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Peter French

Lincoln Chair in Ethics

www.LincolnCenter.asu.edu

Braden R. Allenby

Lincoln Professor of Ethics and Engineering

Robert B. Denhardt Lincoln Professor of Ethics in Leadership

Joseph R. Herkert

Lincoln Professor of Ethics and Technology

Masters/Graduate Program In Applied Ethics and the Professions

Five Concentrations: • Ethics and Emerging Technologies • Leadership, Management, and Ethics • Sustainability and Environmental Ethics • Pastoral Care Ethics and Spirituality (pending approval) • Biomedical Ethics

Beginning Fall 2009

Lincoln Professor of Ethics and Religion

Gary E. Marchant

Barrett/Lincoln Professor Lincoln Professor Ethics, Law and Emerging Technologies

Announcing the Upcoming

Martin Beck Matustik Jason Scott Robert

Ted Humphrey

For more details visit www.LincolnCenter.asu.edu

Caroline Turner

F. Miguel Valenti

Margaret Urban Walker

Lincoln Professor of Lincoln Professor of Lincoln Professor of Lincoln Professor of Ethics Ethics in Biotechnology Ethics and Education Ethics and the Arts and Medicine The Triple Helix would like to thank the Lincoln Professors for mentoring several of this issue’s writers and for helping the Triple Helix reach new levels of academic achievement!

EXECUTIVE MANAGEMENT TEAM Chief Executive Officer Manisha Bhattacharya Executive Editor-in-Chief Nicky Chopra Executive Production Editors Bradley French, Kaitlyn Mitchell, Kim-Yen Nguyen Chief Operating Officer, North America Daniel Choi Chief Operating Officer, Europe James Shepherd Chief Operating Officer, Asia Kevin Pye Phyo Nay Yaung Chief Technical Officers Travis Portz Executive Director of Science Policy Julia Piper Executive Director, Business Development Anshul Parulkar Executive Director, Chapter Operations James Lin INTERNATIONAL BUSINESS DIVISION Executive Director, Marketing Soniya Tambe Director of Corporate Relations and Subscriptions Vivian Jiang Marketing Associates Rebecca Kauffman, Anjali Mennon Corporate Relations Associates Daniel Choi, Kevin Pointdexter, Jennifer Yang REGIONAL EXECUTIVE STAFF: Asia Zarir Ashraf Chowdhury, Thet Lin Thu GLOBAL LITERARY & PRODUCTION Senior Literary Editors Bharat Kilaru, Nikhita Parandekar, Mira Patel, Patty Satkiewicz, Ruchira Srinivasakrishnan, Lena Wang Managing Production Editors Caroline Srisarajivakul, Vivian Cheng, Yang Zhang

Production Editors Albert Chen, Luna Chen, Chu Hsiao, Andrew Johnston, Rahul Kishore, Jessica Lee, Angela Liu, Chikaokili Okaneme, Xin Peng, Tammy Su, Alexandria Sun, Neiman Tan, Randy Wan, Dan Yang BOARD OF DIRECTORS Chairman Kevin Hwang Vice Chairman Erwin Wang Secretary Melissa Matarese Alumni Chair Joel Gabre Finance Chair Kalil Abdullah TRIPLE HELIX CHAPTERS North America Chapters Arizona State University Brown University Carnegie Mellon University Cornell University Georgetown University Harvard University John Hopkins University Northwestern University University of California, Berkeley University of California, San Diego University of Chicago University of North Carolina, Chapel Hill University of Pennsylvania Yale University Europe Chapters Cambridge University London School of Economics Oxford University University College London Asia Chapters National University of Singapore Australia Chapters University of Melbourne

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!

INSIDE TTH

Cover Article 6-7

Debunkning the “Mozart Effect”: The Difference Between Listening to and Making Music

Sarah Benjamin, CMU

Arizona State University Articles 8-10

The Misuse of Science in Drug Policy

Scott Barraza, ASU

11-12

U.S. Energy Independence

Christopher Jackson, ASU

13-14

Towards the Synthetic Nanofactory

Eric Alonas, ASU

15-17 The Science of Good Writing

David Edwards, ASU

18-19 GPS, Privacy Rights, and the Development of the Law

Kara Davis, ASU

20-22

Diagnosing the Geno-hype

Ellen Dupont, ASU

23-24

Countering the Physician Brain Drain in South Africa

Shifat Ahmed, ASU

25-26

Enhancement for Health versus Vanity in Human Genetic Engineering

Amanda Waddell, ASU

International Features 27-28 Avastin: Questionable Hope During Desperate Times 29-30 Nose Job: A Work in Perfection

Jane Yang, Cornell Jack Cossman & Quynh-Giao Nguyen, Brown

31-33

Urban Agriculture: Farming of the Future

Sonia Singhal, Yale

34-36

The Large Hadron Collider: Politics, Pride, and Priorities in Particle Physics

Jonathan Yeh, Yale

37-38

Does Biology Control Your Decisions?

Stephanie Guerra, CMU

39-40

From Sugar Pills to Sedatives: The Ethics of Placebo Treatment

Kara Christensen, UChicago

World image: http://wits.nctc.gov/images/wits-world_poli.gif Cover design courtesy of Bradley French, TTH Central Production

3 THE TRIPLE HELIX Spring 2009

INSIDE TTH

Message from the Chapter President Dear Reader, Change is constant in our lives. Today’s innovations and knowledge advancements are creating solutions to yesterday’s problems and needs. These solutions create evolutionary changes that ripple through societies, cultures, and intellects. People are constantly adapting to new information and knowledge as it is produced and transmitted throughout the world. New frontiers in innovation and knowledge bring new challenges, problems, and opportunities that can strain or improve our lives. The past decade has produced new communication channels, and rising generations are growing up on the internet. I invite you to think about the ways that science and innovation has changed the way that you experience life today.

STAFF AT ARIZONA STATE President Brenden Saline Editor-in-Chief Owen Marshall Managing Editor Adam Gunderson Executive Editors Shifat Ahmed Eric Anderson Public Relations Director Amanda Chan

The Science in Society Review provides a forum for perspectives and introspection on the interactive relations between science, society, law, business, and ethics. Our writers from Arizona State University (ASU), along with contributors from around the globe, discuss current issues at the cusp of present and future evolutionary change. We are excited for you to discover the issues that your global peers feel are important and are changing life as we live it today. You along with our contributors are shaping the future of our world. We are grateful for the support of our sponsors, and we owe a special thanks to all of the professors that served as mentors to our ASU writers for this issue. Thank you for your time and expertise that you have so freely shared. Brenden Saline President The Triple Helix at Arizona State University

Director of Science Policy Ben Lowenstein

Chapter News:

Director of Operations Shirlene Yee Associate Editors Eric Anderson David Reynolds Brendan Mulligan Shirlene Yee Contributing Writers Shifat Ahmed Ellen Dupont Kara Davis Amanda Waddell Christopher Jackson David Edwards Scott Barraza Eric Alonas

A Message from The Triple Helix at Arizona State University As The Triple Helix at ASU continues to promote the discussion of science and society, we are always looking for new faces. If you are interested in contributing, whether by writing an article for publication in our journal, or by working on our editing staff, we invite you to join us. For more information visit our website at www.asu.thetriplehelix.org or email us at info@asutriplehelix.org.

THE TRIPLE HELIX Spring 2009

INSIDE TTH The time has come to usher in a new generation of TTH leaders. It is with great pleasure that I would like to announce that Julia Piper, our current Executive Director of Science Policy, is succeeding me as the Chief Executive Officer of The Triple Helix Inc. I have full confidence that she will be able to take TTH to even higher levels of excellence, and lead us in new directions as we strive to be a truly global forum for science in society. To our members—I wish all of you the best in your TTH careers and beyond. To our audience at large— I hope you will continue to follow TTH as readers and as participants in our campus and community initiatives. Your involvement is what keeps our organization focused, relevant, and cutting-edge. Thank you once more for making my journey with TTH so spectacular and fulfilling. Sincerely, Manisha Bhattacharya Outgoing CEO, The Triple Helix Inc.

Message from the CEO Dear Reader, This is a time of change. National leadership, economic approaches, scientific advancements are all changing at locations around the globe. The Triple Helix is no different. Our broad mission and international presence offer a variety of directions for future initiatives, and before we move forward, it is important to confidently frame our vision by taking a moment to reexamine the mission and meaning of a “triple helix.” The first triple helix was introduced to the world not in 2004 but in 1953, as Linus Pauling’s suggested model for the structure of DNA. It was a complete and utter failure. To add to Pauling’s embarrassment, the fundamental chemical error that lead to his loss of the Nobel Prize was discovered using a college textbook, General Chemistry, which Pauling himself had famously authored. At first glance, this seems a poor story to represent one of the 20th century’s most brilliant scientists or to inspire a young, enterprising organization. However, Pauling’s interdisciplinary research career and passionate social engagement allowed him to succeed as few scientists of citizens ever do, earning him two Nobel Prizes in the process. The story of his triple helix’s failure is crucial in reminding us that not only even Pauling occasionally failed, and fail in a profound and public manner, but that he pushed forward. At the core of TTH’s mission is a desire to span fields, push boundaries, tackle scientific puzzles and social problems, forge new ways of thinking, and expand the horizons of analysis. These are crucial, difficult challenges, and, like Pauling, sometimes we fail. But, even if not every article we write or event we host or initiative we undertake succeeds as we imagine it may, we still push forward. This is a time of change. Manisha Bhattacharya and TTH leadership around the world have transformed what began five years ago as a regular local journal into a truly global forum for science in society. Pauling was a force of change in his time and we have the potential to be so in ours. With the launch of our Electronic Publishing Division, our International Division of Science Policy, and our Career Development Resources, there are even more exciting days ahead. I hope you will join us as readers, members, and supporters as we continue, in the face of changes and challenges, to expand, to move, to push forward. Sincerely, Julia Piper Incoming CEO, The Triple Helix, Inc.

5 THE TRIPLE HELIX Spring 2009

CMU

Debunking the “Mozart Effect”: The Difference Between Listening To and Making Music Sarah Benjamin

n 1994, a New York Times reporter Alex Ross, was researching Ross’ article, there is some truth behind the music and brain for his latest article, about the use of Wolfgang Amadeus connection that the “Mozart effect” phenomenon implies. Since Mozart’s music in studying the connection between music the New York Times article was published, scientists have, to and the brain. When the story was finally published, one line some degree, replicated the study, and found possible causes stood out: “researchers at the Center for the Neurobiology of for its results. Most importantly, though the “Mozart effect” Learning and Memory at the Unimight not create the long term benefits versity of California, Irvine, have implied by Ross, these studies relating determined that listening to Mozart music to the brain have allowed for actually makes you smarter [1].” the discernment of a sort of “pseudo This one line caused such a Mozart effect” in younger children. In sensation that it has warranted its these studies researchers discovered that, own name, the “Mozart effect,” although children did not necessarily whereby listening to Mozart’s become smarter from listening to Momusic, rather than to any other zart, younger children do experience a genre or classical composer, is long term increase in spatial intelligence believed to result in an increase through involvement in music lessons. in a person’s IQ. [3] Though the “Mozart effect” is both But can we really make ourappealing, and false, because it suggests selves smarter simply by turning the that someone only has to listen to Moradio dial from ACDC to Mozart? zart’s music to become permanently The answer, unfortunately, is no. smarter, it also leads us to those much The study Ross was referring to, desired results. Only instead of merely “Music and Spatial Task Perforsitting back and listening, we have to mance” (Rauscher, Shaw, and Ky actively participate. 1993), was based only on results So what might be a cause of the from college undergraduates who so-called “Mozart effect”? One of the were given intelligence tests after theories proposed by Rauscher in relistening to either Mozart, relaxation sponse to the original study was that tapes, or nothing. The problem with Mozart’s complex style of music someReproduced from [6] that study, notwithstanding the limhow “warmed up” the neurotransmitited variety of its tests subjects, was ters in the brain that influence spatial that the results only lasted 10 to 15 reasoning, our ability to perceive and minutes. [2] Instead of permanently interpret patterns [2]. Another possibility But can we really make increasing the subjects’ intelligence, proposed is that the “Mozart effect” is ourselves smarter simply by no more than a representation of the the intelligence tests given to the subjects only showed increased fact that all of Rauscher’s tests subjects turning the radio dial from results for a short period of time, enjoyed Mozart’s music more than they AC/DC to Mozart? before returning to the same results enjoyed the relaxation tapes or silence. as before their exposure to Mozart’s When people are happy, such as when music. The study also only proved they are listening to something they enan impact between Mozart’s music joy, they tend to perform better on tests, and spatial intelligence – intelligence that pertains to under- though this theory does not fully explain why spatial intelligence standing patterns, visualization of figures, and comprehension would be affected more so than general intelligence. One study, of sequences over time. [2] In other words, not only did the “The Mozart Effect: An Artifact of Preference” (Nantais and effects last a very short amount of time but they did not affect Schellenberg 1999), was designed to test this hypothesis, by the general intelligence; there was no basis in that study for exposing the tests subjects to the music of Mozart, the music of such a generalized statement as the one Alex Ross made. Schubert (another classical composer), and a narrated Stephen King novel. The results showed that people who preferred what Despite the misguided public perception that arose from they were listening to, as opposed to the other options,

THE TRIPLE HELIX Spring 2009

CMU experienced an equal increase in performance on intelligence tests no matter which of the three options they were listening to. People who preferred Stephen King over classical music showed a similar temporary increase in spatial intelligence, while they were listening to the narrated King novel, to Rauscher’s test subjects. [4] In other words, the “Mozart effect” seems to be no more than the fact that when people are in a good mood, such as while listening to something enjoyable, they perform better on tests overall, including intelligence tests. Now that we know how the “Mozart effect” came about, what about the previously mentioned success of music lessons? Even though merely listening to music is no way to make yourself smarter, there is another kind of “pseudo Mozart effect” that has come to light because of the research designed to prove the phenomena fake. Along with listening to music, scientists also studied the influence of involvement in music lessons,

So though adults and children alike can’t become smarter simply from turning on the radio, there is something to be said about involving children in music from an early age. However, because of the misperception of the Mozart Effect, some political policies on musical education in school have failed to monopolize on the discoveries made concerning the “pseudo Mozart effect.” Most notably, in 1998, Georgia governor Zell Miller proposed a program to give every child in Georgia a tape or CD of classical music to encourage children to listen more to classical music and receive, what he thought would be, a long term increase in spatial intelligence. In response to his decision, Frances Rauscher, one of the scientists of the original Mozart effect study, recommended that parents spend their money on music lessons rather than CDs, if they really wished their children to receive a long term benefit, in line with her findings [5].

In other words, the “Mozart effect” seems to be no more than the fact that when people are in a good mood, such as while listening to something enjoyable, they perform better on tests overall, including intelligence tests. Reproduced from [7] and [8]

especially on children. The discoveries here have been much more substantial and consistent than the original Mozart effect. The results have been the discovery very young children (about 4 to 7 years old) do receive a long term benefit from music lessons – a slight increase in not just spatial, but general intelligence [3]. Why does this occur? And why does it just occur in young children? The two are interconnected. Firstly, music lessons are similar to school lessons, and so, by way of their commitments to academics and music, the children become more studious, allowing them to increase their intelligence more so than child who only attends school [3]. Secondly, music lessons increase the children’s skills in memorization, concentration, and attention, all of which in turn improve test performance. Finally, there is the additional theory that since musical tunes are abstract patterns that must be listened to instead of observed, when children understand them they also better understand patterns more generally (which we know is part of spatial intelligence).

In reality, the Mozart effect, whether short or long term, is no quick route towards higher intelligence. There are academically excellent students who both have and haven’t been involved in musical programs from a young age. Yet there is something to be said for those who commit to learning an instrument or participate in choir. They receive the benefit of being committed to an activity that not only requires attention, memorization, and motor skills, but also performance skills and rhythm comprehension. Is it a surprise then that those children involved in such from an early age go on to be more successful in the other areas of their life than other children? Learning to make music requires commitment to bettering all of our skill sets, allowing us to better ourselves while enjoying the music we are creating. The “psuedo Mozart effect” is simply an additional bonus.

References:

Psychological Science 1999; 10(4); 370-373 [5] Goode, Erica. Mozart For Baby? Some Say, Maybe Not. The New York Times 1999 Aug 3; Sect. F:1 [6] http://memory.loc.gov/service/pnp/cph/3b30000/3b33000/3b33700/3b33705r.jpg [7] http://www.csm.ornl.gov/SC99/brain.jpg [8] http://lcweb2.loc.gov/diglib/ihas/html/greatconversations/images/mozart-sonata. jpg

[1] Ross, Alex. Listening to Prozac…Er, Mozart. The New York Times 1994 Aug 28; Classical View [2] Rauscher FH, Shaw GL, Ky KN. Music and spatial task performance. Nature 1993 Oct 14;365 (6447):611. [3] Schellenberg EG. Music and cognitive abilities. Current Directions in Psychological Science 2006 Feb 2; 14(6); 317-320 [4] Nantais KM, Schellenberg EG. The Mozart effect: an artifact of preference.

7 THE TRIPLE HELIX Spring 2009

Sarah Benjamin is an undergraduate at Carnegie Mellon University

ARIZONA STATE

The Misuse of Science in Drug Policy Scott Barraza

r u g s h a ve b e e n a c o n t e n t i o u s i s s u e s i n c e humanity’s first use of them. Some of the earliest documentation of this is seen in the Bible, which warns against the effects of ethanol, the chief drug in alcoholic beverages. Now it seems that the number of debates has exploded exponentially, with the most popular fights being over performance enhancers and marijuana use. While the data in these cases is often incomplete, little-known controversies have arisen over two drugs – Plan B and buprenorphine – in which the available science is robust.

