Dark thoughts: why mental illness is on the rise in academia.

University staff battling anxiety, poor work-life balance and isolation aren’t finding the support they need

  • Sad/depressed young woman
Mental health issues among academics in UK universities are on the rise.

Mental health problems are on the rise among UK academics amid the pressures of greater job insecurity, constant demand for results and an increasingly marketised higher education system.

University counselling staff and workplace health experts have seen a steady increase in numbers seeking help for mental health problems over the past decade, with research indicating nearly half of academicsshow symptoms of psychological distress.

“Culture of acceptance”

A recent blog on the Guardian Higher Education Network blog, which highlighted a “culture of acceptance” in universities around mental health issues, has received an unprecedented response, pointing to high levels of distress among academics.

The article, which reported instances of depression, sleep issues, eating disorders, alcoholism, self-harming, and even suicide attempts amongPhD students, has been shared hundreds of thousands of times and elicited comments outlining similar personal experiences from students and academics.

But while anecdotal accounts multiply, mental health issues in academia are little-researched and hard data is thin on the ground.

However, a study published in 2013 by the University and College Union (UCU) used health and safety executive measures, assessed against a large sample of over 14,000 university employees, to reveal growing stress levels among academics prompted by heavy workloads, a long hours culture and conflicting management demands. Academics experience higher stress than those in the wider population, the survey revealed.

Tackling perfectionism

Pat Hunt, head of Nottingham University’s counselling service for staff and students and a member of the UK body for heads of university counselling services, said all universities were experiencing an increase in mental health problems.

“There are increasing levels of anxiety, both generalised and acute, levels of stress, of depression and levels of what I would call perfectionism,” she says.

“By that I mean when someone is aiming for and constantly expecting really high standards, so that even when there is a positive outcome they feel they have fallen short. So instead of internal aspiration helping them to do well it actually hinders them.”

Academics are also caught up in a range of cycles, from league tables and student satisfaction surveys to research league tables, that dominate thinking, she adds. In one case, a department’s top position in a research profile “became a poisonous thing because everyone then fights to maintain that”.

Hunt said higher education should not be stigmatised for the increase in mental health issues, since it reflected a similar increase in wider society. Figures show more working days are now lost to the mental health problems than any other health issue.

Nottingham offers one-to-one and group help to students and staff, including support specifically targeted at men, who make up only a third of those seeking help, a figure likely to reflect the continuing stigma over seeking help for mental illness.

Increased workloads partly to blame

Dr Alan Swann of Imperial College London, chair of the higher education occupational physicians committee, blamed “demands for increased product and productivity” for rising levels of mental health problems among academics.

He says: “They all have to produce results – you are only as good as your research rating or as good as your ability to bring in funding for research.”

Swann says most academics are stressed rather than mentally unwell: “They are thinking about their work and the consequences of not being as good as they should be; they’re having difficulty switching off and feeling guilty if they’re not working seven days a week.”

Academics and researchers can become isolated and not realise how “out of kilter” their working lives are, he says.

The intense pressure of doctoral and post-doctoral study, and early-career academia can also reveal existing mental health problems, he adds. Universities, including Imperial, have improved systems to help, yet academia remains “pretty macho”.

Uncaring academic environment

“There’s still a degree of ‘if you can’t stand the heat, you shouldn’t be here’,” says Swann. He says there are “still people in senior positions in academia who actually don’t care”.

He adds: “But there are measures to counter that and there has been a lot of change for the good. What we have not been able to get rid of are the external pressures from government funding and the academic marketplace.”

Research by Gail Kinman, professor of occupational health psychology at the University of Bedfordshire, on behalf of the UCU, offers one of the few pieces of data on mental health problems among academics.

Kinman used the health and safety executive’s health and safety at work framework to assess the views of some 20,000 academics, and found “considerably higher” levels of psychological distress than in the population as a whole.

She points to poor work-life balance as a key factor, with academics putting in increasing hours as they attempt to respond to high levels of internal and external scrutiny, a fast pace of change and the notion of students as customers – leading to demands such as 24-hour limit for responses to student queries.

Internalised values hard to shake

There are examples of good practice within universities which could be shared across the sector, Kinman says, but, as an independently-minded group who are strongly committed to their work, academics are not always straightforward to support. “We don’t like being told ‘you can’t email at two in the morning’. You can’t impose solutions from other sectors – academics are quite different and there’s no ‘one size fits all’.”

And internalised values are hard to shake. Nadine Muller, lecturer in English literature and cultural history at Liverpool John Moores University, suggests that academia promotes the blurring of lines between the personal and the professional – often described as “doing what you love”.

“This means that doctoral and early-career scholars are seldom trained in how to firmly draw that line and value themselves beyond their work,” says Muller.

UCU says issues relating to mental health are frequently encountered by its representatives. General secretary Sally Hunt says sufferers experience particular prejudice at work. “Further and higher education workers who experience issues relating to mental health face ignorance, discrimination and stigma from their managers and colleagues.

“Negative and inflexible attitudes can often exclude those with mental health conditions from being able to do their job. Often these attitudes can intimidate a person away from feeling able to disclose their mental health condition at all.”

