Additional Info
- Audio File hadassah/hd011.mp3
- Doctors Benbenishty, Julie
- Featured Speaker Julie Benbenishty
- Specialty Intensive Care Nurse at Hadassah who serves as the Trauma Nurse Coordinator at Hadassah Ein Kerem
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Guest Bio
Julie Benbenishty is an Intensive Care Nurse at Hadassah who serves as the Trauma Nurse Coordinator at Hadassah Ein Kerem. Her area of expertise includes Critical and Intensive Care Medicine, Trauma and Cardiopulmonary Resuscitation. Benbenishty has been a nurse since 1978 when she received her Nursing Diploma at the Henrietta Szold Hadassah-Hebrew University School of Nursing. She also holds a Bachelor in Psychology from the University of Vermont where she graduated in the year 2000. In 2003, Julie became Chairman of the national organization for Evidenced Based Nursing in Intensive Care and she also teaches at the Hebrew University.
When she is not on duty as a nurse at Hadassah, she volunteers for Nurses of the Middle East, an organization that seeks to encourage nurses to be ambassadors of caring and through patient care, creating communities of compassion & understanding. Through outreach, nursing exchange, education, and research, they build lines of communication throughout the region and the world trying to facilitate medical services in Israel for Palestinians from the Palestinian Authority and Gaza. She is also an author who has published two books, “Disaster Management for Nurses” and “Autonomy of Patients experiencing Life Threatening Experiences”. -
Transcription
Melanie Cole (Host): Nurses are some of society's most precious resources. Today we're speaking with Julie Benbenishty on this episode of Hadassah On Call. My guest is Julie Benbenishty. She's an intensive care nurse at Hadassah who serves as the Trauma Nurse Coordinator at Hadassah Ein Kerem in Jerusalem, Israel. Julie, why did you become a nurse? As I said in my intro, nurses are some of society's most precious resources, and sometimes pretty under-appreciated.
Julie Benbenishty (Guest): I became a nurse after I made Aliyah to Israel, and I finished my high school here in Israel, and I wanted to learn a profession that for sure I can find a job wherever I go in the world, and so I went to nursing school at Hadassah. I was accepted at Hadassah and I went to nursing school, and that was my main motivation for becoming a nurse at that time.
Melanie: Do you feel as somebody who's been in the United States and in Israel, is there the same sort of stigma? Do you feel that that stigma is going away in nurses? Do they have that in Israel?
Julie: Yeah, you're right. Yeah, there is- it's not thought of as such a wonderful profession, and my parents were disappointed even that I wanted to become a nurse, and it's thought of it's we change diapers, but it's changed tremendously since I've become a nurse in the amount of decision making that we have to make, in the amount of teamwork that I have with my physicians. It's not like they're the boss and we follow. We really come together on all the patients that we take care of. And then I'm in the profession, I have a great sense of satisfaction, and I feel very good in my profession.
Melanie: Well I think it's nurses like you that help to change that scope and some of that stigma. Why did you choose the specialties? Tell us about your specialties.
Julie: Well I have a very high adrenaline level, so I know that I needed something that would challenge me mentally as well as challenge me physically. And I like to work, and I like to move my patients off the bed, and I like to see the change. I really need that immediate satisfaction. So I really like to see changes in my patients fast, and that's why I chose intensive care, and I worked in intensive care for about thirty years, and then I did my bachelor’s degree, and my master’s degree, married, three children, and still working all the time with Hadassah, and now I'm finishing my Doctorate's degree. And I needed- I always wanted something challenging, and sometimes even after I'm at work for ten hours running all over the hospital, or now it's five or six buildings, I'm running all over the place, and I teach in the nursing school, and I do clinical research, and I visit all my patients, and I find- I even have to come home and run for 10k before I can settle down in the evening. So for me it was the right profession for me mentally and physically. Yeah, I need a lot.
Melanie: Wow, sounds like it's so rewarding for you. Now you've spent most of your career at Hadassah Hospital. Why? What do you love about Hadassah?
Julie: Well I really didn't know that Hadassah really has this environment of such a family feeling until I went and visited other hospitals, and I saw the relationship between the nurses and the other staff members, whether it's doctors, or assistant nurses, or the families that they take care of, and at Hadassah it really is a feeling of family. And we have a fierce, fierce loyalty to Hadassah, and we really do consult with each other as nurses, as equals in care for the patient, and it doesn't matter who's a professor, who's a doctor, and who's a nurse, and who's the cleaning worker who says, "Hey you have to wash your hands. Don't forget to wash your hands before you go into the patient." So it is a family, we really feel close to each other. And the level of quality of care that we want to give our patients, we're always in competition with each other to give better care, and more up-to-date care, and more evidence-based care. So I feel it's a very good environment.
Melanie: Well you segued so beautifully into the next question. Tell us about evidence-based nursing, and using holistic health as important to you as a nurse. You mentioned getting those patients up, and getting immediate satisfaction, helping them as quickly as you can, and some of that is a holistic way to think.
Julie: Yeah, most definitely. When we saw that we had- we didn't have enough- for instance, we didn't have enough training in acute stress disorder, which means patients that were in a stress situation after trauma, my doctors along with the nurses went to get training in acute stress disorder. It wasn't that my trauma surgeons, and my ICU physicians didn't think that the emotional state of their patients was less important than any other organ in their body. So this to me also is a reflection of how my physicians feel, how our physicians feel about getting holistic care to our patients. So evidence-based nursing is every practice that I do, every care practice that I provide and deliver to my patients has to be formulated, has to be backed by some sort of science, and it can't be something that's intuitive, it has to be something that has been proven by science, by research as having any kind of good outcome to patients. For instance, we found that if we take a small child's toothbrush and brush the patient's teeth even when they're intubated with a tube, we were reducing the amount of ventilated associated pneumonia that our patients were getting as a result of the tube being in their mouth. So that has to be proven. I mean it sounds like a good idea, brushing a patient's teeth, well we had to prove that it changed any outcomes, that it had any impact on patient outcome.
Melanie: Wow, see that's keen observational skills, and that's being able to look at something and say, "This will make a difference." Now so tell us a little bit about how you train IDF medic trainers in treating injuries and honing those observational skills, like those you were just discussing.
Julie: Yeah, we have a very- I call it basic training where they really go through boot camp with me, the Army medics. The Army medics, not just the regular medics, but the medics who train medics, so they're already very experienced medics, come to me for a week of Hadassah training. And they come, the word go, I mean they can't keep up with me. They want to ask me all the time with their tongues out,because I give them so much work to do. But what I do give them is every day they get a scavenger hunt of things that they have to observe in the operating room, in the ICU, in the recovery room, and in the trauma unit of how our teams work. How do we keep our patients safe and secure? What kinds of measures do we do? We don't talk about it, we just do it because we know that we keep our patients safe and secure. So my main goal in training these medics is that they don't just think that they have to give in the field, 'Just get the patient to the hospital as quickly as possible.' No, even the first aid that they're giving in the field has to be the most optimal care possible, and it has to be continuing of care. So they're giving their first aid, but it has to flow continuously into the next stage of the patient's care in the hospital. So we try to close that gap between the pre-hospital and what happens in the hospital itself.
Melanie: I bet they do have trouble keeping up with you. Gosh, what energy you have. So now tell us a little bit, you work at the hospital, does your work at the hospital contribute to your work as a volunteer for nurses in the Middle East? Or vice versa? Are they working cohesively together for you?
Julie: Okay. I, as I became a very mature nurse, realized that our impact- nurses' impact has a lot to impact on society, and not just what we're doing in the hospital. And I found in addition when I became a trauma nurse, I found that 30% of my patients I was sending back to the Palestinian Authority, which does not have a developed health system as they do in Israel. So we were investing much time, energy, effort, everything, our heart and soul went into healing everybody at the hospital. Healing these patients, and then we were sending them back to a big black hole, we didn't know what was happening there. So what we did do was develop a network of nurses in the Palestinian Authority, and in Israel we worked together also to give continual care to our patients. So whenever my patient is being released home, I call a nurse that I know in that area, either it's in Hebron, or in Mala, or Jericho, or any other Palestinian city, and I will call a nurse and will say, "Look in on him, and see if all his needs are provided for him, and if not, let me know and I'll see what I can do to help him out." So this network is a network of nurses in the Middle East, so we work together.
Melanie: And you've written some books. What prompted you to write them? Tell us about them.
Julie: Well when we started having conflicts in the 1990's and I was a nurse in the ICU, we gained a lot of experience with working with disaster victims, terror victims, mass casualties, blast victims, that as yet there was not that much data on that except for war, what happens in war, and soldiers were not writing- medics were not writing how they were treating the patients in that war situation. So we started collecting data, started doing research, and I wrote a chapter in a book- a few chapters in 'The Book of Disaster Management for Nurses.' So that's one book, printed by Prentice Press out of New Jersey. Another book that I've written is on ethical challenges in the intensive care unit, because we face many challenges, and the ethics that we face day-to-day, whether it's resource scarcity, or braindead patients, or transplant patients, or how to give good end of life care to one who has succumbed to their disease also needs to be documented, and written down, and disseminated through as many people as possible. And my last book was experience of people going through a life-threatening experience as ICU, and what was it like for them surviving ICU.
Melanie: Wow, that's fascinating. And where can people find those books?
Julie: Well I think on Amazon, I think.
Melanie: Tell us the names.
Julie: I don't know about 'Disaster Management.' 'Disaster Management' I think is a textbook.
Melanie: That's so cool. So now I understand your organization is celebrating two milestones. An anniversary of this year, the 100th anniversary of Hadassah Medical Organization. Tell us about your involvement in that, and the 100th Anniversary of Henrietta Szold Hadassah Hebrew University School of Nursing. How are you involved in those?
Julie: Right. Well I know we're having- they're planning a big group of Hadassah people and Hadassah nurses coming to Hadassah, and I am on the board of organizing everything that's going to- all the celebrations that are going to happen when this group comes. So we're talking about what we want them to see, what we want them to hear, what we want these people who are coming on this tour to experience, and local celebrations that we're having at the school of nursing and in the hospital. So we're having celebrations all throughout the year.
Melanie: So Julie, wrap it up for us. What do you want people to know about nursing? About you? About Hadassah Medical Organization? Why you love it so much, but mostly about this passion that you have for taking care of people, and making sure that you follow through all the way to recovery.
Julie: I think the great amount of satisfaction that we receive from our job, I mean that really is why we get up every morning and go to work, is the amount of satisfaction that we have when patients and their families say, "Thank you so much. I know that if it wasn't for you, my father, my mother, my child would not survive." I think there's nothing- I mean that's the meaning. That's the significance of why I'm here and what I'm doing when I'm doing it, is it's a very good feeling that we have. And if it happens to me once a week even that someone says something like that, I mean I know why I did what I did, and why I chose what I chose, and where I am is where I should be.
Melanie: Wow, you've given me chills. Certainly what energy, and passion, and dedication you have as a nurse. You're a precious commodity, Julie, you are. And you do the work of angels. Nurses - and I don't think people really realize this - nurses are the life blood of the medical community. Thank you so very much for being on with us today and telling us your story. This is Hadassah On Call: New Frontiers in Medicine, brought to you by Hadassah, the Women's Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit www.Hadassah.org, and to hear more episodes in this podcast series, please visit www.Hadassah.org/podcasts. That's www.Hadassah.org/podcasts. This is Melanie Cole, thank you so much for tuning in.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd010.mp3
- Doctors Schroeder, Josh
- Featured Speaker Josh Schroeder, MD
- Specialty Spine Specialist and Senior Surgeon at Hadassah Medical Organization's Orthopedic Department
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Guest Bio
Dr. Josh Schroeder is a senior surgeon and spine specialist at Hadassah Medical Organization’s orthopedic department. His areas of expertise include Pediatric and Adult Spine deformities and Robotic Spine Surgery. Dr. Schroeder performed the world’s first two robot surgical repair of a complex spinal break and explained that one of Hadassah’s greatest breakthroughs is finding ways to heal fractures quickly through stem cell therapy. In some cases, he related, “we have been able to cut peoples’ healing time in half.”
Born at Hadassah Hospital-Mount Scopus, Dr. Schroeder grew up in Jerusalem, together with his American-born parents and five siblings. He spent 2 years as a Spine Fellow at Weill Cornell Medical College, Department of Orthopedic Surgery in New York City and at The Hospital for Special Surgery, Spine Care Institute also in New York. He also served as an Israel Defense Forces (IDF) officer in joint teams with the Palestinians, in post-Oslo Accord attempts at regional cooperation in the Bethlehem district and now serves as a reserve military doctor in the IDF. He is an active member of the Young Hadassah International Board and Past Chair of Young Hadassah Israel. Dr. Schroeder also spent several months volunteering in a refugee camp in Uganda and was a fellow at the AO Research Institute in Davos, Switzerland, where he specialized in cartilage and disk regeneration.
