Science in Society Review Spring 2013

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ISSN 2164-4314

SQUARE KILOMETER ARRAY A GIFT FOR BOTH ASTRONOMY AND AFRICAN DEVELOPMENT? 500 Friends Yet All Alone: Exploring Facebook Depression Human Trackers or Medical Saviors?

The Concerns and Technology Behind Implantable Microchips Medically Supervised Drug Injection Sites: More Harm than Good?

ASU Berkeley Brown Harker Harvard JHU BROWN S13.indb 1

Cambridge CMU NUS OSU UC

Cornell Davis

Georgia Tech UCSD UChicago

Georgetown Melbourne

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EXECUTIVE MANAGEMENT TEAM Chief Executive Officer Mridula Nadamuni Chief Operating Officer, Asia Worapol Ratanapan Chief Operating Officer, North America Benjamin Dauber Chief Marketing Officer Megana Roopreddy Chief Production Officer Cassie Yeh Chief Technology Officer Lauren Beck Executive Editor-In-Chief, Print Publication Dhruba Banerjee Executive Director, E-Publishing Edgar Pal Executive Director, High School Outreach Kathryn Scheckel Executive Director, Internal Affairs Brittany Hsu Executive Director, Science Policy Yucheng Pan INTERNATIONAL STAFF Senior Literary Editors Harrison Specht Mary Fei Michael Graw Pallavi Basu Titas Banerjee Victoria Phan Senior Production Editors Emmy Tsang, Cambridge Felice Chan, Cornell Judy Chan, Cornell Matthew Kornfield, Georgetown Dapinder Dosanjh, UC Berkeley Peony Wong, UC Berkeley Andrew Kam, UChicago

Senior E-Publishing Editors Venkat Boddapati Fili Bogdanic Irene Ching Jae Kwan Jang Evan Jin Arthur Jurao Prathima Radhakrishnan BOARD OF DIRECTORS Chairman Erwin Wang Vice Chairman Kalil Abdullah Board Members Manisha Bhattacharya Jennifer Ong Zain Pasha Julia Piper James Shepherd Jennifer Yang TRIPLE HELIX CHAPTERS North America Chapters Arizona State University Brown University Cornell University Carnegie Mellon University Georgia Institute of Technology George Washington University Georgetown University The Harker School Harvard University Johns Hopkins University The Ohio State University University of California, Berkeley University of California, Davis University of California, San Diego University of Chicago Yale University Europe Chapter Cambridge University Asia Chapter National University of Singapore Australia Chapter University of Melbourne

ACKNOWLEDGEMENTS

The Triple Helix at Brown University would like to sincerely thank the following groups and individuals for their generous and continued support:

THE TRIPLE HELIX A global forum for science in society The Triple Helix, Inc. is the world’s largest completely student-run organization dedicated to taking an interdisciplinary approach toward evaluating the true impact of historical and modern advances in science.

Work with tomorrow’s leaders Our international operations unite talented undergraduates with a drive for excellence at over 25 top universities around the world.

Imagine your readership Bring fresh perspectives and your own analysis to our academic journal, The Science in Society Review, which publishes International Features across all of our chapters.

Reach our global audience The E-publishing division showcases the latest in scientific breakthroughs and policy developments through editorials and multimedia presentations.

Catalyze change and shape the future Our new Science Policy Division will engage students, academic institutions, public leaders, and the community in discussion and debate about the most pressing and complex issues that face our world today.

All of the students involved in The Triple Helix understand that the fast pace of scientific innovation only further underscores the importance of examining the ethical, economic, social, and legal implications of new ideas and technologies — only then can we completely understand how they will change our everyday lives, and perhaps even the norms of our society.

Come join us!

The Brown University Undergraduate Council of Students (UCS), The Undergraduate Finance Board at Brown University (UFB), The Brown Science Center, with David Targan, Associate Dean of the College for Science, Katherine Bergeron, Dean of the College, And participating members of the Faculty Review Board: David Christensen Andrew Foster Rachel Herz Andrea Megala Simmons Gary Wessel Daniel Weinreich

© 2013 The Triple Helix, Inc. All rights reserved. The Triple Helix at Brown University is an independent chapter of The Triple Helix, Inc., an educational is published bianually and is available free of charge. Its sponsors, advisors, and Brown University are not responsible for its contents. The views expressed in this journal are solely those of the respective authors.

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Facebook

Drugs

Microchips

Is Facebook making you lonely?

Is the principle of harm reduction actually harming drug users?

How can privacy be preserved in the use of implantable microchips?

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29

Cover Article 6

The Square Kilometer Array: a Gift for both Astronomy and African Development?

Alfie Ireland

Local Articles 8 10 12 15 18 21 24 27 29 32

Are Genetically Modified Mosquitoes a Futuristic Approach to Eradicating Malaria?

500 Friends Yet All Alone: Exploring Facebook Depression Caring for Caregivers: Alzheimer’s Treatments as They Pertain to Loved Ones Designing Babies and Customizing our Future The Importance of Biological Factors in Emotion Medically Supervised Drug Injection Sites: More Harm than Good?

Worming the Developed World Out of Allergies Why India needs an Iron Man: Combating Iron Anemia Human Trackers or Medical Saviors? The Concerns and Technology Behind Implantable Microchips Cognitive Behavior Therapy versus Medication for Sleep Impairment in Postraumatic Stress Disorder

Cindy Abarca Timothy Chou Adam Kopp Julia McGirr Elina-Eleftheria Pliakos Julia Romanski Joaquim Moreira Salles Carlota Pereda Serras Michael Yanagisawa Han Zou

International Features Mathew Ryan Ykema, ASU

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Adapting to the Apocalypse: Using Human Augmentation to Combat Global Environment Catastrophes

39

Buildings as Living Systems

Prathima Radhakrishnan, UChicago

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Crowd and Cloud: A Powerful Approach to Innovation

Kira Rienecker, UC Davis

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The Story of Dual Research: An Interplay Amongst Ethics, Biodefense, and Scientific Censorship

Prashant Sharma, Cornell

Cover designed by Emmy Tsang, Cambridge University

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Message from the Chapter President Dear Reader, On behalf of The Triple Helix (TTH) at Brown University, I am proud to present the latest issue of The Science in Society Review. The Triple Helix began in 2004 as a single chapter, conceived of and established by a small group of students at Cornell University who were dedicated to investigating the underlying connections that bring together the sciences and the humanities. In the past 8 years, TTH has grown to an international scale, and today has chapters at over 20 leading universities around the globe.

STAFF AT BROWN President Michael Spector Editor-in-Chief Eric Sun Finance Director Connor Shinn

Brown’s chapter, founded in 2005, was one of the first to join in The Triple Helix’s progressive mission.

With the support of a uniquely inquisitive and engaged body of students and faculty, The Triple Helix at Brown has since become one of the strongest in North America. Over the last few years, we have centralized, stabilized, and expanded the Brown chapter across the board – including increased participation in our Literary division, a new partnership with Brown’s Science Center, and the creation of our new community outreach program.

Our members firmly believe that academic progress cannot thrive in a vacuum; rather, the greatest understanding comes from exploring the ways in which topics across many fields of study interact with and relate to one another. The Triple Helix exists because our devoted readers, writers, editors, and leaders are passionate about analyzing, questioning, contemplating, and discussing global issues that affect human societies. We are incredibly thankful for everyone that made this incredible journal possible.

Science Policy Co-Directors Lily Chan Elena Suglia

We hope you enjoy!

Outreach Director Justine Palefsky

Sincerely,

Co-Managing Editors Alex Meehan Eric Bai

Michael Spector, President

E-Publishing Director Rachel Occhiogrosso

Message from the Chapter Editor-in-Chief

Outreach Editor Rudy Chen

This Spring 2013 issue of the Science in Society Review is one of this chapter’s finest yet.

It embodies the hard work that the writers, editors and other staff of this publication have put into each article. As an organization we are in a very exciting time of growth and maturity, and as we evolve, our journal continues to reflect the depth of talent and passion that propels us forward.

Webmaster Adam Scherlis Marketing Director Dana Schwartz Marketing Staff Cindy Abarca Pu-Ning Chiang

The articles in this issue span an impressive range of topics and highlight the interdisciplinary nature of the world we live in. From Facebook depression to privacy issues in microchips to medically supervised drug injection sites, our writers have dived boldly into current and controversial topics. At the heart of each article is our passion for exploring the intersections of science, society, and law, and a critical approach that reflects the deep thought behind our writing.

Associate Editors Alysse Austin Oliver Lyman Oyinkansola Osobamiro William Palmer Marjorie Palmeri Alexandra Peseri Kate Nussenbaum Dana Schwartz

As we continue to grow, we are constantly pushing the boundaries of our organization. With our expansion into the digital space, we are now seeking to diversify the content we deliver and interact more with you, our readers. Therefore, I ask that you let us know your thoughts. If you have any comments or if you wish to join our organization, please contact us at brown@thetriplehelix.org. Finally, I must thank our writers, editors and faculty review board members for their hard work, passion, and insight. This issue serves as a fitting tribute to the time and effort you have dedicated to it.

Sincerely, Eric Sun, Editor-in-Chief

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Message from the CEO One important mission of the Science and Society Review is to get our readers thinking critically about the ethical impact of emergent technologies on public policy. There are a number of organizations that do this, but our efforts are unique because we are an independent, studentrun publication. We offer an unbiased report on the topics that are the most interesting to us, the young people of this generation. I imagine that years in the future, these articles will serve as a valuable record of the youth perspective on great scientific debates of our time.

Even as the Triple Helix continues to grow and expand in new directions, the core of what we do remains the same: creating an open forum for discussion and education. We must embrace the path forward and expand our readership by broadening our reach. Let us harness the power of social media to promote our original works so that more people can participate in the conversation. We are doing well, but I know we can do even better.

It has been a privilege to serve with my dedicated team over the past eight months. Together, we have laid the foundations for success to build on in the coming months. To our readers and our Triple Helix Members, I thank you for your continued support and participation. To our graduating alumni, I look forward to hearing of the accomplishments of our TTH family. Please keep in touch so that we may celebrate your successes with you! Finally, I want to thank each of you for a wonderful term.

With best wishes, Mridula

Message from the CPO and EEiC Welcome to the flagship forum for The Triple Helix organization: the Science in Society Review, a journal produced entirely by a network of undergraduate students spread across the world. We dare you to read on and see what the next generation of thinkers and leaders has identified as the most important issues that require interdisciplinary solutions.

We want to remind you that part of what makes our product worthy of the time and effort of dedicated undergraduate TTH members, and worthy of the attention of its readers, is the thoughts behind the words.

Consider the cover article about the Square Kilometer Array, huge radio telescopes spread throughout Australia and South Africa. Alfie Ireland from Cambridge University considers the potential blessings not just to the field of astronomy - but also to the economic conditions of where the technology will be developed and located. The hitch is whether its organizers will choose to bring these benefits to the local villages. And so, the story of these massive telescopes becomes a story for the whole of science. Does scientific advancement always translate to a better society? If not, why? And how can we achieve that?

We hope you will join us in thinking about the issues that now face society. As always, we welcome you to join cross-continental conversation. Connect with us by contacting LettersToTheEditor@thetriplehelix.org As the Executive Editor-in-Chief for the past two years, I especially want to thank our TTH members and long time readers for working with me and enjoying the past four issues of the Science in Society Review. It has been a rewarding experience, and I am happy to say that this journal will remain in good hands next year when Harrison Specht will take the reigns. Harrison, a rising senior at Cornell, has been a Senior Literary Editor for various chapters over the past two years. He will continue to help this journal uncover the fascinating intersection of science, society, and law.

Cassie Yeh and Dhruba Banerjee Chief Production Officer and Executive Editor-in-Chief

Š 2013, The Triple Helix, Inc. All rights reserved.

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The Square Kilometer Array: A Gift for both Astronomy and African Development?

Alfie Ireland

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hen it comes to radio telescopes, the bigger they are, the better. Hence the Square Kilometre Array (SKA) was conceived: 3,000 dishes, each 15m in diameter, spread over southern Africa and Australasia in a spiral arrangement whose arms extend to distances greater than 3,000 kilometres from the centre [1]. With a sensitivity between 50 and 100 times greater than any radio telescope before it, the SKA is expected to make huge advances in the field of astronomy; in particular it is poised that it will teach us more about the nature of dark energy, the driving force behind the accelerating expansion of the universe. But there are many who are excited about the project for reasons other than its potential for scientific discovery: the construction of parts of the telescope in South Africa and other African nations is likely to have hugely beneficial consequences for these countries’ technological development, with potential to generate interest in science amongst students, to encourage qualified Africans to remain in their home countries, and to create vital infrastructure such as roads, electricity supply and internet provision.

The Square Kilometre Array, like the most powerful radio telescopes around today, works on the principle of radio interferometry: because of the way radio waves interfere with each other, the intensity received by each of the dishes will change as the earth rotates and the optical path length between each dish and the source changes. The dishes will feed information back to a central hub, which will be a supercomputer more powerful than any currently available [3], and all of the signals will be collated to form an ‘image’ of the source [2].

One research focus of the SKA will be gravitational waves:

ripples in the fabric of space time left over from the Big Bang and other huge cosmic events such as the collision of two black holes. An approach suggested for detecting these elusive waves involves simultaneously studying a large number of pulsars.

Pulsars are dense, rapidly rotating stars which produce a beam of radiation that sweeps through space like the beam from a lighthouse, intersecting Earth at regular time intervals. With such high sensitivity, the SKA is hoped to detect far more pulsars than have so far been found. These can act as a set of precision clocks in the sky, which can be used as the arms of a giant gravitational wave detector with the SKA at its centre [4].

As well as gravitational waves, astronomers are hoping that the telescope will shed light on the nature of dark energy, the driving force behind the expansion of the universe. This requires the observation of large numbers of galaxies [5], which is made possible by the vastly improved speed with which the SKA can scan the sky: 10,000 times faster than current telescopes [6].

Perhaps the most exciting aspect of the SKA’s job will be the search for extraterrestrial life: whilst current radio telescopes would only be able to detect a signal from alien civilizations if it was a powerful beam directed right at us, the SKA will be sensitive enough to pick up ‘leaked’ signals as weak as television broadcasts on planets orbiting nearby stars [7]. If advanced life forms are out there, this is our best chance of finding them yet.

But even before the SKA makes any breakthroughs in the fields of physics and astronomy, it is sure to start making a difference to the economies of the hosting nations. In addition to the main core of the telescope in South Africa, parts of the telescope are to be built in Namibia, Botswana, Mozambique, Kenya, Zambia, and even out into the Indian Ocean in Mauritius and Madagascar (as well as in Australia and New Zealand) [7]. For the most part, science education in these countries is in need of improvement: less than 4% of students go on to higher education in many of the African countries, and science and engineering are generally undersubscribed as subjects. In Namibia, for example, of the 9% of students who go on to study at university, only 12% of these will study science or engineering subjects.

It is unsurprising therefore, that sub-Saharan Africa produced a mere 1% of the entire world’s output of scientific articles in 2010, despite being home to over 12% of the world’s population [8].

This lack of uptake of science is compounded by The layout of the Square Kilometre Array. Reproduced from [1] the ‘brain drain’ which blights these nations. According

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Around 20,000 African doctors, lecturers, engineers and other professionals leave their home countries every year to work in industrialized nations to the International Organisation for Migration, around 20,000 African doctors, lecturers, engineers and other professionals leave their home countries every year to work in industrialized nations [9]. This occurs for a variety of reasons, with the main one simply being a lack of money: in Senegal for example, researchers who have emigrated to Europe get paid between three and five times more than those who remained in their home nation [10]. A project the size of the SKA has the potential to capture the imaginations of children in the hosting nations, and so may well encourage the uptake of science subjects at a higher level. Even more importantly, it will create well paid jobs for researchers and engineers in their own nations, and so could help to encourage qualified professionals to stay put.

In addition to making jobs for qualified physicists and engineers, the project could create a huge number of ‘blue collar’ jobs. With so many dishes to be built, huge numbers of construction workers, metal workers and drivers will be employed, all paid by foreign money. This will give some of the Less Economically Developed Countries involved a much needed financial boost. Dr. Bernie Fanaroff, the director of the project in South Africa, said “The construction phase alone will last from about 2013 to 2025. So, there’s direct spin-off from construction, and there’s the creation of employment through operations and maintenance that will go on for about 50 years” [11].

To assist with the construction of the dishes, a large amount of infrastructure will have to be built alongside: thousands of miles of roads and power cables will be needed to link up each and every remote part of the telescope, and power stations will need to be built to satisfy the telescope’s huge power demands. This should bring benefits directly to the References 1. Square Kilometre Array website, “The SKA Footprint” [viewed 02/07/12]. Available from htp://www.skatelescope.org/the-location/layout/ 2. National Radio Astronomy Observatory website, “How Radio Telescopes Work”, [viewed 02/07/12]. Available from htp://www.nrao.edu/index.php/learn/radioastronomy/radiotelescopes 3. Square Kilometre Array website, “Software and Computing” [viewed 02/07/12].

Available from htp://www.skatelescope.org/the-technology/software-and-computing/ 4. M. Kramer, D.C. Backer, J.M. Cordes, T.J.W. Lazio, B.W. Stappers, S. Johnston “Strong-field tests of gravity using pulsars and black holes”. New Astronomy Reviews, 2004, page 993.

5. Square Kilometre Array website, “What is Dark Energy?” htp://www.skatelescope. org/the-science/ska-key-science-projects/galaxyevolution/dark-energy/ [viewed 02/07/12] 6. “Square Kilometre Array: the Stats” Cosmos Magazine [viewed 02/07/12]. Available from htp://ska.cosmosmagazine.com/ 7. Jonathon Amos, BBC News “Africa and Australasia to share Square Kilometre Array” (see video on web page) [internet] [viewed 02/07/12]. Available at htp://www. bbc.co.uk/news/science-environment-18194984 8. Unesco Science Report 2010, section on sub-Saharan Africa (page 298) [internet]

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local people, such as providing electricity to areas currently without it, consequently strengthening the local economies.

One of the most advantageous aspects of the project, may be the potential it has to link more Africans to the internet.

Generating enough raw data to fill 15 million 64 GB iPods every day [12], the SKA will require a huge amount of bandwidth to upload this information (even once it has been processed) for it to be accessed by astronomers around the globe. The internet infrastructure built to handle this data is hoped to help get some of the more remote areas online [13]. In the nearer future, the Africa Coast to Europe broadband cable will be finished this December, improving speed and connectivity for many west coast nations [14]. The combination of these two developments is likely to dramatically increase the availability of the internet throughout sub-Saharan Africa, which currently has the lowest internet usage in the world: internet user penetration was 10.6% in 2010 compared with the world average of 30% [14]. The impact this would have on development is enormous, with rural doctors gaining access to vital online medical information, the use of virtual classrooms expanding the knowledge available to students, and small businesses gaining better access to market information, to name but a few [15].

This ambitious project has the potential not just to bring about revolutions in cosmology, but also to contribute to a sorely needed technology revolution in some of the poorest countries in the world. But while its contribution to science is almost certain to be groundbreaking, the extent to which it will improve the lives of average Africans is at this point mere speculation, and will depend on how high African development comes on the organisers’ list of priorities. Disappointingly, despite optimism from the South African government and others [13] about the huge potential of the SKA to do good, there are so far no statements from the people in charge, the SKA Organisation, which detail how they expect the project to affect local communities. Perhaps on this rare occasion when science can have such a direct, positive impact on local people, it should seize the opportunity to go down in history as having played its part in eradicating poverty in Africa.

Alfie Ireland is a second year student studying Natural Sciences at Pembroke College.

9. “Brain Drain in Africa – Facts and Figures” (2008) [viewed 31/07/12]. Available from htp://images.derstandard.at/20080615/factsandfigures.pdf 10. “The Brain Drain: Causes, Effects and Remedies” (2009) [viewed 04/07/12]. Available from htp://www.scribd.com/doc/9695389/THE-BRAIN-DRAIN-CAUSES-EFFECTS-AND-REMEDIES 11. Dr Bernie Fanaroff, quoted in “Africa and Australasia to share Square Kilometre Array” on BBC News. Available at htp://www.bbc.co.uk/news/science-environment-18194984 12. Square Kilometre Array website, “Facts and Figures” [viewed 04/07/12]. Available from htp://www.skatelescope.org/about/facts-figures/ 13. South African Government Information – “the Square Kilometre Array” [viewed 01/08/12]. Available from htp://www.info.gov.za/aboutgovt/programmes/ska/index. html 14. Guardian online – “West Africa’s wait for high-speed broadband is almost over” [viewed 01/08/12]. Available from htp://www.guardian.co.uk/global-development/2012/jun/13/west-africa-high-speed-broadband 15. “Information and CommunicationTechnology, Poverty, and Development in subSaharan Africa and South Asia” Page 13 [Internet]. Produced by the World Bank.

Available from: htp://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2001/09/28/000094946_01091404003925/Rendered/PDF/multi0page.pdf

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Are Genetically Modified Mosquitoes a Futuristic Approach to Eradicating Malaria?

Cindy Jasmin Abarca

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he 2011 World Malaria Report recorded nearly 216 million cases of malaria worldwide, with one infected child dying every minute in Sub-Saharan Africa [1]. Malaria is prevalent in low-income, developing countries, where there are limited resources for prevention; it is a public health problem that must be eradicated or controlled. Malaria is caused by Plasmodium, a parasite that is transmitted through the bites of infected Anopheles mosquitoes to a human host. Once in the body, the parasite multiplies in the liver and infects red blood cells. Symptoms range from fever, headaches, and body aches to severe symptoms such as acute kidney failure, seizure and coma depending on how long the disease goes untreated [1, 2].

Past attempts to control malaria proved unsuccessful as the parasite became resistant to the 19th and 20th century anti-malaria drug (synthesized chloroquine) and to the Preerythrocytic vaccine. Thus, scientists have focused on other methods, such as the method introduced by Dr. Dimonopoulous and others at the John Hopkins Malaria Research Institute, where they created genetically modified Anopheles mosquitoes to block the transmission of malaria by enhancing the immune response of the Anopheles mosquitoes [3].

Although genetically modified Anopheles mosquitoes can be a solution to reduce malaria, there is not sufficient information about their potential impact on the environment.

Thus, genetically modified Anopheles mosquitoes may not be a viable response to malaria when researchers examine the potential ecological and ethical impacts of this intervention.

Instead, public health officials should focus on insecticidetreated mosquitoes nets (ITNs) because they are cost-effective and, unlike genetically modified Anopheles mosquitoes, do not raise controversial environmental and ethical issues.

Debates regarding the ethics of genetically modifying mosquitoes have stalled the implementation of this solution.

Opponents of genetically modified mosquitoes believe there is not enough research about how mosquitoes might affect the ecosystem to allow this proposal to go forward. Many people believe that it is unjust to alter living creatures for human benefit, especially considering the potential cost of afflicting long-term damage on the environment. These debates can be framed in terms of ecocentric and biocentric concerns [4].

Ecocentric concerns deal with the impact that the genetically modified Anopheles mosquitoes will have on the ecosystem as a whole. Biocentric concerns focus on the inherent value of the organism in its natural state [4]. These ecocentric concerns are apparent in environmental policy, such as the Wild Rivers Act of 2005 in Australia. This Act was enacted to protect Queensland’s remaining wild rivers, believed to play a vital role in maintaining their surrounding ecosystems [5]. One piece of biocentric legislation that has been presented in the past 8 THE TRIPLE HELIX Spring 2013 BROWN S13.indb 8

is the American Endangered Species Act of 1973, which was designed to protect animals from extinction and argued for the protection of endangered animals from improper human behavior [4]. Opponents of genetically modified Anopheles mosquitoes on biological grounds believe it is unethical to alter the mosquito’s physiology and biochemical makeup under any circumstances.

