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INFERTILITY www.invivomagazine.com

Think health

No. 11 – APRIL 2017

INFERTILITY

WHEN SCIENCE CREATES LIFE

IN VIVO No. 11 – April 2017

NEW LEGISLATION / ARTIFICIAL SPERM / PSYCHOLOGICAL SUPPORT

CYBERATTACKS Hackers target hospitals PRISONS The new nursing home? REPORT An ambulance for newborns Published by the CHUV www.invivomagazine.com IN EXTENSO POWER OF THE EYE

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IN VIVO / NUMBER 11 / APRIL 2017

CONTENTS

FOCUS

11 / INFERTILITY When science creates life The new stakes behind assisted reproductive technologies BY YANN BERNARDINELLI AND HANNAH SCHLAEPFER

MENS SANA

22 / DECODING In hospitals, viruses can infect computers too BY JULIE ZAUGG

26 / PROSPECTING Prisons: the new nursing home? BY PATRICIA MICHAUD

29 / BACKSTAGE Women in search of that “Eureka” moment

In 2009, an American woman named Nadya Suleman gave birth to octuplets after several embryos were implanted in her uterus following artificial insemination. The multiple pregnancy proved controversial and sparked a debate about the ethical limitations on assisted reproductive technologies.

NANCY PASTOR / POLARIS

BY JADE ALBASINI

CONTENTS

CORPORE SANO

IN SITU

33 / IN THE LENS

09 / HEALTH VALLEY

An ambulance for newborns

The importance of a good night’s sleep

BY WILLIAM TÜRLER

When the lungs go up in smoke

BY PAULE GOUMAZ

CURSUS

43 / COMMENTARY Research is also a matter of time

44 / TANDEM Eva Favre and Anne Fishman join forces to advance patient care practices

GILLES WEBER, PR MICHEL BRAUANER / ISM / SCIENCE PHOTO LIBRARY, SANDRO BACCO

40 / PROSPECTING

Editorial

IN MEDICINE, A WOMAN IS LIKE A MAN

PATRICK DUTOIT

BÉATRICE SCHAAD Chief editor

The number of women choosing to study medicine is constantly increasing. However, starting with chief residents and every level of responsibility above, their number decreases and drops to practically zero when it comes to head physicians and senior faculty professors. Balancing motherhood and a managerial position in research or a clinic remains a seemingly Sisyphean task. A debate emerged during the Suffragette era that remains unresolved even today: is it best to let nature take its course, so to say, by betting on the fact that the most pioneering women will eventually access positions of power, or is it better to shift the gender balance in managerial jobs through a variety of pro-active measures? In medicine and research, the idea that women need support to pursue a professional career and private life is no longer taboo. Even those who opposed a quota system barely five years ago are asking for it today (read p. 29). In a sign that opinions are changing, health institutions are developing measures to support women. At Lausanne University Hospital, the new regulations on job promotions within the hospital state in no uncertain terms that motherhood should not hinder a person’s career. This fundamental principle is paired with original ideas such as sharing executive management positions between two people and the option to use overtime to extend maternity leave. Finally, a pool of professional women will soon be created through which pregnant women can be hired if their normal job is too taxing. The academic world has produced countless ideas about how to revise job promotion criteria and adapt these requirements to fit a professional woman’s lifestyle. The numbers speak for themselves. In 2016, nearly 600 women received a promotion at Lausanne University Hospital. Nearly 60% of all promotions were given to women. In academia, the scales are slowly shifting as well. Between 2011 and 2015, the percentage of women professors hired increased from 15.4% to 25%. Without these initiatives, society as a whole would lose out on the investment made in their education. Women are ending promising careers due to a lack of support even as the country is facing a severe shortage of healthcare professionals. Finally, will not true equality only be achieved when measures allow men to fully enjoy fatherhood without them having to fight to make that possible? The day when this becomes reality, to paraphrase Simone de Beauvoir, man will have finally become, like woman, a human being. ⁄

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 map was designed by Sandro Bacco.

IN SITU

HEALTH VALLEY Panorama of the latest innovations

RENENS

P. 07

MindMaze is the firstever Swiss start-up valued at 1 billion.

LAUSANNE

P. 09

A new book unlocks the mystery of sleep.

LAVIGNY

P. 06

A new service has been created to treat stroke and headtrauma victims.

GENEVA

P. 06

SANDRO BACCO

The start-up PregLem is getting ready to market Esmya, a drug designed to treat uterine fibroids.

IN SITU

HEALTH VALLEY

“Neurological rehabilitation is becoming the spearhead of neuroscience.”

START-UP MARKET LAUNCH

PregLem, a biotech start-up from Geneva, has completed every step in the negotiation process with European authorities regarding the market launch of its flagship medication, Esmya. This fibroid treatment for women between the ages of 30 and 50 is the only alternative to surgery and is now available in Europe.

PHILIPPE RYVLIN IN JANUARY 2017, IN THE JOURNAL “24 HEURES”, THE HEAD OF THE DEPARTMENT OF CLINICAL NEUROSCIENCE AT CHUV PRAISED THE CONVENTION SIGNED BY THE LAVIGNY INSTITUTE, THE CHUV AND THE UNIVERSITY OF LAUSANNE SCHOOL OF BIOLOGY AND MEDICINE. THE AGREEMENT MARKS A FIRST STEP TOWARDS THE CREATION OF THE UNIVERSITY NEUROLOGICAL REHABILITATION DEPARTMENT (SUN), WHICH WILL PROVIDE STROKE AND HEAD-TRAUMA VICTIMS WITH A HIGHER STANDARD OF CARE.

ANTIBODIES

The Vaud-based start-up ADC Therapeutics, specialised in oncological antibodies, raised 104 million Swiss francs. The company hopes to get its first medications for leukaemia and certain kinds of lymphoma to market by 2020.

The value, in billions of Swiss francs, of the 2016 exports of the approximately 1,000 start-ups, SMBs and large companies that make up Health Valley.

ROBOT LAUNCH

ViDi Systems, based in Villaz-St-Pierre, was awarded the international Robot Launch Prize. Founded by the neuroscience doctor Reto Wyss, the start-up specialises in image-analysis software, especially for use in medicine and pharmacology.

Nursing in the spotlight

MASSCHALLENGE

Located in the Innovation Hub of the Swiss Federal Institute of Technology in Lausanne, Xsension is one of six start-ups recognised by MassChallenge Switzerland. The company received 50,000 Swiss francs in prize money, which it will use to develop the first platform able to capture a person’s biochemical data from the skin’s surface.

APPLICATION

EMERGENCY SMARTWATCH Smartwatches could make it easier to monitor hospital patients. Researchers at the Swiss Federal Institute of Technology in Lausanne and the Institute of Technology in Turin have designed an app that can connect a smartwatch to the metabolic data of patients in intensive care. The watch keeps the A&E doctors informed of a patient’s health status and sends them alerts if there’s a problem.

INITIATIVES Switzerland is short 10,000 nurses. The Swiss Association of Nurses (ASI) launched a popular initiative at the start of the year to cast nursing in a more favourable light. Specifically, the group is advocating for increased autonomy, appropriate salaries and more opportunities for continuing education. The initiative was approved by the Swiss Federal Chancellor. A signature campaign has started.

IN SITU

HEALTH VALLEY

MindMaze: Switzerland’s first unicorn The Indian conglomerate Hinduja Group bought a stake in MindMaze—a spin-off from the Swiss Federal Institute of Technology in Lausanne—which is now valued at over $1 billion and has therefore earned the status of “unicorn”. POTENTIAL THE FOUNDER THE PROJECT MindMaze got its start in 2007, when an article by Tej Tadi entitled "Video Ergo Sum" (I see, therefore I am) was published in the journal "Science". Tadi’s idea was to use augmented-reality exercises to facilitate and accelerate rehabilitation after a stroke. The patient is immersed in real conditions, and his or her performance is displayed in the form of scores on the screen, just like a video game. This system motivates the patient to repeat otherwise tedious tasks and speeds up rehab. There are two models currently available: one is designed to be used in hospitals, the other is a portable unit.

Tej Tadi was born in 1981 in India to a family of physicians. He came to the Lausanne region at the age of 23 to pursue his engineering studies, attending first the International Institute for Management Development and then the Swiss Federal Institute of Technology in Lausanne. With a passion for graphic interfaces, Tadi used virtual-reality technology while working towards his doctorate to digitise the human walk for use in robots and avatars. This brilliant scientist is also an entrepreneur, described by colleagues as charismatic and persuasive. At the end of 2016, he received the EY Emerging Entrepreneur of the Year award.

MindMaze’s investors didn’t get it wrong – the company has incredible potential. Tej Tadi has announced an aim to sell over a thousand mobile units by the end of the year and estimates 10 to 15 million Swiss francs in revenue for 2017. Over the long term, his goal is to have his machines in every hospital in every country. But that’s not all. Tadi is launching a brain-training app designed for health users.

I M PAC T Tej Tadi could have chosen to target other markets with his technology, including the video game industry. But he saw there was a real need for new solutions when it came to post-stroke rehab. MindMaze was founded to meet that need and is working to revolutionise the way we practise medicine in the future. Today, MindMaze’s machines are already being used at Lausanne University Hospital and the Rehabilitation Clinic of French-speaking Switzerland in Sion, as well as in England, Germany and countries in Asia.

IN SITU

HEALTH VALLEY

500, 000 OBJECT

SLEEPING GLASSES Even though they look exactly like normal sunglasses, these glasses from the Geneva start-up Goodnight have been designed to help you sleep. Invented by an optometrist and an optical engineer, the lenses filter specific wavelengths emitted by screens and LED lights, which have a negative impact on melatonin, the hormone that prepares your body for sleep.

The number of downloads of “Primary Surgery”, a book republished by Lausanne University Hospital physician Michael Cotton. With support from the American foundation Global-Help.org, this work has been made available online for free. The book provides doctors throughout the world with the information they need to perform emergency surgery in underdeveloped regions.

A Swiss biologist recognised

ROBERT WENNER PRIZE The League Against Cancer awarded the Robert Wenner prize, along with 100,000 Swiss francs, to the biologist Mikael Pittet. Based in Boston, the 41-year-old Lausanne native discovered a technique for making treatmentresistant tumours susceptible to immunotherapy. His work bolsters the hope of finding new immunotherapies that can treat cancer in patients whose tumours do not respond to traditional methods. The Robert Wenner Prize was created in 1983 and is awarded to scientists under 45 who are active in the field of cancer research.

