The New Yorker regularly features some of the best in medicine writing, but this week we were particularly amazed and thrilled by Jerome Groopman’s essay on pre-eclampsia, the complex and potentially devastating disease that affects 5% of pregnancies.
The essay follows a young nephrologist, Ananth Karumanchi of Beth-Israel Deaconess in Boston, as he enters the barren world of obstetrics research with his naive ambition and clever ideas. In just a few years, he may have unlocked the molecular mechanism that lets a fetus commandeer the mother’s blood supply, leading to disastrous consequences:
“I was sifting through all of these data, and I said to myself, ‘It can’t be this obvious,’ ” he recalled. ” ‘It [soluble FLK] can’t be the predominant factor in preeclampsia, because people would have discovered it by now.’ This couldn’t be just waiting for me.”
Ah,.but it was waiting for him — because research on pregnant women has significant barriers. Groopman summarizes many dense science papers with ease and, I think, fairness (at least to this outsider). He ends on a high note: the potential of a blood test weeks before symptoms appear, and eventually, therapy:
Drug-based therapies for preeclampsia may still be years away. But, when I spoke to Karumanchi a few weeks ago, he sounded optimistic. He told me that Scios had recently announced that it could reverse symptoms of preeclampsia in rats by administering its VEGF drug–the first step toward testing it in humans.
In our med school lecture on pre-eclampsia and eclampsia, our professor said that the OBGYN research building where she trained had four pillars by the entrance. Three pillars had engraved names of researchers (such as Papanicolou), the fourth was reserved for the scientist who explains pre-eclampsia. We may be close to breaking out the chisels!
More from a recent BIDMC press release on Karumanchi’s work…