Act of 1951 clearly states that all medicines that are not “dangerous, addictive, or complex to use” should be attainable over-the-counter. [9,15] Plan B fits these parameters snugly. [9] The safety evidence accumulated by the joint committee could be summed up into several major points: the drug is nontoxic and safer than most over-the-counter medications; it has no effect on an already pregnant woman or her fetus; it is easy to use and administer; and no deaths, suicides, or serious incidents have occurred as a result of overdose. [3,9] The contentions of the anti-emergency contraceptive Plan B advocates do have some People who could once On December 16, 2003, a ground, though they generally obtain the drug from their m e e t i n g wa s c o n d u c t e d b y constitute the minority of the Nonprescription Drugs mainstream scientific literature. doctor would suddenly find Advisory Committee (NDAC) in Dr. David Hager, an advisor themselves in a stigmatized a joint session with the Advisory on the ACRHD panel, claimed Committee for Reproductive that there was a distinct lack treatment center. Health Drugs (ACRHD). [9,15] of information about the effect NDAC and ACRHD, both of Plan B on adolescents, and advisory panels for the United he had a point. [15] After States Food and Drug Administration (FDA), were stocked considering this for some time, the majority of the two with pharmacists, physicians, and scientists in order to committees’ members felt that age was not an issue, citing expertly guide the FDA’s Center for Drug Evaluation physiological reasons; Plan B should act on a young girl and Research on the topic of Plan B, an emergency the same as it would on an adult woman due to the high contraceptive available through prescription since July of degree of similarity between their sexual biology. [15] 1999. [9,15] The final vote: 23 to 4. The conclusion: Plan B Dr. Leslie Clapp, of the NDAC panel, pointed out that should be available over-the-counter. [9,15] “morbidity and mortality associated with teen pregnancies In a single stunning, unprecedented move in May is quite high,” [15] and blocking the availability of the of 2004, the Food and Drug Administration overruled drug would only exacerbate this. [3,15] the findings of its advisory committee, citing a lack of For the most part, scientific information is not information on Plan B’s safety. [9] Interestingly, the joint lacking on Plan B. However, long-term studies have not session actually found that there was more than enough yet come to fruition, and demographic information is evidence proving the safety of Plan B [9]; one committee only slowly developing that could increase the beneficial member even went so far as to declare that it was the use of the drug. [1,8,11] For proponents of emergency “safest product that we have seen brought before us.” contraceptives, they will be pleased to know that the [15] What happened? drug is available over the counter now due to pressure Plan B is an emergency oral contraceptive; in other generated in part by women’s rights organizations. words, it is meant to be used to prevent pregnancy within 72 hours of unprotected sexual intercourse. [1,7,9] The Buprenorphine regimen is simple, utilizing two pills taken 12 hours apart. Few compounds have been found to be as clinically useful The sole active ingredient is the drug levonorgestrel, in the treatment of opioid addiction as buprenorphine. which is essentially a synthetic progesterone that mostly Because it is structurally and functionally similar to acts by preventing ovulation. [2,7] Without ovulation, morphine, it can be called a “narcotic” or “opiate.” [2] It there can be no fetus, and because Plan B acts before is sold by several pharmaceutical manufacturers under a pregnancy, its use is not considered an act of abortion. variety of names. For several decades it has been available The FDA’s Durham-Humphrey Drug Amendment for use in analgesia, and beginning in 1996, was approved

THE TRIPLE HELIX Spring 2009

ARIZONA STATE

for its current role in the treatment of opioid addiction. [4] Buprenorphine may be a narcotic, but it has properties distinctly different from that of morphine and similar opiates. It is 25 to 40 times more potent as an analgesic than narcotics (like morphine, codeine, Vicodin, or Oxycodone) which means that far less buprenorphine is necessary to illicit the same effects. [7,17] These effects include analgesia and euphoria – an important factor in addiction. They make people feel good. Likewise, buprenorphine feels good too – to a point. [17] After a certain large amount, the more buprenorphine someone uses, typically the worse they should feel. [7,17] Narcotics tend to have a negative side-effect that only worsens with increasing dose: respiratory depression. At high doses, people’s breathing slows and may stop altogether (respiratory arrest.) The risk of respiratory depression with buprenorphine is significantly removed because buprenorphine acts partially to prevent it. [7] In terms of withdrawal, buprenorphine tends to have symptoms similar to but much less serious than morphine and other narcotics. [7] Therefore, it has a remarkably lower abuse potential, which means that it is also more

9 THE TRIPLE HELIX Spring 2009

difficult to overdose on. In contrast, other opioidaddiction treatments, like methadone and fentanyl, are highly addictive and the mortality associated with these can be quite high. [17] This is especially grave because these medicines are meant to treat people already addicted to opiates and who may require higher doses to achieve their high. [4] Drugs can be organized into “schedules” according to several attributes, summarized in Table 1. The schedules, and their criteria, are defined in the United States’ Controlled Substances Act and (with some differences) in the United Nations’ Psychotropic Substance Convention. In the face of heavy scientific opposition, recent attempts have been made to reclassify buprenorphine (a Schedule III since 1989) as a Schedule II drug in the United States and abroad. [4-6] The rescheduling of a drug is of no minor consequence, since the higher up the scale it goes, the less available it becomes. [4] Many countries abide by the international laws set forth by the 1961 Single Convention on Narcotic Drugs and the 1971 Psychotropic Substance Convention, so signatory countries would be forced to comply should the United Nations change buprenorphine’s status. [4,12,13] Throughout the world, the abundance of buprenorphine can be attributed to its existence as a Schedule III drug, which makes it far more available than other opioidaddiction treatments such as methadone and fentanyl (both schedule II) that can be used only in specialized care centers. [4,5] This large presence over the past several decades has resulted in a large repertoire of scientific information. Studies in France concluded that buprenorphine can be credited with significantly reducing heroine overdose mortality, since 90% of opioid replacement therapy in that country is done with the drug. [4] By contrast, mortality associated with methadone, another opioid-addiction treatment, was substantially higher. Overall, the French documented a “dramatic, positive impact” [4] as a result of buprenorphine’s high availability. Many other studies support the notion that the benefits of buprenorphine vastly outweigh the risks. [5,10,17] Should buprenorphine be rescheduled, its availability would decrease because the laws governing Schedule II substances are far more stringent than Schedule III. [4,12,13,16] People who could once obtain the drug from their doctor would suddenly find themselves in a stigmatized treatment center. [4,5] Developing nations that lack the infrastructure to accommodate the new regulations would find themselves without any significant drug therapy; India, with a high number of heroine addicts, would be without any sort treatment at all. [4] Heroine-related mortality would probably increase considerably, as would the prevalence of diseases like HIV. [4] Opponents or buprenorphine cite its prevalence as a street drug, called “poor man’s heroin,” in countries like

ARIZONA STATE Finland, Scotland, and Spain. [6] Purportedly, it has even become a cheap alternative to heroin in India. [6] Whether this is because of the drug’s availability or as a result of poor medicinal regulations is still unknown (in Norway, patients were getting away with multiple prescriptions.) [6] Still, one study in the United States has shown that abuse is extremely low even in places where the potential is quite high. [10] For the time being, buprenorphine continues to exist as a Schedule III drug. What should be done about all of this? Unfortunately, that can only be answered by personal convictions. In the

ARIZONA STATE

case of Plan B, the issue is one of science versus morality. Scientifically, the answer is very clear, but the answer is morally complicated since no one can agree on what constitutes rightfulness. What is right? What is moral? If anything, hopefully the precedent of Plan B will serve as a reminder to those planning the future policies of buprenorphine. Ultimately, the controversies over these two drugs should show one thing: strong science should not be ignored. Scott Barraza is a student at Arizona State University.

Table 1. Requirements for drug classification in the Controlled Substances Act [13,16]

References:

[1] ACOG Practice Bulletin. “Emergency Oral Contraception.” International Journal of Gynecology and Obstetrics. 78 (2002): 191-98. [2] Block, John H., and Beale M. John, eds. Organic Medicinal and Pharmaceutical Chemistry. 11th ed. USA: Lippincott Williams and Wilkins, 2004. [3] Committee on Adolescence. “Emergency Contraception.” Pediatrics. 116 (2004): 1026-035. [4] Costa e Silva, J. A. “Medicines and the Drug Control Treaties: Is Buprenorphine For Opioid Addiction At Risk of Being Lost?” Human Psychopharmacology: Clinical and Experimental. 19 (2004): 215-24. [5] Fiellin, David A., Herbert Kleber, and Et al. “Consensus Statement on the OfficeBased Treatment of Opioid Dependence Using Buprenorphine.” Journal of Substance Abuse Treatment. 27 (2004): 153-59. [6] Fox, David M. Hogan and Hartson LLP. “Docket No. 01P-0560 (CP/1).” Letter to FDA. 10 Apr. 2002. Columbia Square, Washington DC. [7] Hardman, Joel G., and Lee E. Limbird, eds. The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw-Hill, 2001. [8] Merchant, Roland C, Jennifer A. Damergis, and Et al. “Contraceptive Usage, Knowledge, and Correlates of Usage Among Female Emergency Department Patients.” Contraception. 74 (2006): 201-07. [9] Ranney, Megan L., Erin M. Gee, and Roland C. Merchant. “Nonprescription Availability of Emergency Contraception in the United States.” Annals of Emergency

Medicine. 47 (2006): 461-471. [10] Smith, Meredith Y., J ELise Bailey, and Et al. “Abuse of Buprenorphine in the United States.” Journal of Addictive Diseases. 26 (2007): 107-11. [11] Thomas, J. “Emergency Department Patients May Need Contraceptive Outreach.” Perspective on Sexual and Reproductive Health. 39 (2007): 63-64. [12] United Nations. Single Convention on Narcotic Drugs. 1961. <http://www.incb.org/ pdf/e/conv/convention_1961_en.pdf> [13] United Nations. Convention on Psychotropic Substances. 1971. <http://www.incb. org/pdf/e/conv/convention_1971_en.pdf> [14] United States of America. Food and Drug Administration. Center for Drug Evaluation and Research. NDAC in joint session with ACRHD. “Final Questions to the Committee.” <http://www.fda.gov/ohrms/dockets/ac/03/questions/4015Q1_Final.pdf> [15] United States of America. Food and Drug Administration. Center for Drug Evaluation and Research. NDAC in joint session with ACRHD. “Minutes from Tuesday, December 16, 2003.” <http://www.fda.gov/ohrms/dockets/ac/03/transcripts/4015T1. pdf> [16] United States of America. Food and Drug Administration. “Controlled Substances Act.” <http://www.fda.gov/opacom/laws/cntrlsub/ctlsbtoc.htm> [17] Yassen, Ashraf, Erik Olofsen, and Et al. “Pharmacokinetic-Pharmacodynamic Modeling of the Effectiveness and Safety of Buprenorphine and Fentanyl in Rats.” Pharmaceutical Research. 25 (2008): 183-93. [18] http://www.istockphoto.com

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A Potential Economic Catalyst Christopher Jackson

oday the United States’ dependence on imported fuel-efficient automakers Honda, Nissan, and Toyota. oil is a growing social problem. According This could help restore a portion of the one and a half t o r e s e a r c h f r o m t h e E n e r g y I n f o r m a t i o n million jobs lost this year. [4] Administration conducted during September of Utilizing a portion of our natural gas resources 2008, the United States imports more 1.40 million for increased usage in vehicles will open a door for barrels of oil a day. [1] For the United States, this two developing sources of electricity: Solar and wind. continued activity could prove These sources are currently d i s a s t r o u s . Wi t h o i l b e i n g used sparingly in comparison the primary choice of fuel to natural gas, nuclear, and for vehicles worldwide, the coal power plants. There With over 214 trillion cubic a r e o n l y t w o s o l a r p o w e r nations controlling the bulk of these resources have a great ft. of proven reserves, natural p l a n t s p r o d u c i n g a t l e a s t deal of political control over 100 megawatts in the United other nations dependent on gas is the United States’ most States and 36 plants using their resources. For example, abundant natural resource. wind energy at the same level. the United States imports a In order to properly supply combined 2.190 million barrels our growing need for energy of crude oil per day from these two energy sources Saudi Arabia and Iraq, nations with which the U.S. has should seriously be considered. They both could serve had unpredictable relations. If conflicts were to arise as prominent sources of energy for rural areas, making with countries such as these, they could potentially use of large stretches of undeveloped land. A further cut the U.S. off from their crude oil resources, putting upside for funding this technology would be potential an immense strain on the U.S. economy. job growth sparked by these industries. The solar and This article will examine how finding alternatives wind energy industries could employ hundreds of to foreign oil imports could serve as a catalyst for the thousands of Americans in construction and research, U.S. economy and offer sustainable energy sources for c r e a t i n g a n e w n i c h e i n t h e m a n u f a c t u r i n g a n d the future. it will introduce the potential use of three construction sector. of the United States’ most abundant natural resources; Although exact figures are not available pertaining natural gas, solar, and wind energy as instruments of to the potential cost for these types of investments, it economic growth in the U.S. is obvious that the potential investments discussed With over 214 trillion cubic ft. of proven reserves, would be costly. These investments could prove to be natural gas it is the United States’ most abundant too risky; many towns and cities may not be able to natural resource. [2] Natural gas is primarily used for easily adopt these technologies. There are still worthy powering homes and businesses. In fact, there are 731 concerns about expanded use of solar and wind energy natural gas electric power plants in the U.S. producing as well as natural gas as a more widely used fuel for at least 100 megawatts, outnumbering all other sources vehicles. of electricity. [3] To a lesser extent, natural gas is also F o r s o l a r e n e r g y, a n e f f i c i e n t s o l u t i o n i s n o t being used as fuel for vehicles. Currently, there are c u r r e n t l y a va i l a b l e f o r s t o r i n g s o l a r e n e r g y f o r only about 150,000 vehicles fueled by natural gas, extended use. Similar concerns are present for wind mostly in mass transit and fleet vehicles. However, in energy; there are also no widely used adequate storage an effort to improve fuel efficiency, Brazil, Italy, and mechanisms for wind energy and solutions for what Iran have increased the number of personal vehicles happens when wind is not present. Meanwhile, natural and mass transit vehicles fueled by natural gas. This is gas ultimately presents the same dilemma as oil, being a trend that will likely continue as crude oil resources a non-renewable fossil fuel. That said, use of natural continue to deplete. The struggling U.S. auto industry gas in vehicles would probably be best used as a can make much needed investments in producing the resource while further developments are made with fuel-efficient vehicles of the future. These investments electric powered vehicles. could help them better compete with traditionally Considering the preceding information, developing

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a solution for energy independence proves to be a daunting task, but we should look at it as a necessity. If America’s dependence on foreign oil imports continues to increase, the U.S. could become overly dependent on other nations’ resources to fuel its economy. In closing, investing in the alternative energy resources

References:

presented would not only give our economy much needed resurgence but also sustainable forms of energy when crude oil, heating oil, and natural gas are limited. Christopher Jackson is a student at Arizona State University.

[3] United States Department of Energy [Online]. 2008 Nov 29 [cited 2009 Jan 6]; Available from: URL http://tonto.eia.doe.gov/state [4] Patrick McGee/Sara Sussman. U.S. Preview: Weekly U.S. Jobless Claims to Remain Elevated [Online]. 2008 [cited 2009 Jan 6]; [1 screen]. Available from; http://www. economicnews.ca/cepnews/wire/article/162541 [5] http://www.istockphoto.com

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Towards the Synthetic Nanofactory Eric Alonas

s anyone who has read Michael Crichton’s placement of atoms to lead to novel properties. However, Prey knows, one of the more radical potential he also acknowledges that there are novel problems that applications of nanotechnology is the creation of would have to be overcome at this size scale, such as the “nanorobots” – tiny machines capable of manipulating inherent stickiness of all molecules (due to van der Waals atoms and molecules to do useful work. Although Prey forces) that might cause the particular molecule being was one of the first works to popularize nanotechnology, manipulated to be stuck to a molecular machine. [4] people have been dreaming of nanorobots for years, or Years later, K. Eric Drexler seized upon this idea of more formally “molecular machines”. While the thought “tiny hands” and further developed it into what it is of them is both intriguing and frightening to many, research today. A mechanical engineer by training, he published efforts on this topic are far more benign than their fictional two books on the topic, Engines of Creation (1989) and counterparts. Nanosystems (1992). Drexler ’s version of molecular The current state of the art in molecule machines are those machines (“nanoassemblers”) have several characteristic found in nature, with human understanding just beginning aspects; these include being entirely synthesized from to catch up. Within each cell are thousands of proteins, diamondoid materials, being programmable through a many of which perform mechanical functions analogous mechanical punch-tape mechanism, being able to perform to machines. These proteins in a vacuum, and being able to are most often fabricated using perform “mechanosynthesis” spontaneous self-assembly, with [5]. This last aspect is the ...[I]f there is one truth that the or without the help of chaperone most crucial and also the most proteins. For example, the controversial; although Drexler visionaries cannot be wrong p r o t e i n AT P s y n t h a s e , a takes a well known branch on, it is that there are excellent transmembrane protein the of chemistry as an example makes the cell’s energy storage (piezochemistry), pressing two examples of molecular molecule (adenine triphosphate, molecules precisely together machines in nature... ATP) from its constituents to start a reaction has yet to be (adenine diphosphate, ADP, and demonstrated in a laboratory. inorganic phosphate), possesses It was also this point that a rotating region that moves due sparked a debate with physicist to a proton flux through one of the protein’s subunits [1]. Richard Smalley and an opposition article from chemist Another example is the motor protein kinesin. Kinesin George Whitesides. However, assuming this is true, possess two motor domains connected to a coiled helical Drexler goes on to provide designs for molecular gears, region, similar to two “legs” on a bipedal mover [2]. The pumps, conveyors, and assembler arms that could be legs allow the protein to take discrete 8 nm steps along a energetically feasible [5]. protein track (microtubules), carrying cargoes from inside Most current research into molecular machines has more the cell to the cell membrane. Still more analogies can in common with biology than Drexler’s nanoassemblers. be made: ribosomes can be thought of as assembly lines, Indeed, much effort has been put into adapting biological polymerases can be thought of as copy machines, gates can machines ex vivo to do useful work. An example of this be thought of as ion channels, etc [3]. would be engineering the kinesin-microtubule system in Synthetic molecular machines, along with many a microchannel. This can be done in two configurations, of nanotechnology’s potential applications, were first by either placing the microtubules at the bottom of the envisioned by particle physicist Richard Feynman in his channel (“tracks-down”) or the kinesins at the bottom 1959 speech “There’s Plenty of Room at the Bottom.” In (“motors-down”), attaching a cargo of interest to the it, Feynman predicts the rise of many tools now used in moving component, and observing its transport down the today’s nanotechnology, as well as a scheme to perhaps channel in a microscope. However, this strategy is not build “a hundred tiny hands,” with each successive without problems; the long term stability of the proteins generation smaller than the next by a scale factor. With such and the uniform directionality of the system have yet to control over matter, Feynman opens a door to the possibility be dealt with. [6] of building things “bottom-up,” precisely dictating the On the completely synthetic side, simple motors have

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been developed by exploiting chemical reactions. These “catalytic” motors were often metallic nanowires made of two dissimilar metals [7]. When placed in a fuel solution, a reaction would occur asymmetrically on the surface of the wire due to the two different metals, establishing an electric field within the wire and causing the wire to move at about 10µm•s-1 due to self electrophoresis [7]. By adding carbon nanotubes into one end of the wire, the catalysis of the fuel solution can be sped up to about 50µm•s-1, the speed of some bacteria [8]. However, the speed of the motors is limited due to the inherent limitations of the self electrophoresis mechanism, such as in the presence of increasing ambient ionic strength. Clearly, the current reality of synthetic molecular machines does not add up to the theoretical visions of Feynman and Drexler. In fact, by choosing to make his nanoassemblers out of diamondoid materials and place them in a sterile environment, Drexler seemingly creates References:

[1] United States Department of Energy [Online]. 2008 Dec 29 [cited 2009 Jan 6]; Available from: URL: http: //www.eai. doe.gov/ pub/oil_gas/petroleum/data_publications/ company_level_imports/ current/import.html [2] United States Department of Energy [Online]. 27 Oct 2008 [cited 2009 Jan 6]; Available From: URL: http:// www.eia.doe.gov/oil_gas /natural_gas/data_publications/ natural_gas_monthly/ngm.html [3] United States Department of Energy [Online]. 2008 Nov 29 [cited 2009 Jan 6]; Available from: URL http://tonto.eia.doe.gov/state [4] Patrick McGee/Sara Sussman. U.S. Preview: Weekly U.S. Jobless Claims to Remain Elevated [Online]. 2008 [cited 2009 Jan 6]; [1 screen]. Available from; http://www. economicnews.ca/cepnews/wire/article/162541 [5] Feynman RP. There’s plenty of room at the bottom. J Microelectromech Syst

a discontinuity between the present and the future, a fact that Richard Smalley and George Whitesides were quick to point out. This is evident by the departure of his work from current research, which either relies on engineering biology or special circumstances. Also, by neglecting an aqueous environment and biological building blocks, Drexler neglects the tools that nature uses to build its own molecular machines (e.g. spontaneous self assembly). However, if there is one truth that the visionaries cannot be wrong on, it is that there are excellent examples of molecular machines in nature, and that we should draw inspiration from them when trying to build are own. Still, the nanorobots will not be attacking anyone soon. Eric Alonas is a student at Arizona State University.