THORACIC SURGERY The thoracic surgery departments at Geneva University Hospitals (HUG) and Lausanne University Hospital (CHUV) announced the creation of the Swiss Francophone University Centre of Thoracic Surgery. The goal of this partnership is to ensure an optimal level of patient care, increase research potential and coordinate shifts among thoracic surgeons in French-speaking Switzerland. The chief surgeons from the two wards, Hans-Beat Ris (CHUV) and Frédéric Triponez (HUG) will manage the centre together.

ANNA JURKOVSKA / SHUTTERSTOCK

A new centre at Lausanne University Hospital

IN SITU

HEALTH VALLEY

The importance of a good night’s sleep Two specialists from Lausanne University Hospital have published a comprehensive book on sleep, a research ﬁeld in which Switzerland is one of the world’s leaders. PUBLICATION One in four people in Swit-

zerland suffers from sleep problems. So it’s hardly surprising that a book called I dream of sleep (Je rêve de dormir) is catching readers’ attention. The book sold 10,000 copies in three months according to its co-authors, José Haba-Rubio and Raphaël Heinzer, both physicians at the Sleep Investigation and Research Centre (CIRS) at Lausanne University Hospital. “We didn’t want yet another recipe book about how to sleep well,” said José Haba-Rubio. “There weren’t any books out there that provided scientific data and explained its findings in a way that was accessible to everyone.” The work summarises our current understanding of sleep by referring to multiple international studies as well as research conducted in Switzerland. “We are one of the pioneers when it comes to sleep studies,” said CIRS Founder Raphaël Heinzer. Every year, Switzerland is ranked either first or second in the world in terms of the number of scientific publications on sleep per capita. At Lausanne University Hospital, the study of sleep is becoming increasingly important. When it was founded a decade ago, CIRS was run by four people. It now employs 20 and receives 6,000 visits every year. Study on over 2,000 people CIRS plays a significant role in Switzerland’s ranking as it was this centre that conducted the HypnoLaus study. Between 2009 and 2012, CIRS equipped 2,000 Lausanne residents with electrodes to analyse their sleep. “It was the largest epidemiological study on the topic in terms of general population,” said José Haba-Rubio. “The research provided the necessary basic data to define the standard sleep behaviour of a population. We’ve been invited to present our results in the United States, Australia and Mexico.” By cross-referencing the HypnoLaus data with that of its big sister, the general cohort study CoLaus, researchers 9

TEXT STEVE RIESEN

ABOVE: RAPHAËL HEINZER AND JOSÉ HABA-RUBIO, AUTHORS OF "JE RÊVE DE DORMIR", PUBLISHED BY FAVRE IN 2016.

were able to analyse the link between rest and blood pressure, diabetes and psychiatric disorders. A societal problem Sleep-disorder research is in its infancy in terms of concrete solutions, whether pharmacological or technological. “This is a very young field,” said Raphaël Heinzer. “Science only started addressing the issue 50 years ago. Before that, we weren’t even able to record sleep or identify its different phases”. The sleeping pill, which many considered to be a miracle solution, is not recommended for long-term use by specialists because of its side effects and the body’s tendency to develop a tolerance. CIRS practises cognitive-behavioural therapy. The goal of this approach is to reteach the brain to sleep. “Chronic insomniacs have been sleeping poorly for so long that their brains are afraid to go to sleep,” explains José Haba-Rubio. “One of the techniques the centre uses is to limit the time spent in bed. Often, our patients make themselves go to bed early, such as when they have an important event the next day, for example. But as a result, they can’t go to bed for hours. By going to bed as late as possible, the patient can lay down when he or she is truly tired. Little by little, the brain learns to once again associate the bed with sleep.” According to the book’s two co-authors, it’s not just the brain but our entire society that needs to relearn how to sleep. “We live in a hyperproductive society that values activity,” said Raphaël Heinzer. “We think of sleep as a waste of time, but actually it’s an essential biological function! Nowadays, humanity has never slept less. But that takes its toll on our day-to-day lives in the form of lost productivity, accidents and stress. Over the long term, lack of sleep can also increase the risk of obesity and cardio-vascular problems.” Like work, sleep is good for our health! ⁄

IN SITU

HEALTH VALLEY

BENOÎT DUBUIS President of Inartis Foundation

Drive is the starting point in any success. Health Valley has found the right channels to come together and, tomorrow, must organise the resources it needs to stay together in order to work in synergy thereafter, transforming hopes into promises and turning those promises into concrete plans.

“I’d like to congratulate you for creating this wonderful ecosystem,” Johann Schneider-Ammann said in praise on 1 December 2016, looking at the map of Health Valley and especially realising how much positive energy goes into developing this regional ecosystem. 2016 was indeed a busy year. Nearly 550 million Swiss francs was raised to support the region’s entrepreneurs in life sciences. IPOs achieved outstanding success, such as those for AC Immune and GeNeuro. And the company MindMaze became the first unicorn in Switzerland.

A year ago, I told you about two initiatives that specifically aimed to help you make your drive a reality—the Inartis Challenges and the MassChallenge.

The year also reached an important milestone, with nearly 1,000 companies and 25,500 highly skilled professionals who work every day in defining the medical strategies of tomorrow. That includes researchers, entrepreneurs, producers, manufacturers, product design innovators, service providers and all kinds of “energisers”. MAKING THAT DRIVE A REALITY In a comparison between countries, today life sciences bring key value to Switzerland, which ranks third worldwide in growth of gross added value. That indicator has risen more than 12% over the past 10 years and is expected to climb 4.4% per year between now and 2020. As a result, life sciences currently represent onequarter of the total value of exports in Western Switzerland, i.e. 17 billion Swiss francs in 2016.

The Inartis Challenges are designed to identify and stimulate the emergence of fresh projects by giving new meaning to individual ideas. Building on this mindset and drive to offer hospital patients real support, the first edition of the Debiopharm Inartis Challenge, featuring a prize of 50,000 Swiss francs, was launched with the theme “Quality of life for patients undergoing treatment”. Given the success of the first event, a second edition of the Challenge will be organised. Once again, it will draw on collective intelligence—the intelligence of students, artists, retirees, patients, entrepreneurs and hopefully your own. Turn your drive into reality by joining us!

MassChallenge, the leading international startup accelerator, offers four-month accelerator programmes for the most ambitious innovators. The first edition in Switzerland wrapped up in November 2016, honouring 13 companies and handing out more than 400,000 Swiss francs in prizes. Our region felt the direct impact, with over 50 direct jobs created, 30 agreements signed between start-ups and manufacturers and five foreign MAINTAINING THAT DRIVE companies set up permanently in French-speaking However, this particularly fertile ground must be Switzerland. A second edition is on its way. Onlookers, maintained. It must also be, live and grow basing come take part in the revolution. Join us, join them its structure on its key players so that it does not and create value for our regional ecosystem. ⁄ simply waste away.

FURTHER READING

www.healthvalley.ch www.inartis.ch

FOCUS

INFERTILITY

WHEN SCIENCE CREATES LIFE

A human embryo made up of 16 cells on the head of a pin as seen by a scanning electron microscope.

DR YORGOS NIKAS / SCIENCE PHOTO LIBRARY

Thanks to medicine and fewer legal restrictions, infertile couples are now more likely to conceive a child. But the process is still complicated and extremely challenging.

/ BY

YANN BERNARDINELLI COLLABORATION

HANNAH SCHLAEPFER 11

FOCUS

INFERTILITY

n 25 July 1978, all eyes were on Oldham Hospital to the north-east of Manchester (UK). That day, Louise Brown was born. She was the world’s first “test-tube baby”, meaning she was conceived through in vitro fertilisation (IVF). Since then, millions of children have been born throughout the world thanks to this type of assisted reproductive technology (ART), which has gradually become more and more sophisticated. In 2009, the first in vivo assisted fertilisation procedure was performed in Geneva. These two highly publicised events gave new hope to infertile couples—so much so that they believed visiting their doctor was all they had to do to have a child.

women under 30, and falls to between 10% and 15% for women over 40.” According to the specialist, IVF’s popularity has had a negative impact on research in the field. “Its success limits investment in other techniques and reduces the amount of research funding directed at reproductive medicine,” he says. Despite IVF’s numerous success stories, it doesn’t solve every case of infertility. Other breakthroughs are currently under development, including the “artificial” production of sperm and eggs (see note 2, p. 15).

As reproductive science advances, the law is changing According to the Swiss Federal Statistics Office, how- as well. In June 2016, Switzerland agreed to change ever, only 37.1% of women treated in Switzerland be- its law regarding assisted reproductive technology, came pregnant in 2014. In 72% of those cases, the by lessening the constraints and increasing the pregnancy resulted in birth. “The success rate of IVF chances of carrying a pregnancy to term (see note 2, is around 30% on average,” says Nicolas Vulliemoz, p. 15). Advocates are also working to improve the psychological support provided to director of the Reproductive Medboth male and female patients icine Unit (UMR) at Lausanne TWO DISTINCT throughout a course of treatment University Hospital. “This figure that is both financially and emodepends largely on the age of the DEFINITIONS tionally costly. mother. It reaches 40% to 50% for In medicine, infertility and sterility are not the same. Sterility refers to someone who is permanently unable to reproduce. Infertility is the temporary absence of conception.

1 A RANGE OF CAUSES HER, HIM AND THE COUPLE

In men, the main causes of infertility are sperm cells that are absent, too few in number or abnormal. “A spermogram can determine whether the shape, mobility and number of the sperm cells are sufficient,” says Laurent Vaucher, a urologist at the Reproductive Medicine Unit (UMR) and the Genolier Clinic (VD). “This test doesn’t give information about the fertility of the sperm, though. It’s just an indicator.”

Contrary to popular belief, infertility doesn’t affect only women. “Female infertility is the cause in only 30% of cases,” says Nicolas Vulliemoz. “Male infertility is the reason in a third of cases, and so-called ’couple’ infertility is responsible for the remaining third. As for the remaining 10%, we do not yet know the cause.”

A couple can have normal results and yet still be considered infertile. “In such cases, there are probably a number of negative factors acting together. Average test results in both partners are often more problematic than a decisive result in just one partner. Right now, we don’t fully understand couple infertility.”

A woman’s store of eggs (the sex cells that turn into ovules) is determined at birth. They finish maturing at menopause. So age plays a role in infertility. “Malfunctioning ovaries, an obstruction in the pathways sperm travels to reach the egg and endometriosis are just some of the common reasons why a woman might have trouble conceiving,” says Nicolas Vulliemoz.

