18th January 1998

Your Health

In search of a cure . . .

By Dr. Sanjiva Wijesinha

"The common cold" observed my old friend Bertram the other day, as we sat enjoying a coffee and a chat, "is a lot like parliament. You see, sometimes the Eyes have it and sometimes the Nose."

I have recently discovered that there is another similarity between colds and parliament - they both cost an enormous amount of money. In the US, for example, the annual cost in lost wages and productivity was estimated by Time magazine last month to be ten billion dollars!

The problem with colds is that they are almost impossible to prevent and since they can be caused by hundreds of different germs from various viral groups, discovering a single vaccine is not a feasible option.

Recently, however, some good news on the cold front has come from a research group led by American paediatrician Dr. Richard Turner of the Medical University of South Carolina. Instead of trying to do a frontal attack on all these cold viruses, they went for a different tactical manoeuvre - by resorting to a little camouflage that would in effect hide the nose from its attackers.

Over the past few millennia, myriad cold viruses have evolved a variety of different methods to infect the cells that line the inside of the nose.

But research has shown they all use the same 'gateway' on the surface of these cells, a protein molecule termed ICAM-1, to gain entry.

The theory behind the latest research has been that, if one could flood the nose with decoy ICAM-l molecules, the real viruses could be prevented from attaching to the cells.

With the development of genetic engineering, it has become possible to build an artificial ICAM-1 molecule similar enough to the real thing to use as a decoy. This decoy molecule has been named BIRR 4.

Dr. Turner's group recruited 177 volunteers who agreed to catch a cold for the noble cause of medical research. Half the volunteers (the test group) had their noses sprayed with BIRR 4 solution while the other half (the control group) were treated with a simple spray of saline.

None of the volunteers were told to which group they had been assigned.

To test whether the spray was effective, all the volunteers were deliberately infected by placing droplets of active rhinovirus into their nasal passages.

After a few days about two thirds of the control group and half of the test group got ill - but those who had been pretreated with BIRR 4 suffered only a little discomfort, most of them reporting only a mild case of sniffles .

Dr. Turner was quick to point out that we still have a long way to go before we can start talking about a "cure" for the common cold. There are still a lot of questions to answer - for example, BIRR 4 has only proved effective when it has been given at an early stage of infection, but most of us are not even aware that we are coming down with a cold until a few days after we have been exposed. And since colds for the most part are relatively minor problems from which almost all of us recover without too much trouble, any company that manufactures a "cold-preventing drug" will have to prove that their cure will not be worse than the disease itself.

Says Dr. Turner, "In our small study group we didn't see any side effects - but if you have to give it to a million people, you may find a different answer."

There may be a place for a cold preventing medicine for patients who are prone to severe asthma or obstructive lung disease (emphysema) where colds can sometimes trigger life-threatening breathing difficulties. Or for working parents, who can take a sniff of BIRR 4 when their children come home with a cold. Or for cricketers who cannot miss an important match - or even for politicians who cannot miss an important vote in parliament.

Of course, there is an important difference between the common cold and today's parliamentarians.

A cold cannot change from one side to the other.

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