOTO LIBRARY / PETER MENZEL

United States: Nearly two-thirds of US states (35 in 2011) have introduced a tax on sweetened drinks, but it rarely exceeds 4%. New York banned transfats at its restaurants in 2006. However, a law limiting the size of soft drinks to 16 ounces (0.5 litres) was blocked at the last minute.

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Denmark introduced a trans-fat tax in October 2011, which it repealed in early 2013. “We noted that consumption of fat and oil had fallen 10% to 15% while the tax was in force,” says Sinne Smed, a researcher from the Department of Food and Resource Economics at the University of Copenhagen. “The preliminary findings of a new study showed a 6% decrease in the consumption of saturated fatty acids. People seem to have given up butter and margarine the most.” Just as striking is the example of the cafeteria at Brigham and Women’s Hospital in Boston (USA), which introduced a 35%

Photographer Peter Menzel took the portraits of trucker Conrad Tolby and farmer José Angel Galaviz Carrillo (pg. 44) for the book “What I Eat: Around the World in 80 Diets”, which features women and men from 30 countries around the world along with the food they eat each day.

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hike on the price of sodas. Consumption dropped 26%. But taxing food also brings about negative effects. “By targeting foods like oil and butter, which everyone consumes, we risk driving people towards substitutes that are equally unhealthy,” says Oliver Mytton. “Consumers tend to replace fat with salt.” The risk is that the tax may discourage high-fat but healthy foods, such as avocados and nuts. However, there are few unhealthy substitutes for sweetened drinks. “People will drink water or fruit juice instead,” he says.

Mexico: The Mexican parliament recently passed an 8% tax on foods containing more than 275 calories per 100 grams and a soda tax of one peso per litre. Mexico is the world’s leading consumer of soft drinks – 163 litres per person per year.

“Some consumers may even cut back on fruit and vegetables to buy unhealthy foods, giving up carrots to buy a bag of crisps instead,” says Sinne Smed. In 2012, 48% of Danes crossed the border into Germany and Sweden to do their shopping. Fat and sugar taxes are regressive, disproportionately affecting the poor. “Low-income families tend to live in ‘food deserts’, where they can only

find high-fat, pre-cooked foods,” says Roberta Friedman, director of Public Policy at the Rudd Centre for Food Policy & Obesity at Yale University (USA). Jim O’Hara, from the NGO Centre for

KEYSTONE / SCIENCE PHOTO LIBRARY / PETER MENZEL

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Science in the Public Interest, and one of the first advocates of food taxes, points out that “underprivileged populations are also those that suffer the most from obesity and diabetes and would therefore be the first to benefit from improvements brought by these taxes.”

François Pralong, head of the endocrinology, diabetology and metabolism service at CHUV.

But there is another hurdle: the food industry. Taxes on unhealthy food would also have to overcome that barrier of opposition. “They succeeded in killing a tax on sweetened drinks in New York in 2010,” says Jim O’Hara. The American Beverage Association invested $9.4 million in the campaign while, on the other side, the organisations supporting the tax had to make do with between $2.5 million and $5 million. Sinne Smed observed a similar pheno menon occurring in Denmark. “Before the tax on food was introduced, a majority of the population was in favour of it. Then the food industry spent months arguing that it was a burden on people’s income, causing job losses and generating extra administrative costs for farmers and small producers. As a result, public opinion also changed sides.” By April 2012, 75% of Danes were against the tax. Although a fat tax will not solve the problem of obesity, it plays an important role. Roberta Friedman argues that the tax can raise revenue that can be used to pay for obesity prevention programmes, such as introducing more nutritious meals at schools or promoting exercise. “The money could also be used to subsidise fruit and vegetables, which would gradually reduce their prices as those on high-fat foods rise,” adds Sinne Smed. Denmark’s trans-fat tax raised $216 million. ⁄

“We help patients understand the relationship between diet, physical activity and weight gain” interview François Pralong believes that promoting physical activity and developing food and nutrition education are essential in the fight against obesity.

How do you treat obese patients? fp Treatment includes three areas. The first is diet. We teach patients how to identify hidden fat and sugar, better judge portions and understand the value of different nutrients. The second is psychology. We focus on the eating disorders that caused the weight gain. The third is to encourage physical activity. iv

And that’s not enough? About half of the patients that come to us will end up having gastric bypass surgery. As the operation is irreversible, iv

we have to make sure that the person is prepared, that their weight stabilises and that they are monitored for the rest of their lives. What about obesity prevention? fp We have recently created a consultation for overweight patients. It is designed to catch them in time before they develop morbid obesity, by helping them understand how eating habits and physical activity have an impact on weight gain. Some are not aware of it, or are in denial. iv

philippe gétaz

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commentary

Allen Frances Professor of psychiatry at Duke University

The current focus in neurosciences harms mental health patients. Each of our mental disorders is a final common pathway for hundreds of different pathological processes involving the brain interacting with its physical, psychological and social environment. Sorting this out will require tiny steps forward, achieved painstakingly over decades – with no breathtaking wholesale breakthroughs.

For the neurosciences, this is the best of times. The expansion of knowledge and tools has exceeded all expectations and represents a triumph of technological innovation. For the psychiatric patients who are the presumed beneficiaries, this is the worst of times: a tragic regression into a new dark age in which mental illness is once again criminalized. Why the disconnect? Accomplishing the difficult step between basic science and clinical practice has been frustratingly slow in all of medicine and so far completely impossible in psychiatry. We have learned a great deal about normal brain functioning; but despite mighty and expensive efforts, we know nothing useful about the pathophysiology of mental disorders and have no biological tests for their diagnosis.

By focusing funding and advocacy on finding future breakthroughs, we, to a shameful degree, ignore the desperate needs of patients in the present. In the U.S., the enormous resources of the National Institute of Mental Health are single-mindedly devoted to a narrow neuroscience agenda. Its research portfolio is distressingly short on clinical and health-services studies and almost completely bereft of psychosocial studies.

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During the past 50 years, mental health budgets in the U.S. that were never adequate have been gradually but mercilessly cut. Neglected patients The brain is the most complicated contraption receiving grossly inadequate care (and often we are ever likely to encounter and reveals enough becoming homeless) are frequently its secrets only in the tiny pieces that imprisoned for nuisance crimes that could easily make up an intricate jigsaw puzzle with have been avoided had their basic needs been met. a trillion permutations. In contrast, most European countries have done a better job of combining deinstitutionalization with proper community care and decent housing. The hoped for, but uncertain, gains to be derived from a high-tech future have triumphed over the PROFILe Allen Frances is Professor much less glamorous, but much more useful and Emeritus of psychiatry necessary, task of providing good care and housing at Duke University. He to people who need it now. Neuroscience research is chaired the task force that a great good, but exaggerated claims of what it can produced the 4th edition of the Diagnostic and accomplish and when have inadvertently contributed Statistical Manual (DSMto the great evil of criminalizing mental illness. ⁄ IV) – but has strongly criticized the 5th edition of the “Bible” of psychiatric disorders.

find out more

http://psychiatry.duke.edu/

the promise of electricity Electricity is gaining interest from doctors in treating certain health issues such as asthma, heart conditions or Parkinsonâ&#x20AC;&#x2122;s disease. And new areas of research continue to develop.

