SPOTLIGHTS
Considering Banned Blood Drives
written by ERIKA WILLIAMS
The recent ban on blood drives at San Jose
State University has raised controversy about
issues of both fairness and safety. SJSU
president, Don Kassing, instituted the ban
on January 29th because he decided that
the Food and Drug Administration’s policy
of a lifetime deferral for men who have sex
with men violated SJSU’s non-discrimination
policy.
A Cautious Policy
Men who have had sex with men since
1977 are considered a “risk group” for STDs
(sexually transmitted diseases), especially
HIV, which can be transmitted via blood
transfusion. In California, such men account
for about two out of every three HIV
infections. When the apossibility of infection
through transfusion was discovered in 1983,
the FDA decided that men who have had
same-gender sex would not be allowed to
donate, permanently.
All blood donated is screened for HIV, and
the tests have progressively improved in
accuracy since 1983. There is now only
a 1 in 2 million chance of a positive HIV
donation passing the tests and reaching
the blood supply. This statistic, although a
trivial fraction, still translates to a substantial
number as there are over 20 million blood
transfusions a year, leading the FDA to
maintain its policy.
While the policy seems discriminatory to
some, the FDA regulations are meant to
reduce the possibility of tainted blood
transfusions. As a regulatory agency, the
FDA’s mission is “to protect the safety and
purity of the blood supply,” says Dr. Louis
Katz, M.D., Executive Vice President and
Medical Director at the Mississippi Valley
Regional Blood Center. “This is absolutely
not about discrimination. There are no bad
guys here.”
Katz continues, “[The FDA] did a risk analysis,
and decided that relaxing the policy was an
inappropriate risk.”
The FDA’s regulations about who can donate
blood affect an enormous spectrum of
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people: only 39% of Americans are eligible
to donate at any point. Only a small fraction
of that 39% is willing to donate: 5% of
Americans supply all of our nation’s blood.
Despite these low numbers, the FDA cites
strong justification for banning men who
have sex with other men from donating.
Although the organization recognizes
that it is in no one’s interest to limit blood
donations, it is also crucial to ensure that
such donations are safe.
Calls for Revision
Many groups feel that the FDA’s policy about
men who have had sex with other men is
unnecessarily strict.
Almost all of the false negatives that would
lead to the HIV virus being undetected in
blood are due to a short-term “window”
after a person is infected. That is, HIV
has not yet circulated in a person’s body
long enough to develop the antibodies
necessary to test positive. The window
following person-to-person HIV transmission
presents the greatest danger of subsequent
transmission through a blood transfusion.
The limited duration of the “window” has
caused the Stanford Blood Center, the AABB,
American Blood Centers and the American
Red Cross all to favor a one-year deferral
for men who have had sex with other men,
such as those given to people who have
obtained tattoos or body piercings or have
participated in other behaviors that may
potentially contaminate blood donations.
After this time, these groups believe that
any HIV-positive blood would definitely
be detected, and any concerns about false
negatives would be unnecessary.
In a joint statement, America’s Blood
Centers, the AABB and the American Red
Cross declared: “The current lifetime deferral
for men who have had sex with other men
is medically and scientifically unwarranted
and [we] recommend that deferral criteria be
modified and made comparable with criteria
for other groups at increased risk for sexual
transmission of transfusion-transmitted
infections.”
These blood suppliers also offered their
resources to the FDA for further studies to
determine the consequences of relaxing
the restriction, but the FDA has not yet
responded. Part of the FDA’s unwillingness
to reconsider its policy stems from
controversy over models of HIV transmission
risks. Whereas the models created by
America’s Blood Centers, the AABB and the
American Red Cross predict one tainted
blood transfusion every twenty years, Katz
explains that, “The rate at which HIV is
transmitted is now so low, we all have to use
models based on assumptions. The FDA’s
models are based on different assumptions
than others.” The FDA is unwilling to risk
making looser assumptions when lives are
at risk.
A Costly Protest
The FDA’s lack of action caused President
Don Kassing of San Jose State University
to resort to the measure of banning blood
drives on campus. This ban affects SJSU’s
32,000 students and 6,000 employees.
However, many feel that this new policy only
hurts patients who need donated blood,
and will not have any impact on the FDA.
Katz commented: “Who’s being punished?
Our answer is the patients.”
SJSU’s decision is an attempt to be moral,
but it stops many students and faculty
members from potentially saving lives. High
school and college campuses account for
20% of blood donations and serve as the
starting point of many lifetime donors.