In addition to these biocentric and ecocentric concerns, the ability of genetically modified mosquitoes to completely eradicate malaria and to survive outside laboratory conditions has been questioned. The Anopheles mosquito modified by Dimonopoulous et al. boosts the mosquito’s immune system by inducing higher expression of Rel2 protein, which elicits an anti-parasite immune response. Currently, there are questions regarding the fitness of these genetically modified Anopheles mosquitoes relative to wild mosquitoes, specifically if they are able to survive on non-infected blood. Genetically modified Anopheles mosquitoes are more likely to survive than the wild type mosquitoes when fed malaria-infected blood, but when fed non-infected blood, the mosquito has no advantage over the wild type [6]. In order to control malaria, the genetically modified mosquito must displace the wild mosquito population, even when not exposed to infected blood [6]. According

Debates regarding the ethics of genetically modifying mosquitoes have stalled the implementation of this solution to a study conducted by Dimopoulous, et al. in 2011, “The immune system of the Anopheles mosquito is capable of killing a large proportion—but not all—of the disease-causing parasites that are ingested when the mosquito feeds on an infected human”[7]. Because the Anopheles mosquito does not completely eliminate the parasite, further research should focus on factors that contribute to this outcome and the beneficial effects of high levels of immune-boosting Rel-2 expression, the mechanism by which the modified mosquito kills the parasite.

It is also imperative that scientists conduct exhaustive research on the unintentional consequences of producing genetically modified Anopheles mosquitoes with higher levels of Rel2.

The survival of genetically modified mosquitoes and their interactions with other mosquitoes may likely have a large impact on the environment, and such an impact must first be © 2013, The Triple Helix, Inc. All rights reserved.

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Currently, there is no explicit legislation that provides guidelines regarding the introduction of genetically altered animals in the wild. There is also a lack of data regarding how the transgenic mosquitoes would affect the varying climates of different countries. However, efforts have been made on the responsible use of genetically modified organisms in The Cartagena Protocol on Biosafety issued in January 2000 and enacted on September 2003 w[4]. The international agreement ensures safe handling, transport and use of living modified organisms that may have potential adverse effects on biological diversity and human health [8]. The primary concern of this treaty, though, was the safety and trade of genetically altered food products, not animals being used to combat diseases. A global treaty that rigorously examines genetically or modified organisms is needed, especially because of the ecological risks of introducing genetically modified mosquitoes into the wild will likely vary across climates [8]. It is particularly difficult to evaluate possible effects on various locations, because mosquitoes do not remain in one place. The effect of modified mosquitoes crossing national and continental borders must be considered. [4]. With this in mind, a new treaty should be established where it could provide strict regulation on testing the effects, disadvantages and advantages of genetically altered animals before they are released to the ecosystem and allowed to cross continental borders. In order for affected countries to come to an agreement of whether to approve or reject the use of genetically modified mosquitoes, more extensive research and data is needed. However, such data is costly to acquire, and may even show that altered mosquitoes negatively impact the environment.

It would be irresponsible to alter the Anopheles mosquito without taking the proper precautions to validate it as effective and safe. As stated by Dr. Dimopoulous, “we’ve taken a giant step toward the development of new mosquito strains that could be released to limit malaria transmission, but further studies are needed to render this approach safe and fail-proof” [7]. Specifically, insecticide- treated mosquito nets are an alternative means of preventing malaria that is cost effective, efficient and has minimal environmental effects. ITNs are a form of vector control; the nets contain insecticides such as permethrin and deltamethrin and have been shown to be twice as effective as untreated nets. In addition, this method, which is administered by the United Nations and the World Health Organization (WHO), is cost-effective since each net References 1. Center for Disease Control and Prevention. Malaria Facts [internet]. 2012 [updated 2012 Nov 9; cited 2012 Dec 23]. Available from: http://www.cdc.gov/malaria/about/ facts.html 2. Enayati A, Hemingway J. Malaria management: past, present, and future. Annual Review of Entomology. 2010; 55(1):569-591.

3. Dong Y, Das S, Cirimotich C, Souza-Neto J, McLean K, Dimopoulos G. Engineered Anopheles immunity to Plasmodium infection. PLoS Pathogens. 2011; 7(12): e1002458. doi:10.1371/journal.ppat.1002458.

4. Macer D. Ethical, legal and social issues of genetically modifying insect vectors for public health. Insect biochemistry and molecular biology. 2005; 35(7): 649-660.

5. Smith R. Wild Rivers, wild accusations–wild law in the Cape York wilderness.

International Journal of Liability and Scientific Enquiry. 2012; 5(1): 22-31.

6. Johns Hopkins Bloomberg School of Public Health. Malaria-Resistant Mosquitoes Thrive in Lab [Internet]. 2007 [cited 2012 Dec 23]. Available from: http://www.jhsph. edu/news/stories/2007/jacobs-lorena-mosquito.html 7. Clark L. Genetically-modified mosquito designed to avoid malaria spread

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Reproduced from [12]

costs between $2.50 and $3.50 [9]. ITNs are designed to keep mosquitoes away from humans, and are most effective when placed over beds to prevent nocturnal transmission. A study in Gambia showed that the ITNs reduced malaria-attributable mortality by 30% and overall mortality in children by 37% [10].

In Kenya, a study of 130,000 people showed that the mortality rate for children under twelve months of age had significantly decreased after four years of ITN use [10,11]. This reduction was 77% greater than the reduction in communities that did not use the nets [11]. Despite such positive results, ITNs are fairly underused. In fact, only 2% of children in urban areas in Sub-Sahara Africa use ITNs [9]. Overall, ITNs are a better response to mitigate malaria than genetically modified mosquitoes because they are ethical, practical and cost-effective for low income populations.

Continuing funding for genetically modified mosquitoes to eradicate malaria should be reconsidered. Possible benefits are outweighed by the environmental risks and uncertainties involved with releasing such mosquitoes into the wild. These risks prevent trial testing of this method of control. Instead, funds should be directed towards other prevention methods such as ITNs. ITNs have been proven to slowly decrease the incidence of malaria and provide a secure, cost effective, and ethical method of prevention. Thus, funds should be geared toward a more humanistic and holistic approach that will eliminate malaria without a potential rise of other diseases or environmental problems which can have an irreversible and catastrophic effect on the biosphere, ecosystem, and environment. At this moment, genetically modified mosquitoes cannot provide a safe outcome with certainty.

Cindy Abarca is a freshman at Brown University planning to double major in Community Health and Education Studies with an emphasis in Human Development. Her interest in writing this article arose from learning about malaria and different disease prevention methods in her Introduction to Public Health course.

[Internet]. 2012 [cited 2012 Dec 23]. Available from: http://www.wired.co.uk/news/ archive/2012-06/13/genetically-modified-mosquitoes 8. Ostera G, Gostin L. Biosafety concerns involving genetically modified mosquitoes to combat malaria and dengue in developing countries. JAMA: The Journal of the American Medical Association. 2011; 305(90):930-931.

9. News-Medical [Internet]. 2012 [cited 2012 Dec 23]. Available from: http://www. news-medical.net/health/Malaria-Prevention.aspx 10. Breman. Epidemiology, Prevention, and Control of Malaria in Endemic areas.

2012 [cited 2012 Dec23]. Available from: http://www.uptodate.com/contents/ epidemiology-prevention-and-control-of-malaria-in-endemic-areas 11. Lindblade KA, Eisele TP, Gimnig JE, et al. Sustainability of reductions in malaria transmission and infant mortality in western Kenya with use of insecticide-treated bednets: 4 to 6 years of follow-up. JAMA: The Journal of the American Medical Association. 2004: 291(21):2571-2580.

12. Centers for Disease Control. Anopheles Mosquitoes [Internet]. 2012 [updated 2012 Nov 9; cited 2012 Dec 24]. Available from: http://www.cdc.gov/malaria/about/ biology/mosquitoes/freeborni_large.html

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500 Friends Yet All Alone: Exploring Facebook Depression Timothy Chou

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t’s that party from last Saturday and your friends are getting ready and looking amazing in all those photos. The only problem? You didn’t know about their get-together until you saw it on your Facebook newsfeed. Scrolling down a bit more, you see that a kid from your high school just updated his status; it’s only November, but he already has a paid summer internship abroad—travel expenses included! On the other hand, your own summer plans so far have only amounted to a number of fruitless Google searches. Oh look, your ex just went from “single” to “in a relationship.” Cautiously, you check the offending profile and do some examining. Darn it, they look great together. Somehow, you end up signing off not quite as happy as you were when you first signed on.

Could it be Facebook depression?

According to one Brown student, “I wouldn’t say that I become depressed, but I can see how people could feel bad because of things they see on Facebook.” She added, “Sometimes I see a friend saying hi to another friend, and I do feel a bit sad that they didn’t say ‘hi’ to me” [1].

Of the Brown students interviewed, most stated that they occasionally felt worse about themselves after seeing other people’s activities on Facebook, though they wouldn’t necessarily define their experience as Facebook depression.

Another student said that she definitely believed that Facebook depression exists. She compared Facebook friends’ profiles to celebrities’ lives: “You want that life, but a part of you knows that part of the glamour is media-made. But you actually know your Facebook friends, so it’s more obtainable, and you feel worse when you don’t share those happy moments” [2].

Facebook began in Mark Zuckerberg’s Harvard dorm room and was only accessible to Harvard students. Soon, the networking site spread to other major American universities, and two years later it expanded membership to high school students. In September 2012, the site reached over 1 billion active users [3]. While people of all age groups have begun using the social networking site, it has become especially ubiquitous on college campuses; in fact, some studies have reported that over 90% of all college students have a Facebook account [4].

The release of a mobile application further increased the presence and accessibility of the social networking site, allowing people to be connected at all times [5].

As Facebook’s prevalence grew, especially among members of the younger generation, researchers started examining how the site was affecting the mental health of users. The American Academy of Pediatrics first coined the term “Facebook depression” in their early 2011 clinical report, “The Impact of Social Media on Children, Adolescents, and Families.” They defined this new phenomenon as “depression that develops when preteens and teens spend a great deal of time on [Facebook],

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and then begin to exhibit classic symptoms of depression” [6]. Dr. Gwenn O’Keeffe, the main author behind the clinical report, argues that adolescents who already feel lonely and have low self-esteem could feel even more pathetic when they see all of their “friends” posting statuses or photos online showcasing all the exciting things they are doing [7]. It’s easy for users to forget that Facebook accounts are usually selective projections of only the very best aspects of others’ lives, and that they misrepresent reality by leaving out all of the negative parts [8]. Seeing others’ lives in this skewed form can lead to teens already at risk for developing depression feeling that their lives do not measure up.

Though Facebook depression was initially only applied to younger students, researchers have begun to examine the social networking site’s influence on college students. Research conducted at Utah Valley University showed that undergraduates were vulnerable to the same misconceptions, that others were happier than they were. The research found that these beliefs were stronger when the subject had more connections on Facebook who were only acquaintances in real life. Users were more likely to believe that strangers—as opposed to those who they had closer relationships—were leading desirable lives based solely on their Facebook profiles [9]. The study demonstrated that college students, like adolescents, are prone to misconceptions that lead to feelings of inadequacy and loneliness.

The emerging connections between Facebook and psychological health spurred researchers to also examine the ramifications of social networking on physical health. Specifically, a group of researchers at Regis University looked into the correlation between social networking and the rate of upper respiratory infections in undergraduate students. They defined upper respiratory infections as any one of the set of symptoms usually associated with the common cold, such as congestion, cough, and fever. The researchers hypothesized that larger networks would lead to a healthier mental state and have a positive impact on physical health. They were surprised to find that instead, larger social networks on Facebook were actually correlated with higher rates of upper respiratory infections. They concluded that while larger offline social networks promoted physical and mental health, online social networks could have the opposite effect. Long-term stress induced by activities related to Facebook could have compromised the immune system and led to higher rates of infection [10].

Fewer studies have been conducted on correlations between health and Facebook use of other age groups, but anecdotal evidence suggests that older users also experience Facebook depression. Pamela Newton, an English teacher who writes for the Huffington post, writes in her column, “Facebook has © 2013, The Triple Helix, Inc. All rights reserved.

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Another writer, Kayley Kravitz, endorses Newton’s feelings that Facebook users are “bombarded” with friends’ achievements and can feel depressed at their own perceived lack thereof [12]. Kravitz and Newtons’ personal experiences reveal that those of all age groups are vulnerable to Facebook depression, though maybe older age groups are affected to a lesser extent.

Critics of Facebook depression have argued that the claims of the AAP were premature and unsubstantiated, and that the condition does not actually exist. A year after the term was first coined, researchers at the University of WisconsinMadison conducted a survey with a group of undergraduate students. Their goal was to determine the correlation between Facebook use and depression through periodic questionnaires.

They monitored three different groups who spent different amounts of time on Facebook, tracking individuals’ emotional state via text message. Ultimately, they found no reason to believe that the social networking site in and of itself was causing depression because the three groups did not appear to have any differences in level of depression [13].

Without a definitive consensus about the existence or extent of Facebook depression, most psychiatrists simply recommend monitoring use of Facebook as a general precaution and teaching adolescents about potential dangers of social networking. Dr. O’Keeffe, the original AAP researcher who proposed Facebook depression, suggests that parents maintain an open dialogue with adolescent users about the condition as well as other online risks. She emphasizes that Facebook inherently does not cause depression, but instead acts as a “magnifier” that exacerbates pre-existing conditions [14]. Dr. Megan Moreno at the University of Wisconsin suggested that Facebook can actually have positive influences on emotionally healthy users by increasing “feelings of social connectedness” [15]. However, it can have the opposite effect on those already emotionally vulnerable and prone to depression. The study conducted at Utah Valley University found that Facebook users References 1. Anon. Interviewed by: Timothy C. 26 Nov 2012.

2. Anon2. Interviewed by: Timothy C. 26 Nov 2012.

3. Protalinski, E. Facebook officially passes 1 billion monthly active users [Internet].

2012 [updated 2012 Oct 4; cited 2012 Dec 24]. Available from: http://thenextweb.com/ facebook/2012/10/04/facebook-hits-1-billion-active-users/ 4. Perez, E. Obama approval on the rise among millennials, especially on college campuses, Harvard poll finds [Internet]. 2011 [cited 2012 Oct. 15]. Available from: http://www.iop.harvard.edu/spring-2011-survey 5. Fink, E; Segall, Laurie. Facebook launches speedy new mobile app [Internet]. 2012 [cited 2012 Oct 15]. Available from: http://money.cnn.com/2012/08/23/technology/ facebook-mobile-app/index.html 6. O’Keeffe, G. The Impact of Social Media on Children, Adolescents, and Families [Internet]. 2011 [cited 2012 Oct 15]. Available from http://pediatrics.aappublications. org/content/early/2011/03/28/peds.2011-0054.full.pdf+html?ijkey=76f29031adb1f95a04 cca23436b5ccdebfd5cd9f 7. Rochman, B. Pediatrician should discuss ‘Facebook Depression’ with kids [Internet]. 2011 [cited 2012 Oct 15]. Available from http://healthland.time. com/2011/03/28/pediatricians-should-discuss-facebook-use-with-kids/ 8. Jordan, A. Misery has more company than people think: underestimating the prevalence of others’ negative emotions [Internet]. 2011 [cited 2012 Oct 15]. Available from http://www.ncbi.nlm.nih.gov/pubmed/21177878

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who engaged with friends more frequently offline were less likely to hold inflated perceptions of others’ lives, suggesting that increasing offline social interactions could be beneficial to emotional health [9].

The widespread use of Facebook and concurrent increase in rates of depression among undergraduates renders awareness of Facebook depression a critical part of evaluating and treating the mental health of college students. While it may be impossible to completely extricate social networks from students’ lives, decreased or monitored use should be considered for individuals already discontented with their lives. Further research should explore the experiences of those who have removed Facebook from their lives, in particular the impact on social connections, relations and mental health. Finally, the Facebook depression phenomenon revisits discussion about the overall mental health of our society, and especially what effects increasing connectedness thanks to technology has on impressionable members of the younger generation.

Timothy Chou is a sophomore studying Biomedical Engineering at Brown University.

9. Chou, G. They are happier and having better lives than I am: the impact of using Facebook on perceptions of others’ lives [Internet]. 2012 [cited 2012 Oct 15]. Available from http://online.liebertpub.com/doi/abs/10.1089/cyber.2011.0324 10. Campisi, J. Facebook, stress, and incidence of upper respiratory infection in undergraduate college students [Internet]. 2012 [cited 2012 Oct 15]. Available from http://online.liebertpub.com/doi/abs/10.1089/cyber.2012.0156 11. Newton, P. I Facebook, Therefore I Am [Internet]. 2012 [cited 2012 Oct 15].

Available from http://www.huffingtonpost.com/pamela-newton/facebookidentity_b_1818281.html 12. Kravitz, K. Farewell to Facebook [Internet]. 2012 [cited 2012 Oct 15].

Available from http://www.huffingtonpost.com/kayley-kravitz/farewell-tofacebook_b_1895429.html 13. Facebook use does not lead to depression, according to new study [Internet]. 2012 [cited 2012 Oct 15]. Available from http://www.med.wisc.edu/news-events/facebookuse-does-not-lead-to-depression-according-to-new-study/38208 14. Magid, L. ‘Facebook Depression’: A Nonexistent Condition [Internet]. 2011 [cited 2012 Oct 15]. Available from http://www.huffingtonpost.com/larry-magid/facebookdepression-nonexistent_b_842733.html 15. Tanner, L. Docs warn about Facebook use and Teen Depression [Internet]. 2011 [cited 2012 Oct 15]. Available from http://www.huffingtonpost.com/2011/03/28/ facebook-depression-2011_n_841282.html 16. www.facebook.com

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Caring for Caregivers: Alzheimer’s Treatments as They Pertain to Loved Ones Adam Kopp

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lzheimer’s is a terminal, progressive disease and the most common cause of dementia. Over the course of its development, an increasing number of brain regions become damaged, and sufferers develop a host of symptoms such as memory loss, mood swings, and the inability to communicate and reason. The risk of Alzheimer’s increases with age and most affected individuals are older than sixty-five [1].

Alzheimer’s disease and its symptoms probably sound familiar. Incidence of Alzheimer’s is growing with America’s aging population and care for the disease is anticipated to cost the country around $20 trillion dollars over the upcoming decades [2]. Those lucky enough to not know someone with Alzheimer’s are unlikely to have avoided depictions within the news, advertisements or movies. Often, the media speaks about Alzheimer’s with colorful epithets such as “the long goodbye,” and “the funeral that never ends” [3]. Here, those diagnosed are subjected to an unfortunate social death that precedes their biological one by years [3]. Popular portrayals echo this sentiment. The prominence of Alzheimer’s warrants its inclusion in many Hollywood films – 2011’s “50/50” is a good example. In the movie, the male protagonist’s father suffers from dementia. While the main character battles cancer, his father seems unable to engage with that diagnosis, and acts simply as another burden for the mother.

Representing Alzheimer’s in this fashion creates a culture in which only decline is expected of the diseased. Not all cultures treat dementia in the way that Americans do. In

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Japan, the word boke describes a cognitive decline that corresponds with mild to moderate Alzheimer’s. There, people think boke can be improved with physical stimulus and exercise.

In America, the sufferer is considered to have no role in his improvement. Boke is less stigmatized than our dementia, because its progression is seen as preventable and the onset of the disease avoidable [4]. While it would be irresponsible to deny the effects of Alzheimer’s, the concept shows how culture can affect the lives of caregivers and those with the disease, an idea that should be kept in mind when evaluating pharmacological intervention. Caregivers end up making critical decisions for Alzheimer’s patients: which drug treatments they use, how long they stay on drug regiments, and whether to institutionalize their loved ones. It is an enormous burden and makes evaluating the caregiver perspective all the more important when examining treatments as well as the disease itself.

Current Treatment Paradigm: Drugs and Caregivers The failure of brain cells is at the heart of Alzheimer’s pathogenesis, but the cause of the cells failure is still unclear. An early hypothesis speculated that reduced production of the neurotransmitter acetylcholine was to blame for Alzheimer’s disease, since cholinergic neurons lose function in sufferers.

Today, evidence points towards the “amyloid hypothesis,” which posits that the build-up of a brain protein called amyloid-β causes neuronal degeneration [5].

As researchers look for new therapies, the prevailing theories about the disease’s cause serve to guide them. Four of the five FDA-approved Alzheimer’s treatments work within the parameters of the old cholinergic hypothesis. These acetylcholinesterase inhibitors compensate for lowered levels of acetylcholine by blocking the degradation of extant stores of the chemical [6]. Along with cognitive impairments, many patients develop mental problems ranging from aggression to psychosis and depression. In these cases, antipsychotic drugs are often employed [7].

Drugs and Perceived Quality of Life It is important to consider pharmacological interventions for Alzheimer’s through the dual lens of patient and caregiver, examining carefully the needs of each party. If their goals are ever at odds, what degree of responsibility do doctors and drug makers have to each?

Acetylcholinesterase inhibitors entered the market in 1993. Initial trials yielded modest but statistically significant

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PDF Compressor Pro BROWN improvements in cognitive impairment compared to a placebo when administered over 24 weeks [4]. Whether the results seen in clinical settings translate to tangible benefits for caregivers and patients is less certain. It is important to draw a distinction between the “cognitive impairments” measured by esoteric tests gauging a drug’s efficacy and other impairments that affect day-to-day life, such as agitation and memory loss.

Often, patients and relatives place greater emphasis on the latter group, and when studied systematically, the perceived quality of life reported by patients and caregivers showed no correlation with levels of cognitive impairment [8].

Regardless, acetylcholinesterase inhibitors have demonstrated at least modest success in delaying some aspects of decline for periods of 6 to 12 months [4]. While caregivers are aware of the short-term usefulness of these drugs, they often perceive and administer them as a long-term solution.

Patients persist on acetylcholinesterase inhibitors for at least five years in 10-44% of cases [4]. Several aspects of the nature

Evidently, patients respond differently to different demographics of caregivers of acetylcholinesterase inhibitors contribute to their long-term implementation even though there is no clear evidence that their benefits can be extended that far.

Caregiver’s perceptions of drugs are in part influenced by the way the drugs are branded. Physicians and advertisements suggest that drugs can delay institutionalization, a dirty word that caregivers avoid at all costs [4]. As a loved one loses his personality and self-reliance, at least his physical presence remains as a constant. The fear of losing a proximal connection can lead to caregivers imagining institutionalization as an event in the distant future [4]. Overestimating the time left before institutionalization in turn leads to an overestimation of the utility of a drug that would prevent such an outcome. There are many reasons to avoid placing a loved one in another’s care, but nursing homes can provide valuable services. Ultimately, this is a deeply personal decision made all the more difficult when the burden is placed solely on a caregiver. It is why discussions about what to do in this scenario should take place among elderly couples and their families long before Alzheimer’s affects either party.

Another factor contributing to the long-term use of pharmaceuticals is that the downside of halting treatment generally outweighs the downside of continuing it. Caregivers initially place a large amount of hope in these medications, but often report ambivalence about their effects [4]. One problem with evaluating a drug’s success is that observers lack a point of reference, a sense of where the patient would be in the absence of treatment. The only way to gain this point of reference is to stop the drug regiment, which many are unwilling to do [4]. While caregivers are cautioned against halting acetylcholinesterase

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use, the manner in which psychotropic agents (which combat depression, the symptom that patients find most worrisome) are administered involves a scaling back after stabilization [9]. This could relate to the toxicity of psychotropics, but as with boke, the social environment around various symptoms should be examined. In mental illness the onus of well-being is sometimes considered to be within the sufferer’s control.

The symptoms of Alzheimer’s that mimic mental illness and yield fluctuations of mood need to be treated just as seriously and rigorously as those that are unique to dementia.

The Caregiver Due to growing incapacity, someone with Alzheimer’s becomes increasingly reliant on the assistance of caregivers, a role often filled by close relatives. Caregivers must aid sufferers in most aspects of everyday life and make decisions about how to treat their loved one’s disease.

Often, adults with full lives of their own are forced to divert a large fraction of their time to aid loved ones with tasks from dressing to bathing. These chores are made all the more difficult by having to simultaneously watch a deeply cared for individual struggle with activities that have been trivial since childhood. Perhaps more devastating than the time-loss in caring for a sufferer is a shift-in-time perspective, a metric of how a person relates to and monitors the passing

Often caregiving options are limited, but individuals should have conversations about what source of care is desirable well before they may get sick of time [10]. In looking at the time perspectives of spouse caregivers, researchers studied healthy seniors and dismissed the stereotype of older people disengaging from the present and looking woefully towards their past. Instead, they saw that the elderly had a healthy focus on the present and future, which correlated positively with well-being and a sense of meaning in life [10].