Computer generated image illustrating treatment by deep brain stimulation.

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TIM VERNON, LTH NHS TRUST / SCIENCE PHOTO LIBRARY

Text: Jean-Christophe Piot

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Full of nerve impulses, pulses and neuron activity, the human body is an electric power station. And medical diagnosis could hardly do without electricity. Anyone who has had an electrocardiogram (ECG) can confirm it. However, the therapeutic use of electricity has always been subject to debate. Many believe it is limited to transcutaneous electrical nerve stimulation (TENS). This technique, which involves placing electrodes on the surface of the skin, is very commonly used in hospitals in Germany and the United States. By adjusting the electrical frequency and treatment duration, pain specialists relieve the pain of patients suffering from rheumatism or arthritis who are resistant to analgesics. But other therapeutic applications of electricity are also being explored. Electrotherapy is already effective in treating an irregular heartbeat. This condition is common after age 65 – 5% of the world’s population in this age group suffer from arrhythmias – and can affect younger people as well. “Medicine does not always work, and pharmaceutical research is having trouble finding effective molecules,” says Martin Fromer, chief of the Cardiac Arrhythmia Unit at the Lausanne University Hospital. For several years, he and his team have been treating arrhythmias by inserting a catheter into the heart of patients. “Progress in imaging allows CORPORE SANO

The year during which the Geneva-based physicist Jean Jallabert developed an electrostatic generator used to stimulate muscle contractions in paralysis patients.

us to combine electrical and anatomical information to provide a mapping of — the precise location that is causing problems.” The The frequency in hertz of currents practitioner uses catheters used in transcutaneous electrical to treat strucnerve stimulation, a technique tural abnorused to treat pain. malities using electromagnetic currents at different frequencies. akinesia (inability to perform This technique stabilises the certain body movements) and condition in older patients rigidity. Although promising, and reduces the risk of sudden the procedure requires close death. Patients under age 30 post-operative monitoring as are healed permanently. it can have complicated side Deep brain stimulation effects in 2% to 3% of cases, Electricity is also used to treat which include disorientation, neurodegenerative diseases hemiparesis (partial paralysis) such as Parkinson’s. Deep brain and haematomas. stimulation (DBS) has provided neurologists with a reversible Deep brain stimulation has also and adjustable therapeutic attracted specialists in other technique that has improved neurological disorders. At the over the past twenty years Grenoble Institute of Neuroscithat it has been in use. Docence, physicist Olivier David tors implant an electrode in has been working in close coleach hemisphere of the brain, laboration with the neurologists using a three-dimensional from the Grenoble University reconstruction of the brain for Hospital on certain forms of positioning. The electrodes are epilepsy that are resistant to then connected to an implanted traditional treatments. “When pulse generator, generally the electrode implanted in placed below the clavicle. DBS the brain detects an anomaly in has been a success in severe the neuronal electrical activity, cases by significantly reducing it emits an electrical stimulation the worst symptoms such as to regulate it.” The initial clinical

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INNOVATION

trials are encouraging. “In one out of two patients, we have managed to reduce the number of epileptic seizures by 50%,” states Olivier David. This does not mean that the new form of treatment will be approved immediately. “Technically, the intervention is reliable, but it will take another five to ten years to define procedures and determine how insurance companies will cover this type of therapy.”

Already in roman times

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In the time of the Roman Empire, doctors were already using electricity to heal their patients, using a natural electric power source: fish. Scribonius Largus, Emperor Claudius’s personal doctor, has remained famous for trying to offer his patient relief from gout pain and frequent migraines. He would place a torpedo ray between the emperor’s eyebrows and allow the fish’s electrical discharges to continue until the patient felt numb. Torpedo rays can give off electric shocks that exceed 30 amperes.

INNOVATION

PAUL D STEWART/SCIENCE PHOTO LIBRARY

Relief for asthmatics

In San Antonio, Texas, Pedro Sepulveda, a pulmonologist at the Alamo Clinical Research Center, is at a similar stage of development. He and his team have experimented with electrotherapy in severe asthma cases in which patients do not respond to pharmacological treatments like oral corticosteroids or bronchodilators. “The procedure involves placing, under local anaesthetic, an ultrasound-guided percutaneous electrode (Editor’s note: by needle-puncture through the skin) near the carotid sheath (Editor’s note: in the neck),” the specialist explains. The area was then electrically stimulated for three hours. And the results were conclusive. The maximum expiratory volume per second in patients increased 10% to 15% within 30 minutes following the intervention. “In the future, these non-pharmacological treatments could offer relief for the weakest patients.” /

Sex and psychiatry, a volatile combination? Sexual relations at psychiatric hospitals are implicitly banned to protect patients. However, some institutions in Frenchspeaking Switzerland have begun to use the services of sexual assistants.

text: Julie Zaugg

laude has spent more than two-thirds of his life in psychiatric hospitals. He was sentenced in 1975 for murdering his girlfriend’s lover. The Frenchman, now 69 years old, first spent eight years in prison before being committed to a facility for patients with

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serious mental illnesses. In 2008, when he was at the Cadillac Hospital in Bordeaux, France, he demanded the right to have sexual relations, “in protest against his unit’s regulations which banned any activity of this sort,” says his lawyer Pierre Burucoa. The case reached the Bordeaux Administrative Appeals Court, which ruled in favour of the patient in January 2013, on the grounds that sexuality was a fundamental right, on the same level as respect for one’s private life established by the European Convention on Human Rights. This example is exceptional. “It’s a real taboo in France,” says Pierre Burucoa. “Sexual activity between patients is an issue faced by all psychiatric hospitals, but none of them have any clear-cut rules on the subject.” What is the situation in Switzerland? “At Swiss institutions, there is no explicit ban, but most prohibit it more subtly and implicitly,” says Jean-Louis Korpès, professor at the College of Social Work in Fribourg. “Patients are under constant staff surveillance, from the moment they get up until they go to bed at night, making any form of intimacy impossible.” Until the 1960s, mental patients systematically underwent sexual sterilisation.