John Hamilton, head of safety, health and wellbeing at Leeds Metropolitan University, says academics’ problems are often a question of burnout, which he defines as a “significant disengagement” with an employer, in which a staff member no longer feels in charge of their role.

Some universities, including his own, are working hard to offer support, he says, but while many could “definitely do more”, there remains a fundamental problem that some academics simply do not like the changes in their sector that have taken place over the last 20 years. “For some, it’s going to be a case of ‘I’m sorry, but this is the way it is, this is the political landscape’. So there’s an element of putting up with it.”

If academics already in post must wrestle with the stresses of fast change, what of their successors? Edward Pinkney, a mental health consultant working in education, says: “Institutions have a broader civic duty to educate potential academics about the university environment, so that prospective academics can make a more informed decision about whether or not to proceed.

“As universities become increasingly businesslike, there’s a growing need for them to be independently monitored to ensure that they are not just meeting basic standards of support for their members, but also that they are providing an accurate representation of academic life and not misselling it.”

Mental health in academia: experiences from around the world

PhD in health sciences at a Canadian university

“At the beginning of my PhD, the director of the department gave our entire cohort a lecture about not getting pregnant and told one of my friends when she applied for maternity leave that the PhD should be a time of celibacy. Some of our supervisors publicly and proudly exchanged stories of failed marriages as if this was the ultimate proof of their devotion to research. Others gossiped about promising colleagues who ‘would have achieved so much more’ had they not had children. All of these subtle and not so subtle hints guaranteed that no graduate student, especially those with families, would ever sacrifice enough for their research and would thus, by implication, always be a failure in some respect.”

Lecturer at the Open University, UK

“I had only been working for the university for two years when I suffered a severe breakdown and was hospitalised. It was very difficult indeed to even contemplate going back to work but thanks to transition counselling from the union I was able to resume work after nine months. The transition counselling was invaluable for a number of reasons; it was linked to work so helped me to begin to think about going back; it carried on during my first few weeks back in the workplace, so it was invaluable in dealing with my feelings at returning to that environment again; and it enabled me to see my mental health problem as being no different to any physical one. One of the hardest things to face after a breakdown is facing the stigma (both real and perceived) that occurs in the workplace. The union gave practical and psychological support, without which I would not have been able to return work.”

University of Maine School of Law, US

During my three years of law school, I had to come to grips with my acceptance of and seeking treatment for depression and PTSD. I’ve been lucky to have had a lot of support from close friends, but I’ve never shared these issues with the faculty. The law school culture is effectively one along the lines of ‘suck it up’. When I worked in the law school clinic, I actually hid and lied to my professor about the fact that I was struggling with suicidal thoughts because I was afraid of simply being booted out of a clinic I loved. While a very large amount of law students I have known have coped with mental health issues and even school-related nervous breakdowns, it’s not talked about, or even admitted beyond close friends.”

PhD in chemistry, Bangor University, Wales

“In 2010 I started a PhD in chemistry. A year on, and the pressure began to build, reaching the point where I had a nervous breakdown. I spent time going to counselling for help, but then decided to take a 10-month break from the research I was doing. Upon returning I was able to work for a few months before falling back into depression because I felt I had no chance of gaining the qualification I desired. I eventually got to the stage where I felt I was going nowhere and cleared my desk late one Saturday, saying nothing to anyone that I was leaving. While suffering from depression, I felt isolated, as everyone around me was able to get on with their PhDs. I felt I was the problem. I feel I received some support for my issues but more could have been done to ease me back into full-time study after returning.”

PhD in molecular biology, Uppsala University, Sweden

“My university and department supported me after I admitted I had been diagnosed with depression. In the beginning I took advantage of studenthälsan, the university’s student health centre. Their team of psychologists and psychiatrists helped me to find the right long-term support. Later, my depression worsened and I was offered a private psychologist at the cost of the department. Yes, my PhD studies are still a demanding job full of stress, mentally as well as physically, but I am glad that in the days where death was the only solution to everything, my colleagues, supervisors and other officials became friends that just wanted to help me.”

International Women’s Day 2014: The shocking statistics that show why it is still so important

  • The earliest Women’s Days were held in the first decade of 20th century. This was before women had the vote, before women could legally terminate a pregnancy. In the UK, it was only ten years since a married woman could legally own her own property, rather than be property herself. Marie Curie was yet to become the first woman to win the Nobel Prize.

More than a century later and it’s tempting to see International Women’s Day as redundant, a celebratory event at best. Why do we need the event at all? The causes that triggered those first campaigns have been fought and won. Women in today’s society have all the equality they could ever need, right? Wrong.

International Women’s Day is still needed to motivate change, at home and abroad. Some of these statistics put into sharp relief just how far we still have to go.


Globally, about one in three women will be beaten or raped during their lifetime. About 44 per cent of all UK women have experienced either physical or sexual violence since they were 15-years-old. Britain ranks among the worst countries in Europe when it comes to women being violently abused.

On average, 30% of women who have been in a relationship report that they have experienced some form of physical or sexual violence by their partner.

38 per cent of all murders of women worldwide are committed by a woman’s intimate partner.

