medicor medicinska fรถreningen i stockholm
38 Insight with Elizabeth Blackburn
THE FIGHTER
2014 #4
20 SEK
32 Nobel Prize winner Edvard Moser
Nadja Casadei never lets anything stand in the way of her goals 1
Prelude
All You Want For Christmas... AS THE CHRISTMAS LIGHTS GLOW ALONG THE STREETS AND
the snow lays gleaming at our feet, we gather together with family and friends that we so rarely our time spends. But there is something more – we know that to open the Christmas gifts is what you’re really waiting for. And what better gift could there be than to find the latest issue of Medicor underneath the Christmas tree?
For those of you who would prefer a lighter read, we have everything that you will need. If you ever wondered how Santa’s little helper could get a nose so red, wonder no more and check out the “Julbord” spread. This magazine is filled with all that you could wish, including articles from artificial meat to how to survive the winter bliss. We hope you enjoy this last issue of the year and look forward to seeing you again when the spring is getting near. Finally as always there are a lot of people we wish to thank, because without them these pages would be blank. So from all of us to all of you: Merry Christmas and a Happy New Year to!
Sincerely, Robert de Meijere Editor-in-Chief
Cover photo by Martin Kjellberg for Medicor 2
Photo by Jingcheng Zhao for Medicor
What a Christmas read you would find, because we tell the tale of what make up the positioning system inside our mind. We had the pleasure of talking to Edvard Moser some more, read the entire story on page 34. He’s not the only Nobel Laureate we got, Elizabeth Blackburn is interviewed on the Insight spot. She discovered the secret behind aging, gradually unfolding a story about telomerase that’s indeed engaging. Furthermore, we met with Nadja Casadei to talk about what makes her keep fighting every day. It is a truly inspiring interview about never giving up and letting absolutely nothing stop you.
Medicor Magasin Grundad 2006. Åttonde årgången. Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 Ansvarig utgivare: Robert de Meijere Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm Nobels Väg 10, Box 250, 171 77, Stockholm Utgivningsplan 2014: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december. Kontakta 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.
Overture COVER STORY
KAROLINSKA
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GLOBAL FOCUS
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DID YOU JOIN THE CHASE FOR YOUR FUTURE?
On how the media and our politicians should learn from the massive attention surrounding the Ebola outbreak.
Careers in Health and Science Exposition.
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THE BLACK GOLD Frida Segernäs is pondering on the coffee drinking at KI. Is it too much?
NOV2K 2014 Medicor’s Jessica De Loma Olson reports from the event where Science Fiction becomes Science Faction.
EBOLA - THE NEW BLACK
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mHEALTH
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HEALTH CARE AND REFUGEES
24 THE FIGHTER “WHAT DOESN’T KILL YOU MAKES YOU STRONGER.”
Mobile health applications and the need for evidence before widespread implementation.
James Salisi on on refugees’ rights.
An inspiring interview with Nadja Casadei.
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THE CURIOUS CASE OF THE MIND
INSIGHT
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Karolina Werynska on the psychiatric condition known as DID.
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ORGANIC FOOD – WHAT IS THE POINT?
CULTURE
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IN VITRO MEAT Medicor meets Mark Post, the creator of the world’s most expensive hamburger.
ELIZABETH BLACKBURN A career that will get you the Nobel Prize.
Haroon Bayani goes though the arguments for consuming organic food.
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An overview of the Nobel Prize.
NOBEL
SCIENCE
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NOBEL THEME
THE HISTORY OF CHOCOLATE? Parvin Kumar tell us the story behind the most delicious Christmas treat.
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NAVIGATING THE COMPLEXITIES OF THE BRAIN An interview with Edvard Moser, one of this year’s winners of the Nobel Prize in Medicine or Physiology, and an in-depth look at the cells that constitute the positioning system in our brain.
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FEELING THE WINTER BLUES? A guide to surviving the Swedish winter.
medicor Robert de Meijere • Editor-in-Chief | Oskar Swartling • Associate Editor | Andrey Pyko • Creative Director Ibrahim Rayyes • Proofreader General | Vladimir Choi • Executive Editor | Sergio Scro • Editor of Global Focus | Yasmine Djoumi • Producer Janne Andersson • Senior Advisor | Amanda Kaba Liljeberg • Editor of Campus | Iskra Pollak Dorocic • Editor of Science | Poya Livälven • Editor of Culture Filippa Grönqvist, Vera Berg, Halima Hassan • Reporters | Martin Kjellberg, David Humphreys, Katarina Stojanovic, Maria Belikova • Photographers Gustaf Drevin, Yasmine Djoumi, James Salisi, Haroon Bayani, Karolina Werynska, Jens Magnusson, Parvin Kumar, Anna-Theresia Ekman, Frida Segernäs, Nicolas Guyon, Jessica De Loma Olson, Giulia Gaudenzi, Johanna Tauriainen • Writers | Fergal Horgan • Proofreaders | Mikael Plymoth, Jakub Lewicki • Illustrators
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Aperture Mark Post holding the world’s most expensive hamburger made from cow stem cells. Medicor talked to him about the technology and ethics behind lab-grown meat. Read more on page 18. PHOTO BY: DAVID PARRY / PA WIRE 5
Julbord
Christmas-themed Science EVERY CHRISTMAS THE BRITISH MEDICAL JOURNAL PUB-
lishes a series of articles with a twist. Be sure to check out the BMJ issue around Christmas time to get information on why Rudolph’s nose is red, how James Bond’s drinking habits would affect his physical and mental status, the genetics of magic and much more.
It has been hypothesized that Rudolph’s red nose is the result of a parasitic infection of his respiratory system.
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Ho Ho Ho In Canada the Canada Post uses the characters H0H 0H0 as the postal code for letters to be sent to Santa Claus.
Knäck
and other Christmas hazards
CHRISTMAS IS A VERY STRESSFUL TIME FOR MANY, LEAD-
ing to an increase of injuries around the festive period. Dentists experience an increased income of patients with detached fillings, cracked teeth and toothache, caused by “knäck” and other sweets consumed around the holidays but also grinding of teeth due to stress. Other common injuries are burns caused by boiling “knäck” or preparing the Christmas dinner. Not even the Christmas tree is not as harmless as it seems. Every year people are injured falling from unstable chairs when decorating their Christmas trees, or falling down from lofts when looking for decorations. The decorations themselves are a danger to toddlers that bite into glass baubles or choke on toy-like decorations. So, in order to fully enjoy the holidays without cracked teeth or bandaged body parts, make sure to avoid stress and excessive amounts of alcohol since these are the most common causes of injuries.
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USA A STUDY FROM THE UNITED
States suggests there is no peak in suicides during the holidays. The study, conducted over a 35-year period, saw no increase of suicides before, during, or after holidays. On the contrary, before Christmas the rates of psychiatric visits actually decrease in the US, debunking the popular belief that suicides are more common during the holidays, especially during Christmas. It is believed that this is due to an increase in social support during the holidays.
Sweden MANY PEOPLE GAIN WEIGHT DURING
Christmas and since obesity and cardiovascular diseases are an increasing problem in the Western world, many Swedes have become more conscious of what they eat. Traditional Christmas food can be quite fatty, but there are healthy alternatives. Luckily enough, the most popular dish for Christmas, the Christmas ham is one of the healthier alternatives containing only
3% fat. Herring, salmon and nuts are also healthy alternatives. But the healthiest suggestion would be to enjoy everything in moderation. Swedish studies suggest that nocturnal feasting per se does not make you fat, so enjoying a midnight “lussebulle” is given green light.
Japan CHRISTMAS IS NOT WIDELY CELEBRATED
in Japan, although some American customs has been introduced. Christmas Eve is more similar to Valentine’s Day, a day for couples to spend time together and exchange gifts. Christmas eve, is also, the day for fried chicken. KFC and other restaurants serving fried chicken have their busiest day of the year on Christmas eve. Thanks to an extremely successful campaign in 1974, a bucket of Christmas Chicken is a must during the holidays.
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Pieces of chicken fried in one KFC outlet in Tokyo on Christmas Eve.
2.3% of the Indian population are Christians
India ONLY 2.3 % OF THE INDIAN POPULATION ARE
Christians, meaning that Christmas is a relatively small festival in India compared to the other ones celebrated. However, since the Indian population is about 1.2 billion, there are more than 24 million Christmas celebrators in the country. 7
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Did you join the for your future? Photo by David Humphreys & Katarina Stojanovic As a Healthcare or Life Sciences student, you may not always know which career path to choose once you graduate. Perhaps you are not even aware of all the non-traditional career options available to you. Is your future really set in stone after you have completed your education? Think differently! On the 12th of November, a group of students held the biggest career fair that Karolinska Institutet had ever seen: CHaSE (Careers in Health and Science Exposition). CHaSE is a career fair targeted at all students and graduates in the health and life sciences. If you happened to join CHaSE you had the chance to find out what your future may hold. THE CHASE “STARTUP”
In partnership with Medicinska Föreningen (MF) and Karolinska Institutet, and on behalf of the Business Committee, a group of 12 energized students gathered around a table with the objective of organizing a unique career fair. Many attempts to organize a major career fair had been made in the past and the team was fully aware of the heavy task on its shoulders. A brand was needed, and after a 6 hour brainstorming session on a cold March Saturday afternoon, the idea of CHaSE came up. “It’s catchy and reflects the pursuit of your dreams” – one of the team members said. It was set, CHaSE was going to happen!
Discovery, networking and interaction were the keywords of the day... THE GOALS
During the few months ahead, the CHaSE team worked hard in defining its role and objectives. No business idea is to be successful if: 1) it’s not unique in its field; 2) it does not answer a well sought need. It had to be big, it had to be unique and it would have to answer the current reality. Let’s face it (!): the traditional academia pyramid is collapsing as we speak. So, CHaSE drew up its goals: 1) to create 8
awareness towards alternative careers; 2) to bridge the gap between the academia and the privatized world; 3) to do that in an interactive-stimulating environment.
THE DAY
The 12th of November came fast. The Aula Medica was packed with 40 companies and organizations exhibiting their career prospects. The MF premises were the stage of a carefully selected panel of speakers giving personalized advice to the students, regarding their career aspirations. By inviting major life science companies such as AstraZeneca, Roche and SLL, CHaSE not only reached out to students but also already working professionals. Particularly popular, the “Personal brand”-workshop provided the visitors with the necessary tools to be able to use social media to market themselves. A professional photographer took the participants’ LinkedIn picture. Discovery, networking and interaction were the keywords of the day, experienced by over 1000 visitors. Experience design was a key feature distinguishing CHaSE from any other career fair. The Alice in Wonderland theme was picked as a mean for discovery of the visitors’ opportunities. A lounge with couches and a soccer table, in which you could challenge AstraZeneca for a game, were just some of the details making this day more interactive.
A WORLD OF OPPORTUNITIES
Those who came to the fair had the chance to meet their dream company, their future employer, to expand their network and to improve their career portfolio. If you joined the CHaSE, you may now have discovered that there are many other ways to shape your career than the common tracks in academia. We all greatly hope that CHaSE will become an annual event that keeps answering the needs of students and professionals in our fields.
CHASE YOUR FUTURE!
A big thanks to the organizers who put CHaSE together: Cécile Zaouter, Christian Lind, Daniel Yen, Emelie Braun, Florian Meisgen, Francesca Bignami, Lizan Kawa, Michael Hagemann-Jensen, Moritz Lübke, Susanna M Bächle, Thibaud Richard, Tiago Pinheiro. And also a big thanks to the volunteers at CHaSE.
www.chasesthlm.se
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KAROLINSKA
Stepping up for Access to Health Care Time for students to take action! By Anna-Theresia Ekman* *
Health Care in Danger Focal Point IFMSA-Sweden
HAVE YOU REFLECTED ON WHY HEALTH
care personnel are an actual target in conflicts and war zones? This is the harsh reality in many conflicts and it is believed that the problem is increasing. In armed conflicts, health care personnel are being targeted in attacks, ambulances are being denied access at checkpoints and pharmacies are being raided. We as future health care personnel can either adjust to this development – or take a stand. The International Federation of Medical Students’ Associations (IFMSA) is mobilizing students to take action. We are a global federation for medical students who build a healthier tomorrow through local actions, student commitment and advocacy. Supported by the International Committee of the Red Cross, we have launched the project Health Care in Danger – Ethical Principles of Health Care in Conflicts and Other Emergencies. Increased violence towards health care personnel is a multifaceted area, where factors such as national security polices, infrastructure, and implementation of Human Rights needs to be taken into consideration. Given the complex nature of the threats, it is impossible for us to solve the problem ourselves. What we can do is to focus on part of the problem; the need of the patient and our professional ethic. Moa M Herrgård, the IFMSA Liaison Officer of Human Right and Peace, stress the importance of student action. Expecting conflict zones to be heaven is not realistic. The international society need to assure full implementation of basic human rights in conflict zones. The access to health care is currently under threat due to violence towards health workers and facilities. They can call us naive and young, but IFMSA members have proven a capacity to address the obstacles to access to health and made a meaningful contribution. Let us do this again, be leaders of behavioral change, re-
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establishing the respect to human rights and medical ethics. Access to health care is not only threatened in armed conflicts. Parties and other groups that do not acknowledge the equal and inalienable rights within all humans are part of national and European decision making. The internal disturbances in Ukraine are a reminder that peace can be transient. Swedish ambulance personnel are facing a more violent environment at the same time as personnel in the emergency wards are being trained in self-defense in Stockholm. As part of the global movement, IFMSA-Sweden has arranged activities throughout the semester. We strengthen health care mandate to work as neutral actors by informing of the Human Right to Health, International Humanitarian Law and medical ethics. We build capacity through symposiums, lectures, trainings and workshops. In October, we arranged the Health Care in Danger Symposium. We have ar-
ranged our federations first Health Care in Danger Sub Regional Training for European students inviting experts of International Humanitarian Law, medical field personnel and youth advocacy experts to meet students. During the spring term, we welcome you to take part in our future venture to step up for access to health care. How can we maintain access to health care when violence and threats of violence are right at our door step? We need to find solutions and tools to be able to commit to the Human Right to Health, in armed conflict as well as non-combat zones. It is time for us as health care students to step up and advocate the principles of the sanctity of health care, the right to health and to educate ourselves on Human Rights and access to health care. It is high time to speak up for the patient who seldom has the strength to speak for herself. It is time to speak up as the future care providers.
