The Science in Society Review (Fall 2012)

Fall 2012 | Brown University
ISSN 2164-4314
Nuclear Sovereignty
Radioactive Waste Dumping and Native Lands
Born This Way? Why We Should Be Skeptical of the Science of Sexuality Dying to Feel Young: Re-contextualizing Menopause in America Operating Under the Influence: The Problem with Sleeplessness in the Medical Profession
ASU Berkeley Brown Harker Harvard JHU
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Cambridge CMU NUS OSU UC
Cornell Davis
Georgia Tech UCSD UChicago
Georgetown Melbourne
GWU Yale
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EXECUTIVE MANAGEMENT TEAM Chief Executive Officer Mridula Nadamuni Chief Operating Officer, Asia Worapol Ratanapan Chief Operating Officer, Australia Kristijan Jovanoski Chief Operating Officer, North America Benjamin Dauber Chief Marketing Officer Megana Roopreddy Chief Production Officer Cassie Yeh Chief Technology Officer Lauren Beck Executive Editor-In-Chief, Print Publication Dhruba Banerjee Executive Director, E-Publishing Edgar Pal Executive Director, High School Outreach Kathryn Scheckel Executive Director, Internal Affairs Brittany Hsu Executive Director, Science Policy Yucheng Pan INTERNATIONAL STAFF Senior Literary Editors Harrison Specht Mary Fei Michael Graw Pallavi Basu Titas Banerjee Victoria Phan Senior Production Editors Felice Chan, Cornell Judy Chan, Cornell Andrew Kam, UChicago Emmy Tsang, Cambridge
Senior E-Publishing Editors Venkat Boddapati Fili Bogdanic Irene Ching Jae Kwan Jang Evan Jin Arthur Jurao Prathima Radhakrishnan BOARD OF DIRECTORS Chairman Erwin Wang Vice Chairman Kalil Abdullah Board Members Manisha Bhattacharya Jennifer Ong Zain Pasha Julia Piper James Shepherd Jennifer Yang TRIPLE HELIX CHAPTERS North America Chapters Arizona State University Brown University Cornell University Carnegie Mellon University Georgia Institute of Technology George Washington University Georgetown University The Harker School Harvard University Johns Hopkins University The Ohio State University University of California, Berkeley University of California, Davis University of California, San Diego University of Chicago Yale University Europe Chapter Cambridge University Asia Chapter National University of Singapore Australia Chapter University of Melbourne
THE TRIPLE HELIX

A global forum for science in society
The Triple Helix, Inc. is the worlds largest completely student-run organization dedicated to taking an interdisciplinary approach toward evaluating the true impact of historical and modern advances in science. Work with tomorrows leaders Our international operations unite talented undergraduates with a drive for excellence at over 25 top universities around the world. Imagine your readership Bring fresh perspectives and your own analysis to our academic journal, The Science in Society Review, which publishes International Features across all of our chapters. Reach our global audience The E-publishing division showcases the latest in scientific breakthroughs and policy developments through editorials and multimedia presentations. Catalyze change and shape the future Our new Science Policy Division will engage students, academic institutions, public leaders, and the community in discussion and debate about the most pressing and complex issues that face our world today.
All of the students involved in The Triple Helix understand that the fast pace of scientific innovation only further underscores the importance of examining the ethical, economic, social, and legal implications of new ideas and technologies only then can we completely understand how they will change our everyday lives, and perhaps even the norms of our society. Come join us!
The cover for this years Science in Society Review is designed by Katrina Machado of Brown University. It illustrates a choice, from Navajo folklore, between sustenance and destruction. As the story goes, their people decided between two yellow powders: corn or an underworld substance leading to snakes destroying the world. The tale is an allegory of the dilemma between public health and economic health that Native Americans in radioactive waste-contaminated lands face today.
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TABLE OF CONTENTS
Menopause Sexuality Sleeplessness
11 22
6
Changing negative social perceptions toward menopause may be the best treatment
27
Discarding the nature vs. nurture model to understand behavior and sexuality
34
Pushing for betterrested doctors in an over-burdened healthcare system
Cover Article
Nuclear Sovereignty: Radioactive Waste Dumping and Native Lands Alysse Austin
Local Articles
9 12 15 17 19 22 24 27 29 31 34 37 40 43 46 AcupunctureThe Mysterious Needle Megastructures: Architectures Solution for the Issues of Urban Sprawl Early Detection of HIV Movement: Oral Fluid HIV Testing in the Dental Setting Algae May Be the New Electrode in Psychiatric Research The Future of Vaccinations: From Jet Injectors to Edible Vaccines Dying to Feel Young: Re-contextualizing Menopause in America From Recklessness to Reclamation?: The Future of the Alberta Tar Sands Born This Way? Why We Should Be Skeptical of the Science of Sexuality Engineering Tissue: A Cultural Revolution Then and Now: What the Scopes Trial Can Tell Us About Contemporary Biology, Morality and the Law Operating Under the Influence: The Problem with Sleeplessness in the Medical Profession At a Crossroads: Evaluating Novel Treatment Options for Diabetes Mellitus Farm Subsidies for Commodities Crops: the Need to Revamp Outdated Farm Legislation The Sounds of Science Can Social Media Create Social Change? Jacqueline Chang Rudy Chen Catherine Dang Rigina Gallagher Emily Hartman Ezinne Ihenachor Sara Kinslow Hannah LeBlanc Timothy Lim Kate Nussenbaum
Lakir Patel
Alexa Peseri
Selen Senocak Adela Wu
Digital Highlights International Features

50 53 56 58 61
On the Origin of Knowledge: an Evolutionary Enquiry into the Structure Taylor Coplen, UChicago of Perception Disease and DierentialsWhy Paying Attention to Math Might Save the Chirag Krishna, UCSD World Time to remove your wisdom teeth!? Michelle G. Tran, UC Davis The Mysterious Function of the Female Orgasm Claire Wilson, UChicago Reading the Labels: Off-label Drug Prescriptions Hillary Yu, Cornell
Cover design courtesy of Katrina Machado, Brown University
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Chloe OConnell
INSIDE TTH
STAFF AT BROWN UNIVERSITY President Michael Spector Editor-in-Chief Eric Sun Finance Director Connor Shinn Marketing Director Dana Schwartz Science Policy Co-Directors Lily Chan Shubha Jindal Outreach Director Justine Palefsky Co-Managing Editors Eric Bai Alex Meehan E-Publishing Director Rachel Occhiogrosso Outreach Editor Rudy Chen Webmaster Adam Scherlis Associate Editors Christine Bukowski Eva Chen Rudy Chen Emily Hartman Rachel Occhiogrosso Marjorie Palmeri Alice Preminger Dana Schwartz
Message from the President

On behalf of The Triple Helix (TTH) at Brown University, we the former and current presidents are proud to present the latest issue of our organizations journal: The Science in Society Review. The Triple Helix began in 2004 as a single chapter, conceived of and established by a small group of students at Cornell University who were dedicated to investigating the underlying connections that exist between, and fundamentally intertwine, the sciences and the humanities. In the past 8 years, TTH has grown to an international scale. Today, it has chapters at over 20 leading universities around the globe. Browns chapter, founded in 2005, was one of the first to join in The Triple Helixs progressive mission. With the support of a uniquely inquisitive and engaged body of students and faculty, Browns TTH has since become one of the strongest in North America. Particularly, within the last three years, we are proud to have centralized, stabilized, and expanded our TTH chapter at Brown. Through multiple divisions, including Literary, Science Policy and now Community Outreach, we strive to foster public understanding of interdisciplinary relationships and intersections of knowledge. Our members firmly believe that academic progress cannot thrive in a vacuum; rather, the greatest understanding comes from exploring the ways in which topics across many fields of study interact with and relate to one another. As the articles in this journal will show, we are dedicated to studying how scientific developments impacts both culture and society. The Triple Helix exists and thrives because our devoted readers, writers, editors, and leaders are passionate about analyzing, questioning, contemplating, and discussing global issues that affect human societies. We are incredibly thankful for the staff who helped produce this issue of The Science in Society Review, as well as for our members whose involvement extends into our newly formed outreach efforts and community wide special events. We hope you enjoy the intellectual journey upon which you are about to embark. Michael Spector, TTH President 2012-2013 MariaLisa Itzoe, TTH President 2010-2012
Message from the EiC

We are honored and excited to present the Fall 2012 issue of the Triple Helixs The Science in Society Review. This issue marks the beginning of an exciting period of change for the Brown chapter, yet all the hard work, dedication, inspiration and passion that mark all of our issues remains constant. For the second time in a row, Browns writers have produced the international cover article of The Science in Society Review, an unparalleled feat in Browns chapter history. Alysse Austins article, Nuclear Sovereignty: Radioactive Waste Dumping and Native Lands is exemplary, and it is an apt reflection of the growth and maturity that our chapter has undergone over the past year. Our literary staff is the largest and strongest it has ever been, and with recent additions to our executive board, we have the capacity to expand even further. We will be spearheading our E-Publishing division this year, officially bringing our chapter into the digital age. Behind all of these changes lies the fundamental goal of bringing together science, society and law in one publication and exploring new and important intersections. At this exciting time in our history, we urge you to join us. Whether you would like to write, edit, or otherwise staff this publication, please contact us at brown@thetriplehelix.org. Finally, thank you to our writers, editors and faculty advisors for your hard work, insights and dedication. This issue would not have been possible without all of your contributions. Eric Sun, TTH EiC, 2012-2013 Marissa Palmor, TTH EiC 2011-2012
4 THE TRIPLE HELIX Fall 2012
2012, The Triple Helix, Inc. All rights reserved.
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INSIDE TTH
Message from the CEO

On the face of it, The Triple Helix International is an undergraduate science-policy journalism organization. Dig a little deeper, and you will find a talented group of students interested in exploring the implications of scientific advancement on society. We share our passions through scholarly reflections printed in our biannual journal, provide timely, in-depth analyses on our e-publishing blog site, host lecture series and invest in high school out reach. Providing all of these services is no small feat. A team of tireless content editors, business managers, production editors, event coordinators, and more are working at every level of the organization to facilitate success. To us, the organization is not just an extracurricular; it is a family. Alumni, your Triple Helix journey need not end with graduation. Keep in touch and let us celebrate your successes with you. Our past successes have set the stage for greater heights. TTH Online continues to grow, and the next step is going mobile, reaching wider audiences with our thought-provoking content. Ultimately, we aim to create an open forum for learning, and we can only do it with your help. Join us on Facebook, Twitter, and LinkedIn. Let us know what you think. Voice your opinions, make yourself heard, and make time to enjoy the fruits of your labors. I, for one, am sincerely looking forward to another great year for TTH.
Mridula Nadamuni Chief Executive Officer
Message from the CPO and EEiC

