Xenotransplantation Pigs and Humans What is xenotransplantation? History of . . . Statistics Biological Concept of . . . Ethical Issues of . . . Where are we going with . . . Works Cited Photos Cited (picture) http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825 Rebecca Lewis Frontiers in Biology

What is Xenotransplantation? Xenotransplantation refers to the practice of transplanting, implanting, or infusing living cells, tissues, or organs from one species to another. Xenotransplantion is hoped to help fill the dire need for organs and to possibly completely alleviate the need for human organ donors. Pigs and primates – mostly baboons and chimpanzees – are the animals most often used in medical experiments concerning Xenotransplantation. Pigs are what scientists hope to use as organ donors while the primates are used as substitutes for human patients. Picture - http://www.liberation-mag.org.uk/0413.jpg Notes – Ravelingien, A, F. Mortier, E. Mortier, I. Kerremans, and J. Braeckman. “Proceeding with Clinical trials of animal to human organ transplantation: a way out of the dilemma.” Journal of Medical Ethics. 30.1 (2004) : 92-6

History of Xenotransplantation 1682 – Bone from a dog was used in Russia in an attempt to repair his injured skull. This attempt was reported successful, but the Russian had the bone removed soon after surgery under threat of the church of excommunication. Late 1800’s – Frog Skins were often used as a way of healing burns or skin ulcers by grafting said skin directly onto the patient’s skin. One British Army surgeon was known to have claimed using this procedure a plethora of times with good results. 1905 – French Surgeon grafts kidney tissues from a rabbit into a child, the child died two weeks later 1920 – Doctor Serge Voronoff transplanted tissues from the testicles of monkeys into older men, claiming that the procedure brought sexual rejuvenation. Among his patients was the famous poet William Butler Yeats. The idea of combining human an animal parts is not a new one. Ancient Greeks were known for stories with beings such as centaurs and fauns, while Egyptian gods were represented by human torsos with the head of one type of animal or another. There are still stories about cross species animals such as the jack-a-lope in modern day folk lore and early freak shows were known to take different parts of different animals and sew them together for their audiences to view. However, the earliest know attempt of using this “cross-species” idea for medical purposes is cited in 1682. Picture - http://www.scienceandsociety.emory.edu/GMO/Xenotransplantation_files/image002.jpg Notes – Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6. Sci/Tech at BBC News. “The History of Xenotransplantation” http://www.viewingspace.com Aug. 1999.

History of Xenotransplantation 1963-4 – Thomas Starzl grafts baboon kidneys into six patients. The patients only lasted between 19 and 98 days. 1963-4 – 12 patients received Chimpanzee kidneys , however, most failed within two months of the surgery, though one did live for nine months, the longest time for a xenotransplantation patient to live up to this date. 1964 – A 68-year-old man dies two hours after receiving a Chimpanzee heart. 1969-1974 – Chimpanzee livers were transplanted into three children. They only survived between one to fourteen days. 1977 – A 25-year-old woman receives a baboon heart but dies only six hours after surgery. About the same time a 60-year-old man receives a chimpanzee heart to assist his own heart, but dies four days after. Xenotransplantation attempts did not pick up again until the late 1900’s and since then has maintained a steady interest in the scientific and medical world. Although there have been many attempts on both the young and old, none of the patients have lasted for a significant amount of time. Up to date the longest living patient of xenotransplantation was nine months. Whether the patient is young or old doesn’t seem to have much, if any influence on how well and/or long the patient lasts. Picture – http://www.nature.com/nm/journal/v6/n11/images/nm1100_1195_I1.jpg Notes - Notes – Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6. Sci/Tech at BBC News. “The History of Xenotransplantation” http://www.viewingspace.com Aug. 1999. Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6.

