Hi Reddit! I'm Dr. Ellen Vitetta, biomedical scientist and professor of immunology. I design vaccines. AMA!

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Jenny McCarthy should take an immunology course. Vaccines are the most effective way to protect against deadly diseases. Prevention of disease is ALWAYS far better than treatment. Vaccines don't cause autism, although some people do have mild side-effects. These side effects are due to your immune system and are a good sign. People who claim that vaccines are bad simply don't know what they're talking about. In my mind, the question is really how early to start vaccinations in children, and there is some controversy in this area. For example, it could be argued that vaccines given too early are not as effective on the developing immune system, and could predispose a child to allergy (although this too is controversial). A much bigger problem, though, is all the anti-vaccine hype in the media, which causes parents to wait far too long to vaccinate their children (or not vaccinate at all)... this puts their children at huge risk of infection.

Most memorable project... probably the one that everyone said wouldn't work, and then I proved did! Scientists are notorious nay-sayers, until something is accomplished, and then they say it was obvious anyway! :-)

Jenny McCarthy in an immunology class would be started with "Well, I read online that..."

The one good thing about people like her is that they annoy scientists who know better, so we go on reddit to answer questions. In addition they force us to find better ways and time to communicate with the public. Every cloud has a silver lining!

How close do you think we are using immunotherapy to effectively treat cancer? Thanks!

We're already doing it! and there are 100's more immunotherapies in clinical trials. The challenge is not treatment but cure, of course. And that is going to involve better methods for early detection.

When might we get to see needle-less vaccines?

We already have them in the form of nasal sprays (influenza) and sugar-cubes (polio). Trans-dermal patches are not far away. It may be possible in the future to put vaccines in food!

Science is awesome!

and EXPENSIVE!

Is there a benefit to a needle-less vaccine other than people are big babies and don't like to get shots?

One of the biggest problems with vaccination is compliance. People don't like needles for themselves or their kids. If one did not have needles, compliance would be much higher and our population would be better protected. Scientifically speaking, introducing vaccines into the dermis is a highly efficient way to immunize due to the presence of cells called Langerhans cells. So, it should be possible to give lower doses as well. I am a big fan of this approach for both reasons.

This may or may not be related to the breakthrough you're working on (I know very little biology), but if two antigens share a similar physical trait but are otherwise dissimilar, is it possible to develop a vaccine that will create antibodies that target that specific trait?

YES! Come work in my lab and I'll show you how. :-)

I thought the principle about antibodies is that they attach to foreign antigens. If there are two pathogens that are different in shape then how would a vaccine be able to prevent them from doing the same thing?

I'm an immunologist as well. Antibodies recognize very very specific portions of pathogens or pathogen parts. So if two dissimilar pathogens, let's say bacteriums, both possess this tiny similar portion then that's all an antibody needs to tag it, even if they look and behave completely different.

Agree!

Thanks for doing this!

If you had to pick one of the current bleeding-edge projects in immunology as being the one most likely to lead to knocking another killer disease out of mass circulation, which one would you pick and why?

My crystal ball is at the cleaners, but I think that personalized medicine in all fields of disease will have the biggest impact on human health and well being in the near future. There is no longer any reason to believe that one-size-fits-all when it comes to treating or preventing disease. Many of the breakthroughs will come from understanding genomics, proteomics, and harnessing this information to determine how to handle each individual based on his or her risks, predispositions, and responses to therapeutics.

Could you elaborate on your concerns with the "ethics in scientific endeavors"? I may not know much, but aside from the whole "vaccines are bad for you" train of thought that some people have, what ethical issues do you typically deal with?

There is too much pressure on scientists to publish in order to get funding and promotion. I've been seeing an increase in the incidence of scientific fraud as funding dries up and grants become more competitive. Therefore, they often will take shortcuts in reproducing their own experiments, publish too early, or cherry-pick data to support their claims. This wastes money and time, since others can't reproduce their work, and this gives false hope to the American public. If nothing else it is better to be thorough and honest rather than famous.

Is science becoming too politically correct? Too privately funded? or a combination thereof.

No, not really. The problem is that federal funding often goes to the more "trendy" science, as opposed to translating discoveries that could have huge impact on disease. Private funding is not an issue--if anything, LACK of private funding is a problem. It's really hard to get private pharma to fund anything that doesn't have an immediate and measureable fiscal payoff.

Do you think there could ever be another "plague" that we couldn't find a vaccine to quickly? If so, what traits would that disease have to make it so resilient?

Yes. I think plagues will be constantly emerging, and there is good evidence to support this view. There are many reasons it could be resilent-- it could kill quickly, be airborne, compromise the immune system that's needed to destroy it (a la HIV), it could rapidly mutate such that each vaccine becomes ineffective, etc. The key will be to identify emerging diseases as quickly as possible to isolate the causative agent and to have an effective method to generate a vaccine. The vaccines should be stable, scalable, and rapidly deployable. We are making progress. In today's world, where people can be in China one day and California the next, emerging diseases are a plane-ride away.

Any tips for a layman trying to counter the lunatic fringe anti-vax movement? I'm always seeing crazy articles like this one popping up, and I'm not knowledgeable enough to counter it. They're always a Gish Gallop of inane, unscientific quotes, and there just isn't enough time in the day to go through and try to make sense of why they're nonsense...

I would point out that there is no advantage for scientists or pharma or government to lie to people about vaccines. Vaccines, if you pull a big-pharma financial statement and look at it, are not big money-makers. In fact the government often has to FIND and PAY companies to make vaccines AT ALL, because they're not otherwise profitable. By contrast, the people who trash vaccines are generally benefiting from the media exposure. That's the best non-science argument I can make.

