It’s playoff time – and a reminder that brain health comes first

During the winter holidays, many Americans celebrate our culture of competition by watching football – from state high school championships to college bowl games to the National Football League (NFL) series culminating in the Super Bowl.

However, recent news regarding head injuries has spurred the greatest concerns about player safety in the recent history of the game.

As I wrote last January on the eve of the 2013 Super Bowl, “the negative consequences of football on the brain have come under intense scrutiny.”

I noted that Junior Seau, the former San Diego Charger who had committed suicide in 2012, suffered from CTE (chronic traumatic encephalopathy), a brain disease produced by trauma to the head. According to Seau’s relatives, his behavior included depression, wild mood swings, forgetfulness, irrationality, and insomnia – symptoms noted in other players who have sustained brain injuries.

These symptoms are very similar to those seen in neurological disorders such as Alzheimer’s, Parkinson’s, Lou Gehrig’s, and Huntington’s disease, which claimed my mother’s life.

I carry the mutated gene that causes HD but have so far escaped its inevitable, terrible symptoms.

Today I turn 54, an age at which my mother had already begun a steep decline. Birthdays always make me introspective and retrospective, and as I draw to a close an especially intense year in HD advocacy, professional work, and family life, I feel a special need to reflect on my concerns about HD and CTE while waxing nostalgic and a bit autobiographical.

CTE, the NFL, and a ‘public health crisis’

In August, one week before the start of the NFL season, the league settled a lawsuit brought by some 6,000 former players and families who accused the league of hiding the connection between football and concussions. The NFL agreed to pay the players $765 million and was expected to pay an additional $200 million in legal fees.

However, the settlement did not require the NFL to admit any wrongdoing, nor did it state any conclusions about football and brain injuries.

With a dispute emerging over legal fees, the federal judge overseeing the case has yet to approve the settlement.  New lawsuits filed since the settlement have increased the likelihood that the concussion issue will enter a courtroom (click here to read more).

In August, ESPN (Entertainment and Sports Programming Network) abruptly ended its relationship with the PBS (Public Broadcasting System) documentary program Frontline, reportedly because of pressure from the NFL regarding an upcoming documentary.

Nevertheless, in collaboration with two ESPN-based investigative journalists, Frontline in October aired a two-hour report titled “League of Denial,” revealing the NFL’s attempts to hide the seriousness of brain injuries from the players and the public even as physicians studying concussions found CTE in the autopsied brains of dozens of deceased players.

In early November, it was reported that several former NFL players were diagnosed with CTE. They were the first living players to undergo a new kind of brain scan capable of detecting signs of CTE.

Days later, two former college football players filed a federal lawsuit against the National Collegiate Athletic Association (NCAA), claiming it failed to inform players about the risks of concussions and demanding medical monitoring for former players.

Meanwhile, news organizations reported that Pop Warner, the nation’s largest youth football program, registered a nearly ten percent drop in participation between 2010 and 2012. That suggesets the general public had taken strong note of the dangers of football.

“There has never been anything like it in the history of modern sports: a public health crisis that emerged from the playing fields of our 21st-century pastime,” wrote the ESPN journalists, Mark Fainauru-Wada and Steve Fainuru, in an excerpt from their book League of Denial: The NFL, Concussions, and the Battle for Truth. “A small group of research scientists put football under a microscope – literally…. What the researchers were saying was that the essence of football – the unavoidable head banging that occurs on every play, like a woodpecker jackhammering at a tree – can unleash a cascading series of neurological events that in the end strangles your brain, leaving you unrecognizable.”

Common problems and goals

I am struck by the similarities between HD and what scientists, physicians, and former players have described as the symptoms of CTE. HD effaced my mother’s ability to speak and interact with others, leaving her a mere shadow of herself.

I fear the same fate.

As an HD advocate, I believe the neurological disease communities, as well as victims of stroke and traumatic brain injuries from military combat or other situations, should support the efforts to research the causes and symptoms of CTE and support those afflicted by it. Research on these various conditions is mutually beneficial. We’re all part of a larger quest for improved brain health.

Like HD, CTE involves our most important natural resource: our brains. The brain controls all that we do. It makes us individuals and provides us with enormous capacities.

Conditions such as HD and CTE can put a huge emotional, medical, and financial burden on families and caregivers. We need to find ways to prevent, treat, or cure these conditions as quickly as possible.

Advocacy in the workplace

In November, I brought my advocacy into the workplace.

When the University of San Diego (USD), where I chair the history department, announced its voluntary withdrawal from postseason football competition while it investigates a potential violation of rules regarding financial aid and athletic recruitment, I urged the administration to also conduct a review of player safety in light of the revelations about CTE.

My e-mail message led to a constructive dialogue with the athletic director, the NCAA faculty representative, and others to seek ways in which USD, fulfilling its mission of education and social justice, can inform the campus and the local community on the issue of CTE and brain health.

I hope to report progress on these efforts in the coming months.

The larger implications of sports

I have long cultivated an interest in the social, historical, and health-related implications of sports.