History of Xenotransplantation 1984 – Baby Faye receives a baboon heart and dies 20 days later. 1992 – Using a four-drug “cocktail” to assist the transplantation of a baboon liver a patient lives for 71 days. However, the patient died of a brain hemorrhage and the type of rejection typical was not seen. 1992 – A pig liver was placed besides the patients own liver in hopes that the extra liver would assist the patient’s liver long enough for a human donor to be found. The patient died after 32 hours. 1993 – Baboon marrow and kidney transplant, patient dies after 26 days. 1995 – Immune cells from a Baboon used for an AIDS patient. Condition improved though cells died quickly. 1997 – Pig fetal nerve cells used in patients with Parkinson’s disease. Pig cells survived in one patient for over 7 months One of the most famous attempts at xenotransplantation is known as the “Baby Faye Case.” The infant was born prematurely with a malformed heart. She received a baboon heart which failed after only twenty days despite the use of new immunosuppressive drugs. It is suggested that the baboon heart was too large for her body to handle. Unfortunately such tragedies are becoming more common with the rise of needed organ donors and the supply coming drastically short. Picture – http://www.viewingspace.com Notes - Notes – Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6. Sci/Tech at BBC News. “The History of Xenotransplantation” http://www.viewingspace.com Aug. 1999.

Statistics Only 5% of the organs needed are available 1990 United States – 21,914 people in need of transplants, 12,580 received them 1990-1999 United States – 59% increase in rate of organ donors 2001 United States – 80,374 people in need of transplants 2001 United States – 6,124 people died waiting for transplants Statistics help illustrate the reasons behind xenotransplantation. Only a very small percent, 5% in fact, of people who need transplants to survive get the organs needed. Even the 5% who do get those organs have to be wary of rejection and will more than likely be on medications for the rest of their lives. Even with the increase of organ donors on the rise the problem persists and thousands die each year in the United States alone because of the lack of organs. Just think about how much more dire the need would be if we were aware of every person who was in need of an organ. Pictures - http://www.juris.uqam.ca/images/xenotransplantation.jpg Notes - Molzahn, Anita E, Rosalie Starzomski, and Janice McCormick. “The Supply of organs for transplantation: issues and challenges.” Nephrology Nursing Journal. 20.1 (2003) : 17(12). Platt, Jeffery L. “Biotechnology: Xenotransplantation.” Encyclopedia of Animal Science. Marcel Dekker, 2005. Ravelingien, A, F. Mortier, E. Mortier, I. Kerremans, and J. Braeckman. “Proceeding with Clinical trials of animal to human organ transplantation: a way out of the dilemma.” Journal of Medical Ethics. 30.1 (2004) : 92-6 Thomas, Jodie. “Survey backs animal organs.” Australian Business Intelligence. 22, Aug. 2004: N/A

Statistics 1996-2000 Canada – Waiting list grows by 62% 1996-2000 Canada – Number of transplants increases by 22% 1999 Canada – 170 (approximately 40% of those on the waiting list) people die waiting for transplants 2001 Canada – Almost 4,000 people waiting for transplants, a 15.6% increase in 3 years The problem is much the same in our Neighbor Canada, though because of our higher population the amount seems less drastic. Within four years there is a 62% jump for the need of organs while there is a only 22% increase in organ donors. Though there is a steady increase in both the waiting list and the organ donors, the waiting list consistently and continually out does the organ donors. The need for xenotransplantation is becoming more and more apparent. Pictures - http://www.novartistransplantation.de/pub/organtransplantation/images/geschichte_xenotx.jpg Notes - Molzahn, Anita E, Rosalie Starzomski, and Janice McCormick. “The Supply of organs for transplantation: issues and challenges.” Nephrology Nursing Journal. 20.1 (2003) : 17(12). Platt, Jeffery L. “Biotechnology: Xenotransplantation.” Encyclopedia of Animal Science. Marcel Dekker, 2005. Ravelingien, A, F. Mortier, E. Mortier, I. Kerremans, and J. Braeckman. “Proceeding with Clinical trials of animal to human organ transplantation: a way out of the dilemma.” Journal of Medical Ethics. 30.1 (2004) : 92-6 Thomas, Jodie. “Survey backs animal organs.” Australian Business Intelligence. 22, Aug. 2004: N/A

