medicor medicinska föreningen i stockholm
38 Insight with Åsa Nilsonne
2015 #1
20 SEK
18 The True Face of ‘Three Parent Babies’
THE KING OF INFOTAINMENT
Jesper Rönndahl turns science into stand-up.
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Prelude
Have you heard? WE FEEL THAT MEDICOR IS SUCH AN AMAZING MAGAZINE SO
Photo by Jingcheng Zhao for Medicor
we want to spread the word and give more people an opportunity to read the articles and see the photos. Therefore we are currently working on a project to expand our audience but more on that later. First of all we have a great new issue featuring Jesper Rönndahl, or as he calls himself: The king of infotainment. A welldeserved name as he is truly great at taking science and explaining it in an easy-to-understand humoristic way. Don’t miss out on this exciting interview! Spreading the word is actually a bit of a theme with this issue where we have an extended Insight section featuring senior professor and author Åsa Nilsonne. We talked to her about her motivations, career and her new book “H”. And as always the magazine is filled with a lot more articles including an overview of the new UK law on “three parent babies”, the story of how sugar came to be a part of our everyday life and the first successful uterus transplant. Almost forgot, what about our new project? Well, as you’re reading this our new website is currently up and running. How awesome is that!? Hopefully this will become a complement to the printed magazine and make the wait between issues easier. There you will also find all the old issues and much more. So make medicor.nu your new homepage, save it on your smartphones and tablets and come with us on this new adventure. By the way, do you think you have what it takes to become the next Editor-in-Chief of Medicor? Sure you do, if I can do it how hard can it be right? Send us a mail to chefredaktor@medicor.nu for more information. Until then, enjoy!
Medicor Magasin Grundad 2006. Nionde 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.
Sincerely, Robert de Meijere Editor-in-Chief
Cover photo by Martin Kjellberg for Medicor 2
Overture COVER STORY
KAROLINSKA
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CORPUS KAROLINA Yasmine Djoumi takes us behind the scenes of Corpus Karolina.
COFFEE HOURS WITH S.O.G.H. Sibel Ilter on the Swedish Organization for Global Health
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THE FESTIVAL OF COLOURS The story of how the ancient Hindu religious festival came to KI
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BREAKING THE TABOO
THE KING OF INFOTAINMENT
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IS THERE A VIOLENT EXTREMIST PROFILE?
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“I LOVE THINGS WE DON’T KNOW ABOUT YET”
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MEDITATION AND BREATHING
WHY DO WE STILL HAVE IT AROUND? We know the cause and cure of Malaria. Devy Elling on why it is still a global health problem.
INSIGHT
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Jessica De Loma Olson on cutting and pasting our genome
UTERUS TRANSPLANTATION Mimmi Mononen and the new era of reproductive medicine.
CULTURE
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SUGAR
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COMICS
NATURAL SELECTION Darwin’s theory in the human body, from affinity maturation to antibiotic resistance.
Haroon Bayani on the obesity pandemic as a ticking bomb.
Halima Hassan on the science behind mindfulness.
Halima Hassan show us the true face of “Three Parent Babies”
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OBESITY
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SCIENCE
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What research suggests about individuals who turn to extremist violence.
An inspiring interview with Jesper Rönndahl.
CHROMOTHRIPSIS
GLOBAL FOCUS
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“YOU CAN’T JUST SAY THE BRAIN BELONGS TO NATURAL SCIENCES”
The 500 years of history of a once highly valued product.
Some comic relief from Mikael Plymoth and Anny Truong
Medicor talked with Dr. Nilsonne about her career, her motivations for writing and her newest book “H”.
medicor Robert de Meijere • Editor-in-Chief | Oskar Swartling • Associate Editor | Andrey Pyko • Creative Director Ibrahim Rayyes • Proofreader General | Yasmine Djoumi • Producer | Jessica De Loma Olson • Web Manager | Halima Hassan • Editor of Global Focus Sibel Ilter • Editor of Campus | Iskra Pollak Dorocic • Editor of Science | Poya Livälven • Editor of Culture Irina Pader, Johanna Tauriainen • Reporters | Martin Kjellberg, Anna Vidina • Photographers | Verena Kohlbrenner, James Salisi Haroon Bayani, Karolina Werynska, Erik Müllers, Jens Magnusson, Devy Elling, Mimmi Mononen, Maria Movin • Writers Fergal Horgan, Parvin Kumar, Susanna Atrushi • Proofreaders | Mikael Plymoth, Jakub Lewicki, Anny Truong • Illustrators
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Aperture Holi, also known as the festival of colors or the spring festival has reached KI. The essence is that covered in colors everyone looks the same, everybody is equal and strangers become friends. Read more on page 12. PHOTO BY: SHAHUL LIYAKATH ALI
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Smörgåsbord
Cancer breakthrough
FIRST PUBLICATION AT THE AGE OF EIGHT? A CANCER RE-
searcher at Manchester University asked his little daughter how she would treat cancer stem cells and tested out her idea of using antibiotics. To his surprise, the results were more promising than expected, so he included his daughter as third author on the publication. He himself was listed last.
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It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals ABOUT
40
YEARS
AGO,
PSYCHOLOGIST
DAVID
Rosenhan came up with a creative method of testing psychiatric diagnoses: He instructed eight pseudo participants to briefly report auditory hallucinations to gain admission to psychiatric hospitals but to behave as they normally would afterwards. All were diagnosed with mental disorders and had to take antipsychotic drugs as a condition of their release. Hearing of the events, one hospital challenged Rosenhan to send pseudo participants. Out of 193 new patients, 41 were identified as pseudo participants. In fact, Rosenhan had sent no one to the hospital.
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Mexico DESPITE PROOFREADING, PEER
review and copyediting, minor imperfections are found in published papers every now and then. This way, an unfortunate self-note was published in a recent issue of Ethology. In the middle of a sentence a comment was included asking “should we cite the crappy Gabor paper here?” Only spotted after five months, the paper was updated and information was added that “the following reference has now been included: Gabor, C. 1999” and the authors apologized for the impolite mistake. Lesson learned: It might be better to just leave mocking remarks out of manuscripts.
Sweden YOU MIGHT ALREADY HAVE HEARD IT:
There is an ongoing contest between a small group of researchers at Karolinska Institutet to slip Bob Dylan quotes into research papers. It all started 17 years ago with an article published in Nature Medicine titled “Nitric Oxide and Inflammation: The answer is blowing in the wind.” The winner
will be the one who quotes Bob Dylan in most scientific articles before going into retirement and gets nothing less than a lunch at Jöns Jacob as the prize.
Australia
FOOTNOTES REFERRING TO THE LISTING
of author names tend to seek little attention in publications, however, it can be worth to take a closer look. Reading the small print can introduce you to the method of determining the order of authorship, from “ a twenty-five-game croquet series” to “by a tennis match” as a paper published in the Australian Journal of Agricultural Economics states.
USA TEN YEARS AGO, A GROUP OF
graduate students at Massachusetts Institute of Technology created a program called SCIgen that randomly generates fake computer science research papers. Thanks to SCIgen, fake papers have been routinely published in scientific journals, even leading to a fake author briefly becoming the 21st most highly cited scientist in Google Scholar’s database and Maggie Simpson and Edna Krabappel starting a scientific career.
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Springer and IEEE removed more than 120 papers from their subscription database after it was discovered that they were computergenerated. 7
KAROLINSKA
Corpus Karrolina - 101 By Yasmine Djoumi
A MAN AND A WOMAN ARE STANDING
on stage – hold on was that really a woman? There is tension and sparks between them. “Kiss!” someone shouts from the public. The actors have no choice but to obey. You might be wondering what this is all about. Spring time marks the beginning of a new term, longer days and warmer weather. But to some spring time also equals to Corpus Karrolina’s return to the stage. Many have asked what Corpus Karrolina really is, so here comes your answer. Corpus Karrolina is Medicinska Föreningens male farce theater troupe, or Spex, as it is called in Swedish. It was founded in year 1977 with the first Spex “Karrolina”. Even though the story of that Spex is unknown and lost in the years of history, its name is still commemorated in the title of the troupe. Since then, 36
Spex productions have been performed in theaters all over Stockholm, from Bristol in Sundbyberg to Scala in downtown Stockholm, and even a promotion appearance at Cirkus. The 37th production, which theme is still a secret (a trailer will be released in the future), will be performed at Alias theater at Hälsingegatan 3, premiering on April 21st.
Throughout spring there is a great spirit amongst those who are involved, and bonds of friendship are made for a lifetime. Now some of you might be wondering what a Spex really is? A Spex is a theat-
er piece written with a humorous prose usually with some sort of lesson. The best thing about the Spex is that anyone can contribute to the performance. If you would like to change the development of a scene, you can shout out a command to the actor to change their actions or to storm off the stage. This opens up a dialogue between the actors and the public, making it a whole new way to experience theater. Members of Corpus are of all genders, programs and ages. While those on stage are predominantly male (though, some of them play female roles, and do so very well), behind the stage is a whole different matter. To make a production work and happen, several groups must unite in order to reach a common goal. There is a board who decides the overall matters of theaters, such as directors, a costume group, a make-up group, a music group – you name it. Throughout spring there is a great spirit amongst those who are involved, and bonds of friendship are made for a lifetime. In that sense, Corpus is not only about theater. Several performances are held during the MF parties, committee arrangements, the exam celebrations and more. Corpus Karrolina is a great outlet for creativity in the midst of your studies. Whether you are eccentric or taciturn, a backyard musician or simply a lover of the art, everybody is welcome to join the Spex family!
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Photo: Yasmine Djoumi
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KAROLINSKA
Hej där! Vi ses på nästa InnovatiOnsdag! Välkommen till en inspirerande föreläsningsserie om allt från banbrytande medicinska innovationer till hur man ska använda crowdfunding för att finansiera sin idé! Lyssna på erfarna talare som är ledande inom sitt område och utbyt idéer med andra deltagare. Dessutom ingår lunchmacka! Läs mer på ki.se/innovationoffice
Innovation Office 9
KAROLINSKA
Coffee Hours with By Sibel Ilter Photo by Anna Vidina THE PROFOUND ADHERENCE TO CAF-
feine among students and staff of the Karolinska Institute is not a myth and – for that very special group of coffee fanatics who are yet to find out – neither is the chatter of the freshly brewed KI hour, the “Coffee Hour.”
S.O.G.H. have directed their focus toward the Sub-Saharan countries of the African continent. In fact, the Coffee Hour is known as one of the more effective methods of allurement among the different KI societies. On several occasions throughout the year we have witnessed Coffee Hours hosted by both international and smaller KI communities, events which have resulted in visits by a satisfactory number of students. As of recently, however, a
new particular organization has been registered on that list. Every Wednesday between eleven and one o’clock, Karolinska students of the Swedish Organization for Global Health reside in the entrance of the Solna school library to arrange their own adaption of the Coffee Hour. Their purpose? Distributing free coffee. The ambition behind this purpose?
