Medicor 2013 #1 by Medicor MF Magazine

Prelude

FEATURES

Overture

Dear Karolinska Student,

Sincerely, Gustaf Drevin Editor

ANDERS HAMSTEN

NOBEL NIGHT CAP

Interview with our new president

It’s our turn to arrange the Nobel afterparty!

30 RICHARD HORTON

PS13 Tulsa Jansson. Var går gränsen för psykologin?

16 27

Medicor Magasin Grundad 2006. Sjunde årgången. Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 Ansvarig utgivare: Gustaf Drevin Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm Nobels Väg 10, Box 250, 171 77, Stockholm Utgivningsplan 2013: nr 1: maj, nr 2 och 3: oktober, nr 4: december/januari 2013 Annonsera i Medicor: chefredaktor@medicor.nu www.medicinskaforeningen.se 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.

Why do we do research? An exclusive interview with the editorin-chief of The Lancet

Photo by Martin Kjellberg for Medicor

It is with great pleasure that I introduce you to the first issue of the re-launched Medicor. I proudly write this page, knowing what an incredible journey it has been for me personally, for the working group, and for the magazine itself. Before assuming the editorship in February, I never thought I would have such responsibility during my first semester of medical school here at the Karolinska Institute. I am honoured to have the support of the Medicinska Föreningen and, particularly, our president, Erik Hellsing, who has given invaluable input and support throughout the process of both my appointment and the re-launch. As part of the re-launch, we cover inspirational people that we think would interest our readers. We have been very fortunate to get exclusive interviews with world-renowned profiles such as Hans Rosling, Richard Horton, Barry Marshall, Lennart Nilsson, and Kenneth Chien. The Swedish Society of Medicine was kind to provide us with press passes for the Global Health – Beyond 2015 conference held in Stockholm on April 4th as well as allowing us to set up a photo studio. The equipment that we use to take the amazing front cover picture and the conference photos was borrowed from Rajala Pro Shop, whom we thank for their cooperation. Lastly, we appreciate that the Nobel Assembly helped us arrange the meeting with Barry Marshall. This re-launch issue is two-tiered. Firstly, global health is a passion of mine and one of the reasons I chose to study medicine. I intend to bring the international perspective to my editorship of Medicor. The global perspective is reflected in our cover story, featuring Hans Rosling. Secondly, we will cover life outside of campus that is still Karolinska connected. The aim of the second theme is to inspire, or provoke, you to seek knowledge and inspiration from outside of your studies or chosen line of profession. My belief is that there is much to learn from interprofessional and inter-cultural interaction and that lectures and text books cannot provide the full picture. I have had the privilege of working with very a dedicated group of inspiring people with whom I look forward to develop this magazine further. Ranging from Ph.D. and master level to undergraduates, Karolinska students have come together and created what you now see in front of you. I also really want to encourage you to join our working group or send us feedback to help us improve. Because, gathering and developing our ideas and aspirations together does very much reflect the very essence of what a university is all about. Bottom line, I simply hope that you will enjoy this issue and that it inspires and motivates you to seek new insights beyond those that the Karolinska Institute and Medicor offer.

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HANS ROSLING “The only aim of medical school cannot be training students for Swedish internships”

KENNETH CHIEN The latest addition to KI, all the way from Harvard

BARRY MARSHALL The Nobel Laureate gives his tips for KI students.

THE MDGs An overview of the Millenium Development Goals.

CORPUS KARROLINA Spexet twilight

LENNART NILSSON Intervju. En pionjär inom medicinsk fotografi.

WIN TICKETS TO PEACE&LOVE Photocompetition #MeAndMedicor

medicor

Cover photo by Martin Kjellberg for Medicor. Design by Jingcheng Zhao. 2

Spring feelings Part of the award-winning allergy photo series by Medicor photographers Jingcheng Zhao and Martin Kjellberg

Aperture

KAROLINSKA

Smörgåsbord

Anders Hamsten

Interview with our President By Asma Islam

Puppy stress release

During four days in May, the Aberdeen University Students’ Association will provide a room with puppies for stressed-out students. Students can swing by and cuddle with the animals to get short breaks from their exam anxiety. The aim is to decrease stress and mental health problems due to exam pressure. In the US, Harvard Medical School and Yale Law School offer dogs at their libraries, where you loan them, like books. So, where is our puppy room? 6

“No exercise machines, no juice bar, no mirrors, no excuses” – Charlotte Granström, founder of army fitness. Bootcamps and outdoorfitness – the next training trend has arrived. The back-to-nature-vision behind this has even reached its next level already: back-to-civilization. Or how else would you explain all these bootcampers doing push-ups at Medborgarplatsen recently? Spring is finally here and summer will be in no time. If you feel like panic trimming your body for beach 2013, you don’t even need to change your basic routines. Just head for Söder on thursday nights as usual but hang out with the guys doing push-ups at Medis instead of grabbing a beer. Read more online: armyfitness.se

Drugged fish

High levels of Oxazepam, a common anti-anxiety drug have been found in the River Fyris in Uppsala. This drug is said to have effects similar to those of alcohol. Jerker Fick, a toxicologist from Umeå University has done a study where he exposed fish to different levels of the drug. It resulted in unexpected behavioral changes. The fish stopped swimming in groups, thereby risking being eaten by predators. Moreover, the fish exposed to very high levels became risk takers and

swam through a hatch door more readily than drug-free individuals. Lower levels also made the fish more daring when hunting water fleas, which might cause imbalances in the eco system. Hopefully this study will help to bring attention to how the wildlife is affected and the need for a legal framework to regulate the pollution.

“People don’t believe me when I tell them I’m allergic to exercise. They think it’s just an excuse to be lazy.”

- said by Kasia Beaver in an interview with Daily Mail; a 33 years old woman from Redditch, England who recently has been diagnosed with ExerciseInduced Angioedema (EIA) - a condition that brings on typical allergy symptoms such as a swelling face and inflammation of the airways. The humorous expression “being allergic to exercise” might suddenly have been given a medical explanation to some.

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FORMER PRESIDENT OF KAROLINSKA

Photo by Gunnar Ask

Think about this next time you press play on your iPod. According to new studies, listening to your music stimulates a guessing game in your brain. When hearing a song, your brain not only tries to make sense of the sounds but also figure out what might be coming next. The part of the brain that helps make these predictions is located in the reward center of the brain. When the guessing is right it stimulates a release of dopamine, thus the sense of pleasure when listening to a good song. This could explain why a song you love always gets you in a good mood! Read more at: sciencenews.org, Mental puzzles underlie music’s delight.

Bootcamp

Photo by Paul Falardeau

Music – it’s a guessing game!

Institutet Harriet Wallberg-Henriksson has passed the baton to Anders Hamsten. Anders Hamsten is one of the most sought after names for research regarding coronary artery disease. Along with being a researcher, he is a senior consultant cardiologist at the Karolinska University Hospital's Cardiology Clinic. He has also served as the head of KI’s department of Medicine in Solna from 1999 to 2004 and from 2005 to 2007. Thirty years of experience in research, medical and managerial fields did not tire him out. The oppurtunity to influence the future directions of KI was a major reason that made him interested in this position. Apparently, he has never had this many meetings at such a limited period of time and it has been an intense three months. But he still points out that it has been exciting and very positive. In order to influence the directions of KI, he has to face some challenges. As it is mentioned in his

inaugural speech, the number one challenge is strengthening KI’s position as an international leading research university. “The unique feature of KI is that we are a research oriented university” He plans to build on the existing strengths of KI, that is the exellence in both basic and clinical research. At the same time, he declares that he values the undergraduate and post-graduate teaching since all these fields are interconnected. “We do want to be a complete university”. The second challenge is to set the ambitions for the education system as highly as the research sector. The problem with being a research intense university is that the teaching part might not be prioritized enough. The mindset of some of the high profile scientists needs to be changed, and they should be involved more tightly with the different undergraduate programs. It is also important to expand the career track for the senior academic staff primarily involved in teaching, and to render it as attractive as the research career. “Now we have an imbalance since the vast majority of our professorships are directed towards research”. When it comes to improving the living conditions of students, the greatest challenge is accommodation. Meetings were held with the CEO of Akademiska hus, and a couple of building projects are already underway. Other plans are to reduce the perceived tension between the Southern and the Northern campus by expanding the shuttle bus service. The new president does not seem at all concerned about the current generation of students and researchers. Instead, he thinks that the students of this generation are much better prepared and are equipped with a much wider range of skills. Pushing the students and having a rigorous schedule is not what KI has in store for its students. Dr. Hamsten believes that having a tough system does not necessarily leave one with useful

knowledge, and it should be left to the student to set his or her ambitions. When questioned about his extreme low moments and ways of coping with it, he answers “It is a very, very rare occasion that I’m low spirited. So, I can probably count the number of days when it hasn’t been exciting to go to work on the fingers of one hand. I’m generally in a very good mood and it takes a lot to make me low spirited”. Throwing things or getting into fights with people would not be the approach. Instead, he seeks opportunities even when things don’t go his way. With reading as his favourite hobby, there is usually a tall pile of books on the bedside table. But this high pile will deacrease and even disappear during the summer. His two favourite authors are Ian McEwan and Graham Greene. Other hobbies include gardening, regular visits to art galleries, collecting wines just to name a few. Surprisingly, he has a routine of blocking out work during Saturdays even when KI would be in major trouble. “I think you have to somehow clear the system once a week. Sad thing is that you have to clean up the apartment and fill the freezer on that Saturday, too. I try to find balance because balance in life is important”.

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KAROLINSKA

Nobel NightCap 2013 By Elena Löwdin

ON 10TH OF DECEMBER, MF IN SOLNA IS

the place to be, why? The answer is Nobel NightCap, the afterparty of the Nobel Banquet. In December the City Hall of Stockholm is transformed in a most spectacular way; it’s where the Nobel Banquet takes place. The world’s brightest scientists mingle with politicians, members of the Royal family and other celebrities. But it’s not over when all the courses are finished and the waltzing is done. No, that was just the beginning… The Nobel NightCap, abbreviated as NNC, was initiated by a student at Handelshögskolan in Stockholm back in 1978. The idea was to give the Nobel laureates a chance to get together in a more relaxed environment. Invitations to the Nobel NightCap were sent to the banquet guests, initially generating a lukewarm response, since not many people knew what it was about. What really set it going was when one of the Nobel laureates mentioned during an interview that the thing he looked forward to the most in Stockholm was going to the Nobel NightCap. Rumors about the party started to spread and since then the NNC has been arranged every year, altering between KTH, Handelshögskolan, KI and Stockholm University as hosts. This year it’s KI’s turn. Medicor has spoken to three members of the NNC board about the preparations for the party: Katarina Johansson, in charge of food and drink, Martina Eriksson, responsible for design and one of the two generals, Mikael Yang. The Nobel NightCap is a party entirely run by students. The financing comes mainly from ticket sales and from companies willing to become sponsors. Since previous years, the board of the NNC has kept company contacts as to not need 8

to start from scratch every year, in their pursuit of finding sponsors. Officially there exists no collaboration between KI and KTH, who arranged the party last year. “But all the members from last year have been very helpful, contributing with ideas. All the universities help each other. Because it’s quite unnecessary to invent the wheel again.” Mikael Yang says. At the question if any rivalry exists between the universities, the board members at first give a negative answer but then admit that there is a certain amount of competition, ”Our party will be the best” is their general feeling. Anyone who has ever won a Nobel Prize has gained him- or herself a lifetime’s admittance to the Nobel NightCap. But if you are a student and want to go? Tickets to NNC is a subject surrounded by an air of mystique. Naturally, the Nobel laureates and attachés don’t pay for their tickets. However, Fredrik Reinfeldt, the Swedish Prime Minister, would have to cough up, should he decide to go. “The royal family probably wouldn’t have to pay”, the NNC board members tell Medicor. Perhaps this will be put to the test this year, since it is rumored that Prince Carl Philip may come to the party “It’s all part of the myth surrounding NNC: How do you get tickets?” Katarina Johansson says. “There is no official advertising in e.g. newspapers, but former university students and members of student organizations have the contacts needed to get hold of tickets. This contributes to giving NNC an air of exclusivity. The number of tickets varies each year depending on the size of the building. MF at the Solna Campus can take about 1500 people at the most, but then it would be on the verge of overcrowded. Whether tickets will be

given to university students from other parts of the country, such as Uppsala or Lund, is not yet decided. The process of transforming MF into the best party environment imaginable does require a lot of work. In order to do this “the building week” exists. The week before the party students work about 16 hours a day to shape a number of rooms at MF into something very special, all according to the theme of the party. In 2009, when the NNC was last held at KI, the theme was “The human body” and the rooms were decorated as different organs. However, everyone has to be patient when it comes to this year’s theme. “Everything is top secret” Martina Eriksson, in charge of design, informs us. “But the theme will be absolutely awesome”, she promises. During the building week there will be hard work, but also plenty of opportunity to enjoy oneself. Free food and coffee will be offered to everyone who participates in the building process. The people building a certain room will generally be in charge of that room at the night of the party. As far as possible, friends will be grouped together and if you don’t know everyone, don’t worry, it won’t be long before you do. Katarina Johansson was a volunteer at the Nobel NightCap in 2009. She found it very exciting and remembers deciding right away to do it again. “You have never experienced anything like it before” she assures us. “It’s a great feeling working together with the people in your group”. In each room at the party there will be one person out of each project group, for example “food”, “drink” or “design”. The different project groups are led by project leaders, which are currently being appointed by the NNC board. In to-

tal, two to three hundred students will work at the party. Examples of tasks will be managing the cloakroom, serving food or doing washing-up. During the night, all the volunteers will rotate so that no one has to be in the kitchen all night. “Because it is important that everyone, including those who work, will have an unforgettable evening. Whether you are interested in being in charge of the cloakroom or serving food, NNC will be very interested in you. We really want volunteers from all programs at KI, from both Huddinge and Solna. This is a party for the entire school.” Mikael Yang says. Around ten or eleven o’clock on the 10th of December MF will open the doors to the party that will go on until morning. There will be special busses going between KI and the City Hall to transport Nobel laureates, standard-bearers and other guests. “But one of our main goals this year is to make sure that nobody has to wait more than 10 minutes to get in"”

