TIME medicine

‘Bubble Boy’ Disease Cured With Stem Cells

Alysia Padilla-Vacarro and daughter Evangelina on the day of her gene therapy treatment. Evangelina, now two years old, has had her immune system restored and lives a healthy and normal life.
Alysia Padilla-Vacarro and daughter Evangelina on the day of her gene therapy treatment. Evangelina, now two years old, has had her immune system restored and lives a healthy and normal life. Courtesy of UCLA

Researchers have treated more than two dozen patients with a treatment made from their own bone marrow cells

Alysia Padilla-Vaccaro and Christian Vaccaro owe their daughter’s life to stem cells. Evangelina, now two, is alive today because she saved herself with her own bone marrow cells.

Evangelina, a twin, was born with a severe immune disorder caused by a genetic aberration that makes her vulnerable to any and all bacteria and viruses; even a simple cold could be fatal. But doctors at University of California Los Angeles (UCLA) Broad Stem Cell Research Center gave her a new treatment, using her own stem cells, that has essentially cured her disease. She’s one of 18 children who have been treated with the cutting-edge therapy, and the study’s leader, Dr. Donald Kohn, says that the strategy could also be used to treat other gene-based disorders such as sickle cell anemia.

Known to doctors as adenosine deaminase (ADA)-deficient severe combined immunodeficiency (SCID), it’s better known as “bubble boy” disease, since children born with the genetic disorder have immune systems so weak that they need to stay in relatively clean and germ-free environments. Until Evangelina and her sister Annabella were 11 months old, “We were gowned and masked and did not go outside,” says their mother Alysia Padilla-Vaccaro. “Our children did not physically see our mouths until then because we were masked all the time. We couldn’t take them outside to take a breath of fresh air, because there is fungus in the air, and that could kill her.”

Both parents wore masks at work to lower the chances they would be exposed to germs that they might bring back home. And they took showers and changed clothes as soon as they entered the house.

MORE: Gene-Therapy Trial Shows Promise Fighting ‘Bubble Boy’ Syndrome

SCID is caused by a genetic mutation in the ADA gene, which normally produces the white blood cells that are the front lines of the body’s defense against bacteria and viruses. The Vaccaros decided to treat Annabella in the same way that they cared for Evangelina; “They were crawling and playing with each other, and every toy they sucked on, they stuck in each other’s hands and each other’s mouth, so we couldn’t take one outside to have a grand old time and potentially bring something back that could harm her sister,” says Padilla-Vaccaro.

Christian and Alysia Padilla-Vaccaro and their healthy twins Annabella (left) and Evangelina. Now with a newly-restored immune system, Evangelina lives a normal and healthy life. Courtesy of UCLA

The only treatments for SCID are bone marrow transplants from healthy people, ideally a matched sibling; the unaffected cells can then repopulate the immune system of the baby with SCID. But despite being her twin, Annabella wasn’t a blood match for her sister, nor were her parents. Padilla-Vaccaro and her husband, Christian, were considering unrelated donors but were concerned about the risk of rejection. “We would be trying to fix one problem and getting another,” she says.

MORE: Stem Cells Allow Nearly Blind Patients to See

That’s when the doctors at the Children’s Hospital at Orange County, where Evangelina was diagnosed, told her parents about a stem cell trial for SCID babies at UCLA, led by Dr. Donald Kohn. “As soon as they said trial, I thought, ‘my kid is dead,” says Padilla-Vaccaro of the last resort option. But a dozen children born with other forms of SCID—in which different mutations caused the same weak immune systems—who were successfully treated by Kohn convinced the couple that the therapy was worth trying. Kohn had one spot left in the trial and was willing to hold it for Evangelina until she matured more. Born premature, she was diagnosed at six weeks old and needed more time for what was left of her immune system to catch up to weather the procedure.