In general, if a vaccine has been approved by the FDA and used in the population for several years, you can say it is safe. There is always the possibility that in 30 years your ear will turn purple and if/when that happens the vaccine will be withdrawn.

How deep is the crisis in the lack of federal funding for scientific research?

The crisis is enormous. We are losing a whole generation of new scientists and we are shelving an entire generation of seasoned mentors. Our government needs to get its act together before our profession goes down the rabbit hole.

What makes viruses so much more difficult to find a vaccine for?

Their high rate of mutation and rapid spread through our highly geographically-mobile society. Also, isolating the causative virus to MAKE a vaccine in the first place can take time, while the virus continues to mutate.

Do bacteria not mutate? Or just not as fast as a virus?

Most bacteria mutate less often and in a different way than viruses. Most often, they develop drug resistance. However, if you are able to vaccinate against them in the first place (against bacteria, which CAN be vaccinated against), drug resistance would become a non-issue. This is part of what I find so exciting about vaccines! If you prevent the infection, you don't have to deal with all kinds of downstream problems!

So with HIV/AIDS being a virus how are we able to combat it so well now? Does it not mutate like other viruses?

Left unchecked, all viruses mutate. The biggest problem with HIV is that it grows in the very immune system that you need to combat it, and therefore is more devastating. We still cannot vaccinate against HIV because of the many mutations and different substrains that exist. This is true of many different viruses. With regard to HIV, what we CAN do is treat somebody who is already infected and thereby turn this into a chronic as opposed to an acute disease. This has happened because of the many anti-viral drugs which have come onto the marketplace over the last 20 years. Did I interpret your question correctly?

And the flu, how do we have a flu vaccine. Isn't it a virus?

Yes, it is a virus. Each annual flu vaccine in fact contains 3 flu strains. however, you have to give this vaccine every year because next year the strains may be different or may be the same with additional mutations. Therefore this year's vaccine may not protect against next year's virus.

How do they know which strains will be most prevalent each year?

I thought I answered this...but it did not seem to get posted. In essence we keep a close eye on strains emergency from countries like China. As it becomes more clear which ones will move around the world, decisions concerning which strains to use in the next vaccine are made. Often we get it right...sometimes we don't. That is why we need a universal flu vaccine.

Yes, you did. How do these antivirals work? And do they have antiviral concoctions for other viral infections as well?

They target different pathways in the cell necessary for viral replication and production. By using mixtures of these agents you avoid the problem of a single mutation in one pathway getting around the drug, because there is a backup inhibitor in another pathway. This is why we call HIV drug-regimens "cocktails." Cocktails are finding their way into treating other viral infections as well. My guess is that just like mixed chemotherapies for cancer, we will soon be using cocktails for all chronic viral infections.

One last question regarding this an I'll be done. With the flu vaccine we give people flu viruses I'm assuming to try and boost the immune system to be able to fight it. Why can't something similar work with other viruses like HIV?

It would likely work against that one strain. However there are so many strains of HIV out there all at once that the one you encountered probably wouldn't be the one vaccinated against. In contrast the annual flu strains are more limited and therefore vaccine will protect against this year's strains.

As an aside, trying to convince the FDA to immunize people with dead HIV took a long time.

If you could make a cocktail of ALL possible HIV strains on the planet, kill them thoroughly, and use that as a vaccine, it could work. Theoretically. The holy grail in this field is to find a molecule that is shared by ALL strains of HIV so that one vaccine would protect against all of them.

Finally, if you ask 100 immunologists this question, many would argue that you need something called "T-cell immunity" and that no combination of dead viruses will ever do the job.

I was in the Navy and I got my smallpox vaccine around early 2008. Is it really good for 10 years, and is it worth getting it again in the future?

Smallpox vaccinations can last a lifetime and often do. The smallpox vaccine isn't used anymore in the American population... however the military still uses the vaccine because of the chance of smallpox being weaponized. So if you're out of the Navy I wouldn't worry about it, but if you are still in and it is offered, I would get it (not that you'd have a choice) because it will boost your protection.

I'm out now. I've had way too many vaccines already. I still think the TB shot is the worst. Even compared to the burning Anthrax vaccines.

What is the most painful vaccine in your opinion?

Anything that goes into your muscle with a needle is more painful. It can cause inflammation in the muscle which can last up to two days. That said, sometimes your immune system causes fever, malaise, and aches, and that isn't much fun either. The good news is your immune system is working!

Have you always wanted to make vaccines?

No. My interest in vaccines is a fairly recent one, based on connecting the many dots of immunology into a bigger picture. The more you see the big picture, the more you realize what we are missing in terms of developing effective new vaccines (broad immunogenicity, relationship between auto- and useful-immunity, etc). As I realized this in my own field, I decided to get involved in this very translational type of research. It's terribly tedious and complicated but it's exciting and has a HUGE payoff if you get it right. I'm trying!

I've seen many scientists, when given their own labs, end up spending most of their time in management and grant-writing rather than actual research -- is this because there is a ceiling for seniority in research that they have no choice but to move into management?

The more senior you get, and the more people and projects you are responsible for, the more fundraising and administration fall on your head. Therefore, many senior scientists rarely get into the lab, because they are too busy keeping the ship afloat rather than seeking out new ports. Especially nowadays, even junior scientists who should be in the lab full time are spending much of their time raising money and trying to handle increasing administrative burden.

Can this work be realistically be offloaded to management specialists so that scientists can do more science work?