Mikael Yang points out. The Nobel laureates usually don’t arrive until half past eleven or so, but Martina Eriksson assures us the party will be running at 100% from the very first minute. The idea of a dinner at MF before the party has been proposed and perhaps something will be arranged for the students managing to find their way to the right room before all the chairs at the table are filled. The board doesn’t promise anything but they have taken the thought into consideration. A dinner like this would certainly add to the mystique of NNC. Katarina Johansson tells us the food at the Nobel NightCap will be something extra. Even though many of the guests will already have eaten their way through several courses at the Nobel banquet, people will undoubtedly feel peckish before the night is over. When we ask her, Katarina Johansson gives us a foretaste of the atmosphere at the Nobel NightCap. The food will come with an extra twist, with new experiences in every

corner. When Katarina Johansson last worked at the NNC as part of the serving staff, she was going around feeding the guests whatever she had on her tray. Katarina promises us all flavors imaginable: Sweet and salty as well as smells that will make your mouth water. Pure luxury is probably the best way to describe it. The workload for the board is nothing to speak of right now, but it will intensify as the night of the party draws near. But this is part of the charm of NNC. “No pressure, only fun” the board members tell us. The NNC board members are very keen to make this an enjoyable experience for the volunteers. There will be lots of fun activities and events. As Katarina Johansson says: “Work hard, party hard”. On one thing the board members all agree: “We are a great group. This will be a once in a lifetime party.” -To find about more about Nobel NightCap, please check out the 2013 website: www.nobelnightcap.se/

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“

DEN 6:E APRIL VAR EN KALL KVÄLL, MEN I

det fortfarande delvis snötäckta Solna var Medicinska Föreningens lokaler fyllda med ljus och värme. Det var sittning, och fullt med folk med olika utbildning och bakgrund! De flesta var studenter från Stockholmsskolorna; Sophiahemmet, Ersta, Röda Korset och Karolinska Institutet, och även kadetter från Försvarshögskolan och andra inbjuda. Alla dessa människor, vad hade de gemensamt? De ville bråka! Bråka med landstinget och kräva en rimlig lön för nyexaminerade sjuksköterskor - Inte under 25 000! Under kvällen hölls det flera inspirerande tal. Sjuksköterskesektionens ordförande, Lisa Wennersten, berättade att flera i sista terminen som fått jobb hade fått 25000 i ingångslön, vilket ledde till stort jubel i salen. Efter det var det även ett uppträdande där den mycket sarkastiska 70-talssången "Ska bli sjuksyster jag" framfördes med endast sång och gitarr till allmänt jubel och förstås: omstart! Talen fokuserade mycket på att sjuksköterskorna ska veta sitt värde. Ingen kan göra sjuksköterskornas jobb som de kan, och att de ska stå på sig och vägra gå med på skambud till ingångslöner. När sjuksköterskorna går ut på arbetsmarknaden har de ett legitimerat yrke och en kandidatexamen i omvårdnadsvetenskap - vilket ingen annan yrkesgrupp i vården har! Den 24:e april samlades sjuksköterskorna på torg över hela landet för att demonstrera. Inte bara sjuksköterskorna utan även sjuksköterskestudenter, deras familjer, vänner och andra som är på sjuksköterskornas sida, som också tycker att lönen ska motsvara inte bara deras kandidatexamen, utan även det enorma ansvaret som sjuksköterskorna axlar varje dag, varje kväll, varje natt oavsett vardag, helgdag eller högtider. I Stockholm, Uppsala, Göteborg, Lund och Linköping samlades sjuksköterskor för att markera att det är nog nu!

Av Sofie Eliasson

Men vi kom igenom det. Vi snubblade ut ur skrivsalen, yrvakna och med blodsmak i munnen. Preklintentan var skriven. Termin 5 började. Livet som andra människor lever det började. Allt som jag hade försummat i två års tid knackade på mina axlar, var helst jag vände mig fanns det något nytt att se, något nytt att återupptäcka. Världen fick tillbaka sina färger. Och vad gällde mitt val två år tidigare tänkte jag att det nog hade blivit rätt. Några veckor senare äntrade jag så Karolinska Sjukhuset som nybliven postpreklinare. Mindre oerfaren, mer ärrad och framförallt avskalad högtflygande planer och förväntningar inför vad detta livslånga åtagande härnäst hade i beredskap för mig. Nervöst skruvade jag på min rostiga reflexhammare och sneglade ångestfylld på kompisens metallglänsande motsvarighet i teleskopform, bläckpenna med inbyggd ficklampa och naturligtvis kunde jag inte undgå att se

hur Kloka Listan stack upp precis lagom mycket ur vänster byxficka. Satan. Men så, innan tvivlet ens, turligt nog, riktigt hann få fäste var jag igång. In och ut ur rum fyllda med patienter, som min handledares eviga skugga och följeslagare, fick jag se människor och ta del av livsöden som mitt 21-åriga jag aldrig någonsin hade kunnat föreställa sig inne i Hus 75:s gråa seminarierum. Människor som grät, människor som log. Människor som hade ont. Jag rådbråkade min hjärna som aldrig förr. Jag glömde bort raster och arbetstider. Patienterna var allt, de fanns där för mig och jag för dem och jag lät mig förbehållslöst slukas. Mina forskande ögon sökte statusfynd, mina öron lyssnade efter vad som hade glömts bort och i mitt inre pusslades, trixades och vreds det i det oändliga. Vetgirigheten visste inga gränser och på kvällarna var jag försjunken i böcker från preklintiden, sorglös och utan vidare funderingar på vad som egentligen skulle tentas av en vecka senare. I slutet av dagarna föll mitt huvud till sängkudden med en duns. Vi har alla en tendens att tro att livsavgörande val är välgrundade. Det är fel. I bästa fall har vi en god uppfattning om hur livet kommer arta sig. I bästa fall tror vi att vi är lämpade för det åtagande vi ämnar göra. I bästa fall träffar vi helt rätt. Men vi vet aldrig vilka människor våra val gör oss till. Jag har en känsla av att Bengt och jag äntligen har funnit varandra.

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Foto av Andrea Lindström

föregick våra föreläsare i tanken, när vi tänkte – det där är inte fullständigt nytt. Nyförälskelsen var borta men den hade ersatts av något som jag skulle vilja kalla för kärlek. Försiktigt, hoppfullt, började jag tänka att det var rätt. Ja, det var rätt. Så kom två-årsprövningen. Vi snubblade fram genom vintermörkret och juldagar, tappade de sista kontakterna med omvärlden och höll nära på att brinna av likt en fyrverkeripjäs mot olovliga inkräktare som försynt och aningslöst knackade på dörren in till vårt privata, minerade helvete.

Av Sarah Birgersson

Av Emelie Asplund

Glutaminfosforibosylpyrofosfatamidotransferas blev vår hälsningsfras, illvilliga tentafrågor träffade oss som hagelskott från sidan...

är jag för första gången klev in på Karolinska Institutets område började mitt hjärta banka. Som en stålhammare, obönhörligt, och utan hänsyn till övriga mediastinala strukturer som behövde utrymme. Jag var 19 år, oerfaren och stormande nyförälskad. Allt började bra. Riktigt bra. Mina vildaste förväntningar överträffades flera gånger om, och innan jag ens hade lärt mig att stava till enzym hade jag avlagt mina löften. Sedan började de svåra åren. Vi kämpade, det gjorde vi verkligen. Genom tidiga morgnar till sena kvällar, vidare in på natten och endast med hjälp av höga intag centralstimulantia levererat i en mörkbrun vätskefas tog vi oss över datumgränsen till nästa dag. Dagar blev till månader som blev till år. Glutaminfosforibosylpyrofosfatamidotransferas blev vår hälsningsfras, illvilliga tentafrågor träffade oss som hagelskott från sidan och kontakten med andra människor reducerades till varandras håglösa, apatiska gestalter samt den ständigt återkommande Bengt 86, rökare, hjärtsviktig, från hus 75:s gråa seminarierum. Jag tror att ni kan förstå mig när jag säger att glöden falnade. Trots det fortsatte vi. Kanske mot bättre vetande, kanske för att vi inte orkade börja om. Och något började förändras. Var det miljöombytet, när vi för första gången fick vandra genom Karolinska Sjukhusets entré, full av liv, rörelse och sorl? Var det när vi för första gången

Ursäkta röran, vi bygger om! CAMPUS

SOLNA

ÄR

STÄNDIG

förändring. Hack i häl med nya Karolinska sjukhuset byggs det så det knakar även på institutets sida av Solnavägen. Många av oss börjar morgonen med att sicksacka sig fram mellan halvfärdiga projekt, byggställningar och glada byggubbar. Ibland klarar man sig en hel föreläsning utan ett brummande bakgrundsljud från en borrmaskin som löpt amok någonstans, men oftast inte. Vad är det då egentligen som byggs? När är sista spiken satt, kostar det vad det smakar och vad blir notan? Byggnationerna på campus utförs av Sveriges största hyresvärd för universitet och högskolor - Akademiska Hus - och just nu pågår främst tre större projekt. Biomedicum – Ett högteknologiskt forskningscentrum i storlek XXL Forskningssverige kan hoppas på ett rejält uppsving efter färdigställandet av Biomedicum som, med sina 55 000 kvm, blir ett av Europas största forskningscentrum. Här kommer ca 1700 forskare från olika institutioner att samlas under samma tak, vilket bådar för gränsöverskridande forskning i världsklass. Kalaset beräknas kosta 3,5 miljarder kr och färdigställs 2018. Aula Medica – Institutets diamant Likt en juvel i solsken glittrar den nya aulan längs Solnavägen. Utöver en hörsal för 1000 åhörare finns även restaurang, café och kontorslokaler i byggnaden. Ögonstenen väntas locka besökare från hela världen, inte minst under nobelföreläsningarna, men också under vetenskapliga konferenser och stora publika arrangemang. Bygget kostar ca 500 miljoner kr och finansieras av en privat donation från familjen Erling-Perssons stiftelse. Dess triangulära, ”inåtlutande” design med en fasad täkt av närmare 6000 glasskivor för osökt tankarna till en diamant. Invigningen sker till sommaren och efter det kan vi bara hoppas att någon gillar att putsa fönster… Alfa och Beta har fått ett syskon Med formen av en gigantisk hockeypuck i futuristisk tappning blir

Gamma-laboratoriet det tredje i skaran i Karolinskas forskningscentrum ”Science Park”. Kostnaden uppgår till 375 miljoner kr och liksom i de andra två byggnaderna ska här bedrivas forskning och kontorsverksamhet. I lokalerna finns även runt 60 företag inom forskning och medicinteknik, bland annat Swedish Orphan Biovitrum - ett av Europas största biomedicinska företag. Totala ytan av de tre husen uppgår till 25 000 kvm och beräknas stå färdigt till sommaren. Även MF har en skruv lös. I samband med förnyandet av Campus kommer även Medicinska Föreningen att få sig en makeover. En ny lastkaj och ett soprum med takterrass ska sättas upp i samband med byggandet av nya aulan, likaså ska fasader, inbrott och brandskydd förnyas, allt detta i regi av Akademiska Hus. I ett internt projekt av MFs kårhusstiftelse som, till priset av ca 2 miljoner kr, ska leda till ett nytt ventilationssystem på övervåningen i gamla kårhuset. Projektet beräknas dock i runda slängar spara 200 000 kr per år i energikostnader och har därför finansierats inom tio år. Ombyggnationerna påverkar inte medlemmarnas plånböcker då MF har en stabil ekonomi som tillåter amortering av lån på 300 000 kr varje år. I nuläget figurerar till och med ryktet om byggnation av en ny bar… Inte heller Rom byggdes på en dag och troligen gjorde också detta bygge lite väsen av sig. Även Sveriges ledande centrum för medicinsk utbildning och forskning behöver se sig i spegeln emellanåt, så håll ut gott folk för snart bär alla vägar till Karolinska.

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The bill, please? 1# Biomedicum 1# Aula medica 1# Gamma Laboratory 1# MF refreshment

3 500 000 000 kr 500 000 000 kr 375 000 000 kr 2 000 000 kr

Tip 0 kr Total 4 377 000 000 kr (Källa: Akademiska hus)

KI Profile

Kenneth Chien

Medicor has had the privilege of sitting down and talking to one of Karolinska Institutet’s most recent additions, Professor Kenneth Chien. A professor at Harvard University as well as KI, he is a multiple-award winning scientist and a pioneer in regenerative cardiology. By Jingcheng Zhao

What do you do research on? I’m a cardiologist by training and I make my profession as a scientist, interested in the intersection of biotechnology, cardiology, and stem cell/molecular biology. Our goal is to unravel the molecular underpinnings of human cardiovascular disease, and then to find more biologically targeted therapy. Most of my work has been in the area of cardiogenesis and cardiac muscle disease, with a recent focus on regenerative cardiology. As a physician, what got you into research? Every physician scientist has a unique personal history and career story. Mine starts as an undergraduate. I majored in biology, did some science, did some research. Then when I went to medical school, I didn’t initially decide to do science. I was actually just going to be a practitioner. Then I did a summer internship doing research. It didn’t have anything to do with biological science, but with the epidemiology of drug abuse, resulting in my first publication. So if you go back and look at my CV, you’ll see the first paper doesn’t have anything to do with what I’m doing now. (laughs) Then the next summer I worked with a professor that was a molecular pathologist, who had trained with a Nobel prize winner, Martin Nierenberg, and he was working on membrane biochemistry and asked me to work in his lab for the summer. During this summer, I discovered that I really enjoy science, and had an aptitude for it. Then I began thinking that I want to take a year off to do more science. That year was very productive. Next thing you know, I was making my own Ph.D. program. They didn’t have an M.D.Ph.D. program then, so I kind of made my own. It was very early days. To make a long story short, I was basically inspired by another physicianscientist. This was in Philadelphia. Then I did my internship and residency at a place that had a lot of physician-scientists, in Dallas. A lot of my colleagues went into medical research, many of them were M.D.-Ph.Ds, and one of my 12

fellow medical residents in clinical training in Dallas, was just awarded a Nobel prize few years ago, Bruce Beutler. How does having a clinical background affect your research? Medical training gives you a feel for biology and biological mechanisms, basically because most of medical training is devoted to understanding human biology. Humans are the most fascinating organisms, and who knows that model organism any better than a physician? We study the mouse, and other things, with the idea that they give us insight on the human. Now the technology is so good that we can actually do mechanistic studies in human model systems, and in certain cases, in humans themselves; imaging, genetics, human tissue samples, human stem cell models. If you look at some of the major advances in cancer, they have all been based on human cancer genetics. Not on mouse models. So, I think being a physician gives you a real feeling for physiology, biology, and knowledge of the model organism of most interest in this century, humans themselves. Do you still practice as a physician? No I don’t, but I’m a fully trained cardiologist. I did catheterization for 6 months. I attended the CCU (coronary care unit), did cardiology consults, supervised cardiology clinic, etc. Now, when you have a heart attack, it’s an interventional emergency. In those days, we didn’t have those capabilities; mostly it was passive care. It was easier to be a cardiovascular physician-scientist in the previous era.. Increasingly, it’s more challenging now to combine clinical practice and science at a high level. But that being said, there is a real opportunity for physicians that are clinically well trained who also are scientifically well trained. I think they are going to be the future scientific leaders of this century. When you first entered the research arena; did you find anything unexpected?