During my freshman year at Yale University, I helped support myself by working ten hours per week as an assistant public relations person in the university’s sports information office. I also reported and wrote columns for the Yale Daily News. One of my articles described my experience as one of the first – if not the ­first – male reporters to enter a female locker room.

In another article, a quotation from Yale’s athletic trainer, Al Battipaglia, summed up my own current philosophy about student athletics: “Vince Lombardi said winning is the only thing. Al Battipaglia recites the athletic trainer’s prayer: ‘It’s not if we win or lose, but if nobody gets hurt.’”

At the time, Yale had an extremely cautious, automatic ten-day suspension for any athlete with a head injury.

At Yale I also had the privilege of studying in a seminar on the “American sports syndrome” directed by ABC Sports broadcaster Howard Cosell, one of the most trenchant sports commentators of the 20^th century. Cosell taught us about the contradictions and hypocrisy involved in the world of sports.

Brazil, soccer, and the ‘opiate of the people’

Later, I had far less time to follow American sports as I pursued a career as historian of Brazil, with a specialization in the history of the Brazilian Catholic Church, dictatorship, human rights, and reproductive issues. Throughout much of the 1980s and 1990s, I paid more attention to soccer.

Serious injuries occur in soccer, and fan devotion and violence make our Super Bowl craze seem mild in comparison.

In the past, some political leaders have used soccer as an “opiate of the people” to manipulate the masses. This year millions of Brazilians protested in the streets against their leaders, in part because they were angry over the billions of dollars in government spending on stadia for the 2014 World Cup while public transportation and the health and educational systems remain substandard for much of the populace.

Nevertheless, in terms of the sport itself, I consider soccer as a more graceful and civilized activity when compared to the brutality of football.

Uneasy about football

Starting in the early 2000s, HD rekindled my interest in pro football, thanks to the Chargers’ commitment to the Huntington’s cause.

However, as I’ve reflected on the devastation that disease and trauma can cause in the brain, I’ve become increasingly uneasy about watching football games.

The Frontline documentary “changed forever how I will watch a professional football game – if, indeed, I can bring myself to do so again,” I wrote in my USD e-mail message.

Tracking CTE

My HD advocacy has led me to expand into the history of science, technology, and medicine. Now, with my added concern about athletes and CTE, I will add yet another layer to my advocacy, using my skills as a historian and former journalist.

I aim to track significant news reports about CTE. (Frontline has set up a “concussion watch” of officially reported NFL head injuries. So far this year it has registered 146 incidents.)

I will also monitor the continuing debate about whether football head injuries cause the condition. One worthwhile, in-depth debate about “League of Denial” took place in a published e-mail exchange between journalist Daniel Engber of Slate and author Stefan Fatsis (click here to read more).

Science and risks of CTE

As I’ve learned so well from the Huntington’s movement, effective advocacy requires understanding scientific research. Therefore, I also aim to track the science of CTE.

A number of reports and academic articles on CTE have appeared in the last few years.

The National Institute for Neurological Disorders and Stroke, a division of the National Institutes of Health (NIH), issued a brief report on its December 2012 workshop on the neuropathology of CTE. The report raised more questions than it answered, demonstrating the infancy of research on CTE and outlining a plan for sustained, coordinated research on the condition.

(In August 2013 the NFL donated $30 million to the NIH for research on CTE and other medical conditions affecting athletes.)

Other articles have warned of the potential risks of sustaining brain injuries in contact sports.

“Symptoms of CTE may begin years or decades (after one or multiple concussions) and include a progressive decline of memory, as well as depression, poor impulse control, suicidal behavior, and, eventually, dementia similar to Alzheimer’s disease,” one article states. “Given the millions of athletes participating in contact sports that involve repetitive brain trauma, CTE represents an important public health issue.… It is now known that those instances of mild concussion or ‘dings’ that we may have previously not noticed could very well be causing progressive neurodegenerative damage to a player’s brain.”

Another article outlined the history of traumatic brain injury (TBI) and its relationship to neurological decline, including cases of CTE. “The best data indicate that moderate and severe TBIs increase risk of dementia between 2-and 4-fold,” the authors concluded. “It is less clear whether mild TBIs such as brief concussions result in increased dementia risk, in part because mild head injuries are often not well documented and retrospective studies have recall bias.”

Autopsies of six Canadian Football League players with histories of concussions and neurological problems showed that three had CTE, while the others had Alzheimer’s, Parkinson’s, and Lou Gehrig’s.

Skeptics, the media, and future goals

Some scientists have expressed skepticism about the research on CTE so far.

The latest and most prominent example appeared in a special issue of Neuropsychology Review, published in November and consisting of six articles by a “distinguished panel” of scientists and also an editorial, all on the topic of sports-related concussions.

“One cannot deny that boxing and other contact sports can potentially result in some type of injury to the brain,” the two authors of one article conclude. “There currently are no carefully controlled data, however, to indicate a definitive association between sport-related concussion and increased risk for late-life cognitive and neuropsychiatric impairment of any form.”

While agreeing that CTE is an “important public health concern,” the journal’s editorial highlights the problem of the divide “between media and evidence-based accounts of sports concussion.”

While the Frontline documentary took a positive step in informing the public, it also illustrated a stark societal imbalance.