Statistics The Need for Organ Donors grows at 15% per year 2004 Australia – In a survey two-thirds say they would use an animal organ to save their life 2004 Australia – Survey shows 7 out of 10 males would agree to xenotransplantation 2004 Australia – Survey shows 6 out of 10 woman would agree to xenotransplantation I did look for American Statistics on what the average American thought about Xenotransplantation, but had no luck. However, in Australia at least the majority agrees that they would agree to xenotransplantation if they were in the position of needing any organ or tissue to save their lives. (Here maybe ask the class to raise their hands if, knowing what they know of the subject at this time and assuming their life span would be at least a few years, if they would agree to xenotransplantation, ask why or why not, remember to ask at the end of the lecture to show their hands again and ask why they might have changed their minds) Some people object to the idea and would not go through this process to save their lives, we will go into this a little more later when we discuss ethics. Picture -http://www.xenodiaries.org/images/bab9.jpg Notes - Molzahn, Anita E, Rosalie Starzomski, and Janice McCormick. “The Supply of organs for transplantation: issues and challenges.” Nephrology Nursing Journal. 20.1 (2003) : 17(12). Platt, Jeffery L. “Biotechnology: Xenotransplantation.” Encyclopedia of Animal Science. Marcel Dekker, 2005. Ravelingien, A, F. Mortier, E. Mortier, I. Kerremans, and J. Braeckman. “Proceeding with Clinical trials of animal to human organ transplantation: a way out of the dilemma.” Journal of Medical Ethics. 30.1 (2004) : 92-6 Thomas, Jodie. “Survey backs animal organs.” Australian Business Intelligence. 22, Aug. 2004: N/A

Biological Concepts Modern Uses Transplanted animal cells to be used for hemophillia, diabetes, Alzheimer’s, and Parkinson’s disease Organ Transplants A Way of delivering genes of therapeutic importance Stem cells, an already hot topic, have a high role to play in xenotransplantation. As you might have noted animal stem cells did not make any appearance in the historical overview of xenotransplantation even into the 1990’s, they idea is a fairly new one. The animal stem cells would perform the same function as human stem cells or hoped to assume, and because of the fact that these stem cells would not come from human embryos scientists hope to gain more support in their research. Organ transplants have been the main theme in xenotransplantation for the most part as can be seen in the history of xenotransplantation. There are a couple of different ways these organs can be used. The most common is to replace the original organ with the animal organ. Another idea is to actually add the animal organ as a helper to the human organ as both a permanent and temporary fix. One of the more obscure, but still important uses of xenotransplantation is the delivery of genes for therapeutic purposes. The idea behind this is the hope that certain animal sources might be genetically engineered to better express a gene under regulated conditions. Picture - http://www.wlab.gu.se/em/index-filer/image008.jpg Notes - Boyce, Nell. “Mixing Species – and crossing a live?” U.S. News & World Report. 27, Oct. 2003 : 58+. Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6. Platt, Jeffery L. “Biotechnology: Xenotransplantation.” Encyclopedia of Animal Science. Marcel Dekker, 2005.

Biological Concepts Primates vs. Pigs Pigs have larger organs Pigs are already slaughtered every day for meat Primates have smaller organs Primates share most of our genetic make up Primates are not available in mass The biggest and most obvious reasons pigs are the animal being considered for organ donors is because their organs closely match ours in size while most primates have considerably smaller organs. Another reason is their availability, one does not find baboon farms everywhere while pigs are readily available almost anywhere. Another reason primates are no longer considered candidates as organ donors is because they so resemble humans that more people object to their slaughter than pigs. Even so, both primates and pigs play a part in xenotransplantation. Because primates share 98% of our genetic make up they are ideal to be used as substitute humans until the process is perfected. Because they are used for this purpose primates can be used pretty sparingly in these experiments. Picture - http://www.xenodiaries.org/images/babop3.jpg Notes - Bryan, Jenny and John Clare. Organ Farm. Carlton Books Limited, 2001.