A UN report said 99.3% of women and girls in Egypt had been subjected to sexual harassment.

Female Genital Mutilation

This is where girls have either all or part of their clitoris and inner and outer labia sliced off without anaesthesia, and sometimes have part of their vaginas sewn up too.

Over 130 million women living in the world today have undergoneFemale Genital Mutilation.

There as as many as 24,000 girls are at risk of cutting in the UK.

In one Birmingham hospital as many as 40 to 50 women every month are treated after undergoing female genital mutilation.


Around 14 million girls, some as young as eight years old, will be married in 2014.

An estimated 1.2m children are trafficked into slavery each year; 80 per cent are girls.

In 10 countries around the world women are legally bound to obey their husbands

Only 76 countries have legislation that specifically addresses domestic violence – and just 57 of them include sexual abuse.

Working rights

In the UK, the gender pay gap stands at 15%, with women on average earning £5,000 less a year than their male colleagues. The disparity is even greater in part time jobs, going up to 35 per cent.

Globally only a 24 per cent of senior management roles are now filled by women.

The Equalities and Human Rights Commission estimates it will take 70 years at the current rate of progress to see an equal number of female and male directors of FTSE 100 companies.

This hurts everyone. The gender gap in certain industries is even more apparent and damaging. Zemach Getahun estimates that closing the gender gap in agriculture could reduce the number of hungry people in the world by 12-17 per cent.

If the skills and qualifications of women who are currently out of work in the UK were fully utilised, the UK could deliver economic benefits of £15 to £21 billion pounds per year – more than double the value of all our annual exports to China.

Computer Program Allows the Blind to ‘See’ With Sound.

A  man blind since birth is taking up a surprising new hobby: photography. His newfound passion is thanks to a system that turns images into sequences of sound. The technology not only gives “sight” to the blind, but also challenges the way neurologists think the brain is organized.

In 1992, Dutch engineer Peter Meijer created vOICe, an algorithm that converts simplegrayscale images into musical soundscapes. (The capitalized middle letters sound out “Oh, I see!”). The system scans images from left to right, converting shapes in the image into sound as it sweeps, with higher positions in the image corresponding to higher sound frequencies. For instance, a diagonal line stretching upward from left to right becomes a series of ascending musical notes. While more complicated images, such as a person sitting on a lawn chair, at first seem like garbled noise, with enough training users can learn to “hear” everyday scenes.

In 2007, neuroscientist Amir Amedi and his colleagues at the Hebrew University of Jerusalem began training subjects who were born blind to use vOICe. Despite having no visual reference points, after just 70 hours of training, the individuals went from “hearing” simple dots and lines to “seeing” whole images such as faces and street corners composed of 4500 pixels. (For comparison, Nintendo’s Mario was made up of just 192 pixels in his first video game appearance.) By attaching a head-mounted camera to a computer and headphones, the blind users were even able to navigate around a room by the sound cues alone. Every few steps the system snaps a photo and converts it into sound, giving the users their bearings as they traverse tables and trashcans. One patient even took up photography, using the head-mounted system to frame his snapshots.

The training program also devoted 10 hours to recognizing human silhouettes represented by sound. By the end of the training, participants could detect the exact posture of the person represented by the soundscape and replicate the pose, the team reports online today inCurrent Biology.

When the researchers mapped the brain activity of the participants, they found something astonishing. The generally accepted model of the brain contains regions devoted to each sense, such as the sight-centric visual cortex. Researchers had long believed that if those regions aren’t used for their intended sense, they are repurposed for other uses; for example, the visual cortex of someone blind from birth could be used to help boost her hearing. But Amedi and his colleagues found that the area of the visual cortex responsible for recognizing body shapes in sighted people—called the extrastriate body area—lit up with activity in the study participants when they were interpreting the human silhouettes.

Amedi says the traditional sensory-organized brain model can’t explain this activity; after all, the subjects only heard the information, and scientists believed that the body-recognizing area shouldn’t have fully developed without visual experiences during development. Neuroscientist Ella Striem-Amit of Harvard University, who co-authored the paper, thinks it’s time for a new model. “The brain, it turns out, is a task machine, not a sensory machine,” she says. “You get areas that process body shapes with whatever input you give them—the visual cortex doesn’t just process visual information.”

Ione Fine, a neuroscientist at the University of Washington, Seattle, who studies brain changes and did not work on the project, says Amedi’s work is the best evidence yet for functional constancy—the idea that areas of the brain do the same job even with different kinds of input. “The idea that the organization of blind people’s brains is a direct analog to the organization of sighted people’s brains is an extreme one—it has an elegance you rarely actually see in practice,” she says. “If this hypothesis is true, and this is strong evidence that it is, it means we have a deep insight into the brain.” In an alternative task-oriented brain model, parts of the brain responsible for similar tasks—such as speech, reading, and language—would be closely linked together.

Amedi’s team recently released a successor to vOICe, called EyeMusic, as a free iPhone app. The new algorithm produces more pleasant tones and can even provide color information. In the above video, a man blind since birth uses EyeMusic to “see” drawn faces. Amedi hopes EyeMusic will help blind users gain more independence and improve their quality of life.