Initially, when I was exposed to science, I was an undergraduate at Harvard; it was a very competitive environment in science at the time, at every single level. I didn’t enjoy that aspect of it. I think I shut myself out of it, just because I didn’t like the competitive nature of science. I was in a lab that was quite good, there was another lab that was growing, and it seemed like we were going to be pushed out. Actually, our lab, at the time, was right next to the laboratory of Walter Gilbert, who won the Nobel Prize for DNA sequencing. It just seemed like his lab was getting bigger and bigger and we were getting pushed out at the end of the hall, and that kind of had a negative influence on me. But then I re-experienced doing research as a medical student. It was more disease oriented, and I could appreciate it for the joy of doing it. It’s a lot of fun. What surprised you the most about research? How addictive it is. Discovery is like an addiction. You do something and you wonder how it’s going to turn out. There’s a level of excitement. Sort of like, when people watch sports. A lot of reasons they watch sports is because they don’t know what’s going to happen. It’s not scripted. Science is like that; you don’t know what’s going to happen. When it happens and you figure it out, and it’s kind of like you thought, or not what you thought, and it’s surprising. It’s a real kind of a thrill. It’s fun. It’s like solving puzzles.

Let me put this way. Why would someone play tennis? Someone invited you to hit some tennis balls and then you decided ‘Gee it’s fun.’ But if you never tried to play tennis, you’d never know that it’s a great sport. I play tennis and I really enjoy it. Some people never played tennis and don’t even understand that you can play tennis and enjoy it for the rest of your life. I also want to say that there has never been a more exciting time to be a physician doing science than right now. The tools are so good for working in a human setting. Physicians know the model organism. If you also know the model organism, and have deep training in the science and technology to unravel complex disease in a human setting; what more emotionally, and intellectually [stimulating] thing is there? You wake up every day and you are wondering why they are paying you to do this. It’s amazing that they are paying me to do this. This is fun. This is what I want to do. What made you decide to come to Karolinska? This started out where I was asked to meet with the president of KI, Harriet Wallberg-Henriksson. One of the interests at KI was to strengthen the cardiovascular science, and the other area of interest was regenerative medicine, and of course, my background fits with these goals. Over the years, I had gotten to know Karolinska quite well; I had served as a chair for an external review panel for Karolinska. I knew that the quality of the science, particularly here at CMB, and particularly in regenerative medicine was very strong. What I didn’t realize though, at the time, was how well positioned KI was to capitalize on the opportunity for translating the science of stem cells into clinical medicine. Right around this time, there was a report of KI doing a tracheal transplant coated with stem cells. I happened to run into the person, Paolo Macherini, who did that at a meeting. He told how they did everything at KI; how they flew the patient in from Iceland, originally from Africa. He did all this, and the patient walks out of the hospital, and they paid for everything. I’m thinking to

myself: holy… (laughs) Paolo just did an operation on a 2 year old chld without a trachea in Toronto, which was just reported around the globe….but it started at KI. I had been thinking of making a heart muscle patch, for repairing the heart. We made a discovery related to human heart regeneration, and discovered that it is very different in humans than in mice. So you need to study human systems, and human fetal heart tissue was a really important component. This was a study that we published in Nature in 2009. I learned then that there is a system for obtaining human fetal heart tissue here. Routinely. At a very early stage. This would be very difficult to do in Boston. Thinking about it very carefully, thinking about what I could do in Boston. Sure, if I was going to work on mice, I’d be better off staying in Boston. Mass General (Massachusetts General Hospital) is a very big hospital, but it doesn’t fly in patients from Africa and operate on them, have a hospital-supported GMP facility (Good Manufacturing Practice – national standards for production of pharmaceuticals), support a phase 1 trial center, large patient registries including those for rare diseases, long term patient followup, and the regulatory barriers for novel biological therapeutics (first in-human trials) is considerable. It became clear that at KI many of these issues had been solved and were readily available. The other thing that influenced me was that there is a history of pharma, particularly Astra Zeneca, doing things very closely with Karolinska. I thought this could be an opportunity to maybe integrate some projects with industry, from the very beginning, with your own lab. This is very difficult to do in the United States. Again, to do the translation, you may need more than your own lab; Many times you have to work with the private sector where dedicated professionals with direct experience in drug discovery and regulatory issues are already in place, as well as the financial muscle to move these expensive studies forward. And that integration is becoming more difficult to do in the United States. There are fewer barriers for doing that here.

What has been the most challenging thing in your career? I think the most challenging thing, and this is probably true for many physician-scientists, is time. Time management. You have to become a physician, you have to become a scientist, and you are usually a husband, and many times a father. All those responsibilities take time. That’s probably the most challenging thing. How do you find time? (laughs) I don’t know, I’m still trying to do it. (still laughing) If you could return to your medical school days, what would you do differently? What would you tell your medical school-self? I don’t think you can plan your career, you need to find your own path and find your own passion. Seek wise counsel; seek role models that you can pattern yourself after. Choose your role models well. So much of medicine is like an apprenticeship, science is the same. You need to find good mentors. Being able to focus a bit more sharply would have been something I would have done. As you get older, you get better at picking the really important things to do. You always think, gee I did a lot of work. One of the most important things is to focus on the big questions, on the really exciting things. Because sometimes when you are young, you are doing too many things. It would be like, again using the tennis analogy; trying to win every tournament and enter every conceivable tournament, instead of focusing on the Wimbledon and the US open, and the other big ones. What are you the most excited about at the moment? I’m most excited about our science, because I think we will be in a position to potentially make a difference in cardiovascular patient care. That is the dream of every physician-scientist. That your science could someday put you in a position where you can say “What I did actually helped somebody”. That’s what I’m here to do.

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Why should a medical student/doctor do research? Well that’s an interesting point. I don’t think research is for everyone. One thing that I think is true is that every medical student should experience some research. For no other reason, at least you will understand what research is, how hard it is, what’s involved, and what some of the principles are. There is nothing in a normal medicine curriculum that teaches you to be a scientist. 13

SCIENCE

The Beast from the East

The 50th Shade of White

The abandoned antibiotic

By Przemysław Trzepiński

RESEARCHERS

FROM

RECENTLY

showed that one can’t be sure about anything, even if it has been ‘known’ for years. Aspirin, the wonderful drug described by the WHO as one of the best medicines from the bottom rung of the pain ladder. Of course, everyone knows how helpful these white pills are, especially right before end-of-term exams, when headache is the last thing you want. However, recent findings reveal that they may have a completely different application: cancer therapy. It may be hard to believe, but aspirin is actually older than the Roman Colluseum. About 400BC, the father of western medicine, Hippocrates, recommended his feverish patients to drink decoctions of willow bark. Nowadays, we know that this plant is a rich source of salicylates – the chemicals which aspirin is derived from. The analgesic properties of salicylatecontaining plants were a mystery for a long time. Undoubtedly, many prominent scientists at the time pulled their hair out trying to explain the effects. The development of organic chemistry allowed the Swiss pharmacist Johann Pagenstecher to extract the active substance from a meadowsweet plant. In less than a year later, this led to extraction at an industrialscale. The substance was named salicylic acid. Due to the many side effects of using salicylate-based drugs, such as stomachache, researchers made attempts to obtain safer medicines. Eventually, the acetylsalicylic acid, better known as aspirin was successfully synthesized. Nevertheless, as all magnificent discoveries, there were many controversies surrounding it. Although it’s a common opinion that the synthesis was first performed by Felix Hoffmann and that the pharmaceutics was first produced by the German company Bayer, there is evidence that many smaller companies had sold aspirin ear14

By Rrezarta Rama

lier. Heinrich Dreser and Arthur Eichengrün are often claimed to be true fathers of the success. Nowadays, we know that the aspirin is much more than just a painkiller. It is also used as a successful anti-inflammatory tool which stops negative immunologic effects, e.g. a fever. Moreover there is evidence that aspirin inhibits an aggregation of platelets. Therefore small doses of the pharmaceutics are recommended as prophylactics for heart attack and stroke. Over 100 years after discovery, the drug is still the most recognizable product of Bayer. The name aspirin refers to both the German company’s brand and to all products which contain acetylsalicylic acid. This achievement can be compared to the success of Sony’s brand of mobile cassette players – the Walkman, which was used as a name of all such devices about a decade ago. However, cassette technology is out of date today, and aspirin’s effects are, a century after their discovery, still not fully explored. The possibility of using aspirin in cancer therapy was recently presented in Carcinogenesis. Research led by LenaMaria Carlson – resident physician in pediatrics at Astrid Lindgren’s Children Hospital part of Karolinska University Hospital – argues that low-dose aspirin delays the progression of one of the most common tumors of early childhood – neuroblastoma. The mortality rate of this disease is 60% and 10.5 per million children are diagnosed with it every year. It is usually located in the adrenal medulla and it causes a wide range of symptoms, for example anemia, hypertension or Horner’s syndrome. In their study, Lena-Maria Carlson and colleagues involved mice with an excessive expression of MYCN; a mutation which lead to the development of neuroblastoma. At 4,5 weeks of age all the animals were diagnosed with the cancer

and then researchers divided them into a no-treatment control group, and group which received 10mg/kg of aspirin orally. After 10 consecutive days, a closer look was taken at the mice’s tumors. It turned out that the median tumor burden was much lower in the treated animals than in the control group. Moreover, within untreated tumors, more tumor-supportive cells and cancer associated proteins were found. ”I think the main finding of the paper is that low-dose aspirin appears as a suitable therapeutic option for tumors as exemplified by neuroblastoma” – LenaMaria Karlson said when she was being asked about the article. Although, this optimistic statement needs to be verified with more extensive research and clinical trials, the finding could be very valuable. It is the first evaluation of low-dose aspirin in pediatric cancer and the first in vivo experiment with such a low dose of the drug. The idea of using aspirin to treat cancers has to do with the anti-inflammatory properties of the medicament. Despite its great complexity and effectivity, the immune system is not perfect and it sometimes fails to protect us from diseases. Over the last decade, much evidence points to that components of the human immune system are instructed by a tumor to promote its growth. Therefore, inflammation as an expression of increased local activity of the immune system is suggested to be a hallmark of cancer. Hopefully, it is also a potential target for modern cancer therapy; if aspirin can be can be considered modern.

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SINCE

THE

MID

20TH

CENTURY,

humanity has been spared many lives and much agony thanks to the discovery of penicillin and its derivative antibiotics. However, we have reached a point where we’ve come full circle, and the evolution of multiresistant bacteria has clouded the prognosis of tomorrow’s bacterial infections. As desperation constantly pushes scientists to find new antibiotics to fight new strands of bacteria, resorting to old techniques of fighting bacteria seems almost too obvious and too good to be true. At the Eliava Institute (EI) in Georgia, an old cure for bacterial infections called phage therapy is being refined. Drawing from nature’s most important relationship - that between prey and predator phage therapy aims to kill bacteria by using their natural enemy. A virus referred to as a bacteriophage can eradicate bacteria by injecting its own DNA or RNA into the bacterium in order to highjack its ribosomes, multiply itself and kill the bacterium host. There are many different types of bacteriophages; each of them being specific to only one or a few species of bacteria. Nina Chanishvili, head of the Research & Development Department of the EI explains how phage therapy also is able to overcome the problem of resistance among bacteria: “If bacteria manage to develop a resistance against a certain virus through mutation, the virus will also have to modify itself in order to continue its multiplication, just like any other predator in nature would have to adapt to its prey.” Similarly to antibiotics, bacteriophages may be administered orally, but can also be put straight onto an infected wound or be intravenously administered in the case of infection of the liver or immune deficiency. An important difference Chanishvili stresses is that phage therapy can be made much more individual to the patients needs as the bacterium causing

illness has to be identified beforehand. A mix of several bacteriophages that should be able to kill the bacteria are then given simultaneously to ensure that at least one manages to annihilate the bacteria at first attempt and hence quicken recovery. Despite phage therapy being such a successful concept in Georgia – “even the most rural farmer here is well acquainted with phage therapy”, Chanishvili ensures - it is yet to hit the Western markets. “The iron curtain is still there, isolating this therapy from Europe and the U.S. thanks to Western regulations”, Chanishvili says with regret. In Sweden, the only project developing phage therapy is found at Stockholm University and is lead by Anders Nilsson. So far Nilsson has been able to isolate several bacteriophages that can

In terms of a possible establishment of phage therapy globally, Nina Chanishvili informs us of that U.S. medical companies are currently developing bacteriophages to be used as prophylactics, instead of alcohol-based hand sanitizers. This could hopefully open doors for antibiotic uses of bacteriophages as well. However, Anders Nilsson believes it will take a while before it becomes an established therapy in Sweden. “Here, we haven’t been hit with too many harsh multi-drug resistant infections, so I don’t believe the demand for phage therapy is very high. But if no one puts any money into research on the therapy it will take very long before it becomes an alternative.” Although phage therapy is yet not considered an approved therapy in Sweden, it can legally still be used under certain ethical conditions, as a last resort if lives can be saved. For many it may sound counterintuitive to use viruses, which we think of as harmful, in order to get rid of a sickness but now we have learnt that any enemy of bacteria also can be our friends! Whether our world leading medical university also will pick up on this however, still remains to be seen.