Learn more about Josh Schroeder, MD -
Transcription
Melanie Cole: What a show we have for you today. Our guest performs a two-robot surgical repair of a complex spinal break and in another amazing procedure, a teen can actually walk again thanks to a first in Israel complex spinal surgery at Hadassah. Today, we’re speaking with Dr. Josh Schroeder on this episode of Hadassah On Call.
My guest today is Dr. Josh Schroeder. He's a senior surgeon and spine specialist in the orthopedic department of Hadassah Medical Organization in Jerusalem, Israel. You're noted as performing the world’s first of its kind dual robotic surgery, a four-hour reconstructive surgery with two robots on Aaron Schwartz who was severely injured when a heavy wall of steel fell on him at work. How did you decide to do this instead of a more standard approach?
Dr. Josh Schroeder, MD: Aaron came to us after the complex spine fracture and a two-ton wall fell and pinned him down. Luckily, he survived, he had a broken tibia and broken multiple vertebrae in the spine. What we usually would do for this kind of surgery is either be an open surgery, which would be mostly four hours and heavy on the blood loss, or a single robot surgery which we do percutaneously, which would be a more advanced surgery. The problem was with so many fractures in the spine, everything would be more around and any kind of pre-op imaging would not be accurate enough in order to allow a safe procedure. What we decided to do is to go and harbor a second robot, which is called the Artis Zeego. It’s a robot that is an imaging robot. It allows us very accurate intraoperative imaging, which means once we position the patient in a specific position, the actual location of each one of his broken vertebras will be imaged to us and we’ll able to send the second robot, the Mazor, for the accurate location.
The complexity is to a point where you got to know each one of the robots to allow it to work properly. There are great teams at Hadassah supporting and allowing us to use these robots. The second thing is to have the robot talk to each other. It’s trying to get a navigation robot to talk to a procedure robot and to get two languages and two different companies, one Israeli company, the Mazor company, to speak to Siemens, which is a German company. It’s getting the two technologies to speak in the same interface, that was one of the challenges so we had our teams work on it for quite some time, and when we got that set up, we were able to allow Aaron to have the safest and maybe the most advanced and the most automated kind of surgery that we had to happen.
Melanie: That’s amazing. All this complex going back and forth with the languages and getting the robots to talk to each other. How is Aaron doing now?
Dr. Schroeder: He's great. He was out of the hospital a couple days later. He's up walking on his feet. It turned a very complex injury and procedure into a pretty straightforward fancy walk in the park, but a much easier procedure that's safe for him, which allowed him to get out of the hospital and into rehab a few days later.
Melanie: That’s incredible. Now tell us a little bit about how you came to perform the spinal surgery of Yusef Rabaya. He's a citizen of the Palestinian Authority and why was this surgery so rare.
Dr. Schroeder: Yusef is a young boy and he was in a very bad car accident in the area Jenin. Several people were killed in the accident and his sister had a bad injury and he was transferred to a small hospital, one of the hospitals in the Palestinian Authority. At that point, he had emergency surgery to stop and control the bleeding, but they noticed that he was paralyzed in both of his legs and the bleeding was coming from the broken spine. What happened was that his spine at the lowest level was disconnected from the rest of the spine, what we called spondylolysis, where one of the vertebrae jumps forward and it completely out of place, which means the spine is pretty much divided at the lowest area segment of the L5-S1 that's totally severed. He couldn’t move his legs at all and he was transferred to us. I got a phone call Friday morning from the person in charge of transfers and I said we have an injured child transferring right over from Hadassah. The most complicated cases that people in the Palestinian Authority cannot deal with on their own, they're responsible enough to transfer them to us. We get him at Hadassah, he was sent to the pediatric ICU where the ICU team did a great job stabilizing him over Saturday, which allowed us to plan a surgery in a really small child to allow us to reduce the vertebra that has jumped out of place and allow his nerves to go back into place and to start functioning afterwards. A kid that I thought was going to be wheelchair bound is now up and going. Again, we use the dual robotic technology, which is now become one of our state of art procedures for complex spine injuries and we were able to pinpoint these very fine pedicles, which are probably two to four millimeters in size, and to allow them to bring this terrible injury as part of a team to bring it back to its original anatomical location and allow a stable fixation.
Melanie: One of the things that is so amazing to me is that it seems with you that politics have no effect on your obligation to save human lives, to help people walk again, to help people move their limbs again. Tell us how you came to this feeling.
Dr. Schroeder: I think medicine and politics never take part in Hadassah. For sure, it's one of the things that we stop everything at the door and you can see we have a staff that comes from all over the world – Jewish, Arab, Palestinian, Israeli – now our business is dealing with people and healing people and trying to get people from all around the world better off, and politics has no place to do with medicine. People are people and regardless of their opinions and their personal voice, my job as a doctor is to try and get them better, not get involved in their education. The way I see it is that there's no politics in medicine and I'm happy to deal with any person, anytime with any kind of a conviction.
Melanie: Isn't that wonderful? I wish more people felt as you do. Tell us a little bit about your volunteer work and the refugee camps and Uganda.
Dr. Schroeder: I had a great opportunity to go and volunteer several months in a refugee camp. It’s always great to perform medicine in a western setting. I trained in New York, I trained in Switzerland and Israeli and I always had the feeling that I would like to try to do something in a totally different setting. I had a great opportunity to go and volunteer in Kampala. There's a refugee camp right next to the capital of Uganda and I spent a couple of months there doing primary health and dealing with the deworming and water sanitation and basic medical care in small villages around the area in Uganda. It was a great experience at a personal level to see how things can be totally different and how the systems work in different stages, and at some places to be the first white person that these people have encountered and to try to bring health to a place that nothing exists over there. That has allowed me to become a doctor and thank God I can go out and do some good in places that people don’t have any other person to be there and it’s part of the fun of being a doctor.
Melanie: What a great experience for you and for them as well. As we wrap up, tell us a little bit about your work as a military doctor and in the IDF.
Dr. Schroeder: Israeli is always preparing for war and we live in a dangerous neighborhood and we always say let us train forever and never need to use our skills. I'm in charge of military units that is an advanced lifesaving unit, which is deployed in the field in case of a combat situation. Our job is to save as many wounded soldiers as we have. We have a team of doctors and surgeons and about 40-50 medics and paramedics, like a small mash hospital which opens up in the field, and our job is to come and train and do whatever we can in order to save lives, and that’s what we do very well. We’re definitely trained quite a bit for it and we hope that until we retire, we never need to use these skills in order to save soldiers, but as Israelis and Jewish people, we do not have the privilege of sitting back. We have the obligation to take part and our job is to try to win the war and save as many people whenever we can donate and continue to society.
Melanie: Your mother must be so proud of you. We hear you're going to Ethiopia soon. Tell us a little bit about that.
Dr. Schroeder: Next week. Hadassah has a long-standing relationship with a hospital in northern Ethiopia in a city called Mekelle. It's one of the largest cities in Ethiopia altogether and it has about eight million people in that district. Professor Moses, and Professor Anian microbiology team definitely have a very good relationship and they have been training them with medical students going over there. They came to us with a problem. There are eight million people and there's a lot of deformity going on in these countries, but there are no spine surgeons in Ethiopia. Most of these children have a very bad deformity. They go down to Addis Ababa, but they get transferred over a former teacher of mine to have surgery by Professor Boachi in Ghana. That’s a great project, but it doesn't help the children who do not have the facilities to transfer them to Addis Ababa. We go to the hospital and they said please come see if we can have spine surgery by you guys and this is a big surgery, it’s not something done by day surgery, but it needs a large facility and ICU teams and the whole process altogether in order to allow us to do it in a safe manner and allow these children who have very deformed spines to have a nice safe procedure with good and stable spines and reduce their mortality by reducing the chances of pneumonia or other kinds of complications associated with such a bad back.
We went down to Ethiopia several months ago, we put a team together and we’re going to go down to Ethiopia to do surgery over there. What we've set out to do is a procedure at the same level that we do them at Hadassah. We got Medtronic to donate the instrumentation that we use here, we spoke to the Foreign Ministry of Israeli which kindly transferred everything for us to Ethiopia because it's heavy equipment that we need their help to bring it into the country. Now everything is there and hopefully we'll be flying there Saturday night and starting next week we'll be performing surgeries all next week on these children that have been previously selected by us as cases that we can do over there. Once we're successful on this trip, we'll learn the challenges and we'll perform a future mission in order to continue to work over there. In the long process, we're hoping that we'll be able to bring one of their surgeons to Hadassah for a year or two of training to allow them to be independent that we'll be his mentors from afar and we'll fly in to help him on difficult cases. That way, we're not going to only deal with the problem, but hopefully, train a future generation of Ethiopian surgeons that will be able to deal with the pathologies they encounter.
Melanie: Wow Dr Schroeder, your passion for what you do really comes through and you are such an inspiration to us all. We could sure use more compassionate people such as yourself in this world. Please be sure to come back on and give us some updates. We'd love to hear more of the exceptional work that you are doing on behalf of so many people suffering with spinal injuries. Thank you again for being on with us today. This is Hadassah On Call, New Frontiers in Medicine brought to you by Hadassah, The Women’s Zionist Organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit hadassah.org. To hear more episodes in this podcast series, please visit hadassah.org/podcasts. That’s hadassah.org/podcasts. I'm Melanie Cole. Thanks so much for tuning in.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd009b.mp3
- Doctors Reubinoff, Benjamin
- Featured Speaker Benjamin Reubinoff, MD, PhD
- Specialty Director of Hadassah Human Embryonic Stem Cell Research Center
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Guest Bio
Prof. Benjamin Reubinoff, MD, Ph.D, is the Director of the Hadassah Human Embryonic Stem Cell Research Center and Senior Physician at the Department of Obstetrics and Gynecology at the Hadassah Medical Organization (HM)) in Jerusalem. He is one of the pioneers of human embryonic stem cell (hESC) research. Prof. Reubinoff has been the Chief Scientific Officer at Cell Cure Neurosciences Ltd. since 2006 and serves as a member of Scientific Advisory Board at Kadimastem Ltd. He is also a full Professor of Obstetrics and Gynecology and serves as Chairman of the Department of Obstetrics and Gynecology at HMO.
Prof. Reubinoff derived hESC in collaboration with scientists from Monash University in Melbourne and the National University of Singapore. The group was the second in the world to derive hESC lines and was the first to show somatic differentiation of the hESCs in culture. He completed his residency in Obstetrics and Gynecology at Hadassah Hospitals. Prof. Reubinoff also holds a PhD degree in developmental biology from Monash University, Melbourne, Australia.
Learn more about Prof. Benjamin Reubinoff, MD, Ph.D -
Transcription
Melanie Cole (Host): This is part two of our two part series with Professor Benjamin Reubinoff, world-renowned stem cell pioneer and Director of Hadassah Human Embryonic Stem Cell Research Center, on this episode of Hadassah on Call.
Melanie: Professor Reubinoff, What do you see are some obstacles that must be overcome before some of these potential uses can be realized? Are there regulations? With embryonic, it’s so amazing, but what’s going on in the world that might preclude some of this research?
Professor Reubinoff: Indeed, it is a big challenge to develop embryonic stem cells from the stage of the research – laboratory research, basic research, to clinical application. Actually, in the last twenty years, we have been going in this roadmap towards developing human embryonic stem cells to clinical application, so the first step in this path is developing stem cells that will be usable in clinical applications. What does that mean? It means that you have to derive stem cells from embryos under specific conditions which are highly sterile and highly monitored to develop stem cells that can be used from the quality point of view in transplantation in human beings. At Hadassah, we have been pioneers in developing these types of stem cells, which we call clinical-grade stem cells, and we develop them under very specific conditions without the use of any animal-derived product, so that they will be suitable for transplantation and to serve as the starting material – the stem cells – the primitive stem cells – the starting cells – for further development of specialized cells that can be transplanted. This is the first step to develop clinical grade, new stem cells, and we are providing these stem cells that we developed to other groups worldwide that are developing specialized cells for clinical applications.
The second step is to of course to develop the methodology to direct the maturation of the stem cells into one type of mature cell. You need to be able to direct the maturation into a population that will include only one type of cell and will not include other types of cells. Why is this a challenge? Because the stem cells will spontaneously give rise to multiple types of cells in the human body. This is their role in the development, and this is what they tend to do. You need to develop the techniques and methodology to control this process of maturation of stem cells and to be able to direct them to become a single type of cell, whether it will be a nerve cell or whether it will be a retinal cell or a pancreatic cell. This is a very big challenge.
Once this is overcome, you have to prove that the pure population of mature cells that you obtained is safe. When you transplant them, you do it of course, in animal models initially to show that these cells are safe in the animal model and to show that they have a therapeutic function in the specific animal model that is relevant to the disease. This is also a very big challenge.
Once all of this is done, of course, you have to present it to the regulatory agencies, like the FDA or in Israel, it’s the Ministry of Health of Israel, and to show them all the data and to get their approval to move to patients. This is actually the process, and we have been following this process. We have focused – at Hadassah, initially, on developing cells for transplantation in retinal degeneration and more specifically, the disease, which is called age-related macular degeneration.