This Real-Time HD Video From Space Is Going To Change The World.

This imagery is from the world’s first commercially available, real-time HD video satellite system. Watch it.

The footage, from Skybox Imaging‘s SkySat-1 micro-satellite, is as mesmerizing as the implications are powerful.

In a blog post this week, John Clark of SkyBox wrote:

Businesses can, for the first time, monitor a network of globally distributed assets with full-motion snapshots without needing to deploy an aircraft or field team. The movement captured in these short video windows, up to 90 seconds in length, yields unique insights that improve operational decisions.

Skybox’s vision is to “leverage timely satellite data to provide insight into daily global activity.”

Digital cartographers are figuring out ways to use the new source of geospatial data, but simply being able to watch the world in real-time is profound.

What the insights are, and who benefits from it, has not been seen yet. No one outside the military has ever been able to access data like this. Theoretically, one could follow individual people from space.

Nevertheless, the potential in industries like agriculture, airports, asset monitoring, security, supply chain management, nuclear plants is vast.

The technology is cutting edge. The company asked: “What’s the smallest box I can fit something of real commercial value into?”

The challenge is that space assets are traditionally extremely valuable, extremely expensive, and extremely risky.

So the next technological frontier for quality imaging from space involves systems that can both capture data of high enough quality (resolution) to show economic activity and be cost-effective enough to deploy in large numbers (timeliness).

And Skybox thinks they’ve nailed it:

Screen Shot 2014 03 07 at 11.29.37 AMSkybox is currently taking off as it sells its full-motion video and imagerysystems and build SkyNode ground station in various countries. Welcome to the future.
Read : http://www.skybox.com/news/HD-Video-From-Space

You Could Soon Read An Entire Harry Potter Book In Under 90 Minutes With This App

Soon you could read all 309 pages of “Harry Potter and the Sorcerer’s Stone” in under 77 minutes. Yes, you.

To get through it that quickly (a pace of 1,000 words a minute) you’ll have to use an about-to-be released app and forgo the idea of reading page by page.

With Spritz, which is coming to the Samsung Galaxy S5 and Samsung Gear 2 watch, words appear one at a time in rapid succession. This allows you to read at speeds of between 250 and 1,000 words per minute. The typical college-level reader reads at a pace of between 200 and 400 a minute.

Try reading this at 250 wpm:

Pretty easy, right? Now you can bump up the speed to 350 wpm:

After you have 350 wpm mastered, try 500 wpm below:

Spritz goes all the way up to 1,000 wpm, but there isn’t a visual for that yet.

Spritz isn’t the first to suggest reading one word at a time. Apps like Velocity show the reader one word at a time in quick succession, allowing for much faster reading. And another speed reading method, works almost the same way: Rapid serial visual presentation, or RSVP, has been around for years and has proven to be successful for many.

The one-word-at-a-time technology is particularly good for smaller devices like smartphones and smartwatches. No more scrolling, zooming or pinching.

Boston-based Spritz, which says its been in “Stealth Mode” for nearly three years, is working on licensing its technology to software developers, ebook makers and even wearables.

Here’s a little bit more about how it works: In every word you read, there is an “Optimal Recognition Point” or ORP. This is also called a “fixation point.” The “fixation point” in every word is generally immediately to the left of the middle of a word, explains Kevin Larson, of Microsoft’s Advanced Reading Technologies team. As you read, your eyes hop from fixation point to fixation point, often skipping significantly shorter words.

“After your eyes find the ORP, your brain starts to process the meaning of the word that you’re viewing,” Spritz explains on its website. Spritz indicates the ORP by making it red, and positions each word so that the ORP is at the same point, so your eyes don’t have to move. That’s what makes it different from RSVP speed reading, which just shows you words in rapid succession with no regard to the ORP. Here’s a graphic that shows how Spritz keeps your eyes still while reading:

spritz reading

Study Sets Sights on Substandard Stem Cells.

Reject! Study Sets Sights on Substandard Stem CellsStem cells are produced in commercial quantities, but they fly off production lines without passing through quality control, that mainstay of commercial operations. Stems cells do have to satisfy FDA regulations, but such guidelines address only safety issues—they do not attempt to determine whether stem cells are fit for any particular purpose, such as disease study or drug development.
  • In the absence of quality control standards, commercially sourced stem cells may or may not meet the expectations of drug developers. For example, as substitutes for patients in pharmaceutical screening applications, they may underperform or simply fail altogether.

    Dissatisfied with this state of affairs, a team of scientists at Harvard University’s Wyss Institute for Biologically Inspired Engineering has proposed a stem cell quality index. The scientists were particularly interested in stem cell-derived cardiomyocytes, but it is conceivable that their suggestions could be generalized to other kinds of differentiated cells.

    According to a press release issued by Harvard, the scientists identified a set of 64 crucial parameters from more than 1,000 by which to judge stem cell-derived cardiomyocytes. The result, a “multiparametric quality assessment rubric,” promises to give scientists and pharmaceutical companies the ability to quantitatively judge and compare the value of the countless commercially available lines of stem cells.

