Duke Research Blog

Following the people and events that make up the research community at Duke.

Category: Medicine Page 1 of 16

The evolution of a tumor

The results of evolution are often awe-inspiring — from the long neck of the giraffe to the majestic colors of a peacock — but evolution does not always create structures of function and beauty.

In the case of cancer, the growth of a population of malignant cells from a single cell reflects a process of evolution too, but with much more harrowing results.

Johannes Reiter uses mathematical models to understand the evolution of cancer

Researchers like Johannes Reiter, PhD, of Stanford University’s Translational Cancer Evolution Laboratory, are examining the path of cancer from a single sell to many metastatic tumors. By using this perspective and simple mathematical models, Reiter interrogates the current practices in cancer treatment. He spoke at Duke’s mathematical biology seminar on Jan. 17.

 The evolutionary process of cancer begins with a single cell. At each division, a cell acquires a few mutations to its genetic code, most of which are inconsequential. However, if the mutations occur in certain genes called driver genes, the cell lineage can follow a different path of rapid growth. If these mutations can survive, cells continue to divide at a rate faster than normal, and the result is a tumor.

As cells divide, they acquire mutations that can drive abnormal growth and form tumors. Tumors and their metastases can consist of diverse cell populations, complicating treatment plans out patient outcomes. Image courtesy of Reiter Lab

With each additional division, the cell continues to acquire mutations. The result is that a single tumor can consist of a variety of unique cell populations; this diversity is called intratumoral heterogeneity (ITH). As tumors metastasize, or spread to other locations throughout the body, the possibility for diversity grows.

Intratumoral heterogeneity can exist within primary tumors, within metastases, or between metastases. Vogelstein et al., Science, 2013

Reiter describes three flavors of ITH. Intra-primary heterogeneity describes the diversity of cell types within the initial tumor. Intrametastatic heterogeneity describes the diversity of cell types within a single metastasis. Finally, inter-metastatic heterogeneity describes diversity between metastases from the same primary tumor.

For Reiter, inter-metastatic heterogeneity presents a particularly compelling problem. If treatment plans are made based on biopsy of the primary tumor but the metastases differ from each other and from the primary tumor, the efficacy of treatment will be greatly limited.

With this in mind, Reiter developed a mathematical model to predict whether a cell sample collected by biopsy of just the primary tumor would provide adequate information for treatment.

Using genetic sequence data from patients who had at least two untreated metastases and a primary tumor, Reiter found that metastases and primary tumors overwhelmingly share a single driver gene. Reiter said this confirmed that a biopsy of the primary tumor should be sufficient to plan targeted therapies, because the risk of missing driver genes that are functional in the metastases proved to be negligible.

 In his next endeavors as a new member of the Canary Center for Cancer Early Detection, Reiter plans to use his knack for mathematical modeling to tackle problems of identifying cancer while still in its most treatable stage.  

Post by undergraduate blogger Sarah Haurin

Post by Sarah Haurin

Inventing New Ways to Do Brain Surgery

This is the sixth and final 2019 post written by students at the North Carolina School of Science and Math as part of an elective about science communication with Dean Amy Sheck.

Dr. Patrick Codd is the Director of the Duke Brain Tool Laboratory and an Assistant Professor of Neurosurgery at Duke. Working as a neurosurgeon and helping with the research and development of various neurosurgical devices is “a delicate balance,” he said.

Patrick Codd

Codd currently runs a minimally invasive neurosurgery group. However, at Massachusetts General Hospital, he used to run the trauma section. When asked about which role was more stressful, he stated “they were both pretty stressful” but for different reasons. At Mass General, he was on call for most hours of the day and had to pull long shifts in the operating room. At Duke, he has to juggle surgery, teaching, and research and the development of new technology.

“I didn’t know I was going to be a neurosurgeon until I was in college,” Codd said. Despite all of the interesting specialties he learned about in medical school, he said “it was always neurosurgery that brought me back.”

Currently, he is exclusively conducting cranial surgery.

 Neurosurgeon U.S. Air Force Maj Jonathan Forbes,looks through loupes as he performs brain surgery at the Bagram Air Field in Afghanistan, Oct. 10, 2014. 

Though Dr. Codd has earned many leadership positions in his career, he said he was never focused on advancement. He simply enjoys working on topics which he loves, such as improving minimally invasive surgical techniques. But being in leadership lets him unite other people who are interested in working towards a common goal in research and development. He has been able to skillfully bring people together from various specialties and help guide them. However, it is difficult to meet everyone’s needs all of the time. What is important for him is to be a leader when he needs to be.