Medical treatments can also damage a person’s ability to reproduce. For example, chemotherapy and radiotherapy—which are toxic to the body’s reproductive cells—can result in temporary or permanent infertility in either sex. In French-speaking Switzerland, the French-speaking Cancer and Fertility Network

WHEN TREATMENTS RESULT IN INFERTILITY

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INFERTILITY

“IMAGINING A LIFE WITHOUT CHILDREN IS LESS STIGMATISED THAN IT WAS IN THE PAST” Fertility rates in Western countries continue to drop. The sociologist Laura Bernardi explains why. BASED ON AN INTERVIEW WITH

YANN BERNARDINELLI

A growing number of couples are struggling with fertility. Why? lB Couples often put off having children because they think it might not be compatible with their education or with entering the job market. One of the reasons for this delay is the duration of higher education and the fact that more and more women are pursuing

What is the situation in Switzerland? lB Not very good! In Switzerland, family size is primarily limited by the cost per child.

Is the solution political? lB Yes. Politics can improve the compatibility between parenthood, education, work and leisure. Age limits for employment and education must be less strict, and men and women should receive equal pay and parental leave. In addition, the costs and hours of childcare and school must remain compatible with those of both working parents.

Have changing norms and behaviours also played a role? lB Imagining a life without

LAURA BERNARDI IS A SOCIOLOGIST AT THE UNIVERSITY OF LAUSANNE.

these degrees. Another reason is the extended period of financial instability prior to finding a job that pays well enough to support a family. iv

ERIC DÉROZE

ur approach to fertility changed drastically in the twentieth century. Starting in 1900, the average number of children per woman declined significantly from 3.7 to 1.8 just before WWII. That figure began to rise in 1938, reaching 2.6 by 1945. Since 1975, the average number of children per woman has remained stable, fluctuating between 1.5 and 1.6 for women living in Switzerland.

children is less stigmatised than it was in the past. Individuals value personal fulfilment over family life. Ever since contraception use became normalised, sexuality has become more disconnected from reproduction. Deciding to have a child means choosing to stop a default behaviour—using contraception—in order to reproduce. This represents a sea change in the decision process that leads to becoming a parent.

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INFERTILITY

(RRCF) provides support to these patients. There are techniques that can be used to preserve an individual’s fertility, including gamete (ovules and sperm) cryopreservation prior to treatment. “For women, the cryopreservation of eggs using vitrification is a major step forward,” says Sébastien Adamski, director of the UMR sperm bank. “Thanks to this technique, pregnancies from frozen eggs are just as successful as pregnancies from fresh eggs. Vitrification prevents the formation of crystals, which damages the egg.” (See our photo report on cryopreservation in In Vivo no. 1 or at www.invivomagazine.com). Semen cryopreservation has been available for a long time, but it remains problematic for young boys. “They

don’t yet produce mature sperm,” says Sébastien Adamski. “If they have to undergo a toxic treatment, however, it is possible to remove immature testicular tissue and preserve it in the hopes that a procedure for maturing reproductive cells will be developed in the future.”

CONTRACEPTION AND INFERTILITY Some contraceptive methods can also play a role in infertility. A vasectomy, which consists of severing the canals through which sperm travels, is a very reliable contraceptive technique that does not at all change a man’s ability to have an erection or ejaculate. Ejaculation does not just contain reproductive cells. “You should always consider a vasectomy to be irreversible,” warns Laurent Vaucher. In reality, though, it is

“WE OPTED FOR EGG DONATION ABROAD.” P. and B.*, a couple from Geneva, travelled to Spain to receive an egg donation. They share their experience, which resulted in the birth of their son.

Their new doctor suggested alternatives. “He discovered that I had endometriosis, and operated on me. We were hopeful. But when the doctor saw the state of my eggs during the third IVF treatment, there was no question—we either had to adopt or use a donated egg. After struggling for seven years, we wanted to give ourselves another chance and opted for Spain.” The most disorienting part of the experience was encountering Spain’s business-oriented approach to

medicine. “To get the treatment, we waited in line like at the butcher shop.” Organising this type of trip is complicated. “You have to take off from work, weather the side effects of hormone treatments and go about your day-to-day work without being able to talk about it. It was all the more difficult because the first two transfers didn’t take. But finally, the third one worked!” After a significant amount of work on herself, the mother had a successful donation and carried her pregnancy to term. The couple spent over 60,000 Swiss francs for all the treatments. But it wasn’t the lack of insurance coverage the couple found shocking: “I don’t understand why sperm donation is allowed in Switzerland but not egg donation.” (read p. 19)

*NAMES HAVE BEEN CHANGED

The eight-month-old baby tries to turn over in his crib beneath the watchful eyes of his parents. The happy scene contrasts with the decade of challenges and setbacks that led to this moment. “It felt like an eternity,” says the young mother. “After three years of trying to become pregnant, my partner and I consulted a reproduction medicine specialist in Switzerland. Our tests were normal except for a low sperm count. After three artificial-insemination procedures, we still didn’t have any medical explanations. It was when we switched to IVF that the technician discovered the problems with my eggs. The doctor remained optimistic, so we tried IVF another

time, without success. The lack of explanation led us to consult another doctor.”

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INFERTILITY

easy to reconnect these passages to the testicles and allow sperm to pass through once again. However, a vasectomy can affect spermatogenesis, which is no longer 100% guaranteed. The contraceptive pill in women has often been accused of contributing to sterility. But according to Nicolas Vulliemoz, the pill does not decrease a woman’s fertility. A woman simply needs to stop using contraception for a time. Laurent Vaucher indicates that “an increase in oestrogen (a hormone produced by the ovaries and present in some contraceptive pills) has been clearly observed in the groundwater, where it accumulates because it is present in women’s urine. If the dose is too high, it can cause problems for men. Oestrogen is an endocrine disrupter that affects sperm production.”

2 TECHNOLOGICAL ADVANCES: GOING BEYOND IVF PROGRESS WITHIN THE BOUNDS OF THE LAW Medicine has a range of IVF-based tools that it can use to treat fertility problems. In some cases, issues with sperm production and ovulation can be corrected through medication. For example, women can be given hormones that trigger ovulation. Certain cases may require artificial insemination, in which sperm is delivered to the uterus. In Switzerland, health insurance reimburses three inseminations. If this method is unsuccessful, most couples attempt IVF, which is not covered by insurance. Fertilised eggs are cultured to obtain embryos. In accordance with current practice in Switzerland, three are selected at random to be transferred to the uterus. In the case of male infertility, the eggs are not incubated. Instead, they are injected with a single sperm in a procedure known as intracytoplasmic sperm injection (ICSI). Once it comes into effect, Switzerland’s new law on assisted reproductive technology, which was voted in favour of in 2016, will make it possible to culture 12 embryos, freeze them and perform a pre-implanta15

TRUE / FALSE “Sperm donation is anonymous”

FALSE In Switzerland, children

of sperm donors can learn the donor’s identity when they turn 18. Before conception, a donor is selected depending on ethnicity and hair and eye colour. Each country has its own legislation on the matter. Some foreign sperm banks provide donors’ photos or even Facebook pages depending on the price paid by the recipient. “Global fertility rates are declining”

FALSE It’s fecundity that is decreasing, meaning the fulfilment of a person’s desire for a child. In addition, even though it’s widely known that hormone and pesticide pollution is causing a drop in sperm count in men, “their rates remain far above a level that would constitute infertility,” says Laurent Vaucher. A study published in the review PLOS in 2012 and validated by the World Health Organization confirmed this conclusion. The research, which used data collected between 1990 and 2010, indicates that global fertility has not dropped except in South Asia and Sub-Saharan Africa. “It’s possible to transplant a uterus”

TRUE In 2015, the first child whose mother had received a uterine transplant was born in Sweden. The study, which was published in the journal The Lancet, reports that the mother received a uterine transplant from her 61-year-old menopausal friend. One year after the operation, the mother underwent IVF using her own eggs and her husband’s sperm. “This technique is extraordinarily complex and involves multiple risks. We weren’t sure the procedure was even feasible, which makes this breakthrough very significant,” says Nicolas Vulliemoz. “A sperm donor can be the father of hundreds of children”

FALSE In Switzerland, donation is limited to eight children per donor to limit consanguinity.

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INFERTILITY

tion diagnosis under strict conditions. “We can protect future babies from certain genetic diseases, but most importantly we can select embryos prior to transfer, which makes the treatments more effective and reduces the rate of multiple pregnancies. This new law will bring assisted reproductive technology in Switzerland up to international standards while also providing the necessary safeguards,” says Nicolas Vulliemoz. At international level, research on the topic is making significant strides and could eventually offer complementary solutions. One breakthrough that scientists are working towards involves the production of spermproducing cells in vitro. “Several international research groups have announced they’ve reproduced mice sperm

that has resulted in the birth of baby mice,” says Laurent Vaucher. Another field of research seeks to generate sperm from skin or bone marrow stem cells in animals, though it is not as far along. “Some of these techniques could yield results in just a few years. Nevertheless, the maturing process is more complex in humans than in mice,” says Sébastien Adamski.

FERTILITY IN SWITZERLAND

85,648

The number of births in 2016. 43,759 boys and 41,889 girls were born.

31.9

A mother’s average age at the birth of the first child, in 2016.

6,269

In 2014, the number of couples who used “in vitro” fertilisation. This technique has resulted in the birth of 1,955 children.

The production of artificial gametes could potentially no longer require a donation. “There aren’t enough sperm donors,” says Sébastien Adamski, “whereas egg donation is flat out banned in Switzerland.” As a result, many Swiss couples mus t travel abroad to receive this type of donation (see testimonial, p. 14).

28,483

The number of births by Caesarian section in 2015, or over one in three births. SOURCE: FEDERAL STATISTICS OFFICE

Glossary ENDOMETRIOSIS This is a gynaecological disorder whose name derives from the endometrium, the inner lining of the uterus. In some women, tissue that resembles the endometrium grows outside the uterine cavity, resulting in extreme pain, bleeding, adherence and ovarian cysts. This disorder increases the risk of infertility. IN VITRO FERTILISATION With this type of assisted reproductive technology, an egg is fertilised with sperm outside the woman’s body in a laboratory test tube, i.e. in vitro. The resulting embryo is then implanted in the mother’s uterus.

IN VIVO FERTILISATION This kind of assisted reproductive technology selects an egg and sperm before implanting them directly in the uterus. Fertilisation occurs within the woman’s body—or in vivo—rather than in a laboratory. OOCYTE A female sex cell produced by the ovaries. Oocytes become ova after they mature. SPERMATOGENESIS This term describes the process of sperm production. It starts at puberty and occurs within the testicles.

