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medicor
2016 #1
medicor medicinska föreningen’s
student magazine
12 Macchiarini & KI’s crisis of confidence 22 Nanotechnology in medicine
34 Reducing tobacco health risks 36 Festivals 2016
A
HIddEN DANGER
The problem of antibiotic resistance 1
Prelude It is a great pleasure to present the first issue of Medicor for 2016 - celebrating our 10th anniversary. Since 2006, Medicor has been reflecting the views of students in important aspects related to our education, our experience at Karolinska Institutet and about issues taking place at a global level. The magazine has passed through many different editorial teams and contributors, all of which have made a collective impact by informing our readers about our core values, our concerns and our opinions. With every new team comes a learning period in which to reassess the magazine, get accustomed to our new charges and try to do things as smooth as possible.
In this first issue of Medicor 2016, we take a closer look at the “crisis of confidence” that Karolinska Institutet is currently undergoing as a result of public allegations accusing the renowned surgeon, Paolo Macchiarini, for scientific misconduct. We shine light on the most important events that have taken place and explore how this case may be affecting students. In our cover story, we focus on the issue of antibiotic resistance, a topic whose interest is re-emerging as antibiotic resistant infections are becoming a serious threat . Along with other interesting articles, we discuss the Zika virus, review the most exciting festivals taking place in Sweden this summer and offer tips about noteworthy events happening at Karolinska Institutet in April. With that, I would like to thank all the Medicor contributors that make this magazine possible and to highlight that we are always looking for passionate people that would like to make a change by taking part in this student magazine. Tell Your Story.
Sincerely, Teresa Fernández Zafra Editor-in-Chief
Cover photo by Peggy Ler for Medicor 2
Photo by Jingcheng Zhao for Medicor
As a doctoral candidate, I began my position of editor-in-chief last September, with limited experience in team management but with a strong motivation to continue to deliver a magazine of high standards to our readers. Since then, Medicor has continued to grow; we have consolidated as a team and have gained invaluable experience along the way. We have had our share of successes and certainly made a few mistakes. Among those, we failed to give all contributors the opportunity to view the final layout of the issue 2015:3 before sending it for publishing - something, which I later found out, was customarily done by the previous editorial team. To prevent further mistakes and to ensure that Medicor operates with full transparency, we are currently working on setting up guidelines that will streamline the publishing process from beginning to end so everything is clear and fair to all contributors. We believe that it is through our concerted effort and continuous improvement that Medicor can continue to develop and remain a highlight of Karolinska Institutet’s student culture.
Medicor Magasin Grundad 2006. Tionde årgången. Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 Ansvarig utgivare: Teresa Fernández Zafra Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm Nobels Väg 10, Box 250, 171 77, Stockholm Utgivningsplan 2016: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december. Kontakta Medicor: chefredaktor@medicor.nu www.medicinskaforeningen.se http://medicor.nu Frilansmaterial: Medicor förbehåller sig rätten att redigera inkommet material och ansvarar inte för icke beställda texter eller bilder, samt tryckfel. Upphovsman svarar för, genom Medicor publicerat, signerat frilansmaterial; denna(e)s åsikter representerar nödvändigtvis inte Medicors eller Medicinska Föreningens. Freelance material: Medicor retains the right to edit incoming material and does not take responsibility for unsolicited texts or pictures, and printing mistakes. The contributor agrees that, through published and signed Medicor material, their opinions do not necessarily represent those of Medicor or Medicinska Föreningen.
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medicor
Overture 12 KI CAMPUS
32 10
10 11 12
THE NEW BOARD OF MF CHAse 2016 the Macchiarini affair
Science 18 19 20 22
SCIENCE SNIPPETS the inner critic hela cells nanotechnology in medicine
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Photo by Jingcheng Zhao for Medicor
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the zika forest
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A HIDDEN DANGER Medicor caught up with Otto Cars to find out more about the issue of antibiotic resistance.
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Global Focus 32 34
35
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ZIKA: Reality and rIsks reducing tobacco health risks around the world with smog
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Culture 36 38 40
festivals 2016 eurovision grown in sthlm
42 COMICS
22
medicor
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Teresa Fernández Zafra • Editor-in-Chief | Radek J. Góra • Associate Editor | Saket Milind Nigam • Director of Photography | Jessica De Loma Olson, Joanna Kritikou, Alex Browne • Web Managers | James Salisi • Editor of Global Focus | Sibel Ilter • Editor of Campus | Emily Clark • Editor of Science | Martha Nicholson • Editor of Culture Anna Vidina, James Salisi, Vaso Basinou, Nira Nirmalathas, Teresa Fernández Zafra • Layout Design |Peggy Ler, Jingcheng Zhao, Anna Vidina, Katarina Stojanovic, Oliver Ljong, Simon Guérard, Erik Sjödin • Photographers | Jessica de Loma Olson, Joanna Kritikou, Sarah Marshall, Martha Nicholson, Frida Hellström, Teresa Daraio, Euan Mackay, Alex Browne, Caitrin Crudden, Eveline Shevin, Markus Karlsson, Luke Fry, Devy Elling • Writers | Mina Saleem, Camille Wilhelmi, Amanda Sundberg, Se whee Park, Saket Milind Nigam, David Nicholson • Proofreaders | Mikael Plymoth • Senior Comics Coordinator | Anny Truong, Eveline Shevin, Emily Clark, Pedro Veliça • Comic Illustrators | Mikael Plymoth, Freepik.com, flaticon.com • Infographics
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Aperture After-skate Fika By Simon GuĂŠrard Want to showcase your photographic talents in our magazine? Send an email to medicor@ medicinskaforeningen.se for a chance to have your own work featured in the Aperture section of an upcoming issue of Medicor!
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Smörgåsbord
It’s a fish! It’s a tetrapod! It’s the fishapod! 6th of April, 2006 – A connection between fish and tetrapods was found. Paleontologists had been wondering how the transition from water to land occurred. Which was the first brave creature to go on that arid adventure? Taking place during the Devonian period – 410 to 356 million years ago – it starred the fishapod! Formally known as Tiktaalik roseae, it is a transitional species dating 375 million years old and was found to be the bridge between fish and tetrapods. The fishapod was discovered on Ellesmere Island in the Nunavut Territory of Canada by Farish A. Jenkins Jr and his team.
500,000,000 tweets/day
15th of July, 2006 – “Cleaning my apartment”, “hungry” and “bored at the office” were statements that suddenly seemed to matter. Twitter was first launched publicly during this night in San Francisco, California. With the initial idea of being called “stat.us”, it then shifted to “Twttr” for the first prototype introduced in March 2006. Since then, their numbers have been rocketing. One tweet was even posted from space in January 2010 by astronaut Timothy Creamer. Oops! This was more than 140 characters.
What’s mine is mine 4th of April, 2006 Anthony Atala and his group at Wake Forest University School of Medicine in North Carolina (USA) published their results on how to reconstruct human bladders with engineered tissues from the same patient. The autologous engineered bladder tissue – meaning that the same individual is both the donor and recipient – was made up of urinary tract cells and muscle cells. These were grown on collagen-polyglycolic acid scaffolds and then the tissue was used to reconstruct the patient’s malfunctioning bladder.
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medicor
Jessica De Loma Olson
The solar system and the five dwarfs 24th of August, 2006 – The International Astronomical Union (IAU) General Assembly, held in Prague, established that the Solar System is formed of 8 planets: Mercury, Venus, Earth, Mars, Jupiter, Saturn, Uranus and Neptune. But what about Pluto? Pluto, initially considered as a planet, was downgraded to a dwarf planet. The decision was taken after the discovery of 2003 UB313, a more massive object than Pluto that also had a satellite. So after reconsidering what exactly constitutes a planet, the lucky ones that are currently in the category of dwarf planet are Ceres, Pluto, Haumea, Makemake and Eris, formerly known as 2003 UB313.
iPS – Turning back the cell clock 10th of August, 2006 – Shinya Yamanaka and Kazutoshi Takahashi, two Japanese researchers, published for the first time the magic potion to obtain pluripotent stem cells - in the lab! They converted adult mouse fibroblasts into pluripotent stem cells, which means they were able to become any type of cell in the body. These induced pluripotent stem cells (iPS) were the result of genetic reprograming adult cells. They began with 24 transcription factors but in the end the wizardly combination was reduced to four: Oct3/4, Sox2, c-Myc and Klf4.
Medicor, Medicinska Föreningen’s student magazine, has been around longer than you would probably expect. Previously published as Bukpressen, it was renamed as Medicor in 2006. For our 10th anniversary we wanted to share with you some events that took place exactly 10 years ago. It seems like yesterday… 7
01-03 SOLVIK FIXING WEEKEND medicinskaforeningen.se
13 SEMINAR - MAKING OF THE MIND Hugo Lagercrantz ki.se/en/cns/calendar
14 KAROLINSKA RESEARCH LECTURES @ NOBEL FORUM Mary-Claire King ki.se/en/news/ki-calendar
KI CAMPUS
EVENTS
APRIL.16 8
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24 VALBORGSPUBRUNDA medicinskaforeningen.se
26 NETWORKING SEMINAR & MINGLE Andrew Hennigan
ki.se/careerservice
19 SEMINAR - EDUCATION & DEMENTIA Dominika Seblova ki.se/en/news/ki-calendar
22 BIOMEDICUM PUB Solna
medicinskaforeningen.se
27 HOW TO PREPARE FOR A JOB INTERVIEW ki.se/careerservice Photo by Oliver Ljong for medicor9
Kar KI CAMPUS olin ska
The New Board of Medicinska Föreningen By Frida Hellström Photo by Katarina Stojanovic
From left to right: Pontus Dannberg, Andrea Montano Montes, Andrea Olofsson, Frida Hellström, Carl Lundeberg, Jennie Sporre, Simone Setterberg, Ghonchehgol Assadi, Anna Petterson, Puck Näsman Norell and Iris Peña Arriarán.