As the documentary contrasted a scene showing thousands of journalists attending an official 2013 Super Bowl pre-game media event with the handful of reporters who covered a press conference where scientists presented evidence on CTE, it’s painfully evident that sports coverage remains largely an act of cheerleading rather than skeptical journalism.

Further, sports sections of daily newspapers routinely give footnote status to most news about athletes’ injuries. Such coverage focuses on the injury as a factor in a team’s success and rarely in terms of the athlete’s long-term health.

Although the scientific articles referenced here (as well as others) differ in perspective and conclusions, one fact is clear: more research is needed, because the number of case studies of CTE still remains quite small.

A playoff party and nagging concerns

I must admit that, even after keeping the TV and radio off most of this NFL season, I listened with excitement to last Sunday’s radio broadcast of the Chargers’ overtime victory, which, against enormous odds, secured the team a spot in the postseason quest for the Super Bowl.

My family and I are planning a Chargers playoff brunch and mini-party for next Sunday morning, when the team plays in the first round against the Bengals in Cincinnati. We’re inviting friends who, like us, know the devastation of Huntington’s disease – and the Chargers’ many contributions to the HD cause.

I’m sure we’ll all root for the Chargers.

However, we’ll also be crossing our fingers that nobody suffers a concussion or any other serious injury.

Personally, I’m torn between participating in a cultural ritual and standing up for my position as an advocate for brain health.

It’s playoff time – but also time to think of how we can all make the world a better and healthier place in the New Year.

For me, that includes resuming my role as an advocate for brain health and, with the rest of the neurological and genetic disease communities, imagining a world in which CTE, HD, and other similar disorders can be fully treated and, even better, prevented.

Creating a Christmas memory for a Huntington’s family

As he slowly succumbs to Huntington’s disease, Dan Boyle of Bakersfield, CA, is building a legacy for his five-year-old at-risk son Colby to remember when the symptoms make impossible his greatest professional love: conducting music.

On the evening of December 19, with his musically inclined wife Audrey and Colby present, Dan, 45, will lead the Poway High School Band in a performance of “Russian Christmas Music,” the piece that inspired him to pursue a musical career when he played trumpet in the band in the mid-1980s.

“Every aspect of music is cool,” Dan said as we sat outside the Poway High band room this morning after he conducted a half-hour rehearsal of the song along with 175 band members. “I just want him to see this particular aspect. He can already pick up my trumpet and make a sound. He’s been to all our performances. The more avenues he can see, the better.”

A tradition more than three decades old, the annual Poway High Winter Band Concert involves band alumni in the performance. This year, because of Dan’s popularity and his struggle against HD, alumni from around the country and as far off as Japan will visit and play their instruments under his direction.

“He’s the last person in the world that deserves this, although we knew there was a possibility,” said Ron Schei, a childhood friend who lives near Toyko, referring to Dan’s diagnosis and his family’s history of HD. “It’s just a horrible, horrible thing.

“It’s a beautiful event. It’ll be important for Dan and for us. And if it leads to more awareness – most people don’t know about Huntington’s – and brings in some donations for the cure, it’ll have a positive effect.”

“They want to share that experience with him,” Sylvester Sybilski, the assistant band director, said of Dan’s friends. “That’s what I think is touching everyone’s heart: how he’s trying to create these moments for his son and videotape them so that eventually, when the disease gets the best of him, his son will have a record of all these events he’s going to be doing for the next five, ten years.”

Christmas this year has a special meaning for Dan. “Seeing how many friends are coming, it really makes you feel good,” he said.

Ron Schei (left) with friends Colby and Dan Boyle at Poway High School (photo by Gene Veritas)

The first symptoms

Over the years, Dan had garnered recognition for his musical talent and leadership. A native of Rancho Bernardo, CA, he was part of a world champion drum corps team at the University of California, Los Angeles, where he and Audrey met while both receiving degrees in music education. In Bakersfield, CA, where the couple worked as music educators, he was teacher of the year at Highland High School, and in Kern County he was named jazz educator of the year, orchestra educator of the year, and band director of the year.

However, Dan’s fate would include an encounter with HD. His mother, aunt, and grandmother all died of HD. He first noticed symptoms in himself in 2009 and received an official diagnosis in 2010.

After more than a decade of employment, he was no longer able to work. He receives a public school teacher’s pension and Social Security disability, while Audrey, 40, continues to work as a junior high school music instructor and band director.

In a typical progression of HD symptoms, Dan said that he can no longer multi-task, and his short-term memory is bad.

“Packing yesterday, there were three different times when I went to get the same item,” he said with a bit of a chuckle. “In the big realm of things, I would rather have short-term than long-term memory loss. Long-term is your real memories. Short-term is convenience.”

Fear of falling

HD is also affecting him physically. He has a still mild version of the involuntary movements experienced by most HD patients. His eyes move irregularly or sometimes seem to stare into space, and his face freezes up. He also has some difficulty in speaking.

“I used to hike and ski,” Dan said. “I was never very fast, but I hiked the Grand Canyon rim to rim back in 2005.