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“At the Hospital of Cery in the Vaud canton, sexual relations are considered a fundamental right and are not formally banned. But the institution’s handbook asks patients to refrain from sexual activity during their stay,” says Philippe Conus, chief of the General Psychiatry Service at the Lausanne University Hospital. He points out that “psychiatric hospitals are no longer places where patients live. Those who do are experiencing an acute crisis and come for a short stay (20 days on average at Cery).” These precautionary guidelines reflect a concern about causing additional suffering. “People admitted to psychiatric facilities are in a situation of intense distress and vulnerability,” says psychiatrist Giuliana Galli Carminati, former senior physician at the Belle-Idée Hospital in Geneva. “They’re incapable of making a well-thought-out decision on their sexuality.” Underpinning this hypothesis is the question of judgement. It is particularly difficult to assess the capacity for good judgement in people with impulsive behavioural disorders or who have hallucinations. Sexual desire can also impact the choice of medical treatment. “Antipsychotic drugs can cause sexual dysfunction,” says Philippe Conus. “Some patients stop taking them to avoid this unpleasant side effect. That’s one of the reasons why we talk to them regularly about all side effects, to try to find alternatives and help them live a normal life.” Another danger is that CORPORE SANO

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sexual desire is sometimes actually one of the patient’s symptoms. “Mania in bipolar patients can be associated with a tendency towards promiscuity, disinhibition or even exhibitionism,” says Philippe Conus.

“behind the ban of sexual relations between patients lies the fear that they will result in pregnancies that cannot be taken care of.” Jean-Louis Korpès

Some disorders are believed to cause unpredictable behaviour. “People with sexual perversions can become violent or dangerous,” says Catherine Agthe, sex educator and president of the organisation Sexualité

et Handicaps Pluriels (SEHP). “Others have a tendency towards paedophilia or fetishes that they want to impose on others.” The issue of the sexuality of psychiatric patients raises another taboo. “Behind the ban lies the fear that sexual relations will result in a pregnancy, a child who cannot be cared for,” says Jean-Louis Korpès. “The point is not to forbid a patient from getting pregnant. But before she makes that decision, we will discuss it with her, to see if it’s the right time in her life and how she could care for the child,” says Philippe Conus. “This way, we can offer close support during the pregnancy and after the child’s birth.” He adds that the risk of postpartum depression is higher in women with mental disorders. Some medication is incompatible with a pregnancy, and treatment needs to be adjusted. Despite all these obstacles, many experts wonder if prohibiting sexual relations is really the right choice. “Some patients will break the rules regardless,” says Catherine Agthe. And when patients

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secretly engage in sexual activity, they sometimes resort to deviant behaviour that is far worse than the act itself. “They can even get obscene, with sexual acts being performed in toilets or gardens,” says Jean-Louis Korpès. “Due to the lack of information provided and absence of contraception, there is a risk of sexually transmitted diseases or unwanted pregnancies.” Banning sexual relations becomes less and less arguable as the age of psychiatric patients lowers. “Early intervention and prevention methods deployed over the past few years and the use of mobile teams reaching out to the mentally ill have reduced the average age of patients,” says Philippe Conus. “At Cery, the average age is 35.” It is even less acceptable if their stay is extended. “The average hospitalisation time is supposed to be quite short, but some residents have been and are committed for years,” says Catherine Agthe. In some cases, sexual assistants can offer a solution. These people receive specialised training to offer disabled people sexual assistance. These sexual “surrogates” have been operating in French-speaking Switzerland since 2009 and in German-speaking Switzerland since the early 2000s. “In Geneva, psychiatric services already work with us occasionally,” says Catherine Agthe, whose organisation trains both male and female sexual assistants in Frenchspeaking Switzerland. “In Lausanne, they are beginning to look into

TABOO

the option.” Some 20% of the requests handled by SEHP come from the mentally ill. “If one of our patients is aggressive or tense, and it seems to stem from some form of sexual frustration, we have been known to use the services of a sexual assistant,” confirms Giuliana Galli Carminati, referring to the practices at the Belle-Idée Hospital in Geneva.

However, each case had to be carefully reviewed. “This solution is only an option for patients with a sufficient level of self-control and some degree of emotional maturity,” she says. And it must remain an outpatient service, which takes place outside the hospital. “Mixing settings is out of the question,” she insists. “Medical care and sexual relations must not take place in the same environment.” /

Transgressing the taboo for the mentally disabled Although sexual relations between patients and psychiatric staff remain questionable, sexual activity between the mentally disabled is now quite the norm. “The staff at psychiatric facilities is trained to deal with the emotional and sexual issues in patients’ lives, and residents are allowed to express themselves,” says Catherine Agthe, sex educator and president of the organisation Sexualité et Handicaps Pluriels. “Over the past twenty years, new solutions have been created to address these issues, in the form of evening events, slow dating, double rooms for couples and, since the 2000s, sexual assistants.” Carmen Wegmann from the organisation Insieme believes that Switzerland’s ratification of the UN’s 2006 Convention on the Rights of Persons with Disabilities stepped up the “standardisation” of all aspects of their lives, including sexual intimacy. Stark differences remain between facilities. “Some allow patients to share rooms and talk very openly about the sexuality of their residents, while others deny it, assuring that that never happens at their facility,” she says. The sexuality of the mentally disabled has also created new challenges. “Supporting them by offering sexual assistance is essential, but they can become too attached or fall in love with the person providing the service,” says Carmen Wegmann. The issue of a potential pregnancy has not yet been solved. “Having a child is a fundamental right, but it remains very complicated in practice,” she says. “These women themselves often need day-to-day support.” CORPORE SANO

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Text: Clément Bürge illustration: leha van kommer

The quest for immortality A growing number of research projects are looking for ways to extend lifespan. Tests on human beings are set to launch shortly.

he science of immortality has always captivated researchers. In 1914, the French surgeon Serge Voronoff tried to extend life expectancy by grafting monkey glands into humans. In more recent years, research on methods to stop – or at least slow – ageing has been rejuvenated. In 2013, Google founded Calico, a company aimed at finding a cure for ageing. Another example is Dmitry Itskov, a Russian multi-millionaire who has brought together researchers from around the world to develop a solution to immortality. “The number of projects is increasing for one simple reason: we are getting closer to the end goal,” says Aubrey CORPORE SANO

de Grey, an immortality specialist. He believes that, for the first time in the history of humanity, we have the fundamental knowledge needed to prolong life expectancy. Now it is just a question of time. Here we present an overview of the most compelling projects.