Age-related macular degeneration is the most common reason for blindness in the elderly population in the western world. There are really millions of patients that are suffering from this condition. It is related to the malfunctioning and death of specific cells in the retina, which are called the pigmented cells of the retina. As these cells are dying, the patients gradually lose their vision. Unfortunately, today, there is no treatment that can halt the progression of the vision loss and the progression of the disease. We hope that if we replace the malfunctioning and dying pigmented cells of the retina of the patients by the same retinal pigmented cells that we derived from the stem cells, we can at least halt the progression of vision loss. If we do it early enough, the patients will have their vision sustained, and they will not lose their vision, and we can prevent the progression of this devastating disease and prevent blindness of a patient.
This has been our focus in the last fifteen years. The whole project of developing of the hESC for transplantation in retinal degeneration diseases was developed in tight collaboration with Prof Eyal Banin and his team from the Department of Ophthalmology at Hadassah. We went through the path that I described before, and we received approval from regulatory agencies, both the FDA and the Ministry of Health in Israel -- and we initiated by a startup company that we established for this purpose – Neurosciences, a clinical trial in AMD patients and we transplanted quite a few patients so far. The main goal of these early clinical trials is mainly safety. We need to show as a first step that transplantation of these pigmented cells of the retina that we generated is safe and does not cause any complications. This is the main goal of this current trial, and initial patients that are being transplanted are legally blind, so we want to make sure that we transplant into patients that can’t really lose much if there will be a significant complication. So far, the trial is going very well, and in the next group of patients that we are going to transplant, these patients will have better vision. We also hope that we will be able to show some functional effect of the transplanted cell.
Melanie: Absolutely fascinating, Professor Reubinoff. Do you think -- as complex as these situations are that you have been describing and the regulatory way that stem cells have to go through to be approved – do you think that sometimes their current applications are a little exaggerated by the media or other parties who don’t fully understand the science or the current limitations that you have to go through or some clinics that are looking to capitalize on some of this stem cell hype by selling treatments to chronically ill or seriously ill patients, do you think that there is an issue with this at all?
Professor Reubinoff: Yes, so I think that we need to be very careful and I think that you have mentioned there are some clinics that are offering various stem cell treatments. I think people have to be very careful and examine proposals for stem cell therapies very carefully and to make sure that these offers for therapies are substantiated by a hard – correct clinical data by regulatory approvals and so forth. This is a big problem and problematic issue in the field of stem cell therapy and developing a treatment that is based on stem cells is a complex process that I have described, and it requires a lot of investments both of scientific expertise, time, and financial support. I think that the main point is that the people that are seeking stem cell therapies should really be careful and to look deeply into any such offer. There are just very few clinical trials with pluripotent stem cells or embryonic stem cells that are ongoing at the moment, and they are mainly focused on safety, as I have mentioned. On the other hand, around the globe, there are quite a few suggestions for a clinical transplantation of stem cells where I am not sure that these offers are based on hard data that support these offers, so it’s very important to be very careful when someone is looking into such a trial or such a treatment.
Melanie: Professor Reubinoff, in summary, what does current research indicate for future developments and treatments? Give us a little blueprint for future research and your best advice.
Professor Reubinoff: I think that, as I mentioned before, the field of pluripotent stem cells and embryonic stem cells is at this stage today, that it is in early stages of very few clinical trials and there are other few groups that are preparing themselves toward initiating clinical trials. As I mentioned, the focus of these trials at the moment is safety. The vision, for the next, I would say five or ten years, would be that these clinical trials will continue and will show a function – of course after showing safety. We will get data that will support the safety and will also show the function of stem cells in a few candidate conditions that are ongoing at the moment, including Parkinson’s Disease, diabetes, retinal degeneration, as well as heart failure, and the vision is really that we will see a functional effect and eventually, we will have stem cell therapies as off the shelf therapies that will be offered to the million patients in need. I think that we are in a very exciting period at the moment where stem cell therapy – embryonic stem cell therapy is entering the clinic, and we have a very exciting few years ahead of us where we really hope that we will be able to get the stem cells to become a therapy that will be available to these conditions where there isn’t any other effective therapy at the moment.
Melanie: Thank you so much, Professor Reubinoff, for being with us today and for all of the unbelievably amazing work that you’re doing. This is Hadassah On Call, New Frontiers in Medicine, brought to you by Hadassah, The Women’s Zionist Organization of America. The largest Jewish Women’s’ Organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, you can go to Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that’s Hadassah.org/podcasts. This is Melanie Cole. Thanks so much, for listening.
Melanie Cole (Host): Stem cells are the foundation for every organ and tissue in your body. Twenty years ago, when stem cell therapy was highly regulated in the United States and other countries, it was well underway at Hadassah Medical Organization’s Labs. Stem cells have changed the medical equation. Today, we’re speaking with Benjamin Reubinoff on this episode of Hadassah On Call. Welcome to the show. My guest today, is Professor Benjamin Reubinoff. He’s a world-renowned stem cell pioneer and Director of Hadassah Human Embryonic Stem Cell Research Center. Welcome to the show, Professor Reubinoff. Please tell us your story of bringing the first line of stem cells to Israel.
Professor Benjamin Reubinoff (Guest): Okay, thank you, Melanie. We are going back about twenty years ago when I was a young physician, and I was looking for a fellowship that will have a vision, and that can bring medicine a step forward. I start to concentrate my work on the derivation of human embryonic stem cells. Human embryonic stem cells – or embryonic stem cells are unique and universal. They are derived from the in vitro fertilized embryo at an early stage – few days of its development, and they are unique because they can proliferate indefinitely so they can serve as an unlimited source of human cells. They can give rise to any cell of the human body.
It was a big dream to derive these cells from human embryos that were created in in vitro fertilization treatment of couples suffering from infertility. It was a dream, and it was my dream when I went for this fellowship in Australia. It was a collaborative project of us and the Australian scientists and Singapore scientists. Eventually, we succeeded to derive these stem cells from human embryos. It was very exciting. We were pioneers and the second group in the world that succeeded to derive these stem cells from human embryos, and I brought these stem cells to Hadassah upon my return to Hadassah and established here the Center that has been focused since then, all these years on developing the stem cells for transplantation therapy.
Melanie: Absolutely fascinating. What diseases do you foresee that stem cells potentially have the ability to make a difference with?
Professor Reubinoff: So, the diseases are mainly diseases where there is malfunctioning of the cell of the patients or death of certain cells. These diseases include Parkinson’s disease where a specific type of nerve cells are dying, or retinal degeneration diseases, or diabetes. In all of these diseases specific cells in the body are malfunctioning, and the vision is to replace these malfunctioning or dying cells with the same type of cells that will be derived and developed from the embryonic stem cells.
Melanie: What are a few of the ways that stem cells are already being used. As you were speaking about embryonic stem cells, and people hear about stem cells from their own body, explain a few of the ways that you are able to use them now.
Professor Reubinoff: At the moment, embryonic stem cells are not used in the clinic for therapy. They are not at this stage of development. At the moment, adult – what we call, adult stem cells – are those that are used in the clinic. An example of adult stem cells that are used is hematopoietic stem cells. Those are the cells that make all types of blood cells. These are being used for many years for bone marrow transplantation. If we mention these – there are actually two main types of stem cells, adult stem cells which are the stem cells that exist in the body of every person. These stem cells mainly renew specific tissues in the body like the bone marrow that is renewing the blood system. And as I mentioned, these adult stem cells are being used in the clinic for many years. Embryonic stem cells, they are not used for clinical therapies, they are at an early stage of initial use in the clinical trial.
Melanie: So, with adult stem cells or tissue-specific stem cells, Professor Reubinoff, are they automatically safe to use for treatments if they come from your own body? What has to happen to them?
Professor Reubinoff: Well, they may have some issues of safety as well as embryonic stem cells, but they are less problematic, I would say. In some cases, you have to expand these cells before you transplant them. They may change in culture. In some cases, you want to modify them in culture before you transplant them, and again, this modification may be associated with some risks. However, when you are transplanting stem cells from the patient’s own body, you don’t have problems and issues of immune rejection that we have to overcome with embryonic stem cells, so there are issues that are not problematic with adult stem cells.
However, I must stress that the ability of adult stem cells to regenerate and to replenish malfunctioning cells is limited mainly to the tissue from which they originated. Therefore, bone marrow stem cells are used mainly to repopulate the bone marrow in the blood system. There are stem cells in other tissues like the nervous system, the cardiac system, but these are difficult to expand and difficult to obtain functional, mature cells from these types of stem cells for transplantation when we know that embryonic stem cells are more amenable to maturation for specific types of cells of the body that will be functional.
The bottom line is that we think that the embryonic stem cells, which mean stem cells that can give rise to any cell type and tissue of the human body are probably going to be a better source of mature, functional cells that can be used for transplantation, regeneration, and replenishment of malfunctioning or dead cells in the patients’ body.
Melanie: That was an excellent explanation, Professor Reubinoff. Isn’t it amazing what you do? What do you see are some obstacles that must be overcome before some of these potential uses can be realized? Are there regulations? With embryonic, it’s so amazing, but what’s going on in the world that might preclude some of this?
Professor Reubinoff: Indeed, it is a big challenge to develop embryonic stem cells from the stage of the research – laboratory research, basic research, to clinical application. Actually, in the last twenty years, we have been going in this roadmap towards developing human embryonic stem cells to clinical application, so the first step in this path is developing stem cells that will be usable in clinical applications. What does that mean? It means that you have to derive stem cells from embryos under specific conditions which are highly sterile and highly monitored to develop stem cells that can be used from the quality point of view in transplantation in human beings. At Hadassah, we have been pioneers in developing these types of stem cells, which we call clinical-grade stem cells, and we develop them under very specific conditions without the use of any animal-derived product, so that they will be suitable for transplantation and to serve as the starting material – the stem cells – the primitive stem cells – the starting cells – for further development of specialized cells that can be transplanted. This is the first step to develop clinical grade, new stem cells, and we are providing these stem cells that we developed to other groups worldwide that are developing specialized cells for clinical applications.
The second step is to of course to develop the methodology to direct the maturation of the stem cells into one type of mature cell. You need to be able to direct the maturation into a population that will include only one type of cell and will not include other types of cells. Why is this a challenge? Because the stem cells will spontaneously give rise to multiple types of cells in the human body. This is their role in the development, and this is what they tend to do. You need to develop the techniques and methodology to control this process of maturation of stem cells and to be able to direct them to become a single type of cell, whether it will be a nerve cell or whether it will be a retinal cell or a pancreatic cell. This is a very big challenge.
Once this is overcome, you have to prove that the pure population of mature cells that you obtained is safe. When you transplant them, you do it of course, in animal models initially to show that these cells are safe in the animal model and to show that they have a therapeutic function in the specific animal model that is relevant to the disease. This is also a very big challenge.
Once all of this is done, of course, you have to present it to the regulatory agencies, like the FDA or in Israel, it’s the Ministry of Health of Israel, and to show them all the data and to get their approval to move to patients. This is actually the process, and we have been following this process. We have focused – at Hadassah, initially, on developing cells for transplantation in retinal degeneration and more specifically, the disease, which is called age-related macular degeneration. The whole project of developing of the hESC for transplantation in retinal degeneration diseases was developed in tight collaboration with Prof Eyal Banin and his team from the Department of Ophthalmology at Hadassah.
Age-related macular degeneration is the most common reason for blindness in the elderly population in the western world. There are really millions of patients that are suffering from this condition. It is related to the malfunctioning and death of specific cells in the retina, which are called the pigmented cells of the retina. As these cells are dying, the patients gradually lose their vision. Unfortunately, today, there is no treatment that can halt the progression of the vision loss and the progression of the disease. We hope that if we replace the malfunctioning and dying pigmented cells of the retina of the patients by the same retinal pigmented cells that we derived from the stem cells, we can at least halt the progression of vision loss. If we do it early enough, the patients will have their vision sustained, and they will not lose their vision, and we can prevent the progression of this devastating disease and prevent blindness of a patient.
This has been our focus in the last fifteen years. We went through the path that I described before, and we received approval from regulatory agencies, both the FDA and the Ministry of Health in Israel -- and we initiated by a startup company that we established for this purpose – Neurosciences, a clinical trial in AMD patients and we transplanted quite a few patients so far. The main goal of these early clinical trials is mainly safety. We need to show as a first step that transplantation of these pigmented cells of the retina that we generated is safe and does not cause any complications. This is the main goal of this current trial, and initial patients that are being transplanted are legally blind, so we want to make sure that we transplant into patients that can’t really lose much if there will be a significant complication. So far, the trial is going very well, and in the next group of patients that we are going to transplant, these patients will have better vision. We also hope that we will be able to show some functional effect of the transplanted cell.