Welcome to the Science in Society Review, the print publication of The Triple Helix. In the following pages you will find engaging discussions written by talented undergraduate writers, assisted by dedicated editors, and laid out by production editors. Each article will be unique in its subject matter, but will weave a common theme of how science, society, and law interact in the world. Our cover article, Nuclear Sovereignty: Radioactive Waste Dumping and Native Lands by Alysse Austin of Brown University, for instance, asks us to consider how our need to dispose nuclear waste has trumped respect for disenfranchised groups of people. The practice of dumping nuclear wastes on tribal lands to help alleviate dire economic conditions is only one of many examples of how socioeconomic health clashesironicallywith public health in our flawed socio-eco-political system. We at The Triple Helix encourage you to consider, as you read, the words of Chief Seattle: All things are connected like the blood that unites us all. Man did not weave the web of life, he is merely a strand in it. Whatever he does to the web, he does to himself. To the next generation of world problem-solvers, remember that complex issues require interdisciplinary solutions. Our name The Triple Helix represents the web, or intertwined disciplines, of science, society, and law, and represents one way to approach these problems. Consider this, and feel free to join our global forum for science in society at triplehelixblog. com. It is a small, but first, step toward seeking solutions The Triple Helix way. On behalf of the entire International Editorial Board, welcome to our journal. We hope you will find some fascinating reads here, and will return for our next issue in the Spring 2013!
Dhruba Banerjee and Cassie Yeh Executive Editor-in-Chief and Chief Production Officer
THE TRIPLE HELIX Fall 2012 5
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Nuclear Sovereignty: Radioactive Waste Dumping and Native Lands

Alysse Austin
he warning sign that often signals the boundary of a nuclear waste repository is, appropriately, a foreboding one. The fan-like, black-and-yellow trefoil symbol has become a universal archetype for mysterious operations, for eerie desolation, for sinister danger. Many have only rarely, if ever, encountered these signs as thankfully most people are never situated near a long-term nuclear waste site. Not in my backyard, American citizens adamantly declare. The reaction on the part of these NIMBY campaigners with respect to nuclear repositories is understandable; nobody wants a radioactive waste site situated on the land in which they build their homes and lives. But such waste has to go somewhere, so where do these signs exist? The answer is a dark reflection of one aspect of Americas nuclear energy policy. One of the most surreptitious and tragically common methods of disposing of nuclear materials in the United States is to site, or place, repositories on sovereign or semi-sovereign Native American tribal lands a practice which bears the gilding of legality but completely defies respect for our fellow citizens and for environmental justice. The practice is rarely questioned but hopefully will be more closely scrutinized as the possibility of a future more reliant on nuclear energy increases. The entanglement of Native American tribes and hazardous radioactive waste goes back several decades, but the treaties binding the U.S. government to civil treatment of indigenous land can be traced back to well over a century ago. In June of 1855, in what is today Washington State, the Yakama Tribe signed an agreement with the federal government, ceding a plot of desert land along the westward Cascade Mountains to the United States [1]. The plot of land encompassed a piece of the Columbia River, and the treaty enumerated the rights of the Yakama to use and continue to subsist on the ceded land and water resources. Over a century and a half later, the Yakama nation still possesses the rights to fish and use other resources in the areaat their own risk. 6 THE TRIPLE HELIX Fall 2012
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Today, the danger of gleaning resources from that particular segment of the Columbia lies in the fact that this land is now home to the most contaminated toxic waste site in North America [2]. Its called the Hanford Site, and it was a fully-operating nuclear production facility from 1944 until 1983 [3]. It housed the plutonium reactors used to manufacture the infamous Fat Man, dropped on Nagasaki in the last days of World War II. The cores of its nine nuclear reactors were cooled by the waters of the Columbia River on which the Yakama people depend, which at the time of the facilitys operation was purportedly the most radioactive stream in the world [4]. Declared a Superfund site by the Environmental Protection Agency a year after ceasing operation, today the Hanford Site is still undergoing the cleanup process, with the Department of Energy spending an additional $2 billion a year to restore it to its natural state [5]. The Yakama, along with the nearby Umatilla and Nez Perce tribes, have been active in holding the federal government accountable for the site. In addition to lawsuits, such as the 2003 case urging the federal government to Reproduced from [20] adequately restore the fish runs in this territory (as only the land, not the waters, were deemed eligible for cleanup by the EPA), the Tribal Council has submitted comments on the restoration process and approached officials to remind them of the land treaty to which the United States is still bound [6]. They received less than hopeful responses. In a 2007 speech to Heart of America Northwest, an organization dedicated to the Hanford site cleanup, head of the Yakama tribes Environmental Restoration and Waste Management Program Russell Jim said, As a Tribal Councilman in the mid-1970s, I made government-to-government requests to Hanford officials, to inform them of their trust responsibility and of our Treaty rights...I was often met with a response along the lines of, What Treatywhat does that have to do with Hanford? [7].
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The ongoing account of the Hanford Site is one of various indigenous sustainability group Honor the Earth, are referscenarios throughout the United States in which a native tribe ring to the siting process as radioactive colonialism [13]. has faced or is facing the threat of nuclear waste (imposed The settlements springing up in the midst of tribal lands in by both governmental organizations and the private sector) todays nuclear age are not colonized by human beings, but within its community. Other examples include that of the by cancerous materialspainful demonstrations of the lack of Goshute tribe and the White Mesa Ute tribe in Utah, the Gila respect for age-old treaties and the disregard for human welfare River Indian community in Arion the part of the United States. zona, the Fort Mojave, ChemeThe Navajo tribes struggle with huevi, Quechan, Cocopah, and cancer ever since Cold War-era It is time that we develop an Colorado River Indian Tribes in uranium mining on their lands ethical nuclear waste disposal Southern California, the Navajo reminds us of the reality of the Tribe throughout the southwest, risks. The Navajo had previously program that does not prey and countless others [8]. The difexperienced relatively low cancer upon economic disadvantage ference between these tribes rates than the general populastruggles and the case of the tion, but after years of inhaling Hanford Site is that the latter uranium dust, drinking water demonstrates indigenous tribes shared desire to mitigate which had dwelt among uranium pit mines, and eating foods harm to their communities; their investment in their own which, while in their living state, had absorbed the radioacenvironmental safety is unhindered by any conflict of interest. tive substances, the cancer rate in their community doubled But as in the case of the other aforementioned tribes, there is between the 1970s and 1990s (while the nation as a whole an insidious facet to the narrative linking Native American experienced a decline in cancer) [14]. lands with nuclear byproductsa caveat which pits public This issue is vital to track as the United States explores health against economic health and which further contorts alternative energy programs and attempts to lessen its depenthe state of environmental justice for indigenous groups in dence on fossil fuels over time, as nuclear energy is a viable the United States. It is the fact that there can be substantial future option. Nuclear energy already currently supplies twenty economic incentive attached to storing nuclear waste on tribal percent of American power, and the history of nuclear waste lands or to selling lands for the same purpose, which makes storage in the United States reveals a disproportionate amount the prospect attractive to tribal leaders [11]. of off-site waste residing on Native American reservations [11, While siting is a voluntary process on the part of the 12]. Nuclear waste storage is heavily regulated in the United sites owners, some activists, like Winona LaDuke, head of States, but as reservations are sovereign or semi-sovereign ter-
Reproduced from [21]
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ritories, they are not necessarily bound by the same regulatory the consideration of Yucca Mountain as a waste repository laws. This puts their citizens in a vulnerable place, as twice as suggests that indigenous interests would have little to do with many Native American families are below the poverty line as swaying the decision to build or not to build. It is doubtful, the rest of the population and tribes are therefore less likely to the report explains, given the mood of the federal courts on reject a source of income, even if it comes at a non-monetary views of the sacred by Native American[s], that they alone cost: the risk of radioactive exposure and associated health will impede the project [15]. It is time that the United States develops an ethical nuclear effects [11]. Such is the basis for the conflicting dichotomy of interests at stake, and such is the truly sinister aspect of waste disposal program that does not prey upon economic disadvantage. A piece of the Navajo hazardous nuclear waste siting creation story describes the Naon indigenous lands. vajo people being given a choice As early as 1986, the DeI made government-tobetween two yellow powders partment of Energy was looking for sustenance: one is yellow into Yucca Mountain, Nevada, government requests to Hanford corn powder, and the other is at this time the property of the officials, to inform them of their a substance from the ground Western Shoshone Tribe, as a po[19]. They called this substance tential nuclear waste repository trust responsibility and of our leetso in ancient times, but it is [15]. The 2004 Western Shoshone Treaty rights...I was often met now recognized as radioactive Distribution Claims Act allowed uranium ore. In the story they the U.S. government to buy 24 with a response along the lines choose the yellow corn, which million acres of landincluding of, What Treaty? represents life and vitality, and Yucca Mountain, sacred to the decide that leetso is from the Western Shoshone peoplefrom underworld, a substance meant the sovereign tribe for $186 million dollars, distributed by the Bureau of Indian Affairs [16]. to stay in the earth undisturbed lest it transform into a snake Approved in 2002 by Congress, the Yucca Mountain nuclear above the earths surface and wreak havoc. This ancient story waste plan would effectively wedge the Western Shoshone is an eerie augury of the problem Native American communipeople between a high-level radioactive waste repository and ties now must grapple with; it is the push and pull between the already-existing Nevada Test Site, a nuclear weapons testing that which will sustain them and that which will cause them range. The proposal was met with widespread disapproval to languish. In recent decades, sadly, the separation between from environmentalists, Nevada citizens, and Native groups the two has been muddled. alike and was eventually scrapped in 2010. A victory for the Western Shoshone, perhaps, but an indirect one; the Nuclear Alysse Austin is an Environmental Studies concentrator at Brown Regulatory Commission cited budgetary concerns over all University and grew up in Northern Nevada. else as the reason the plan was nixed [17,18]. A 1991 report on
References 1. Stevens, Isaac L. Treaty With the Yakama, 1855. Territory of Washington; June 1855. 2. Economic risks to the region - Hanford, the Columbia River and the economy [Internet] 2009 [cited 2012 Mar 12]. Available from: http://www.ecy.wa.gov/features/ hanford/hanfordecon.html. 3. Hanford Overview [Internet]. 2012 Jan 8 [cited 2012 Mar 12]; Available from: http:// www.hanford.gov/page.cfm/HanfordOverview. 4. Alvarez, Robert. Poisoning the Yakama. Counterpunch [Internet]. 2010 Dec 17 [cited 2012 Mar 12]. Available from: http://www.counterpunch.org/2010/12/17/ poisoning-the-yakama/. 5. Frank, Joshua. Hanfords Toxic Avengers. Seattle Weekly [Internet]. 2012 Feb 22 [cited 2012 Mar 12]. Available from: http://www.seattleweekly.com/2012-02-22/news/ hanford-s-toxic-avengers/. 6. Yakama Nation Seeks to Expand Hanford Lawsuit. U.S. Water News Online [Internet]. October 2003 [cited 2012 Mar 12]. Available from: http://www. uswaternews.com/archives/arcrights/3yaknat10.html. 7. Jim, Russell. The Yakama Nation & Restoration of the Hanford Site. Heart of America Northwest [Internet]. 2007 June 4 [cited 2012 Mar 12]. 8. Environmental Health, Justice, and Sovereignty. Greenaction [Internet]. Available from: http://www.greenaction.org/indigenouslands/index.shtml. 9. Native Americans: Uranium Mining/Nuclear Testing/Nuclear Dumping. Friends of the Earth [Internet]. Available from: http://www.motherearth.org/h-rights/america. php. 10. Understanding Radiation: Health Effects. USEPA [Internet]. 2011 July 8 [cited 2012 April 25]. Available from: http://www.epa.gov/radiation/understand/health_ effects.html#q1. 11. Reservations about Toxic Waste: Native American Tribes Encouraged to Turn Down Lucrative Hazardous Disposal Deals. Scientific American [Internet]. 2010 Mar 31 [cited 2012 Mar]. Available from: http://www.scientificamerican.com/article. cfm?id=earth-talk-reservations-about-toxic-waste. 12. United States Environmental Protection Agency. Nuclear Energy [Internet]. 2012 Feb 29 [cited 2012 Mar 14]. Available from: http://www.epa.gov/cleanenergy/energyand-you/affect/nuclear.html. 13. Gowda M.V.R., Easterling D., Nuclear Waste and Native America. Risk, Health, Safety and Environment 1998; 9(3); 248. 14. Fowler, Catherine S. Native Americans and Yucca Mountain: A Revised and Updated Summary Report on Research Undertaken Between 1987 and 1991. State of Nevada Agency for Nuclear Projects. 1991 October [cited 2012 Mar 12]. Available from: http://www.state.nv.us/nucwaste/library/se-039-91v1.pdf. 15. Pasternak, Judy. A Peril that Dwelt Among the Navajos. Los Angeles Times (Los Angeles, California) [Internet]. 2006 Nov 19 [cited 2012 May 21]. Available from: http:// www.latimes.com/news/la-na-navajo19nov19,0,89720,full.story. 16. Harding, Adella. BIA updates Western Shoshone on Money. Elko Daily Free Press (Elko, Nevada) [Internet]. 2010 June 21 [cited 2012 Mar 12]. Available from: http:// elkodaily.com/news/local/article_0a5a56c8-7d0a-11df-aaca-001cc4c002e0.html. 17. Environmental Justice Case Study: The Yucca Mountain High-Level Nuclear Waste Repository and the Western Shoshone. University of Michigan School of Natural Resources and Environment [Internet]. 2004 June 18 [cited 2012 Mar 12]. 18. Winter, Michael. NRC Clears Way for Scrapping Yucca Mt. Nuke Dump. USA Today [Internet]. 2011 Sept. 11 [cited 2012 Mar 12]. Available from: http://content. usatoday.com/communities/ondeadline/post/2011/09/nrc-clears-way-for-scrappingyucca-mt-nuke-dump-/1#.T2YUHWJWpJ8. 19. Environmental Justice for the Navajo: Uranium Mining in the Southwest. University of Michigan School of Natural Resources and Environment [Internet]. 2004 June 18 [cited 2012 Mar 12]. Available from: http://www.umich.edu/~snre492/sdancy. html. 20. Hanford Site. Wikipedia [Internet]. 2005 January [cited 2012 August 11]. Available from: http://en.wikipedia.org/wiki/File:Hanford_Site_sign.jpg 21. Yucca Mountain Nuclear Waste Repository. Nevada Division of Environmental Protection [Internet]. [cited 2012 Aug 11]. Available from: http://ndep.nv.gov/boff/ yucca03.jpg

