Mark Pine

The second of two virologists who created potentially deadly forms of H5N1 (bird flu) viruses spoke out yesterday, a month after the first scientist to disclose his work sparked a heated controversy over the safety of the research. Yoshihiro Kawaoka of the University of Wisconsin-Madison and the University of Tokyo argued in a commentary in Nature magazine that research on H5N1 pathogens should move forward, since the viruses “circulating in nature already pose a threat, because influenza viruses mutate constantly and can cause pandemics with great losses of life.”

The investigations conducted at Kawaoka’s laboratory and that of Ron Fouchier, who did similar work at Erasmus Medical Center in the Netherlands, demonstrated that the viruses could evolve into strains that are highly lethal and easily transmissible from person to person. In their laboratories, scientists manipulated the genes of the viruses, creating strains that have the potential to spread through the air in droplets emitted in coughs and sneezes. The research is important for “pandemic preparedness,” Kawaoka went on to say, and “there is an urgent need to expand development, production and distribution of vaccines against H5 viruses.”

The H5N1 form made by Fouchier may be especially lethal, since it is derived from one that had circulated among humans and caused severe disease that killed half of about 600 people who caught it. Last month, while Fouchier’s research paper was under review at Science magazine, the U.S. National Science Advisory Board for Biosecurity asked that journal and Nature to refrain from publishing the articles by Fourchier and Kawaoka as they were originally written, and instead omit crucial methodological details describing the creation of the strains.

A highly public debate ensued. Some scientists and experts believed that the research or its publication should be curtailed. Richard Ebright, a bioweapons expert at Rutgers said, “This research should not have been done.” But proponents of the research, including Fouchier and Kawaoka, said that continuing to investigate the nature of the viral threat would pose less danger than stopping it, since it is probable that the deadly strain of virus would evolve naturally or be created in some laboratory as a weapon.

For the time being, Fouchier and Kawaoka have agreed to temporarily interrupt their work. Science and Nature intend to publish only abridged versions of the papers. Next month, a WHO-sponsored international conference in Geneva will provide a forum to discuss the thorny issue of how to allow vital research on disease-causing germs to proceed, while at the same time protecting the public against the potential for pathogens to escape and spread widely.

One of the attendees, Anthony Fauci, who directs NIAID, the infectious disease institute of NIH, said the meeting would “address some of these difficult issues on an international scale instead of something restricted to the United States government.” Although he supports continuing the research, Fauci urged the scientists involved in it to agree voluntarily to the moratorium. “I think we need to get greater input on the conditions in which it goes forward,” he said.

Last month, in a blog posting on the H5N1 research, I referred to the findings on methods of creating the deadly strains. I wrote that it “will require careful supervision of the information and its release only to competent and trustworthy scientists.” That still seems the best course of action. The scientists who think this information should be as widely published and freely available as biological research usually is apparently believe it is pointless and counterproductive to take any precautions. As a member of the scientifically literate public, I am not prepared to assume that they are right.

Having spent the first part of last night trying unsuccessfully to fall asleep, I’m writing about insomnia. It’s a problem I have often, particularly in the last few days.

Difficulty falling asleep is a common type of insomnia. The usual causes — noises, stresses, worries, discomforts, changes in schedule, use of stimulants or withdrawal from sedative medications — don’t apply to me. My nights this week have been quiet as usual, I’ve not been stressed or uncomfortable, and I don’t drink coffee or tea in the late afternoon or evening. I only use sedatives when, as last night, I can’t sleep.

Getting older, apparently, may also be a factor in insomnia. Too bad, nothing I can do about that. I suspect, however, that in recent days my brain has gotten too stimulated late in the day. Yesterday, I watched the State of the Union address. Obama always makes an impressive speech and gets me thinking.

Also, in the last week I’ve been reading “Crashing Through,” a remarkable book about a man who lost his eyesight in an accident at the age of three and then had it restored with a corneal transplant when he was about 30 years old. The author, Robert Kurson, presents a clear, perceptive account of the difficulties the man encountered in adjusting to vision after so many years. It’s a thought-provoking story — and perhaps too mentally activating for evening reading. The book may be the main reason for my DFA in the last few nights.