SWISS LAW ON ASSISTED REPRODUCTIVE TECHNOLOGY (LPMA) The Swiss law on assisted reproductive technology regulates the methods, such as IVF, that can be used to artificially induce pregnancy. In Switzerland, this law was first adopted in 1998 and later modified in 2016. It allows up to 12 eggs to be harvested and authorises a pre-implantation diagnosis on the embryos to detect potential abnormalities prior to transferring them to the uterus. The goal of the pre-implantation diagnosis is to only transfer healthy embryos, thereby optimising the likelihood of pregnancy for struggling couples.

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THE PROCESS OF FERTILISATION With or without medical assistance, the embryo implants itself in the uterus a dozen days after the sperm meets the egg.

Fallopian tube

Ovary

Uterus Endometrium

NATURAL PROCESS

Cervix

Vagina

DAY 0 Fertilisation

DAY 2 2-cell stage

DAY 8–9 Implantation

DAY 3–4 8-cell stage

IN VITRO PROCESS

During “in vitro” fertilisation, the ovum is fertilised by a sperm cell outside of the uterus. The ovum grows into a pre-embryo, at which point it is inserted into the uterus. If it implants itself, it will continue to progress just like a pregnancy that did not require medical assistance. DAY 0 Fertilisation

DAY 2 2-cell stage

DAY 3–4 8-cell stage

INFOGRAPHIC: BENJAMIN SCHULTE

EMBRYO TRANSFER

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ERIC DÉROZE

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“MEDICINE DOESN’T ADDRESS THE EMOTIONAL ASPECT OF THE PROCESS” Geneva resident Pascale de Senarclens* speaks about her personal experiences and conferences on the desire to have children led by her association. “It was my partner at the time who really wanted a child. I realise now that he wanted one more than I did. In some ways, it was when I found out that I was infertile that I wanted to have a child. It quickly became a problem. It was a source of frustration for me. I felt like I couldn’t fulfil my role as a woman. I felt disabled—like I was no longer a woman. It was really hard to be constantly surrounded by something that I didn’t actually want.”

She saw a specialist for the first time in 2013. The young woman received treatment after treatment over the course of one year. “It was a complex emotional process of loneliness, misunderstanding and suffering that medicine didn’t relieve in the slightest.” In response, the couple decided to let it go and stopped all treatment. “It was an unusual choice, and I attribute it to the fact that I wasn’t very excited about having a child— which is the exact opposite of most women. Having children is so central that they’re ready to do anything and everything. If a woman chooses to stop treatment,

she does so after suffering a lot, spending huge amounts of money and experiencing isolation or even depression. Through my association, I’ve organised many women’s groups on this topic. The participants often speak about the inappropriate attitudes of their doctors. By that I mean a lack of empathy and a cold approach that makes women feel like they’re cars that have been taken into the shop. It’s a form of emotional mistreatment that almost all women experience, and it disgusts me.” *PASCALE DE SENARCLENS IS THE DIRECTOR OF THE GENEVA ASSOCIATION BLOOM AND BOOM, WHICH WORKS TO SUPPORT WOMEN’S EMANCIPATION.

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3 LISTENING TO HARDSHIP NECESSARY PSYCHOLOGICAL SUPPORT In addition to medical treatments, specialists strongly recommend that couples receive psychological care as well. Moreover, Switzerland’s law on assisted reproductive technology makes it a requirement before, during and after treatment. “The road isn’t a simple one,” warns Danièle Besse, sexual health counsellor at the Reproductive Medicine Unit. “When a doctor looks for the causes of infertility, one partner might feel responsible or even guilty, which can create problems within the relationship.” In addition, once the diagnosis has been made, a more or less complex treatment is recommended. “Couples don’t always expect how the treatments will affect their bodies and sexuality. They underestimate the probability of failure. Assisted reproductive technology involves waiting, hoping and experiencing setbacks. It’s a roller coaster that is hard on the psyche,” she says. “Often, couples feel that doctors aren’t listening or even supportive,” says Estelle Métrot, a pre-conception support specialist based in Geneva and Paris and the author of the book 1001 fécondités. “It’s imperative to pair medical innovation with opportunities for counselling.” Suffering can affect both people in the couple. “Some people might not feel like women if they can’t be mothers,” says Danièle Besse. “Men are quicker to associate fertility with virility and can therefore have a hard time dealing with infertility.” Estelle Métrot points out that reproductive medicine takes a greater toll on the woman’s body. “Women can be put through many tests during the exploratory and treatment phases. It’s the woman who undergoes stimulation treatments, who is poked and prodded and whose body is exposed to others on a regular basis.” Geneva-based Pascale de Senarclens decided to end her treatment because of inadequate psychological support, among other reasons (read testimonial, p. 18). “The technology doesn’t mitigate the emotional impact.” / 19

CONNECTED OVULATION Smart technology can also be used to help reproduction. A Swiss-designed connected bracelet is a notable example of this type of technology. The accessory, created by the Zurich-based start-up Ava, used physiological measurements that correlate with changes in hormone levels—such as pulse, sleep and temperature—to predict ovulation. The bracelet was approved by the FDA and will soon be marketed in Switzerland. Ava raised $9.7 million in November 2016. The money will be primarily invested in research and clinical studies. There have reportedly been eight babies born to mothers using Ava in 2017 already.

THE CONTROVERSIAL BAN ON EGG DONATION Even though it’s authorised in 20 other European countries, human egg donation is still banned in Switzerland. As a result, hundreds of Swiss couples travel abroad every year to receive treatment (read testimonial p. 14). Several members of Parliament have already questioned why Switzerland continues to ban egg donation even though the country’s first law on assisted reproductive technologies (LPMA) legalised sperm donation in 2001. In 2014, the Swiss National Councillor Jacques Neirynck (PCD/VD) submitted a parliamentary proposal to authorise the practice. The initiative was eventually abandoned in 2016. “There was no opposition to the substance of the law,” said Isabelle Chevalley (PVL/VD). “However, several laws would have had to be modified to lift the ban on egg donation. At the time, some members of Parliament thought it was too complicated. In my opinion, that is not a valid reason.” Last March, the National Councillor co-signed a motion to ask the Swiss Federal Council to legalise egg donation. If the Council agrees, the decision would enter into effect in two years at the earliest—a timetable Isabelle Chevalley judges to be “very optimistic”.

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INTERVIEW BY

YANN BERNARDINELLI

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INTERVIEW “TRANSFERRING EMBRYOS IS SOMETHING MAGICAL”

Nicolas Vulliemoz discusses his vision of reproductive medicine and analyses the latest challenges inherent to a practice that combines ethics, technologies, and human relationships.

What led you to chose reproductive medicine?

in vivo

I was taking part in the Erasmus study abroad programme in Bristol when I decided to go into obstetrics and gynaecology, even though I was only in my fourth year of medical school. I met a very experienced professor nearing retirement who absolutely fascinated me. He had taken part in the first-ever “in vitro” fertilisation trials with the Nobel-winning scientist Robert Edwards, who developed the technique. Assisted reproduction technology (ART) quickly became my passion, and it has met and exceeded my every expectation. The blend of technology and patient interaction makes this job incredibly vibrant. Receiving a baby photo from our patients is priceless!

nicolas vulliemoz

An expert in reproduction Nicolas Vulliemoz has been the chief physician at the Reproductive Medicine Unit since April 2015. At Lausanne University Hospital, he created a multi-disciplinary consultation programme for endometriosis, which provides patients with individualised follow-up care. He also coordinates the French-speaking Swiss Cancer and Fertility Network, which helps patients undergoing oncology treatment protect their fertility. Nicolas Vulliemoz has previously worked at the Fribourg Cantonal Hospital, Columbia University (USA) and Oxford University (UK). 20

What is your experience of the ethical controversy surrounding ART and the fact that it’s far from being unanimously accepted?

nv It’s one of the facets of my job, and it makes it even more interesting. I’ve had a very good experience, actually, because transferring an embryo is always something magical. I respect people’s opinions, but you should be against it for the right reasons. Religious reasons are okay, but a misunderstanding of the treatment shouldn’t be. I’m not here to sell my services, but rather to offer medical options for addressing infertility. You have to be able to demystify a certain number of issues related to ART and accept others’ opinions.

Does Swiss law adequately prevent ethical abuses?

nv Absolutely. Switzerland’s law on assisted reproductive technology is a good thing and limits abuses. Even with the new law, the legal framework in Switzerland remains strict. In our unit, we organise symposiums to discuss legal and ethical issues. We’ve had to refuse treatment when, following a multi-disciplinary evaluation, we found the parents were not able to raise their child to adulthood, as stipulated in the law.

Isn’t ART a business-driven form of medicine that exploits couples’ desire for children?

nv Yes, that is a risk. Because the Swiss health insurance regime does not reimburse IVF, patients can undergo treatment wherever they want. In addition, IVF has grown significantly in the private sector—so much so that people don’t always know that it is also performed in university hospitals. These types of institutions play a vital role in research, education and ethics.

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GILLES WEBER

Nicolas Vulliemoz, director of the Reproductive Medicine Unit at the CHUV

Does it cost the same?

nv Yes.

One cycle of IVF costs 8,000 to 10,000 Swiss francs, and prices are more or less comparable throughout Switzerland. A twelve-month round of ovarian stimulation and three inseminations are reimbursed up to the age of 40.

Do you think insurance will cover the procedure one day?

nv I hope so, because price is a real barrier to treatment. In my opinion, it will be reimbursed eventually. But strict criteria regarding age, weight and tobacco use will apply.

Starting treatment is a major decision. Do you provide patient counselling during treatment?

nv Yes. It’s extremely important. Switzerland’s law on assisted reproductive technology specifies that patients must receive psychological support. Our unit employs specialised nurses and psychologists. All our patients are referred to these specialists. The greatest failing in reproductive medicine is that patients who underwent treatment and did not become pregnant did not receive adequate psychological support. 21

We hear a lot of news about women choosing to freeze their eggs. Companies like Facebook are paying for the procedure for their employees who are focused on their careers. Have people approached you about freezing their eggs for personal reasons?

nv Yes. This is the reality of modern society. We receive a lot of requests, but at the same time we don’t want it to turn into a business. We assess the relevance of the procedure for each individual and don’t hesitate to say no when the benefits of the treatment are too low. For example, if the woman is 44, it’s not an option.

