A Good Life

Linda Norgrove

attribution unknown

I've been thinking about writing about Linda Norgrove since last week. Her courage and her good work resonated so deeply in my thoughts. With a happier outcome of her kidnapping, she would surely have been counted an Uppity Woman on this blog. She did amazing things, all over the world in her brief 36 years. Sadly though, so many media accounts, instead of focusing on her amazing good works, have focused on the tragic mistakes that led to her death.

I can't even being to process just how brave Linda Norgrove was. 2010 has been a very bad year in Afghanistan. Deaths in the military have certainly risen. But, in recent months, it's especially been bad for humanitarian workers. In July, Shaun Sexton, a 29 year old security guard working with her at Development Alternatives, Inc., was killed along two Afghans and a German, in DAI's offices in Kunduz. In August, Dr. Karen Woo, who had been providing ophthalmological care to local villagers was killed along with nine other aid workers when gunmen attacked a village. Against this backdrop, Norgrove persevered until her kidnapping by Taliban militants in late September.

Linda Norgrove was a dedicated and very experienced humanitarian aid worker. She appeared to have a great love of learning. After earning a doctorate in ecology, she was completing an MBA with the University of Warwick, through "distance" learning, while she worked in Afghanistan. Norgrove knew Afghanistan very well, having worked with the UN there from 2005-2008 before returning to become the Jalalabad-based Regional Director of Development Alternatives, Inc. in 2010. After earning her doctorate she had first worked with the World Wildlife Fund before joining UN projects. She had worked in Peru, Mexico, Laos and Uganda, in addition to Afghanistan. She was fluent in Dari and Spanish and was learning Pashto. At the time of her death, Norgrove was directing DAI's implementation of the USAID project for rebuilding businesses and infrastructure in Afghanistan.

The best piece I've seen on Linda Norgrove was by Trudy Rubin, for the Philadelphia Inquirer. Rubin met Norgrove this past spring, while traveling in Afghanistan. She describes a photo she took of Ruben:

"I have a photo of her dressed in a long, black skirt and loose tunic, her hair under an enveloping shawl, as she stood beside several Afghan elders. I recall the respect those grizzled men showed her as she discussed their new crops, which had replaced opium poppy fields."

~ Trudy Rubin, Philadelphia Inquirer 

As Rubin points out, Norgrove's projects were successful while those of many others failed. One of the reasons for her her successful work with the Afghani people was that she  really lived among the Afghan people. She lived in a simple villa, not a razor-wired UN compound. Instead of driving around in Humvees with a string of guards, she went with a driver and a guard. She wanted to be able to freely communicate with the local people and while she realized they couldn't offer guarantees, the tribal elders in her area evidently really did try to safeguard her.

At the time of her tragic death, those same tribal elders were evidently bartering desperately for her release. They wanted her back, safe, because she had done so much good. However, intelligence reports had suggested that the Taliban militants holding her might either execute her or take her into Northern Waziristan (Pakistan), where there would be little chance of rescuing her. Reportedly, both locals and the US forces in the area were simply astonished that the Taliban had kidnapped "such a good person". I am still not quite sure that I comprehend their astonishment, since if you're going to kidnap someone to barter with or make a big display with, clearly taking someone who is a prize makes the biggest statement. The Taliban may be a group of barbarians but they're not stupid barbarians.

It really doesn't matter much how she ultimately died, whether because of a Taliban suicide vest or a misguidedly tossed US grenade. She's dead and the people who loved her, both at home in Scotland, and in the villages she helped, are much the poorer for her loss.

Days after Norgrove's death, there were a lot of announcements (see one example) that the Afghan government and the Taliban are in negotiations, that the Taliban are trying to reconcile with the Kabul authorities.

I really want to believe that the Taliban will be done mutilating women, stoning people to death, and kidnapping brave and goodhearted souls who wanted nothing other than to do good for the Afghan people.

I really want to.

Once again, I look at the past decade in Afghanistan, and even the role the US has played in the country for the past thirty years and I'm just so saddened. For the Afghani people, and for Dr. Norgrove's family and for all the aid workers who will look at recent months in Afghanistan and think no matter how much they want to help, or how much good they could do, that it is just not worth the risk.

There are a lot of things that I don't like in the Qur'an or in hadith. But one thing that I'm pretty certain of is that if we were to ask What Would Muhammed Do? it wouldn't be kidnapping female humanitarian workers, dragging them all over Afghanistan, doing who knows what to them in the process, and ending up, no matter who detonated what, responsible for the death of someone who had only done good for this planet.

I hope that the Taliban are as God-fearing as they say they are.

Because if they are right and there is a God, they should be.

© Bright Nepenthe, 2010

Congo Women Protest

and who can blame them...


© Bright Nepenthe, 2010

A Moving Book...

© Bright Nepenthe, 2010

Sunday Happy

© Bright Nepenthe, 2010

Palate Cleanser #121

Autumn Maple, Japanese Garden, Portland, OR

by ahp_ibanez

One of my favorite places on earth...