Some of it can...but you need to write the grants and do the administrative work to higher the management specialists...to then manage the hiring of more managers...:(

Dr. Ellen Vitetta, SOMETHING IS WRONG WITH THIS SYSTEM! Do you think many scientists could be persuaded to join an institution with less prestige but more opportunities to do science rather than management?

Yes it is. In my view (and just about everybody's) we need MORE Federal funding, a serious paperwork reduction act, fewer compliance courses and more scientists than administrators. When I entered this profession, administrators worked for scientists... Now it's the reverse. We scientists are terrified of litigation... And lawyers are getting rich.

I really don't think that the institution matters. There are just too many government agencies making too many rules. Ther are too many expensive and time- sucking lawsuits. We need to infuse some common sense into our government and into our science policy. Scientists have little time to THINK and be creative these days. Personally... I think that the tail is wagging the dog. Our government works for US , not the reverse. If you agree with me, contact your reps in Congress. Our constitution starts with "We the people"...

I am currently going to graduate school for my PhD in Immunology, and I am a woman. Do you have any advice for a woman in such a male dominated field?

Keep your eye on the ball and don't let people derail you with sexist comments or anything that makes you waste your time obsessing over the fact that you're a woman. In the end, your good work will shine through. Be careful before you say "yes" to serving on committees and giving lectures, because every committee/course/group in biomedical science "needs a woman." Nobody is keeping track of the number of times you say "no." So take care of yourself and be as productive as possible, first and foremost. When all fails, humor is hugely helpful! :-)

In your career and field, what kind of progressions would you like to see by the end of your career?

Two things. First, I would like to see more interactions between basic and clinical scientists and far less time-sucking compliance. By the end of my career, I would like to see many things, but the first that comes to mind is to promote science more--locally, nationally, and internationally. We are wasting too many hours and too many dollars on administration, compliance, politics, and egos, and not spending enough time solving problems.

What would you say to those who choose not to vaccinate their children?

What would you say to Adults who choose to not get vaccines?

They are both making big mistakes based on a lot of misinformation and hype. Side effects from vaccines, when they occur, are trivial compared to the diseases they prevent. Would you rather have a headache for two days for be sick with flu for 3 weeks? Remember too, that if you don't get vaccinated, you risk more than disease in yourself. You risk spreading it to other people as well, and this is very selfish.

What do you think will be the next big breakthrough with vaccines?

With all humility, I think I may be working on it. The idea is to make vaccines that are broadly protective against all strains of a pathogen (e.g. a vaccine against ALL strains of influenza or HIV) by using entirely safe synthetic structures.

How much of a risk is it that viruses are becoming more resistant or immune to vaccines?

Virtually any virus can mutate in the population to evade a previous vaccination. The key will be to develop vaccines against conserved structures that cannot mutate. I don't think the problem is necessarily getting worse, but that we are becoming more aware of it as we develop more and more sophisticated vaccines.

How long do you think it will be before we have this type of vaccine?

It all depends on funding (and how well it continues to work). Right now I'm trying to raise money for my broken mass spec! Go figure.

However... if I had all the money in the world AND it continues to work, I believe I could have it done and in clinical trials in 6-8 years. That said, these predictions are very difficult to make. Sometimes things take longer than you think... occasionally you have sudden breakthroughs.

Aside from cancer, what major ailment/disease seems the most daunting from a research perspective?

Alzheimer's and other brain disorders. In general, as we live longer, and are not as susceptible to infectious diseases because of vaccinations, we will be dealing more with "diseases" of the elderly. i.e. wear and tear on organs, degeneration of mental capacity, etc.

many hospitals have mandatory flu vaccination policies to protect patients. what do you think about health care workers who refuse vaccination because it conflicts with their religious beliefs? from 1-10 how stupid do you think that is?

I think if it conflicts with their religious beliefs, that is their belief and should be respected, but they should find another profession which does not conflict with their religious beliefs. Remember that if they get the flu they will spread it through an entire hospital population of already sick patients. A key feature of religious freedom and tolerance is not to force the consequences of your religious beliefs on others.

This. I understand people have religious concerns towards everything from vaccines to blood transfusions, to teaching evolution, but why in the holy hell would you become a biology teacher/doctor/nurse if you aren't prepared to put your religious beliefs aside for the well-being of those you assist in your job?

Like when a bio teacher refuses to teach evolution to a class or a nurse refuses to get a vaccination, I can only think to myself: "Really? You entered a field that included subjects/practices you failed to agree with and didn't see any problem continuing in that field all throughout your educational history?" I'm glad you understand how ridiculous this can be, and this AMA really is great. /end rant

Humans never cease to amaze me! We all do odd things...and I do not exclude myself !

Hi there, thanks for taking the time to do this AMA and for all your thorough answers. What sort of ethical considerations/limitations do you take into account when developing a new vaccine?

One more question, and I'm sure you'll get asked about this more than a few times since it's a hot button issue on reddit, but what can be done about the resurgence of diseases in the wake of the claims of people like Edward Hooper or Jenny McCarthy? Obviously we need to simply keep educating people and continuing to push forward with vaccination programs, but is there anything else that you think we should be doing?

Most of the ethical considerations involve the clinical trials in humans. You must acquire enough safety data in animals to be convinced that you are not going to cause unacceptable side-effects in humans. You must also be willing to design your trial whereby you start with very low doses and gradually escalate, watch every vaccinated individual carefully for a period of time (usually a month) and make sure you are DILLIGENT about following your protocol.