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IFMSA Stockholm Local President Gustaf Drevin talks about the Health Care in Danger - Ethical Principles in Conflict and Other Emergencies initiative (HCiD) during IFMSA Stockholm’s inspiration night in October. Photo: IFMSA
KAROLINSKA
The Black Gold Time to ponder on the coffee drinking at KI. Too much? Nah, just enough! By Frida Segernäs THE BLACK GOLD IS SOMETHING AL-
most every student is depending on, and because most of us haven’t got a car, it’s not oil I’m talking about. The smell of coffee when you enter any lecture hall at the Karolinska Institute is a warm welcome in the morning, and by the look of most students, they need it. I wonder if the students at KI drink more coffee than the rest of Sweden. Viktor Lind, medical student at KI, is one of many students who are carrying a thermos in their bag alongside of their books and computer. He explains that it’s because of the money, it’s simply too expensive to buy coffee in the cafeteria everyday. He has done some calculating, and on a normal day with lectures he drinks about four large cups of coffee. That would sum up to 200 SEK a week, and 1000 SEK a month, spent in the caf-
eteria entirely on coffee. Viktor adds that during the so-called exam periods, the volume of coffee adds up a bit, meaning that he will both bring his own coffee from home and buy some more at KI. No good for his finances, but maybe for the exam result. In Sweden the average annual consumption of coffee per person is 8,9 kilos, which means 3,4 cups of coffee every day. By talking to students at KI, I found that the ones who drink coffee often are above, and in many cases very much above, the average Swede. But the tea drinkers have their place at campus as well. If you add those to the equation, I guess the school as a whole would match the Swedish average. Branka is working in the Sodexo cafeteria in Jöns Jakob. She says that the consumption of coffee varies a lot over the
DRINKING COFFEE = EXCESSIVE PEEING?
A myth from the ‘70s says that coffee is a diuretic and if you drink coffee when it is hot outside you need to be careful not to become dehydrated. Coffee is not a diuretic if you are drinking it regularly, and in a period of 24 hours there is no difference whatsoever between a glass of water and a cup of coffee. That means that a glass of water and a cup of coffee generate the same volume of urine if you see it in a one-day perspective.
DEPRESSION? NO THANK YOU, I HAVE COFFEE.
If you are a coffee drinker the risk of being depressed is 20% less than a person who does not drink coffee at all. This is caused by stimulation in the brain, which leads to an increased release of serotonin.
GETTING SOBER WITH COFFEE
For a while one of the most used ways to sober up if you had an alcohol problem was to drink coffee as a ”substitute”. Research shows that this had an opposite effect, because people drank both coffee and alcohol, which did not lead to a reduction of alcohol consumption. Instead, the effect was that people felt better after drinking coffee and the number of car accidents actually added up when this was a trend because drunk people high on coffee drove around.
year, and at the beginning and end of the terms they sell more coffee compared to the rest of the time. This of course has to do with the number of students actually studying at the campus, and the very well known exam period at the end of the terms. On a usual day the cafeteria in Solna sells around 800 cups of coffee, and on a busy day it can be up to 1500. We can easily come to the conclusion that the volume of coffee that is consumed at KI on a regular day is massive, and that the staff working in the cafeteria get a good work out through lifting about 120 liters of coffee every day. All though many of us are completely sold on this delicious beverage, there are some things we don’t know about the black gold we drink everyday. Therefore, I will now present some interesting facts about coffee, and also bust some myths.
I CAN’T SLEEP!
A very common thought about coffee is that it causes insomnia. Not everybody knows that when drinking a cup of coffee, the caffeine is very quickly absorbed by the body and after 4-5 hours it is flushed out of the system. If you drink two or three cups of coffee on a daily basis, the effect from caffeine is too small – therefore your insomnia is probably caused by something else.
AVOID THE WINTER COLDS!
Coffee has a positive effect on our immune system. This is because coffee contains more than a hundred kinds of antioxidants, which mildly stimulate the immune system. Coffee contains about three times the number of antioxidants compared to green tea.
I’M ADDICTED TO YOU…
An addiction is very seldom a good sign. But the morning coffee, with the last sun in your face before Sweden turns into complete darkness, is very special. But of course, after a regular consumption of coffee for a long time withdrawal symptoms will appear, if you suddenly stop drinking the daily dose that your body is used to. But remember that morning coffee I talked about? At least for me – it is totally worth the addiction!
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KAROLINSKA
From Science Fiction to Science Faction; an inspiring symposium to unravel the mysteries By Jessica De Loma Olson HUMAN BEINGS HAVE A NATURAL TEN-
dency to be creative, to explore their own imagination and to create universes that are far from reality. Superheroes with unimaginable powers, alternative universes where anything is possible and incredible robots that overcome humans, are only a few examples. Jules Verne is popularly known for somehow predicting the future. As a science fiction writer, he described futuristic machines and concepts, such as submarines and videoconferences, that seemed impossible in his time. Humans have the incredible capacity of being imaginative, speculating about the future and of being creative to invent new possibilities. But, are our scientific discoveries catching up to our imagination? This year’s Nov2k conference can help provide insight to this question. Nov2k is an event organized by graduate students from Karolinska Institute and Stockholm University that year after
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year gathers some of the best scientists from different fields. During the 20th and 21st of November all students, professors and general public were able to enjoy fascinating lectures about, to mentions a few, regenerating the heart, creating Petri dish food and analyzing our upcom-
...where some of the most brilliant minds can share ideas – Nobel Prize winner Edvard Moser participated in last-year’s event... ing future. For 15 years in a row, and with the help of the Center for Gender Medicine and other postgraduate programs, this event aims to create a comfortable intellectual environment where some of
the most brilliant minds can share ideas – Nobel Prize winner Edvard Moser participated in last-year’s event – as well as create new possibilities and inspire future generations. Regenerating body parts, enhancing humans and creating a map of our neurons might seem like science fiction indeed. And that was this year´s theme for Nov2k: analyzing current discoveries that not so long ago seemed like complete science fiction, and understanding in what direction we are going with these. During this two-day event the public could enjoy a multitude of sci-fi lectures, workshops aiming to stimulate our imagination in solving future upcoming challenges and an incredibly creative poster battle. Among the keynote speakers was Kenneth R. Chien, a professor at Karolinska Institute who delivered an inspirational lecture on his field of interest: cardiac regeneration. Science has always struggled against the fact that the heart is one of the organs incapable of regenerating itself. However, Professor Chien’s talk alluded to a promising future as the field is gradually advancing towards the possibility of regenerating cardiac tissue. Choosing big challenges, recognizing when to take the right chance and having no fear at all, are the three main advices Chien gave his audience to conclude his inspiring lecture. From regenerative medicine to transhuman design, a lecture given by Ronald Jones, faculty at the Graduate School of Design at Harvard University. Humans are “fixed” all the time nowadays. From hearing aids to leg prosthesis, we can now not only preserve our lives but enhance our abilities. Jones then motivates us to question ourselves to think if we are really crossing moral boundaries. Will
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Live 3D printing during Nov2k, Photos by Stephanie Wiegner
normal humans someday not be able to compete against these improved transhumans? If so, should we start putting limits to our own creativity? “Can we create transhumans? Yes, but the real question is if we should,” explains Jones.
...this contributes to what is known as “the active couch potato syndrome” Relating to the need for analyzing our own abilities and their impact in the near future, Kathryn Myronuk, from Singularity University, showed the public around the exponential growth of technology. A paradigm shift in the use of robotics will affect the current job positions available to humans. However, rather than worrying about the possible non-desirable impacts, Myronuk emphasizes that society should focus instead on how to overcome these limitations and start adapting to this coming future. Other keynote speakers that were invited to the event were Mark Post, responsible for creating a new viable meat source in the lab; Björn Högberg, who uses DNA as Lego bricks opening the doors to new possibilities for drug delivery in the future; Ruth Ley, analyzing how genes can modulate our microbiome and how this can affect our phenotype; and Jesper Ryge, whose aim is to understand the brain’s circuits by modeling its complex network. But Nov2k is not only about hearing brilliant scientists speak. Several events are organized to showcase the best among of the new generation of scientists. This year it included exceptional student
speakers like David Schmidt, who denounced how science is producing paper and not knowledge, reporting the “cherry picking” process when selecting data. Other student speakers included Nina Kaukua, who gave an insight to her research focused on adult stem cells and the possible regeneration of teeth, and Matthias Lidin, with a speech titled “The Swedish lifestyle paradox”. Sweden is probably considered all around the globe as having a healthy and fit population. However, recent studies show a different perspective. Although only 9% of the Swedes say they never exercise, being one of the most active countries in Europe, 21% of the population admitted to sit more than 8,5 hours a day. Lidin explains that this means people in Sweden have a tendency to workout and exercise during concrete periods of time, but do not mind sitting the rest of the day, maybe due to their work environment; this contributes to what is known as “the active couch potato syndrome”.
Science is much more than that. It is passion. In addition to these incredible lectures, participants also had the chance to get in contact with 3D printing. Daniel Ljungstig, from 3DVerkstan, talked about the different types of 3D printing that currently exist and all the possibilities and applications related to it. Have you ever imagined reconstructing a skull with what seems to be plastic puzzle pieces? Or having a hand like the superhero Iron Man? It might sound foolish, but it is now a reality. This “Iron Man” option is an affordable, practical and fast solution
for children that need a prosthetic hand and that might require several of them throughout their growing period. And last but not least, one of the best activities of the event: the poster slam. Seven young researchers had three minutes each to defend their research and make the public want even more. For this, they could pick any type of format to present it but they all had to have one thing in common, it had to end with a cliffhanger. This initiative showed that science is not all about being static in a lab and sharing knowledge in a plain and formal way. Science is much more than that. It is passion. Endless hours in a lab that in the end can be presented in some of the most original ways possible. Arts and crafts, superheroes and superb actors had their spotlight for a couple of minutes during that amusing morning. This year’s Nov2k was a stunning experience with an irresistible theme. Who has never seen a superhero movie and thought about those alternative worlds where anything is possible? With this event the scientific community was reminded that almost everything is possible as long as we can imagine it. Our responsibility as scientists is to let go of old established concepts and to push the borders of reality through our own creativity. These inspiring two days had the aim to motivate science to blend conflicting concepts and to convert science fiction into science “factions”, one step at a time. Like every November, Nov2k will be back next year with even more astonishing experiences for you with the will to inspire the future of medicine and science. As Carl Sagan said: “Imagination will often carry us to worlds that never were. But without it we go nowhere”.