Melanie: Absolutely fascinating, Professor Reubinoff. Do you think -- as complex as these situations are that you have been describing and the regulatory way that stem cells have to go through to be approved – do you think that sometimes their current applications are a little exaggerated by the media or other parties who don’t fully understand the science or the current limitations that you have to go through or some clinics that are looking to capitalize on some of this stem cell hype by selling treatments to chronically ill or seriously ill patients, do you think that there is an issue with this at all?
Professor Reubinoff: Yes, so I think that we need to be very careful and I think that you have mentioned there are some clinics that are offering various stem cell treatments. I think people have to be very careful and examine proposals for stem cell therapies very carefully and to make sure that these offers for therapies are substantiated by a hard – correct clinical data by regulatory approvals and so forth. This is a big problem and problematic issue in the field of stem cell therapy and developing a treatment that is based on stem cells is a complex process that I have described, and it requires a lot of investments both of scientific expertise, time, and financial support. I think that the main point is that the people that are seeking stem cell therapies should really be careful and to look deeply into any such offer. There are just very few clinical trials with pluripotent stem cells or embryonic stem cells that are ongoing at the moment, and they are mainly focused on safety, as I have mentioned. On the other hand, around the globe, there are quite a few suggestions for a clinical transplantation of stem cells where I am not sure that these offers are based on hard data that support these offers, so it’s very important to be very careful when someone is looking into such a trial or such a treatment.
Melanie: Professor Reubinoff, in summary, what does current research indicate for future developments and treatments? Give us a little blueprint for future research and your best advice.
Professor Reubinoff: I think that, as I mentioned before, the field of pluripotent stem cells and embryonic stem cells is at this stage today, that it is in early stages of very few clinical trials and there are other few groups that are preparing themselves toward initiating clinical trials. As I mentioned, the focus of these trials at the moment is safety. The vision, for the next, I would say five or ten years, would be that these clinical trials will continue and will show a function – of course after showing safety. We will get data that will support the safety and will also show the function of stem cells in a few candidate conditions that are ongoing at the moment, including Parkinson’s Disease, diabetes, retinal degeneration, as well as heart failure, and the vision is really that we will see a functional effect and eventually, we will have stem cell therapies as off the shelf therapies that will be offered to the million patients in need. I think that we are in a very exciting period at the moment where stem cell therapy – embryonic stem cell therapy is entering the clinic, and we have a very exciting few years ahead of us where we really hope that we will be able to get the stem cells to become a therapy that will be available to these conditions where there isn’t any other effective therapy at the moment.
Melanie: Thank you so much, Professor Reubinoff, for being with us today and for all of the unbelievably amazing work that you’re doing. This is Hadassah On Call, New Frontiers in Medicine, brought to you by Hadassah, The Women’s Zionist Organization of America. The largest Jewish Women’s’ Organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, you can go to Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that’s Hadassah.org/podcasts. This is Melanie Cole. Thanks so much, for listening. - Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd009a.mp3
- Doctors Reubinoff, Benjamin
- Featured Speaker Benjamin Reubinoff, MD, PhD
- Specialty Director of Hadassah Human Embryonic Stem Cell Research Center
-
Guest Bio
Prof. Benjamin Reubinoff, MD, Ph.D, is the Director of the Hadassah Human Embryonic Stem Cell Research Center and Senior Physician at the Department of Obstetrics and Gynecology at the Hadassah Medical Organization (HM)) in Jerusalem. He is one of the pioneers of human embryonic stem cell (hESC) research. Prof. Reubinoff has been the Chief Scientific Officer at Cell Cure Neurosciences Ltd. since 2006 and serves as a member of Scientific Advisory Board at Kadimastem Ltd. He is also a full Professor of Obstetrics and Gynecology and serves as Chairman of the Department of Obstetrics and Gynecology at HMO.
Prof. Reubinoff derived hESC in collaboration with scientists from Monash University in Melbourne and the National University of Singapore. The group was the second in the world to derive hESC lines and was the first to show somatic differentiation of the hESCs in culture. He completed his residency in Obstetrics and Gynecology at Hadassah Hospitals. Prof. Reubinoff also holds a PhD degree in developmental biology from Monash University, Melbourne, Australia.
Learn more about Prof. Benjamin Reubinoff, MD, Ph.D -
Transcription
Melanie Cole (Host): This is Part One of our two part series on stem cells. Stem cells are the foundation for every organ and tissue in your body. Twenty years ago, when stem cell therapy was highly regulated in the United States and other countries, it was well underway at Hadassah Medical Organization’s Labs. Stem cells have changed the medical equation. Today, we are speaking with Professor Benjamin Reubinoff on this episode of Hadassah On Call. My guest today, is Professor Benjamin Reubinoff. He’s a world-renowned stem cell pioneer and Director of Hadassah Human Embryonic Stem Cell Research Center. Professor Reubinoff. Please tell us your story of bringing the first line of stem cells to Israel.
Professor Benjamin Reubinoff (Guest): Okay, thank you, Melanie. We are going back about twenty years ago when I was a young physician, and I was looking for a fellowship that will have a vision, and that can bring medicine a step forward. I start to concentrate my work on the derivation of human embryonic stem cells. Human embryonic stem cells – or embryonic stem cells are unique and universal. They are derived from the in vitro fertilized embryo at an early stage – few days of its development, and they are unique because they can proliferate indefinitely so they can serve as an unlimited source of human cells. They can give rise to any cell of the human body.
It was a big dream to derive these cells from human embryos that were created in in vitro fertilization treatment of couples suffering from infertility. It was a dream, and it was my dream when I went for this fellowship in Australia. It was a collaborative project of us and the Australian scientists and Singapore scientists. Eventually, we succeeded to derive these stem cells from human embryos. It was very exciting. We were pioneers and the second group in the world that succeeded to derive these stem cells from human embryos, and I brought these stem cells to Hadassah upon my return to Hadassah and established here the Center that has been focused since then, all these years on developing the stem cells for transplantation therapy.
Melanie: Absolutely fascinating. What diseases do you foresee that stem cells potentially have the ability to make a difference with?
Professor Reubinoff: So, the diseases are mainly diseases where there is malfunctioning of the cell of the patients or death of certain cells. These diseases include Parkinson’s disease where a specific type of nerve cells are dying, or retinal degeneration diseases, or diabetes. In all of these diseases specific cells in the body are malfunctioning, and the vision is to replace these malfunctioning or dying cells with the same type of cells that will be derived and developed from the embryonic stem cells.
Melanie: What are a few of the ways that stem cells are already being used. As you were speaking about embryonic stem cells, and people hear about stem cells from their own body, explain a few of the ways that you are able to use them now.
Professor Reubinoff: At the moment, embryonic stem cells are not used in the clinic for therapy. They are not at this stage of development. At the moment, adult – what we call, adult stem cells – are those that are used in the clinic. An example of adult stem cells that are used is hematopoietic stem cells. Those are the cells that make all types of blood cells. These are being used for many years for bone marrow transplantation. If we mention these – there are actually two main types of stem cells, adult stem cells which are the stem cells that exist in the body of every person. These stem cells mainly renew specific tissues in the body like the bone marrow that is renewing the blood system. And as I mentioned, these adult stem cells are being used in the clinic for many years. Embryonic stem cells, they are not used for clinical therapies, they are at an early stage of initial use in the clinical trial.
Melanie: So, with adult stem cells or tissue-specific stem cells, Professor Reubinoff, are they automatically safe to use for treatments if they come from your own body? What has to happen to them?
Professor Reubinoff: Well, they may have some issues of safety as well as embryonic stem cells, but they are less problematic, I would say. In some cases, you have to expand these cells before you transplant them. They may change in culture. In some cases, you want to modify them in culture before you transplant them, and again, this modification may be associated with some risks. However, when you are transplanting stem cells from the patient’s own body, you don’t have problems and issues of immune rejection that we have to overcome with embryonic stem cells, so there are issues that are not problematic with adult stem cells.
However, I must stress that the ability of adult stem cells to regenerate and to replenish malfunctioning cells is limited mainly to the tissue from which they originated. Therefore, bone marrow stem cells are used mainly to repopulate the bone marrow in the blood system. There are stem cells in other tissues like the nervous system, the cardiac system, but these are difficult to expand and difficult to obtain functional, mature cells from these types of stem cells for transplantation when we know that embryonic stem cells are more amenable to maturation for specific types of cells of the body that will be functional.
The bottom line is that we think that the embryonic stem cells, which mean stem cells that can give rise to any cell type and tissue of the human body are probably going to be a better source of mature, functional cells that can be used for transplantation, regeneration, and replenishment of malfunctioning or dead cells in the patients’ body.
Melanie: That was an excellent explanation, Professor Reubinoff. Isn’t it amazing what you do? Thank you so much for being on with us today. This concludes Part One of our special two part series on stem cells with Professor Benjamin Reubinoff. We invite you to listen to Part two in order to hear the rest of this fascinating interview. This is Hadassah On Call: New Frontiers in Medicine brought to you by Hadassah, The Women's Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization in Jerusalem Israel.
For more information on the latest advances in medicine please visit Hadassah.org and to hear more episodes in this podcast series, including part two of this fascinating interview, please visit Hadassah.org/podcasts, thats Haddasah.org/podcasts.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd008.mp3
- Doctors Kerem, Eitan
- Featured Speaker Eitan Kerem, MD
- Specialty Head of the Division of Pediatrics at the Hadassah Medical Center, and founder of its Center for Children with Chronic Diseases
-
Guest Bio
Prof. Eitan Kerem is Head of the Division of Pediatrics at the Hadassah Medical Center, and founder of its Center for Children with Chronic Diseases.
Learn more about Prof. Eitan Kerem -
Transcription
Melanie Cole (Host): Advances in the field of medicine and technology have led to an increase in the survival rate and life expectancy of children with chronic diseases and special needs. Today, we are speaking with Dr. Eitan Kerem on this episode of Hadassah On Call.
Welcome to the show Dr. Kerem. What kinds of chronic diseases do children suffer from that you treat at the Center for Children with Chronic Diseases at Hadassah Medical Organization?
Dr. Eitan Kerem, MD (Guest): Hi, hello. Chronic diseases in children are common in about 10% of the children in different degrees of severity. Some of the diseases are life shortening, some of the diseases are reducing quality of life and some diseases children can cope with but they still know that they carry a chronic disease.
Melanie: Dr. Kerem, tell us how you came up with the idea for the pediatric chronic disease center and what is it like for families?
Dr. Kerem: So, the idea to have such a center came from a family of a very sweet small child who had many, many medical problems and they asked me to be their doctor. And I told them, look you are all very nice but your child has many diseases, none of them in my area of specialty and they said oh no, no, you don’t understand exactly what we meant because we feel that we are lost in the medical system and they pull out a very thick file with lots of letters of different doctors and they say we – on Sunday we go to the cardiologist, on Monday to orthopedic surgeon and Tuesday to ophthalmologist; each one of them sees us, writes a note but none of them speak with each other and our doctor does not have the time and expertise to give us the coordination on the different diseases that we have.
And we thought that instead of having a disease oriented center, we are going to have a patient oriented center which means we put the patient in the center and all the doctors will come to see this patient on one day and then at the end of the day, we will sit together and discuss the different aspects of the diseases of the child. And the child will have a medical home where we know the child and when the child has even trivial problems with fever or vomiting; we know what different drugs the child is taking, and we know to consult the child. However, when we say, it’s a medical home; we mean that it is not only a place for the child, but it is also a home for the whole family where we relate to the whole different aspects of raising a child with chronic disease. Not only the emotional challenges that the children have when they grow, but also the emotional challenges and marriage challenges the parents have and not only that but also the healthy siblings. They have also emotional stress that not always they have the place and the atmosphere where they can express it.
Melanie: What an absolutely amazing way to approach this. Tell us about some of the other subspecialties when you say there are so many different doctors involved and that you all get together and speak about a particular patient. Tell us what some of those other subspecialties are.
Dr. Kerem: Well, the center is a cluster of different what we call disease oriented centers. So, we have center for children with chronic lung diseases. We have center for children with neurological developmental problems. We have center for children with eating and swallowing problems. We have a national center for children and adults with Down syndrome. We have a center for endocrinology, juvenile diabetes, rheumatic diseases. All sorts of different diseases that children grow with and need a comprehensive approach that will see not only the disease but also the child. But what is even makes it more efficient we can use the support team for the different diseases because for a social worker; a child with chronic lung disease or juvenile diabetes or rheumatology problem; it’s the same challenges and we can use the same social working team for this – in the center for different diseases which will make it more efficient on one end but even more professional and more expert in the whole aspect of raising – for a family raising a child with chronic disease.
Melanie: Dr. Kerem, along those lines, and you mentioned that marital problems with couples that have children with chronic disease and the siblings; everybody kind of goes through that together. So, how does the Center for Support of Social and Psychological Challenges, how do they help the families? What do they do?