When she was two months old, Evangelina was admitted to UCLA and had bone marrow drawn from her tiny hip. It contained the stem cells that go on to develop into all of the cells in the blood and immune systems. Kohn treated them with gene therapy, co-opting a modified virus to carry the healthy ADA gene so it could infect the stem cells from Evangelina’s bone marrow. The idea was that by transplanting these healthy ADA-containing cells back into Evangelina, she would soon be making her own healthy immune cells. And because they were made from her own cells, her body wouldn’t reject them.

MORE: Woman Receives First Stem Cell Therapy Using Her Own Skin Cells

“After the transplant of this miraculous tube of stem cells, which literally took five minutes, we had to just wait and see for a good six weeks,” says Padilla-Vaccaro. “The week after Christmas [in 2012], Dr. Kohn came in and told me, ‘It worked.’ It worked. Those words…besides the birth of my children, that day will always be the best day in my life.”

The success was a long time coming for Kohn as well. His group has been researching the best way to treat SCID with gene therapy for more than two decades. In the first trial, in 1993, they used cord blood, treating it with the healthy ADA gene and hoping enough of them would “take” to rebuild an immune system. It didn’t work.

In 2001, they tried a different way of delivering the precious gene in four patients. That failed as well.

MORE: Type 1 Diabetes Treatment Gets Boost from Stem Cells

Then, in 2009, he and his team began the trial that Evangelina eventually joined. After reading about a group in Italy that completely obliterated the patients’ existing immune systems with chemotherapy first, before introducing the new bone marrow cells to repopulate the system, Kohn tried that strategy on 10 babies. “Of all the patients we treated, all have had good immune reconstitution,” he says. “Within a month or two, we start seeing cells appear in the blood that are making the missing gene. When they are six months old or so, their immune systems are good enough for them to go out and not be protected, and by age two, they are pretty stable—their immune systems are reset.”

That’s where Evangelina is now, able to finally enjoy the world outside her home and the hospital. She got her first kisses from her parents when she was 18 months old. “My worry was that I couldn’t raise my daughter without her sister,” says Padilla-Vaccaro. “Now I don’t have to.”

TIME Developmental Disorders

Why Screening Young Children for Language Delays Isn’t Helpful

language delay
Bruno Ehrs—Getty Images

Evidence to support language screening for all young children is weak

Doctors and new parents are eager to do everything they can to help young babies develop well. But the latest research shows that testing infants for signs of speech or language difficulties may not end up helping the young ones.

The U.S. Preventive Services Task Force, a government-appointed group of experts that reviews existing health and behavior data, analyzed the available studies on how effective screening for speech and language delays during infancy can be in improving children’s communication skills later. Most such screening is done by pediatricians during routine well-child visits and includes specific tests requiring parents to answer questions about their babies’ development, as well as the doctors’ own observations of the babies’ behavior and responses to verbal cues.

The task force reviewed 24 studies that looked at how accurate the most popular screening tools are. The trials involved children younger than five years old and revealed that the data is not strong enough to support using these studies as a reliable way to identify children who may have speech or language delays or who might have the early symptoms of language disorders.

The group came to a similar conclusion when it evaluated interventions designed to improve children’s development in speech and language areas. The studies showed inconsistent results and were of varying quality.

“There’s not enough evidence to say that these instruments should be used regularly,” says Dr. Alex Kemper, professor of pediatrics at Duke University and a member of the task force. “It could be that the instruments work well, and it could be that they don’t; we just don’t have enough evidence to say that all children ought to receive these tests at well-child visits routinely. We just don’t know whether or not they lead to benefit.”

In fact, the committee noted, the tests could contribute to harm, as the identification of potential problems could cause anxiety and result in time, effort and money spent by parents to address the problem. While an estimated 2.6% of children between ages three and five years received additional services for speech and language disabilities in 2007, the researchers say that many children who may be slower to develop speech or language skills eventually catch up and may not need specific services or interventions.

In his own practice, Kemper says that he employs the screening only when he or the parents of infants have concerns about a child’s language development. And that should be the guideline for other physicians and parents as well, he says—at least until stronger data can provide support for the idea of screening all infants, and for determining how to conduct the screening so that infants who need the most help can receive it.