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SCIENCE
Science snippets
By Jens Magnusson, Jessica De Loma Olson, Nicolas Guyon, Iskra Pollak Dorocic LINKING THE BRAIN WITH THE GUT A recent hot topic in neuroscience is the effect of the microbiome – the bacteria living in our intestines – on mental health. Research now suggests that the trillions of bacteria found in the gut may have a profound impact on psychiatric conditions such as autism and schizophrenia. The microbiome seems to exert its greatest impact on the brain earlier in life. In one study, mice born by Caesarean section (which results in an altered microbiome) were found to be significantly more anxious and depressed. Another study from 2013 discovered that the mice model for autism harboured a lower level of the common gut bacterium Bacteroides fragilis. Studies are ongoing to find concrete mechanisms behind these correlations. (Nature News, November 14 2014) MAKING FUNCTIONAL PANCREATIC β CELLS Some 387 million people suffer from diabetes. The minority with type 1 diabetes, in which insulin-producing β cells gradually die, could potentially be cured if the cells could be replaced with new ones. However, acquiring enough new, functional β cells is difficult. Now, a group of researchers at Harvard University have developed a protocol to produce β cells from patient-derived stem cells. The new cells reversed symptoms when transplanted into diabetic mice, and the method, which is scalable for humans, could be a significant step towards curing type 1 diabetes. (Pagliuca et al., Cell, October 2014)
Image credit: afgooey74 (Flickr)
HUMAN POPULATION GROWTH The UN estimates that there will be 1012 billion humans by 2100, a projection that fuels discussions about the environmental impact of overpopulation on our planet. To build an evidence base for this discussion, researchers used computers to model population dynamics under different scenarios. They found that even with draconian one-child policies it would take centuries to decrease population size. Therefore, reducing overpopulation is no “quick fix”; instead, our focus should be on attenuating our environmental impact in other ways. (Bradshaw et al., PNAS, November 2014)
Image credit: Anders Sandberg (Flickr)
EVADING HIV Around 1 percent of people infected with HIV are asymptomatic, but the genetic mechanisms behind this are still not understood. Researchers have found a genetic mutation that caused two men (one of whom was diagnosed HIV-positive 30 years ago) to not show any clinical symptoms. The virus was shut down as a result of a modification of its genetic code due to a group of enzymes, usually repressed, that causes further DNA changes. This could lead to future treatment whereby activation of these enzymes can disable HIV even after infection has already been established. (Colson et al., Clinical Microbiology and Infection, October 2014) Image credit: Brick red (Flickr)
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HALLUCINOGENIC BRAIN CONNECTION Magic mushroom users usually report enhanced feeling of touch, more intense colors, and synesthaesia, amongst other hallucinations. Looking at new ways to analyze how the brain is connected, researchers gave subjects a dose of psilocybin, the active ingredient in magic mushrooms, and placed them into an MRI machine. They found dramatic changes post-psilocybin, with increased integration between cortical regions that is not present in the placebo subjects. This hyperconnected brain could explain the changes in perceptions associated with psilocybin. (G. Petri et al., Journal of the Royal Society Interface, October 2014)
RESUSCITATING DEAD HEARTS Australian doctors at St. Vincent’s Hospital in Sydney have successfully transplanted the first dead heart by making it beat again in a special chamber. Despite what we would expect, it is possible to resuscitate dead hearts instead of using live ones from brain-dead patients. This presumed miracle has been developed with the help of research from the Victor Chang Cardiac Research Institute and consists of a preservation solution and an ex-vivo organ care system that can keep the organ warm and functional; making it possible to revive the heart even 20 minutes after the donor has died. It is hoped this groundbreaking development will help reduce the problem of donor shortage. (Victor Chang Cardiac Research Institute - http://www.victorchang.edu.au)
The curious case of the mind By Karolina Weryńska
OUR BRAIN HOLDS MANY MYSTERIES:
some will kindle your interest and others will baffle you completely. Let’s take a peek at one of them. “Kathy”, 29 years old, mother of three, was brought to hospital by her husband after overdosing on sleeping pills. Since the age of four, she was sexually abused by her father. That led her to become “Pat”. At age nine, her mother started having sexual relations with her. “Kathy” couldn’t accept that and so “Vera” emerged. At 14, she suffered from yet another traumatic experience. She was raped by an older man (a close family friend) and following this, “Debby” appeared. When “Kathy” was 18 years old, she ran away from home, and was ultimately forced by poverty into prostitution, for which “Kathy” began calling herself “Nancy”. Some time later “Debby” rejected “Nancy” and drove her to a suicide attempt. During assessment, “Debby” was identified as the most dominant of her identities. What is the diagnosis? Dissociative identity disorder (DID, previously known as multiple personality disorder) is one of the most controversial psychiatric diagnoses. Some consider it to be connected with borderline personality disorder, whilst others doubt its very existence. DID is a psychiatric condition with at least two distinct identities that control behavior during different situations (one is dominant, whilst the other emerges in specific situations). A classic example is “Dr. Jekyll and Mr. Hyde”, portrayed in a famous novella by Robert Louis Stevenson. It is a thrilling tale of the struggle between two sides of one individual, re-
The Strange Case of Dr. Jekyll and Mr. Hyde (Wikimedia commons)
flecting the eternal fight between good and evil. Dr. Jekyll desperately tries to suppress his worryingly vicious urges. He creates a serum that turns out to be rather surprising – instead of masking the evil inside, it transforms him into his ruthless, violent alter ego, Mr. Hyde. Before long Hyde begins to dominate and take control of Jekyll. Emergence of the first additional identity is usually triggered by early childhood trauma (sexual abuse more often than physical). The terror is so monumental that the child cannot deal with the truth and represses the reality (“it happened to somebody else”), thus creating a new personality state that is better prepared to process the traumatic event.
The number of identities can vary from two to 100. Some disappear with age, others remain constant companions deep inside. The first switch is followed by a tendency to create new personality states in response to further trauma. The number of identities can vary from two to 100. Some disappear with age, others remain constant companions deep inside. Differences amongst identities are often astounding. Not only do character traits change, but so does the tone of voice, posture, and handedness – even sexuality and gender can be altered. Furthermore, the first identity doesn’t have
to be the main one. The unconscious use of “we” instead of “I” is also common. DID is often accompanied by episodes of amnesia and time distortion. The main identity (called “the host personality”) is usually unaware of the split inside. The switch leaves behind memory lapses, which cannot be explained by forgetfulness. Although not common, communication between the personality states is possible (e.g. older identities offering advice to the younger ones). More often, however, one identity is unable to recollect external information presented to another. Without any biological correlates, there is no consensus on diagnosis or treatment. It is known that people suffering from DID are more vulnerable to hypnosis and therefore more prone to suggestions. Indeed, hypnosis is often used in therapy sessions. The goal is to integrate all the personality states whilst maintaining all the experiences of each alter ego. On a final note, DID can be viewed as an extreme version of what occurs naturally in all of us. Nobody has a truly “integrated” personality – we adapt s to new roles and change our behaviors in response to changes in our external environment. In this light, we can think of DID as the result when different aspects of an individual do not function properly together. Our mind works in mysterious ways. This is just one condition, yet there are countless other personal peculiarities creating separate worlds inside us, making each of us singular and unique.
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SCIENCE
Image credit: Ksayer1 (Flickr)
Organic food – What is the point? By Haroon Bayani IN THE LAST TEN YEARS, OUR CONSUMP-
tion of organic food has increased tremendously. While it can sometimes be priced twice as much as non-organic food, people are still willing to pay for it, justified by our presumptions that it is healthier, more environmentally-friendly, and simply tastier. Nobody can argue with anybody’s individual taste, but there is evidence to suggest that the first two assumptions are not necessarily correct. First of all, what is organic food? Here, it is defined as organic food one finds in the supermarket or at small, exclusive shops, and not home-grown food, for which evidence is limited. Additionally, it should be mentioned that organic food, unlike conventional food, is usually grown without the use of pesticides, fertilizers, antibiotics, or hormones. The manufacturers of these products endorse the principles of fairness, care, ecology, and health. No wonder people relish them. Although it seems plausible that food without pesticides, etc. is healthier, there is no evidence showing that organic food is more beneficial for health when compared to conventional food. In September 2012, a systematic review was published in Annals of Internal Medicine, synthesizing 17 studies, of which three examined clinical outcomes. None of the latter displayed a significant difference for allergic outcomes (eczema, wheeze, atopic
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sensitization). Furthermore, analysis of biomarkers and nutrient levels in serum, urine, breast milk, and semen did not reveal any substantial disparities between organic and conventional food. When it comes to vitamin content, again, no significant differences could be found. Phosphorus levels, on the other hand, have been found to be higher in organic food than conventional food. This, however, is not clinically relevant as one must be close to starvation in order to induce phosphorus deficiency.
Perhaps a mixture of both systems is needed, depending on the demands of people and geography Nonetheless, organic food does appear to be superior in one aspect. Pesticide contamination is remarkably lower in organic food, which is not a surprise considering that no pesticides are supposed to be used. That being said, does this have any clinical relevance? No. The levels of pesticide contamination in conventional food are already far below the maximum allowed safety limits.
In addition, a few words should be said about the environmental impact of organic food, since a large portion of consumers purchases it with the belief that it is more environmentally-friendly. We can reason that reduced pesticide use should result in less pollution of Mother Earth. A meta-analysis published in Journal of Environmental Management showed that organic farming did indeed have a lower environmental impact per unit area than conventional farming. On the other hand, mainly due to lower yields, organic farming had a higher impact per product unit. Perhaps a mixture of both systems is needed, depending on the demands of people and geography. In conclusion, you should not by any means stop consuming organic food if you already do so. In some cases it tastes better, and in others it simply looks better. Despite this, one should not automatically assume that conventional food, whilst occasionally less tasty or attractive, is any less nutritious. Secondly, one cannot easily judge whether or not organic food is more environmentallyfriendly, as the reality is more complex than one may think. And lastly, if you want the ultimate assurance, there is always the option of growing your own food.
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SCIENCE
Tricking our sense of taste By Jessica De Loma Olson
Image credit: Alisha Vargas (Flickr)
OF OUR FIVE COMMON SENSES, WE
might think taste is at the bottom of our list when considering their relative importance. If we had to lose a sense, almost no one would think twice about discarding our sense of taste. However, the relevance of taste for survival is well known despite being often underestimated. When humans were hunter-gatherers, it is likely our taste receptors were critical to our survival. Unpleasant tastes are often associated with poisonous substances or non-edible goods that should be avoided. This is the case for bitter substances, usually characteristic of alkaloids derived from plants that are poisonous, and sour ones, normally related to rotten food. But our sense of taste does not only serve to warn us about potential dangers – it is also related to pleasure. The refreshing taste of freshly-picked vegetables or the juiciness of a piece of meat can get any of us to salivate. And this is no coincidence. Both our senses of taste and smell initiate the process of digestion, which means that, as you start eating, the stomach automatically becomes active even before the food gets to it, preparing itself for digestion. Another interesting fact is our propensity towards sweets. If you have a sweet tooth, you do not have to feel guilty anymore – genetics are behind this. Different alleles of the gene Tas1r3, which codes for one of the subunits of the sweet receptor,
have been associated with differences in perception and tolerance for sweet tastes. This could explain why sweets are a soft spot of many people, whilst others simply cannot stand them.
If you have a sweet tooth, you do not have to feel guilty anymore... Another aspect to this is our perception of bitter taste and resulting facial expressions. Remember that feeling of eating broccoli? You would probably stick your tongue out, wrinkle your nose, and retract your upper lip. Now, think about what face you would put on if you were “grossed-out” by the look of rotten food. Feel familiar? The connection between visceral disgust (induced by looking at rotten food) and bitter taste has been widely studied. Both produce the same contraction of facial muscles and have been linked to the same neurological area, the anterior insular cortex. Even though there seems to be an obvious connection, the biological relevance of this remains unknown. Many questions have yet to be solved, but our interest in understanding this sense is growing. During the process of uncovering answers, there have also been attempts to alter and trick it. Miraculin is
a glycoprotein naturally found in Synsepalum dulcificum, otherwise known as the miracle berry. This molecule binds to sweet receptors on the tongue and when exposed to sour substances, changes its conformation and activates the wrong sweet receptors. In this situation, sour is interpreted as sweet, opening the doors to a universe of confusion for our taste buds. Sometimes, tricking our sense of taste can involve much more than altering our tasting perceptions. The presence of bitter receptors (TAS2R) has been documented in smooth muscle cells in the airways. Studies have shown how bitter substances can activate these receptors to induce the relaxation of bronchial muscles. Such discoveries could bring new therapeutic options to treat asthma, showing us that there is more to learn about our senses than we know. This leaves us with a final question: are we capable of manipulating our sense of taste to suit our own purposes? Getting children to eat their vegetables or even treating diseases such as asthma are only some of the possibilities the future may hold. As long as our insatiable appetite for scientific discovery does not subside, we inch ever closer to the taste of victory.
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SCIENCE
In vitro meat:
from science fiction to the future of food
By Iskra Pollak Dorocic Medicor talks to the creator of the world’s most expensive hamburger about the technology and ethics behind lab-grown meat. WOULD YOU EAT A HAMBURGER THAT
was grown from stem cells in a lab? Does it sound appetizing in any way? Chances are you would say no. I thought so too until I spoke to Mark Post, the scientist behind the stem cell-derived hamburger unveiled last year. There are a number of compelling reasons to support this budding technology and they do not just include animal welfare. Dr. Post, who recently spoke at the Nov2k conference at Karolinska Institutet, says his main motivations for this endeavor are “for the potential societal impact that it has: on food security, the environment and animal welfare.” The maintenance of livestock has an enormous environmental impact. According to a 2006 UN report on food security, livestock accounts for 18% of worldwide greenhouse gas emissions, mostly due to the release of methane, a greenhouse gas which is 20 times more potent than carbon dioxide. This makes the meat industry worse than the entire transportation sector in terms of emission. Going vegetarian would do a lot more for the environment than swapping in an SUV. Not only that, the amount of land used for grazing takes up 26% of the habitable land on the planet, 70% of all land used for agriculture and 8% of global human water use. We are quickly running out of resources necessary to continue increasing livestock for a growing global population – the global herd amounts to a staggering 60 billion land animals. In contrast, cells taken from one cow could produce 175 million burgers. With our current technology this would take 440,000 cows. The point would not be to completely eliminate livestock, but to reduce their numbers drastically. Current livestock farming practices also facilitate the rise in epidemic viruses. Both swine and avian flu, for exam-
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ple, originated from industrial livestock. Prevalent bacterial contamination make meat recalls common. A huge amount of antibiotics is used on cattle, fuelling the rise of antibiotic resistance. Growing meat in sterile facilities could avoid all of these problems. During his talk, Dr. Post emphasized that we do not actually need to consume animal protein in order to survive and thrive. Being vegetarian is a perfectly reasonable option, nevertheless only 3% of Europe’s population chooses this alternative, and this proportion has remained relatively even over the last 35 years. Clearly, most of us prefer to keep eating meat, despite knowing that it’s not great either for our health nor for the environment. What’s more, global meat consumption is projected to more than double by 2050 due to the developing world’s increasing ability to afford it. So how is cultured beef actually grown in the lab? The process begins with harvesting stem cells from a cow, specifically the muscle-precursor cells which are able to regenerate throughout life. The cells differentiate and multiply a trillionfold, then assemble into myotubes, which are basically muscle fibres, each less than 3 mm long. Muscle cells naturally contract and relax, making the myotubes form rings of muscle tissue through this movement. These rings are then cut into strands, and 20,000 of the strands are assembled into one burger.