© Bright Nepenthe, 2010

Stem Cells, Part 3

Diseases and conditions where stem cell treatment is promising or emerging. (See Wikipedia:Stem cell#Treatments). Bone marrow transplantation is, as of 2009, the only established use of stem cells. Image credit: Mikael Häggström. 

So we've explored embryonic versus somatic stem cells. We know the advantage of embryonic stem cells (tabla rasa cells, effectively) and of somatic cells (plentiful and unchallenged ethically but perhaps harder to work with). But what type of cell therapy are we talking about with stem cells? What can you do with them to fix people?

Well, you've already heard of one treatment that is proven with stem cells, even if you don't really think of it as being one: that of bone marrow transplants, which can be used to treat a huge variety of acquired and congenital diseases or disorders. But what are doctors and researchers planning to do with stem cells if the federal spending is finally freed to work with all kinds, embryonic and somatic?


I can tell you after days of researching this article that there is a huge amount of hype out there on stem cell therapy. People at centers all over the country talk about stem cell therapy as if it is already accepted, proven and fully vetted. In fact, it's not. 


Somatic stem cell therapy is much better understood at present and there are a number of promising indications for using somatic stem cell therapy to treat cancer patients, spinal cord patients and cardiac patients. But embryonic stem cell therapy is barely begun. In fact, the first clinical trial of an embryonic stem cell treatment started this week. And it's caused quite a lot of controversy, even among proponents of embryonic stem cell therapy.

"Without knowing more clinical detail, there's little that I can say," said Steve Goldman, chairman of the Department of Neurology at the University of Rochester in New York. "In more general terms... I remain concerned about the long-term safety of unpurified grafts of embryonic stem cell derivatives. Time will tell."

~ from The Washington Post 

Yes, in addition to the ethical controversy, there are still a number of concerns that need to be addressed scientifically about using stem cells. If these cells are always turned "on" for division, for instance, what will stop their rapid cell division and growth? Uncontrolled cell growth is usually called cancer. Or, leaving aside that unlikely outcome, what if reprogrammed cells just somehow lose their programming? What happens if a mesoderm stem cell differentiated into ectodermal tissue reverts back? All of these are questions that have been posed at various points in time, and not just in the lay literature opposed to stem cell research, as you can see from Dr. Goldman, above. Another worrisome factor has been contamination of the stem cell lines. This has actually been reported, and was cause for concern about the present stock of embryonic stem cell lines which scientists have been using for the past decade. In 2005, a group of researchers at UC San Diego and the Salk Institute in La Jolla reported in the journal Nature Medicine that they found solid evidence that human stem cells were contaminated with non-human sialic acid as a result of the culture media which was using non-human serum to sustain the cells. Subsequent work by Robert Lanza, et al. was published in The Lancet reporting a new embryonic cell line that was grown without serum feeding and therefore less likely to be contaminated. Yet the original group's finding draws attention to the fact that there is much that needs to be refined in the field of stem cell research. How that refinement will occur without federal research dollars may turn out to be very unfortunate for anyone who needs stem cell treatment. With only private sector funding of embryonic stem cell research and therapies, one can only imagine the simply exorbitant costs that these therapies will be have when they finally are offered. It will truly be medicine for the wealthy, no doubt.


The first clinical trial of embryonic stem cell treatment in human subjects was approved by the FDA in January 2009 for transplantation of differentiated neural cells called GRNOPC1, progenitor oligodendrocytes, into patients with spinal cord injuries. The study was on hold for more than a year because of microscopic cysts found in rat test subjects. That hold was lifted in July of this year. On Monday, October 11th, 2010 Geron Corporation announced that the first spinal cord patient was treated with the differentiated stem cells in Atlanta, at the the Shepherd Center. 


There is much argument about whether embryonic stem cell therapy is safe, is ethical and even whether it is likely to be effective. What is clear, however, is that if funding is not available to sufficiently research and test, even if in non-human subjects¹, that the likelihood of success on any level is poor. When contamination was reported in cell lines in 2005, within months Robert Lanza's group at the private firm American Cell Technology reported not just a potential way to grow cells without serum, but within a year, a way to extract the inner mass stem cells without destruction of an embryo. Research findings drove the science of stem cell technology forward.


If we don't publicly fund medical research in this country there will be two devastating outcomes: we will fall farther and farther behind the rest of the world, and we will end up with novel treatments that only the very wealthiest Americans will be able to afford.


Think of anyone you know who has any of the ailments in that figure above, who might potentially be treated by stem cell therapy. How much is too much to pay? 


So hopefully, when you next hear 'stem cell research' you'll ask what kind of stem cells and you'll ask whose research it is. Is it publicly funded and therefore yours, mine and ours? Or is it privately funded? And how about just saying "Yay! More research!"


Research and peer review drive science, and medicine, forward.


They are your very best hope for a healthy future.

¹ Readers should remember that the Dickey Wicker Amendment prohibits any embryonic stem cell research with embryos even from other organisms to be funded with federal dollars. Specifically:  For purposes of this section, the term "human embryo or embryos" includes any organism, not protected as a human subject under 45 CFR 46 (the Human Subject Protection regulations) . . . that is derived by fertilization, parthenogenesis, cloning, or any other means from one or more human gametes (sperm or egg) or human diploid cells (cells that have two sets of chromosomes, such as somatic cells).