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Acupuncture: The Mysterious Needle

Jacqueline Chang
any people cringe at the thought of needles. Others voluntarily get ten to fifteen needles stuck in them for therapeutic reasons each week. Acupuncture is the ancient Chinese healing art used to treat just about any physical disorder. Early records suggest that acupuncture has been around since 1600 B.C. [1]. Not only is it still widely practiced in Asia, it has also gradually permeated Western culture since the 1970s [2]. How does the penetration of needles cure physiological disorders? The simple answer is that there is no proven answer. Despite the lack of an accepted explanation, placebo studies and patient satisfaction surveys have shown that the treatments are effective in removing symptoms of certain diseases. Unfortunately, cultural stigmas, healthcare systems, and costs of treatment in the US and other countries prevent the expansion of this medical practice. The lack of understanding behind the treatment makes the healthcare system wary of implementing this alternative procedure. However, with its natural analgesic (painkilling) properties, acupuncture should be included in modern healthcare, and people should be made aware of this alternative treatment option. What is Acupuncture? The therapeutic basis of acupuncture lies in the proposed existence of meridians. Meridians are pathways that allow qi (pronounced as chi) to circulate around the human body. Qi is an energy form that flows through these invisible meridian channels and propels growth in the human body, controlling the physiological functions of organs [3]. Traditional Chinese Medicine (TCM), believes that the cause of any disease is directly related to a disharmony in qi. Acupuncture needles serve to rebalance the flow of energy and to restore harmony in qi by targeting specific acupoints, areas where needles should be inserted. People have tried to study the mechanism of acupuncture. It has been found that acupoints tend to be located in areas of abundant connective tissues. Acupuncturists will manipulate the needle through rotational movements in order to achieve what is known as needle grasp [4]. The movement of the needle causes the connective tissue to wrap around the needle and form a whorl. This process results in the polymerization of the contractive protein, actin, which induces contraction of fibroblast cells in connective tissue [5]. During this time, the patient will feel a temporary aching sensation known as deqi. This process leads to the release of neurotransmitters, such as endorphins, that can ease pain.
Acceptability of Acupuncture Current trends in the healthcare system favor making acupuncture more accessible. The Los Angeles Times conducted a survey in which forty-two percent of hospitals surveyed said they offer one or more alternative therapies to the standard ones found in American hospitals [6]. Hospitals are gradually accepting acupuncture because of its potential to reduce hospital resource use. In 1994, a study compared stroke patients that received acupuncture treatments with those that did not. On average, those who got acupuncture were able to leave the hospital 73 days earlier than those who did not receive the treatment [7]. Integrating acupuncture in hospitals benefits both healthcare providers and patients as it lowers costs, increases treatment options, and limits the need for care in specialized clinics. In addition to accessible providers, it is also important to have willing patients. In order to encourage people to consider this alternative practice, physicians must be aware of the thought process of their patients: what makes people willing or unwilling to try acupuncture? The effectiveness of acupuncture in enabling the management of chronic disease encourages patients to consider this form of treatment. For example, Dr. Tian, a member of the National Advisory Council for Complementary and Alternative Medicine, reports that in
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his clinic he observes acupunctures ability to treat arthritis. The therapy tackles arthritis symptoms such as joint pain, swelling, [and] stiffness, and helps patients deal with this chronic disease [8]. Moreover, the personal element associated with the physical and psychological contact between an acupuncturist and his or her patient also enhances acupunctures desirability and the overall quality of the treatment. According to Dr. Heffron, a certified acupuncturist and medical doctor in Providence, Rhode Island, some patients may leave feeling better not purely because of the treatment but also because they are satisfied with the attention they received [9]. This phenomenon is explored in a study testing the correlation between the intimacy of nurses and the effects on their patients. When nurses were scripted to act distant, neglectful, or insulting, the patients responded by participating less in their treatment. Nurses that were told to be accessible, personable, and attentive influenced patients to be more actively involved in their treatments [10]. From this study it could be extrapolated that the emotional factor becomes an additional noninvasive therapy that accompanies acupuncture treatments. Thus, it is both the physiological and psychological benefits of acupuncture that stimulate patients to try this traditional Chinese practice. However, compared to Western treatments, acupuncture is still relatively obscure and unpopular. For some, it is because they are not aware of the treatment. For others, it is the negative cultural stigma that colors their opinion of acupuncture. People are naturally squeamish about needles, which makes the thought of acupuncture quite daunting. Furthermore, without a complete scientific explanation, acupuncture is not as credible as Western therapies to Western consumers. Acupuncturists are not considered doctors in the United States. Attending acupuncture school results in a masters or doctorate degree, but not a M.D. [11]. In the US, people are accustomed to consulting only medical doctors for their
Successful integration of acupuncture into Western culture involves tackling the cultural stigma against the practice
medical issues. This ideology makes it hard for these people to even consider going to someone who is not a doctor for serious health-related problems. Successful integration of acupuncture into Western culture involves tackling the cultural stigma against the practice. One possible way to remove this stigma is to include acupuncture as a rotation in medical school and subsequently develop it as a field that medical interns can choose to specialize in. Allowing certified medical doctors to become acupuncturists will remove some of the skepticism people associate with the practice and bring awareness to this form of treatment. However, without further scientific studies on the correlation between qi and modern physiological systems it may be hard for acupuncture to be approved as a field of study in medical schools. Affordability of Acupuncture Cost is another reason why some shy away from acupuncture. According to the New York Times, acupuncture could cost between $65 and $120 per session [12]. Although it differs between patients, one or two treatments a week for several months is recommended for those with long-term health issues a significant sum for one to pay [13]. Individual sessions cost so much because the majority of acupunctural clinics are private. In addition to treatment costs, the therapists must also pay for general equipment that hospitals usually supply (thermometers, sphygmomanometer, etc.). Furthermore, these treatments are not covered by most health insurance plans, including Medicare. This drives up the out-of-pocket expenses for patients and, as a consequence, those with lower incomes will naturally be less able to try this form of treatment. Lowering costs will also increase the number of patients willing to receive acupuncture treatments. Cities like Providence, Rhode Island, have programs such as the Community Acupuncture Movement working to tackle this problem. The mission of this program is to provide affordable acupunctural care to the residents of the Providence area. In fact, the front page of its website says that patients decide how much to pay on their sliding-scale of $15 to $35 per treatment [14]. This gives patients the flexibility to pay an amount based on their own financial capabilities and makes the treatment more accessible to low-income families. In addition, costs may also decrease if more hospitals included acupuncture as a therapeutic option. Hospital resources and funds could cover the costs of equipment so that the therapists would not need to charge high prices to compensate for their increased expenses in private clinics. Some hospitals are already starting to implement acupuncture. However, most public hospitals