Existing Problems and Worries Biological Concepts Existing Problems and Worries 25 known diseases can be contacted from pig to human Rejection rate is higher Public Health risks Perfection of Cloning Of the 25 diseases that humans can get from pigs, including anthrax, influenza, scabies, rabies, leptospirosis and erysipelas,the one scientists are chiefly concerned with is pig retrovimses. Scientists agree that the other 24 diseases can be easily taken care of by containment, but pig retrovimses is more worrying because one it is part of a pigs genetic make up and two because HIV is a form of retrovimses and is also connected with causing mutations that form into cancer. As a consequence there could be a public health risk and some are afraid of a massive outbreak. Although this is a big concern a bigger concern is rejection. Our bodies have cells called T-Cells which will attack any substance that the body believes to be invasive and harmful. Human to human organ transplants often have problems with organ rejection so one could just imagine the problems of rejection when it comes to human to pig transplants. One other problem is not in the procedure but in the breeding. It is likely that once they have the “perfect” genetically engineered pig that there will be a lot of cloning. While we are getting closer and closer to getting cloning perfect, we are not quite there. There are still problems with deformations and abnormalities which is a valid concern for those who expect to be getting organs from these animals. Picture - http://www.crt-online.org/cartoons/xeno3.gif Notes - Berger, Alan H. and Gil Lamont. “Animal Organs Won’t Solve the Transplantation Shortage.” USA Today. 128.2654 (1999) : 56 D’Silva, Joyce. “Dying to live.” Chemistry and Industry. 4 Dec. 2000: 767 Editorial. “Xeno’s paradox: putting animal organs into humans is a risk to public health.” The Economist. 341.7997 (1996) : 16. Travis, John. “Pig virus raises xenotransplantation alarms.” Science News. 151.16 (1997) : 245

Biological Concepts Solutions to the Problems Selective breeding Genetic alterations Containment New and more powerful drugs More Research One of the easiest fixes is selected breeding. By selecting the healthiest pigs for breeding you are more likely to get healthy, strong piglets, and if once the piglets are born there is still worry then the piglets can be taken away from their mother by early weaning and hand raising into isolation. Another step for getting healthy pigs is genetic alteration and then cloning of these “super pigs”. While cloning has not been perfected, further research will hopefully solve those problems still present. Not only can all this specialty breeding help get rid of the threat of diseases, it can also lead to organs that are less likely to be rejected by the human body. While there are already drugs for people who have had transplants to treat and prevent rejection, more powerful ones are being worked on and tested, though the ultimate goal is to be rid of the need for these drugs, which are often taken for life by the patient. And of course, more research will always bring more understanding which leads to improved methods. Picture - http://www.schrem.de/viszeralchirurgie/forschung/situs2.jpg Notes - Cooper, David K.C. “Clinical Xenotransplantation – how close are we?” Lancet. 362.9383 (2003) : 3. Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6. Pig Organ

Ethical Issues Religion Jewish – Forbidden to eat any part of a pig Heart is the seat of the soul No hybridization of man with any other species There is a surprising lack of opposition from the religious community. Although the heart was considered the seat of the soul for many years by many religions the idea has mostly faded out to be replaced with the idea that the body is of little importance when it comes to the soul. By far the biggest problem, as seen by religious people, is that have hybridization, but few are even worried about this since there is no actual sexual contact. Picture - http://www.ul.ie/elements/Issue7/images/Xenotransplantation_files/image002.jpg Notes - Hutchinson, Ian. “The ethics of xenotransplantation.” Biological Sciences Review. 12.2 (1999) : 36.