The overwhelming stress of caring for someone with Alzheimer’s often shifts the time perspective of caregivers as it relates to the future. Caregivers find themselves far less focused on and more pessimistic about the future than their peers [10]. Elderly couples have often engaged in a highly symbiotic relationship for the majority of their lives, where planning for the future becomes a wholly shared endeavor.

Thus, when one spouse develops Alzheimer’s disease, the other is forced to deal not only with the devastation of seeing and caring for her slowly deteriorating loved one, but with a fundamental change in the way she orientates herself towards the future. Unfortunately, this altered time perspective persists and worsens after the afflicted spouse’s death. Even the caregiver’s view of the past becomes skewed, as they associate

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it with the period of caregiving they just overcame [10].

Differences in perspective between caretakers and patients The goal of medicine as a science and profession is essentially to make sick people better. Unfortunately, as it stands today, there is no treatment for Alzheimer’s that offers to slow or stop its progression. In no uncertain terms, a patient will continue to decline after an Alzheimer’s diagnosis. Drugs can, however, offer to ease certain symptoms of the multifaceted affliction. On a case-by case basis, it must be decided what ills warrant the most attention. Caregivers and patients have very different experiences of Alzheimer’s so that the symptoms that most concern patients don’t always align with those that most worry their caregivers [8].

While caregivers prioritize the patient’s degree of autonomy, this parameter was of less concern to patients who may have an easier time coming to terms with their own disability [8]. Paramount among caregiver’s fears is that of institutionalization. Along with autonomy, caregivers judged quality of life based on physical behavior of the patient, specifically presence of agitation, anxiety and aberrant motor References 1. Alzheimer’s Society. What is Alzheimer’s disease? [Internet]. 2011 [updated 2012 March; cited 2012 Nov 7]. Available from: http://www.alzheimers.org.uk/site/scripts/ documents_info.php?documentID=100 2. Alan Silverleib. Obama to boost Alzheimer’s research funding. CNN Health [Internet]. 2012 Feb 7 [cited 2012 Nov 26]; Available from: http://www.cnn. com/2012/02/07/health/alzheimers-funding/index.html 3. Traphagan J.W. Localizing senility: Illness and agency among older Japanese.

Journal of Cross-Cultural Gerontology. 1998; 13(1):81-89.

4. Smith A. The controversial promises of cholinesterase inhibitors for Alzheimer’s disease and related dementias: A qualitative study of caregivers’ experiences. Journal of Aging Studies. 2011;(25):397-406.

5. Hardy J. Amyloid deposition as the central event in the aetiology of Alzheimer’s disease. Trends in Pharmacological sciences. 1991;12(10):383-8.

6. MedlinePlus. Donepezil. [Internet]. 2010 Sept 1 [updated 2012 Nov 20; cited 2012 Nov 7]. Available from: http://www.nlm.nih.gov/medlineplus/druginfo/meds/ a697032.html 7. Ballard C. The effectiveness of atypical antipsychotics for the treatment of

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behavior. Interestingly, these issues were of less concern to the patients, who considered their own quality of life to be most influenced by depression and apathy [8]. After a time, caregivers will make most of the decisions regarding treatment, and it is important for them to consider that their loved ones are not experiencing the disease in the same manner that they are. Above all, the patient’s voice cannot be dismissed.

The way quality of life is perceived not only varies from caregiver to patient, but also depends on a host of different factors. For instance, caregivers and patients evaluated quality of life higher for male sufferers than female ones, perhaps because the traditional female role of maintaining the house is greatly compromised by Alzheimer’s. Adult children caregivers perceived quality of life more negatively than spouse caregivers, a result that can be partially attributed to the aforementioned fear of institutionalization, which becomes less of a concern when the patient is living with their caregiver [8]. Evidently, patients respond differently to different demographics of caregivers.

Often caregiving options are limited, but individuals should have conversations about what source of care is desirable well before they may get sick. Furthermore, caregivers should be aware of how families outside their own approach their shared ask. By taking a more universal perspective, they’ll increase their ability to adapt to the new lifestyle thrust upon them.

Conclusion In the case of vexing diseases, cures are hoped and raced for.

Unfortunately, despite the painstaking work of scientists, a cure for Alzheimer’s has remained elusive. In dealing with the disease, the absence of a cure must be remembered, and caregivers and doctors must work together to handle Alzheimer’s accordingly. At the time of diagnosis, patients may be unable to articulate how they want their condition to be handled, so it is imperative that people establish a dialogue with loved ones regarding issues such as drug options and institutionalization.

Through vigorous partnership, loved ones have built fulfilling lives together, and they should avoid letting an Alzheimer’s diagnosis derail that partnership and sense of fulfillment.

Adam Kopp is a sophomore Neuroscience concentrator at Brown University.

aggression and psychosis in Alzheimer’s disease. Cochrane Database of Systematic Reviews. 2006;(1): CD003476.

8. Conde-Sala J.L. Factors related to perceived quality of life in patients with Alzheimer’s disease: the patient’s perception compared with that of caregivers.

International Journal of Geriatric Psychiatry. 2009;(24):585-594.

9. Cummings J.L. Guidelines for Managing Alzheimer’s Disease: Part II. Treatment.

American Family Physician. 2002;65(12):2525-2534.

10. Potgieter J.C. The time perspective of the Alzheimer caregiver. Dementia.

2012;(11):453 11. NIH Medline Plus [image on the Internet]. 2010 [cited 2012 Dec 12]. Available from: http://www.nlm.nih.gov/medlineplus/magazine/issues/fall10/articles/fall10pg20-21. html 12. NIH Senior Health [image on the Internet]. [cited 2012 Dec 12]. Available from: http://nihseniorhealth.gov/alzheimersdisease/symptomsanddiagnosis/meal_bed_ popup.html

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Designing Babies and Customizing our Future Julia McGirr

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hat if we had the power to direct our own human direct competition with the genetically-enhanced designer evolution, controlling what traits we pass on and babies [4]. Their “natural” progeny would then have a deshaping future generations, even to the point of creased likelihood of perpetuating their now relatively unfit surpassing what is recognizably human? “Reprogenetics” is genes. So, in a biological sense, individuals not able to enhance an umbrella term referring to genetic technologies relating their children, might be at a disadvantage in passing on their to reproduction, and the specific case of human germline genes. This would then be detrimental for self-efficacy since engineering has been the center of much controversy. Hu- the individual who doesn’t pass on their genes is ultimately mans’ ability to directly influence evolution by selecting for impotent, evolutionarily speaking. the genetic traits of embryos and creating “designer babies” Moreover, humanity might not want to accept the use has become a very real possibility. The question now turns to of genetic engineering to manipulate our own offspring bewhy this possibility is so controversial. What are the biological, cause it lends credence to the idea of biological determinism. psychological, and social factors at play here in determining Biological determinism, or the concept that genes are the sole public reactions to reprogenetics, and where does this leave determinants of an individual’s personality and actions, can us for the future? have drastic effects upon self-effiThe capabilities of reproduccacy. As a genetically-engineered tive technologies are constantly society, we would be placing Humanity fears that the changing, and recent developmore emphasis upon nature as ments include generating egg cells opposed to nurture and personal reprogenetic technology will from stem cells and non-invasive character formation. In this way, quickly accelerate and escape genetic screening of fetuses [1,2]. just acceptance of the idea would In addition, advances in gene adversely affect self-efficacy if our control, creating a foreign, modification and recombination individuals begin to view their apocalyptic future could allow for the complete prechoices as inconsequential since determination of the genotype of the genetic determinants of their a child, allowing for the selection lives are already solidified. of certain genes and not of others. This manipulation would In a social context, individuals can oppose the idea of specifically modify the genes of the sperm or egg, not only reprogenetics for its potential effect upon human solidarity. affecting all the cells of the developed human, but also the As members of a social group, humans are motivated by a cells of any future progeny. In this way, the alteration of the natural, social expectation to “retaliate against others pursuing genes of one child could have a considerable effect upon future anti-social behaviors” [5] in order to preserve the best interests generations. of the group. Genetic engineering can be seen as anti-social in One idea that could potentially help explain resistance to that it could embody the complete restructuring of not only “designer babies” and other forms of reprogenetics is that of the germline, but also of society as a whole. Reprogenetics self-efficacy. Self-efficacy, or the perceived ability to be effective could be a very real and viable threat to existing moral codes and induce change, is a fundamental concept underlying most and the nature of human-human interactions. If there is no of human social behavior. The greater a person’s perceived longer a stable set of natural capacities, a massive overhaul self-efficacy is, the greater the likelihood that they will attempt might be seen in not only human rights but also entities such to affect social change and work to fulfill goals. Reprogenet- as human interconnectivity, solidarity, and empathy. This ics can be threatening to the self-efficacy of individuals in a could be manifested in the possibility that in the future these number of biological and social ways. technologies can give some individuals certain advantages in Biologically, humans are driven to pass on their genes to the battles with disease, aging and death [6]. Although current future generations. In addition, humans have certain pronatal- economic and social factors may already interfere with this ist (pro-reproduction) drives, including the drive for social human solidarity, it is possible that the disparity will only get status [3]. The presence of this drive for social status can be worse with the advent of genetic engineering [4]. In this way, explained by the positive correlation between the wealth and this socially based objection to reprogenetics can be seen as a power of social status and the ability to attract the fittest mate. desire to prevent further diminishing the solidarity of society.

In conjunction, these drives can begin to explain why the This resembles more of a group embodiment of the concept of percentage of the population to whom this technology would self-efficacy as we tend to fear that messing with established be unobtainable might be hesitant or even resentful of its us- norms can make us a less functional societal unit as a whole. age by others. The “natural” progeny of those for whom the In addition, self-efficacy can have large-scale implicatechnology would be unaffordable would suffer through more tions for how society views not only the idea of designer

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babies, but the fate that designer babies could usher in- the fate of self-directed evolution. According to Albert Bandura, “it is mainly perceived inefficacy in coping with potentially aversive events that make them fearsome” [7]. In this way, it isn’t so much fear of genetic engineering in and of itself that is at the root of things, but rather the fear that genetic engineering will bring about a future with which humanity will be incapable of coping. Humanity fears that the reprogenetic technology will quickly accelerate and escape our control, creating a foreign, apocalyptic future. This plays into the idea of transhumanism, or the concept that humans are not the endpoint of evolution and that we will ultimately be transcended by a greater “post-human” [8]. Humanity then would be guiding evolution along a path farther and farther removed from itself.

In this vein, some people are vehemently opposed to the idea of genetic engineering because they perceive it as meddling in the domain of the higher (often believed to be divine) power currently controlling evolution. But what we must consider is the fact that the idea of a higher mediating power is not fundamentally incompatible with the concept of self-directed evolution. The fact that the course of natural evolution has brought humanity to the point of cognitive capability for engaging in genetic engineering in the first place seems to suggest, or at least not exclude, the possibility that

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self-directed evolution is a logical next step.

Overall, many factors can explain the hesitancy in accepting genetic engineering, with self-efficacy as a core idea.

Despite this, however, further constructive debate regarding reprogenetics should be explored in its entirety. Public policy in the United States regarding reprogenetics is largely non-existent and the policies that do exist regarding stem cell research are ambiguous, serve as points of contention and vacillate from president to president. The fact that policies such as the Dickey-Werner Amendment (which prohibits federal money from funding stem cell research involving the destruction of embryos) are constantly being re-evaluated by each new Presidency demonstrates how deeply intertwined with politics these policies are. Considering this, it seems an entirely logical and necessary suggestion that an independent committee composed of bipartisan geneticists, ethicists, and other experts in various scientific and anthropological fields should be established in the U.S. to develop policy, set standards, and instigate public discussion regarding these issues. Parens and Knowles proposed a plan for this very type of committee in 2003. It could be modeled after Britain’s Human Fertilization and Embryology Authority—a group composed of scientific, rather than political, authorities and is outside, but still accountable to, the government [9]. Nearly a decade later, a comprehensive committee of this nature is

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While the U.S. is without a comprehensive authority on reprogenetics, it remains unregulated within the private sector.

Instead, comprehensive research should be done into areas of possible concerns in germline engineering and self-directed evolution, and a committee coordinating research and public debate on these issues would be the most effective means of doing so. Specifically, concerns that should be considered include bottleneck effects created by intentionally selecting for certain traits and thus decreasing genetic diversity. This decreased genetic diversity could leave humanity less equipped to handle future adversity since the pool of available traits would be diminished. In addition, selecting against certain traits deemed deleterious could prove unwise if perhaps it provides a previously unseen advantage (for example through a heterozygote advantage). Moreover, another interesting idea to consider is the possibility of the social structure of humanity evolving into eusociality as a result. This is a phenomenon seen in species such as bees in which reproduction itself undergoes a division of labor, and the transmission of genes of the majority are sacrificed for the few. Especially if relatedness and kin selection (strategies to increase the fitness of kin at expense of an organism’s own survival) are considered to play a role in the evolution of eusociality [10], the potential proliferation of the genetically enhanced could decrease genetic diversity and increase overall human relatedness so that this possibility wouldn’t be so outlandish. The potential effects of

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References 1. Dillow, C. Scientists Use Stem Cells to Generate Human Eggs in the Lab. Internet.

2012 Feb 27 [cited 2012 Sep 26]. Available from: http://www.popsci.com/science/ article/2012-02/scientists-isolate-reproductive-stem-cells-generate-human-eggs-lab 2. Motluck, A. Fetal genome deduced from parental DNA. Nature. 2012 Jun 06 [cited 2012 Oct 7]. Available from: http://www.nature.com/news/fetal-genome-deducedfrom-parental-dna-1.10797 3. Morgan, S. P. and King, R.B. Why Have Children in the 21st Century? Biological Predisposition, Social Coercion, Rational Choice. European Journal of Population [Internet]. 2001 [cited 2012 Oct 7]. Available from: http://www.springerlink.com/ content/x236666070775315/ 4. Silver, L. M. Remaking Eden: How Genetic Engineering and Cloning Will Transform the American Family. New York: Harper Perennial; 2007.

5. Bowles, S. and Gintis, H. The Moral Economy of Communities: Structured Populations and the Evolution of Pro-Social Norms. Evolution and Human Behavior [Internet]. 1998 [cited 2012 Oct7]. Available from: http://www.sciencedirect.com/ science/article/pii/S1090513898000154 6. Lauritzen, P. Stem Cells, Biotechnology, and Human Rights: Implications for a Posthuman Future. The Hastings Center Report [Internet]. 2005 [cited 2012 Oct 7].

Available from: http://www.jstor.org/stable/3527760

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such a division of reproductive labor in society are certainly something to be considered in the reprogenetic discussion.

So, although the debate surrounding the controversial issue of reprogenetics might be stalled presently by various public views, committee-led consolidated research and efforts at public policy formation will provide a crucial step forward.

Even though fundamental differences might seem to be insurmountable obstacles to advancement, these differences could

The prospect of self-directed evolution that reprogenetics has ushered in is gamechanging, and hiding behind old tendencies and refusing to look past reservations could leave us forever chained to human disease and frailty merely stem from a universal human need for self-efficacy.

When viewed in this light, differing opinions seem less polarizing and less insurmountable. The theme of self-efficacy can also provide a useful starting point for reprogenetic public policy. The use of genetic engineering to prevent disease, if done responsibly, would not only be beneficial to society as a whole, but would also increase the self-efficacy of the individuals that are then allowed to participate in society unhindered by disease. Overall, the societal advantages to be gained by the responsible advancement of reprogenetics should not be overlooked. Also, the prospect of self-directed evolution that reprogenetics has ushered in is game-changing, and hiding behind old tendencies and refusing to look past reservations could leave us forever chained to human disease and frailty.

Julia McGirr is sophomore at Brown concentrating in Biology. She is interested in the philosophical intersection of ethics and biology, especially in terms of new advances in biotechnology.

7. Bandura, A. Self-Efficacy Mechanism in Human Agency. American Psychologist [Internet]. 1982 Feb [cited 2012 Oct 7]. Available from: http://rl3tp7zf5x.scholar. serialssolutions.com/?sid=google&auinit=A&aulast=Bandura&atitle=Self-efficacy+me chanism+in+human+agency.&id=doi:10.1037/0003-066X.37.2.122&title=American+psy chologist&volume=37&issue=2&date=1982&spage=122&issn=0003-066X 8. Bostrum, N. Human Genetic Enhancements: A Transhumanist’s Perspective.

Journal of Value Inquiry [Internet]. 2003 [cited 2012 Oct 8]. Available from: http:// www.nickbostrom.com/ethics/genetic.html 9. Knowles, L. P. and Parens, E. Reprogenetics and Public Policy: Reflections and Recommendations. [Internet]. 2003 July-August [cited 2012 Oct 8]. Available from: http://www.thehastingscenter.org/Publications/SpecialReports/Detail.aspx?id=1350 10. Hughes et al. Ancestral Monogamy Shows Kin Selection Is Key to the Evolution of Eusociality. [Internet]. 2008 [cited 2012 Nov 20]. Available from: http://www. sciencemag.org/content/320/5880/1213.short 11. Amanda Mills. ID #13529 [Image on the Internet]. 2011 [cited 2012 Dec 29].

Available from: http://phil.cdc.gov/Phil/details.asp 12. James Gathany. DNA Study [Image on the Internet]. 2004 [updated 2010 May 3; cited 2012 Dec 29]. Available from: http://www.icrc.org/eng/resources/documents/ misc/5vdjaf.htm

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Importance of Biological Factors in Emotion Elina-Eleftheria Pliakos

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t is part of our daily observation that people experience different emotions when exposed to the same stimuli.

What causes happiness in one person may cause sadness in another. Due to a desire to understand such differences and control them, people began to study emotion. Since then, philosophers and intellectwered to be a product of the mind and were explained in terms of the mind-body problem: “what is the relationship between mind and body?” [1]. Descartes proposed dualism: the idea that the brain and the mind are made up of completely different properties that interact [2].

Spinoza proposed the dual aspect theory: the idea that the brain and the mind are two ways of expressing the same thing [2]. Hobbes proposed materialism, the idea that “human beings are completely material” [3], in order to emphasize the biological nature of emotion. These views show that the

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distinction between the biological and the cognitive aspects of emotion was grasped early on.

In 1962 this idea of the interaction between the two components of emotion led to the development of the Two Factor Theory of emotion. According to this theory, proposed by Schachter and Singer, an external stimulus causes a general physiological arousal that is then labeled by cognitive appraisal and, following cognitive processing, leads to an appropriate emotion. For example, a frightening object such as a ghost leads to fear. Emotional arousal often leads to the “flight or fight reaction.” This reaction is evolutionarily important because it causes increased levels of adrenaline, dilation of the pupils and decreased blood flow to the digestive tract and thus allows for a quick physical response. Therefore, people

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placed in a situation they perceive as dangerous are more likely to experience the emotion of fear in the “flight or fight response” – hence, the physiological component of the Two Factor Theory is activated [4].

More recent literature is primarily concerned with the importance of emotional differentiation, or distinguishing between emotions, for improved emotional regulation. That is, the focus of study is determining the experiences of negative or positive feelings and using this evaluation to modify these emotions if they are negative. Researchers have coined two important terms: emotion knowledge (EK) that “consists of accurate understanding of the expressions, feelings, and functions of discrete emotions” and emotion utilization (EU) that “consists of the processes involved in making adaptive use of emotion arousal” [5]. These theories, however, are mainly concerned with cognitive processes and, as a result, the role of physiological arousal is often overlooked. This article aims to draw attention to the necessity of the coexistence of general physiological arousal and the cognitive appraisal of an event in order to experience an emotion. Physiological and cognitive components of emotion constantly interact, and understanding the relationship between biology and cognition in emotion allows us to better attribute our own behavior and the behavior of others to enhance emotional management.

The Two Factor Theory in Understanding Aggression The original experiment conducted by Schachter and Singer provides strong evidence of the Two Factor Theory. In their experiment, participants were divided into three groups: ‘‘Epinephrine Informed’’ (injected with epinephrine and told the real side effects of the drug), “Epinephrine Ignorant” (injected with epinephrine but told no symptoms at all) and “Epinephrine Misinformed” (injected with epinephrine and told the false side effects of the drug). They were then placed in a room with a research confederate who acted either euphorically or angrily. External observers rated the behavior of the participants. They found that the people who were misinformed about the effects of the drug copied the behavior of the confederates. This occurred because they were physically aroused by the drug, but could not attribute that arousal to any event and so used the confederate’s cues to identify it [6].

These results show that only when participants are injected with a chemical substance that causes physiological arousal and are afterwards presented with a stimulus that leads to cognitive processing do they have a strong emotional reaction. In this case, confederated behavior, not the particular nature of the physical arousal, is what eventually determines the emotion. As a result, the experience of emotion relies on a general physiological arousal and not a specific one. This data is particularly important because replication of similar studies would not be permitted today; it severely violates

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the code of ethics of psychological research by employing deception and by potentially causing harm to the patients due to the injection [7].

In a subsequent experiment it was demonstrated that if a person is insulted while they are running, biking or physically exercising they are more likely to become aggressive.

In Zillimann and Byant’s experiment there were two groups of participants. The participants first performed an arousing task such as riding an exercise bicycle and then a non-arousing task such as threading a disk. While they were performing these activities, a confederate insulted them. It was found that the aroused subjects (those who were exercising) were more likely to respond aggressively [8]. Thus, if a person is physically exercising and this puts them into a state of physiological arousal and then they experience something unpleasant then they are more likely to develop an aggressive reaction towards the unpleasant event than they would if they were not exercising. Under different circumstances, their behavior would be more reserved and less assertive.

With this knowledge, misunderstandings can be avoided and communication facilitated.

What Does Love Have to Do With It? Interestingly, there is a grain of truth in our tendency to assign love to the heart. We use words such as “heartbroken” to show emotional frustration, we have cartoons whose heart pumps out their body when they are excited and we use the heart as a symbol of love. Initially, this was due to ignorance of its crucial role in the circulatory system, but now it is because the heart is a commercialized symbol for love. But, according to research, if a person is physiologically aroused in the presence of another person (meaning their heart is more active), they will attribute their arousal to that person (cognitive labeling) and they will be more likely to fall in love. This situation has been coined as the Misattribution of Arousal Paradigm, which states that if a person attributes their arousal from an

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emotional source (e.g. fear) to a non-emotional source (e.g. drug), the perception of the emotion is diminished [9].

In Dutton’s and Aron’s experiment, males that were either on a high suspension bridge that caused physiological (fear-induced) arousal or on a low suspension bridge that did not cause physiological arousal were approached by a female interviewer who gave them a Thematic Apperception Test (TAT) to answer, as well as her phone number. The Thematic Apperception Test asks patients to comment on certain TAT cards and an analysis of these comments can provide information about the views of the respondents [9].

The males that were on the high suspension bridge tended to call the interviewer after the study in order to ask her on a date, while the ones on the low suspension bridge did not.

Sexual content was also found in the analysis of the TAT tests of those who were on the high bridge. In a similar experiment male participants were placed in the same room as female confederates that pretended to be participants. During the study they were threatened to receive mild or strong electric shocks. Sexual content was again found in the analysis of TAT test completed by the male participants, as the idea of the electric shocks produced arousal and the presence of the female acted as a cue to why they were aroused [10]. These studies show that if people are physically aroused and they experience some stimulus associated with romantic feelings they will think they are in love [10].

Clinical Applications Knowledge of the Two Factor Theory of emotion is also useful in clinical settings. Expecting a particular stimulus or expecting stimuli in general, can make the negative feelings of people less intense. This is particularly true for hospital patients.

If a doctor tells a patient they will administer a drug, their fear of their illness might be diminished because the patient attributes their arousal from an emotional source (e.g. the perception that the drug will cause pain) to a non-emotional

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PDF Compressor Pro BROWN source (e.g. the drug itself) [6]. Furthermore, Johnson and Leventhal found that if patients are given details about what they will experience during a surgical procedure they are less likely to experience stress and they will feel less pain [11].