TIME Heart Disease

Daily Aspirin May Not Prevent Heart Attacks

Aspirin
Getty Images

Taking low dose aspirin may not help people with high blood pressure, high cholesterol or diabetes to avoid a heart event

There’s a lot of evidence that taking low doses of aspirin daily can help heart attack patients avoid a second event. Aspirin’s ability to reduce inflammation and keep blood from forming vessel-blocking clots can be a life-saver. But what about the many Americans who take it daily hoping to avoid a first heart attack or stroke? The data there is more conflicting, and a large new study in JAMA published Monday suggests it may not make much of a difference.

The Food and Drug Administration recently said there was not enough evidence to support the idea that aspirin can prevent a first heart attack. So researchers in Japan decided to investigate the issue among 14,646 volunteers between the ages of 60 years and 85 years. Between 2005 and 2007, these participants, none of whom had had any heart events, but all of whom had at least one of the risk factors that could make them vulnerable, were randomly assigned to take a low-dose aspirin every day or not. They were allowed to continue taking whatever medications they were already or, or begin taking new drugs if their doctor prescribed them during the study.

Now, reporting in JAMA, scientists say that after five years, the study’s review board ended the trial when it was clear that there were no significant differences between the two groups when it came to heart attacks, strokes, other heart events or death. In that time, 58 people in the aspirin group died of heart-related causes, while 57 in the non-aspirin group did. Overall, 2.77% of those taking aspirin had a heart attack or stroke, compared to 2.96% among those not taking the drug — a difference that was not statistically significant.

MORE: A Low Daily Dose of Aspirin Can Cut Deaths From 3 Kinds of Cancer

The results add to the growing data on what role aspirin can play in preventing first heart events; previous studies showed that the over-the-counter drug was linked to anywhere between a 12% to 23% lower risk of events compared to non-aspirin use. But concerns over aspirins side effects, which include gastrointestinal bleeding, have made doctors more wary of recommending it for patients who have not yet had a heart event. Studies on aspirin in this group of otherwise healthy people are also difficult to conduct, since many people currently take multiple medications for various heart risks, including blood pressure drugs and cholesterol-lowering medications, making it difficult to determine what effect aspirin may have.

That’s why three other studies are currently investigating aspirin’s potential role in helping patients who have not yet had heart disease to avoid having heart attacks or strokes. One involves those with diabetes, another focuses on those with multiple heart-disease risk factors and the final trial concentrates on people over 70. Until those results are available, the authors say that patients should discuss with their doctors whether daily low-dose aspirin can help them to lower their risk of having a heart attack. For some, the benefits may outweigh the risks of bleeding, while for others, the side effects may not be worth the risks.

 

TIME ebola

New Ebola Treatment Filters Virus Out of the Blood

Researchers say that a new device that yanks Ebola virus from the blood may have saved an infected doctor’s life

Battling a virus is all about timing, and Ebola is no exception. Our immune systems are capable of destroying Ebola, but once in the body, the virus multiplies furiously, spreading like wildfire. Pretty soon the invader overwhelms the body’s immune system. In most cases, the virus wins.

But what if doctors could tip the odds in the body’s favor and pull out Ebola from the blood in order to give the immune cells a fighting chance? Reporting at the Kidney Week conference of the American Society of Nephrology on Friday, doctors at Goethe University hospital in Frankfurt described their experience doing just that several weeks ago when an Ebola patient arrived from Sierra Leone.

Dr. Helmut Geiger and his colleagues knew they had a challenge on their hands. They made sure the patient, a Ugandan pediatrician who had been treating Ebola patients, was hydrated and received the proper nutrients. They also tried several experimental therapies, but despite their efforts, the patient quickly deteriorated. He needed a ventilator to breathe, and as the virus ravaged his body, several of his organs, including his kidneys, failed. The medical team placed him on dialysis and hoped for the best.