“I just started to feel weaker. I hadn’t gone skiing since Colby was born, and last winter we went. Before I was diagnosed, I could do the intermediate slopes. (This time) I was on the easiest slope there was, and I fell like ten times.”

He adds, chuckling, “I have no sense of balance! I think I know when to say when.”

Falling presents the biggest threat to Dan’s health. He recently needed to receive staples for a gash he suffered on his head. During our conversation, he turned his head to show me a very large, red bump on the back of his head from another fall just yesterday.

He plans to start using a motorized wheelchair soon.

Dan also suffers from diabetes caused by another genetic condition, hemochromatosis.

“I won the lottery, I guess,” he said with a laugh.

The conductor’s passion

However, HD’s onslaught has not stopped Dan from conducting again for the first time in several years. In today’s rehearsal of “Russian Christmas Music,” he sat in a conductor’s chair and will do so again at the concert.

“I conducted ever day, five hours a day,” Dan recalled. “When you teach music, you stand all day. It would never bother me, even a little bit.

“Over the last six to eight months, I have noticed an extreme shrinking of the time that I can stand without pain.”

Sylvester and band director Mike Cook are “bending over backwards” to make it possible for him to conduct, Dan said. He happily complied with Mike’s request for a taped audition.

Poway High School band director Mike Cook (left) and assistant director Sylvester Sybilski (photo by Gene Veritas)

“You can easily ruin a performance as a conductor, and because the score is an advanced score, he just wanted to make sure I could still do it,” Dan said.

Although Dan experienced some HD movements during the rehearsal, he successfully finished the piece along with the students.

“’Russian Christmas Music’ is a very challenging piece of music,” said Sylvester. “So, even for someone in perfect health, it would be a challenge. I think it went very well.”

“His mind seems pretty clear,” noted Mike, adding that Dan has “an extremely bright wit” and an “obviously still strong” sense of humor.

“It’s a pretty cool feeling to get to control all that sound at once and have it respond to you,” Dan said of the work of conducting. “I couldn’t believe I didn’t really have any good videos of me conducting. I have lots of me playing, but not of my conducting. I’m glad they gave me the opportunity to do this.”

You can watch the rehearsal in the video below.

'Russian Christmas Music' Conducted by Huntington's Disease Patient Dan Boyd from Gene Veritas on Vimeo.

Planning a future for Colby

Dan is also writing an autobiography he wants Colby to read someday. It will include fatherly advice for a young man. It will also address the family’s experience with HD.

During our interview, Colby sat next to Dan. Engrossed in a hand-held video game, Colby raised five fingers when asked to tell his age.

Like many HD families, the Boyles faced difficult decisions. Colby was born not long before Dan’s symptoms began. Even though the couple knew of Dan’s risk for HD, he had not been tested. Nor did they resort to methods for avoiding the transmission of the mutation. They preferred to let life take its natural course.

“Obviously I worried about passing it on,” said Dan. “I just figure there’s always hope for the cure. He could get hit by a bus tomorrow. I could, too. I got a scholarship to UCLA. I played trumpet in 40 of the 50 states. I’ve travelled. I’ve done a lot of good things. Hopefully he’ll be able to experience those things before whatever.”

However, Dan and Audrey are proactive about his HD. They keep informed about the latest developments in HD research. They attended the annual convention of the Huntington’s Disease Society of America in Jacksonville this year and in Las Vegas in 2012. Dan is also participating in a clinical trial to examine the efficacy of the supplement creatine. He plans to enter any other trial for which he qualifies in the future.

“I just want to make sure, whether Colby has it or not, that I’ve done everything possible to help the cause of research,” Dan said. “That’s one of my big responsibilities. When I was a kid they said, ‘Oh, you don’t really have to worry about it, because by the time you’re old enough, they’ll have it cured.’ I remember hearing that time and time again. But that didn’t happen.”

It’s never too late

For now, Dan is taking advantage of every moment.

He uses music, especially playing the trumpet, to try to stave off the impact of HD on his brain.

“There’s so many decisions every second in music,” he said. “It's unbelievable how active your brain is while you’re playing.”

He, Audrey, and Colby will spend Christmas at home in Bakersfield – preceded, of course, by Dan putting out milk and cookies for Colby and Santa Claus.

Audrey didn’t believe people still did that. “She found out the hard way,” Dan said.

“One of the silver linings of this is, because I am home for Colby, I feed him every day, I give him his bath, I wash his clothes, I do his homework with him, I read to him,” Dan said. “We have a really close relationship.”

Dan has a simple message for the HD community, one he will put into practice on December 19: “It’s easy to withdraw and just go into a shell, but it’s never too late to do some of the things that you’ve always done.”

(The winter concert, which will take place in the Poway High School gymnasium, starts at 7. The event is open to the public. Admission is $5. The band directors recommend arriving early to obtain seating. The school is located at 15500 Espola Road.)

‘Alive and Well’ captures struggle against untreatable genetic brain disorder

Watching the recently released documentary film Alive and Well this past Monday evening, I re-experienced the torrent of emotions involved in the fight against Huntington’s disease.

Filmed on three continents, the 75-minute Alive and Well takes us on an odyssey through the lives of six families affected by HD and one HD researcher whose “reason for getting up in the morning is just to do something to solve this problem.”