1992;1:60-6. [6] Drexler KE. Nanosystems: molecular machinery, manufacturing, and computation. New York: J. Wiley & Sons; 1992. [7] Stewart RJ, Limberis L. Engineering a molecular railroad. In: Shoseyov O, Levy I, editors. Nanobiotechnology: bioinspired devices and materials of the future. New Jersey: Humana Press; 2008. p. 433-60. [8] Paxton WE, Sen A, Mallouk TE. Motility of catalytic nanoparticles through selfgenerated forces. Chem-Eur J 2005;11:6462-70. [9] Laocharoensuk R, Burdick J, Wang J. Carbon nanotube induced acceleration of catalytic nanomotors. ACS Nano 2008;2(5):1069-75. [10] http://www.istockphoto.com

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The Science of Good Writing: Improving Communication Skills Among Undergraduate Scientists

David Edwards

rom portable defibrillators in hospitals to flat literacy in science education majors. [5] screen televisions in living rooms, science and While similar programs are good examples of technology is everywhere. Its prevalence in the education for scientific communicators, their modern society naturally demands a greater public m e t h o d o l o g y c o u l d b e i m p r o ve d t h r o u g h m o r e understanding of these technologies, namely the innovative methods of teaching. One study that analyzed scientific principles which have made such ubiquitous the effectiveness of scientific literacy education suggests devices possible. Responsibility falls upon scientists as that significant changes should be made to current the architects of these technological improvements to classroom learning strategies. [6] Many undergraduate communicate their findings to mass audiences. science courses lack some important requirements that However, “scientific communication” is entirely are identified by this study. For example, the course different from the technical description for the University writing common among o f Te n n e s s e e ’s “ S c i e n c e most scientific publications, Wr i t i n g a s L i t e r a t u r e ” While examples are important, which often alienates readers course consists of analyzing simply because they cannot the literary qualities from less emphasis should be understand the jargon. [1] a “survey of important placed on demonstrating good The current state of scientific science writing.” [3] While communication inadequately examples are important, less scientific communication addresses these issues. emphasis should be placed and more on providing The British Broadcasting on demonstrating good Company, one of the largest scientific communication opportunities for students to news organizations in the and more on providing discuss and communicate that world, has only six science opportunities for students reporters. [2] A Nepali to discuss and communicate information themselves. science journalist remarks that information themselves. that “the chances are minimal [6] This particular example that there would be a huge is not meant to criticize community of science journalists and broadcasters,” t e a c h i n g p r a c t i c e s , b u t t o i l l u s t r a t e t h e g e n e r a l because no institutions currently exist to train them. improvement that is necessary for similar institutions [1] to enrich more traditional teaching methods. [6] Providing early, institutionalized education for Ideally, all scientific education would take a more science communicators is one answer to this problem. integrative approach, making science and scientific Many courses taught at the undergraduate level already research more relevant and accessible to students. It exist in universities across the United States and the has been suggested that students originally interested world. The University of Tennessee, for example, has in science lose that interest when their courses become a Science Communication Program which features six irrelevant to their personal experiences. [6] Regular courses, one of which involves analyzing the literary coursework, therefore, should be complemented with qualities of successful science writing. [3] The Australian so-called socio-scientific issues, which recommends National University offers similar courses with the teaching science through “context-based situations” same intention of improving scientific communication, instead of identifying fundamental concepts [7] suggesting that its participants will have a competitive One suggestion for using socio-scientific issues edge over non-participants. [4] Interestingly, many of involves engaging students in mediated scientific these programs are concentrated at the undergraduate debates that would require them to clearly articulate instead of the graduate level. By requiring that students their ideas. Such opportunities for discourse would take classes at an undergraduate level, these institutions help revitalize the current method of specific education are ensuring that scientific communication is taught as by promoting an active knowledge of a broad range of early as possible. This method of early instruction has scientific issues. [6] One university professor argues been shown to produce better knowledge of scientific that a collaborative exchange of ideas would improve

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ARIZONA STATE scientific communication by encouraging constant interaction among other scientists. If such open-minded scientific discussions can be held in the classroom, students “will be motivated to share those lessons.” [8] Debates like these are examples of an “outcomes-focused approach” to scientific education, which involves a combination of students investigating scientific issues cooperatively and professors interacting more directly with students. [6] Opportunities for students to weigh the accuracy of different hypotheses based upon empirical evidence is both an important application of the scientific method and “the essence of intellectual growth.” [8] Another recommendation of using socio-scientific issues involves undergraduate research journals, which can bridge the gap between the publication of important

research and the recognition of college-level research. [9] Improving education on scientific communication is important, but practicing and implementing those techniques outside the classroom is essential. While ordinary peer-reviewed scientific journals like Nature and Science publish articles with innovative and unique research, undergraduate journals are designed simply to communicate that research to the general public. [9] Undergraduate scientists should be encouraged to conduct small-scale laboratory or investigative research projects and publish their findings in peer-reviewed undergraduate journals. Through publication, students will become intimately involved in the scientific community and gain a firm understanding of the social components of scientific discovery. Both scientific debates and undergraduate research

Undergraduate scientists should be encouraged to conduct small-scale laboratory or investigative research projects and publish their findings in peer-reviewed undergraduate journals.

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publications are demonstrations of “education through science,” or a scientists’ involvement in society, rather than “science through education,” or a scientists’ involvement in science. [7] “Science through education” involves the rote memorization of facts and the application of knowledge and decision-making skills from a scientist’s perspective. This method of education is only geared toward solving science-related problems and often ignores environmental and ethical implications. [7] Conversely, “education through science” involves fostering communication skills and recognizing how scientific knowledge can influence societal values. This method of education is inclusive rather an exclusive, relying upon scientific literacy to improve “learning across multiple, heterogeneous settings.” [7] Nevertheless, this concept of “education though science” raises some important questions about

the social and political function of scientists. First, simplifying scientific research may inadvertently result in the misrepresentation of findings, either through simple inaccuracy or through oversight influence by political or legal organizations. [10] People could mistakenly interpret data and give it unintended societal implications. Government scientists could be pressured against producing research that contradicts administration policies or current lawsuits. Second, scientists are supposed to be nonpartisan entities that report facts without personal prejudice. One source of public mistrust in scientists is the politicization of science and the belief that scientific research is conducted inequitably and is chiefly motivated by self-interest. [10] Such personal involvement with controversial topics may lead future scientists to overstep their professional boundaries by loudly campaigning for policy change. Ultimately, education in scientific communication shouldn’t be limited to the undergraduate level. Improving undergraduate scientific communication would merely provide a stepping stone for scientists interested in careers related to scientific communication s u c h a s s c i e n t i f i c j o u r n a l i s m . P r e s u m a b l y, t h e s e graduate programs would include the same integrative approach suggested for the undergraduate program. By incorporating concepts like socio-scientific issues and “science through education” in the education of undergraduate scientists, communication between sci e n t i st s a n d ma ss a u di e n ce s ma y i mp r o ve a n d ordinary people may better understand the science and technology that surrounds them. David Edwards is a student at Arizona State University.

References:

[1] Khanal P. Relevance of effective science communication [monograph on the Internet]. Islam Online. 2003 September 17 [cited 2008 November 4]; [about 5 pages].In editor. Available from: http://www.islamonline.net/English/Science/2003/09/article11.shtml. [2] PhysicsWorld. Embargoed science [homepage on the Internet]. IOP Publishing [updated 2008 May 1; cited 2008 November 4]. Available from: http://physicsworld. com/cws/latest/print;jsessionid=20A0617B2F43A11C5771AE30D57E490C. [3] University of Tennessee: Knoxville. Science communication program [homepage on the Internet]. School of Journalism & Electronic Media; [cited 2008 November 4]. Available from: http://www.cci.utk.edu/jem/sciencecommunication. [4] The Australian National University. Undergraduate science communication [homepage on the Internet]. [updated 2006 September 21; cited 2008 November 4]. Available from: http://info.anu.edu.au/StudyAt/010PP_Undergraduate/_AOI_ Science%20Communication.asp. [5] Chin, Chi-Chin. First-year Pre-service Teachers in Taiwan - Do they enter the teacher program with satisfactory scientific literacy and attitudes toward science?. International Journal of Science Education. 28 October 2005 [cited 2008 November 20]; 27 (13): pp. 1549-1570. Available from: http://ejournals.ebsco.com.ezproxy1.lib.asu.edu/direct.asp ?ArticleID=405DB2EEA9BAD5B5D1A3. [6] Rennie L. J., D. Goodrum and M. Hackling. Science Teaching and Learning in Australian Schools: Results of a National Study. Research in Science Education. 2001 [cited 2008 November 20]; 31(4) : pp. 455-498. Available from: http://ejournals.ebsco.

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com.ezproxy1.lib.asu.edu/direct.asp?ArticleID=KFXQM6VL09F3H5M2EKDP. [7] Holbrook, J., and M. Rannikmae. The Nature of Science Education for Enhancing Scientific Literacy. International Journal of Science Education. 2008 April 3 [cited 2008 November 20]; 29(11): pp. 1347-1362. Available from: http://ejournals.ebsco.com. ezproxy1.lib.asu.edu/direct.asp?ArticleID=4C5284CFE6140A30E37A. [8] Martin, TW. Scientific literacy and the habit of discourse [monograph on the Internet]. Seed Magazine. 2007 September 27 [cited 2008 November 4]; [about 3 pages]. Available from: http://www.seedmagazine.com/news/2007/09/scientific_literacy_and_ the_ha.php. [9] Tatalovic, M. Student science publishing: an exploratory study of undergraduate science research journals and popular science magazines in the US and Europe. JSC [serial on the Internet]. 2008 September [cited 2008 November 4]; 7(3): [about 9 pages]. Available from: http://jcom.sissa.it/archive/07/03/Jcom0703(2008)A03/. [10] Barbour, M. T., N. L. Poff, R. H. Norris, and J. D. Allan. Perspective: Communicating our science to influence public policy. Journal of the North American Benthological Society. 2008 September [cited 2008 December 26]; 27 (3): [about 7 pages]. Available from: http://www.bioone.org.ezproxy1.lib.asu.edu/perlserv/?request=gete=562&volu me=27&issn=0887-3593&issue=3&ct=1. [11] http://www.istockphoto.com [12] http://science.nasa.gov/newhome/headlines/images/dpl3.jpg

ARIZONA STATE

GPS, Privacy Rights and Development of the Law Kara Davis

n 2008, Global Positioning System (GPS) sales were estimated control. According to law professor Sandy Askland, Director of to be twenty million dollars, double the sales from 2007. [1] the Center for the Study of Law, Science, and Technology at the Used most prominently in cell phones and automobiles, GPS Sandra Day O’Connor College of Law, the loss of control becomes has immersed itself into people’s everyday lives. The technology an “imminent threat to the user’s privacy.” [5] Users are less and can give directions, indicate location in emergencies, find the less in command of what entities obtain and know about them. closest retail store, and relay speed of movement. Overall, Furthermore, these entities are not limited to businesses, such the capabilities of GPS have had a positive effect on society. as cell phone companies. Individuals can also utilize GPS to However, the technologies that utilize GPS also create records track other individuals, without their express consent, by phone or vehicle. The courts, to date, have of information about the user which chosen to define privacy rights in such can be readily accessible to various Not only can establishments away that allows this to occur. entities such as companies, other Similar means of data collection people and the government. Rather or individuals track who by businesses can also threaten one’s than allowing consumers to ‘opt a person called and when, privacy rights. For instance, rental in’ for special GPS features, courts companies are combining GPS have found that the ability to ‘opt but now they can tell where car with event data recorders to monitor out’ sufficiently protects consumers. that person was when they renters’ driving activity. If found Whether the average person realizes in violation of a traffic law, such it or not, GPS has become a standard placed that call. as speeding, renters can face fines feature in products, producing and imposed by the company without storing personal information, such as calls placed, location, and speed of travel. [2-3] The law has the actual citation of a traffic ticket. Other companies are tracking done arguably little to protect consumers on this issue, raising employees in a comparable manner, by placing GPS in company concerns of privacy and the fear that society is inching toward a vehicles. [2-3] A large concern raised by employees is that the use of the GPS in the vehicle implies that the company has access to a ‘big brother’ state. The GPS is an intricate network of satellites which send person’s location at all times, whether on the job or off, assuming information to receivers on earth. The development of GPS they are always in the vicinity of their vehicle. Moreover, this began in 1973 when the U.S. Department of Defense directed the information has the potential to be obtained by the police or as Space and Missile Center to establish, develop, test, acquire, and character evidence in a court case. [2-3] A common example which deploy a space borne positioning system. [4] The outcome was is already prominent is the use of such information in divorce a total of twenty-four evenly spaced satellites orbiting the earth, cases. By obtaining GPS records, whether the records are from providing a minimum of four satellites of coverage at any given the cell phone or driving records, the prosecution can prove the point in time anywhere in the world. The satellites communicate defendant called someone at a specific time, at a specific place with receivers on earth, calculating the distance between each and then drove to a specific location. The information can be satellite and receiver to configure a precise longitude, latitude and damaging to a person’s profile and an intrusion into their private height. Velocity is determined by radio signals and the frequency lifestyle decisions. One law that attempts to protect consumers from improper of broadcasts. [4] The combination of data transmitted through GPS became a premier navigational tool. Its first users were usage of recorded data is the Privacy Act of 1974. The act requires primarily military personnel, but as the technology has advanced agencies to “inform each individual whom it asks to supply and costs have decreased GPS has become increasingly available information.” [6] However, while often found in the fine print of cell phone contracts, consumers rarely notice this information. to the general public. Though most are well aware of the utility of GPS, many users Thus, many consumers unknowingly give consent to phone do not realize that GPS technologies have added an unprecedented companies to keep these records without knowledge of what is dimension to the data that entities such as businesses and private being recorded and for what purposes. The Privacy Act of 1974 individuals can receive and collect about them. Not only can also prohibits companies from disclosing information contained establishments or individuals track who a person called and in their system without written consent of the client. This rule is when, but now they can tell where that person was when they followed by several exceptions including need by workers within placed that call. [2-3] Unless the consumer has the capability to the agency to utilize the information, as well as governmental use. turn off the GPS, the information being recorded is beyond their [6] This allows records to be transmitted to individuals directly

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associated with the agency without a warrant. Created shortly after development of GPS began, the Privacy Act of 1974 does not encompass any requirements specifically dealing with GPS technologies and instead has left the courts to debate the issue. The overall consensus of the courts concerning GPS technology and privacy rights has primarily been based on the determinant that privacy does not exist in public places. Katz v. United States established a two prong principle to determine when privacy rights do apply. According to the principle, one must have a clear expectation of privacy and the public must accept the expectation as reasonable. [2-3] By the rule, the only guaranteed place where one can indefinitely have privacy, unless a warrant is issued, is a private residence or home. To many, this may seem inadequate, as there are times when people certainly expect some level of privacy in public. In June of this year Judge Stein dissented on a New York court case stating people “have a reasonable expectation that their every move will not be continuously and indefinitely monitored by a technical device without their knowledge, except References:

[1] Kim N. GPS on the go. Cars.com [article on the internet]. Cars.com; 2008 Sep 23 [cited 2008 Oct 28]. Available from: URL: http://www.cars.com/go/advice/ Story.jsp?se ction=gdgt&subject=nav&story=navSystems [2] Hutchins RM. Tied up in knotts? GPS Technology and the Fourth Amendment. The Regents of the Univ of Cal [Online]. 2007 [cited 2008 Oct 6]; vol (409): [51]. Available from: Lexis Nexis. URL: http://www.lexisnexis.com [3] Richmond, DP. Can you find me now? - - tracking the limits on government access to cellular GPS location data. The Cath Univ of Amer CommLaw Consp [online]. 2007 [cited 2008 Oct 6]; vol (283): 48. Available from: Lexis Nexis. URL: http://www.

