This year, in celebration of International Women’s Day, we reached out to some of the female members who are an integral part of our Society (44% of our membership base!) to find out know what motivates,… More
Following on from part one of our three blog posts, we look at some endocrinology-related news stories you may have missed in the months between May and August 2016.
May: 3-D printing life
3-D printing human organs isn’t just exclusive to the TV show Westworld, it’s also new science. In May this year, scientists from Northwestern University in the U.S successfully implanted mice with fully functional 3-D printed ovaries. The results were presented at the Endocrine Society’s annual meeting ENDO 2016 in Boston.
The mice went on to deliver healthy babies, had normal hormonal cycles allowing them to nurse their offspring, and their offspring were able to produce healthy babies of their own.
The researchers used a digital “plan” to make a 3-D printer print the structure layer by layer using gelatin (derived from collagen) as a scaffold. They then implanted human-derived oocytes into the structure. Researchers next hope to test the technique in pigs, before moving onto humans.
“We hope to one day restore fertility and hormone function in women who suffer from the side effects of cancer treatments or who were born with reduced ovarian function,” said lead author Monica M. Laronda.
Media headlines causing a buzz:
Common diabetes drug may raise risk of developing cancer (The Telegraph)
Psoriasis linked to higher risk of obesity and type 2 diabetes (Nature World News)
Scientists successfully made sperm-like cells from human skin cells (The Science Explorer)
Is obesity contagious? (Daily Mail)
On the potential of androgens (Wall Street Journal)
June: Give breast cancer patients letrozole for 10 years
Women with early stage hormone receptor positive breast cancer may benefit from treatment using hormone suppressor letrozole for 10 years, rather than the standard 5. A study presented at the Oncology Society’s annual meeting, and published in the New England Journal of Medicine, shows that women who took the aromatase inhibitor for ten years were 34% less likely to have a return of breast cancer, or occurrence of new breast cancer.
HR positive breast cancer, the most common type, can be fuelled by hormones such as oestrogen and progesterone. Aromatase inhibitors inhibit the enzyme aromatase, preventing the conversion of androgens to oestrogens, and the subsequent fuelling of breast cancer.
“Aromatase inhibitors are now readily available around the world and therefore our results will further improve the outcome of women with breast cancer globally. It will help tens of thousands of women. It will have an enormous impact,” said the lead author Dr Paul Goss.
The drug did not affect overall survival rate, but Goss comments that this is because the drug did not prevent the cases of recurrence outside the breast, which most often causes death.
The drug is known to increase osteoporosis, with 14% of women in the treatment group and 9% in the placebo group suffering fracture.
“It’s really bone versus breast cancer, is what it really comes down to,” said Dr Carey of the University of North Carolina. The treatment may not be for everyone, but could be beneficial for patients who are at high risk of breast cancer recurrence and who are likely to tolerate the side effects of the therapy.
Media headlines causing a buzz:
New rules to regulate Europe’s hormone-disrupting chemicals (The Guardian)
Bone hormone boosts exercise (Nature)
July: Vitamin D supplements advised for everyone
The lack of sun in the UK is a downer, but it also has real effects on our health. In May, Public Health England advised that everyone aged one and over needs 10 micrograms of vitamin D every day in order to maintain healthy muscles and bones.
One in five people in the UK have low levels of vitamin D, which in children can lead to rickets, and in adults can lead to bone weakness and pain, and is also linked to other health problems.
In winter we don’t get enough vitamin D from the sun, and it is difficult to get enough from natural food sources such as oily fish and red meat. The recommendations came from the Scientific Advisory Committee on Nutrition (SACN) following an intensive review.
“SACN was right to say that we can’t rely on sunshine in the UK to meet the vitamin D requirements. That’s a major and important change. It’s a big step forward that this is now officially recognised,” said Adrian Martineau from Barts and the London School of Medicine.
Media headlines causing a buzz:
Male hormone reverses cell aging in clinical trial (Science Daily)
Cravings for high-calorie foods may be switched off by new food supplement (Imperial College London)
August: Caster Semenya in the Rio Olympics
The world’s media attention turned once again to Olympian Caster Semenya, who this August won Gold at the women’s 800m race in Rio. In 2009, the 18 year old athlete was greatly scrutinised after she improved her personal best by 7 seconds in 9 months. She was subject to gender testing and barred, ensuing scientific and ethical debate.
In 2011 the IAAD created a policy requiring women with especially high testosterone levels take hormone supressing drugs in an effort to control their testosterone levels under the threshold of 10nmol/L. The ruling was suspended for two years due to lack of evidence of the real benefits of high natural testosterone on performance.
Semenya’s performance has once again revived the debate on hyperandrogenism, gender and what constitutes fair play at the Olympics.
