Thursday, October 20, 2011

Baruch Blumberg: Finding The Hepatitis B Virus

Great Advances in Science

 Hepatitis A and B are vaccine preventable diseases, yet they continue to be the most commonly reported vaccine preventable diseases. Getting vaccinated, especially if you are at high risk, provides the best protection from these diseases.
J Robert Galvin, 
Commissioner of the Connecticut Department of Public Health,
May 18, 2009

Barry Blumberg was a great biochemist and researcher. He was a leading light in the scientific community and a great humanitarian. He also was a loyal and supportive friend to NASA, Ames Research Center and the nation's space program.
Pete Word, Ames Center Director

This is what drew me to medicine. There is, in Jewish thought, this idea that if you save a single life, you save the whole world, and that affected me.
Baruch Blumberg, in a 2002 New York Times article

Baruch Samuel Blumberg [1925-2011]: In his later years, Blumberg took a position at NASA, where for five years he was a Distinguished Scientist at its Lunar Science Institute, part of the Ames Research Center in Moffett Field, California. Much of his later work at NASA was searching for micro-organisms in space.
Photo Credit: Tom Tower. NASA, 1999.
Source: Wikipedia
Baruch "Barry" Blumberg might not be a name you would know well unless you were well versed in the field of vaccinology and medical science. But his contributions to science and humanity are immeasurable. In 1976, Blumberg, an American, shared the Nobel Prize in Medicine (along with  D. Carleton Gajdusek) for discovering "new mechanisms for the origin and dissemination of infectious diseases."

Blumberg has often been compared to Jonas Salk, the developer of the polio vaccine. In his case, Blumberg is best known for discovering the origins of the hepatitis B virus in 1967, then creating a blood test for hepatitis B and the development of a proto vaccine against hepatitis B in 1969. It took more than a decade for a vaccine for hepatitis B to become available to the general public, since pharmaceutical companies generally look at vaccine manufacturing as an unprofitable business, more as a public service than a highly profitable venture.

Even so, Big Pharma eventually conceded, likely seeing it as a moral duty, I presume, to prevent the spread of infectious diseases. In terms of the hepatitis B vaccine, Blumberg developed it with Dr. Irving Millman, a colleague at the Institute for Cancer Research of the Fox Chase Cancer Center in Philadelphia, Pennsylvania. At first, his findings were met with resistant from the medical community.

In the end, however, Blumberg's scientific work prevailed, proving a viable link between hepatitis B and liver cancer. The vaccine they developed, becoming commercially available in 1982, became known as the first so-called cancer vaccine. As Blumberg later said in a 2002  New York Times article, saving lives drew him to medicine. “There is, in Jewish thought, this idea that if you save a single life, you save the whole world, and that affected me.”

Blumberg's contribution to medical science and the betterment of humanity is notable and undisputed, but still has to be placed in context, especially today. Hepatitis B is an infectious disease that causes inflammation of the liver, and its cause is directly linked to a virus called hepatitis B, or HBV. This virus is about 100 times more infectious than HIV and the severest of the various forms of hepatitis thus far identified. Like many contagious diseases, hepatitis B is spread by the blood and body fluids of infected persons.

It is not transmitted by coughing, sneezing or shaking hands with an infected person, which is the case with influenza or the common cold (human rhinovirus), Chronic hepatitis B is treatable. If left untreated, however, it can lead to cirrhosis (scarring) of the liver, other liver problems and liver cancer. (More information can be found here.)

The disease in entirely preventable by having persons vaccinated. Despite the wide availability of vaccines, hepatitis B is still prevalent today, as are the two other chief forms of hepatitis (A & B). In Canada, the incident rate is low, with no more than 1,000 new cases of hepatitis B reported each year, the rates dropping with increased vaccination rates. In total, about 200,000 persons in Canada live with chronic hepatitis B, says the Public Health Agency of Canada. The United States has a similar low incident rate of less than 0.5 per cent of the population, with 40,000 new cases of hepatitis B each year, says the Center for Disease Control (CDC). It says that an estimated total of between 800,00 and 1.4 million persons live with chronic hepatitis B infection in the U.S.

It is in developing nations where the numbers are greatest. In developing nations, the rate of infection often is greater than 10 per cent. For example, as of 2010, China has 120 million infected people, followed by India with 40 million, and Indonesia with 12 million. Globally, more than 520-million people have some form of hepatitis, says the World Health Organization, a body that monitors infectious diseases, it contributing to 1.5-million deaths a year worldwide. (Here is some background information on the various forms of hepatitis by the World Health Organization.)

