An Australian railway man saved more than 2 million babies—including his own grandchild—with a simple donation of blood

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James Harrison. Photo by: Australian Red Cross

An Australian man who required blood transfusions to survive surgery as a teenager decided to repay the kindness of strangers by becoming a blood donor himself. Little did he know at the time that his blood contained a rare antibody required for a life-saving medication. By the time he retired from donating this month, James Harrison had saved an amazing estimate of 2.4 million babies!

James Harrison came to blood donation from personal experience. When he was 14 years old, he underwent major lung surgery that took hours and required a vast quantity of transfusions—13 units of blood, in fact. He remained hospitalized for three months. So he decided to pay it forward as soon as he could. In Australia, blood donors must be a minimum of 18 years old; so in 1954, when he turned 18, Harrison gave his first units of blood. Despite a fear of needles, he returned to donate every few weeks for a remarkable 60 years.

But the Good Samaritan’s good deed turned out to be more beneficial than he ever could have imagined. In the 1960s, researchers discovered that Harrison’s blood contained a rare antibody used in a medication called Anti-D that helps save babies from a potentially fatal disease. The Australian Red Cross reports that Harrison’s blood has been used in more than 3 million doses of Anti-D since 1967, and that he has helped save the lives of 2.4 million babies, including that of his grandchildren. His daughter, Tracey Mellowship, received the injection and had two healthy babies. The Red Cross called him “the man with the golden arm.”

The Anti-D injections are given to pregnant Rh(D) negative women carrying Rh(D) positive babies, whose blood-type incompatibility can result in miscarriage, brain damage, or even stillbirth, according to the Australian Red Cross. Around 17 percent of Australian women need the injections, which come only from blood plasma from a “tiny pool” of around 160 donors who have the rare antibody that Harrison has. Attempts to make a synthetic version of the medication have so far failed.

Harrison had been donating for a decade when researchers discovered his blood was perfect for their new Anti-D program.

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On May 11, Harrison, now 81 and retired from his job as a railway administrator, lay back and had his arm strapped and swabbed as he got ready to give his last donation. As always, he looked away from the needle, and gripped a stress ball in his other hand. Medical officials with the Red Cross said it was time for Harrison to retire and save his blood for his own health. He received the Medal of the Order of Australia in 1999 for his service to the Anti-D program. He also made it into the Guinness Book of World Records in 2003.

Harrison’s last donation at the Town Hall Blood Donor Center in Sydney was videotaped and shown on the local TV news. (Harrison, ever the proper railway man, wore a tie to the occasion.) Helium balloons above his head had the numbers 1, 1, 7, and 3 to represent the 1,173 times he had donated blood. A half-dozen moms who had benefited from the Anti-D injection program showed up, their babies in their arms, to commemorate the unassuming hero.

“The end of an era,” Harrison, who lives in New South Wales, told the New York Times. “It was sad because I felt like I could keep going.”

Harrison was proud of having helped though not unduly vain about his accomplishment. He hopes the publicity surrounding his retirement will inspire other blood donors to come forward; perhaps one will also carry the rare antibody.  “Saving one baby is good,” Harrison told the New York Times. “Saving two million is hard to get your head around, but if they claim that’s what it is, I’m glad to have done it.”

 E.L. Hamilton

Darwinian medicine

Darwinian medicine, field of study that applies the principles of evolutionary biology to problems in medicine and public healthEvolutionary medicine is a nearly synonymous but less-specific designation. Both Darwinian medicine and evolutionary medicine use evolutionary biology to better understand, prevent, and treat human disease. These goals are very different from concerns about the human species pursued under the rubric medical Darwinism in the late 19th and early 20th centuries.

Darwinian medicine, which is named for English naturalist Charles Darwin, whose theory of evolution by natural selectionbecame the foundation of modern evolutionary studies, is not a method of practice or a specialized area of research. Like embryology, evolution provides a basic science foundation for all research and clinical practice. Some applications are very practical, such as using evolutionary modeling to understand antibiotic resistance or the reasons why disease-causing genespersist. Other applications are more fundamental. For example, an evolutionary foundation deepens scientists’ understanding of what disease is, and it explains why the metaphor of the body as a designed machine is inadequate.

Evolutionary applications in medicine are diverse, ranging from established methods such as population genetics to newer attempts to understand why the body has traits, such as the narrow birth canal in females, that leave it vulnerable to disease. Evolutionary explanations can be based on the phylogeny (evolutionary history) of the trait or on its proposed adaptive significance. They can address five kinds of traits acted on by evolution (human traits, human genes, pathogen traits, pathogen genes, and cell lines). The intersection of these two kinds of explanations with five objects of explanation defines 10 areas of work in the field.

Established Applications

Much of Darwinian medicine consists of well-established applications of evolution to medicine. For instance, population genetics is intrinsically based on evolutionary biology, phylogenetic methods have long been useful in medicine, and antibiotic resistance is recognized as an example of natural selection. New methods and data have expanded these applications. In genetics, for example, methods have been developed to identify chromosome locations subjected to strong recent selection, such as locations near the lactase gene that influence whether adults can digest milk. Modern phylogenetic methods use genetic data for diverse tasks, from tracing the specific source of an infection to tracing the genetic heritage of an individual. Informal evolutionary thinking about antibiotic resistance has been replaced by rigorous mathematical models that have major implicationsfor public health.