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where a warrant has been issued based on probable cause.” [2-3, 7] Consequently, if people possessed a reasonable expectation that their every move would be constantly monitored, twentyfour hour surveillance could be deemed constitutional. Though, constitutionality does not necessarily determine legality under any state or federal law. Law inevitably faces the challenges of the past, as technology advances at a much faster pace than the law can reach a consensus. The capability that GPS represents is vast. It possesses the ability to simplify people’s lives, however, this may be at the cost of details about one’s everyday actions. GPS technologies will proceed to develop, whether the law keeps up or not. As issues of privacy become more pressing, regulations and laws will need to be developed that clearly define one’s right to use GPS technologies, while being careful not to diminish one’s right to privacy. Kara Davis is a student at Arizona State University.

lexisnexis.com [4] Hofmann-Wellenhof B, Lichtenegger H, Collins J. GPS theory and practice. 5th ed. Austria: Springer-Verlag Wien; 2001. p. #. [5] Askland, Sandy. Personal Interview. October 2008. [6] The Privacy Act of 1974 [Online]. 2003 Sep 26 [cited 2008 Sep 22]; Available from: URL: http://www.usdoj.gov/oip/privstat.htm [7] Supreme Court of New York, Appellate Division, Third Department. The People of the State of New York v Scott C. Weaver. Lexis 4811; 2008 Jun 5 [8] http://www.istockphoto.com

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Diagnosing the Geno-hype: Genetic Determinism in the Mass Media Ellen Dupont

he initiation of the Human Genome Project in 1990 kicked off a new era in molecular biology and biomedicine. As the scientific community set out on a quest to uncover the secrets of human identity hidden deep within our genome, the public’s excitement was palpable—and the media was there to report every new discovery. News articles reporting advances in genetics research seized public attention with titles announcing the discovery of genes for everything from alcoholism to autism to altruism. The trend has continued as more behaviors, characteristics, and diseases are linked to specific genes. Most human traits, however, do not reduce to such simplistic genetic explanations. Scientists have long been frustrated with media coverage of their research, in part because it leads to public misperceptions; in this case, does the popular version of genetic research foster a belief in genetic determinism, and if so, what are the implications of such public misperceptions? The ‘gene for X’fallacy, which implies that a single gene is responsible for a single phenomenon (a trait, characteristic, or disease), is an established trend in mass media coverage of genetics research, and it may be contributing to a public attitude of genetic determinism [1]. Genetic determinism—“the idea that genes are the only major contributor to the form,behaviorandlifecourseofanorganism”[2]—wasmorecommonly accepted in the past, when molecular biologists were beginning to discover the vast power of genes in directing human development. Early studies attempting to link genes to characteristics or diseases gravitated toward traits that lent themselves to being explained in terms of genetics, and some early discoveries fit the ‘one gene, one disease’(OGOD) model. The idea that defective genes are largely responsible has been, and still is, a powerful tool in understanding certain diseases. The problem arises when the idea is applied beyond the scope of its explanatory power, extrapolated beyond the traits or diseases it can explain to others with more complex etiologies. Modern geneticists have an increasingly accurate and nuanced understanding of the effect of the interaction between genes and environment on the development of an organism [3]. Today, genetics research is not a race to determine which factor is the predominant influence on development; rather, it is motivated by the understanding that the interplay between the factors is different for any given disease or characteristic. Even strictly within the realm of diseases, identifying a genetic marker can mean vastly different things. Scientists identified the gene for Huntington’schorea,ahereditaryneurodegenerativedisease,in1993.The ‘Huntington’s gene’ is aptly named—anyone who has it will inevitably develop the disease at some point, and those without it never will [4]. On the other hand, confidence in the diagnostic power of BRCA1, the original ‘breast cancer gene’, has changed over time.A2008 study found that the lifetime risk of developing breast cancer for BRCA1 carriers is significantly lower and much more variable than previously thought [5]. Afinal example demonstrates the importance of considering both genetic and environmental factors: Phenylketonuria (PKU) is a metabolic disease

caused by mutations in the PAH gene. Carriers do not make enough of the enzyme that metabolizes phenylalanine, so the chemical builds up in the bloodstream, causing mental retardation and other adverse effects. But while PKU, like Huntington’s, is caused by a malfunction in a specific gene, the disease is not inevitable for defective PAH gene carriers because of the environmental component; in fact, most people who have the mutation suffer no symptoms at all. Since the problematic chemical (phenylalanine) is obtained through food, a carefully controlled diet limits the effects of the gene and properly treated patients experience no deleterious symptoms. PKU is a case in which a true understanding of the disease and the development of a treatment plan are only possible if both genetic and environmental factors are taken into account [6]. Guided by examples like these and many more, the scientific community has largely abandoned strict genetic determinism, instead subscribing to a more comprehensive explanatory theory that posits the interaction of genes and environment as key to a person’s development [7].

Even strictly within the realm of diseases, identifying a genetic marker can mean vastly different things. Molecular biologists and geneticists are making continual progress toward understanding the complex forces that shape human life, but while media coverage of genetic science has been increasing, it seems that public understanding is not keeping pace [8]. Though scientists have abandoned genetic determinism, opinion polls show that almost one third of Americans still subscribe to the idea [2]. When in search of medical and science news, the public turns first to the mass media [8,9]. Unfortunately, inaccurate and misleading media portrayals foster public misunderstanding of the fundamentals of genetic science [1]. Scientific findings follow a circuitous path and pass through numerous intermediaries on their way from the laboratory to the newsstand, and both the scientific and journalistic communities share responsibility for the way results are portrayed. With gene-based therapeutic applications already in use and personal genome sequencing becoming more affordable and widespread, comprehensive and unbiased coverage is essential to promote the public understanding necessary for members of society—both as patients and as voters—to make informed decisions regarding the direction, application, and regulation of genetic research [8]. Scientists have often been unhappy with the press’s coverage of their fields; the two groups are driven by differing, sometimes competing sets of values and motivations [10]. Science reporters must

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ARIZONA STATE first and foremost attract readers, a difficult task when competing with more attention-grabbing topics like war and pop culture. Likely in response to this pressure, two trends have emerged in media coverage of genetics: oversimplification and sensationalism [2]. In an attempt to simplify complex concepts for public consumption, reporters often use metaphors that misrepresent genetic mechanisms [2], calling genes a ‘medical crystal ball’(which inaccurately insinuates that they are reliable predictors of future health) [1], a ‘blueprint’, or a ‘recipe’ (both of which are problematic because they suggest conscious design) [2]. Journalists also tend to make the mistake of leaping from correlation to causation, assigning or implying causal power where only associations have been found, and frequently downplay or altogether ignore the role of environmental influences [1]. In 2003, Science published a study linking a certain gene-environment interaction with depression, specifically the association between a certain allele of the 5-HTT gene and stressful life events. Two years later, an analysis of press coverage of the study found that while the original article clearly indicated that the allele alone was not correlated with depression, media coverage still framed the study’s results as a discovery of the ‘gene for depression’ [11]. Sensationalism may be even more problematic. Many articles describegeneticsresearchaspresentingeitheranopportunityformiracles or, occasionally, an imminent threat—and including both aspects brings added controversy [2]. This hyperbole is especially common in reference to genetic engineering. Coverage of a 1993 experiment that successfully “twinned” a nonviable human embryo diverged dramatically. Across the board, the media assumed the technique had essentially created

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an applicable human cloning technology, but while the Los Angeles Times celebrated the results as the dissolution of physiological barriers to pregnancy, Time magazine warned of a “Brave New World of cookie cutter humans” [12]. Confused, the public has developed the somewhat dichotomous view that genetics simultaneously offers the potential for both utopian and dystopian futures [1]. Though many are quick to blame journalists for misrepresenting scientific findings, some evidence suggests that fault does not lie solely withthemedia.Inmanycases,thetoneandgeneralhypethatcharacterize genetics reporting actually closely mirror that of the original scientific publicationsitcovers—bothoveremphasizethepositiveaspectsofgenetic discoveries and associated technologies.According to a study published in the Journal of the Canadian Medical Association, though newspaper articles and scientific journal articles are equally likely to discuss potential benefits of a genetic discovery (97% and 98%, respectively), geneticists’ publications are three times less likely to discuss costs or risks associated with the findings than the newspaper articles that cover them (5% compared to 15% of newspaper articles) [9]. This makes sense; journalists aremotivatedbythepressuretoattractreaders,sosensationalism in either direction will do. Geneticists’ bias is more unilaterally positive, as they are motivated by their earnest enthusiasm for their work as well as the constant pressure to gain visibility, which is key in drumming up both public support and funding [2]. Scientists are aware of how powerful a tool the media can be and have learned to use it to their advantage [13]. Both geneticists and journalists play a role in the process that ultimately leads to the news coverage that reaches the American public.

ARIZONA STATE This coverage, however, often does not accurately represent current scientific understanding of the role and function of genes and may be pushing public perceptions toward the idea of genetic determinism [1,2]. A further problem lies in identifying the implications of public acceptance of genetic determinism.Alook intoAmerica’s not-too-distant past provides an example of the possible consequences of such beliefs. Though the modern understanding of the gene did not exist in the early 1900s, a similar belief in the exclusive power of heredity gave rise to the American eugenics movement—the so-called self-direction of human evolution, which eventually led to the forcible sterilization of tens of thousands of people [14]. It is noteworthy that the qualities of these ‘socially inferior’citizens that warranted involuntary sterilization during the eugenics movement—“the feebleminded, the insane… the inebriate, the diseased” [14]—find close parallels in the traits that society is so eager to label as genetically determined today: retardation, schizophrenia, alcoholism and countless diseases. Today, the consequences of genetic determinism take a different form. The tone of some media coverage borders on resignation to the idea of an immutable future prescribed by our genetic makeup [2]. The idea has even found its way into the courtroom, as an increasing number of legal defense teams consider turning to behavioral genetics as a mitigating factor in criminal cases [15,16]. How such evidence, if deemed admissible, will be viewed by judges and juries remains to be seen; though the presence of a certain ‘violence’ or ‘aggression gene’ could partially absolve a defendant of responsibility, it might instead be used as a rationale for a harsher sentence [16]. The iconography of media coverage suggests the issue is already being debated: “Born Bad?” asked the title of a 1997 U.S. News & World Report cover story, superimposed on the image of an infant dressed in prison stripes [15]. Genetic determinism itself is a significant problem, but it gives rise to others as well: namely, public expectations of forthcoming gene-based therapiesandapprehensionaboutpotentialabusesofgeneticinformation. Media hype that overemphasizes the role of genes in determining disease suggests an obvious corollary—the possibility that cures lie within the realm of the genome as well. Indeed, a common trend in coverage of breakthroughs in biomedical genetics is the portrayal of therapeutic applications as right around the corner; the media often fails to emphasize the painstaking and lengthy process of moving from identifying a genetic

References:

[1] Nelkin D. Genetics and the media. International Encyclopedia of the Social and Behavioral Sciences 2004;6130-6135. [2] Condit CM. How geneticists can help reporters to get their story right. Nat Rev Genet 2007;8:815-820. [3] Robert JS. Embryology, epigenesis and evolution: Taking development seriously. New York: Cambridge University Press; 2004. [4] Mayo Foundation for Medical Education and Research. Huntington’s disease [document on the Internet]. Mayo Clinic; 2007 [cited 2008 Dec 15]. Available from: http:// www.mayoclinic.com/health/huntingtons-disease/DS00401/DSECTION=causes [5] Begg CB, Haile RW, Borg A, Malone KE, Concannon P et al. Variation of breast cancer risk among BRCA1/2 carriers. J Amer Med Assoc 2008;299(2):194-201. [6] National Human Genome Research Institute. Learning about Phenylketonuria [document on the Internet]. National Institutes of Health; 2008 [cited 2008 Nov 21]. Available from: http://www.genome.gov/25020037#4. [7] Sarkar S. Genetics and reductionism. New York: Cambridge University Press; 1998. [8] Geller G, Bernhardt BA, Holtzman NA. (2002). The media and public reaction to genetic research. J Amer Med Assoc 2002;287(6):773. [9] Bubela TM, Caulfield TA. Do the print media ‘hype’ genetic research? A comparison of newspaper stories and peer-reviewed research papers. Can Med Assoc J 2004;170:13991407. [10] Friedman SM, Dunwoody S, Rogers CL. Communicating Uncertainty: Media

marker for a disease to developing a therapeutic treatment [2,8]. While it garners attention in the short term, headlines that promise “New Hope for Victims of Disease” may breed feelings of betrayal in the public when suggested therapies do not materialize [1,2]. Eventhehopesbredbythemedicalpossibilitiesofgenomemapping bring concomitant fears.Thesametest that can identify a health risk might be a health risk in itself if health insurance companies view a genetic predisposition to a disease as a pre-existing condition. Public anxiety regarding privacy violations and genetic discrimination was the most commonly cited concern about the sequencing of the human genome [8]. Congress passed the Genetic Information Nondiscrimination Act of 2008, which prohibits insurance companies and employers from discriminating against individuals based on genetic information [17]. Science, law, policy, and public opinion are guided by a tangled web of influence: the scientific community chooses the direction of future research, but is largely influenced by funding, apportioned by politicians who are keenly aware of public opinion, which is in turn shaped by the media. Genetic determinism has potential implications in numerous facets of society: social and legal responsibility are at risk as criminal defense teams begin to cite defective genes as a source of criminal behavior [16]; hype of gene therapies and failure to produce results may contribute to public distrust of the scientific community [1]; fear of discrimination by employers and health insurance companies has already necessitated legislative action from Congress [1,17]; and public misunderstanding itself can be a direct problem as personal genome sequencing becomes more widely available and less expensive [13]. The new questions raised by these issues stem at least in part from the idea of genetic determinism perpetuated by the media’s favored ‘gene for X’ frame. The solution, like the problem, will be multifaceted. Several pathways of communication are key: from scientists to doctors to patients, from scientists to the media to readers, and from scientists to policymakers. All of the groups involved must collaborate to enable public education and ensure that our society is reliably informed. Only then can we can greet the often exciting, sometimes revolutionary scientific breakthroughs in genetic research with informed appreciation instead of misguided hopes, fears or prejudices. Ellen Dupont is a student at Arizona State University.

coverage of new and controversial science. Mahwah, New Jersey: Lawrence Erlbaum Associates; 1999. [11] Horowitz AV. Media portrayals and health inequalities: a case study of characterizations of gene x environment interaction. J Gerontol B Psychol Sci Soc Sci 2005;60:48-52. [12] Nelkin D. From promises of progress to portents of peril: Public responses to genetic engineering. In: Wear S, Bono JJ, Logue G, McEnvoy A, editors. Ethical issues in health care on the frontiers of the twenty-first century. New York: Springer; 2002. p. 155-170. [13] Petersen A. Biofantasies: Genetics and medicine in the print news media. Soc Sci Med 2001;52(8):1255-1268. [14] Eugenics. In: Encyclopædia Britannica. Encyclopædia Britannica Online; 2008 [cited 2008 Nov 5]. Available from: http://www.britannica.com/EBchecked/topic/195069/ eugenics. [15] Herbert W. Born Bad? The politics of biology: How the nature vs. nurture debate shapes public policy—and our view of ourselves. U.S. News & World Report 1997 Apr 13. [16] Moran M. Jury still out on impact of genes on trial verdicts. Amer Psychiatr Assoc 2006;41(21):12. [17] National Human Genome Research Institute. Genetic Information Nondiscrimination Act of 2007-2008 [document on the Internet]. National Institutes of Health; 2008 [cited 2008 Nov 7]. Available from: http://www.genome.gov/24519851. [18] http://www.istockphoto.com

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Countering the Physician Brain Drain in South Africa Shifat Ahmed

he use of Africa’s resources has been a source of controversy for decades [1]. With the colonization of South Africa by Dutch Afrikaners and Boers, many South Africans found themselves displaced by racial apartheid [1]. Apartheid in South Africa separated society along racial lines and gave legal preference to individuals of European origin [1]. Between 1948 and 1990, blacks in South Africa received very little help from government social programs. With their resources effectively depleted, these native Africans have since suffered due to economic as well as racial disenfranchisement [1]. Nelson Mandela spent the majority of his life fighting to eliminate the apartheid establishment that is still prevalent in South African society [2]. To counteract the economic disparity caused by apartheid, foreign nations have invested heavily in South Africa, but an increase in the quality of day to day life of Africans has not yet been observed [3,4]. The Millennium Development Goals Report shows a marked increase in the health of individuals in Asia and Latin America, but Sub-Saharan Africa still lags significantly behind these two areas and has not shown significant improvement since 1990 [4]. In South Africa, the lack of progress in healthcare is not a consequence of a lack of aid, but, rather, an “outflux” of trained physicians; the physician brain drain has been crippling South Africa for decades. Western nations face an ethical dilemma as they pour money into this nation while simultaneously importing the pool of trained physicians vitally needed to help South African development. The Health Crisis in Africa The Millennium Development Goals Report was developed by the United Nations to monitor the progress of developing nations regarding human rights and the overall well being of such nations. This report outlines eight goals; of those eight,

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three are directly related to health. Goals four, five and eight aim to reduce child mortality, improve maternal health and combat diseases such as HIV/AIDS, malaria and other common diseases, respectively. The UN estimates that eleven million children die from preventable diseases each year, and it is believed that child mortality could be minimized via expanding health programs in addition to ensuring that they are inexpensive [4]. It is estimated that over a half million women die during child birth, and countless others suffer serious injury and disability [4]. Programs that are aimed to lessen the grip of ailments such as HIV/AIDS on Africa are proving to be ineffective, as both the rates of infection and deaths continue to increase. In addition, new cases of tuberculosis continue to grow rapidly in the subSaharan, whereas such outbreaks are unheard of in the Western world. It is estimated that 1.7 million people die yearly from T.B., and many of those deaths occur in sub-Saharan Africa [4]. The three aforementioned goals all attempt to reduce, if not eliminate, the effects of many preventable health issues. Many of these diseases can be rectified via consultation between a physician and a patient. The Recruitment of Physicians for Developed Nations Taking into consideration that sub-Saharan Africa lacks vital manpower in the health industry, exporting these qualified professionals from Africa may be considered to be a great injustice to the affected underdeveloped nations. Australia, the United States, Canada, the United Kingdom, Saudi Arabia and the United Arab Emirates relentlessly recruit foreign physicians, including those that hail from the sub-Saharan. Despite the fact that they already have a relatively high number of physicians relative to population, these nations still continue to recruit from developing nations [5]. For example, the United Kingdom had an estimated 2.14 physicians for every one thousand people, as opposed to Malawi’s ratio of 0.02 doctors per one thousand people. Additionally, for every ten physicians practicing medicine in the United Kingdom, one is from sub-Saharan Africa [6]. In fact, it has been established that there is an inverse relationship between healthcare professional density in a given population and mortality (i.e. an increase in the proportion per population size will decrease mortality and vice-versa) [7]. Active recruitment in the sub-Saharan takes form in foreign employment agencies setting up camp and using mass media, such as television, newspapers and even more personalized communication such as text messaging and e-mails, to recruit physicians for developed countries [8]. This continuous migration of physicians out of Africa may ultimately result in a single physician treating twenty-six thousand patients as opposed to nine thousand currently. This ratio is a result of two

