Medical implications of this years Nobel Prize (telomere end maintenance)

This years Nobel Prize in Physiology and Medicine was awarded for findings that revealed the crucial role telomeres play in maintenance of linear chromosomes. A recent review in NEJM covers the medical implications of these discoveries. It always gets tricky when alteration of a single molecular mechanism underlies a wide range of pathological conditions but we already seem to have some critical knowledge. The review covers some examples of telomere associated diseases, namely Bone Marrow Failure, Dyskeratosis Congenita, Acquired Aplastic Anemia, Pulmonary Fibrosis and a sometimes associated Liver Diesease. All of these show mutations in genes responsible for certain functions in telomere end maintenance like DKC1 which codes for the telomerase complex stabilizing protein dyskerin, TERC coding for the telomerase RNA component or TERT the telomerase reverse transcriptase itself.

Again there is the major drawback that we have no idea how to make use of this knowledge. We know that telomere end maintenance affects ageing, induces tumors and plays an important role in the above mentioned diseases, yet we do not fully understand why and how we can interfere. Yet.

The Mystery of Swine Flu

Since the Leading Edge Forum published last summer in Cell some time has passed. Back then it was considered obvious that the number of severe illnesses or deaths linked to this specific virus strain did not necessarily lead to the assumption H1N1 could be worlds next pandemic. 6 months later not much has changed. A constant hiss of imminent danger accompanies most news broadcasts covering swine flu and people are waiting in lines to get vaccinated. Fact is, H1N1 viruses are circulating constantly in human population since the ‘70s and are a component of standard annual influenza vaccines. No molecular markers of pathogenicity have been discovered in the current flavor (H1N1 swine influenza) yet. One might even add that most of the deaths resulting from infection with Spanish flu in 1918 were caused by secondary bacterial pneumonia, a complication we would be able to tackle, considering we live in the era of antibiotics and antiviral medication.

Are we missing a quality indicator for physicians wellness?

A recent review in Lancet reminds us that a working health-care system is directly linked to the well-being of its practitioners. What might seem rather intuitive on first glance reveals a rather unpleasant truth. Most health-care systems couldn’t care less about physicians wellness. The review covers in detail the risks associated with fatigued, overworked or stressed physicians trying to cope with superhuman workloads. The persistence of this problem is widely known (and not exclusive to American health-care) and if we are unable to improve this conditions, we should at least keep an eye on the consequences. A first step could be the mentioned “quality of work competence survey” and linking the physicians own perception of well-being with observed efficiency and risk of medical errors. Since we are aware of the potential consequences of unwell physicians I agree that health-care systems could benefit from actually paying attention to it.