...cells taken from one cow could produce 175 million burgers The actual scientific process of invitro meat production is relatively simple. “If I can do it, anyone can”, insists Dr. Post. He envisions a future where one could grow his or her own meat. To him the science behind it is quite trivial, and very much in the realm of possibility today. “It’s something that’s scientifically kind of boring. So you shouldn’t do this
Professor Mark Post with a burger made from Cultured Beef Photo: David Parry / PA Wire
kind of experiment in the walls of academia. It is more of an industrial project.” The next step is to make it into a commercial enterprise. “The investors are there, but the food companies are reluctant. They are conservative.” The funding for the initial phase of development came partially from Sergey Brin, the co-founder of Google, who said he got into the idea for animal welfare reasons. He is the one who picked up the €250,000 tab for the first lab-grown burger ever produced. At a much-publicized and broadcasted event in London during August 2013, the world’s first “cultured beef” burger was presented to the world. It was cooked by British chef Richard McGeown and tasted by a panel including Josh Schonwald, a food critic, Hanni Rützler, a nutritional researcher, and Dr. Post himself. Dr. Post describes the taste as being “not perfect yet and we knew that. But it’s definitely getting there. It’s definitely better than any other meat substitute that I have tasted. I know it will be there when I can no longer distinguish it from real meat.” The burger was made up entirely of cultured muscle cells, with an addition of powdered egg and breadcrumbs, which are used for binding even in regular burgers. Some beetroot juice and saffron was
also added to enhance colour and make the meat look more natural. The main difference from a regular burger is that the cultured burger contains absolutely no fat, as it is pure muscle. Still, the panel members were sympathetic and praised the burger’s texture for its ‘realness’ and ‘whole mouth feel’. Dr. Post says that the public reaction has mostly been positive. “Most people understand that there are issues with meat production. And any alternative that you present they look at it favorably.” In the UK, 68% of people on the street say they support the technology. In the Netherlands, 63% feel the same, and 50% say they would buy in-vitro meat in the supermarket if it were available. “The real initial scare has faded somewhat, because a lot of people have been writing about it, and most people now know what it is. Which is actually pretty amazing.” Beside education, the other obstacle is just pure habit. Dr. Post thinks once people get accustomed to the idea there will be little obstacle in getting cultured meat into kitchens. “Making it accessible makes it less ‘frankenstein-ish’. “ According to Dr. Post, the best part of talking to the public about cultured
meat is the feedback he gets. “This subject requires a lot of public debate. And for that you need to engage, there is no way around it.” When asked how he feels about being the face of this new technology and all the publicity surrounding it, he laughs, “I’ve been in medical research for 25 years and there has never been a medical journalist interested in that work. And now all of a sudden they are interested in something that seems almost trivial to me.”
“This subject requires a lot of public debate.” Dr. Post has been working as a tissue engineer with an expertise in building blood vessels, and meat engineering started out more as a side project. “I wasn’t really looking to get into a new type of tissue, or new type of tissue engineering, but I just very much like the application.” Growing in-vitro meat proved to be much more achievable compared to for example growing functional organs for transplantation. “I like the idea to start achieving your goal with tissue engineering at an earlier stage.“
In order to start producing more complex types of meat, such as steak, a few engineering obstacles still need to be solved. A thick steak would need a vasculature in order for the cells to receive sufficient oxygen and nutrients. Another goal is to eliminate serum (which comes from animals) from the culture media used to feed the cells as they are growing – this would make the procedure even more cruelty free. And then of course there is the cost. It will need to substantially decrease to ever be plausible commercially. Looking to the future, the development of cultured meat looks bright. Who knows, maybe in a few years we’ll be enjoying some guilt-free hamburgers. And even if not, in-vitro meat is provoking some necessary dialogue on the subject of future technologies as well as the issues with mass production of meat. Bon appetit?
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GLOBAL FOCUS
Worlds AIDS Day 2014 at Karolinska Institutet By Halima Hassan
The Human Immunodeficiency Virus (HIV) targets and weakens the immune system in infected individuals. Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection and people with AIDS have severely damaged immune systems which places them at risk for opportunistic infections and some cancers. Currently there is no cure for the disease however effective treatment with antiretroviral drugs (ARVs) can control the virus, lowering the risk of developing AIDS and allowing patients to enjoy healthy and productive lives.
and this is the primary aim of activists. Though it goes without mention that activists should have a good theoretical basis of the issue they wish to change. Therefore the idea of researchers as activists is ideal.
THE CENTRAL THEME OF THE WORLD
Is it the responsibility of scientists to condense their findings, avoiding complicated terminology, before sharing?
AIDS day conference that took place at Karolinska this year was the idea of researchers as activists and speakers with different roles within the HIV community were invited. The key factor that underlay the immense and unprecedented progress made in respect of the response to HIV and AIDS, compared to other public health issues, is activism. The current Ebola epidemic has, if anything, conveyed to us the necessity for strong lobbyists within our research communities. It is difficult to achieve much within global health without putting pressure on the policy makers to achieve change,
However, the unfortunate reality today is that HIV related activism is not as dynamic as it once was. Ophelia Haanyama, author and Senior Advisor to the Swedish NGO Noah’s Ark, explains that, realistically, “activism has to be at the same impact, the same noise as the problem at hand.” HIV remains a global public health issue however a lot of progress has been made in the past 30 years; many of the initial complaints of the activists, such as the need for drugs with fewer side effects, have been addressed. As a result of the progress, over time, the movement waned in terms of activity. However as a
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result majority of people today are very uninformed with regards to the disease. Professor Anna Mia Ekström, Department of Public Health Sciences, Karolinska Institute, spoke about how there is still ignorance among the young and old alike about HIV. Some people are still unsure about the various ways in which HIV can be transmitted and whether its safe to have sex with an infected individual. Furthermore, this reduction in HIV related activism appears to have led to a lack of interest in the issue by young scientists, the media, politicians and funding bodies. Professor Kristina Broliden, part of the department of Medicine, Karolinska Institute, explained how it may be the lack of funding within HIV research that is repelling young scientists from pursuing a research career in this field. Additionally, Haanyama argues that it is also partly the fault of the current HIV scientists and the media, rather than the government for allocating little money to the field, “Researchers and HIV workers are part of the reason for the lack of interest in HIV because we have somehow communicated that the problem is sorted.” A counter that arises when discussing the notion of scientists as activists is that science should ideally be neutral. Dr Pia Engstrand, who works at the Ministry of Foreign Affairs, argues that there is actually no such thing as neutral research. All funding bodies have vested interests in the projects they are funding. Although some scientists may find it difficult to engage directly in activism, they can still aid change by sharing their information. Engstrand argues that better information sharing between researchers and policy makers is the key to more effective responses to public health issues like HIV. Ideally there should be a constant flow of information between the scientists and policy makers in order for the best decisions to be made. A relating issue also discussed at the conference was the accessibility, in terms
GLOBAL FOCUS
Photos by Chantal Marchini
of presentation of information and writing style, of research results to the policy makers and public. Is it the responsibility of scientists to condense their findings, avoiding complicated terminology, before sharing? Ekström stated that to some extent researchers should also consider themselves public health informants. Researchers and academics are ultimately the experts and they should try to convey what they know and find in layman terms so as to easily engage with policy makers and collaborate with activists. Its only through such a coalition that the greatest change can be observed. Ekström believes that scientists need to improve the way results are communicated and should try to make themselves more accessible to the everyone. After all, “science is funded on tax payers money therefore we have a responsibility to share... We cant just leave it to the public health officials to communicate to the general public.” Broliden counters with a slightly different argument: “some scientists are interdisciplinary and others prefer staying behind the microscope and generating data. Maybe we should focus on doing what we are good at.” Broliden believes that though every scientist should be available to answer questions and be accessible to policy makers if need be, not everyone should have to; particularly if communication is not their strength. The keynote speaker at the conference was Dr. Kent Buse, Director of Strategic Planning and Special Advisor to the Executive Director at UNAIDS. His talk focused on ways to improve communication between scientists, policy makers and activists. Through activism, the HIV movement achieved, amongst other
things, better patient-provider interaction, changes in the way clinical trials are conducted and a reduction in the cost of drugs. Buse argues that that although “it would be a wonderful world if academics could become activists, it is more realistic to focus on some incremental steps that can be taken to support activists and to provide them with incentives to better engage in policy processes by improving activist-researcher partnerships.” Buse wants researchers and activists to be better allies as this may be the best way to bring about more evidence based, socially progressive policy. “Align yourselves as researchers more closely to activists so they can bring about change for all.”
“it would be a wonderful world if academics could become activists...” Though finding ways of improving partnerships between the key players in the HIV agenda is important, its also vital that the current efforts carried out to address the epidemic are reviewed and improved if necessary. All the invited speakers at the conference agree that the real focus should be on HIV prevention through education and treatment. This idea of treatment as prevention came from the observation that infected individuals with low viral load, as a result of treatment with anti-retroviral drugs, have a 96% reduced risk of transmission. However with this action plans comes many problems. How can this ‘treatment as prevention’ plan be implemented in re-
ality, around the globe? How can health workers and the industry sustain millions of people on antiretroviral drugs for long periods of time? Haanyama believes that before addressing these issues there are some basic but important barriers that need to be addressed. Firstly, the HIV health care strategy used should be tailored to the region and community being targeted. For example the issue for many African communities affected is access to hospitals or health care agencies to receive drugs, let alone continually taking drugs. “Healthcare efforts need to be localized, strategic and specific. Everything doesn’t work for everyone.” For this, Ekström comments that what is needed is research into developmental corporations and implementation strategies so health care officials know exactly what works and where. The HIV response has come far since the 1980s when it first gained momentum. It has resulted in the development of better drugs for those infected and today there also exists many support groups. Though not as publicized as it once was, it is necessary that the pandemic is forgotten in the mist of the many other global health issues. People are still dying all around the world from this disease, primarily from a lack of access to treatment. The need for policies which are evidence based and tailored to specific HIV communities is also an issue today. It is vital that relationships between policy makers, scientists and activists improve, in order to observe further progress with issues such as access to treatment. Stronger alliances between these three groups within the HIV community is the key to one day ending the battle with HIV.
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GLOBAL FOCUS
Ebola – the new black
Image credit: European Commission DG ECHO (Flickr)
By Haroon Bayani IN SEPTEMBER, AT THE UN GENERAL
Assembly, President Barack Obama voiced the three most significant global threats. In third place came the extremist group Daesh (also known as ISIS or ISIL), spreading terror and slaughtering innocents in the Middle East. In second place came “the Russian aggression in Europe”. In first place, however, came none other than the notorious Ebola virus disease, which has spread to over three African states, killed under 20 000 so far, and has taken the life of one American citizen. However, when compared to other diseases, it is not as horrendous as one might think. First of all, let us have a glance at the development of Ebola. Researchers believe that a two-year-old boy in Guinea was the index case, back in December 2013. Several of his female relatives became ill and displayed similar symptoms, and later died. The virus spread when the initial cases infected people, spreading it to other villages. Since it took several months before the authorities recognized it as Ebola, it spread easily across borders to neighbouring countries. As of the 2nd of December, approximately 7000 people have died of Ebola. Whilst it may seem too high a number for some, in reality it is not even a fraction of the casualties caused by the major infectious diseases. Those that kill more than Ebola (deaths numbering in the millions) include HIV,
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malaria, lower respiratory tract infections, diarrhoeal diseases, and tuberculosis. A greater sense of perspective would better serve the public perception of infectious diseases.
If people took obesity as seriously as they did Ebola, perhaps it would not be so prevalent. My point is not to undermine the casualties, nor am I claiming that the Ebola epidemic should be neglected. It is a disease with a high mortality rate, and thus should be taken seriously and eliminated as soon as possible. However, we must not disregard other serious health threats around the world. Apart from the infectious diseases mentioned, there is a more urging disease – a ticking bomb if I may say so – the obesity epidemic. Now imagine if the media, our politicians, and President Obama panicked about that one. Would that not be helpful? If people took obesity as seriously as they did Ebola, perhaps it would not be so prevalent. At the same time, the hype surrounding Ebola has possibly done more good than harm. As a result of the ensuing panic, many countries felt obliged to take
drastic measures. If the officials did not warn the public in time, there probably would have been more casualties. Unfortunately, Ebola has already led to significant economic losses in sub-Saharan countries, even those without any cases. Tourism and mining are two sectors that have seen dramatic declines in revenue. It should be mentioned that without the actions taken, many more lives would have been lost. Even though things could have been done better, the threat of Ebola as a pandemic seems to have been averted, at least for now. Furthermore, a vaccine is currently being developed by the British pharmaceutical company GSK and the US National Institute of Allergy and Infectious Diseases. The Ebola outbreak has also exposed the fragile infrastructure and allegations of corruption within affected countries – issues that are much more deep-rooted. Nonetheless, Ebola is only one of many pressing health issues that the world has to deal with. My hope is that our future politicians and the media take these other concerns as seriously as the Ebola epidemic.
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GLOBAL FOCUS
Image credit: Sean MacEntee (Flickr)
mHealth
Evidence first before widespread implementation By James Salisi MOBILE
HEALTH
APPLICATIONS
(mHealth) have been touted as a low-cost tool to improve health. This is mainly because of mobile phone ubiquity and widespread use, especially in low- and middleincome countries. It is estimated that by the end of 2014, 4.55 billion people worldwide will use mobile phones. In fact, there are countries like the Philippines where there are 1.5 times more mobile phones than people and India where there are more mobile subscribers (564.73 million) than people who had access to proper sanitation (366 million). Mobile phones are flexible tools for communication, education and research and many health experts support its use in public and personal health. A technical report by Alain Labrique and colleagues published in 2013 described 12 common mHealth applications in a new framework to use such applications as health systems strengthening innovations across the reproductive health continuum. These mHealth applications are client-education and behavior change communication, sensors and point-ofcare diagnostics, registries/vital events tracking, data collection and reporting, electronic health records, electronic decision support, provider-to-provider communication, provider work planning and scheduling, provider training and education, human resource management, supply chain management and financial transaction and incentives. In developing countries, hundreds of pilot projects have been started and ended, with only a limited number progressing to large-scale implementation.
