Another day, another miracle

February 1, 2006

In case you have been so busy with your practice and other obligations that you missed it, two medical miracles (my opinion) have recently been reported. Each is only partially relevant to the practice of ophthalmology, but it seems to me that these are worth awareness.

Eradicating malaria

Malaria is a terrible burden in Africa and parts of Asia. There were a half billion cases of the deadliest form of malaria in 2003, and each year this parasitic disease kills about one million people (mostly African children). I have never personally seen a patient with malaria-induced eye disease, but it occurs.

In the study, malaria infections and deaths plunged 96%, the disease was nearly eliminated from an area as large as Indiana, and poor clinics and hospitals saved enormous amounts of money from not having to treat malaria patients.

I understand that DDT has its downside (its former widespread use in this country almost caused extinction of the bald eagle), but to me this development qualifies as a medical miracle. It gives me hope that the people of Africa, freed from this scourge, might dramatically improve their standard of living and quality of life.

Medical Miracle number two is Gardasil, a vaccine developed by Merck against two types of human papillomavirus (HPV). This virus is sexually transmitted and oncogenic, responsible for some 70% of cervical cancers worldwide. There are reportedly 500,000 new cases of cervical cancer diagnosed each year, leading to 290,000 deaths. HPV also appears to be responsible for at least some cases of squamous cell carcinoma of the conjunctiva and limbus, something I see not infrequently as a corneal surgeon.

In a study of 12,000 sexually active women in the United States and 12 other countries, Merck reported that the vaccine was 100% effective in preventing cancers and precancerous growths caused by the two types of HPV. According to Al Sommer, an ophthalmologist and former dean of the Bloomberg School of Public Health at Johns Hopkins, results like this mean there may come a day when routine pap smears will no longer be necessary. According to most women with whom I have discussed this, dispensing with pap smears would be a welcome advance.

Although the consequences of infection with malaria or HPV are not high on the radar screens of most ophthalmologists, these recent advances should be of interest to us all, and might even cause us to feel proud of biomedical science.

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 North Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu

References

1. http:// http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020368.

2. Beare NA, et al. Prognostic significance and course of retinopathy in children with severe malaria. Arch Ophthalmol 2004;122:1141-1147.

3. McDonnell JM, et al. DNA of human papillomavirus type 16 in dysplastic and malignant lesions of the conjunctiva and cornea. N Engl J Med 1989;320:1442-1446.

4. Vaccine prevents cervical cancer. Baltimore Sun, Friday, October 7, 2005.

5. http://www.nytimes.com/2005/10/07/health/07vaccine.html