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Prognosis Positive


7 It's a Cinch to Lose Weight
With America getting fatter by the minute, it's no surprise that obesity-related surgeries are now among the fastest-growing in the country; more than 40,000 were performed last year. Most decrease the amount of food that can be digested or absorbed by removing part of the stomach or small intestine. Carnie Wilson became the poster child for this type of surgery after she lost 150 pounds. A new variation, now being tested in New York, promises a safer, less dramatic alternative.

Mount Sinai is leading a nationwide clinical trial to evaluate the effectiveness and safety of a new device called a laparoscopic band, or lap band in industry parlance. The idea: Instead of surgically dividing the stomach, doctors insert a small silicone band, like a tiny belt, by means of laparoscopic surgery (through small incisions in the abdomen, about an inch across), and cinch it around a portion of the stomach to limit the amount of food that can pass through. While not quite as dramatically effective as other methods, the lap band is believed to be safer, with less recovery time and easier reversibility than other versions of this surgery.

Dr. Michel Gagner, chief of laparoscopic surgery for the Mount Sinai School of Medicine, says lap-band surgery is already approved and wildly popular in Europe, and that patients typically lose between 25 and 30 percent of their total weight within a year. Once formal approval has been given in the United States (which could happen within months), Gagner expects the lap band to quickly become a popular choice for patients who are uncomfortable with the complexity and severity of a traditional gastric bypass.

8 The Next Generation of HIV Drugs
Since 1996, the protease-inhibitor cocktail has extended the life spans of millions of people infected with HIV. But that was simply one step, admittedly a huge one, in the battle against AIDS. Soon, David Ho and his team at the Aaron Diamond AIDS Research Center at Rockefeller University, who were at the forefront with protease-inhibitors, hope to begin human clinical trials of a drug, made by New Jersey-based Schering-Plough, that is the first of a new class of drugs designed to fight HIV.

These new drugs are known as entry inhibitors, and they do pretty much what the name suggests. Unlike protease inhibitors, which stem the growth of the virus after it is already inside the cell, entry inhibitors are designed to prevent the virus from getting in the door in the first place.

Here's how they work: Certain cells in the body have two docking points where a virus can attach itself and then enter. One of these docking points, or co-receptors, is called CCR5. The idea behind the new drugs is that if you can block the CCR5 docking point, the virus can't get in. Entry inhibitors won't replace protease inhibitors as a treatment option; rather, they'll open a new line of attack. Ho is cautiously optimistic. "Our excitement is reminiscent of the excitement we had when, in 1994, we first put these protease inhibitors into patients," he says. "And they obviously have had a tremendous impact."

In addition to studying the entry inhibitors, Ho and his team are also starting production of two vaccines they have been developing over the past three years. He says that because the need is currently greater in places like Africa (where 26 million people are estimated to be carrying HIV) and the Far East, they will first seek approval from foreign regulatory bodies, which often move faster than the FDA.

The FDA, however, has quickened the pace when it comes to HIV. "In the AIDS field, the drug-development process has been shortened considerably," says Ho. "If you look at protease inhibitors, we first put them into patients in 1994, and they were licensed in early 1996. That's remarkable compared to the usual time line for drug development."

9 A Picture Worth a Thousand Tubes
Imagine a tiny submarine floating through your body, taking pictures and examining your innards for signs of disease. It may sound like a scene from the sci-fi flick Innerspace, but it's actually a reality (minus the miniature Dennis Quaid), and for the moment it's available only in New York.

For people who may have tumors or bleeding in their small intestines, there now exists a tiny camera, complete with a flash and a battery, that can be swallowed like a pill and that snaps more than 50,000 pictures as it winds its way through you. It can uncover a host of problems that standard methods (which are not only incomplete but unpleasant) often miss. In fact, it's already been tested on more than twenty New Yorkers, and if the FDA approves it, you, or someone you know, may very well be swallowing it within a year.

The pill, which is the size of a large vitamin, is equipped with four flashing LEDs, which illuminate in time with the pictures. As each picture is taken (at a rate of about two per second), the images are wirelessly transmitted to a mini hard drive on your belt. The camera passes through you in roughly twelve hours, at which point it is, well, flushed into retirement.

An Israeli company called Given Imaging has been working on the pill for years, and last October, Dr. Blair Lewis of the Mount Sinai School of Medicine launched clinical trials on humans. Those trials are now complete. According to Lewis, the results, which will have been submitted to the FDA for review, were better than expected.

"It is a phenomenal tool," says Lewis, who has been comparing the results of the pill with those of a standard enteroscopy, where a tube with a camera in it is used to examine the twenty feet of a person's small intestine for things like internal bleeding, tumors, and ulcers. "We were very effective in diagnosing causes of bleeding, and there was no diagnosis the enteroscope made that the capsule didn't make. In some ways, some of the data is better than what's available now." That's because the pill runs the length of the entire small intestine, reaching places that an enteroscope can't. In two cases during the trials, tumors were spotted that the standard enteroscopy missed. If the camera pill gains approval later this year, regular enteroscopy may have a run for its money.

Dr. Jeffrey Peters, a professor of surgery at USC and a former president of the Society of American Gastrointestinal Endoscopic Surgeons, thinks the pill, for all it's Buck Rogers pizzazz, has a very real future in the world of endoscopy. "The idea that you could swallow a camera and have it examine your insides has always been out there as a futuristic concept," he says. "But here it is. It's real and it works."

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