ARIZONA STATE factors: an increase of patients and a decrease of physicians. The number of patients increases dramatically due to the inability to effectively contain easily curable infections, while the mass exodus of these professionals diminishes the number of available healthcare providers [9]. Factors that Favor Emigration To achieve the goals described in the Millennium Goal Report, a thorough understanding of why physicians choose to leave their communities becomes vital. There are numerous push and pull factors that ultimately force African physicians to seek employment in the developed worlds. These factors can be broken down into two categories: societal and job-related [10]. Societal issues include ethnic strife and social inequality (i.e. apartheid) whereas job related issues include strenuous workloads, inadequate pay, and inability to advance professionally [10]. Remuneration is something that is often overlooked. Some may feel that leaving patients in need for monetary gain is strongly against the Hippocratic Oath, which stresses patient welfare above all else. Understanding that personal welfare is equally as important as a patient’s well-being goes a long way in explaining a physician’s choice to emigrate. Many sub-Saharan physicians find themselves living paycheck to paycheck, and oftentimes are unable to provide the basic necessities for their families, including an education for their children [11]. Based on simple economic principles, an increasing population combined with a dearth of doctors would yield a substantial increase in salaries for physicians. Unfortunately, raises are either rare or minimal in these developing nations, largely as a consequence of civil unrest and/or political corruption [12]. In addition to seeing more patients, many sub-Saharan physicians find themselves performing tasks that are normally reserved for professionals that require less training, such as nurses or pharmacists, who also have left sub-Saharan Africa to seek better lives [13]. Physician multitasking severely undermines healthcare delivery. The inability to delegate job duties to nurses and pharmacists results in less patients being treated, less time allotted to each patient and an overall decrease in the quality of the healthcare delivered. Reversing the Brain Drain Several solutions have been suggested to help keep physicians

References:

[1] J. Camaroff, Body of Power, Spirit of Resistance (The University of Chicago Press, Chicago, 1985) [2] K.A. Bentley, R. Southall, An African Peace Process (HSRC Press, Cape Town, 2005). [3] D.A. Bräutigam, S. Knack, Foreign Aid, Institutions, and Governance in Sub-Saharan Africa, EDCC 52, 255-285 (2004). [4] UN MDGS, The Millennium Development Goals Report, http://www.mdgs.un.org (2006). [5] B. Pond, B. McPake, The Health Migration Crisis: the Role of Four Organisations for Economic Cooperation, Lancet 367, 1448–1455 (2006). [6] WHOSIS, WHO Statistical Information System, http://www.who.int/whosis/ whostat2007/ en/index.html. [7] S. Anand, T. Barnighausen, Human Resources and Health Outcomes: Cross-country Econometric Study, Lancet 36,1603–1609 (2004). [8] U.S. Dept. of Health. Code of practice for the international recruitment of healthcare professionals, http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@

in their communities. Some aim to greatly increase the pay of physicians. Funding for these raises would be provided by programs that are aimed to prevent the spread of diseases such as HIV/AIDS, malaria, T.B., etc [13]. Increasing salaries of nurses and pharmacists will also help lessen the detrimental effects of placing too many job duties on physicians by keeping professionals from these two groups in their respective communities [13]. Providing incentives for African medical school graduates to practice in rural communities in the subSahara is vital as these areas are the most underserved [13, 14]. Of all physicians educated and trained in Africa, 86% come from Nigeria, Ghana and South Africa. Of this 86%, 79% come from 10 specific medical schools [14]. Programs aimed to entice students from these 10 medical schools would dampen the affect of years of physician migration [14]. Fair distribution of work duties, increased pay and additional programs aimed to retain medical students will likely be effective in minimizing the brain drain and slowly begin reversing its effects. African nations have actively tried to retain their physicians by creating a code of conduct for foreign nations to abide by when hiring healthcare professionals from abroad. These guidelines have been set at local, regional and national levels by many sub-Saharan nations in addition to several international organizations [8]. An integral part of this problem is the inability to determine where to place blame for the disparity: the private recruiting companies, the developed nations or the sub-Saharan nations. The American Department of Health constructed a code of conduct that clearly demands these recruiting firms and foreign nations pay fees to revitalize the failing health systems of these African nations. Other developed nations have similar measures in place that halt the acquisition of new physicians when there is a shortage, but interruption of the physician outflow in these developing nations is a rare event [8]. It is counterproductive to place blame solely on one of these three parties; it may be more productive to analyze why these African physicians are leaving Africa and what it will take to keep them in their communities. Ultimately, the ability to salvage the subSaharan health system lies in part with the ability of these nations in the region to retain their health professionals. Shifat Ahmed is a student at Arizona State University.

en/ documents/digitalasset/dh_4097734.pdf, (2004). [9] E.J. Mills, et al., Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?, Lancet 371, 685-688 (2008). [10] PHR. An Action Plan to Prevent Brain Drain: Building Equitable Health Systems in Africa,. http://physiciansforhumanrights.org/library/documents/reports/report2004-july.pdf, (2004). [11] D. McCoy, Economic and Health Systems Research on Health Workers in sub-Saharan Africa: Drawing out Themes from a Case Study of Malawi, http://www.ukzn.ac.za/heaRD/ERG/ERGMcCoy.pdf, (2008). [12] G. Oraeki, Nigeria: LG health workers get 15% salary increase in Bayelsa, http:// www.allafrica.com/stories/200712200296.html, (2007) [13] D. McCoy, et al., Salaries and Incomes of Health Workers in sub-Saharan Africa, Lancet 371, 675 – 681 (2008). [14] A. Hagopian, et al, The Migration of Physicians from sub-Saharan Africa to the United States of America: Measures of the African Brain Drain, HRH, 2:17 (2004) [15] http://www.istockphoto.com

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Enhancement for Health Versus Vanity in Human Genetic Engineering: Can We Draw the Line?

Amanda Waddell

e want to be faster. We want to be stronger. We want solely on the subjective diagnosis of a doctor [7]. Many treatments to be more beautiful. We want to be more intelligent. are later found to treat a range of health conditions once they are In today’s society, such qualities determine our social released. By observing the medicinal effects on various patients, placement. With pressure to fit these standards, people are the uses can be expanded. Therefore, there is a broader range of making the decision to physically alter themselves, from using people and conditions that can be treated, making the drug more pharmaceutical drugs to gene manipulation, in order to keep accessible. The next step for science technology in the world of pace with our advancing society [1]. With the recent identification of genes through the Human Genome Project, the possibility of medical diagnosis and treatment deals with the study of the finding specific genes that code for different traits and aspects effect of genetic expression on human development. With the of the human form is a viable one [2]. From these progressions, human genome identified, the idea of targeting specific genes people are expressing hope and precaution towards altering to alter specific human traits is becoming a distinct possibility specific genes at the germ-line as a means of change. Although [2]. With such technology, human genetic engineering hopes this idea arose for the intent of medicine and overall health, the to remove genes that code for disease, mutation, and other possibility for eugenics, using gene intervention to create an genetic aberrations as a means to eliminate their expression. By modifying the gene at the germ overall perfect person to society’s line, the condition would not be standards, is inevitable and a expressed in future offspring of the source of much uneasiness within Ethical concerns remain genetically modified individual [8]. society. This scientific breakthrough could regarding how embryos Personal enhancement has help to eliminate need for the large followed progress in science and would be tested throughout amounts of money, research, and medicine. Technologies originally time being used to fight disease by the developmental stage and developed to treat diseases or removing the disease altogether. other health problems are now throughout their life. Nevertheless, hesitations have being used for unintended stopped the progress of this genetic reasons: personal enhancement. advancement. Ever since the idea The treatments developed for many forms of health issues have shown to create enhancement arose in the early 1960s, this concept has been overshadowed on a person who does not express the corresponding health by ethical debate over research techniques and the indefinite issue [1]. Because the original intents of these technologies were possibilities for the future of this technology [9]. A main source considered socially acceptable, society continues to accept the of debate involves research and forms of testing. The research technology regardless of hesitations surrounding enhancement process involves experimental use of embryos. Ethical concerns options. Some cases where medical treatment has been used remain regarding how embryos would be tested throughout the for enhancement are the use of Ritalin, a drug to treat ADD developmental stage and throughout their life [8]. Additionally, and ADHD, for increased concentration [3], Human Growth this testing would occur only if the correct sequence is determined Hormone, a treatment to counteract stunted growth, for increased and the genetic transplantation can be identified as successful. height [4], and the insertion of the myostatin gene, used to treat If it is not successful, the debate arises as to what to do with the embryo, whether to continue its implantation despite a problem muscular dystrophy, for increased muscle mass [5]. Once these drugs are approved by the Federal Drug that could have taken place during the genetic modification Association (FDA), they become available to the general public. process, or to discard the embryo. From an ethical standpoint, Though the use of the drug is monitored, it is not completely many people and societies believe that an embryo is a potential controlled. The proven success of the drug, implied in the FDA’s person with a future, and therefore, deserves human rights [10]. approval, gives physicians and clinical researchers the opportunity The difficulty in researching and perfecting techniques of human to prescribe the drug or perform the treatment in cases where genetic engineering is the question of whether or not it is ethically he or she finds it necessary [6]. Dr. Gary Marchant, Professor and socially viable to use human embryos as test subjects, some and Executive Director Center for the Study of Law, Science & which would be discarded due to the experimental nature of Technology at the Sandra Day O’Connor School of Law at Arizona research [11]. Debates like these have halted the little research State University, argues that once a procedure or drug has been that has been conducted, putting all of this science at a standstill approved, it has the possibility of reaching anyone, depending based on a group of people’s moral outlooks.

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ARIZONA STATE

The intentions of human genetic engineering cannot help but perplex researchers, policy makers, and society. If the technology can be developed to eradicate disease, it would have the potential ability to change anything related to the human genome--anything from physical attributes to intellectual capabilities can, to some extent, be manipulated at their source [12]. There is even a possibility that the range of human emotion could be censored to eliminate feelings of hurt, sadness or stress [13]. With the trends seen with the other enhancement drugs and treatments, it can be predicted that advances in personal enhancement will parallel the progression in health. It can be seen from the use of drugs and treatment in the past that people are willing to invest in these eugenic concerns. Policy makers, unwilling to let eugenics make its way into the project, have been developing ways to incorporate censorship into this project [14]. Here, the governing body over the research and development of this project could state which diseases could be altered and which ones would not. However, like prescription drugs, there are ways that genetic modification will adapt to the vanity aspect of society. Along the lines of eugenics, this technology does have the possibility of altering everything from health to beauty. On the other hand, the idea of selecting for a trait of a future offspring has been happening for years. For much time, people have selected mates based on physical, intellectual, and emotional traits as a means of their translation into a possible offspring. This idea, coined ‘directed evolution’ by Maxwell J Mehlman, has been an ongoing process, assisted recently with scientific technology [15]. Today, people have the opportunity to choose sperm and/or eggs from people with specific traits in in vitro fertilization. Even the sterilization of some traits has been tried with help from this advancement. As reproductive technology improves, the chance to select traits of a potential offspring becomes a viable option [15]. A References:

[1] Human Enhancement and the Means of Achieving It. The American Association for the Advancement of Science. Cited Washington DC : June 2006. Available at http:// www.aaas.org. [2] Copeland NG, Jenkins NA, O’Brien SJ. Mmu 16—comparative genomic highlights. Science 2002; 296:1617-1618. [3] College Students Using Ritalin® to Study, Get High. National Drug Study Network. Available at http://ndsn.org/. [4] Hellerman Caleb. Human growth hormone use rises, but is it legal? CNN Health. May 9, 2007. Available at http://www.cnn.com/2007/HEALTH/. [5] Ruder Kate. Strong Boy Could Benefit Research on Muscular Dystrophy. Genome News Network. Available at http://www.genomenewsnetwork.org. [6] Laws Enforced by the FDA and Relative Statutes. USA Food and Drug Association. Available at http://www.fda.gov. [7] Dr. Gary Marchant [Personal Interview]. November 7, 2008. [8] Dresser Rebecca. Designing Babies: Human Research Issues. IBR: Ethics & Human Research. 5th ser. 26 (September-October 2004). [9] Martin Paul. From Eugenics to Therapeutics: The Impact of Opposition on the Development of Gene Therapy in the USA. The Social Management of Genetic Engineering. By Peter Wheale. Grand Rapids: Ashgate, Limited, 1998. [10] Marquis Don. Why Abortion is Immoral. Six Problems in Applied Ethics. Comp.

natural instinct drives a parent to want the best possibly future for their offspring. Therefore, the desire to have traits that have been deemed successful by society would only improve chances of a promising future. Genetic modification, even if for enhancement purposes, would only expand upon similar selection technology available today. Working with genes comes with an added risk, based on their complexity. The genes coding for the trait would need to be distinguished to have clear phenotypic, physically expressed, connection to the specific genotype [16]. If there is not a strong correlation, it can be hard to predetermine the actual expression of the gene over time. Also, many diseases and mutations are polygenic, related to a sequence of genes, or even result of multiple gene interaction [17]. This would cause even more difficulty in the identification of the problem and performing the genetic modification. This complexity will directly lead to difficulty in further advancement of genetic manipulation. The advancement of human genetic engineering has been and will continue to be laced with debate. But, should the possibility for eugenic enhancement determine whether disease, mutation, and other gene-related abnormalities should be treated in this manner? By looking too far into the future, the original goal of the project is overlooked. Although using this technology for enhancement can be expected over time, the opportunity to eliminate disease and other health issues should drive the continued research and application of human genetic engineering. By halting research and development, it may be sacrificing great strides that could be taken in disease and the development of future generations. Until the divide between intention and fear of expansion becomes clear to all, advancement will be at a standstill. Amanda Waddel is a student at Arizona State University. Ted Guleserian. 3rd ed. Mason, OH: Thomson, 2006. [11] Culver KW. Gene Repair, Genomics and Human Germ Line Modification. Designing Our Descendants : The Promises and Perils of Genetic Modifications. Ed. Audrey R. Chapman and Mark S. Frankel. New York: Johns Hopkins UP, 2003. [12] Duster Troy. The Hidden Eugenic Potential of Germ-Line Interventions. Designing Our Descendants : The Promises and Perils of Genetic Modifications. Ed. Audrey R. Chapman and Mark S. Frankel. New York: Johns Hopkins UP, 2003. [13] Love Rosaleen. Deleting Sadness? Clones and Designer Babies. Recoding Nature : Critical Perspectives on Genetic Engineering. Ed. Richard A. Hindmarsh and Geoffrey Lawrence. New York: University of New South Wales P, 2004. [14] Cohen Cynthia B. Designing Tomorrow’s Children: The Right to Reproduce and Oversight of Germ-Line Interventions. Designing Our Descendants : The Promises and Perils of Genetic Modifications. Ed. Audrey R. Chapman and Mark S. Frankel. New York: Johns Hopkins UP, 2003. [15] Mehlman Maxwell J. Whither Man [Lecture]. November 12, 2008. [16] Wenstrom KD. The correlation between genotype and phenotype. Recombinant DNA Advisory Committee. Prenatal Gene Transfer: Scientific, Medical and Ethical Issues. 2000. Available at http://www4.od.nih.gov/oba/rac/gtpcreport.pdf. [17] Parens E. Genetic differences and human identities: On why talking about behavioral genetics is important and difficult. Hastings Center Report 2004 [18] http://www.istockphoto.com

THE TRIPLE HELIX Spring 2009

CORNELL

Avastin: Questionable Hope During Desperate Times Jane Yang

hen a patient with advanced cancer faces a bleak prognosis, the “wonder drug” Avastin appears as a tantalizing promise for a longer life. Manufactured by Genentech, Avastin is a monoclonal antibody that combats cancer cells by disabling vascular endothelial growth factor, which, in turn, severs nutrient supplies to cancer cells. Praised for this combative mechanism, Avastin is one of the most popular cancer drugs worldwide [1]. But even during desperate times, is this drug a worthwhile investment? Recently, Avastin has been criticized for its inability to extend patients’ lives, which is especially troublesome considering the costliness of the drug. Avastin failed its first trial against breast cancer and only slowed the growth of colorectal cancer when compared with current chemotherapy. Despite such drawbacks, patients desperate for the slim chance of survival are willing to give Avastin a chance. And so the dilemma presents itself: on the one hand, this cancer drug is a beacon of hope for patients who have no other options; however, these patients may also be pouring money into a treatment that can theoretically prolong life for a few months, if at all. Furthermore, the price of this drug is so high that some patients do not have the luxury of receiving treatment. In the case of Avastin, the controversial approval by the Food and Drug Administration, compounded with its costly charges and debatable advantages, creates a multitude of problems for the patients [1]. Avastin: Mechanism, Treatment, and Side Effects Avastin, also known as bevacizumab, is a monoclonal antibody that is specifically designed to attack one target— vascular endothelial growth factor. By binding to vascular endothelial growth factors, Avastin inhibits the growth factors’ interaction with tyrosine kinase receptors found on the cell surface. This growth factor plays a key role in regulating angiogenesis, the physiological process of blood vessel growth. Research has shown that inhibiting angiogenesis may be an effective method to combat cancer, because it would separate nutrient and oxygen sources from cancer cells. In doing so, Avastin halts the growth of tumors and delays the worsening of cancer [2]. This mechanism would possibly extend the life span of patients. Avastin first arrived on the market in 2004, fifteen years after its initial development. The FDA approved the drug for treatment of metastatic colorectal cancer when it was found to extend patient life by four months. In 2006, the drug was approved for lung cancer treatment, and was recently approved in February 2008 for treatment of breast cancer. Patients using this drug reported an improvement in the quality of life, such as alleviation of pain and exhaustion [1].