Dr. Codd said there are typically five to eight research papers necessary in to lay the groundwork for every device that is developed. However, some technologies are based on the development of a single paper. He has worked on devices that make surgery more efficient and less minimally invasive and those that help the surgical team work together better. When developing technologies, he tries to keep the original purpose of the devices the same. However, many revisions are made to the initial design plans as requirements from the FDA and other institutions must be met. Ironically, Dr. Codd can’t use the devices he develops in his own operating room because it would be a conflict of interest. Typically other neurosurgeons from across the country will use them instead.

Post by Andrew Bahhouth, NCSSM 2020

Working Through Frustrations to Understand Nature Better

This is the fifth of six posts written by students at the North Carolina School of Science and Math as part of an elective about science communication with Dean Amy Sheck.

Research is a journey full of uncertainty in which scientists have to construct their own path, even if they’re unsure of what the end of the journey actually is. Despite this unpredictability, researchers continue their journey because they believe their work will one day drive their fields forward. At least, that’s why Kate Meyer Ph.D. says she has investigated something called m6A for several years.

Kathryn Meyer, Ph.D.

“Virtually every study that I have ever been part of had some frustrations involved because everything can fall apart in just one night,” Meyer said. “Despite all the frustrations you might have, you are still in the research because you know that at the end of the day, you will get new knowledge that is worthy to your field, or perhaps to the world.”

N6-methyladenosine (or m6A) is a modification to one of the four main bases of RNA – adenosine. Because RNA plays a significant role as a bridge between genetic information and functional gene products, modifications in RNA can alter how much of a certain product will be produced, which then controls how our cells and eventually our whole body functions.

The idea of this tiny but powerful modification was first proposed in the 1970s. But scientists struggled to find where m6A was located in the cell before research Meyer made a major contribution to as a trainee was published in 2012. Combining a newly developed antibody that could recognize m6A and gene sequencing techniques that became more accessible to the researchers, Meyer’s work led to the first method that can detect and sequence all of the m6A regions in a cell.

m6A’s interaction with a neuron, as depicted on Dr. Meyer’s laboratory site.

Meyer’s work was transformative research. Her method allowed laboratories around the world to investigate what regulates m6A and what its consequences are. Meyer said this first study which ignited m6A field is one of her most prideful moments as a researcher. 

Significant progress has been made since 2012, but there are still lots of questions that need to be answered. Currently, Meyer’s research team is investigating the relationships between m6A and various neurological issues. She believes that regulation of m6A controls the expression, or activity level, of various genes in the brain. As such, m6A may play an important role in neurodegenerative diseases and memory.

Author Jun Hee Shin, left, and Kate Meyer in her lab.

As an assistant professor of both biochemistry and neurobiology at Duke, Meyer is definitely one of the most important figures in the m6A field. Despite her many accomplishments, she said she had experienced and overcome many frustrations and failures on her way to the results.

Guest Post by Jun Shin, NCSSM 2020

Infants, Immunity, Infections and Immunization

This is the fourth of several posts written by students at the North Carolina School of Science and Math as part of an elective about science communication with Dean Amy Sheck.

Dr. Giny Fouda’s research focuses on infant immune responses to infection and vaccination.

Her curiosity about immunology arose during her fourth year of medical school in Cameroon, when she randomly picked up a book on cancer immunotherapy and was captivated. Until then, she conducted research on malaria and connected it to her interest in pediatrics by studying the effects of the parasitic disease on the placentas of mothers.

Genevieve Giny Fouda M.D., Ph.D.

As a postdoctoral fellow at Duke, she then linked pediatrics and immunology to begin examining mother to child transmission of disease and immunity.

Today she is an M.D. and a Ph.D. and a member of the Duke Human Vaccine Institute. She’s an assistant professor in pediatrics and an assistant research professor in the Department of Molecular Genetics and Microbiology at Duke University School of Medicine.

Based on the recent finding that children of HIV-positive mothers are more susceptible to inheriting the disease, Fouda believes that it is important to understand how to intervene in passive immunity transmissions in order to limit them. Children and adults recover from diseases differently and uncovering these differences is important for vaccine development.