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fight ESBL bacteria; bacteria that have acquired multi-drug resistance through developing an enzyme that can break down beta-lactam antibiotics. Nilsson believes that one of the main reasons behind phage therapy receiving such little attention in the West lies in its administration. “Our healthcare system is adjusted to traditional antibiotics. You can’t change that with the wink of an eye” Nilsson argues, as he claims phage therapy’s pharmacodynamics require more individually based analyses as specific bacteria need to be identified.

How well does phage therapy compare to traditional antibiotics? Pros: no drug resistance, personally adjusted therapy, no diarrhea or kidney failure Cons: Isn’t efficient on intracellularly proliferating bacteria and infections in tissues with low blood circulation; could be costlier

SCIENCE

Nobel Interview Barry Marshall speaks to KI students By Ruslan Alam

THERE ARE FEW EXAMPLES IN REAL LIFE

of rewards stemming from patience. Patience can however be a strong method of becoming aware of the opportunities around you. For students studying some form of medicine, this can bring about more exciting careers and possibilities through some form of research which, whether it is a 6 week research program during the summer or if it is a matter of a PhD degree, can at the very least set in motion the opening of countless doors to a successful academic career. This was the case for the Nobel Prize laureate in physiology or medicine, Barry Marshall, who was willing to share some of his experiences and advice with Medicor and the students who strive for an academic life. Barry Marshall, perhaps best known for the discovery of Helicobacter pylori’s role in peptic ulcers, which earned him the Nobel Prize, thought of himself as impatient during his time in medical school. The mistake of wanting to finish medical school and start treating patients as soon as possible reminds him of how a career is longer than one may think. When asked what advice he would give to himself as a medical student, he replies: “I think what I would do is [to] try to find the resources to do a research year. […] you can do an M.D. or Ph.D. It really sets you up for a

I think what I would do is [to] try to find the resources to do a research year. […] you can do an M.D. or Ph.D. It really sets you up for a more interesting academic start career 16

more interesting academic start career”. Marshall does however point out that if one is not an academic then there are always patients that need to be treated. However, he also stresses how it is difficult to advance further without an academic degree after a graduation. Having done research projects before finding himself working with Helicobacter pylori, Marshall expresses how he has enjoyed it and continues by revealing something that many people may not know about him: “I’m actually an expert on heat stroke in marathon runners”. He further states how, through a PhD research project, one can become an expert within a field in months to such an extent that the value of peer review is reduced to insignificance because no one understands the field better than you do. Even if these projects did not lead to Nobel prizes, they were still rewarding in other ways. Marshall’s interest for research aroused during medical school. He was curious of how things worked. This led to his disappointment following his graduation: “It was a bit disappointing for me when I graduated to find out that for half the diseases or half the patients, you didn’t really understand the etiology of the disease”. He elaborates on this further, stating that in order to develop efficient therapies, it is desirable to find the root of every problem. This was an issue Marshall encountered with his research projects. Finding the cause of ulcers was not as straight forward as it seemed. Pharmaceutical companies were funding all the research. Unfortunately, this caused

most research to be steered into the interests of the pharmaceutical companies, and other research which may be of high value goes unfunded. The research that does take place will mostly involve discovering new drugs that may have nothing to do with the causes of the disease, perhaps because it doesn’t financially aid the pharmaceutical companies as much as the drugs. “None of them could even imagine that you would ever find a cure for ulcers, and so there was no research going into etiology”. However, Marshall managed to work around the problem by using the ulcer research of numerous people that appeared to yield very little, if any, progress. By using the combined data of the results and observations, Marshall managed to strengthen his own hypothesis regarding the involvement of the Helicobacter pylori in ulcers. “So you can actually put together the whole picture by little bits of information from other people’s research”. Continuously fighting against issues like these surely rewarded Marshall in ways he would not imagine. The purpose of Marshall sharing his experiences with research mostly narrows down to what we as a younger generation can learn from it. Through his journey he would like us to remember: “You have to be in the right place. You have to be confident in your own ability, so that you don’t care what other people say”. As aspiring students, we can look up to Marshall and follow his example. Be patient. Look for opportunities and take them. It is hard to say where we will end up, but we will never know until we try.

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Aktuellt

PS13 STHLM Var går gränsen för psykologin? By Simon Jangard Nielsen

EN KONGRESS FÖR SVERIGES PSYKOLOG-

studenter hölls för första gången 2008 på initiativ av psykologprogrammet vid Lindköpings universitet. Sedan dess har kongressen anordnats av en rad universitetsstäder och i år var det Stockholms tur att anordna PS13. Tanken har från början varit att skapa en mötesplats för landets psykologstudenter att utbyta erfarenheter och funderingar kring psykologiämnet som sådant och den framtida yrkesrollen. Årets kongress anordnades den första helgen i maj av psykologstudenter vid Karolinska institutet och Stockholms universitet. Föreläsare från vitt skilda ämnesområden hade bjudits in för att tala om de gränser som uttalat och outtalat finns mellan psykologin och andra vetenskapsområden. I samband med kongressen har Medicor intervjuat Tulsa Jansson, utbildad filosof och verksam filosofisk praktiker. Tulsa Jansson – filosofi för att hitta tillbaka till världens komplexitet Även om tanken är gammal och kan spåras ända tillbaka till Sokrates dagar (470 f.Kr. – 399 f.Kr) har filosofisk praxis som det används idag sitt ursprung hos den tyske filosofen Gerd B. Achenbach som 1981 öppnade sin första mottagning. Syftet är att hjälpa människor med att undersöka sina liv; att förstå, förtydliga och utforska filosofiska aspekter av sådant som känslor, fysisk sjukdom, livsval och åldrande. Metodologiskt utgår man från den så kallade Sokratiska dialogen vilket börjar med att en fråga ställs. Det kan till exempel vara funderingar kring vad kärlek egentligen är för någonting eller något så svindlande som meningen med livet, något som kan ske både i enskilda samtal och i grupp. Syftet är inte att hitta ett svar utan tanken är att undersökningen av frågan ska få personen eller gästen att konfrontera sina egna uppfattningar; att vidga och skifta sitt perspektiv. Här används språket som ett verktyg för att rikta blicken mot våra resonemang och definitioner med syftet att definiera begrepp 18

som ”kärlek” och ”mening” som i vanliga fall är väldigt otydligt definierade. Att definiera dessa begrepp i sitt liv kan vara en nyckel till att förstå omvärlden och sig själv bättre, då de ord vi använder delvis är baserade på våra egna erfarenheter, våra associationer och det vi sedan tidigare har lärt oss, skriver Tulsa Jansson i sin nyligen utkomna bok Du har svaren! – Filosofi till vardags. Att undersöka våra ord är därför i viss mån att undersöka oss själva. Tulsa är ordförande för det Svenska sällskapet för filosofisk praxis och föreläste på lördagen och menar att ett problem i dagens samhälle är att människor tenderar att förenkla världen så pass mycket att det många gånger leder till cynism. Här kommer filosofin in som ett slags botemedel för att hitta tillbaka till världens komplexitet, berättar hon. ”Målet med filosofisk praxis är att hitta former och verktyg för att återuppväcka människors nyfikenhet – metoder för att öka den empatiska-, kreativa- och logiska förmågan, som ett slags botemedel mot den allt för starka världsförenkling vi ofta ägnar oss åt. Denna typ av förenkling försvårar ofta för oss att leva de liv vi egentligen vill leva. Det är ett exempel på ett visdomshinder – något som hindrar oss från att bli så visa som jag tror vi alla strävar efter att bli.” Förenklingen syftar visserligen till att göra världen mer begriplig för oss och är i detta avseende något helt avgörande för att vi ska fungera som människor. Samtidigt riskerar en allt för stark förenkling av vår upplevelse av världen till att vi förminskar oss själva och andra, berättar hon. För att undvika dessa typer av fallgropar handlar det hela tiden om att bedriva ett nyfiket undersökande, att skapa mening och inte uppleva oss själva som offer inför våra omständigheter. Uppfattningen bottnar i vad som kanske är en delvis annorlunda syn än den allmänt vedertagna på vad det innebär att vara människa.

”Hon är ständigt sökande och ständigt skapande och äger makten att skapa mening i sitt eget liv. Det är många gånger förödande när man börjar tala om hur människan är då man genast stänger dörrar till andra saker som man samtidigt säger att hon inte är. Exempelvis påstår vi ofta sådant som att ”jag är aggressiv”, ”han är ytlig”, ”hon är påhittig” och så vidare. Jag tänker att man är mycket mer än vad man vet att man är - och att det ligger något hälsosamt i att vara ödmjuk inför sig själv och sina egna möjligheter.” För att råda bot på denna allt för starka världsförenkling betonas individens eget ansvar för sina handlingar och sin situation framför den befriande skuldfrihet som bland annat en patient inom vården många gånger med all rätt har gentemot vårdande instans. Bakom detta individuella ansvar ligger tanken på ett jämlikhetsförhållande i mötet mellan gästen och filosofen, berättar hon. Detta är en av de stora skillnader gentemot framförallt psykoterapi där istället olika typer av tolkningsmodeller förespråkas med avseende på ett visst önskat behandlingsutfall. ”Att vara i den typ av problemförhållande man är i inom psykoterapi är där man syftar till att överkomma det ena eller andra problemet är för den filosofiska praxisen helt främmande. Det har att göra med att något sådant bygger på instruktion medan det som är kännetecknande för filosofiska samtal är att du inte kan vara auktoritet annat än som samtalsledare. Du sitter inte på några svar på hur man ska bli fri från någonting utan du möts som jämlik på ett sätt som både är antiauktoritärt och icke-instruerande till sin natur. En dialog är att mötas som två och där är filosofin som enda vetenskap extrem på det sättet att man som proffs och amatör möts på samma nivå och många gånger kan hitta något nytt som ingen har tänkt på. Detta kan inte ske med en neurokirurg eller en psykoterapeut därför att där sitter man på en annan typ av expertis.”

Filosofins plats inom vården är dock något som sedan 1990-talet vuxit sig allt starkare till viss del på grund av de studier som visat på behovet av kompletterande etisk och existentiell stimulans hos dem som drabbats av allvarlig sjukdom eller handikapp. Filosofisk praxis har delvis fyllt detta tomrum vilket för övrigt ligger i linje med den hälsodefinition som formulerades av Världshälsoorganisationen (WHO) 1948 och som betonar ”ett tillstånd av fullkomligt fysiskt, psykiskt och socialt välbefinnande, inte endast frånvaro av sjukdom.” Trots att detta perspektiv på hälsa är något som i teorin är gällande inom all typ av vårdarbete lever en syn kvar på kroppen som en maskin där det huvudsakliga syftet är att få tillbaka rörelse och funktion, skriver Tulsa i sin nyutkomna bok Du har svaren!. Att ett stort arbete i vården ofta återstår efter det att de akuta faserna är över har bland annat aktualiserats med hjälp av läkarna Richard Levi och Claes Hulting som använt sig av det filosofiska samtalet i sitt förändringsarbete inom vården för ryggmärgsskadade. De har med hjälp av ett mer holistiskt ideal startat Spinalis – centrum för ryggmärgsskadade där klassisk rehabilitering kombineras med filosofisk praxis, både i form av enskilda samtal och i grupp.

”Väldigt mycket av att leva går ut på att förstå och att skapa mening och sammanhang. När man går igenom en allvarlig olycka eller sjukdom så skakas många gånger hela ens existentiella fundament i grunden - vem är jag nu när jag inte kan gå längre? Det livet man levde innan man fick sin cancerdiagnos kanske man av fysiska skäl inte längre gå tillbaka till eller så vill man helt enkelt inte det. Diagnosen kan ha ställt djupare och mer livsavgörande frågor på sin spets och då står man där och funderar - funderingar som man bör fånga upp och peka på som något eventuellt välgörande och inte alls som något i motsättning till att bli frisk. I vissa fall tror jag att det finns en missuppfattning i vården där man allt för lättvindligt ”botar” ledsna människors förvirring eller oro med exempelvis psykofarmaka. Ledsamhet kan också vara en helt naturlig reaktion och ett tecken på att man just inte är psykiskt instabil. Om exempelvis hela ditt liv har gått ut på att åka mountainbike och du helt plötsligt inte kan röra dig längre blir det under en längre tid mycket tufft – och du behöver hjälpmedel för att hitta andra saker som är värdefulla. Dessa funderingar görs inte bäst utifrån att du är patient utan utifrån ett uppriktigt undrande och då gärna tillsammans med andra som man kan hämta kraft ur. Det ligger något tröstande och

enormt välgörande i att man inte är ensam i sina upplevelser utan att man tillsammans med andra ges möjlighet att undersöka dessa teman.” Tulsa berättar vidare att denna typ ”illusoriska” ensamhet som vi inte bara upplever i vårdsammanhang utan i livet i övrigt många gånger bygger på en myt om oss själva som allt för individuella. Hon tar upp ett personligt exempel från Världsfilosofidagen i Helsingborg nyligen, då hon bedrev så kallad ”gerillafilosofi” på stadens gator genom att helt slumpmässigt gå fram till människor och fråga om vad ett värdefullt liv skulle innehålla. Responsen var överlag mycket positiv och människor uppskattade verkligen att fundera i dessa banor, men hon slogs samtidigt av hur pass stor andel som svarade med motfrågan ”menar du för mig eller?”. Även om hon förstår att människor tänker så är det slående hur detta avspeglar en syn på det egna meningsfulla livet som något helt annorlunda från hur andra uppfattar ett meningsfullt liv. I själva verket är det mycket få människor som har en avvikande idé på vad ett gott liv innebär, förklarar hon. ”Vi tror oss helt enkelt vara mer individuella än vad vi faktiskt är - och jag tror att jag följer i min käre föregångare Sokrates fotspår här. Likt han var upptagen med att slå hål på de myter som rådde på hans tid är jag starkt ifrågasättande till individualismmyten - denna masspsykos som råder. Det kan säkert ha sin orsak i att vi av uppenbara skäl vill känna att vi är i kontroll över våra liv, någon form av försvar vilket i sig är helt okej. Men det är viktigt att vara medveten om detta - dels att man är utsatt för påverkan och samspel från den allmänna kulturen och dels det faktum att vi alla ställs inför stora val – detta ständiga mer eller mindre; vem är jag, vem vill jag vara, vad är värdefullt, vad innebär det att bli förälder etcetera. Alla dessa val är kopplat till en väldig förvirring och sökande och vad människor ofta inte inser är att vi alla sitter i samma båt – vi bär alla med oss dessa funderingar. Så istället för att tänka att vi är så speciella, och att ingen förstår oss finns möjligheten att se oss själva på ett mer medvetet sätt. Att undersöka i vilken mån man är fri är en förutsättning för att vara sådär fri som man själv säger sig vilja vara. Om man inte vill reflektera kring detta finns ju alltid risken man inte alls är fri och att man plötsligt går och marscherar med blanka stövlar – vad är det som säger att man inte hamnar där?”