The new board of Medicinska Föreningen (MF) has been active from the 1st of January this year. Among their projects, they aim to create a more active student life on Campus Huddinge, recruit more members to MF, improve student health and make MF feel united. Another special project is the union house renovations – but more of that in the next issue! The new president of MF, Frida Hellström, started her job together with vice president Jennie Sporre on January 1st. To have time for this great task they have both taken a pause from their studies. Frida is a medical student, currently on a break between the 7th and 8th semester. Before being elected as president, she spent her time in the union with the skit groups, the medical students section and as a project leader for Twinning in the International Committee among other things. Jennie is a biomedical laboratory scientist student, on a break before her last semester, and she was the president of MF last year. With them, they have a new MF board, currently consisting of nine people: Ghonchehgol Assadi, 4th semester psychology student, member of the string orchestra Stroket and the Psychology section (PsyKI). In the board she works with both health questions and implementing the vision. 10
Pontus Dannberg, 7th semester medical student with long term involvement in, and currently president of, the Events Committee (Programutskottet, PrU). His main project during the year will be Huddinge Campus. Carl Lundeberg, 5th semester medical student and former treasurer of Queerolinska, MFs LGBT community, whose responsibility during 2016 is communication. Andrea Montano Montes, 6th semester biomedical laboratory scientist student, former vice president and works in the board with focus on the Union’s facility renovations. Andrea Olofsson, 4th semester psychology student involved in PsyKI and the Reception Committee (MU). She will work together with Ghonchehgol on health questions. Iris Peña Arriarán, 8th semester medical student involved in both skit groups; Corpus Karrolina (the male skit group)
and Flix (the female skit group), and former president of Flix. She works in the board as a part of the Vision group and the member recruitment group. Anna Petterson, 6th semester medical student is involved in the Medical Student section (Läkarsektionen, LS) and MU. She is the head of the member recruitment group. Simone Setterberg, doctoral student and member of the Doctoral Students Association (DSA). Simone’s main task is to work with internationalization and helping with the member recruitment. Leonard Wahlroos, 5th semester nurse student, secretary of PrU and member of the Nurse Student Section (SSEK). He will work with Pontus on project Campus Huddinge. As of February 24th Puck Näsman Norell (bachelor in Biomedicine) and Iuliia Savchuck (doctoral student) are also part of the MF board. •
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medicor
KI CAMPUS
CHaSE 2016 - Careers in Health and Science Exposition On the 11th of February 2016, CHaSE took place in Aula Medica, Karolinska Institutet. The program included company presentations, booths and workshops where students and working professionals had a chance to learn about career opportunities in life science sector. By Teresa Daraio Photos by Anna Vidina Collage by Saket Milind Nigam The idea of having a career fair at Karolinska Institutet originated from the need for students and healthcare professionals to know more about possible career paths after graduation. After the first edition in 2014, in partnership with Medicinska Föreningen and Karolinska Institutet (KI), a group of 10 students started to work on the CHaSE 2016 project. The purpose was to create a unique career fair, where visitors could get an overview on careers in life sciences. We counted with the participation of pharmaceutical companies, consulting firms, recruiting enterprises and with professional associations. The exposition included company presentations from Novo Nordisk, MSD, E-Phy Science, Militenyi and AstraZeneca aiming to inform about their career opportunities and which skills they look for in their future employees. The session “Meet the Alumni” served as a discussion platform with KI alumni who work in the life science industry, and was followed by the session “Meet the recruiters” where life science recruiters gave tips on job applications and how to succeed in job interviews. Naturvetarna held an interactive workshop to provide guidance and tools on how to access career paths and effective ways to get there. Finally, the “LinkedIn Pop-Up Workshop” held by PhD career Link, offered the chance to have a 1-to-1 session with a LinkedIn coach to create a strong profile and get a professional profile picture
How did visitors experienced CHaSE 2016?
The visitors, mostly Master students, PhD students and Post-Docs, were very satisfied according to the surveys. The value they experienced came from useful information about companies they did not know about before. Furthermore, over 70% of the visitors got in contact with potential employers and almost 90% got insights into their career planning.
Medicinska Föreningen is currently recruiting a new team for CHaSE 2017 Send your candidature to: nu@medicinskaforeningen.se
The participants particularly appreciated the opportunity of having close contact with company representatives and getting tips for entering the job market. The interactive presentations and workshops were also regarded of high value. Overall, 94% of visitors said they would come back for CHaSE 2017.
How did exhibitors experience CHaSE 2016? The exhibitors participated in CHaSE primarily to increase the visitors’ knowledge about their companies and to recruit potential employees. Regarding feedback, the companies achieved their goals - 91% got in contact with potential employees and were satisfied with the student interaction throughout the day. Furthermore, the exhibitors were very pleased with the overall organization of CHaSE 2016 and many responded that they would come back for CHaSE 2017
A big thanks for their commitment and hard work to the CHaSE 2016 team members: Arya Kurumathur, Camilla Maffezzini, Daniela Papadia, Firoz Roshan Kurudenkandy, Fosco Giordano, Huanling Lai, Laura Liimatainen, Nino Hallén, Subu Surendran Rajasekaran, • Teresa Daraio and to the volunteers.
CHaSE 2016 Exhibitors Apotekarsocieteten AstraZeneca AltasAntibodies BearingPoint CobraBio Dfind E-Phy-Science Eli Lilly HealthiHabits IMS Health KI Career Service LunchBack PhD Career Link Region Kronoberg Militenyi MSD Naturvetarna NGS Group Nordic BioSite Novo Nordisk Poolia SRAT Synergus Techtum Work in Denmark
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Macchiarini’s Case Photo: Staffan Larsson (ki.se) In this first issue of Medicor 2016, we take a closer look at the “crisis of confidence” that Karolinska Institutet is currently undergoing, as a result of public allegations accusing the renowned surgeon Paolo Macchiarini for scientific misconduct (pages 13-16).
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medicor
KI CAMPUS
The Macchiarini affair and the situation at Karolinska Institutet
The Macchiarini case is fading from the news headlines, but what is happening inside the walls of Karolinska Institutet (KI)? With a crisis of confidence in KI after the damning documentary on experimental surgery conducted by Paolo Macchiarini, Vice-Chancellor Anders Hamsten has resigned and investigations at KI have started. This article is written to shine a light on what is currently happening at KI, how students are affected and how they are represented.
By Frida Hellström The background on Paolo Macchiarini
Paolo Macchiarini was born in Basel, Switzerland to Italian parents, where he grew up and studied medicine. He is a researcher of regenerative medicine, currently employed by Karolinska Institutet. Macchiarini has worked on advanced airway surgery and was internationally acclaimed for his tracheal transplants from deceased donors. In 2011, he conducted the first transplant of a synthetic trachea at the Karolinska University Hospital in Huddinge. Since then, seven further transplants have been done, and six of these patients have died. His work has been investigated by SVT and his private life by Vanity Fair, both highly critical.
KI’s response
Since the public allegations against Paolo Macchiarini started in January 2015, the Vice-Chancellor, the Dean of Research and the Senior Adviser Rectorate have all stepped down from their positions. The KI University Board (Konsistoriet) has started the recruitment process for a new Vice-Chancellor and meanwhile, the government has appointed Karin Dalman-Wright (Pro-Vice-Chancellor since the 1st of January) to substitute the ViceChancellor until the official recruitment process is finalized. There are currently 12 investigations going on regarding the Macchiarini case, five and a half of which
are being conducted at KI. An external review of KI’s handling of the case - led by Sten Hecksher – has been instigated by the KI University Board. KI has also started internal investigations including two led by the University Director on the rules for extra-mural occupations (jobs outside KI during your employment at KI) and the recruitment process. This is due to the fact that Macchiarini’s subsidiary occupations, such as his research in Russia, were not mapped out properly and mistakes in the hiring process. The delegation rules are also to be reviewed and clarified if needed, so that responsibility is legitimately allocated. KI has also initiated a review of the borders between health care and research in collaboration with the Karolinska University Hospital.
How does the crisis of confidence affect the students?
Students are worried about how the crisis will affect the brand name of Karolinska Institutet, something that, at least before the crisis, was a very good thing to have on one’s CV. The Dean of Higher Education stated during the information meeting on the 25th of February, that she believes that this situation will not affect the students a great deal. The last crisis, where KI had to shut down the nurse programme, did not result in lasting negative effects on the students. Instead, it had a rather
The Managment Group Vice-Chancellor - Karin Dahlman-Wright Pro-Vice-Chancellor - Henrik Grönberg University Director - Per Bengtsson Deputy University Director - Marie Tell Dean of Higher Education - Annika Östman Wernerson Dean of Research - Hans-Gustaf Ljunggren (to be substituted) Dean of Doctoral Education - Anders Gustafsson Two Student Representatives - MF president and vice president
positive effect, as a new programme was started which was much better than the last. In a similar way, the Dean of Higher Education hopes that, if anything, KI and its education will only benefit from this crisis. The aim is to review the education plans for all undergraduate education at KI, looking specifically at areas of ethics and scientific development to improve them where needed.
What does the student union do?
The student union, Medicinska Föreningen (MF) makes sure that students are represented in the highest deciding organs of KI. MF has two doctoral students in the KI University Board and the president and vice president of MF represent the students in the KI Management Group or “Ledningsgruppen”. The MF president is also present at the appointment meetings for the Vice-Chancellor. Through these meetings, the student union has remained informed about what is happening at KI and were able to organize two information meetings for students on the 25th of February - one in Huddinge and one in Solna - where the Dean of Higher Education Annika Wernerson and the acting Vice-Chancellor Karin DalmanWright were present, together with Per Bengtsson, the KI University Director. •
The KI University Board
The highest governing body at Karolinska Institutet Members appointed by the government Lars Leijonborg - Former Cabinet Minister, Chairman Annika Andersson - CEO, Vice Chairman Torbjörn Rosdahl - County Council Finance Commissioner Dan Andersson - Former Chief Economist Susana Borrás - Professor Charlotte Strömberg - CEO Eskil Franck - Director Anders Blanck - CEO
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By Frida Hellström
Autumn 2010 - Paolo Macchiarini is recruited as a guest professor at KI within the area of regenerative medicine/ stem cell biology. He is also recruited as a surgeon at the Karolinska University Hospital. 2011-2012 - Three different transplants with stem cellcovered synthetic tracheas are conducted at the Karolinska University Hospital after a decision from the hospital to go through with the surgeries on vital indication (meaning: last resort to save a patient). In November 2011 Macchiarini publishes an article in The Lancet describing the first operation. 2012 - The second patient dies a few months after the surgery, the first survives two and a half years and the last one is still alive but in critical condition. 2013 - The Karolinska University Hospital stops all further surgeries with synthetic tracheas and decides not to prolong Macchiarini’s employment. December 2013 - Paolo Macchiarini starts clinical studies in Krasnodar, Russia, as an extra-mural occupation approved by his institution at KI. June 2014 - A Belgian researcher reports Macchiarini for scientific misconduct found in an article published in Nature Communications (Report 1). Vice-Chancellor Anders Hamsten turns to the Ethics Council for a statement. June to September 2014 - Four medical doctors at the KI University Hospital report Paolo Macchiarini for scientific misconduct on seven different papers (Report 2). The medical doctors were also researchers at KI and three of them were co-authors on those publications.
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March 2015 - The Ethics Council at KI responds to the first report (from the Belgian researcher) by stating that the reported issues are a matter of ‘theory of science’ rather than ‘ethics of science’, meaning that it is not scientific misconduct even if the research is not of scientific quality. April 2015 - Paolo Macchiarini replies to Report 2. April 2015 - KI decides that Macchiarini is not guilty of scientific misconduct in reply to the report from the Belgian researcher. May 2015 - Bengt Gerdin submits his statement to KI with the conclusion that Macchiarini is guilty of scientific misconduct. June 2015 - Paolo Macchiarini and co-authors submit a statement on Bengt Gerdin’s statement. 28th of August 2015 - KI decides to free Paolo Macchiarini from suspicions of scientific misconduct but also states that his research has not fulfilled KI’s demands on quality. The decision is made according to complementary statements from Macchiarini and his co-authors. November 2015 - Macchiarini’s employment as a guest professor is terminated and he gets a time limited contract as a researcher at KI until November 30th 2016. December 2015 - Bengt Gerdin states that he sticks to his conclusion after reviewing the new material submitted by Macchiarini and e-mails this to the Vice-Chancellor Anders Hamsten.
August 2014 - Macchiarini replies to Report 1.
2016
November 2014 - Bengt Gerdin, Professor Emeritus at Uppsala University, receives the task of reviewing the case of the two reports against Macchiarini and to make a statement.
5th of January - Vanity Fair publishes an article about Macchiarini on the public media with information of a falsified CV, KI investigates.