The Two Factor Theory Today Today, research also relies on neural imaging (eg., fMRI and PET scans) to show the correlation between brain states and emotional responses as well as feelings. A more functional approach provides quantitative data and does not rely simply on the observation of behaviors. Different brain structures can be associated with different components of emotion. For example, evidence suggests that the amygdala, is a brain area

The idea of the role of biological factors in the formation of emotion should become part of folk psychology that is related to processing threat or danger is most important for fear. The orbital and ventromedial sectors of the prefrontal cortex are involved in emotional aspects of social behavior [12]. For example, in a study conducted by Herbert et al., participants were asked to silently read words that were either emotionally arousing, or non-arousing, or neutral. Functional magnetic resonance imaging (fMRI) revealed that when the participants read the emotion-arousing words there was activation in visual, limbic and prefrontal brain regions (specifically, the left amygdala and the left extrastriate visual cortex) [12].

Finally, we see that there is a plethora of studies demonstrating the salient role of biological factors in emotion compared to the cognitive factors. Therefore, it would be reasonable to suggest that the idea of the role of biological factors should become part of folk psychology, commonsense psychology used to explain everyday behavior. There are several studies that have shown how awareness of this theory is actually useful for emotional control. A study conducted by Sze et al., References 1. Stanford University. Dualism, Stanford Encyclopedia of Philosophy [Internet].

2003 [cited 2012 Oct 11]. Available from: http://plato.stanford.edu/entries/ dualism/#MinBod 2. Ward J. The student’s guide to cognitive neuroscience. 2nd ed. Hove: Psychology Press ; 2010 3. Duncan S. Thomas Hobbes [Internet]. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. 2009 Mar 11 [cited 2012 Mar 10]. Available from: http:// plato.stanford.edu/entries/hobbes/#3 4. Schachter S, Singer JE. Cognitive, Social, and Physiological Determinants of Emotional State. Psychological Review. 1962; 69(5):379-399.

5. Izard CE, Woodburn EM, Finlon KJ, Krauthamer-ewing ES, Grossman SR, Seidenfeld A. Emotion Knowledge, Emotion Utilization, and Emotion Regulation.

Emotion Review. 2011; 3(1):44-52.

6. Cotton JL. A Review of Research on Schachter’s Theory of Emotion and Misattribution of Arousal. European J of Social Psychology. 2011; 11(4):372-375.

7. Holah M. The Schachter and Singer Page. [Internet]. 2008 [cited 2012 Sep 25].

Available from: http://www.holah.karoo.net/schachter.htm 8. Zillmann D, Bryant J. Effects of residual excitation on the emotional response to provocation and delayed aggressive behavior. J of Personality and Social Psychology.

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showed that the awareness of a person’s bodily sensations led to better emotional coherence [13]. Specifically, there were three groups of participants: one of experienced dancers, one of Vispassana meditators, and one of control participants. The results indicated that emotional coherence was higher for the meditators and dancers than for the control participants [13].

One explanation could be that the meditators and the dancers were more aware of the role of physiological arousal due to their expertise and so labeled the emotions more appropriately.

Similarly, a study by Zaki et al., shows that there is increased activity in the insula, a brain region associated with the regulation of emotion, in two situations: (1) when participants have high awareness of their emotion according to the way they rated their emotional responses to films and (2) when people are more aware of their internal bodily states according to heart rates measured during the same films [14]. This study demonstrated that body awareness, or physiological arousal, is important for emotional regulation as there is activation of a brain region important for this type of emotional control.

Conclusion The studies cited clearly demonstrate the importance of understanding the interaction between biological and cognitive factors. What is important in all of these cases is that controlling emotions can allow us to make valid attributions. This is particularly important because improved control of emotions can help prevent psychological disorders while valid attributions can provide us with clues as to how to respond to others, facilitating communication and cooperation.

Elina Pliakos is a premedical first year planning on concentrating in biochemistry/molecular biology. After taking a class on cognitive neuropsychology, she realized the broad appeal of the topic of emotion and thus this article was born.

1974; 30(6):782-791.

9. Dutton DG, Aron AP. Some evidence for heightened sexual attraction under conditions of high anxiety. J of Personality and Social Psychology. 1974; 3(6):353-356.

10. Berscheid E, Walster E. Interpersonal Attraction. 2nd ed. Reading: AddisonWesley Publishing Co; 2010.

11. Nisbett RE, Schachter S. Cognitive manipulations of pain. J of Experimental Psychology. 1966; 2(3):231-259.

12. Berscheid E, Ethofer T, Anders S, Junghofer M, Wildgruber D, Grodd W et al.

Amygdala activation during reading of emotional adjectives—an advantage for pleasant content. Social Cognitive and Affective Neuroscience. 2008; 4(1):35-49.

13. Sze JA, Gyurak A, Yuan JW, Levenson RW. Coherence between emotional experience and physiology: does body awareness training have an impact? Emotion.

2010; 10(6):803-814.

14. Zaki J, Davis JI, Ochsner KN. Overlapping activity in anterior insula during interoception and emotional experience. Neuroimage. 2012; 62(1):493-499.

15. MRI_Location_Amygdala_up.png (704x666) [image on the Internet]. 2011 [cited 2012 Dec 30]. Available from: http://en.wikipedia.org/wiki/File:MRI_Location_ Amygdala_up.png 16. Gym_HDR.png (3853x2028) [image on the Internet]. 2012 [cited 2012 Dec 30].

Available from: http://commons.wikimedia.org/wiki/File:Gym_HDR.png

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Worming the Developed World Out of Allergies Joaquim Moreira Salles

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rom birth we are cautioned about the dangers of exposure to germs and bacteria. The idea that dirt is bad and sterile is good enjoys a broad-based consensus—and not without merit. Cleanliness prevents exposure to harmful germs, slows the spread of disease and prevents food contamination, among countless other health benefits.

There is, however, a flip side to our germ-free culture.

As we have co-evolved in a world teeming with pathogens and so-called harmful microorganisms, human beings and their resident microorganisms have developed a symbiotic relationship. Some microorganisms provided benefits to our health and were exempted from immune attack. This symbiotic relationship has been compromised over the course of the last fifty to sixty years, as the rise of modern medicine exposed the health benefits of hygiene. As these benefits became known, we excluded from our body microorganisms that for thousands of years helped us coordinate different bodily functions.

Remarkably, losing contact with these microorganisms has substantially increased the frequency of a wide array of diseases such as multiple sclerosis, Type 1 diabetes and allergies of various kinds [1].

Jasper Lawrence, an England native who spent most of his adult life in the US, dedicates his life to bringing these forgotten microorganisms and human beings together again.

He argues: “We function like rainforests; we are ecosystems and we have entirely eliminated a class of organism that coevolved with us and our genetic predecessors for millions of years” [2]. Lawrence suffered from acute asthma and allergies.

For a long time, Lawrence thought he was part of an unlucky group whose dysfunctional immune systems forced them to live in a haze of runny noses, swelling eyes and wheezing lungs. But eventually he stumbled upon substantial evidence suggesting that there was more to his condition than just bad luck. He learned that incidences of asthma and other allergyinduced conditions are significantly lower in the developing world than in the developed world [3].

The answer to this strange phenomenon was long believed to lie in the Hygiene Hypothesis, which argues that decreased exposure to germs has relieved our immune systems of the burden of fighting infections and made them more prone to developing autoimmune conditions and allergies [4]. Recent studies have found that while the general idea behind the Hygiene Hypothesis is correct, the nuts and bolts of it are not.

The notion that our immune systems have been weakened by a lack of challenges is false; rather, they have been weakened by decreased contact with regulating microorganisms [5]. Ironically, our world of disinfectant wipes and hand sanitizers has, in some instances, made our immune systems less effective, causing our white blood cells to overreact to everyday stimuli.

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The developing world, however, does not have the problem of “over cleanliness,” and, while lack of hygiene is responsible for conditions like cholera, tuberculosis and helminth infection, the rate of conditions such as allergies, Crohn’s disease, asthma and ulcerative colitis, are much lower. In the developed world, allergic children are 4 times more likely to have asthma than non-allergic children, while children with allergies in non-affluent countries are only 2.2 times more likely to have asthma than their non-allergic counterparts—almost half the rate in the developed world [6]. Alarming data like this begs the question: how clean is too clean?

According to Lawrence, we breached the “too clean” barrier long ago. While the general consensus is that microorganisms

Ironically, our world of disinfectant wipes and hand sanitizers has, in some instances, made our immune systems less effective, causing our white blood cells to overreact to everyday stimuli are foreign and therefore harmful, Lawrence believes that our health can benefit from restoring our body’s natural fauna.

His conviction is rooted in the fact that he cured his severe asthma and allergies by infecting himself with hookworm.

Lawrence suffered from allergies throughout his life.

He would have severe allergy attacks on a day-to-day basis.

Even low exposure to airborne allergens would cause severe symptoms. Lawrence’s asthma became more severe as he got older; he developed a constant cough and had attacks so intense that he was hospitalized several times a year during his late twenties and early thirties. He tried virtually every allergy treatment modern medicine had to offer but nothing seemed to work.

As Lawrence delved deeper into the Hygiene Hypothesis he learned a crucial fact: allergic diseases are much less common in areas with high helminth parasite exposure and much more common in areas where helminth exposure is lacking or significantly reduced, like his native England or the US [7]. Most importantly he learned that contraction of a specific helminth parasite, the hookworm, was associated with a significantly strong reduction (about two thirds) in allergy-induced asthma [7]. From that point, Lawrence beTHE TRIPLE HELIX Spring 2013 21 5/27/2013 3:41:43 PM

PDF Compressor Pro BROWN came fixated with contracting hookworm, and went to great lengths to do so. He embarked on an epic quest to contract the helminth, travelling to Cameroon where he walked barefoot in over thirty open-air village latrines. Amazingly enough, a few weeks after his return from Africa, Lawrence was completely cured of his allergies and asthma.

The theory behind this miracle cure is that once the hookworm gets inside the gut, it stimulates the immune system to stop unwanted attacks, like an allergic reaction.

As we have co-evolved in a world teeming with pathogens and so-called harmful microorganisms, human beings and their resident microorganisms have developed a symbiotic relationship “Helminths interact with both the host’s innate and adoptive immunity to stimulate the immune regulatory circuitry…”

[8]. The hookworm gets a home, and the human’s immune system is regulated to avoid unwanted action; both parties get something out of the relationship.

There is obviously much to be skeptical about. Despite several studies on helminthes and autoimmune diseases, the science behind helminthic therapy is still uncertain. Hookworm infection is definitely not risk-free and is a major health problem in the developing world. Exposure to hookworm has ample side effects from nausea, vomiting, diarrhea and constipation to more serious symptoms like anemia and protein deficiency [9].

These severe symptoms, however, only arise due to overexposure, when the number of hookworms in one’s body is excessive, causing severe infection. This tends to be the case in the developing world. If hookworm therapy was to be systematized, with a purposeful and controlled contraction of the parasite, severe symptoms could be avoided.

This is exactly what Lawrence has attempted since his return from Cameroon. For a while he sold hookworms online.

The supply was plentiful; he would collect them from his stool.

After collection he would wash the hookworms in solutions of antibiotics and ship the microorganism to interested patients, who are subjected to a questionnaire and a blood test before treatment. By April 2010, Lawrence had successfully infected 85 people with hookworms from his own stool. He expressed puzzlement with the fact that demand was not through the roof: “It’s simple, it’s cheap… all people have to do is open their minds” [10]. Turns out it takes an especially open mind to willingly house a parasite. Naturally, people are skeptical of helminthic therapy, especially since the scientific community believes Lawrence’s efforts are premature. Once the FDA got wind of what Lawrence was up to, they paid a visit to his lab in Santa Cruz and ordered him to shut down his hookworm operation. That same night, Lawrence fled the country in order to keep harvesting and selling hookworms.

Today, Lawrence is working with Dr. Jorge A. Llamas in Tijuana, providing helminthic therapy to those brave enough to try it. Results have been encouraging, with a 75% success rate not only for allergy-induced conditions but also for serious autoimmune diseases such as Crohn’s disease [11]. The process is simple. Hookworms are very small organisms, about a centimeter long and half a millimeter thick. The physician applies a clear solution containing hookworm larvae to a BandAid, which is then applied to the patient’s arm. The patient experiences severe itching from the hookworm piercing the skin and entering the body. The Band-Aid is removed 24 hours later. The rest of the process occurs inside the patient’s body, while the hookworm goes on an epic and, some would say, grotesque journey towards the patient’s small intestine. After penetrating the skin, the larvae are carried through blood vessels to the patient’s heart and then the lungs, where it penetrates the alveoli and go up the bronchial tree to the pharynx. The larvae are then unconsciously swallowed by the patient and eventually reach the small intestine through the digestive tract. Once there, they mature into adults and latch on to the intestinal wall [12].

In most cases, there are initial side effects. Todd Troutman, one of Llamas’ and Lawrence’s most successful patients, reported feeling fatigued and having diarrhea for a few weeks after contraction, followed by “really vicious gas” [13]. His asthma was gone almost immediately and he was completely

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PDF Compressor Pro BROWN cured of allergies in 3-4 months. Troutman’s hypoglycemia, a serious lifelong condition, was also completely cured. Helminthic therapy, in a sense, saved Troutman’s life. He was allergic to virtually every common allergen and lived his life in a fog of anti-histamines and other prescription drugs he eventually developed a tolerance for. He tried immune therapy for 3 years and achieved no significant results. Desperation drove him to helminthic therapy. Before he reached out to Lawrence his life was “going downhill at a precipitous rate” and he was having suicidal thoughts. His visit to Tijuana changed the course of his life.

We function like rainforests; we are ecosystems and we have entirely eliminated a class of organism that coevolved with us and our genetic predecessors for millions of years The health benefits of helminthic therapy are coming to light not only because of Lawrence’s efforts but also due to numerous formal scientific studies on the subject, namely studies by Professor David Pritchard, an immunologist and parasitologist at the University of Nottingham. Pritchard was the first to conduct human clinical trials with hookworms.

His studies were mostly successful, with clear reduction in inflammatory immune response in worm recipients. Patients reported little discomfort; those that received the worm chose to keep them and those that had received placebos asked to be given hookworms. Prior studies of communities in Africa and Oceania suggest a strong correlation between helminth exposure and low allergy and autoimmune disease rates [12].

Other studies have shown that helminthic therapy is not only effective in curing allergic diseases but also more serious conditions such as Crohn’s disease and multiple sclerosis among others [14]. Numerous other animal and clinical trials from around the world are producing evidence that alludes to the References 1. Hygiene Hypothesis Updated to ‘Old Friends’ Hypothesis [Internet]. 2012 [updated 2010 Oct 3; cited 2012 Nov 5]. Available from: http://www.newsmedical. net/news/20121003/e28098Hygiene-hypothesise28099-updated-to-e28098OldFriendse28099-hypothesis.aspx 2. Episode #404 Enemy Camp 2010 [radio broadcast]. This American Life. Chicago, IL: WBEZ, Chicago Public Media; 2010 Apr 2 3. Graham-Rowe D. When Allergies Go West. Nature. 2011 Nov; 479 S2-S4. doi:10.1038/479S2a.

4. Asthma: The Hygiene Hypothesis [Internet]. 2009 [updated 2009 Jun 18].

Available from: http://www.fda.gov/biologicsbloodvaccines/resourcesforyou/consumers/ucm167471. htm 5. Smith RS, Bloomfield SF, Rook GA. The Hygiene Hypothesis and its Implication for Home Hygiene, Lifestyle and Public Health. International Scientific Forum on Home Hygiene. 2012 Sep. Available from: http://www.ifh-homehygiene.org/ 6. Weinmayr G, Weiland SK, Björkstén B, Brunekreef B, Büchele G, Cookson WOK, et al. Atopic Sensitization and the International Variation of Asthma Symptom Prevalence in Children. Am. J. Respir. Crit. Care Med. 2007; 176: 565-574.

7. Flohr C, Quinnell RJ, Britton J. Do helminth parasites protect against atopy and

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Reproduced from [16]

helminth’s immune-regulatory power.

Yet, despite all the scientific progress made on helminthic therapy over the past decade, it is far from being part of the mainstream. The science is by no means settled and no one knows exactly how the healing capacities of hookworms work.

Most doctors consider what Lawrence is doing very dangerous and are skeptical about treating patients by infecting them with an organism that is known to have harmful effects. The next step in the research is to identify the element in the hookworm that is the cause of its healing qualities, find a way to isolate it and make it into a drug. Such leaps in progress are still several years down the road. Until then, brave allergic souls are welcome to try helminthic therapy in Tijuana—at least stepping into open air latrines is no longer necessary for those that hope to cure their asthma. They have Jasper Lawrence to thank for that.

Joaquim Salles is a junior at Brown University studying Political Science and History. He is interested in politics, with a focus on environmental issues, and enjoys reading about bizarre developments in science in his spare time. allergic diseases? Clin Exp Allergy. 2009 Jan; 39(1):20-32.

8. Weinstock J, Elliott D. Helminths and the IBD hygiene hypothesis. Inflamm Bowel Dis 2009; 15: 128–133. doi: 10.1002/ibd.20633 9. Brooker S, Bethony J, Hotez P. Human hookworm infection in the 21st century.

Adv Parasitol. 2004; 58:197-288.

10. Episode #404 Enemy Camp 2010 [radio broadcast] This American Life. Chicago, IL: WBEZ, Chicago Public Media; 2010 Apr 2 11. Helminthic Therapy FAQ [Internet]. 2008 [updated 2009]. Available from: http:// autoimmunetherapies.com/helminthic_therapy_FAQ.html 12. Zvoboa E. The Worms Crawl In. The New York Times. 2008 Jul 1.

13. Interview with Todd Troutman [Internet]. [uploaded 2009 Mar 15]. Available from: http://www.youtube.com/watch?v=v3oTHKUac-E&feature=relmfu 14. Wang SS. In a Squeaky Clean World A Worm Might Help Fight Disease. The Wall Street Journal. 2012 Feb 14.

15. Centers for Disease Control and Prevention. Hookworm [Image on the Internet].

2010 [updated 2010 Nov 2; cited 2012 Dec 29]. Available from: http://www.cdc.gov/ parasites/hookworm/ 16. LICENSE PURCHASED. Hookworm [Image on the Internet]. 2012. Available from: http://www.canstockphoto.com/images-photos/hookworm.html#file_view. php?id=2271859

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Medically Supervised Drug Injection Sites: More Harm Than Good?

Julia Romanski

W

hile the harms of illegal injection drug use are universally recognized, no single strategy exists to reduce or prevent drug abuse. Relatively recently, a new drug policy paradigm has surfaced: that of harm reduction, which seeks to mitigate the consequences of illicit drug use.

One example of a harm reduction mechanism is a medically supervised drug injection site (MSDIS). In an MSDIS, people inject drugs under the supervision of medical staff who intervene in the case of an overdose. The goals of MSDIS’s are to reach the target population, encourage the use of treatment services, improve health while reducing risky behaviors, reduce the incidence of infectious disease such as HIV, reduce overdoses and overdose deaths, reduce disorder, and avoid an increase in crime [2]. The most comprehensive studies on MSDIS’s have been on the sites in Sydney, Australia and Vancouver, Canada, which both opened in the early 2000s. In order for these pilot sites to retain their legal exemptions from drug laws, they must show that they are achieving the objectives.

However, there is overwhelming evidence that many of these aims have not conclusively been met. Moreover, evidence suggests that MSIDS’s have a negative impact on public safety and the health of drug users.

Impacts on Public Safety Several evaluations of MSDIS’s after the year 2000 have claimed that these sites contribute to decreases in public drug use, public disorder, and crime, but they failed to mention two key confounding factors possibly responsible for these decreases: the heroin drought that began in 2000 and increased policing around drug injection facilities [3]. For example, in Australia, the heroin drought reduced heroin-related deaths by 60% to 70% from 2000 to 2010 due to a significantly lower supply [3].

Therefore, the data would have had to show that drug use rates fell below the declining baseline in order to conclude that the MSDIS reduced public drug use [5]. In the 2007 evaluation of the King’s Cross MSDIS in Sydney, KPMG, a consulting firm, claimed that the drug injection site had contributed to the 48% reduction in discarded needles (a measure of public drug use) from 2000 to 2007, a reduction that could also be attributed to the heroin drought [3].

Furthermore, in Sydney, there were more police officers deployed to the area around the MSDIS when it opened, leading to a dispersion of drug users into neighboring areas and therefore an artificial decrease in discarded needles [3]. Data for ambulance callouts clearly shows this displacement effect.

In the state of New South Wales, where the King’s Cross MSDIS is located, there was a 61% reduction in ambulance callouts for heroin overdoses from 2000 to 2007, with an 81% reduction in the King’s Cross area [3]. However, only a 45% reduction was 24 THE TRIPLE HELIX Spring 2013 BROWN S13.indb 24

seen in neighboring Darlington and Surrey Hills, indicating possible displacement [3]. An evaluation by the NSW Bureau of Crime Statistics and Research also showed that percentage reductions in crime rates in King’s Cross, where the injection center is located, were on par with the rest of Sydney under heroin drought conditions [3]. However, greater reductions would be expected if one takes into account the increase in policing [3]. These medically supervised drug injection facilities may not be fulfilling the goals of decreasing public drug use and its associated crimes, and may actually be exacerbating these problems since decreases in public drug use and crime were lower than expected [3].

Impacts on Individual Drug Users While supporters of medically supervised drug injection sites believe that MSDIS’s provide a safe environment for drug users to inject, this is not being taken advantage of by the vast majority of drug users [3]. At the Sydney facility the 7% of clients who attended the facility most regularly injected outside the MSDIS 80% of the time [3]. The next 26% of more frequent attendees injected outside the MSDIS 95% of the time [3]. Together, these groups were responsible for 92% of injections in the center, leaving few injections for the remaining

Reproduced from [15]

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PDF Compressor Pro BROWN 67% of the clientele [3]. This indicates that a significant number of injections still happened outside the MSDIS. While some policy makers and members of communities where drug use is high advocate opening more injection sites, existing ones, such as the Sydney MSDIS, see usage significantly below full capacity [3].

Although the purpose of MSDIS’s is to decrease the problems associated with injection drug use, these sites may be doing more harm than good. What is most troubling is evidence that the proximity of medical staff may promote risktaking behavior among drug users. For example, the Sydney MSDIS sees a 32-fold higher rate of drug overdose inside the facility than outside [3, 4]. Although the KPMG evaluation attributed the higher overdose rate to the clientele being highrisk [6], Drug Free Australia’s analysis of the Sydney MSDIS data controlled for this confounding factor by comparing the clients’ overdose history with overdose rates inside the facility.

Further, an evaluation by SAHA, an advisory firm, incorrectly used the non-fatal overdose rates inside the facility to calculate the number of lives saved without correcting for the fact that overdose rates were so high inside the facility [3, 7]. Instead, it concluded the lives saved by the Sydney MSDIS to be 25 per year [3, 7]. A more accurate way of estimating the number of lives saved is by using known facts about drug users: 100 heroin users inject 100,000 times per year on average and the mortality rate for heroin users is 2% per year [3, 4]. Based on the number of injections in the Sydney MSDIS, the effective number of lives saved by the facility would amount to only four in nine years of operation [3, 4]. Similar rates of lives saved were calculated for Insite, the MSDIS in Vancouver, Canada [5]. This implies that MSDIS’s may not be saving as many lives as some people believe they are.

How Drug Policies Have Been Shaped by Possibly False Assertions The statements and findings in science and the media are very influential in garnering public support for MSDIS’s as well as shaping drug policies, despite the possibility that MSIDS’s do more harm than good [1]. One year after the Sydney MSDIS was opened, its medical director misinformed the public by telling the media that the facility had saved more than a hundred lives [6]. In a study from the major scientific journal The Lancet, the researchers claimed that Insite, which opened in 2003, was responsible for the decrease in overdose deaths [5, 8]. However, they included 2001, a peak year in drug overdose deaths, in the baseline [5, 8]. Between 2001 and 2002, drug overdose deaths dropped precipitously and between 2002 and 2005 overdose deaths actually increased in Vancouver [5]. By including 2001, a peak year in drug overdose deaths, the cited decrease in overdose deaths may not have been representative of the upward trend that continued after the opening of the MSDIS [5]. Another common claim regarding client health is that MSDIS’s prevent HIV, but not all studies are in agreement. Reliance on these possibly false assertions of lives saved, either by averting fatal overdoses or reducing HIV prevalence, can be seen in the reasons for judgment from the appeal to the Supreme Court of Canada to keep Insite

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open following the Minister of Health’s decision to close it: Insite saves lives. Its benefits have been proven.