The stories embody the deepest fears and highest hopes of the HD community.

Alive and Well portrays the utter helplessness of HD patients in the final stages of the disease. The filmmakers visit a medical facility where several HD patients reside. Their bodies appear almost lifeless as they sit in chairs, unable to care for themselves. Their faces are half-frozen, revealing only a wisp of the personalities they once expressed.

These HD people are in a movie, but they cannot even speak their lines.

Honoring HD people, creating an advocacy tool

“Huntington disease has been described as the most devastating disease known to man, and it’s devastating because it robs you of who you are,” says world-renowned HD scientist Dr. Michael Hayden, interviewed in his native South Africa. “You lose the ability to speak. You lose the ability to communicate. Yet your perception is fine. You can perceive things around you.”

Dr. Hayden uses “Huntington disease,” the way people spell the term in Canada, where he has spent much of his career.

“The other devastating part of this is that it’s progressive,” he adds. “There is no way to intervene in the course of the illness. And what’s particularly ironic is that it’s continuous from one generation to the next.”

In their struggles, Huntington’s families provide great inspiration for humanity, “so-called ordinary people doing extraordinary things,” Dr. Hayden continues.

“If people knew the stories that are in these families with Huntington disease, these would fill books and books of adventures and sources of inspiration for the rest of the world. The stories are really profound.”

As the filmmakers say, Alive and Well is about a disease that exists everywhere but is still unknown. It’s also about human resilience.

“We made this film to honor the people who trusted us with their stories, to have this film seen by as many people as possible and to raise awareness of Huntington's disease,” says director Josh Taft, first introduced to HD by Seattle advocate Liz Weber, in a press release. “We wanted a way to share these very personal stories with compassion, strength and beauty. We wanted to create a solid tool for the community to share their stories and to be proud of.”

No regrets

Viewing the film in a downtown San Diego movie theater at a screening organized by Misty Oto of the local chapter of the Huntington’s Disease Society of America (HDSA-San Diego), Alive and Well carried me through the peaks and valleys of my own experience with HD.

My mother was diagnosed with HD in 1995 and died in 2006 at the age of 68. I tested positive in 1999; thankfully, I have yet to show any of HD’s classic symptoms. Our daughter tested negative in the womb and is today a thriving eighth grader.

In the first profile, of 19-year-old Heather Alimossy of Medford, OR, I saw how innocence is lost and life changed forever when someone tests positive for the HD mutation – confirmation that Heather will follow in the footsteps of her HD-afflicted mom.

As shown, Heather forges on in the quest to live a full life. She continues to ride her dirt bike – and she lovingly cares for her mother.

“I don’t want to regret anything,” she says, the film then showing her on a ride through the countryside.

Taking a chance

I was heartbroken by the story of Katy Bradley and her family, of Olympia, WA. Katy married Scott despite learning that his father had HD. At one point, the couple visited him in a nursing home in California.

“I knew by then, especially, what this could turn into,” Katy says. “I guess I took a chance.”

The couple refused let HD “ruin” their lives. They decided to bear children without Scott getting tested. However, without their knowing it, Scott passed on the HD gene to their son Matthew. Scott’s symptoms didn’t begin until well into his adult years, but Matthew developed juvenile HD as a toddler.

In a matter of a few years, Matthew’s symptoms worsened to the point where he was “in a constant state of seizure,” Katy says. “His brain is constantly firing.”

“Today’s it,” says Katy. “So let’s have fun today. So let’s do what we can. Let’s make muffins.”

The vignette finishes with people quietly attending Matthew’s burial. The couple’s small daughter Anna is also at risk for HD. Meanwhile, Scott continues to decline.

A very hopeful note

The other profiles in the film focus on Courtney Rifkin, a gene-positive woman shown climbing Mount Kilimanjaro to raise awareness about HD; Brooks and Dunn drummer Trey Gray, portrayed in his desperate struggle to maintain his skills after HD onset; Mandy Kipfer, a young woman who wants to start a family, filmed as she receives her HD-negative test result; and the middle-aged former NBC News war correspondent Charles Sabine, presented in his role as the HD community’s global advocate while striving to avoid onset.

I could empathize deeply with Trey, because I fear losing my ability to write. I felt terribly jealous of Mandy, although ultimately happy for her, because I want to be free from the shackles of HD. I felt strengthened by Courtney and Charles, because they refuse to give up and are willing to share their stories with the world.

During the film, I sat next to HDSA-San Diego president George Essig, whose extended family is affected by HD. He, too, was moved by Alive and Well.

“It’s been the best representation really of the disease I’ve seen on a variety of levels – physical, emotional, and in terms of the devastation,” George said afterwards, as the audience of 140 filed out of the theater.

The film features an original score plus songs from Radiohead, Pearl Jam, Fleet Foxes, and Sigur Ros. The overall effect is saddening but also upbeat.

“I would also say it has a very, very hopeful note,” George said.

HDSA-San Diego president George Essig with daughter Julia and wife Theresa at the screening of Alive and Well (photo by Gene Veritas)

Spreading the word

George added that he is “anxious to get copies out, because I think we could spread this virally as well as in movie theaters and a part of the whole education process and awareness process for the Huntington’s community.”