Rejuvenating the hearts of mice

Amy Wagers and Richard T. Lee, researchers from the Harvard Stem Cell Institute (USA), surgically connected the circulatory system of a young mouse to that of an older mouse. After only four weeks, the symptoms of cardiac hypertrophy due to the older rodent’s ageing had reversed. “The heart’s prospection

walls thicken with age in mice, as they do in humans,” says Richard T. Lee. “This is the primary cause of age-related heart failure. In our experiments, the older mouse’s heart had clearly regained the size of the younger mouse’s. It was visible to the naked eye.” The researchers also noticed that this rejuvenation was caused by the presence of a blood protein, GDF-11. They are now trying to establish what effects the protein could have on other types of tissue. “We hope to begin clinical trials within four to five years.”

The paradox of natural selection

Natural selection favours organisms that have the best chances of survival and

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prospection

reproduction. Based on this logic, the process should prevent genes that trigger ageing from being passed on. But that is not the case. British researcher John Pannell,

Keeping things under control Regulating production The development of medication to treat ageing may be a sensitive subject for the pharmaceutical industry. “The treatments that will be developed will primarily be preventive,” says Hugo Aguilaniu. “The pharmaceutical industry can theoretically sell an infinite number of drugs. But how far will it go? I fear that those companies are not capable of setting reasonable limits.” These drugs could potentially generate almost infinite revenue. “External regulation would be necessary,” says the longevity expert. Another obstacle is that, to prove that these drugs increase lifespan, clinical trials would have to be conducted for 50 years. “And no company has the means to do that.”

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professor in the Department of Ecology and Evolution at the University of Lausanne, wanted to understand why. He studied the longevity of the “Silene latifolia” plant. “It’s

Preventing social repercussions Every human has to die someday. Certain people believe that artificially extending human life is unnatural. “Some think a distinction should be made between ageing and age-related diseases, which is absurd,” says Aubrey de Grey. “We are trying to slow the accumulation of junk in our bodies to cure diseases caused by ageing. It’s merely preventive medicine.” Extending life expectancy will also present a huge challenge for society. “The social repercussions will be dramatic,” says Rafael de Cabo. “How can we take care of people who live to age 120 or 150? How can we pay for their care? It would require major social reforms.” The Japanese researcher Shin Kubota also believes that the demographic growth would be unmanageable.

prospection

a paradox. Ageing and the deterioration of the organism decrease survival and reproductive performance,” he says. His team led an experimental study on quantitative genetic models. “We discovered that organisms do not develop genetic mutations at the beginning of their lives because they have greater chances of reproduction,” the scientist explains. “However, as they age, the reproductive performance in these organisms declines. That’s when they develop signs of senescence.” The genes that cause ageing are then passed on from generation to generation for one important reason. We might expect natural selection to eliminate these genes, he says, but they offer a set of advantages, mostly reproductive, which it is difficult to do without. His findings offer insight about how ageing functions and increases the chances of developing a treatment.

The seven causes of ageing

British researcher Aubrey de Grey has become a key figure in the fight against ageing. With his long bushy beard, pale skin and elongated silhouette, the University of Cambridge (UK) educated software engineer turned self-taught expert in biogerontology resembles a character worthy of a Shakespearian play. He has identified seven

types of ageing damage. These include cells that die and cannot be replaced, cells that should die but continue to live, mutations in the nuclear and mitochondrial DNA and junk aggregates inside and outside cells. To address these seven points, Aubrey de Grey founded the United Statesbased research foundation SENS – Strategies for Engineered Negligible Senescence. “We fund regenerative medicine projects and lead a number of them,” says de Grey. “Our goal is to prevent age-related illnesses.” Aubrey de Grey is convinced that the first man to live one thousand years is already alive. He gives it a 30% to 40% chance that the people in his age bracket – in their forties – are young enough to benefit from these therapies.

Reproduction, the key to longevity?

Research by Hugo Aguilaniu from the école Normale Supérieure de Lyon (France) is based on an observation that during reproduction animal organisms rejuvenate radically. “When a child is conceived, cells that are several decades older – those of the parents – combine to create cells that are age zero,” says Hugo Aguilaniu. “I wanted to understand how that worked.” The French researcher used a nematode worm, Caenorhabditis elegans, as a model and discovered that CORPORE SANO

the oxidation of its oocytes slowed considerably during reproduction. “Once the process is revealed, we can identify the genes and proteins that can slow ageing in humans.” Hugo Aguilaniu also applies another approach. “We analyse the impact of some genes that potentially increase the organism’s longevity.” There are thought to be about fifty of them that notably boost stress resistance. “The problem is that if we activate them, we risk jeopardising the human’s reproductive abilities.” The researcher has already filed patents on some genes, such as nhr-80. “We are continuing our work, but we are still several years away from beginning experiments on humans.”

The promises of the immortal jellyfish

In 1988, a young German researcher named Christian Sommer discovered the Turritopsis dohrnii jellyfish off the Italian coast while conducting research on hydrozoans. He noticed that the little creatures did not die. In 1996, a team of researchers observed that the jellyfish can revert to polyp form, the earliest stage of life, at any time. As such, this gelatinous being can “escape death” and become immortal. The transformation is comparable to a chicken becoming an egg, then a chick again. prospection

The discovery drew the attention of a Japanese researcher, Shin Kubota, who is convinced that this jellyfish holds the key to longevity in humans. He has published more than fifty scientific articles on these animals and how they work, but has not yet unlocked the secret to their immortality.

A molecule for living longer

Rafael de Cabo works for the National Institute on Aging, a US government-led organisation formed by Congress in 1974 to study life extension. The institute discovered that the activation of the protein sirtuin 1 delayed the onset of age-related diseases. “We used a small molecule called SIRT1720 on mice to increase their sirtuin 1 level,” says the Spanish-born researcher. He gave a 100-mg dose of SRT1720 to mice from age six months to the end of their life. De Cabo found that the mice’s life expectancy increased 8.8%, and their muscular function improved. At the same time, their weight and the proportion of fat in their body fell. “Our research illustrates that we can develop molecules that ameliorate the burden of metabolic and chronic diseases associated with ageing.” The National Institute of Aging plans to launch clinical tests on sirtuin 1 activators in 2014. ⁄

What your tears can say about you Text Jean-Christophe Piot

Blood and urine are not the only bodily fluids that can be used to form a diagnosis. New methods of medical screening are proving their worth.