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still do not have specialized departments for Complementary Alternative Medicine (CAM). In fact, a 2001 study was conducted on thirteen hospitals affiliated with Harvard Medical School or the New England School of Acupuncture. It was found that only one hospital actually offered acupuncture to inpatients [15]. These results indicate that a push is necessary to increase the number of hospitals that have a specialized acupunctural department. By lowering treatment costs, more people may be willing to try acupuncture. results in enormous costs and risks of side effects that the patients will have to deal with. Acupuncture may be more cost effective than taking medications and may also reduce the number of side effects through its ability to help patients manage pain. In addition, the natural physical contact with the doctors might even encourage patients to go see an acupuncturist more often which could lead to an early detection of the disease. This may save a patients life. Conclusion The study of traditional Chinese medical practices like acupuncture is still incomplete. There remain many unsolved mysteries behind how all the concepts in acupuncture are interrelated from a Western scientific perspective. Although it may still be years before the science behind acupuncture can be fully understood, studies done on patients with chronic pain problems clearly indicate the success of this form of treatment. To improve the accessibility of acupuncture, the US will need to promote its acceptance in public hospitals and by insurance plans. This could remove many of the cultural and financial barriers to access. Some of these changes are presently occurring and acupuncture is slowly rising in popularity. In fact, statistics show that between 2002 and 2007, the use of acupuncture by adults in the US increased by approximately 32% [18]. It is important to encourage people to be open-minded about acupuncture because it has the potential to improve the quality of life for many. It will also expand peoples trust in what is now considered unconventional medicine and will promote the globalization of other beneficial alternative practices. Jacqueline Chang is an undergraduate student at Brown University. She is concentrating in biology and is also a pre-medical student. She is interested in exploring complementary alternative therapies in the future.
com/2010/05/08/health/08patient.html?pagewanted=1. 13. American Academy of Medical Acupuncture [Internet]. 1997-2006 [cited 2012 Mar 26]. Available from: http://www.medicalacupuncture.org/acu_info/articles/ aboutacupuncture.html. 14. Providence Community Acupuncture [Internet]. 2011 [cited 2012 Feb 20]. Available from: http://providencecommunityacupuncture.blogspot.com/p/about-us. html. 15. Highfield E.S., Kaptchuk T.J., Ott M.J., Barnes L., Kemper K.J. Availability of Acupuncture in the Hospitals of a Major Academic Medical Center: A Pilot Study. Complementary Therapies in Medicine Journal. 2003 Sep; 11(3): 177-183. doi: 10.1016/ S0965-2299(03)00069-4. 16. Wang E.S., Li P-W., Nilius B., Li G. Ancient Chinese Medicine and Mechanistic Evidence of Acupuncture Physiology. Pflugers Archive [Internet]. 2011 [cited 2012 Feb 14]; 462(5): 645-653. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3192271/. 17. Roxby P. Will 10-year-olds be popping pills to live longer? BBC [Internet]. 2012 Mar 17 [cited 2012 Apr 24]. Available from: http://www.bbc.co.uk/news/ health-173903041. 18. National Certification Commission for Acupuncture and Oriental Medicine [Internet]. 2009 July 8 [cited 2012 May 19]. Available from: http://www.nccaom.org/ uncategorized/new-study-reveals-number-of-visits-to-acupuncturists-and-amountof-out-of-pocket-spending-annually-for-practitioner-visits-and-self-care-such-as-taichi-and-qi-gong-up-significantly-from-previous-2002. 19. NYCTCM: Acupuncture Treatment After insertion the needle is twirled a little. Tenderloin, New York. 2008 Nov. 1. 20. NYCTCM: Students learn Acupuncture at NYCTCM This point helps the sinuses. Advanced NYCTCM student inserting acupuncture needle between the eyebrows. Mineola, New York. 2008 Sept. 12. 21. NYCTCM: Acupuncture Treatment Pulse Diagnosis. Tenderloin, New York. 2008 Nov. 1. 22. Mot: Acupuncture Poster Profile. 2007 Jan. 28.
The simple answer is that there is no proven answer
Implications of Acupuncture in the Mainstream Culture Clinical trials have shown acupunctures success in reducing migraines, knee and back pain, chemo-induced nausea, vomiting and hot-flash among other aches and pains [16]. Other benefits of acupuncture include its affordability compared to other available methods of treatment, its lack of prescription medicines that could have negative side effects, and its low level of risk for patients. With these advantages, acupuncture has so much potential for improving healthcare in modern societies. It should be integrated into the mainstream culture because it is a beneficial complementary therapy to treat various illnesses. A real life example of the benefits of utilizing acupuncture as a treatment method could be seen in patients with chronic diseases. As the average lifespan increases, people become more prone to chronic diseases such as heart disease, diabetes, stroke and cancer [17]. Often, people with these illnesses will have to consume medical pills for the rest of their lives. This
References
1. Mann F. Acupuncture The Ancient Chinese Art of Healing. New York: Random House Inc.; 1971. p.1. 2. Tsuei J.J. The Science of Acupuncture Theory and Practice. Engineering in Medicine and Biology. 1996 May-June; 15(3): 52-57. doi: 10.1109/51.499758. 3. Hao Y., Liu H., Yue S., Liu X. Introducing Traditional Chinese Nursing: A review of concepts theories and practices. International Nursing Review. 2011 Sep; 58(3): 319-327. doi: 10.1111/j.1466-7657.2011.00918.x. 4. Langevin H.M., Yandow J.A. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The Anatomical Record. 2002 Dec; 269(6): 257-265. doi: 10.1002/ar.10185. 5. Langevin H.M., Yandow J.A. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The Anatomical Record. 2002 Dec; 269(6): 257-265. doi: 10.1002/ar.10185. 6. Helfand D. More Hospitals Offering Alternative Therapy Services Los Angeles Times [Internet]. 2011 Sep 8 [cited 2012 Feb 20]. Available from: http://articles. latimes.com/2011/sep/08/business/la-fi-alternative-medicine-20110908. 7. Johansson K., R.N., Lindgren I., L.P.T, Widner H., Wiklund I., Johansson B.B. Can sensory stimulation improve the functional outcome in stroke patients? Neurology. 1993 Nov; 43(11): 2189-2192. 8. American Autoimmune Related Disease Association [Internet]. [cited 2012 May 19]. Available from: http://www.aarda.org/research_display.php?ID=85. 9. Heffron R. Interview. 2012 Feb 20 [cited 2012 Feb 25]. 10. Larsson I.E., Sahlsten M.J.M., Segesten K., Plos K.A.E., Patients Perceptions of Nurses Behaviour That Influence Patient Participation in Nursing Care: A Critical Incident Study. Nursing Research and Practice. 2011 Apr: 1-8. doi:10.1155/2011/534060. 11. The Accreditation Commission for Acupuncture and Oriental Medicine [Internet]. [cited 2012 Feb 26]. Available from: http://www.acaom.org/. 12. Alderman L. Acupuncture is popular, but youll need to pay. New York Times [Internet]. 2010 May 7 [cited 2012 Feb 26]. Available from: http://www.nytimes.
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Megastructures: Architectures Solution for the Issues of Urban Sprawl

Rudy Chen
n the contemporary era, both population growth and technological innovation in the United States have resulted in a unique pattern of growth. Horizontal expansion consumes rural, unoccupied land, and suburban areas constantly increase in size and quantity. Unfortunately, this strategy places unnecessary strain on the environment and on the population; environmental damage, human health problems, and financial burdens are just a sampling of the direct and indirect consequences. While most developed societies continue to pursue cutting-edge developments separately in environmental science and health care, a more integrated solution to the consequences of urban expansion lies in field of architecture: megastructures. If constructed, these proposed complexes could one day eliminate many of the negative impacts of urban sprawl. What are Megastructures? In the 1960s, architecture groups such as Archigram and the Metabolists recognized the issues caused by the rise of suburbia. In response, they designed megastructures, which are massive complexes that could avoid the environmental issues rooted in suburban sprawl by integrating residential, social, and economic centers [1]. Often, these planned designs featured enough structural flexibility to accommodate the rapidly shifting needs of inhabitants. They emphasize vertical expansion rather than horizontal expansion; they are taller than they are wide, minimizing the plot of land required for construction. The ultimate goal of a megastructure is to achieve
The ultimate goal of a megastructure is to achieve efficiency and function as one environmentally friendly unit
efficiency and function as one environmentally friendly unit [1]. In spite of the intentions of the architects who designed these projects, the majority of them were never built. The Track Record of Suburban Expansion in America One of the most significant results of todays urban planning strategy is the harm it does to the environment. The native vegetation of a particular region must be cleared in order for developers to construct suburban areas, which by itself creates a myriad of concerns. Land clearing results in the destruction of natural habitats and therefore poses a threat to popula-
tions of native species. Rainfall is reduced over cleared areas, and deforestation creates a dramatic rise in carbon dioxide emission levels [2]. Replacing natural soil with impermeable building material also prevents rainwater from replenishing the groundwater supply. Worse, as the rainwater flows across land, it accumulates oils and other chemicals, eventually entering the groundwater supply contaminated. The existence of a suburb itself is enough to cause the problems mentioned above before even considering the impact of the humans who live within it. In addition to the direct consequences of horizontal expansion, the way people adapt to live in the pattern of suburban sprawl exacerbates environmental damage as well. Suburban islands are isolated from urban city centers as well as from each other, which creates a higher demand for automobile travel. A study investigating the effect of urban sprawl in Germanys Ruhr area reveals that dislocating people from urban areas to suburban areas leads to a 16.7% increase in distance traveled and a 12% spike in four types of harmful emissions: carbon monoxide, nitrous oxides, volatile organic compounds, and particulate matter [3]. As the size of suburbs increases, the environmental damaged caused by humans further compounds the direct consequences of suburban expansion. Suburban sprawl also plays a major role in lowering the quality of human health. As distance increases between residential areas and non-residential areas, the reliance on automobile transportation increases while walking becomes increasingly inconvenient. Less physical activity on a daily basis results in an increase in body weight. A national study evaluating data from 448 counties across the United States indicates that the expected weight for an adult of average height is six pounds greater in areas with more sprawl compared to adults in more compacted regions [4]. Since weight is strongly linked to chronic disease, the rate of chronic disease is higher for people who live in less dense regions [4]. For instance, the rate of hypertension for residents of the 25 most compact counties surveyed is more than two percent less than the rate for the 25 most expansive counties [4]. Type-2 diabetes, coronary heart disease, and colon cancer are some of the other chronic conditions that could cause undesirable health consequences because they are more likely to affect the overweight population. How Megastructures Can Mitigate the Consequences of Suburbia A change in suburban planning strategy can simultaneously address the environmental impacts and health concerns detailed