Developing Applications

Other applications of evolutionary biology to medicine are still developing. In particular, studies to test hypotheses about why natural selection has left the human body vulnerable to disease expanded after 1991, when an article titled “The Dawn of Darwinian medicine,” published in The Quarterly Review of Biology and written by American evolutionary biologist George Williams and physician Randolph Nesse, argued that evolutionary explanations are needed to explain not only why bodies usually work well but also why they have aspects that leave them vulnerable to disease. The major evolutionary reasons that explain why bodies remain vulnerable to disease can be organized into six categories. Mismatches between the environments that humans evolved in and that they now occupy account for the prevalence of substance abuse, obesityhigh blood pressureatherosclerosis, and breast cancer. A second reason for vulnerability is the speed with which infectious organisms evolve ways to deal with antibiotics and the protective defenses of the human body. This process of coevolution results not in benign coexistence but in levels of virulence (ability to damage tissues) shaped to maximize the rate of pathogen spread. Virulence often depends on the route of transmission. For instance, respiratory viruses severe enough to keep victims in bed are likely to be displaced by less-severe strains whose victims are mobile enough to infect others. In contrast, malaria parasites spread faster when they make the host too sick to defend against mosquitoes; thus, malaria tends to be quite virulent.

Vulnerability results also from constraints. For example, the eyes of vertebrates are poorly designed, with a blind spot, and nerves and vessels run between the point where light enters the eye and the retina. The octopus eye, by contrast, has no blind spot. Another constraint is the inevitability of DNAreplication errors. Bodies are also subject to engineering constraints and trade-offs. Bones could be thicker, but bodies would then be heavier and slower. Darwinian medicine emphasizes that nothing in the body can be perfect, since every trait is subject to constraints and trade-offs.

Selection shapes bodies for maximum reproduction rather than health. Usually optimal health and reproduction coincide, but mutations that increase reproduction tend to spread, even if they decrease health and longevity. Higher male than female mortality rates in polygynous species (species that have more than one mate) are an example. In such species an incremental investment in bodily protection and repair increases reproductive fitness more for females than for males.

Additionally, many symptoms are not diseases but protective responses shaped by natural selection. Painfever, cough, and anxiety are aversive and useful responses. Nonetheless, medications can often safely block their expression, because of the “smoke-detector principle.” Humans put up with sensitive smoke detectors set off by making toast because such false alarms are a minor nuisance compared with the huge cost of not being alerted to a fire. Likewise, the cost of many bodily defenses is low compared with the cost of not expressing a defense when it is needed, so the normal mechanisms shaped by natural selection give rise to many false alarms and apparently excessive responses.

Practical Implications

Darwinian medicine has narrowed the gap between evolutionary biology and medicine and contributed to improvements in the understanding of health and disease. Some advances have been straightforward, such as new public health policies based on formal evolutionary models of antibiotic resistance and evolutionarily informed searches for genes that cause disease. Other advances have come from asking new evolutionary questions about why natural selection has left bodies vulnerable to disease. Applications of these advances are less direct, but they may be more fundamental. They encourage new studies of phenomena with enormous clinical importance, such as why males die younger than females and how selection shapes mechanisms that regulate protective responses such as pain and fever. They offer a more fully biological view of the body and disease

Written by Randolph M. Nesse

How Radioactive Isotopes are Used in Medicine

Symbol radiation on grass background
© Lebedev Alexey/Dreamstime.com

Radioactive isotopes, or radioisotopes, are species of chemical elements that are produced through the natural decay of atoms. Exposure to radiation generally is considered harmful to the human body, but radioisotopes are highly valuable in medicine, particularly in the diagnosis and treatment of disease.

Nuclear medicine uses radioactive isotopes in a variety of ways. One of the more common uses is as a tracer in which a radioisotope, such as technetium-99m, is taken orally or is injected or is inhaled into the body. The radioisotope then circulates through the body or is taken up only by certain tissues. Its distribution can be tracked according to the radiation it gives off. The emitted radiation can be captured by various imaging techniques, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET), depending on the radioisotope used. Through such imaging, physicians are able to examine blood flow to specific organs and assess organ function or bone growth. Radioisotopes typically have short half-lives and typically decay before their emitted radioactivity can cause damage to the patient’s body.

Therapeutic applications of radioisotopes typically are intended to destroy the targeted cells. This approach forms the basis of radiotherapy, which is commonly used to treat cancer and other conditions involving abnormal tissue growth, such as hyperthyroidism. In radiation therapy for cancer, the patient’s tumor is bombarded with ionizing radiation, typically in the form of beams of subatomic particles, such as protons, neutrons, or alpha or beta particles, which directly disrupt the atomic or molecular structure of the targeted tissue. Ionizing radiation introduces breaks in the double-stranded DNA molecule, causing the cancer cells to die and thereby preventing their replication. While radiotherapy is associated with unpleasant side effects, it generally is effective in slowing cancer progression or, in some cases, even prompting the regression of malignant disease.

The use of radioisotopes in the fields of nuclear medicine and radiotherapy has advanced significantly since the discovery of artificial radioisotopes in the first decades of the 1900s. Artificial radioisotopes are produced from stable elements that are bombarded with neutrons. Following that discovery, researchers began to investigate potential medical applications of artificial radioisotopes, work that laid the foundation for nuclear medicine. Today diagnostic and therapeutic procedures using radioactive isotopes are routine.

WRITTEN BY:  Kara Rogers
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