This area of research is personally important to her, because she learned from her service in health campaigns in Central Africa that it is much easier to prevent disease than to treat.

Babies!

However, she believes that it is important to recognize that research is a collaborative experience with a team of scientists. Each discovery is not that of an individual, but can be accredited to everyone’s contribution, especially those whose roles may seem small but are vital to the everyday operations of the lab.

At the Duke Human Vaccine Institute, Fouda enjoys collaborating as a team and contributing her time as a mentor and trainer of young scientists in the next generation.

Outside of the lab, Fouda likes to spend time reading books with her daughter, traveling, decorating and gardening. If there was one factor that improve how science in immunology is conducted, she would stress that preventing disease is significantly cheaper than treating those that become infected by it.

Dr. Fouda has made some remarkable progress in the field of disease treatment with her hard working and optimistic personality, and I know that she will continue to excel in her objectives for years to come.

Post by Vandanaa Jayaprakash NCSSM 2020

Understanding and Addressing Vaccine Hesitancy

In the midst of increasing outbreaks of vaccine-preventable disease, Duke global health researcher Lavanya Vasudevan (PhD, MPH, LPH) is investigating the reasons for vaccine hesitancy with focus on America and Tanzania.

Vaccine hesitancy refers to the refusal of or delay in accepting vaccinations, despite their availability. Vasudevan hopes to figure out what interventions will change the minds of target populations on such a heated topic.

She presented at Duke’s Global Health Institute on November 15th about her “big 5 research areas:” identification of sub-optimal vaccine uptake, contextualization of barriers to uptake, measuring parental concern, debunking misinformation, and developing and testing strategies aimed at addressing vaccine hesitancy.

Lavanya Vasudevan presenting at Duke’s Global Health Institute.

Globally, Vasudevan says that there are too many kids playing catch-up with their vaccines, meaning that even when children are getting vaccinated, the vaccinations they receive are not on time with the scheduled progression of immunizations, putting them at risk for contracting disease. Different countries measure vaccination coverage in different ways and on different timelines, which makes it harder to understand where sub-optimal vaccine uptake is happening. A better standard for assessing timeliness of vaccines is crucial. Vasudevan is working to confront this issue to gain better understanding of who and where hesitancy is coming from.

Identification of specific regions of vaccine hesitancy is crucial to navigating interventions, she added. Vasudevan wants to be able to pinpoint areas and understand the context-specific issues that vary across time, place, and vaccine type in order to be most effective.

She said that her work in Tanzania has provided insight to the problem of geographic accessibility and lack of proper supplies in the country, prompting delayed and missed vaccinations among 72% of children, according to self-reporting by their mothers. Tanzanian mothers expressed their frustrations during interviews. They frequently arrange to go to a clinic where vaccinations are offered on specific dates and travel long distances to get there. However, if there are not enough kids who come to be vaccinated, the facilities just won’t vaccinate those who did manage to show up for immunizations.  

Though the qualitative data gained through extensive interviewing and group discussions has been extremely useful and rich, Vasudevan says there is a need for quantitative tools that can rapidly screen for parent’s concerns when it comes to the vaccination of their children. Qualitative data is simply not informative on a large scale.

A review of pre-existing measures evaluated 159 studies, but the quantitative scales found were often complex and context-specific, as well as designed and validated for high-income settings. On this basis, Vasudevan and her larger research team decided to design a scale for use in Tanzania because of its specificity in addressing the contexts of the region. Tailored counseling is also being used to address the local concerns and issues.

Another parallel research project that Vasudevan is involved with aims to identify common vaccine myths, creating a taxonomy to tag these myths and developing and testing an intervention that will highlight and debunk misinformation found on the internet. The current end-goal for the work being done is a “vaccine fact-checker” that could be used on web browsers to identify the myths in vaccine-related information found online.

A common example of needles and vials containing immunization products (Creative Commons).

In closing, Vasudevan identified three main areas for developing and testing intervention strategies. She says these are behavioral nudges, educational strategies, and vaccination policy and legislation.

There is a need for parent-focused strategies that recognize parental concern for their child’s safety on all sides of the vaccination issue, she said. Stringent policies are likely to alienate hesitant parents rather than increasing vaccine uptake. This is why Vasudevan is so focused on understanding and contextualizing issues specific to hesitancy among parents. It seems that increase of vaccinations and improvement of immunization timeliness lies in hearing and reconciling with parental apprehensions and underlying root causes of these hesitations.

