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Office of News and Information
Johns Hopkins University
3400 N. Charles Street
Baltimore, Maryland 21218-2692
Phone: (410) 516-7160
Fax (410) 516-5251

Monday, September 22, 1997
CONTACT: Joyce Yaeger,
Annmarie Wasnok
(212) 481-7000

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.

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