Second question--How to answer that? You are right, education is everything. We all know that people love conspiracy theories or feel that the medical profession is hiding things from them. I think it becomes the responsibility of every scientists to COMMUNICATE effectively with the population, rather than hole up in our labs and ignore the fact that people are social creatures and need interaction. By building trust amongst researchers, physicians, and the population at large, I hope that this problem will... go away...

Thanks for your answer. It seems that effective science communication is really vital skill, yet remains one that's sorely undervalued by far too many scientists. Vaccine researchers, climate scientists, evolutionary biologists, (list continues forever!) would all benefit significantly, and so would society, from more effectively being able to communicate the importance of their work the general public.

I think what's really lacking isn't the 'science' part of the communication, rather it's the ability to frame the information in an emotional context that deniers and naysayers find palatable.

I agree. Just because you're a good scientist doesn't mean you're a good communicator, or have time to communicate. However, as the federal funding for science decrease, scientists are going to have to make the importance of their work more understandable to the general public. The public is ALSO responsible to make their priorities known to their legislators so that more of the federal budget is allocated to scientific research.

What was your dream job coming out of college?

To do exactly what I'm doing now, but with lots more funding and lots less compliance!!

Where can I send funding to?

It depends on what you want to support. Virtually every disease has a society that collects donations for research. For example, the American Cancer Society. You can also give money to a University or a specific investigator. But in my own view, the best thing Americans can do to make sure that science is funded is to contact their representatives in government and tell them that this is a priority! Until our government's funding priorities get untangled, science funding will continue to be an enormous problem. We scientists MUST get better at communicating our needs to the American Public; that's why I'm sitting here, typing on reddit! Go SCIENCE!

Hi Dr. Vitetta. You were my wife's mentor a few years back (Kimberly). She still speaks highly of you. But I need dirt. Do you any good stories about her?

Oh yes. The first time she went into the mouse room, she fell off the chair and fainted! Her partner carried on and the experiments got done! Say "Hi" to Kim for me. I hope you are both well! :-)

Ha! She told me that, but we have friends reading this. She's doing well. I'll tell her to drop you a note to update you.

Now tell everyone about your epic Halloween costumes!

Okay! Trinity in the Matrix. Dorothy in the Wizard of Oz. A Prisoner of Compliance (with a bona-fide striped prison suit from Huntsville)... and others not appropriate for mixed company. :-P

Is it true that mercury and other harmful things are put into vaccines? If so, why?

In the past, yes. Less so now. These agents were/are used as stabilizers or preservatives. As we acquire more knowledge and information, nasty things are no longer added to vaccines.

Just think, who knew that cigarette smoke was harmful 50 years ago? Who knew that trans-fats in foods could kill you? Changes happen as we learn more. Hindsight is always 20/20.

Hi, I am female and want to be a Professor in Conservation Biology. Just finished my undergrad and about to head of to grad school. What's the best way to make a positive impact on this world with this career goal? Sorry for the vague question, but any advice would be appreciated!

Try to ask important questions and to design thorough and well-controlled experiments. Interpret the data honestly and objectively and make sure that you can and DO repeat everything. Write your papers carefully and clearly, and send reprints to every living person you know. Finally, realize that things fail 9/10 times, so suck it up, move forward, and enjoy your successes when they come!

How would a vaccine for a Biosafety level 4 pathogen go through human trials?

I don't know a lot about vaccines or whatever, but would that just not happen?

The FDA requires safety testing of the vaccine in humans, and efficacy testing in 2 species prior to approval. It is not necessary for one of those species to be human for the challenge tests when it comes to the types of pathogens and toxins you are talking about.

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In the aspect of my work that involves clinical trials in humans, I work closely with them. In my basic science research, rarely.

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When new experimental drugs or vaccines are being tested, it is very important for the scientist to have strong interactions with the pharmacy to make sure that the storage and use of the drug follow protocol and if any strange things happen that they are communicated to the entire clinical trials group. Sometimes a simple observation by a pharmacists about the appearance of a drug that has been stored or thawed prior to administering it to the patient can change an entire clinical trial.

Where did you go to undergrad at? Favorite fruit? What did you want to grow up to be, when you were 10?

I graduated from Connecticut College. My favorite fruit is Rock Hudson. A scientist or vet.

Hi, I'm 15 and still unsure of what I'd like to do after school, but creating vaccines is something that has always interested me. What made you want to develop vaccines? What subjects should I study in school that would help me to pursue such a career?

Hi Clara! Vaccines are exciting because they prevent diseases, which is much better than having to get sick and then try to cure being sick. To me, as an immunologist, this is a great thing to study because it has immediate benefits for the Human Race. It also combines my interests in medicine and basic science!

As far as your future is concerned, take whatever courses fascinate you and develop your brain. Obviously you'll want to take a variety of science and math courses, but don't let that become your whole life. The key is to study hard, do as well as you can, be enthusiastic, and go well beyond the minimum requirements. Try to interact with your teachers, read lots, and stay healthy. Good luck!

Thanks Dr. Ellen you are a true heroine! Science and science education is the future.

Thank you. But heroine ....not so much. I am just one of the many scientists on this planet who work hard, love what I do and sometimes get lucky!

How close are we to a treatment for multiple myeloma? I've read that immunologist in Australia have been developing a monoclonal antibody treatment with great success in the lab, could this be a viable cure?

Advanced MM is indeed a difficult disease to treat but life can be prolonged with steroids, thalidomide, and bone marrow transplants. Several monoclonal antibodies are being tested now and results are encouraging but early.

Lets hope that a cure is not far away.

I am from Mumbai, India.

How can I improve my immunity against cold infections? I seem to have cold throughout the year.