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Avastin is able to enhance the beneficial effects of chemotherapy, but is not effective when used alone [1]. It also displays certain side effects that are particularly detrimental, such as blood clots, perforation of the colon, heart failure, and kidney damage. In rare instances, Avastin was shown to cause inflammation of the eye [3,4]. Testing for Efficacy One research study demonstrated that there was little difference between patients who took the drug and those who only had chemotherapy and a placebo [1]. Furthermore, many studies proposed the use of Avastin with standard chemotherapy drugs, such as Taxol. In these dual drug prescription cases, the patient inevitably experiences the side effects of chemotherapy, an adverse reaction Avastin originally meant to avoid [1,5]. In its first clinical trial, Avastin failed to meet its goal of delaying the worsening of cancer [1]. Out of 363 female patients who received Avastin for treatment of breast cancer in another trial, five or six patients died from the drug itself [6]. In a phase III trial, 722 patients were treated with either paclitaxel, a chemotherapy drug, or Avastin with paclitaxel. The results from the trial showed that Avastin doubled median progression-free survival, the time during which the disease did not worsen, from 5.9 months to 11.8 months [7]. Dr. Ian Haines of Monash University in Melbourne, Australia, however, claims that progression free-survival was “an unreliable measure of benefit in metastatic cancer” [8]. Additionally, the overall survival time among patients who received Avastin with paclitaxel was similar compared to those who received paclitaxel alone. Results exhibited a statistically insignificant improvement of 1.5 months. In the same study, incidences of hypertension, proteinuria (excess of proteins in urine), and headaches were higher in patients who received Avastin with paclitaxel [7]. Expensive Promises On top of its questionable efficacy, Avastin also wields a high price tag. As one of the most popular drugs in the world, Avastin accumulated $3.5 billion in sales worldwide in 2007. The extension of the drug’s use to breast cancer was predicted to help Genentech’s sales by $1 billion or more per year [6]. Using this drug can cost from $4000 to more than $9000 a month. Therefore, one patient spends roughly $100,000 a year—a high price tag considering only about five percent of patients benefit significantly from the drug [1]. The rising costs of cancer drugs in general have prompted some insurance companies to begin restructuring their tiered copayment policies, which assign a fixed amount for the patient to pay

CORNELL to the type of drug. Avastin, now considered a tier 4 drug for its high cost, will require “coinsurance.” Unlike copayments, coinsurance charges a percentage, usually 20 to 33% of the cost [10]. Therefore, a patient can pay up to $20,000 a year in order to sustain treatment. Genentech justified these costs as years of costly research, testing, and approval processes— all amounting to the “‘high side’ of the industry average” [1]. Compared to other cancer drugs that attack a tumor’s blood supply, Avastin is second highest in cost behind Bristol-Meyers’ Erbitux, which costs $9,600 per month. Unlike most other cancer drugs that target one cancer type, Avastin is approved for three types of cancer, which broadens its influence in the drug market [9]. FDA’s Role Leads to Bigger Question In 2008, the U.S. Food and Drug Administration approved Avastin for advanced breast cancer against the advise of its panel experts [1]. Some factors the FDA considers for efficacy of cancer drugs are survival, quality of life, tumor response, and time until treatment failure, with survival and quality of life as the primary parameters. Even though the requirement of survival is inconsistent among different classes of drugs, survival is the main concern of metastatic cancer patients [11]. The vote against approval of the drug by the FDA’s advisors was a slim 5-4 margin in December 2007. Based on data from clinical trials, the panel of experts, comprised of oncologists and patient representatives, was not convinced of Avastin’s ability to improve the patient’s quality of life or prolong their lifespan. Trials also demonstrated the toxic effects of the drug [6]. References :

[1] Kolata G, Pollack A. Costly cancer drug offers hope, but also a dilemma. The New York Times 2008 Jul 6 < http://www.nytimes.com/2008/07/06/health/06avastin. html?ref=policy>. [2] Muhsin M, Graham J, Kirkpatrick P. Bevacizumab. Nature 2004 Dec; 3:995-996. Shih T, Lindley C. Bevacizumab: an angiogenesis inhibitor for the treatment of solid malignancies. Clinical Therapeutics 2006 Nov;28[11]:1779-1802. [3] Fintak DR, Shah GK, Blinder KJ, Regillo CD, Pollack J, Heier JS, Hollands H, Sharma S. Incidence of endophthalmitis related to intravitreal injection of bevacizumab and ranibizumab. Retina 2008 Sept 26. [4] Mitchel L. New anticancer drugs can trigger hypertension; Cardiovascular Medicine; Report. Internal Medicine News 2008 Jul 1;41[13]:36. [5] De Gramont A, Van Cutsem E. Investigating the potential of bevacizumab in other indications: metastatic renal cell, non-small cell lung, pancreatic and breast cancer. Oncology 2005 Nov 21;69:46. [6] Pollack A. Advisory panel rejects new use for cancer drug. The New York Times 2007 Dec 6 <http://query.nytimes.com/gst/fullpage.html?res=9F03EEDD123AF935A35 751C1A9619C8B63&fta=y>. [7] Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, Shenkier T, Cella

The FDA ultimately overruled their advisors’ decision, because Avastin reduced tumor volume and increased progression free-survival [6]. From their standpoint, the drug’s ability to hamper disease progression overshadowed its toxicity. These two opposing opinions raise issues that plague guidelines for approving cancer drugs: what should determine the efficacy of a cancer drug— its ability to prolong life, or its ability to delay the worsening of cancer? In a clash between a federal agency and its advisory committee, whose opinions should dominate? [1]. While some experts like Dr. Haine believe progression free-survival is an unreliable indicator, supporters of the drug believe that Reproduced from [14] the goal of the drug is to “maximize disease control and quality of life, thereby, sparing patients for as long as possible from symptoms of progressive breast cancer … and the psychological burden and uncertainty that come with progression” [8]. The case of Avastin epitomizes the ambiguities surrounding the cancer drug approval process. Although increased survival is the main criterion for approval of a drug, the FDA based its decision on a drug’s ability to control disease. This form of measurement for efficacy is still debatable among experts. For the past four years, Avastin demonstrated its staying power in the cancer drug market. Currently, Avastin is studied as a potential treatment for eye diseases and even brain cancer, one of the most formidable cancers [12,13]. However, if an expensive drug delays disease progression but does not extend life, it may not be as cost-effective as manufacturers, regulators, or patients have hoped. Jane Yang is currently a student at Cornell University. D, Davidson NE. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 2007 Dec 27;357[26]:2666-76. [8] Haines I. Paclitaxel plus bevacizumab for metastatic breast cancer. N Engl J Med 2008 Apr 10; 358[15]:1637-1638. [9] Berenson A. A cancer drug shows promise, at a price that many can’t pay. The New York Times 2006 Feb 15 <http://www.nytimes.com/2006/02/15/business/15drug. html?scp=3&sq=avastin&st=cse>. [10] Lee TH, Emanuel EJ. Tier 4 drugs and the fraying of the social compact. N Engl J Med 2008 Jul 24;359[4]:333-5. [11] Johnson JR, Temple R. Food and drug administration requirements for approval of new anticancer drugs. Cancer Treat Rep 1985 Oct; 69: 1155-1159. [12] Lu F, Adelman RA. Are intravitreal bevacizumab and ranibizumab effective in a rat model of choroidal neovascularization? Graefes Arch Clin Exp Ophthalmol 2008 Sep 10; 247(2):171-7. [13] Desjardins A, Reardon DA, Herndon JE 2nd, Marcello J, Quinn JA, Rich JN, Sathornsumetee S, Gururangan S, Sampson J, Bailey L, Bigner DD, Friedman AH, Friedman HS, Vredenburgh JJ. Bevacizumab plus irinotecan in recurrent WHO grade 3 malignant gliomas. Clin Cancer Res 2008 Nov 1; 14(21):7068-73. [14] http://www.fda.gov/oc/tfrm/image17.gif

THE TRIPLE HELIX Spring 2009

BROWN

Nose Job: A Work in Perfection Jack Cossman & Quynh-Giao Nguyen “Behold the nose that mars the harmony Of its master’s phiz! blushing its treachery!”

o Cyrano de Bergerac says of his infamous nose [1]. In response to his dull critics, Cyrano rattles off a list of intelligent insults for his big nose, a demonstration of pride for possessing a nose of such size. In reality, Cyrano’s pride is hard to come by---v; many Westerners are dissatisfied with their appearance and rely on cosmetic procedures for permanent change. This is not a recent phenomenon, though. Indeed, the attempts to reconstruct, correct, and perfect the organ through rhinoplasty—a common subdivision of plastic surgery— are ancient, passing through Indian, European, and American civilizations. Rhinoplasty today hardly resembles its earliest stages of evolution, but the desires and principles underlying the procedure today are a modern translation of those surrounding a procedure integral to human history. The Nose in Ancient Indian Society Nasal surgery dates back over 3000 years to ancient Indian society. In its earliest forms, nasal surgery existed as deliberate mutilation of the nose, most notably rhinectomy—complete or partial excision of the nose. Hindus had regarded the nose as a symbol of honor and respect, an organ that is readily apparent and not easily concealed [2]. It was in fact common in ancient Indian society for children born with facial defects to be killed at birth or left to die, an act to spare the disfigured child from “diminished social acceptability” [3]. Thus, those with congenital nasal defects rarely reached an acceptable age to undergo surgery to correct the nose. As the nose was symbol of self-pride, it is not surprising, then, that the nose was the target of punishment, through rhinectomy, for the convicted. The Hindus created a specific term, nacta, to describe this procedure [2]. As early as 1500 B.C.E., cultures in areas such as the state of Gujarat cut off the noses of women condemned of witchcraft. The common procedures of nose amputation in India eventually led to nasal reconstruction, a procedure more similar to our modern definition of rhinoplasty [2]. The techniques learned from nacta allowed surgeons to more proficiently operate on the nose, and, in conjunction with a rise in need for nasal repair, led to the invention of techniques to repair the mutilated or congenitally deformed nose. Since the nose was regarded with esteem, the advent of nasal correction quickly gained popularity. Notable during this period was surgical pioneer Sushruta (600 B.C.E.), who discovered and recorded techniques of nasal reconstruction in his book Sushruta Samhita [3]. After 600 B.C.E., Hindu medicine transformed from being a superstitious art to a more practical craft. Sushruta fathered one of the earli-

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est forms of rhinoplasty, using a method of removing flaps from the cheek to reconstruct a nose. His Indian successors then created a variation of Sushruta’s method using skin flaps from the adjoining forehead instead of the cheek, what is now known as the “Indian Method” [2]. The Indian Method finally allowed people with nasal defects to achieve a semblance of societal acceptance and personal satisfaction. Evolution of Rhinoplasty in Europe Conservatism, or the belief of plastic surgery as bodily desecration, buried most worldwide practices of plastic surgery, including rhinoplasty, after Sushruta’s time until the Renaissance. In Renaissance Europe, anatomical discoveries and medical innovations blossomed in combination with artistic, scientific, and societal advancements. The advancements effectively moved rhinoplasty into the realm of reconstructive surgery, owing to the increasing numbers of syphilis-sufferers, punished thieves, and duel-losers whose noses had been chopped off in brawl [4]. Additionally, as human anatomy was explored and glorified, it became increasingly taboo for society to accept somebody with a visible deformity, especially if it involved the nose [4]. Driven by inquiry and demand, plastic surgery grew into a field increasingly more scientific and aesthetic. Beginning in the fifteenth century, more or less contemporaneous with Leonardo da Vinci—whose anatomical drawings and medical treatises spurred further medical inquiry—were the Brancas, a Sicilian family of surgeons known for developing new plastic techniques. In regards to their new rhinoplasty technique, Italian poet Elisio Calenzio wrote in a 1442 letter: “Branca of Sicily… has found out how to give a person a new nose, which he either builds from the arm or borrows from a slave…. Now if you come, you shall return home with as much nose as you please. Fly!” [3] Their practice is not only credited with introducing the Indian rhinoplasty to Europe but also of apprenticing Gaspare Tagliacozzi (1545-1599), who perfected the Branca technique and formalized a consistent procedure of rhinoplastic surgery [3]. Although this procedure became highly praised, surgery in Europe languished again for several hundred years after Tagliacozzi when conservatism again prevailed [5]. Despite this conservatism, plastic surgery and rhinoplasty as medical practices did not fall into oblivion. The practices continued, but broader medical concerns, arising specifically from the lack of anesthesia, prevented rhinoplasty from becoming a commonly performed procedure. Throughout the nineteenth and early twentieth centuries, surgeons continued to publish

BROWN new techniques, shaping rhinoplasty into a standardized procedure [6]. The World Wars then accelerated the development of reconstructive surgery in response to increasingly severe facial injuries. Improved reconstructive techniques inspired surgeons to expand the market for aesthetic surgery, including rhinoplasty [7]. While rhinoplasty had always served to recreate an appropriate nose, the capabilities to aesthetically enhance the nose began to improve. Rhinoplasty in the Modern World Thereafter rhinoplasty entered mainstream Western medicine, its ancient cultural roles transforming into a modern practice. Just as it was removed to decrease social status in ancient India as well as glorified in Renaissance art and medicine, the nose today is aesthetically perfected to promote a sense of self-worth and societal acceptance. Even corrective and reconstructive rhinoplasties consider the natural aesthetics of the nose. According to Rhode Island Hospital cosmetic and reconstructive surgeon Lee Edstrom, M.D., “One end [of rhinoplasty] is the purely cosmetic and the other end is the purely reconstructive or corrective. But most of the things [surgeons] do are in the middle, a combination of the two” [8]. Although modern techniques have advanced from the earliest forms of rhinoplasty, the goal is still to render the nose both functional and aesthetic. Despite that aestheticism is always the goal of a rhinoplasty, the ancient connection between aesthetics and status, social and personal, has been lost. Whereas older societies consciously perceived the nose, independent from other features, as a symbol of status, modern Westerners tend to focus on the nose’s relationship to its surrounding features [7]. According to Edstrom,

References:

[1] Rostand, E. Cyrano de Bergerac: A Play in 5 Acts. Simon and Schuster; 1897. [2] Brain, DJ. The Indian Contribution to Rhinoplasty. Journal of Laryngology and Ontology 1988 Aug;102:689-693. Available from: Cambridge. http://journals. cambridge.org/. [3] Walter, C. The Evolution of Rhinoplasty. Journal of Laryngology and Ontology 1988 Dec;102:1079-1985. Available from: Cambridge. http://journals.cambridge.org/. [4] Bishop, WJ. The Early History of Surgery. New York: Barnes and Noble Books; 1995.

any aesthetic enhancement is considered an “economic luxury” and, thus, not ordinarily reimbursed by insurance companies [8]. Insurance companies today have, therefore, categorized cosmetic rhinoplasty as inessential and distinct from medical procedures. This distinction is further noted in malpractice regulations: The law will protect a patient when an improper rhinoplasty jeopardizes health, but offers little protection when a patient is only unhappy with the outcome [8]. By categorizing aesthetic rhinoplasty as a non-reimbursable and superfluous procedure, the modern medical system connotes that ailing self-esteem and pride have little value in the conception of human health and wellbeing. Whether modern rhinoplasty is an economic luxury or a necessity, concerns for nasal aesthetics are consistent with the focus placed on the nose throughout human history. The nose was denigrated as punishment and also glorified as beauty; as the centermost feature of the face, civilizations have given it a status equivalent to the entire human identity. However, most modern perceptions of rhinoplasty regard it as a procedure completely unrelated to social evolution. Indeed, society has evolved to the point that medical procedures are taken for granted without understanding how a procedure fits a modern definition. Although rhinoplasty today is sought as a readily accessible option for beautification, the fundamental desire to perfect the nose is not a new notion for human history. Modification of the nose has always been symbolic for a status or identity change. A rhinoplasty is more than a mere nose job: it is central to historical human conceptions of beauty, status, and health. Jack Cossman and Quynh-Giao Nguyen are currently students at Brown University.

[5] Zimbler, MS. Gaspare Tagliacozzi (1545-1599). Arch Facial Plastic Surgery 2001 Oct-Dec;3:283-4. [6] Lupo, G. The History of Aesthetic Rhinoplasty: Special Emphasis On the Saddle Nose. Aesthetic Plastic Surgery 1997;21:309-327. [7] Gilman, Sander L. Making The Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton: Princeton University Press; 1999. p.3. [8] Edstrom, L. Interviewed by: Nguyen, Q. 8th Dec 2008. [9] http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/10173.jpg

THE TRIPLE HELIX Spring 2009

YALE

Urban Agriculture: Farming of the Future Sonia Singhal

rban agriculture” sounds like an oxymoron; agriculture is normally associated with large fields in rural areas, not the hustle and bustle of a city. Interestingly, many cities around the world have citizens who practice farming. For very poor families, keeping a small garden can be one of the main ways to bring food to the table. However, the practice is expanding to include a wide range of citizens, not just impoverished ones. Urban farming allows city-dwellers to receive fresh produce, cuts down on transportation of food to the city, and even heightens city aesthetics. Ultimately, urban agriculture increases the sustainability of food consumed in cities.

and speed were emphasized over quality [3]. Our current food production system relies heavily on coal, oil, and natural gas. Fertilizers and pesticides are made out of petrochemicals (petroleum or natural gas); fossil fuels are also required to run the machines that harvest, process, and transport crops. A single calorie of food requires 10 to 15 times as much fossil fuel energy for its production and distribution [3]. The food sector uses 17% of our national supply of fuel—more than any other sector [1, 3, 4]. With oil supplies diminishing, it is doubtful whether the current system of food production can be sustained for future generations [3, 5].