THE MAAMA PROJECT.
As of summer 2014, members of the Swedish Organization for Global Health, S.O.G.H for short, have directed their focus toward the Sub-Saharan countries of the African continent. The donations raised from the Coffee Hours here in the Northern part of the world is done to fund the progression of the described Maama project, a special charity program unfolding on lands four-thousand miles further South. In return for the donations, the Maama project primarily sees that expectant Ugandan mothers are gifted with the commonly-named “birth kit”. The birth kit contains the supplement of essential material to promote safe and hygienic delivery. In relation to infections, a consistent implement of hygiene measures is imperative, which leads us to the second goal of the Maama project – increasing the antenatal care. The antenatal attendance serves an essential role in raising awareness of maternal
and new-born health, pregnancy danger signs, and also assists in detecting HIV. In order to enhance the antenatal attendance amongst Ugandan mothers, the Maama project ensures that the birth kit is offered to the mothers after their last visit of antenatal care. It is seldom that the impact a few
...this summer means closing the fourthousand miles long gap between Sweden and Uganda. coins could have across the world goes noticed by casual by-passers and students. To catch their interest, one must first have their attention – hence the coffee, the S.O.G.H members seem to say. For having started only the previous fall semester, the S.O.G.H have managed to organize a numerous amount of Coffee-Hour events in the booked library spot by the entrance, and have intentions to continue with these reoccurring hours, every Wednesday, throughout the rest of the spring semester. Once the cradle of science and knowledge, the S.O.G.H transform a corner of the library into a small, flexible event. During lunch, there is a constant presence of students in the library. Sometimes, students mold into groups, some eager to have a coffee, some eager to have a cookie, and others both.
It is seldom that the impact a few coins could have across the world goes noticed by casual by-passers and students.
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KAROLINSKA
Eventually, as rush-hour wears on, the afternoon lectures start and the herds lessen, leaving room for chitchat between S.O.G.H members and two or three curious students, eager to know more about the organization.
OF COURSE, THERE IS MORE.
In a few short months, KI students will be finishing off their final examinations for the spring semester. For most, what comes after that is a long summer of reoccurring visits to the beach and flaky skin. For a selected number of KI students, however, this summer means closing the four-thousand miles long gap between Sweden and Uganda. While some of these members will proceed into evaluating the progression of the Maama project in the respective project areas, others will be working alongside nurses and doctors in clinics and hospitals, most of which are medical students. For some of these medical students, this will be their first encounter with patients in a hospital environment. At one o’clock, the S.O.G.H members proceed to pack up and dump any remnants from their weekly event. At two o’clock on those Wednesdays there are no traces left of the S.O.G.H group except the distinct smell of coffee which seems to linger on for a little longer.
S.O.G.H.
The Swedish Organization for Global Health was founded summer 2014 by students from the Karolinska Institutet. Today they work as a non-profit organization alongside their partners of other NGOs (non-governmental organizations) in low-income countries, expanding and establishing old and new projects. In Rwanda, for example, the implementation of a sexual health education program is under progression. The program will train Rwandan university students and educators in matters of sexualand reproductive health and contraceptives. A partnership with the Health Development Initiative has allowed them to expand their Rwandan project into teaching about the topic and similar issues in secondary schools of more rural areas of Rwanda where STIs (sexually transmitted infections) and teenage pregnancies are high in prevalence. More information about the different projects can be found on www.sogh.se.
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KAROLINSKA
The Festival of Colors at KI By Erik Müllers HOLI IS AN ANCIENT HINDU RELIGIOUS
festival also known as the festival of colors or the spring festival. It is a thanksgiving celebration for a good harvest and it celebrates the victory of the good over evil spirit Holika. Like the Valborg celebration in Sweden it marks the end of the winter and the approaching of warmer, sunnier times. The essence of Holi is colors. People chase each other with bright color powder in a playful fight where everybody can take part. Covered in colors everyone looks the same, everybody is equal and strangers readily become friends. Last spring, when the sun slowly started to warm up Stockholm, Shahul Hameed, an Indian PhD student at the
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department of Cell and Molecular Biology (CMB), had the idea to celebrate the arrival of the summer season the way that Indians do – by bringing the joy and happiness of Holi to KI campus.
Covered in colors everyone looks the same, everybody is equal and strangers readily become friends. Shahul teamed up with Jonathan Mudry and Erik Müllers and, together
with many friends and generous support from the Department of Molecular Medicine and Surgery (MMK), the Department of Cell and Molecular Biology (CMB) and the International Committee of Medicinska Föreningen, they started organizing the first ever Holi festival at KI. Shahul had celebrated Holi with friends and colleagues already in the years before, but an event for everybody in KI was a different story. “Organizing the colors was trickier than I first thought. I couldn’t find them in Sweden and we also couldn’t order colors from India, because these are not certified by the European Union.” explained Shahul. “In the end it worked out to get six boxes
KAROLINSKA
of colors shipped from Germany - purple, yellow, pink, green, blue and orange.” These so-called Gulal colors are made from cornstarch and herbal ingredients, making them non-toxic, biodegradable and easy to wash out. The colors arrived in Stockholm on time and thanks to many helping hands lots of BBQ food, cold drinks, music and games were prepared. Even the Stockholm weather played along. With sun, blue sky and summer-like temperatures more than two hundred people gathered, curious on what was about to come. These were way more people than expected and so there were some queues at the grill waiting to taste Shahul’s homemade spicy chicken. After the food the color fun was set to begin. Participants started chasing and
coloring each other with the bright color powder, having water fights and throwing color-filled water balloons. Within minutes the lawn in front of Jöns Jacobs blurred into a colorful mess of laughing, playing, dancing and singing.
With sun, blue sky and summer-like temperatures more than two hundred people gathered... Following the true spirit of Holi festival in India, the festival of colors at KI brought people from all over the world
together enjoying a day of colors and happiness. Motivated by lots of positive feedback after last year’s event, the three organizers are back to bring the KI community an even more colorful day this year. In India Holi is celebrated on the 6th of March, but as Stockholm is usually covered in snow that time this year’s festival of colors will take place in May. More information will be coming up soon. And if you like to join the team to help organize ‘Holi 2015 – The Festival of Colors at KI’ you are more than welcome to contact Shahul, Jon or Erik.
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Photos by Shahul Liyakath Ali
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SCIENCE
Science snippets By Jens Magnusson, Irina Pader, Iskra Pollak Dorocic LANGUAGE EVOUTION LINKED TO CLIMATE If you’ve ever tried to learn Chinese, you might have found it difficult to master the fantastically varied pronunciation of its vowels. In contrast to English or Swedish, the tonal complexity of Chinese is very high. In a new study, researchers found that tonal complexity tends to be higher in languages that evolved in warm, humid climates (like Chinese) than in those where it’s cold and dry. This is because humidity affects the precision of the vocal cords. As a result, speakers in arid spots have come to rely less on tonal variations for transmitting information. (Everett et al., PNAS, 2015)
WAKING UP NEURONS As spring arrives, mammals that have spent the winter in hibernation are waking up. This poses a surprising challenge to their brains. Synapses, the connections between neurons, have degenerated during the cold winter, in a process similar to what happens in early stages of Alzheimer’s disease in humans. Unlike humans, hibernating mammals re-establish lost synapses perfectly upon waking up. A new study found that RBM3, a cold-shock protein, is responsible for this synaptogenesis. The results suggest cold-shock as a potentially protective therapy for neurodegenerative diseases. (Peretti et al., Nature, 2015) Image credit: michael davis-burchat (Flickr)
IMMUNE SYSTEM NOT ONLY GENETIC Have you been sick the whole winter and asked yourself why everyone healthy seems to be blessed with better genes? New research suggests that it is our life habits and environmental factors that determine our immune system and not our genes. In this study, 105 healthy twin pairs were vaccinated against the flu and 204 parameters were analyzed in blood samples from before and after the vaccination. Interestingly, most of the parameters were influenced by diet, prior infections and environmental influence instead of the genetic background. (Brodin et al., Cell, 2015)
YOUNGER SCIENTISTS MORE INNOVATIVE A new study has shown that the conventional wisdom is true: younger researchers are more creative than old ones. Analysis of 20 million biomedical papers found that junior researchers published on more innovative topics than their senior counterparts. The method could not directly measure creativity, rather the researcher’s eagerness to embrace new ideas, by looking at key words in titles and abstracts of papers. All is not lost for older scientists though, a previous study showed that the age at which scientists make Nobel Prize winning discoveries is in fact going up. (Nature News, February 15, 2015)
LESS CANCER PROTEIN, LONGER LIFE Mice live longer, seem to age slower and are healthier if they express lower levels of the cancer-promoting transcription factor MYC. MYC is required for survival as it promotes cell growth, but high levels are often found in cancer. Recent research shows that low levels of MYC, e.g. mice with only one copy of the Myc gene, lived 15 % longer than those with two copies of the gene, although both mice types developed identically. But mice with low levels of MYC had a faster metabolism and less severe age-related conditions. (Hofmann et al., Nature, 2015)
Image credit: Tambako The Jaguar (Flickr)
Image credit: Allan Ajifo (Flickr)
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HUMAN VS MOUSE BRAIN The human brain is unique because of its size and the folded structure of its cortex, something that animals with smaller brains lack. Scientists have now found one gene which seems to be involved in these evolutionary changes of our brains, and thus our cognitive powers. The team genetically compared the stem cells of human and mouse brain tissue. The human brain expressed 56 genes which the mouse didn’t, the most active of which is ARHGAP11B. This gene was then inserted into the mouse genome which resulted in doubling of the animal’s cortical stem cells, and even in some cases developing of cortical folds. (Florio et al., Science, 2015)
SCIENCE
“True or false?” that is the question
Illu
str
Your mind is a trickster
ati
on
:J
ak
ub
By Karolina Weryńska
WE ARE BUILT BY OUR PAST AND IT
acts as a foundation for our future. Everything that has happened has been woven into our psyche. There is no way around it, just simple physics: action-reaction. Waking up, you safely know who you are, where you are and what brought you there. This safety is provided by your memories, good or bad, they stabilize your universe by setting a context. However, consider for a moment that what you deem a fact is actually a fallacy, your memories are false. Could that be? You are probably thinking: psychosis! Give the poor fellow anti-psychotic drugs and be done with it. Unfortunately, the issue is more complicated. Surprisingly, false memories are quite a common occurrence. Scientists agree that memories are highly suggestable and can be altered by external factors. Most likely, all of us have some memories that are not our own. A photo or a story about the early childhood could make us believe we remember the event first-hand. There have been indications that probing questions or hypnosis can induce false memories. In fact, there is a therapeutic process called a recovered memory therapy, where allegedly repressed memories are restored. In the most severe cases patients started wrongly believing themselves to be victims of child sexual abuse. Naturally, there is much controversy around the subject, and it is not included in mainstream psychiatry. On the other hand, there is another face of false memories. Imagine, a sudden, overwhelming belief enters your life that you are a murderer. You know that is true, you remember after all. The strength of
the experience remains haunting, orientating your very being around it. Furthermore, all contrary evidence is ignored or avoided. In that case anti-psychotic drugs will probably be involved. False memory syndrome could be dangerous and shouldn’t be taken lightly. Confabulation is another syndrome associated with false memories. Induced by brain damage or dementia, this disorder is manifested by fabricated, misconstrued memories. It leads to bizarre lies, with no malicious intent as people believe the information is correct. Simple confabulation may have its origin in damage of the medial temporal lobe (where the hippocampus is located and memories are formed), whereas the more fantastic form is assumed to be caused by dysfunction of the frontal cortex (abstract thinking). Another intriguing phenomenon is cryptomnesia. Here, a memory returns, but is not recognized - therefore, considered as a novel thought. This brilliant idea appears just waiting to be used and there is no doubt in your mind – it is your own creation. The situation could very easily lead to unwitting plagiarism. Indeed, it has happened before. Let’s look at a case of a
great, albeit controversial thinker, Frederick Nietzsche. In his book “Thus spoke Zarathustra” he describes an incident almost identical to the one included in a book he read as a young boy. His progressive neurosyphilis and (suspected) frontotemporal dementia could very well be a reason behind that cognitive deterioration. He’s not the only one! Lord Byron (one of the greatest British poets) or Robert Louis Stevenson (the author of “The Treasure Island”) are also suspected of a bout of cryptomnesia. Trust your mind! Just not unconditionally. Whilst in most cases memories are more or less accurate, never forget that they are fluid and mischievous beings. Considering, they can subtly transform without your notice, a hint of doubt could prove beneficial if the situation demands. Time changes everything, memories included. A distortion now and then is not yet pathological, the worry should start once the quality of life is influenced.