After tossing and turning for a couple of hours, I took half a tab of alprazolam (1.25 mg), a medicine I resort to a few times a month on average. When I finally got to sleep (the med took another hour or so to work), I slept soundly. I had set the alarm for 7 am, so as not to sleep late and set myself up for another restless night. I got about 5 hours sleep.

Insomnia should be taken seriously, says WebMD. According to an article on that website, it has been linked to high blood pressure, heart failure and diabetes. I suppose I should avoid reading or doing anything stimulating in the evening.

But intellectual stimulation is the most important thing in my life these days. I’m retired and lead a quiet life. Without thought-provoking activity, life would be boring. I listen to the news each evening, having little interest in other kinds of shows, because I find reports of the actual happenings around the nation and the world so much more fascinating than most other types of television programs.

On the other hand, ScienceDaily informs us this week that brain-stimulating habits have been linked to lower brain levels of Alzheimer’s protein, the substance called “beta amyloid” that accumulates in the brains of Alzheimer’s patients and to some degree in all older persons, as well. it is believed to play a role in causing the dementia.

The finding by researchers at UC Berkeley suggests that intellectually stimulating activities might actually slow down the pathological process of beta amyloid build up. The scientists studied 65 older volunteers and 10 Alzheimer’s disease patients in their 70s and 11 younger control subjects in their 20s. The older people who had been most active intellectually during their lives (by regularly reading, writing and playing games) had levels of beta amyloid (assessed with PET scans) comparable to the low levels of the young controls. The older subjects who were least active intellectually had levels of the substance comparable to the patients with AD.

If it isn’t one thing, it’s another. Perhaps I ought not to worry so much about insomnia that I resort to pills, even now and then. Since I don’t have to get up and go to work, it’s not terribly troublesome to be sleepy during the day. Rather than just toss and turn in bed at night, perhaps I should get out of bed and read or watch TV until I’m ready to drop. Maybe I’ll try that and see how it works.

From the beginning of the year, actually the day before, repeated reports of problems in the supply of medicines have appeared. On New Year’s Eve, the NYT ran a story on drugs for ADHD, which described parents who were unable to find pharmacies to fill prescriptions for medicine for their restless kids. Reporter Gardiner Harris wrote that the parents had gotten caught in a squeeze between the drug manufacturers, which were trying to maximize profits, and the Drug Enforcement Agency, which was setting strict quotas for the production of the Schedule II drugs (methyphenidate and amphetamine) used to treat the disorder.

The article noted, however, that there was no shortage of the more expensive brand-name drugs for ADHD, just of the inexpensive generic versions of the medications. Seeking to “maximize their profits,” Harris wrote, “each manufacturer divides its quota among its own ADHD medicines — preparing some as high-priced brands and others as cheaper generics.

During January, reports of supply problems with other kinds of drugs followed, including injectable anti-cancer medications; anti-infective drugs; injectable acetaminophen for pain; propofol for anesthesia; and succinylcholine and epinephrine, which are used in surgery. Many of the shortages involved injectable medications, and all are older, off-patent, less expensive drugs, used in common medical conditions and procedures.

The American Society of Heath-System Pharmacists, which maintains a website on the problem, currently lists 218 medications in short supply, everything from Vitamin A to zinc injection. The organization attributes the shortfalls to the interplay of production problems, raw material shortages, and business decisions about manufacturing, distribution, and mergers. In an “Action Alert!” ASHP asks consumers to “help ensure that the FDA has the tools it needs to help minimize the impact of drug shortages on patient care by urging your senators to cosponsor the Preserving Access to Life Saving Medications Act (S. 296).”

The legislation, which is in the early stages of Senate action, gives the FDA the ability to monitor drug supply problems by requiring manufacturers to report production difficulties sooner, and it empowers the agency to work with the companies to establish contingency plans to deal with supply disruptions.

S.296 was introduced in the Senate by Amy Klobuchar (D-Minn). The senator has accused brand-name drugmakers of limiting production of low-profit medications and paying generic drug manufacturers to delay introduction of new generic versions of medicines. Other Democrats in Congress have taken action on the drug shortage issue since October, when Rep. Elijah Cummings (D-Md), the Ranking Member of the House Oversight and Government Committee, began investigating so-called “gray market” companies, which engage in the trading of drugs and may be hoarding drugs and price gouging with those in short supply.

