TIME EUROPE
January 15, 2000, Vol. 157 No. 2
The Hunt for Cures
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To get a better idea of what could be in store, it helps to know what physicians believe lies at the root of most heart attacks. The trouble begins decades earlier, when the inside of a coronary artery becomes damaged — usually as a result of chronic high blood pressure, high cholesterol or the deleterious effects of smoking. The body tries to repair the damage, and a kind of internal scab is formed. Years go by, and the scab develops into a fatty deposit, filled with cholesterol, proteins and bits of cellular detritus. Sometimes the plaque is quite stable, and nothing much happens. Other times, for reasons that are still unclear, it becomes inflamed and prone to rupture. If the plaque breaks open, a clot forms, choking off the supply of blood. If the interruption lasts long enough, a heart attack ensues.
Doctors have already shown that drugs called statins, which curb the body's ability to manufacture excess cholesterol, can significantly reduce the risk of suffering a heart attack. But statins don't work for everyone. So drug companies are studying the biochemical pathways by which the body pulls cholesterol that has already been manufactured out of a cell. "By turning this reverse cholesterol transport on, you'd be able to stimulate removal of cholesterol from vessel walls back to the liver for excretion," says Dr. Richard Gregg, vice president of metabolic- and cardiovascular-drug discovery at Bristol-Myers Squibb. Taken in combination with statins, such drugs could virtually sweep the arteries clean of cholesterol.
Researchers are also searching for new drugs to dampen the inflammation process. The goal of such treatments is not so much to remove a fatty plaque from inside an artery but rather to convert it from a more dangerous form to a more stable one. This may be one of the reasons a daily dose of aspirin, which is both an anti-inflammatory and a blood thinner, can help prevent heart attacks. But doctors would like to have a drug that targets coronary inflammation more specifically and aggressively than aspirin.
There's more to heart disease, of course, than heart attacks. More and more Americans are developing a condition called congestive heart failure, in which the cardiac muscle becomes weakened and can no longer pump blood efficiently. Investigators are currently studying a group of specialized hormones that are released whenever the heart muscle falters. Some of these hormones help restore the heart's vigor while others, paradoxically, make the muscle stiffer and more difficult to contract. The goal is to figure out a way to boost the levels of the beneficial hormones while lowering those that make the weakened heart's job more difficult.
Drugs are bound to play a major role in any new advances based on genetic or tissue engineering as well. For example, doctors hope one day to repair the muscle damage that occurs during heart attacks by transplanting precursor cells called stem cells into the affected areas. However, the stem-cell implants can take hold only if the levels of a number of different enzymes and molecules are boosted — a task that pharmaceuticals are particularly well suited to fill.
Of course, there would be much less need for new medications to treat heart disease if we all exercised more, watched our weight and stopped eating so much food that is high in saturated fat. Public-health experts estimate that you can reduce your risk of heart disease as much as 80% by adopting a healthy lifestyle. But as long as our culture and our genes conspire to clog our arteries and strain our hearts, it's good to know that there will be some powerful drugs to help undo the damage.
Parkinson's Disease
Lubricating Gummed-Up Brains
By JEFFREY KLUGER
It's hard to imagine asking a doctor to destroy a part of your brain. For the more than 1 million Americans suffering from Parkinson's disease, however, such a drastic measure — in which an electrode is used to kill tremor-causing neurons — may become necessary.
The irreversible procedure is just one of many therapies, both surgical and pharmacological, that Parkinson's patients have tried over the years to control the tremors, rigidity and other symptoms that characterize the disease. All the treatments offer some relief, but none can remotely be called a cure. Now that may be changing. The further scientists peer into the human genome, the more they are uncovering the secrets of Parkinson's — and the more they are becoming convinced that next-generation drugs may at last be able to beat back the disease. What's more, the benefits may not be limited to Parkinson's but may also be used to treat Huntington's, Lou Gehrig's and even Alzheimer's disease — all of which have similar neurodegenerative roots and may respond to similar drugs. Says neurobiologist Michael Zigmond of the University of Pittsburgh: "A breakthrough in any of these diseases could have an impact on the others."
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COVER STORY
Special Report: The Future of Medicine
With the mapping of the human genome the process by which new drugs are developed is being turned upside down. These drugs will also change our lives
Brave New Pharmacy
Using high-speed robots and the secrets of the human genome, scientists are changing forever the way they discover new medicine
The Hunt for Cures
Genetic information could lead to treatments for everything from AIDS to obesity
EUROPE
Prague Winter
When Jiri Hodac was named director of state television, Czech journalists saw a return to government meddling in the media
See Vous in Court
France is the latest nation to join the litigation game
Going up in Smoke
Switzerland, land of luxury watches and bank secrecy, has a new growth industry: marijuana
UNITED STATES
The True Blue Bush Cabinet
Its ethnic and gender balance is correct, but can a divided nation deal with the superconservative bent?
BUSINESS
Transparency has its Price
Executives at many German companies are finding it hard to adjust to the more rigorous financial disclosure required by global investors
On Spreading the Word
When it comes to selling merchandise, word-of-mouth marketing may be a company's best weapon
Essay: Meat Matters
Critics of industrialized farming may be forgetting about world hunger, writes TIME's Rod Usher
THE ARTS
Rebel with a Cause
The real-lifestory of an anti-Mafia activist in Sicily makes for a handsome film with a political message
The Upmarketeer's Tale
Bernard Arnault built his house by selling at deluxe prices and in his book he's still giving nothing away
The Art of Noise
For Europe's freely improvised music, the only rule is no rule
DEPARTMENTS
Techwatch
World Watch
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