Dr. Kerem: What are the challenges of the young couple that had a dream of their healthy child that they will grow together and now they are facing a completely different situation? And as one father told me, it’s like you take your family for a holiday in the Caribbean and then the pilot tells you we are apologizing, but the world changed, and we are going to land now in a desert in Bangladesh and there is no way to get out of it. So, we now need to adjust ourselves to a new way of life, forget about the vacation, forget about the bathing suit and now we need to change, adapt our life to this different way. And many times, what happens is that the mother gives up her career ideas or dreams and devotes her time to taking care of this child. And on the other hand, the more financial challenges for the family, the father takes more time in work in order to compensate for the loss of income from the mother’s side. And at the end of the day, the father comes tired, wants to sit, have a drink, and fall asleep in front of TV. The mother would like to have someone to share her day and thoughts and feelings and they start to get separate from each other without noticing. And they start feeling angry to each other. The father says you don’t see how difficult is my day and I work, I work so hard, I need now some silence and the mother says you don’t see how I’m dealing with the difficulty of raising the child and taking care of the house and I need someone to talk with. And one day something happens, and they start to fight and the rate of divorce in families where the child has a chronic disease is almost double the rate of divorce in the regular population.
And we tell the parents this story when we first meet them. And we tell them, look if you don’t take care on your relationship, if you do not nourish it; this will be the end and if you don’t want it to be the end you need to start working on it together now. And we have parents group and we refer them to individual therapy or consultation in order to help them coping with this stressful situation.
Melanie: So, if someone wants to make an appointment and their child has a – something suspicious and they haven’t really seen many doctors, they don’t know what’s going on; tell us a little bit about your medical inquiry unit and how does a new family come into the center?
Dr. Kerem: They make an appointment and then we have the one doctor that does the intake and writes down the list of problems that they have and then we invite them to another meeting where all the subspecialties will see them and order the tests and then we try to make all the tests on one day. In parallel, we have the support team, the social worker, the psychologist, the nutritionist, the physical therapist, whoever also needs to be involved in this- with this family and we start building the relationship on one hand and on the other hand, we activate all the medical expertise that we have in order to get them a final diagnosis and a plan of treatment.
Melanie: And tell us about your team that works there and helps with all of these outside aspects of bringing families into the pediatric center.
Dr. Kerem: The team needs to be composed of very special people with very special personalities. They have the empathy of being part of growing a child and a family with chronic disease. I can tell you that for many families, we are the closest people for them and if they have a sinchar or something good happen in the family or on the other hand, somebody dies; many times, we are the first that they call in to share the news or to share their feelings about what happened in their family. We build relationships many times which is very intimate. They share with us things that happen at home and for the children; we are also part of the family because they know us many times more than they know the teachers in school, that every year may change.
Melanie: And so wrap it up for us with some of your goals for the Pediatric Chronic Disease Center at Hadassah Medical Center and the philosophy, what you want families and listeners to know about this amazing center that you have helped to create.
Dr. Kerem: I think the major message is that the patient is in the center. The patient is a human being which is a challenge for our society because young families with little resources, with dreams that they need to give up are the weakest part in our society. And if we want to make our society strong; we need to make the weak part stronger. And as they get stronger, we will become stronger. And what I am amazed at is the number of people that come and volunteer and want to give and giving is something that whatever you gave, always will stay with you.
Melanie: Thank you so much Dr. Kerem, for being with us today and for all the wonderful work that you are doing on behalf of these children and their families. This is Hadassah On Call New Frontiers in Medicine brought to you by Hadassah, the Women Zionist Organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the Center for Children with Chronic Diseases, please visit Hadassah.org., that’s Hadassah.org and to hear more of these podcasts, please visit Hadassah.org/podcasts, that’s Hadassah.org/podcasts. I’m Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd007.mp3
- Doctors Elpeleg, Orly
- Featured Speaker Orly Elpeleg, MD
- Specialty Head of the Department of Genetic and Metabolic Diseases at the Hadassah Medical Organization
-
Guest Bio
Orly Elpeleg is a Professor of Pediatrics, Head of the Department of Genetic and Metabolic Diseases at the Hadassah Medical Organization. She specializes in inborn errors of metabolism, and high throughput diagnosis of monogenic disorders. She graduated from the Hebrew University Hadassah Medical School in Jerusalem and completed her pediatric residency in 1988. During 1986-7 she was a research fellow in inborn errors of metabolism in the Royal Hospital in Copenhagen. In 1997 and 2003 she spent sabbaticals in neurology and genetics in Great Ormond St. Hospital in London. Her main research interest was metabolic disorders especially mitochondrial respiratory chain defects. However, over the past decade she has focused on gene discovery in a large array of rare disorders, and published 70 novel disease-associated genes. She has extensive national and international collaborations and co-authored over 230 peer-reviewed articles.
Learn more about Prof. Orly Elpeleg -
Transcription
Melanie Cole (Host): A previous unrecognized genetic mutation causing a rare, and devastating pediatric neurological disease, which has puzzled doctors around the world for years, was recently identified by Hadassah Medical Organization researchers in Israel. Today, we’re speaking with Professor Orly Elpeleg on her life as a gene detective on this episode of Hadassah On Call. My guest today, is Professor Orly Elpeleg. She’s a Professor of Pediatrics, Head of the Department of Genetics, at Hadassah Medical Organization, in Jerusalem, Israel. Welcome to the show, Professor. Are you really a gene detective? Tell us a little bit about your background, and how did you get into this fascinating specialty?
Professor Orly Elpeleg (Guest): Hi, thanks for having me. Well, in fact, I’m a pediatrician that got frustrated by not knowing what’s wrong with some of our patients. That has been a lifelong agenda for me. Whenever others were treating infectious diseases, I was attracted to patients that no one knew what’s wrong with them, kids that were either born with some abnormalities or developed them in the early years of their childhood. At first, we were trying to use biochemical tools, and recently, we started using genetic tools to decipher – to solve this enigma. I’m not sure I can explain any further, this urge that would keep you awake throughout the night, to try and read the patient’s DNA in order to see where is the mistake – where is the error? What is the – who is the murderer? Who is the one that kills this child’s health?
Melanie: Wow, so as these things kept you up at night -- you went into this specialty, how did you discover this rare gene? Tell us about this disease that has no name that we’re discussing today.
Prof. Elpeleg: It always starts with a single patient that comes into the clinic and the parents are telling me that they have been all over the place and no one could tell them what’s wrong, and the child is deteriorating. This is nearly always the beginning. Recently, we were able to institute really advanced technology to read the patient DNA -- at least the coding parts, the exons -- we are able to read it routinely. We have done so since 2010, and I think we were one of the first centers in the world to employ this technology. We are reading it like a book, trying to find where is the mistake.
We have done that to the first girl that we saw here in Israel. This was a child that was completely normal up to the age of three, and then she started regressing. She has lost gradually her ambulation; she could not walk, she could not draw and use the pencil as before. she lost her self-care skills that she had and needed help throughout all of her daily activities. She had experienced feeding difficulties, and so – and she lost her speech, which was most devastating for the family – and became very unstable while walking and eventually stopped walking. This is like seeing a child losing milestones instead of acquiring them. It’s really very tragic. It’s a very sad disease. We have identified in this girl, a change in the DNA that we haven’t seen before, and neither did we find it in any large databases of healthy individuals – their DNA.
There is a software nowadays, which is called Gene Matcher, which is like the person who makes decisions, but it tries to find a match among other centers that may have the same genetic variant. We have mounted our variant, our patient’s variant into it, and within a few minutes, we had I think five or six more patients that were diagnosed with the same variant worldwide in Canada, in France, in the States in two centers. All of them experienced the same clinical course with a completely normal period which lasted up to three to four years, sometimes even up to seven. And then, invariably, all of the patients regressed.
We had a single genetic mistake causing – or associated with the same clinical course in altogether seven patients. And then we were trying to understand what went wrong, why this change is causing the disease? We collaborated with a group in Philadelphia, and they had a lab which could actually model the same change, and they have checked our patients’ cells and identified that there is a problem with the ribosome – this part of the cell, which translates the DNA – the RNA into protein. By that, we decided to publish it because we saw that there may be more patients out there that are not part of the Gene Matcher program and would still be important for them to know that this is a disease, and this is the genetic defect. Indeed, nearly every month we hear about another patient in the world that has the same variant and with the same course.
Now, in all the cases, this is not inherited. I mean all the parents do not have this variant, so it occurs de novo. It occurs new only in the patient, so for the families, it’s in a way a good message that they can have more children without having to be worried about a recurrence. For the patients, it’s important that two have identified this change because now it opens perhaps the way for designing therapy for the long run.
Melanie: So, that would have been my next question as there are other researchers and doctors around the world collaborating with you as they come up with patients with this similar variant. First of all, will you be giving this a name, and do you think that this discovery is going to enhance treatment options?
Prof. Elpeleg: Well, I know that the NIH has already supported a research project of this gene without even knowing there are so many patients out there. That was the wonderful thing to learn. The DNA match already recognized it – there is an issue with this gene. I believe that the solution for these patients may come from suppressing the mutated alleles. You see all these patients; they have one normal gene and one abnormal mutant gene, and the trouble is the mutant. If you suppress the mutant and leave the patient on 50% of the normal gene, it would be sufficient for health – for a normal lifespan and normal life progress. You don’t actually need to correct; you can simply suppress.
The question is whether it would help doing it at this early stage – at this late stage, sorry – because all of the patients are in their late teens or even older. But basically yes, this should be able to help these patients. The fact that this is now a group, I think this is very helpful because you are not dealing here with a single case, but this is a serious issue. These are multiple cases.
Melanie: So Professor, when other doctors from around the world call you for advice on suppressing this gene or dealing with treatment options, what do you tell them? And then give us a little – what are you doing in the future? What are you doing on the horizon for this and other unnamed diseases?
Prof. Elpeleg: Myself, I’m a very small part of this huge arena of – I think that my part is to name the defect. It would be people that are dealing with gene therapy, with genome anything, people that are able to really manipulate the human DNA that would come into play in trying to help. Basically, it’s not something that’s done in my lab. We limit ourselves to the identification of the genetic defect. I think of myself as a very humble doctor that annotates the human DNA to tell people what’s wrong.
In 2003, when the Human Genome Project was first announced, it was clear that for about 50% of the genes, we have no idea what they’re doing, so my patients are in a way telling the world – telling science what’s the importance of any certain gene. It would be then for others that are specializing in genome editing, in genome therapy to come up with solutions, but as I said, generating a group of patients and defining them, I think it’s a great help.
Melanie: Well, it certainly is. And where do you see the world of genetics going in the future? What do you see happening? What are you doing that’s really exciting right now?
Prof. Elpeleg: Well, I think that our mission right now is to move from reading only the coding parts of the DNA to reading the entire DNA. It’s about reading 50 times more volume of genetic material than we did before for every patient, and that’s our next goal saying to move from exon to genome. We should try and start out there. I believe that for every patient this would be the standard of care in the future and even prenatally, so during pregnancy they would be – or even for people that are undergoing in-vitro fertilization. It would be a standard of care to read the entire DNA before continuing. We should probably stop at this point because others that as I said, are specializing in genome editing and gene therapy, they would take over and try and correct the defect, but they would need us to first, link the clinical findings with the patient’s DNA finding and then to corroborate – to validate the finding and giving it to them with its proper name.
Melanie: Thank you so much Professor Elpeleg, for being with us today. It’s absolutely fascinating work that you’re doing. Thank you so much, for joining us. This is Hadassah On Call, New Frontiers in Medicine, brought to you by Hadassah, The Women's Zionist Organization of America. The largest Jewish organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Haddasah.org/podcasts. I’m Melanie Cole. Thanks so much,h for listening.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd006.mp3
- Doctors Kerem, Eitan
- Featured Speaker Eitan Kerem, MD
- Specialty Head of the Division of Pediatrics at the Hadassah Medical Center, and founder of its Center for Children with Chronic Diseases
-
Guest Bio
Prof. Eitan Kerem is Head of the Division of Pediatrics at the Hadassah Medical Center, and founder of its Center for Children with Chronic Diseases.
Learn more about Prof. Eitan Kerem -
Transcription
Melanie Cole (Host): For Ashkenazi Jews, there is a one in 24 chance of being a carrier for the gene mutation that cause cystic fibrosis. If two people who carry the mutated gene have a child; the child has a one in four chance of having cystic fibrosis. Today, we are speaking with Dr. Eitan Kerem on this episode of Hadassah On-Call.
Welcome to the show. My guest today, is Dr. Eitan Kerem. He is the head of the division of pediatrics at the Hadassah Medical Center. He is also the founder of the Center for Children with Chronic Diseases and the Director of the Center for Cystic Fibrosis at Hadassah Medical Organization. Welcome to the show Dr. Kerem. So, first explain for the listeners, what is cystic fibrosis?