The BBC recently summarised the case the following way:
“But there is a catch-22 which may haunt her all the same: if Semenya runs as well as she can, destroying the field, mangling that old record, it could end her career as it stands at the same time.
For what greater indication of unfair advantage could there be, when the IAAF is trying to buttress its case, than a victory unlike anything history has ever seen before?”
Media headlines causing a buzz:
Mystery of the female orgasm may be solved (The Guardian)
Sleep ‘resets’ brain connections crucial for memory and learning, study reveals (Nature Communications)
2016 will go down as a landmark year in history. Amongst endless grant applications, journal submissions, clinics, lab work, teaching and everything else, you would be forgiven for not having enough time to read the news. But as the year winds down and you have a little more time to yourself, check out our top picks of endocrine news stories in 2016. In part one of three blog posts, we look at the period between January and April.
January: Man flu
Flu season has well and truly begun, and along with it, man-flu season.
It’s a common belief that colds hit men harder than women. Whether men simply exaggerate their suffering or actually experience worse symptoms is a subject of much debate. In February, research from the John Hopkins Bloomberg School of Public Health in Baltimore revealed that the dreaded ‘manfluenza’ may not just be a product of our imagination. The culprit? Oestrogen – or, rather, men’s lack of it.
The study, published in the American Journal of Physiology – Lung Cellular and Molecular Physiology
revealed that woman may be protected from the worst of the flu by the female sex hormone oestrogen. Oestrogen dramatically slowed the replication of the influenza virus in nasal cells from women, but not men.
The biology is uncertain, but researchers believe it could be linked to oestrogen receptor Beta, which affects more than 30 genes involved in cell metabolism, slowing down viral replication. These receptors are sparsely present in male cells and may explain why oestrogen offered no protection in men’s nasal cells.
“If women are taking oestrogen-like hormones for other reasons, an added benefit might be less susceptibility to influenza during the flu season,” Klein says.
Media headlines causing a buzz this month:
New guidelines for treatment of severe primary adrenal insufficiency symptoms (Endocrine Society)
February: To gel or not to gel
For decades, men have been using testosterone gel with the hope it will improve their libido, energize and rejuvenate them. Some enthusiasts even label is the elixir of life. But so far there is very little data on the short term effects of testosterone supplementation on men’s health, and no long term data. Whether the decline in wellbeing is causally linked to low testosterone is unclear.
In February, the issue became clearer when a study revealed that testosterone has very modest effects on sexual function in older men who have very low testosterone. The landmark study, published in the New England Journal of Medicine, is the largest randomised trial on testosterone replacement so far.
The men in the study reported “improved their sexual function, mood and depressive symptoms, and perhaps walking,” according to lead author Peter Snyder, an endocrinologist from the University Of Pennsylvania Perelman School Of Medicine.
The study did look at a specific group of men, all aged over 65, and all with particularly low testosterone (<9.5nmol/L).
“The findings don’t apply to younger men, or men with borderline low testosterone,” said Society for Endocrinology member Professor Frederick Wu.
So while we can’t say testosterone supplementation will make men feel young again, it might help in a small subgroup of older men who have low testosterone.
Media headlines causing a buzz this month:
A step closer to understanding fertilization (EurekAlert)
March: Winter babies
Maternal vitamin D is particularly important for babies born in winter, according to a study published in The Lancet Diabetes & Endocrinology.
We know from observational studies that mothers who have higher levels of vitamin D during pregnancy tend to have babies with higher bone mass. Until now, there have been no randomised placebo controlled trial to see if supplementing pregnant women with vitamin D can actually improve bone mass in their babies.
In this study more than a thousand women between 14 and 17 weeks pregnant either took a placebo, or vitamin D for the remainder of their pregnancy. When the researchers looked at the group as whole, they found no effect of maternal vitamin D supplementation on babies bone mass compared to placebo. However, amongst babies born in winter, maternal vitamin D supplementation did improve bone mass.
“Babies’ bones strengthen during the last stages of pregnancy. Since sunlight is our most important source of vitamin D, mothers’ levels of vitamin D tend to drop from summer to winter,” said Professor Nicholas Harvey from the University of Southampton.
“The trial has given us the first evidence that supplementing mothers with vitamin D during pregnancy counteracts the seasonal drop in maternal vitamin D levels and may help to ensure good bone development in these winter births,” he added.
Media headlines causing a buzz this month:
April: “If it’s not a cancer, let’s not call it a cancer”
In one of the biggest endocrine stories 0f the year, a type of thyroid tumour is no longer classified as a cancer. As it turns out, certain types of tumours are encapsulated in impenetrable tissue and should not be classified as cancer. The tumour, known as encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), makes up 10-20% of all thyroid cancers diagnosed in Europe and North America.