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SCIENCE
Chromothripsis – A Miraculous Catastrophe Cutting and pasting our genome By Jessica De Loma Olson
Illustration: Jakub Lewicki
CAN YOU IMAGINE YOUR CELLS DOING
patchwork with your genome? Cutting and pasting together fragments to produce a new work of art. In 2011, a study led by P.J. Campbell from Cambridge defined it as chromothripsis: a single catastrophic event for a chromosome. During a short period of time and in a specific region, the chromosome is cut into fragments and randomly rearranged back together, altering the chromosomic structure. Pure chaos for your initially neatly organized chromosomes. This process was first described when sequencing the genome of a patient with chronic lymphocytic leukemia. There were 42 rearrangements in chromosome 4. After this initial discovery, the new phenomenon has been linked to 2-3% of all cancer types and 25% of bone cancers. Common cancers with up to 100 rearrangements are melanoma, small cell lung cancer and colorectal cancer, just to name a few. The importance lies not only in linking this concept to cancer but, if so, how it would change our definition of it. The current idea is a gradual gain of mutations spread through multiple chromosomal locations accumulating over decades. But chromothripsis could shift this paradigm. With only one hit, the structure and the number of copies of multiple genes could be altered. When this happens, typically in biology there are two options: adapt or die. And this is also the case when chro-
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mothripsis occurs. If essential genes are affected, the cell will die. But, on rare occasions, the shattering alters genes involved in cell growth and increases it. So, what unchains this chromosomic explosion? M. Jones and P. Jallepalli proposed in their 2012 paper in Developmental Cell that DNA double strand breaks (DSB) could be the trigger. Cutting both DNA strands, as if you had a pair of scissors, can be caused in nature by ionizing radiation, failed cell death and stress during DNA replication, among others. Once these DSBs are formed, the cell can fix them in a tidy way by specific repair mechanisms, die if they are unbearable, or if this death is avoided, chromothripsis can come into play.
If the Hulk existed and needed a biological explanation, chromothripsis would probably be it. Despite the facts and figures, some scientists are still skeptical. C. Righolt and S. Mai state that for now there is not enough data to confirm that these multiple arrangements actually occur all at once. If it does occur in a single event, is one event enough to lead to cancer? It is also questionable if the concept of chro-
mothripsis fits the idea of tumor heterogeneity, where different cells within the same tumor present distinctive characteristics. All in all, these authors suggest using the safer term complex rearrangements instead of chromothripsis, which implies a specific time frame. However, no matter if the term is adequate or not, there seems to be some magic behind the science. Fun fact: If the Hulk existed and needed a biological explanation, chromothripsis would probably be it. Scientist Sebastian Alvarado from Stanford University believes that if it were to happen, this chromosomal shattering would be the only current way to explain his superpowers. But miracles do happen in real life. It is the story of a 58 year-old woman that used to suffer from WHIM syndrome, a genetic immunodeficiency characterized by a mutation in the chemokine receptor CXCR4. She presented warts and multiple infections since birth. At the age of 38, she suddenly stopped having them. She was cured. A study from 2015 published in Cell by D. McDermott and J.L. Gao showed that the affected gene and 163 other normal genes were lost. It was the result of chromothripsis. Gene CXCR4 was just in the right place at the right time, confirming there are always two sides of the same coin. You just have to be lucky when you flip yours.
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38 Insight with Åsa Nilsonne 16 The 5:2 Diet with Kerstin Brismar
32 The Ebola Epidemic in West Africa
38 Insight with Elizabeth Blackburn
A SPACE ODYSSEY
THE FIGHTER
Christer Fuglesang and how our body functions in microgravity
Nadja Casadei never lets anything stand in the way of her goals 1
‘Th
THE KIN OF INFOTAINME
32 Nobel Prize winner Edvard Moser
Jesper Rönndahl turns science into
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Do you want to be the next Editor-in-Chief of medicor? Contact chefredaktor@medicor.nu for application and more information.
medicor
Tell your story. 17
SCIENCE
Breaking the Taboo: The True Face of ‘Three Parent Babies’
By Halima Hassan ON FEBRUARY 3RD, POLITICIANS IN THE
UK came together to become the first country to approve a motion that would change the limits of assistive reproductive technology forever. The mitochondrial donation in vitro fertilization technique, more popularly referred to as the ‘three parent babies’ technique, is a procedure which allows couples to have children without mitochondrial diseases. Mitochondria are organelles present in the majority of our cells, responsible for producing the energy we need to function. They contain a small amount of genetic material; overall the sum of mitochondrial DNA is just 0.054% of all DNA. Because of the important role mitochondria have, inherited mitochondrial diseases, which result from mutations in the mitochondrial DNA, are severe and lead to a low quality of life. What this procedure enables is an opportunity for couples observed to carry harmful mitochondrial mutations to have disease free children that are genetically theirs. This revolutionary technique could transform the lives of many people, allowing those who previously thought they could not conceive healthy children to do so, and for those children to lead full lives. An example of an inherited mitochondrial disease is Leber’s hereditary optic neuropathy (LHON). Inheriting LHON leads to the degeneration of retinal ganglion cells and their axons resulting in acute or sub acute loss of central vision. This disease, as with most inherited mitochondrial diseases, affects predominantly adult males. This is because transmission of inherited mitochondrial diseases is through the mother, as only the egg contributes mitochondria to the embryo. To outline this technique: the isolated nucleus from the egg of the mother is inserted into an enucleated (nucleus-lacking) egg of another woman, with healthy mitochondria. If this nuclear transfer is done prior to fertilization with sperm from the father, it is called ‘Maternal Spindle Transfer.’ If the nuclear transfer into an enucleated egg from a healthy do-
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nor occurs after fertilization, it is called ‘Pronuclear transfer.’ This technique was developed by scientist Doug Turnbull, Professor of Neurology at Newcastle University, and the findings were published in 2010. The approval of this technique by the UK government has simply made the issue legal in the eyes of the UK authority; individual licenses are yet to be issued to facilities that can provide mitochondrial donation to families. In order for a facility to be approved and licensed they would have to demonstrate that they have the appropriate knowledge to carry out the procedure safely and effectively. Treatment for patients would require approval on a case-by-case basis, based on scientific evidence and advice submitted to the facility in question. It is important to note that mitochondrial diseases caused as a result of mutations in the mitochondrial genome, which this technique would successfully prevent, only represent 15% of all mitochondrial diseases. Without getting into too much detail, many of the proteins mitochondria require to function correctly are encoded by nuclear DNA. Therefore if a mutation in the nuclear genome affects a protein destined for the mitochondria, a whole host of other diseases can arise. Notwithstanding this limitation, the new treatment should be an appreciated addition to fertility clinics.
Those lacking a biological background may well interpret, from the headline alone, the procedure to be one that generates a baby from three parents... The initial concerns and hesitations regarding passing this motion were based on the incorrect belief that this technique would indeed result in three parent babies; a belief based on ignorance of the differences between mitochon-
The Science Behind It Illustration: Robert de Meijere
drial and nuclear DNA. Not only has this gross mislabelling confused politicians, but also many ordinary people who accessed these reports and headlines. Inaccurate headlines like this can lead to reduced public acceptance and can raise fear among the target patient group for this treatment. Although very few articles condemned the technique, headlines alone can act to denigrate someone’s work and instill negative connotations into the minds of readers. Those lacking a biological background may well interpret, from the headline alone, the procedure to be one that generates a baby from three parents, not understanding that the egg donor is only contributing mitochondria to the future child and nothing else. It is nuclear DNA that determines our appearance and personality and this technique will keep nuclear DNA, from the two parents, intact. A further controversy has been the existence of a study by a group in China where the procedure had been performed, which has not yet happened in the West, with tragic consequences. The treatment was carried out by an American clinician on a single patient in China and as a re-
SCIENCE
1
2
The mother’s egg containing faulty mitochondrial DNA is fertilized with the father’s sperm in a laboratory.
The parents’ genes are then transplanted into a donor egg with healthy mitochndrial DNA.
3 The reconstructed embryo is then implanted back into the mother resulting in a baby with three genetic parents.
Parents’ genes
Faulty mitochondrial DNA sult the patient became pregnant with triplets, one of whom was aborted and the other two born prematurely and died. It is important to note however that the clinician attributed the outcome entirely to multiple pregnancy and obstetric complications and not to the method of conception. Mitochondrial donation has, overall, been well received as shown by the approval of the UK government and the fact that this has stimulated many countries to also reconsider their policies in embryonic research. This acceptance can be attributed to great science communication and increased public engagement of the scientists involved. Professor Turnbull has, since the early days of developing this technique, publicly advocated for it, speaking to potential patients, church groups, the media and politicians to build support for mitochondrial donation. Ultimately it is only with support from the public that any scientific finding could be incorporated into society and change lives for the better. Turnbull mastered scientific communication and learned how to communicate his findings accurately but in a way that
Donor’s gene removed
can be easily understood by the layman. What Turnbull’s plight has shown is how crucial scientific communication and public engagement of scientists remains to be for the progression of science itself. Without engagement, a scientist’s work may remain in the confines of a lab and never impact lives like science should.