Dr. Eitan Kerem, MD (Guest): Hi. Cystic fibrosis is a genetic disease that causes a defect in the protein which is a channel that secretes chloride in the airways and in the intestinal system in order to maintain hydration of these organs. If the gene is defective; then the protein which is call CFDR is defective; then there is less hydration and dryness of secretions in these airways in the lungs and mainly in the pancreas and as a result, in the pancreas there is lack of secretion of enzymes which digest the food, and in the lungs there is dryness of secretions and what we call mucus plugging which predisposes to infection, inflammation and progressive lung damage that causes end-stage lung disease and in this stage patients require lung transplantation.
Melanie: So, how is cystic fibrosis inherited and can it skip a generation? As I mentioned in the intro, that if a couple is known to carry this gene, then it can be an inherited trait. So, can it skip a generation? How is it inherited?
Dr. Kerem: Well, if both parents are carriers of a defect in the gene which we call a mutation; then there is a chance or a risk in every pregnancy of 25 percent, of child being born with the disease. So, if it skips a generation, it is just by chance that none of the children were in the 25 percent. We have families with four children with cystic fibrosis and we have a family that has ten children without cystic fibrosis and the eleventh one had it, so the chance is in each pregnancy for 25 percent.
Melanie: Is there a way to tell if someone is a carrier, and if there is, who should get screened, Dr. Kerem?
Dr. Kerem: Okay, so this is a very important question because the CF gene is a large gene, actually it is the second largest gene in humans. So, there are many, many mutations. We here at Hadassah, we did a work together with the Hebrew University to map the different mutations in different ethnic origins of Jews. So, we now can map 99 percent of mutations among Ashkenazi Jews, a similar number among Jews from different origins from Morocco, Algeria, Libya, Egypt they have different reporting organizations. It is much less common among Jews who came from Iraq or Iran. We have specific mutations for Jews who came from Georgia and the map that we published, is now serving in every genetic consultation clinic worldwide when Jewish couples are coming for consultation. So, also in Israel, we have a program for free carrier screening, so every couple can be screened before pregnancy to see if they are carriers. And we recommend that Jewish couples will be screened also for cystic fibrosis in addition to other diseases that are more common among the Jewish population; the Ashkenazi Jewish population.
Melanie: So, the current screening guidelines, you’re just saying that every Jewish couple, before they get pregnant should get screened?
Dr. Kerem: Absolutely.
Melanie: What about here in the states?
Dr. Kerem: Well, in the states, there is another program which is newborn screening where they identify children that are born with cystic fibrosis; however, they cannot enable prevention of the birth of such children. And therefore, we recommend that in families where prevention of birth of a child either by termination of pregnancy or by in vitro fertilization and diagnosis in the fetuses who are sick and who have CF and returning to the mother only those who do not have CF, are options to prevent the birth of such children.
Melanie: So, what is the current standard of care if you have a child with CF?
Dr. Kerem: With treating, the most important strategy is to prevent damage to the lungs because the lungs are those that determine the prognosis of the child with CF. One of the key issues is nutrition. Children, most of them require enzymes, artificial enzymes in order to digest the food and many times we supplement them with high calorie, high fat diets in order to maintain good nutrition. Then we recommend physiotherapy which are exercises to drain the thick mucus from the lungs. We give inhalations to the children with salt and with enzymes that degrade the thick mucus. They need frequent visits to the CF centers, frequent use of antibiotics. So, a child with CF may need three to five inhalations every day, physiotherapy which is about forty minutes every day and swallow twenty, thirty sometimes forty different pills every day. So, it is on one hand, a major burden, depending how you see it. But, on the other hand, it brings hope to the families because now we are in the stage that here at Hadassah, most of our patients are adults and in the last year, we were celebrating the birth of nearly ten children or babies to mothers and fathers with cystic fibrosis.
Melanie: That is incredible, Dr. Kerem. So, what are some of the latest breakthroughs in treatment? What’s exciting in the field right now? And what role is gene therapy playing in care and treatment?
Dr. Kerem: So, the ultimate therapy might be introducing the normal gene to the lungs and a study was done in the UK by inhalation of the normal gene that failed to show advantage over placebo. And the reason is that the gene which is a large gene, needs to penetrate the thick mucus layer of the lungs and then into the cells and we have billions of cells and this is probably a challenge that we are not there yet. So, there is another approach where we try to fix the mechanism by which the mutation is causing the disease and I will give you an example. Among the Ashkenazi Jews, the most common mutation is a mutation that causes a premature command to stop translating the program to produce the protein and therefore the protein that is being produced is short, truncated and nonfunctioning. So, since this is a common mutation only among Ashkenazi Jews and it is common here in Israel; we undertook ourselves to develop therapies that will be specific to these kinds of mutations. And we have shown that some drugs can cause what we call read through, ignoring the premature stop command and having the translation system to translate the gene until the end and produce normal protein. So, we have shown it in a small scale and now there are several companies including one here in Israel, that produced compounds that we are just about to start clinical studies with patients with these new compounds.
Melanie: That’s fascinating. Dr. so, people have heard through the media that people that are growing up and becoming adults with cystic fibrosis can’t socialize with each other. Speak to that for just a minute.
Dr. Kerem: Well, in the past, we used to have summer camps for children with cystic fibrosis, but we noticed that children cross the infections from one to the other and we would like to prevent cross infections. However, on the other hand, growing with cystic fibrosis, with a disease that you know that is life shortening; with burden of treatments; imposes on the child and the family very special challenges – emotional challenges. And speaking with the children, they tell me that the only ones that can understand me and I can speak freely with is someone with cystic fibrosis. They tell me I have very good friends in school, but they do not really know what I have in my life. And only children who have the same problem as me, can understand me. So, in order to avoid encounters, there are today technologies through the internet, through the social media that they can be friends and can talk and can meet but do not endanger each other with infecting them with the wrong bacteria.
Melanie: And wrap it up for us Dr. Kerem, what an interesting topic and fascinating research that you are doing, with what current research indicates for future developments and treatment. Where do you see this going and give us a little wrap up here?
Dr. Kerem: Cystic fibrosis is the most common severe genetic disease among Caucasians. It was a pioneer in identifying the gene that causes the disease and a technology that was pioneering at that time, not finding a gene without knowing what it is causing. And now it is leading the research in treating genetic diseases and the strategy that is being used today is already being used in other diseases. I mentioned correcting the premature stop command, now in Israel, children with Duchenne muscular dystrophy which is a muscular disease, are being treated with these kinds of therapies. So, it is a severe disease, but with lots of hope. And I tell the parents today when I meet them, with a child with CF; I have bad news and I have good news for you. The bad news is that you are going to work very hard. The good news, if you are working hard, with your child you will be a happy and healthy grandfather or grandmother. And I think this is the future that we can, not promise but we can describe to these families and to the children that the disease is today, life-shortening but with the therapies that we have today, we don’t know how long people can survive and we believe that they will survive – will have survival as the regular population.
Melanie: Thank you so much Dr. Kerem for being with us today. This is Hadassah On-Call, New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical organization. For more information on the latest advances in medicine please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Haddasah.org/podcasts. I’m Melanie Cole, thanks so much for listening. - Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd005.mp3
- Doctors Zfat-Zwas, Donna
- Featured Speaker Donna Zfat-Zwas, MD, MPH
- Specialty Director of the Linda Joy Pollin Cardiovascular Wellness Institute for Women, Hadassah Medical Organization
-
Guest Bio
Donna Zfat-Zwas, MD, MPH, is a cardiologist and the Director, Linda Joy Pullin Cardiovascular Wellness Center for Women, in the Division of Cardiology at the Hadassah University Medical Center of the Hadassah Medical Organization in Jerusalem, Israel.
Learn more about Donna Zfat-Zwas, MD, MPH -
Transcription
Melanie Cole (Host): Did you know that heart disease is the number one killer of women and is more deadly than all forms of cancer combined? The more a woman knows about heart disease, the better her chances of beating it. We are chatting today with Dr. Donna Zwas of this episode of Hadassah On Call.
Melanie Cole (Host): Lately, there has been progress in preventing and treating heart disease, but women are still more affected by this disease than men. My guest today is Dr. Donna Zwas. She is a cardiologist and the director of the Linda Joy Pullin Cardiovascular Wellness Center for Women in the division of Cardiology at the Hadassah University Medical Center of the Hadassah Medical Organization in Jerusalem Israel. Welcome to the show Dr. Zwas. So, tell us how prevalent is cardiovascular disease in women and are you seeing a difference in Israel and in the US as far as incidence and even awareness?
Dr. Donna Zfat-Zwas, MD, MPH (Guest): We are seeing increased awareness in women very, very slowly. And we are seeing a decrease in mortality from heart disease both in the United States and in Israel.
Melanie: So, the studies have always been focused on men for years. Do you see this changing at what do you think prompted the change?
Dr. Zwas: I am not convinced that it is changing. One of our big challenges in recruiting women into these studies, is the fact that they tend to be somewhat older when they have heart disease and their caregiver status. Meaning if the husband wants to participate in the study, the wife tags along, but if the wife wants to participate in the study, there’s a lot of resistance or the patient is the grandmother caring for the grandchildren or she has other caregiver demands which adversely affect her ability to participate in research.
Melanie: Well and I can see why it would. Women, we are the caregivers of society and they say put your own mask on before you put the mask of your loved ones on, but women don’t always do that, do they? We sort of brush off symptoms or we are too busy to deal with things within our own bodies.
Dr. Zwas: That’s really the crucial part of the awareness campaign. Because when a man has chest pain or discomfort in his chest or shortness of breath; immediately everyone thinks, oh my God, this could be a heart attack and they immediately call for help. When a woman feels these symptoms, a thousand things come up in her head, but the last one on the list is that it could be her heart. She thinks I lifted something, I did too much, I ate something, and it just doesn’t even occur to her that this really could be a heart attack. And then even if it occurs to her that it could be a heart attack; even then she says well, maybe if I go to the hospital they will think I’m hysterical. I don’t want to bother people. I don’t want my relatives to have to take me anywhere. I don’t want to be a burden to anyone and even if she does think it’s a heart attack she doesn’t call for help. So, the key in the awareness campaign is understanding what are the triggers that will actually help a woman call for help.
One of the things that we have been using, is a survey that we did, a pattern on a survey that they did in the United States. They asked women what would you do if the person next to you had the signs and symptoms of a heart attack? And between 75-80 percent of them said they would call for help. And then they asked well what would you do if you had signs of a heart attack? And only 50% of them said they would call for help. So, one of the focal points of the campaign that we are organizing is if you call for someone else, call for yourself. We really want to empower women to make the decision to call for help.
Melanie: That’s really a great idea. So, tell us about your work for heart disease besides this awareness campaign, and how it can be a model for other countries. What can we learn from your studies?
Dr. Zwas: Well, we’ve developed a very comprehensive center where we work on addressing the individual, the community and the digital world. So, we have a clinic, a multidisciplinary clinic that focuses on women who either have heart disease or three of more risk factors for heart disease and we work with them to develop a plan that works for them to make the changes that they need to make to prevent heart disease. Very often a woman goes to the doctor and the doctor says oh go lose weight. Go do more exercise. It is very hard to translate that into the stressful reality of day to day life. So, we work with the woman, we work with her to overcome her old emotional barriers to making change and we work with her to create specific doable goals that she can really do, and we thereby build her health self-efficacy, her ability to know that she can really take care of herself and we are seeing real change.
We are also working on the community level because people just don’t like going to the hospital and they don’t like to be medicalized, so we are going out to the community and working with all sorts of different infrastructures within the community to build intervention programs that improve nutrition, physical activity, and stress reduction. So, we work in partnership with the city of Jerusalem and women’s support groups. We work at schools. We work in community centers. We work in the Arab community, the ultraorthodox community, the general community and we are building programs in the community where women get together and support each other to make the kind of changes that will make our communities healthier communities.
We are also working in the digital world and that’s with using digital media to get really to everyone in this country, Arab, Jew, it is a little harder to get to our ultraorthodox because they don’t admit to using any media, but we are trying to use specific campaigns to really work on the awareness of heart disease in respect to what we were talking about before, when and how to make the call.
Melanie: And tell us about your work in underserved populations in Israel.
Dr. Zwas: Well I have to say it has been a tremendous educational experience for me to really understand the social challenges the different populations in Israel face. In order to reach the women in the Arab community, we have been going to schools because it is socially unacceptable for a woman to leave her house to do something for herself. So, if she is doing something that’s related to the education of her children then that’s okay. So, we go into the schools. We take programs for the kids and then we include the mothers and then we train them in nutrition and the importance of physical activity and then we can really reach out to them once we have gotten them in. So, the other challenge that we faced in the Arab community which we are working very hard on addressing is second hand smoke; because more than 50% of Arab men smoke and it is socially very challenging for them to - for the women to get them to not smoke in the house. And that is something that we are working very hard on developing a program and campaign, a comprehensive approach in order to get the houses smoke free.