However, the state of evidence for mHealth effectiveness is still dismal to justify investing in them. A systematic review of mHealth interventions by Caroline Free and colleagues found modest benefits in outcomes for provider support interventions on diagnosis and management, and SMS reminders. In contrast, the review also found reductions in correct diagnoses using mobile technologies compared to gold standard. In addition, a systematic review by Gerald Bloomfield and colleagues found insufficient evidence to support the effectiveness mHealth use for non-communicable diseases in Sub-Saharan Africa.
...evidence for mHealth effectiveness is still dismal to justify investing in them Nevertheless, the scarcity of evidence has not stopped the development and implementation of mHealth interventions in many parts of the world; even if the majority of these projects do not move beyond the pilot stages and the communities that they are run in are left hanging. This situation has prompted experts such as Mark Tomlinson and his colleagues to call for a systematic approach for searching for evidence to support the scale-up of mHealth in a paper published on PLOS Medicine, an open-access medical journal.
In terms of evidence, Tomlinson et al cites the model published by the Society for Preventions Research to expound on the necessary steps that proponents of mHealth interventions should take in order to support scale-up. The following should be completed before country-wide implementation or scale-up is started: “two high quality efficacy trials, two high quality effectiveness trials, followed by dissemination research that has established that the intervention can be delivered with fidelity being tested, as well as information about the intervention’s costs.” Efficacy trials are tests set in ideal conditions while effectiveness trials are tests set in real-life conditions. According to Tomlinson and colleagues there are currently no mHealth interventions that meet the standards for scale up. Thus, they recommended innovative research designs such as multi-factorial strategies, which can take advantage of many similar pilot projects to design and test small sets of factors with multi-factorial design; randomized controlled trials, which are the standard of testing clinical benefits; and data farming, which can take advantage of the enormous amount of mobile data usage that are already available to gather the evidence for mHealth scale-up.
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THE FIGHTER Story by Filippa Grรถnqvist & Vera Berg Photo by Martin Kjellberg
COVER STORY
“ T
What doesn’t kill you makes you stronger.
he athlete that added another category of sports to her seven. By winning the fight against cancer she once again proved to herself and the world what one can accomplish with a determined mind-set. Eight months have passed since her last treatment of chemotherapy. Today, she aims to compete in the upcoming Summer Olympic Games. We decided to meet Nadja at Bosön, a sports camp as well as her second home. She enters the cafeteria full of energy and
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with a big smile. After buying a quick breakfast we start the interview. She is very open when she starts telling us her story. Already at the age of 18, she was considered one of Sweden’s leading athletes in heptathlon. This would end abruptly on October 17th 2013. She had recently recovered from an achilles’ tendon rupture and for several months, she had been suffering from fatigue and a gastric ulcer. During her training she felt tired and lactic acid easily built up. Having done several tests at the doctor’s on the morning of the 17th, she was sitting with her boyfriend Gunnar at a café when she received the phone call that nobody wants to receive. Her doctor told her the results from the tests showed signs of lymphoma. She repeated the word “lymphoma” in disbelief. Immediately, Gunnar, her boyfriend, started googling, and the word “cancer” was the only thing she saw on his screen. Suddenly, people, cars, everything moved in slow motion, and several hours later she found herself in another café. The first thing she did when she came home was to call her family and update her Facebook
status. She wrote: “Cancer. Do you know what that is? An Achilles tendon rupture was nothing. Today I got the answer of my fatigue during summer. I got cancer in the lymph nodes. This might be my most challenging journey but my attitude is still the same: I will be back. But please, hold my hand, because this time I am afraid.” She was determined to survive, no other options were plausible. After updating her Facebook status the phone did not stop ringing. Media, friends and family wanted to know that she was well and to give her strength and faith.
...when she received the phone call that nobody wants to receive. Nadja had been shaking all day following the shocking phone call. She did not stop until she had heard her dad’s calm voice and encouraging words on the phone. He said what he always says, “Everything will be all right, Nadjis. You will get through this. I promise.” The next morning she was hospitalized. Despite the circumstances, she felt safe, as if nothing could kill her among all the doctors and nurses that were taking
care of her. She dreaded the bone marrow biopsy, but it passed easier than she had expected. But the fear came, along with the unknown. Waiting for the test results was exhausting, and the first night alone in the hospital was a nightmare.
“Everything will be all right, Nadjis. You will get through this. I promise.” Nadja suddenly reacts to someone passing by calling her name and the interview is paused for a moment while she and her friend chat for a little while. When they are done she continues telling us about what happened after the tests were finally done; it was one week later, and to announce the results six people in white clothes entered the room. Her first thought was “this is not good”, and her boyfriend who was sitting relaxed on the couch in the room, seemed to be thinking the same thing as he sat up straight as soon as the procession came in. The thought crossed her mind that she might actually die, but it was more of a calm realization than a shock. They told her that she had an aggressive form of cancer in
both the stomach and the throat. The diagnosis of aggressive cancer was bad, but she told us that it at least was susceptible to chemotherapy. The problem with chemotherapy, Nadja said, was that one has to become really sick before one can get better. With all her energy, Nadja was sure she would be able to exercise even during the treatment. She asked her doctor how often she would be able to exercise and they looked at her as if she was stupid. She was, however, convinced that she would be able to pull it off. Had they ever treated an elite athlete? “No, wouldn’t think so?” But as the chemotherapy started, her confidence in making it through without major difficulties was gone. She, who did not vomit, even after the most exhausting race, suddenly found herself feeling like a helpless little child. Finally she realized that she was mortal. Since Nadja is a person with an inquisitive mind, her blog helped her a lot during her struggle with the disease. By sharing her thoughts she could let others think for her, and could get away from being overwhelmed by a lot of thoughts at a time. Now, looking back, she sometimes gets scared. She describes the social media as a process for her to handle the
overwhelming feelings and letting other people worry for her. Nadja, who never was keen on eating pills took 13 pills for breakfast and another 18 for dinner. Just swallowing all of them took more than an hour. The workouts she had planned on doing soon became walks because her body was unable to do much more. Working out was so physically demanding that on the days that she did so had to sacrificed as she was unable to do anything but sleep afterwards. The workouts still helped her fight the cancer, both physically and mentally. She felt like a warrior.
The workouts still helped her fight the cancer, both physically and mentally. She felt like a warrior. Today, she is cancer-free, but will not be declared completely cured for another five years. Lymphoma, as Nadja described it, is a lottery. She has never been drinker or a smoker, but has lived healthily her entire life. Yet, fate picked her cells to go crazy.
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COVER STORY
“
This might be my most challenging journey but my attitude is still the same: I will be back.
Today she is still the same Nadja, but more worried. Life is uncontrollable and she is constantly aware of time, never feeling safe, knowing that what she has today might be gone by tomorrow. She says she has neither clue nor control. She knows this new feeling will stay with her, and the only way to get by is to accept it and learn how to live with it.
...the only way to get by is to accept it and learn how to live with it. She is also a lot more indecisive regarding her training. Her mind-set had always been “what doesn’t kill you makes you stronger” and to work out until exhaustion was the best thing she could do. Today, she is scared; the things that exhaust her might actually kill her. Although she is motivated, there is an uncertainty concerning how her body will respond to the training. Challenges are something she always has liked and to compete in the Olympic Games in Rio de Janeiro 2016 is the goal. The number 28
of top athletes that have been diagnosed with lymphoma as well as suffered from an Achilles tendon rupture are scarce. Even fewer have planned on participating in the Olympic Games on top of that. Nadia, however, is about to change things Undoubtedly, Nadja has high ambitions and she realizes that reaching her goals will not be a piece of cake. Plan B is not a failure yet irritating, she describes. Design is something Nadja has a desire to work with in the future, and her latest project is a book. The book will be released in February and consists of a collection of her blog entries and photos created during her illness.
Today, the hospital department at Karolinska Sjukhuset feels like home to her. She described the care during her illness as “fantastic”. Today, the hospital department at Karolinska Sjukhuset feels like home to her. The hospital staff was always present and saw her as Nadja in-
stead of as just ‘another patient’, although she feels excluded since finishing her treatment. Thoughts and speculations do not get answered and she emphasizes the importance of having a knowledgeable medical person to call. Nowadays she dedicates a lot of time inspiring others in all kinds of difficult situations to keep on fighting for their sake even though the odds might be bad. Using her blog and lectures she reaches out to these people in hope of becoming a source of inspiration. She emits light and warmth, and her winning mentality is limitless. A year ago she was diagnosed with cancer and today she is more alive than ever. The heptathlon became an octathlon.
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COVER STORY
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THE GHOSTS OF NOBEL PRIZES PAST By Yasmine Djoumi Hurrying down the empty hospital ward, I could not help but notice the steady beeps of a heart monitor, the shuffling feet of a patient with a prescription in his hands or the wailing of a newborn baby. Objects, treatments and new ways of thinking which we now take for granted were once major breakthroughs in medical and human history. A select few were awarded the most prestigious award of them all. Let us now take a stroll down memory lane and revisit the ghosts of Nobels’ past. INSULIN INSULIN IS A PEPTIDE HORMONE PRODUCED BY THE ISLET
cells of the pancreas. Its role includes regulation of blood sugar concentration and metabolic pathways. Its absence or dysfunction gives rise to Diabetes Mellitus. In the early 20s Frederick G. Banting, a Canadian scientist, had an idea of how to isolate a large fraction of the islet cells of the pancreas without the death of the subject; in this case dogs. He travelled to his friend and colleague John J. R. Macleod with the request to carry out his research in Macleod’s lab. Skeptical at first, Macleod agreed and supplied Banting with 10 dogs and two medical students to assist him. Banting wanted only one, so the students tossed a coin and the winner was Charles Best. During the summer, Banting and Best carried out their experiments and by the end of the summer, they were able to extract an exudate from the islet cells which they supplied to a diabetic dog named Marjorie who survived for the whole length of the summer. Upon Macleod’s return they showed him their results and were granted more dogs and research money. At that point, it took 6 weeks to isolate the insulin. In order to speed up the process, Banting suggested they try with fetal calves instead, which worked perfectly. On January 11, 1922, the first insulin sample was given to a 14 year old boy, dying of diabetes, named Leonard Thompson at Toronto General Hospital. While it was Banting and Best that carried out and discovered insulin, it was Banting and Macleod who received the Nobel Prize in 1923. In the spirit of camaraderie, Banting shared his prize money and the glory of the discovery with Best.
Although a lot has been discovered and a lot of Nobel Prizes have been awarded, there is an immense pool of knowledge waiting to be unleashed. And while the Nobel present is about the brain’s own GPS, one cannot help but wonder what Nobels’ future might bring.
1923
ORGAN AND CELL TRANSPLANT JOSEPH E. MURRAY, AN AMERICAN PLASTIC SURGEON,
performed on the 23rd of December 1954 the world’s first successful renal transplantation between the identical twins Ronald, who was healthy, and Rickard, who was dying of renal failure. The operation lasted for 5.5 hours. The use of immunosuppressive medicine was not needed in this case because of their identical genes. This surgery opened up the doors to the field of transplantation surgery. Murrey shared 1990’s Nobel Prize with E. Donnall Thomas, who discovered that cell transplantation from the bone marrow - a so called hematopoietic stem cell transplantation - could cure Leukemia. Donnall’s studies showed that hematopoietic stem cells could proliferate and become new blood cells. His methods also reduced the impact of a condition called graft-versus-host disease. Donnall carried out this research from the 50s to 70s at Fred Hutchinson Cancer Research Center. Donnall’s results went on to be used by several doctors around the world. One of them was John Kersey, who performed a bone marrow transplant on 16 year old Dave Stahl, dying of Birkitt’s lymphoma. Dave is still alive today and is currently the longest living lymphoma transplant survivor.
ELECTROCARDIOGRAPHY
1924
IN THE BEGINNING OF THE 20TH CENTURY,
it was known that the beating rhythm of the heart involved electrical currents. Unfortunately, they had no proper way of calculating these currents without putting electrodes directly on the heart. Willem Einthoven developed a new string galvanometer, a thin filament passing between very strong electromagnets. When current passed through, the electromagnetic field would cause the string to move. Light would cast a shadow on the moving roll of photographic paper producing a continuous curve corresponding to the movements of the string. The original machine needed a water cooling system for the magnets, 5 people to operate it and weighed over 270 kg. Instead of patches of electrodes, limbs were submerged into tanks of salt solutions. Einthoven received the Nobel Prize in 1924 for his invention and went on to describe various cardiovascular disorders.
207 people have
recived the Nobel Prize in medicine since 1901
0
BLOOD GROUPS
193
IN THE EARLY 1900S, AUSTRIAN SCIENTIST
Karl Landsteiner, discovered the so called ABO-system, a collective name for the various blood types. During that time, it was already known that the mixing of blood from two individuals gave an agglutination. During Landsteiner’s experiments he found that blood transfusion between people with the same blood type gave no destruction of blood cells, whereas the opposite happened with transfusions involving different blood types. Landsteiner called the different blood types for A, B and C, referring to the type of antingen present on the surface of the red blood cells. C is now known as the O or 0 (zero) to signify the absence of both A and B antibodies. For his pioneering work, Landsteiner has been called the father of transfusion medicine. The first successful blood transfusion was performed by Reuben Ottenberg at Mount Sinai Hospital in New York.
“I wish I had my beta-blockers handy.” James Whyte Black’s comment when told that he had won a Nobel Prize, referring to the drug he discovered for the treatment of heart disease.