•

Vinn Tulsas bok Du har Svaren! Filosofi till vardags, se sida 39.

Viewpoint

Hans Rosling

“

The only aim of medical school cannot be training students for Swedish internships

By Gustaf Drevin

MY FIRST MEETING WITH PROFESSOR

bilist’. Whether speaking to Bill Gates or a star-struck student from Karolinska, he is just as passionate about his subject. At times, it is hard not to feel intimidated by his straightforwardness and energy. He adds “huh?” and “isn’t it?” to many sentences, which witnesses of his stay in Mozambique, where one uses those sort of affirmation-seeking interjections to engage the listener in the conversation. His, at times, playful approach to teaching and pedagogy contrasts the serious messages he delivers, but the two never collide. Instead, the juxtaposition of humour and seriousness enhances the message. The Global Health elective has opened the eyes of thousands of students at Karolinska. Ironically, one seems to learn more about one’s own life when experiencing that of those less privileged. “One thing the students said was ‘damn, now I understand Swedish healthcare!’ They had not understood that somebody has to pay for ambulances,” Rosling says. “You understood health economics when you saw a much more meagre system, and what the price was.” The course was an immediate success and more countries were added to the list. “It was like going up Kaknästornet: ‘Aha! Now I see Stockholm!’” Class discussions intensified and deepened when the students came home and began to regard healthcare from another angle. “We got a very good perspective on the course /…/ as students went to different places, India, Africa, Cuba, Iran, and then talked among themselves.” The elective helped broaden the students’ view of the profession and improved the quality of their education. Rosling acknowledges that it would not be the same if the course were taught only via books and lectures. “I call it experiencebased knowledge.” He adds that it would

be useful to have a course early in the education as it expands students’ view on high-income-country healthcare. He also notes that this international awareness benefits the pharmaceutical industry, international relations, and the struggle against antibiotics resistance. It was important that students realised that there are brilliant colleagues outside of Sweden and that resource scarcity certainly does not entail incompetence. On the contrary, Karolinska invited foreign physicians to train students in their clinical skills. Because, “in Sweden, you do not examine patients – you send them on to the X-ray department.” He truly emphasises that we must respect our foreign colleagues and that resource limits mean nothing when it comes to skills. “We came to India and went on rounds. Sixty patients, four rows, fifteen beds in each. And then there were these brilliant doctors who read The Lancet on Saturday and knew everything. And nurses, taking pulse and blood pressure of all patients in a way that never worked in Sweden. ‘Such skilled people – and such a bad hospital?’” He puts on a big smile that reflects the absurdity of these prejudices. He knows what he talks about since he was prejudiced himself, as a young student studying in Bangalore, India. “It took me 30 minutes to realise that from being in the top quartile of the class [in Sweden], I was in the bottom quartile. They read thicker books, more often, than we did.” Rosling indicates that many assume that affluence automatically makes you better than a colleague from a poorer country. “People still have a bloody Tintin attitude towards colleagues from other countries”, he says and gives the example of students asking a midwife in Tanzania if she trained her daughter in the same profession. What follows is a miniature

Photo by Martin Kjellberg for Medicor

Hans Rosling included a nervous handshake and a stuttering “You are such a source of inspiration.” He answered by reflex: “Well, I hope someday I become a source of knowledge.” I walked away, silenced. Embarrassed. Ashamed even. I had become a groupie. He does not desire a rock-star status. He is a statistician; a scientist. Fortunately, he did not hold our first meeting against me when we, a few weeks later, spoke on the phone. During what became a one-sided, half-hour lecture on everything from apathetic child refugees to the Uygur in China, one question in particular stuck with me as he talked about global health and Karolinska: “Är det enda målet med läkarprogrammet att utbilda studenter inför svensk AT?” In other words, what is the aim of Swedish medical school, or any programme at Karolinska? The only aim of medical school cannot be training students for Swedish internships. Most people know of Rosling through his work in Africa and by his TED talks. Few know as much of his professorship. For instance, he set up the precedent to the Global Health elective offered at eleven programmes at Karolinska, in the late 1980s at Uppsala University. The course highlights social determinants of health. He brought it to Karolinska in 1996 and it has since been one of the most popular electives, receiving praise and pedagogical prizes. Rosling has travelled with it twice per year for ten years, up to 2006, and has spent 40 working weeks abroad with students. Thus, he has seen many paradigm shifts among them. It was, not surprisingly, here that the idea to Gapminder Foundation and the Trendalyzer bubble software was born. He is passionate, but yet not an activist or optimist. He calls himself a ‘possi-

Viewpoint | Education

Extreme inequalities still exist. And grow. All of this is made more comprehensible if you have been in these settings. It is difficult to get the larger picture from high-income countries, since we enjoy such a high standard of living. He jokes that while in many countries no analgesics can be afforded for performing abortions, it would be scandalous in Sweden if you would not apply numbing cream when taking blood pressure. While some countries afford the €8,000 titanium hip implant, many countries still use the primitive Pinard horn, instead of the ultrasound, to do prenatal health checks [see our front cover].

...a toxic combination of arrogance and ignorance “[Swedish] healthcare is so well-organised that it constantly gets harder to understand resource scarcity.” Something that followed this, he remarks, was that students had problems with that resource scarcity meant spending less time with patients. Some students were offended, as if the behaviour towards the patients were badly intended. “I have noticed this through the years: you have greater and greater expectations of how to behave toward patients. You are not used to working under tough pressure.” But, the Global Health elective teaching this is on the verge of atrophying. Following an administrative reform a few years back, the course is today doublecharged. It pays for facilities even during weeks when students travel to their respective universities abroad. Rosling implies that prefects, who are given insufficient budgets, use this loophole to strengthen their economies. It is not the prefects’ fault. Still, the new reform ventures the future of the elective. “We have run this course for fifteen years, a hundred students every year, and now it is going to hell because of double taxation. To even call it ‘double taxation’ would be putting it nicely. To be honest, it is gangster protection money.” There is a justified disappointment in his voice. The course is one of the most appreciated at our university and is invaluable not primarily for the medical education, but for students’ personal edification. He brought it himself to Karolinska 17 years ago. Now it may fall apart. Rosling is doubtful that it is an easily resolved problem and his frustration is palpable. “It is ridiculous! It is beyond my wildest imagination that I would be lecturing the world’s leading banks. UBS in Switzerland and Goldman Sachs in Manhattan. I give lectures to their boards about the development of the world. That

is easier – to be one of Time Magazine’s 100 Most Influential People in the world is easier – than to get an honest economy for [the] global health [course] at KI.” We ask how far it can continue. “They are killing the course! It is so rank that it is without parallel! When will you give up if I strangle you?!” He bounces up from his chair, grabs the tie of our photographer, and pulls it like a snare. Laughter ensues. Again, a light approach with a heavy message. Although the noose tightens, Rosling notes that the course does not demand more money. Only a fair price for the services it uses. It would be unworthy a university of the Karolinska Institute’s stature and reputation to cancel one of its most popular courses. The Global Health Department at Karolinska (IHCAR) even considers the course its flagship. Since the problems result from an administrative change that the university has brought upon itself, it is embarrassing that this problem exists to begin with. As one of the leading forces in the field, it would be interesting to see what Rosling would do if he were the president of Karolinska. He acknowledges that he likes the three recent presidents very much. “Hans Wigzell (1995-2003) reformed KI in a very nice way, almost like a new crush. He gave us a more dynamic system where money went to those who performed. Harriet (Wallberg-Henriksson, 2003-2013) took over that system, but a crush is always easier than a marriage. A crush is good, it is before you have to decide who takes out the trash and who defrosts the freezer. But, after three or four years a marriage becomes a bit boring. Harriet had to take care of that.” The new president, Anders Hamsten, has said he will focus more on education and give professors increased freedom. Rosling declares his hope in that Hamsten will keep his word. Additionally, Rosling argues that a university reaches a high standard only if individual researchers and teachers are allowed to form their own research and teaching. Only then, the teaching becomes interesting to students. “You cannot come dragging along with something that you say is so very important, and then, when you teach, it is so boring that students fall asleep.” After all, electives such as this must be driven by “its own force, motivation, and quality of the education,” he states, so “that it gets the students to say that this is where they want their money to go.” He would give students a short but intense introduction to international health early in our programmes. “It is better to let them attend the course early in their training, because, later you ask the right questions.” Of course, the quality of these few days of global health should be of a

Photo by Martin Kjellberg for Medicor

monologue with gestures and a dramatic voice as he enters the role of the Tanzanian woman: “‘My daughter? A midwife? Never! I have fought all my life so that she can attend high school and now she has a job in front of a computer in Dar Es-Salaam. Do you think I am stupid?!’” If you ask Rosling, it is not that we necessarily think of ourselves as better, but that we romanticise about poverty as something making people appreciate other aspects of life more. Rosling’s famous TED talks dealing with everybody’s right to a washing machine and the sandal-to-aeroplane comparison strike the same point. This is important for us to understand, since we are to reconcile the, at times, conflicting ends of development and sustainability in future international debates. One argument cannot be that poverty is something advantageous. Hans Rosling has too often encountered this. “I call it a toxic combination of arrogance and ignorance.” There is a risk of romanticising in the opposite direction, too. During the Global Health – Beyond 2015 conference, Richard Horton (editor-in-chief of The Lancet) pulled down a wave of applause with his endnote speech where he said that although he has flirted with both “Marxism” and “God”, he considers global health his life philosophy. Rosling, who seemed to have intense discussions with Horton between the sessions, argues that this is wrong. One should not put this field on a pedestal because one feels sorry for the world. “I loathe his attitude, that it is his ‘philosophy’. I feel a damned disgust toward that attitude to global health. I was about to cry out ‘Hallelujah’ in the end.” Just as I had said that he was a source of inspiration, Horton’s almost religious approach to the field bothers Rosling. “I want it to be an academic subject. It should not be made an ideology. You should simply know how things are. I have become very humble to that, simple knowledge.” However, acquiring knowledge and insight is not simple. The gaps in knowledge still exist. They have only marginally decreased, as Rosling shows in a complementary ‘unethical study’ chart” he compiled earlier this spring on students’ knowledge of international differences in child mortality. “These misconceptions of the world remain. Obviously, students are not taught the right things in school.” Hence, the Global Health elective at our university holds relevance and importance. Especially so, as we get richer while the extremely poor two billion still try to lead their lives on less than two dollars per day. “It becomes increasingly difficult by each decade to comprehend extreme poverty and resource scarcity.”

EXTREME AFFLUENCE AND EXTREME POVERTY

There are seven billion people on Earth. One billion are rich (blue). Four billion are in the middle of the scale (yellow). Two billion are extremely poor (red). While Sweden consider the titanium hip transplant a human right, the extremely poor will have little resources but e.g. the wooden Pinard horn that since the 19th century has been used to listen to the foetus’ heartbeat through the abdomen and uterus of the mother. In the middle three billion, the main problem is to prevent noncommunicable diseases (NCDs), such as lung cancer from smoking. The black bricks show millions of children dead before their fifth birthday per year. Six out of the seven million children aged under-5 dying each year are born into the poorest two billion. 23

Viewpoint | Education high standard. “Give them two days and make them so good that the students demand more. New education must be driven by that students say ‘this was relevant, this was exciting, this was interesting, we want more.’” Now, why bother? Many will end up practising their profession in Sweden for their whole careers. The majority of us, in fact. Why should we care about child mortality in Bangladesh or drug-resistance in the Ukraine? “There is not only a northern sky, there is also a southern sky. You do not see it from Sweden, but there are comets there too. Geologists study volcanoes, although there are none in Sweden. Why would they do that? They are geologists in Sweden, why study volcanoes?” Medical professionals owe it to the universality of medicine and to the human condition to know that there is a wide range of variances in the world. We must be humble toward these transformations and not forget what goes on around us. “Since we are very different from the rest of the world, we have to keep contact with the realities in these parts of the world.” There is much to learn from our colleagues in other countries and even more from experiencing healthcare and social

settings different from our own. Although not all wisdom can be quantified in coloured bubbles, we should be attentive as to how the world develops. It is not only a responsibility toward our future patients but also to ourselves as human beings accountable for what happens at our planet. It will be most relevant in our careers and lives to update ourselves constantly. Because, the changes going on in the world are of immense gravity. According to Professor Hans Rosling, so large that we do not even realise it. “It is not globalisation that we are witnessing now. This is not even the beginning of globalisation. This is just the end of the non-globalised world.” • The course administration responds to the criticism The course administrator at the Global Health Department (IHCAR), Anna Mia Ekström, says that money is a problem, but also the only problem she knows of. “The funding problem is caused by indirect costs (INDI), which is an overhead cost that institutions and the central administration adds on to the course.” Decision-making lies not with the course administration, although it, together with the prefects, considers alternatives.