“College campuses are really the bulwark of
our blood collections,” says Katz.
Stanford Blood Center issued a statement in
response to SJSU’s decision. It first reiterated
the Center’s conclusion that the FDA’s
lifetime ban on donations from men who
have sex with men is overly restrictive and
stated that the Stanford Blood Center has
offered to work with SJSU to lobby the FDA
to change that policy. However, the Stanford
Blood Center then declared, “It is not
appropriate to withhold life-saving blood
donations while taking on a national health
SPOTLIGHTS
policy issue. Individuals and institutions that
would like to lobby for change are urged
to do so by contacting the FDA and their
U.S. congressional representatives, not by
jeopardizing their community’s local blood
supply and putting patients’ lives at risk.”
The Stanford Blood Center’s website has
posted an explanation of the deferral
regarding men who have had sex with
Stanford Professor Wins Sophie
Prize
written by ADRIENNE BRYAN
Overpopulation is considered a pressing
problem and a shocking reality in the
world today. From 1980 to 2000, the world
population has grown from around 4.4
billion to 6 billion people, according to the
World Bank website. If the population can
grow by 1.6 billion people in around twenty
years, then what does the future hold in
store in terms of population growth?
Gretchen Daily, a professor of biological
sciences and director of the Tropical
Research Program and the Interdisciplinary
Program on Environment and Resources
at Stanford University, has been studying
environmental issues related to population
growth. Through her research and written
work, Professor Daily has promoted
sustainability and ecological conservation to
many different audiences.
As a result of Daily’s work in ecological
conservationism, she has recently been
awarded the prestigious Sophie Prize. This
award is given annually to one individual
who has “created awareness of alternatives
to modern-day development and/or
initiated such alternatives in a pioneering or
particularly inventive manner.”
Inciting the Passion
Daily’s passion for conservation started
when she was growing up in California.
When she moved to West Germany when
she was twelve, her concern for the
environment increased. She explains, “Acid
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men, as well as a sidebar with this crucial
note: “You can lobby for change without
jeopardizing an adequate blood supply. If
eligible people decide not to donate, or if
deferred people encourage others not to
donate in protest of this policy, the blood
supply may be further jeopardized and
patients may not receive life-saving blood
products.”
rain was a huge issue there, and it was
stunning for me to learn that acid was falling
from the sky, killing the forests and lakes of
Northern Europe that have such powerful
cultural significance.”
Since her childhood, Daily has become
interested in preserving and improving
a variety of ecosystems. These include
“production of goods (seafood, timber); life-
support functions (water purification, flood
control, climate stabilization, pollution);
life-fulfilling conditions (aesthetic beauty,
cultural stimulation); and preservation of
options (genetic diversity for future use).”
Advocating for Action
Professor Daily has worked toward
creating awareness and finding solutions
for overpopulation and its effects on
ecosystems and the environment. She
strives to develop political and economic
support for preserving the environment and
the existing ecosystems.
Daily argues that overpopulation is one of
the main causes of ecosystem disruption,
because humans currently require more
food supplies than the environment
can sustain. She feels that humans can
incorporate protective measures in order to
minimize the damage of their environmental
impact. Such measures would include
“providing access to healthy care and family
planning; opportunities for education and
employment, especially for girls and women;
Katz agrees that the complete ban
on donations was unnecessary and
unwarranted: “I think they were wrong to
do this,” he says. Although SJSU officials
reiterate that the decision is temporary,
many students and other critics feel that
any stoppage of life-saving donations is
counterproductive and unfair to the wrong
group of people.
old-age security; and general improvement
of the status of women.”
Another measure that Daily proposes is to
offer governmental incentives for those who
decide not to cut down trees or otherwise
deplete the environment. These incentives
would work on a case-by-case basis. The
key for promoting these policies would be
to teach citizens and the government to
“see ecosystems as natural capital assets to
bringing human impacts into balance with
what the biosphere can sustain.”
Tangible Success
Professor Daily has written several world-
renowned books and papers, including The
New Economy of Nature: The Quest to make
Conservation Profitable and The Stork and
the Plow: The Equity Answer to the Human
Dilemma.
Daily is also one of the founders of the
Natural Capital Project, which answers the
question “What is nature worth to people?”
She has contributed immensely to the
project’s purpose by serving as the primary
contact between this organization and many
governmental and economical leaders. In
addition, Professor Daily has also served on
committees ranging from the World Bank to
the United Nations.