“W

e’ll take a blood sample.” When faced with a number of symptoms, doctors look to samples of haemoglobin or urine for information to establish their diagnosis. “These two bodily fluids provide a wealth of precious information on a patient’s state of health, revealing biochemical markers, antibodies, proteins, and so on,” says Natacha Turck, assistant lecturer with the Department of Structural Biology at the University of Geneva. However scientists are now looking into other bodily CORPORE SANO

Trends

substances to perform their biological analyses. “Blood and urine tests have their limits. Urine is very rich in salt and crystals, which makes it difficult to analyse protein biomarkers. And blood is full of proteins such as albumin, which hides the fainter traces left by other indicators.” Your breath speaks volumes

One of the most encouraging fields of research, volatile organic compounds (VOCs) – substances in the air that

Rose-lynn fisher

Based in Los Angeles, Rose-Lynn Fisher is a photographer who explores the links between art and science. Pictured here are her works “Tears for those who yearn for liberation” and “Tears of ending and beginning”, from her series on the “topography of tears”. CORPORE SANO

Trends

humans can ingest by breathing – is without a doubt the most popular. Some procedures are already commonplace, in particular in gastroenterology, where they are used to identify the bacteria present in the digestive system. In these tests, the patient ingests a specific amount of various sugars (lactose, fructose, etc.) that are broken down in the digestive tract. Then traces of these elements found in the hydrogen exhaled are compared with the patient’s base reading to detect any abnormality. The urea breath test is the most common and is used to diagnose the presence of Helicobacter pylori, the bacteria mainly responsible for gastric and duodenal ulcers. What’s next? Researchers hope that they can use these methods to diagnose serious diseases earlier. The first symptoms, which closely resemble those of minor health issues, can be difficult to catch in time, as in the case of stomach or lung cancer, hepatic diseases, and others. This is crucial in oncology, where early diagnosis can make all the difference. These tests offer vast potential, with more and more studies being conducted worldwide. They aim to identify and list the relevant biomarkers and associate a given pathology with a given variation in chemical make-up detected by the electronic “noses”. Tecnalia, one of the largest private research groups in Spain, is developing biosensors “capable of detecting the presence of tumor markers of lung cancer in exhaled breath,” explains Eva Ibanez, head of the Medical Innovation department. “In parallel, we’ve increased the sensitivity of the devices.” After collec ting breath samples from patients at a partner hospital, Tecnalia staff compared them with breath samples from healthy people to determine the most representative compounds to act as markers. CORPORE SANO

Self-diagnosis sparks debate Cheap do-it-yourself biological tests now allow anyone to screen for diseases such as glycemia, cholesterol and certain cancers in their own home, rather than solely in a laboratory. Over-the-counter availability is within reach, stirring debate among the medical community. Healthcare authorities hope this trend will reduce costs and administered care, but doctors are more sceptical. They fear a misuse of these kits, which could result in false positives or flawed interpretations. Similar red flags are being raised by biologist organisations and Switzerland’s Federal Office of Public Health (Office fédéral de la santé publique or OSFP), which believes that all analyses of a biological test should take place in a doctor’s office.

Trends

Sweat and tears

In the future, screening may very well move beyond the breath into the eyes or under the arms of patients. Sweat and tears are some of the most telling bodily fluids. For years, Natacha Turck has been working on spotting protein biomarkers as well as parasites present in tears. They are likely to detect a viral infection, determine a medical diagnosis, identify the risk of a stroke or improve the monitoring of diseases such as multiple sclerosis. “These tests have the advantage of being painless, inexpensive, fast and practical. All it requires is placing a blotter near the cornea to collect a sample,” says Natacha Turck. And sweat? It takes slightly longer but is also practical. By wearing a simple patch for a few days, the required amount of perspiration is collected to analyse the metabolic markers that can provide indications as to the state of health of cancer patients. And adjust the therapeutic treatment accordingly. “For patients who have been subjected to lumbar punctures on a regular basis, the advantage is clear. And, financially speaking, healthcare systems could also gain from using these methods,” states Natacha Turck. As for VOCs, it’s off to a great start. Now all that remains is the long process of conducting clinical trials to extend the applications of these new biological analyses. “This is just the beginning, but the concrete applications are within reach.” Within five to ten years, tear analysis could become as useful as blood tests. ⁄

The leech, a tiny creature that wishes you well Text: MELINDA MARCHESE and Erik Freudenreich

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in the lens

Hirudotherapy Leeches have been known for their medicinal properties since ancient times. At the Lausanne University Hospital, they are used in emergency transplants and reconstructive surgery.

These invertebrate animals from the phylum of ringed worms are coming back in vogue in both certain private medical practices and surgery services at university hospitals. “Leeches are mostly used in two ways,” says Dr Dominique Kähler Schweizer, an expert on leeches and co-founder of Hirumed, the only medicinal leech farm in Switzerland. “In hospitals, leeches are primarily used for their mechanical effect of draining blood in the event of congestion after reconstructive surgery.” Not only are they the best way to salvage a graft, leech saliva is also popular for its anti-inflammatory and anticoagulant properties. “Its saliva contains more than a hundred active compounds, but only about thirty are really wellknown today,” she says. “In private doctors’ offices, they are mainly used for their success in treating tendinitis, arthritis and boils, as well as some forms of back pain.”

FARMING

The company Hirumed, set up in Wil in the canton of St. Gallen, has the only leech farm in the country. “Leech eggs develop inside cocoons during six weeks (left). It takes nearly two years on average from the time leeches hatch until they can be used for medicinal purposes,” says Dominique Kähler Schweizer, who founded the company with her husband in 2002.

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in the lens

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in the lens

ORDERS

The Lausanne University Hospital orders medicinal leeches from Hirumed on a regular basis. They are shipped by lorry and placed in an aquarium in the main hospital pharmacy as soon as they arrive. When a doctor decides to use a leech in treating a patient, a prescription is sent to the hospital pharmacy. Five or six leeches are placed in a jar and sent to the nurse from the service that placed the order.

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in the lens

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in the lens

CARE

The leech is removed from the jar using sterilised forceps. The first challenge is to distinguish the animalâ&#x20AC;&#x2122;s head from its tail so that the mouth is placed on the area to be treated. Leeches can survive without eating for several months. They are actually starved to promote blood absorption during treatment. Once the leech is in place, its suction drains excess blood from the congested area. Leech saliva contains hirudin, which also thins the blood.

The nurse monitors the leech regularly. Its meal takes about thirty minutes, after which the animal should immediately be removed from the patientâ&#x20AC;&#x2122;s wound. Leeches often regurgitate some of the blood they ingest, increasing the risk of infection.

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DISPOSAL

IMAGES: Heidi diaz, philippe gĂŠtaz, thierry parel

After treatment, the nurse places the leech in a jar with a powerful disinfectant to euthanise it. The airtight container is disposed of in a bin used for special waste before being incinerated by the city of Lausanne.