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Global Perspective It works hard at creating a funding plan or bringing about a revision of INDI so that the loophole goes away. The Dean of Education, Jan-Olov Höög, confirms that “there are no plans to cancel the course”.•

Professor Hans Rosling is most known for his appearances at the TED conferences, where he famously revealed his Trendalyzer software in 2006. Having practised medicine in Mozambique, Rosling started a global understanding course at Uppsala University in the 1980s and helped establish the Swedish branch of Médecins Sans Frontières in 1994. In 1996 he brought his course to Karolinska, and 80-100 people travel with it every year. With a 7,5% KI employment today, Rosling travels the world to lecture banks, companies, and governments on improvements and shortcomings in the world. Having been praised by the likes of Bill Gates and Al Gore, he is a driving force in the field of international understanding. Time Magazine listed him among the 100 Most Influential People in the world in 2012, together with Barack Obama, China’s President, Xi JinPing, and Brazil’s President, Dilma Rousseff.

Global Health

Beyond 2015. What kind of world do you want to live in? By Andrea Jacobson

THE OPENING LINE IN THE INTRODUCING FILM AT THE

conference Global health – beyond 2015 encourages reflection and action. Global Health – beyond 2015 is an initiative taken by the Swedish Society of Medicine (SLS) to encourage different society sectors and disciplines to collaborate around the issue of global health. The conference focused on the post-2015 process, which is the year of the expiry of the Millennium Development Goals. The vision of the conference is to give a picture of what the world looks like today and increase the knowledge and awareness about global health issues. Of significance is also the exhortation to integrate sectors and collaborate across different disciplines in future work concerning global health, which is a reason for the broad mix of participators at Global Health – beyond

It’s important that this conference doesn’t result in a one dayeffect. We have to keep several discussions running, having a sort of countercurrent-mechanism, listening to different arguments from various disciplines on the way forward

2015. “It’s important that this conference doesn’t result in a one day-effect,” Peter Friberg, chairman of SLS, explains. “We have to keep several discussions running, having a sort of countercurrent-mechanism, listening to different arguments from various disciplines on the way forward”, he says. A concrete goal of the conference is to create The Stockholm Declaration on Global Health, an official document on the continuous efforts to improve global health. The document will be built on basis of the main themes of the conference; inequality, non communicable diseases (NCDs) and climate. A bottom-up framework for the declaration had been compiled by a research group from Umeå University before the conference and in connection with the conference a workshop-day was organized by SLS to receive further inputs from experts as well as students. Along with those inputs, opinions from partners of the conference will contribute to the final result of the declaration, which will be published in the end of May. Peter Friberg explains that we are creating a new world by this post-2015 work and he encourages students to take part in the action. A good way to start is to engage in non-profit associations. “Commitment at a grass-roots level is essential to make this work”, Peter Friberg says. Through that, the main message of this conference shines through – it’s your agenda and the future is everyone’s responsibility.

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Graphic design by Christine Ringsmose . www.ringsmose.com

GLOBAL PERSPECTIVE

The MDGs

Perspective from a Global South

What stands behind the UN’s Millenium Development Goals? By Jack Ziomek

With Dr. Renzo Guinto

GLOBAL

Medicor is privileged to meet Dr. Renzo Guinto during the “Global Health – Beyond 2015” conference held last April 4-5, 2013 in Stockholm. Renzo is a member of the Youth Commission for Global Governance for Health hosted by The Lancet and University of Oslo, and is also the current Liaison Officer to the World Health Organization of the International Federation of Medical Students’ Associations, a global network of 1.3 million medical students from 107 countries. We asked him about his perspectives on global health and the role of young people.

Are you saying that global health’s mission today should be reducing health inequities? In 1978, the Alma Ata Declaration – perhaps the most visionary document in the history of modern global health – already deemed health inequities as completely unacceptable. This message still rings true until today. The Occupy Movement that swept one of the world’s most inequitable countries reflects the growing discontent for gross and unfair 26

How else can health inequities be addressed? Health equity – the absence of inequalities that are avoidable and unfair – can only be achieved by addressing the social determinants of health (SDH) – conditions in which people are born, grow, live, work, and age. SDH encompass a wide range of factors, from proximal ones such as supermarkets selling unhealthy food, to distal ones like trade agreements and labor policies. The SDH approach recognizes that people’s health is shaped by external factors that can be remedied through sound policies and interventions. For example, there is strong evidence that improving early childhood education, advancing women empowerment, and fostering community participation can reduce health inequities. Acting on the SDH requires whole-of-society approaches, which means that not only the health system but also sectors beyond health should be involved. What is young people’s role in the fight for health equity? First, young people must adopt a truly global perspective – and this means a deeper understanding of the plight of human beings beyond your own society.

For example, here in Sweden, you are privileged to have resources to travel overseas. Grab the opportunity to study the roots of hunger in Africa or environmental degradation in Asia, and perhaps participate in a community project or field research. But don’t stop there. Work begins at home, because local health is global health. Sweden may have one of the most equitable healthcare systems in the world, but I learned that the health of migrants here may soon be at stake with new reforms being proposed. Join these domestic discussions and partake in advocacy and lobbying work. Furthermore, Sweden plays a vital leadership role in global health, in priority-setting and financing for example. You can serve as advocates for the world’s poor in your own backyard. Are you optimistic that health equity can be achieved in our lifetime? We need to first embrace “health for all” as our individual and collective mission. Change does not happen overnight, but it happens when people with the will power lead and shape it. Just look at your country’s example – with utmost solidarity, you were able to achieve health and equal opportunities for all citizens. We also need to be humble. I truly believe that, contrary to a self-interested view of humanity, we have an advanced quality to think beyond ourselves – that we, by nature, are kind-hearted. This is what the Asian tradition teaches us. If our generation will be more giving of ourselves, and humbler in accepting responsibility, then certainly it is not unthinkable that we will live in a much healthier and more sustainable world in the 21st century.

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Photo by Martin Kjellberg for Medicor

How would you assess the state of world’s health today? Global averages indicate that indeed, we live in a much better and healthier world today. Thanks not only to medical interventions but more so to advancements in infection control, sanitation, nutrition, and urbanization, the past century added 30 years to the world’s life expectancy – this your very own professor Hans Rosling was able to beautifully illustrate through his country bubbles. However, there also remains at least a 30-year divide between developed and developing countries. The gap in other health outcomes, like maternal mortality, is even worse.

inequalities. Social inequalities breed health inequities – and these can be addressed through redistributing wealth and spreading opportunities. Furthermore, health needs to be protected not just from biological but also from social and financial risks. Strong social protection mechanisms are needed, such as the universal healthcare system that you enjoy here in Sweden. Hence, nearly a hundred countries are now racing towards the finish line of universal health coverage.

DEVELOPMENT.

UNITED

Nations. You hear those two expressions every week: in the TV, newspapers, the Internet, probably even from your friends – if they are the social activist type (we all know one). UN has become such a cliché that many of us take its actions for granted. But have you ever wanted to know in detail what UN is doing for global development? Here you will have a chance to explore The United Nations Millennium Development Goals (MDGs) - eight goals that stem from the United Nations Millennium Declaration, signed in September 2000. MDGs commit all 191 UN member states to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women by the end of 2015. They were chosen to “advance the means to a productive life”, as stated by the United Nations. However broadly it sounds, the authors emphasize that in order to fulfill the goals, they need to be tailored to the needs of a particular country. The UN member states are left free as to how to adopt the MDGs on local ground. As the Millennium Development Goals stem from the Millennium Declaration, they aim to bring the declaration’s ideas into life – that is to provide every human being with dignity, freedom, equality, a basic standard of living, including freedom from hunger and violence, while supporting tolerance and solidarity. To help fulfill these ambitious goals, all eight MDGs have specific targets and indicators, which help measure the outcomes and ease their assessment, in a fifteen-year timeframe. While conceived by the United Nations, other stakeholders helped lay the foundations for the creation of MDGs. The Goals are a mutual effort of global thought-leading institutions: Organization for Economic Cooperation and Development (OECD), the World Bank and the International Monetary Fund. The roots of MDGs lie in the 1990s, when several UN-led conferences focusing on the problems of children, nutrition, human rights and women were held. A report entitled We the Peoples: The Role of the

The MDGs at a Glance Goal

Description

Eradicate extreme poverty and hunger. By 2015, the proportion of people living on less than $1.25 a day will be halved. This will be supported by achieving decent employment (over $1.25 per day) for women, men, and the youth; and halving the proportion of people who suffer from hunger (existing below minimum level of dietary energy consumption).

Achieve universal primary education. By 2015, all children will be able to complete a full course of primary schooling. Success will be assessed by enrollment and completion rates.

Promote gender equality and empower women. Gender discrepancies will be eliminated on all levels (from primary to tertiary). Measured by women-to-men ratios in education, employment and the parliament.

Reduce child mortality rates. Under-five mortality rate will be reduced by two thirds by 2015, supported by increasing the number of 1-year-old children immunized against measles.

Improve maternal health. By 2015, maternal mortality ratio will be reduced by three quarters, with the help of skilled personnel attending births. Maternal health will be supported by achieving universal access to reproductive health via increasing contraceptive access, and pre- an postnatal care coverage.

Combat HIV/AIDS, malaria, and other diseases. By 2015, the incidence ratio for these diseases will be halted and will start to reverse. HIV/AIDS pandemic will be combatted with the help of educating youth, promoting condom use, and universal access to HIV/AIDS treatment. Malaria and other major diseases will be combatted by appropriate therapies (anti-malarial drugs for malaria, Directly Observed Treatment Short Course for tuberculosis).

Ensure environmental sustainability. The principles of sustainable development will be adopted by countries’ policies and programs. Biodiversity loss will be significantly reduced by 2010. By 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation will be halved.

Develop a global partnership for development. A transparent, predictable and non-discriminatory trading and financial system will be developed and implemented internationally. Developing countries will have their special needs addressed, that is: debt relief, access to essential drugs, access to new technologies (internet, cellular communication).

United Nations in the 21st Century was issued in 2000 and directly led to the Millennium Declaration, which, in turn, fathered the MDGs. By this time, the OECD had already formed its International Development Goals (IDGs) and it was com-

bined with the United Nation’s efforts in the 2001 meeting hosted by the World Bank’s to form the MDGs. Although seemingly covering a vast array of different fields, the Goals are interdependent and influence one another. 27

GLOBAL PERSPECTIVE

Photo by Jingcheng Zhao for Medicor

For example, MDG#1 aims to eradicate extreme poverty and hunger, which is aided by MDG#2 - achieving universal primary education and managed by MDG#8 - developing a global partnership for development. Nevertheless, Millennium Development Goals did not avoid criticism by the media and the global health community. The main put-downs portray MDGs as merely “a historical statement, not a blueprint for global development”. Critics pan the lack of deeper analysis and justification behind the chosen objectives; lack of country specifications, which leads to the difficulty or lack of measurements for some of the goals; uneven progress towards reaching the goals and finally lack a focus on local participation and empowerment. Furthermore, there is a great disparity between UN member states in reaching the Goals. While some countries are exemplary students, having achieved majority of the objectives (Brazil, India, China), others, like the sub-Saharan states, so

far performed poorly. Rural communities in El Salvador know nothing about the Millennium Development Goals, having received no support in this regard. Few weeks ago, The Guardian reporter met Salvadoran peasants and inquired what should come next after completing the Goals. The journalist was met with blank faces expressing surprise and annoyance at the same time – not only the Salvadorans did not have an opinion about what should follow the MDGs, they didn’t even have a clue what MDGs were! In parts of the world the impoverished still feel excluded and lack attention they need from major players of global economics. Not so shockingly, half of people in the least developed countries (LDC) - the world’s poorest 49 countries – still live below $1.25 a day, the World Bank’s measure of extreme poverty. Nonetheless, The Goals have greatly leveled the awareness of global development. The number of people living in extreme poverty has been reduced, water access and number of girls at-

tending schools is on the rise, whereas infant mortality is decreasing. Having said that, international support is critical for the world’s poorest countries so they can catch up with the good performers and fulfill the MDGs – as stated by Gyan Chandra Acharya, the UN undersecretary general for the LDC group last week. In the beginning of April, we observed the 1000-day mark to the target date for the MDGs – year 2015. According to the World Bank’s revised evaluation of the progress regarding The Goals, under optimistic view, extreme global poverty could be eradicated by 2030. If the UN and its collaborators want to open champagne bottles before 2030, they must aggressively accelerate their actions on reducing hunger, improving sanitation, maternal health and gender equality, among other remaining fields of the Millennium Development Goals.

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Health&Climate

“

Every Penny Invested in the Climate is a Penny Invested in Health

By Andrea Jacobson

THE WATER ISSUE, POLITICS AND THE superstore Walmart; Johan Rockström, executive director for Stockholm Resilience Center, gave a broad environmental twist to Global Health – beyond 2015. In his lecture at Global Health – beyond 2015 Johan Rockström recounted for humanity’s entrance in the Anthropocene, a new geological era where mankind has become a driving geological force. Making a comparison between the superstore Walmart and nature – you enter the store and you take whatever you want – Johan Rockström presents a picture of the human conduct. But unlike Walmart, nature has resource limits which can result in transgressions of so called tipping points. And to transgress a tipping point can have great impact on global health, flipping over fundamental living conditions for humans. “It’s pointless to work with health separate not dealing with environmental issues at the same time, they are so closely connected”, Johan Rockström says. “It’s a bit naive to be proud of the progress of the Millennium Development Goals considering hunger, poverty and health, when we’ve done almost nothing on the environmental side,” he says, “that’s like pulling away the rug for our own achievements”.