There has been no discernable negative impact on the public safety and health objectives of Canada during its eight years of operation. The effect of denying the services of Insite to the population it serves is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics. [9] Perhaps harm reduction is not the best method for controlling the problem of injection drug use. In its 2001 report the United Nations International Narcotic Control board stated: The operation of [supervised injection] facilities, where addicts inject themselves with illicit substances, condones illicit drug use and drug trafficking and runs counter to the provisions of the international drug treaties [4].

The effectiveness of harm reduction ought to be questioned.

Sweden used to have the highest level of drug use in Europe but now it has the lowest level among OECD countries thanks to a restrictive drug policy that focuses on prevention with a low emphasis on harm reduction [4]. In contrast, Australia, which focuses on harm reduction, has the highest rate of illicit drug use among OECD countries [4]. In 2000, a three-year average of lifetime prevalence of drug use among 15-64 year olds in Sweden was found to be 12% while in 2004, the lifetime prevalence of cannabis alone was 33.6% in Australia [11-12].

Why has harm reduction become the dominant ideology in so many countries? Much of it has to do with misinterpretation of data as discussed above. The politicization of what ought to be a science-based issue has caused individuals and policy-makers to overlook evidence that medically supervised injection sites may not be the best option for drug policy [1].

Some MSDIS supporters claim that MSDIS’s could be restructured to fulfill their objectives. Arguably, more referrals could be made, which would connect drug users to treatment.

However, this is not a strong argument for opening more MSIDS’s as there are many negative consequences, such as the promotion of risk-taking behavior, associated with these facilities. MSDIS’s by their very nature encourage, condone and enable drug use [4, 6]. According to a former Sydney MSDIS client: [Drug users] feel a lot more safer (sic), definitely because they know they can be brought back to life straight away. […] So in a way they feel it is a comfort zone, and no matter how much they use, if they drop they will be brought back [6].

This risk-taking behavior consequently increases the profits of local drug dealers [3, 4]. The whole idea of harm reduction is inherently wrong, because it is akin to placing an invisible net under a bridge; such a net would save those trying to commit

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PDF Compressor Pro BROWN is weak in addicts with blood-borne illnesses [3]. Treatment should also include screening for diseases that may be transmitted through syringe sharing, such as HIV/AIDS and hepatitis B and C, which could provide a gateway to treatment and prevent further transmission [14]. Additionally, many drug users suffer from mental health conditions that can be treated with medicine and behavioral therapy. Treatment puts faith in the individual to stop using drugs, rather than condoning and encouraging the use of drugs like MSDIS’s do.

Reproduced from [16]

suicide but it would not solve their underlying depression [13]. Similarly, MSDIS’s do not solve the problem of drug injection, but rather promote drug use as evidenced above.

Alternatives The alternatives to harm reduction are prevention and treatment, in addition to tougher policing. One must consider the idea of distributive justice: funds must be allocated in a way to help the greatest number of people in the greatest possible way. For example, the $2.5 million used each year by the Sydney MSDIS could fund 109 drug rehabilitation beds or 700 naltrexone implants for a year [4]. Naltrexone blocks opioid receptors in the brain, leading to reduced activation by opioids such as heroin [10]. It has been shown to reduce the risk of relapse [10], and to boost the immune system, which References 1. Mangham C. A Critique of Canada’s INSITE Injection Site and its Parent Philosophy: Implications and Recommendations for Policy Planning. The Journal of Global Drug Policy and Practice [Internet]. 2010 [cited 2012 Oct 15]. Available from: http://www.globaldrugpolicy.org/Issues/Vol%201%20Issue%202/A%20critique%20 of%20Canada’s%20INSITE.pdf 2. Davies G. A Critical Evaluation of the Effects of Safe Injection Facilities. The Journal of Global Drug Policy and Practice [Internet]. 2007 [cited 2012 Oct 15].

Available from: http://www.globaldrugpolicy.org/Issues/Vol%201%20Issue%20 3/A%20Critical%20Evaluation.pdf 3. Drug Free Australia. Analysis of KPMG Evaluation of the Sydney Medically Supervised Injection Centre [Internet]. 2010 Oct [cited 2012 Oct 15]. Available from: http://www.drugfree.org.au/fileadmin/library/Policies__Legislation_and_law/ DFA_Analysis_Injecting_Room_2010.pdf 4. Drug Free Australia. The Case for Closure [Internet]. 2003 [cited 2012 Oct 15].

Available from: http://www.drugfree.org.au/fileadmin/Media/Reference/DFA_ Injecting_Room_Booklet.pdf 5. Pike G, Santamaria J, Australia V, et al. Analysis of the 2011 Lancet study on deaths from overdose in the vicinity of Vancouver’s Insite Supervised Injection Facility.

Drug Free Australia [Internet]. 2011 [cited 2012 Oct 15]. Available from: http://www.drugfree.org.au/fileadmin/Media/Global/Lancet_2011_Insite_Analysis. pdf 6. Christian G. Blinded by the Dominant Ideology. Quadrant Online [Internet].

2010 Nov [cited 2012 Oct 15]; 54 (11). Available from: http://www.quadrant.org.au/ magazine/issue/2010/11/blinded-by-the-dominant-ideology 7. KPMG. Further evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011) Final report [Internet]. 2010 Sep 14 [cited 2012 Oct 15]. Available from: http://www.health.nsw.gov.au/resources/mhdao/pdf/msic_kpmg. pdf 8. Marshall B, Milloy M, Wood E, et al. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a

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Conclusion The debate on MSDIS’s must be depoliticized to examine the scientific evidence objectively. The merits of MSDIS’s have been overstated and their flaws excluded in scientific literature, the media, and political rationale, to the detriment of injection drug users. The implementation of MSDIS’s is not justified if one considers that they are not proven to decrease crime, HIV rates, or overdose deaths, and may actually exacerbate some of these outcomes. Administrators and government officials should seriously consider the termination of MSDIS’s and the reallocation of funds to reliable prevention and treatment programs.

Julia Romanski is majoring in Biology at Brown University. She first became interested in this topic when she participated in a debate about whether or not large cities ought to have medically supervised drug injection sites. retrospective population-based study [Internet]. 2011 Apr [cited 2012 Oct 15].

Available from: http://www.sciencedirect.com/science/article/pii/S0140673610623537 9. Canada (Attorney General) v. PHS Community Services Society. Supreme Court of Canada [Internet]; 2011 Sept 30 [cited 2012 Oct 15]. [134] Available from: http://scc. lexum.org/en/2011/2011scc44/2011scc44.html 10. SAMHSA. Division of Pharmacologic Therapies. Naltrexone [Internet]. 2012 [cited 2012 Oct 15] Available from: http://www.dpt.samhsa.gov/medications/ naltrexone.aspx 11. Lafrenière G. National Drug Policy: Sweden [Internet]. 2002 [cited 2012 Oct 15]. Parliament of Canada. Available from: http://www.parl.gc.ca/Content/SEN/ Committee/371/ille/library/gerald-e.htm 12. Ross J, editor. Illicit drug use in Australia: Epidemiology, use patterns and associated harm. (2nd Edition). National Drug & Alcohol Research Centre [Internet].

2007 [cited 2012 Oct 15]. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Conte nt/17B917608C1969ABCA257317001A72D4/$File/mono-63.pdf 13. Kay B. Insite clinic enables drug users and helps spread human misery. National Post [Internet]. 2011 May 18 [cited 2012 Oct 15]. Available from: http://fullcomment. nationalpost.com/2011/05/18/barbara-kay-insite-clinic-enables-drug-users-and-helpsspread-human-misery/ 14. National Institute of Drug Abuse. DrugFacts: Treatment Approaches for Drug Addiction. National Institutes of Health [Internet]. 2009 [cited 2012 Oct 15]. Available from: http://www.drugabuse.gov/publications/drugfacts/treatment-approachesdrug-addiction 15. REPRODUCED WITH PERMISSION. Pike, G; Santamaria, J; Australia, V, et al. Analysis of the 2011 Lancet study on deaths from overdose in the vicinity of Vancouver’s Insite Supervised Injection Facility. Drug Free Australia. [Internet] 2011 [cited 2012 Oct 15]. Available from: http://www.drugfree.org.au/fileadmin/Media/ Global/Lancet_2011_Insite_Analysis.pdf 16. United States Drug Enforcement Administration. [Internet] [cited 2012 Dec 20].

Available from: http://www.justice.gov/dea/pr/multimedia-library/image-gallery/ heroin/heroin_powder.jpg

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Why India Needs an Iron Man: Combating Iron Anemia Carlota Pereda Serras

I

ron deficiency anemia (IDA), a deficiency of red blood cells [1] is one of the most widespread health issues in the world: it affects over one third of the world’s population [2]. IDA is a particularly severe health problem in India. According to the World Health Organization [3], 74.3% of the population in India suffers from this deficiency. Although IDA is especially common in children, pregnant women and people under the poverty line, high prevalence is not limited to these groups. High prevalence of iron deficiency anemia in India results from the lack of iron in the traditional Indian diet, ineffective initiatives in India, and a lack of awareness among the Indian population about this issue. Anemia is thus a widespread problem, and combating it will require better consideration of these factors.

Iron deficiency anemia is a blood disorder in which there is an iron deficiency and, therefore, a hemoglobin deficiency.

The lack of hemoglobin in the body limits or fully hinders the function of red blood cells to carry oxygen around the body.

Symptoms include weakness, fatigue, loss of concentration and attention, sudden episodes of fainting, miscarriages and chest pain. It is the most prevalent type of anemia in India, with economic, social and physiological implications. For instance, work output and productivity decreases with IDA, which greatly affects society as almost 60% of India’s workforce is employed in the agricultural sector [4], which requires great amounts of physical activity. Additionally, these symptoms can cause premature delivery, and higher risk of fetal and maternal death and malformations in the fetus. Anemia causes about 20% of all maternal deaths and is a complicating factor in another 40% of maternal deaths [5]. Anemia also reduces the ability to concentrate and memorize.

Indirect Causes of Iron Deficiency However, iron deficiency does not only result from a lack of iron intake IDA. Thalassemia, a genetic condition that causes a deficiency of folic acid, contributes greatly to the prevalence of iron deficiency in India. Folic acid is essential for the absorption and assimilation of iron in the body and thus, also causes a deficiency of iron. Unlike IDA, thalassemia is a genetic condition that causes malfunctioning hemoglobin chains, originating from a defect in the gene coding for that particular protein; it can thus only be inherited. Patients with homozygous recessive thalassemia genes will need lifelong blood transfusions, but will most likely still have a lifespan of about 20 to 30 years. By contrast, thalassemia minor patients with only one recessive thalassemia gene only need to take folic acid and iron-rich supplements initially, in order to increase the initial low level of iron in the blood. Thalassemia minor traits are therefore hard to detect due to the fact that

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the symptoms are mild (just as in IDA), often causing it to remain untreated. As a result, addressing IDA will help detect and treat other diseases such as thalassemia.

Other causes for prevalent iron deficiency that stem from nutritional deficiencies in the Indian population include vitamin C deficiencies and vitamin B12 deficiencies that, like a lack of folic acid, hamper the absorption of iron. Vitamin C deficiency anemia is usually caused by a lack of vitamin C intake. Vitamin B12 deficiency anemia can be caused by a lack of vitamin B12 intake but can also be caused by an intestinal worm infestation that sucks blood from the mucosa, releasing the red blood cells into the small intestine. Both vitamin C and vitamin B12 deficiency anemia present themselves with the same symptoms as iron deficiency anemia, causing the detection of the conditions to be slow, and the symptoms to be untreated and severe.

These nutritional deficiencies prevail in populations of the lower socioeconomic strata that, due to a lack of resources, lack the right nutrients in the daily diet. With a large portion of the population under the poverty line, it is expected that hemoglobin levels are low in patients within the lower economic strata: malnutrition in India occurs in lower socioeconomic classes, as low income leads to a lack of the right nutrients and thus, lack of iron intake.

Another factor that increases the prevalence of anemia in all socioeconomic classes in India is a the absence of education about nutrients needed for a better health. This dearth of knowledge exacerbates the suffering from anemia; even if the patient has access to iron-rich types of food, unfamiliarity with anemia as an ailment leads to a low daily iron intake. As the traditional Indian diet does not contain enough iron to satisfy the daily requirement, a conscious effort needs to be made to make a change in one’s daily diet in order to obtain the necessary daily dosage of iron. Furthermore, the lack of a practical iron-rich staple in the Indian diet renders awareness of the importance of maintaining a stable hemoglobin level insufficient. Therefore, both awareness and nutritional supplements are needed to combat anemia.

Due to vegetarian habits, there is still a large prevalence of iron deficiency anemia in higher socioeconomic classes as certain iron-rich types of foods are not frequently present in the daily diet. A large percentage of the Indian population follows vegetarian eating habits due to religious reasons, which further reduces the possible sources of iron; meat, poultry and fish are very uncommon in the daily Indian diet. The main sources of iron in the Indian diet are cereals, pulses and vegetables.

However, the type of iron in vegetables and grains, non-haem iron, is much harder to absorb: only 1-6% of non-haem iron is absorbed by the human body. In contrast, haem iron presTHE TRIPLE HELIX Spring 2013 27 5/27/2013 3:41:45 PM

PDF Compressor Pro BROWN ent in animal products is much more readily absorbed [7].

Additionally, Indian dishes contain large amounts of spices that contain polyphenols known to inhibit the absorption of iron. Iron absorption can be facilitated by an intake of vitamin C, present in tomatoes, cauliflower and green beans, but the vitamin C is usually denatured by cooking [8].

Responses to Anemia in India Several initiatives to reduce the prevalence of iron deficiency in India have been unsuccessful because they have concentrated on short-term treatments for anemia, such as the distribution of iron tablets, rather than the underlying causes of anemia: malnutrition, worm infestations and lack of awareness [5].

The Ministry of Health and Family Welfare of India [9], other government programs such as the Targeted Public Distribution System [10], the National Nutrition Anemia Prophylaxis Program [11], and the UNICEF 12 by 12 Initiative [12] provide iron tablets to pregnant or lactating women, pre-school children, and adolescents, respectively. Another government program, the Mid-Day Meal program, provides free meals for school children as well as iron tablets to anemic children.

These initiatives provide artificially produced iron supplements because of the low production cost and the perception that a large dose of iron administered immediately is more effective.

Although the treatment provided can prove to be effective, none of these initiatives target these causes directly as they lack a monitoring mechanism that can provide a possible long-term treatment for anemia. It is also poorly distributed: the supplement supply tends to be irregular, causing the treatment to be ineffective [5].

Iron tablets are an unsuccessful treatment for two further reasons. First, providing a large intake of iron into a patient’s body does not mean that the patient will be able to absorb it, especially if it is artificially ingested and not complemented by natural sources of iron [13]. Second, if the patient does not alter his or her nutritional intake after treatment, remission is possible as only the symptoms have been addressed.

Therefore, even if these initiatives are implemented and are References 1. PubMed Health. Anemia [Internet]. 2012 [updated 2012 Feb 7; cited 2012 Nov 2].

Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001586/ 2. United States Agency for International Development. Anemia Prevention and Control: What Works [Internet]. 2003 June [cited 2012 Nov 1]. Available from: http://siteresources.worldbank.org/NUTRITION/Resources/281846-1090335399908/ Anemia_Part1.pdf 3. De Benoist B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993-2005, WHO Global Database on Anaemia [Internet]. World Health Organization; 2008 [cited 2012 Nov 3]. Available from: http://whqlibdoc.who.int/ publications/2008/9789241596657_eng.pdf 4. Mittal R. Rejuvenating India’s agriculture sector [Internet]. The Economic Times; 2012 Jan 2 [cited 2012 Nov 1]. Available from: http://articles.economictimes. indiatimes.com/2012-01-02/news/30587452_1_agriculture-private-sector-supply-chain 5. Tara S.N. India’s anaemia woes- a study [Internet]. IIMB Management Review; 2012 [cited 2012 Nov 5]. Available from: http://tejas-iimb.org/articles/59.php 6. Unicef. India Statistics [Internet]. 2003 [updated 2003 Feb 26, cited 2012 Oct 27].

Available from: http://www.unicef.org/infobycountry/india_statistics.html 7. Baker S. J. Nutritional anemia – a major controllable public health problem [Internet]. US National Library of Medicine, National Institutes of Health; [cited 2012 Nov 1]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2395670/?page=5 8. Thankachan P. An analysis of the etiology of anemia and iron deficiency in young women of low socioeconomic status in Bangalore, India [Internet]. Food and Nutrition Bulletin, The United Nations University; 2007 [cited 2012 Nov 7]. Available

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able to eliminate anemia in certain patients, there is a high likelihood that they can acquire iron deficiency anemia again, as their iron-deficient eating habits will persist.

The Flour Fortification Initiative [14] attempted to tackle IDA by scientifically enriching flour and rice with iron in order to produce an iron-rich product that would facilitate the absorption of iron, but the product proved to be ineffective.

Additionally, a percentage of the Indian population, especially those most in need, were not able to afford the fortified flour as the price was very steep due to the high costs of production, eliminating this initiative as a possible solution to IDA. As a result, prevalence of anemia in India is still very high. Among children ages 6 to 59 months, 4.7% were given iron supplements within 7 days between 2005 and 2006 [15]. Furthermore, only 14.6% of children between the ages of 6 and 35 months consumed iron-rich food every 24 hours [16], causing 79.2% of children in this category to be anemic.

Conclusion Iron deficiency anemia is extremely prevalent disorder in India – one that requires exigent attention. There have been several obstacles hindering this process, such as the unavailability of affordable iron-rich products, vegetarian eating habits and lack of awareness of the issue. The programs instated by the government and non-governmental organizations have failed to research these factors fully and have only approached this issue with the provision of artificial iron supplements, which are hard to absorb and are ineffective in the long run. Thus, the Indian population needs an affordable source of iron that will be accepted by the Indian society. It’s time to start combating anemia by adopting a long-term, comprehensive approach.

Carlota Pereda is a student from Brown University studying Biology.

She is currently working with an NGO in India that tackles iron anemia and has worked in India for a few months, trying to find a solution to the critical problem of iron deficiency anemia in India.

from: http://www.ncbi.nlm.nih.gov/pubmed/17974366 9. National Institute of Health and Family Welfare. Mid-Day Meal Programme [Internet]. 2009 [cited 2012 Oct 25]. Available from: http://www.nihfw.org/NDC/ DocumentationServices/NationalHealthProgramme/MID-DAYMEAL.html 10. Jain Singh D. Report of the working group on integrating nutrition with health [Internet]. New Delhi: Government of India Ministry of Women and Child Development; 2006 Nov [cited 2012 Oct 25]. Available from: http:// motherchildnutrition.org/india/pdf/mcn-integrating-nutrition-with-health.pdf 11. Legislation of National Nutrition Anemia Prophylaxis Programme [Internet].

National Institute of Health and Family Welfare; 2003 [cited 2012 Nov 3]. Available from: http://nihfw.nic.in/ndc-nihfw/html/Programmes/NationalNutritionAnemia. htm 12. Addressing Iron Deficiency Anemia: 12 x 12 Initiative [Internet]. World Health Organization India; [cited 2012 Oct 27]. Available from: http://www.whoindia.org/en/ Section6/Section324_1467.htm 13. Hallberg L, Björn-Rasmussen E, Ekenved G, Garby L, Rossander L, Pleehachinda R, Suwanik R, Arvidsson B. Absorption from iron tablets given with different types of meals. PubMed. 1978 Sep;21(3):215-24.

14. Flour Fortification Initiative. Plan for Fortification [Internet]. 2003 [cited 2012 Oct 27]. Available from: http://www.ffinetwork.org/plan/index.html 15. National Family Health Surveys. Nutritional Indicators in India [Internet]. 2006 [cited 2012 Oct 27]. Available from: http://www.searo.who.int/LinkFiles/Nutrition_ for_Health_and_Development_Nutrition_Profile_India.pdf 16. National Family Health Surveys. Nutritional Indicators in India [Internet]. 2006 [cited 2012 Oct 27]. Available from: http://www.searo.who.int/LinkFiles/Nutrition_ for_Health_and_Development_Nutrition_Profile_India.pdf

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Human Trackers or Medical Saviors?

The Concerns and Technology Behind Implantable Microchips Michael Yanagisawa

G

eorge Orwell’s 1984 envisions a future where technol- a chip reader’s radio waves was enough to evoke a simple, ogy invades every facet of life. Every action—from sixteen-digit number response that could then be linked to brushing your teeth to going to bed—is broadcast external databases to retrieve information. It was in essence to an outside source; each citizen, a slave to an unknown a frequent flier number that covered all aspects of life, from observer. With the advent of new technologies, though, will medicine to luxury to general convenience. this dystopic future remain fiction?

With governmental approval, the VeriChip gained a The implantable microchip, a budding technology, brings foothold in everyday life. Doctors imagined the technology with it innovation but also fears of an Orwellian future. Imagined as a voice for the unconscious; it could transmit the medical as a vital technology for healthcare and luxury, it could make records of any patient, relaying vital information like allergies many everyday actions obsolete; payments could be made with and blood type. First responders saw it as a way to identify the wave of an arm, unconscious patients could relay health bodies in the wake of a natural disaster; the carnage from information to doctors with a simple scan, and lost relatives September 11 and Hurricane Katrina underscored its potential could be found in an instant. The microchips however are not importance. Gerontologists would be able to track patients with a part of our everyday lives yet; Alzheimer’s and other debilitatserious privacy concerns prevent ing diseases. Credit card users their universal use. What if the could pay with a wave of their For many, the upsides may technology is nothing more than chip-implanted arm, outmoding a conduit for Big Brother? For physical cards. The technology’s not be large enough to all their benefits, implantable mipotential was eventually realized: counterbalance the privacy crochips have some unintended the attorney general of Mexico but frightening effects. Is such implanted his staff with chips as issues that haunt the a technology one that science an additional security measure technology should invest in and embrace, for restricted areas. Even trendy or is it one that is better off left by European nightclubs offered to the wayside? The technology has implant their patrons to allow already failed once, but is slowly making a case for its future. them VIP access [1]. The VeriChip made life, well, futuristic: at a bar, a microchip reader could verify your age, pay the Initial Failure cover, and alert the bartender of your arrival. You could pick At its core, the implantable microchip is simply a means of up your drink (already made) and scan into the VIP area identification. Its predecessor, the humble tattoo, has served without ever taking out your wallet. The microchip seemed as a symbolic identification for thousands of years [1]. Such poised to succeed. outward representation has its flaws, though; it broadcasts Despite the technology’s hype, though, a paltry two-thouinformation to everyone and is difficult to remove. As tech- sand devices were implanted before VeriChip was discontinued nology has progressed, some scientists imagined moving the in July 2010. The company folded in part because it could not identification signal inside the body, invisible to others and address the microchip’s “dark side,” the privacy worries that safe from harm. One possibility was a computer within the evoked an omniscient Big Brother. The overarching question body that could transmit limitless information. arose: would privacy worries be too great for the technology In 2004, this dream became a reality. The U.S. Food and to overcome? Or would the microchip reinvent itself enough Drug Administration approved a radio-frequency identification to dissipate these concerns?

(RFID) microchip produced by VeriChip Corporation. The chip, about the size of a grain of rice, contained an identification Present and Future Innovations chip and an antenna surrounded in a glass capsule, allowing After all, the microchip could only come as a surprise; its miit to transmit information [1]. It was easily injected into the crochip after all could only transmit a string of numbers. Since body with local anesthesia and just as easily removed. Once then, though, the implantable microchip field has made great inside the body, it anchored itself to the surrounding muscle, strides, introducing novel advancements that may outweigh assuring that it would remain stationary. The energy from the risks and fears from the first iteration.

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Adapted from [11]

In particular, the latest innovations seem ripe for the field of medicine. The microchip is moving away from a simple bar code, incorporating specific functions in the chip. A recent human trial reported the effectiveness of wirelessly-controlled implanted microchips in delivering osteoporosis medicine to elderly patients [2]. The devices by their very nature made patients never miss a dose, improving their health significantly.

PositiveID Corporation, a company formed from VeriChip, has also introduced an implantable microchip to measure blood glucose without drawing blood, a needle-free option for diabetics [3]. The United States military is even looking into technology that could relay vital health information like heart rate and oxygen levels to medical support [4]. It could transmit life-or-death measurements in real time, but could just as easily be applied to the elderly and the general public.