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in the lens

Morphine C 17H 19NO 3

C 17H 19NO3 every molecule tells a story Text: bertrand tappy

Its image is cyclical, at times glorified, while at others, demonised. The molecule’s existence has been a chaotic one since its discovery in the early 19th century. But the poppy, the plant from which morphine is derived, has been used by humans for thousands of years. “We’ve always known that ingesting opiates was dangerous and could result in addiction,” says Thierry Buclin, chief of the Clinical Pharmacology Service at the Lausanne University Hospital. “We thought we finally had the solution with the development of the modern syringe in the 1850s, which would replace oral administration.” At the time, surgery was spreading fast with the invention of anaesthesia. Doctors no longer operated only in desperate cases, as patients howled in pain. More delicate operations could be performed on a patient who was peacefully sleeping and who would be

Out of all drugs, the perception of morphine has swung the most between either extreme.

given an appropriate pain killer once he woke up. The product is powerful, easy to transport and rapidly showed up on battlefields. But the issue of addiction did not go away. It was even aggravated by the use of injections. There were endless stories of addicted patients and health care staff who would steal supplies for their personal consumption. The situation worsened to the point where an active campaign to restrict and control narcotics was launched during World War I. “The crisis might also be explained by the moral

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attitudes of the period, along with the tragic negligence towards patients’ suffering,” says Thierry Buclin. “I remember when I was a student, decades later, morphine still had an image surrounded by an aura of death, reserved only for lost cases.” This trend was reversed in the 1960s with the activism of pain relief pioneers such as Cicely Saunders, a nurse at the time, who was shocked by the fate of her patients forced to live with their pain. She led a lifelong battle, which turned her into an internationally recognised figure. She is most famous for setting up the first

zoom

modern hospice centre in the United Kingdom. “It was the beginning of the global awareness of the suffering experienced by patients in hospital,” says Thierry Buclin. “A number of books were written on the subject (namely “Anthropologie de la douleur” (“Anthropology of Pain”) by David Le Breton) and transformed the way pain management was taught to professionals, promoting pain prevention and using plenty of morphine.” Nearly 150 years after its arrival, morphine remains irreplaceable. “But that’s not the whole story,” says Thierry Buclin. “While pain relief remains very inadequate in developing countries, the consumption of opiates is increasing considerably in industrialised regions, and overdoses, abuses and even deaths are back on the rise.” Might attitudes begin to swing back in the other direction? /

Diane morin

Professor Diane Morin, director of the University Institute of Training and Research in Patient Care

To better control health care costs, the effectiveness of care should be proven by scientific evidence. practices. The movement raised research standards for all health professionals, allowing them to take better account of the effectiveness of their interventions. It also increased the involvement of patients and families, who began to play an essential role in complex decision-making. One of the precursors of evidencebased clinical practice was without a doubt Archibald Cochrane, known for his influential 1972 book, Effectiveness and Efficiency â&#x20AC;&#x201C; Random Reflections on Health Services. In the book, he explains that the resources available for health care will always be limited and that they should be used to provide care proven by research to be clinically effective. He also urged professionals to weigh the costs of providing the care against the benefits. Forty years on, his arguments are still valid.

However, a number of barriers to evidence-based clinical practice have also been identified. Among them, the lack of experience in research is one of the most limiting. The University Institute of Training and Research in Patient Care in Lausanne was founded by seven French-speaking Swiss partners to help increase the effectiveness of care for the non-medical health professions. It offers masterâ&#x20AC;&#x2122;s and PhD programmes, develops structured research programmes and promotes local, national and international collaboration devoted to research on innovation, effectiveness and efficiency.

As international support for this movement grew, initiatives were created to produce rigorous methods and standardised tools for measuring the effectiveness and analysing the cost-benefit ratio of health care interventions. Both the Cochrane Collaboration Centre and the Joanna Briggs Institute have established branches in a number of countries, including Switzerland. And the National Institute for Health and Care Excellence in the United Kingdom has been used as a model for several national institutes that promote effective and efficient clinical

In addition to providing guidelines for integrating a cost-benefit analysis into the decision-making process, evidencebased clinical practice fosters leadership, accountability, innovation and collaboration between health professionals, patients and their families. â &#x201E;

patrick dutoit

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www.unil.ch/sciences-infirmieres

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commentary

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has to be fully integrated into the institution or company’s development strategy. At the CHUV, the function is represented Antonio Racciatti on the Executive CommitDirector of tee. Human resources is Human Resources an important partner that contributes to the development of the hospital by hether it is in offering high value-added services such industry, new as skills development, change managetechnologies ment, coaching and advice in work proor medicine, cess optimisation. This integration also innovation guarantees that the recruitment policy has become will align perfectly with the hospital’s the main strategic needs. driver of development. Its capacity is a Human resources should no longer key value for both private companies and be considered a support function, but public institutions such as the Lausanne an actor that fully contributes to creating University Hospital (CHUV). However, value for the organisation. All of the proit is not the organisations themselves jects to develop and modernise human that innovate, but the people who work resources management at the CHUV at them. work towards this goal of making the This gives the human resources HR function a catalyst for innovation. ⁄ department at the CHUV a vital role to play. We need to create the most attractive environment possible to bring innovators to our institution. Flexible work time options and career advancement opportunities are key factors that boost the appeal of our establishment and bring personal satisfaction for employees. This also means that we must be creative in our management methods, for example, by encouraging remote work when possible. To drive innovation, human resources

Willy Blanchard

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career at the chuv

“Innovation is our greatest value”

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news

Fever in children

Publication in Nature Neuroscience

A study published in the New England Journal of Medicine described for the first time the exact causes of fever in children living in Tanzania. This study was conducted by a research group led by Dr Valérie D’Acremont, a specialist in tropical medicine and infectiology at the Lausanne University Medical Polyclinic. BT

The research work by Drs Alexandre Croquelois and Michel Kielar, from the Laboratory of Developmental Brain Disorders of the Department of Clinical Neuroscience was published on 25 May 2014 in Nature Neuroscience. The study covered developmental disorders of the cerebral cortex caused by abnormal neuronal proliferation. When this happens, clusters of normally differentiated neurons form in places where they should not be during foetal development and the construction of the brain.

PAEDIATRICS

Lausanne University Hospital receives an award in Madrid More than 750 poster and e-poster projects were presented at the European Wound Management Association (EWMA) conference. Lucie Charbonneau, a specialised nurse, and Raul Prieto from the Lausanne University Hospital training centre, presented an e-learning programme intended to train professionals about pressure ulcers (bedsores). Their presentation won one of the three prizes awarded to the best projects. BT

formation

NEUROSCIENCE

These disorders can lead to motor or mental disabilities and epilepsy. Dr Croquelois work began eight years ago when he discovered by chance a mouse that spontaneously developed the condition in the colony at the laboratory of the Department of Fundamental Neurosciences at the University of Lausanne, directed by Professor Egbert Welker, with whom he worked closely on the project.