Johan Rockström, executive director for Stockholm Resilience Center: “An easy step for Sweden would be to establish an environment-health-finance committee in the Swedish Parliament” 28

Johan Rockström explains that it’s important to break the tendency of strictly dividing different sectors like health, economical growth, environment and labour. “We’ve reached a point where we’re beginning to see the interplay of these sectors in a new way in reality”, he says. “An investment in poverty reduction can be lost because of climate changes just as great progresses concerning the treatment of infection diseases can be lost because of a collapsing agriculture”. It doesn’t have to be difficult for sectors to approach and a new way of working in the field of politics could be a good way to start. “An easy step for Sweden would be to establish an environmenthealth-finance committee in the Swedish Parliament”, Johan Rockström says. “We have to make a shift from single politics to working in pairs, for example health-growth, health-environment”. Water is an essential matter considering global health. Johan Rockström tells that the most important work regarding the water issue surprisingly lies in the agricultural sector. “The greatest challenge is to render the water use more effective within agriculture”, he says. “Since agriculture is the world’s largest source of water consumption, about 80-90 percent of a citizen’s water requirement is used to produce food, we need to increase the use of drip irrigation and attain a more highly rain supplied agriculture for example”. The other side of the water issue is probably more recognizable. “The more classical aspect is to provide access to fresh water globally, that might be the cheapest and most immediate health gain we can accomplish to avoid waterborne diseases”, Johan Rockström says. “A problem though is that water is free of charge and is therefore administered

ineffectively, which originates from our low appreciation of ecosystem services”. To face the new reality of the Anthropocene, with more rapid shifting living conditions, includes working to avoid future risks and adapting to those coming. That’s a global responsibility. Sweden has for a long time been spared to deal with big crises, on the other hand that has given us a lack of experience and knowledge in this area. “Today many poorer countries lay ahead of us when it comes to disaster planning,” Johan Rockström says, “they have a social structure and an exercise of public authority which makes them much more prepared for big disasters”. “We have a lot to learn from countries like India, Taiwan and Ethiopia regarding the way of handling large and rapid change processes”. A great deal can be done, simply here in Stockholm, to increase our knowledge of future risks. Johan Rockström tells that there’s an important agenda of connecting the research on sustainability, health and development. “Karolinska Institutet and Stockholm University should co-operate more, doing research jointly about in what way sustainability can contribute to better health and in what way unsustainability threatens health”, he says. So, what’s most important with Global health – beyond 2015 according to Johan Rockström? “To once and for all break the myth of the greatness of unilateral thinking and to start acting on all fronts,” he says, “every penny invested in the climate and environment is a penny invested in health”.

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GLOBAL PERSPECTIVE

Why do we bother with research? By Jingcheng Zhao

BEING AT SUCH A RESEARCH-HEAVY

of why we do research in the first place. “What is research for? Research is not to publish papers in The Lancet. Research is not to get big grants. Research is not to become a professor. Research was originally supported as an idea of society because it seemed to have a social value. So, let’s make sure that the research that we do has some social value. “ Reintroducing a global health perspective to the journal has been one of Horton’s main goals – something that has made him an icon for global health worldwide. “The role of the scientist, the role of the health worker, and certainly the role of the journal is to be an instrument, a political tool, to improve the well-being and to protect the planet. “

Science became an industry /.../ without a clear purpose Asking the editor-in-chief about his role at his newspaper, he replied “I am very, very lucky to work at a publication that has a fantastic commission. I’m simply the caretaker of an institution which has a larger part to play in the global conversation about health. My job is to in a sense reinvent the values and ideals of The Lancet as they were founded in 1823 for a new generation. And the new generation today is one which is younger, more global, and more socially and politically committed, and I want The Lancet to reflect all of those dimensions.” While most agree that progress in global health needs to take place, few agree on how we should get there.

Should governments have an active role, or should it be up to private companies and individuals? “I don’t distinguish between public and private sectors because I think that is an irrelevant distinction. We are all people and we have all trained in medicine or nursing or whatever and our obligation is not to the public sector or the private sector, our obligation is to one another.“ Although curiosity and philanthropy may be key motivators for scientific research, there is still incongruence in the juxtaposition between the problems we have and the areas research funds are being put into on a global scale.. There is more research, for example, into male baldness, than there is for malaria. As researchers and health personnel of the next generation, we should try not to forget that there are needs beyond those in our immediate environment. There are very real health problems out there that we need to solve, and this is something we should remember during our studies. I mean, if we are going to do all that pipetting anyways, we might as well do it to make the world a better place, no?

Photo by Martin Kjellberg for Medicor

university as Karolinska Institutet; it’s sometimes easy to forget why we do research. It’s easy to get lost in the jungle of impact factors and journal rankings, and it’s easy to obsess over credits and citations, not to mention ANOVAs and p-values. If there’s one thing that we’ve learned from being medical students at Karolinska, it’d have to be ‘Ph.D. good. No Ph.D. bad.’ But, why? Why do so many people dedicate their life to research? Surely it can’t be because they think pipetting is fun. I mean, it’s not fast and exhilarating like a driving a sports car, it’s not instantaneously rewarding, and it’s certainly not for the pay (unless you work for a company, then maybe). In fact, most of the time, you are probably spending lots of money to produce unusable results. But it is inarguably fun. There is something intrinsically exciting with research that is hard to ignore, a sense that you are doing something worthwhile, something worth the long nights and hair loss. Dr. Richard Horton, the current editor-in-chief for The Lancet, is an enthusiastic advocate of purposeful research. We shouldn’t do research without a purpose. “If you go back and look at the journals of the 19th century, they are very much driven by the idea that knowledge should be used for social progress.” He laments that we left that mentality behind in the 20th century. “Science became an industry, a production line of producing papers, getting grants, of building up knowledge, but without a clear purpose.“ The doctor strongly subscribes to the view that people need to be reminded

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Editor-in Chief Dr. Richard Horton has been the editor for The Lancet since 1993.

Win a signed issue of The Lancet. See page 39.

GLOBAL PERSPECTIVE

ENTERTAINMENT

Spotlight på Twilight

The Green Health Revolution

Av Louise Forlin

Both climate and business play a fundamental role in the future work of global health. At least according to the former doctor, now part of Stordalen Foundation and GreeNudge, Gunhild Stordalen. By Andrea Jacobson

AT THE CONFERENCE

question of today; what kind of world are we saving people to? “We’ve been firemen to a too great extent in the health sector,” she says, “we’ve been running around putting out fires not being able to keep two thoughts in mind at the same time”. “Therefore we’ve forgotten about prevention, preventing the fires from starting, and we’re still too busy saving lives so that our preventive measures are not enough,” Gunhild Stordalen says, “that’s important to address”.

Photo by Georg Navér for Medicor

she says. “It’s also important that we’re beginning to shed light upon the interplay of chronic diseases and climate change”. Since the consequences of different issues are tightly linked together an important task is to make that fact widely known among the public. “People don’t understand the meaning of ‘it’s so dangerous if we reach 500 parts per million in the atmosphere’” Stordalen says. “We need to stop speaking in those kinds of terms and instead talk about the health consequences, what impact the climate changes have on our ability to get fresh water and to provide access to food globally”. Even though a lot has been done since the Millennium Development Goals came into being, relying on old dissolving methods and having a too narrow mindset can be dangerous. Gunhild Stordalen provides an eye-opener for the post2015 process. “The Millennium Development Goals deals with survival and saving people,” she says, “but the world has changed and it’s different compared with 13 years ago”. Furthermore Gunhild Stordalen poses a vital

LJUSET

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Gunhild Stordalen Photo by Martin Kjellberg for Medicor

Gunhild Stordalen took part in a concluding panel debate where she talked about the importance of keeping a longer agenda in mind, not thinking in such short terms. “We don’t have 40 years to only focus on the poverty problems and then set about dealing with climate issues,” Gunhild Stordalen says, “we have to act in both ends now”. The industry is compelled to be a part of that action, according to Stordalen. She pushes the fact that companies who don’t carry on their business sustainably will vanish, since responsible and sustainable entrepreneurship is part of a new green revolution. “It’s not about getting more out of less any longer,” she says, “the consumers will make greater demands on the industry in the future and new requests of transparency come with the globalization”. Gunhild Stordalen is talking with a great amount of commitment explaining the significance of this conference. “The most important thing is the bridgebuilding between the areas that constitute the three themes of this conference,”

TÄNDS

DEN

FULLSATTA

salongen på Teater Bistrol och på scen uppenbarar sig ett klassrum där de färgstarka karaktärerna i årets spex introduceras. Publiken kastas in i de spännande intrigerna som uppstår när den nya eleven DrakUlla introduceras för sina klasskamrater på Spoon High School. De som står på scen är Corpus Karrolina, Medicinska Föreninens herrspex. Deras spex har nu varit en tradition i över 35 år och i år är det vampyrer som är temat i Spexet Twilight. Det är ett spex som har alla ingredienser ett klassiskt spex bör ha. Det är en kombination av teater och sång - allt på rim, kantat med dansnummer och omstarter. Och trots att det bara är herrar på scen betyder det inte att det bara är manliga roller. Herrspexet brukar alltid ha en kvinnlig huvudroll, vilken i detta spex är DrakUlla, precis som att tjejspexet Flix alltid har en manlig huvudroll. Något annat som präglar spexet är att publiken får vara med och styra vad som händer på scen, vilket gör varje föreställ-

ning unik. ”Om man får ett infall så ska man ropa det” uppmanar Fredrika Fabri, en av spexets regissörer. ”Det kan vara roligare, sexigare, eller att man vill att de ska hjula”. Under kvällens föreställning utnyttjas denna möjlighet till fullo då Frank Einsteins Moster (Mikael Sölvberg) och Ylva (Gabriel Thorstensson) tvingas byta kjolar mitt i en scen, eller då publiken vill höra ett sång- och dansnummer dubbelt så fort. Vad som är beundransvärt är att skådespelarna hela tiden stannar i karaktär, vad som än kastas mot dem. Förberedelserna inför spexet har pågått i två månader. Traditionsenligt brukar Flix hjälpa till inför och under Corpus Spex och vice versa.”Det har varit en ganska kort, intensiv period, och vi har repat väldigt mycket” säger Fredrika. Bakom scen händer det lika mycket som det gör på. Allt från manus, sånger och regi, till kostymer, dekor och fika är gjort av studenter vilket kräver insatser från många håll. Alla som vill och tycker det är roligt är välkomna, och man engagerar

sig i den mån man kan.”Det är mycket jobb runt om men det ska vara rolig för alla, inte bara för ensemblen” säger Fredrika. Nytt för i år är så kallade Storrep varannan vecka där alla medverkande är inbjudna, just för att bygga på gemenskapen och alla gruppen ska lära känna varandra. Och när Mikael Sölvberg, som varit med i två spex tidigare, tillfrågas varför han engagerar sig igen detta år är just gemenskapen en av anledningarna. Allt jobb har verkligen gett resultat. Corpus bjuder på en fartfylld föreställning där publikens inrop sätter kronan på verket, och ensemblen ser ut att ha lika roligt som publiken när scener spinner iväg åt alla håll. De årliga Corpus spexen är verkligen inget som bör missas, så om ni gjorde det i år – ta chansen och gå och se nästa år. Och vill ni inte vänta så länge så spelas nästa spex i MF regi redan i höst då Flix står på scen.

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ENTERTAINMENT

Lennart Nilsson En pionjär inom den medicinska fotografin. Av Simon Jangard Nielsen

DEN 30 APRIL 1965 PUBLICERADES DET

förstasidesreportage i Life Magazine som skulle komma att bli Lennart Nilssons stora internationella genombrott. Han hade lyckats porträttera fostrets olika utvecklingsstadier inifrån livmodern och succén var given. En nyfikenhet på livet och inför det outforskade har alltid motiverat honom och är en lika självklar del i hans person idag som den varit tidigare under karriären. Han föddes i Strängnäs 1922 och kom tidigt att fastna för fotografin. Redan som elvaåring tog intresset fart när han fick sin första kamera av pappa Nils. Då detta var tidigt i fotografins historia var någon autofokus för att automatisera skärpan i motivet ännu inte aktuellt. Detta till trots hade hans första kamera de manuella inställningsmöjligheter som möjliggjorde ett exakt fokusavstånd till det objekt som fotograferades. Det var en kamera man kunde ställa in avståndet på och den första bilden jag tog var av gullregn som stod i blom, minns Lennart. Redan i sin ungdom sålde han sin första bild till Dagens Nyheter för 8 kronor föreställande en uppåtnedvänd Volvo i ett dike i Solna, varpå karriären fortsatte som fotojournalist, främst för bildtidskrifterna Se och Veckojournalen. I slutet av 40-talet började hans reportage att slå igenom internationellt, bland annat i samband med publiceringen av en norsk isbjörnsjakt utanför Svalbard i den då mycket välansedda amerikanska fotooch reportagetidningen Life Magazine. Lennart hade fått upp ögonen för sjukvården och tog 1949 kontakt med Beckomberga mentalsjukhus i Stockholm vilket resulterade i ett 10-sidigt bildreportage i Veckojournalen från en lobotomering. När han tänker tillbaka på reportaget idag slås han av hur pass skrämmande operationstekniken var. Att göra reportaget var skakande men det I samband med firandet av Lennarts 90-årsdag i höstas, donerade denne sin fotoutrustning till Karolinska institutet, vilken från och med den 8:e mars i år går att beskåda på Tekniska Museet i Stockholm. 34

