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Prognosis Positive


3 The End of Needles As They Know Them
It used to be that when Ted Calamia ate out, there was always a course that preceded the appetizer, one he'd rather have skipped altogether. Calamia, who is 53 and lives in Park Slope, is diabetic, one of about 500,000 in the New York area. Before unfolding his napkin, he would first prick his finger to measure his blood sugar, then pull out an insulin-filled syringe as discreetly as possible and slip the needle through his pants into his thigh. "Believe me," he says, "it's not a fun experience."

So when he saw an ad last year looking for people to try out a new insulin inhaler at St. Luke's-Roosevelt Hospital, he jumped at the chance. The inhaler is being tested by New York-based Pfizer (in partnership with New Jersey-based Aventis), which along with the rest of the industry has been searching for an alternative to the needle for almost 75 years. According to Pfizer's Dr. Michael Berelowitz, scientists have unsuccessfully tried everything from nasal sprays to skin patches. Berelowitz says Pfizer hopes to submit results from clinical trials to the FDA later this year, which means the product could gain approval and become available as early as next year.

Gone untreated, diabetes can lead to blindness, kidney disease, loss of limbs, and even cardiovascular disease in some patients. And fully half of Americans who have the disease don't even know it. Dr. Gerald Bernstein, who is an endocrinologist at Beth Israel Medical Center and a past president of the American Diabetes Association, thinks there will be a huge psychological advantage to this method of delivery, noting that some people refuse to use needles at all: "If taking the insulin is a simple thing to do, people will be more apt to control their blood sugar and therefore eliminate the complications."

Dr. Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia-Presbyterian Medical Center, is overseeing one of the trials. While she cautions that the device may not work for all diabetics, depending on the specific type of insulin needed (only the short-acting kind is available for now), she says the early indications are that the inhaler will be a welcome addition to the current arsenal. "Both in our experience and from what I've read, it looks very successful," says Goland.

After using the inhaler for seven months, Calamia is down to only one shot a day and feels more comfortable in public. "It's a lot easier for me to socialize," he says.

4 An Off-the-Wall Solution
One of the reasons coronary heart disease is the leading killer of Americans is that its primary manifestations -- heart attacks and strokes -- usually arrive without warning. Many people die within minutes or hours of heart attacks if not treated immediately. But what if you could see them coming?

Dr. Valentin Fuster, who runs the cardiac program for Mount Sinai, and Dr. Zahi Fayad have been working on a new procedure called the Black Blood MRI, which they expect will do just that, and which may eventually be as routine as a mammogram for people who are predisposed to heart disease. "This is the first time that you can go noninvasively and look at the coronary artery," says Fuster. "Four years ago, no one could even dream this would happen."

With traditional diagnostic tools such as angiograms, where dye is injected into the body and a catheter is inserted through the groin area and moved up near the heart, doctors can use an X-ray to spot clogged arteries. But a more serious potential problem -- plaque build-up on the walls of the coronary, carotid, and aorta arteries -- has been hidden from doctors' eyes until now.

Basically, it's a twist on an existing MRI technology that allows doctors to change the look of the blood on the image from white to black, thus allowing the walls of the artery to stand out as a white circle when viewed as a cross-section, making the wall alone visible for the first time (previously, the blood and arteries all appeared as one solid white image).

So what's the big deal? Doctors can now identify places on the artery walls where plaque is building up in little patches (the plaque, which is basically a soft fatty deposit, shows up as a lump on the inner wall of the artery), even if the arteries aren't "clogged" in the traditional sense. Eventually these hard-to-spot plaque deposits soften and become susceptible to rupture. A rupture can trigger a blood clot that can block an artery and the oxygen that flows through it.

"They're really on the cutting edge," says Dr. Richard Lee, a Harvard Medical School research scientist who recently published a study about the dangers of fatty plaque deposits on arterial walls. "What they're doing is absolutely crucial."

Dr. Fayad, the 33-year-old who has been refining the technology, says that the hospital is now applying the technology to an average of two patients a day, so far with remarkable success. And once patients have been diagnosed, they can begin drug therapy to reduce the deposits and thus lower the chance of heart attack or stroke. Fayad expects that within a year or two, the technology will be widely available.

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