I am taking a tab everyday for allergies but it hasn't helped much

Your "colds" are probably allergies to some very common allergen like dust mites. That might be why you have "colds" year long. You should go to your doc and get tested. Once s/he knows, you can be desensitized. In general, all other things being equal colds can be avoided by not touching your face with your hands, good sanitation, staying out of crowds, regular healthy eating exercise and sleep (Nothing new there!)

I did go to an ENT doctor. My allergy tests revealed allergies to dust mites, dog dander, rice, garlic and certain shell fish.

Since the past 6 months I have been taking Mondeslor tablet (Desloratadine 5mg Montelukast 10mg) and Sompraz 20 (for acidity). I have also been taking a Nasal spray.

I haven't really seen major changes.

Another thing I observed is if I drink alcohol even at normal temperature, my sinuses get clogged and my nose starts dripping badly. This used to not happen a few years back.

Any suggestions besides the obvious ones about good sanitation, diet, exercise and sleep?

As I said you have allergies to things that are present all year and therefore think that you are getting colds. You are likely just having constant allergic symptoms. Besides taking anti-histamine and steroids, you should consider de-sensitization. On another note, get a new bed to protect from the gazillions of dust mites that you spend the night with. Stop eating garlic, give your dog away and avoid anything for which you test positive. Many people do this with good results. Alcohol generally makes allergies worse because of its effect on the vasculature. Sometimes you are even allergic to ingredients in wine! Its not simple but if you are willing to do the testing and rid your environment of the allergens you will improve.

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Molecular mimicry has both positive and negative sides. Obviously, one could end up mimicking a self protein...this is always a problem with both vaccines and infections. I think that many autoimmune diseases have both a genetic component and a trigger. The trigger could be an infection, or a wound that releases self-antigens.

There are many immunologists who worry about this effect of certain adjuvants. In answer to your to wit: yes this is possible, immunologically speaking. BUT, I do not know of any data that bear directly on it. This is just the kind of thing that we immunologists/vaccinologists/cancer-immunotherapists think about all the time.

PS--back to YOUR grant writing too. Good luck!

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Agree with you!

Hi Ellen, I have two questions:

1. Do you have any advice for an college senior (graduating in a month) who is hoping to pursue research as a career path?

2. When she was your student, did you have any idea that Linda Buck would be as successful as she turned out?

Thanks! (from a fellow NESCAC undergrad)

1. Think twice. It's a hard slog, particularly in the current funding environment. In thinking ahead, try to pick something where you know there is a job at the other end in the event that the NIH money-tap doesn't turn back on. Some good fields are Biomedical Engineering, Bioinformatics, MD/PhD tracks, and environmental sciences.
2. No. The things that really distinguished Linda Buck from most of my students were her endless and often incessant questions (she followed me to the ladies room multiple times, but NOT to use it) and her incredible determination and stamina.

All my students are very smart. But this is not enough. It takes hard work, determination, curiosity, the ability to deal with failure, and laser-like focus. PLUS a lot of luck. Linda had/has all these things. Therefore it is hard to predict who will capture the brass ring. I hope you're enjoying the beautiful spring weather in NE.

Hi Dr Ellen!

In your opinion, besides the ones already almost wiped out like polio, what is the next disease that will become totally cured like smallpox?

Years ago I remember reading about "patches" where the vaccine is absorbed slowly through the skin. If such a thing exists, why are we still using needles? Or is it simply impossible to administer certain vaccines and meds except directly into the bloodstream?

BTW I find your work inspiring. You and all your colleagues are the true heroes of modern humans. Keep it up.

Thank you I will convey your kind words to the study-section reading my grants! Indeed, transdermal or intradermal vaccinations are extremely effective. It is my hope that someday all vaccinations will be given this way. Conversion from needles to patches is a slow process (and some people/agencies are resistant to change).

It's possible that the approved HPV vaccine or some modified form of it will wipe out cervical cancer.

Personally, I'd like to see hepatitis and herpes wiped out, and this should be possible with vaccines, if we can get the money to develop them. In the future it would be nice to identify and vaccinate against all cancer-causing viruses or pathogens that lead to chronic infections. Such chronic infections could cause seemingly unrelated diseases later in life such as autoimmunity and (maybe) Alzheimer's.

How close is the medical community to actually finding a cure to cancer

There are many, many types of cancers, and so the challenges with treating them are also diverse. There are several cancers that we can already cure, and many that we can treat effectively to prolong life. However, until we understand all the causes of different cancers and can detect all of them very early, it remains a difficult problem. THIS IS WHY WE NEED TO INVEST IN SCIENTIFIC RESEARCH!

But you can't CURE cancer. You KILL it.

Yeah! If it's dead, you're cured!

However, in all seriousness, what normally happens is that you don't eliminate every last cancer cell, so the goal is to have the patient "outlive the cancer." That is, have them live long enough that they die of something besides cancer. One of the things we scientists are interested in is creating a state of cancer-dormancy where the few cancer cells remaining are kept in check by either your immune system or other mechanisms.

Or nanites. Nanites could just detect cancer cells and eliminate them. Also, it's not that far off - nanites have been used to deploy medicine in a cockroach! Just a few more years, BOOM! A plague of nanites that cure all diseases!

Well, that's a little optimistic but I'd imagine that it'd be amazing. SPREADING immunity! Imagine!

Sounds cool. When it works, let me know!

You mention women in science, but I haven't seen any questions on it. I have a few.

What changes have you seen in promotion or discrimination regarding gender over your career?

What can female scientists do to promote or encourage women to reach the peak of their field?