Previously, people diagnosed with the non-threatening condition would have their entire thyroid removed, undergo treatment with radioactive iodine, and have regular check-ups for the rest of their lives. EFVPTC involves small abnormal lesions in the thyroid gland which look like cancer, but are completely contained by a fibrous capsule and unable to spread.
A group of 24 pathologists, two endocrinologists, a thyroid surgeon and a psychiatrist reviewed a hundred cases of patients with EFVPTC, who had the capsules removed but no further treatment. After 10 years, all patients with encapsulated tumours were cancer free.
The move means thousands of patients world-wide will be spared the diagnosis of cancer, avoiding excessive treatments and the psychological trauma of cancer diagnosis.
The new name for the lesion is NIFTP or “Nift-P” which stands for non-invasive follicular thyroid neoplasm with papillary-like nuclear features”. Pretty Nifty.
Media headlines causing a buzz this month:
New hormone regulates glucose (Nature)
Pancreatic cell transplantation: a breakthrough for type 1 diabetes? (Medical News Today)
Hormone Therapy for Prostate Cancer Tied to Depression (NYTimes Blog)
The Journal of Molecular Endocrinology is the only Society-owned basic science journal dedicated to looking at hormones at the cellular and molecular level. In a series of blog posts, we look back at some of the most cutting-edge research published by our members in our journals. This first piece was written by Douglas Gibson (@douglasagibson), a postdoctoral research at University of Edinburgh.
Remember that members can now publish in JOE, JME and ERC free of charge!
We often think of hormones as ‘male’ or ‘female’ because of how they shape the features we associate with each sex. So androgens – the ‘male’ hormones – might make you think of ‘manly’ things like body hair, muscles and deep voices, but what if I told you that they play an important role in women becoming pregnant too?
It’s difficult to separate androgens from their macho reputation, particularly when examples of androgen excess in women, such as in athletic doping, also produce masculinizing effects. Despite this, androgens have long been known to be important in controlling many processes in female physiology. Indeed, androgens can be detected at significant concentrations in the blood of women and in some cases may even exceed those of men! However, although androgens are abundant in the blood they are usually only activated in specific tissues when they are needed. In this clever way they don’t have widespread and uncontrolled effects.
One surprising place where androgens were recently found to be activated is inside the womb. Every month, the structure of the womb lining – known as the endometrium – is reorganised to create an environment that can support and sustain pregnancy. However, without the right hormonal signals, the endometrium will not provide the conditions required for a fertilised egg to implant.
Recent studies have found that hormones produced inside the womb play a pivotal role in the early stages of pregnancy. It was previously thought this vital role was carried out solely by hormone signals from the ovary but new research has found that ‘male’ hormones (androgens) help to prepare the womb lining to encourage a successful pregnancy.
In our study, we wanted to understand how the signals inside the womb lining affected the early stages of pregnancy. In fact, we found that androgens can act in two key ways; by acting as a direct signal in the womb but also by being converted into ‘female’ hormones (estrogens) in the early stages of pregnancy. We found that estrogens within the womb signal to cells that control blood vessel development which is essential for promoting exchange of nutrients between mother and baby.
So amazingly, androgens seem to provide a delicate balance to control key changes in the womb in pregnancy. However as fewer of these key hormones are produced as women age, this could partly explain why some older women find it difficult to conceive. Our research is now focussing on how changes in the availability of androgens can affect the way the womb lining prepares for pregnancy. We hope to be able to apply this new understanding to improve fertility treatments which in the future may mean that older women seeking motherhood may have a better chance of successfully conceiving.
Earlier this year, the Endocrine Society and the Endocrine Society of Australia published a paper titled ‘Career advancement: Meeting the challenges confronting the next generation of endocrinologists and endocrine scientists‘. Endocrinologists are facing challenges in reduced funding, competing responsibilities and gender issues. Giving us the personal side of the story, Australian prostate cancer researcher Luke Selth tells us about the ups and downs of life as a young lab head…
“As I sit down to write this, there is a foul odour permeating my cancer research lab. I know what you’re thinking: one of the PhD students has left a Bunsen burner on and I’m on butane high. I wish it was so simple.
No, the stench is a heady mixture of stress and worry. I am expecting the outcomes of two National Health and Medical Research Council (NHMRC) Project Grant applications this week. We also have two research papers currently under review at a prominent journal in the field of cancer biology (seriously, how can it take 62 days to review a paper?).
It feels as though the next week could literally make or break my career. Is this an exaggeration? Well, no, actually. Let me break it down for you…
The grant applications
My lab’s research is focused on identifying the molecular mechanisms underlying prostate cancer progression, and developing new therapeutic strategies for this important disease. Both of my Project Grant applications are in this field and, realistically, there’s every chance neither will be funded.