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above. Instead of unsustainable horizontal sprawl, vertical expansion via megastructures may alleviate the burdens associated with the rise of suburbia. Two of these megastructure complexes, Paolo Soleris Arcosanti and Constant Nieuwenhuiss New Babylon, provide a glimpse of responsible architecture and its potential impact on environmental and human health. Paolo Soleris main concerns about suburban sprawl were excessive energy consumption and sustainability, which led to his creation of arcology. Arcology is a hybrid of architectural and ecological principles in an attempt to create sustainable structures [5]. Thus, the features within his projects are directly designed to avoid extraneous use of resources. In Soleris Arcosanti, a planned megastructure in the Arizona desert, sunlight is incorporated as a natural source of energy. Photosynthesis from greenhouse plants would provide heat during winters, and structures would be angled to maximize sunlight to illuminate interiors and provide heat [5]. Also, since the completed structure would occupy only a small plot of land compared to a suburb, the majority of the original land and biodiversity would remain undisturbed. The majority of rainfall would also flow unimpeded through the soil layers without the disturbance of synthetic surfaces, which eliminates the problem of polluted runoff. Through its planned internal efficiency and ecological harmony with its surroundings, Arcosanti strives to mitigate the strain on natural resources and reduces man-made environmental damage. In addition to the ecological advantages of the complex, the layout of Arcosanti favors a more active way of life rather than the sedentary suburban lifestyle. The dense structure accomplishes this through a web of systems that interact using efficient circulation of people and resources [6]. This network includes living quarters, businesses, and open space that are all equally accessible by walking. Since the primary method of transportation shifts from personal vehicles to walking, physical activity serves a more practical purpose while private vehicles become less needed. The completed project harbors a strategic layout that improves overall health by promoting active lifestyles, which decreases the prevalence of chronic diseases. Unlike Soleri with his direct approach to addressing environmental issues in architecture, Nieuwenhuis envisioned New Babylon as more of an ideological reaction to the monotony and lack of creativity found in suburban regions. Movable walls and adaptable stairways are found throughout the plan In addition, advanced technology offers readily adjustable color, sound, light, and climate settings to change the functions of spaces [7]. These features reflect the notion that architecture should readily adapt to a dynamic life. While the main goal of New Babylon differs from that of Arcosanti, the design of New Babylon shares many of the environmentally friendly elements of Soleris design. The flexibility and resulting proximity of spaces in the structure encourages commuting by foot or cycling. Most of the structure is raised off the ground and supported by scaffolding and pillars [7]. Since the structure would have minimal contact with the ground, large-scale land clearing is unnecessary. The structure would be less invasive on the surrounding nature. Compared to a sprawling suburban island, New Babylon would not pose as big of a threat to wildlife. Also, the percolation of rainwater into the ground is less hindered by synthetic ground cover in the megastructure. This would reduce the amount of polluted water replenishing groundwater supplies. Overall, the plan of the entire complex mirrors Soleris Arcosanti; both projects highlight a step away from waste and progress toward environmental responsibility. Criticism of Megastructures Despite the advantages detailed above, there remain several obstacles to address before these megastructures become reality. First, many are unwilling to relinquish the idyllic, American way of life characterized by private transportation and sprawling suburbs. However, as mentioned above, todays strategy for suburban growth is unsustainable and cannot remain the only approach. Still, not everyone must abandon private homes and live in a megastructure for the complexes to be effective. As long as some people are willing to reside in megastructures, there will be fewer people living in suburban developments, which will decrease environmental damage. Unlike people living in high rises today, these people will have fewer health concerns since the megastructures layouts
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often promote physical exercise. With time, sustainability will become a more important issue as resources become scarcer, and many people could be more likely to consider megastructures for their residences. Even with these potential advantages, there exists much criticism of megastructures. One such argument stems from the social environment of western culture. Big buildings often evoke highly centralized political power and the oppression of individual freedom [8]. However, these connections do not accurately portray reality. For instance, a scene in Terry Gilliams film Brazil features massive buildings that constantly rise from the ground to block the protagonist, which suggests that these giant structures are weapons of the oppressive ruling force [9]. In the real world, the towering Ryugyong hotel in North Korea also has become a symbol of the countrys totalitarian regime. Despite these two examples, megastructures actually have no correlation with oppression in the real world. Moshe Safdies Marina Bay Sands complex in Singapore is a resort that encompasses over ten million square feet of space, and contains venues for shopping, entertainment, and relaxation. These activities are not usually associated with oppression, but rather lean toward the notions of freedom, leisure, and flexibility. Many other large, population-dense structures are located in democratic nations, such as the Commerzbank tower in Germany. These examples illustrate that the sizes of the structures are not indicators of political oppression and that the size of megastructures is not a major problem, especially in light of their potential environmental advantages. Despite the social opposition to megastructures, the most challenging roadblock is still accommodating the mass of one of these complexes. Some designed megastructures, like the Shimizu Mega-City Pyramid planned in Japan, are
References 1. Neumann D. Urban Visions, Megastructures [unpublished lecture notes]. HIAA0860: Contemporary Architecture. Brown University; lecture given 2012 Feb 1. 2. Chiras DD. Environmental Science. Sudbury: Jones & Bartlett Publishers; 2010. 3. Ridder KD, Lefebre F, Adriaensen S, Arnold U, Beckroege W, Bronner C, et al. Simulating the impact of urban sprawl on air quality and population exposure in the German Ruhr area. Part II: Development and evaluation of an urban growth scenario. Atmos Environ. 2008 Sep; 42(30): 7070-7077. 4. McCann BA, Ewing R. Measuring the Health Effects of Urban Sprawl: A National Analysis of Physical Activity, Obesity, and Chronic Disease. Washington DC: Smart Growth America; 2003. 5. Arcology Theory [Internet]. Mayer: Arcosanti; 2003 [cited 12 March 2012]. Available from: http://www.arcosanti.org/theory/arcology/intro.html 6. Arcosanti Project History [Internet]. Mayer: Arcosanti; 2003 [cited 12 March 2012]. Available from: http://www.arcosanti.org/project/background/history/main.html
too massive to support with todays construction materials However, developments in carbon nanotube technology could soon synthesize strong, lightweight materials to make such complexes feasible. Nanotubes developed recently have been shown to withstand tension up to 63 gigapascals. This means that a wire one millimeter in diameter can support a hanging weight of 6,422-kilograms, which eclipses the strength of traditional construction materials and opens up new possibilities for construction [10]. Since the development of stronger structural materials should be able to overcome the main obstacle associated with megastructures, there is no reason to reject the viability of these large structures as a new approach to suburban expansion. Using Megastructures to Plan for the Future In the near future, the United States will still be able to accommodate horizontal expansion of suburbs. However, there may be a day when the only direction capable of supporting growth is upward, since land is not an unlimited resource. The megastructure represents an effective planning strategy that integrates environmental science, architecture, and human health to solve the inefficiencies of suburbia. With limited options for continued expansion remaining, constructing megastructures may be the most practical solution for sustaining the constantly quickening pace of life. Rudy Chen is currently a sophomore at Brown University and is studying neuroscience. Besides devoting time to academics, Rudy is an accomplished pianist and enjoys classical music. The topic for this article was inspired by Professor Dietrich Neumanns Contemporary Architecture course at Brown University. Rudy can be contacted at rudy_chen@brown.edu.
7. Nieuwenhuis C. New Babylon. From: Conrads U., editor. Programs and Manifestoes on 20th-Century Architecture. Cambridge: The MIT Press; 1971, 177-178. 8. Dietrich Neumann, Postmodern Urbanism (lecture, Contemporary Architecture, Brown University, Providence RI, February 24, 2012). 9. Gilliam T, director. Milchan A, producer. Brazil [DVD] Universal City (CA): Universal Studios; 1985. 10. Yu MF, Lourie O, Dyer MJ, Moloni K, Kelly TF, and Ruoff RS. Strength and Breaking Mechanism of Multiwalled Carbon Nanotubes Under Tensile Load. Science. 2000; 287(5453): 637640. 11. Suburbia [image on the internet]. [cited 2012 May 21]. Available from: http:// en.wikipedia.org/wiki/File:Suburbia_by_David_Shankbone.jpg 12. Arcosanti [image on the internet]. [cited 2012 May 21]. Available from: http:// en.wikipedia.org/wiki/File:Arcosanti-Panorama-800.jpg 13. Petronas Towers [image on the internet]. [cited 2012 May 21]. Available from: http://upload.wikimedia.org/wikipedia/commons/8/85/Petronas_Panorama_II.jpg

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Early Detection of HIV Movement: Oral Fluid HIV Testing in the Dental Setting
Catherine Tuyet Mai Dang
Importance of Oral HIV Early Detection One of every five people infected with HIV is unaware of their diagnosis [1]. There are currently around 36 million people around the world who are infected with HIV, and every nine minutes and 30 seconds another American is infected. HIV is incurable, yet treatment is available and it is` important for patients to be educated on their options. Making more people informed of their HIV diagnosis may also decrease the number of new casesonce people are aware of their status, they may become more careful about putting others at risk. There are many reasons why HIV-positive individuals are unaware of their diagnosis. People experiencing mild early symptoms consistent with HIV rarely make the effort to get checked. Those who elect not to receive an HIV test cite varied reasons for their decision. Some people fear the stress of receiving HIV test results, while others dislike doctors or question the accuracy of the test. Busy medical practitioners may not regularly make an effort to detect early signs of HIV because of time constraints and patient consent [2]. Oral HIV testing could help improve awareness and provide easier access to HIV testing. The test uses a device with an absorbent pad, which is placed against the outer gum. Then the absorbent pad is placed in a vial of solution connected to a handheld screen, which will show a red line if HIV-1/2 antibodies are present [3]. Dental offices are especially well-suited to properly diagnose the early stages of HIV infection using this methodology of HIV screening. There are oral conditions that can serve as clear indicators of HIV and if properly identified will enable advise an HIV patientdentists can be involved as well. Dental Screening Dentists have traditionally played a substantial role in screening for medical conditions. For instance, dental practitioners are presently well-educated about hypertension, including the procedures for detection and proper referral [4]. Dentists also play an integral role in early detection of diabetes, as elevated sugar levels from diabetes can significantly reduce the amount of saliva in the oral cavity, causing dry mouth. The field of dentistry has also been involved in HIV primary care for many years. While patients may struggle to identify early signs of HIV, dentists and dental hygienists are oftentimes the first to notice early warning signs located at the oral cavity. At least 90% of HIV-positive patients also have yeast in the mouth, canker sores with a red lining surrounding the gum line, which are symptoms that are directly linked to the HIV progression. Currently, dentists can only refer high-risk patients to doctors rather than perform an HIV test themselves, so a dentist can never be sure whether the patient followed up or not [4]. Oral HIV testing with oral fluid specimens in dentists offices could increase acceptability of testing individuals with high susceptibility for HIV infection. A study conducted at NYUs College of Dentistry surveyed patients regarding their opinions on oral HIV testing. Almost 75% of the people indicated that they would accept dental screening, praising the process as convenient and helpful in detecting more cases of HIV. A small minority raised concerns regarding privacy, the extra stress on dentists, and potentially creating a fear of dental offices. The participants also offered suggestions that patients be notified of their results after confirmation tests are done and that professional counseling resources be readily available for patients [7]. Oral HIV Testing Despite the great need for rapid oral HIV testing, it comes with many disadvantages. Some dentists are opposed to incorporating HIV testing in their offices because they are concerned how they will deliver news to a patient who is HIV-positive [8]. Others are concerned about the accuracy of oral HIV testing and its safety. Also, dentists would need additional training to perform HIV tests [8] and are debating whether the HIV tests should incur additional costs to the expense of insurance. Still, the benefits of oral HIV testing outweigh the drawbacks. This methodology of rapid HIV testing has been concretely proven to produce reliable results. The procedure, which typically takes 20 minutes, fits easily into the time frame of a dental visit. Risk of transmission is low with oral fluids,
With oral HIV testing, a medical practitioner is not the only person that can diagnose and advise an HIV patientdentists can be involved as well
oral health practitioners to discuss, counsel, and offer referrals for further HIV testing. Many people visit dental offices during year but do not have access to any other forms of medical care. Therefore, endorsing dental offices to integrate HIV testing into their check-ups will broaden the available resources of early HIV detection and work towards improving the health and quality of life for more people. With oral HIV testing, a medical doctor is not the only person that can diagnose and
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and administering the tests would be safe because it does not require handling contaminated needles or glassware. Oral HIV testing uses only one collection device, which is an absorbent material to collect saliva, making the disposal of the collection samples safe [8]. Also, the introduction of oral HIV testing in dental offices only requires basic training. The supplies and tools required for testing are inexpensive, ranging from $0.50 to $1.50 per test [8]. Implementing oral HIV testing in dental offices would be cost-effective and safe. The Steps in Implementing Rapid-HIV Screening Despite the obvious benefits, there are still certain steps that need be taken before implementing HIV screening in dental offices. Dental programs must read and understand the state HIV testing laws that ensure that their testing processes is legal, and they must complete the Clinical Laboratory Improvement Amendment (CLIA) application [4]. Dental offices that choose to implement these oral HIV testing in their check-ups must also have all clinicians receive training or certification on the procedures of HIV screening. It is important for dental office employees to serve as resources to direct patients to centers that provide confirmatory testing, counseling, and follow-up care. This way, dentists dependably diagnose HIV, direct patients to resources of help and facilitate HIV treatment [4]. Implemented Screenings Dental offices in Casper, Wyoming and upstate New York were
While patients may struggle to identify early signs of HIV, dentists and dental hygienists are oftentimes the first to notice early warning signs located at the oral cavity
two of the first offices to incorporate HIV screening in their routine dental care [5]. Several other dental clinics in cities such as Kansas City, New York City, Detroit, and Washington, DC, are currently researching the potential benefits of this methodology and may soon implement the test as well [5]. The integration of dentists into early HIV detection will help control the spread of HIV infection. Oral HIV testing offers a new methodology that will be able more easily integrate into dental offices, emergency centers, and other public health centers. Rapid oral HIV testing is cheap, efficient, and should be implemented into the dental setting. Catherine Dang is an economics concentrator and pre-dental student who was excited to show how dentistry can become involved in health related conditions such as HIV.
Reproduced from [9]
References
1. HIV and AIDS in America [Internet]. [cited 2012 April 14] Available from: http://www.avert.org/america.htm. 2. HIV Testing and Written, Informed Consent [Internet]. [cited 2012 April 03]. Available from: http://www.thebody.com/content/art47059.html. 3. HHS Extends Use of Rapid Oral HIV Test to New Sites Nationwide [Internet]. [cited 2012 April 14]. Available from: http://archive.hhs.gov/news/ press/2004pres/20040625b.html. 4. Rapid HIV Testing in the Dental Setting [Internet]. [cited 2012 April 14]. Available from: http://www.hivdent.org/_Main_/main_RHTD0709.htm. 5. How Can Dentists Diagnose Undetected Diabetes In Their Patients? [Internet]. [cited 2012 April 25]. Available from: http://www.hivehealthmedia.com/dentists-
diagnose-undetected-diabetes-patients/. 6. Breaking Down Barriers [Internet]. [cited: 2012 April 04] Available from: http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=8966. 7. VanDevanter N, Combellick J, Hutchinson K, Phelan J, Malamud D, Shelley D. A Qualitative Study of Patients Attitudes toward HIV Testing in the Dental Setting. 2012 Feb. 8. Tamashiro H, and Constantine N. Serological diagnosis of HIV infection using oral fluid samples. 1994; 72(1): 135143. 9. HIV Rapid Test Kit OraSure. Wikimedia Commons [Internet]. 2012 Feb 16. [cited 2012 Aug 11]. Available from: http://commons.wikimedia.org/wiki/File:HIV_Rapid_ Test_Kit__Orasure.jpg.