One area of focus that Vasudevan feels is underutilized is pre-natal care. Reduction of the divide between obstetrician/gynecologists (OBGYNs) and pediatric care may be a crucial component to educate parents and enrich their understanding about vaccinations following the birth of the child.

Beyond everything else, she said, building trust is essential; simply providing information to parents is not enough. It takes time and empathy to be enable parents to make healthy vaccination choices. Providing credible resources in a safe environment while tuning in to the causes of hesitancy may be the next step to the reduction of vaccine-preventable disease, a current top ten threat to global health.

Post by Cydney Livingston

Dreams of Reality: Performing Dementia

White Lecture Hall’s auditorium is a versatile space. It hosts classes, speakers, and student organizations. And this Wednesday, White 107 was an institution for the elderly, an elementary school classroom, a lake, and an old blue house.

On October 23, Duke welcomed solo artist Kali Quinn to the stage to perform her now 13-year-old, one-woman show, Vamping. Vamping is an artistic and humanistic rendition of dementia, inspired by Quinn’s personal experience with a grandmother who moved into an institution just as Quinn was leaving for college on the other side of the country. It tells the story of 91-year-old Eleanor Butler, who drifts in and out of old memories, joys, and regrets as she experiences dementia in an elderly care facility.

Eleanor undergoing a PET scan

Throughout the hour-long performance, the physicality of the stage remains constant. There is one actor, Quinn herself, accompanied by a few props: a projector, a wheelchair, a blanket, a voice recorder. Yet each of these, Quinn included, shapeshift constantly. Quinn plays not only Eleanor, but also a caregiver, a granddaughter, and Eleanor’s younger selves at different stages of life.

That’s what dementia is like, Quinn explains. It’s experiencing a hundred different things all at once. 

“I don’t know what’s dream and what’s awake,” says an elderly Eleanor as she returns from an old memory and just before she’s immersed into another one.

Vamping captures the existence of identity and personhood in diagnosis, according to Jessica Ruhle, Director of Education at the Nasher Museum of Art. While the story has no clear plot and no clear resolution, it flows in a way that is real and personal. At 91, Eleanor re-experiences her elementary school spelling bee, her 16-year-old flirtationship with the boy who would become her husband, the birth of her first child, her regret at not being a better wife and mother and grandmother, and so much more. She doesn’t particularly succeed in making sense of it all, but neither does she try. The resolution is simply an acceptance of life’s complexity.

A series of memories, materialized through pieces of film, are held over a 91-year-old Eleanor. This is the last scene of the performance.

Janelle Taylor, a medical anthropologist at the University of Toronto and one of the panelists following the performance, explained that this complexity is what differentiates pure medicine from an anthropological approach. “I do kind of the opposite of what medicine does,” she said. “Medicine makes sense of things by excluding possible causes and contexts. Anthropology seeks to bring it all together.”

The entanglement of all these different possible factors perhaps explains why Quinn’s performance also offers glimpses into the lives of caregivers, family members, and others who share in the experience of dementia. In many cases, a single diagnosis affects a far larger network than just the diagnosed patient.

And though that’s true in Vamping as well as the panelists’ experiences with dementia, they acknowledge that other stories of the same condition often go untold. “We’re very alike in our whiteness, our economic condition and ability to afford professional care,” said Ruhle, referring to herself and Quinn. After all, Eleanor experiences dementia within a care institution—which, according to Eleanor in the play itself, costs about $85,000 per year.

Taylor added that she was searching for more data on diagnosed persons who have no healthcare or no family. Unfortunately, there isn’t much existing research on such people, and the data are difficult to find. And adding onto that, there are many cases of dementia that are never formally diagnosed at all.

But even so, Quinn’s performance is important to share. Vamping doesn’t attempt to do the impossible by telling a universal narrative of aging and dementia; instead, it gives an immensely personal and humanistic story of one patient’s experience of life.

Even the cold realities play into its personal nature as well. As Eleanor exclaims at one point in the performance, more money is spent yearly on Viagra and breast implants than on Alzheimer’s. The implication is clear: there’s a need for more research, and there’s a need for more humanness.

By Irene Park

Meet the New Blogger: Meghna Datta

Hi! My name is Meghna Datta, and I’m a freshman. I’m from Madison, Wisconsin, so North Carolina weather has been quite the adjustment. Apart from the humidity, though, I’m so excited to be at Duke! I’m an aspiring pre-med student with absolutely no idea what I want to major in. And it’s funny that I’ve grown to love science as much as I do. Up until tenth grade, I was sure that I would never, ever work in STEM.