I’d like to stress that this isn’t because they are bad applications. ‘You’re biased’, I hear you muttering, and I can’t argue with that – of course everyone thinks their own research is the most novel and exciting. However, I have evidence to back this notion up: both have made it through the dreaded ‘Not for further consideration’ cut, which means they were ranked in the top 50% of applications.
So we are through the first hurdle. However, given that last year’s success rate was 13.7%, this means that both grants still only have around a 1 in 4 chance of being funded. Of course, that’s if the success rate doesn’t decrease even further this year – there’s every indication that it will. When I started writing NHRMC grant applications 5 years ago, 22.9% of applications were being funded. This worrying trend, largely due to the lack of real increase in the overall NHMRC budget, has caused a lot of scientists to change professions or leave the country – a “brain drain” that will be difficult to recover from.
The low success rate means the outcomes often feel like a bit of a lottery. All of the applications still in the hunt are strong; it’s extremely difficult for a review panel to choose the best. In a perfect world (or, more accurately, a perfect Australian economy), most of them would be funded. But this isn’t a perfect world, and so some randomness ensues. This process of assessing applications in this type of funding scheme has been studied: Fang and colleagues provided evidence that the peer review process used by the National Institute of Health (USA) does not necessarily fund the best science – and that using a lottery-style system to awards grants would actually yield equivalent, if not better, research outcomes.
In short, a bit of bad luck could see both of my applications – which collectively took around 2 months of full-time work to prepare – down the drain.
The old mantra of “publish or perish” is stronger than ever in Australian science. Consistently publishing in high quality journals is required for grant success, which in turn is required to keep consistently publishing in high quality journals; it’s a feedback loop that sadly consumes much of my attention.
The two papers that are currently under review are both strong bodies of work. But, again, there’s every chance they will be rejected – the current acceptance rate at the journal I have submitted to is around 20-25%.
The possible outcomes
OK, so what happens if my grant applications and research papers are both tossed out like old agar plates? Well, I will have just enough funding to keep my small research group going next year, but virtually nothing for the following year (not even my salary). The stench of worry in my lab will become even more pungent. I’m a passionate guy, and in such a situation I’d like to allow myself the release of smashing a glass beaker or two – but I couldn’t afford the cost of replacements…
Alternatively, there is the possibility that I win the lottery. Sure, there’s been a lot of work done by my group, but in the end I truly believe there is a significant amount of luck involved. If the papers are accepted and grants are funded, suddenly the lab’s future and finances will look flush again. There will be no need to let anyone go, and I can cancel that online barista course I signed up for!
This roller-coaster we call a science career
Of course I’ve simplified things. There is a whole spectrum of possibilities between total failure and total success. But what I’m hoping to convey is the reality of life for a young lab head trying to make his or her way in the world of biomedical research. This job is a bloody roller-coaster, and it seems perverse that I spend up to half of my time applying for money so that I can simply do my job.
I’m often asked by my close friends and family why I stick with it. One response is that I’m not sure any café would want a washed-up scientist as their barista! Seriously though, I love my job for many reasons, the most important being that I have a scientific curiosity that can probably only be sated by this type of research and a vision to improve outcomes for cancer patients. Fortunately, the satisfaction of discovery, coupled with a real chance to improve the health of our society, far outweigh my grant- and paper-related pessimism.
So, even if the grants and papers don’t come through this week, I’m going to persist – and I have many inspirational colleagues and mentors who do the same, year in and year out.
- Fang FC, Bowen A, & Casadevall A (2016) NIH peer review percentile scores are poorly predictive of grant productivity. Elife 5.
Meet your new President…
A new era begins for the Society as Professor Graham Williams takes over as President at SfE BES 2016. Associate Editor of The Endocrinologist, Amir Sam, finds out more about Graham’s background, reflections and aspirations for the Society for Endocrinology. The full interview will be published in the winter issue of The Endocrinologist.
Tell us about your background
I worked as an SHO in Kidderminster and did my general medicine rotation at the Queen Elizabeth and Birmingham General Teaching Hospitals. I then got an MRC Training Fellowship with Michael Sheppard and Jayne Franklyn in Birmingham to work on thyroid hormones. I did a year of my PhD there and then completed it at Harvard Medical School with Reed Larsen and Greg Brent at the Brigham and Women’s Hospital in Boston, where I also did some of my post-doctoral training.
I came back with an MRC Clinician Scientist Fellowship and started as a Lecturer in Birmingham with a completely empty lab and had to start from nothing! About six months before I left Boston, I had a meeting with Reed, who was very happy to support me but said that I shouldn’t work on the same subject that he was working on because it was too small a field and it was important I develop my own independence. He urged me to read the literature and find a new area to pursue.