    The Harvard team described their recommendations in a paper entitled “Quality Metrics for Stem Cell-Derived Cardiac Myocytes.” In this paper, which appeared March 6 in Stem Cell Reports, the scientists described how they “chose a set of experimental measurements that provide insight into not only the expression profile of the cells, but also the morphological and functional characteristics that are intimately tied to the contractile function of cardiac tissues.”

    By using these experimental measurements and isolated neonatal ventricular myocytes as thier reference phenotype, the scientists developed a quality index that, in their words, “utilizes the magnitude and variance of these measurements to provide a numeric score indicating how closely the stem cell-derived myocytes match the characteristics of the neonatal cardiac myocytes.”

    In addition, the scientists used a combination of gene-expression, morphological, electrophysiological, and contractility measurements.  Doing so, the scientists said, allowed them to pinpoint specific differences in the structural and functional properties of the mESC- and miPSC-engineered tissues versus the neonate tissues. These differences may have important implications for the utility of such tissues in vitro assays.

    The need for quality metrics, confided study leader Kevin Kit Parker, a Harvard Stem Cell Institute(HSTI) principal faculty member, goes back at least as far as 2009, when he and Sean P. Sheehy, a co-author and graduate student in Parker’s lab, visited a number of companies that were commercially producting stem cells. “I’d never seen a dedicated quality control department, never saw a separate effort for quality control,” recalled Parker, who added that many companies seemed to assume that it was sufficient simply to produce beating cardiac cells from stem cells, without asking any deeper questions about their functions and quality.

    “We put out a call to different companies in 2010 asking for cells to start testing,” Parker continued, “some we got were so bad we couldn’t even get a baseline curve on them; we couldn’t even do a calibration on them.” The quality of the human stem cells was so disappointing, Parker’s team resorted to using mouse stem cells to begin its study.

    While limited in their utility, the mouse stem cells allowed Parker’s group to begin setting parameters. “We could tell which cells were better, how they contracted, how they expressed certain genes,” Parker explained. “Using the more than 60 measures Sean developed”—which Parker is calling the Sheehy Index—“we can say ‘these cells are good, and these aren’t as good.” Prior to this, no one’s had a quantitative definition of what a good stem cell is.”

    The importance of the quality index has been discussed by HSCI co-director Doug Melton. The index, said Melton, “provides a standard for the field to move toward reproducible tests for cell function, an important precursor to getting cells into patients or using them for drug screening.” Similar comments were offered by Brock Reeve, HSCI executive director: “The faster we can help develop reliable, reproducible standards against which cells can be tested, the faster drugs can be moved into the clinic and the manufacturing process.”

Scientists discover world’s oldest cheese buried on mummies.

The cheese was discovered buried in China’s Taklamakan DesertBlocks of the cheese were found around the neck and chest of the Beauty of Xiaohe. Researchers believe the cheese may have been buried with the mummies so they could enjoy it in the afterlife.

The Xiaohe tomb complex was first discovered by Swedish archaeologist Folke Bergman in 1934. Full archaeological excavations were finally undertaken between 2002 and 2004 by the Cultural Relics and Archaeology Institute.

The Taklamakan Desert’s hot dry sand and arid land provides excellent conditions for mummification. The burial conditions also may have created a vacuum- like environment that would have helped to preserve the cheese, researchers said.

Researchers from the Max Planck Institute of Molecular Cell Biology and Genetics collected 13 samples of organic matter from ten tombs and mummies, including the Beauty of Xiaohe, in the Small River Cemetery Number 5.

Protein analysis performed in Dresden showed the organic material was a cheese made by robust, easily scalable kefir fermentation. Researcher Andrej Shevchenko told USA Today the team collected evidence to suggest skimmed ruminant milk was combined with bacteria and yeast used to make a kefir cheese.

“We not only identified the product as the earliest-known cheese, but we also have direct evidence of ancient technology,” he said.

“It’s the earliest known dairy practice that persists until present times in an almost unchanged way,” University of Chinese Academy of Sciences archaeologist Yimin Yang told Discovery News.

“The discovery moves the mysterious history of kefir as far as to the second millennium BC, making it the oldest known dairy fermentation method.”

This Glass Sphere Could Revolutionize Solar Power On Earth

German architect André Broessel, of Rawlemon, has looked into his crystal ball and seen the future of renewable energy.

In this case it’s a spherical sun-tracking solar energy-generating globe — essentially a giant glass marble on a robotic steel frame. But this marble is no toy. It concentrates both sunlight and moonlight up to 10,000 times — making its solar harvesting capabilities 35 percent more efficient than conventional dual-axis photovoltaic designs.

This glass sphere might revolutionize solar power on Earth
André Broessel was a finalist in the World Technology Network Award 2013 with the globe’s design and afterward produced this latest version, called Betaray, which can concentrate diffuse light such as that from a cloudy day.

Let me repeat that. This is 35% more efficient than current solar panels and is able to operate on cloudy days. It concentrates light by 10,000 times.

The AIDS Cure.


In 2007, a little-known German doctor applied to speak at a prestigious AIDS conference, claiming to have cured a single case of the disease. He described a 41-year-old man, dubbed the “Berlin patient,” who had had both AIDS and leukemia. The patient received a bone-marrow transplant from an HIV-resistant donor and no longer showed any sign of the virus.