My first love was the humanities. As a child I was hooked on books (still am!) and went through four or five a week. In high school, I channeled my love for words into joining my school’s speech and debate team and throwing myself into English and history classes, until being forced to take AP Biology my sophomore year completely changed my trajectory.

Science had always bored me with its seemingly pointless intricacies. Why would I want to plod through tedious research when I could be covering a groundbreaking story or defending justice in a courtroom instead? But the lure of biology for me was in its societal impact. Through research, we’ve been able to cure previously incurable diseases and revolutionize treatment plans to affect quality of life.

Meghna Datta repping the Devils

In AP Bio, understanding the mechanisms of the human body seemed so powerful to me. Slowly, I began to entertain the notion of a career in medicine, one of many scientific fields that works to improve lives every day.

Now, the research going on at Duke doesn’t cease to amaze me. Specifically, I’m interested in science for social good. Be it sustainable engineering, global health, or data-driven solutions to problems, I love to see the ways in which science intersects with social issues. As I have learned, science does not need to be done in isolation behind pipettes. Science is exciting and indicative of society’s shared sense of humanity. At Duke, there’s no shortage of this environment.

As a blogger I’m so excited to see the inspiring ways that peers and faculty are working to solve problems. And because science isn’t a traditionally “showy” field, I am looking forward to shining the spotlight on people at Duke who tirelessly research behind the scenes to impact those at Duke and beyond. The research community at Duke has so much to celebrate, and through blogging I’m excited to do just that!

Designing Tomorrow, One Healthcare Innovation at a Time

Imagine a live, health-focused version Shark Tank open to the public: presentations from real health professionals, presenting real innovations they developed to address real health care issues. And yes, there are real money awards at stake.

It’s the 2019 Duke Health Innovation Jam.

At ten minutes ‘til show time, people gather in small groups clothed in suits, business attire, and white coats. They chat in low voices. The hum of comfortable conversation buzzes through the room. The sixth floor of the Trent Semans Center is quite the setting. Three sides of the room are encapsulated in glass and you can easily see an expansive view of both Duke’s West and Medical campuses, as well as luscious green trees comprising parts of Duke’s Forest. Naturally, there is a glorious view of the Chapel, basked in sunlight.

This light finds its way into the room to shine on various research posters at the back displayed on a few rows of mobile walls. Though a few strays meander through the stationary arrangements – stopping to look more closely at particular findings – most people make their way into the room and find a seat as the minutes dwindle away. The hum grows and there is a bit of anticipatory energy among those readying themselves to present.

At three minutes after 10, the program director of the Duke Institute for Health Innovation, Suresh Balu, takes position at the front of the room, standing before the small stage at center that is surrounded by lots of TV monitors. No seat in the room is a bad one. Balu indicates that it is time to begin and the hum immediately dissipates. He explains the general format of the event: six pitches total, five minutes to present, eight minutes to answer questions from investors, a show-of-hand interest from investors, and transition to the next pitch, followed by deliberation and presentation of awards.

After a round of thanks, introduction of the emcee – Duke’s Chief of Cardiology, Dr. Manesh Patel – the curtains opened – figuratively – on Duke’s fifth annual Innovation Jam.

Groups presented on the problems they were addressing, their proposed innovations, and how the innovations worked. There was also information about getting products into the market, varying economic analysis, next steps or detailed goals for the projection of the projects, and analysis of the investment they are currently seeking and for what purposes.

The first group pitched an idea about patient-centric blood draw and suggest a device to plug into existing peripheral draws to reduce the frequent poking and prodding that hospital patients often experience during their hospital stay when blood is needed for lab tests. Next up was a group who designed an intelligent microscope for automated pathology that has a programmable system and uses machine learning to automate pathological blood analysis that is currently highly time consuming. Third at bat was a group that made a UV light bag to clean surgical drain bags that frequently become colonized with bacteria and are quite frankly “nasty” – according to the presenter.