“We have within our reach the possibility of eradicating mitochondrial disease... For the few who remain skeptical, it is important to remind them of a procedure that when it was first approved was met with a lot of hostility and is today widely embraced: In Vitro Fertilization (IVF). IVF brought hope into many lives and if anything, mitochondrial donation is simply the next step in allowing families to have their own biological children. With time, I think mitochondrial donation will too be viewed in such a positive light. I would like to conclude this piece with a quote from Luciana Berger, min-
ister of public health to the UK government: “We have within our reach the possibility of eradicating mitochondrial disease from families who have been blighted by it for generations: families who have endured a disease for which there is no cure, who have suffered daily battles with painfully debilitating symptoms, and who have sadly lost their children prematurely. Those families have had to face up to the risk, and perhaps the certainty, that to be a parent must come at the expense of a difficult and, in too many cases, painful life for their children. Not only would children born through such techniques be free of such conditions, but so would their children and grandchildren. This treatment would break a chain of misery that would otherwise have ruined generations of lives.”
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SCIENCE
Natural Selection in the Human Body
By Oskar Swartling AFTER HIS VOYAGE WITH THE BEAGLE,
Charles Darwin started to go through the massive amounts of notes he had written during the almost five year long trip around the world. With these notes, including a tree of life with the words ‘I think’ written above it, Darwin composed what would later be known as The Origin of Species by Means of Natural Selection or the Preservation of Favored Races in the Struggle of Life. During the authorship, Darwin received an essay from the field naturalist Alfred Russel Wallace. He presented almost the exact same theory, although lacking the extensive amount of data that Darwin had collected during his travels. Darwin’s papers and Wallace’s essay was published together in 1858. The theory of evolution by natural selection is arguably the most important scientific concept of history. Since it was presented by Darwin and Wallace it has not only explained a lot of the wonders we are surrounded by, but has also been essential for the advancement of an array of scientific fields. Evolution never stops to amaze, best described by the famous evolutionary biologist Richard Dawkins: “We are surrounded by endless forms, most beautiful and most wonderful, and it is no accident, but the direct consequence of evolution by non-random natural selection – the only game in town, the greatest show on Earth”. The process of natural selection spans further than just creating the endless forms we are surrounded by. It is a central mechanism in the human body, in sickness and health. Since the theory of evolution is questioned by some outside of the scientific community, it might be easier to grasp the idea of natural selection when it is connected to the human body, instead of ancient life forms evolving over millions of years. Our immune system consists of a lot of different cells, commonly divided into the innate and adaptive immune system. One of these cell types are the B cells, part of the adaptive immune system and responsible for producing antibodies against specific antigens. Although the B
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cell-receptors are unique, binding only to one antigen, it does not necessarily mean that the interaction between the receptor, i.e. antibody, and the antigen is strong. To solve this, B cells undergo a process called affinity maturation, based on Darwin’s natural selection. In short, affinity maturation is a process of increasing the affinity of produced antibodies to an antigen. In germinal centers, B cells activated by antigen and T-helper cells are dividing rapidly in order to produce antibodies to fight the infection. Since all these B cells stem from the same ancestor, all the antibodies have the same affinity to the antigen. During this process, the activated B cells allow a part of their genome, the Ig gene, to be extensively mutated, a process called somatic hypermutation. These point mutations in the antigen-binding part of the antibody randomly create slightly different antibodies, with slightly different affinity for the antigen. Due to somatic hypermutation, we now have randomly created antibodies with a varying degree
of affinity to the antigen. The important part of the affinity maturation is the selection and preservation of antibodies with an increased affinity. Activated B cells that fail to bind to an antigen will die by apoptosis. An antibody with higher affinity is more likely to bind to an antigen that an antibody with less affinity. Therefore, the B cells producing more effective antibodies (i.e. with higher affinity) will survive. As this process is continued and the concentration of antigen is declining, the affinity of antibodies is increased during a prolonged or persistent infection. Affinity maturation, with random variation among antibodies and the selection of the most effective, is very much analogous to the natural selection of Darwin and Wallace.
The theory of evolution by natural selection is arguably the most important scientific concept of history. Cancer is a genetic disorder, a result of mutations, either induced by an environmental insult or acquired spontaneously. These cells also express some degree of epigenetic variation. When these mutations result in a change in the expression of key genes that regulate cell growth, survival and other essential cellular processes, a cell can be transformed. One crucial feature of these mutations is that they are heritable, meaning two daughter cells will express the same genetic anomalies, making the mutated cells prone to Darwinian selection. Cells with mutations that provide them with advantages in cell growth and cell survival will be more favoured during the selective pressure that exists, therefore outcompeting and dominating the population. Since all the cancer cells originate from a common ancestor, and all the cells express the same genetic alterations, every new mutation that arise and give a cell a further advantage will be selected and
SCIENCE
Photos: Darwin’s tree of life from 1837 (Left). Potrait of Darwin by Julia Margaret Cameron (Right) Credits: Wikimedia
able to pass these new alterations on. It is important to remember that all the mutations that arise are not beneficial, but that random variation is followed by nonrandom selection. During this process, there is an accumulation of mutations in the cancer cell population, giving rise to a set of characteristics called hallmarks of cancer, including properties such as independence of growth signals, evasion of apoptosis and ability to invade local tissues. Tumour progression means that over time, tumours become more aggressive and more malignant. This process is probably due to different subclones acquiring different mutations over time. This means that although all the cells in a tumour are monoclonal in the beginning, a tumour may later be very heterogeneous. Heterogeneity is an advantage for the tumour, since individual cancer cells may be differently adapted for various selective pressures. As the tumour grows, the population is enriched for cells with a higher malignant potential. This Darwinian selection and “genetic evolution” explains two properties of cancer with immense consequences: over time, can-
cer tends to become more aggressive and less sensitive to therapy. Antibiotic resistance is an increasing global health problem and may leave the world without any efficient antibiotic in the future. Fortunately, the issue of antibiotic resistance is getting more and more attention outside the medical sciences and the recent findings of a potentially novel antibiotic substance brings hope. The reason for the increase of various degrees of resistant bacteria is manifold, but includes overuse of antibiotics, uncontrolled sales and the use of broadspectrum antibiotics when not needed. Not surprisingly, genes carrying antibiotic resistance occur naturally. Penicillin, for example, is a group of antibiotics derived from Penicillum fungi. Since bacteria and fungi has been in an arms race long before humans came into the picture, it naturally follows that some organisms have evolved properties to harm, like Penicillum fungi, and to defend. An interesting example of the latter is when scientists analysed dried soil from the British Museum that had been stored since 1689, they discovered dormant bacteria expressing penicillinase. Although antibiotic resistance occurs naturally, the
misuse of antibiotics changes the microenvironment and the joint selective pressures, permitting resistant bacteria to be favoured, survive and spread. The modern use of antibiotics has allowed an unprecedented evolutionary pressure, allowing multi-resistant bacteria to become a serious health issue. The international scene is now taking action, but one third of the public still believes that antibiotics will work against coughs and colds, and some sources states that the common cold is the most common reason antibiotics are prescribed. Evolution by the means of natural selection is clearly not only for the history books. It does not only describe how we, or all the other vast types of living organisms, came to be. The principles of evolution are very much something that affects us today – everyday. Richard Dawkins wrote: “Without the ever-escalating arms races between predators and prey, parasites and hosts, without Darwin’s ‘war of nature’, without his ‘famine and death’ there would be no nervous systems capable of seeing anything at all, let alone of appreciating and understanding it.”
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GLOBAL FOCUS
Obesity A Ticking Bomb By Haroon Bayani
IN RECENT YEARS SEVERAL GLOBAL
conflicts have been escalated, resulting in tens of thousands being killed and several million having to flee from their homes. The civil war in Ukraine and the onslaught of Daesh in Syria are only fractions of all the conflicts in our world. While armed violence, war and terrorism have tremendous social burdens on our societies, as well as costing approximately 2.1 trillion dollars annually, the obesity pandemic is not far behind. According to McKinsey Global Institute the economic impact of obesity is roughly 2.0 trillion dollars annually, and it is not getting better. If the trend continues on the current trajectory, by 2030 nearly half of the world’s adults will be overweight or obese. Whilst these figures might show a grim future, one must not forget that obesity, as well as most other diseases of affluence, is preventable in vast majority of the cases. Furthermore, while the causes for obesity may have been evident, recent research has displayed a more complex picture.
...the economic impact of obesity is roughly 2.0 trillion dollars annually... Recently a group of international scientists identified 97 genes, of which some were involved in the central nervous system, regulating satiety and some monitoring adipose tissue turnover. This is not much of a surprise from an evolutionary perspective. The thrifty gene hypothesis postulates that during human evolution food scarcity has made people more prone to obesity. While admittedly genetics plays a large role, there are other factors to take into consideration. Besides an increased sedentary lifestyle and dietary changes, sleep insufficiency, environmental endocrine disruptors, de-
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creased irregularity in ambient temperature, and pregnancy at a later age all contribute to the pandemic. Obesity is indeed a complex disease with an array of causes. Nevertheless, what can be done about it? And which health policies should governments adopt? As is always the case, there are not any simple answers. Nonetheless there are systems to restrain the obesity pandemic. First of all, personal responsibilities along with education are crucial elements in tackling the issue. People with obesity must accept the problem at hand and address it by making lifestyle changes. However these measures are not sufficient. Societal norms and environmental changes such as reduced default portion sizes, altering marketing methods, facilitating physical activity in our urban environment is equally important. Lastly one must not omit the fact that all sectors within a country need to be involved. The state, corporate and state media, retailers, companies, employers, health care providers, and educators and the like must all do their part in order to have a broad impact on the matter. Regrettably though I believe certain actors are not taking it seriously. Or rather, why would they? The soda producers, candy makers, and barley farmers all have a vested interest in us not making optimal dietary decisions, and buying their products instead of nutritious and wholesome alternatives. In reality, sadly, they pour billions of dollars each year in advertisement as well as research in order to persuade us that their products are not harmful. Moreover, instead of improving their products and making them healthier, they are trying to put focus on exercise and make us neglect the dangers of unfavourable food. Whilst exercise is undeniably of great importance to our health, so is food. And, dare I say, food may even have a larger impact on our health, although it does vary from case to case.
The obesity pandemic is a multifaceted problem that needs to be dealt with from all angles. Whereas it is true that the individual has a high degree of responsibility keeping themselves fit we will not get far by blaming them. The state and the private sector have to chip in as well. Expecting the food industry to reform is naĂŻve, which leaves us with the state. Whether the state will interfere I will leave unanswered.
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GLOBAL FOCUS
International Women’s Day 2015 By Halima Hassan INTERNATIONAL WOMEN’S DAY, PREVI-
ously international working woman’s day, was celebrated on March 8th, this years theme being empowerment. Coincidentally this year also marks the 20th anniversary of the Beijing Declaration and Platform for Action, a blueprint for advancing women’s rights and gender equality, that came out of The Fourth World Conference on Women convened by the United Nations during September 1995 in Beijing, China. The declaration addresses several critical areas of concern for women’s rights and today it remains a source of guidance and inspiration for global powers. It stresses the fundamental principal that the rights of women and girls are an “inalienable, integral and indivisible part of universal human rights.”