What advice would you give to women transitioning from the role of a postdoc to the role of a PI/mentor? Do you have any tips or tricks on how to be as ambitious/hard-ass/confident as male counterparts without being perceived negatively? In 2014, is that even a concern on the level that it might have been in the '70s/'80s/'90s?

1. Things are slowly improving. Men and women are entering grad. and med. school in the U.S. in equal numbers. The real bottleneck now is getting women to the top levels. There are many reasons for this bottleneck... some involving the women themselves. Many women simply don't want to march into battle each day. Also remember that even though discrimination is more subtle now but it has not gone away. We women have to focus on our goals and not on the things that could de-rail is.
2. Mentor...mentor...mentor. Network and interact. Talk to and support your trainees but don't baby them. Spend time with your female colleagues discussing your concerns/solutions and theirs.There is strength in numbers!
3. Its always a concern...that has not changed. There are no tricks. Believe in yourself and work hard to achieve your goals. Smile and BE confident when you know what you are talking about. If you don't, go and find out. Don't be a pleaser (as many women are). Be fair but tough and straightforward. The more successful you are, the less you will care about the negative perceptions of others. That is THEIR problem, not yours. Men don't seem to mind being called tough or hard-assed. Why should women? Think about that...

Thanks for the answer, that's all solid advice! On the third point, I absolutely agree. The real problem as I understand it is that "Men of a Certain Generation" sometimes think that when a woman is a hard-ass, they're instead being "bitchy" and when they're confident, they are "stuck up", etc. Well, making it generational is unfair to young sexists, but you get the idea.

Thanks for doing the AMA, and thanks for being a strong woman in science. I know I've met at least one, and I think a few, of your "science granddaughters" (i.e. mentored by someone you mentored.) At least one of them was really helpful to my wife during her PhD and if your mentoring was part of that, I owe you. So thanks again.

Bitchy and stuck up are just words. Ignore them and move forward!

If your son had a choice of going into software development or biology/chemistry, which would you advise and why?

As with many professional choices, it depends on what kind of lifestyle he envisions for himself. For example, scientists who do bio/chem must work virtually all the time these days, and under a great deal of pressure. And funding is very short. My understanding of software development is limited, but it seems obvious that there will be many more jobs available.

Thank you for doing this, and for your patience in answering all that you have.

You're most welcome... now I'm back to grant writing and rebutting reviewers!

in reality how far away are we from seeing a vaccine for HIV?

Obviously we dont know. Like everyone else, I am hoping that it will be soon. The challenges and expenses are enormous...

Hello...there is a lot of controversy about the safety of vaccines. Claims of links to autism and other health problems from taking them. Some contain thimerosal and other things that I don't necessarily want in my body. What's the truth behind these claims? Are vaccines safe?

Thanks for taking time to answer questions!

Hi! I understand your concern. People are often very careful when choosing what to put in their bodies, as they should be. In the case of autism, this link has been debunked. Yes, there are chemicals in vaccines to keep them stable and immunogenic but these additives are being constantly refined and evaluated for safety. In my view, a short-term side effect from a vaccine formulation trumps getting the disease.

Thanks or the reply...it's not the short term effects but the long term effects that concern me. For instance, taking a vaccine year after year will build up these toxins in your body. And then years later neurological problems appear with no "explanation".

This is of course, possible. Nothing is 100% risk free, but rather a series of trade-offs in which we evaluate what we know and what we don't know. However, again, I believe preventing a serious disease (which itself has long-term consequences) trumps the possibility of a side-effect 40 years downstream. If and when we prevent all infectious disease by vaccination and people live to be 120, there will likely be some long term effects from additives, vaccines themselves, and so on. But the fact is we live longer WITH vaccines, than without them.

Hi, do you have anything on the design board that pertains to the CBD cannabidiol?

No, I'm focused on our new vaccine platform, and there is only so much that any one laboratory can do... well.

Medical student here!

Are we at all close to using bacteriophages as a therapy for MDR/XDR-TB, MRSA, etc.?

Thanks for your time!

Its still experimental but a worthwhile avenue of research. Of course it would be used AFTER one is infected. Quite honestly a vaccine against the causative pathogens is a much better way to go in my mind.

Do you do any work on self immune disorders, do you ever see a time we can cure diseases like Rheumatoid arthritis by a vaccine or something else that alters the immune system.

It's complex but I believe it will happen eventually. Immunomodulators are all the rage now! There is also a great deal of progress in understanding the molecular basis of many autoimmune diseases. Understanding brings new ideas and strategies to treat, cure and prevent.

Why do they cause autism!?!?!?!

Nah I kid. Thank you for your work.

:)

Don't thank me...call your reps. In Congress to keep us funded! Spread the word.

Dr. Vitteta, It's so great to see your words! I was an employee at the med school where you work and had the opportunity to see your lectures. (AV Department geek here) You are a great teacher and I know several of your graduates-they agree with me. I have a 16 year old daughter now who is interested in science and medicine. What can I do or better yet what can we avoid doing to keep her interest in the sciences alive? BTW you let me hold a Harvard mouse once. I believe that is what they are called-a mouse without an functioning immune system. Poor little guy.

Well thank you and good luck with your daughter! That was a NUDE mouse...not a Harvard mouse. Yes, its hard being a mouse with no T cells AND no fur!

Hi Dr. Vitetta!

I am currently a biomedical engineering undergrad and have been working in a systems biology lab for the past two years. The post-doc I have worked under this entire time has just left our lab, and now I am working on my project all by myself. Unfortunately, it seems like everything in my experiments that could go wrong has gone wrong. It has all been extremely discouraging, especially now that I have no one to give me advice or to serve as a mentor, and I'm starting to freak out a little. My question is, what advice could you give in regards to not going completely crazy when your research project/experiments doesn't/don't go according to plan?