In a Viewpoint article in JAMA this month, a Washington state physician, Barbara Gehrett, noted that the number of drugs in short supply has increased from 62 in 2005 to between 200 and 300 last year. Most of the drugs, she said, are “older, generic sterile injectables,” that are manufactured through complex processes subject to a variety of defects. Common production problems may easily disrupt drug supplies in cases where only one company produces a product, or a drug has a limited shelf life and is available via inventories that use just-in-time control methods.

Gehrett said, “Industry must take the risk of redundant capacity to provide a more reliable supply stream,” but she also blamed the FDA for the slow approval of new manufacturing sites, which usually takes an “unreasonable” 2 to 3 years. Moreover, she wrote, the profit margins on the medicines in short supply “are typically small,” and drug manufacturers may abandon production of a medication that does not yield a sufficient return. She concluded, “In the current situation, high quality and low cost have led to scarcity. The brief years of cheap generic intravenous drugs may be coming to an end.”

My conclusion differs from Gehrett’s. Whatever the cause of the supply disruptions — and there are many — it boils down to price and profit. The fact that the shortages affect cheap medications, while expensive brand-name drugs remain plentiful, tells the story. In this era of rapidly rising health care costs, however, it is not a feasible solution to the problem to raise the costs of low-priced generic drugs to match to the levels, many times higher, of brand-name drugs.

Health care is a sector of the American economy where the free market has failed. It has failed to provide Americans with adequate health care of all types at affordable prices, including access to drugs. There is good evidence that government can do a better job. The government should be supplying some prescription medicines in short supply.

The evidence of government’s superior capabilities in health care comes from other countries, where most health care systems are government-run, but they are more affordable and sometimes even free. Yet, these government health care systems consume a smaller percentage of the national GDP than does the more privately run health care system of the U.S. The evidence also comes from the lower costs of large managed care organizations, which operate more like a government-run system would. Finally, there is the evidence of Medicare, itself, the government-run health care program for the elderly, which is more efficient, in terms of cost, than purely private insurance.

Technological advances, particularly those involving the internet, are putting long-established privacy protections under stress. That was the take-home message from a panel four experts in privacy and the law, who spoke at a conference yesterday organized by the Electronic Privacy Information Center.

The meeting, titled “Constitution 3.0: Consitutional Rights in the Digital Age,” brought together Adam Liptak, Supreme Court reporter at the NYT; Jeffrey Rosen, professor of law at G.W. University and author of the book “Constitution 3.0“; Paul Smith, a Supreme Court litigator, and Ginger McCall, director of the Open Government Program at EPIC.

Technology has not only enabled and enhanced surveillance by government, the speakers said, but it has also made it possible for private companies, like Google and Facebook, to keep track of and compile private data on millions of people. Also, most people carry cell phones, making it possible for telecom companies to follow the whereabouts of users in real time. And soon GPS devices may be found in just about every car on the road, which could facilitate the tracking of automobiles by police, as well as by private companies that have the capability to receive GPS signals.

Governments now have aerial surveillance drones, of course, but as the devices become less expensive, private organizations and even terrorists may seek to acquire and use them. As webcams become ubiquitous, entire populations of a nation could be tracked by governments and organizations using large computers to store the data and running ingenious algorithms to sift and search it.

Anonymity has also come under threat, as personal identity data has spread through the internet. Are emails private? Most people who communicate by email assume so, but currently nothing guarantees emails won’t be searched by organizations and agencies of government. And, many people are now storing financial and other vital personal data “in the cloud,” on massive servers operated by large web hosting companies. Currently nothing guarantees this data won’t be subject to inspection by some third party.

The ordinary expectation that one’s past will be forgotten as time moves forward may no longer apply. For instance, there is a Facebook module called Timeline, which displays an index of all of someone’s entries posted to that social network. Thus a person’s past might be checked out quickly and easily, and it might never fade away.

To enable the removal of such indelible impressions, one of the speakers suggested, legislatures might enact laws guaranteeing users of websites and social networks the option of deleting their information. In Europe, another speaker noted, there is the concept of the “droit à oublier,” the right to forget, which has been codified in laws that give citizens the right to control their own image and reputation. Should we have similar laws in this country?

We Americans expect that our freedoms to congregate, communicate and conduct business in private are protected by our Constitution and our laws. But the speakers at the EPIC colloquium questioned whether the founding document and current laws are adequate shields from hi-tech surveillance.