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Algae May Be the New Electrode in Psychiatric Research

Rigina Louise Gallagher
or decades, deep brain stimulation (DBS) has been available as therapy for patients with mental disorders such as Parkinsons disease, depression, and obsessivecompulsive disorder [1]. However, DBS can sometimes have compromising side-effects, such as confusion of identify, memory loss, and seizures in patients being treated for psychiatric disorders [2, 3]. This is because despite their efficacy in mimicking neurological impulses, electrical charges lack precise direction when funneled through electrodes, causing the neurons surrounding these metal conductors to become excited [1]. This imprecise activation of neurons poses a challenge for researchers as nervous system function requires precise activation of neurons in complex circuits [1]. In a situation where a dysfunction of the nervous system can be traced to the faulty firing of a single class of neurons, manipulating individual cells is key [1]. One alternative to electrode use has surfaced in channelrhodopsin. A novel tool for Deep Brain Stimulation therapy presently resides in a small membrane protein from a sea alga, known as Chlamydomonas reinhardtii. It is the uncommon ability of
channelrhodopsin proteins in Chlamydomonas reinhardtii to transport protons only when activated by the simple stimulus of light; this makes their use attractive in research and therapy development [4]. Channelrhodopsin accomplishes this through a unique process. While many other plants transform light into food energy via the process of photosynthesis, C. reinhardtii is able to coordinate a similar process without a specialized organelle, called the chloroplast [2]. In this sea alga, the plasma membrane used generate energy because of the ability of transmembrane channelrhodopsin proteins within use light to move protons across a membrane [2, 4]. Particles of light are absorbed by retinal associated with channelrhodopsin, which triggers conformational changes within channelrhodopsin [2, 5]. These alterations break hydrogen bonds and activate the active transport of protons through channelrhodopsin proteins from the cytoplasm to the extracellular surface [5]. Outside the cell, the buildup of positive ions creates a gradient. The flow of ions down this gradient creates the energy for the synthesis of ATP (adenine triphosphate), which fuels numerous cell life processes. The medical impact of channelrhodopsin was realized in 1999, when Professor Roger Tsien of the University of California, San Diego, collaborated with Peter Hegemann, one of the biologists credited with the discovery of channelrhodopsin in the earlier part of the decade [2]. Together, they identified the gene, which encodes channelrhodopsin [4]. Since a single gene encodes the channelrhodopsin protein, the ability to respond to light can be easily incorporated into any cells genome [1]. By utilizing a method known as genetic transformation, the team inserted the channelrhodopsin gene of the channelrhodopsin into a mammalian chromosome [2]. For the first time, it was possible for cells of a living vertebrate to respond light in a similar fashion to the C. reinhardtii alga itself. A decade later, Dr. Karl Deisseroth of Stanford University saw the advantage opsins activity would have in Parkinsons research. To be clear, Parkinsons is a neurological disease in which the dopamine-generating cells of the central nervous system degenerate [6]. This loss of dopaminergic function leads to lack of motor control, uncontrollable shaking, difficulty walking, and lack of coordination [6]. Deisseroths strategy was to localize stimulation to the subthalamic nucleus in Parkinsons patients [2]. The subthalamic nucleus is a region deep within the right posterior section of brain, near the thalamus, that neuroscientists have long regarded to be responsible for motion control [2, 7]. The idea Reproduced from [10] was that if the team could find a way to localize the
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direction of light impulses into this area, motor movement in Parkinsons patients could be regained without the confusion of identity, memory loss, and seizures that accompany the scattered electrical pulses of deep brain stimulation. The localizing agent they took advantage of was channelrhodopsin. Utilizing the research of Hegemann and Tsien, Deisseroths team developed optimal viral vectors to transform the channelrhodopsin gene and its regulatory sequences into specific subthalamic neurons cells in mice [2]. When the motor neurons targeted with opsin were stimulated by light via a thin optical cable, the team observed that the mice would perform specific actions, such as spinning in a counterclockwise circle [2]. As soon as the light pulse was removed, the mice returned to a normal state [2]. Remarkably, the results proved for the first time that impulses could be precisely targeted to specific types of mammalian neuron cells in the live animal [1]. The mice performed the very specific action of running in a circle because only the cells of the subthalamic region targeted with the channelrhodopsin promoter had been activated [2]. This optogenetic method could bypass the unnecessary and harmful activation of extraneous neurons that often occurs with deep brain stimulation. By demonstrating that targeting a select group of cells was possible, this first step of research also supplied a method, which could make future results more directed [1]. After establishing that impulses could be localized, Deisseroths team moved forward towards applying optogenetics to Parkinsons research by trying to stimulate the subthalamic nucleus region. This time, Parkinsons model mice were used [2]. The team found that by stimulating channelrhodopsintargeted neurons on the surface of the mouse brains, which were linked to the subthalamic area, signals into the nuclear region itself could be controlled [2]. In an indirect way, the deep, subthalamic neural region was indeed activated [2]. More than half of the Parkinsons-inflicted mice regained the ability to walk [2]. Because neighboring neurons were not erroneously activated, the opsin-targeted mice lacked the seizures associated with deep brain stimulation therapy. Even though discovery of the protein preceded that of channelrhodopsin, halorhodopsin is often used in conjunction with channelrhodopsin in neuroscience research [3]. Belonging to the same family as channelrhodopsin, halorhodopsin is activated by light in a similar fashion to channelrhodopsin, but represses neural activation by transporting chloride ions across membrane surfaces [8]. Essentially, channelrhodopsin activates signals; halorhodopsin shuts them off [9]. In this
References
1. Deisseroth, K. Controlling the Brain with Light. Scientific American [Internet]. 2010 Oct 20 [cited 2012 Mar 9]; Mind and Brain. Available from: http://www.scientificamerican.com/article.cfm?id=optogenetics-controlling. 2. Chorost, M. Algae and Light Help Injured Mice Walk Again. Wired Magazine [serial online]. 2009 October 19 [cited 2012 Mar. 9]; 17(11). Available from: http:// www.wired.com/magazine/2009/10/mf_optigenetics/all/1. 3. Synofnik M, Schlaepfer T E. Electrodes in the brain-ethical Criteria for research and treatment with deep brain stimulation for neuropsychiatric disorders. Brain stimulation. 2011 Jan; 4(1):7-16. doi: 10.1016/j.brs.2010.03.002. 4. Bacteriorhodopsin (Molecular Biology) [Internet]. The-Crankshaft Publishing. [cited 2012 March 9]. Available from: http://what-when-how.com/molecular-biology/ bacteriorhodopsin-molecular-biology/. 5. Lanyi C J. Proton Transfers in the Bacteriorhodopsin Photocycle. Biochimica et Biophysica Acta. 2006 Dec 6; 1757(8): 1012-1018. doi: 10.1016/j.bbabio.2005.11.003.
way, halorhodopsin offers a means for better control can be had over channelrhodopsin silencing activity and over neural pathways [2, 1]. Although the method of incorporating the channelrhodopsin gene into host cells appears promising, there is no reason to assume that optogenetics will make deep brain stimulation therapy obsolete. The effectiveness of DBS is continually being improved [1]. Research applied from Deisseroths laboratory has indicated that DBS therapy could yield better results than conventional electrode therapy by globally targeting the groups of cells instead of just specific neurons in some cases [1]. Even if a complete optogenetic revolution is not in the cards for the psychiatric industry, findings such as these hold the potential to improve present neuroscience research. Currently, application of optogenetics in psychiatric research is still nascent, as research has yet to yield a successful
The answer to electrode therapies presently lies in a small membrane protein of sea algae known as channelrhodopsin
study on humans. The ethics and technology of creating, in effect, transgenic humans is daunting. However the application of channelrhodopsin to optogenetics research is providing insight into the studies of the psychiatric diseases of Parkinsons, schizophrenia, and depression without the cellular damage electrodes induce [1]. By placing LED lights on selected surfaces of the brain, Deisseroths team has contrived a method by which cells transformed with the channelrhodopsin gene can be stimulated without the use of cables [2]. Experiments testing this method on primates are currently underway. If we can successfully stimulate select regions of the brain, and overcome the challenges of introducing genes into human neurons, channelrhodopsin could provide a useful alternative to funneling electricity through electrodes in human psychiatric therapy [2]. Optogenetics must still be tested, but this field is well on its way to future eminence. Rigina Louise Gallagher is a freshman at Brown University. She is currently looking to double concentrate in biophysics and literary arts.
Available from: www.ncbi.nlm.nih.gov. 6. Parkinsons Disease. [Internet]. 2007. [cited 2012 Mar 30]. Available from: http:// www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001762/. 7. Basal Ganglia. [internet]. [updated ; cited 2012 Mar 30]. Available from: http:// www.nationmaster.com/encyclopedia/Basal-ganglia. 8. Varo, G. Analogies Between halorhodopsin and bacteriorhodopsin. Biochimica and Biophysica Acta (BBA)-bioenergetics. 2000 Aug 30; 1640(1):220-229. doi: 10.1016/ S0005-2728(00)00141-9. 9. Optogenetics-Combination switch turns neurons on and off [Internet]. Munich: Max-Planck-Gesellshaft; 2011 Dec 22 [cited 2012 Mar 9]. Available from: http://www. mpg.de/4748101/optogenetics_switch. 10. Image of Neuron with Light (Julie Pryor) [image from internet]. 2011 [cited 2012 April 22]. Available From: http://www.flickr.com/photos/ mcgoverninstitute/5877883861/