Are the children who are the product of ART less healthy?

nv Nearly 40 years after the first test-tube baby, we have enough perspective and quality studies to know the long-term consequences of births using ART. On a cognitive level, there is no difference. However, there is an increased risk of developing certain malformations in the heart and urinary tract. These malformations are nevertheless rare, and their causes are not fully known. ⁄

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I n h o s p i ta l s , v i r us e s ca n i n f ect computers too TEXT JULIE ZAUGG

Health facilities can be a target of cyberattacks. Hackers want not only their money, but also their medical data— which is worth its weight in gold on the dark web.

anks, supermarkets and individual citizens are often victims of cyberattacks. Though it’s less well known, hospitals can be targets too. A study conducted in the United States by the research institute Ponemon showed that 90% of the country’s health organisations had experienced at least one cyberattack in 2015. There are even more attempted hacks. In Switzerland, the average university hospital is targeted every day by 11,000 attempted cyberattacks of all kinds according to the association Ingénieur Hôpital Suisse. Hospitals have become an attractive target for hackers because they are often poorly protected. Martin Darms, a computer engineer who runs an SME in the canton of Zug, has developed a vulnerability index for hospitals, which he has used to analyse the servers of seven Swiss facilities as part of his Master’s thesis. He found that four

* /= de

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had vulnerabilities of varying degrees of severity. The worst security flaws were found in the facilities’ internal networks, which used out dated software, standard passwords and unprotected test servers. Hospitals are lagging in cybersecurity, according to Franck Calcavecchia, computer security manager for Geneva University Hospitals. “While the financial industry was quick to seize upon data security, this was not the case in the medical sector,” he says. Cybersecurity is not the primary focus of a medical provider’s job. “For medical personnel, the emergency is not knowing if your computer networks are well protected, The hackers’ but taking care goals of patients,” says Solange Ghernaouti, a cybercrime specialist at the University of Lausanne.

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Care providers focus more on their IT equipment’s effectiveness and quickness, and neglect its security. Hospitals don’t take even the most basic precautions. “How many times have I found myself in a treatment room next to a computer that’s on?” she asks.

Hollywood Presbyterian Medical Center was the first hospital to be targeted by ransomware. The hospital lost access to all its files in February 2016 after a virus encrypted them. It had to pay 17,000 bitcoins—about 15 million Swiss francs—to recover them. “This created a precedent,” says Daniel Gougerot of Lausanne University Hospital. “Since then, many other hospitals have been targeted.” Three other American hospitals in Kansas, California and New Jersey have also paid ransoms for their data.

also increased the amount of information stored by hospitals and, by extension, the number of targets for malicious actors. Another challenge is that medical devices are too often without any kind of protection against viruses and other forms of malware, even though they are now connected to IT networks. “Equipment manufacturers were very slow to react and make their devices resistant to cyberattacks,” says Daniel Gougerot, IT system security manager at Lausanne University Hospital.

PHISHING AND INTERNAL THEFT

Hackers’ favourite method of attack is called phishing, which involves sending an email that contains a link to a fake website. “The goal is to install software on the victim’s device in order to use his or her computer to carry out the attack,” says the manager at Lausanne University Hospital. These emails can contain very personal information gleaned from social networking sites in order to gain the reader’s trust. Hackers can also use more physical methods. A report published in 2014 showed that 68% of medical data hacks committed in the United States since 2010 occurred after the loss or theft of a laptop or smartphone. The Baltimore-based consultancy Independent Security Evaluators was able to infiltrate a hospital’s IT network by hacking an information kiosk in the building’s entry way.

= def .keyboard The rise of electronic patient records, genetic databases and medical equipment that automatically records vital signs has

“Health facilities are often rather protected from outside attacks, but they tend to forget about internal sources of risk, such as an upset employee,” says Tomas Bucher, president of the association Ingénieur Hôpital Suisse. A simple USB key inserted into a computer is all it takes to extract data or introduce malware into the hospital’s network.

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RESELLING MEDICAL DATA

What remains is the question of why someone would attack a facility whose primary purpose is to provide care. “Ransomware attacks are the main threat we have to deal with,” says Daniel Gougerot. In this type of attack, a criminal organisation encrypts a hospital’s data, then asks for money (most often in the form of bitcoins) in exchange for allowing the facility to access its systems again. “The hack can be quite elaborate. Some groups have set up hotlines in case the victims don’t know how to make a payment using bitcoins,” he says. Lausanne University Hospital experienced its first attack of this type in early 2015 and has had two or three since. “However, we’ve been able to stop them before our data has been taken hostage,” he says. Hackers who attack hospitals are also looking for information. “Medical data is extremely valuable,” says Frank Calcavecchia. “On the dark web, it’s sold at 10 times the price of a credit card number.” This data can be used to steal someone’s identity in order to get medication, make fraudulent health insurance claims or collect unwarranted welfare payments. “In France, one woman used stolen health data to receive welfare payments on behalf of 19 pairs of twins,” says Solange Ghernaouti.

Medical data is also confidential. “Information about a celebrity’s or politician’s medical treatment can easily be sold to a tabloid or used as blackmail,” says Frank Calcavecchia. These types of hacks can also affect everyday people. Few would want the results of their pregnancy or AIDS test published. The consequences of data theft can be felt long after the initial hack. In the United States, some banks and insurance companies buy this type of data and use it to assess M e d i c a l d ata the risk theft their clients represent. In December 2014, the American insurance They won’t company Anthem was targeted by a cyberattack that allowed a group of hackers to access a grant a loan database with medical information on 78.8 million or sell a life patients. The breach wasn’t discovered until two insurance months later, when a company employee noticed policy to that their login had been used by someone someone else to search the database. Some of the stolen with terminal data was sold on the dark web. cancer.

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:1 Y ddict()){ø} This information is particularly valuable because it has to do with very emotional issues. “Imagine the parents of a child in the terminal phase of an illness who receive an email saying their child has been selected to take part in a new, promising clinical trial,” says Rick Kam, director of the IT security consultancy ID Experts in Portland in the United States. “They aren’t going to be as careful as they would in normal circumstances.”

HACKED MEDICAL DEVICES

A more serious form of cyberattack targets connected medical devices. “MRI machines, insulin pumps, pacemakers and defibrillators are just some of the machines that can be hacked, whether it’s to deliver a wrong dose of medicine, deactivate the device or falsify a result, with potentially deadly consequences,” says Billy Rios, an American IT security expert who works for WhiteScope Group in San Francisco. Sometimes, the entire hospital is the target of the attack. “The building’s doors, HVAC

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systems, electricity supply and water treatment systems are now controlled by IT tools that in theory could be targeted by a cyberattack,” says Tomas Bucher. In UK, hackers have taken over the locking system used to control the hospital’s doors. This type of attack can be the work of a disgruntled employee who wants to harm the hospital’s reputation or a criminal organisation looking for ransom.

LZK1d #3

At Lausanne University Hospital, data is saved every hour. Another measure is to compartmentalise a hospital’s various networks. “That’s how a submarine is designed. If one chamber has a problem, you can close it, and it won’t impact the rest of the sub,” adds Frank Calcavecchia. For example, the system that controls the defibrillators should be kept separate from the one used to set appointments. “It’s also important to use logbooks that list all the people who have consulted sensitive data,” continues Daniel Gougerot. “This makes it possible to spot suspicious behaviour.” On a more general note, access to this type of information should be limited to the people who really need it. The fewer people there are with access to sensitive information, the fewer targets hackers will have. ⁄

S a b o ta g i n g c o n n ect e d devices In May 2014, Billy Rios, an American IT security expert who works for WhiteScope Group in San Francisco, sent a warning to the US health authorities. He had found significant flaws in the Hospira Lifecare PCA III infusion pump. “I discovered a vulnerability that let someone take control of the device remotely,” he says. “This would have made it possible to administer a dose of medication that was too low or too high.” It would have even been possible to turn the pump off. Following the discovery, most hospitals stopped using these devices.

But hospitals have many ways to combat the problem. “Data must be saved regularly,” says Daniel Gougerot. “If a hacker takes data hostage, you’ll still have a copy.”

" end 25

#4 R e p u tat i o n da m ag e In the spring of 2014, 4.5 million patient records were stolen from Community Health Systems, a company that manages 206 hospitals in the United States. The records included social security numbers, birth dates and addresses, but did not contain medical or financial data. An analysis concluded it was the work of hackers hired by the Chinese government, which suggests the attack’s primary goal was to harm the company’s reputation and disrupt its operations.

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PRISONS: THE NEW NURSING HOME?

SOBLI / SABINE WUNDERLIN

THE NUMBER OF PRISONERS OVER AGE 60 IN SWISS INCARCERATION FACILITIES HAS TRIPLED. BUT MANAGERS IN CHARGE OF THESE ELDERLY PRISONERS ARE HAVING DIFFICULTY IMPLEMENTING MEASURES TO MEET THEIR SPECIAL NEEDS.

TEXT PATRICIA MICHAUD

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Lenzburg Prison, located in the canton of Aargau, is the only facility in Switzerland with a unit adapted to treat detainees over the age of 60.

PROSPECTING

n 1985, Swiss prisons held some 55 inmates over age 60. Thirty years later, this figure has more than tripled, now at 203 according to the Swiss Federal Statistical Office. The ageing of the Swiss prison population is on a roll and is unlikely to stop. By 2030, the number of senior citizens behind bars could reach up to at least 600 individuals. And the statistics for prisoners aged 50 and up are even more startling. In three decades the number has jumped from 236 to 691. Several factors explain why the number of older prisoners has shot up: longer average life expectancy, increase in the rate of crimes committed by seniors, fewer releases and more severe sentences (e.g. internment measures). This trend comes at a time when society increasingly feels a need for security, says the Swiss prison staff training centre (CSFPP).

A PIONEERING PROJECT THAT IS (SLOWLY) CATCHING ON With 12 cells slightly roomier than the average, special wheelchair access to showers and, more generally, adapted to the elderly in terms of both the equipment and the activities and training available, the â&#x20AC;&#x153;60plusâ&#x20AC;? unit at the Lenzburg prison, opened in May 2011, is a small revolution in the world of Swiss prisons. Since then, a number of incarceration facilities have initiated similar projects. For the past few years, the staff at Bostadel prison in the Canton of Zug have also been talking about creating a unit for elderly prisoners. It could take the form of a quarter of about 30 places in the existing complex or even a new building with up to at least 60 specially equipped places. In the Canton of Geneva, the future Dardelles prison could also provide special infrastructure for the elderly, amounting to some 45 spots spread throughout three-quarters of the facility.

I A GROWING MENTAL-HEALTH PROBLEM

SOBLI / SABINE WUNDERLIN

Given that a 50-year-old in prison is in the same state of health as a 60-year-old living freely, the prison staff in charge of caring for them have reason to be worried. Professor Bernice Elger from the University of Basel established this striking comparison while she was carrying out her research project financed by the Swiss National Science Foundation.