The Fourth Amendment, with its prohibition against warrantless searchers and seizures, is the basis of privacy protection. But it was conceived and written in terms of physical intrusions and retrieval of hard documents, not in terms of electronic tracking and scrutiny. Does the Fourth Amendment clearly apply to electronic forms of surveillance that don’t involve the physical entry of private spaces and seizure of material items?

One speaker gave an example of a surveillance activity that might raise the issue of when and where Fourth Amendment protections apply. It may come as a surprise to most Americans, but the Department of Homeland Security has been combing the internet looking for comments unfavorable to its work and mission, the speaker said.

The assumption of privacy during everyday activities is a necessary component of the sense of autonomy and dignity, which people need in order to behave and converse spontaneously, free of the feeling of being watched. But sometimes that feeling may be an illusion. In London, where I vacationed a last summer, surveillance cameras are everywhere. I assumed I was not personally being tracked, but I wonder whether that assumption always correct?

In this country, the NSA, our electronic monitoring agency, has put up a system called “Einstein 3,” for the collection, processing and analysis of all person-to-person communications contents — ALL of it. It is likely, I suspect, that a similarly comprehensive program for tracking the movements of Americans, using webcams, GPS devices, and face/body recognition software, is in the works or already in operation in selected regions around the nation.

The direst threat to America’s security is not Iran or any foreign power. It is the heating of the planet. In an article this month in Scientific American titled “Devastating Drought Seems Inevitable in American West,” authors from the environmental organization Pacific Institute describe the “worst and most consistent dry period” in the history of Australia during the last ten years. Fires and dust storms are sweeping across the island nation. The writers point to evidence that climate change is playing a role in Australia’s water woes, and they warn, “What happened in Australia could happen in the U.S., with devastating consequences.”

This morning on C-SPAN, I listened to the comments yesterday of a dozen or so Republican members of Congress, who howled in anger at President Obama’s rejection of TransCanada’s application to build the Keystone XL pipeline to transport bitumenous tar through the Midwest from Alberta to the Gulf of Mexico. They bemoaned the construction jobs that will be lost, and the continuing damage to America’s energy security from having to depend on foreign oil. But not a one of them mentioned global warming.

Which is worse for America — the loss of jobs that would last only a few years or the severe weather that could last a century? Which is better for America — continuing and reinforcing our dependence on petroleum or moving now to find other supplies of energy and develop renewable energy resources?

The Washington Post — more a centrist than a liberal news organization — made the case for building the oil conduit, arguing, “Without the pipeline, Canada would still export its bitumen. … And U.S. refineries would still import low-quality crude — just from the Middle East.” Perhaps so, but oil from outside the U.S. could not leak into aquifers in the Midwest. Besides, the Post comment misses the most important point.

The NY Times, the Post’s competitor, pointed out the most relevant factor: “The extraction and production of tar sands oil in the fields of northern Alberta would also cause far more greenhouse gas emissions than drilling for conventional crude.” The reasons for this have to do with the extremely dirty nature of the Canadian tarry crude.

The Canadian petroleum reserves, moreover, are the world’s second largest supply after Saudi Arabia. Does it make sense to bring a second Saudi online, when climate change is already underway?

I feel the growing warmth this winter, when a cold day in Maryland is one when the temperature drops below freezing. Just two decades ago, I remember, the thermometer would sometimes fall near zero in January, and one year the Potomac River froze over across to the Virginia shoreline. But these days, it feels as though the fall doesn’t end before spring begins. It’s nice for now, but how much longer will the good weather last?

At one point in my career, while working on an issue regarding the safety of infant vaccines, I had occasion to prepare a graph of infant mortality as a function of gestational age at birth. Unsurprisingly, the plot showed that premature babies die in infancy much more often, and the mortality rate rises as the gestational age at birth goes down. For that reason, perhaps, an article this week in JAMA caught my attention. It examined the effectiveness of drug caffeine, the active component of coffee and tea, in preventing death and disability among premature infants.

The authors, neonatologists and medical researchers at academic hospitals in Canada, Australia, Europe, and Israel enrolled 2000 infants born from 1999 and 2004 in a randomized placebo-controlled trial of caffeine. The babies received the drug for about 5 weeks to prevent or treat apnea (failure to breath) of prematurity. The doctors examined the outcomes of the treatment in terms of preventing death and disability, when the infants were 18 months and 5 years old. The present paper reported the results of the 5-year assessments.