Instantaneous health feedback could even allow every citizen a type of personalized medicine, a luxury not afforded today.

RFID microchips have already been used to monitor the health of kiwi plants [5]; given the recent progress, it is a small leap to consider that microchips may inherit greater functions in human healthcare [6].

The possible applications extend beyond the hospital.

Implantable global positioning system (GPS) chips are not new; dogs have long been chipped should they get lost. Applying this technology for human purposes has tremendous potential. For example, wandering Alzheimer’s patients could be quickly rescued from danger, whereas in countries where human trafficking and kidnappings are rampant, implantable GPS devices could revolutionize law enforcement [7]. Implantable microchips may also serve to relay identification and credit card information—think of a hassle-free replacement for a passport, driver’s license, and credit card. Should the microchip take off, the potential applications would explode.

Just as Apple’s App Sore has encouraged countless innovations, a successful microchip could spur further and presently unforeseen uses.

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Further Concerns The reality is that most people today simply do not want to be chipped. People actively avoid regular shots, so the chip implantation process—essentially a big shot given with local anesthesia—is dreaded. Also, in its present form the microchip is not a medical necessity; the VeriChip, unlike a pacemaker, is not vital to one’s health. It is about as important as Facebook—potentially useful, but far from vital. This lack of real perceived function may also discourage potential consumers.

The unknown effects to human health also present hurdles for widespread chipping. The microchip is coated in a special polymer to help hold it in place in the body, but the implantation has been associated with cancer [9]. In many studies done over thirteen years on rodents and dogs, cancers appeared around the microchip, suggesting a cause-and-effect relationship [9]. The association with cancer, however preliminary, is worrying enough to question the true uses of the technology.

To many, the risk is not worth taking.

The microchip’s largest adversary, though, is the specter of Big Brother, a feeling of fundamental privacy invasion.

Even at the surface it is a visceral invasion of one’s body, a foreign device crawling under the skin. Furthermore if one’s personal information—health records, credit card number,

As the Internet has proven, technologies struggle with security etc.—are just a scan away, they become exceedingly difficult to protect from intruders. As the Internet has proven, technologies struggle with security; one researcher has already shown that the VeriChip’s unique number can be replicated easily [8]. If the number cannot be safeguarded, the information that it connects to would be compromised.

That corporations could obtain the chip’s information is disconcerting to many, as such companies already relentlessly collect personal information. They consult credit bureaus and Facebook to tailor advertisements, while internet ads update to our latest purchases and browser history. Even innocuous loyalty programs track us; stores like Stop and Shop and CVS personalize coupons to our likes, stalkers within the system.

Incorporating a microchip that could potentially track locations and purchases would only magnify this eerie targeting, bringing us one step closer to an Orwellian future. Widespread microchip implanting may end up creating a world without privacy.

Is Better Enough?

Despite recent innovations, the implantable microchip still leaves many questions for the future. The first round of microchips, VeriChip’s, withered under concerns of privacy, and new security methods will likely be porous [8]. The truth is that wireless technologies are notoriously hard to protect; supposedly secure online bank accounts are routinely hacked,

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PDF Compressor Pro BROWN exposing not only Social Security numbers but also the cracks in the electronic security systems. No matter how strong we build the walls, a hacker can find a way to tunnel through them. It is less a matter of if than of when. The security risks, however, extend beyond hackers. Many people do not feel secure knowing that they are traceable down to the heart beat; such close monitoring may unwittingly harm the patient’s mental health. Even if the trackers are off, it is hard to shake off the paranoia, the feeling that at any second someone could be watching you. For many, the upsides may not be large enough to counterbalance the privacy issues that haunt the technology.

The health concerns likewise go unanswered. Implantable

Would privacy worries be too great for the technology to overcome? Or would the microchip reinvent itself enough to dissipate these concerns?

GPS microchips have long been “good enough” for pets; in many states, they are required by law. Our sue-happy society today does not allow for error, though; any whiff of microchips causing cancer would lead to devastating legal repercussions. The microchip is also not a unique solution to many of the problems it aims to solve, so given its health risks, are microchips the best solution for healthcare?

Any upside the microchip has to offer could just as easily be abused. The GPS technologies that could locate lost people could just as easily imprison hapless victims. Likewise, theft of a chip could result in total identity theft; the payoff of stealing one would be immense, and one might imagine gory alleyway excisions to steal the victim’s life.

It is undeniable that enhancements to the microchip continue to make them an extremely powerful tool. Whereas a sixteen-digit number limited the VeriChip, recent innovations have already demonstrated increasing functionality. Sure, microchips for posh nightclubs seem frivolous, but being able References 1. Foster K, Jaeger J. RFID Inside: the murky ethics of implanted chips. IEEE Spectrum. 2007 Mar: 24-29.

2. Farra R, et al. First-in-Human Testing of a Wirelessly Controlled Drug Delivery Microchip. Science. 2012 Feb; 4(122): 1-10.

3. Positive ID Corporation. Our Products: GlucoChip. 2012 [cited 2012 Oct 16].

Available from: http://www.positiveidcorp.com/products_glucochip.html 4. Clemson University. Department of Defense Awards Clemson $1.6 Million for Biochip Research. 2007 Jul 30 [cited 2012 Nov 4]. Available from: http://grad.clemson. edu/news/recentNews.php?tag=chip&PHPSESSID=a4bhte2datqau5qtralvi314d3.

5. Luvisi A, et al. Biosecurity of kiwifruit plants: effects of internal microchip implants on vines for monitoring plant health status. New Zealand J of Crop and Horticultual Sci. 2012 Feb: 1-11.

6. Lymberis A. Progress in R&D on Wearable and Implantable Biomedical Sensors for Better Healthcare and Medicine. Proceedings of the 3rd Annual International IEEE EMBS Special Topic. Conference on Microtechnologies in Medicine and Biology. 2005 May 12-15.

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Reproduced from [12]

to monitor vital signs is compelling. The ability to implant high-risk patients with tags in case of emergency seems like a no-brainer. There is no argument that the latest innovations in microchips are marked improvements over the primitive VeriChip.

Overall, the implantable microchip’s benefits are ultimately outweighed by all of its concerns. The complete microchip centralizes all of your confidential information, drawing tremendous temptation for theft and abuse, perhaps even by the government. The implantable microchip however continues to inspire hope in the medical field; a future iteration may be a brilliant solution to a current disease. Still, the security concerns rankle even the medical promise of the microchips; it is hard to trust a device with such malevolent potential.

Whether the microchip manages to reach its fullest revolutionary potential depends on whether it can minimize these security risks enough to ease the public’s worries.

Michael Yanagisawa ‘13 is a senior at Brown University double concentrating in materials chemistry and biology. He is interested in pursuing medicine and is also fascinated by the role that truly innovative technology will play in the future of our society and its 7. Ivanov S, et al. The Microchipped Tourist: Implications for European Tourism.

2012 Jun [cited 2012 Dec 11]. Available from: http://papers.ssrn.com/sol3/papers. cfm?abstract_id=2117801.

8. Halamka J, et al. The Security Implication of VeriChip Cloning. J Am Med Inform Assoc. 2006 Nov-Dec; 13(6): 601-607.

9. Albrecht, K. Microchip induced tumors in laboratory rodents and dogs: A review of the literature 1990-2006. CASPIAN Consumer Privacy. 2007 [cited 2012 Dec 11].

Available from: http://www.antichips.com/cancer/albrecht-microchip-cancer-fullpaper.pdf.

10. Lawrence Berkeley National Laboratory. Travel Express [Image on the Internet].

2012. Available from: http://www.lbl.gov/Workplace/CFO/Travel_Express/archive/ TE_spring12/images/spring12/cartoon.png.

11. Original Image Modified By Author. Lawrence Berkeley National Laboratory.

Travel Express [Image on the Internet]. 2012. Available from: http://www.lbl.gov/ Workplace/CFO/Travel_Express/archive/TE_spring12/images/spring12/cartoon.png.

12. Image available from: http://upload.wikimedia.org/wikipedia/commons/c/c7/ Microchip_rfid_rice.jpg

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Cognitive Behavior Therapy versus Medication for Sleep Impairment in Posttraumatic Stress Disorder Han Zou

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osttraumatic stress disorder (PTSD) is diagnosed in those who persistently re-experience a traumatic event, avoid stimuli related to the event, and have some symptoms of anxiety and hyper arousal when reminded of the event [1].

PTSD can affect those who personally experience a catastrophe, those who witness it, and those who pick up the pieces afterwards. For example, many of those who witnessed the 9/11 attack firsthand, have been sexually assaulted, or have been victims of a natural disaster suffer from anxiety, flashbacks, and serious sleep disturbances every day. These symptoms, although seemingly psychological, may have physiological roots in an altered structure of the brain [2, 3]. The United States Department of Veterans Affairs estimates that 830,000 Vietnam War veterans suffered from symptoms of PTSD [4], and also that women exposed to trauma develop PTSD at twice the rate men do [5]. The United States has the fourth highest PTSD prevalence of the 25 most populous countries [6].

Researchers refer to sleep disturbances in psychiatric patients as “psychiatric insomnia” , meaning that insomnias and nightmares are secondary to a specific psychiatric disorder like PTSD [7]. Recent studies at New York University and the New York–Presbyterian Hospital show enduring psychological and neurological repercussions in adult witnesses of the

Reproduced from [17]

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World Trade Center collapse and in children who lost a parent in the tragedy [2, 3]. Recent studies have also found correlations between PTSD and cardiovascular diseases, cancer, and the presence of other psychological disorders [8]. Common treatments are almost always inspired by psychotherapeutic or pharmacological approaches.

Cognitive behavior therapy (CBT) is an umbrella term encompassing all therapies in which the therapist seeks to understand and change the patients’ perception, evaluation and emotions toward real-life situations. CBT treatments for PTSD expose the patients to thoughts, memories and situations that are related to the trauma. Therapy works to break the link between the distorted emotions and the memory, replace the false beliefs with rational expectations, help restore a sense of control, and build a more balanced worldview. By focusing on the causes of PTSD or by targeting behaviors such as nightmares, psychotherapists are often able to help the patients overcome irrational thoughts and emotions.

Medications, on the other hand, lay more attention on treating symptoms caused by the trauma. However, most medications that are used to treat PTSD were not specifically designed for PTSD, but to treat secondary symptoms such as anxiety, depression and other related disorders [9].

Common medications for insomnia induced by PTSD are antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs) or anti-anxiety medicine, such as benzodiazepines. The medications prescribed for treating PTSD symptoms act upon neurotransmitters related to the fear and anxiety circuitry of the brain including serotonin, norepinephrine, GABA, and dopamine, among many others [10].

It is a tough call to decide whether therapy or medication is better in the treatment of PTSD. This article is aimed at examining the advantages and disadvantages of both CBT and pharmacological approaches towards insomnia and nightmares caused by posttraumatic stress disorder. With more understanding of the different characteristics of the two approaches, we might find that medications could be used in the short-term to ready patients for CBT, and CBT can prepare patients to cope with real world scenarios. Recognizing the importance of therapy alongside medication is crucial for patients with mental illnesses.

CBT An Example CBT Technique: Desensitization and Imagery Rehearsal Desensitization and imagery rehearsal are usually conducted in two phases. First, the therapist informs the patient about the

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PDF Compressor Pro BROWN cause of nightmares and taught how they can be controlled.

The patient is also told that “nightmares persisting for months may no longer serve useful purposes and may be viewed more pragmatically as a sleep disorder” [11]. Patients are encouraged to think that, as time goes on, nightmares no longer act as an automatic mental response towards the trauma, but instead as a habit that needs modification.

Second, patients will be asked to use imagery rehearsal therapy (IRT) on a single, self-selected nightmare. As Dr. Barry Krakow, former medical director of at University of New Mexico School of Medicine stated in 2001, “The participant writes down her disturbing dream… [and] is instructed to ‘change the nightmare any way you wish’ and to write down the changed dream” [11]. The treatment group in Dr. Krakow’s research had three IRT sessions and no additional intervention.

After the treatment and practice at home, the participants are followed up at three months with a mailed package of questionnaires and are invited to a personal interview at six months.

With a randomized, blind control group, the frequencies of both nightmares as well as other PTSD symptoms are noticeably reduced with active treatment. The data at three and six months after the treatment also indicate that there is almost no relapse with IRT. Further research conducted by Krakow suggests that sleep hygiene, the controlling of all behavioral and environmental factors that precede sleep and may interfere with sleep, can also be improved by CBT, and all changes in sleep quality were large, roughly equivalent to a change from severe to moderate sleep disturbance [12, 13].

Drawbacks of Cognitive Behavior Therapy Although there is a low risk of relapse, cognitive behavior therapy requires a high time commitment. Practicing and learning are time-consuming, both for the therapist and the patient, involving perhaps more than 13 hours of therapy over a 6-week period, not including independent practice [13].

Krakow et al. report a relatively high dropout rate in IRT [11].

In addition, CBT requires patients to be highly functional in order to cope with the therapy, with strong skills of emotion control to overcome the distorted thoughts and beliefs. This is not possible for patients that are troubled with other kinds of mental illness that may interfere with their mental functioning.

For some patients, medication could be a valuable first step, providing enough relief from symptoms that they are motivated to enroll in CBT later.

Medication Medications are increasingly being used to treat anxiety disorders or insomnia, and they have generally been found to be successful in helping people with their symptoms. Notably, however, no medications have been specifically designed to treat the particular symptoms of PTSD, although some medications commonly used to treat anxiety disorders and depression have been found to be effective in helping people manage symptoms such as insomnia and nightmares. Medications work for PTSD by affecting the concentration and activity of the neurotransmitter serotonin, a chemical in the brain

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thought to be linked to anxiety disorders.

Medications for PTSD or insomnia Presently, SSRIs are recommended as first-line treatments for PTSD. Sertraline and paroxetine (SSRIs) have received FDA approval for the treatment of PTSD based on positive findings in large multisite trials [10]. They also appear to promote reduction of clinically significant symptoms that are often associated with PTSD, such as suicidal, aggressive, and impulsive behavior. Finally, SSRIs have a side effect profile that is relatively benign compared to other medications [10].

Although SSRIs are recognized as the best medication for PTSD, other types of medication might have an upper hand in treating insomnia and nightmares, which are secondary symptoms of PTSD. Medications in the classes of antiadrenergic agents and benzodiazepines have a marked efficacy for PTSD nightmares and insomnia [10]. Benzodiazepines bind with the GABA receptor in the brain, a neurotransmitter, to increase a chemical that inspires drowsiness or sedation. Most

These symptoms, although seemingly psychological, may have physiological roots in an altered structure of the brain benzodiazepines are very quick to act and decay quickly, making them particularly useful for treating sleep onset insomnia or middle insomnia.

Medications, unlike CBT sessions, are relatively less time consuming. Patients enjoy improvements to their sleep and emotional state almost immediately after use. Medications also do not require patients to cope with the intrusions of a therapist, avoiding additional uneasy feelings from reliving the trauma in treatment. Additionally, patients with mental disabilities can handle a pharmacological treatment. Disregarding possible side effects such as withdrawal and habituation, medications seem to have the upper hand.

Limitation of medications There seems to be a tricky conflict in treating PTSD insomnia, which is that many methods of treating PTSD increase sleep impairment. According to Morin et al., even though SSRIs generally work for PTSD symptoms, they have side effects such as producing insomnia, and restlessness, contributing to sleep impairment [13]. Also benzodiazepines, used to improve sleep quality, have no impact on PTSD itself, and may exacerbate depressive symptoms [10]. There is also some evidence suggesting that sleep medication interferes with the efficacy of trauma-focused interventions for PTSD [10].

SSRIs can cause various types of sexual dysfunction such as anorgasmia, erectile dysfunction, and diminished libido. Initial studies found sexual side effects are not significantly different from placebo, but since these studies relied on unprompted

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PDF Compressor Pro BROWN reporting, the frequency was probably underestimated. In Medications are also an easier treatment method for the patients, more recent studies, doctors have specifically asked about compared with the difficult emotional and thought processes sexual difficulties, and found that they are present in between one has to go through with CBT. Of the two, CBT has a lower 17-41% [14, 15] of patients, although the lack of placebo control chance of relapse and fewer side effects in the long run, and in these studies means they are likely overestimates. appears to be the more successful course of treatment.

In addition to general side effects such as dizziness, faInvariably, medication—which changes neurological tigue, and nausea, both benzodifunctioning—stops exerting its azepines and SSRIs are associated beneficial effect when the paPatients are encouraged to with potential adverse effects tient stops taking it. The positive and increased risks of physical changes in thoughts, feelings, and think that, as time goes on, and psychological dependence. behaviors no longer exist. Evennightmares no longer act as Cognitive behavior therapy for tually, the symptoms return. For insomnia, combined with superpatients that are less functioning, an automatic mental response vised medication tapering, can medication can be used as a start, towards the trauma, but facilitate withdrawal, usually with but CBT needs to be introduced a success rate at 64% [16]. But even for longer effects. When a patient instead as a habit that needs with CBT and medication taperreceives both medication and CBT, modification ing, results showed a substantial however, the medication should relapse rate after discontinuation, be at a low enough dose that the with 20 patients out of 47 (43%) patient can still feel the sensations relapsed during a two year follow up [16]. that led to panic in the past for the therapy to be effective.

In fact, the dose should be gradually decreased so that the Conclusions patient can experience enough anxiety to be increasingly able Cognitive behavior therapy, including desensitization and to make use of CBT methods. imagery rehearsal, cognitive processing therapy, and prolonged Though CBT is ultimately more effective, it must be exposure, is a successful treatment for insomnia and nightmares remembered that medication is often a short-term solution associated with improvement in symptoms of PTSD: anxiety, needed to stabilize the patient enough for CBT to be usable. and depression. Both uncontrolled and controlled studies have Determining the correct balance between the two is still primarily shown that sleep quality of patients with PTSD has improved a matter of trial-and-error, and reflects an area of psychiatry following several weeks of talking therapy. Researchers have that requires further study. followed up the patients for longer periods and found evidence of few, if any, relapses. Further research is needed to Han Zuo a senior at Brown University concentrating in Economics. determine for which populations CBT is most effective, since Although not a psychology concentrator, Han has a strong interest in CBT requires strong coping and understanding skills. the study of psychopathology and its applications in our everyday life.

The pharmacologic approach towards PTSD sleep impairment requires less time for both the patient and the therapist.

References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington D.C. American Psychiatric Association; 2000.

2. Sharot T, Martorella E, Delgado M, Phelps E. How personal experience modulates the neural circuitry of memories of September 11. Proceedings of the National Academy of Sciences of the United States of America 2007; 104(1):389–394 3. Phelps E. Emotion and Cognition: Insights from Studies of the Human Amygdala.

Annual Review of Psychology 2006; 57(1):27-53 4. Mintz S, McNeil S. The War’s Costs [Internet]. 2012 [cited 24 Dec 2012]. Available from: http://www.digitalhistory.uh.edu/disp_textbook.cfm?smtID=2&psid=3468 5. Christopher O. Psychological Costs of War: Military Combat and Mental Health [Internet]. 2012 [updated 27 Feb 2012; cited 25 Nov 2012]. Available from: http:// journalistsresource.org/studies/government/federalstate/psychological-costs-warmilitary-combat-mental-health/ 6. World Health Organization. Mortality and Burden of Disease Estimates for WHO Member States: Persons, all ages [Internet]. Feb 2009 [cited 24 Dec 2012].

Available from: http://www.who.int/entity/healthinfo/global_burden_disease/ gbddeathdalycountryestimates2004.xls 7. Nowell PD, Buysee DJ, Reynolds CF III, Hauri PJ, Roth T, Stephanski EJ, et al.

Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders. Am J Psychiatry 1997; 154(10):1412-1416 8. Sledjeski E., Speisman B. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). Journal of Behavioral Medicine 2008; 31(4):341–349 9. Maxmen JS, Ward NG. Psychotropic drugs: fast facts. 3rd ed. New York. W. W. Norton; 2002.

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10. Friedman MJ, Pharmocologic management of posttraumatic stress disorder.

Primary Psychiatry 2003; 10(8):66-68, 71-73.

11. Krakow, B, Hollifield, M, Johnston, L, Koss, M, Schrader, R, Warner, TD, et al.

Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized control trial. Journal of the American Medical Association 2001; 286(5):537-545 12. Van der Heijden KB, Smits M, Boudewijn Gunning W. Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia. Journal of Sleep Research 2006; 15(1):55–62 13. Krakow, B, Johnston, L, Melendrez, D, Hollifield, M, Warner, TD, ChavezKennedy, D et al. An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. American Journal of Psychiatry 2001; 158(12):2043–2047 14. Hu XH, Bull SA, Hunkeler EM, Ming E, Lee JY, Fireman B, et al. Incidence and Duration of Side Effects and Those Rated as Bothersome With Selective Serotonin Reuptake Inhibitor Treatment for Depression: Patient Report Versus Physician Estimate. The Journal of Clinical Psychiatry 2004; 65(7):959–965 15. Landén M, Högberg P, Thase M. Incidence of Sexual Side Effects in Refractory Depression During Treatment With Citalopram or Paroxetine. The Journal of Clinical Psychiatry 2005; 66(1):100–106 16. Morin CM, Belanger L, Bastien C. Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy 2005; 43(1):1-14 17. Johnston A. USMC-120503-M-9426J-001 [Image on the Internet]. 2012 May 2 [cited 2012 Dec 30]. Available from: http://commons.wikimedia.org/wiki/File:USMC120503-M-9426J-001.jpg

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Adapting to the Apocalypse: Using Human Augmentation to Counter Global Environment Alterations Matthew Ryan Ykema

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pocalyptic scenarios have been part of the human imagination since the beginning of human history and remain popular in the chaos of the modern world.

Ancient religious texts, stories, and pieces of art have helped to fill our minds and media with scenes of scorched desert plains, horrific storms, dying crops, artic wastelands, and dry riverbeds. These scenarios may only happen in fiction, but it is becoming more difficult to ignore the evidence of human fueled climate change. The U.S. Environmental Protection

The company [Takram] claims that, with the augmentations, a human being could survive on thirty-two milliliters of water a day.

Agency has stated that in 2008, U.S. industrial production of carbon dioxide totaled 2,047 million metric tons, the most notorious contributor to the greenhouse effect [1]. Even if all greenhouse gas from industrial sources were stopped, Robert Goodland and Jeff Anhang, environmental advisers for the World Bank Group, estimate that up to 51% of the world’s greenhouse gases come from the planet’s livestock [2]. Long term environmental solutions to these problems would require huge lifestyle and policy changes. In the most extreme scenario, it might Reproduced from [18] be possible that Earth would be unable to support humanity in our current form sometime in the future. If cataclysmic climate change comes to pass, it will affect every aspect of our society. Even if it does not occur, this problem requires consideration, and the discussion surrounding this topic could lead to further scientific development through the testing of possible methods of combating climate change. There are many possible ways to combat the climate change © 2013, The Triple Helix, Inc. All rights reserved.

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problem, but there are an unlikely and controversial set of scientific developments that have yet to be considered in this discussion.

Many fields of science focus on improving the quality of people’s lives, but there are new emerging technologies that take that concept to the next level. With improvements in genetic engineering, biomechanics, biomedical engineering, and many other disciplines, it is theoretically possible to augment, improve, or replace the basic functions and features of the human physiology. This human augmentation can take the form of simple procedures that improve the overall quality of life for people, such as LASIK eye surgery, or they can be major changes that could affect how people live their lives, such as using genetic engineering to slow or stop the aging process [3]. Many of these technologies would be excessive for small environmental changes, but they could be implemented on a much larger scale for their benefits to people. Many of these proposed technologies are still in the theoretical or development stages, but the variety and quality of benefits they can offer cannot be ignored. It is important to consider human augmentation now as a part of environmental policy to help decide if society is willing to accept these technologies.

Human augmentation has been an extremely polarizing issue amongst multiple groups. Some of these groups, like Humanity +, are strong supporters of human augmentation and believe that these developments will become a vital part of our lives in the coming years [4]. Other organizations, such as the Center for Genetics and Society, note the possible dangers of human augmentation and are extremely cautious about implementing any form of human augmentation [4].