In terms of the ultraorthodox communities the challenges are different. The challenges tend to come from just the extreme stress that these women are under in terms of the logistics of their lives. They have seven kids, ten kids, they are working, they are dealing with poverty and it’s almost impossible for these women to find the time to do anything for themselves. So, we are really working with them on incorporating exercise into daily life. We have actually developed a very interesting program where they exercise in each other’s houses. They don’t want to go to health clubs. They don’t want to go to the health plan because there are people outside the community there, so we have developed a program where they each pay a small amount of money to an exercise instructor and they meet in each other’s living rooms. We have a coordinator who runs this program and it has been amazingly successful in increasing the exercise in that community.
Melanie: Are you seeing a decline in heart disease deaths in Israel and if you are, do you think that diet is playing a factor? Tell us the role that diet plays within the heart disease community.
Dr. Zwas: So, there are two separate questions that you are asking. We are seeing a decrease in mortality after heart attack, but I don’t think it is related to diet. I think it is related to increased awareness in physicians. I think the doctors are now realizing that women have heart disease. The doctors are treating the women faster. The doctors are treating the women better and that’s why I think that our mortality is going down. In terms of diet, I am concerned about the opposite. For many years, the diet in Israel was the Mediterranean diet and is very healthy. But in Israel as well as in America, we are suffering from the sheer overwhelming abound of high carbohydrate, high fat, low nutritional value food which is just assaulting you from every venue. If you go into a local store; it’s almost impossible to find something healthy to eat in there. If you go to a supermarket; out of the ten rows, maybe one and a half of them have healthy food and I think that the increased economic status in Israel is adversely affecting the diet here.
Melanie: So, what do you want women to know about preventing cardiovascular disease? Give us a little kind of summary wrap up about exercise, lifestyle factors, diet, people have heard a lot Dr. Zwas, in the media, but you put it into us such a nice easy way for us to understand. So, kind of summarize it all for us, what you tell people every day.
Dr. Zwas: What I think people need to know in terms of preventing heart disease is that diet and exercise are the key. So, in terms of exercise; you need to do 150 minutes a week of moderate exercise, approximately 30 minutes five times a week and just doing that, will protect you to a significant degree. There are studies that show that people who are fat and fit, meaning you are overweight, but you are in shape, those people have a better prognosis than people who are skinny and out of shape. So, it is not your weight that matters, it’s your exercise level and it is also what you eat. The new data about the Mediterranean diet and really the American Dash diet or the American version of the Mediterranean diet, they are both the same. If you eat a lot of fruits and vegetables, whole grains, legumes, nuts, fish, and low-fat dairy and really decrease the high fat, high animal fat parts of your diet, just eating those foods is protective. And the other stuff you eat is less important. So, if you manage to get a very diverse diet that in and of itself is protective.
Melanie: What a great message. And tell us about the Linda Joy Pullin Cardiovascular Wellness Center for Women.
Dr. Zwas: So, the Pullin Center was founded by Mrs. Irene Pullin of Washington DC, in order to promote cardiovascular wellness. She and we have tried to adopt her global vision of wellness as our goal. So, rather than trying to think about disease, we try to understand what it is that we can do to make women healthier longer and keep their hearts healthy. So, that’s why we work on the individual level, the group level, the community level and we try to get our message out to as many people as possible. And I just want to add, that even exercising one time per week can make a significant difference in a woman’s heart health and her prognosis. It can keep those heart attacks away. All women need to take the time to take care of themselves, to put in that extra bit so that we can be here to take care of those we love.
Melanie: Thank you so Dr. Zwas for being on with us today and thank you so much for all the great work that you do. This is Hadassah On Call, New Frontiers in Medicine, brought to you by Hadassah the Women’s Zionist Organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Haddasah.org/podcasts. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd004.mp3
- Doctors Arzy, Shahar
- Featured Speaker Shahar Arzy, MD
- Specialty Director of the Computational Neuropsychiatry Lab and Neuropsychiatry Clinic and the Epilepsy Center, Hadassah Medical Organization
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Guest Bio
Prof. Shahar Arzy studied medicine (MD) and cognitive neuroscience (MA) at the Hebrew University, and completed his PhD in neuroscience at the Swiss Institute of Technology and the University of Geneva. Specializing in the human cortex, he now works in the clinic of neuropsychiatry and the epilepsy center at the department of neurology at Hadassah Hebrew University Medical Center, and leading the Neuropsychiatry Lab. His main interest is the human self and its subjective experience in physiological and pathological states. He is involved in developing new tools for evaluation and management of neuropsychiatric patients, and puts special efforts in translating clinical neuropsychiatric concepts into a neuroscientific model of a "neurology of self".
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Transcription
Melanie Cole (Host): Did you know that with seriously high computer and math skills, medical insights and extreme motivation; experts are dedicating their talents to both understanding the mysteries of the human brain and at the same time, solving some of the most crucial needs in clinical practice, such as Alzheimer’s Disease. Today, we are speaking with renowned neuroscientist Dr. Shahar Arzy on this episode of Hadassah On Call.
Welcome. My guest today, is Dr. Shahar Arzy. He is the Director of the Computational Neuropsychiatry Lab and Neuropsychiatry Clinic and the Epilepsy Center of the Hadassah Medical Organization in Jerusalem Israel. Welcome to the show Dr. Arzy. So, what conditions are your main interests? What are you studying?
Dr. Shahar Arzy (Guest): Hi. It is a great pleasure to speak to you Melanie. There are so many wise questions that you evoke. So, we are in the computational psychiatry lab and what we are interested in mostly are high cognitive function and specifically the new field in essence new field of the human self, what it is like to be a self and the status that we have in the world. And it is a relatively new, like several years of researching the domain of spatial cognition and temporal cognition and this divides through fundamental domains like memory or body and from memory and body we can go to the disorders of memory and especially Alzheimer’s Disease and also dissociative disorder that are suffering or neuropsychotic suffering that are related to the human body. So, this is the framework of the lab in general.
Melanie: So, how did you begin exploring what’s going on the patient’s brain using data from patient’s own world taken from digital media, Facebook, smartphones? How did you begin to explore this? It’s fascinating.
Dr. Arzy: Yeah so, that’s exactly the thing and that’s why I was a little bit concerned with respect to the self-question because it is much easier to speak about memory. Like if somebody has memory problems and then there is a function named memory and then that is a concept that is easy to perceive and to understand. However, we actually now know that things are much more than that. It is not that we say that we know everything, but we know that memory is just some sub function of something that is much broader than this and this is like what it is we call the self or the behaving self or the experience. Because memory is a way to serve the experience, the experience of being alive, the experience of meeting people, the experience of going to different places, the experience of experiencing important events; which is especially important for old people, I think for all of us, but for old people it is more prominent like what is the most important like really from event to event, from birthday to birthday, of grandchildren, from a bat or bar mitzvah, Chatunah wedding and graduation of their great child from the university so these are the most important things in life. So, what we claim is that these are much more than just memories. You cannot compare it to a memory test like when I ask you to remember 3 words. It is something that is very substantial. And this defines our life in a much better way than just call it memory.
And then when we go to the world let’s say of Alzheimer’s disease, so we hypothesize that this is quite the same. It is not that people who suffer from Alzheimer’s or they just suffer from memory decline. Because if you have some memory problems, okay you can write a note and then compensate for it. It is something that is much more substantial. Like people that lose their way in their surroundings or that they don’t remember the most dearest person for them and this a huge suffering in Alzheimer’s disease. And this is much more than just memory.
Now with respect to your question, so now old neuropsychology just used the term, paper test in order to examine all of these just ask you to remember and so well and then I wait one-minute and see if you remember them or not. But now here we speak about something that is much broader. And the question is how we as clinicians can get access to all of this. It is much easier to ask about three items, but I have to ask you about your own life, I don’t know anything about your own life. But now, in the recent years, with the huge amount of data that is available over social media and over the digital world, these things actually do it better. We are not wealthy because we just use our smart phone and we just use our computers but actually people in the world know everything about us. They can Google everything about all of us, so use Gmail and Facebook now all of us if we use Facebook. And this thing availability things are also accessible with the permission of the patient. And then we can with one click, can use our algorithms to go – our robots to go into the patient’s digital world and then create the world either for our scientific research or for clinics and then using this world, we can really test the patient on this world and not only this, we can also create a virtual world for the patient in order to enhance and to augment his or her ability to use or to restore the relation to this most important things in life like close family members, or important events in one’s life.
Melanie: Absolutely brilliant. So how can neuro imaging examinations of the brain, how does that enable this early detection, if you are using the social media, which is so fascinating that you are able to take this information that people put out there themselves and use it to recreate somebody’s memories and their life; so how can this neuro imaging, the MRIs and such that you are using, how can this help to improve the prognosis for people with Alzheimer’s or even detect it early?
Dr. Arzy: So, in neuro imaging, we speak about structural neuro imaging and functional neuro imaging. Structural neuro imaging is the MRIs, it is all of us that know that shows the brain. The functional neuro imaging shows the function of the brain, how does the brain function, how does the brain create thoughts and memories and all of this cognitive and emotional stuff. And in the last thirty years, it becomes available to detect the function of the brain using functional MRI which is a way to look for blood changes in the brain which are correlated to the functions of neurons. So, we can see this almost in real time nowadays and the old neuro imaging functional imaging what people did is to show generic simulations. How function neuro imaging works is you show the patient or subject with stimulus and then you see the reaction in the brain to this stimulus. Most stimuli are generic like if I want to detect the area in the brain that is responsible for face, I show faces, faces of whoever just any face will evoke it, even a drawing of face. But here, we are looking not from some generic thing like to retain words or to identify faces, but we want to identify what it we call mental orientation. Orientation of one to the world. And as I stated earlier, this orientation is different if I refer to my own beloved daughter, who is for sure know the most brilliant, smart and beautiful creature on earth and you would say the same for yours and I would say how come that the two take the same place. With all due respect, to your daughter or granddaughter, for sure mine is more beautiful. We don’t talk about it. So, it will be what we presume to just – if we just show an image of a baby to everybody, all of us love – most of us like babies and this will evoke a response. But it will be different if we show the dearest ones, but this is difficult because if we can – how can we in clinical practice create such a thing?
So, we take all of this from the social media and digital media, the stupid smartphones that we carry with us all over and they are stuck to them and they know everything about us, so we can just take all of this information out of it, then show it to the individual patient and then see how this patient is oriented to his own world and then when we see how you are oriented to your own world, we can offer you a precise medicine, not something generic that is good for everybody, but something that will take your own situation with your own difficulties and with respect to your own needs and this circles of family members and people that are important to you, specifically. So, this is new era of precise decision medicine that is enabled by this data revolution and the computational revolution that we face nowadays.
Melanie: Well and in this precision medicine, you are able to use human patients that you are working with to be able to compare their own self before and after whatever interventions you offer, so is that better than working with animals, because they can actually tell you the difference, yes?
Dr. Arzy: Yeah, that’s very wise what you just said. First of all, in my domain, I don’t know about other domains, but in my domain of neuropsychiatry, animal models are very problematic because you know I really love dogs, but I never saw a dog who came to me and said that I’m the Messiah. However, I did see several people who said so. So, for example this is an example of a delusion, so it is something that is very difficult to study in animal models. And so, where it is that we overcame it is what you just suggested is to do things on longitudinally and now all this is available because we have all of this information now. My phone knows not only that I am now at Hadassah Medical Center in Jerusalem, but he knows that this morning, I was at my home and didn’t forget it and moreover it can even predict that in two hours I will be teaching in the neuropsychiatry computational psychiatry course at Hebrew University. Now how smart this guy is. So, we can use and compare things longitudinally and then we can track not only the static state of the patient off of this but the most important dynamics of the disease and if we know the dynamics, we can predict what will be in the future of the disease and then we can make our intervention much more precise and much more helpful.
Melanie: And that’s the whole point of this. So, what’s one key point you have learned in regard to Alzheimer’s disease for medicational intervention?
Dr. Arzy: in general, you know the world is so wide, so I don’t like questions that say one thing, but if you ask me for one thing, and you really understand so, I think that the main – the most important thing is that we treat Alzheimer’s far too late. It is like patients with the heart attack and then if you come and do an intervention two days after and not in the first five minutes, so there is nothing to - nothing to save. And people are coming to us to the doctors when things are already very, very deep into the disease and then the drugs that are developed are not helpful. And if you want to cure Alzheimer’s we have to present drugs much, much earlier and like ten or even twenty years before the time that people come now to us. And therefore, this we have learned together with the Hadassah Medical Organization in New York and with the Alzheimer’s Foundation of America and we are working on it to do a huge effort that we may call it Screening America and like the people will go and undergo our mental orientation tasks with that we were describing and then we can run our machine learning algorithm on this huge amount of data and then we can identify people at risk and when people are at risk, can come early enough so hopefully, drugs may be much more effective than at the very time point when they finally present to the clinic.
Melanie: We only have a few minutes left Dr. Arzy, but how are your team’s efforts able to translate some of this interesting research into usable clinical applications, because as you mentioned smartphones, and everybody is carrying them, these clinical apps are what people are looking to especially those in your field. So, how are you able to translate that? What are you doing with that?