1988
1990
HELICOBACTER PYLORI CHRONIC GASTRITIS AND PEPTIC ULCERS ARE A MAJOR HEALTH PROBLEM IN
2005
the world, affecting inhabitants of rich as well as poor countries. Today, we know that peptic ulcers are not only caused by an overproduction of gastric acid, but also by the gram negative Helicobacter Pylori bacteria. According to the World Health Organization, H. Pylori is the cause of 92% of cases diagnosed with gastritis or peptic ulcers. Barry J. Marshall and Robin Warren, two Australian scientists, discovered in 1982 H. Pylori in biopsies from patients diagnosed with ulcers. The general dogma at the time was that no bacterium could live in the conditions of the human stomach due to its low pH. Marshall and Warren concluded that the bacteria they found must be the cause of the non-curative chronic ulcers. Alas, they were met with criticism and became the laughing stocks of the whole scientific community. But Marshall did not give up. He was so convinced of his findings that he had to prove it to the world one way or the other, so he decided to drink a beaker full of Helicobacter. To the surprise of the gastroenterologists of the world, Marshall, previously healthy, was after a few weeks diagnosed with peptic ulcers. This discovery now made a chronic disease into a highly curable one. His stunt not only stunned his colleagues. Some thought he was mad while others called him a cowboy, but the Abbott Company chose to commemorate his feat by making it into a comic strip. Marshall and Warren shared the Nobel Prize in 2005. 31
NOBEL
THE NOBEL PHYSICS
LITERATURE
By Amanda Kaba Liljeberg
By Poya Livälven
THIS YEAR’S NOBEL PRIZE IN PHYSICS IS
I AM IN GAMLA STAN ON A CHILLY, BUT
awarded to Isamu Akasaki, Hiroshi Amano and Shuji Nakamura, for the invention of efficient blue light-emitting diodes, which has enabled bright and energy-saving white light sources. The white light we see in light-emitting diodes, or LED lamps, can only be created by a triad of colors; green, red and blue. Green and red diodes were invented in the 1960s and are created in the same way, with a technique that however does not work in the production of blue diodes. For three decades scientists tried to figure out a way to create blue diodes, until the work of Akasaki, Amano and Nakamura finally paid off. The LED lamps are more efficient than regular light bulbs, as they shine brighter and need much less electricity to do so. Since the LED lamps are so energyefficient, they can be powered by solar power. In the parts of the world where access to electricity grids is not possible, this makes a big difference and the invention of LED lamps could increase the quality of life for over 1.5 billion people. In addition, LED lamps last longer, up to 100,000 hours compared to the light bulb’s lifetime of 1,000 hours. With saving the Earth’s resources as well as diminishing material consumption, this invention truly is revolutionary.
sunny autumn day. While I am walking down the streets of cobblestone, a cold wind makes me shiver and I tighten my scarf around my neck. Today, a colleague from Medicor and I are supposed to witness the delivery of the Nobel Prize in literature in Börshuset, the seat of the Swedish Academy. We head toward Stortorget, and slowly, a large, timeworn and yellow building appears in front of our eyes. Fast, we find the discrete side entrance of the building for press personnel. There are hordes of huge cars from different news media on the outside and the streets of Gamla Stan that usually dwell with tourists and street artists at this time of the day is now the site on which the eyes of the literature world lay their gaze. My colleague and I enter the building and find our way to Börssalen where the world press is positioned. The atmosphere is tense and anticipatory. Everybody is busy finding the best spot for photography and filming. People whisper and gossip about whom they think will win; will it be Ngugi Wa Thiong’o, Assia Djebar or Haruki Murakami? We successfully manage to find our place close to the famous door, from which the permanent secretary of the Swedish Academy will enter the room and announce the
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winner of the Nobel Prize in literature 2014. The hour is at hand and with only seconds left we grab our cell phones and prepare them for taking pictures while professional photographers stand beside us with their mighty system cameras. The time is now 1 p.m. and the boisterous atmosphere from before is gone with the wind. Everyone gazes at the door handle that slowly turns downward. The door opens and Peter Englund, wearing a suit, proudly enters the room and announces the winner to the rhythmic clatter of the camera shutters. He looks across the room and announces that Patrick Modiano is the winner of the Nobel Prize in 2014. A sense of relief and surprise washes through the room. Who is this Patrick Modiano? The winner was not part of the fancied candidates, but when you hear the reasoning behind giving him the award, you really appreciate their choice; the Nobel Prize in Literature for 2014 is awarded to the French author Patrick Modiano “for the art of memory with which he has evoked the most ungraspable human destinies and uncovered the life-world of the occupation”. Just as fast as the press was gathered they vanish with these final words. The room is emptied and life in Gamla Stan is returned to normal. Now Börshuset is waiting for next year’s 15 minutes of fame.
...for the art of memory with which he has evoked the most ungraspable human destinies and uncovered the life-world of the occupation - The Nobel Prize in Literature for 2014 is awarded to the French author Patrick Modiano
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NOBEL
PRIZES 2014 CHEMISTRY
ECONOMY
By Ibrahim Rayyes
By Halima Hassan
THE 2014 NOBEL PRIZE IN CHEMISTRY
has been jointly awarded to Eric Betzig, Stefan W. Hell and William E. Moerner for their work in the “development of super-resolved fluorescence microscopy”. Dating back to the latter half of the 19th century, a resolution of 0.2 micrometres had been established as the physical limitation of light microscopy. Although it has been enough to provide us with tremendous insights into structures of cells and tissues - amongst other things - since its invention, seeing smaller organelles has been an impossibility. Delving deeper into the microenvironment of the organic world has required the use of the electron microscope. With the use of fluorescent molecules, Betzig, Hell and Moerner have, in effect, overturned this limitation of light microscopy. More specifically, this year’s Nobel Prize recognizes the exploitation of fluorescent molecules using two different principles; stimulated emission depletion (STED) microscopy and single-molecule microscopy, with the former being developed by Stefan Hell whereas the latter has been made possible by the independent works of Betzig and Moerner. In sim-
plistic terms, STED microscopy utilizes two different laser beams; one that excites fluorescent molecules to glow and a second one that quenches the fluorescent glow in all but one nanometre-sized area. By scanning over a larger area, a super-resolved image can thus be obtained. As the name implies, single-molecule microscopy involves repeatedly activating a miniscule, but different, subset of fluorescent molecules at a given time and thereafter superimposing the images. By having a distance greater than 0.2 micrometres between the fluorescent molecules, a superresolved image is thus generated. It is noteworthy to add that the use of fluorescent molecules still provides the possibility of studying cells in their living state. Thus, with the use of fluorescence microscopy, looking at cellular processes such as neuronal synapses, transcription and translation as they occur in real time has now become very possible. Truly, these pioneering principles have helped evolve microscopy into nanoscopy and the extent of knowledge that will result from this awaits to be seen.
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THE 2014 PRIZE IN ECONOMICS HAS BEEN
awarded to Jean Tirole, a French economics professor, for his work on market power and regulating competition. Tirole had been working since the early 1980s on regulation in economics, with a particular focus on ways to control the dominance of major companies. His studies covered a wide range of areas within the economic sciences including the banking industry, pay and credit card fees. These areas have become increasingly important in recent times as governments have privatised former public monopolies such as telecoms, water and electricity. One of Tirole’s many contributions to the field of economics is the introduction of game theory in industrial organization. This has allowed economists and policymakers alike to regulate large firms more efficiently and fairly. His theories have been particularly helpful in ‘asymmetric information’ situations, where the regulators do not have access to the same knowledge as the firms they are regulating. Tirole’s theories have proved immensely important; they have been implemented by many competition regulators worldwide. Therefore it comes as no surprise that the Nobel committee describe Tirole as “one of the most influential economists of our time.” Tirole’s selection for the prize was not controversial. On the contrary, it was met with much praise. “Most people thought he’d get it at some point,” comments Mark Armstrong, a professor at Oxford University. Tirole felt proud after receiving the award but emphasised that his win could not have happened without help from others: “It’s also being with the right people, in the right place, at the right moment. And, you know, it’s team work too.”
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The Nobel Prize in Chemistry 2014 was awarded jointly to Eric Betzig, Stefan W. Hell and William E. Moerner “for the development of super-resolved fluorescence microscopy”. Photo by David Humphreys
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NOBEL
Photo by Gustaf Drevin
Navigating the complexities of the brain By Iskra Pollak Dorocic Infographics by Jakub Lewicki
A
s Edvard Moser stepped off the plane from Trondheim – blissfully unaware that the 150 emails and 75 text messages on his phone were a sign that this day would be like no other – he was on his way to give yet another guest lecture. But as soon as he entered the terminal in Munich, the news came via a congratulating representative. The unsuspecting Dr. Moser finally realized that he had just won the most prestigious prize in science - the Nobel Prize in Physiology or Medicine. “I’m terribly grateful, it’s absolutely fantastic”, said Dr. Moser to the Nobel spokesperson who contacted him shortly thereafter. “I didn’t even know it was today, I really didn’t even think about it. So even more pleasant when it’s such a surprise.” Edvard Moser, alongside his lifetime scientific partner and wife May-Britt Moser and their ex-supervisor John O’Keefe, received this year’s prize “for their discoveries of cells that constitute a positioning system in the brain”. The trio described the specific cells in our brains which are responsible for mapping the space around us and giving us a sense of where we are. The research spans several
34
decades, starting with the discovery of the “place cells” in 1971 by O’Keefe, who demonstrated that very specific brain cells are active only when one is in a specific location. The Mosers added to this in 2005 with their discovery of the “grid cells”, which generate the coordinate system used by the brain for exact positioning. Both cell types were initially discovered in rats, but have since also been shown in humans.
What they found took them completely by surprise. Medicor had the privilege to speak to Dr. Edvard Moser over the phone just a few weeks after the announcement.
LINKING MEMORY AND SPACE
For over two and a half millennia, scientists and philosophers alike have contemplated the ways in which our minds create internal maps of the environment and enable us to navigate through space – tasks crucial for survival. The ancient Greeks were the ones who developed
the memory trick still used today, where one imagines walking through a specific space, such as a house, and associates each phrase or number to be remembered with a specific object or location in the house. This trick allowed them to memorize long speeches and recite them effortlessly while mentally walking through the imagined space. Today, participants in memory championships use this strategy to memorize exceptionally long strings of numbers, or the order of cards in multiple decks. So it was obvious that memory and navigation are somehow linked in the brain. The first person to coin the term “cognitive map” was Edward Tolman, a mid-20th-century psychologist and adamant anti-behaviouralist. He observed rats navigating through a labyrinth and realized the animals must have been forming an internal representation of the external environmental in their mind and using it to find their way through the maze. But how exactly is this cognitive map represented in the brain? How do the cells in our brains, the neurons, code spatial orientation? In the late 1960’s the American-British neuroscientist John O’Keefe was just em-
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barking on a promising academic career at University College London (UCL). He was interested in how brain activity directly controls behaviour, and decided to record the activity of single neurons located in the hippocampus of rats while they moved around an enclosed environment. The hippocampus also happens to be the structure where memories are formed in our brains. Neurons communicate with each other via tiny electrical currents, and it is possible to record the electrical activity of a brain cell using small wires, called electrodes, implanted into the brain. O’Keefe discovered that only certain neurons became active when the animal was in a particular spot in its box. So the same neuron was active each time the rat was in the middle of the box, and another specific neuron fired each time the rat moved to the left corner, and so on. O’Keefe coined these special hippocampal cells “place cells”, and proposed that the hippocampus generates different cognitive maps which are represented by collections of specific neurons active in different environments. Effectively, the brain forms a memory of a particular place based on the combination of place cells that are active in the hippocampus.
REVEALING THE HIDDEN PATTERN
May-Britt and Edvard Moser spent some time in O’Keefe’s UCL laboratory in 1996, as part of their post-doctoral research. This is where they learned how to record single-cell activity in rat brains while the animals moved
through space. The Mosers took this skill with them and started their own laboratory in their native Norway. It was there in 2005, that they made the seminal discovery of “grid cells”. Aiming to figure out the control mechanism for O’Keefe’s place cells, the Mosers first looked upstream of the hippocampus, in an area called the entorhinal cortex. This region sends prominent inputs to the hippocampus, and thus also to the place cells. Not much attention had previously been paid to the entorhinal cortex, but the Mosers decided to implant their electrodes into this particular structure and record while the animal moved around its environment. What they found took them completely by surprise.
As the animal moved through particular spots in the box, specific neurons fired, not unlike the place cells in the hippocampus. But in contrast to the place cells, these entorhinal cells fired in other places too. They seemed to form a pattern. “The discovery was a longer process”, says Edvard Moser. The researchers first had to make changes to the recording setup, in order to recognize the pattern produced by the neurons. “We found quite early on that the cells in the entorhinal cortex have a special firing correlate. Each of them have many firing fields that are very regular.” The pattern that emerged was one of many hexagons placed on top of each other as the animal moved through the environment, basically forming a honeycomb pattern. “But then to see that this was really the hexagonal pattern, we had to increase the size of the recording environment so then you could really see how these firing positions were spaced in relation to each other. So I would say that it was a process that took place over maybe half a year, where we became more and more certain that it was a hexagonal pattern. And of course there were those really exciting moments, but it wasn’t really one single moment.” There is a certain elegance and unusual simplicity with this pattern of grid cell activity. It turns out that the hexagonal geometry is an optimal configuration that allows for maximal spatial resolution and energy conservation of the system. This unexpected simplicity is a scientist’s dream, especially in brain research 35
NOBEL
where the complexity often seems overwhelming. Discovery of patterns starts the journey to understand the computation underlying a complex process, in this case, spatial navigation.
