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News Release
Office of News and Information
Johns Hopkins University
3400 N. Charles Street
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Phone: (410) 516-7160
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EMBARGOED FOR RELEASE: 6 p.m. EDT
Monday, September 22, 1997
CONTACT: Joyce Yaeger,
Annmarie Wasnok
M BOOTH & ASSOCIATES
(212) 481-7000
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1997 Albert Lasker Clinical Medical Research Award
Goes to Alfred Sommer, M.D.,
Pioneer in Vitamin A Therapy in Children
in the Developing World
NEW YORK, September 22, 1997 -- The 1997 Albert Lasker
Clinical
Medical Research Award goes to Alfred Sommer, M.D., Dean of the
School of
Hygiene and Public Health, and Professor, Ophthalmology,
Epidemiology and
International Health at The Johns Hopkins University for his
discovery
that vitamin A not only prevents blindness in children in the
developing
world but also protects them from a range of life-threatening
infections.
Dr. Sommer is one of two Johns Hopkins researchers to win
Albert
Lasker Awards this year. Victor A.
McKusick,
M.D., University Professor of Medical Genetics at Hopkins,
received
an Albert Lasker Award for Special Achievement in Medical
Science for founding an entirely new
branch of medicine
called medical genetics that has led to the mapping of tens of
thousands of
genes and to the
Human Genome Project.
The Awards will be presented during the Awards Luncheon at
the
Pierre Hotel in New York City on Friday, September 26.
Throughout the developing world, in Indonesia and Tanzania,
in
South Africa and Nepal, in virtually all countries where vitamin
A
deficiency was once common, millions of children owe their
eyesight and
their very lives to a visionary, persistent doctor from
Baltimore. Alfred
Sommer, winner of the 1997 Lasker award for clinical medical
research,
discovered that vitamin A, known to prevent blindness from
xerophthalmia,
also gives children the biochemical strength to recover from
life-threatening
infections that are common in most of the poorest nations on
earth.
Xerophthalmia often begins with nightblindness, which in
some
cultures in called "chicken blindness" because afflicted children
mimic
chickens' inability to see at dusk. As xerophthalmia progresses,
"Bitot27s
spots" appear on the eyes -- white, foamy or cheesy accumulation
of
tissue that is known as a sign of vitamin A deficiency. If
vitamin A
deficiency progresses untreated, the patients deteriorate and may
develop
eye ulcers that, as Sommer puts it, "eventually turn the cornea
to mush."
Vitamin A deficiency is one of the oldest recorded medical
conditions. The ancient Egyptians treated nightblindness with
animal liver
(where vitamin A is stored) 3,500 years ago. By the early 1900s,
the
connection between xerophthalmia, overall resistance to infection
and
vitamin A was well-documented by American and Danish
nutritionists who
treated their patients with cod liver oil, butter, and whole
milk. For all
practical purposes, xerophthalmia was erased from the medical map
in
Europe and North America.
In the developing world, xerophthalmia remained a serious
problem
whose importance was grossly underappreciated. In Indonesia and
Tanzania,
in South Africa and Nepal, in places where respiratory and
gastrointestinal
infections commonly kill children before they are old enough to
go to
school, xerophthalmia was considered relatively unimportant --
except to
ophthalmologists. According to Dr. Sommer, "a profound amnesia
appears to have
settled over the broader context of vitamin A deficiency once it
ceased to be
a major concern of wealthier nations. Although animal studies and
clinical
observations had seemingly delineated the wide spectrum of
disease associated
with vitamin A deficiency, particularly growth retardation and
reduced
resistance to infection, clinical interest soon fixated on the
ocular
manifestations."
After graduating from Harvard Medical School, Dr. Sommer
spent
time in Bangladesh as part of a medical relief team. It was that
experience
that later came together academically when he received a degree
in
epidemiology from Johns Hopkins and then continued through a
residency in
ophthalmology. In 1976, Dr. Sommer was looking for a chance to
return
overseas when the opportunity to study xerophthalmia in Indonesia
presented itself. Dr. Sommer designed a series of research
questions to
provide "everything you need to know" to control vitamin A
deficiency and
prevent blindness. In one of those studies, he and his colleagues
examined
4,600 children in rural Indonesia every three months during one
and a half
years, primarily to determine why some developed xerophthalmia
while
others did not. Severe xerophthalmia was often associated with
excess
mortality, but that was attributed to the fact that these
children, on the
verge of blindness, also had other, more obviously
life-threatening
illness. Now, Dr. Sommer's combined training in epidemiology and
ophthalmology
was about to pay off. His study included not only children with
signs of
xerophthalmia, but matched controls with no evidence of
xerophthalmia.