Dr. Arzy: So, at President Obama stated once in one of his very many remarkable notes and he spoke with children and he said don’t use smartphones, talk on them. We, are facing in the recent years, are facing a tremendous change in the way that we are related to the world and the same very ways that the world relates to us. And this is composed from two things. One is the data revolution, that there is so much data on us and it’s stored in so many places, everything is known. And the second is the computational revolution and this is especially related to the new relatively new domain of machine learning and artificial intelligence that by the combination of these two, of this huge data set what we call big data and algorithms together, we can extract knowledge about ourselves t even us and even the most genius expert could not extract or come with. And this combination enables it. Now, this can be related to everything. But if you relate it especially to one’s life because we carry all of the things and what we do with our smartphones, we communicate with other people, so this is social, this is relation and then we trek our way, we use navigation aids but we also – we have this GPS that will remember where we are all the time and we plan our future and we come back to old memories by using cameras and stuff like that. So, these are the three main components. So, one today has to be a little bit, if we are gonna understand, in order to capture all of this because you have to – you have to do cognition like all of these things together. You have to do the computation. You have to do the algorithms. You have to relate to the data. And if you want to apply into medicine you also have to be a clinician, that’s exactly what we do at Hadassah.
This is a model of Hadassah. It is a combination of all these things together. And then we can just take the algorithms and direct them to take all of this information and to extract what is relevant to the clinic and we are indeed we just finished a study and if we compare our performance, the performance of our algorithms in identifying as the very, very early stage of Alzheimer’s Disease, so our accuracy is 95% when the best experts, the best human experts can go into a precision of only 71%, which is really a huge, huge difference. So, and then that’s the way of the world is going and we at Hadassah, should lead it.
Melanie: Thank you so much Dr. Arzy for being on with us today in this absolutely fascinating segment. This is Hadassah On Call, New Frontiers in Medicine brought to you by Hadassah the women’s Zionist organization of America. The largest Jewish woman’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Haddasah.org/podcasts. I’m Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Audio File hadassah/hd003.mp3
- Doctors Levine, Hagai
- Featured Speaker Dr. Hagai Levine, MD, MPH
- Specialty Head of the Environmental Health Track at the Hadassah-Hebrew University Braun School of Public Health and Community Medicine
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Guest Bio
Dr. Hagai Levine, MD, MPH, is the head of the Environmental Health Track at the Hadassah-Hebrew University Braun School of Public Health and Community Medicine.
Learn more about Dr. Hagai Levine -
Transcription
Melanie Cole (Host): The sperm count of men in western countries has been declining according to new research, bolstering a school of thought that male health in the modern world is at risk, possibly threatening fertility for many couples. Today we are speaking with Dr. Hagai Levine on this episode of Hadassah On Call.
Welcome to the show. My guest today, is Dr. Hagai Levine. He is the head of the Environmental Health Track at the Hadassah Hebrew University Braun School of Public Health and Community Medicine in Jerusalem Israel. Welcome to the show Dr. Levine. When did sperm count start being investigated as a factor in male infertility?
Dr. Hagai Levine (Guest): Actually, the method of counting sperm was first described in 1902 and the method did not change much since because it is very simple and validated method. You put sperm on the slide and count under the microscope the number of sperm. Very simple, very accurate and a very good marker for male fertility.
Melanie: I mentioned in my intro that research is showing that we are seeing a decline in western countries. So, what are you seeing as a difference now and what do you think and what have you found as the reason for this decline?
Dr. Levine: So, here we have a very good measure. The measurement system did not change. So, we can really see whether or not there was a change over time. Now there was a previous report 25 years ago Nicholson et al that claimed that there was a decline in sperm count in the world since the since the 30s. However, this report was accepted with a lot of criticism and actually was not accepted by the entire medical and scientific community. So, we conducted the most comprehensive and using state of the art equipment to model and study the trend over time of sperm count around the world. We did this systematically to help review including more than 7500 studies that we screened and what we found is a clear and steep decline of over 50% in two measures both the total sperm count and the sperm concentration of western men unselected by the fertility status from 1973 to 2011. Can you imagine any other biological measures that decline by more than 50% in 40 years?
Melanie: It’s really amazing and so why are western countries seeing this decline? Is it environmental and lifestyle influences? What is it?
Dr. Levine: So, first of all, we looked for information for non-western countries and simply there is not enough data because you need a lab and a researcher to collect and conduct such studies and we did not have enough studies from non-western countries to conclude the trend. Actually, recent studies from East Asia did find declines there as well. So, I cannot say much about non-western countries. In western countries, although we did not study the causes, we see a clear decline. We should remember that when we looked for the causes, to elaborate hereafter, when we look at the causes, we should also think about 20-30 years before the men were studied, when they were born, because actually we know that the prenatal period is a critical period for the development of the male reproductive system. So, something is disrupting this development and indeed the modern lifestyle and environment surrounding the development of the male reproductive system, we should look for the change over time, 20-30 years before 1973. So, from the 40s, from the 50s. Now we know, we all know that exposure of fumes and to manmade chemicals among other factors have changed dramatically over this time and men are exposed now to chemicals in an extent and viabilities that they have not been exposed ever before in evolution.
Melanie: So, what important public health implications do these findings have and let’s speak about some of those influences that are more of a factor now.
Dr. Levine: So, before speaking about the causes, I will speak about three implications. First and above all, as you said, we have a clear public health problem of male subfertility and infertility. We know it in Israel and in other states and in many other countries, a huge proportion of couples are unable to conceive naturally. And many more takes a longer time than they want to get pregnant. So, we have a fertility problem and we should understand and understand that the solution a long-term solution could not be only technological solution, because there is something causing it. So, this brings us to the other public health implication, that there is something wrong with our environment in a broad sense that caused this decline. It could not be genetic. So, this is the candle in the coalmine to put the signal for us that we need to change something with the way that we are living around the world. And the third implication is that new studies are showing that sperm count is a predictor and the marker of male general health and men with lower sperm count are more likely to die, to be hospitalized and to suffer from diseases. So, if we see this decline in sperm count, it most probably indicates a decline in the health of men in western countries. So, we have three implications; the fertility problem, the causes that we must address and the health problem of men around the world.
Melanie: That’s fascinating. So, what would you like men to know about these environmental and lifestyle influences and are we even looking at things like cell phones and alcohol and sedentary lifestyles? So, speak about some of these influences and how they might change a man’s mind about those lifestyles.
Dr. Levine: So, first we should separate the suspected causes into two. The causes that may affect in the prenatal life and causes that may affect in the adult life. Some of them are the same but not necessarily. I would focus, first of all, in research and in prevention on the causes in prenatal life. This is probably the more important factor. For example, studies have shown that smoking of the mother during pregnancy is a worse risk factor for lower sperm count than smoking of the man himself when he is an adult. So, smoking of the mother is worse than smoking of the man himself later on. So, this is an example how disruption in early life, this is probably the most critical. However, our listeners want to know what they can do besides blaming their mother.
So, in adult life we know that exposure to pesticides and specific toxic chemicals harm the production, the spermatogenesis and men produce sperm every day by millions. So, exposure now can affect your sperm for the next three months. So, you can do – so you can change your exposure now so if you are exposed occupationally or by other ways to pesticides or other chemicals that are known to be toxic to sperm such as drugs – medical drugs and drug use, you should avoid them. Smoking of course, lack of physical activity, even TV viewing was linked to lower sperm count and the basics of keeping a normal weight and a good diet can improve your sperm count. Now for the cell phone. This is not proven. We know that heating your testicles is not good for them and we know that cell phones and mobile computers are heating your testicles if you put them directly next to your testicles, so you should definitely avoid that. We don’t know yet about the possible impact of non-ionizing radiation, so I would focus on what we know for sure you can do for your little one.
Of course, the other side is that we need to protect the babies, the fetuses now, to prevent from exposure to phthalate or other chemicals or even stress or smoking of the mother that we know that disrupts the development of the male reproductive system.
Melanie: Dr. Levine, so along those lines, if 30 years ago women didn’t realize that smoking during pregnancy was so detrimental and you are seeing this decline now, now that there is more of an awareness, of smoking during pregnancy, do you think, in your opinion that in another 20 years, you might see this trend head back up because women are not smoking as much during pregnancy or do you think they are?
Dr. Levine: I think that we must use surveillance methods like we do for cancer and for infectious diseases as a public health physician and I used to be Chief Epidemiologist for the UN Defense Forces, so I did a lot of surveillance and so in the studies, we need also to follow the reproductive health trends continuously, including semen quality indicators for example and we don’t do it at all at the moment. So, we will not be able to answer this question unless we start following it now. Now I am worried, I am very worried because we know that there are epigenetic changes. The effect, the detrimental effects for example smoking during pregnancy do not only affect the sperm but also affect the grandson and maybe also the grand grandson. So, we already see an effect in the contour of the genes at the epigenome level that is changing, and this may be the reason why the effect may be cumulative. If you are exposed to toxins in smoking or to chemicals such as phthalates and in intersect the developing fetus, it also affects his son and his grandson, etc. and we may see even if we stop now the exposure, we may not see any improvement. So, it is a very serious issue of the question of the extinction of the human species. Okay, so we don’t know what will happen, but we can’t necessarily be sure that we can reverse the damage. We can stop the continuation of the damage, but not necessarily reverse. So, we must understand this is a clear and present emergency to humans the possibility that we will become less and less fertile and we will not be able to reverse.
Melanie: So, do you think this is a wakeup call for health professionals and for men with a goal in reversing this change and if it is a wakeup call, what is the take home message for men, their partners and health professionals? What would you like to see happen immediately and in the future?
Dr. Levine: Okay so immediately at the personal level, like we understand that a woman is planning a pregnancy and we say, the doctors, that pregnancy is twelve-month period because there is three months of preparation and even before. So, women are trying to keep better health before they are trying to conceive. We should so exactly the same for men. We should take this opportunity that if the man wants to bring life to improve his own health and you can do more physical – the same recommendations for general health like physical activity, keeping normal weight, keeping a healthy and balanced diet, avoiding smoking and drug use etc. are good for your sperm, for your fertility, for your future kids and for your own health. So, that’s one thing that you can do now, and we should restructure the medical system to focus not only on treatment but also prevention.
I know for sure, that in many clinics, the standard I visited when I was in Mount Sinai in New York and in Israel and in other countries there is much focus on the treatment side and technological solution and not on health promotion. So, we should think differently and put much more focus and attention to male fertility. So, this is one side of it and study of course, much more male fertility in animals and in humans and what are the causes. Now, we already know some of the causes. So, this is a wakeup call to address the causes. Now currently, we are doing a mass experience on mankind by exposing mankind to many, many chemicals that for many of them we know that they have serious effects on our health and the health of future generations. We must change this frame of thought and put our health before other considerations, for example economical consideration. So, the needs for proof should be on the producer of this chemical and not on the consumer. So, we must, like Europe is starting to do, we must regulate much better regulate chemicals and that is something that I hope that the studies like our own study will help change this way of thinking because I’m really worried now what this is beginning of the much larger problem later on.
Melanie: And where do you see research going from here? What’s your next move in this case?
Dr. Levine: So, I’m studying specific possible causes of poor sperm count for example in Israel, there is much exposure to pesticides. So, we are conducting a study on the effects of pesticides on semen quality in Israeli men and my colleagues are doing other studies around the world, but there is really not much funding in this area. Now that like women were neglected – or females were neglected in medical research for many years. The issue of male fertility or reproduction is considered a female issue and this trend is neglected in research so there is maternal and child health funds and clinics but not for paternal.
So, I think we should study much more paternal effect, we should study much more the impact of prenatal exposure including exposure to environment in the broad sense and the effect on health later on in life for both males and females and we should integrate fertility and semen studies within current ongoing studies as an important outcome. You can take a cause study of this conduct and then add an evaluation of the semen and actually this is a great source of learning because it is so susceptible to the environment. it is not only important by itself, it’s a good model to study the effect of the environment on our own health. It’s complex.
We should first start with research agenda. Currently, there is no research agenda in the field at all. So, once we work with researchers and governments from all around the world we can set the agenda for research.
Melanie: It is such great information Dr. Levine. So, just summarize it, restate this research study about the declining sperm count in western countries and really what you want men and other health professionals to know about this and things that they can do right now.
Dr. Levine: One of the most important things is life, the finishing of life itself is the ability to reproduce. We men reach to a state that cannot reproduce naturally. This is a wakeup call for each and every one of us. And of course, to the decision makers to identify male infertility as a major public health problem, to act on the personal level, to study and examine your fertility and what you can do improve it and to change in the global level and the country level to take action to reverse this decline by better regulation of chemicals, by health promotion activities and by research, a lot of research into the causes of this decline.
Melanie: Thank you so much Dr. Levine for being with on with us today. This is Hadassah On Call New Frontiers in Medicine brought to you by Hadassah, the Women’s Zionist Organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Haddasah.org/podcasts. I’m Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole, MS