MORE: Ebola Treatment Trials to Start in December

That’s when Geiger recalled reading about a novel way of treating viruses that didn’t involved drugs. Aethlon Medical, a California-based company, was testing a way to quite literally filter viruses out of the blood of infected patients. The team had been testing their device, which attached to standard kidney dialysis machines, on hepatitis C and HIV patients in India. The German doctors, desperate to help their patient, asked to test it for Ebola.

“We did not know if it was possible to retract viruses from the blood,” says Geiger. “But we knew from earlier data that viral load is directly correlated to the outcome of the patient. We thought if we could reduce the viral load through some kind of intervention, then it would be positive for the patient.”

MORE: WHO: These Are the Most Promising Ebola Treatments

Their hunch paid off. The device, called the Hemopurifier, was attached to the dialysis machine that was already filtering the patient’s blood. The specially designed filter is made of a protein that acts as glue for proteins found on the Ebola virus’s surface. Over a period of 6.5 hours, the filter extracted the virus from the blood that flows through. While most dialysis filters can pull out molecules that are less than 4 nanometers in diameter, the virus filter boasts a mesh that’s able to filter out larger viral particles that are less than 250 nanometers. That means only the virus is pulled out, and the immune cells remain in the blood, ready to fight off any remaining viral invaders.

“We had no [idea] about how much [virus] would be extracted, because this was the first patient, but I was very surprised because the drop in viral load was deeper than I expected,” says Geiger. Before the filtration began, the patient’s virus count was about 400,000 per mL blood. After the session it had dropped to 1,000 copies/mL.

MORE: The Fight Against Ebola Could Lead to Surge in Measles and Malaria

What’s more, when Geiger’s team sent the filter, which was designed to safely contain the Ebola virus it had extracted, to the University of Marburg, which has a biosafety level 4 laboratory for safely handling the virus, they learned that the device had managed to trap 242 million copies of the virus.

Freed from that viral burden, the patient soon began to improve rapidly. His own immune system began fighting off the remaining virus, and he no longer needs dialysis or a ventilator. The patient is walking and waiting to be released from the hospital.

MORE: See How Ebola Drugs Grow In Tobacco Leaves

Geiger stresses that it’s not clear yet whether the Hemopurifier alone was responsible for the patient’s recovery, since he was given other experimental therapies, but the amount of virus removed from his body and his rapid recovery after the filtration suggests that it at least played a role in helping him survive his infection.

While puling viruses out of infected individuals has never been tried before, Geiger believes it will be an important strategy for treating not just Ebola but other vial infections as well, including HIV, hepatitis and even influenza. “It’s a very interesting concept. The big advantage is that the plasma is filtered, and only the virus is removed and the other plasma components like immune cells go back to the patient. That’s important because with viral infections, the patient is in a reduced immune situation.”

The device works with most standard kidney dialysis machines, so Geiger says most hospitals would have no problem using it. And his team have worked out the mechanics of setting the blood flow to the proper levels to ensure the filter works at its best. “We have all the data that could be applied at other centers and for other users of the device,” he says.

TIME ebola

WHO: These Are the Most Promising Ebola Treatments

A laboratory technican of the company Icon Genetics prepares proteines from Tobacco plants (Nicotiana benthamiana) for weighing in a laboratory in Halle
14 Aug 2014, Berlin, Germany --- A laboratory technican of the company Icon Genetics prepares proteines from Tobacco plants (Nicotiana benthamiana) for weighing in a laboratory in Halle, August 14, 2014. Icon Genetics develop a technology to mass produce Ebola vaccine with the help of tobacco plants. REUTERS/Axel Schmidt (GERMANY - Tags: HEALTH SCIENCE TECHNOLOGY) --- Image by © AXEL SCHMIDT/Reuters/Corbis Axel Schmidt—Reuters/Corbis

Experts decide which experimental Ebola treatments to test

On Nov. 11 and 12, the World Health Organization (WHO) called the world’s leaders on Ebola to decide which promising experimental therapies to begin rigorously testing in order to fight the West Africa outbreak.