By the way, all of the answers you have given so far are awesome, I am nerding out just a little...or a lot :)

Hi there! YOU are much to young to freak out just now. Yes, Murphy was an optimist. What you need is another mentor. Talk to you PI and explain that you need some guidance in writing and implementing your protocols. If s/he wont provide it, find someone in the program who will. Obviously you are not yet at the point where can work completely independently. It takes time...and that's fine. Research is complex. Its fine to admit that you are having problems. Now go find some help!!

What kind of diet do you eat? I never hear or know what doctors eat.

Don't assume that doctors eat any better than anyone else!! Some do and others live on donuts and peanut butter. I happen to be a vegan and chocoholic who occasionally indulges in seafood. I rarely drink alcohol..perhaps 1-2 glasses of wine a times a month. Most importantly I exercise and try (usually not very successfully) to keep my stress levels low....that is my biggest challenge.

Thank you for the response, Doctor. Are stress levels important to keep low primarily for the inflammatory response - or is it a different factor that adversely affects you?

Stress causes MANY problems. Immunologically speaking, it raises our cortisol levels. Cortisol suppresses the immune system so you become more susceptible to infections. It also shortens your telomeres so you age faster. The list goes on. In general stressed-out people have many health problems. If you can avoid or decrease the stress in your life it is a GOOD thing!

I know Lyme disease, especially spirochetes a are difficult to vaccinate due to their extremely adaptive enzootic cycle. As someone who lives in a Lyme prevelant area...how close are we to developing this vaccine?

Read this: http://www.historyofvaccines.org/content/articles/history-lyme-disease-vaccine There WAS a vaccine and it was withdrawn from the market. Most people think that there will be little impetus for a new vaccine. I am not so sure.

What do you believe the chances of a "super flu" wiping out humanity are? Reading a book called The Stand at the minute and it deals with the topic of a rapidly developing super flu that wipes out most of humanity so I am curious!

It is of course possible. However, its likely that even if a superflu emerged, some people would not become infected. Even if it were to happen, we would hope that either an old, new, or cocktail of viruses would work as a vaccine to partially or fully protect people.

I have heard that, since they have found a way of treating HIV, they have considered giving it to cancer patients so the HIV kills the cancerous cells and doctors can then treat the HIV. Is this true?

Its a work in progress using HIV as a "vector". Thats all I know about it. I seriously doubt that anyone is giving an infectious virus!!

Hi, hopefully this AMA is still ongoing:

I'm due to graduate with a degree in Biomedical Science in July this year and was wondering if you had any tips to possibly help break into my career? Everywhere seems to be asking for experience, but I firstly have to get registered with the HSPC (uk). Also, what's a typical day on the clock like for you?

Thank you :)

My advice would be to get as much training in the best settings that you can. Interact with lotsa people and read until your eyeballs fall out. My typical day? Think endless....lots of hours.. Maybe 80 per week....Some tedious, some fun. I deal with experiments, funding issues, personnel issues, (increasingly with ) lawyers and administrators, students, fellows, faculty, teaching, writing, reading, committee meetings, traveling,lecturing, etc. Now and then I eat, sleep, see my family, play with my cats and water my plants. The one thing that is sacrosanct is exercising! I am also compliant with my annual physicals and COMPLETELY up on my vaccinations.

What do you think about the FDA making 23andme stop their genetic health risk info and their new requirements for them to start it back up?

I liked 23and me and hope that they will start it up again. However, I do understand the concerns that some people have. Its a complicated ethical issue...at least for some people. When they have hashed out all the objections, it will likely return in some guise.

I understand some people misread it but since I only have half of my familial history it would like to know things to look out for, but I can see how it would cause some hypochondriasis and over sensitivity.

Exactly!

I hear a lot about the next coming pandemic, like spanish influenza back around 1918. How likely do you think there will be something like this and what time frame? Also, do you think the world is ready for something like this and its effect?

Highly likely. Scientist now accept this fact. The question is how to best deal with it. Identifying new and "recycling" pathogens in the world's population in real time is key. We must also speed up the way we generate protective vaccines as quickly as possible. I hope that we are up to the challenge!

I was told that through future research, could re-form keratin cells and fight "the balding" gene through vaccine injection. Would you pose this hypothetical theory crazy? or subtly possible..? As a male who is starting to bald, this interests me greatly..

Crazy and not crazy. Balding is a complicated issue, not helped AT ALL by testosterone. I am not an expert in hair follicles, but I would not be surprised if we could delay balding (or indeed anything else) but either ramping up, or damping down the immune system. Who knows.. The nice thing about being a scientist is that you can usually test even the craziest theories and sometimes actually find something interesting.

What do you think of the idea going around that research should be less hypothesis-confirming and more discovery-driven? This concept came up in a research course and I am wondering how that shift would impact immunology.

Hypothesis and discovery are, in my view, equally important. Many times we hypothesize X and find Y. Sometimes Y leads to Z and Z refutes, agrees with or totally changes X. The key is to think hard, test hypotheses rigorously and be OPEN to discovery even if it is the opposite of what we hypothesized in the first place. Scientific research is a life-long work in progress.

I've always wondered about this. How many antigens and T cells and APCs are present in our body? How is it that our body creates a sense of self antigen or how does it determine what to create a response against and what not to? There are so many things coming inside our bodies, do we really have that robust of a response?