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medicor
The timeline of Macchiarini’s case and its repercussions on KI
13th, 20th and 27th of January - SVTs documentary series “Experimenten” is broadcasted in a three-part series with new information of experimental work, including his work in Russia. 28th of January - Vice-Chancellor Anders Hamsten comments on the documentary and says that some of the information is new to the KI Management Group, which could lead to a re-opening of the scientific misconduct case. 29th of January - A clarification of responsibilities in the case of Paolo Macchiarini is published by KI. 1st of February - KI reports that the allegations in Vanity Fair about the falsified CV are true. 4th of February - KI University Board (Konsistoriet) decides to start an external investigation on Paolo Macchiarini’s case from his recruitment to this day. The KI University Board also announces that Anders Hamsten will continue as KI Vice-Chancellor during the investigation with their full support. The same day, Anders Hamsten announces that Paolo Macchiarini’s employment contract will end in November, and that until then he will work only to phase out his research. 9th of February - Investigators are appointed to conduct an external investigation instigated by the KI University Board to map out the Macchiarini case: Sten Heckscher (legal expert), Ingrid Carlberg (author) and Carl Gahmberg (Professor in biochemistry at Helsinki University). 13th of February - Vice-Chancellor Anders Hamsten steps down and announces that the investigation of Paolo Machhiarini’s alleged scientific misconduct is reopened. 15th of February - Pro-Vice-Chancellor steps in as acting Vice-Chancellor.
16th of February - Professors belonging to the Nobel Assembly decide to step down as they are also part of the investigation. 17th of February - KI University Board decides to ask the government to appoint Karin Dahlman-Wright as substituting Vice-Chancellor and instigate the recruitment of a new Vice-Chancellor. 18th of February - Karin Dahlman-Wright is appointed acting Vice-Chancellor by the government. 22nd of February - The Dean of Research, Hans-Gustaf Ljunggren, requests to step down. Jan CarlstedtDuke, Senior Adviser Rectorate and Head of the Board for the Medicine programme also steps down from his charges, but continues to be employed by KI with new responsibilities that are independent of the scientific misconduct investigations. KI also decides to start the process of terminating Paolo Macchiarini’s employment. The same day, the KI Professor’s Collegium met and discussed how they could contribute to the development of KI in light of all this new information. “It was emphasized that we should have an atmosphere guided by ethics, common values, a communicative leadership and transparency. At the next meeting our acting vice-chancellor will be present, and I look forward to a discussion of more hands-on issues and measures.” - Nancy Pedersen, Professor at the Department of Medical Epidemiology and Biostatistics 29th of February - Henrik Grönberg is appointed acting Pro-Vice-Chancellor by the KI University Board until a Vice-Chancellor is elected. He started his work as Pro-ViceChancellor on the 7th of March.
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opini on ar ticle
The Macchiarini affair is highly relevant to students’ education
by a K I studen t
A series of documentaries on Swedish National Television about stem cell covered plastic tracheal implants have stirred the pot at Karolinska Institutet and the entire Swedish research community. In what way does this relate to our education and why should students be concerned? The author argues that a dismissive leadership culture and an environment too focused on getting results is damaging to our education and future careers and – ultimately – to society as a whole. These past months, Karolinska Institutet (KI) has been rocked to its core by allegations made publicly available through international publications and a three-part documentary program (“Experimenten”) on national television. Through the series, we learn about clinical experiments with fatal outcomes, a complete lack of preceding animal testing, blatant lies told to patients and of how KI’s Board of Research ignored the pleas of fellow medical doctors calling for the operations to be stopped. We also heard of a thorough investigation indicating academic fraud being disregarded. This resulted in continued support for Dr. Paolo Macchiarini – a man whose research brought both big money and prestige to the university. As a student at KI and future researcher, I was shocked: “Could this be true?” The discussions on scientific misconduct and a tarnished reputation for KI and the Nobel Prize are of course bothering and regrettable. However, how KI handled the case may be an issue of greater importance to both employees and students at KI. It is frightening to hear public statements by the former chairman of the Research Ethics Committee describing our institute to be in “ethical meltdown” [1], a Nobel Prize-winner declaring our system to be “sick” [2] and to hear testimonies revealing a culture at the top consisting of yes-men (and women) [2,3], whose ideas regarding our education are unavailable for criticism [4], whom are engaged in distributing reprisals [5], and who value prestige above ethics and academic ideals [6]. A culture of secrecy, self-importance and protection of possible scientific misconduct does little to prevent future cases of fraud or dishonesty from occurring in labs or clinics – environments where students can be found and potentially involved. Ultimately, both patients’ lives and society may be at a risk as such a culture poses a threat to the honorary codex of all scientists and challenges the Hippocratic Oath of medical doctors. Despite being a university, Karolinska Institutet has excluded its students since the beginning, regardless of our grave concern about our education in the wake of these allegations. On February 2nd, the 16
KI staff got first-hand information and was able to ask questions on the “crisis of confidence” accredited to “the extensive media coverage about Paolo Macchiarini”. However, students were not invited to join the session. Only recently, with the resignation of the former Vice-Chancellor Anders Hamsten, the student union (MF) together with the acting Vice-Chancellor decided to arrange a Q&A for students – nearly 1.5 months after the airing of the documentary. During this period, we depended on rumors and the media when trying to piece together this puzzle. Accordingly, we risked spreading misinformation when relatives, friends, test subjects and patients asked us about “the Macchiarini affair”. More importantly, by keeping us in the dark for so long, the leaders of KI are signaling three things to its students: Firstly, our concerns are not particularly important to KI and we are not an integral part of its community. Secondly, we learn that transparency is not an ideal that KI holds in high regard. Lastly, we fail to understand the procedures for expressing our concerns over potential wrong-doings that we may experience as students at KI. The Macchiarini affair also raises the question of whether it is safe for us to report misdeeds, given that the whistle-blowing Chief Physicians (see part two of “Experimenten”) faced threats of being reported to the police for comparing the actual medical records to what had been presented in the Lancet [5]. Now that it’s clear why the Macchiarini affair and KI’s handling of the situation concerns students, how do we proceed from here? There are several actions we may consider, let me give you two examples: Firstly, in this defining moment for student unions, we should turn to MF and request that it acts as our advocate in matters regarding our education and to con-
vey our concerns directly to the leaders of KI. We should also communicate with student representatives in the university boards and committees at KI. Secondly, current values at KI seemingly teaches us to stay put, avoid criticism and focus on getting results – increasing the risk of rushing work or even cheating. Our education ought to focus on exploration, nourishing our curious minds and developing our skills and critical thinking – getting results should be secondary at this stage. To this regard, Nobel Prize-winner and KI alumni Tomas Lindahl has pointed out that constant demands on young researchers to present preliminary results are damaging their development [7]. To overcome this, we must feel confident in raising uncomfortable questions and act to achieve a less result-oriented environment. One way could be to weaken or even abolish KI’s publication requirement for receiving a Doctor of Philosophy (PhD) degree; currently, half of all manuscripts presented in the thesis must be published. Some of the most reputable universities in the world, such as Harvard and Oxford, have already removed publication requirements – why not follow their example? The Macchiarini case is now subject to scrutiny on several fronts, which everyone at KI – including students – should welcome. Only time can answer the many and justified questions we at KI have at this moment. In the meantime, use your democratic right and duty to influence the shaping of the education at Karolinska Institutet: Find your representative under your study program’s section at the MF homepage. Together, we can make a change. Signed, A Concerned KI student
1. www.lakartidningen.se/Opinion/Debatt/2016/01/Karolinska--etikens-Tjernobyl/ 2. www.svt.se/nyheter/inrikes/nobelpristagaren-hela-ki-styrelsen-maste-avga 3. www.dn.se/debatt/ki-rektorn-hade-alla-fakta-men-lat-kirurgen-fortsatta/ 4. www.dn.se/kultur-noje/kulturdebatt/ darfor-gar-systemfelet-vid-ki-djupare-an-macchiariniaffaren/ 5. www.svt.se/dokument-inifran/se-program/dokument-inifran-experimenten-avsnitt-2 6. www.expressen.se/debatt/prestige-kan-inte-ga-fore-manniskoliv/ 7. www.dn.se/nyheter/vetenskap/nobelpristagaren-slapp-de-unga-forskarna-fria/
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Science Snippets By Joanna Kritikou
Sneezing: the Shapes of Snot You probably knew that a sneeze is pretty gross, but how gross exactly is explained in a recent study by researchers at MIT. They used high-speed cameras to capture what happens during a sneeze. They discovered that when people sneeze they eject fluids in compact sheets that then break up into long filaments. The spray of droplets that we usually associate with a sneeze comes only at the end. This, they claim, is important to further understand transmission of airborne diseases in order to design strategies to reduce contamination and spread of pathogens. (Experiments in Fluids, Feb. 2016) Photo credit: Tina Franklin (Flickr)
Einstein’s gravitational waves Einstein’s Theory of General Relativity says that gravity can bend space-time; and the bigger an object is, the larger the effect. So, when massive objects move they create an oscillation in space-time, called gravitational waves, like the waves forming in front of a moving ship. They were observed for the first time on September 14, 2015 by the Laser Interferometer Gravitational-Wave Observatory (LIGO) and were produced by a pair of merging black holes. In the 20 milliseconds of the merger, the energy of the waves was equivalent to annihilating the mass of three Suns (!). (Physical Review Letters, Feb. 2016)
Photo credit: Hans Splinter (Flickr)
from a single cell to cancer A tumor begins from a single cell within a group of cells that acquires genetic mutations. Scientists have for the first time investigated cancer development and spread from a single cell inside live animals. They used zebrafish and a fluorescent reporter that specifically shows neural crest progenitor cells, which are only present during embryogenesis or during melanoma formation. The appearance of the tumor correlated with a set of genetic regulatory elements whose identification and manipulation may prove beneficial in detecting and preventing melanoma initiation. (Science, Jan. 2016) Photo credit: Sparky (Flickr)
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Human embryo editing in UK The UK Human Fertilization and Embryology Authority (HFEA) is now allowing scientists to genetically modify early embryos and have them develop for up to seven days. By doing this, researchers want to unravel which genes are involved in the development of human embryos, how this process can go wrong, and how it can lead to infertility and miscarriages. There are strict guidelines to adhere to, however. Embryo editing cannot take place until the research receives independent approval from an ethics committee. It is also illegal for any edited embryo to be implanted into a woman. (hfea.gov.uk, Feb. 2016)
Vikings and lung disease Archaeological studies of Viking latrines have found massive infestations of parasitic worms, while genetic analyses reveal that a particular mutation of the Alpha 1 Anti Trypsin (A1AT) gene was prevalent and may have protected the Vikings from these parasites. However, with the demise of the worms, this genetic adaptation is now being associated with the development of lung diseases. It increases inflammation and the release of proteases. These damage the air sacks in the lungs and cause them to merge into one large air chamber, reducing the surface area of the lungs, rendering them less efficient and thus causing emphysema. (Scientific Reports, Feb. 2016)
cotton candy blood vessels Apart from making a delicious snack, cotton candy machines can also be used in the lab to create functional, artificial capillary networks. Researchers took advantage of the machine’s ability to spin thin threads of sugar into a network. They used materials such as hydrogel and PNIPAM (the latter being insoluble in temperatures over 32oC) and formed microfiber structures. These were infused with living cells from natural capillaries in an incubator and then moved into roomtemperature. There the PNIPAM threads dissolved, leaving behind thin channels that closely resembled capillaries. (Advanced Healthcare Materials, Feb. 2016)
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The Inner Critic
Can neuroscience explain our relationship with art?