I had been working on the biochemistry of transcriptional activation by thyroid hormone and retinoid X receptors and wanted to apply the basic science to clinically and physiologically important questions. I decided to find a relevant thyroid hormone responsive target tissue that wasn’t being studied; most people were working on pituitary, heart and liver and other labs were getting into the brain. I spent a lot of time talking to various people and eventually settled on the skeleton, a clearly important target organ that had not been investigated in the context of thyroid hormones in any detail. Having not known anything about bone, I had a blank canvas and started from scratch! In 1995 I was approached by Raj Thakker and James Scott to move to Hammersmith as a senior lecturer.
When did you know you wanted to be an endocrinologist?
When I qualified from medical school I was all set to do surgery, but realised pretty quickly that I did not have the dexterity to be any good. My first house job was in endocrinology at the Queen Elizabeth Hospital in Birmingham with David London. At the time there were some really fascinating cases, and working with him got me enthused and hooked on endocrinology straight away. He was definitely the biggest influence on my career selection.
By the time you finish your term of office as President, you will have held major roles at the Society for Endocrinology for over a decade. How has the Society changed over the time?
The financial aspect of the Society has substantially increased over time. When I took over the treasurer’s role the gift aid to the Society from Bioscientifica was around £100,000 per year, and when I ended my term as treasurer it had grown to about £1 million per annum. The Society has grown incredibly in terms of its diversity; it is reaching out further to different countries and continents in a way that was never possible and is now a very professional and superbly run organisation.
How do you see the Society developing over the next few years?
We have a much greater role in education and the development of opportunities for young endocrinologists. I don’t think my plans for the future will be to fix anything in particular because I think the Society is functioning extremely well. We need to develop it further along these roles for the benefit of the next generation. We have to support our younger scientists and clinicians, retain them and hopefully attract more people to the discipline with the ultimate aim of benefiting our patients and endocrine science. We also need to strengthen our international collaborations, both scientifically and clinically.
Petros Perros is a Consultant Endocrinologist at Newcastle Hospitals, and Honorary Senior Lecturer at Newcastle University. He is the Project Lead for the PRAGMA Study, a Society for Endocrinology research project which compares the incidence of dysthyroidism in post-radioiodine patients treated with difference management strategies.
Petros will be presenting the PRAGMA study’s latest findings next week in Brighton, which is hosting this year’s SfE BES conference. Ahead of the event, we asked him to write about the project and why it’s such an important Society project.
For more information, be sure to check out Petros’ talk at 16.45 on Tuesday 8 November in Syndicate One. Our Scientific Programme has more details.
Grave’s Disease, an autoimmune condition, is the most common cause of hyperthyroidism. Radioiodine (RI) is an effective, safe and cheap treatment for hyperthyroidism, though it results in most patients with RI-treated Graves’ disease requiring life-long thyroid hormone replacement.
Ideally the transition from hyperthyroidism to a stable thyroid status (through thyroid hormone replacement) should be rapid and smooth. However, in practice fluctuations in thyroid status in the first year after RI are not uncommon.
In an attempt to achieve and maintain euthyroidism (in which the thyroid gland is functioning normally) after RI, endocrinologists employ different strategies. These will eventually include the introduction of levothyroxine, a synthetic thyroid hormone chemically identical to thyroxine. The two most typical treatment strategies are:
- The use of anti-thyroid drugs for a period of time after RI. These are used either alone or in combination with levothyroxine – with levothyroxine is known as the “block and replace” strategy
- Watchful monitoring and introduction of levothyroxine when required
This variation in management in response to fluctuations in thyroid status following RI was the inspiration for the PRAGMA Study. We set out to determine the extent of thyroid instability after RI, and to explore whether different strategies of management are associated with different degrees of thyroid instability.
The study was funded by the Clinical Endocrinology Trust and was included in the NIHR portfolio.
What has been achieved so far?
Thirty-four hospitals in the UK have recruited 812 patients over 2 years. One of the most striking findings was that a very large proportion of patients – 67.2% – had at least one episode of hypothyroidism within the first year after RI, and 36% had an episode of hyperthyroidism. Patients treated with the “block and replace” regimen after RI were least likely to experience hypothyroidism and gain weight, though hypothyroidism was still experienced in 26% of cases.
We continue to collect data in the management of this condition. Additional interventions need to be identified and implemented to improve outcomes for patients with Graves’ disease treated with RI, and this study provides us with great possibility.
The level of engagement of colleagues with the PRAGMA Study proves that large scale studies addressing common, simple, clinically relevant questions can be conducted with ease and minimal cost. It is a great asset to the field of clinical endocrinology research.