Batting cleanup was PILVAS – Peripherally Inserted Left Ventricular Vent Anticoagulation System – which is a device that would be accessory to VA ECMO support to reduce thromboembolism and stroke that are risks of ECMO. Fifth was the ReadyView and ReadyLift, a laparoscopic tool set that is much cheaper than current laparoscopic tools and methods, and because of its ability to be used with any USB compatible laptop, it would increase access to laparoscopic surgery in countries that have a high need for it. Last, but not least, was an innovation that is the first synthetic biometric osteochondral graft for knee cartilage repair that hopes to improve knee osteoarthritis surgical care as the first hydrogel with the same mechanical properties of cartilage.

Following a quick ten-minute break for investors to huddle around and discuss who should win the awards – $15,000 for Best Innovation and $15,000 for Best Presentation – the winners were announced. Drumroll, please.

ReadyView won Best Presentation and the synthetic osteochondral graft won Best Innovation. A pair of representatives from Microsoft were also in attendance – a first for the Innovation Jam – and awarded SalineAI, the group who designed the intelligent microscope with an independent award package.

Patel, the emcee, says we are in the midst of a fourth industrial revolution.

“What is the biggest cinema in the world?” Patel asked. “Netflix,” he says. Industries are reimagining themselves and healthcare is no exception.

What is the best healthcare system of the future going to look like? Of course, we really don’t know, but there are certainly people who are already doing more than just think about it.

Beyond Classroom Walls: Research as an Undergrad

“Science is slow,” says Duke undergraduate Jaan Nandwani. That’s one of the takeaways from her first experience with scientific research. For Nandwani, being part of a supportive lab makes it all worthwhile. But we’re getting ahead of ourselves. This statement needs context.

Nandwani, a prehealth sophomore, currently conducts research in the lab of neurologist Nicole Calakos, MD, PhD. The Calakos lab is focused on synaptic plasticity: changes that occur at the communication junctions between nerve cells in the brain. The lab researches how the brain responds to changes in experience. They also investigate the mechanistic mishaps that can occur with certain neurological conditions.

A neuron from a mouse brain. From Wikimedia Commons.

As a continuation of an 8-week summer research program she participated in earlier this year, Nandwani has been studying dystonia, a brain disorder that causes uncontrollable muscle contractions. She’s using western blot analysis to determine if the activity of a protein called eIF2α is dysregulated in the brain tissue of mice with dystonia-like symptoms, compared with their normal littermates. It is currently unclear if and when targeting the eIF2 signaling pathway can improve dystonia, as well as where in the brain “selective vulnerability” to the signaling occurs. If Nandwani is able to identify a specific region or time point “in which the pathway’s dysregulation is most predominant,” more effective drug therapy and pharmacological interventions can be used to treat the disorder. 

Outside of her particular project, Nandwani attends lab meetings, learning from and contributing to the greater Calakos lab community. Scientific work is highly collaborative and Nandwani’s experience is testament to that. Along with providing feedback to her own presentations in meetings and answering any questions she may have, Nandwani’s fellow labmates are always eager to discuss their projects with her, give her advice on her own work, and have helped her “develop a passion for what [she is] studying.” They’ve also helped her learn new and improved ways to conduct the western blot process that is so integral to her work. Though she admits it is tedious, Nandwani said that she enjoys being able to implement better techniques each time she conducts the procedure. She also says she is thankful to be surrounded by such a supportive lab environment.

It might seem hard to believe granted the scope and potential impacts of her work, but this is Nandwani’s first experience with research in a lab. She knew when coming to Duke that she wanted to get involved with research, but she says that her experience has surpassed any expectations she had – by far. Though she doesn’t necessarily foresee continuation of research in the form of a career and is more fascinated by clinical applications of scientific research, the experience cannot be replicated within a classroom setting. Beyond the technical skills that Nandwani has developed, she says that the important and valuable mentoring relationships she has gained simply couldn’t be obtained otherwise.

Duke undergraduate Jaan Nandwani doing research in the Calakos lab.

Nandwani hopes to continue in the Calakos lab for the remainder of her time at Duke – that’s two and a half more years. Though she will work on different projects, the quest to pose and answer scientific questions is endless – and as Nandwani said, science is slow. The scientific process of research takes dedication, curiosity, collaboration, failure, and a continued urge to grow. The scientific process of research takes time, and lots of it. Of course the results are “super exciting,” Nandwani says, but it is the experience of being part of such an amazing group of scholars and scientists that she values the most.

By Cydney Livingston

Vaping: Crisis or Lost Opportunity?