Professor Daily accepted her most recent
achievement, the granting of the Sophie
award, on June 12 in Oslo, Norway
SPOTLIGHTS
Y2E2: Building for a Sustainable
Future
written by BYRON MILLIGAN
Rapidly depleting oil reserves, receding
groundwater reservoirs, and huge
carbon footprints may make for a grim
looking future indeed, but the new Jerry
Yang and Akiko Yamazaki Environment
and Energy (Y2E2) building serves as a
refreshing reminder that the fight against
environmental devastation is not impossible.
Stanford’s new flagship building for
sustainability embodies innovative features
and smart design to create an atmosphere
cultivating interdisciplinary interaction while
at the same time positively impacting the
environment.
So what is the secret to building such a feat
of sustainability? The answer lies in a well-
executed strategy that creatively addresses
many flaws of modern architecture.
Energy and Water
Conservation
Blending efficiency with comfort and
function with style, Y2E2 uses 56 percent
less energy and 90 percent less potable
water than a standard building of
comparable size and activity would. Within
its thermostatic stone walls are a myriad of
sustainable features that enable the building
to attain such efficiency.
Stanford’s Assistant Director of Project
Management Tom Bauer measures
sustainability in terms of water and energy
usage. Maximizing natural lighting is key in
reducing energy use, and many steps have
been taken to make this possible. From a
very fundamental standpoint, Bauer states
that orientation of the building is “hugely
important and really starts with the master
plan.” Elongating the building along the
East-West axis allows easier control of solar
gain—increase in temperature from solar
radiation—and sunlight, as the longer North
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and South walls can capture sunlight and
use reflective exterior “light shelves” to
bounce light into the building.
Even more integral to bringing light into
the building are the four main atria, giant
rectangular prisms of open space that span
all 89 vertical feet of the building. Bauer
says each atrium can be viewed as “a big
controlled shaft of light bringing natural
sunshine into the core of the building.” But
with Y2E2, nothing serves just one purpose.
The atria are also fundamental components
of the natural ventilation system. Bauer
likens them to “big straws in the middle of
the building that suck up air,” for they create
a “thermal siphon” pulling warm air to the
top of the building and expelling it out of
vents.
This process is only one means of
temperature regulation that the building
employs. Another exciting method is the
use of actuated windows that automatically
open when the temperature-sensitive
controls of the building mandate it. Like
the stomata of a plant, these self-operated
windows capitalize on cooler night time
temperatures (“night-cooling”) to acclimate
the building before people begin their
day. Y2E2 has also implemented one of the
largest applications of chill beams, a form
of air conditioning, in the country. Beams
installed in the ceiling maintain a flow
of chilled water, so that rising warm air is
cooled and falls back to a lower level. Bauer
says “They’ve been used very little in this
country and in very limited applications, but
I think they’re beginning to catch on.”
Energy reductions through these types
of features are only one part of the story.
This paragon of sustainability is extremely
efficient in the realm of water use as well.
Stanford’s central energy facility creates
by-product waste water which, before Y2E2,
ran off through the storm sewer. The design
team, however, surmounted many obstacles
with the county in order to be allowed to
have the building import and treat this
water to be used in restrooms, the principal
area in which water is wasted.
A Template for Future
Buildings
Y2E2 is a testimony to green architecture
and environmental practices, and it proves
that efficiency does not have to come at
the expense of comfort. The minimization
of air conditioning does not lead to
uncomfortable warmth but rather to breezy
corridors. The desire for natural lighting
leads to glass, open space, and a welcoming
environment. As people continue to
adapt and learn to interact better with the
building, its efficiency will increase. But the
work of Y2E2 does not end here. Its role
in encouraging sustainability and green
construction will carry into the future.
Bauer believes “the building serves as a
really important kind of case study and
example for all of the strategies we’ve talked
about,” and states that “one of the goals of
the Y2E2 executive committee was that the
building serve as a model for future campus
construction and beyond.” He asserts that
it already has “a huge impact—the Y2E2
building is a substantial building, it’s an
important building, and it does and will
continue to serve as a motivator for others.
Many other buildings are following in its
footsteps. It’s a really important part of the
story.” And though it may not be the end of
the story, it could be the opening of a new
chapter; a chapter in which, one building
at a time, the future will appear not so grim
after all.
SPOTLIGHTS
From Normal to Cancerous
written by JENNIFER HUANG
Truly defeating cancer, including preventing
its return, will require a thorough
understating of how the disease begins
and propagates. In a study published in the
April 2008 issue of Cell Stem Cell, Dr. Howard
Chang, Assistant Professor of Dermatology
at Stanford’s School of Medicine, and Dr.