© Bright Nepenthe, 2010

Palate Cleanser #120

The Barcolana Regatta, Trieste, Italy

Image credit: Mauro Cattelani, 2007

visual palate cleanser concept © Bright Nepenthe, 2010

Stem Cells, Part 2

Stem Cell Differentiation

University of Kansas

Today's post is the most complex of the Stem Cell posts. The illustrations should break it down for the reader, so please stick with it. At the very least, it will give you a healthy respect for the inventiveness of scientists who are trying to develop stem cell therapies to cure all manner of diseases.

Yesterday we talked about embryonic stem cells. Because of their potential to be more versatile, embryonic stem cells have been more coveted for research. You may wonder how they are acquired. 

The most common means for acquisition of the inner mass of cells that yield pluripotent stem cells is to harvest them from unwanted embryos (morulas or blastocysts) that are left over after successful in vitro fertilization. Generally, couples can donate their no longer wanted/needed embryos for medical research. Of course, some of you may remember from my post back in August that some people think that choice shouldn't be left to the parents of these embryos... Even if the embryo is five days old and the size of the period at the end of this sentence, and is the result of tens of thousands of dollars of in vitro fertilization care and has 'parents,' some people believe it is unethical to harvest stems cells because clearly it will destroy the embryo.

So what were scientists doing during the Clinton/Bush years, when stem cell research was limited by the charming Dickey-Wicker amendment? (This amendment expressly forbad expenditure of federal research dollars on any program in which human embryos, or embryos in general, would be discarded, destroyed or subject to any injury or risk of cell death greater than that allowed on fetuses, which is pretty much nil...) When scientists could not gain access to embryonic stem cells, they tried to work with adult or somatic stem cells.

Somatic stem cells are so called because they originate from a developed body's tissues. That can be a child's body, or that of an adult. The differences are best illustrated in this handy image from Nature, the premier journal in the sciences:

Differences between embryonic and somatic stem cells.

Copyright 2006 Nature Publishing Group, O'Connor, T. P., & Crystal, R. G., Genetic medicines: Treatment strategies for hereditary disorders, Nature Reviews Genetics 7, 261–276

The problem with using somatic stem cells is that most of the time, tissue is well differentiated in a formed body (again, differentiation means the job of the cell line has already been determined. Liver cells are liver cells, nerve cells are nerve cells. So researchers have sought the chemical signals or hormones that would turn back the clock so to speak, and allow these dedicated cells to achieve undifferentiated growth again. Although, restriction of cell lines still is an issue. But clever ways around that problem involved using the placenta, fat tissue, bone marrow hemopoietic cells (cells that will develop into blood cells of all kinds) among others. A lot has to do with the origins of the cell type in the germ layer of the embryo.

Image attribution uncertain.

As shown above, the embryo has three different layers, called germ layers. They are the endoderm, the mesoderm and the ectoderm. Stem cells that originate from one layer can, by a process called transdifferentiation, develop into tissue of another layer. For instance, when we look at the fate of cells in the ectoderm, as shown above, we would be very surprised if we were to get ectoderm cells that could be differentiated into liver cells. That's in theory the job of endoderm cells. There is currently a serious debate about whether transdifferentiation, or essentially reprogramming of a stem cells's germ layer assignment,  can occur in humans. Even if you are capable of making stem cells transdifferentiate into other cell lines, who's to say that the reprogramming remains true? Along germ layer lines, though, we can see how for instance bone marrow stromal or mesenchymal stem cells be used to create blood and bone:

While this might be useful for a number of different disorders, it is not a solution for things like central nervous system dysfunction, cardiac disease or liver disease. Better results have been suggested, within the past few years, with the use of placental and umbilical cord stem cells or so called non-adult, postnatal stem cells. Many parents decide to bank the placenta and cord stem cells in case of future need and well developed stem cell therapies. Placental stem cells are pluripotent, just like the cells harvested from a blastocyst. Placental and cord stem cells might be capable of differentiation into a variety of useful cell lines, as shown below:

This diagram appears to have been based on the one below, from the University of Kansas Stem Cell Research Center. Remember that a blastocyst yields embryonic stem cells, however. The applications in the diagram above have NOT been clearly established.

The important thing to consider when using somatic stem cells is that you may have to work much harder, and the errors can be greater, in getting the cell differentiation you desire for your stem cell therapy. Pluripotent cells, either embryonic or postnatal placental and cord stem cells, offer the best guarantee. However it must be recognized that the placenta and umbilical cord are organs, that is that the tissue is inherently already largely differentiated. You can consider the situation like that with the bone marrow cells above.

Cell lines created from organs can have limitations that cells that have not yet even differentiated into germ layers (blastocyst embryonic stem cells) do NOT have. Blastocyst derived stem cells provide in all likelihood the best source for stem cell lines.

© Bright Nepenthe, 2010