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T he P ortland O bserver » A ugust 23 1995______________________________ ______ ____________________________________________________
Scientis
Scientists at the National Insti­
tute o f allergy and Infectious Diseas­
es (N IA ID ) and their colleagues in
California and the United Kingdom
have uncovered the key to how the
most common and deadly species of
human malaria parasite escapes im­
mune detection and causes a lethal
syndrome o f coma and death.
Each year, between 300 million
and 500 m illion people develop ma­
laria and up to 1 million-mostlyyoung
children in tropical Africa--die, ac­
cording to the World Health Organi­
zation (W HO ).
In three back-to-back reports in
the July 14 Cell and one paper in the
July 18 Proceedings o f the National
Academy o f Sciences, the scientists
describe a newly identified family o f
thousands, perhaps millions, ofgenes
P age A7
Discover Marlaria's Immune Escape Genes
that encode proteins critical to the
development and persistence o f Plas­
modium falciparum malaria. "The
lack o f specific information about
these genes has been a major road­
block to research on malaria,” says
Louis H. M iller, M.D., ch ie f o f
N IA ID ’ s Laboratory o f Parasitic
Diseases (L P D ) and senior author on
one o f the papers.
The proteins made by these genes
allow the parasite to survive in red
blood cells and enable the infected
cells to attach to blood vessel walls in
the brain, causing the most serious
complications o f malaria: coma and
death.
Variability or var genes, as they
have been named by the N IA ID sci­
entists, may lead to the identification
o f molecular targets for drugs or vac-
cines to prevent these potentially
deadly complications. "N ew treat­
ments are needed because in many
areas where malaria once was con­
trolled or elim inated it has re-
emerged, largely because the para­
sites have become resistant to
chloroquine and other standard drug
treatments,” comments Anthony S.
Fauci, M.D., N IA ID director.
Senior author on two papers,
Thomas E. Wellems, M.D., chief o f
the MalariaGenetics Section in LPD,
comments, “ Scientifically, it’ s excit­
ing because we’ ve explained obser­
vations made decades ago by the
previous generation o f scientists and
with new tools uncovered what’s
going on at the molecular level.”
In 1965, scientists reported ob­
serving that malaria infection in mon­
keys waxes and wanes regularly,
gradually fading away months to
years later. With every w ave o f par­
asites, they saw a different, specific
immune response.
Dr. Wellems uses the analogy of
the human immune system to de­
scribe what they have learned about
how such a chronic P falciparum
infection becomes established in hu­
mans. The human immune system
can produce millions o f different an­
tibodies, he explains. When the body
combats infection, specific rearrange­
ments in immune system genes give
rise to specific B cells that produce
specific antibodies. “ The malaria
parasite mirrors the immune system’s
ability to make novel protein forms,”
he says. “ Every time the human im­
mune system generates an antibody
that can kill parasites expressing one
form o f the protein, some parasites
have already switched to expressing
a new form. It’s a battle o f the pro­
teins, a thrust and parry between the
host and the parasite.”
This elaborate ploy allows the
parasite to avoid a more certain de­
struction in the host’s spleen. When
the parasite infects a circulating red
cell and matures, the parasite modi­
fies the red cell, which the spleen can
then detect and destroy.
To escape that destruction, the
parasite produces large proteins that
collect in knobs that are on the sur­
face o f the infected red cell. The
infected cell then attaches via con­
tact at these knobs to receptors on the
endothelial cells lining tiny blood
vessels. Here the parasite matures
and the red cell ruptures and releases
more parasites to infect other cells,
thus circumventing the spleen.
Scientists suspected that the
c e ll’s adhesiveness depends on spe­
cific surface proteins known collec­
tively as PfEM P-l (P. falciparum
erythrocyte membrane protein-1).
What was unknown is precisely what
these proteins are and why they vary
over time.
The new papers are the first to
offer a molecular explanation for how
red cells infected with P. falciparum
adhere to endothelial cells and elude
immune attack: the var genes pro­
duce PfEM P -l and enable the para­
site to change both the antigenic and
adhesive character o f the infected
cells, thereby staying one step ahead
o f the immune system.
Decreasing Work And Leisure Time Quality Are Health Hazards
The combination o f rising over­
work, under- and unemployment, and
decreasing opportunities for public
recreation is threatening the health
and well-being o f North Americans,
according to a group o f international
recreation and parks experts.
Leaders from the National Rec-
reation and Park A sso c ia tio n
(N R PA ), representing park and rec­
reation professionals and officials in
the United States, and its counter­
part, the Canadian Parks/Recreation
Associat ion (C R PA ), are meeting this
week in Ottawa to discuss critical
issues facing North American com­
munities.