Literally millions! The answer to your question of self-tolerance is LONG and complex and requires knowing quite a bit of immunology. The short answer is that our cells are educated NOT to attack self tissues since APCs present a universe of self antigens. There are also suppressor cells that prevent these responses in "uneducated" cells. Recently it has become appreciated that cells of the innate immune system have receptors for conserved structures on pathogens. Once these cells recognize these structures, inflammation occurs. Inflammation= danger. The immune system then wakes up and goes on the warpath. As you know, when this whole system gets messed up, autoimmunity occurs. That's a very oversimplified answer, but the best I can do in 3 minutes.!! You might want to read about self-tolerance...its really fascinating.

Are hybridomas being used for anything other than pathogen testing? Could it be possible to control gene expression or direct cloning through hybridomas? It seems there is so much potential and the immortality of the cells is very interesting! Is the main problem the lack of termination?

Hybridomas are used to generate monoclonal antibodies. These antibodies are then purified and used to develop a variety of agents used in laboratories world wide. They can be used as diagnostics, and therapeutics. Pathogen testing is only one application. To terminate the cell lines, you just freeze them down!! In essence they are biological factories.

The cancer used in hybridomas are specific to plasma cells, is there any talk of using other cancers to make hybrids for other uses?

Thanks for answering! I didn't know you could freeze them to stop, I just imagined they went on forever and ever lol!

Yes they are immortalized hybrids between malignant plasma cells (myeloma cells) and cells making a specific antibody. Other cancer cells have indeed been immortalized by a variety of methods. ..and some just grow on their own for many,many generations. These cells are used for a variety of purposes in research. As you likely know frozen hybridomas can be thawed and grown when you need them again. We have recovered frozen cells after more than 20 years In liquid nitrogen.

If there is a chance to completely eliminate a whole (dangerous) disease by vaccines - would there be some ethical reason not to do it, e.g. because it would eliminate a species of viruses that are not able to communicate with us?

I imagine it would/will be possible to develop vaccines that target cells of other humans instead of bacteria/viruses - let's say sperm cells - would it be ethical to refine this to a point that you can be vaccinated against having children with known gene defects? What about a vaccine against the sperm of only one specific person? Or a group of people? Don't want a daughter? Just train your immune system to kill any y chromosomes...

Every field of science, almost without exception can be used for evil or unethical purposes. That is why we care so much about ethics. Overall we try not to eliminate microbes that do no harm. But of course we can develop vaccines to alter good things as well as other bad aspects of our lives.. Think alcoholism, obesity etc. There are many such experiments going on. Where it all lead remains to be seen.

Just remember that developing a vaccine is only step 1. It has to be patent protected, and licensed to a company. The company needs to carry out advanced clinical trials and THEN to receive FDA approval. Finally, and perhaps most importantly in a "reality- check sense"there has to be a market to recover the $100 million R&D cost and THEN make a profit. Lots of issues besides science. Look at all the trouble that the HPV vaccine had getting through the ethics firewall. Things are complicated..to put it mildly..

After over a decade, millions of $ in research,2 clinical trials in human volunteers, a patent trail and out-licensing our ricin vaccine it has not yet reached the finish line in the National Vaccine Stockpile! Let's hope that my bottle of champagne will not be salad dressing by the time it is:)

Thanks for the answer, I'm just thinking about the ones that actually DO harm. Could there be unintended side effects (other than the intended one of fewer human deaths) to e.g. making polio go the way of the dodo? Are there studies in that direction or is everybody just happy that some disease is (practically) gone?

Well, after all it's just a random thought that crossed my mind after you said in the opening post that you are especially concerned about ethics and are on the other hand actively working in a field that (I assume) has the ultimate goal of eliminating whole species of microorganisms.

When in YOUR life have you seen "everybody just happy"?Everything we do in science has possible concerns and... even if rare... Downsides. That us why we must be vigilant, and constantly re-evaluate what we are doing.

My ethical concerns relate to doing honest and reproducible research, respecting our peers and not misleading the public with breakthroughs that are "not", taking credit due to others, and hyping things that are untrue. I am also concerned that all living creatures ( from cockroaches to humans) be treated humanely and with respect in research and medical practice.The list goes on...

I have a question about the swine flu immunization in 1975. I did get it and later noticed a slight numbness in two fingers on both hands. Only later I read that it was possibly related to Guillain–Barré syndrome. Did the vaccine just trigger an auto immune reaction in some people? Am I more likely to react to newer flu vaccines or was there something specific to that vaccine that caused problems? Thanks and sorry for being so late to the party.

The cause of this autoimmune disease (GB syndrome) is thought to be the result of molecular mimicry. In other words you make antibodies against a pathogen (by infection or vaccination) and these antibodies also attack peripheral nerves causing neuropathies...tingling, numbness and rarely paralysis. Since 1976 there is about 1 case per million vaccinations. Indeed I had tingling fingers following my 1976 influenza vaccine and this went on for nearly a year. Fortunately it was only annoying and it disappeared. I have gotten the flu vaccine every year since then and it never happened again. So that particular flu virus (swine) induced a transient immune/autoimmune response.

Just realize that this can happen when we are infected with influenza as well. So yes, there is a risk.

On the other hand, I have not had influenza since I got my first flu shot. (Once you have had severe influenza, you never want to get it again)!!

Molecular mimicry is unpredictable and can, in theory, happen with any infection/immunization.

Why do you believe media hype has so much more sway in public opinion over peer reviewed double blinded controlled trials?

It's kind of the same reason advertising/profit-driven media is so popular and of such poor quality--people love controversy; hard-science journals are challenging to understand and often boring to the average reader; scientists don't get involved in the dialogue after they publish, and nay-sayers are generally charismatic entertainers.