Also collaborating with several Paris groups, the research team was able to identify the “eml1” gene responsible for the defect in the mouse. The authors of the study then examined children with cortical malformations whose cause is unknown. They found several cases in humans from two families with the same gene mutation. These results have broadened our knowledge of genes and the mechanisms involved in disorders caused by cortical development. They could eventually be used to diagnose these pathologies during the prenatal stage and, potentially in a more distant future, to correct some of them with gene therapy. BT

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Career at the chuv

Daniela Dunker Scheuner teaches former alcoholics how to stay dry through meditation. Text: Emilie Veillon

ith floor mats, blankets, benches and round cushions, the plain room in one of the pavilions at Cery, the headquarters of the psychiatry department of CHUV, takes on a peaceful ambiance a few hours each week. Seated in the lotus position, about ten patients are meditating, eyes closed, guided by the soothing, southernaccented voice of Daniela Dunker Scheuner.

“Being fully aware of what’s happening within you helps identify and bring out automatic reactions that control our actions, thoughts and emotions,” says Daniela Dunker Scheuner. “This increases our ability to tolerate our emotional states and desires and to deal with them.” Offered to patients working to overcome alcohol dependency through abstinence, these weekly sessions are based on a new approach that is growing fast in Switzerland.

Psychologist and head of the Cognitive and Behavioural Therapy Teaching Unit of the Department of Psychiatry and associate psychologist with the Alcohol Treatment Centre at the Lausanne University Hospital (CHUV), she asks them to focus on the sounds around them, their breathing, sensations in their body, emotions, desires and the thoughts that pass through their minds like clouds, without judging them.

Inspired by two areas that at first seem diametrically opposed – eastern meditation and western science – Mindfulness-Based Relapse Prevention (MBRP) aims to teach people with addictive behaviours to accept their temptations with compassion, rather than fighting them, because they will eventually diminish and disappear. “There’s nothing esoteric about it,” says the thirty-something Brazil native. “Actually, focusing your attention on physical sensations

that are already there is very concrete.” She studied psychology in Sao Paulo, at the University of Geneva and at Claude Bernard University in Lyon, where she specialised in cognitive and behavioural therapy. In 2004, as part of her new position at the Alcohol Treatment Centre at the CHUV, she contacted Alan Marlatt, professor of psychology and director of the Addictive Behaviours Research Centre at the University of Washington, who developed the MBRP programme. Daniela Dunker Scheuner became increasingly involved in the two approaches, to the point of participating in the translation of the founder’s book, “Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours”, into French, which was published in 2008. She was then trained as an official MBRP instructor and trainer by Alan Marlatt’s team. She now divides her time between her groups of patients, individual consultations and training other professionals to develop this method in Switzerland and France. She also practises mindfulness meditation herself every day. ⁄

Career at the chuv

gilles weber

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Inspired by both eastern meditation techniques and western science, â&#x20AC;&#x153;Mindfulness-Based Relapse Preventionâ&#x20AC;? (MBRP) is offered as a therapy to help treat alcohol addiction or as an approach to abstinence. This method was developed in the United States and teaches patients to accept their temptations as a means of better preventing relapse.

Stefan Kunz

tandem

Alexandre Roulin

cursus cursus

Career at the chuv

ith their Ornithologist Alexandre Roulin is people, he invited large, researchers working with biochemist Stefan Kunz different piercfrom the Faculty of to study the genetic correlations ing eyes and their Biology and Medicine hoo-hooing that to a presentation between owls and humans. resounds throughout of his research last Text: Emilie Veillon, photos: eric déroze the moonlit countryyear. One of his side, owls have fascinated since time immemoguests was Stefan Kunz, a biochemist and rial. As protected species that can only be associate professor of Fundamental Virology observed in the wild, they have been studied at the Microbiology Institute (IMUL) of the very little in scientific disciplines...except by keen Lausanne University Hospital, who recognised ornithologist Alexandre Roulin. He has dedicated the need for scientific collaboration between twenty years of research to the nocturnal bird of their two fields. prey, which he has been monitoring through the two hundred and fifty nest boxes set up in barns Six months ago, a team was formed comprising and hangars in the Broye and Orbe valleys. Antonella Pasquato, a specialist in proteases (enzymes that break down proteins) at the IMUL, As professor of evolutionary biology at the and post-doctoral student Karin Löw from the University of Lausanne (UNIL), his field work Department of Ecology and Evolution. They meet on barn owls has led him to one conclusion in once a month to discuss the latest developments particular: they are not the same colour. Owls in their respective areas of research and to within a single group have feathers ranging from develop a shared methodology. Their goal is white to dark red, and they may be more or less to target these gene systems and try to adjust spotted. Even more curious is that these differthem to influence certain metabolic diseases ences in melanin levels are associated with such as obesity. certain behavioural patterns such as appetite, sexuality and stress resistance. “This colouring “Laboratory researchers and field biologists is believed to be caused by melanocortin, a rarely work together to try to develop a common hormone that stimulates melanin synthesis,” language,” says Stefan Kunz. “Having access to says Alexandre Roulin. “The higher the level an extensive database on wild animals featuring of melanocortin in a dark-feathered owl, the such genetic diversity is an extraordinary more aggressive it will be, and the stronger opportunity for microbiologists, who generally its resistance to parasites and stress.” only have access to lab rats.” And the biologist adds that this collaboration is made possible On a hunch that the correlation between because the UNIL is the only establishment in molecular factors and physiological behaviour Switzerland where biology and medicine are could also apply to humans, especially sick part of the same faculty. ⁄

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TEDxCHUV are back

nominations

last name Bongiovanni

Massimo Service of Clinical Pathology first name position

The Lausanne University Hospital is organising the second edition of TEDx Talks in Lausanne! The event will take place on Thursday, 13 November, at the new Swiss Tech Convention Center that is part of the Swiss Federal Institute of Technology. Several specialists from our hospital, including Professor George Coukos and Dr Jocelyne Bloch (see “In Vivo” No. 1) will be speaking on the topic of “Sparkling Innovation”. Find out more in our November issue. BT event

A site for rare diseases The Lausanne University Hospital and Geneva University Hospitals have teamed up to launch a unique information platform in Frenchspeaking Switzerland dedicated to rare diseases. The site rapidly directs patients, families and practising doctors towards specialised resources dedicated to a given disease in order to reduce waiting times between diagnosis and care by an expert team. www.info-maladies-rares.ch. BT

Umberto Simeoni taught at the Louis Pasteur University and University Hospital of Strasbourg until 2001, where he was responsible for the neonatal and paediatric reanimation units as well as the Regional Delegation for Clinical Research. He has authored about 130 listed scientific articles and various books on neonatal care and has presented more than 250 lectures worldwide.