Noting recent U.S. and Canadi­
an labor data, the group o f 95 recre­
ation leaders urged government, la­
bor, business and communities to
partner in strategic alliances to help
create a balance between work and
leisure. They cited several trends that
threaten individuals, families, com­
munities and their economies:
• The dichotomy o f increasingly
longer work weeks for some people
and low-wage, part-time jobs or un­
employment for others both contrib­
ute to poor-quality work, less time
for leisure and, consequently, a less­
er quality o f life.
• The experts cited a U.S. Bu­
reau o f Labor Standards report that
overtime for manufacturing workers
is the highest since 1957, when the
bureau began keeping overtime sta­
tistics. A 1994 Department o f Labor
study o f working women said that
employees’ major concern is the dif­
ficulty o f balancing work and family
obligations.
• The number o f Canadians in
longer-hour jobs has been rising
steadily since the 1970s, according
to the Advisory Group on Working
Time and the Distribution o f Work,
authorized by the Canadian federal
minister o f human resources devel­
opment. Ten percent of all adult male
workers and six percent o f al I female
workers are now working more than
50 hours a week. Two-earner fami­
lies, which constitute 50 percent o f
the Canadian labor force, are doubly
impacted.
• Everyone should have the right
to contribute to society by participai
ing in meaningful work. At the same
time, increasing leisure is one o f the
p rin cip al benefits o f econom ic
progress, a public good and a mea-
New Survey Shows Pharmacists Wary
Of Measure 16 Compliance
A new survey o f more than 1,000
Oregon pharmacists concludes that
the persons responsible under Mea­
sure 16 for dispensing lethal doses o f
prescription drugs are divided even­
ly on the question o f assisted suicide,
but a majority are against the lan­
guage ofO regon’scontroversial leg­
islation.
The survey also suggests that
pharmacists are concerned that phy­
sicians might not comply with all of
the requirements o f the controversial
measure before writing a “ Prescrip­
tion for drugs to end life.”
The survey was conducted by
researchers from the Oregon State
University College o f Pharmacy and
endorsed by several major groups,
including the Statewide Pharmacy
Task Force on Measure 16.
According to the survey, 45 per­
cent o f Oregon pharmacists support
physician-assisted suicide, while 43
percent oppose it. The rest were un­
sure, had no opinion, or did not an­
swer the question.
However, when asked if they
supported Measure 16 as written,
only 26 percent o f the pharmacists
came out in favor o f the legislation,
while 63 percent opposed it. Nearly
half - 47.8 percent - suggested they
would not knowingly participate in
physician-assisted suicide.
The survey was mailed to all
2,403 Oregon pharmacists; a total of
1,015 individuals, or 42 percent, re­
sponded.
Jim Slater, a pharmacy doctoral
student at OSU and one o f the princi­
ple researchers in the study, said
many o f the pharmacists who oppose
Measure 16 are concerned with its
vague language and unclear “ end
results.”
“ There also is concern that the
medication prescribed must be oral­
ly ingested,” he added. "Fo r the drugs
currently available, it would take sev­
eral handfuls o f pills to ensure a
lethal dose and that could result in
discomfort and vomiting...and not
necessarily death.”
Slater said many pharmacists are
concerned about potential liability.
While the measure grants civil and
criminal immunity to “ health care pro­
viders,” it does not specifically in­
clude pharmacists in the that category.
Protein Important Early In Pregnancy
Women who restrict dietary pro­
tein early in pregnancy may limit the
development o f the placenta and,
eventually, the fetus.
Results from a pig study at the
U S D A ’ s children’s Nutrition Re­
search Center at Baylor College of
Medicine in Houston indicate that
such restrictions affect the size and
weight o f the mother-fetus connec­
tive tissue that transports nutrients
and oxygen and removes wastes.
“ Ifthe placenta's size is reduced
early, its ability to transport nutrients
is compromised,” said Dr. Wilson
Pond, a U SD A scientist.
A c c o rd in g to D r. P a tricia
S ch o k n ech t, a form er C N R C
postdoctoral fellow who directed the
study, the placenta’s size is often
related to the size and birthweight of
the infant.
Recommendations for pregnant
women include a balanced diet with
additional protein, which is avail­
able form meat, fish, legumes and
dairy products.
Asthma Requires Teamwork
Keeping asthmatic children out
o f the hospital can be accomplished
with family teamwork.
parents should take the lead as
“ coaches,” making the child the “ star
player” whose role is to keep the
asthma treatment current, said Dr.
Kristin Moore, and allergist at Baylor
Elevated Eye Pressure Sufferers
May Benefit From National Study
Devers Eye Institute at Legacy
Good Samaritan Hospital contin­
ues to recruit for patients who suf­
fer from elevated eye pressure to
participate in a study to determine
whether using eyedrops to lower
eye pressure w ill prevent or delay
glaucoma.