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PDF Compressor Pro ASU Both sides make valid points regarding human augmentation technologies, and both positions should be considered when discussing and deciding on these issues. The element that is

day [6]. These augments are designed for use in scenarios where water availability is reduced for long periods of time, such as survival scenarios or severe droughts. Even if the technology does not work to this level, this system sets the precedent for other technologies by enforcing the idea of reducing inefficiencies in the human body rather than improving function.

Another form of implant could boost the functions already present in the human body.

In his novel White Devils, author Paul McAuley suggests a “magic bullet” - an implant that introduces thousands of antigens programed from known pathogens that are meant to supercharge the human immune system [7]. As climate shift occurs, areas that once supported large portions of the world’s livestock and crops may become unusable or compromised in terms of quality because of a reduction in available water and changing temperatures [2]. This instability could allow for more food and waterborne pathogens to develop or be introduced into the food supply.

It would be much more difficult to develop an augment that can adapt to the environment and synthesize immune boosters on the fly; it may be possible to prepare our bodies to defend against these well-known and developing pathogens. This technology could be based off of research done by members of the Memorial Sloan-Kettering Cancer Center in New York and the Laboratoire de Génétique Moléculaire in France, who have been working to develop magnetic beads that can deliver antigens and quickly build up immune response Reproduced from [19] cells [8]. This augment could also make future enhancements easier, because, genetic engineering critical to consider or the climate change discussion is that, commonly uses viruses as a way to introduce new pieces of no matter the social issues surrounding these technologies, genetic information. Researchers at the Mount Sinai School of these advancements can be used to quickly change various Medicine have supported the idea that viruses used for gene functions of the human body. This modularity would allow therapy can be manipulated to deliver the genes more effectively, humanity to adapt to the environment, rather than have the and by preventing the immune system from targeting these environment adapt to humanity. viruses, genetic engineering can be conducted more quickly These augmentation technologies can be broken and efficiently [9]. Manipulating existing biochemical processes down into different classifications based upon how the body in the human body may lead to more socially acceptable and is augmented. One way to augment the body could be through cost effective solutions to climate change. upgrades to current organ systems. In survival scenarios, clean Even if our most basic nutritional needs are met, a water is most often a person’s most valuable resource. On average, a man requires 3.7 L of water a day and a woman requires 2.7 L of water a day [5]. A set of augmentations called the hydrolemic Shenu system would reduce our water needs It will be up to the will of the to a fraction of the current amount. The Japanese design firm individual and the permission Takram developed this Shenu system, which is composed of implants that are inserted into or replace the nasal cavity, of society for people to even rectum, bladder, sinuses and neck [6]. The company claims be able to utilize human that, with the augmentations, a human being could survive on thirty-two milliliters of water a day. In order to reach this augmentation as a method of level of efficiency, Takram has also developed a candy-like survival. product that would provide exactly thirty two milliliters of water and all of the nutrients a person needs to survive for a 36 THE TRIPLE HELIX Spring 2013 BROWN S13.indb 36

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PDF Compressor Pro ASU major threat of global climate change could be the changes in climate temperatures. The temperatures could rise so high or drop so low that basic biochemistry that runs the human body may no longer be stable. High temperatures put a large amount of stress on the human body, which is countered by the release of compounds called heat shock proteins [10]. These proteins

Reproduced from [20]

protect cells from the damaging effects of high temperatures, allowing the human body to function in higher temperatures for longer periods of time [11]. By reengineering our own genetics, it is possible to have the body produce more of the heat shock transcription factor, the key compound that activates the genes that make heat shock proteins. Dealing with low temperatures would require a different class of augmentation.

Humans can only defend against cold through movement, like shivering, or wearing extra layers of clothing. A large variety of organisms, ranging from Tenebrio molitor, a species of beetle, to Hemitripterus americanus, the sea raven, to various species of microorganisms, such as bacteria from the genus Colwellia, all have antifreeze proteins that prevent ice formation and cellular damage in low temperatures [12, 13, 14]. As genetic engineering methods improve, it might become possible to integrate the genes that code for these unique proteins into our own genome, and long term survival in sub-zero climates would be viable, allowing people to live in areas that would otherwise be inhospitable without expensive and encumbering equipment.

If it is possible to adapt our biochemistry to function in these extreme temperatures, other daily functions need to be considered. For example, handling a piece of metal is nearly impossible in extreme heat because of burns, or extreme cold because the skin would adhere to the metal.

Protective gloves may prevent harm being done, but they cause the user to lose fine motor functions needed to perform complex tasks. Studies by the U.S. Army have found that the activation of upper body muscles cause an increase in core temperature; therefore, increasing the risk of heat stroke in hot environments and hypothermia in cold environments [15].

A possible solution to this problem would be replacing full body systems, specifically replacing one’s biological arms with mechanical replacements. Current prosthetic arms, such as

Š 2013, The Triple Helix, Inc. All rights reserved.

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the Bebionic 3, function using twitches in upper arm muscles and can do many day-to-day functions [16]. In a few years, the bionics will be able to perfectly emulate a human arm,

In the most extreme scenario, it might be possible that Earth would be unable to support humanity in our current form sometime in the future.

with the added bonus of helping to regulate core temperature.

Such drastic augmentation will be the target of speculation and resistance by the general public, and removing The largest deterrent to using these technologies as a solution to climate shifts may not be how our bodies react to the technologies, but how the public reacts to the issues in climate change and human augmentation A 2012 Gallup poll has indicated that only 15% of the adults surveyed believed that humans evolved without some form of divine intervention [17]. It will always be difficult to predict public reactions to new technologies, but it is highly unlikely that people will seriously consider using augmentation, which could be considered human driven evolution, as a solution if they do not agree with the concept of evolution. The human body is a very complex system, allowing many branches of science can be applied to human augmentation. As science continues to advance, there may be enhancements that will guarantee humanity’s survival in any terrestrial environment with no assistance from outside equipment, such as cumbersome winter

Even if every human on the planet could be augmented, this only means humanity would be able to survive the apocalypse, but it may not be willing or able to deal with the ramifications. clothing or SCUBA gear. It will come down to the society to accept or deny the use of human augmentation.

It is possible that these technologies may never be implemented as augments, but there will not be a shortage of available research to be applied for this purpose. Even if the augments were ready for human use, there would be massive THE TRIPLE HELIX Spring 2013 37

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PDF Compressor Pro ASU Reproduced from [21]

logistical issues related to production and implementation. Even if every human on the planet could be augmented, this only means humanity would be able to survive the apocalypse, but it may not be willing or able to deal with ramifications. Current discussion about climate change and human augmentation is often bogged down by political opinions, economic interests, and social stigmas, making any kind of constructive discourse on either subject extremely difficult. If society wants to be prepared for future climate issues, it must be prepared to consider a whole range of solutions, even something as drastic as human augmentation.

Humanity has an instinctive drive for self-preservation.

Given enough time, technology should advance far enough to allow humans to inhabit any environmental conditions. It will References 1. The U.S. Environmental Protection Agency. Quantifying Greenhouse Gas Emissions from Key Industrial Sectors in the United States [Internet]. 2008 May [cited 2012 Nov 18]. Available from: htp://www.epa.gov/sectors/pdf/greenhouse-report.pdf 2. Goodland R, Anhang J. Livestock and Climate Change: What if the key actors in climate change are cows, pigs, and chickens?. World Watch.2009; 10-19.

3. Williams EA. Good, Beter, Best: The Human Quest for Enhancement. In: Frankel MS. Invitational Workshop Convened by the Scientific Freedom, Responsibility and Law Program. June 1-2, 2006. Washington, D.C. American Association for the Advancement of Science 4. Overview of Biopolitics [Internet]. 2012 [cited 2012 Dec 7]. Available from: htp:// ieet.org/index.php/IEET/biopolitics 5. Sawka MN, Cheuvront SN, Carter R 3rd. Human water needs. Nutr Rev.2005;63(6 Pt 2):30-39 6. Takram. Shenu: Hydrolemic System [Internet]. 2012 [cited 2012 Nov 12] Available from: htp://www.takram.com/?page_id=699 7. McAuley P. White Devils. 1st ed. New York. Tom Doherty Associates, LLC; 2004 8. Kim JV, Latouche JB, Rivière I, Sadelain M. The ABCs of artificial antigen presentation. Nature Biotechnology.2004; 22:403-410 9. Palese P, Zheng H, Engelhardt OG, Pleschka S, Garcia-Sastre A. Negative-strand RNA viruses: Genetic engineering and applications. Proc. Natl. Acad. Sci. USA.1996;93:11354-11358 10. Santoro MG. Heat shock factors and the control of the stress response. Biochem

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be up to the will of the individual and the permission of society for people to even be able to utilize human augmentation as a method of survival. Discussion and discourse about human augmentation now, while the threat of drastic climate change is present but not threatening to eradicate human life, will be the best tool to ensure that the quality of human life can be protected. Global climate change may never make Earth inhospitable to humans, but if it does, it is our responsibility to be physically and mentally ready to do whatever it takes to ensure the human race survives.

Matthew Ykema ‘15 is studying Molecular Biosciences and Economics at Barrett, the Honors College, at Arizona State University.

Pharmacol.2000; 59(1):55-63 11. Wu C. Heat shock transcription factors: structure and regulation. Annu Rev Cell Dev Biol..1995;11():441-469 12. Graham LA, Liou YC, Walker VK, Davies PL. Hyperactive antifreeze protein from beetles. Nature.1997;388:727-728 13. Ng NF, Hew CL. Structure of an antifreeze polypeptide from the sea raven. Disulfide bonds and similarity to lectin-binding proteins. J Biol Chem.1992;267(23):1606916075 14. Raymond JA, Fritsen C, Shen K. An ice-binding protein from an Antarctic sea ice bacterium. FEMS Microbiology Ecology.2007; 61(2):214-221 15. Sawka MN, Lazka WA, Pandolf KB. Temperature regulation during upper body exercise: able-bodied and spinal cord injured. Med Sci Sports Exerc.1989; 21(5):132140 16. RSL Steeper. bebionic 3 [Internet]. 2012 [cited 2012 Nov 16]. Available from: htp:// bebionic.com/ 17. Newport F. In U.S., 46% Hold Creationist View of Human Origins [Internet].

2012 Jun 1 [cited 2012 Nov 18]. Available from: htp://www.gallup.com/poll/155003/ Hold-Creationist-View-Human-Origins.aspx 18. htp://fallout.bethsoft.com/eng/art/fallout3-conceptart1.php 19. htp://secularstudents.org/sites/default/files/transhuman.jpg 20. htp://www.nsf.gov/news/mmg/media/images/efri1_h.jpg Reproduced from [22] 21. htp://www.blisteredthumbs.net/wp-content/uploads/2011/07/augmentation.jpg

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Buildings As Living Systems Prathima Radhakrishnan

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ichael Pearce, an architect from Zimbabwe, believes that the world we live in is a lie [1]. In order for all 6 billion people on Earth to obtain the lifestyle they strive towards, the lifestyle they pay for with hard work and unyielding determination, “the natural resources of 4 more planets would be required” [1]. We aren’t about to extract minerals and energy from outer space anytime soon, and neither are we about to engage in massive wealth redistribution to uplift those in need of progress. Therefore, we turn to environmentalism. The reasoning is fairly intuitive. If we conserve our resources, we can slow the rate at which they are depleted, and ensure a comfortable existence for more

a field of science that studies the correspondence between structures and functions in nature. Design principles emerging from these studies are then applied to create fabric, power sources, multi-story buildings and more: objects which not only reduce disturbances to the environment but are even higher in quality and better performers than more conventional counterparts. By contributing to biomimetic architecture, Pearce is part of an environmental movement that doesn’t just call for sacrifice and accountability, but is positive, progressive, and incredibly creative as well.

The termite is Pearce’s muse. While outside temperatures may vary between 35°F and 104°F, termites, “themselves architects of sorts”, build towering mounds that are maintained at a generally steady temperature of 87°F [4]. They do so without the aid of electricity-draining air conditioners or heaters running on natural gas, using one of two mechanisms of mound ventilation that Pearce combined to design the Eastgate Center in Harare, Zimbabwe, the largest office and shopping complex in the country. In the first mechanism, called a thermosiphon flow, heat produced by the termite colony rises to the mound’s porous surface. The exchange of heat, water vapor, and other gases with the external environment cools and refreshes the air, which is forced downwards into open spaces below the nest and eventually through the nest again [4]. Heat generated by the Eastgate Center’s machinery and occupants flows upwards towards its rooftop stacks, creating a similar thermosiphon flow. The second mechanism, called an induced flow, is found in termite mounds that have an open vent [4]. Here, higher wind velocities near the chimney result in fresh air being

Imagine if our buildings, our bridges, machines, all of our bricks could actually compute

Reproduced from [12]

of those who earn and deserve it. Owning, or at least living in, a home is central to the desired way of life, but energy requirements of existing buildings account for 39% of all energy used nationwide [2]. It is not surprising, then, that the federal government subsidizes efficient heating systems [3] or that 63 colleges in the US offer degrees in architecture with an emphasis on sustainability [4]. Energy-efficient building is a crucial component of energy conservation as a whole.

Michael Pearce uses nature as a model to design structures that consume less energy. His work falls under biomimicry, © 2013, The Triple Helix, Inc. All rights reserved.

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drawn into openings close to the ground and then travelling up though air spaces in the mound, before exiting through the chimney. The structure of the Eastgate Center—two towers, separated by an open, glass-covered atrium—is similar to that of a termite mound [5]. In both cases, outside air is drawn in through floor slabs and vented through the atrium, allowing for this induced flow [4].

Furthermore, a termite mound’s steady temperature can be attributed to the fact that nests are embedded in deep soil, which has a high capacity to absorb and store heat [4]. The concrete walls and floor slabs of the Eastgate Center also have a high heat capacity. During the day, the building’s walls THE TRIPLE HELIX Spring 2013 39 5/27/2013 3:41:48 PM

PDF Compressor Pro UCHICAGO absorb warm air. At night, fresh cold air flows into cavities in floorboards and cools offices through baseboard vents [5].

Consequently, the building is cool at the beginning of each day and experiences minimal temperature increase as the day progresses. In spite of the above measures, low-power fans are required to ensure that every story receives an equal amount of cooling air and steady temperatures are maintained yearround [5].

Pearce views termite Reproduced from [13] mounds as structures “honed to sleek efficiency by the relentless refining of natural selection” [4]. His building embodies this efficiency, and conserves not only energy, but money as well. The design of the Eastgate Center allows it to consume 90% less energy than a conventional building of its size in Harare. Due to reduced maintenance costs, tenants pay 20% less in rent than they would have otherwise [6]. Energy efficiency, therefore, can uplift the poor not only indirectly in the long term, but very directly in the short term, by reducing the cost of housing.

The Eastgate Center, though unquestionably successful, does not accurately mimic a termite mound. No termite colony uses high thermal capacity fans at nighttime to empty walls of heat stored during the day [4]. Recent discoveries have also revealed that the thermosiphon and induced flows are merely two components of a multi-phased system of ventilation in termite mounds. To understand exactly how tunnels and air conduits regulate temperature, Rupert Soar of Loughborough University organized the TERMES project, in which 3D computer models are built from digital scans of mounds [7]. Analysis of these models could lead to the redefinition of a fundamental building unit: the wall. In the future, walls could function as adaptive interfaces, intelligently managing the exchange of matter and energy [7], instead of as barriers to the external world [4]. As a result, wind-ventilated buildings would no longer require fans. The building’s structure, like an organism’s structure, would permit it to maintain internal homeostasis in the face of a changing external environment. Our future would include buildings that are, in a sense, alive.

The idea of such a self-sufficient building, capable of coming alive resounds strongly with Skylar Tibbits, architect-turned-professor at MIT. “Imagine if our buildings, our bridges, machines, all of our bricks could actually compute

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[8],” he said, drawing an analogy between the construction of a building and the assembly of a protein. In nature, basic building blocks, like cells and amino acids, are able to come together, in the correct order and orientation, to form complex structures. Tibbits believes that this “bottom up” approach of programmed self-assembly is relevant to architecture. He regards the processing of raw materials by machines to be energy-consuming and unnecessary, wanting instead to “watch as the materials assemble themselves” [9].

Tibbits describes four principles governing self-assembly.

First, the ultimate shape of the structure Reproduced frommust [10]. be decoded into a simple sequence. Secondly, programmable parts capable of using the coded sequence to fold up into the appropriate shape must be acquired. Thirdly, there needs to be an external energy source that will allow the assembly to occur, and finally, a repair mechanism, ensuring that the parts come together in the right configuration must be instituted [8].

These four principles mimic self-assembly in the natural world. For example, the ultimate three-dimensional shape of a protein is decoded into a series of codons that make up one gene. Amino acids that correspond to specific codons and tRNA that delivers the amino acid to its corresponding

The building, no longer a machine for living in, has become the building, as a living system codon constitute the programmable parts capable of reading the message. The ultimate shape of the protein is therefore determined by its sequence (i.e., the types and order of amino acids), as protein folding is guided by interactions between different amino acids. Protein folding also has a built-in repair mechanism, as the correctly folded conformation of the protein has the lowest Gibb’s free energy.

Another repair mechanism is the molecular chaperone, which prevents polypeptide chains from aggregating into incorrect structures, and also assists degraded or misfolded proteins in folding back into the right conformation [10].

The macrobot and decibot are two of Tibbit’s self-assembly projects. Here, sensors, along with other mechanical and electrical Reproduced from [14] elements, are embedded into individual building blocks. The desired shape of the final structure is encoded into a series of angles and the code is sent through a wire that connects these blocks. Each component reads the code, turns to the appropriate angle, checks itself, and passes on the message to its neighbor. While the macrobot and decibot are valid

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PDF Compressor Pro UCHICAGO examples of programmed self-assembly, their high cost of production, both in terms of time and money, prevent them from representing valid alternative strategies to conventional building [8].

A third self-assembly project in Tibbits’s lab is called, “Biased Chains.”

A biased chain is constructed using components that are identical to each other, except for being biased to turn left or right. Therefore, when elements with different biases are connected in a particular order, they are programmed to take a particular shape. They can be assembled into this shape, with the provision of kinetic energy. Currently, different biased chains, when shaken, fold into spirals, cubes and more [8].

While Tibbits has built self-assembling toys, stools, and chairs, the image of a multi-story building constructing itself is yet a far off dream. However, the enormous promise of a self-assembling future is rendered visible when the construction of a conventional Reproduced from [13] building is contrasted with that of DNA. A skyscraper has 500,000 to 1 million parts and is built in approximately 2.5 years [8].

A strand of DNA has 3 billion base pairs and the human genome can replicate in about an hour [8].

There is a clear difference in efficiency here.

Self-assembling Reproduced from [17] buildings would still require machinery to bring together and “embed assembly information” into raw materials [9]. Yet, the References 1. Pearce, M. From Eastgate to CH2: building on the energy watershed; African Perspectives. 2007, Dec 7; Delft, Netherlands.

2. Western North Carolina Building Council (US). Why Green Building Is Important.

[Internet]. Ashville (NC). [Cited 2012, Sep 16].

3. Rosenthal M.(US). Electric Cars, Home Power And Heating Systems And Government Subsidies. Alternative Energy Tax Credits. [Internet] [Updated 2010; Cited 2012, Sep 16.]

4. Turner JS, Soar CR. Beyond biomimicry: What termites can tell us about realizing the living building. Proceedings of the First International Conference on Industrialized, Intelligent Construction; Loughborough University; 2008, May 14-16.

[Cited 2012, Sep 16.]

5. Baird G. Architectural Expression of Environmental Control Systems. London: Spon Press; 2001.

6. Fehrenbacher J. Green Building in Zimbabwe Modeled After Termite Mounds.

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step in which the parts form a whole and the building folds into its final shape would not require external machinery, allowing energy to be saved.

Tibbits and Pearce are biomimetic architects who share a greater connection.

They mimic one particular quality of nature in their work: its self-sufficiency, which can be observed in its ability to regulate itself, to respond to changes in the external environment, to assemble and to repair itself. In both cases, self-sufficiency functions as a pathway towards sustainability. This may be because natural ecosystems have evolved over billions of years, functioning as entities restricted by boundaries and finite resources, and capable of “regenerating raw material inputs and absorbing waste outputs” [1]. In other words, when an ecosystem acts as a self-sufficient whole, it practices sustainability. Following nature’s strategies could help us do the same.

Environmentalism is often opposed because it is viewed as a sacrifice: trading in the luxury of a gas-guzzling SUV for a smaller car that runs on ethanol. Pearce’s and Tibbits’s use of environmentalism, with its stress on efficiency, proves that this doesn’t have to be the case. “Green” products can be innovative, futuristic, desirable: two steps forward, instead of one step back. Another opposition is illustrated in Mitt Romney’s words: “President Obama promised to begin to slow the rise of the oceans and heal the planet. My promise is to help you and your family” [11]. This statement implies that preserving nature is somehow divorced from coping with human suffering. We should remember that natural resource depletion is real, and affects human beings and society, just as hunger, disease, and poverty do. Pearce’s vision for the future can be summarized as follows: “The building, no longer a machine for living in, has become the building, as a living system” [1] And this is a truly humanitarian dream.

Reproduced from [15]

Prathima Radhakrishnan is a third year student from the University of Chicago majoring in the biological sciences and biochemistry and minoring in creative writing.

Inhabitat [Internet] [Updated 2007, Nov 29.]

7.Biomimicry Institute. Termite Inspired Air Conditioning. [Cited 2012, Sep 16.]

8. Skylar Tibbits (US). Can We Make Things Make Themselves[Internet].TED- Ideas Worth Spreading. (US) [Updated 2011 Sep; Cited 2012 Sep 16.]

9. Ball P. Material witness: Material computation. Nature Materials. 2012 Apr; 11(362).

10. Ellis, R. J., and S. M. van der Vies. Molecular Chaperones. Annual Review of Biochemistry. 1991 July; 60: 321-47.

11. Hoft J (US). Mitt Romney: “Obama Promised to Slow the Rise of the Oceans & Heal the Planet… My Promise Is to Help You and Your Family”[Internet]. Gateway Pundit. [Updated 2012 Aug 30; Cited 2012 Nov 26].

12. http://en.wikipedia.org/wiki/File:Natural_ventilation_high-rise_buildings.svg 13. http://ehp.niehs.nih.gov/2013/01/121-a18/ 14. http://gaslighter.org/blog/a-glance-at-some-cool-electronic-gadgets/ 15. http://www.flickr.com/photos/93452909@N00/3491333666/

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Crowd and Cloud: A Powerful Approach to Innovation Kira Rienecker

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nsularity is hindering innovation. For example, NASA, a globally recognized force for problem solving and creativity, spent four years struggling to find an effective solution for forecasting havoc-wreaking solar events. The experts in solar events were unable to make headway, but within 90 days of opening the challenge to the public, a retired researcher and amateur ham radio operator had a solution that doubled the prediction lead-time and increased the accuracy of the prediction by 30% [1]. This solution did not arise purely by chance.

It was the website InnoCentive and its new solution strategy

In fact, 72.5% of winning solvers stated that their submissions were partially or fully based on previously developed solutions

which brought this innovative solution to light when NASA finally exhausted traditional methods. As we build our knowledge of the universe and increase our access to it through the Internet, the amount of information we encounter on a daily basis has exceeded our ability for individual understanding and interpretation.

Traditional innovation is clearly becoming more laborious. In his paper, “The Burden of Knowledge and the ‘Death of the Renaissance Man’: Is Innovation Getting Harder?”, Benjamin Jones points out that the enormous accumulation of knowledge over the course of human history creates inherent difficulties in learning, understanding, and synthesizing [2].

As exemplified by NASA, we are taking increasingly longer to gain the understanding necessary push the envelope of what we know.

As Dwayne Spradlin explained in his TED talk [1], Research and Development (R&D) companies formerly pushed the closed innovation model with a dogged zombie mentality. This strategy feverishly chucked time, energy, and money towards attempts to appease our hunger for innovation. Companies created the best facilities, stressed secrecy about potential leads, and hired the top experts in the field [1]. We essentially threw brains at “the situation” (aka the thought process of the aforementioned barreling zombie).

As these resources began to reach their limits (there are only so many brains lying around), the concern over preventing 42 THE TRIPLE HELIX Spring 2013 BROWN S13.indb 42

plagiarism and protecting discovery rights led to the development of secretive and segregated departments in industry and academia. That model is no longer working. We should be concerned with our mindless stagger towards obvious and ineffective solutions. The slowing rates of innovation and a rising price of research beg for our attention. For instance, the Congressional Budget Office found R&D spending in the pharmaceutical industry tripled between 1990 and 2005 [3].