Such makes getting children vaccinated, it a viable protection against possible liver cancer and other liver diseases. Such is an important consideration for parents who want to make informed choices for their child's welfare. In that respect, the scientists who made vaccinations possible deserve our respect and admiration and are among our true heroes of humanity.

Growing up in New York City

Baruch Samuel Blumberg was born to Meyer Blumberg and Ida Blumberg (nee Simonoff) in New York City on July 28, 1925, one of three children born to the couple. His father was a lawyer. Baruch attended an Orthodox school, the Yeshiva of Flatbush, where, as he put it in his Nobel Prize biography, "We spent many hours on the rabbinic commentaries on the Bible and were immersed in the existential reasoning of the Talmud at an age when we could hardly have realized its impact." Indeed, scientific and personal curiosity combined with the need to know, is a potent force that often leads to discovery.

As does field experience. After graduation from Far Rockaway High School in 1943, Blumberg served in the military, as a U.S. Navy deck officer during the Second World War. This experience profoundly influenced him, he said:
Sea experience placed a great emphasis on detailed problem solving, on extensive planning before action, and on the arrangement of alternate methods to effect an end. These techniques have application in certain kinds of research, particularly in the execution of field studies.
He attended college while still in the military, graduating from Union College in Schenectady, New York, in physics with honours in 1946. It was then that he was also discharged from the navy. From there, he entered the graduate program in mathematics at Columbia University, but switched to medicine at the advice of his father, enrolling at Columbia's College of Physicians and Surgeons, from which he received his medical degree (M.D.) in 1951.

He furthered his medical education and knowledge, remaining at Columbia Presbyterian Medical Center for the next four years, first as an intern and then as a resident, including a stint at Bellevue Hospital, which, as he says in his 2003 book, Hepatitis B: the hunt for the killer virus, "reinforced my curiosity about the mechanics of clinical diversity." In his 1976 Nobel Prize biography, he elucidates his fascination with Bellevue:
The wards were crowded, often with beds in the halls. Scenes on the wards were sometimes reminiscent of Hogarth's woodcuts of the public institutions of 18th century London. Despite this, morale was high. We took great pride that the hospital was never closed; any sick person whose illness warranted hospitalization was admitted, even though all the regular bed spaces were filled.
It was during this period that he met Jean Liebesman, an artist. They married in 1954, having four children: Anne, George, Jane, and Noah. Blumberg won a fellowship, in 1955, to Oxford University' Balliol College, where he earned his doctorate in biochemistry in 1957, spending as he said, "some of the happiest years of his married life."

They returned to the U.S. in 1957 and for the next seven years, he worked at the Geographic Medicine and Genetics Section of the U.S. National Institutes for Health, in Bethesda, Maryland. He traveled extensively to such places as Alaska, Africa, the Pacific, South America, Europe and Australia in search of answers to a basic question—why some people get sick and others do not? It is the nexus between anthropology and medicine, with philosophy thrown into the mix, the work of a powerful intellectual mind.

In 1964 he left NIH when he was appointed associate director for clinical research at the Institute for Cancer Research (later named the Fox Chase Cancer Center) in Philadelphia. By this time, Blumberg continued his research on the Australia antigen, and in 1966 he discovered the link between Au and hepatitis B.

Hepatitis B Vaccine: Hospital Corpsman 3rd Class Natasha Wooden administers a Hepatitis-B vaccine to a sailors aboard the Nimitz class aircraft carrier USS Ronald Reagan (CVN 76) somewhere in the Pacific Ocean (June 2, 2005).
Photo Credit: U.S. Navy photo by Photographer's Mate Airman Apprentice Christopher D. Blachly, June 2, 2005
Source: Wikipedia

Finding the Hepatitis B Virus in Australia

His interest in the diversity of other cultures started when he was a navy officer during the Second World War and later as a medical student. A medical anthropologist in the early 1950s, Blumberg was interested in whether inherited traits could make different groups of people more susceptible to a particular disease. This was before there was mechanisms and technology to identify genetic markers, so they had to resort to innovative ways to conduct research and make sense of the results. The Hepatitis B Foundation in Pennsylvania explains how Blumberg went about making that important discovery:
Dr. Blumberg and his team traveled the globe to collect blood samples from native populations in remote parts of the world. They planned to look for genetic differences, and then study whether these differences were associated with a disease. However, since they did not have the technology to analyze these blood samples at the genetic level, a new indirect method had to be developed; they turned their attention to hemophiliac patients.