By Euan Mackay
Miracle Science
The Artistic Mind Dissected
It seems there’s nothing neuroscience can’t do. Promoted as a panacea, neuroscience has been tipped as the future of understanding the human condition. We live in the era of fMRI, where it is possible to investigate brain activity in response to external stimuli. As such, researchers increasingly look at all schools of knowledge through the lens of our neurology. The “neuro” prefix has been haphazardly slapped onto all manner of disciplines: neuroethics, neuroeconomics, neurophilosophy, neuromarketing, neuropolitics.
The creative process is the stuff of myth. Central to Western tradition is the image of the tormented artist, who suffers madness and depression in order to create transcendent works. Neuroscience seems to reinforce the link between mental disorders and creativity. Personality traits associated with vulnerability to schizophrenia have been found to predict a person’s creativity. First degree relatives of patients with anorexia, bi-polar and schizophrenia are over-represented in creative fields. On a neuroanatomical level, the inability to suppress the precuneus area of the parietal lobe is typical in schizophrenics and also is associated with increased creativity. However, it is greatly debated whether these quantitative measures of creativity are representative of the artistic experience.
The phenomenon is deeply reminiscent of the cultural legacy of psychoanalysis. Seen as an educated alternative to self-discovery by religion or spirituality, and coated with a quasi-scientific patina, the theories of Freud and Jung entered the public consciousness via the films of Hitchcock and Woody Allen, as well as major works of philosophy and literary criticism. The allure then was the same as it is now: to better know ourselves and each other. It is understandable then that, as with psychoanalysis before it, neuroscience is being used to aid our understanding of art. The field of neuroaesthetics seeks to use quantitative biomedical techniques as well as qualitative methods to elucidate the mysteries of why we create. But is neuroscience the right tool for the job?
Perhaps more interesting is the study of established artists who have suffered neurological disorders. The American artist Wiliam Utermohlen, following his diagnosis of Alzheimer’s Disease in 1995, painted a series of self portraits that chart his deterioration. The series of works becomes increasingly abstract and chaotic as Utermohlen’s Alzheimer’s affects both his motor skills and perception, and the works turn into a measure of the progression of the disease itself. A study that sought to look at the variability of words used in the novels of Agatha Christie
found a huge decrease in her later works. It was then discovered that this decrease in vocabulary was likely linked to Christie’s unpublicised dementia; the author’s disease mirrored unknowingly in her writing. German painter Lovis Corinth suffered a stroke which damaged his right hemisphere. His works following the injury showed subjects with the left side of their faces left indistinct, exhibiting altered visual processing. It has even been controversially suggested that Van Gogh’s pre-expressionist style of waves and swirls are due to visual distortions from an undiagnosed schizophrenic condition.
Neuroaesthetics seeks to determine if our love of art is innate. Are we simply like Gabriel von Max’s Monkeys as Judges of Art? Of course, neuroaesthetics has also been criticised for it’s reductive view of art. There are fMRI studies where works of art the brain finds “pleasing”, i.e promote activation of pleasure regions, are said to be of artistic merit. This simplifies the vast range of emotional responses people feel when they encounter a powerful work, and neuroaesthetics too often conflates beauty and value. Neuroaesthetics may be able to teach us a thing or two, but it still has a lot to learn. • 19
Becoming accustomed to science textbooks can lead us into the false idea that scientific discoveries are very ordered and neatly progressive events, yet the truth, which is often left to one side, is the very human nature of scientific discovery and progress. Most science accomplishments or milestones are really a rich story of human desire, dedication, collaboration and, as with every realm where humans are involved, can all too often involve mistakes, corruption and deceit. While there are of course valid reasons to neatly arrange progress stones one by one for our understanding, every once in a while it is worthwhile to explore the true reality of how that stone was discovered and its journey to the great wall of scientific progress.
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HeLa: The cells that changed the world By Caitrin Crudden
Photos: Lacks Family via The Henrietta Lacks Foundation/Associated Press
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One such story evolves around the world famous HeLa cells. If you have ever worked in a cell culture laboratory, the chances are you have worked with, or are at least familiar with, the cell line HeLa. HeLa cells were the very first immortalized cell line to be grown in vitro (outside the body), catapulting the cell biology field into progress and very rapidly spreading the world over. Yet HeLa cells have a somewhat more sinister beginning. Henrietta Lacks was a poor black tobacco worker, admitted to the “coloured” wards of John Hopkins Hospital in Baltimore, Maryland in the 1950s. She had an aggressive form of cervical cancer, and was being treated with radium tube inserts, as was standard at the time. One day, prior to starting her scheduled treatment, a doctor took a sample of her cancer cells, without her knowledge, and gave them to a laboratory down the hall aiming to immortalize human cell lines. A cancer researcher named Dr. George Gey at John Hopkins had been trying to grow human cells in his laboratory for decades and every single previous attempt had failed. Dr. Gey had devoted his professional life to trying to optimize conditions in which to grow human cells in the laboratory, knowing how precious this technology would be to the field of cancer biology. If cancer cells could be grown in the lab, they could be studied in a level of detail just not possible within human subjects. To everybody’s astonishment, Henrietta’s cells did not die. They not only survived but grew rapidly in the lab setting, and have not stopped growing since. Normal cells undergo a finite number of cellular divisions before they die. For a long time, nobody knew how a cell kept count of how many times it had divided or knew when it was time to die, but the reproducibility of the sequences suggested there was some sort of count-
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ing mechanism. In 2009 the Nobel Prize in Physiology or Medicine was awarded to Elizabeth Blackburn, Carol Greider and Jack Szostak, for answering this exact question. They discovered that this “cellular clock” is, in part, controlled by elongated ends of chromosomes termed telomeres. Every time a cells genomic DNA is copied for the next set of daughter cells, a very small amount of telomeric DNA is not copied, and therefore these ends get progressively shorter over cellular generations. Once these protective ends have completely run out, true genomic DNA begins to be degraded and this signals to the cell that the time has come to commit “cellular suicide” through apoptosis. Cancer cells acquire, through the accumulation of genetic mutations, abilities to survive and grow uncontrollably. One survival strategy of cancer cells is to reactivate an embryonic enzyme, telomerase, which keeps adding bits of telomere back on, and in doing so, can render cells immortal. Scientists believe that the aggressive nature of Henrietta’s disease, fuelled by fact that she was positive for both human papillomavirus (HPV) and syphilis, has given rise to this extraordinarily resistant and highly proliferative immortalized cell line. Although Dr. Gey never aimed to profit from Henrietta’s cells, and sent them to any biomedical researcher that requested them at no charge, their potential did not go unnoticed nor unexploited, and now HeLa cells have been bought and sold by the billions in every corner of the globe. More than 60,000 medical research journal articles have thus far been written using these cells and over 11,000 patent applications involve HeLa cells. Some estimates suggest that somewhere in the region of 50 million tonnes of HeLa cells have been grown. HeLa have been in outer space, in order to determine the effects of outer space on cancer cell growth. In the 1960’s HeLa cells were fused with
mouse embryonic cells to create the first cell hybrid, which led on to the process of mapping the human genome. They have been instrumental in vaccine development: Zur Hausen won his Nobel Prize using HeLa cells to create a HPV vaccine. Richard Axel went on to win a Nobel Prize by infecting HeLa cells with HIV. The virologist Jonas Salk used HeLa cells to develop the Salk vaccine which led to the near world-wide eradication of polio. The Nobel prize winning work regarding telomeres, was, you guessed it, carried out on HeLa cells. Their contribution to medical research is astronomical.
The story is soon to be made into a HBO film by Oprah Winfrey and Alan Ball Henrietta died of her disease nine months after her initial diagnosis, on the 4th October 1951. She was 31 years of age and had five young children. It wasn’t until the 1970’s that Henrietta’s family had any idea of her contribution, when they were contacted by researchers hoping to explore in greater detail HeLa’s genetics. Although her family have since learned of their mother’s/grandmother’s unwitting contribution to the world, they struggle with this legacy and the damningly unfair bioethics and legalities that surround it. Despite the fact that one small vial of HeLa cells is now sold for around 4,000 SEK, and have been profited upon for decades, Henrietta’s family live in poverty in Baltimore and to this day cannot afford health insurance. It took 60 years before Henrietta‘s grave could be given a headstone. The surreal complexity of some biological entities such as subcellular signaling networks can seem almost extraterrestrial in nature, and so abstraction from
the human element can become commonplace. Once in a while, we as scientists can become so engrossed in the detail that we can forget how or why we got here. The story of Henrietta Lacks gave the world so much, not simply in cell biology and medical progress, but in the development of the field of bioethics, moral experimentation and the questions surrounding ownership of one’s own body, constituents of which now can survive long after death. Cases such as Henrietta’s, and the infamous Tuskegee syphilis trial in which African-American men were unknowing research subjects in the study of the progression of untreated syphilis, that continued long after a treatment was found, led to the development of laws such as informed consent, diagnosis communication and clinical trial standards which upheld the protection of human research subjects. As scientists, it is imperative for us to bear in mind that although human help is most often our end point goal, it is not a distant issue. Real human beings are behind almost every biological sample we work with; these are not infinite inanimate tools, and our work often depends on the generosity of human samples and participation. The people behind these entities have hopes, desires and a dignity that needs to be upheld. •
HeLa cells belonged to Henrietta Lacks. And her story deserves to be told. For those interested there is a great book “The Immortal life of Henrietta Lacks” by Rebecca Skloot, and the story is soon to be made into a HBO film by Oprah Winfrey and Alan Ball.