A large part of the increase is due to the greater average costs of technological complexity in drug development [3].

Perhaps the closed model was useful for low hanging fruit, but we are reaching complexities that exceed the capabilities of this approach. Naturally developing trends responding to this roadblock include individual specialization and teamwork. These trends are greater in fields where knowledge is deeper as seen in the Jones figures [2]. His data shows that as specialization increases by about 6% per decade [2], team size is also increasing by about 17% per decade [2]. Individuals must be more specialized to understand the phenomenon, but this also means they have a narrower expertise. We now require larger and more diverse teams to provide the wide spread of information and perspective necessary to overcome barriers to innovation. By consciously recognizing how the new flow of information works, we can reengineer our society and ourselves such that we internalize these methods.

InnoCentive is spearheading this trend. In contrast to the closed innovation model of traditional R&D companies, the online company InnoCentive uses a model of open innovation that employs crowd sourcing through the Internet [1].

We need to naturalize crowd sourcing. This method poses a problem to a public forum through mediums like the Internet.

Generalists will facilitate the flow of information between disparate sources It uses the diversity and knowledge of the masses to generate creative solutions. The crowd sourcing model allows hundreds of thousands of minds to work on the same problem at the same time while being highly self-selective only those who have a viable idea are going to work on it [1]. This eliminates wasted time and forced creativity. Another appealing part of this strategy is the pay-for-success arrangement. This is especially attractive to companies and governments search© 2013, The Triple Helix, Inc. All rights reserved.

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Reproduced from [11]

ing for cost-effective solutions. Organizations only pay for solutions that meet their requirements. They do not pay for failure and therefore reduce the cost and time required to solve the problems.

The effectiveness of the open innovation model is astonishing. InnoCentive claims their website has helped solve 57% of challenges concerning theoretical or practical application since January 1, 2009 [4]. Why exactly were problem solvers outside the company successful where experts within were not? A Harvard study of InnoCentive constructed a clear picture of successful problem and solver profiles. Figure 1 from the Lakhani paper [5] plots probability of problem resolution against the number of diverse scientific interests of the solvers. It clearly shows that problems one-standard deviation above the mean in the number of scientific interests of the potential problem-solvers showed a 39% increase in their probability of resolution [5]. The more diverse the audience attempting the problem, the more likely it was to be solved.

Additionally, while heterogeneity was advantageous in the population of solvers, specialization was advantageous for individual solvers [5]. Problems with successful resolution were those that were able to attract specialists from many different fields. In fact, 72.5% of winning solvers stated that their submissions were partially or fully based on previously developed solutions [5]. The crowd sourcing strategy made connections between knowledge that already existed in order

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to stimulate innovation, rather than pouring enormous energy into reinventing solutions.

The history of science has shown innovative solutions to difficult scientific problems can arise by applying knowledge from one scientific discipline to another. A famous example is Charles Darwin’s application of Thomas Malthus’s paper on the economics of human population growth to evolutionary biology. Without Malthus’s insight into economics, Darwin would have had a much more difficult time in developing his theory of natural selection and survival of the fittest, a concept that revolutionized not only biology, but also our society and philosophy. Today, the key is asking the right people about potential parallels between fields by asking as many as possible through crowd sourcing. The “positive and significant” correlation of the distance between the problem field and the solver’s expertise indicates that broadcast searches recombine pre-existing knowledge in innovative ways [5], just as Darwin did.

We can also actively promote teamwork and facilitate specialization by encouraging innovators, data analysts, and researchers to take advantage of cloud computing. This tool allows individuals to temporarily and remotely use massive computer processing power to store and analyze massive amounts of data. For instance, Amazon’s Cloud Computing services reduced the cost of an experiment screening 21 million chemical compounds down from the in-house multi-year,

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PDF Compressor Pro UC DAVIS millions-of-dollars project it would have been to a three hour, up and emerge from the past isolation of disparate fields. $15,000 dollar solution [6]. Renting massive computing power Participate in crowd sourcing and share data! for a short time allows organizations, and even individuals, to The trends towards specialization seem bleak for generalists, process huge amounts of data quickly and cheaply, accelerating but they will actually be key participants in this new thought the process of scientific discovery. The reduction in the invest- process. Generalists will facilitate the flow of information bement that companies put into understanding their data also en- tween disparate sources. Large and diverse teams with great courages collaboration between creative potential will have enorresearchers. Cloud computing mous trouble communicating if makes it more profitable to share everyone has a narrow expertise.

Specialists have the important data than to maintain secrecy, Generalists are the bridges—they because the true benefit of the see the big picture because job of pushing the boundaries of will data now lies not in its analysis they do not focus too much on the knowledge forward but in creative and innovative details and therefore have time applications. to explore several fields. This is The combination of crowd a good strategy for finding the sourcing and cloud computing existing but unnoticed connecconstitutes a powerful approach to innovation. Using pro- tions that will lead to innovation. grams such as InnoCentive and services such as Amazon’s The key to our future innovation on all levels, from indiCloud Computing can help solve problems with little cost of vidual to corporate to national, is our ability to identify and time, energy, and resources: all precious commodities, espe- master the developing trends of individual specialization and cially for a national government. By applying this new model diverse collaboration. Without significant innovation in all fields, of innovation to government issues, we can create efficient spanning across academia and through business and governbudget allocation on broad and local levels. We will have bet- ment, we will become the incognizant society towards which ter organizational systems for bureaucracy and government we are moving. We will encounter an increasing number of programs as well as more effective R&D grants. We can attack problems we cannot solve. Our exploration of the universe will the important questions of health care and education. These grind to a halt as the creativity and curiosity that should define significant problems deserve an informed and strategized ap- us as humans starts to stagnate (zombie apocalypse!). Rather proach. The federal government spent more than $25 billion than continue in the paradigm of isolated innovation, we must on health-related R&D in 2005 [3]. Efficiency in innovation instead take advantage of our access to the globe by sharing our will make this investment cost effective. Adopting this new specialized knowledge and reaching out to very different fields. approach requires us to stimulate interdisciplinary research, We must find the connections that will help us rejuvenate our provide ways to connect experts from different fields, over- creativity and productivity. You can share your expertise with come funding and culture barriers, and improve open access the world and help solve problems outside your defined field. to information. If we are able to change our paradigm, our country will lead innovation with an energy and efficiency Kira Rienecker is a third year Genetics major in the College of not seen since the space race.

Biological Sciences and History major in the College of Letters and Besides spreading this new paradigm among companies, Sciences at the University of California, Davis. She works with academic centers and government, we need to internalize it the UCD integrated Agriculture, Medicine, Science, Technology, as individuals. Those who are naturally specialists have the Engineering and Math (iAMSTEM) Hub to improve the educational important job of pushing the boundaries of knowledge forward. tracks of STEM students and the university’s ability to provide We will always have new questions about the universe and meaningful and practical experiences. will need to collect new data for innovation. Specialists now also need to learn how to listen for information from other sources and be prepared to ask for or provide it. Try to open References 1. Innovating Our Way to the Future: Dwayne Spradlin at TEDxHelvetia. Perf.

Dwayne Spradlin. YouTube. YouTube, 27 Sept. 2012. Web. 28 Oct. 2012. <http://www. youtube.com/watch?v=iOOo-QTCzFU>.

2. Jones, Benjamin F. “The Burden of Knowledge and the ‘Death of the Renaissance Man’: Is Innovation Getting Harder?” The Review of Economic Studies 76.1 (2009): 283-317. Oxford Journals. Oxford Journals. Web. 28 Oct. 2012. <http://restud. oxfordjournals.org/content/76/1/283.abstract>.

3. “A CBO Study: Research and Development in the Pharmaceutical Industry.” The Congressional Budget Office, Oct. 2006. Web. 28 Oct. 2012. <http://www.cbo.gov/ sites/default/files/cbofiles/ftpdocs/76xx/doc7615/10-02-drugr-d.pdf>.

4. “InnoCentive.” Challenge & Solver Statistics. InnoCentive, 1 Oct. 2012. Web. 28 Oct. 2012. <http://www.innocentive.com/about-innocentive/facts-stats>.

5. Lakhani, Karim R., Lars B. Jeppesen, Peter A. Lohse, and Jill A. Panetta. “The Value of Openness in Scientific Problem Solving.” Harvard Business School, Oct. 2006.

Web. 28 Oct. 2012. <http://www.hbs.edu/research/pdf/07-050.pdf>.

6. Kaufman, Wendy. “Cloud Computing Saves Health Care Industry Time And Money.” All Things Considered. California, 1 Oct. 2012.

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NPR. NPR, 01 Oct. 2012. Web. 28 Oct. 2012. <http://www.npr.org/blogs/ alltechconsidered/2012/10/01/162080613/cloud-computing-saves-health-careindustry-time-and-money?sc=17>.

7. Lakhani, Karim R., Lars B. Jeppesen, Peter A. Lohse, and Jill A. Panetta. Figure 1: Marginal Impact of Increasing Intellectual Heterogeneity in Solver Base. Digital image. Hbs.edu. Harvard Business School, Oct. 2006. Web. 7 Jan. 2013. <http://www. hbs.edu/faculty/Publication%20Files/07-050.pdf>.

8. Jones, Benjamin F. Figure 1: Basic Time Trends. Digital image. Nber.org. National Bureau of Economic Research, May 2005. Web. 7 Jan. 2013. <http://www.nber.org/ papers/w11360.pdf?new_window=1>.

9. Effects of Solar Events. Digital image. Dailygalaxy.com. Daily Galaxy, n.d. Web. <http://www.dailygalaxy.com/photos/uncategorized/2007/03/21/earths_magnetic_ field.jpg>.

10. Charles Darwin. Digital image. Smithsonian.com. Smithsonian Magazine, Feb. 2009. Web. 7 Jan. 2013. <http://media.smithsonianmag.com/images/CharlesDarwin-1880-631.jpg>.

11. http://stargazers.gsfc.nasa.gov/resources/magnet_in_space.htm

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The Story of Dual Research: An Interplay Amongst Ethics, Biodefense, and Scientific Censorship Prashant Sharma “How and why is it that I do not describe my method for remaining underwater and how long I can remain there without coming up for air? I do not wish to divulge or publish this because of the evil nature of men, who might use it for murder on the sea-bed.”

—Leonardo Da Vinci [1]

I

n 1346, the Tartar army decimated the sieged city of Caffa by catapulting thousands of their own men who were infected by the plague over city walls [2]. This is just one incident of many throughout history when biological substances were used as tools for warfare. It was not until the beginning of the last decade when the specter of bioterrorism began to haunt the American people. With the anthrax attacks of 2001, in which letters laced with virulent anthrax were delivered to news media offices and the US Congress, the issue of bioterrorism was brought to the national and international stage. According to the BioResponse Report Card, “a single employee [of the U.S. Army] with no work experience in the weaponization of pathogens […] using equipment that could be readily purchased over the Internet, was able to produce very high-quality, dry-powdered anthrax” [3]. The Anthrax Attacks revealed the feasibility of terrorist groups to develop and employ biological weapons and served as the catalyst behind the massive effort of the United States to reform and intensify its bio-defense policies. In the spring of that year, the Defense Science Board report recognized that increased scientific knowledge has made it easier to produce bioweapons, concluding that “major impediments to the development of biological weapons […] have largely been eliminated in the last decade by the rapid spread of biotechnology” Reproduced from [1]

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[3].

The Anthrax Attacks highlighted the vulnerability of the United States toward bioterrorism and revealed alarming gaps within the country’s defense program. Consequently, the United States government allocated a significant amount of its resources towards the preparation and prevention of bioterrorism. The federal budget for biodefense programs vastly increased, and in the 2001-2013 fiscal years, a total of $71.83 billion was dedicated towards programs with specific and broad goals encompassing biodefense [4]. Furthermore, a multitude of policy reforms were made. Some notable initiatives include the Bioterrorism Risk Assessment initiative by the Department of Homeland Security [5], hijacking simulations at Biosafety Level 4 containment facilities by the Government Accountability Office [6], and the Pandemic and All Hazards Preparedness Act of 2011 [4]. Additionally, the United States invested in the research and development of various vaccines, and augmented the Strategic National Stockpile, increasing the number of available vaccinations by hundreds of millions of doses [3]. Using increased funding and policy reform, following the Anthrax Attacks, the United States made great strides in improving their bioterror preparation, response capabilities, and protocols for the identification and prevention of potential threats [7]. Through a decade long endeavor, it is clear that the US addressed many of their most urgent vulnerabilities.

However, many critics believe that that the US government may have overlooked some of their most striking weaknesses [3].

In recent years, media attention has focused on a variety of unresolved issues, particularly the issue of dual research, a term coined to describe sensitive scientific information which could be misused by malevolent individuals [5]. Increasing scientific advances have led to increased amounts of sensitive scientific information. This has led to many notable scientists and public policy officials to regard the issue of the open publication of scientific information as a major blind spot within our biodefense program. The publication of this type of sensitive scientific information has drawn a great deal of attention within the past decade. A notable example is a paper regarding mousepox that was published in 2000 by a team of Australian scientists: Expression of Mouse Interleukin-4 by a Recombinant Ectromelia Virus Suppresses Cytolytic Lymphocyte Responses and Overcomes Genetic Resistance to Mousepox [8].

Their research modified mousepox by inserting a spliced gene known as IL-4 in order to stimulate antibodies against mouse eggs [8]. While the hope was to regulate mouse populations, the researchers inadvertently disabled the immune system’s cell

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PDF Compressor Pro CORNELL mediated response, killing the entire population [8]. The genetic similarity between the mousepox and smallpox virus, a lethal virus which infects human, and the effect of IL-4 splicing led to widespread concern regarding the publishing of this paper [9].

This incident was one of the first to elucidate the importance of responsibly disseminating scientific information, and it brought to light the conflicting self-interests that could be at play. In modern times, publication has become increasingly crucial to the advancement of one’s career in the scientific field. Because individual scientists may have such large vested interests in the publication of their research, they alone should not be the ones to make deliberations. Many critics may argue that the numerous committees which deliberate upon prospective scientific articles provide sufficient and unbiased regulation.

With the increasing influx of dual research with such large implications, it stands to reason that that the burden of selfregulation should not be given to the scientific community alone, regardless of the self-interests involved.

Another event which further brought this dilemma to light was from 2002 when SUNY Stony Brook scientists published a paper detailing the synthesis of an infectious poliovirus: Chemical Synthesis of poliovirus cDNA: generation of infectious virus in the absence of natural template [10]. The scientists described how they were able to use genetic sequences to determine the procedure for generating an infectious polio virus using common laboratory methods along with commercially available chemicals and equipment [10]. This paper drew great concern due to speculation that anyone with access to the correct chemicals, laboratory equipment, and Internet access¬–in order to learn the genome of a virus and the pertinent lab methods–could generate a lethal human pathogen [9]. This example along with the previous one both suggested the potential harm that could come from dual research. However, this example was one of the first to explicitly show the applicability of dual research for malicious purposes. While there was widespread interest in this case and it exposed dual research as an unperceived hole in the biodefense program, the controversy that was generated did not lead to any significant policy changes regarding the scrutiny of scientific documents before they are published.

The most significant incident which further illuminated the need for policy reforms regarding the regulation of dual research was the publishing of two independent studies regarding the avian flu just within the last year. That incident was crucial in bringing the issue of dual research to the public sphere, and it portrayed the intrinsic risk that is not being challenged by the current biodefense polices [9]. These studies, conducted at the University of Wisconsin-Madison in the United States and the Erasmus Medical Center in the Netherlands, have garnered international notoriety. Both studies conducted research on the mammalian transmissibility of the, H5N1, avian flu as a result of genetic manipulation [9]. The studies were able to determine the precise mutations that were necessary to make the avian flu transmissible in ferrets through respiratory droplets [10]. While these studies were under review for publication, risk assessments carried out by notable agencies, such as the U.S. National Science Advisory Board for Biosecurity (NSABB), were very critical of potential

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risks of publishing the results [11]. In a statement, published in Nature, the NSABB strongly recommended the censorship of the particular methods that were used as well as the specificity of the results. Their recommendation, along with other appeals by scientists and individuals of public policy, caused a great deal of alarm [12]. In response, the primary scientists of the

...the burden of selfregulation should not be given to the scientific community alone, regardless of the self-interests involved studies along with many other researchers across the world decided to momentarily suspend their research, some up to multiple months, to allow policy makers ample time to deliberate before continuing with their work [13].

While many scientists believed that the results would be instrumental in bolstering efforts to develop methods of prediction, prevention, and treatment, a great deal of uproar was generated regarding the possible contribution that disseminating these results could provide for terrorist efforts to weaponize influenza. Over the following months, a great deal of controversy was generated regarding possible solutions to this issue. There were two major sides to the argument. In the first side, many individuals argued that sensitive scientific information should be censored due to its risk to national security and public health. They believed that that potential danger that could result from the misuse of the information was too great. These individuals called for the regulation of the open publication of scientific results and the censorship, as necessary, of sensitive information. Spurred by estimates that outbreaks could kill between 20 to 150 million worldwide, there was a great deal of support for governmental censorship [14]. The second side of the argument believed that censorship would undermine the scientific process, decrease the attractiveness of doing research in areas that could have the greatest impact for humanity, and slow down collaborative efforts between different scientists. Many of these individuals argued that terrorists did not have the adequate ability to utilize this knowledge, and that the chances were too low that they would be capable of weaponizing influenza. Scientists argued that other susceptible countries could benefit from the information of the study and learn how to fight the disease which had killed nearly 60 percent of the 600 known people who had been infected since 2003 [15].

In February, the World Health Organization recommended that the studies be published, stating that they would be crucial for continued research on vaccinations and other areas of prevention. The fact that the virus was naturally evolving in nature, and that it would one day be necessary to be prepared to combat spurred a great deal of support. In April, the National Institutes of Health agreed to the potential benefits as outweighing the immediate risks. After almost

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PDF Compressor Pro CORNELL half a year of debate, the studies were published on June 21st of 2012. That incident was important in indicating that the government cannot, by itself, successfully regulate dual research. Governmental intervention led to an appalling 2 month standstill in scientific research. The debate and controversy that ensued for months was an utter mess and it perpetuated a great deal of antagonism between scientists and policy makers and pitted biodefense interests against world health ones.

Although this instance put research at a standstill for several months and undoubtedly led to substantial financial losses, it did eventually lead to the paper being published. While many may perceive this as a triumph of cooperation between scientists and policy makers, and a sign of progress, , in lieu of the fact that no long-term system was established to deal with future arbitration when another controversial paper comes about, it is more compelling to characterize it as just another failure. Ultimately, this instance brought to light, that moving forward a long term system to address the lingering problem of dual research has now become crucial.

While science has been considered one of the noblest pursuits to better humanity, advances in science have led to information that could be used for harm. The 20th century revolution in atomic physics came with great possibilities to better and devastate mankind. . Innovations in biomedical science have led to vast improvements, and the publishing of these discoveries have been necessary, but they have also opened the doors for terrorists to cause harm. Since the Cold War, nuclear policies monitoring and restricting the nuclear capabilities of other countries have been fiercely and successfully advocated. However, few policies preventing terrorists from gaining the knowledge or capability to produce biological weapons have been approved. There is certainly a great deal of criticism regarding the current philosophy of the biodefense program which does not directly acknowledge this as a problem.

Such debates appear to only be growing the divide between scientists and national security. While the American biodefense program has taken great strides, it is evident that efforts to make further improvements have hit a roadblock.

Through increased media exposure and widespread attention before and after the publishing of the H5N1 studies, the issue of “dual research” censorship has continued to become References 1. White, M.. Leonardo: The First Scientist. 1st ed. London. Abacus; 2000 p206 2. Chen, S. & Zeng, M. . Anthrax Bioterrorism and Current Vaccines.Bioterrorism & Defense.2012;S4(3):1-5 3. Glassman, J.. We’re Letting Our Bioterrorism Defenses Down. http://www.forbes. com/sites/jamesglassman/2012/04/04/were-letting-our-bioterrorism-defenses-down/ (accessed October 11, 2012).

4.Franco, C. & Sell, T. K. . Federal Agency Biodefense Funding, FY2012FY2013. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science.2012;10(2):162-181 5. Committee on a New Government-University Partnership for Science and Security, National Research Council. Science and Security in a Post 9/11 World: A Report Based on Regional Discussions Between the Science and Security Communities . 1st ed. Washington, D. C.. The National Academic Press; 2007 6. Heyman, D.. Lessons from the Anthrax Attacks Implications for US. Bioterrorism Preparedness A Report on a National Forum on Biodefense. http://biotech.law.lsu. edu/blaw/anthrax/dtra02.pdf (accessed October 11, 2012).

7. Graham, B. . World At Risk The Report of the Commission on the Prevention of WMD Proliferation and Terrorism. 1st ed. New York City, NY. Vintage Books; 2008Jackson, Ronald 8. Alistair, J., Ramsay, J., Carina, D., Christensen, S. B., Hall, D. F., Ramshaw, I. A..

Expression of Mouse Interleukin-4 by a Recombinant Ectromelia Virus Supresses

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increasingly relevant in both the scientific and political spheres.

Although the H5N1 has been just one of many important incidents, it stands in stark contrast to its many counterparts due to the gravity of its context, perhaps having the greatest potential for a world-wide epidemic, and the widespread awareness of its importance within the scientific, political, and general community. Although it is clear that the H5N1 incident did not elicit as great of an immediate response as the Anthrax attacks did, it was still able to garner international attention towards the issue of scientific censorship and served an integral role in elucidating the potential magnitude of the problem at hand. It may have not caused specific policy changes within the US biodefense program, but it was an essential incident that has instigated widespread concern for this issue.

In incidents, such as the H5N1 incident, regarding dual research, the problems with finding an appropriate solution have come to light. Censorship poses a great threat to the philosophy of science and the freedom of expression, while the open dissemination of sensitive scientific information could have potentially catastrophic consequences. From previous examples, it has become clear that relying on scientists or editors for voluntary self-regulation is unacceptable; however, the government alone cannot either be trusted to manage these competing interests. Moving forward, it has become apparent that uniting the collective efforts of the intelligence and scientific communities will be critical to national security, and only through a future collaborative effort between these two groups will we be able to truly minimize the challenges posed by the proliferation of biological research and growing terrorist interest in biological weapons. In order to continue crucial research in the biological sciences and to continue augmentation of the United States biodefense program, responsible methods for the dissemination of knowledge must be created, and it is clear that it will require the equal communication and collaboration between the scientists and national security.

Prashant is a second year student double majoring in Biology and Chemistry at Cornell University.

Cytolytic Lymphocyte Responses and Overcomes Genetic Resistance to Mousepox.

Journal of Virology.2001;75(3):1205-1210 9. Selgelid, M. J. . A Tale Of Two Studies: Ethics, Bioterrorism, and the Censorship of Science. Hastings Center Report.2007;e.g. 32(May-June):35-43 10. Cello, J.. Aniko, V. P., and Wimmer, E.. Chemical synthesis of poliovirus cDNA: generation of infectious virus in the absence of natural template. .

Science.2002;297():1016-1018 11. Nature Publishing Group. Publishing risky research: Imperfect global biosafety standard and a threat to researchers’ motivations from biosecurity concerns are among the significant risks in current flu research. Nature.2012;485(5):5.

12. Enserink, M. . Infectious diseases. Controversial studies give a deadly flu virus wings. Science.2011;334:1192-1193 13. Fouchier, R. A. M., Garcia-Sastre, A., Kawaoka, Y. . Pause on avian flu transmission studies. Nature.2012;481():443 14. Vergano, D.. Has bird flu biology opened bioterror box. http://usatoday30. usatoday.com/tech/science/story/2012-01-25/bird-flu-human/52794524/1 (accessed October 11, 2012).

15. Schorow, S.. Fears of bioterrorism or an accidental release. http://news.harvard. edu/gazette/story/2012/02/fears-of-bioterrorism-or-an-accidental-release/ (accessed October 11, 2012).

16. http://oba.od.nih.gov/oba/biosecurity/documents/B_Dual_Use_Educational_ Module_FINAL.pdf

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