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Professor Elger also noted that, like their younger counterparts, older prisoners suffer from twice as many diseases on average as Swiss residents. The most frequent health issues are those affecting the musculoskeletal system, connective tissue, circulatory system, endocrine glands and metabolism. “Not to mention mental disorders, which are also much more commonplace behind bars,” says Bruno Gravier, chief of the Service of Correctional Medicine and Psychiatry at the Lausanne University Hospital (CHUV). II HIGHER RISK, ALL-ROUND

What is it that makes us age faster in prison? “A combination of factors explains the phenomenon,” Professor Gravier says. They include “losing social ties, isolation, restricted movement and worsening hygiene.” Not to mention exposure to smoking—“in preventive detention, cells are sometimes shared with a smoker”—and, although it’s officially forbidden, the consumption of alcohol or even drugs. “Prison is a place where people take more risks than on the outside,” the expert says. On top of that are age-related diseases and the gradual loss of mobility of elderly prisoners, making the ageing of the prison population quite a hefty challenge. Both the equipment and support offered to prisoners have been designed for relatively

PROSPECTING

young, healthy people. “Take the case of a prisoner in a wheelchair. The vast majority of Swiss prisons don’t have threshold-free showers or spacious enough cells.” So far, the facility in Lenzburg (Aargau) is the only prison in the country that has set up a special division for the elderly. But this model is slow in being rolled out nationwide (see inset p. 27). Equipment is by far not the only aspect that does not meet the needs of the ageing prison population. Switzerland could also improve in terms of its legislation. Mr Gravier points to the country’s labour laws. “The penal code applies to all prisoners.” This means that, officially, there is no retirement for prisoners. But in practice, some cantons have made adjustments. In the Canton of Vaud, an internal rule encourages working beyond age 65, but with conditions adapted to the person’s age. III DYING WITH DIGNITY

Even though there is not (yet) any magic formula for dealing with the transformation of the prison population, prison management experts agree that dividing them up by age group is not the right solution. “I visited prisons in the United States that held only elderly prisoners. It was awful. People were just sitting around, waiting to die,” Gravier says. Instead, the CHUV

physician advises creating areas, within traditional prisons, with facilities and amenities specially designed for the elderly. Similar recommendations come from the CSFPP, which also points to the need to provide special training for prison staff. Then there is that delicate end-of-life issue for very old or sick prisoners. A scientific study conducted by researchers at the University of Bern and University of Fribourg, also financed by the Swiss National Science Foundation and led by the anthropologist Ueli Hostettler, showed that the country’s prisons are ill-prepared for the death of inmates, as well as caring for them throughout the period prior to it. Meanwhile, prisoners express their well-founded anxiety about not being able to die with dignity. The research concluded that Swiss prisons should be able to turn to specialised healthcare providers or even palliative care. Prisoners who wish to die outside confinement should be granted some leniency for this last stage of their life. ⁄

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WOMEN IN SEARCH OF THAT “EUREKA” MOMENT TEXT JADE ALBASINI

At a time when gender equality is such a hot topic, and despite all the initiatives currently being taken, balance between men and women in fundamental and clinical research is only in its nascent phase. A closer look.

espite more and more women graduating from university, only a handful of them will pursue a career in academics. In 2015, only 11.6% of full professorships were filled by women at the Faculty of Biology and Medicine (FBM) at the University of Lausanne (UNIL). This under-representation of women in high-level academia seems to stem from the difficulty in juggling motherhood, family life and professional life in this extremely competitive environment. But in French-speaking Switzerland, initial strides towards progress have been taken. “Five years ago, the macho attitudes were definitely there, but things are changing,” says François Pralong, vice dean for Academic Affairs at FBM and chief of the Service of Endocrinology, Diabetes and Metabolism at the Lausanne University Hospital (CHUV).

Baby steps towards equality This gentle shift is reflected in the most recent statistics provided by UNIL’s Equality Office. The percentage of women hired in all categories of new professorships rose from 15.4% to 25% between 2011 and 2015. But this encouraging figure needs to be clarified, says Susy Wagnières, project manager with the dean’s office of FBM on the Equal Opportunity Commission (Commission Pro-Femmes). “If we look at the actual percentage of women in top academic positions, i.e. full and associate professors, the figure has only risen from 12.9% to 15.7% in those four years.” But significant progress has been made on the scale of FBM. “Things are moving in the right direction,” says Christine Sempoux, co-president of the Equal Opportunity Commission and full professor at the University Institute of Pathology. “It takes time for the wave of women to reach the top of the narrow pyramid of research. They’re starting to climb to senior positions such as associate professor,” says François Pralong. Nicole Déglon is one of these women. The associate professor at the Department of Clinical Neuroscience and director of the Cellular and Molecular Neurotherapy Laboratory at CHUV confirms that the situation is changing. “I’ve noticed at meetings that I’m surrounded less and less by male colleagues only. Things are evolving, but at a Swiss pace.” The shift is a welcome change, but as yet far from equality.

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Programmed since childhood To understand these findings, the biases that subsist in our intrinsically gender-driven society must be analysed. “Behavioural differences” endure between male and female candidates. “Men are achievers, while women question themselves more. This male personality trait is a strength in a job interview, but I think we could gain a lot from having more scientists who have a greater tendency to question what they’re doing,” says François Pralong. With a passion for biology, Nicole Déglon admits that she hesitated before choosing to go down the academic route. “I took a one-year sabbatical after my dissertation. Should I go into this type of career? Should I branch out into a different path? In the end, passion won,” the scientist says. But many women have doubts. “They wonder if they can balance their professional and personal lives. And they’re afraid they can’t do it,” Sempoux says. Having a family herself, she hopes to dispel their fears through the support programmes (read below) organised by the Equal Opportunity Commission and women’s mentoring programmes. “Women researchers aged 30 to 50 have incredibly vast potential. But the social pressure, felt in the attitudes towards mothers who focus heavily on their work, is still too strong.”

15.7% OF THE PROFESSORS AT THE FACULTY OF BIOLOGY AND MEDICINE OF THE UNIVERSITY OF LAUSANNE IN 2015 WERE WOMEN.

Elsa Juan, a post-doctoral student in neuroscience, accuses this very society of programming children from a very early stage, thus holding school-age girls back from the notion of risk-taking. “From the time they’re little, boys are trained to try everything, while we push girls to focus on results.” To venture into a career as a researcher, they must learn how to handle failure. “Women need to forget about proving themselves!” the scientist says. The 2016 winner of the “My Thesis in 180 Seconds” competition—a competition dominated by men— Ms Juan doesn’t understand why women don’t get more actively involved. “I could do without some of the sexist remarks from my male counterparts, but I’ve fit in just fine at my laboratory.”

“Publish or perish” Another obstacle often mentioned is everything that is now involved in being a researcher. Academics of both genders must meet ever higher criteria to be taken on in a permanent position. They are expected to perform in a number of demanding areas, including fund-raising, publication in scientific journals, teaching, networking and pure research. Given the strain of this strict environment, women suffer even more from the timing factor required by universities. “Post-doctoral students have five years to confirm their positions. Researchers are often between 28 and 35 years old, the age when women start thinking about starting a family. With increased international competition, it’s hard to replace a woman researcher on the cutting edge of her field if she goes on maternity leave,” Pralong says. Ms Déglon understands the demands of the job perfectly well. “I read that 70% of researchers have already thought about giving up their position because their duties were too far removed from pure science. If you throw the feminine aspect into the performance factors, you understand why my colleagues feel the situation is impossible.”

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BACKSTAGE

The challenges of climbing the academic echelons also reduce the chances of reaching any position with clinical responsibilities. “To be appointed to a position of chief or head of a department or service at a hospital, you have to be a professor, generally a full professor,” Wagnières says. To change that, FBM and the Equal Opportunity Commission are rethinking how things are done, guided by new initiatives. The Commission provides a variety of tools for attracting women researchers and has come up with long-term solutions to foster advocacy and bring more women into science. A number of opportunities are available, from financial aid for the women’s mentoring programme to grants during parental leave to secure the resources needed to hire a replacement who can lead the project during her absence. Other innovative ideas are also being discussed to improve access to jobs in academia. “In the appointment process, they should for example take into account the number of publications versus the number of years active in the position rather than age, so that women who’ve put their careers on hold for one or more periods of maternity leave are not penalised,” the Commission co-president says. Another idea is to review the lists of male and female candidates separately in the procedure for filling professorships. “We’d bring in the same number of men and women to avoid having one woman competing with four male applicants,” the vice dean says. Then there’s the touchier issue of quotas. “I used to be fiercely opposed to quotas, but I’ve changed my mind because it’s time to re-invigorate the old, stale system,” says this father of five girls. “Encouraging part-time work, by offering the head of a laboratory two male co-directors and two female co-directors who work 60% of the time, while devoting time to passing on knowledge, would also offer a response to Generation Y, who often seek greater work-life balance.” Christine Sempoux,

EQUAL OPPORTUNITY COMMISSION: KEY DATES

1991 1999 2013 CREATION

FIRST GRANTS FOR WOMEN

ACTION PLAN FOR GENDER EQUALITY

co-president of the Equal Opportunity Commission, secretly dreams of a much more flexible day-care system—modelled after certain projects in the United States—that would be better adapted to the extremely variable time demands involved in a career in science. It would be a win-win situation both for innovation and for families. ⁄

MENS SANA

COMMENTARY

MARTIN WINCKLER Physician, novelist and essayist

It’s up to patients to decide on the care they receive. There is still no way of being sure what others experience without asking them. Only the person in pain can describe what they are feeling and which treatments ease that suffering. Caring for patients therefore means taking all necessary steps so that the person in need feels better (or less pain) after receiving treatment. And being willing to hear that, sometimes, the treatment has not worked.

We’d like to think that people who dedicate their life and energy to caring for others always do so out of kindness. But that’s a misleading and dangerous illusion.

Empathy (the capacity to feel the suffering of others) and altruism (behaviour aimed at helping others) may be common qualities, Likewise, only the person affected can say but they are not distributed equally among what (or who) is causing them to suffer. And humans. The religious and scientific values we can administer care with nothing but the touted by health professionals in no way best intentions while completely mistreating guarantee that their acts are carried out in the person. This mistreatment does not lie “kindness” or “compassion”. The Catholic in the intention, but in the attitude of the Church prohibited the dissection of cadavers healthcare professional. but allowed it for prisoners sentenced to death. Nazi doctors and physicians from the Gulag Mistreatment begins when healthcare providers used to conduct experiments on their prisoners maintain or accentuate feelings of dependency, in the name of “medical progress”. Similarly, vulnerability, distress or shame in the person in the 1960s French psychiatrists tested calling on them for help. We can indeed feel countless drugs on patients without their consent to “make advances in therapeutics”. mistreated through looks, attitudes, remarks, They had all forgotten about—or ignored—the words or simply when others deny what we’re idea of “first, do no harm”. feeling. What all these forms of mistreatment have in common is the refusal to regard the Although once driven by the values of doctors, person in need as an independent and competent today medical definitions and practices need a subject. It is mistreatment as soon as patient dramatic shift in paradigm. perception is ignored.