Ethical Issues Animal Rights Physical discomfort Psychological discomfort Why should animals suffer for humans? The right to life The belief that animals should never be used in scientific experiments to aid humans is not new. However, the reasons and logic vary from one group to another. Some people just think it’s physically cruel, others think more about the psychology and others think equally about both. Many think it should start with the right simply to live. Because pigs are used to slaughter for meat anyways, most people seem to be concerned about the well being of the primates. Also the pigs are not generally harmed until the actual time of death. The primates, however, will be put through many operations and physical discomforts. Many also claim that because primates of a thinking process closer to our own that they suffer much more psychologically. The primates also tend to live in smaller cages with more uncomfortable transfers from one place to another. (picture) http://images.google.com/imgres?imgurl=http://www.graphicwitness.org/coe/xeno1.jpg&imgrefurl=http://www.graphicwitness.org/coe/prntlist.htm&h=500&w=392&sz=55&tbnid=sUx3e_BhI_EJ:&tbnh=127&tbnw=99&hl=en&start=2&prev=/images%3Fq%3DXenotransplantation%26svnum%3D10%26hl%3Den%26lr%3D Notes - Berger, Alan H. and Gil Lamont. “Animal Organs Won’t Solve the Transplantation Shortage.” USA Today. 128.2654 (1999) : 56 Bryan, Jenny and John Clare. Organ Farm. Carlton Books Limited, 2001. D’Silva, Joyce. “Dying to live.” Chemistry and Industry. 4 Dec. 2000: 767 Hutchinson, Ian. “The ethics of xenotransplantation.” Biological Sciences Review. 12.2 (1999) : 36.

Ethical Issues Arguments For Xenotransplantation Bible technicalities Importance of human life Inspectors for animals Pigs are already slaughtered daily Use as few primates as possible Because religious objections are far and few between there are not many arguments against their logic. What arguments there are come directly from the Bible or Torah, such as saying God put animals on earth for our benefit and that because there is no sexuality involved its alright. One of the biggest arguments is that human life comes before animal life. One way to look at is if there was a pig in the road or a person and you were forced to hit one or the other with your truck which would you choose to hit? Scientific facilities all claim that the animals under their care are never unnecessarily injured and the fact that they are regularly inspected for malpractice should be good enough to solve any doubts. Many scientists also feel that before anyone complains about pigs being killed for xenotransplantation they need to get the meat off people’s tables first. As far as the primates used, they use as few as possible and never used endangered species. Now, before going further I’d again like a show of hands of those who would agree to xenotransplantation. For those of you who have changed their mind since the last time I asked, explain why. Picture - http://www.mos.org/cst/article/2904/image_14691.jpg Notes – Bryan, Jenny and John Clare. Organ Farm. Carlton Books Limited, 2001. Hutchinson, Ian. “The ethics of xenotransplantation.” Biological Sciences Review. 12.2 (1999) : 36.

Where are we headed? Although to date there still hasn’t been any long term success with xenotransplantation scientists are optimistic that humans will no longer have any shortage of organs, tissues, or cells for transplantation. Scientists are continually conducting experiments to find new ways to solve any existing problems and to help prevent any new problems. These range from developing new medications for rejection to breeding genetically engineered pigs for the specific use of xenotransplantation. Although there have been some ethical issues raised, there doesn’t seem to be any obstacles in the way of these remarkable experiments.

Works Cited Berger, Alan H. and Gil Lamont. “Animal Organs Won’t Solve the Transplantation Shortage.” USA Today. 128.2654 (1999) : 56 Boyce, Nell. “Mixing Species – and crossing a live?” U.S. News & World Report. 27, Oct. 2003 : 58+. Bryan, Jenny and John Clare. Organ Farm. Carlton Books Limited, 2001. Cooper, David K.C. “Clinical Xenotransplantation – how close are we?” Lancet. 362.9383 (2003) : 3. D’Silva, Joyce. “Dying to live.” Chemistry and Industry. 4 Dec. 2000: 767 Editorial. “Xeno’s paradox: putting animal organs into humans is a risk to public health.” The Economist. 341.7997 (1996) : 16. Hutchinson, Ian. “The ethics of xenotransplantation.” Biological Sciences Review. 12.2 (1999) : 36. Lanza, Robert and David K.C. Cooper. “Xenotransplantation”. Scientific America. 277.1 (1997) : 54-6. (picture) http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825