Alive and Well is not yet available on DVD and currently can only be viewed in small screenings, but event organizer Misty pledged to advocate for greater distribution of the film.

Alive and Well has shown in a number of other U.S. cities. Advocates can arrange for showings in their communities by contacting the Theatrical on Demand organization GATHR.

“We’re incredibly proud that Liz Weber and the team in Seattle developed this film,” said HDSA CEO Louise Vetter in a phone interview today. “There are a lot of multimedia tools to raise awareness about HD. We’re supportive of all the efforts.”

The producers aim to “bring the film to life” by encouraging HD families to share the opportunity to view it, Louise added. It’s also a way for HD community to “learn how to be alive and well with HD,” she said.

“That’s a very powerful effort,” she observed of the film’s promotion, which has relied heavily on social media. “They’ve been very committed to that grassroots effort from the beginning.”

In recent years, a number of advocates have been producing other films on the disease. Notable examples include: Chris Furbee’s just-completed, 89-minute Huntington’s Dance, chosen to appear at the 2014 edition of the highly competitive Slamdance Film Festival; Kristen Powers’ still- in-progress Twitch; and James Valvano’s still-in-progress The Huntington’s Disease Project: Removing the Mask.

(To read more on HD’s place in the news and entertainment media, click here.)

Yesterday, polio – tomorrow, HD?

Alive and Well begins – and ends – with a message of hope from Dr. Hayden.

“For each of us, we have to find our own passion,” he says at the outset. “That’s what makes life meaningful.”

We all can and must contribute, Dr. Hayden urges us.

“When you grow up in (apartheid) South Africa, you learn very quickly not to accept dogma,” he recalls of his youth in the closing minutes of the film.

Nobody believed HD existed in Africa, he adds. “Unfortunately, it’s alive and well throughout Africa.”

He recounts how, in conducting his Ph.D. research on HD in South Africa, he visited every mental hospital in the country to attempt to measure the frequency of HD among the populace.

Today Dr. Hayden is focused on the pathways to treatments that, although they may not cure the disease, could delay onset to offer people a longer life. (In 2012, Dr. Hayden became the president of global research and development and chief scientific officer for Teva Pharmaceuticals, Inc., a large, Israel-based drug firm, where he continues to promote HD research.)

“I’m really hopeful that we are going to be able to change the course of this illness,” he concludes, “and I think it’s in the near as opposed to distant future. I don’t know what ‘near’ is, but I’m convinced that with the … incredible donations of organs and blood and stories and financial support that’s come from so many quarters that we’ll be able to do something….

“Who would have thought in the late ‘50s there’d be treatment for polio? We can and will overcome this.”

A Huntington’s Thanksgiving message: gratitude for health and the ability to work

Thanksgiving, my favorite holiday, leads me to take stock of the many good things in my life.

First, I am thankful that I have not yet experienced the classic symptoms of Huntington’s disease. At year’s end, I will turn 54 – at least several years beyond the age of onset for my HD-afflicted mother. At my annual HD checkup last month, my neurologist said I was symptom-free.

After testing positive for HD at the age of 39 in 1999, I had expected to be incapacitated by now. Doctors and scientists still don’t know enough about HD to explain why someone like me has remained asymptomatic beyond the parent’s age of onset. As I have written in the past, I keep striving toward a well-informed strategy for avoiding onset.

I am thankful for many of the other reasons people celebrate Thanksgiving, especially family. My HD-free daughter is a thriving eighth grader, and next month my wife and I will commemorate 21 years of marriage.

This year, I am particularly thankful that, without the symptoms that typically disable HD people, I can still perform my job as a university professor.

The financial burdens of HD

This past Monday night, attending our local HD support group’s annual holiday potluck, I saw once again how Huntington’s causes the involuntary movements known as chorea and inexorably robs people of their cognitive abilities, severely hampering their capacity for work.

As a result, HD devastates families financially. When an HD-affected breadwinner loses his or her job, family income falls dramatically.

Other family members often must reduce their own work hours to help care for the sick individual. In some instances, they change occupations to adjust to care needs. They might even quit salaried work altogether.

As the story of caregivers Mike and Raima Fernald illustrates, local and state government assistance in such situations is sorely lacking. The HD community also has fought to improve access to Social Security benefits, denied to many because outdated government guidelines don’t account for HD’s cognitive and behavioral symptoms.

In the case of my parents, HD wiped out their “golden years.” Instead of enjoying retirement, my “HD warrior” dad became my mother’s full-time caregiver from the mid- 1990s until her death in 2006 at the age of 68.

Instead of trips and time with their grandchildren and friends, they struggled together to address my mom’s decreasing ability to walk, talk, and eat. In the last six months of her life, they spent several thousand dollars per month on nursing home care.

“HD is more than a disease,” I wrote as my heartbroken father precipitously lost his own cognitive abilities in the wake of my mother’s death. “It is a destroyer of families.”

One thing I fear most about the inevitable onset of my own HD is that it could put my family into a similar financial bind. Both my wife and I work full-time, and my salary currently accounts for more than half of our income.