There are many encouraging candidates, from the blood of Ebola survivors to drugs that use the latest developments in genetic engineering. None, however, have been properly tested for safety or effectiveness in human patients. Some have been tested in animal models of the disease and have successfully controlled the virus, but the gold standard for any human treatment, be it drug or vaccine, is testing in patients who have been affected by a disease. Since scientists can’t ethically intentionally infect volunteers with the Ebola virus, regulatory agencies like WHO are considering moving some of these treatments directly from animal studies to infected patients in West Africa.

The committee also reviewed information from 18 Ebola patients who were treated outside of West Africa, some with the experimental therapies.

Medecins Sans Frontieres recently announced that it will host three trials of such therapies at its centers starting in December. The humanitarian aid organization will help an international group of researchers test blood from Ebola survivors, as well as two drugs—favipiravir and brincidofivir, both of which interrupt the Ebola virus’s ability to replicate and were initially developed to control other viral infections.

The WHO committee also discussed how the trials should be set up in order to collect valuable data on the treatments’ effects that will guide future treatment decisions. The process is ongoing as new data and products become available, but here’s what the committee concluded so far:

Four drugs should receive priority

The committee evaluated many different types of drugs but prioritized those that manufacturers are able to make in large amounts quickly. Drugs like ZMapp, the cocktail of antibodies that successfully treated the U.S. aid workers Dr. Kent Brantly and Nancy Writebol, are promising but only available in small quantities. Other antibody-based therapies have the same problem, as do cutting-edge treatments that seek out and bind to the virus’s genes.

The committee therefore focused on other drugs that can be made in sufficient doses to test. These include favipiravir, brincidofivir, toremifine and interferons. While there is little evidence in humans about how well these drugs work against Ebola, their availability made them good candidates to begin testing in trials in West Africa.

Anti-viral drug lamivudine is not effective against Ebola

Data presented by experts to the committee did not show that the antiretroviral drug, which is used to treat HIV and hepatitis B infections, works against Ebola. Ebola belongs to a different family of viruses than HIV and hepatitis B, and while the drug disrupts those viruses’ ability to reproduce, it does little to stop Ebola. The committee recommended that lamivudine not be used to treat Ebola; it will include a list of other ineffective treatments on its website to guide doctors caring for Ebola patients.

Three trials of blood from Ebola survivors are underway

These trials will test both the whole blood and the plasma alone from people who have survived Ebola. WHO announced that it will begin working with local health officials to establish blood donation centers in Liberia to allow survivors to provide blood for study and potential use in treating patients.

Ensuring the proper collection and treatment of the blood is crucial to eliminate other potential infections, including malaria and HIV, the committee said. It also called for a standard way to make sure that all patients receive the same blood components. That way, the trials can precisely determine which parts of the survivors’ blood are useful in fighting Ebola, and which are not.

TIME Cancer

The Cancer Breakthrough With Big Implications

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Lung cancer cell STEVE GSCHMEISSNER—Getty Images/Science Photo Library RM

Screening tumors could lead to smarter decisions about which cancer treatments will work best for individual patients

Once you’ve been diagnosed with cancer, you’re sent for a dizzying array of tests — but most of them are focused on you, as the living host of the tumors, and not on the malignant growths themselves.

That may soon change, as researchers report in the journal Science. Some cancer centers already take biopsies of tumors and run them through genetic tests, to get a better sense of what’s driving the cancer. That information can be helpful in deciding which of the growing number of targeted anti-cancer drugs will work best to stop those growths.

MORE: Promising New Cancer Treatment Uses Immune Cells

But the down side of these powerful drugs is that tumors become resistant to them relatively quickly, often within a year or two. So to find better ways of stopping such resistance from developing, Jeffrey Engelman and his co-senior author Cyril Benes from Massachusetts General Hospital took tumor testing one step further. They actually allowed some of those tumor cells — from lung cancers — to grow in a lab dish. That made it possible to throw various anti-cancer drugs at them to see how the cancer cells responded — providing a valuable window into how the tumors inside the body might react.