Works Cited Molzahn, Anita E, Rosalie Starzomski, and Janice McCormick. “The Supply of organs for transplantation: issues and challenges.” Nephrology Nursing Journal. 20.1 (2003) : 17(12). Platt, Jeffery L. “Biotechnology: Xenotransplantation.” Encyclopedia of Animal Science. Marcel Dekker, 2005. Ravelingien, A, F. Mortier, E. Mortier, I. Kerremans, and J. Braeckman. “Proceeding with Clinical trials of animal to human organ transplantation: a way out of the dilemma.” Journal of Medical Ethics. 30.1 (2004) : 92-6 Sci/Tech at BBC News. “The History of Xenotransplantation” http://www.viewingspace.com Aug. 1999. Thomas, Jodie. “Survey backs animal organs.” Australian Business Intelligence. 22, Aug. 2004: N/A Travis, John. “Pig virus raises xenotransplantation alarms.” Science News. 151.16 (1997) : 245 (picture) http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825

Photos Cited “Baby Fae.” Photo. Aug. 1999. The History of Xenotransplantation. 20 Oct. 2005. <http://www.viewingspace.com>   Collony, Sandra. “Baboon Near Cage.” Illustration. Xenotransplantation. 20 Oct 2005. <http://www.ul.ie/elements/Issue7/images/Xenotransplantation_files/image002.jpg> Collony, Sandra. “Lots of Little Pigs.” Photo. Xenotransplantation. 20 Oct 2005. < http://www.ul.ie/elements/Issue7/images/Xenotransplantation_files/image002.jpg> Collony Sandra. “Two Pigs Cartoon.” Photo. Xenotransplantation. 20 Oct 2005. < http://www.ul.ie/elements/Issue7/images/Xenotransplantation_files/image002.jpg> (picture) http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825

Photos Cited “Doctors at Work.” Photo. Xenotransplantation. 20 Oct 2005. <http://www.scienceandsociety.emory.edu/GMO/Xenotransplantation_files/image002.jpg>  Forna, Shiela. “Baboon/Pig.” Illustration. 2000. Merger Signals in Xenotransplantation Research. 20 Oct 2005. <http://www.nature.com/nm/journal/v6/n11/images/nm1100_1195_I1.jpg> “Heteroptic Mouse Model of Xenotransplantation.” Illustration. 2001. Vascular Biology and Xenotransplantation. 20 Oct 2005. <http://www.wlab.gu.se/em/index-filer/image008.jpg>  Loss, Martin. “Pig Organ.” Photo. 2004. Xenotransplantation. 20 Oct 2005. <h Organ Farm. “Monkey Under.” Photo. Primates, Baboons, and Pigs. 20 Oct 2005. <http://www.xenodiaries.org/images/babop3.jpg> Pharma, Novartis. “Little Pig and Organ.” Illustration. 20 Oct 2005. <http://www.novartistransplantation.de/pub/organtransplantation/images/geschichte_xenotx.jpg> (picture) http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825

Photos Cited “Pig to Human.” Illustration. Xenotransplantation. 20 Oct 2005. <http://www.liberation-mag.org.uk/0413.jpg>  “Porky Cartoon.” Illustration. 2000. Xenotransplantation Humor. 20 Oct 2005. <http://www.crt-online.org/cartoons/xeno3.gif>  Sue Cue Direct. “Xenotransplantation: She Has the Right to Listen, but Not to Speak.” 02 Oct. 2005. Prints by Sue Coe 1979-Present. Sue Coe Direct. 11 Oct. 2005. <http://images.google.com/imgres?imgurl=http://www.graphicwitness.org/coe/xeno1.jpg&imgrefurl=http://www.graphicwitness.org/coe/prntlist.htm&h=500&w=392&sz=55&tbnid=sUx3e_BhI_EJ:&tbnh=127&tbnw=99&hl=en&start=2&prev=/images%3Fq%3DXenotransplantation%26svnum%3D10%26hl%3Den%26lr%3D>  “Three Pictures Combined.” Photos. 20 Oct. 2005. <http://www.juris.uqam.ca/images/xenotransplantation.jpg>  Unipublic. “Xenokunst.” Illustration. 26 July 2003. Dr. Claude Kaufmann. 11 Oct. 2005. <http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825> (picture) http://www.unipublic.unizh.ch/lenya/unipublic/live/magazin/gesundheit/2003/0726.html;jsessionid=AB7AB6E55EFEF6E6D61FD907ABE42825