As Dr. Sommer sat analyzing his data one night, it suddenly
hit
him: children with even the mildest xerophthalmia were dying much
more
frequently than children with normal eyes. Dr. Sommer refers to
Pasteur:
"Chance favors the prepared mind," and to Bertrand Russell:
"Never let
sleeping dogmas lie." He published his data in a paper in The
Lancet in 1983,
reporting that children with night blindness and/or Bitot spots,
died on
average four times more frequently, and in some age groups eight
to 12 times
more frequently, than children without xerophthalmia.
Furthermore, treating
children with vitamin A for their xerophthalmia, not only saved
their sight;
it also saved their lives.
"The present study demonstrates that even mild xerophthalmia
(e.g.,
vitamin A deficiency) is associated with a marked increase in
mortality,"
Dr. Sommer wrote in The Lancet. But no one paid much attention.
Ordinary
vitamin A, at a cost of a few pennies, reduces mortality by as
much as
50 percent. It seems too good to be true. And, indeed, when Dr.
Sommer first
presented his data, his colleagues (including specialists in
vitamin A and
micronutrients) dismissed his work.
During the course of his research, Dr. Sommer also made a
remarkable clinical observation about measles, which in
developing
countries is a life-threatening infection. Vitamin A, given as
acute
therapy for two consecutive days to children hospitalized with
severe
measles, reduces their risk of blindness and their mortality by
50
percent. He'd proved that measles often blinds and kills by its
acute,
dramatic interference with vitamin A metabolism.
Despite intense skepticism among his peers, Dr. Sommer
expanded
his studies, conducting randomized trials involving hundreds of
villages and
tens of thousands of children and he encouraged colleagues in
several
developing countries to do the same. At one point, when he had to
abandon a
study in the Philippines because of "civil unrest," he moved his
team to
Nepal, where ongoing studies now focus on vitamin A nutrition and
the health
and survival of impoverished pregnant women.
Today, all of the important players on the world health
scene
recognize the significance of Dr. Sommer's acumen as a clinical
investigator
and epidemiologist. This is patient-based science at its best.
Within
the decade, another half-dozen significant community-based
randomized
trials and epidemiological investigations confirmed Dr. Sommer's
data. The
physiological importance of vitamin A as a micronutrient is now
widely
accepted.
By 1993, the World Health Organization, UNICEF, and other
United Nations
organizations had launched campaigns to eliminate vitamin A
deficiency.
The World Bank concluded that giving children periodic doses of
vitamin A
is one of the most cost-effective treatments in all of medicine.
Furthermore,
world health institutions recognize, again on the basis of Dr.
Sommer's
controlled vitamin A trials, that giving the vitamin orally is
every bit
as effective, and a lot more efficient, than giving it by
injection -- the
once favored route of administration.
Because of Dr. Sommer's persistence and his determination to
blend clinical observation with basic science, new work in his
laboratory
and elsewhere is dedicated to understanding the role of vitamin A
in all
its biochemical and molecular detail. It is clear that, in the
face of
even mild vitamin A deficiency, the development of the epithelial
lining of
the respiratory, gastrointestinal, and genitourinary tracts fail
to
develop normally, leaving these crucial organs vulnerable to
infection,
while failure of normal differentiation of immune cells
interferes with a
fully competent immune response.
No less important, Dr. Sommer's work has encouraged further
serious studies by others of the biochemistry, molecular biology
and
genetics of vitamin A, a molecule that is now known to affect the
expression of some 300 genes. His work has also stimulated
broader
enquiry into the existence and clinical significance of seemingly
mild
deficiency of other micronutrients, such as zinc, iron, and
iodine.
Dr. Sommer will receive an honorarium, a citation
highlighting his
achievements, and an inscribed statuette of the Winged Victory of
Samothrace, the Albert and Mary Lasker Foundation's traditional
symbol of
humankind's victory over disability, disease and death.
Johns Hopkins University news releases can be found on the
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http://www.jhu.edu/news_info/news/
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