cemcav, dr

ORIENTATION

Trained in pathology and cytology at the Geneva University Hospitals, Massimo Bongiovanni worked as Deputy Director of the Ticino Cantonal Institute of Pathology in Locarno. Appointed Associate Professor at the University of Lauslast name Müller anne (UNIL), he will take on his duties first name Pierre-Yves at the Lausanne University Hospital position Chief of the Department starting in July 2014. “I believe that paof Hospital Logistics thology should live and evolve along with the other specialities in medicine, A mechanical engineer by training, in a hospital context. Sharing with my Pierre-Yves Müller held a number peers, research in management posia university environtions at the Bobst ment and participatgroup between nominations ing in training of the 1999 and 2012, future generation are where he worked all essential for me.” as the director of procurement, production and logistics and as CEO of Bobst SA. Before last name Simeoni joining the Lausanne University first name Umberto Hospital, Pierre-Yves Müller was the position Chief of the Paediatrics operations director of the Tornos SA Service group in Moutie.

cursus

Career at the chuv

migration

Joachim Rapin went to Canada for a year and a half to study at the University of Montreal’s Faculty of Nursing. A few weeks after his return, he met with us to discuss his experience. Why did you want to pursue your master’s degree in nursing in Montreal? Danielle D’Amour, professor at the Faculty of Nursing [at the University of Montreal], gave a presentation at one of our conferences at the Lausanne University Hospital (CHUV). I was impressed with the quality of her research. So I decided that if I wanted to continue my training, I had to go to Montreal! How did you go about organising your trip? It took me about a year to prepare. I wasn’t travelling alone. There were four of us, with my wife and two children. In terms of my budget, the CHUV covered about one-third of the costs. For housing, we happened to have a chance encounter with someone in Switzerland who helped us find a house to rent. And once there, we were amazed by the support of our neighbours, who really helped us get settled.

philppe gétaz

What about the programme? I did a master’s in nursing mainly for its administration option, which is specifically designed for nursing departments. I was able to condense the coursework and completed the programme in 16 months instead of 24 months. The number of classes offered – some of which are now also taught

last name Rapin first name Joachim with the chuv since 2000 TITLE Senior staff nurse at the Department of Paediatric Care and Surgery

at Lausanne – was impressive. After all, the Faculty of Nursing at Montreal dates back to 1926! You’ve just returned home. What conclusions have you drawn from your experience in Montreal? If I could do it all over again, I would in a heartbeat. Whether you’re a caregiver, doctor, etc., you always gain by opening up to new horizons and other professional cultures. I couldn’t imagine being trained in only one place. My experience in Montreal will leave a lasting mark on how I practise nursing. And I hope that my hospital can also benefit from it! ⁄ BT

BACKSTAGE LEECHES Photographers Heidi Diaz (CEMCAV) and Thierry Parel set off to learn more about medicinal leeches at the Lausanne University Hospital and the Hirumed breeding facility in Wil, Switzerland (p. 61).

Eternal youth

For â&#x20AC;&#x153;In Vivoâ&#x20AC;?, artist Leha Van Kommer created the illustration for the article on the quest for eternal youth (p. 54).

contributors

julie zaugg

thierry parel, DR

Julie Zaugg has been working with various Swiss publications for many years. Currently based in New York, she interviewed Dr. Paula Johnson for “In Vivo” (p. 30). Also in this issue, she looked into the taboo of sexual activity between patients in psychiatric hospitals (p. 50) and the impact of a “fat tax” in the fight against obesity (p. 42).

romain guerini With a bachelor’s degree in visual communication and a wealth of experience in design, Romain Guerini joined LargeNetwork in 2013. As a graphic designer, he has the opportunity to develop the visual aspect of the agency’s publications, always looking for ways to make the pages look amazing.

Benjamin Keller

Heidi Diaz

Holding a bachelor’s degree in international relations and master’s in journalism from the University of Geneva, Benjamin Keller works as a journalist for LargeNetwork. For this issue of In Vivo, he investigated pharmaceutical drug tests on patients in Switzerland (p. 39) and described a surprising optical illusion, “the Troxler effect” (p. 27).

After studying at the Centre d’Enseignement Professionnel art school in Vevey, Heidi Diaz joined the Medical Teaching and Audiovisual Communication Centre (CEMCAV) at the Lausanne University Hospital in 2008. For this issue of “In Vivo”, she contributed to the photographic report on medicinal leeches (p. 61).

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-Renée Leyvraz, Melinda Marchese Anne-Marie Barres, Anne-Marie Vuillaume, Bertrand Hirschi, Brigitte Morel, Cannelle Keller, Céline Vicario, Graphic design managers Christian Sinobas, Christine Geldhof, Deborah Sandro Bacco and Diana Bogsch Gonzales, Denis Orsat, Diane de Saab, Dominique Kähler Schweizer, Elise Méan, Emilie Jendly, Enrico Ferrari, Fernando Mendes, Fiona Amitrano, editorial staff Gilles Bovay, Jeanne-Pascale Simon, Jocelyne LargeNetwork (Jade Albasini, Benjamin Bollmann, Céline Bilardo, Clément Bürge, Bouton, Katarzyna Gornik-Verselle, Laure Espie, Marie-Adèle Copin, Erik Freudenreich, Benjamin Keller, Serge Maillard, Laurent Meier, Lauriane Bridel, Manuela Palma, Melinda Marchese, Jean-Christophe Piot, Geneviève Ruiz, Emilie Veillon, Julie Zaugg), Marie-Cécile Monin, Marité Sauser, Massimo Béatrice Schaad, Bertrand Tappy Sandri, Muriel Cuendet-Teurbane, Muriel Faienza, Nathalie Jacquemont, Nicolas Jayet, Odile Pelletier, Pauline Horquin, Philippe iconographic research Coste, Philippe Dosne, Serge Gallant, Sabrine Elias Ducret Sonia Ratel, Stephan Studer, Stéphane Coendoz, Stéphanie Dartevelle, Thuy Images Oettli, Virginie Bovet, Valérie Blanc, Véronique Séchet et le Service de CEMCAV (Willy Blanchard, Eric Déroze, Heidi Diaz, Patrick Dutoit, Philippe Gétaz, Gilles Weber), Oram Danreuther, Leha van Kommer, João Lauro, Thierry Parel communication du CHUV. distribution partner

BioAlps

Layout

Diana Bogsch and Romain Guerini

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.

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jeroen bennink

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perception www.invivomagazine.com

Think health

No. 3 – JULY 2014

five SENSes / illusions / Brain

MIND YOUR perceptions

IN EXTENSO The birth of a human In Vivo No. 3 – July 2014

Infographic supplement