They found, not surprisingly, that hitting tumors with combinations of targeted drugs could effectively shut down the cancer cells’ ability to resist the treatment. When they transplanted the human tumors into mice, those given the combination of drugs saw their growths shrink, and the drugs remained active nearly twice as long as the single drug in suppressing tumor growth. The findings could help doctors to tailor cancer treatments specifically to individual patients and help them to avoid drug resistance and ultimately improve their chances of surviving their cancer.

MORE: Here’s How Well Your Genes Can Predict Your Breast Cancer Risk

“It’s a substantial step,” says Engelman of the results. “Because before we just had the genetic information but we wouldn’t have the cells alive so that we could test what types of therapies might work.”

He and Benes stress that they haven’t used their screening method yet to guide any patient treatment decisions, but hope that will happen soon. They’re encouraged by the fact that their method identified several mutations that might be driving cancer that hadn’t been known before, thus opening up the number of drugs that target these abnormalities that patients could take.

“Sometimes there are genetic mutations in genes that we can’t target [with a drug]. Sometimes there is ambiguity in genetics — we know the mutations but we don’t know what they mean, or there are multiple mutations together and we don’t know how to treat them. And sometimes we don’t know what mutations are driving the cancer,” says Engelman. But by testing the actual tumor cells against well known drugs or drug combinations, researchers wouldn’t have to know the answers to all of these questions. Instead they could cut straight to the arguable most important outcome — finding the best drugs for treating a particular patient’s cancer. Ultimately, the researchers see such drug screening as going hand in hand with genetic screening – the gene tests would identify the known mutations, and that would inform which drugs to test tumor cells against.

Before that happens, Engleman and Benes admit that more refinements need to be made in their process. Now, it takes two to six months to grow the tumor cells properly in order to be screened by the drugs. That time needs to be shrunk to a weeks or even days if doctors and patients can take advantage of the information. But they’re confident that will happen. “We know ways to cut this shorter,” says Engelman. “What’s exciting is that this technology make you think you have a real shot at getting there. And we’re going to take that shot.”

TIME ebola

Ebola Treatment Trials to Start in December

The international humanitarian aid group Doctors Without Borders will start testing three new Ebola therapies at their sites in Africa in December

The health group Doctors Without Borders said Thursday that it will begin testing three therapies it hopes will prove effective in treating Ebola, as the death toll from the disease’s worst outbreak ever surpassed 5,000 and with and with more than 14,000 still affected in West Africa.

The group, which is leading the on-the-ground care of Ebola patients in Guinea, Liberia and Sierra Leone, is partnering with researchers and clinicians who want to learn more about the most promising treatments for Ebola, so that their doctors can provide patients more than the supportive care they deliver now.

MORE: We’re getting closer to vaccines and drugs for Ebola

“We are on the front line, and when you have a disease that kills 50% to 70% of patients, then we have a certain responsibility to try to do our best to host trials for treatments in our facilities,” says Bertrand Draguez, medical director of Doctors Without Borders.

None of the therapies have been tested in the traditional way of moving through all stages of animal models and then into safety and efficacy trials in people. Instead, they are jumping from animal trials and early human safety studies in healthy people directly into patients. But given the urgency of the escalating epidemic, Draguez says, “the worst case scenario would be to not test anything.”

MORE: How Guinea found the vest way to survive Ebola

One trial, spearheaded by the French National Institute of Health and Medical Research (INSERM) will see how well the antiviral drug favipiravir fares against Ebola in Gueckedou, Guinea. Another, headed by the Wellcome Trust, will test the antiviral drug brincidofovir at one of Doctors Without Borders’ treatment centers in the region that hasn’t been designated yet. Finally, the Antwerp Institute of Tropical Medicine will look at the effects of whole blood and plasma from Ebola survivors at the Ebola treatment center in Conakry, Guinea.