The Mosers are not your typical Nobel winners. “What is fascinating about studying the positioning system, is that it is a simple form of cognition that is kind of away from sensory receptors and also far away from the motor neurons. I often say that it is in the middle of the brain.”, says Moser. Indeed, since the entorhinal cortex receives no direct sensory input, unlike say, the visual system (which receives information from the retina) the hexagonal pattern is created internally. “Why that is interesting is that unlike most other functions in the brain that are computed in the association cortices, this one has a very clear correlate in the outside world, which is the position of the animal. So it’s very easy to measure and can then be related to the computations that are taking place [inside the brain].”
TWO MINDS, ONE GOAL
It really takes special minds to unlock the brain the way the Mosers did. Dr. Cori Bargman, distinguished neurobiologist and head of the $100 million BRAIN initiative, tweeted not long after the Nobel Prize announcement, “Lesson from O’Keefe and the Mosers: the brain is stranger than you could imagine. Yet by intelligent observation, you can understand it.”
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The Mosers are not your typical Nobel winners. The humble Norwegians defy stereotypes of old, white-haired scientists who made their groundbreaking discoveries many decades ago. Edvard and May-Britt Moser are youthfullooking 50-somethings, who not only hike the mountains surrounding their home in Trondheim, but also volcanoes around the world – in fact, they got engaged on top of Mount Kilimanjaro in Tanzania. Edvard is known to wear his red Converse sneakers at conferences, showing off his laid-back style – both physical but also personality-wise. In fact, he seems a bit overwhelmed with the attention since receiving the Prize. “For sure I enjoy it, as long as it does not become too much, I enjoy it”, he replies when asked how he is handling all the attention. “The days are very chaotic because there’s so many thing that I need to do, many interviews and all these preparations for the things in Stockholm, that’s part of it. I would assume that it comes back to a bit more normal after New Year.” Both Edvard and May-Britt grew up on islands off the coast of Norway in nonacademic families. When they met as undergraduates at the University of Oslo, they discovered their mutual interest in brain and behaviour, and through unrelenting motivation ended up in the lab of Per Andersen. At the time he was studying neurons in the hippocampus, and was initially apprehensive about pursuing the project the Mosers had in mind. Since the beginning, the Mosers worked as a team. “We share our involvement in all projects, but there are some projects where May-Britt is more
involved and some I’m more involved in. But basically we run the group together, we have one common goal, one set of key questions which we want to investigate”, says Edvard Moser about working with his wife. “It’s an advantage in the sense that we are complementary, and that she has strengths that are somewhat different from mine, so if you put those together we become stronger than just the sum of us.”
“The Human Brain project is somewhat more controversial, there’s a big resistance in Europe.”
Despite the advancement in our understanding of the mind, many mysteries still abound. Moser considers, “There are many questions still unanswered, we are just grasping the surface on understanding how higher brain functions come about. Let’s say cognitive functions: how
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we think, how we plan, how we make decisions, all that. By and large, there is a lot we still don’t know for many of the higher functions.” Indeed, brain research has recently been gaining momentum. Within the last year, both the EU and the US invested substantial amounts of funding in researching the mind and its many disorders. The EU initiated the €1-billion Human Brain Project, while the US followed suit with the BRAIN initiative. When asked how he sees these large initiatives, Moser replied, “The BRAIN initiative in the Sates is a very good document, they have formulated key questions that can be addressed with some really new and upcoming techniques and technologies.” For the EU project, Dr. Moser reserves some skepticism, “The Human Brain project is somewhat more controversial, there’s a big resistance in Europe. Not
against involvement in neuroscience, because that is what everyone wants. But the way it is done and maybe the focus on the collection of a lot of data, while it’s not always clear how knowledge is going to come out of all this data.”
“My advice to young researchers would be...” The Mosers have a common laboratory at the Kavli Institute for Systems Neuroscience, with a large number of PhD students and post-docs. “My advice to young researchers would be try to find a question that really interests you, that hasn’t quite been solved yet, and go for that using new technologies that have come - but don’t forget the question”, says Moser, referring to the many recent tech-
nological advances. He continues, “because there are many fancy technologies but it’s even more important to actually find the problems that you really want to solve. Sometimes one has to do more adventurous things if you really want to get far, and that always involves some risk.”
FROM MICE TO MEN
Place and grid cells have more recently also been shown to exist in humans, not just in rats, the model that O’Keefe and the Mosers first investigated. This has potential relevance in Alzheimer’s disease, where both the hippocampus and entorhinal cortex are affected early on. The functional deficits in these regions translate into devastating spatial memory loss, where patients gradually fail to recognize their environment and even loved ones. Understanding the basic mechanisms behind spatial navigation will help shed insight into the cognitive decline seen in such neurodegenerative disorders.
...have shed light on a very fundamental function of our minds. It is still early days in our understanding of the brain. John O’Keefe alongside May-Bitt and Edvard Moser have shed light on a very fundamental function of our minds. Past Nobel Prizes have honoured other essential findings in neuroscience, particularly in the visual, olfactory and memory systems. This year’s winners can rest assured they have added to the progress of understanding one of the greatest mysteries of the universe – our brains.
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I didn’t even know it was today, I really didn’t even think about it. - Edvard Moser realizing that he had just won the Nobel Prize 37
INSIGHT Insight is Medicors feature with the purpose to shine light on some of the different occupations and branches within the medical field. Each edition feature an interview with a selected person and a presentation of his or hers specific area of specialization. The intention is to inspire and to give students some insight into some lesser known career paths and specialties.
Elizabeth Blackburn
Professor of Biology and Physiology and a Nobel laureate. By Halima Hassan THE NOBEL WEEK DIALOGUE IS AN AN-
nual event that takes place in Stockholm where previous Nobel laureates are invited to discuss a particular theme. This years event was focusing on aging and attendees included Professor Elizabeth Blackburn. Blackburn won the 2009 Nobel prize in physiology and medicine for co-discovering the enzyme telomerase. Telomerase catalyzes the replenishment of DNA stretches found at the ends of chromosomes called telomeres, which otherwise shorten whenever a cell divides. Telomere length is an indicator of systemic aging, with shorter lengths being associated with chronic diseases of aging and earlier mortality. I met with Professor Blackburn prior to the dialogue to discuss her work.
THE NOBEL WORTHY DISCOVERY AND ITS IMPLICATION “It was pretty clear that right from the get go you needed something to maintain the ends of DNA.” The Blackburn lab has sought to, and continues to seek, the full extent of a role telomerase and telomeres play in a cellular processed besides aging. “The cre38
do of molecular biology tends to be that things are very universal in life and things are not going to be profoundly different. I sensed that this [finding] was going to be pretty fundamental. The question then was, we had no idea how this was going to play out in humans.” Today we know that telomere length underlies the proliferative capacity of a cell and telomere shortening, as a result of reduced telomerase activity with each cell division, is associated with the aging process and many age related diseases. However many factors besides aging can contribute to telomere maintenance such as chronic stress and lifestyle.
HEALTH(Y) BEHAVIORS AND TELOMERE MAINTENANCE
“Everybody has external stressors, there is nothing that can be done about this. It turns out that giving people tools to cope with these, when you look at people who have the ability to manage how they perceive stress, they do better in terms of their telomere maintenance.” Studies from the Blackburn lab and others focusing on the external factors which have an impact on telomere length show that en-
gaging in, for example, mindfulness and healthy eating habits can have positive effects on telomeres; reducing the rate at which they shorten. These are early findings however provide insight into the sort of behaviors which possibly contribute to the aging process. “All that telomeres give us is a quantifiable, molecular, concrete readout that gives you some kind of a handle, statistically speaking, on [aging].”
SOCIAL REALITY AND TELOMERE MAINTENANCE
“[There has been] telomere research looking at people in chronic stressful life situations: those with socio-economic problems, people in war-torn countries, refugees... We see the effects of traumatic events on children relating to how short their telomeres are when they are middle aged. There are a lot of things we have to start thinking about.” A paper from the Blackburn lab looked the impact of discrimination and racial bias on telomere length in African-American men. Results suggested that “multiple levels of racism, including experiences of racial discrimination and the internalization of negative racial bias, operated together to accelerate
INSIGHT
biological aging among African-American men.” When discussing these findings Blackburn commented “...we all know that [these] social [attitudes] have ill effects; we know that this is not good for people and their health. But to see it hit people in this way, I think, well this is a way of making a message come through very clearly. We know concretely that this is happening. In so many ways it speaks to you.”
FUTURE
Future research into telomeres should study the molecular mechanisms which mediate changes in telomere length. “Part of my lab is [currently] focusing on trying to understand the very elaborate molecular ‘dance’ involving the telomere ends, telomerase and the telomere binding proteins. Really trying to elucidate all the molecular details.” Should clinicians start monitoring patient telomere length? Blackburn notes that “monitoring [of telomere length] is like weighing; that single piece of information, is useless without context,” but along with patient data could, in the future, aid prognosis and provision of suitable care. “A study looked at depression and its correlation with bladder cancer in a cohort of patients. They found that those with depression had almost two times the likelihood of dying from the cancer. [Later it was also found that] if their telomeres where in the lower portion of length distribution, in addition to being depressed, their odds of dying increased by 5 fold.” The Blackburn lab are working hard to elucidate everything there is to know about telomeres and considering how critical this area of science is, I believe there is chance this lab will be recognized by the Nobel committee once more.
Photo: Maria Belikova
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’09 Nobel Prize in Physiology or Medicine ’07 Named one of TIME Magazine’s 100 Most Influential People ’98 President of the American Society for Cell Biology ’75 PhD from the University of Cambridge
’01 Appointed a member of the President’s Council on Bioetichs ’70 Bachelor of Science
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GLOBAL FOCUS
Health care and Refugees an issue of rights and responsive policies
By James Salisi “WORKING WITH REFUGEES CHANGES
your perspective about the challenges of health care and the priorities related to health policies,” said Jad Shedrawy, a first year student in the Master’s Programme in Public Health at Karolinska Institutet (KI). Before starting his studies at KI, Shedrawy worked as a field officer at the United Nations High Commissioner for Refugees (UNHCR) Office in Lebanon. Refugee camps provide temporary relief from armed conflicts, famines or insecurities but are inherently unsustainable without aid from outside or from the communities that they are in contact with. The refugees are vulnerable to infectious diseases, malnutrition, poor sanitation, post-traumatic stress disorder, and violence against women and children. Thus, it is important for humanitarian organizations and the UNHCR to prevent situation in refugee camps from deteriorating. “As most of our work as healthcare professionals focuses on preventing and delaying progression of diseases, with a huge emphasis on emerging antibiotic resistance, when I switched to field work with refugees, I realized that much more basic needs should be gratified and my knowledge could be oriented in a way that lead to even more disease prevention and drug misuse than my clinical work,” Shedrawy explained. Indeed, health care in refugee camps poses a special challenge to government, policy-makers and service providers. It is a key component of protection according to UNHCR. In addition to water, sanitation and shelter, healthcare determines the wellbeing and sometimes survival of refugees according to Médicins Sans Frontières (MSF) manual on Refugee Health. However, deeper issues of rights and status confront displaced populations, even those in refugee camps, around the world that need to be addressed in order
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for the UNHCR and its partner agencies to respond adequately protect them until stability and lasting solutions to the causes of displacement have been found.
THE RIGHT APPROACH BUT INADEQUATE POLICIES
In principle, the approach to the refugee emergency response and to health care in this situation is based on rights and community participation. Therefore the granting of refugee status is important as this defines access to all the rights of refugees that the UNHCR and host countries that signed the 1951 convention are obliged to provide. However, granting refugee status to displaced population takes circuitous routes in some countries. For example, in Turkey, displaced population were initially labeled as “guests” then later on modifying the term as “under temporary protection” without clarifying what exactly these terms mean, according to Birsin Filip in an article published on Global Research website about the plight of Syrian refugees in Turkey.
...the adequacy of protection and the danger of being returned are still issues that need to be addressed. Recently, the United Nations Relief and Works Agency (UNRWA) sounded the alarm on the plight of Palestine refugees from Syria who have suffered from closing of borders and a series of forced returns from neighboring countries. In addition, many Palestine refugees have irregular status in other countries such as Lebanon and Egypt, which bars them from accessing social services and civil documentation. Although host governments to some degree take on the responsibility of pro-
tecting the refugees and providing for their basic needs, in partnership with UNHCR and international humanitarian organizations, the adequacy of protection and the danger of being returned are still issues that need to be addressed.
REFUGEES: HISTORICAL BACKGROUND
Going back to the history of refugee rights helps in understanding the importance of these rights in places where these are not granted. The Convention Relating to the Status of Refugee in 1951 defines a refugee as “any person who, owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership in a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it”. The 1951 Convention and its 1967 Protocol promulgated the rights of refugees which include access to courts, access to primary education, right to work, provision for documentation, including a refugee travel document in passport form and prohibition of expulsion or return or refoulement. Protection of and assistance to the refugees are the objectives of granting these rights. The access to these rights of displaced individuals will be effectively barred if governments vacillate on the status of the displaced crossing their borders.
HEALTH CARE IS A KEY COMPONENT OF PROTECTION
At the heart of protection is the access to primary care. Refugee health care is focused on primary care and is an integral part of the relief and assistance extended to displaced populations. Plans for health
GLOBAL FOCUS
Image credit:Sharnoff’s Global Views (Flickr)
care interventions are based on needs, risks and vulnerabilities. These determinants change as the situation that forcibly displace people and/or the situation in camps stabilize. In the acute phase, UNHCR and its partners focus on measles immunization, nutritional support, control of communicable disease and epidemics, implementation of the reproduction health measures and public health surveillance. During this phase, primary health care fulfills the basic needs of the refugees and contributes to the attainment of the UNHCR mandate to provide protection to the displaced. The services are eventually expanded to include treatment of cardiovascular and chronic diseases and cancers. However, the protracted nature of some conflicts preclude immediate return to normalcy and puts on hold the rebuilding of health systems that could respond to the long-term needs of the displaced populations. Additionally, providing health care to displaced populations where their status is in question becomes increasingly difficult for humanitarian organizations.