At 18.30 on Monday 7 November Professor Jeremy Tomlinson is chairing a debate on the treatment of adrenal insufficiency at SfE BES 2016. Ahead of the debate, we asked Professors Stafford Lightman and Karim Meeran to give you a little taste of their stance on this hot topic in endocrinology.
Professor Jeremy Tomlinson, University of Oxford – Chair
The optimal strategy for glucocorticoid replacement in patients with adrenal insufficiency remains a contentious issue. In the majority of cases, hydrocortisone is used, but there are issues relating to the need for three times a day administration alongside the high costs of treatment. Are there alternatives?
Prednisolone is significantly cheaper, has a longer duration of action and therefore can be administered twice daily. However, it is a synthetic glucocorticoid that does not act in an identical way to hydrocortisone.
Head-to-head comparisons with meaningful clinical end points are lacking, and in the modern NHS, treatment costs play an increasingly important role.
Let the debate begin!
Professor Stafford Lightman, University of Bristol – AGAINST
The evolution of Homo sapiens from early mammals has taken about 200,000,000 years. During this time we have developed many highly specialised physiological systems –including the key homeostatic system we call the Hypothalamo-Pituitary-Adrenal axis. This system maintains key cognitive, metabolic and immunological systems in optimal state and is also a rapid response system to protect us against stress. The hormone that has evolved to do this is cortisol.
In the absence of endogenous cortisol no-one would disagree that the gold standard therapeutic hormone replacement should be the closest we can get to normal physiology, so if we have to go second-best and provide a different steroid or pattern of plasma steroids it is incumbent on us to prove that this alternative treatment is as good as the best possible therapy available with the native compound.
Prednisolone differs from cortisol in many ways. Not only does it have different characteristics of glucocorticoid mediated gene transcription with no simple dose response comparison to cortisol, but its plasma half-life and metabolism are also unphysiological.
During the debate, I shall demonstrate why these aspects of prednisolone replacement are potentially disadvantageous at cognitive, metabolic and immunological levels. I will explain why I feel it would be dangerous to submit patients to such long duration therapy unless appropriate long term studies are able to show non-inferiority of this regime.
Professor Karim Meeran, Imperial College London – For
Patients with endocrine deficiency need replacement therapy.
We are getting better at making new analogues of replacement hormones that are more patient friendly and improve compliance by lasting longer. Thus for insulin, we have moved away from normal human insulin to analogues of insulin that have variable half-lives, but are a totally different molecule. There is no evidence that the new analogues are any better than native insulin, but production of some preparations of native human insulins have ceased and many of us use these new insulin analogues. Vasopressin is replaced with a modified molecule, 1-desamino-8-D-arginine vasopressin; the D-enantiomer is used (which never occurs in nature) because it lasts longer. The argument in some quarters that “natural” cortisol would be better thus has no basis.
Similarly, rather than give hydrocortisone several times a day, we need to modify the molecule slightly by inserting a double bond, which increases its half-life and potency, and enables once daily administration. A slow release preparation has been developed and costs £400 per month, but it is far better to use a drug that has an appropriate half-life.
We don’t need to develop one because, remarkably, prednisolone has a half-life that is perfect for a once-daily administration. It happens to be extremely cheap, but that should not deter us from using it!
We now have an assay available for prednisolone, and present data at a number of posters at the BES in November confirming that a once-daily dose of prednisolone 3mg is equivalent to hydrocortisone 10mg plus 5mg plus 5mg. I have converted several patients, who regularly report how well they feel on prednisolone 3mg, and how much easier it is to take.
The main reason that patients should take once-daily prednisolone is its convenience. Added benefits for those in the UK are the low price of prednisolone compared to hydrocortisone, which is substantially more expensive in the UK than in other countries because of a peculiar licensing issue, and the fact that the NHS is not allowed to import it.
We have a serious problem in the UK with the cost of hydrocortisone, and every patient who is switched to prednisolone will save over £100 per month.
On the 5th of September 2016, news broke of a study which showed that taking Vitamin D supplements in addition to asthma medication cuts the risk of severe asthma attacks and the number of people needing steroid treatment. BBC World News contacted the Society for Endocrinology for expert comment on the story – here Honorary Associate Professor at the University of Warwick Rosemary Bland describes what she learned from the experience and leaves her top tips for dealing with the media.
My Tuesday started off pretty normally. It was around 10.30 in the morning and I had just returned from B&Q with a car full of compost and wood when my mobile rang. It was the press office at the Society for Endocrinology, wanting to know if I could do an interview for the BBC.
“Phone or radio?” I asked.
“Live TV,” they responded.
My instant reaction was to try and get out of it, thinking about my appearance as I was decorating the house. I gave some names for other experts in the field but I‘d barely had time to consider my lucky escape when a BBC producer rang. I guess they couldn’t contact my scapegoat!