Most will acknowledge that a lot still needs to be done for women but of all the advancements over the years, there is an unfortunate lack of progress within women’s health care rights. From the Lancet: “Although maternal and child deaths have fallen since 1995, an unmet need still exists for family planning, gender-based violence is still a huge unaddressed problem, and deaths due to pregnancy-related causes still prevail, especially in developing countries and particularly among the poorest in society.” It is imperative that we work towards to world where women do not have to fear violence against them or lack of access to basic health care as these limitations act as obstacles for the equality, development and peace that we are working towards. However the future
is not bleak. Now more than ever, with the many improvements in technology, medicine and access, we can really envision a bright future for all women.
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Take the chance to present your undergraduate project at an international conference in Dublin By Mimmi Mononen and Maria Movin LAST
YEAR,
TWO
STUDENTS
FROM
Karolinska Institutet, Maria Movin and Mimmi Mononen, were nominated as highly commended for their undergraduate degree projects in an international competition, Undergraduate Awards, and attended the UA Global Summit in Dublin. Maria, a medical student, was nominated for her research on the impact of childhood asthma and atopy on growth in adolescents, and Mimmi, a biomedicine student, for her paper about the role of fractalkine in microglia-glioma communication. Two other KI students, Linnea Jonsson Axelsson and Elin Persson, became also highly commended in the competition. The competition consists of 25 categories ranging from medicine and life sci-
ence to politics and art history, the most relevant categories for students from Karolinska Institutet being Chemical & pharmaceutical sciences, Life science, Medical sciences, Nursing & midwifery,
...is designed to celebrate student achievements... and Psychology. Each year, the winners and highly commended entrants in each category are invited to Dublin to attend the UA Global Summit. The Summit is exclusive in that only winners and highly commended students can attend, and is designed to celebrate student achievements and inspire them with speakers
assembled from a diverse range of backgrounds. International Office at Karolinska Institute has now decided to send two highly commended students to the summit covering all the cost including travel and the conference. Winners can attend the Global Summit for free. If you are an undergraduate student carrying out your degree project during this spring, do not hesitate to send your project at www.undergraduateawards.com by 29th of May 2015.
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THE KING OF INFOTAINMENT Story by Johanna Tauriainen Photo by Martin Kjellberg
COVER STORY
“
I should not do so many things. But often they cross-fertilize each other.
W
e meet up with Jesper Rönndahl in a photo-studio in a basement in Vasastan on a chilly February evening. He is tired, but cheerful, it has been an eventful week. Not only did he win this year’s edition of the Swedish TV quiz show “På spåret” together with his partner Elisabeth Höglund, but he and his girlfriend also welcomed their very first child, a baby boy. Even on a normal day, Jesper is a busy man; he hosts a number of radio shows and TV-shows, runs his own production company, does stand-up comedy and gives lectures on different subjects. But he seems to like it that way “Sure, it’s stressful, I should not do so many things. But often they crossfertilize each other. I can use something I’ve come up with for the radio show and use it in a lecture and then use the same joke when doing stand-up comedy. Of course I have to reformulate it in different ways, but the basic facts are the same. They work separately and in combination. It all creates a synergistic effect that’s really great”. Jesper started his career as a comedian and as a producer and host on Swedish radio in shows such as Hej Domstol!, Så funkar det, Pang Prego and P3 HipHop. Comedy has long been his bread and butter, he has set up stand-up shows, formed a comedy group called Einsteins kvinnor with colleagues and has toured Sweden with his comedy show Hej Framtiden! Since an early age Jesper wanted to make people laugh, however it has not always been easy. “As for many others things it has been a matter of practice, I’ve told
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many bad jokes and jokes that were misunderstood. But eventually you become better at it and you find your own way of making jokes”. He indeed has come up with something unique in terms of entertainment which has made him popular and his Youtube channel where he posts short movies and humoristic sketches has thousands of followers. Another thing that has been in his life for a long time is science. Jesper states finding out scientific facts as one of his main hobbies, “Ever since I was a kid I’ve had an interest in space…There is just something about the fact that it is right there, but we just don’t know where it ends. Then there are all of these other subjects, for example I used to hate Geology in school, but now we’ve covered it on the show (Institutet in P3). And as for many things that we do research for the show I get interested because I understand more about the subject. Some time ago I was really interested in quantum mechanics and then it could be magnets and so on. But my interests change over time”.
Another thing that has been in his life for a long time is science Not only is Jesper one of the funniest people in Sweden, he also has a keen interest in science, but how did it all begin? “It all started in many different ways, which in combination created a strong interest in science. My dad bought Sci-
ence Illustrated, which I found when I was little. Also, it really irritates me when I don’t understand things; I think it irritates me more than others. It just makes me feel dumb. Maybe that is what drives me; that I don’t want to feel dumb. Then there’s this know-it-all thing, that I’ve had and still have, although I am working on it, I have an urge to tell people about what I know and the more I know, the more I have to tell people about”. In today’s information society, where anyone can find out about scientific facts in a matter of seconds using their smart phones, it has also become easier to expose know-it-alls and challenge them. Does he ever feel that it has become more difficult to be a know-it-all with all the modern technology around? “It’s good that it’s more difficult to be a know-it-all, at least in the negative way, like when you are a pain is the ass. To be a know-it-all in the positive aspect that is to actually know things has become a lot easier since it is easier to find out about things. So I predict a bright future for the know-it-alls despite of the information society we live in.” For Jesper, science and humor have led parallel lives for a long time, until he decided to combine them. He is lucky enough to be able to combine his work with his hobby and describes it as “humor is what I do for a living, I am not a scientist, humor is my main focus and then science comes in once in a while. But it’s the best thing ever to be able to combine my job and my hobby”. He has done this successfully, the radio shows he hosts with his colleague Karin Gyllenklev “Institutet
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COVER STORY
“
I love things that we don’t know about yet.
med Karin och Jesper”, has earned them the award for “Popular educators of the year” at the Swedish Radio Awards in 2013 and in 2014 the prize for “Entertainers of the year” at the same awards. In the show, the pair bring up a wide variety of scientific topics such as biofilm formation, the Higgs particle and banana-HIV, in an easy-to-understand humoristic way. “Popular education and making people understand that science and knowledge in general is exciting is a driving force for me. But it is also that for me it is the easiest subject to make jokes about. Some people may think about funny facts about their girlfriend and joke about that or joke about themselves like their height. But I find that difficult and I don’t find that particularly funny myself. So instead, often when I have a fact to start from I can base my jokes around that fact. But I don’t just joke about science, I also make a lot of silly jokes, but as for the science part is just something that comes easily to me” Jesper has a very wide area of interest when it comes to science and when asking him about where he gets all of his ideas he says: “It could be anything. I read a lot of popular science magazines. For example, lets say than in a text about Uruguay I find a phrase about an armadillo that can walk 500 meters under water and then they go on about Uruguay but I feel like: What?! What about the armadillo! And then I want to find out everything I can about that fact. It’s all about going through a lot of stuff, but even though it’s hard work, it’s also a lot of fun”. A 28
think that strikes me with Jesper is that he seems to be bursting with ideas and that he has a genuine interest in science. “What’s amazing are the random discoveries. People can work really hard on something and then they go off on a vacation in Spain and when they come back they have made penicillin. I don’t know if it is about taking delight in someone else’s misfortune, but there is just something very liberating about it” “Then I also love magnets. It is great because they are everywhere, but no one really knows how they work. I find that really interesting. It started when I was making a segment on the show about magnets. I wanted to explain how they work and contacted experts and started reading up about it and found out that there are many different theories about how they function, but no one knows for sure. I love things that we don’t know about yet” When asked about what he would like to invent himself, he stops to think for a while. “I would invent a matter that would make it possible to change the shape of one-self or things. I recently moved to a new apartment, so if you could make something fluffy, it would be easier to pack things. Like, if you would use a memory metal, you know the kind that changes its shape when electricity is run through it. That’s what I would invent, just off the top off my head. What’s great is that I can just come up with things, but I am not a scientist, I don’t need to figure out how things work. That’s what happened with warp-drive, from Star
Trek. The writers of the series, as far as I’ve understood, just came up with the idea and then someone watched the show and started thinking about how to make it work in reality and now it has become something that is theoretically possible, which is interesting”. Jesper is known for being the wellread, funny guy. Does he ever feel a pressure of having to be funny and smart all the time? “ Yes, but it is easy to use humor to make people forget about it. Now, after På Spåret, people think that I am really well read, but I have an enormous lack of knowledge in many areas. But the show is all about luck. It’s like, what did I read about yesterday? Maybe it’s Sao Paulo and then there happens to be a question about Sao Paulo. I don’t know the answer to more than half of them, but then hopefully Elisabeth (Höglund, his partner in På Spåret) will know it. A lot of people focus on what you know, but forget about the things that you don’t know”. It is time for the photo session and Jesper, dressed in a suit and bow tie gets ready for the shoot. It is a fitting outfit for the guy that once joked about becoming “the king of infotainment” at a party. By combining the things he loves, he has made science easily accessible to people who might not have been interested otherwise. He has, whether it was a conscious effort or not, really become the king of infotainment.
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COVER STORY
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GLOBAL FOCUS
Is there a violent extremist profile? What research suggests about individuals who turn to extremist violence. By James Salisi
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GLOBAL FOCUS
H
is name was Islam Yaken, a young and educated man from a middle class family in Cairo, Egypt. He had been dubbed as the “hipster jihadi”, a moniker people used to draw attention to the dissonance between his background and his path to extremist violence. He was a law graduate and an aspiring personal trainer before he joined the Islamic State also known as ISIS or ISIL. Recently,
...how such a transformation could happen and what does research say on possible factors... The New York Times published a profile of Islam Yaken and his friends, all from similar middle class backgrounds. Yaken took a radically divergent path from them. In December 2014 the International Business Times reported that he was killed in suicide mission. The fascination for his story may be traced to what the public perceive as a drastic change from a seemingly secular and modern lifestyle of going to gyms and aspiring to be a trainer to one of religious extremism. One is led to ask how such a transformation could happen and what does research say on possible factors that influence the process. Is there such a thing as a violent extremist profile? Process and Profiles: Individual Radicalization Brian Jenkins, a terrorism scholar, defines radicalization as “the process of adopting for oneself or inculcating in others a commitment not only to a system of [radical] beliefs, but to their imposition on the rest of society.” The use of violence is the final stage of this process. The nature of this process is poorly understood and there are different theories and stages that researchers have described that explain how this happens. A study on a particular type of violent extremism could shed light on the radicalization process. In 2011, a report published by the United Kingdom Home Office found that “the empirical evidence base that makes an individual more vul-
nerable to Al Qa’ida-influenced violence is weak”. However, based on this limited evidence base they concluded that certain social, psychological and physical factors or situation make individuals more vulnerable to Al Qa’ida-influenced violent extremism. In terms of social factors, the report found individuals involved in violent extremism tend to be male, young to middle-aged, married and possibly with children. They tend to be educated to a similar level and have similar socio-economic status as the broader population in which they live. However, they may be working at a skill set lower than their educational attainment. The decision to use violence is spurred by multiple and varied reasons in Al Qa’ida-influenced violence. Popular notions that lead individuals to violent extremism such as deep religiosity and mental illness are not backed up by evidence. Neither deeply religious upbringing nor education is necessary for and individual to be involved in this type of activity. In fact, a large number of violent extremists influenced by Al Qa’ida were found to have a secular upbringing, according to the report. In addition, compared to the general population mental illness or personality disorder is not more pronounced or prevalent in these individuals. Social spaces such as Mosques and prison that act as meeting points for individuals to link up with and be influenced by extremist ideologies, increased surveillance and policing of public spaces that drive radicalization and recruitment to private spaces, and the Internet are some of the physical factors or situations that can make a person more vulnerable to Al Qa-ida-influenced violent extremism. Some theorize that people sympathize with violent radicalization and terrorism due to “grievances about social and health inequalities, discrimination, poverty, poor education, poor mental health and poor political engagement.” In contrast, a recent study on the association of violent radicalization with poverty, migration, poor self-reported health and common mental disorders among Muslims in England found evidence to the contrary.
