News feature: A few good scientists
Researchers who have no financial entanglements with companies are a rare breed. Given that, asks Meredith Wadman, is the push to police conflicts of interest realistic?
News Feature: Revolt in Bethesda
Lynn Gerber was an idealist when she first arrived at the US National Institutes of Health (NIH) as a college student in the summer of 1962. Gerber wanted to work in “the world’s most exciting laboratory” where future Nobel Laureate Marshall Nirenberg was doing ground-breaking research on protein synthesis. Today Gerber is chief of rehabilitation medicine at the NIH Clinical Center, where researchers from the agency’s 27 institutes conduct trials. Gerber says that overall, her 32-year career at the NIH has been exciting and rewarding, thanks to a supportive environment. But what was once a collegial atmosphere has been tarnished by new policies that have left the agency’s staff, including Gerber, disheartened. “I’ve lived through every administration since [President] Carter,” she says. “But fundamentally, I have not experienced so much change as now.” From 1998 to 2003, the NIH adjusted to growing pains that accompanied a massive expansion, which effectively doubled its annual budget. In May 2002 it also gained a new director, Elias Zerhouni, filling a post that had remained vacant for more than two years. Zerhouni had made a name for himself at Johns Hopkins University, where his work on advanced imaging techniques led to 157 peer-reviewed publications and eight patents. But at the time of his appointment, few basic researchers knew of or trusted him (Nat. Med. 8, 311; 2002). Zerhouni’s tenure has, perhaps by chance, coincided with one of the most turbulent times in the agency’s history. The NIH has been under near-constant fire from the media and the government, with allegations ranging from financial improprieties to sexual misconduct. Scientists there have also been under much tighter control of the administration. “After the arrival of Dr. Zerhouni three years ago, there was a lot more apparent distrust for the judgment of scientists,” says Hynda Kleinman, chief of cell biology at the National Institute of Dental and Cranofacial Research. “Everything from travel to meetings to being on editorial boards was questioned.” Demoralized by the soured environment, some senior researchers such as Kleinman are deserting the NIH after long careers there. “The atmosphere is punitive, very restrictive now and a lot of our time has been spent talking about the changes instead of science,” says Derek LeRoith, who was chief of diabetes at the National Institute of Diabetes & Digestive & Kidney Diseases. After 26 years at the institute, LeRoith in September begins work at the New York–based Mount Sinai School of Medicine. “The bureaucracy has become overwhelming,” LeRoith says, “and the atmosphere has just gone very negative.”
Direct orbital manometry in patients with thyroid-associated orbitopathy.
PURPOSE
To determine orbital tissue tension and orbital compartment compliance in patients with and without thyroid-associated orbitopathy (TAO).


DESIGN
Prospective case series.


PARTICIPANTS
Orbits of patients with TAO (18 orbits) and control patients without TAO (35 orbits) were studied.


METHODS
An orbital manometer was designed to directly measure orbital tissue tension in patients undergoing ocular or orbital surgery.


MAIN OUTCOME MEASURES
Tissue tension was recorded before, during, and for 5 minutes after a 5-ml retrobulbar injection of anesthetic. Orbital compliance was calculated as change in volume divided by change in tissue tension.


RESULTS
Resting orbital tissue tension was 4.4 +/- 2.2 mmHg (mean +/- SD) in normal orbits and 9.7 +/- 4.8 mmHg in orbits of TAO patients (P = 0.0005) Following retrobulbar injection, orbital tissue tension rose to 12.0 +/- 3.6 mmHg (P = 0.0000000000000006 compared with baseline) in the control group and to 36.3 +/- 15.2 mmHg in the TAO group (P = 0.0000007 compared with baseline, and P = 0.000008 TAO group versus control group). Orbital compartment compliance was 0.80 +/- 0.50 ml/mmHg in the control group and 0.27 +/- 0.21 ml/mmHg in the TAO group (P = 0.00001). Resting orbital tissue tension in 8 TAO orbits with compressive optic neuropathy was 12.4 +/- 4.9 mmHg, and was 7.8 +/- 3.5 mmHg in 10 orbits of TAO patients without compressive optic neuropathy (P < 0.05). No adverse events occurred.


CONCLUSIONS
Retrobulbar injection causes consistent measurable changes in orbital tissue tension. Orbital manometry safely demonstrated higher orbital tissue tension and lower orbital compartment compliance in the orbits of TAO patients versus those of normal subjects. Resting orbital tissue tension was higher in the orbits of TAO patients with compressive optic neuropathy than in those orbits without. Compressive optic neuropathy may partially result from an orbital compartment syndrome in some patients with TAO. Directly assessing orbital dynamics in vivo may prove useful as an adjunct in the clinical evaluation of patients with TAO and other orbital disorders.