It was exactly 10.41AM and I was asked if I could make it down to the London studio for 12.15PM. This is where the speedy nature of journalism and my first lesson really sunk in – what would be a stressful, logistical nightmare for most is just a regular request from the BBC.
London was out of the question. Luckily, Coventry has a BBC studio and a taxi was booked to pick me up at 11.45. The producer asked me a few questions to give the interviewer some background on the subject and she asked who I was and what I did so they could introduce me. Easy enough? Actually I found it difficult to decide.
I know a lot about vitamin D, but what did I know about this asthma study? Not much more than I’d seen on breakfast TV that morning. After a quick Google, I found all 71 pages of it. Here was the second lesson: you will not have time to do any homework in detail.
After absorbing what I could, I began to think about how the only thing I had to sort out now was myself (no hair and makeup in regional studios). However, remember the quote from Alien “in space, no one can hear you scream” well when on BBC World News ‘no one in the UK can see you’, so that was strangely comforting.
The third lesson was on how to dress. The microphone clips on, but the wires go inside your clothes. A blouse was easy; a dress would have been more difficult. In regional studios the camera only grabs your head and shoulders, so shoes don’t matter, but the white blouse was too pale (I’m wearing a coloured top next time). The cameraman kept in touch with London, but it’s weird not being able to see the interviewer. Try not to glance at yourself on the adjacent TV – it doesn’t help.
The next thing I knew, Philippa Thomas in London was introducing me to the hundreds of millions of viewers watching BBC World News around the world.
Like a politician might do, I had thought of three main points I wanted to get across, so I found myself answering her questions that way. Is that a good idea? I don’t know, but it gave me something to focus on and I found that helpful. Here is one of the most important lessons – think about what you want to say, don’t rely on the interviewer’s questions. This is especially important for public health messages where caution needs to be urged. Just try and remember that you are the expert. As it was World News, I also had to remember not to be UK specific – so not ‘the NHS’, but ‘health services’.
Whether it was the producer (get a phone number for your BBC contact just in case and text them afterwards to ask for the clip), Coventry staff, or the VERY calm man in London who talked into my ear, everyone at the BBC was efficient and helpful. Remember that they do this every day, and so if they have forgotten the little things that might be worrying you; just ask.
When I rang the press office to tell them I was doing it they asked if I was excited. At the time it didn’t feel like it, but after it was all over I think I was. Would I do it again? Probably, but I hope I get the call when I’m not decorating.
Peer Review Week 2016 is taking place from September 19-26. The global event celebrates the essential role that peer review plays in maintaining scientific quality. The central message is that good peer review is critical to scholarly communications.
This year, the theme is ‘Recognition for Review’, so we have asked some of our members to tell us about how they first got involved in peer review, why it’s important to them, and why is it essential for the continuation of high-quality science and clinical research.
Li Chan is a clinical scientist in paediatric endocrinology at Queen Mary’s University London. She discusses why peer review is important to her – and you.
Remember that peer review isn’t just about the journals and funding bodies; it’s also important to the author and the reviewer. The author receives constructive feedback to ensure that their work is presented in the best way and backed up by necessary experimental data. Reading other reviewers’ comments and alternative views on a given set of data may allow you to consider your work from another point of view – and that could make the difference between published and unpublished.
On the other hand, the reviewer gains career development and insight. The reviews you write for others will only aid your own future submissions. Over the years I have learnt an immense amount from both writing reviews and receiving them – and I believe this understanding of both sides of the process is necessary for it to work really effectively.
But how did I get into peer review? During my PhD years, my supervisor would ask me if I wanted to review a submission. I always said yes – working with my supervisor at the start was a useful way of learning the process as I could discuss my final report with someone more experienced. Gradually, I developed my own style and expertise.
If you are a young researcher wanting to get into peer review, I would recommend you speak to senior members of staff. They will only view your enthusiasm with positivity. And don’t think for a moment you’re underqualified; science is such a broad subject – we need reviewers with expertise in all areas, and that includes yours!
Karen Chapman is the Society General Secretary, as well as a member of the Editorial Board for the Journal of Endocrinology and Journal of Molecular Endocrinology. She discusses the importance of peer review in career development.
Publications are the main criterion we are judged on – and I believe the quality of our outputs is dependent upon a thorough review process. With this in mind, I believe we all must do our part to get involved in peer review. We depend on others to review our own papers, and so we all need to reciprocate.
After over 30 years as a research scientist (and not far off 30 years as an Editorial Board member of one sort or another), I have plenty of experience of peer review – from both sides. Yes, it is tough to read the rejection letters and to have your research critically appraised by someone whose identity you can only guess at, but most of the time the reviewers have a fair point, and often their comments substantially improve a manuscript.