var också intressant att vara först ut med att dokumentera denna nya operationsteknik, berättar han. Detta var första gången en hel lobotomering visades i svensk press, från själva operationen till tillfrisknandet flera veckor senare. I samband med detta kom intresset för den medicinska fotografin att väckas genom vidareutvecklandet av ett sedan barnsben stort naturintresse. Lennart studerade under en tid under forskaren Harry Kinnander vid Stockholm Universitet för att lära sig att fotografera i mikroskop. De tog sig tillsammans ut till Hässelby för att fånga vattenloppor och genom mikroskopet se hur dessa djur föder sina ungar. Vidare inspirerades jag av de bilder jag sett från olika organ i tidskrifter och de forskare inom medicin som jag mötte kom att visa mig en värld som inspirerade mig starkt, förklarar han. Vid 50-talets början växte en idé fram som nästan 15 år senare skulle komma att få honom att bli en av världens mest kända fotografer. Det var i samband med ett besök på Sabbatsbergs sjukhus i Stockholm som han i en läkares arbetsrum fick syn på några gamla glasburkar innehållande embryon och foster i formalin. De var avsedda för undervisning men han kände direkt att detta var något människor utanför den medicinska sfären måste få se. Övertalning skedde, glasburkarna lånades ut och Lennart tog sina första makrobilder av människans tidiga embryo- och fosterutveckling. Lennart minns detta som något helt fantastiskt, människans liv innan födseln är ett mirakel. För att undvika kontrovers var han noga med att undvika användning av foster som kom från selektiv abort för att istället använda sig av utomkvedshavandeskap; en misslyckad graviditet där det befruktade ägget utvecklas utanför livmodern, vilket medför att en ofta livsavgörande terapeutisk abort måste utföras. Dessa foster kom tillsammans med en banbrytande titthålsfotografi inifrån livmodern att resultera i ett avbildande av barnets hela utvecklingsfas, från det att spermien tar sig in i ägget tills barnet är färdigutvecklat och ska födas. Grunden hade lagts till vad som 1965, efter ett omfattande arbete resulterade i

ett förstasidesreportage för Life Magazine, Drama of Life Before Birth – med en tredagars försäljningssiffra på åtta miljoner exemplar samt publiceringen av den fotobok som kommit att bli världens mest spridda, Ett barn blir till. Vid denna tid var abortfrågan hett debatterad och hans bilder var i detta sammanhang något helt banbrytande. Bilderna kom som befarat att användas i debatten men främst som ett slagträ av båda sidorna och inte riktat mot Lennart själv. Abortmotståndarna menade att bilderna stärkte deras uppfattning av att det ofödda barnet var en människa redan på ett mycket tidigt stadium och

förespråkarna å sin sida använde bilderna som ett argument för sexuell avhållsamhet och preventivmedel. Men jag tar inte ställning för eller emot något förklarar han, mitt syfte har hela tiden varit att dokumentera människans tillblivelse. Det ena ledde till det andra och forskare från Karolinska institutet började visa intresse, med vars hjälp Lennart 1969 gavs tillgång till ett svepelektronmikroskop. Förstoringar kunde göras upp till flera tiotusen gånger vilket möjliggjorde utforskande av sådant som hjärtat och hjärnan på en aldrig tidigare skådad nivå. Det är ett helt annat sätt att arbeta än vad jag som reportagefotograf varit van

vid, eller kanske inte tillägger han, jag är ju bildjournalist. Det finns däremot inga tvivel om att det vetenskapliga förhållningssättet och den kompetens forskarna på KI uppvisat har varit en avgörande del i det lyckade samarbetet. Men samtidigt långt ifrån tillräckligt då denna typ av fotoreportage kräver något så mycket mer. Där forskare tar bilder av det som mikroskopet ”visar”, hittar Lennart nya perspektiv för att på en konstnärlig nivå tydliggöra sådant som celldelningar, tumörer och virus. Hans bilder har ofta efterliknats färggranna naturlandskap och på frågan om det vackraste han fotat beskriver han befruktningsögon-

Kritik Lennart Nilsson kommenterar på Medicor-fotograferna Jingcheng Zhao och Martin Kjellbergs vinnarbild. Foto Jingcheng Zhao. blicket, när äggcellen med få spermiers hjälp snurrar likt en planet i rymden. Genom åren har hans bilder hjälpt till att illustrera den forskning som pågår vid KI som till exempel cancerforskning, virologi och kartläggning av cellens inre. Ett mycket lyckat forskningssamarbete som bland annat resulterat i utnämningen till medicine hedersdoktor vid KI 1976. Det har varit mycket spännande att få medverka med mina bilder i dessa forskningsprojekt berättar han, ett enda långt positivt minne.

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ENTERTAINMENT

En kväll på El Mundo

Mellan medicinen och författarskapet

Av Shwan Ghaderi

DET DOFTAR KORIANDER, KÖRSBÄRSTRÄ

och mojito till ljudet av skratt. På scenens vägg hänger bland annat två leksaksskelett som håller hand, en Bollywoodreklamaffisch och ett foto på Elvis. Det är måndag kl 20 på El Mundo och liksom på alla måndagar är det dags för standup-kvällen att kicka igång. Och idag är det den 138:e gången. Ute är det grått och riktigt ruskväder men inne på El Mundo på Söder är det långt ifrån kallt och rått. Interiörens varma färger och de märkliga, upphängda arketyperna får en att känna att inredningen är långt ifrån fantasilös. ”För er som inte varit här innan så är detta en rookie-klubb för komiker, en experimentverkstad helt enkelt”, berättar Henrik Blomkvist som tillsammans med Anders Sparring driver El Mundo sedan några år tillbaka. Men det är sällan det faktiskt blir besvärande tystnad. ”Det är någonting speciellt med El Mundo”, berättar Cecilia Von Strokirschsom står utanför och röker efter att ha hållit sin standup-show om livet som bibliotekarie. ”Det blir liksom aldrig tyst” berättar hon vidare och jämför El Mundo med andra standup-klubbar som vissa kvällar nästan helt saknar publik.

Av Gustaf Drevin

John Keats, Sir Arthur Conan Doyle och nedan citerade Tjechov var medicinare som förtjänstfullt kombinerade sina yrken med att skriva. Men, till vilken grad är till exempel läkarprofessionen förenligt med författarkonsten? Medicor satte sig ned med Christian Unge, till vardags biträdande överläkare på Huddinge Sjukhus, som under våren 2013 släpper pocketversionen av sin thrillerroman Turkanarapporten, inspirerad av dennes arbete för Läkare Utan Gränser (MSF).

”Medicinen är min äkta hustru och litteraturen min älskarinna.” Anton Tjechov i ett brev till författarkollegan Alexej Suvorin, 1888 CHRISTIAN HAR GEDIGEN ERFARENHET

var att få skriva av sig men också att ge uttryck för sina intryck; terapi lika mycket som nöje. Belöningen finns enligt Christian inte i antalet sålda verk, utan snarare i den dialog som uppstår mellan författaren och läsaren genom sidorna. 10 kronor per såld pocket går direkt till MSF, då Christian vill bidra med ett annat initiativ än vanliga donationer. Han menar på att verket ställer en del frågor och inspirerar folk till att resa utomlands för humanitärt arbete. För även om verket är någorlunda romantiserat och actionpackat, ger det föraningar om arbete utomlands. ”Man får en känsla av hur det är att jobba ute i fält. Jag tror att man efter att ha läst mina deckare [en uppföljare är på väg] kanske känner sig lite sugen på att ta sig ut i världen och jobba utomlands”, säger han. Christian är, till skillnad från de i ingressen nämnda personerna, ett levande bevis på att det visst går att förena medicinen med konsten. Den förra kan te sig mekanisk men ger upphov till de omgivningar och filosofiska frågeställningar som i slutänden kanske utgör stommen för konsten. De medicinska och naturvetenskapliga professionerna torde således inte undertrycka den själsliga kreativiteten. Tvärtom. De sporrar, inspirerar och förser oss med intryck till skönlitteratur, poesi, målande och musik. Kanske hade alltså Tjechov fel när han menade på att medicinen och konsten var åtskilda. De är ju ett och samma. För visst är målet med de två ändå strävandet mot och förståelsen och uppnåendet av den mänskliga potentialen?

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avslöjar Tobias och berättar vidare att han i dagsläget enbart arbetar med komedi. Tobias skämtar om allt möjligt under sitt uppträdande och allt eftersom framgår det att han mer eller mindre improviserar större delen av tiden. ”Jag gillar att improvisera, jag får en endorfinkick av det! Men det är klart att man har några ess i rockarmen om man skulle komma av sig” berättar han vidare efter sitt framträdande. Men trots risken i att improvisera lyckades Tobias verkligen kamma hem hela publiken med sina teatraliska gester och sin uttrycksfyllda mimik. Avslutningsvis, trånar man efter trevligare måndagar och mer lustfyllda avbrott i vardagen så är ett måndagsbesök på El Mundo helt klart att rekommendera!

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Vad? Gratis stand-up Var? Erstavägen 21 När? Varje måndag, kl 20-22 Pris? Gratis inträde

Serier

Photo by Andrea Lindström for Medicor

av MSF. Han lärde inte bara känna Johan von Schreeb, Hans Rosling och de andra grundarna av den svenska MSF sektionen under 1990-talet då den startades, utan arrangerade också välgörenhetsspelningar och hade siktet inställt på att upptäcka världen och uppleva andra sjukvårdssystem. Efter AT:n arbetade han för MSF i såväl Burundi som Kongo och under doktorandtiden forskade han på MSF:s kliniker i slumstaden Kibera i Kenya. Jo, visst är Christian världsvan. Det märks i Turkanarapporten, där allt från metropolen Paris, tätpackade Kiberaslummen till torra, rurala Turkana-distriktet i nordvästra Kenya beskrivs. Redan under sina första MSF-uppdrag skrev han hem till familj och vänner via e-post. Även om boken baserad på de e-posterna endast hamnade på den egna bokhyllan och ej publicerades, fanns stoffet kvar. ”Historierna fanns där, det var inget problem. Sedan rann det liksom bara till”, säger han. Thrillern är skriven i deckarformat, med högt tempo och enkel dialog. Platser beskrivs främst ur karaktärernas perspektiv och formas av författarens MSF-tid. Atmosfären är snarare mystisk än obeha-

glig, även om vissa scener är medicinskt realistiska. Formen och omgivningarna var självklara. ”Jag visste miljön, med många parallellhistorier. Det är det jag gillar själv. Jag skulle ha svårt för att göra ett kostymdrama från sextiotalet.” Han har tagit hjälp av sitt arbete. ”De miljöer jag beskriver, det är Läkare Utan Gränser.” Att arbeta inom medicin är att upptäcka, precis som att skriva. Man penetrerar djupt in i det mänskliga psyket och sökandet efter en högre förståelse av det mänskliga djuret är det ultimata målet med de båda sysselsättningarna. Vi diskuterar lite hur skrivandet också kan vara terapi för själen samt hur läkaryrket här hemma i Sverige påverkar författarsidan av läkaren. ”Att vara läkare är väldigt okreativt [sic]. Jag tror det är just därför många läkare håller på med någonting vid sidan av. För, man känner av en frustration av att man inte är kreativ i sin vardag.” ”Det blir ganska torftigt. Det blir väldigt mycket produktion av det hela. Tidspressen tar död på en del av stimulansen.” Han tillägger dock snabbt att det ändå är yrket som inspirerar skrivandet. ”Ur själva jobbet skapas det många olika, spännande frågeställningar om livet, döden, smärta, etik, kostnadseffektivitet. En uppsjö av spännande grejer man kan skriva om. Man har miljöerna. Man har mötena.” Kanske är det alltså tur att skrivandet finns. Det länkar det mekaniska med det själsliga och låter oss upptäcka världen och oss själva från ett annorlunda perspektiv. Målet med just Turkanarapporten

Framåt kvällen är det Messiah Hallbergs tur att hålla sin sketch och han lämnar milt sagt ingen åskådare oberörd. Han lyckas under sitt korta framförande skämta om funktionshindrade, homosexuella samt feminister. Messiah berättar efter att han tycker att man absolut kan skoja om allt, såvida det finns en rolig tanke bakom det. ”Jag gillar att leka med gränsen kring vad som är okej och att leka med konceptet den goda människan. Men jag tycker inte att man ska skämta om allt bara för gränsöverskridandet skull.” Messiah lyckas kamma hem Söderpubliken trots påhopp på en ”bög”, en ”gammal kvinna” och en ”miljöpartist” i publiken och dessa scenarion utgör därför praktexempel på att förstaraden är till för den orädde. Sist ut av alla kvällens sju komiker framträder Tobias Persson och ikväll råkar det vara hans allra första framträdande på El Mundo. Men han är långt ifrån oerfaren - han har varit aktiv sedan år 2000 och för oss många är han känd som ”göteborgaren från ÖB-reklamen.” ”Ända sedan jag var tio år och tittade på sketcher på TV gjorda av till exempel Monthy Pyton så har jag älskat komedi”

Av Shwan Ghaderi 37

Lös korsordet och skicka ordet som de oranga rutorna bildar till korsord@medicor.nu! 1a-4e pris, signerat exemplar av Turkanarapporten, skriven av Christian Unge. Läs intervjun med Christian Unge på s36!

Win 2 Tickets to Sweden’s Largest Festival! Take a photo of yourself with this issue of Medicor and get a chance to win 2 full festival passes + camping to this year’s Peace & Love festival! (Worth 3920kr) Why not take a picture with Medicor while climbing a tree, with your favorite lecturer, or in front of the Eiffel Tower? To enter, just upload a picture via Instagram with the hashtag #MeandMedicor, or post it on our facebook page fb.me/MedicorMF by June 1st. Winners will be announced on our Facebook page! Take as many pictures as you want. The most creative ones will be handsomely rewarded! Oh, and by submitting a photo, you agree to give us the right to post your photo on our facebook wall, to publish it in Medicor, or other print media, including for commercial purposes for Medicor, without compensation to you. We want to show it off to everyone!

#MeAndMedicor

1st place: 2 tickets to Peace & Love, camping included, worth 3920KR 2nd place: 1 ticket to Peace & Love, camping included, and the book Du har Svaren! Filosofi till vardags, by Tulsa Jansson 3rd-5th place: Du har Svaren! Filosofi till vardags, by Tulsa Jansson 6th place: a copy of The Lancet, signed by Richard Horton.

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Photo by Jingcheng Zhao

It’s been a great term. Let’s make the next one even better. 40

Join Mottagningsutskottet to arrange activities for next year’s students, Medicor, or any of many other committees and societies at Medicinska föreningen! Send an email to erik.hellsing@medicinskaforeningen.se or drop by the MF building on Solna Campus if you have any questions or ideas! See you soon!