Sustainability and food Growing food is the “ultimate green energy” [1]. Plants are able to store energy they receive from sunlight by converting it into sugar. Later on, the plants (or the animals that eat them) break the sugar back down into its components to use the stored energy for mechanical work. This system does not require fossil fuels in order to run. For centuries, the energy used to produce food came from solar or other renewable energy resources [2]. In the mid-1900s, the Green Revolution changed the food production system to facilitate large scale growth and transportation of food. To feed the maximum number of people, quantity

Organic farming One way to make food production sustainable is to grow it organically. Organic farming cuts down on the use of petrochemicals in the growing process by eliminating fertilizers and pesticides. Instead, organic farmers use natural cycles to keep their crops healthy. For example, solar farms in Argentina rotate beef and grain in an 8-year cycle, growing beef on grass for 5 years and then using the land to grow grain for 3 years. Waste products from the cattle create large deposits of nitrogen, an essential nutrient for plants. After five years of such nitrogen buildup, wheat thrives, but weeds do not. Similarly, by rotating wheat and potato crops, farmers can lower the number of potato pests [1]. For all its benefits, though, traditional organic farming continues to use fossil fuels for transportation. Organic food sold in stores is often shipped thousands of

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YALE miles from a distant farm, perhaps even from another country [6]. Local production of food needs to be an integral part of sustainable agriculture. Farming in the city At first glance, the city may not seem like the ideal place for food production. Just finding space to grow food seems to be a daunting task. However, urban agriculture has much to offer cities. It allows food to be produced locally, reducing the carbon footprint of transportation. It means that city-dwellers, too, can receive fresh fruits and vegetables. Finally, the green spaces created by urban farms can enhance a city’s aesthetic appeal. Grassroots urban farming Particularly in times of economic stress, urban agriculture can help offset the severity of a food—and money—shortage. For example, during World War II, 20 million Americans planted Victory Gardens to help with the war effort and provided 40% of the nation’s supply of produce [7, 8]. Urban farmers in third-world countries like Ghana, Tanzania, and Guinea Bissau are able to provide substantial percentages of their city’s fresh produce, meat, and dairy, from 10% up to 90% or even 100%. Moreover, around the globe, impoverished families that practice urban agriculture have greater food security than families that do not [9]. The increasing popularity of urban agriculture can be seen in the successes of sustainable and organic community gardens across the United States. The New Haven Land Trust in New Haven, Connecticut, which initially established three community gardens in 1991, now helps neighborhoods manage more than 40 [10]. On a broader scale, the Urban Farming non-profit organization manages 600 different community gardens in 15 cities and 5 countries [8], including Newark, Los

Angeles, Detroit, and Montego Bay, Jamaica [11]. The gardens are usually planted in vacant lots in impoverished inner city regions; otherwise, Urban Farming will use any and all available space to create a garden, including rooftops, mall planters, and even walls [11]. Proponents of community gardens are setting their sights even higher: In an open letter to the President, Michael Pollan proposes that five of the White House lawn’s 18 acres be used to create an organic garden [7]. Community gardens bring many advantages to a neighborhood in addition to food. Planting gardens in run-down areas brightens them up with greenery and encourages its citizens to fix up their own homes and yards [8]. Urban Farming encourages businesses to incorporate edible landscaping into architectural designs [11]. Most importantly, the gardens act as community centers to bring together and educate the people of the neighborhood. Citizens learn about farming, science, and health by helping to plant food. They can also develop business techniques and entrepreneurship by selling the produce they grow and by managing the gardens. However, community gardens take time, effort, and

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YALE money to implement and sustain. Ideally, the community would eventually learn to keep and manage the garden on its own, without outside help. The reality of it, though, is often quite different. The New Haven Land Trust, for example, must buy compost for the gardens from another municipality [10]. In impoverished neighborhoods in Detroit, it can be hard to keep people involved in the gardens. Although they are interested by the idea and willingly pick the food for their tables, numerous other stresses often leave them with no motivation or energy to do much more [8]. In addition, communities are allowed to plant in their garden whatever they would like. While this helps to raise people’s investment in the garden, a truly self-sufficient urban farm would need to take into account the plants that best grow in the region and establish a rotation system to prevent depletion of nutrients in the soil. Vertical farming A revolutionary attempt to commercialize urban farming was first put forth in 1999 by Dickson Despommier, a professor of microbiology at Columbia University. Over the past five years, Despommier and his students at Columbia have been developing the concept of a vertical farm—growing crops and small livestock on every floor of a 30-story, city blockwide skyscraper. Growing food indoors is not a new concept. Greenhouses are already widely used to grow plants that might not survive the region’s climate or that have particular care requirements. What makes Despommier’s proposal unique is its scale. Not only would the farm take up an entire building, but it would also use automated, state-of-the-art technology to closely monitor plant growth [12]. According to Despommier, the design is not only sustainable but would also have a significantly reduced carbon footprint [13]. This would be accomplished by recycling wastes and resources. Waste water, for example, would be filtered through plants, gravel, and mussels, then re-circulated back through the building. Similarly, by having a number of different plants and animals in the same location, one can take advantage of their complementary strengths and needs. Hydroponic systems, in which plants are grown on a layer of water rather than in soil, require that nutrients be consistently replenished, while fish tanks need a constant supply of clean water. Combining the two might alleviate both problems: Fish wastes would provide nitrogen-rich References:

1. Gross T, Miller D. Food as a National Security Issue. Fresh Air from WHYY [radio program]. National Public Radio; 2008 Oct 20. 2. Gianpietro M, Pimentel D. The tightening conflict: Population, energy use, and the ecology of agriculture. 1994 [cited 2008 Dec 1]. Available from http://www.dieoff. com/page69.htm. 3. Tomczak J. Implications of fossil fuel dependence for the food system. Tompkins County Relocalization Project. 11 December 2005 [cited 2008 Dec 1]. Available from Energy Bulletin. http://www.energybulletin.net/node/17036. 4. Pimentel D, Gianpietro M. Food, land, population, and the U.S. economy. 1994 [cited 2008 Dec 1] Available from http://dieoff.org/page40.htm. 5. Church N. Why our food is so dependent on oil. Powerswitch 2005 Apr 1. Available from Energy Bulletin. http://www.energybulletin.net/node/5045. 6. Organic food miles take a toll on the environment. Science Daily [online]. 2007 June 7 [cited 2008 Dec 1]. Available from Science Daily. http://www.sciencedaily.com. 7. Pollan M. The food issue: An open letter to the next farmer in chief. N.Y. Times

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nutrients for the plants, while the plants would filter the water [14]. One of the most attractive aspects of the vertical farm is that it gives cities high food security. Each crop is given the precise light, nutrient, and water requirements that it demands, ensuring stable growth. Because production is indoors, crop yield is independent of climate change, natural disaster, and disease. Furthermore, food can be produced year-round, giving cities access to a variety of exotic and out-of-season produce [13]. Farmers of the future Although fully-automated, vertical farms can also act as important education centers, allowing students and citizens alike to gain sophisticated training in plant growth and technology [8]. Without education, sustainable agriculture cannot be maintained in any location. Farmers of the next generation will require interdisciplinary knowledge for sustainable agriculture [1, 8]. Whether students, citizens, or workers, farmers must understand how various factors such as climate, compost, and surrounding plants influence crop growth. Organizations such as the New Haven Land Trust and Urban Farming already include this educational component in their construction of community gardens. College campuses can also train farmers of the future. Yale University was planning to use the flat rooftops of Morse and Stiles Colleges to grow native grasses and flowers. The plants would not only serve as habitats for birds and insects, but also reduce energy needs by cooling the buildings and filter rain runoff for reuse in toilets and showers. Such a design could also incorporate urban agriculture. A sustainable garden on a university campus would be a living laboratory, where students could learn hands-on about agriculture and the biology of food. To involve students from all disciplines, the gardens could be used to field-test growing techniques for community gardens or new technology for vertical farms. “Urban agriculture” may sound like an oxymoron today. But an increasing population and changing climate may make farming in the city an important contributor to the food supply in the future. Sonia Singhal is an undergraduate at Yale University.

[newspaper online]. 2008 Oct 9 [cited 2008 Dec 1]. Available from The New York Times Magazine. http://www.nytimes.com. 8. Sevelle T. Presented at the Urban Farming Panel sponsored by Yale Sustainable Food, New Haven, CT. 2008 Nov 6. 9. Mougeot LJA (Ed.). Agropolis: The Social, Political, and Environmental Dimensions of Urban Agriculture. London: Earthscan; 2005. 10. Randall C. Presented at the Urban Farming Panel sponsored by Yale Sustainable Food, New Haven, CT. 2008 Nov 6. 11. Urban Farming [homepage on Internet]. [cited 2008 Dec 1]. www.urbanfarming.org. 12. Ehrenberg R. Let’s get vertical. Science News 2008 Oct 11;174:16-20. 13. Despommier D. The Vertical Farm Project [homepage on Internet]. 2008 [cited 2008 Dec 1]. http://verticalfarm.com. 14. Kuang C. Farming in the sky. Popular Science 2008 September 4 [cited 2008 Dec 1]. Available from Popular Science. http://www.popsci.com. 15. http://iloapp.greenroof.dk/data/_gallery/public/7/1223163682_resized.jpg

YALE The Large Hadron Collider: Politics, Pride, and Priorities in Particle Physics Jonathan Yeh

n August of 1982, a bold proposal was put forth by Dr. Leon M. Lederman, director of the Fermi National Accelerator Laboratory (Fermilab) in Chicago, Illinois. After fifteen years of operation, the particle accelerator at Fermilab had become worn down and was in need of expensive upgrades. A project to make another particle accelerator, ISABELLE, at the Brookhaven National Laboratory in New York, was dropped after three years of poor planning and designing. Dr. Lederman proposed to set aside

them apart into smaller, constituent particles which are not seen under normal conditions. One such particle is the Higgs boson, or what Dr. Lederman famously called the “God Particle,” in the title of his 1993 book. This infinitesimal particle, hypothesized for decades under the Standard Model of quantum theory, is important because it gives all other particles their mass. The discovery and analysis of the Higgs Boson would teach physicists much about how and why objects have mass – a fundamental property of

both machines in favor of a larger and more powerful particle accelerator [1]. It would be a behemoth – a massive monster of a particle accelerator roaring underneath the Texan desert—and would have 20 times more energy than the existing accelerator at Fermilab.

all matter in the universe. [3]. Because of its small size, only a strong-enough accelerator can generate the powerful collision needed to prove Higgs Boson’s existence. To meet this goal, the Superconducting Super Collider (SSC) was approved for construction in 1987, after years of extensive review [1]. Nearing the end of a military nuclear arms race, the United States did not intend to lose the analogous academic race in experimental nuclear physics, in which it had long dominated. Once completed, the SSC would be the most crucial machine of modern physics, Texas would be home to the most groundbreaking

A Dream Deferred The purpose of the particle accelerator was simple: take two particles, smash them together with as much energy as possible, and observe the result. The energy of the particles’ collision would break

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YALE experiments of the coming century, and America would stand at similar opinions; drawn to the field of high-energy physics by the pinnacle of the scientific world forever – or so it seemed. the prospect of a fundamental breakthrough, they did not want The SSC project soon ran into difficulties. Congress had to miss this exciting new opportunity, regardless of which side originally been told that the project would cost $4.4 billion; after of the Atlantic it ultimately occurred. six years and multiple design issues, the price tag had leapt to But even if high-energy physics was worth the intellectual over $12 billion. Worse yet, international financial investment in effort, would it be worth the huge financial sacrifices as well? the project dwindled as investors in Japan and Taiwan realized Faced with limited finances, the Department of Energy would that they would be paying large sums of money and receiving have to cut funding at American physics laboratories in order to little credit or practical use for the research. Europe, meanwhile, contribute to the LHC, which, like its doomed predecessor, was was preparing to rally behind its own project at the European looking more and more expensive as the project evolved [5]. As Organization for Nuclear Research (CERN) and was not inclined to Harvard theorist Mitch Goldin said, the dilemma came down to lend money to its rival across the Atlantic. Left with little support, “people’s livelihood versus science. Something has to give somethe citizens of Texas were left to bear the burden of the SSC, which, where” [4]. Money spent across the Atlantic instead of in American at this point, was little more than an 87-kilometer-long hole in laboratories would result in the loss of domestic jobs, and many the ground. Public opinion turned Americans couldn’t afford to be against the scientists, funding dried generous. Congressman Joe Barton, up, and Congress finally voted to representing the would-have-been Already, scientists are halt the project in 1993 [1]. home of the SSC, swore to oppose proposing plans for the The failure of the SSC taught the Department of Energy’s coopthe scientific community several eration with CERN, complaining even more powerful particle lessons. First, research funding that CERN “didn’t help us, and accelerator, the International was limited, and businessmen and they went out of their way to stop taxpayers alike preferred to fund the SSC. I’ll be beep-beep-beeped if Linear Collider, which may projects that would lead to tangible we send a dollar to Europe” [6]. provide even more detailed and applicable results. Second, and However, CERN understood more importantly, the experiment the dynamics of this debate in the results than the LHC [9]. Will had grown too large and too sophisUnited States, and it took steps to countries spend billions of ticated for even a country as large ensure a sense of open, internaas the United States to conduct by tional involvement in the LHC. taxpayers’ money on it, too? itself. For further advances to be Knowing that American physicists made in research – especially in wanted to be a part of the project particle physics – science would but were financially handicapped, have to rise to the world stage. The SSC project was a solemn CERN promised to accommodate as many as 400 U.S. physicists warning that, in the future, cooperation among the international in return for financial help. “We can’t make it on our own recommunity would be a necessity. The Higgs boson would have sources,” admitted CERN’s director-general, Christopher Llewellyn to wait for another day. Smith. However, he noted that the United States should receive a stake in the direction of the project in return for its resources, The Large Hadron Collider acknowledging that Americans “don’t want taxation without In 1994, after a decade of scientific planning and prototype experi- representation” [4]. ments, CERN approved the construction of the Large Hadron With this openness, CERN shattered the national boundCollider (LHC), a massive, circular particle accelerator under the aries of scientific involvement that had so badly crippled the Franco-Swiss border, one of the largest scientific experiments in SSC. The United States, along with many other countries, soon history. The global community looked, hopeful but also doubtful, announced its financial and scientific commitment to the LHC, upon the birth of the future of high-energy physics. Fresh from the and construction was slated to begin in 1998. The machine was collapse of the SSC, some American citizens, including a number completed ten years later in September, 2008. Equipped with of physicists, wondered whether the Higgs boson was really the most sophisticated sensors ever built, supported by the most worth the effort. The Cold War had ended, and the immediate powerful supercomputer in the world, and spanning more than 26 applicability of nuclear physics had diminished significantly in kilometers in circumference underneath the Franco-Swiss border, the public mindset. Princeton physicist William Happer lamented the Large Hadron Collider was ready for its debut [7]. the prevailing attitude, saying that thousands of Americans were “doing nothing” in weapons factories, and that “high-energy The Last Frontier… Or Is It? physics labs suffer[ed] from a less severe form of the same disease” Atthetimeofthiswriting,theLHChadonlyjustwitnesseditsinauguration [4]. Calling the LHC “the last frontier of physics,” Happer argued ceremonyonOctober21,2008.However,themachinesitsdormant;afaulty for American financial and scientific involvement in the quest electricalconnectionledtoaheliumleakonSeptember19–only9daysafter to verify the existence of the Higgs boson. “As a nation that has aprotonfirstacceleratedto99.9999991%thespeedoflightintheLHCtunnel. prided itself on attacking every frontier, I can’t believe we would Theinfluxofheliumgascreatedpressureinthenormallyvacuum-liketunnel, back out of this,” Happer stated in 1994 [4]. Many physicists had damaging several magnets in one section. Because the machine

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YALE is now undergoing extensive investigation, repairs, and precau- change – require urgent scientific attention. Days before the LHC’s tionary maintenance, it will not resume operations until spring first test run, Sir David King, former chief scientist of the United of 2009. For the next few months, and perhaps for the next few Kingdom, commented, “It’s all very well to demonstrate that we years, the world will have to continue holding its breath as it can land a craft on Mars; it’s all very well to discover whether awaits the results of one of the greatest scientific collaborations or not there is a Higgs boson…but I would just suggest that we in history [2]. need to pull people towards, perhaps, the bigger challenges, With regards to the existence of the Higgs Boson, there are where the outcome for our civilization is really crucial” [11]. In only two possible outcomes. If the Higgs boson does not exist, his opinion, the quest to validate the Higgs Boson is just that – a the Standard Model of quantum physics will be missing its final, quest for glory. fundamental piece. For many physicists, this would mean an But those who label the Large Hadron Collider as “science anticlimactic return to the drawing board, perhaps to look more for science’s sake” have failed to see its greatest significance. This closely at alternative theories of how the universe works. Profes- machine isn’t just a tool for physicists to test impractical or pointless sor Stephen Hawking, a world-renowned theoretical physicist theories. It isn’t just a thumbs-up or thumbs-down to a miniscule and best-selling author, believes that the “God Particle” will not particle that most of us will never know existed. It is a tribute to be discovered. Hawking believes the ingenuity of the human race – a that “it will be much more exciting symbol of what we can achieve if we don’t find the Higgs. That with our intelligence, our curiosity, Some leading scientific will show something is wrong, and our passion. Furthermore, the and we need to think again” [8]. Large Hadron Collider represents figures have criticized the Even if the Higgs boson is never what the world can accomplish international focus on the found, many experts agree that a through international cooperation, machine as powerful as the LHC mutual investment, and shared LHC, arguing that the most will reveal other surprises, offering responsibility. As Nobel laureate immediate issues that are us some direction regarding what Frank Wilczek put it, the LHC is to do next. “modern civilization’s answer to affecting our world – such And what if the Higgs boson the pyramids of Egypt, but betas poverty, genocide, and does exist and the LHC’s sensors ter: a monument to curiosity, not detect it? What if the Standard superstition, whose scale reflects climate change – require Model is fully supported, and function, not vainglory” [12]. If we, urgent scientific attention. scientists gain crucial insight into as an international community, can the properties of fundamental visualize the infinitely small Higgs particles? What happens next? boson, is there a feat we cannot Already, scientists are proposing plans for the even more pow- accomplish? If we can answer the fundamental questions of the erful particle accelerator, the International Linear Collider, which universe, is there a problem that we cannot solve? may provide even more detailed results than the LHC [9]. Will These questions are the most pivotal ones facing us as we step countries spend billions of taxpayers’ money on it, too? forward into the 21st century. Through the catalyst of the LHC, The answers to these questions are neither simple nor im- science has emerged on the international stage as an endeavor mediate. The struggles of modern physics are grand in scale and that is grander in scale and larger in importance than ever before. scope, and physicists strive to explain subjects as lofty and abstract Like the physicists from around the world who have prepared as faraway astronomical anomalies, the fundamental properties history’s greatest physics experiment, we must face forward, join of nature, and the beginning and end of the universe [10]. Some of forces, and ready ourselves to tackle the problems confronting these struggles are about to cross over into our observable world, our world. Next spring, when the Large Hadron Collider comes inside the chamber of a gigantic particle accelerator, but it is not to life once more, the last frontier in particle physics may very easy to see why they are relevant to our everyday lives. Indeed, well be broken – but a new age of science will have only just some leading scientific figures have criticized the international arrived. Will we, as a world, be there to answer its call? focus on the LHC, arguing that the most immediate issues that are affecting our world – such as poverty, genocide, and climate Jonathan Yeh is a student at Yale University. References:

[1] Sterling B. The Dead Collider. Magazine of Science and Science Fiction 1994 Jul. [2] Moyer M. Breaking Open the Unknown Universe. Popular Science. 2008 Oct; 273:64-69. [3] Schewe P. In Pursuit of the God Particle. Humanist. 2008 Nov; 68:41-43. [4] Flam F. Physicists struggle for consensus about the future. Science. 1994 Feb; 263:749. [5] Abbott A. France, Switzerland “must pay more” for LHC. Nature. 1994 Jun; 369:695. [6] Marshall E. Texan vows to fight LHC funding. Science. 1997 Mar; 275:1555. [7] Ananthaswamy A. Ultimate machine. New Scientist. 2008 Aug; 199:31-33. [8] Henderson M. Stephen Hawking’s £50 bet on the world, the universe, and the God particle. Times Online [newspaper on the internet]. 2008 Sep 9 [cited 2008

Oct 25]. Available from: URL: http://www.timesonline.co.uk/tol/news/uk/science/ article4715761.ece. [9] Cho A. International Team Releases Design, Cost for Next Great Particle Smasher. Science. 2007 Feb; 315:746. [10] Why a Large Hadron Collider?. Seed Magazine. 2006 Jul 6. [11] Amos J. “Climate crisis” needs brain gain”. BBC News [newspaper on the internet]. 2008 Sep 8 [cited 2008 Oct 25]. Available from: http://news.bbc.co.uk/2/hi/ science/nature/7603257.stm. [12] Wilczek F. “National Greatness” versus real national greatness. Science News. 2008 Oct; 174:32. [13] http://antwrp.gsfc.nasa.gov/apod/image/0802/atlas_cern.jpg

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CMU Does Biology Control Your Decisions? Stephanie Guerra

to random blasts of white noise. Those with a heightened sense of fear had higher blink amplitude corresponding to a greater “startle reflex” [1]. The “startle reflex”, again was indicative of an individual’s response to threat. By using these two quantitative tests, skin conductance and blink response, the research team was able to accurately gauge the strength of each subject’s response to perceived threat. Those with a more heightened response tended to favor political policies that favored the protection of the social unit [1]. Such socially ‘protective’ policies include support of the Iraq War, pro-life abortion stance, and opposition to gay marriage, to name a few [1]. Conversely, those subjects with a more mellow response to perceived threat were more likely to support less socially ‘protective’ issues such as gun control and abortion rights. Thus, a connection between biology and politics was discovered; a person’s natural response to threatening stimuli directly correlated to their political views. The approach pioneered by University of Nebraska, Lincoln, is unique to the scientific community in its procedure and conclusions. However, this research is by no means the first time that a relationship between biology and politics has been established. A concurrent study by researchers at the University of California, San Diego, also established a relationship between genes and politics. It

Reproduced from [9]

an is by nature a political animal.” Aristotle’s words have recently taken on new meaning due to numerous studies seeking to establish a connection between genetics and political attitudes. Like in most biological matters, the issue of nature vs. nurture is at hand. Scientific studies point toward genetics as a determinant for political ideology while more traditional analysis asserts that environmental factors are the main source of political views. Recently, a biological connection has been established to justify the source of political behavior. Multiple studies have sought to confirm this previously tenuous connection between physiology and political behavior by surveying various groups both scientifically and qualitatively. Researchers at the University of Nebraska, Lincoln conducted one such study, which was headed by PhD student Douglas Oxley and political science professor Kevin B. Smith [1]. The research team studied the political attitudes of 46 Nebraska residents by identifying subjects with strong political views at each end of the spectrum and then scientifically surveying them [2]. The research team sought to scientifically define a connection between biology and politics through the examination of the human physiological response to perceived threat, commonly referred to as the “startle reflex” [2]. Perceived threat in this case was a laboratory-controlled hazard that causes the body to react in a protective manner. Two methods were utilized to quantitatively determine an individual’s response to threat. The first method involved the measurement of skin conductance as threatening images were shown to each participant. Skin conductance is related to increased moisture content on the outer layers of the skin, in layman’s term the amount of sweat that the body produces in response to threats. This response is often associated with activation of the sympathetic nervous system which prepares the body for danger, acting primarily on the cardiovascular system, accelerating heart rhythm and raising blood pressure—all indicators of a threat response [2]. The second physiological method utilized “startle blink response”, an involuntary response to startling noise. Sensors that were attached to the muscles right below the eye measured how ‘hard’ someone blinked (blink amplitude) after exposure

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CMU focused on genes and voter turnout as an experimental means [3]. The goal of this study was to determine whether political participation including the act of voting is heritable. The study matched the voter turnout records in Los Angeles to a twin registry that listed individuals in the twin population of the area. The goal was to determine whether there was a link between who voted and who did not. A comparison was made between monozygotic (identical) twins and dizygotic (fraternal) twins. Those monozygotic twins that shared identical DNA tended to have the same political action tendencies, both or neither voting. On the other hand, dizygotic twins differed in their political involvement [3]. This unique correlation pointed toward a connection between an individual’s genes and his or her political participation. Through these two studies, a connection between biology and the political topics of ideology and participation has been experimentally supported. The biological basis of political ideology is fairly new and cutting edge. Despite this recent research, other influences on

[A] connection between biology and politics was established; a person’s natural response to threatening stimuli directly correlated to their political views. political behavior also exist. Political scientists have historically viewed ideology to result from both familial upbringing and life experience, environmental features that support the ‘nurture’ side of this argument [4]. In regard to the environmental basis of political ideology, there are three major factors that provide long-term influence on one’s political values; family, peers, and authoritative figures. The authors of “The American Voter Revisited,” published this year, found that about 75 percent of the time parents who share the same party affiliation pass it to their children [5]. Furthermore, a study by the University of Massachusetts, Boston, found that childhood experience, particularly that of abuse, can be displaced onto adult political values. Specifically, those subjects with high punishment backgrounds without therapy tend to be more conservative than others with high punishment backgrounds with therapy. When comparing other subjects, those with a background of childhood abuse tended to be more conservative than those without a history References: [1] Oxley, Douglas R., and Kevin B. Smith. “Political Attitudes Vary with Physiological Traits.” Science 321 (2008): 1667-670. [2] National Science Foundation. “Some Political Views May be Related to Physiology.” Press release. 18 Sept. 2008. National Science Foundation. 8 Oct. 2008 <http://www.nsf.gov/news/news_summ.jsp?org=olpa&cntn_id=112246&preview>. [3] Folwer, James H., Laura A. Baker, and Christopher T. Dawes. “Genetic Variation in Political Participation.” The American Political Science Review 102 (May 2008): 233-48. [4] Carey, Benedict. “Some Politics May Be Etched in the Genes.” NYTimes.com. 21 June 2005.New York Times.8 Oct. 2008 <http://www.nytimes.com/2005/06/21/ science/21gene.html?pagewanted=print>. [5] Lewis-Beck, Michael, Helmut Norpoth, William Jacoby, and Herbert Weisberg.

of abuse [6]. Secondly, individuals of the same generation tend to share similar values due to the effect of peers on political ideology. Eric L. Dey, an Associate Professor at the University of Michigan School of Education, argued in his essay, “Undergraduate Political Attitudes: Peer Influence in Changing Social Contexts”, that socialization is integral to early political development because it is a process through which individuals acquire knowledge, habits, and value orientations that will be useful in the future [7]. Dey furthers his argument and suggests, “that student political orientations consistently tend toward the institutional norm, whether liberal or conservative, regardless of social era in which students attend college” [7]. This assertion advances the notion of the malleability of the younger generation. Authoritative figures that mostly include teachers tend to have a significant impact on political leanings. Teachers are widely responsible for influence during childhood years. In addition, post-secondary education significantly increases political awareness. This is reflected in the high percentage of undergraduates registered to vote. A study conducted in October 2004 of 1,202 college students showed that 87% of undergraduates are registered to vote as compared to 64% of American adults [8]. Beside these long-term influences, other more transient factors are also involved in the inculcation of political values. These factors include but are not limited to media impact, political environment, current issues, and self-interest. These factors do not warrant further explanation, as the nature of their influence is quite ubiquitous. Political ideology is obviously quite complex. Each person’s political profile may be cultivated by a combination of biological and environmental factors. Though the scientific side of this issue is fairly recent, it still provides great context and in fact complements the environmental view of political values. The Lincoln research team of the University of Nebraska acknowledges that their research “provides one possible explanation for both the lack of malleability in the beliefs of individuals with strong political convictions and for the associated ubiquity of political conflict” [1]. Though it may be extreme to attribute the success of a political candidate purely to the biological motives of voters, it still begs the question of how much control over our own decisions do we actually have. The very suggestion that biology has some effect on political ideology should make us all carefully consider our past voting history and our future choices as we head to the voting booth. Stephanie Guerra is currently an undergraduate at Carnegie Mellon University. The American Voter Revisited. The University of Michigan P, 2008. [6] Milburn, Michael A., S. D. Conrad, Fabio Sala, and Sheryl Carberry. “Childhood Punishment, Denial, and Political Attitudes.” Political Psychology 16 (1995): 447-78 [7] Dey, Eric L., Undergraduate Political Attitudes: Peer Influence in Changing Social Contexts, Journal of Higher Education, Vol. 68, 1997 [8] Simas, Beth. Ethics and Political Behavior: A Portrait of the Voting Decisions of Santa Clara Student. Markula Center for Applied Ethics. 2004. Santa Clara University. 5 Nov. 2008 <http://www.scu.edu/ethics/publications/submitted/simas/ politicalbehaviour.html>. [9] http://www.nigms.nih.gov/NR/rdonlyres/3A575A02-9F76-4101-BB819AF76C0A7756/5162/dna.jpg [10] http://www.azsos.gov/Images/State_Symbols/american_flag.gif

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UCHICAGO From Sugar Pills to Sedatives: The Ethics of Placebo Treatment Kara Christensen

erived from the Latin for “I shall please,” “placebo” is the term used for a medication prescribed with the administering physician’s knowledge that the substance lacks a disease-relevant and specific pharmacological effect [1, 2]. Scientists attribute the improvement in health after treatment with a placebo, called the placebo effect, to the symbolic nature of the treatment , which is arguably more psychological than physiological in nature. Though the mechanisms of placebo action are unknown and theories thereof vary, placebos nonetheless do have clear effects on patients [3]. Because of this phenomenon, the use of placebos has become important in two realms: clinical trials and medical treatment. Because of the possibility of patient improvement merely by the administration of a medical treatment, clinical studies often contain a placebo control group, in which patients do not receive an active drug. The effects of the treatment on the experimental group can then be compared to those on each of the control groups to examine the efficacy of the treatment beyond the possible placebo effect. The use of a placebo in this context differs from that in medical treatment. In medical treatment, the placebo is prescribed with the intent of using the aforementioned psychological benefits to improve patient health. There are several contexts for placebo prescription. The patient can unknowingly request a treatment that involves a placebo, such as insisting on being prescribed antibiotics like penicillin for the treatment of a cold. In this situation, the doctor must decide whether to prescribe a medication with no medically relevant effect in order to expressly appease the patient [10]. The physician could also prescribe a placebo at his or her own discretion, unsolicited by the patient. The placebo can be used as a diagnostic tool as well [11]. Examining patient response to a placebo aids a physician in determining the nature of the illness in question. A placebo can take one of two forms. An impure placebo is a substance that contains some pharmacological or biochemical effect irrelevant to the condition being treated, such as penicillin when used to treat a cold. These types of placebos can include vitamins, analgesics, or antibiotics [3, 4, 5]. A pure placebo is defined as an inert substance, or a treatment with no known pharmacological effects. Common

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examples of pure placebos include sugar or starch pills and saline injections [5, 6]. The inert pill placebo is thought to be less common in medical treatment now because of physicians’ decreased ability for its prescription as a result of the increased regulation of the pharmacological industry [5]. For pharmacies to possess these inert pills, pharmaceutical companies and doctors must admit that these prescriptions are solely being made for the placebo effect. Despite over 200 years of use, this practice has become more ethically controversial in the last century. [11] This issue has become particularly relevant in light of recent studies demonstrating that impure placebos and pure placebos such as saline injections are more often prescribed by physicians than previously thought [4, 5, 8]. The central controversy in the debate on the use of placebos is the issue of informed consent. In order for informed consent to be given according to the American Medical Association, the physician must tell the patient: a) The diagnosis, if known b) The nature and purpose of a proposed treatment or procedure; c) The risks and benefits of a proposed treatment or procedure; d) Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance); e) The risks and benefits of the alternative treatment or procedure; and f) The risks and benefits of not receiving or undergoing a treatment Reproduced from [11] or procedure. Ethically, a physician must be given informed consent by the patient prior to the implementation of any treatment. The issue that arises with placebos is that there is an inherent use of deception. The placebo effect derives its power largely due to the patients’ belief that they are receiving beneficial, noninert, medical treatment. By not informing the patient of the exact nature of the treatment, the physician violates principles b) and c) in the guidelines for informed consent. The patient cannot appropriately give permission for the procedure, since he or she does not understand its exact mechanisms. In addition, the patient may not be able to appropriately refuse the procedure if viable alternatives are not presented [2]. Another consideration regarding informed consent is that with impure placebo usage, there is a possibility of adverse biochemical interactions or increased dependence upon the medication [1]. For example, increased use of penicillin diminishes its

UCHICAGO effectiveness, which could result in it not being as potent a treatment when needed for its intended use [10]. The doctor cannot explain the biochemical interactions in detail because doing so may cause the true nature of the treatment to be discovered, thus negating a possible placebo effect. Another issue in this ethical debate is the extent to which the doctor can make decisions for the patient. Advocates of placebo treatments argue that the physician possesses the knowledge for the appropriate use of this treatment and, as the treatment itself should possess no harmful side effects, the physician should be able to exercise his or her own discretion in its practice [3]. This argument calls into nature the paternalistic aspect of the physician-patient relationship. In this model, the physician assumes that because of his or her more expert knowledge, he or she is more competent to decide the course of treatment the patient should take [3]. Opponents of the unrestricted use of placebo treatments argue that the use of placebos inadvertently enforces the paternalistic relationship by giving the physician’s decisions, however well-intentioned, priority over the patient’s rights [3]. On an economic level, the use of placebos causes the patient to consent to a monetary fee without understanding exactly what the payment is made for. They are led to believe the medication is more efficacious than it actually is. Thus, the patient is given an unfair economic burden set by the physician. It is also important to note that the payment would not explicitly be made without the use of deceit on the part of the physician. When used as an attempt to appease the patient, placebo use presents additional ethical dilemmas. If the physician prescribes a placebo because he or she thinks the patient just wants a medication to feel better and does not have a legitimate illness, then there is little incentive to fully investigate the other medical possibilities for the ailment [11]. In turn, a placebo is not always the best treatment, and prescribing one without investigating other options constitutes a compromise of proper patient care. Opponents of the placebo treatment worry that this will be the case, as physicians can dismiss illnesses as psychological in nature and neglect more rigorous examination of other options [3]. The American Medical Association has examined these issues and attempted to define a set of guidelines for the acceptable use of placebo treatment.2 However, studies have shown that these recommendations for ethical behavior are not always precisely followed and that the prescription of placebos such as vitamins, analgesics and even sedatives is

not a rare practice [4, 5, 8]. In the circumstances examined in the studies, the patient’s autonomy and ability to make informed decisions regarding his or her health were not respected, which violates the guidelines for the proper use of placebos. One way in which the physician can follow these ethical recommendations is to obtain the patient’s permission to use placebo treatment. This can be done by having the patient sign a written consent prior to the initiation of care which states that placebos may be potentially used as a form of treatment [9]. Once permission has been given, the physician is free to administer the treatment at a later date without having to specifically identify its use to the patient. The placebo effect can still occur, as the patient does not know when the placebo is being administered or the form of its administration. The American Medical Association’s recommendation attempts to strike a balance between the potential benefits of the use of the therapy and restricting the use of deceit. The issue of informed consent is somewhat resolved, as the patient is informed of the nature of the possible placebo treatment and is able to decide for him- or herself whether or not he or she wishes to be given this sort of treatment if the physician deems it appropriate at a future date. The patient is still able to derive the benefits of the placebo effect, as well. Thus, these guidelines provide a method for the physician to make use of this treatment while still maintaining a trusting relationship without deceit between the physician and the patient. Recent studies have shown that 40-60% of physicians prescribe placebo treatments for patients without their knowledge, a fact that suggests that although there are guidelines for acceptable placebo treatment, they are not being consistently upheld [4, 5, 8]. This increased use suggests that there is a disconnect between physicians’ views of the acceptable use of placebos and the AMA suggested guidelines for their administration. This highlights a need for increased dialogue within the medical community as well as with patients to reconcile these differences and determine more definitively how to appropriately, if at all, use this method of treatment.

References:

(2008, Mar 20). AMA (legal issues) informed consent. Retrieved November 5, 2008, from American Medical Association Web site: http://www.ama-assn.org/ama/pub/ category/4608.html [7] Nitzan, U. and P. Lichtenberg (2004). “Questionnaire survey on use of placebo.” BMJ 329(7472): 944-946. [8] Lione, A. (2003). “Ethics of placebo use in clinical care.” The Lancet 362(9388): 999-999. [9] Lynˆe, N., B. Mattsson, et al. (1993). “The attitudes of patients and physicians towards placebo treatment--A comparative study.” Social Science & Medicine 36(6): 767-774. [10] Ross, S. and L. W. Buckalew (1983). “The placebo as an agent in behavioral manipulation: A review of problems, issues and affected measures.” Clinical Psychology Review 3(4): 457-471. [11] http://publications.nigms.nih.gov/moleculestomeds/images/pills.jpg

[1] Giordano, J. (2008). “Placebo and Placebo Effects: Practical Considerations, Ethical Concerns.” American Family Physician 77(9): 1316-1318. [2] American Medical Association. (2006). “Placebo use in clinical practice.” CEJA Report 2-I-06, from www.ama-assn.org/ama1/pub/upload/mm/369/ceja_recs_2i06. pdf. [3] Brody, H. (1982). “The Lie That Heals: The Ethics of Giving Placebos.” Annals of Internal Medicine 97(1): 112-118. [4] Gray, G. and P. Flynn (1981). “A survey of placebo use in a general hospital.” General Hospital Psychiatry 3(3): 199-203. [5] Tilburt, J. C., E. J. Emanuel, et al. (2008). “Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists.” BMJ 337(oct23_2): a1938[6] Wolf, S. (1959). The pharmacology of placebos. Pharmacological Review, pp 689-69o.

Kara Cristensen is a second year Chemistry major at the University of Chicago. Her article will also appear at Harvard University.

THE TRIPLE HELIX Spring 2009

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