The authors noted that “caffeine is the most frequently used medication in preterm neonates,” and the drug “has been called a ‘silver bullet’ in neonatology.” Nonetheless, it turned out that while caffeine helps, it may not do all that much in the long run.

When the infants were 18 months old, the researchers found, caffeine significantly improved the rate of survival without disability by “reducing the risks of cerebral palsy and cognitive delay.” But in the 5-year followup, among the approximately 1600 children who remained in the study, the 800 treated with caffeine did not do significantly better than the 800 who didn’t get the stimulant. The authors wrote:

The rates of motor impairment, severe cognitive impairment, behavior problems, poor general health, blindness, and deafness were not significantly different between the 2 groups.

Comparing the two groups of 5-year-old children, the odds of a child dying or surviving with one of the impairments were 18% lower for those who received caffeine, but the result was not statistically significant (p = 0.09). Certain secondary assessments of the children for motor function and visual perception did show a somewhat better long-term outcome in the caffeine-treated group. But other assessments failed to find a difference, including those pertaining to mortality, cognitive development (IQ), behavior, and general health.

In an editorial in the same issue of JAMA, two neonatololgists at Vanderbilt University wrote positively of the results of the caffeine treatment, particularly in terms of the improvements in motor function. Although at 5-year followup, the clinical trial “found no effect of caffeine on the primary outcome of death or survival with severe disability,” the commenters wrote, the trial nonetheless “highlights how fortunate preterm patients have been in the routine use of caffeine, a drug previously untested in newborns.”

In contrast, it seems to me, an alternative lesson might de learned from this editorial. As the writers said, “long-term follow-up is essential for reaching accurate conclusions about the efficacy of new therapies in preterm infants.” Indeed, long-term followup might yield surprising results in regard to many drugs and conditions for which “silver bullet” medications are assumed to be effective.

As for premature infants, in two cases I’ve been blessed to observe personally, I’ve learned that these children continue to come closer and closer to full developmental potential throughout their childhood years. I wonder what these investigators might find, if they were to reexamine the children and compare outcomes between the two groups when the subjects were 10, 15 and 20 years old. Would the treatment show any effect at all?

Antidepressant therapy doesn’t work for about a third of psychiatric patients suffering from depression. A medical website of the Royal College of Psychiatrists and the rating service Consumer Reports (pdf) agree that only about half to 70% of people treated pharmacologically for depression with the most frequently used antidepressant medications exhibit a substantial response. The depressed patients who don’t respond are often included among those termed “treatment resistant.”

In this month’s Archives of General Psychiatry, medical researchers at Dartmouth College and Emory University report that a selected group of 17 treatment-resistant patients, who suffered from major depressive disorder or bipolar depressive disorder, improved substantially during 24 weeks of electrical stimulation deep into their brains. Moreover, 11 of the patients, who continued the treatment for two years, achieved remission or near-remission of their illnesses.

The deep brain stimulation was delivered through electrodes implanted in the cores of both hemispheres of the brain, in areas of white matter containing nerve fibers. The electrodes were 3 mm long and 1.4 mm in diameter, and they were inserted neurosurgically below a brain region called the anterior cingulate cortex, which is involved emotions, decision-making, and control of physiological processes such as heart rate and blood pressure. DBS was delivered as a series of very brief (< 0.1 msec) electrical pulses through the electrodes. Since the brain receives no sensory input from itself, the stimulation was painless. In addition to implanted electrodes, the patients were implanted with electrical pulse generators below their collarbones.The generators delivered continuous electrical pulses when turned on.

For 16 of the patients, treatment with active stimulation was assessed every 1 to 2 weeks for 24 weeks. Fourteen of the patients continued the treatment until 1 year, and 11 did so until 2 years. According to the researchers, the results were remarkable, with very susbtantial reductions of depressive symptoms at the 24-week time point, and remission or only mild symptoms remaining at the 2 year time point.

Because the trial was uncontrolled, it is possible that a substantial proportion of the improvement may have been due to a placebo effect or have resulted from the natural course of depressive illness, which tends to subside with sufficient time. However, the patients had previously demonstrated severe and prolonged depression that resisted treatment. Prior to the study, they had all suffered continuously with depression for at least a year and had not responded to at least four trials of antidepressant therapy.