Kamaldeep Bhui, Nasir Warfa and Edgar Jones conducted a cross-sectional survey of men and women aged 18 to 24, of Muslim heritage to assess social, health and economic risk factors for sympathizing with violent protest terrorist acts. They found that young healthy people, educated and employed, and born in the UK were more likely to sympathize with violent radicalization and terrorist causes. Furthermore, “people with poor health, migrants, and older actually were more likely to condemn violent radicalization.” Lastly, discrimination, poverty, social and health inequalities, political engagement and attitudes to foreign policy in this population were deemed not relevant.
...The nature of this process is poorly understood... There seems to be no specific profile of a potential violent extremist apart from being “a loner, having psychological issues and having experienced a drop in social standing prior to their illegal extremist activity” according to the National Consortium for the Study of Terrorism and Responses to Terrorism (START). They published preliminary findings from START’s Profiles of Individual Radicalization in the United States (PIRUS) project. PIRUS is “a database of Islamist, Far Left and Far Right individuals who have radicalized to violent and non-violent extremism in the United States.” The START project also found some specific conditions and events that were common among certain ideologies. For Islamists, group dynamics were common, those who radicalized in the United States were likely to have been actively recruited into an extremist group. A loss in social status at work or at school before radicalization was more common among Far Left Extremists. In summary, there is no single profile of an individual prone to violent extremism. Several factors influence the radicalization process but they are not the ones that the public usually expects.
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GLOBAL FOCUS
Mindfulness through meditation and breathing. Bear yourself in mind for a better (or potentially worse) life. By Halima Hassan NOBEL
LAUREATE,
PROFESSOR
Elizabeth Blackburn, suggests that in order to lengthen your cellular lifespan, and thus your life, you should consider adopting the practice of mindfulness. In several scientific studies, it has been observed that this activity can help those suffering from depression and anxiety deal with their condition and lead more productive lives. In fact, many large and well established institutions are now incorporating mindfulness into the workplace. From the National Health Service in the UK providing mindfulness seminars for patients with depression, to cut-throat firms like Goldman Sachs and Google, one cannot deny the rising popularity of mindfulness from how it is permeating into so many facets of society. So what exactly is mindfulness and is it really as miraculous as some scientists and Google will claim it is?
...it has been observed that this activity can help those suffering from depression and anxiety... Lets begin with a definition: “Mindfulness is the intentional, accepting and non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment.” Essentially, being mindful is to be aware of oneself in the present and this ability can be honed through meditation and breathing exercises. Regular practice of mindfulness is believed to have many benefits such as improving memory, cognition and lowering stress levels. The ability to focus underlies a lot of productivity and considering how we live in an age where attentions spans are shorter than ever, we could all, in theory, do with some mindful practice.
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Practicing meditation and deriving mindfulness was once, thousands of years ago, a practice associated with Buddhist monks. To them mindfulness constituted only a small component of their faith and the greater struggle of striving for enlightenment. So what bought this ancient, once sacred practice, to the secular west? None other than Jon Kabat-Zinn, currently Professor of Medicine Emeritus at the University of Massachusetts medical school. In the 1970s, Kabat-Zinn began studying under Buddhist teachers. This inspired him to combine what he had learned from his Buddhist teachers informally with his formal education in science. The result, a program called Mindfulness-based stress reduction (MSBR): a therapeutic application of mindfulness which claimed to help patients with psychological conditions cope with the illness. Since then mindfulness has been marketed to everyone as a means to improve your life. With continued practice of mindfulness, the hope is that you’ll acquire the ability to not become overwhelmed with the emotions that result from daily dilemmas and instead learn how to focus your attention; understand that you have the ability to not allow your emotional state to take over your life. “Your ability to recognize what your mind is engaging in, and control that, is really a core strength,” remarks Peter Malinowski, a psychologist and neuroscientist at Liverpool John Moores University in the UK. “For some people who begin mindfulness training, it’s the first time in their life where they realize that a thought or emotion is not their only reality, that they have the ability to stay focused on something else, for instance their breathing, and let that emotion or thought just pass by.” Naturally there are some staunch critics of mindfulness. But they should not be dismissed as mere ‘haters’ of what appears to be a generally positive practice. Starting off, many psychiatrists are
questioning the methodology used in the studies that exist in support of mindfulness practice. “Many of the studies are small. [They are] pilot studies and are carried out on those who are not very ill,” says Professor Patricia Casey of University College Dublin. Additionally, many of these studies have not compared how mindfulness performs compared to the usual pharmaceutical interventions for individuals with serious illnesses like depression. It would be interesting to read a study investigating what exactly may be underlying the positive effects some may have experienced after practicing mindfulness.
“...it’s the first time in their life where they realize that a thought or emotion is not their only reality...” The parallels between mindfulness and prayer or other religious practices are undeniable. It is well known that individuals who practice a religion are generally thought to be happier and that in general, prayer and meditation have many beneficial effects on the brain. So is this surge in mindfulness and its popularity just a marketing thing, making a practice usually tied to a religion secular and more digestible for individuals in the west? Journalist Melanie Mcdonagh writes, “[Mindfulness is] non–doctrinal, non-prescriptive, non-demanding in terms of conduct apart from an insistence on not being judgmental.” The perfect new religion for westerners. Is it wise to remove just a single practice from a religion? This is the question Mcdonagh asks in her critique of mindfulness. “Taking an established religion — Buddhism in this case — and picking bits from it piecemeal can be a more dangerous business than it might seem. However much people may dislike the idea,
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the major world religions have developed incrementally over time to be a comfort and support for humans in their quest for meaning. Even the seemingly eccentric bits can serve a vital purpose, hidden from non-believers. One rejects ‘the boring bits’ of an established religion at one’s peril.” This ‘danger’ is understood clearly once you learn about Dr Willoughby Britton’s ‘Dark Night Project’, also known as ‘Varieties of Contemplative Experience’, at Brown Medical School in the US. Dr. Britton deals with the psychological disturbances that meditation can sometimes cause. Not everyone has the strength to confront their inner self, and when meditation becomes an affliction to you rather than a therapy, then Dr Britton is the one to contact. Dr. Britton is an assistant professor of psychiatry and human behavior. Her study of this phenomenon is an effort to document, analyze, and publicize accounts of the adverse effects of contemplative practices such as meditation. Britton has presented her findings at major Buddhist and scientific conferences and even to the Dalai Lama at the 24th Mind and Life Dialogue in 2012.
The perfect new religion for westerners. Mindfulness is currently the trend. I would be surprised to hear of someone who had not yet encountered anyone speaking about the practice or about their quest to incorporate meditation into their lives. Though I do not doubt there are benefits in taking some time in the day or every now and then to destress, I do not agree that mindfulness and meditation are the only ways to do so. Take a walk perhaps, listen to some calming whale sounds or watch a show
on Netflix. Regardless, if you do decide to take a seat next to google in the sauna of mindfulness, enter with an open mind and a pinch of salt. It may work for you, and if so wonderful. On the other hand, it may not. If at any point you feel it is weighing you down in any way get out. And breathe.