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Nanotechnology in medicine By Eveline Shevin
Photo: IsaacMao (Flickr)
How can this multifunctional technique improve quality of life? “It is so exciting that I want to use all my time effectively to be able to contribute, life is so short!” says young Maria Strømme, professor in Nanotechnology at Uppsala University in Sweden. She wants to revolutionize the world with her new discovery - and join the growing movement that uses nanotechnology to repair damage and treat illnesses in the body. It started in 2011 on a Thursday afternoon when her research group tried to synthesize a material of magnesium carbonate that several scientists had failed to make before. After a few alterations in the procedure they forgot about it and it was left over the weekend in the reaction chamber. When the team arrived on Monday they discovered that the material had formed a gel. They had successfully synthesized a material that was impossible to make; they called it Upsalite. Upsalite is a unique material that contains small pores that can be filled with pharmaceutical drugs. According to Strømme, Upsalite could be loaded with a cancer drug, and be cleverly engineered to uniquely identify tumour cells. There is no evidence yet if this works, however ongoing research suggests that this material can improve the solubility of active pharmaceutical ingredients which means that it may have a potential effect in treating cancer. Another type of nanotechnology, shown in the photograph, is a magnetized nanocrystal that has been developed 22
by a research team in Australia. This nanocrystal can be filled with a chemotherapeutic drug, swallowed by the patient and targeted to a tumor using magnetic resonance. Apart from the drug, the nanocrystal can also contain antibodies or receptors that recognize and guide them specifically to the cancerous cells. Using magnetic resonance imaging, it is then possible to obtain specific images of the nanoparticles, and therefore clear images of the location of the cancer cells can be obtained. This could be useful for identifying any spread or metastasis of the cancer, which will guide diagnosis, staging and treatment plans. It could also aid planning of surgical interventions, so that minimal tissue can be resected, enabling the patient to recover faster with less trauma. The images could also be used to monitor for relapse. Furthermore, activating the pharmaceutically-loaded nanoparticles, by using ultrasound waves to break and push the nanoparticles apart, allows them to be taken up by the targeted cell and release the drug inside the cell. This provides locally targeted chemotherapy, contrasting to standard chemotherapy which is indiscriminate in terms of the cells it affects; causing side effects such as gastrointestinal symptoms and alopecia. A different form of nanotechnology, known as nanofibers, is hoped one day to be used for treatment of patients with paralysis by inserting an artificial nanostructure in the damaged part of the spi-
nal cord. A research group led by Samuel Stupp developed bioactive nanofibers that self-assemble in the spinal cord. They have an amino acid signal that binds to receptors of neural cells, and when the signal binds to a receptor it stimulates axons to grow in the damaged area. The group injected the nanostructures in the spinal cord of a paralyzed mouse and discovered that the axons crossed through the lesion. After a while the mouse showed signs of movement, indicating that the nanofibers had regenerated the damaged cells. If future human trials show the same effect, this technology could improve the prognosis and quality of life for patients suffering from paralysis after a spinal cord injury. Nanomedicine has a bright future ahead in the realm of research and clinical practice, especially in targeting diseases that are difficult to treat due to the absolute requirement for a highly specific intervention such as repairing damaged cells in the human body. Within a couple of years, scientists hope to use nanotechnology in treating oncology patients by simply injecting a nanoparticle loaded with chemotherapy drugs that can specifically recognize cancer cells, leaving healthy cells undamaged. This article has discussed two of the many thrilling approaches of the use of different types of nanotechnology in medicine, and we look forward to seeing how they develop in the future. •
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A Walk Through the Zika Forest By Jessica de Loma Olson
Declared as a global health emergency during the 2015 outbreak in Brazil, the Zika virus has been in the spotlight since. New headlines and reports are being published daily – but where has the virus been hiding until now? Is it all that new? Let’s wander through the basics of the Zika virus and go into the Zika forest to unravel its origin. Lost in the forest – The origin The star of the day: a feverish Rhesus monkey. When its body temperature increased from 37.7°C to 39.7°C, Dr. Alexander Haddow and Dr. George Dick knew it was time to investigate. It was April 18th, 1947. Uganda. Initially interested in the study of yellow fever viruses, Dr. Haddow was the team leader of this research back at the Uganda Virus Research Institute. The Institute, located in Entebbe, was founded in 1936 and led the discovery of multiple arboviruses (ARthropod-BOrne viruses) such as Chikungunya virus, West Nile virus and O’nyong’nyong virus. But going back to our lead actor: the monkey happened to be in the Zika forest. This tropical forest belongs to the Uganda Virus Research Institute and access is restricted to research purposes only. During the spring of 1947 the Zika virus was isolated for the first time, however, it was not until 1952 that the first written description of the virus was published in the journal Transactions of the Royal Society of Tropical Medicine and Hygiene by the same scientists. Since then, the virus has been known to affect multiple locations in Africa and Southeast Asia but has generally been unnoticed by the general public. All that changed in 2007 when there was an outbreak in the Yap Islands, a group of islands in Micronesia in the Pacific Ocean.
Until that moment, the Zika virus had not spread outside of Africa and Asia.
Symptoms and potential complications
For almost 7 decades the Zika virus has been little noticed by history - at least in the global media. Until now. The Zika virus has “jumped” to Brazil and it is still spreading to other areas of South America and Central America provoking a global health emergency.
The signs and symptoms of the Zika disease are mild fever, skin rashes, conjunctivitis, muscle and joint pain, malaise or headache. The disease usually lasts for 2 to 7 days, not normally causing any severe outcomes. However, during the last outbreak in Brazil, an increased number of babies have been born with microcephaly – a rare neurological condition where the child’s head is smaller than expected. Despite this coincidence, little can be said conclusively at the moment about the causality. Having said that, a recent study published during February in The Lancet Infectious Diseases strengthens the connection between these events. It describes evidence of zika virus presence in the amniotic fluid of two women who were affected by symptoms of zika whilst pregnant, and whose babies both have microcephaly. Ana de Filippis, one of the authors of the study from the Oswaldo Cruz Institute in Rio de Janeiro, told BBC News that their study suggests the virus “could cross the placental barrier and infect the fetus”. Nevertheless, this is not enough to complete the missing link and further investigation regarding the pathophysiology is still required.
The virus The Zika virus – or ZIKV – is a group IV single strain RNA virus that belongs to the genus Flavivirus, which also contains the Dengue virus, yellow fever virus and West Nile virus. The biological mechanism causing the disease is thought to be the invasion of dendritic cells surrounding the site of infection. The virus then spreads to the rest of the body through the blood stream or lymphatic system.
The diagnosis Currently, there are two main ways of confirming an infection. One is the detection of viral RNA present in the patient’s blood by amplifying the viral genetic material by polymerase chain reaction (PCR). However, this is only feasible during the first week of infection. After this period of time, zika-specific antibodies can be detected in blood, but there are many issues regarding cross-reactions with antibodies against related viruses. For this reason, the method lacks specificity causing diagnostic uncertainty.
Despite having been known of for quite a few years, little is still certain about the physiological consequences of Zika virus infection. Ongoing research, spurred by the declaration of a global health emergency, will prove fruitful for broadening our understanding. • 23
ANTIBIOTIC A hidden danger
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Story by Markus Karlsson Photography by Peggy Ler 25
Cover S tor y
- Martin Luther King, Jr.
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mma was finally on vacation – she and her classmates had been saving money the whole year to afford the long trip abroad. It was time to have fun and enjoy the sunshine, white beaches, cocktails, fresh fruit and vegetables and getting to know a new country. On her last vacation days, Emma started feeling a bit unwell: she had intestinal cramps, her appetite was suddenly gone and she was visiting the toilet way too often – “nothing too serious”, she told herself. Back home, things started to get worse: Emma developed a fever and her body was aching all over. She was still having difficulty keeping down anything she ate, and was unable to get up from bed. It was then that her parents took her to the doctor, who prescribed a one-week treatment with broad-spectrum antibiotics. Despite feeling somewhat better after a few days, Emma’s condition suddenly worsened. Her fever was now over 40°C and the intestinal cramps were absolutely unbearable. She was vomiting frequently and had blood in her stools. She was dehydrated and pale, without any energy left in her body. She was immediately taken to the hospital where she was informed that she was infected with a type of antibiotic resistant bacteria, known as ESBL-producing Escherichia coli. The infection was spreading all over her body and her condition continued to worsen. Then came the tubes, one after another. They went into her chest, her airway and 26
her vessels, delivering oxygen, nutrients and drugs. For some days, Emma’s condition showed no sign of improving, but with a combined drug therapy her body was eventually able to fight off the infection. However, as a result of the damage, she ended up losing all hearing in her right ear. Her story is one of many - an unclear but growing number of cases involving broad antibiotic resistance. The political will to tackle this issue has been lacking for some time. However, in late October 2015, the Nordic Council hosted an open seminar on the subject in the Swedish Parliament. This is where I first met Otto Cars. Dr. Otto Cars is a senior professor of infectious disease at Uppsala University, and has been a driving force of the Swedish efforts to tackle the issue since the foundation of the Swedish strategic programme against antibiotic resistance, or the Strama network for short, in 1995. In recent years, he has been focusing on international action through his network ReAct - Action on Antibiotic Resistance. In a cold morning in the beginning of November, I entered the office of ReAct in central Uppsala. Cars welcomed me at the door and offered me a cup of coffee, but having had one on the pendeltåg from Stockholm, I politely declined. In the entrance to the glassy but charming office landscape there were a number of appreciatory gifts from organizations in Africa and other locations around the world.
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Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity
We entered a conference room in the back, with a projector hanging over a long table. One of the walls was covered by a large world map, as if displaying the scene for the global problem we were about to discuss - large-scale antibiotic resistance.
What is antibiotic resistance?
Antibiotics are a group of pharmaceuticals that directly attack various basic functions or structural components of bacteria, for example by breaking down their cell membrane, or inactivating protein synthesis. The development of antimicrobial resistance occurs through evolutionary mechanisms. Some bacteria may carry mutations that make them resistant to an antibiotic agent. This can occur by various mechanisms, such as enzymes that break down or inactivate the drug molecule, or a pump that transports the drug out of the bacterial cell. When a particular antibiotic is administered, most of its target bacteria are eliminated. However, resistant bacteria are able to survive: they have been selected for. These remaining bacteria will now have access to a surplus of nutrients, allowing them to grow into a new population that is resistant to the original treatment. The risk of this happening increases with the overuse of antibiotics. In the 1980s and 1990s, Sweden experienced a steady rise in the use of an-
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tibiotics. This led to a corresponding increase in the number of antibiotic-resistant pneumococci by the early 1990s. Physicians recognized this as a potential problem, and after discussions between various official agencies, the Strama network was founded in 1995. Chosen to lead the project was Dr. Otto Cars. “This is something that develops slowly, over time”, Cars explains. “We are trying to find ways to express this a slow tsunami, or, perhaps even better, a slow pandemic. Because it is really a pandemic.”
What is the current situation?
Statistics from hospitals in the Stockholm region indicate that local antibiotic resistance is on the rise. Danderyds sjukhus, Södersjukhuset, and the Karolinska University Hospital in Solna and Huddinge all report an increased prevalence of ESBL-producing Escherichia coli during recent years. ESBL stands for extended spectrum beta-lactamase, enzymes that work to break down or inactivate a class of antibiotics known as beta-lactams. These drugs account for more than half of the global antibiotic market, and include penicillins, cephalosporins and monobactams. Furthermore, genes coding for ESBL production are often found in plasmids, a kind 28
of bacterial DNA unit that can be easily transferred between species. Sweden, nevertheless, is very well off compared to other parts of the world. The average domestic E. coli ESBL rates lie around 5%. Karolinska University Hospital carries most of the burden, with a rate of around 12%.
the worldwide death toll of all antimicrobial resistance is at least 700 000 per year This is consistent with the European average, according to a global survey conducted by the WHO in 2014. Meanwhile, Africa and the Middle East hovers between 34-40%, while in India and Indonesia the numbers reach a staggering 55%. Of course, this is not the only looming threat. Staphylococcus aureus is a bacterium commonly found on the skin and in the nose, which does not necessarily cause symptoms. However, some strains are pathogenic and can cause infection. Furthermore, the bacterium has shown a great genetic flexibility, and strains resistant to multiple antibiotics have quickly emerged in the form of methicillin-resistant Staphylococcus aureus (MRSA).
This is primarily spread in hospitals, and while the rates are highly variable among different regions, it is one of the most important causes of resistance. The Nordic countries show consistently low rates, around 1-3% of S. aureus isolates, while the European Center for Disease Control reported a European mean of 17.4% in 2014, with some countries ranging between 30-50%. Meanwhile, the WHO survey lists Africa and the combined Americas as having 40% and 44% of MRSA respectively. According to a review commissioned by the UK Government, the worldwide death toll of all antimicrobial resistance, including tuberculosis and malaria, is at least 700 000 per year.
How did we get here?
Unfortunately, the development of antibiotic resistance is accelerated in many ways through overuse and improper handling. According to the Center for Disease Control (CDC), as many as 50% of antibiotic prescriptions in the US are not needed to treat a current bacterial infection, or are misused in some way, for example by being prescribed in the wrong dose. Weakly dosed antibiotics promote resistance by creating a selection pressure on infectious bacteria, while not being able to completely eliminate them.