CLAUDE GASSIAN

PROFIL

Under the pseudonym Martin Winckler, the French general practitioner Marc Zaffran writes for several blogs, including L’école des soignants, a participatory platform on the medical system that he created. He has also written several books, namely Les Brutes en blanc in October 2016.

To uphold “first, do no harm”, we must constantly ask, “What do you want and what don’t you want?” and listen to the answers! We need to support and guide patients in their choices and uncertainty without forcing them to understand or agree with them. Patient perception and expectations should come before our concept of care. To uphold “first, do no harm”, we must acknowledge that the subject of care is always the patient. ⁄

READ

“Les Brutes en blanc, pourquoi y a-t-il tant de médecins maltraitants?”, Flammarion, octobre 2016. https://ecoledessoignants.blogspot.ch

AN AMBULANCE FOR NEWBORNS

TEXT: WILLIAM TÜRLER IMAGES: GILLES WEBER

NEONATOLOGY A new medical system for transporting infants was created in early 2017. “In Vivo” reports on the transfer of a very young patient from Lausanne to Morges.

IN CORPORE SANO

The Lausanne University Hospital Neonatal Service contains the only neonatal intensive care unit for the cantons of Vaud, Valais, Fribourg and Neuchâtel. Around 16,000 babies are born in this region every year. When an infant requires intensive care, doctors call on the service’s highly specialised emergency transport team to continue the child’s treatment at Lausanne University Hospital. “Specialised emergency medical teams transport around 250 to 300 patients each year,” explains Matthias Roth-Kleiner, head physician at the Neonatal Service. “Once the patient becomes stable, which can be days or even weeks after he or she is admitted to Lausanne University Hospital, a second transfer to the hospital closest to the parents’ home is discussed with the infant’s parents and the new hospital’s paediatricians. These transfers require the same highly specialised type of equipment. The large number of sick newborns requiring transport justifies the use of a dedicated ‘baby rescue’ ambulance.”

AT THE CHUV

Following treatment at the hospital, which can vary in duration, the patient stabilises enough to be transferred to a hospital close to the parents’ home to continue treatment. The patient is swaddled and kept warm in a transport incubator.

CORPORE SANO

IN THE LENS

DEPARTURE

A transport incubator is the smallest possible version of an intensive care unit. It is also mobile. The incubator can be used to transport babies in ambulances, helicopters, and Rega planes, known as Swiss Air-Ambulances.

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IN THE LENS

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IN THE LENS

ARRIVAL

Once the ambulance reaches the new hospital, the transport team provides a medical report to the personnel who will take over and continue the patientâ&#x20AC;&#x2122;s treatment. The newborn is then removed from the incubator and placed in his or her new bed.

IN THE AMBULANCE

The placement of the equipment allows the transport team to monitor the patient as if he or she were still hospitalised in the neonatal intensive care unit. High-performance shock absorbers and a specially designed attachment system mean the newborn can be transported in complete safety. If needed, the team can still reach the infant through portholes.

CORPORE SANO

IN THE LENS

AT THE NEW HOSPITAL

The new team of doctors and nurses performs a clinical intake exam on the patient then connects the newborn to monitoring equipment. The porthole is closed to keep the patientâ&#x20AC;&#x2122;s environment warm and calm.

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IN THE LENS

BÉATRICE PERRENOUD Specialised nurse with a doctorate in educational science

Science must be used to help humanity

The very nature of the knowledge obtained through research can create confusion. Some studies contradict each other, scientific doubt is ever-present, and the recommendations are not always clear. There is also the matter of context. For example, can the measures that effectively prevent poor nutrition among the elderly in Lebanon or Singapore achieve the same results in Lausanne? Not always.

By simply considering the impact the invention of eyeglasses has had on our lives, it is easy to see the significant benefits that the advancement of science has brought us. However, some scientific knowledge seems easier to incorporate into our daily lives than others. In healthcare, evidence-based practice (EBP) entails providing clinical services that are rooted in scientific knowledge. It makes it possible to use available resources more efficiently, improve the quality of healthcare and the results obtained, and potentially decrease costs. And yet, the use of convincing data by professionals seems to come up against quite a few invisible barriers. For example, studies estimate that 45% of the healthcare provided is not up to the latest standards and that there is a 17-year delay between the publication of scientific proof and the resulting update of provider practices.

Finally, human complexity is probably the most determining factor. When research results in a technological improvement to smartphone batteries, the manufacturing sector adopts it immediately. When it demonstrates that a given measure is more effective than another at preventing infection or bed sores in the hospital, each and every professional must adopt it and decide whether changing their practice is relevant given their context, their own judgement, and the specific characteristics of the population they care for. Different viewpoints may clash with each other, and healthcare providers must also be able to recognise situations in which choosing a different course of action is necessary. This is especially the case when the expected benefit is called into question or when the patient’s values or choices go against the practice.

PHILIPPE GÉTAZ

Science must be used to help humanity. However, the path from one to the other is often very complex in healthcare and requires an extensive thought process. Does this mean we should turn away from science altogether? No. After all, who in this day and age would want to give up their glasses? ⁄

CORPORE SANO

COMMENTARY

TEXT PAULE GOUMAZ

WHEN THE LUNGS GO UP IN SMOKE KNOWN AS “SMOKER’S DISEASE”, CHRONIC OBSTRUCTIVE PULMONARY DISEASE WILL BE THE THIRD LEADING CAUSE OF DEATH IN THE WORLD IN 2030. THIS ARTICLE EXPLORES A TYPE OF RESPIRATORY DISEASE THAT IS NOT VERY WELL KNOWN.

hronic obstructive pulmonary disease (COPD) develops silently over a period of years. Sufferers are unaware of their condition. COPD affects nearly 400,000 people in Switzerland, where tobacco use is the leading cause. Among non-smokers, microparticles in air pollution have become a well-documented risk factor in the past few years. “The inhalation of smoke or other irritating substances causes the bronchial tubes to contract and become inflamed, resulting in pulmonary obstruction and a diagnosis of COPD,” explains Alban Lovis, associate physician at the Lausanne University Hospital Pulmonary Service. “This same phenomenon causes pulmonary emphysema, or the destruction and dilation of the lung’s alveoli. The alveoli are no longer able to extract oxygen from the air we inhale so that it can be sent throughout the body.” CORPORE SANO

A DIAGNOSIS THAT COMES TOO LATE

COPD symptoms include trouble breathing at the slightest effort as well as chronic expectorations and coughing. But symptom onset is insidious and very gradual. In the beginning, sufferers don’t notice the signs of the disease, then adjust to the changes. “Instead of walking up Rue du Petit-Chêne in Lausanne on foot, they take the metro,” says the lung specialist. “They think they can’t catch their breath because of their age.” These symptoms should serve as a warning though, because they often mark the start of a descending spiral. In some serious cases, the patient can only walk a few steps at a time. “Because they are out of breath, COPD sufferers exercise less and less,” says Alban Lovis. “They no longer get out to do their shopping. They eat less, and lose muscle mass. They also become socially isolated PROSPECTING

because they are no longer strong enough to climb a flight of stairs, for example.” Because of their weakened state, these patients often contract respiratory infections. This can cause their health to decline to the point that they are at risk of dying. “Generally speaking,” says the specialist, “these patients come to see us when they are 60 years old. At that point, they are severely impacted already, with less than half their normal lung capacity.” The specialist recommends visiting your GP if you use tobacco products, even if you aren’t experiencing early symptoms of COPD. The doctor can perform a spirometry test, which measures respiration, and provide advice about how to stop smoking. “Remember that one in two smokers dies as a direct result of tobacco,” says the specialist. “Only 20% of smokers develop COPD. But it’s vital that these patients

REDUCING LUNG VOLUME TO BREATHE MORE EASILY

receive an early diagnosis, because damage caused to alveoli and bronchial tubes cannot be reversed.” IMPROVED PHYSICAL SHAPE

SCIENCE PHOTO LIBRARY

The first step towards preventing lung damage is to stop smoking. Next, bronchodilators—medications that expand the bronchial tubes—help patients breathe more easily. But doctors focus on a comprehensive approach to the disease. A rehabilitation programme followed at Rolle Hospital, for example, over the course of several weeks helps patients have a better quality of life. The course includes psychological support as well as exercises and nutritional advice to help them regain muscle mass. “COPD patients can gradually reverse their decline in health,” says Alban Lovis. “By increasing their respiratory capacity, they regain confidence and can move more easily.” But they must continue their new, healthy CORPORE SANO

lifestyle every day to stop the progression of COPD symptoms. While it is not the norm, some patients receive lung volume reduction surgery in addition to rehab. This procedure is either performed surgically or endoscopically (see inset). According to the World Health Organization, 64 million people throughout the world currently suffer from COPD. This figure is projected to rise. As a result, COPD is likely to be the third leading cause of death by 2030. “In developing countries, this disease is most commonly caused by burning wood and coal inside homes for heating and cooking,” says Alban Lovis. “In Switzerland, however, it’s the consequence of the smoking boom.” Even though it’s becoming less common, the effects of this silent killer will continue to be felt for many years.” ⁄

PROSPECTING

Patients suffering from severe pulmonary emphysema can undergo surgery to reduce their lung volume. “The destruction of alveoli makes the lung less elastic,” explains thoracic surgeon Michel Gonzalez. “The lung dilates and resembles a balloon that can no longer deflate.” This air bubble compresses the diaphragm and the surrounding healthy lung tissue until they can no longer move when the patient inhales or exhales. In such cases, the volume of the damaged lung can be reduced. The operation is performed by thoracic surgeons or lung specialists. Thoracic surgeons remove the damaged portions of the lung through incisions made in the patient’s thorax. Pulmonologists, however, use an endoscope to insert valves, which let the excess air escape the lung, or coils. These small spring-shaped structures compress the damaged area of the lung. “These treatments improve the patient’s respiration and therefore well-being,” says the surgeon. “But they are not palliative. They do not fix the damaged portion of the lung. To prevent COPD and its consequences, you have to get back to basics—which means getting rid of cigarettes!”