Ocular Hypertension Treat­
ment Study participants must be
aged 40 to 80, and have at least
m ildly elevated eye pressure but no
worse than 20/40 corrected vision
in both eyes.
The study seeks African Amer­
icans in particular, since they are a
high risk group for both elevated
eye pressure and glaucoma. Others
at risk include nearsighted people,
diabetics, and those with high blood
pressure or a family history o f glau­
coma.
Volunteers receive specialized
eye care for at least five years, com­
plete eye exams every six months
and standard drugs for elevated eye
pressure.
Devers Eye Institute, the north­
west center for the $22 million Na­
tional Institutes o f Health funded
study, currently leads the nation in
recruitment.
College o f Medicine in Houston
“ Start by taking as much time as
needed with the doctor so that both
child and parents understand why
and how drugs are to be taken,” Moore
said.
Then recruit other team members
so the child will not feel he or she is
facing asthma alone. Possible team­
mates: siblings, parentsof friends with
whom the child may spend the night,
teachers, school nurses.
“ Having friends and supporters
in many places can help ease the
child’s embarrassment about the con­
dition or about having to interrupt
school or play to take medication,”
Moore said.
sure o f national wealth,” said Herb
Pirk, C P R A president and commis­
sioner o f parks and recreation for the
city o f Toronto. “Quality recreation
experiences, available through in­
creased leisure, is a right o f all peo­
ple."
• The lack o f quality work and
leisure exacerbates other social ills.
"Social problems include alarming
increases in number o f youths resid­
ing in family and environmental con­
ditions that put them at high risk o f
health, safety and academic failure,”
said R Dean Tice, N RPA executive
director.
owing pressures on parks
and open spaces coupled with a grow­
ing recognition o f the importance o f
trees, open space and urban forests
are challenging parks and recreation
leaders to maintain and enhance lo­
cal environments. Meanwhile, deep
cuts in many public budgets reduce
the capacity o f agencies to provide
high-quality public recreation ser­
vices and park resources.
The delegates called for a na­
tional debate on the issues to influ­
ence public policies and decisions.
Speakers at the week-long meeting
include experts on social and eco­
nomic trends, and leaders in public
park and recreation management, fi­
nance and planning. Among the ex­
perts were: Arthur Donner, a Toronto-
based economic consultant who
chaired the Canadian report on work­
time trends; Ben Hunnicutt, a profes­
sor at the University o f Iowa, Iowa
City, and co-director o f the Interna­
tional Society for the Reduction of
Oregon Health
Forum Focuses On
National Reform
Human Labor; and Barbara Brandt,
staffperson o f Shorter Work-Time
Group, Boston. Other attendees were:
David Welch, chiefexecutive, Royal
Parks Agency, London; Don Hunter,
director, Saanich, British Columbia,
Parks and Recreation, and chair o f
Active Living Canada; James Col ley,
director o f Parks, Recreation and
Libraries, Phoenix; David Fisher,
superintendent, Minneapolis Park
and Recreation; Wanda Wetterberg,
general manager o f personnel,
Edm onton, A lb erta; M a rilo u
McPherdran, corporate director for
community women’s health issues,
Women’s College Hospital, Toronto;
Ed Koenemann, director, Vermont
State Parks and Recreation; and Diane
Huffman, Friends o f the Earth, Otta­
wa.
Lonnie’s Beauty Salon
A leading expert on national
health care reform, Carson Beadle,
w ill share his insightson what’s com­
ing down the turnpike from Wash­
ington D.C. the breakfast forum will
be held 7:30a.m ., Sept. H a t the Red
Lion in downtown Portland and is
sponsored by Oregon Health Forum,
an independent health policy news­
letter and information resource.
This forum w ill help business
leaders and insurance executives
understand the impact o f the latest
health care reforms -- revisions to
employee pension plans, the future
o f medical savings accounts as well
as changes to Medicare and Medic­
aid.
Beadle, managing director o f
W illiam Mercer, Inc., in New York,
also chairs the Assn, o f Private Pen­
sion and Welfare Plans.
Following his presentation, a
panel w ill discuss the implications of
those reforms on Oregon. Panelists
include Colleen Cain, president o f
Benova; Leigh Dolin, M D, past pres­
ident o f the Oregon Medical Assn.;
Denise Honzel, vice-president and
health plan manager o f K aiser
Permanente and Rand Sherwood,
director o f human resources, Port­
land General Corp.
Registration is $25 for Oregon
Health Forum subscribers; $40 for
non-subscribers. T o register, contact
Oregon Health Forum at (503) 226-
7870 or POB 2942, Portland, 97208.
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