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The Future of Vaccinations: From Jet Injectors to Edible Vaccines

Emily Hartman
accines are the most powerful medical intervention currently available [1,2]. Every year, vaccines are believed to prevent up to three million deaths worldwide, and over 750,000 children are protected from disabilities caused by infectious diseases [1]. Deadly diseases such as diphtheria, measles, rubella, and mumps were reduced over 98% in the United States between 1901 and 2001, greatly alleviating the devastating health and economic cost of childhood infectious disease [1]. Despite this remarkable success story, there is still a pressing need for improved vaccination techniques. Needle vaccinations carry an enormous safety risk and economic cost, particularly in developing nations where needles are re-used to reduce cost [3,4]. This drastically increases the risk of infecting a healthy individual with blood-borne pathogens such as Hepatitis B virus (HBV), Hepatitis C virus (HCV), or HIV [3]. One study revealed that between 20-80% of new HBV infections are a result of unsafe vaccinations [3]. This danger results in an enormous social cost to mass vaccination programs. Using a theoretical cost model analysis, one study calculated the total cost of each needle-based vaccination to be as high as $26.77 in developing countries, after the cost of medical care and lost productivity was factored in [3]. While vaccinations are intended to reduce the economic burden of infectious diseases, such techniques are severely undercut by disease transmission.
a chain of expensive equipment and time-consuming protocols designed to maintain vaccines within a specific temperature [3]. This cold chain costs vaccine programs an estimated 200 to 300 million dollars every year [3]. Improved vaccination techniques While vaccines have been profoundly successful at reducing the economic and social cost of infectious disease, an improved delivery mechanism could alleviate many of the problems associated with needle vaccinations. This need is most pressing in developing nations, where access to safe vaccinations remains limited due largely to cost [2]. Developed nations could also benefit from safer vaccination strategies, particularly in light of recent concerns about the threat of bioterrorismif a disease such as anthrax or smallpox were released as an act of terror, our current vaccination system would not be nearly efficient enough to prevent significant morbidity and mortality nationwide [1]. Recently, attention has turned to developing a robust needle-free vaccination system. Ideally, this system would have comparable protection against infectious diseases and lower cost. The vaccine should be heat-stable, unable to spread blood-borne pathogens, and should not require trained health care workers to administer. For mass vaccination programs, the delivery mechanism should be simple and fast. While significant advances have been made in needle-free vaccinations, as of yet no single vaccination strategy accomplishes all of these essential goals. Still, there are a number of promising alternatives to needle injections that are not yet widely accepted. Realistically, this is due in part to stringent FDA regulations for vaccinations [6]. Vaccines are administered to a large percentage of Americas population, and fear of sickening currently healthy individuals keeps FDA restrictions incredibly tight [4]. For each new vaccination, the combination of vaccine, adjuvant, and delivery mechanism must be individually approved by the FDA [6]. Any changes in vaccination route must establish that the new method is equal or superior to the current method [3]. Research strategies towards developing needle-free vaccinations are highly varied. The three most common needle-free immunization techniques are needle-free injection devices, transcutaneous (skin) immunization, and mucosal immunization. Needle-free Injection Devices Perhaps the simplest solution to improving vaccinations is to replace the needle with a needle-free injection device such as jet injectors. Jet injectors are devices that deliver vaccines through a nozzle via a high-pressure liquid stream [3]. The immune response and mechanism are similar to needle-based
Needle vaccinations carry an enormous safety risk and economic cost, particularly in developing nations where needles are re-used to reduce cost
Needle-based vaccinations require trained health care workers, which also increases the cost of vaccination [3]. Furthermore, health care workers in developing countries experience increased health risk due to needle-stick injuries. Many of those needles are contaminated with HIV, HBV, or HCV, which further increases the societal cost of needle-based vaccinations [3]. In Egypt and Pakistan, health care workers on average experience needle-stick injuries 4.7 times per year, which is over 25 times higher than the risk in the United States and Canada [3]. Needle vaccinations reduce compliance due to needle phobias, and liquid vaccines require a cold chain, or
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For each new vaccination, the combination of vaccine, adjuvant, and delivery mechanism must be individually approved by the FDA
vaccines, and serum antibody titers are similar or somewhat improved compared to needle injections, likely because the vaccine is delivered in a slightly wider path [3]. Jet injectors can either be multi-use or single-use. Both types avoid many of the safety drawbacks of needle injections while generating a comparable immune response [4]. This method is fast, effective, and does not require trained health care workers to distribute [3]. In particular, the speed of multi-use jet injections would be an enormous advantage in the event of a bioterrorism emergency a single device can vaccinate up to 1000 individuals every hour [3]. Jet injectors cause more pain than needles, and patients experience soreness, swelling, and redness following an injection. Perhaps the most pressing drawback is that multi-use jet injectors, like needles, can transmit blood-borne pathogens in rare cases when contaminated blood splashes back onto the device following injection [3,4]. Disposable, single-use jet injectors eliminate that risk but are more expensive and slower (600 individuals / hour) [3]. Jet injectors still require the cold chain, though powder injections are currently being investigated as a potential alternative to liquid injections [3]. Jet injectors have been well-studied and are far superior to needle injections. Unlike other needle-free systems, the mechanism of immunization is theoretically identical to needle injections. Still, these devices are not yet widely used, due largely to FDA regulations. Switching from needle to jet injections requires separate FDA approval, even if the combination of antigen and adjuvant is already proven to stimulate an immune response. These regulations were made abundantly clear when the FDA pulled influenza jet injectors off of the market in October 2011, citing fears that the jet injectors would not function like needle injections [7]. While vaccines have long been used to reduce flu infections, the FDA [had] no data to support the safety or effectiveness flu vaccines delivered via jet injectors [7]. PharmaJet, a company that markets jet injectors, contradicted this argument, claiming that their devices have been used successfully used for decades to immunize against many diseases, including influenza [7]. This decision by the FDA is a clear example how a promising needle-free technique was suppressed by stringent FDA regulations. While there are indeed drawbacks to jet injectors, this device is far safer and equally as effective as needles. Transcutaneous Immunization Transcutaneous immunizations include any immunization that primes immune cells within the skin [3]. Scientists have recently re-categorized the skin as important immunologic organ rather than a barrier to immunizationskin has the potential for safe, effective, and fast vaccination [3]. The immune cells in the skin reside in the epidermis, or the middle layer of the skin. In order for transcutanous immunization to be effective, the top layer of skin must be permeabilized so the antigen can move through the top layer and interact with the immune cells. Skin immunizations have been shown to provoke powerful immune responsesantibodies, a major immunologic defense mechanism, were produced throughout the body and in mucosal areas [3]. Researchers have developed several techniques to permeabilize the top layer or the skin, called stratum corneum [3]. Hydration allows antigens to pass through the skin, as do physical (mild abrasive device such as adhesive tape) and chemical abrasion. Electroporation, or applying an external electric field, also disrupts the stratum corneum to allow large antigens to interact with the immune cells [3]. This method allows for easy delivery, no pain, no occupational risk, and no risk of transmitting blood-borne illnesses. Before this method is FDA-approved, novel immune-boosting compounds, called

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adjuvants, will be necessary to provoke blood antibody levels high enough to pass FDA approval [4]. Mucosal Immunization Mucosal immunization (oral, nasal, and aeorsal immunizations) is the only alternate vaccination strategy that is commonly used [3]. Studies have shown that mucosal immunizations are effective at preventing infections caused by pathogens that invade through the mucosa or mucosal bacteria. Current FDA-approved mucosal immunizations, such as FluMist, an influenza vaccine, use a live but weakened infectious agent to provoke a systemic, or full-body, immune response. Unfortunately, substantial risks accompany live, attenuated vaccines. In rare cases, live, attenuated viruses or bacteria can revert back to their stronger, deadlier forms, which could cause an epidemic and result in many deaths. Mucosal vaccines that do not use live, attenuated vaccines are less effective at mounting a systemic immune response, and the resulting blood antibody levels are highly varied [3]. In the last decade, oral vaccines have produced perhaps the most technologically groundbreaking vaccination strategies. Researchers investigated the use of E. coli or Salmonella bacteria that display exogenous antigen. For example, researchers engineered Salmonella to express polio antigens, which in turn immunizes against polio. These techniques are currently in clinical trials, though research is in very early stages. This technique is exceptionally promise for vaccines against agents of bioterrorism, such as the Black Plague or smallpox, where reversion would cause devastating effects. Edible vaccines are a novel mucosal immunization strategy with fewer health risks than live, attenuated oral vaccines. The idea of edible vaccines grew from an experiment performed in 1990, when scientists expressed a surface protein of Streptococcus mutants in tobacco plants [8]. This proved that plants could function as bioreactors to synthesize useful biomolecules including vaccines. Plants are an appealing production system: low cost, easy scale-up, and minimal risk of contamination with human pathogens [8]. Since then, plant bioreactors have been refined to increase and standardize the yields of molecules of interest.
Scientists have recently recategorized the skin as important immunologic organ rather than a barrier to immunization skin has the potential for safe, effective, and fast vaccination
Still, edible vaccines are much more complex to produce than plant bioreactors. Most importantly, engineering plants to express foreign antigens is only the tip of the iceberg. For edible vaccines to function properly, each plant must have a standard amount of the antigen, so patients are not over- or under-immunized. Currently, the mechanism of oral immunization in cases without live, attenuated bacteria is not well understood, leading some scientists to fear that edible vaccines could cause a patient to tolerize an antigen [9]. This disastrous outcome would not only fail to immunize; the patient may be unable to mount an immune response at all if later infected. Furthermore, regulatory agencies will likely never fund a vaccine delivered in variable doses, and clinical trials to determine the safety of edible vaccines are few and far between [9]. Conclusion Needle-based vaccinations need to be replaced to fully harness the power of immunization. Jet injectors are a well-developed alternative, but they are more painful and less cost effective than other immunization strategies. Because of stringent FDA regulations, it is a risky investment for companies to research alternative vaccination strategies when needles already work well in America. Despite promising new technologies, without better support from the FDA and international vaccine programs, needle vaccinations may be here to stay.
Reproduced from [11] References