DBS has been shown to lead to improvement in other illnesses of the brain besides depression, including Parkison’s disease, chronic pain and muscle tremor and rigidity. Moreover, electroconvulsive therapy, an electrical treatment of the entire brain that induces a seizure, has also been very effective in treating depression.

This small trial of DBS, as reported in this month’s Archives, suggests considerable promise. But a larger, well-controlled study of DBS will be needed, in order to better assess its efficacy before it is applied more widely.

As people live longer and fewer die of infections, autoimmune illnesses are becoming more common causes of debilitating disease. One of the principal factors in such diseases is type of antibody, a component of a person’s immune system. Normally, antibodies prevent infections and neutralize toxins by binding to and triggering the destruction foreign organisms and substances that enter the body. But in certain cases, for reasons that are unknown, the antibodies get misdirected and instead of neutralizing alien microbes or poisons, they attack a person’s own bodily tissues, giving rise to autoimmune disease.

Rheumatoid arthritis, type I (“juvenile”) diabetes, and lupus (SLE) are among the more common illnesses that may afflict people who have autoantibodies in their blood. Although autoantibodies don’t always result in illness, they often do. Now a survey of blood samples of almost 5000 Americans has shown that about one in seven persons carries such antibodies. The survey was conducted by researchers at the National Institute of Environmental Health Sciences, and the results are the subject of a press release the institute posted on Friday. A preliminary version (pdf) of a publication based on the research has appeared in the journal Arthritis and Rheumatism.

The researchers found that about one in seven Americans (32 million people) have autoantibodies in their blood. Twice as many women as men carry autoantibodies, 17.8% (more than one in six) compared to 9.6% (less than one in ten). The number of people who have them increases with age, from about one in ten in the teens to about one in five over age 70. But surprisingly, people who are overweight or obese have a lower prevalence of autoantibodies. Edward Chen, one of the scientists involved in the research, suggested that perhaps fat cells might secrete a substance that inhibits the immune system.

The fact that more women than men carry autoantibodies is not very surprising, however. It goes along with the fact that more women than men suffer from rheumatoid arthritis, by a ratio of 3:1. Linda Burnbaum, director of the NIEHS and an author of the survey paper, said that the female hormones estrogen and progesterone might play a role in autoimmunity. The survey results showed that the prevalence of autoantibodies in women compared to men rises steadily from childhood through the childbearing years and reaches a maximum between ages 40 and 49, tapering off afterward.

While RA, type I DM and lupus appear to be related to the activity of autoantibodies, there are other types autoimmunity that may not result from misdirected antibodies. Examples of these others include Crohn’s disease and ulcerative colitis, which affect the intestines and colon; multiple sclerosis, which attacks the nervous system; psoriasis, which mars the skin; and polymyositis and some other forms of muscle disease. These illnesses may perhaps involve the misdirected actions of the white cells of the immune system, which normally seek out and destroy microbial invaders and cancerous cells.

Several scientific articles in recent weeks have provided evidence that animals have minds that work somewhat like those of us humans. In November, Scientific American published a story about ravens gesturing with their beaks to other ravens, in order to point to items of interest. Late last month, a piece in ScienceDaily described chimpanzees in the wild calling alarm to other chimps at the appearance of a snake. The article said that the chimps were more likely to sound the alarm, if the other individuals in the group were unaware of the snake. Thus, it suggested that the animals possess a concept of mind, with which they assessed the information that their companions possessed.

Earlier this month, the NYT ran a story about the rising number of “Animal Studies” courses at colleges. The study programs focus on the connections and continuities between animals and humans, in all aspects including that of mind. The article contains this paragraph about Jacques Derrida, a French writer on the subject:

In “The Animal That Therefore I Am,” for example, [Derrida] discusses at length not only what he thinks of his cat, but what his cat thinks of him. In a fairly simple sentence — and thought — for him, he writes about his cat: “An animal looks at me. What should I think of this sentence?”