Dr. Blumberg reasoned that hemophiliacs who had received multiple blood transfusions would have been exposed to blood serum proteins that they themselves had not inherited, but had been inherited by their donors. As a result of this exposure, the immune systems of the hemophiliac patient would produce "antibodies" against the foreign blood serum proteins, or "antigens", from the donors. Since antibodies are programmed to lock onto specific antigens, Dr. Blumberg decided to use antibodies from hemophiliac patients to test the blood samples collected around the world.
Using this new lab technique for matching antibodies with antigens, an unusual match was identified between an antibody from a New York hemophiliac and an antigen found in the blood sample of an Australian aborigine, which they called the "Australia antigen".
That was in 1967. That same year, the Australia antigen was identified as part of the B virus itself and was renamed HBsAg (hepatitis B virus antigen). A couple of years later, along with a colleague, Irving Millman, they developed the first vaccine for hepatitis B. But it was not met with much enthusiasm, says a New York Times article:
Vaccines are not an attractive product for pharmaceutical companies in that they are often used once or only a few times and they ordinarily do not generate as much income as a medication for a chronic disease that must be used for many years,” Dr. Blumberg wrote in an autobiographical essay for the Nobel committee.
Moreover, he said, the medical research community in the early 1970s remained skeptical about the claim that a virus had been identified and a vaccine developed.

Ultimately he and Dr. Millman signed an agreement with Merck & Company, whose vaccine laboratories were near Philadelphia.
After being awarded the Nobel Prize in 1976, the year of America's bicentennial (and perhaps somewhat appropriate and poetic that Blumberg resided in Philadelphia, the home of the Liberty Bell), Blumberg became professor of medicine, human genetics, and anthropology at the University of Pennsylvania. He lived with his family in the center of old Philadelphia, a few blocks from Independence Hall.

In 1989 he returned to Oxford to become master of Balliol College, the first American and first scientist to hold that position, which he held until 1994. When he returned to the United States, he resumed his post at the Fox Chase Cancer Center, with the title of Distinguished Scientist, and continued to teach as professor of medicine and anthropology at the University of Pennsylvania

At NASA: Dr. Baruch Blumberg was introduced as the first director of the NASA Astrobiology Institute during a press conference held at NASA's Ames Research Center in May 1999.
Photo Credit: Dominic Hart. 1999/NASA
Source: NASA

Move to NASA

Blumberg had a second career that made sense if you understood that he was a curious person. In 1999, Blumberg was asked to serve as director of the NASA Astrobiology Institute in Moffett Field, California. It was a relatively new field and many scientists from different disciplines were active in astrobiology at the time. “He was inspired by the questions that astrobiology asks," says Carl Pilcher, NAI's current Director in an article (May 2011) in The Lancet. “One of the things he frequently said was that in astrobiology we are asking some of the most fundamental questions about where else and under what circumstances life might have arisen, and also about the nature of life, which was one of his passions as a physician and a researcher.”

He held that position for five years, before once again returning to his home base in Philadelphia at the Fox Chase Cancer Center. In 2005, Blumberg was elected president of the American Philosophical Society, founded in 1743 in Philadelphia by Benjamin Franklin and his colleagues. As Blumberg wrote, "It is, probably, the oldest academic, scientific, or scholarly society in the United States."

Baruch Blumberg died of a heart attack on April 5, 2011. It was shortly after he gave the keynote speech at a NASA conference at the Ames Research Center in Moffett Field, which is in the San Francisco Bay area. He was 85. (See obituary in New York Times.). The talk was on the value of citizen science. Baruch Blumberg was a scientist to the end.

His funeral was held on April 10, 2011, at Philadelphia's Society Hill Synagogue, a self-described egalitarian non-denominational synagogue where he was a long-time member. The next day he was buried at Antietam Meadows Farm, which the family co-owned, located two miles from the historic Civil War battlefield in Sharpsburg, Maryland. He is survived by his wife, four children and nine grandchildren.

Personal Note: I am a firm believer in vaccines, since they have been proven scientifically effective in savings lives and in preventing epidemics, and more so pandemics. As both a parent and a journalist, I have done extensive research on the matter, and I remain convinced of their efficacy. (see On Vaccines: A Matter of Life.)

Accordingly, this week my nine-year-old son received the vaccine against hepatitis A & B, along with the rest of his Grade 4 classmates.  A second dose will follow six months later. Although initially nervous about the "shot," he said, with confidence and intelligence beyond his years, "it was important to be protected against getting sick."