Wikimedia Commons

Whether you’re doing vape tricks for YouTube views or kicking yourself for not realizing that “USB” was actually your teenager’s Juul, you know vaping is all the rage right now. You probably also know that President Trump has called on the FDA to ban all flavored e-cigarettes to combat youth vaping. This comes in reaction to the mysterious lung illness that has affected 1,080 people to date. 18 of them have died.

At Duke Law School’s “Vaping: Crisis or Lost Opportunity” panel last Wednesday, three experts shared their views. 

Jed Rose, a professor of psychiatry and behavioral sciences and director of the Duke Center for Smoking Cessation, has worked in tobacco research since 1979, focusing on smoking cessation and helping pioneer the nicotine patch. Rose also directs Duke’s Center for Smoking Cessation.

According to Rose, e-cigarettes are more effective than traditional Nicotine Replacement Therapy (NRT). A recent study found that e-cigarettes were approximately twice as effective as the state-of-the-art NRT in getting smokers to quit combustible cigarettes (CCs). This makes sense because smokers are addicted to the action of puffing, so a smoking cessation tool that involves inhaling will be more successful than one that does not, like the patch.

Rose also took issue with the labeling of the current situation surrounding vaping as an “epidemic.” He called it a “crisis of exaggeration,” then contrasted the 18 deaths from vaping to the 450 annual deaths from Tylenol poisoning

Even in the “pessimistic scenario,” where e-cigarettes turn out to be far more harmful than expected, Rose said deaths are still averted by replacing cigarettes with e-cigarettes. 

The enemy, Rose argued, is “disease and death, not corporations”, like the infamous (and under-fire) Juul. 

James Davis, MD, an internal medicine physician and medical director for the Center for Smoking Cessation, works directly with patients who suffer from addiction. His research focuses on developing new drug treatments for smoking cessation. Davis also spearheads the Duke Smoke-Free Policy Initiative.

Davis began by calling for humility when using statistics regarding e-cigarette health impacts, as long-term data is obviously not yet available. 

Davis did present some known drawbacks of e-cigarettes, though, stating that e-cigarettes are similarly addictive compared to conventional cigarettes, and that a whopping 21% of high school students and 5% of middle school students use e-cigarettes. Davis also contended that “When you quit CCs with e-cigarettes, you are merely transferring your addiction to e-cigarettes. Eighty-two percent [of test subjects who used e-cigarettes for smoking cessation] were still using after a year.” 

However, according to Davis, there is a flipside. 

Similar to Rose, Davis looked to the “potential for harm reduction” — e-cigarettes’ morbidity is projected to be only 5-10% that of CCs. If the main priority is to get smokers off CC, Davis argues e-cigarettes are important: 30-35% of CC smokers say they would use an e-cigarette to quit smoking, where only 13% would use a nicotine patch. 

Furthermore, Davis questioned whether the mysterious lung disease is attributable to e-cigarettes themselves — a recent study found that 80% of a sample of afflicted subjects had used (often black-market) THC products as well.

Lauren Pacek, an assistant professor in psychiatry and behavioral sciences at Duke, examines smoking in the context of addiction and decision-making.

Pacek stated that flavored electronic nicotine delivery systems (ENDS) are important to youth: 61-95% of current youth ENDS users use flavored products, and 84% of young users say they would not use the products without flavors. So, banning flavored ENDS would ostensibly reduce young adults’ use, potentially keeping them off nicotine entirely.

However, Pacek pointed to the importance of flavors for adult users too: the ones that are purportedly using ENDS not for recreation or social status (as young people have been known to do), but for smoking cessation. Many former CC smokers report that flavored ENDS were important for their cessation. By banning flavored ENDS, the products look less appealing, and smokers are more likely to return to much more harmful cigarettes.  

So where do we go from here? 

Pacek did not take a concrete stance, but said her “take-home message” was that policymakers need to consider the impact of the ban on the non-target population, those earnest cigarette smokers looking to quit, or at least turn to a less harmful alternative. 

Rose also did not offer a way forward, but made clear that he does not support the FDA’s impending ban on flavored e-cigarettes and thinks the hysteria around vaping is mostly unfounded.

Davis did not suggest a course of action for the US, but as leader of Duke’s Smoke-Free Policy Initiative, he certainly suggested a course of action for Duke. The Initiative prohibits combustible forms of tobacco at Duke, but does not (yet) prohibit e-cigarettes. 

By Zella Hanson

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