Photo credit: Wikimedia
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The buzzing killer We know the cause and cure of malaria. Why do we still have it around? By Devy Elling
CHALLENGES THAT ARISE FROM DISEAS-
es that emerge amongst the poorest in the population are yet to be understood. For many of these diseases, cures and vaccines have already been developed, and are ready for commercial markets. However, many life-threatening and endemic diseases without a successful vaccine still exist. An example of this is malaria, caused by Plasmodium parasite, carried by mosquitoes. Of the four different types of Plasmodium parasites that cause malaria in humans, P.vivax and P.falciparum are most common, where the fatal consequence are due to P.falciparum. Malaria is the cause of approximately 500 million new cases and over a million deaths annually, worldwide. People, especially children and pregnant women, who live in sub-tropical climates, are particularly vulnerable, as hot and humid areas facilitate the breeding of Plasmodium infected mosquitoes. Sonia Shah, in her book The Fever, states that the reasons underlying why Malaria still exists in today’s society are due to scientific, economic, cultural and political challenges, which have prevented the development of an effective vaccine. Researchers have agreed upon the complexity of the pathogen, and research has produced effective cures, used as treatments for affected individuals. Yet, it is still a struggle to develop a vaccine. This is because the parasite changes its morphology throughout its life cycle in the host organisms: mosquito and human. As malaria develops, it starts to interfere with people’s daily activities because the more people get sick, the less they will work, and thus, the more likely they end up in poverty. In addition, people who live in societies ridden with the disease normally see malaria as a normal issue of life. People that work in the health sector may start to think, ‘If they think it is a normal problem, how do we get them to change their behaviour to prevent further
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Malaria infected Anopheles mosquito. Photo credit: Public Health Image Library. Centre for Disease Control and Prevention (CDC)
transmission, get diagnoses and treatment, and to make sure they do not get infected again?’ The answer to this question is much more complicated than pure science. These challenges emerge into a more complex discussion; it has become a political issue. Policies in these societies tend to rely on cheap and highly available tools, such as the use of insecticides. For instance, a large-scale experiment conducted in Sardinia during the period 19461950 aimed to develop a new strategy to fight malaria by spreading DDT over the island. This experiment resulted in the elimination of malaria using solely DDT; however, the Anopheles mosquitoes were not eradicated. This has proven that the use of insecticides, without any other interventions, work only short-term. The elimination of mosquitoes is done through environmental control, and it is the responsibility of individuals as well as the society. According to the American Mosquito Control Association (AMCA),
mosquito control is important, not only for public health reasons, but also for economic reasons, as it can negatively affect livestock production. The effects of livestock production can result in a decrease in the products from respective animals affected by malaria, or any other mosquito borne diseases. Again, this is reflected back to the poverty-disease cycle; where poverty can cause various illnesses and vice versa. Although malaria prevention is now well known, millions of people are still greatly affected by it. One of the most effective ways to prevent further malaria transmission is to cover clear and stagnant water, where mosquitoes lay their eggs. This, however, is not very efficient because societies that have high malaria prevalence usually have clear stagnant water not only at their homes, but also in the pits after a heavy rainfall. It is not only the responsibility of every household to keep this behaviour, but it is also
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the responsibility of the society. Without proper information, it is difficult to raise awareness to respective households. A preventive medication, malaria prophylaxis, is another well-known and widely available means to prevent transmission from malaria-infected mosquitoes to humans. Travellers coming from non-infected areas, pregnant women as well as children from high malaria prevalence areas, are advised to take precautions. Nevertheless, anti-malarial medicine has to be used repetitively, and it does not have perfect success rate yet in malaria prevention. Furthermore, the emergence of drug-resistant malaria in countries such as India, limits the effectiveness of post-exposure drugs, existing in the today’s markets. A vaccine, therefore, is of great significance in the reduction of malaria prevalence and incidence. For over a decade, several researchers have been trying to develop an effective malaria vaccine. Some of the vaccines under development have already reached clinical stage. The Bill and Melinda Gates Foundation awarded their research grant in Grand Challenges in Global Health to Dr. Stefan Kappe, who has dedicated a decade of his career on developing malaria vaccine by using a weakened form of the parasite to invoke an immune re-
sponse. This genetically attenuated parasite still undergoes clinical trials. To date, there is no licensed vaccine against malaria, or any other human parasite, even though the development of a vaccine looks promising. Nevertheless, before any medical product reaches the commercial market, it needs safety approval at different stages of the development. Thus, a commercial, and ready-touse product is still years away. Assuming that there is an effective vaccine against malaria on present day, another question then comes to mind: how will we distribute it to millions of people who suffer from the disease, or people who are exposed to the pathogen every single day? How much would it cost to distribute this vaccine to these people? The answers to these questions are complicated because it involves several factors, namely cost of production, access and availability, and population-level effectiveness. Looking at present day, and the possible questions and other thoughts on malaria vaccine, the distribution of malaria vaccine to the general population is nearly impossible. With this in mind, the World Health Organisation recommends high malaria prevalence areas to control, and possibly eliminate the disease. Four key
points suggested by the WHO included; ensure the use of evidence-based guidelines, attention on updates of the global progress, improvement of infrastructure and strengthen malaria surveillance, and identification of potential threats to control and elimination of malaria in new areas. It is difficult to tackle the malaria-related challenges from societies with high, as well as low malaria prevalence. Solutions that will work long-term will take several years to implement, but it could possibly improve all other factors that could attribute to malaria cases, such as an improvement of standard of living. Difficulties to understand the complexity of malaria remain, even though the general population knows basic prevention and cure for the disease. Research on malaria vaccine is still ongoing and it will take a couple more years for us to see its effects. Normally, a paper would conclude its discussion by, “further research need to be done…” For the case of malaria, and other diseases, in which a vaccine is not yet developed, a deeper understanding of the complexity of the science behind the disease is indeed to be acquired.
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Malaria global distribution, World Malaria Report 2010. Photo credit: World Malaria report©
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The first successful uterus transplantation - opening a new era of reproductive medicine By Mimmi Mononen
CONTRACEPTION AND IN-VITRO FERTI-
lization have reformed reproductive medicine and currently benefit families, women and men all around the world by addressing their predicaments concerning family planning and childlessness. Approval of the first contraceptive pill dates back to 1960 following the discovery of synthetic progesterone a decade earlier. Two decades later, in 1978, an article published in The Lancet reported about the first baby that was born after in vitro fertilization, IVF. Another milestone was met this year, as Members of the Parliament in UK voted to allow mitochondrial donation, opening the possibility of three-parent-babies. Five and half decades after the first contraceptive pill was launched, advances in reproductive research now can give hope for women with a diseased or even lacking a uterus to give birth to their own children with help of a uterine transplant. The first successful birth of a child following uterus transplantation was carried out at Sahlgrenska University Hospital in Gothenburg on September, as reported in The Lancet by Mats Brännström and colleagues.
...the Parliament in UK voted to allow mitochondrial donation... The story begins in University of Gothenburg, where uterus transplantation has been studied since 1999. Goal of the research is to give women lacking a functional uterus, as a result of cancer operation or other defect, the possibility to give birth to their own children. In total nine women were transplanted in Gothenburg during 2013 with uteri received from living donors. In most cases the donor was mother of the patient, but even 36
a relative or close family friend could act as a donor in some of the cases. Two out of nine transplantations lead to rejection shortly after the operation. The seven remaining women with successful transplantation started in 2014 with IVF treatments, in which a cryopreserved embryo was implanted in the transplanted uteri. Last spring, a year after the transplantations, first pregnancy within the patient group was reported and the baby was delivered on September with help of Caesarean section. The transplant recipient was a 35-year-old woman lacking uterus due to Rokitansky syndrome, a congenital defect of the reproductive system, and the uterus was donated by a 61-year-old woman with no family connection to the patient. The 35-year-old thereby became the first in the world with a successful childbirth after uterus transplantation. Applying to any novel medical procedure, the arising clinical and ethical considerations after a successful uterus transplantation cannot be disregarded. Regarding uterus transplantation, women’s health and issues related to reproduction call for careful case-by-case consideration. Underlining the importance of informed consent, all the donors must understand both the benefits and possible risks of removal of the uterus. The previously reported complications of the transplant donors include bleeding, infection, and organ injury, along with subsequent fistula development. Uterus transplantation also requires longer time than other organ transplantation procedures, which increases the risks related to the operation time and anesthesia. In addition to the risks related to the procedure itself, considerations regarding the age and childbearing of the donor must be taken into account. In the reported case the donor was a 61-year-old menopausal woman, and the decision was made for her to use
combined oral contraceptives beforehand to ensure optimal uterine vasculature. The success rate of the transplantation is significantly increased by the contraceptive treatment, but it also elevates the risks for the donor to suffer from thromboembolic events. Also the transplant recipients need to
...considerations regarding the age and childbearing of the donor must be taken into account. be aware of the risks of the operation. As mentioned above, two out of nine recipients suffered from rejection of the transplanted organ causing a life-threatening condition requiring immediate actions. The complications were caused by thrombosis and intrauterine infection, and both the patients underwent removal of the transplanted uterus. Moreover, pregnancy of the reported case did not proceed without complications as the mother suffered three events of rejection of the transplanted organ. In the case of the 35-yearold, the rejections could be kept under control by immunosuppressant drugs. In addition, her Caesarean section was performed earlier than planned, at week 32, as she was suffering from preeclampsia, a pregnancy complication characterized by high blood pressure and damage to kidneys or other organ systems. Lastly, Brännström and colleagues state in their report that the plan after successful childbirth is to eventually remove the transplanted uterus in order to avoid risks connected to prolonged usage of immunosuppressant drugs. However, this procedure has to be voluntary decision made by the transplant recipient herself, which arises yet another set of ethical considerations addressing the will of
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Photo credit: Wikimedia
the patient and her partner, and the judgement of the medical doctor responsible for the procedure. The successful childbirth after uterus transplantation is unavoidably accompanied by several clinical and ethical issues that need consideration. Despite this, the experiment carried out in University of Gothenburg indicates that the impossible is possible, as the scientific proof for successful uterus transplantation now exists. Both the mother and the child are currently healthy, and the newborn baby boy develops normally, which brings hope for women and their families suffering from childlessness.
...the impossible is possible, as the scientific proof for successful uterus transplantation now exists. A SHORT HISTORY TRANSPLANTATION
OF
UTERUS
The first successful childbirth after uterus transplantation was reported last October in The Lancet, starting a new chapter in the history of reproductive
medicine. However, the first documentation of successful uterus transplantation dates back to as early as 1966, when American scientists published a study reporting the first autotransplantation on a dog, subsequently followed by pregnancy and delivery. The first ovarian transplantation on a rabbit was carried out even earlier, 1896, in Austria. The history of experimental uterus transplantations on humans is nearly as long as that of the animal trials. One of the most fascinating examples is the case of Lili Elbe, a Danish transgender pioneer born as Einar Mogens Wegener, also being the first documented recipient of sex reassignment surgery. During the first two years of 1930s, she received a series of five operations in Germany, being well aware that the procedure was experimental with no guarantees of success. Within the timespan of two years, surgeries were performed to remove the testicles and penis, and to transplant ovaries taken from a 26-yearold woman. The transplantation lead to rejection, and due to the severe complications the transplants were removed. Despite the drawbacks, Lili was determined of being able to become a mother, and in 1931 she had her fifth and last surgery to transplant a uterus. The operation was followed by another rejection leading to
Lili’s death shortly after the transplantation. The life of Lili Elbe has inspired several authors, and a film version of The Danish Girl, an international bestseller from 2001, is being developed. Eddie Redmayne, the Oscar-winning actor of The Theory of Everything, has been announced to play the role of Lili Elbe.
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INSIGHT Insight is Medicor’s feature with the aim to shine light on some of the different occupations and branches within the medical field. Each edition features an interview with a selected person and a presentation of his or her area of specialization. The intent is to inspire and to give students insight into some lesser known career paths.
Åsa Nilsonne
Senior professor at Karolinska Institutet, psychiatrist, psychotherapist and author. She has published several books, including crime novels and non-fiction literature. By Iskra Pollak Dorocic and Irina Pader Photo by Martin Kjellberg Medicor talked with Dr. Nilsonne about her career, her motivations for writing and her newest book “H”.
Å
sa Nilsonne has always been fascinated by human behaviour, and this interest is what drew her to medical school. “Konrad Lorenz had won the Nobel Prize for research into behaviour, and he was a doctor, so I thought this is a wonderful way to become a researcher”, explains Dr. Nilsonne. Now in her 60s, Nilsonne has retired from medical work, instead focusing on the writing career she started while working as a doctor. Despite her soft-spoken voice, she comes off as confident and passionate, with a bright red streak in her short edgy haircut. On her quest to explore human behaviour, Nilsonne quickly realized that the path is not as straightforward as she had imagined. Instead of immediately throw38
ing herself into research after medical school, Nilsonne spent most of her days seeing patients. Psychiatry was an obvious choice. Despite short stints in orthopedics and gynecology, ultimately her initial interest prevailed, and led her to treat psychiatric disorders.