PRESENT CHALLENGES
By the end of 2013, the UNHCR reported 16.7 million refugees. They were part of
the 51.2 million individuals who were displaced from their home because of persecution, conflict, generalized violence, or human rights violations - the highest level of displacement on record.
...UN refugee agency may yet see another record high in the number of displaced persons... The displacement of populations is often drawn out for years and puts the refugees in desperate situations. For example, scattered in Syria’s neighboring countries, such as Turkey, Lebanon, Iraq and Egypt, are more than three million Syrians displaced by the armed conflict that started in 2011. Their numbers have steadily increased over the years and are straining the resources of the communities that have accepted them. Refugees with enough resources flee to other countries such as Sweden to start a new life but the vast majority of them have no option but to stay in refugee camps or find temporary shelter in the region until there is peace in their home country.
As 2014 draws to a close, the UN refugee agency may yet see another record high in the number of displaced persons as conflicts in several regions of the world have escalated. The capacity of UNHCR, humanitarian organizations, and governments receiving refugees is being stretched to the limit. In fact, UNHCR spokesperson Melissa Fleming warned of winter crisis for almost a million displaced people in Iraq and Syria, thus prompting the agency to call for increased funding and for foreign aid to enable it to handle not only this imminent crisis but also the other concerns in refugee camps in the Horn of Africa, Liberia, Mali, South Sudan, and the region surrounding Syria. The 1951 Convention and its Protocol may have been adequate in the years immediately after it was ratified but needs to be revisited to respond adequately to the changes in the nature of displacements around the world. Governments need to rethink the policies that govern granting refugee status for displaced populations and pool more resources to respond to acute phases of refugee emergencies and to find lasting solutions to causes of displacement around the world.
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GLOBAL FOCUS
Building the Ebola Training Centre at Karolinska Institutet By Giulia Gaudenzi DURING A WEEK IN OCTOBER SEVERAL
students and teachers from the Industrial Design program from Stockholm’s University College of Arts, Crafts and Design joined forces with the Centre for Global Health at Karolinska Institutet to build a simulated Ebola treatment center. Just in few days an empty sport facility located at ECDC (European Centre for Disease Control and Prevention) became a realistic medical camp to train fieldworkers. The training facility follows Médecins Sans Frontièrs guidelines, making it it as realistic as possible, even with heaters in place to simulate working in hot conditions. The facility was built with continuous interaction between the Industrial Designers and Interior Architect students with the medical staff at Karolinska who have been recently in West Africa, and other experts. Often architecture can help in disaster relief. Architects are system thinkers, trained in producing ideas or solutions by applying their technical, social and environmental knowledge. “A crisis like the Ebola epidemic in West Africa requires a system of rapidly deployable and modular isolation and treatment units” and say Dzenis Dzihic, architecture graduate student from the Royal Institute of Technology doing research on mobile and modular hospital units to be used in a crisis. “In the current Ebola-crisis there is a need to quickly take care of a large number of patients in a short span of time in a specific region of the world – which already suffers from poverty and lacking infrastructure”. “There is a lot of potential for a architects to work on improving and optimizing these facilities”.
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Photo by Giulia Gaudenzi
HONORARY ACKNOWLEDGEMENT – BUT TO WHAT EFFECT? By Gustaf Drevin INFLUENTIAL TIME MAGAZINE MADE PUBLIC ITS ANNUAL PERSON
of the Year on December 10: ”The Ebola Fighters” – such a significant choice. Few stories have inspired us students of the medical sciences as have those pouring out of western Africa lately. These people answered the call when nobody else did, treated when nobody else dared to, and died when the rich countries did not care. But remember; expatriates made up a small percentage, as virtually all deaths of healthcare workers in the outbreak have been national staff. Western media, the United Nations, and even the WHO, should remain under heavy criticism for lagging behind in the fight against the virus. The disease rages on. While Karolinska Institutet’s former Professor Hans Rosling has tweeted that there is “[n]o longer a virus hunting humans. Now we hunt the virus!”, many experts warn that while the increase is slowing, the absolute number of people affected each month reaches a constant level. Imagine the forcefulness of this virus establishing itself as endemic in the region. We are relieved that “The Ebola Fighters” stepped in. Imagine how many lives they have saved in western Africa and have indirectly saved for the future. However, the work is not over, and these “fighters” have probably not yet paid their last sacrifice to the cause. This is maybe why the choice of “The Ebola Fighters” as TIME Magazine’s Person of the Year is so important.
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CULTURE
The history of chocolate By Parvin Kumar
Photo: John Loo (Flickr)
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heobroma Cacao, food of the gods, hardly an exaggeration. Chocolate is a delicious and popular food group. If you’re not in agreement consider yourself uniquely extraordinary, mysterious or incomprehensible. Perhaps you’d rather wax lyrical about coffee. I grant you that. But now let’s talk about chocolates. Chocolate loving is a cosmopolitan affair. You can imbibe the thick warm liquid as ancient American cultures did or eat it as a candy, a relatively modern and European affair. Some have rules for how they eat the creamy blocks. One such routine as follows: Break a small piece. Let it rest on your tongue. Feel it melt away with your troubles. Theobroma Cocoa is indigenous to the luscious tropical forests of America. We have the Mayans and the Aztecs to thank for discovering the food of the Gods, but Linnaeus a Swede to thank for that particular appellation. Today the crop is grown in most of the world’s tropics and spurs a multibillion dollar trade. On the production end you could be a cocoa farmer, a chocolate maker, a chocolatier, a food scientist, an Oompa Loompa or a cocoa climatologist. On the consumption end; well, there’s the rest of us. Cocoa production occurs in the tropical regions of the world about 10 to 20
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degrees north and south of the equator. Today several African countries lead the production in cocoa. The cacao flower is pollinated by a gnat midge and hence the cacao bean is conceived. From pollination to the maturation of the pod it takes about 6 months. The plant flowers perennially and so it is common to find a plant with flowers and pods that have varying states
But now let’s talk about chocolates. Chocolate loving is a cosmopolitan affair. of maturity. The farmer is very careful to make sure that a pod is fully ripe before harvesting as this determines the quality and the taste of the derived cocoa products. Harvest is done by hand as it has been for many centuries. The harvested pods are smashed with a machete and then prepared for fermentation and roasting. The roasting ensures that unwanted germination does not ensue and the fermentation melts the pulp away from the cocoa beans but not before imparting their flavor to the cocoa beans. Next the enriched and fermented beans are laid out on flats
and dried in the sun. Now they are ready to change hands: from cocoa farmers to Oompa Loompas at the chocolate factory. The beans are first sieved and cleaned to remove unwanted non-chocolate making entities. The beans themselves are then winnowed to remove hulls then ground into a paste or made into chocolate liquor. The Dutching process uses alkali salts to reduce the bitterness of cocoa and extract a tangible mass. The paste or cocoa mass is mixed with other ingredients to give us the holy trinity of chocolate: dark, milk and white. The world of chocolate making is complex with many technical and chemical steps between the beans of the cocoa pod and the truffles which you purchase at a master chocolatier in Switzerland. It is a common travesty that chocolate is much more accessible to the rich world even while the beans come from lesser developed agrarian economies. It is often that the farmer who grows the crop for its monetary value has little knowledge of what a chocolate bar tastes like. The first people to experiment with the beans of the cocoa tree were the Olmecs of modern day Mexico. They brewed a drink from the beans which was thought to be invigorating. The Mayans and the Aztecs of central and North America 8th
CULTURE
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Theobroma cacao, Photo: Malcolm Manners (Flickr)
They considered it a food of the divine realm...
century AD offered hot chocolate in chalices to the Gods in gratitude. They considered it a food of the divine realm that had been bequeathed as a gift to humanity. Archaeological evidence suggests that cocoa was creatively taken together with honey, cornmeal, vanilla, chili and the dried flowers of Mesoamerican trees. One anonymous spanish colonial of the Americas describes how the Aztechs made a chocolate drink.
The value of this drink to cure hunger was perhaps the basis for its use as a currency. “These seeds which are called… cacao are ground and made into powder, and other small seeds are ground, and this powder is put into certain basins… and then they put water on it and mix it with a spoon. And after having mixed it very well, they change it from one basin to another, so that a foam is raised which they put in a vessel made for the purpose. And when they wish to drink it, they mix it with certain small spoons of gold or silver or wood, and drink it, and drinking it one must open one’s mouth, because being
foam one must give it room to subside, and go down bit by bit. This drink is the healthiest thing, and the greatest sustenance of anything you could drink in the world, because he who drinks a cup of this liquid, no matter how far he walks, can go a whole day without eating anything else.” The value of this drink to cure hunger was perhaps the basis for its use as a currency. The following list gives us an idea of how the beans were traded with other commodities of value. • • • •
of the humoral medicine system. As in the Mesoamerican cultures it was mainly a drink that was afforded and consumed by the elite and thus was a symbol of status. The consumption of solid chocolate bars and candy was made possible only after the Dutching process was invented by Van-houten. This paved the way for making everything chocolaty from Snickers to chocolate cakes. The rest as they say is history.
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1 good turkey hen=100 cacao beans 1 turkey egg=3 cacao beans 1 fully ripe avocado=1 cacao bean 1 large tomato=1 cacao bean
The Spanish Colonials were the first to introduce chocolate as a beverage to Europe. They used the term chocolatl a marriage between the Mayan word for hot ‘chocol’ and the Aztec word for water ‘atl’. The reason for this was that the word Cacao sounded similar to the term for feces in romance languages. In the 16th and 17th century Europe, hot chocolate quickly became a drink to improve health. In the Baroque era it was a prescribed medicine 45
CULTURE
Feeling the winter blues? A guide to surviving the Swedish winter By Johanna Tauriainen
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Photo: Seth Sawyers (Flickr)
ave you felt a bit down lately? Had the feeling that you would like to attend an activity but refrained since it is too cold outside? Do you feel an increased need to sleep? Do you have problems adjusting to the fact that the sun sets at 15:00? Well, the Swedish winter has arrived and it is truly long, dark and cold. This time of year many residents in the Northern countries experience the winter blues. The major cause of the winter blues is the lack of sunlight, which decreases our production of melatonin, a hormone that regulates the sleep cycle and that usually reaches its highest levels during nighttime. The dark also affects the levels of serotonin, a neurotransmitter, known to be involved in depression. During December and January our levels of serotonin reach their lowest levels, adding to the winter blues. The lack of sunlight also affects the circadian rhythm that, in part, is influenced by sunlight, causing many people to feel an increased need for sleep. Many of us experience the winter blues, but approximately 12 million people in Northern Europe suffer from actual depression during the winter, a disorder appropriately termed SAD (Seasonal Affective Disorder). In these cases medical attentions is required. Luckily, not all of us suffer this bad, but the darkness and the cold can make anyone miserable, so Medicor has compiled a guide for how to survive the Swedish winter.
KEEP WARM
If the cold is what’s getting to you, there are easy solutions. Invest in high quality winter clothes like woolen socks, long johns, winter boots, a warm hat and gloves, and a winter jacket. It won’t help against the darkness, but you will never freeze again.
SUNLIGHT
Lack of sunlight is the major factor causing the winter blues. So whenever possible, try to soak up some daylight. Going for a walk during lunchtime is a good idea. Another suggestion is to take up ice-skating or cross-country skiing or any other winter activity. This will require snow and some appropriate clothes, but once you get the hang of it, you’ll actually keep pretty warm even though the temperatures are low. These activities not only give you an opportunity to get some sunlight but also some physical exercise, which is proven to decrease depression. If you are not one for sports, gather up some friends and channel your inner child – go sledding, arrange a snowball fight, build a fortress out of snow. Preferably bring a large thermos with something hot to drink to keep warm. If you cannot find true sunlight, there are artificial alternatives. Light therapy is commonly used to treat Seasonal Affective Disorder. In Stockholm, several light café’s offer light therapy. The treatment consists of hanging out in a room with special lights, mimicking sunlight, for 1-2 hours, while having tea, reading a book or even doing yoga. The exposure to light is said to make up for some of the lack of sunlight and might thus help those suffering from the winter blues. 46
FAKE IT ‘TIL YOU MAKE IT TO SUMMER
Arrange a summer party. Prepare summer-themed food and drinks and have a dress-code for summer clothes (though, on the way there you might need to put on your long johns). Make a playlist of summer songs and for a couple of hours, get reminded of those summer feelings. Visit a beach volleyball hall – it’s like visiting an indoor beach! Even if you don’t enjoy volleyball, many halls also have a restaurant part where you can hang out after enjoying the feeling of walking bare-foot on warm sand.
INDOORS ACTIVITIES
Turn the darkness into something positive! Light candles, invite your friends for dinner, watch a movie or find a TV-series to follow (preferably one that will last through the winter). Cuddle up on the sofa underneath a warm blanket with a cup of hot cocoa and enjoy a good book. Enjoy long baths or treat yourself to a spa visit to get your mind off the winter blues. Arrange a glögg (Swedish mulled wine) party and warm yourself with a bit of glögg and gingerbread cookies.
Finally, if none of these things work, do as the Swedes do – book a trip to Thailand for a week or two of sunbathing.
CULTURE
The Elephant By Mikael Plymoth
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