“What if I become disabled before my daughter finishes college?” I frequently ask myself. “What if my wife must work many extra years to compensate for my lost income? What if I become a burden to my family?”

Happy to be busy

News reports about the needy at Thanksgiving remind me of the troubling backdrop to the holiday: the anemic state of our economy.

As a local radio report noted yesterday, “food stamp cuts that took effect this month will make Thanksgiving even harder for low-income San Diegans. A typical Thanksgiving meal will cost the average family nearly $50 this year, which is far beyond reach for the nearly half-million people in San Diego County who struggle every day to put food on the table — especially the 270,000 people who depend on food stamps for meals.”

So this Thanksgiving I am grateful that I can work, help support the household (including our daughter’s private school tuition), and save for the future. I’ve also enjoyed the present with family vacations and home improvements such as my just remodeled home office, which replaced a rickety and ugly setup persisting from my days as a frugal graduate student and starting assistant professor.

This year, I’m thankful for the health that has allowed me to have a highly productive year at the University of San Diego, where I am wrapping up my fifth calendar year as department chair. It’s been especially busy as my colleagues and I search to fill an exciting new position in the history of science, technology, and medicine.

With the gift of being asymptomatic, I’ve also maintained the pace of my HD advocacy, with major trips to Iowa in August and to the World Congress on Huntington’s Disease in Rio de Janeiro in September. Until today I’ve written 26 blog articles this year, my second-highest annual output since starting At Risk for Huntington’s Disease in 2005.

This is article No. 27, written with a deep sense of gratitude for the gift of life, family, and health – and the hope of effective treatments and a better future for the entire Huntington’s community.

Braving bioethical challenges: the importance of Huntington’s disease

Huntington’s disease, one of the first conditions for which a predictive genetic test was developed, spotlights the psychosocial ramifications of the Genomic Era.

In addition to the profound impact of HD on people’s health and social well-being, the difficult decisions involved in genetic testing have created new ethical challenges.

Over the past few decades, the rapid advance of medical and scientific research has caused ethics – our standards of right and wrong and the study of those standards – to expand into bioethics.

Bioethics is a vast topic. Georgetown University, for example, has an entire library dedicated to research on bioethics, and a number of other universities have centers dedicated to the subject.

Biomedical innovation puts bioethics into a seemingly constant state of flux.

The passage of the Genetic Information Nondiscrimination Act of 2008 (GINA) and the Affordable Care Act of 2010 (Obamacare) are two prominent examples of how society has sought to adapt to new biomedical realities and ethical consequences. GINA seeks to protect individuals from new forms of discrimination made possible by advances in genetics, while Obamacare aims to make health care more inclusive as it undergoes profound transformations.

HD families like mine have lived on the frontier of bioethics, often constructing new, personal solutions to the predicaments posed by the disease.

Understanding our contribution to this historic process helps us appreciate our part in the overall effort to combat disease.

New tools, new challenges

I addressed the topic of HD and bioethics at the invitation of the graduate program in bioethics at the Centro Universitário São Camilo, a private Catholic college, in São Paulo, Brazil, during a presentation on September 21.

About 50 people attended the event, including at least a dozen members of the HD community and also Dr. William Saad Hossne, the program’s founder, described by one writer as “the guardian of bioethics” in Brazil. Started in 2004, the program was the first of its kind to receive official sanction.

Gene Veritas speaking at the Centro Universitário São Camilo

Focusing on how the new “tools” of medicine and biotechnology have deepened our understanding of human biology, I explained how my family braved three predictive tests in just five years: my mother’s confirming test for HD in 1995, my own gene-positive result in 1999, and our daughter Bianca’s negative test while still in the womb shortly afterward.

All of these tests brought potentially fatal news: a positive test for the HD mutation meant a 100 percent chance of developing the untreatable disorder.

“Because Regina and I wanted to have children, I also had to think about whether I wanted to get tested,” I told the audience, speaking in Portuguese.

Rather than following my initial impulse to get tested immediately after learning of my mother’s results, I waited for several years. As I explained to the audience, my mother’s geneticist had warned me of the possibility of discrimination by my employer, health plan, or insurance companies.

As demonstrated by the discussion around GINA, discrimination has become a major concern of bioethics.

The risks in having a family

“I did the test, and, unfortunately, I tested positive for Huntington’s,” I continued.

I showed the audience slides illustrating the varying number of CAG repeats (part of the “alphabet” of our DNA) on the huntingin gene. People normally have 10-26 CAG repeats on this gene. An expansion of the gene to 40 repeats signals that a person will develop HD. The tests for both my mother and me showed 40 repeats.

Research shows that the higher the number of repeats, the earlier the disease usually starts, with juvenile onset HD becoming possible if the repeats exceed 80, although even fewer repeats have caused this form of the condition.

Because of the instability of the HD-afflicted male’s huntingtin gene in the reproductive process, he can pass on a much higher number of repeats and possibly trigger juvenile HD.

“Having a family becomes like the Way of the Cross,” I said with pain in my voice. “In our case, because we wanted to have a family – and that’s why I got tested when I did – we faced a third test. First my mom’s. Then mine. Then a third one: of our potential child.