NAME NEMATODE C. ELEGANS

ith its elegant, crystal-clear shell, the nematode C. elegans wins the prize for the most extensively studied organism in science. This tiny, limpidly flowing worm thrives in petri dishes to reach its adult size in just two and a half days. Speedy and adaptable, it feeds on the bacterial blooms that grow on decomposing fruit. Its qualities as a model organism for molecular biology research earned its “father”, South African scientist Sydney Brenner, the Nobel Prize in Physiology or Medicine in 2002. His discoveries about the genetic code were made possible thanks to the active contribution from this minuscule 1-mm long mollusc. CORPORE SANO

SIZE 1 MM LONG FEATURES TRANSPARENT, HERMAPHRODITE, LIFE CYCLE OF 2.5 DAYS

Nematode C. elegans Biologists just love this transparent little roundworm and use it in the majority of their in vitro studies. TEXT: JADE ALBASINI

FAUNA & FLORA

“Nematode C. elegans was the first organism to have its entire genome sequenced in 1998, because it was much easier to understand than that of humans,” says Dr Alexandra Bezler from the Department of Ecology and Evolution with the Faculty of Biology and Medicine at the University of Lausanne. “It’s the pioneer of DNA reading.” From the C. elegans genome, 19,099 genes were decoded, of which 40% had equivalent genes in the human code. With only 300 neurons, compared with 86 billion to 100 billion in humans, the worm offers a “simplified” mirror of our genome and is the ideal tool for neurobiology research. “It provides a simpler way of studying how the brain functions,” the scientist says. “For example, due to the similarity in ageing molecules, researchers use C. elegans to better understand the human ageing process.” ⁄

SCANNING ELECTRON MICROSCOPE, RALF J. SOMMER, JÜRGEN BERGER / MAX PLANCK INSTITUTE FOR DEVELOPMENTAL BIOLOGY.

CURSUS

COMMENTARY

Research is also a matter of time

situation is in part due to the fact that academic research is not typically the first choice of Jocelyne Bloch new physicians. Deputy head of the NeuroIt is precisely with this logical Surgery Service and in mind that Lausanne president of the “Pépinière” University Hospital and (incubator) commission. the University of Lausanne came together last year to create a support programme called romoting research” “Pépinière”. This initiative encourages may just sound like an electoral promise, the heads of the various clinical services to promote profiles and projects that but it actually deserve the limelight. If the project is represents a major approved by a commission made up of challenge for a university care facility. a representative of each clinical and Lausanne University Hospital can adjust research department, it receives 50% a variety of factors—including working of the value of the winner’s working time conditions, funding and reach—to help for two years, allowing the researcher its clinicians publish more research. to have a “protected” amount of time so But the hospital’s most ambitious that he or she can work hassle-free. lever is doubtless its ability to recognise This year, three researchers were as early as possible researchers whose selected, including Chantal Berna Renella work would benefit from an “extra boost”. from anaesthesiology (investigations into The alternative would mean running the central nervous system and stress the risk of talent sources drying up, or resistance in patients suffering from even heading elsewhere. At the start chronic neurogenic pain), Noémie Boilat of their education, doctors can sign up Blanco from the Infectious Disease Service for an MD-PhD programme, which is (development of a decisional algorithm an excellent launch pad for pursuing a that aims to reduce antibiotic use among career in research. Much later, at the patients visiting their GPs for respiratory professional level, there are many infections) and François Kuonen from programmes to support physicians’ work our Dermatology Service (in vitro and in once they have proven their scientific vivo research using mouse models on the bona fides. But for doctors in between these two stages, such as clinical directors invasive profile of basal-cell carcinoma). These projects represent the first three and young chief residents, the path chapters of a story we hope will be leading to the coveted research grant productive and rewarding! ⁄ is full of obstacles. This complicated

CURSUS ERIC DÉROZE

CAREER AT THE CHUV

“P

ANNE FISHMAN

TANDEM

EVA FAVRE

CURSUS

CAREER AT THE CHUV

or the first was complementary In the intensive care unit, Eva Favre time in this to our own, but no and Anne Fishman join forces to section one knew exactly advance patient care practices. of “In Vivo”, we what her role would are featuring two be as she was the TEXT: BERTRAND TAPPY, PHOTOS: GILLES WEBER colleagues who share first CNS we had. the same profession and work at the same hospital My responsibility was to initiate a constructive unit. Eva Favre is a clinical nurse specialist (CNS), process with the medical and nursing team to and Anne Fishman is the head nurse with the make sure that Eva could most effectively apply intensive care unit. her strengths to what we do.” The duo deserves our attention as they symbolise the fundamental transformation at work in nursing since 2011. The University Institute of Training and Research in Patient Care in Lausanne, created four years ago, released its first graduating class of specialist nursing clinical practitioners with a Master of Science in Nursing Sciences onto the French-speaking Swiss market. “These specialised nurses offer care for patients with complex needs,” Favre says. “In addition to our clinical role, which remains our focus, we also take on an advisory role for the teams in the unit. That means we have to try to go by results published in scientific literature, bring theory in line with real-life situations and actively participate in clinical projects. We’re real agents of change in the healthcare system.” Eva Favre completed her Master’s degree in 2013 and was immediately hired as a CNS with the Service of Adult Intensive Medicine at Lausanne University Hospital. That is when she began gradually integrating into the service. The guidance from management played a key role for her during this phase. Anne Fishman agrees, “Eva brought the team advanced expertise that

The CNS adds, “the new aspect was incorporating the scientific culture into the already very specialised expertise that my intensive care nursing colleagues had. And like any cultural change,” she says, “it can’t happen on its own, or in a few days. We start by getting to know each other, developing a common language, gaining trust and achieving success together!” Ms Favre chiefly intervenes in complex situations. “Patients that remain in intensive care for an extended period are a real challenge, mainly because their stay involves decisions that are not only sensitive but must also factor in a huge amount of information and issues,” Fishman says. “A CNS can drive other nursing staff members in providing key information used to take these decisions when all the disciplines are brought together.” In a final note, Eva Favre adds, “Through their training and by working closely with those who benefit from the care as well as their loved ones, these nurses are excellent patient experts. Updating their practices, by drawing on solid fundamentals, makes their contribution for patients even more crucial, and science has a lot of answers to bring to their questions!” ⁄

NEWS

A new approach to geriatric care

LAST NAME

BÜLA

FIRST NAME

CHRISTOPHE

Over the past few years, the Geriatrics and Geriatric Rehabilitation Service has worked to constantly improve its care strategies, providing elderly patients with treatment options that are increasingly varied and tailor-made. The service, which is directed by Dr Christophe Büla, now counts 250 employees, 123 beds, and four units, namely a senior intensive care unit, geriatric rehabilitation, a geriatric outpatient and community unit, and a separate senior intensive care programme. Each unit adopts an interdisciplinary approach to better meet the complex and specific requirements of elderly patients. It also creates a framework for long-term social and medical support both at home and in the hospital.

TITLE

CARE

LANG PIERRE-OLIVIER TITLE Chief physician LAST NAME

FIRST NAME

Dr Pierre-Olivier Lang was the former privatdozent at Geneva University Hospital. He is now an associate professor at Anglia Ruskin University in Cambridge. With a speciality in internal medicine and geriatrics, he has been directing the Senior Intensive Care Unit since April 2015. Every year, the unit cares for nearly 600 elderly patients.

Head physician After studying medicine at the University of Lausanne (UNIL), Dr Christophe Büla specialised in geriatrics at the University of California, Los Angeles. With a speciality in internal medicine and geriatrics, he teaches UNIL students as well as paramedical professionals and holds offices in several public institutions. In 2003, he became head physician of the Geriatrics Service and today directs the service’s four units.

BOSSHARD WANDA TITLE Chief physician LAST NAME

FIRST NAME

Dr Wanda Bosshard received her degree from UNIL and has worked with several hospitals, including the Internal Medicine Service at the CHUV. Since February 2017, she has been directing the Geriatric Rehabilitation Unit, where she helps over 1,300 patients annually in CUTR Sylvana Hospital’s 95 beds regain their independence.

CHASSAGNE PHILIPPE TITLE Chief physician LAST NAME

FIRST NAME

Dr Philippe Chassagne was formerly the head physician of the Geriatrics Service at Rouen University Hospital. He joined the CHUV in May 2016. Specialised in internal medicine and geriatrics, he directs both the Senior Intensive Care Programme within the Geriatrics Service and the Outpatient and Community Geriatrics Unit.

HEIDI DIAZ, OLIVIER MAIRE, GIILLES WEBER, DR

CURSUS

A closer look at Zika A team at CHUV conducted a study on the impact of Zika virus on pregnant women. Out of the 500 patients infected with the virus, the foetuses of eight women had cerebral malformations. These changes are undetectable through amniocentesis and can only be seen halfway through the pregnancy. Zika can make itself invisible during the first weeks of pregnancy. The results increased science’s understanding of how the virus works. DISCOVERY

New deputy director

SÉBASTIEN KAULITZKI / SHUTTERSTOCK

Oliver Peters APPOINTMENT became CHUV’s new deputy managing director on 1 January 2017. Formerly an executive with the Swiss Federal Public Health Office, he had already been working at the hospital as a financial and administrative director. His goal is to increase clinical efficacy within the hospital and with external partners, organise the use of new hospital infrastructure, and oversee CHUV’s relations on a cantonal, regional and national level.

NEWS

Understanding the mechanisms behind fear and anxiety The Neurobiology research unit was just awarded funding for two unique projects.

NEUROSCIENCES

What neurobiological mechanisms are responsible for fear and anxiety? How are our bodies’ reactions and fear thresholds regulated? It’s this type of question that the Neurobiology research unit at the Psychiatric neuroscience centre, directed by Dr Ron Stoop, tries to answer.

Tonsil

of the brain affected by anxiety, fear and social behaviour.

Two of the unit’s projects obtained funding. The first, which received support from the Commission for Technology and Innovation (CTI), seeks to test the effectiveness of new oxytocin receptor molecules used to treat anxiety and some autism spectrum disorders. The effects of these components, which were developed by the company Roche, will be compared with the effects of oxytocin that is naturally produced in the brains of rodents, especially in the areas

The second project received funding from the European Community via the Marie Curie Fund and involves translational research between clinicians at the Lausanne University Hospital University Service of Advanced Age Psychiatry (SUPAA) and researchers at Cape Town University. The aim is to test if hyper-anxiety experienced by Alzheimer’s patients is caused by a neuro-degeneration of the amygdala, which is a part of the brain that is especially active during periods of stress.