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If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine
Furthermore, the market for counterfeit medicine is highly attractive in developing countries, due to their strong demand and lack of proper regulation. According to a review article published in 2012, counterfeit antibiotics account for five percent of the global antibiotic market. While rare in industrialized countries, they account for 10-30% of sales in some developing countries. Most of these are of bad quality or dosed with little to no active ingredient. Therefore, apart from lacking efficacy to treat lethal diseases and causing hundreds of deaths worldwide per year, these fake drugs also directly promote the development of antibiotic resistance. In many countries, antibiotics are also used on livestock animals for non-medicinal purposes, notably as prophylactics to decrease their risk of developing infections and, in turn, increase animal growth rate. These practices also accelerate the evolution of resistance. Resistant strains can then be transmitted to other animals or people who work in slaughterhouses and on farms. Bacteria may also remain on meat, and while most die during cooking, improper handling may result in transmission to humans.
How bad could it get?
Nightmare scenarios may already exist under the radar, in Africa and other locations that lack resources for antibiotic regulation and laboratory surveillance. A 2009 study describes an orphanage in Mali, where adults and children were examined for the presence of ESBL-producing bacteria in their normal gut flora. One hundred percent of the children were colonized.
the worldwide mortality from all antimicrobial resistance could grow to 10 million per year by 2050 Since these bacteria are part of the normal flora, they do not necessarily produce symptoms. However, this indicates that resistance genes are ubiquitous within the local ecosystem, so that when an infection does occur, it is more likely to be untreatable by conventional means. Another study from Tanzania indicates a 28% mortality rate in pediatric sepsis with ESBL positive blood cultures, compared to 8% for negative cultures. Of course, these are only a few examples from already strained health-care systems, but the overall picture is worry-
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– David Cameron, UK Prime Minister
ing. The ubiquity of drug resistance could completely change the face of medicine as we know it. Superficial infections and routine surgical procedures could once again become life threatening, with immune-compromised patients and implant carriers being especially at risk. A review commissioned by the UK government estimates that the worldwide mortality from all antimicrobial resistance could grow to 10 million per year by 2050.
What can we do about it?
In the current situation, the development of new antibiotics may not be enough to compete with evolving bacteria. Most of the traditional drugs were discovered by screening soil-derived bacterial samples for anti-microbial activity. However, only around 1% of these organisms can be cultured and grown in the lab, and these methods reached their limit in the 70’s. More high-tech approaches have been developed since then, but finding new antibiotics and getting them on the market costs increasing amounts of time and money. Furthermore, with health care authorities attempting to limit antibiotic usage, the economic prospects are unattractive. Meanwhile, Cars himself focuses on education and regulatory change. 29
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“In many countries, there is simply no way to put antibiotics under prescription, because there are too few doctors to prescribe them”, says Cars. “You have to accept that antibiotics are being sold over the counter, and work towards a system with more quality control, that provides at least some education to antibiotic suppliers.” “This means that the public, too, must have a better idea of when and how it is appropriate to use antibiotics. It is an issue of changing existing systems, social norms, and behavior. Of course, the world is getting better, and health authorities are getting stronger, but all of that takes time - it then becomes largely a question of public education.” However, that’s not always easy: the issue of antibiotic resistance is more complex and diffuse than other killers like tuberculosis and malaria. Those are diseases with a distinct face, and are easier for people to understand. Furthermore, the problem spans multiple sectors of society, which means that many separate organizations often need to be involved. Dr. Cars thinks that we can still become a lot better at reducing antibiotic consumption, even in Sweden. He stresses the importance of being able to effect change on a local level, for example, by providing antibiotic prescribers an anonymous prescription record of their institution. It could make people more aware of what they are doing, and more actively consider their reasons. “However”, he says, “forcing guidelines should be avoided. Real cases are complex, and health care workers need to have the right to trust their personal judgment and make exceptions.”
Financial models
Existing financial models provide incentives to increase sales, which for antibiotics is the opposite of what society would like to achieve. Cars also notes that 30
it can be hard for less well-off individual sellers to reduce their sales or reject wellpaying offers from the pharmaceutical industry. During the seminar in the Swedish Parliament, new models were discussed for funding antibiotic drug development. For example, the government or some other central organization could offer to buy the rights to new drugs, with a guaranteed lump sum to offset development costs. Furthermore, a centralized incentive for reducing antibiotic sales could be possible.
Are our efforts paying off?
The Nordic countries have adopted a model called “One Health”, which focuses on the interaction between humans, animals, and nature. “This is good”, Cars explains, “because they are starting to view it as an ecological problem, where antibiotic resistance genes and antibiotic molecules are circulating in the environment.” In Sweden, veterinary antibiotics are under prescription and may be used for medical purposes only. The practice of using antibiotics as growth promoters was banned in Sweden in 1986, and the EU gradually followed suit until the introduction of a complete ban in 2006. The total sale of active antibiotic substance for animal medical use in Sweden amounted to 10.3 tons during 2014, according to a report from the National Veterinary Institute (SVA). This means that the total use of antibiotics for animals and livestock has been reduced by around 60% since the early 1980s. Likewise, the overall consumption in humans has decreased by 11% between 2000 and 2014 and now sums up to 60.5 tons. These excellent statistics of the Nordic countries can help influence policy abroad. According to Cars, ReAct has helped to build a national policy in Ghana, partly based on the Swedish system.
“Copy and paste doesn’t work, of course, but all the parts required for this issue are generic”, explains Cars. “You need to work on surveillance, regulation, hygiene, education, and research. But it must be implemented in a way that makes sense for their country.”
Future solutions
One big stumbling block, the inability to culture most soil microorganisms in the lab, may be about to be overturned. A research group at Northeastern University in Boston has developed a technology called the iChip, which is able to mimic the bacteria’s natural environment. This has resulted in the discovery of Teixobactin, the first antibiotic with a truly novel mechanism of action in almost thirty years. Nevertheless, antibiotics may not be the final solution. We also have to be creative and think beyond the usage of these drugs. Cars mentions gene editing as a promising example, which has become much more widely available with the introduction of techniques using the CRISPR-Cas9 system. “One possibility would be to somehow modify a patient’s bacterial genome, and simply cut away genes that code for antimicrobial resistance. But this is not my area”, he emphasizes, “and it is hard to predict the future. We will have to rely a fair bit on serendipity and chance.” •
Swedish Strama Network: www.strama.se ReAct - Action on Antibiotic Resistance: www.reactgroup.org World Health Organization: www.who.int/en/
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Global Focus
Zika: reality, risk mitigation or scare campaign? By Sarah Marshall
Z
ika, a catastrophic, rampant infectious disease has hit the Americas and the outbreak is forecast to be an epidemic of explosive proportions. Heard that before? The current Zika outbreak has been mirrored with a media frenzy, all too reminiscent of the recent Ebola crisis. The recommendations to enhance communication and awareness in order to best manage and mitigate the issue are all well and good, but has it caused an undue global scare? Let’s get the facts straight before we launch into yet another dramatic media amplification. An outbreak of the Zika virus was announced on May 15 of 2015 by the Brazilian Ministry of Health, stating that the Zika virus was circulating in the country and preliminary results indicated 16 cases in Bahia and Rio Grande do Norte. Since this time, cases have rapidly increased and spread throughout the Americas and the Caribbean, with an estimated number of people infected to be near one million in Brazil and surrounding areas.
Why the hype and is it justified? What is it about Zika that has provoked worldwide media publicity and alarm among international public health organisations? The Zika virus is not new, it was discovered decades ago. Even with a recent outbreak in the South Pacific island of French Polynesia during 2014, Zika did not receive international attention. So why this time? A combination of factors have caused concern: the continued rapid spread of detected cases, the likelihood of an association with birth defects and an incomplete understanding of the virus aetiology and clinical significance. Warranted concern, but perhaps unwarranted panic. From an epidemiological perspective, there are some key issues that have brought this outbreak into the spotlight. Here we look at these key issues and consider their context and factual grounds.
There is no vaccine or cure for the Zika virus disease. Yes, this is true and cannot be argued. However, the same scenario exists for many other infectious diseases such as 32
Photo: Centers for Disease Control and Prevention (Wikimedia Commons)
Chagas and Chikungunya. No licensed vaccine and no direct cure are not reasons for panic. The treatment for Zika virus disease is based on the symptoms which can include fever, rash, joint pain, conjunctivitis, muscle pain and headache. The illness is usually mild with symptoms lasting from several days to a week and people very rarely die.
Zika infection during pregnancy may be linked to birth defects in babies. Following the Zika virus outbreak in Brazil, in October 2015 it was found that the number of reported microcephaly cases had increased compared with previous years in several Brazilian states. Microcephaly is a rare condition where the baby’s head is smaller than expected
when compared to babies of the same sex and age, resulting in potential physical complications and learning difficulties. The overlapping increase of reported Zika virus disease cases and microcephaly cases sparked an investigation into the potential association. Subsequently, additional birth defects are being examined, such as neurological disorder GuillainBarre syndrome. Despite seemingly convincing evidence, it is unknown whether there has been an increase in cases identified and reported opposed to a true increase in microcephaly among infants. Additionally, longitudinal research and surveillance is required to confirm causality; that the Zika virus disease directly causes these particular birth defects. This research is happening now and results are anticipated very soon.
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Global Focus
The World Health Organisation (WHO) declared the Zika outbreak a Public Health Emergency of International Concern. Linked to the previous point, this year on the 1st of February 2016, the WHO declared a Public Health Emergency of International Concern (PHEIC)due to the rise in microcephaly and other birth defects coinciding with some of the Zika-affected areas in the Americas and the Caribbean. The Centre for Disease Control (CDC) then promptly raised its Emergency Operations Centre to the highest level of activation. The question here is: was this declaration driven by the criticisms of the WHO’s response to the Ebola outbreak in 2014 (particularly the Lancet publications) or a warranted warning flag for an immediate response. There are vast differences between the
“The underlying risk, as with the recent Ebola outbreak, is a distortion of priorities; similar infectious diseases such as Malaria, Dengue and Chagas are still widespread and the podium must be shared not dominated.” Ebola outbreak and the current Zika outbreak (such as risk of death, transmission modes and communities affected), and therefore cannot be directly compared, however certain learnings can be shared. This time, yes, a warranted warning flag; the WHO has alerted the international community with a prompt PHEIC declaration, providing appropriate early warning for assistance and coordination if and when required.
Modes of transmission are not fully understood and the populations affected are increasing. It is known that Zika is a virus carried and transmitted by the female Aedes mosquito (the same culprit that can carry the dengue, chikungunya and yellow fever viruses). What is unknown is whether the Zika virus has additional modes of transmission. Sexual transmission and transmission via saliva are plausible with limited evidence, however cannot be overlooked. With this, in addition to the exponential increase in cases reported of the Zika virus disease, the cause for concern has heightened. Without complete knowledge of the way the virus works, curbing the spike in cases and the spread of the virus is incredibly difficult. The best approach is to implement what we
do know: strong surveillance, case management and continue to reduce vectorborne transmission through established methods such as insecticide-treated bed nets, indoor residual spraying, and individual protection.
Where does this leave us? There is a sensitive difference between risk communication and a scare campaign spurred by the media. In the case of Zika, the large degree that is unknown, the rapid increase in people affected combined with the global risk have raised the alarm. The Government of Brazil, with their ‘Zero Zika’ public awareness campaign, the WHO and the CDC are soundly attempting to convey the situation: what we know (and what we don’t), what is being done and what requires action. As with many health issues in the global spotlight, the media have amplified the story. This is double-edged as it aids public awareness and risk communication, but it can also instigate fear among the public. Critical and calm assessment of the facts and context allow for the best possible outcomes. With what we know, we must adhere to best practice for surveillance, interventions to reduce the spread and mitigate the negative impacts for individuals, communities and popula-
tions. The underlying risk, as with the recent Ebola outbreak, is a distortion of priorities; similar infectious diseases such as Malaria, Dengue and Chagas are still widespread and the podium must be shared not dominated. There is much effort being invested into understanding the Zika virus and our knowledge is building. With this, we must stay tuned with a critical eye to gain the full picture as it evolves and avoid being led on a journey written by the media. Stay informed through the frequently updated WHO and CDC websites with advice for International Public Health Organisations, Governments and Health Departments, people living in high risk areas, pregnant women and travellers. •
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Global Focus
Reducing the health impacts of tobacco: Are electronic cigarettes a healthier alternative?