Many of us (me included) get into peer review by appraising a manuscript passed to us by a co-worker or lab head. My first one took me forever. I think I read all the references! However, I soon learned to speed up, and concentrate on the data and how they are interpreted. This process also taught me what to look for in my own research and how to evaluate my data through a reviewer’s eyes. I believe reviews work best when a writer suggests a mechanistic experiment that can really nail the conclusions presented. It does happen; and this could be the sign of a great reviewer!
You stand to gain an awful lot from getting involved with peer review, but if you still aren’t convinced, remember that reviewing is also beneficial for keeping up with what is new. It’s a great way to stay ahead of the game!
We’ll be on Twitter all week showing our support for the campaign using the official hashtag #RecognizeReview – and we’d love to hear your experiences of peer review! Also, check out some of our online talks for even more advice on getting into the peer review game:
You can also sign up for free webinars and talks through the Peer Review Week 2016 official website.
Did you know that the thyroid gland, which regulates metabolism, “is often an area out of balance, and that [yoga] poses that stimulate the gland, such as shoulder stands, can help redress this”? Or that testosterone is the new botox? Neither did consultant endocrinologist Professor Maralyn Druce. Having had enough of the extraordinary claims echoed in the tabloids, she pens an open letter to the public in response.
Dear reader of newspapers, magazines and websites
Like you I am often interested in the latest developments in health and beauty; the many new things on the horizon that promise me happiness, youth or energy. Recently I have noticed a trend in the press for thinking about our hormones – our endocrine systems – as a route to improving our health and wellbeing.
I am a clinical endocrinologist, a doctor for people with health problems relating to the malfunctioning of hormone glands, and I can tell you that the many hormonal systems in the body are fascinating and complex. The complexity arises because these systems control and support functions for many different body functions, and they must be able to produce the correct amounts of the right hormones in response to the internal and external environment.
When you read some of these articles’ claims, you might be forgiven for thinking that your hormone glands are very fragile and that all sorts of measures need to be taken to ‘boost’ the production of certain hormones and support the limited supply of others. This is not true. Your thyroid gland in your neck produces thyroxine to control your metabolism, and it does so in response to another hormone called TSH. It does not need extra ‘boosting’ by complex poses in specially designed and costly yoga classes.
While yoga in general may be very positive for your health, mood, wellbeing or flexibility, there is no evidence that stretching the thyroid gland will change the amount of hormone it makes. Nor indeed is there any evidence, even if this were the case, that the proposed hormone boost would benefit you. Likewise, I’ve seen a lot of myths in the press concerning adrenal glands, which sit at the top of the kidneys and produce the hormone cortisol in response to both emotional and physical stress – helping the body to adjust and cope. Contrary to what you may read, your adrenal glands are not delicate bowls containing a small amount of precious cortisol that might run out. Different types of exercise will not cause your adrenal glands to ‘fatigue’ and run out of hormones – the adrenal glands are factories that make just the right amount of hormone to meet your body’s needs. There is also no evidence that you will benefit from special and often expensive supplements that are marketed to ‘support’ your hormones or your glands – a sensible diet and a healthy lifestyle are the only things that you need to do this, unless you have a specific illness that requires treatment.
We are also told that growth hormone is important for stronger bones and muscle growth, but there is no evidence that doing particular types of exercise to ‘boost’ levels has special benefits on bone strength or fitness over and above any other kind of fitness regime. In fact people with excessive levels of growth hormone actually suffer from a condition called acromegaly, which leads to a number of negative health effects. More is not always better.
For men who are healthy, the sex hormone testosterone varies across the day. Regular sleep results in regular cycles of hormonal change – and you don’t need special sleep products or sleep apps to help this happen, just some insight into how to live healthily.
If you are a woman trying to decide whether or not to use hormone replacement, for example when you reach the menopause, you should be able to weigh up the possible benefits against measured risks. Should you decide to opt for hormone replacement, this always needs to be discussed with your doctor. As yet there is no evidence that so-called ‘bioidentical’ or ‘natural’ hormone replacements are better for you, despite claims made to the contrary where potential profits are at stake. You should be very careful when you consider taking hormones that have not been properly safety-tested in clinical trials and whose long term side effects have not been measured or monitored. The risks are totally unknown.
Your hormones are doing a great job supporting the functions of your body, responding to your environment and coping with the effects of what is going on around and inside you. Our glands have been doing this for millennia. As yet there has been no evidence that the purchase of extra and expensive support systems – be they yoga poses, supplements or other interventions – will truly boost your hormone health.
Got an axe to grind with sensationalism about hormones in the media? Get in touch with your Society for Endocrinology press office and find out how we can support you.