Perhaps the conference organizers didn’t know what to make of the case. They asked the doctor, Gero Huetter, to present the results on a poster instead of in a talk. So he did. The poster ended up hidden toward the back of a room.

“I ran into the poster by mistake. No one was paying attention to it; there was no buzz,” says Stephen Deeks, professor of medicine at the University of California at San Francisco. Deeks was blown away by the poster’s claim and recalls thinking, “Why does no one seem to care about this remarkable case?” He moved on and didn’t discuss it with any of his colleagues.

Weeks later, Jeffrey Laurence, a researcher at Weill Cornell Medical College, stumbled across Huetter’s abstract in the conference program. As the first author of a seminal 1984 paper showing that HIV causes AIDS—a controversial idea at the time—Laurence was all too familiar with the deadening silence that can greet revolutionary discoveries. He wanted to believe Huetter’s claim, and so in his role as a consultant for AmfAR, The Foundation for AIDS Research, he organized a think tank of 12 people in September 2008.

Huetter was there, as were Deeks, Harvard University immunologist Judy Lieberman, and David Margolis, a leading AIDS researcher at the University of North Carolina. After scrutinizing the evidence, this jury of sorts unanimously decided that the Berlin patient, by then identified as Seattle native Timothy Ray Brown, was indeed cured of AIDS.  “It was absolutely a turning point,” says Deeks.

Until then, the best scientists had hoped for was to control HIV infection by impeding the virus’s ability to reproduce. Brown’s case galvanized them into action. There are now dozens of labs investigating how to eliminate HIV from the body entirely. Several companies are developing techniques that mimic the genetic mutation that made Brown’s donor resistant to the virus; a handful are now in clinical trials. Funding agencies have changed course as well. In December, the National Institutes of Health (NIH) announced it would dedicate $100 million over the next three years to accelerate such efforts.

“It’s a huge shift,” says Nobel Laureate David Baltimore, who is spearheading one of the new trials. “There is a real recognition that it’s possible that we can get a cure.”

Even among intractable diseases, AIDS is particularly challenging. It starts with HIV (human immunodeficiency virus), which embeds itself in a victim’s DNA. Once infected, cells cannot get rid of it, as they can most other viruses. What’s more, HIV targets cells in the immune system, converting them from disease fighters into mini factories, which then churn out more copies of the virus. Months or years later, the number of immune cells drops so low that a person becomes susceptible to all sorts of opportunistic infections and develops AIDS (acquired immune deficiency syndrome).

If taken early enough, antiretroviral medication can prevent AIDS by keeping HIV levels in check, and there are more than 30 drugs designed to do that. Brown began taking antiretro-virals when he was diagnosed with HIV in 1995. Ten years later, he developed an unrelated case of acute myelogenous leukemia and deteriorated so rapidly that he soon needed a bone-marrow transplant. Bone marrow is the source of all of the body’s blood and immune cells, so a transplant essentially replaces the old immune system with a new one.

Huetter, Brown’s hematologist, recalled reading about a genetic mutation that prevents HIV from infiltrating cells. Called CCR5-delta32, it’s a mutant form of CCR5, a receptor that HIV needs to gain entry into one of its well-known targets: CD4+ T cells. The mutation occurs naturally in only about 1 percent of people, and Brown was lucky enough to find a matching bone-marrow donor who carried it.

“I was told that if I got his stem cells, it would probably take care of my HIV,” Brown says. “I thought, ‘That would be nice,’ but I didn’t really believe it.”

Before his bone-marrow transplant on February 6, 2007, Brown underwent a punishing regimen of chemotherapy and total-body irradiation to wipe out his immune system. Two weeks later, he left the hospital with someone else’s. “That was the beginning of my new life,” he says.

Huetter’s original treatment plan called for Brown to continue taking antiretroviral drugs after the procedure. But Brown says his partner at the time, a massage therapist, had an “intuition” that the stem cells from the transplant wouldn’t reproduce properly if flooded with the chemicals. The transplant team was likewise reluctant to risk damaging the fragile new cells, says Huetter, and so Brown went drug-free. After the first few months, it slowly became clear that even without the medication, Brown showed no sign of HIV.

Deeks was blown away by the poster’s claim and recalls thinking, “Why does no one seem to care?”

Other cases have since emerged that hold similarly tantalizing promise. Last March, a team of scientists reported that a three-year-old girl born with HIV in Mississippi remains free of the virus months after she stopped aggressive therapy. And French researchers published results showing that 14 people (now 19) who had been treated with antiretrovirals within 10 weeks of being infected have remained healthy for years after going off the drugs—more than 11 years in one instance.

Of these cases, only Brown has had a follow-up long and thorough enough—including brain, gut, colon, and lymph-node biopsies evaluated by multiple labs—to merit the unequivocal label of “cure.” But bone-marrow transplants are hardly an option for the 34 million people infected with HIV worldwide: They’re arduous and highly risky procedures-; up to one third of transplant recipients don’t survive.