Why these three therapies? Draguez says they rose to the top of the list because of a combination of their promise in controlling the Ebola virus and their availability. Other treatments, such as ZMapp, a combination of antibodies that helped at least two U.S. aid workers survive their infections, are worth studying but won’t be available in enough doses to properly test in West Africa. “We said ‘OK, even if a drug looks promising we have to start with what we have,’” says Draguez. Both brincidofovir and favipiravir also have the added advantage of being oral pills and therefore more easily given to and taken by patients, many of whom are too weak to eat.

MORE: Here’s what scientists know about Ebola in Sierra Leone

Patients at the trial sites will be asked if they want to participate in testing new, experimental therapies for treating Ebola, and will be given detailed information about the drugs and their potential risks. Any patient can refuse to participate, and his care will not be affected by his decision.

The trails will focus on how well they help patients to survive for 14 days after the therapies start—enough time, the researchers hope, to suppress Ebola’s activity and encourage the patients’ own immune systems to fight the infection and begin to clear the virus.

MORE: WHO chief says Ebola response ‘did not match’ scale of the outbreak

The trials represent an important first step in gathering critical information about how best to treat Ebola infection. To date, such data is sparse—most of the information comes from case studies, and those primarily involved supportive care such as hydration and nutrition, which are important for patients in the early stages of infection, but can’t help those who are sicker. The handful of cases involving some of the experimental therapies aren’t enough to guide doctors on proper dosing, nor are they sufficient to give physicians confidence that they aren’t doing more harm than good when they use them.

The World Health Organization (WHO) and the countries’ Ministries of Health are also working with Doctors Without Borders and the study leaders to conduct the trials. WHO also recently announced plans to test two vaccines in West Africa as well.

All of these trials are designed to finally provide some order in the house of Ebola treatments. While the goal is to turn the results around quickly—the first data are expected in February 2015—it’s possible that much of what is learned from these trials may come too late for those currently infected. But they will prove invaluable for the inevitable outbreaks that emerge in the future.

MORE: See How Ebola Drugs Grow In Tobacco Leaves

TIME Diet/Nutrition

Which Fad Diet Is Best for Weight Loss?

Researchers combed through all the available data on these popular diets and compared them head-to-head on weight loss and how well they lowered risk of heart disease

If you’re going to go on a diet, you might as well pick one that meets the most basic criteria of actually working. But proving a diet can deliver weight loss over the long term requires reliable data—and lots of it. That’s what Dr. Mark Eisenberg, professor of medicine at McGill University, and his colleagues went looking for. They scoured existing research about Atkins, South Beach, Weight Watchers and the Zone diets to find out which was most effective and which had the most scientifically rigorous proof to back up its weight-loss claims, especially over the long term. Their results were published Tuesday in the journal Circulation: Cardiovascular Quality and Outcomes.

Each year, north Americans spend more than $66 billion on these and other diets in an effort to shed pounds and keep them off. But when the scientists culled they data on these diets, they could find only 12 studies that met criteria for being scientifically sound and well designed. “What is incredible to me is that dieting is a multibillion-dollar industry, and if we look at the amount of data out there, it’s miniscule in comparison to the market,” he says. “There are very few well-done studies, and most of them look at the short term. And weight loss is obviously a long term issue.”

To qualify as well-done, studies had to involve enough people to produce statistically significant results, have a control group that wasn’t put on a diet but simply educated about good nutrition and the importance of exercise, and follow individuals for more than a year to see if the results held. “In heart-health studies, they involve thousands, and tens of thousands of people. With [diet] studies we’re talking about hundreds at the most,” says Eisenberg.

The 12 strong studies revealed that none of the four diet plans led to dramatic weight loss, and none was significantly better than the others when it came to keeping weight off for a year or more. All were effective in helping dieters to shed about the same number of pounds in the short term: around 5% of their starting body weight. Weight Watchers was more effective than average care in dropping weight, but head-to-head comparisons showed that at one year, Atkins, Weight Watchers and Zone resulted in similar weight loss on average, and that after two years, some of the lost weight was regained by people who followed Atkins or Weight Watchers.