Photo: TBEC Review (Wikimedia Commons)
By Luke Fry
Cigarette consumption is decreas-
ing in high income countries but increasing in low and middle income countries. This is concerning as 84% of the world’s smokers live in low and middle income countries and often die from non communicable diseases at a younger age than those in high income countries. The World Health Organisation (WHO) proposes several measures that can reduce demand for tobacco products. They include price and taxes, regulation of their contents and what is disclosed about the products, packaging and labelling, education and public awareness, controls on advertising, promotion and sponsorship and demand reduction concerning dependence and cessation. They also propose several measures that aim to reduce production, distribution, availability and supply Non toxic cessation aids are one method that can reduce tobacco use. This would allow smokers to obtain nicotine without endangering themselves and reduce passive smoking. It recognises the addictive nature of nicotine and argues more for a harm reduction strategy. “It has been shown that approximately 80% of smokers who attempt to quit on their own relapse within the first month of abstinence, and only about 5% achieve long term abstinence”. A switch to an equally addictive
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Skycig was bought by US tobacco group Lorillard in 2013 for 30 million pounds. According to some with the help of celebrity use by individuals such as Leonardo di Caprio and Kate Moss. It is important to question the tobacco industry’s motives and intentions. Do they want to control the cessation market through electronic cigarettes or do they want people to quit smoking? It seems counter intuitive that they would want to essentially destroy their customer base. In the past tobacco companies have used harm reduction strategies for a better public image and have also used them to attract new smokers.
Implications for policy and practice Electronic cigarettes pose a few problems for policy makers. One of the main issues is that there is still a lack of evidence in terms of the benefits and harmful effects of electronic cigarettes.
product but with less health risk could be a way of potentially saving life. Electronic cigarettes are operated by batteries and vaporise liquids and flavours into an aerosol form. The toxins in electronic cigarettes are often lower than in traditional cigarette. According to some they are 95% less harmful than cigarettes, however the long term health effects are still unknown. There is agreement among most scientists and commentators that complete tobacco cessation is the best outcome for everyone. Arguing that if safer products are made they need to be part of a larger effort to control tobacco, minimise it’s use and help smokers quit. They argue that a safer alternative may stop smokers from quitting completely. The concerns around public health are that electronic cigarettes may be marketed as ‘healthy’, enable smokers to quit, and that this may attract new and younger individuals who may not have otherwise started smoking. In this context industry has a great influence. Many of the larger tobacco firms have in recent years bought out many of the e-cigarette companies. For example,
This has meant the classification and control of electronic cigarettes is problematic as it can be unclear if these products are or should be of classified as consumer goods, controlled substances, or medical devices. In response to the increasing availability of electronic cigarettes the WHO released a report on October 2014 through the Framework Convention on Tobacco Control. It encouraged stronger control measures on the manufacture and sale of these products, including restrictions to avoid attracting youth and new smokers along with a ban of smoking in public places. In Europe the restrictions are set to get tighter. From May 2016 they will be regulated as a consumer product with new rules limiting amount/strength of nicotine, list of ingredients, health warnings and bans on advertising. In Australia like Sweden the sale of e-cigarettes containing nicotine in banned. Nicotine can only be imported for use in electronic cigarettes on a medical prescription. It will be interesting to see how this debate unfolds in future years as the research begins to be more substantial. A ban has some benefits in terms of reducing the normality of smoking, limiting new smokers and production of electronic cigarettes. However, banning a less harmful product while allowing a more harmful product to be sold freely is somewhat illogical. •
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Around the world with smog
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Global Focus
By Devy Elling It is no surprise that we are exposed to air pollution, and sometimes, you can even see a cloud of smog coming from industries in some parts of the world. Recently, there have been several conferences, reports and discussion revolving around climate change, and as expected, air pollution was a huge part of it. The World Health Organisation (WHO) has issued a warning regarding air pollution, emphasising on the poor air quality and its impacts on public health. The WHO spokesperson, and head of public health, Maria Neira has stated the shockingly high numbers gives rise to a new “global health emergency” that will have significant financial implications for governments. Some years ago, we know that air pollution has negative effects on respiratory diseases, such as pneumonia and asthma. In the recent years, a number studies have been conducted, which resulted in increase of awareness of non-respiratory-related diseases, for instance cardiovascular diseases and even, dementia. As awareness increases, we have deeper understanding that air pollution does not only constitute visible smog, but also other substances in the air that contribute to global warming.
This includes even the production of food we eat on everyday basis. With many of the diseases associated to chronic diseases, one might start to wonder how much we lose with the rise of these diseases, not only monetary costs, but also quality of life. We might start to contemplate about things such as, “where has it all gone wrong? How should we address this issue? What can we, as a community, do to improve the current situation? Is there anything in particular that I, as an individual, can do to help reduce this issue?” It might be easy to blame urbanisation, in particular the rapid growth of industries, but surely, this cannot be the only factors that contribute to striking change in the environment. If this reason is the only reason we have, what can we do? It is not possible that we stop all industries, but it is always possible to inform people how to deal with different issues in a sustainable way. Many people, at least in Sweden, are aware of how serious air pollution can get and how we should deal with it. In the bigger cities in Sweden, where there are good public transport and pathways
WHO air quality guidelines can reduce air pollutionrelated premature deaths by 15%
Private vehicles accounts for approximately 55% of household’s footprint, and the use of public transportation reduces it to 25%
Use of public transport can reduce potential years of life lost from road-related outcomes by 60%
for cyclists and pedestrians, it is easier to opt from personal cars. However, in many places of the world, it is nearly impossible to get anywhere when you do not have a car yourself. In this case, a good policy for better infrastructure and public transport should be implemented. Several companies around the globe have started a motion in order to reduce air pollution from different perspectives. Industrialised countries are still trying to find the best way to reduce the level of different substances to be able to improve population’s health. With all the information we have on what we have done “wrong”, what can we do to reduce the excessive amount of pollution? Well, there are two means of reducing air pollution. On individual level, we all can reduce our own carbon footprint, in which we can take the public transport and bicycle more often, eat more sustainably produced food, and recycle our wastes. On an aggregate scale, governments need to take more actions to limit emission of carbon dioxide and other greenhouse gases, such as putting higher tax on petrol and encourage the population to conserve energy and pollute less. •
On average, public transportation contributes to 0.17 kg CO2 per 1.6 passenger mile compared to 0.44 kg CO2 per 1.6 passenger mile with single-occupancy vehicle
CO2 emission increases by approximately 4% annually
Reduction of at least 50% of global CO2 emission by 2050
Photo: Owen Bryne (Flickr)
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CULTURE
Festivals 2016 By Alex Browne
Summerburst 27-28 May – Gothenburg 10-11 June – Stockholm summerburst.se Summer starts here! Summerburst kicks off the festival season with x2 two day events in Gothenburg and Stockholm. If mainstream club dance is your thing, then this is the festival for you. With dif- ferent artists between both locations, the line-up in Stockholm includes David Guetta and Steve Angello, whilst Gothen- burg headlines with Axwell & Ingrosso. Swedish duo Icona Pop play in both cities along with Kygo.
June
Bråvalla 30 June-2 July – Norrköping bravallafestival.se This is the festival for you if rock, indie and rap get your eardrums going. Set up on the outskirts of Norrköping, Bråvalla is one of the few camping festivals and biggest in Sweden. The line-up this year is impressive. International artists in- clude: Mumford & Sons, Rammstein, The 1975, Macklemore & Ryan Lewis and not to mention rappers Wiz Khalifa and A$AP Ferg.
July Distortion
1-5 June – Copenhagen cphdistortion.dk “A week of emerging dance music and or- chestrated chaos” - seems an apt tagline for a festival based on huge street par- ties by day, a clubbing festival by night and a two-day rave around Copenhagen harbour. Dixon (#1 Resident Advisor DJ for the past 3 years), headlines this year making it a massive contender on the European, let alone Scandinavian summer. Previous performers include Todd Terje, Diplo, Hot Chip and Simian Mobile Disco.
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Gangnef
7-10 July, Dalarna skankaloss.com Around 250km north-west of Stockholm, this tiny festival is the hipster homeland for 3 days in July. A mixture of music, art, spoken-word, longboarding and ekofood is the theme for the weekend. No big names music wise, but quality will be high as artists are selected based on intimacy and originality. Spend most of the time listening to a band you’ve never heard of, meet interesting people and eat oysters by the lakeside. So chill..
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Into the Valley 29-30 July, Dalarna intothevalley.se New onto the festival scene in 2015, this will be the second year of Into the Val- ley. Centred inside an abandoned stone quarry the location is spectacular (pho- to). With only one year passed, the or- ganisers are already attracting big names across the electro world. Announced so far DJs include: Motor City Drum Ensem- ble, Dixon, Joy Orbison, Nina Kraviz and Axel Boman. Bring your dancing shoes and a tent.
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Popaganda
26-27 August, Stockholm | popaganda.se As always, the closing of the Scandi festival season is Popaganda. Located in Södermalm’s Eriksdalsbadet, feel free to have a swim whilst listening to your favourite tunes. Line-up to be announced. Pool party confirmed.
Festival Tips 1. Buy tickets early – all festivals have early bird options and some have incremental price increases each month.
Way out West
11-13 August – Gothenburg wayoutwest.se Gothenburg’s premier music festival covers a range of genres. 2016 brings over Australia’s queen singer-songwriter Sia for her first performance on Swedish soil. She’s also joined by the incredible Sein- abo Sey who is an absolute mustsee of the weekend – “Younger” made famous by the Kygo remix. Others include: M83, Jamie XX and Chvrches. It’s a party in the Slottsskogen park!
2. Plan travel and accommodation – places to stay will get booked up pretty quick and prices are hiked up during popular periods. Camping is rare. 3. On a tight budget? Be a volunteer – every event has volunteer opportunities to help out with security, entrance and bars. Most are rewarded with free festival passes. 4. Priorities. Schedule which artists you want to watch – multiple stages and band clashes are the worst. Look up timings and locations to avoid disappointment. 5. Food and drink prices at festivals are usually extortionate. Refuel and rehydrate before arrival on-site.