David Wong, Instructor of Dermatology and
a post-doctoral scholar in the Chang lab,
shed new light on the process by which
normal stem cells turn cancerous by creating
cancer stem cells. Targeting these stem cells,
which are responsible for the proliferation of
tumors, is a key step towards preventing the
spread of the cancer and maximizing patient
survival.
Gene Module Maps
Like embryonic and adult stem cells, cancer
stem cells are able to differentiate into a
variety of cell types. This suggests that
different families of stem cells may each
be regulated by a common “stemness”
factor, an observation that led researchers
to question whether all stem cells respond
to a single transcription pathway or if
multiple pathways are involved. Previously,
researchers had had little success in isolating
shared stemness genes. However, because
a number of potential candidates had been
identified, the Stanford group set out to
determine the key players in this process.
With the expectation that the proposed
“stemness” factor was present in all stem
cells, the Stanford researchers decided to
utilize a systems-level analysis approach that
could identify common gene expression
patterns in embryonic stem cells (ESC),
adult stem cells, and cancerous stem cells.
Using stem cell expression array profiles
and a large collection of genes, they built a
“gene module map” to catalog expression
programs that are shared among the
different cell types. A “module” is a group
of genes that show concerted expression,
suggesting they interact to regulate a
common process. According to Wong,
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these maps are equivalent to “the genetic
‘fingerprints’ of different types of stem cells.”
The researchers created a genome-wide
gene module map for both humans
and mice and compared the expression
patterns between stem cells from normal
or cancerous tissues. In this manner they
identified several key gene groups involved
in stem cell signaling as well as genes
specifically required for ESC and adult stem
cell signaling.
In support of previous research, no single,
shared factor could be identified in all stem
cell types. However, the group did identify
different modules that appeared to be
crucial for differentiation. These modules
could subsequently be divided into two
distinct groups, one of which was associated
specifically with embryonic stem cells,
while the other was responsible for normal
differentiation and growth. Interestingly,
it is the embryonic stem cell transcription
pathway that is frequently activated in
human cancers and allows tumors to
metastasize.
c-Myc as the Cancer
Stem Cell Trigger?
Based on these findings, researchers in the
Chang lab were able to identify a key stem
cell transcription factor that was able to
reprogram differentiated epithelial cells into
cancer stem cells. Specifically, they found
that activation of the c-Myc gene had the
ability to induce the ESC program, causing
the cancerous transformation. This allowed
the group to first identify and then use other
stem cell transcription factors to stimulate
cancerous growth and proliferation in
previously non-cancerous epithelial cells.
When asked about the goals of this research,
Wong explained that he and his colleagues
“wanted to investigate the consequences of
activation of the ESC-like program by c-Myc
in a human cancer model.” Was c-Myc alone
capable of setting off a signal cascade that
could lead to the formation of cancer stem
cell differentiation? To test this theory, the
group produced a squamous cell carcinoma,
a model of human cancer in the epithelial
cells of mice. They then activated c-Myc in
the cancer cells and injected the cells into
immunodeficient mice to create model
tumors. In these c-Myc activated tumors, the
group found gene signatures characteristic
of both embryonic and cancer stem cells.
From these observations, Wong concludes
that “reactivating the transcriptional
program characteristic of embryonic stem
cells is a key mechanism for converting
a normal cell into a cancer stem cell.”
Moreover, this data supports the hypothesis
that the expression of certain genes may
affect the severity, prognosis, and chance of
metastasis of different cancers.
The Future of Cancer Research
The research in this field is groundbreaking
and has many widespread implications that
could change the way cancer is treated or
diagnosed. According to Wong, “this ability
to experimentally create cancer stem cells
offers a new resource to investigate the
mechanism by which cancer stem cells
arise from normal cells.” Likewise, the ability
to create cancer models in vitro will allow
pharmaceutical companies to test their
therapies in a more diverse sample of cancer
models that nonetheless appropriately
represent real cancers.
Dr. Wong and his colleagues in the Chang
lab are now working towards “further
dissection of the genetic mechanism
that turns a normal cell into a cancer
stem cell.” Looking beyond the arena
of cancer research, he believes further
discoveries could be important “not only for
understanding cancer but also for refining
methods to reprogram somatic cells to
pluripotent stem cells for regenerative
medicine.”