1. OHagan DT, Rappuoli R. Novel Approaches to Vaccine Delivery. Pharm Res. 2004 Sep; 21(9):1519-30. 2. Moxon ER, Das P, Greenwood B, Heymann DL, Horton R, Levine OS, Plotkin S, Nossal G. Lancet. 2011 Jul 23;378(9788):298-302. 3. Guidice EL, Campbell JD. Needle-free Vaccine Delivery. Adv Drug Deliv Rev. 2006 Apr 20;58(1):68-89. 4. Mitragotri S. Immunization Without Needles. Nat Rev Immunol. 2005 Dec;5(12):905-16. 5. Simon JK, Carter M, Sztein MB, Kotloff KL, Weniger BG, Campbell JD, Levine MM. Safety, Tolerability, and Immunogenicity of Inactivated Trivalent Seasonal Influenza Vaccine Administered with a Needle-Free Disposable-Syringe Jet Injector. Vaccine.
Emily Hartman is a chemical biology major interested in plants as bioreactors and the social implications of needles.
2011 Nov 28;29(51):9544-50. 6. Amorji JP, Hinrichs WL, Frijlink HW, Wilschut JC, Huckriede A. Needle-free Influenza Vaccine. Lancet Infect Dis. 2010 Oct;10(10):699-711. 7. Hartman B. FDA Warns Pharmaceuticals to Stop Pushing Needle-Free Vaccines. ABC News [Internet]. 2011 Oct 21. Available from: ABCNews.go.com. 8. Gomez E, Zoth SC, Berinstein A. Plant-based vaccines for potential human application: a review. Hum Vaccin. 2009 Nov;5(11):738-44. 9. Vermi P. Edible vaccines not ready for main course. Nat Med. 2004 Sep;10(9):881. 10. http://www.flickr.com/photos/wethesolution/6819339020/sizes/l/in/ photostream/ 11. http://www.flickr.com/photos/ekigyuu/4270298263/sizes/l/in/photostream/
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Dying to Feel Young: Re-contextualizing Menopause in America

Ezinne Jane Ihenachor
eart palpitations, disorientation, bone loss, and depression are merely four of the 24 alarming effects of menopause listed in a 2009 article entitled, Preparing for Menopause, published on Oprah.com [1]. The article featured tips from Dr. Christiane Northrups 2001 book, The Wisdom of Menopause, detailing diet and lifestyle choices that promote physical and emotional well-being during menopause and thereafter to ease symptoms. In her book, the American obstetrician and gynecologist explained in concise detail how to have a positive and healthy menopause, highlighting the impact of a good diet and positive attitude during this period of tremendous personal growth [2]. Northrup provided an alternative to long-term Hormone Replacement Therapy (HRT)a treatment that came under fire in 2002 when higher incidences of breast cancer and stroke were noted in the infamous Womens Health Initiative (WHI) clinical trial [3]. For years, American women were uncertain about how to treat their menopause: fearful of HRT, yet distrustful of Northrups natural alternative as physicians began to reconsider the long-term use of HRT Reproduced from [18] without offering any consensus on other viable options [4]. The reintroduction of Northrups ideas on such a popular forum signified a push toward acceptance of alternative approachesa push in the right direction with regard to womens health. But what if, in addition to this push, our society ventured to stop pathologizing menopause as a condition that necessitates treatment and start viewing the process as a natural part of womens biological program? If we viewed menopause as a sign of wisdom and maturitya hallmark of the social perception of menopause in Benin, where reported symptoms are incidentally less severerather than a loss of youth and vitality, we may more effectively find the best solution to menopause [5]. Menopause is a naturally occurring process that usually occurs when women reach the ages of 45 to 55 [6]. During menopause, a womans ovaries stop releasing eggs. She produces less estrogen and progesterone and begins to have fewer periods. After one year of not having periods, menopause is considered to be complete and she is termed post-menopausal [6]. But, as the feature on the popular and widely read Oprah. com illustrates, this natural biological process has long been a source of concern for the modern American womana problem to be addressed with tips and techniques. HRT has become increasingly popular throughout the years as a treatment that counteracts the adverse effects of menopausenamely, hormone surges that cause mood swings, hot flashes, and other more debilitating symptoms. HRT first 22 THE TRIPLE HELIX Fall 2012
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burst onto the stage as a remedy for menopausal symptoms when Brooklyn gynecologist, Dr. Robert Wilson, published a book entitled Feminine Forever in 1966, hailing estrogen replacement as the proverbial fountain of youth [7]. Images of haggard and moody women advertising HRT flooded magazine pages and small screens across America, effectively offering women an out regarding their condition. Menopause became highly pathologized, as side effects became known as symptoms, and hormone therapy the logical remedy. The first widespread wave of resistance to HRT came about when clinical trials were halted in 2002 due to increased risk of breast cancer and stroke [3]. This was reinforced by a study done in the UK, called The Million Women Study, in which about 20% of women who underwent HRT developed invasive breast cancers. Seven percent of breast cancer deaths were registered after an average of 4.1 years of follow-upcausing the medical community and general public alike to reconsider the treatment [8]. Although mainstream media outlets and individual healthcare practitioners have endeavored to educate women about the dangers of HRT, there is much potential in focusing energy on redefining menopause within our specific social context [9]. Although the pros and cons of HRT have been debated for over 20 years, epidemiologic studies report both beneficial and deleterious effects of HRT that have left women at a type of deadlock. There are two main types of HRT that promise relief from the various symptoms of menopause that women experience: bioidentical hormones include synthesized versions of naturally-occurring endogenous hormones like estriol, estradiol, and progesterone, while synthetic hormones are versions of these same hormones with different chemical structures. One example of a synthetic hormone used in HRT is conjugated equine estrogen, an equine version of estrogen and medroxyprogesterone acetate along with other synthetic progesterone analogs [10]. Both therapies involve taking a daily dose of estrogen as part of a complex with progesterone. In fortunate contrast, bioidentical progesterone alone was shown to have beneficial cardiovascular effects. Progesterone has been well studied and is shown to maintain and augment the protective cardiovascular effects of estrogen, thus decreasing the risk of heart attack and stroke [11]. Unfortunately, progesterone alone is only half the coin, as it is not a therapy that can alone combat the symptoms of menopause. In the wake of the WHI, women were left with a type of pathology and a hard choice about whether or not to seek potentially dangerous medical treatmentone that our society has encouraged for years.
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If, on the other hand, Americans could change their families and communities that come with menopause [13]. general attitude towards menopauseinto one that mirrors It is important to note that research on the long-term health the positive social perception of menopause in Beninone and menopausal symptoms of women in developing counwonders whether American women would not experience tries is lacking. Population-based cross-sectional studies can the severity of symptoms outlined above, much like women provide the initial step in developing cohorts to make direct in Benin [5]. Moreover, it is useful to explore the possibility comparisons between characterized symptoms across cultures. that medical practitioners and womens health groupswho However, the psychological reaction of women to menopause have authority and are in positions to reach large numbers of reflects the values of the societynamely, one that embraces those most affectedcan make strides toward redefining our this process versus one that rebukes it [13]. Thus, a social attitudes toward menopause in a more nuanced approach, thus reconstruction approach to redefining menopause could prove drawing women away from potentially dangerous therapy. efficacious in promoting better decision-making among women Before embarking on such an amregarding their health. Within bitious task, we must consider this framework, physicians and how our views about menopause the scientific community, along The language used to describe came to be, how these views have with institutions and media menopause in America has led women to HRT, and whether organizations, could relay via reshaping these views would patient visits, press releases, served to pathologize the eliminate the perceived necessity and television advertisements of HRT. Reorganizing the social that, though it has undesirable experience entirely perception of menopause could side-effects, menopause is a potentially improve the appeal naturally-occurring process of more holistic, natural, and less severe approaches to deal- rather than a disease that needs to be treated. Reorganizing ing with uncomfortable feelings associated with menopause. the social context of menopause would change the way it is The language used to describe menopause in America perceived, eliminate the immense pressure to undergo these has served to pathologize the experience entirely. Medical and therapies, and effectively reduce the number of women who public literature refers to the experience as having symptoms make ill-informed decisions regarding HRT, which may have or difficulties that in turn necessitate treatment. Symptoms deleterious consequences to their health. provide the justification for medical intervention, so women The Oprah.com article only briefly mentions hormone naturally sought HRT as a remedy. A multiplicity of sympreplacement therapy as a medical treatment available to toms has been associated with menopause across cultures women experiencing symptoms of menopause. In light of but with very different connotations. American researchers the controversy around HRT, the article is sure to caution tend to focus on the negative aspects of menopause, while women to consult their doctor for advice, as there are serious emphasis is placed on the more positive aspects of menopause drawbacks to long-term treatment. The article emphasizes in descriptions of women in developing countries. A study more natural approaches to menopausal health, rather than in Benin revealed these aspects to include freeing women resorting to HRT. It is well worth evaluating our societys role from the burdens of childbirth and from cultural restrictions in pathologizing menopause and reflecting on how negative imposed on the social lives of women of menstruating age perceptions of menopause have driven women to potentially [5]. In a 2011 article entitled, Features and Perceptions of harmful treatments like HRT. Only then can those holistic Menopausal Women in Benin City, Nigeria, investigators solutions seem appealing. While recommending natural apfound that 78% of women in this descriptive, cross-sectional proaches is a start, changing negative perceptions is the key to study of 533 randomly selected Nigerians adjusted very well allowing women to make better decisions about their health to the events of menopause, with none revealing any serious during menopause. maladjustment. Only seven percent were even aware of HRT and none were on or had ever had HRT [12]. The paper also Ezinne Jane Ihenachor graduated in Human Biology from Brown University in May 2012; her honors thesis focused on examining revealed that women do not regret reduced sexual activity possible cardiac arrythmogenic effects of HRT in the aging rabbit model. and in fact, appreciate the freedom and influence in their
References 1. Preparing for Menopause. 2009 [April 25th, 2012]; Available from: http://www. oprah.com/health/Treat-Your-Body-Right-During-Menopause. 2. Northrup C. The wisdom of menopause: creating physical and emotional health and healing during the change: Bantam Books; 2001. 3. Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, et al. Influence of estrogen plus progestin on breast, cancer and mammography in healthy postmenopausal women - The Womens Health Initiative Randomized trial. Jama-J Am Med Assoc. 2003 Jun 25;289(24):3243-53. 4. Cowley G, Springen K. Reconsidering HRT. Newsweek. 2002 Apr 29;139(17):71. 5. Sargent C. Maternity, Medicine, and Power: Reproductive Decisions in Urban Benin. United States: University of California Press; 1989. 6. Menopause [database on the Internet]. A.D.A.M. 2011 [cited April 25th, 2012]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001896/. 7. Wilson RA. Feminine Forever: M. Evans; 1966. 8. Beral V, Banks E, Reeves G, Bull D, Collaborators MWS. Breast cancer and hormone-replacement therapy: the Million Women Study - Reply. Lancet. 2003 Oct 18; 362(9392):1330-1. 9. Mosconi P, Donati S, Colombo C, Mele A, Liberati A, Satolli R. Informing women about hormone replacement therapy: the consensus conference statement. BMC Womens Health. 2009;9:14. 10. Holtorf K. The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgraduate Medicine. 2009 Jan;121(1):73-85. 11. Wagner JD, Martino MA, Jayo MJ, Anthony MS, