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Scientists say they’ve found an efficient way to make red blood cells from human embryonic stem cells, a possible step toward making transfusion supplies in the laboratory. The promise of a virtually limitless supply is tantalizing because of blood donor shortages and disappointments in creating blood substitutes.

Red blood cells are a key component of blood because they carry oxygen throughout the body.

Experts called the new work an advance, but cautioned that major questions had yet to be answered.

The research, published online Tuesday by the journal Blood, was reported by scientists at Advanced Cell Technology in Worcester, Mass., the University of Illinois at Chicago and the Mayo Clinic in Rochester, Minn.

The researchers said the cells they made behaved like natural red blood cells in lab tests, and that their process could be used in large-scale production. The results suggest that embryonic stem cells could someday supply type O-negative “universal donor” red cells for transfusion, they wrote.

Mohandas Narla, director of the Lindsley F. Kimball Research Institute at the New York Blood Center, called the results “a very good start.”

Now it will be important to show that the complex lab process really can pump out red cells on a large scale, and that the cells will survive long enough in the human body to be useful, he said. Natural red cells circulate for an average of 120 days.

Good chronic pain treatment can be hard to find. A chronic pain patient has every right to believe that his or her doctor will listen sympathetically and prescribe the appropriate treatment, but that is not always the reality.
Truth is, many doctors have not been trained to deal with the complex, changing area of chronic pain treatment. One 2001 survey of primary care physicians’ attitudes toward prescribing certain medications found that only 15 percent said they enjoyed working with patients who have chronic pain.
This can lead to frustrating encounters at the primary-care level, especially if your doctor is rushed.
Pressures on doctors
“Doctors don’t want patients to suffer; they want people to get better,” said Dr. Bill McCarberg, founder of the Chronic Pain Management Program at Kaiser Permanente in San Diego, California. “But they feel stress; they feel time constraints; they have to deal with pre-authorizations; it’s not the kind of practice they wanted. They’re stressed, and that leads to moving patients along.”
“As a doctor in today’s medical system, it’s difficult to deal with chronic pain conditions,” agreed Dr. S. Sam Lim, a rheumatologist at Emory University School of Medicine in Atlanta, Georgia. “Most practices are forced to see a certain number of patients in a limited amount of time. [With chronic pain,] it’s not so simple as five minutes, a few questions and handing out a pill. It takes some time. And our system isn’t set up for that.”
“The patient needs to realize that the doctor may not be able to discern what’s going on in the first visit. Often, it takes a few visits,” Lim said.
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Doctors are frustrated by what they can’t “fix.”
In 25 years of caring for her chronically sick husband, who was injured in an industrial accident, Ann Jacobs, 62, of Laramie, Wyoming, has watched physicians struggle with the trial-and-error progress of his treatment. “Doctors are programmed for success stories,” she said.
Because of its complexity, pain treatment has emerged as a separate, multidisciplinary specialty. That’s good, but pain patients often need to get to a pain specialist through their primary care physicians. Emotions can cloud the diagnosis
The emotional effects of chronic pain may make diagnosis more difficult. Maggie Buckley, 46, of Walnut Creek, California, learned this the hard way. She has Ehlers-Danlos syndrome, a rare genetic tissue disorder that leaves her with chronically painful joints.
“If you say, ‘it’s really depressing and upsetting me; I’m in so much pain,’ ” Buckley said, “doctors will see it in terms of emotion and treat it as an emotional problem, referring you to psychiatric care or antidepressants.”

That is sometimes the appropriate treatment route, because antidepressants can treat chronic pain, and there is a link between pain and depression, but you need to stand your ground and make sure any treatment is addressing your specific problems.
Be gentle about your pain, but be firm
It’s important to be clear about your pain and explain the way it impacts your life when you’re talking to your doctor. Don’t be intimidated. Stand your ground, calmly.
“Patients really need to be persistent about their complaints in a way that is constructive to get across to the physician that this is something real,” Lim said. “There are some physicians who are more open to listening than others. It may take a few doctors to find a marriage.”
“You have to go very gently to start with,” Jacobs advised. “Listen to what the doctor has to say first.”
Then, if you’re not satisfied, press harder. But remember that the most important thing is to create a relationship with your doctor in which you’re a team, both looking for the best way to alleviate your pain. After he or she has assessed your needs, you can consider seeing a pain specialist.

Both aggressive and hard to treat, liver cancer kills more than 650,000 a year worldwide. The American Cancer Society pegs the overall survival rate at less than 10%. Enter Aura Biosciences, a student startup that has developed an ingenious new means of delivering cancer-killing drugs to liver (and other) tumors.

Aura’s founders - Elisabet de los Pinos, 35, her brother Jordi, 33, an electrical engineer, and biochemist Zeid Barakat, 29 - are selling a tiny, hollow protein particle developed by scientists at a European cancer research center. That particle, which Aura markets under the name Nanosmart, is an organic envelope that carries chemotherapy drugs directly to cancer cells, making treatment safer and more effective, the founders claim.

Traditional chemotherapy releases drugs directly into the body, killing both cancerous and healthy cells and causing side effects that can include nausea, hair loss, mouth ulcers, and even death. By contrast, Nanosmart encapsulates the drug until it reaches tumor cells inside the liver, where it is released. The protein can also carry a fluorescent marker detectable by magnetic resonance imaging (MRI), which allows doctors to measure a tumor’s size, see whether it has spread, and judge the efficacy of treatment.

Aura was launched last November in Cambridge, Mass., where Barakat and Jordi de los Pinos were attending the Sloan School of Management at MIT. They plan to market Nanosmart to Eli Lilly (LLY, Fortune 500), Sanofi-Aventis (SNY), and other makers of widely prescribed chemotherapy drugs. Many of those drugs will be coming off patent in the next three to five years. When that happens, the drugs could be combined with the Nanosmart particle, says Aura CEO Elisabet de los Pinos, a former marketing manager at Eli Lilly. That could result in new formulations patentable for another 20 years.

To speed up the long approval process for new drugs, Aura is applying for an orphan-drug designation from the FDA and its European counterpart, the EMEA. Orphan-drug status carries significant benefits. In the U.S. it allows a company to use fewer patients in clinical trials, opens access to tax credits and grant funding, and guarantees market exclusivity for seven years.

Startup showdown 2008
The designation is usually given to drugs that treat rare diseases but can also be granted if a life-threatening illness has no satisfactory treatment. Liver cancer fits the second category, though not the first.

Aura took ninth place at the 2008 Rice University Business Plan Competition, co-sponsored by FSB. Although the judges praised Aura’s business plan, they also pointed out some significant hurdles in its path. Even if Aura manages to obtain orphan-drug status, it must still prove that Nanosmart beats other drug-delivery systems on the market.

“That’s an extremely tough row to hoe, especially in oncology,” says contest judge Jerry Cobbs, a venture capitalist and managing director at Signet Healthcare Partners in Houston. “There just isn’t enough data yet to know if this will work.”

Although Nanosmart is new, the idea of using proteins to encapsulate drugs is not. Many drugs today are formulated in protein envelopes called liposomes. Nanosmart is a variation on that theme, says oncologist Louis Weiner, director of the Lombardi Comprehensive Cancer Center at Georgetown University. Nanosmart could be more targeted and more efficient than other nanodelivery systems, Weiner says, but it could also break apart in the body or attach to a healthy cell by mistake.

“You might end up with surprising side effects,” says Weiner, whose research focuses on tumor targeting.

The founders acknowledge that there’s no way to know whether Nanosmart will work in humans until after clinical trials. But like many early-stage biotech startups, Aura faces a catch-22: The trial research won’t be cheap, yet it’s tough to attract investors without clinical data. The company has about $300,000 in hand and expects to raise another $3.1 million in grants and seed financing by January.

If clinical trials prove Nanosmart’s safety and efficacy, the company hopes to market the particle for use in treating breast and bladder cancer as well.

“The potential is huge,” says nanotechnology analyst Marlene Bourne, president of Bourne Research in Scottsdale. “I think these guys are really onto something.”

Editor’s Note: An earlier version of this story incorrectly stated that incorrectly stated that liver cancer kills more than 650,000 a year in the U.S. alone. The National Cancer Institute estimates that liver cancer will cause 18,410 deaths in the U.S. In 2008; the 650,000 figure is a worldwide one. Fortune Small Business regrets the error.

Have a baby when it’s so hard!
1. Get Dad out of the hot tub
Couples often forget that 40 percent of infertility is due to something wrong with the man, according to Sheryl Kingsberg, chief of the division of behavioral medicine at Case Western Reserve University School of Medicine.
That means Dad has to watch what he does. Hot tubs are one example.
“Sitting in a 103-degree tub for prolonged periods of time may impair sperm quality,” said Dr. Alan Copperman, with Reproductive Medicine Associates in New York.
Being obese, smoking, drinking heavily, or using illegal drugs also can affect sperm count. Women need to follow the same advice, because all of these can affect her fertility, too, Copperman added.
2. Use an ovulation predictor kit
This isn’t necessary, but it might speed a referral to a fertility specialist, according to Madsen.
“When you go to the doctor and you say you’re having trouble getting pregnant, they might tell you to just keep trying,” she said. “But if you’ve been using an ovulation kit, you can prove to the doctor you’ve been trying at the right time of the month.”
How long you should wait depends on your age and your health history. Fertility experts say if you’re under 35, try for a year before proceeding with fertility treatments. If you’ve had certain problems — endometriosis, for example, or irregular periods — don’t wait that long, said Dr. Andrew Toledo with Reproductive Biology Associates in Atlanta, Georgia.
Women over the age of 35 should wait no longer than six months before getting help, experts said.
“There’s definitely a need to be proactive, but not panicky,” Toledo said.
3. Go to a clinic that’s open seven days a week
When it comes to procedures such as harvesting eggs and implanting embryos, one day can make a difference,” Madsen said. “If they’re not open seven days a week, they’re manipulating your cycle to fit their schedule.”
For help finding a fertility clinic, check success rate statistics at the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology. Also, ask these questions suggested by the American Society for Reproductive Medicine.
4. Get a “cycle buddy” — real or virtual
Madsen said one of the smartest things she did while trying to get pregnant was to strike up a conversation with another would-be mom over the coffee maker in her doctor’s waiting room.
“It turned out she was on the same cycle I was, and we became ‘cycle buddies,’ ” she said. “I’d talk to her for hours about the size of my follicles and the fluffiness of the lining of my uterus. Believe me, no one else, including your husband, wants to talk endlessly about those details.”
If you’re too shy to accost another patient in the waiting room, find one on discussion forums at fertility groups such as Resolve, Inciid and the American Fertility Association.
5. Get a second opinion
“If you feel like your doctor isn’t paying attention to your case, or you feel like you’re just a number, or you’re not having success after several cycles, it’s really OK to ask for a second opinion,” Madsen said. “And if your doctor isn’t OK with that, that’s reason enough for you not to be there.”
In the midst of all this, don’t think you’re nuts if you start to feel little bit crazy, Kingsberg advised.

“The psychological impact of infertility cannot be overstated,” Kingsberg said. “Your sexual lives are now open for scrutiny, your financial lives may be in jeopardy, the time commitment tends to interfere with work.”
Madsen agreed, and said couples should control what they can. For example, early on, she asked nurses to call her husband with the results of pregnancy tests.
“I felt like I could handle it better hearing the news from my husband,” she said. “We had six ‘failure’ phone calls, and then one day my husband delivered flowers to my work that said “All my love to the both of you.”