The diets also did not result in differences in heart-disease risk factors, such as high cholesterol, high blood pressure or blood sugar levels. “We couldn’t find big differences between the different diets,” says Eisenberg.

MORE: 14 Fad Diets You Shouldn’t Try

Some of the studies he and his team reviewed included information on how much the dieters were exercising, but others did not. It’s possible that some people who change their eating habits to lose weight may also start exercising, which can contribute to weight loss—suggesting the diet alone may not be responsible for the dropped pounds.

He says that these results shouldn’t discourage dieters who need to lose weight, and suggests that since the diets produce similar results, people should find the one that’s most suited to the way they live and therefore are more likely to stick with. Weight Watchers, for example, involves a more group-based, behavior-modification approach that may be better for people who work well in groups and need some external motivation, while the other three are more centered around individuals and dependent on their own ability to stay with a program over several months. Atkins and South Beach and Zone all focus on lowering carbohydrates and increasing consumption of healthy fats and proteins.

MORE: Americans’ Diets Are Improving (Sort Of)

Given the enormous amount of money spent on diets—and the rates of obesity and type-2 diabetes in the U.S. and Canada—Eisenberg says what’s really needed is more information that can help people to make better choices about which plan is right for them, and to improve their chances of losing weight, not just for a few months but for the long term.

Read next: How to Get in Shape Using Psychology: 6 New Tricks From Research

TIME ebola

Ebola Patient in New York Is Cured and Released From Hospital

Physician who worked in Guinea urged public to refocus attention on West Africa

Craig Spencer, the physician who became the fourth person diagnosed with Ebola in the U.S., was released Tuesday after being deemed free of the virus.

“Today I am healthy and no longer infectious,” he said at a news conference.

Spencer was treated at Bellevue Hospital in New York City for just under three weeks. It’s not clear exactly what therapies Spencer received, although officials said he received “innovative, state of the art treatments” that were learned from other facilities that have successfully treated Ebola patients in the U.S., including Emory University, the University of Nebraska and the National Institutes of Health. Both Spencer and the medical staff at Bellevue, however, did also mention the importance of the supportive care he got, including hydration and nutrition fluids.

“My early detection, reporting and recovery from Ebola infection speak to the effectiveness of the protocols in place for health staffers returning from West Africa,” he said. “I am a living example of how those protocols work. Early detection is critical for both surviving Ebola and ensuring that it is not transmitted to others.”

With his parents in attendance, and surrounded by the doctors, nurses and lab technicians who contributed to his care, Spencer thanked the staff at Bellevue. New York Mayor Bill de Blasio mentioned that staffers had delivered Spencer’s banjo to him as well to help him pass the time.

Spencer, however, was eager to turn the conversation back to West Africa, where he spent five weeks in Guinea, one of the three hardest-hit nations in the outbreak that has killed some 5,000 people. “I cried as I held children who were not strong enough to survive the virus,” he said. Within weeks of his own diagnosis, he received calls on his personal cell phone from many of the patients he had cured who wanted to wish him well and offer any help he might need.

“Please join me in turning the attention back to West Africa, to ensure that medical workers and volunteers do not face stigma upon returning home,” he added. “Volunteers need our support in order to fight the outbreak at its source.”

Sophie Delaunay, executive director of Medecins Sas Frontiers (Doctors Without Borders)-USA, the group for which Spencer was working when he was infected in Guinea, echoed that message. “We could not be more proud of Craig,” she said at the news conference. “He and others [who volunteer to work in west Africa] are to be respected and honored. They protect us all. As they tirelessly care for the sick and try to stop this outbreak, it is imperative that our focus remains squarely on west Africa, the source of the Ebola epidemic. Stopping it there protects us here.”

Spencer’s fiancée, one of the four people who had direct contact with him before he was placed in isolation, remains in quarantine out of an abundance of caution as she monitors her temperature for any potential signs of Ebola. Her quarantine is expected to be lifted on Nov. 14.

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