Nilsonne quickly realized that the path is not as straightforward as she had imagined Nilsonne followed a ‘conventional’ medical and academic route, specializing in psychiatry, completing a researchheavy PhD and ultimately becoming a professor. But looking at the fine-print, her career was far from conventional. “I decided early on that I didn’t want to do psychopharmacology, because I didn’t trust the drugs that were given to psychi-
atric patients”, she says. Instead, Dr. Nilsonne went for psychotherapy training and started using it as a treatment tool. “My colleagues said this is ridiculous, you can’t be a psychiatrist and not prescribe drugs. And I couldn’t see why not. And it worked out perfectly well, I’ve been able to find employment and do well without ever prescribing anything.” Continuing on her own path, Nilsonne once again took an unusual step. She completely stopped seeing male patients in psychotherapy sessions. While treating one particular patient, suddenly realizing she was completely bored, Nilsonne came to the realization that she just could not relate to her patient. “He had some sort of hierarchical problem with his boss and it just bored me to tears. And at that moment I realized that I was in exactly the same situation as many male doctors have been sitting with female patients and not understanding the problem and be-
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Everybody thinks that doing artistic things is different from doing other things
ing very bored. And so I thought what I was doing was unethical. I stopped seeing men completely.” From there on she worked in an eating disorder clinic and following that, with women who are suicidal and emotionally unstable. The transition from medicine to literature was a fairly smooth one. “Everybody thinks that doing artistic things is different from doing other things, for me it hasn’t been”, says Nilsonne. Her first endeavor into writing novels did not veer too far from the familiar setting of the clinic, in fact it was set in a psychiatric unit and featured a gruesome death of a patient.
The transition from medicine to literature was a fairly smooth one. Early on in her writing career, while contemplating the structure of a good story, Nilsonne realized that the crime novel has a very familiar and straight-forward organization, not unlike the course of a medical diagnosis. “You have something that happened, then you have the question of who did it, then you have sorting things out, and then you have an end. Which is very much what happens every
time a patient visits a doctor. There’s a problem, you try to find out what kind of problem it is, you do it by investigating the symptoms, and then figuring out the diagnosis.” Not so different from the typical ‘whodunit?’ detective story. Writing crime novels came easy. However, the genre did not come with the ultimate fulfillment. “In Sweden, crime novels are not considered serious. And anybody who writes crime novels is not considered serious”, laments Nilsonne. She wanted to discuss actual issues in her writing, and soon gave up on the genre to pursue topics she considered more meaningful, and often more personal in nature. More recently, Dr. Nilsonne has begun writing novels that are based on realworld cutting-edge scientific research. “My last two books have predicted the Nobel Prizes”, explains Nilsonne with a smile. In the novel En passande död [A fitting death], the story is based around the scientific breakthrough of creating pluripotent stem cells from adult cells, the discovery which was awarded the Nobel Prize in Physiology and Medicine in 2012, the same year the novel was finished. Coincidentally, her current novel H features a main protagonist who is a neuroscientists studying the place cells in
the hippocampus, which happens to be the discovery that the most current Nobel Prize recognized. “I just try to pick up what I think is interesting”, explains Nilsonne, who still follows the latest developments in the scientific world and aims to keep her literature scientifically accurate.
This is one way of bringing science to people who don’t normally bother about science A big motivation for writing about these topics is to introduce the general public to science. “This is one way of bringing science to people who don’t normally bother about science, who don’t understand that science is interesting and who don’t understand that science is relevant.” Nilsonne finds it surprising that so many people, including members of the media, know so little about science. The Nobel Prizes are supposed to be the big showcase for science every year, but when her first novel about induced pluripotent stems cells came out it was described as science fiction in the news41
INSIGHT
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You can’t just say the brain belongs to natural sciences
papers. “The journalists had no idea that this type of research actually goes on [today]”, she adds with disbelief. Part of the effort is demystifying human behaviour and the brain. “If you want to be serious about understanding human behavior you can’t just say the brain belongs to natural sciences, and is not interesting and that the brain doesn’t concern me”, explains Nilsonne. Her most current book, H, features a main protagonist, but we do not learn much about him beside the first initial of his name. Instead, different parts of his brain are the main characters – the amygdala, the prefrontal cortex, and most centrally the hippocampus. Each area has its own personality, and tries to convince the protagonist to follow its advice while he is in the process of falling in love (or not) – depending on which part of the brain he chooses to listen to. Again, inspiration came from medical experience. During psychotherapy sessions with patients, Dr. Nilsonne introduced the different regions of the brain based on their functions and used their ‘personalities’ as a treatment tool. The amygdala, for example, is involved in 42
emotional processing and is fast to react to stressful situations, while the prefrontal cortex is involved in rational thinking. Nilsonne would ask her patient, “What does your amygdala say?”, and then “What does your cortex say?” and contrast the two approaches in a given situation. “Conceptualizing the parts of the brains as motivational systems with their own agenda and with their own voice was very, very helpful.” Now that she is retired, Nilsonne spends most of her time on writing, and also with her dogs – she loves training them and entering competitions. The next book will also be a blend of science and literature, with alcohol as its central theme. As for advice for doctors and researchers who are interested in writing, Dr. Nilsonne enthusiastically says: “Just go for it!” – and not to believe that a journalist is better at writing than a scientist.
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INSIGHT
’15 Published latest novel ‘H’ ’06 Became professor ’90 Started working as specialist in psychiatry ’87 Received a PhD
’82, ‘82, ‘86 Had three sons. Nilsonne disagrees with the common idea that childbearing and a career do not match ’75 Finished Medical School at Karolinska Institutet
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CULTURE
Breakfast, coffee hour, and dessert. Sugar, sugar, and some more:
By Devy Elling
We leave home in a hurry because we are late to go to university or work in the morning. We go to the nearest shop, get some coffee and a cinnamon bun while we eat it in a crowded bus. After a couple of hours of sugar rush, we crave more sweet things. Does this sound familiar? The consumption of sugar in Sweden has increased exponentially. Even though sugar-making techniques were developed in China and India centuries ago, it was introduced in the Western world less than 500 years ago, and it has become one of the products that are present in almost all food items in today’s market.
COLONIAL SUGAR
Sugar was considered a valuable product when it was imported to Sweden from the Caribbean. It was sold to mostly wealthy people in the cities for banquets and other enjoyment. This was the beginning of the increase of sugar consumption. The usage started in medical practices exclusively, to half a kilo sugar per capita in sweets and desserts. One of the most common pastries, the croquembouche, which is a tower of pastries, made of crystallised sugar decorated with sugar figures, flowers, and gold was a must-have in any upper-class banquet. In the 1800s, sugar propaganda started with anti-sugar movements to fight actively against slavery. However, it did not take long until bought sweets were back in the markets and were purchased by people of all social classes for festive dinners. Shortly after, sugar was not considered a luxury; rather it was regarded as a basic condiment.
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CULTURE
WHOLESOME SWEETS
According to the Greco-Roman medical practice dated around 5th century B.C., diseases arose from imbalance of bodily fluids; blood, phlegm, yellow and black bile. The balance of these fluids was assumed to be restored with the right diet, with help from active herbs and blood flow. Sugar, mixed with different herbs, was believed to have a cooling, mucokinetic, and cleansing effect. The spread of sugar throughout Europe progressed as advanced medical practices were developed in the Mediterranean, and the use of sugar in medicine began in the Greek and Arabic medical practices. Almond paste, also known as marzipan is a common use of sugar. It is a mixture of almond ground mixed with various herbs and spices, and it was commonly known as “heart sugar”. Around the same time, sugarcanes were grown in these areas. In Sweden, sugar was first introduced in the 16th century – as medicine. It was known as the “precious honey-dew from India, [and it gives] soothing effects”. It was a valuable product primarily to treat fevers, coughs, and stomach problem. Pharmacies in Sweden used sugar as preservatives for ingredients in different medication, for instance herbs preservation in syrup, which was later formed into sugar-coated hard tablets. In the same era, sugar was known as sweets, or confectio, and it became popular amongst the nobles and royals, not only as a healing product, but also for enjoyment.
EVERYDAY FOOD
In the early 1900s, sugar began to be considered as a nutritious product. Some nutritionists suggested that it could easily be converted into fuel and energy, similar to meat, fish, and other vitamin-rich products. In addition, it was cheaper than other more nutritious products, which resulted in a must-have product in any kitchen. Preservation campaigns were launched in around the same time of both World Wars. Every household had pantries with stored goods, using sugar as preservation. Sugar was sold this time for merely one Swedish krona in shops. From this point on, sugar had become more accessible with more convenient packaging. Fewer people ate less cooked meals. More and more people began eating porridge with jam and sugar, or sugar was used in coffee, buns, and sandwiches. The sugar industry was getting subsidies from the government in the 1930s to avoid agricultural crisis, as well as unemployment. The Swedish fika started when sugar was highly accessible and recipe books, such as sju sorters kakor, also known as seven kinds of biscuits became popular among housewives. An inscription from the first edition of the book in 1945 stated that, “…you offer [the guests] a cup of coffee with a delicious biscuit…good baker [makes] people want to visit”. This quote demonstrates that sweet food had become essential to people’s social life. It has also been recorded that sugar purchase had reached approximately 50kg per person per year.
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CULTURE
TRANSITION OF SUGAR – THREAT TO HEALTH “Too much of something good is never good for you” – the risks of good and sweet taste is related to an excessive consumption of sugar. Even though we hear warnings, debates and new discoveries regarding the risks of sugar, we still eat an enormous amount of it, at least compared to previous generations. The association of sugar and health issues have been known for a relatively long time. The population has been warned about the health effects; the visible-on-appearance effects and the ones happening inside the body. Warnings concerning the fattening effects of sugar over-consumption began in 20th century. Medical doctors started to recommend regular meals rich in vitamins and minerals. Furthermore, health workers strongly suggested avoidance of sweet things altogether. At the end of the century, the trend to become slim was launched, and scales were installed in public places, with the purpose of people’s amusement and benefits. In addition, artificial sweeteners started to be marketed to replace “the strongly fattening sugar”. Health professionals have notified us about the obesity epidemics as a global health issue. Several risk factors, such as large consumption on beverages and processed food were identified. Later on, different diet techniques were introduced, such as the LCHF, Atkins, and the 5:2 diets. Half of the Swedish adult population was
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estimated to have tried at least one of the diet techniques in order to lose weight. During most of the 21st century, fatty food products were considered the focus of the negative health impacts. Researchers started to determine the association between sugar consumption and cardiovascular diseases during the 1970s. However, the findings were not immediately recognised. The association between sugar consumption and various health impacts raised interest, and thus, further findings have been focused in this particular area. How do we keep ourselves from overconsuming sugar? Additionally, how can we, as consumers, have an impact on the market? Warnings on the health impacts caused by sugar are everywhere, yet we still have sugar in forms of sweets and cakes, and these have been part of our social life for a long time. In comparison to our previous generations, we have consumed sugar more than ever before. Many healthier choices in the market tend to be more expensive, and less available to everyone than the less-healthy choice. “Hidden” sugar in most food products in today’s market has made it nearly impossible to have a complete sugar-free diet, or even allow the society to reduce sugar consumption. We need to truly understand the impacts we get from over-consuming sugar and make an effort as individuals to limit our sugar intake.
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