What he might think, I think, is that the cat has a mind similar his own. In fact, it was precisely this issue that got me interested in writing about consciousness. Around the turn of the millennium, the NYT hosted a discussion thread on its website called “Explaining Consciousness” — the paper called it a “forum” rather than a thread. As a participant, I engaged in a long-running debate with another contributor, Paul, over the question of whether his dog named Lucy was conscious and had a mind. The debate had started off with just such an encounter as Derrida described between Paul and his dog looking at each other. I contended that Lucy was conscious, but Paul insisted that she was not.

The question of consciousness in animals points inevitably to the question of when and how consciousness arises. At what point in the agglomeration and arrangement of matter does consciousness appear, and how does this happen? Are there degrees of consciousness? How complex does an animal (or plant, for that matter) have to be to be conscious?

In other words, when and how does the “light switch” of consciousness flip on?

There is evidence, I think, that there is no such moment and no such switch. Consciousness exists in a continuum of varying degree; it is not an all or nothing thing. We see this in brain-traumatized patients as they move in and out of coma. There have been many reports of patients in minimally conscious states (pdf), who appear comatose to observers but continue to experience some level of awareness. Asleep, while dreaming, we may also experience a diminished degree of consciousness, and on awakening, we may experience consciousness gradually returning.

Thinking repeatedly over the years about consciousness, it has become my view, that there is no clear line separating it from inert matter. The question is better formulated as, “How are consciousness and matter connected?” The connection is difficult to understand because consciousness is an immaterial thing, while matter is … well … material. They are two very different sorts of things entirely.

That ostensibly comatose patients and lower animals have consciousness to some degree suggests that consciousness may in some way be a fundamental to all forms of matter. This conclusion gradually but ineluctably grew in mind during the several years of discussion in the Explaining Consciousness forum.

In the end, I came upon notion that the relationship of consciousness and matter is the same as that of wave function and particle in quantum mechanics. In this space, it’s not possible to explain all my reasons for deciding this. One of the most important reasons, however, is that a wave function, like consciousness, is an immaterial thing, and a particle, of course, is a unit of matter. Moreover, QM describes how the two are connected. Quantum mechanics has that fundamental status in physics that would seem necessary for a theory capable of explaining such a relationship.

Important insights into the nature of multiple sclerosis emerged last month, at about the same time that a new, possibly more effective treatment of the disease may soon be forthcoming. A neurological condition, MS usually begins in young adulthood and follows a relapsing or progressive course, causing weakness, paralysis and abnormal or diminished sensations. It has long been thought to result from the destruction of the myelin sheaths that surround and insulate nerve fibers, which ensues when the body’s immune system erroneously attacks its own nerves.

Researchers at the Mayo and Cleveland Clinics, publishing in the New England Journal of Medicine, examined 138 brain biopsies from MS patients, which were done mainly to rule out brain tumors. Microscopic examination of the biopsy specimens revealed the presence of white cells — T-lymphocytes and macrophages — which confirmed that MS is an inflammatory disorder.

According to an article on the research in ScienceDaily, the scientists found that the specimens from recent-onset cases of MS were “highly inflammatory,” and in 20% of them, the inflammation occurred entirely within the cortex. That suggested that MS may begin in the brain’s outer layer and progress inward, advancing in the direction opposite to that previously thought to occur.

Reported almost the same day in the journal Neurology, researchers at University of London provided new insight into the relationship of MS and the Epstein-Barr Virus, a common pathogen, which occasionally causes mononucleosis in young adults. The scientists discovered that even though EBV may not be actively spreading in the brain, the virus may nonetheless release small RNA molecules, which stimulate the body’s immune system and cause inflammation and MS.

Meanwhile, a promising new treatment has emerged in the form of a drug that destroys T-lymphocytes. A large study of alemtuzumab, a monoclonal antibody in the late stage of drug development, appears to demonstrate dramatic reduction in the relapse rate of the relapsing form of MS. Of patients treated with the antibody, 78% remained relapse-free for two years. The drug latches onto a protein, designated CD52, which is found in the outer membranes of the lymphocytes, causing their disintegration. An earlier and smaller trial of alemtuzumab suggested that the drug might even reverse some of the neuronal deficits that result from MS, but the more recent study has thus far failed to confirm this.

Other monoclonal antibodies that attack T-lymphocytes have also proved efficacious for treating MS. But in some cases, these treatments have triggered progressive multifocal leukoencephalopathy, an acute brain inflammation that may often cause death. It remains to be seen to what extent alemtuzumab treatment avoids this adverse effect.