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CULTURE
Countdown to Eurovision 2016 A beginner’s guide to the weirdest cultural institution in the world By Euan Mackay
Lock the door, bar the windows and hold tight your loved ones, because in May the Eurovision Song Contest is coming to Stockholm. The garish bacchanal, watched by 180 million people, is descending on the Swedish capital for 2 weeks of celebrations, culminating in the finale on May 14th when the people of Europe will exercise their democratic freedom by voting on which country had the least bad song. In anticipation, we present a crash course on Eurovision. What? Why? How? Really? Nah Europe has a long, storied history of fighting. However, after an especially heated fracas in the 1940s, a massive political and cultural drive emerged to develop institutions to foster international unity and promote peace. And of all the enterprises undertaken in the name of peace and stability, no project better reflects the lofty ambitions and grubby reality of international relations than the Eurovision Song Contest. In 1955, the European Broadcasting Union, a conglomerate of European and Mediterranean broadcasters, sat in humbled awe as a deranged French man called Marcel Bezençon became a conduit for the divine and prophesised a live television event the likes of which had never been seen: the countries of Europe would each submit a musical act and song and compete against each other for the vaunted honour of being crowned the Eurovision Song Contest winner. Oh, so is the contest for EU countries or all countries in Europe? Sorry, you still
haven’t grasped the black hole of logic that is Eurovision. Participants are not selected by geography or political affiliation, and in the past Morocco, Israel and Australia have all taken part. China has even officially stated that it’s wants to join.
accusations of cheating. During the 2013 contest, Lithuania gave Azerbaijan full points. How nice! Reports then arose than Azerbaijani men had been videoed in Lithuania bribing students and giving them multiple sim-cards to call in and vote repeatedly for Azerbaijan. Yikes!
Since it’s inception, Eurovision has given the world more than 1,400 songs. The world, unfortunately, has not been able to give them back.
But at the heart of it all, it’s all about the music. Since it’s inception, Eurovision has given the world more than 1,400 songs. The world, unfortunately, has not been able to give them back.
The climax of the final is the voting, where people from all participating countries vote for their favourite song of the night. Countries are ineligible to vote for themselves, and each country has an equal vote regardless of population. Eurovision is plagued by voting blocs, where neighbours reliably vote for each other, and countries hash out old grievances by giving former enemies low scores. The contest has been repeatedly marred by
The Right Stuff So what makes a winner? Ask the Irish because they’ve won it seven times, the most of any country (g’wan the lads). So often in fact that they don’t really care anymore. In 2008 they sent a turkey puppet called Dustin to represent them. The Swedes are close behind though with six wins. ABBA won it for the country in 1974 with Waterloo, propelling them to stardom. In contrast, neighbouring Norway are the biggest losers, finishing last 11 times.
The climax of the final is the voting, where people from all participating countries vote for their favourite song of the night. So what language do contestants sing in? Countries often pick between their native language or English. Four of Sweden’s wins have been in English, and the common knowledge is that performing in English improves your chances. Or you copy Belgium, who in 2003 submitted the song “Sanomi”, written entirely in a made-up language, winning second place. In the immortal words of Terry Wogan, “They’ve got four languages in Belgium and they’re singing in an imaginary one, the very essence of Eurovision”.
Photo: Wolfgang Heilemann (UK Metro)
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Comic from: ukineurovision.com
Eurovision songs tend towards glitzy populism with camp performances. Sequins and pyrotechnics and writhing bodies flash across the screen, comedic acts mug to the camera, but sometimes you catch a glimpse of the political theatre behind it all.
Realpolitik Although set up to foster unity between countries, Eurovision is often used to advance national agendas. In 2012 Russia was represented by Buranovskiye Babushki (The Grannies from Buranov), a group of old women in traditional garb who sang “Party for Everybody”, a song about cleaning and cooking over euro-pop beats. The submission was part of a push
dancing grannies publicly signed a petition to support Putin’s military actions in Crimea and the Ukraine, lol. Not to be outdone in propaganda, this year the Ukraine’s leading contestant at time of writing is a Crimean woman called Jamala. If she makes it to Eurovision she’ll perform her song “1944”, about the forced deportation of Crimean Tartars by Stalin during WWII. Fun! And following their 2008 conflict with Russia, Georgia tried to submit a song called “We Don’t Wanna Put-in” about, yep, Mr Putin where they imply they’d like to shoot him. It’s a real funky track.
... neighbouring Norway are the biggest losers, finishing last 11 times.
Winning Eurovision is also of political significance because the winning country becomes the host of the next year’s final. The 2012 contest in Baku, Azerbaijan, allowed the government to showcase their Dubai modelled development, whilst whitewashing their record of human rights violations.
by the Russian political establishment to rebuild Russian nationalism based on a pre-soviet iconography. This new nationalism then fuelled the government’s expansionist policies. So in 2014 the funny
Eurovision turns 61 this year and Europe is becoming more fractured. Far right movements are on the rise, Britain will vote in June 2016 on whether to leave the EU or not, and the refugee crisis
has brought into question the Schengen agreement and freedom of travel between countries. But despite this Eurovision plods on, with disco balls and gaudy colours, cheesy and naïve and tacky, believing in a Europe united by song. At the heart of the ridiculous, the sublime.
Not Without a Drink The Eurovision Village at Kungsträdgården Park (open from May 2nd to 14th) will have live music, restaurants and bars. As well as that, a café and nightclub will be built in front of the Royal Palace, The Eurocafe and Euroclub, for fans who want to party and watch rehearsals. Finally, every bar in Stockholm will hold parties for the long anticipated grand finale on May 14th, so keep your eyes open. •
Important Dates May 10th &12th Semi-Finals in Stockholm Globe Arena
May 14 th Final in Stockholm Globe Arena
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CULTURE
Grown in Stockholm: The Future of Food A guide to urban farming in our capital By Martha N icholson Photos by Erik Sjödin
Stockholm is home to one of Europe’s fastest growing populations. With a projected 2.5 million people living in the city by 2024, segregation, unemployment, food and housing shortages are all challenges. Urban farming is now widely recognised by city planners, academics, public health practitioners and architects alike as part of the solution for a sustainable and resilient future. Here’s a guide on how the practice of urban farming has taken Stockholm by storm, and how to muck in and start farming yourself.
Have people farmed in cities before?
Urban farming is not a new phenomenon. Since the dawn of city life people have grown their own food at times of economic hardship and supply chain disruption. Take wartime Britain for example; in 1917 a home gardening campaign was launched brandishing the mottos “food will win the war” and “dig for victory”. Then there’s the green-fingered allotment and backyard farmers. They grow in pursuit of weekend pleasure and perfect lettuces, but prefer to act alone (not usually seen in groups). These urban farming members have become somewhat of an elite in Stockholm. The rising prices of land and the 10-20 year waiting list for allotment space means not everyone can be part of this exclusive club.
Why start farming now?
Now’s the time for new community initiatives to gain traction in Stockholm. Exciting high-tech ideas have swept through cities with the aim to reduce the distance from farm to fork. Heard of the INFARM hydroponics system in Berlin? It’s more or less a highly sophisticated Perspex cube that grows herbs, radishes and greens inside grocery stores with the power of LED lighting and fertilizers. Then there’s the Brooklyn Grange Farm project in New York City which has developed a cultivation network on rooftops and unused space for a “fiscally sustainable model for urban agriculture”. These cities are making giant leaps in fulfilling Sustainable Development Goal (SDG) 2.4 which aims to “ensure sustain40
able food production systems and implement resilient agricultural practices”. So what have Stockholm’s residents done to build systemised urban farming? There are lots of exciting projects, but my favourite has to be the renaissance of farming land on the abandoned rail tracks of Södermalm. It’s been built by the community initiative Trädgård på Spåret, or “Garden on Tracks”. Sustained by volunteers and a summertime café, this really is the essence of urban farming. Then we have the home-grown organisation, Plantagon (plantagon.com), a vertical farming initiative that has designed an inner city greenhouse based in Linköping to produce 500 tonnes of crops every year. Construction is due to start in 2016, so watch this space.
Erik Sjödin
Artist and urban farming researcher Erik Sjödin invited me to his studio in Årsta to discuss the social benefits of the urban farming movement in Stockholm. This is not a new concept to Erik. Having collaborated with farmers in and around Stockholm for over five years, he has seen
progress with community initiatives and has campaigned for the protection of green space where it is needed the most. Erik has a portfolio of art and research projects exploring human relationships to bees and growing alternative food sources such as the water fern Azolla. As we sat in Erik’s studio on a frozen February afternoon (too cold for farming), he was planning a talk on the “Future of Food”, at the Openlab’s Dome of Visions at KTH, which is also a KI collaboration. I wanted to know what his main message to the audience was going to be. Erik explained that in the midst of our citydwelling and consumerist lifestyles, we project our own socially constructed values onto our food. “We are conditioned to seek the perfect shaped vegetables and let the food industry dictate our choices through advertising campaigns for addictive fatty and sugary foods. The food industry is cutting corners on the quality of products to ensure profits. That has to change.” Erik admits that the industry is beginning to adapt to a more produceraware consumer that is interested in eat
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• Under Tallarna near Järna (accessible by commuter train): www.undertallarna.se • Hästa gård on Järvafältet near Akalla: www.hastagard.se
Vertical Farming
For the lucky few with access to a rooftop or balcony, the world truly is your cabbage patch. Try growing your own vegetables this spring. Start simple with potatoes, lettuce and tomatoes and very soon you’ll have your own personal harvest. Openlab is running workshops and events throughout 2016 to help beginner farmers develop more sophisticated permaculture techniques. There’s also plenty of online resources to help you make the most of your space, no matter how small, with vertical farming strategies.
ing a diverse, healthy and low-impact vegetarian diet. Erik adds, “so it’s up to us all to check where our food is produced and hold industries accountable.” Urban farming is an opportunity for us to shift our values as city-dwellers and focus on the process of nurturing plants and rearing animals. This will reduce waste and nurture healthy lifestyles in urban communities. Communal farming creates spaces where you find diverse activities and groups of people coexisting. City planners are on it and are now using these spaces as a tool to break down the barriers between socio-economic, ethnic and age groups, creating a more cohesive society.
Health benefits
Erik told me about some of the therapeutic effects of producing your own food. “It goes without saying that eating fresh produce is good for you, but another benefit to urban farming is the action of getting outside and interacting with other people and the natural world. It is the perfect medium for contact with outside space for people with rehabilitation and care needs. Scientific studies at the Agricultural University of Sweden have shown the mental health benefits to farming, but in a way it’s common sense that having exposure to daylight and being physically active is good for you. There are many community initiatives in and around Stockholm that have used urban farming to help people with health problems such as burnout, depression, or neurodevelopmental disorders. Also, hospital gardens have shown therapeutic effect for people with longterm chronic conditions.”
to find a locally sourced product to buy or an urban farming group to sign up to. Erik explained: “Urban farming is adapting. Since allotments in the city have long waiting lists and are increasingly expensive to upkeep, we’re seeing a new group of people interested in community action, with collaborations from sociallyaware groups that want to see a greener and more intelligent use of urban space”. With spring just around the corner, why not investigate how you can help with urban farming at an elderly people’s home, school or daycare centre in your community? Alternatively, Erik had four recommendations for volunteer-friendly urban farms and community gardens in and around Stockholm:
Erik described some of the architectural design ideas being factored in when building or renovating apartments. “Architects can make it easier for us to grow crops on balconies by building integrated drainage systems for water and even integrating clever automated watering systems and composting. Providing infrastructure for access to soil and water in public spaces will also facilitate more people to start farming”.
• Trädgård på Spåret in Södermalm: www.pasparet.org/start/urban-gardening
Addressing the challenges that Stockholm will face in the next few years will take more than just urban farming. To sustain a happy and resilient population, we need more than just local harvests and cohesive communities. But what we can do is to shorten the gap between farm and fork, bring communities together with collaborative projects and redesign the perception of the “perfect plate”. We are moving one muddy step at a time in the right direction for a more sustainable future.
• Vintervikens Trägård in Liljeholmen: www.vinterviken.com
You can read more about Erik Sjödin’s work at eriksjodin.net. •
Getting involved in communal cultivation
So how can we all get involved in this green revolution? It’s simpler than you think. You won’t have to shop around long 41
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