“A low number of repeats: no possibility of having the disease. As the number of repeats rises, the possibility of the disease increases…. The more the repeats, the earlier the disease manifests itself, to the point where five to ten percent of the cases are juvenile Huntington’s.”

I pointed on the slide to a picture of Olivia Ruggiano, a 12-year-old girl who died of juvenile HD in 2012.

“In my case, with 40 repeats, I could pass on to another person 45 or 55,” I continued. “There’s a case where a father has 50 some repeats and the children have 80 or 90 repeats. That’s when juvenile Huntington’s happens.”

Very serious questions

I then delved into the heart of HD and bioethics as I had not done before in such detail in a public presentation.

“A family that faces that situation is suddenly confronted with two very serious questions,” I said. “If they are thinking of the possibility of aborting the fetus, at what number of repeats would they abort? If you’re a couple with the father carrying the gene and the mother gets pregnant, and you’re afraid that the child could have the gene, you can test the child in the uterus to see what type of gene it has, whether it’s normal or abnormal. If it’s abnormal, you can know exactly how many repeats it has.

“And that’s where a question of bioethics is forced upon people. Are you going to have that child – or not? Are you going to face a situation of death at the age of nine or 12? Or are you going to end the pregnancy?”

I explained that, living in California, Regina and I faced the additional burden of raising a potential child without familial support. My father dedicated himself to caring for my mom back in my home state of Ohio, while Regina’s parents lived in far off Rio de Janeiro.

“How would Regina be able to care of me, a sick person in his forties or fifties, and also a child with symptoms or dying early?” I asked, pointing again to the picture of Olivia.

“These were the questions we dealt with and reflected on as we embarked upon the pregnancy,” I observed. “Today there is a method for avoiding that question, with the implantation of healthy embryos. In 1999, that technique didn’t exist. The only way was to get pregnant, then test.”

Fighting on other fronts

The day our geneticist called with the news of Bianca’s negative test in the womb was the happiest of our lives to that moment.

The next slide in the presentation showed two pictures: one of Regina, our gene-negative baby Bianca, and I together in the hospital the day of her birth, another of me clutching our “miracle baby” close to my face.

That terribly difficult and drawn-out part period forms just one part of our journey with HD.

As I pointed out to the São Paulo audience, HD families live the reality of bioethics in numerous other ways: by combatting the stigma and discrimination associated with the condition, negotiating intra-family conflicts arising from the disease, advocating for new and controversial treatments like stem cells, struggling to obtain various kinds of insurance, facing financial ruin, and dealing with the lack of care facilities and personnel specialized in HD.

Sadly, I also reminded that audience of the high rate of suicide among HD-affected people. Euthanasia is another bioethical issue that comes into sharp focus for HD families.

Emotional testimony

After my 85-minute presentation, the audience offered commentary and questions for another 50 minutes. The emotional testimony from members of HD families and the poignant questions from the audience further underscored the seriousness of the bioethical issues surrounding HD and confirmed their global nature.

One man in his 30s cried as he recalled how his sister, who has the involuntary movements typical of HD, was called a “drunk” by the children at her 12-year-old daughter’s school.

A middle-aged woman told how her brother, a computer programmer, lost his job after his performance declined significantly. Despite his obvious cognitive difficulties and aggressive behavior, two telltale signs of HD, both a caseworker and government psychiatrist working for the Brazilian social security system denied him public benefits.

“The psychiatrist said he was able to work and had no problems whatsoever,” said the woman, who quit her job to care for her brother at home.

The family appealed the decision, but was denied again. They have sued in an attempt to obtain benefits.

At the last hearing in August, held before a federal judge, the caseworker, still unaware of how HD symptoms are manifested, asked whether the HD man drank alcohol.

At my talk, the HD man’s sister referred to government doctors handling the request for benefits as “ignorant” and “stupid.” The case is still pending.

“I’m angry and worn out,” she said, adding that she is attempting to bring the case to the attention of the Brazilian media. “We need help.”

I noted that in the U.S., HD advocates are working towards passage of a federal law to oblige the Social Security Administration to remedy a similar situation in which an inaccurate, outdated definition of the disease has kept many afflicted individuals from obtaining assistance.

Proactive involvement and the hope of treatments

Another, more positive area of bioethics involves participation as subjects in research studies and clinical trials. On this front HD people, gene carriers, untested at-risk individuals, and other family members are taking a proactive approach to contributing to the search for treatments and a cure, usually in a context of high bioethical standards.

Ultimately, allowing HD patients to manage their symptoms with effective remedies, or perhaps someday even curing the disease, will obviate many of the bioethical challenges, although new ones surely will arise – for example, as gene-positive people clamor to try untested drugs.

Our community can and should continue to show leadership on these issues.

For now, as I concluded my presentation, “It’s time to conquer Huntington’s!”

(The many Brazilian readers of this blog can watch my presentation and the Q & A in the videos below.)

 


A Doença de Huntington e a Bioética: Um Estudo de Caso from Gene Veritas on Vimeo.

A Doença de Huntington e a Bioética: Debate sobre a Palestra de Gene Veritas from Gene Veritas on Vimeo.