The transplants may not even work consistently. In July 2012, doctors announced that two men in Boston seemed HIV-free following bone-marrow transplants like Brown’s. But unlike Brown, the men had remained on antiretroviral therapy after their procedures. When they stopped taking the drugs early last year, their infections came roaring back. It’s not yet clear why—whether it’s because their transplants didn’t come from HIV-resistant donors, or because their pretransplant treatment didn’t eliminate all of the infected immune cells, leaving some HIV hiding out in the body.

Still, Brown’s case offers hope. It is evidence of something that until recently had been only a theory: that even after many years of infection, when HIV has presumably wormed its way deep into a person’s body, it is possible to eliminate it entirely, given the right approach.

HIV tests typically measure the amount of viral RNA in the blood. If you imagine blood vessels as highways, with some number of cars, or HIV-infected CD4+ T cells, traveling along them, the tests essentially try to extrapolate the number of cars on the road into the number of cars in the whole country.

The problem with this logic, says Mike McCune, professor of medicine at the University of California at San Francisco, is that there may be only a few cars on the highways because people have chosen not to drive, or gas stations have run out of fuel, or the factories that make the cars have been bombed.

In fact, in 1995, a team led by Robert Siliciano at Johns Hopkins University School of Medicine found that the vast majority of HIV hides silently in “resting” CD4+ T cells. When people go off therapy, the virus from this latent reservoir of infected cells rapidly resurges. In the analogy, this means that cars are idling in garages, waiting for an opportune moment to pull out.

But even that is probably not the whole picture. For example, scientists have begun to realize that the reservoir contains other types of infected immune cells, such as dendritic cells, monocytes, and macrophages. In October, Siliciano and his colleagues reported in the journal Cell that the reservoir of resting CD4+ T cells alone may be up to 60 times larger than was previously thought.

Perhaps the biggest obstacle to curing AIDS, then, is this: No one knows what the reservoir is, where it is, or how to rouse the latent virus from it, much less how best to determine that it has been eradicated once it has been roused. These questions have prompted a tremendous amount of research, with scientists around the globe studying as many infected tissues as possible, both in people and animal models.

The goal is to somehow jump-start the dormant virus and then destroy it once it’s vulnerable.

So far, one of the most popular strategies for obliterating the reservoir is the “shock and kill” approach. The goal is to somehow jump-start the dormant virus into becoming active, and then destroy the infected cells once they’re vulnerable—in other words, lure the cars out of the garages and onto the highways, and then blow them up.

Of the three AIDS research collaborations the NIH has recently funded, one focuses on this approach; academic researchers and the pharmaceutical giant Merck hold weekly calls to share unpublished results. “The idea is to find agents or small molecules or drugs that can reverse latency,” says Janet Siliciano, a virologist at Johns Hopkins University and a member of the group. “That’s a really, really hard problem. Right now there’s nothing out there that’s doing that.”

Brown’s case, she says, “created huge, huge excitement. It was a proof of principle that you could eliminate the reservoir if you could give someone a bone-marrow transplant.”

The Mississippi baby was given antiretroviral drugs starting at birth, and the most popular theory is that she was treated so early that the HIV reservoir never had a chance to fully  form. The group of patients in France had also been treated soon after infection. As a result, their reservoirs may be so small that their immune systems can control the virus. The French researchers estimate that as many as 15 percent of patients who receive similarly early intervention may become “elite controllers”—a concept akin to that of cancer remission.

But Robert Siliciano cautions that these are unusual cases. “In most people, we’re going to have to deal with this reservoir somehow or other,” he says. “We’re not going to cure anybody unless we get rid of it.”

Scientists have known for many years that HIV’s dependence on the CCR5 receptor might prove to be its downfall. Brown’s case has given that hypothesis new momentum. Two California companies, Sangamo Biosciences Inc. and Calimmune, are using gene-therapy techniques to disable or delete CCR5.

In Calimmune’s trial, researchers take blood from an HIV-
infected person, isolate stem cells, disable CCR5, and then transplant the stem cells back into that individual, where they will develop into new immune cells.

Theoretically, this approach has two advantages: The stem cells provide a steady stream of HIV-resistant immune cells, and altering a patient’s own stem cells rather than those from a donor circumvents the risk of rejection. The trial kicked off last summer, however, so it’s too soon to say if the strategy is as powerful in practice as it is in theory.

Sangamo’s approach is further along. It also modifies CCR5 but in T cells, which is easier to do. The company uses molecular scissors called zinc-finger nucleases to snip both copies of the CCR5 gene out of an HIV-infected individual’s T cells. Researchers then grow the modified T cells to large numbers and transplant them back into the patient.

In a trial of nine people, Sangamo found that a single infusion of the engineered T cells shrank the size of the reservoir in all of the participants three years later. In a separate trial of eight people, one person has maintained undetectable levels of the virus for 20 weeks (as of December) after stopping therapy.

“This is the first study to show a long-term durable increase in CD4 counts but a concomitant reduction in the reservoir,” says Geoff Nichol, Sangamo’s executive vice president of research and development.

Still, it’s way too early to say whether this effect will persist. Because T cells have a limited life span, it’s not clear how long a single infusion’s benefits will last. Sangamo is planning to apply the same technology to stem cells, which might be able to provide an unending supply of HIV-resistant T cells.

Experts seem to agree that any global strategy for eradicating HIV may need to combine a cure with a vaccine.

A more interesting question is why this approach should have any effect on the latent reservoir—that is, why should an infusion of healthy immune cells decrease the number of cells that are already infected?

One controversial idea holds that the reservoir isn’t entirely dormant. Imagine the reservoir as a sink half-filled with water. Each day, the water level is exactly the same as on the previous day. “But what you didn’t realize is that the faucet’s a little bit open, and the drain is also a little bit open,” says Mario Stevenson, professor of medicine and chief of infectious diseases at the University of Miami. So even though the water level seems unchanged, there is fresh water in the sink. In the same way, the reservoir may be dynamic, with some cells getting infected and others dying every day.

In a person infused with the engineered T cells, the virus would gradually kill all infected cells without infiltrating new ones. In a sense, “you allow the infection to proceed untreated until the virus itself eliminates all of the nonengineered host cells,” says Deeks. “It’s a pure Darwinian experiment.”

Even if Sangamo and Calimmune’s approaches prove successful, and even if they turn out to have no serious side effects—and these are big ifs—they are too expensive and invasive to treat everyone infected with HIV. In fact, experts all seem to agree that any global strategy for eradicating HIV may need to combine a cure with a vaccine. After decades of failure with candidate vaccines, that field, too, has seen promising developments.

For example, after working with only a handful of neutralizing antibodies—immune molecules that can drive a vaccine—Dennis Burton and his colleagues at The Scripps Research Institute introduced two powerful new ones in 2009. That catalyzed an explosion of others. “Now there are literally hundreds,” says Burton, a professor of immunology and microbial science.

Researchers have also created vaccines that spur healthy T cells to attack HIV-infected cells. They’ve shown dramatic protection in a monkey model of AIDS. And last October, scientists revealed the elusive structure of the protein protruding from HIV that the virus uses to latch onto CCR5. This protein is a target for antibodies elicited by vaccines. Put all of this together, Burton says, and “you start to glimpse the possibility of controlling or even eradicating the virus.”

In the meantime, Brown still holds the distinction of the first and only confirmed patient cured of AIDS. He has some survivor’s guilt, he says, and is often called “lucky” by HIV-positive individuals. But his recovery was speckled with a series of nightmarish scenarios: At various points, he was incontinent and unable to walk, placed in an induced coma because of an acute sepsis infection, and so delirious he had to be admitted to a hospital for people with severe brain injuries.

The Youth Corps

Each year, an estimated 250,000 children worldwide are born infected with HIV. What if hundreds, maybe even thousands, of them are now free of the virus and don’t know it? This is the hope that the case of a baby in Mississippi offers.

The baby was born to an HIV-positive mother and received antiretroviral drugs within 30 hours. Normally, when a baby is diagnosed as HIV-positive, he or she begins treatment and continues it indefinitely. But the Mississippi baby stopped getting the drugs when she was about 15 months old. By the time she returned to the health care system, she had been off therapy for about a year. Instead of being desperately sick, she showed only a faint trace of HIV.

This discovery has led to speculation that the antiretroviral drugs killed off all of the virus before it had a chance to form a reservoir. To test whether that’s plausible, some groups are embarking on ambitious projects to treat infected newborns within a day or two of birth, discontinue treatment after one or two years, and then monitor them to see if the virus rebounds.

“Essentially the plan, based on the Mississippi baby, is going to be: Can you replicate this under controlled conditions in a larger number of people?” says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is funding one such trial. If doctors follow enough of these children over time, they may eventually be able to verify that they are cured, Fauci says.

Other groups are looking to see whether HIV-positive teenagers who go on “drug holidays” and temporarily stop taking medication remain free of the virus. “The first step is remission. Maybe cure will be the next one,” says Christine Rouzioux, a virologist at Necker Hospital and University of Paris Descartes in France. “It’s the beginning of the story.”

Update: On Wednesday, scientists announced that a second baby may have been cured of HIV.

How HIV Invades Cells—And How To Stop It

1) HIV attacks immune cells that express a surface receptor called CD4. The best known is the CD4+ T cell. First, the gp120 portion of a protein protruding from the viral envelope, or virus’s outer coat, latches onto CD4.

2) The binding triggers a structural change that exposes another viral protein, gp41. This protein docks with a second surface molecule called CCR5 (or for some cell types, another co-receptor called CXCR4), which enables HIV to penetrate the cell’s membrane.

3) The virus then releases its genetic material, which embeds itself in the cell’s DNA. The infected cell either begins churning out copies of HIV or silently waits to be activated.

4) Immune cells that carry a mutant form of CCR5 don’t allow HIV to bind. Several research groups are trying to mimic this natural resistance by introducing mutant versions of CCR5 into HIV-infected people.

Through all this, Huetter’s team kept testing Brown and couldn’t find any trace of HIV. But Brown says he didn’t really believe his extraordinary situation until the New England Journal of Medicine published his case report in 2009. “Then I thought, ‘Okay, the medical establishment is accepting that I’m cured,’ ” he recalls. “I guess I’m cured.”

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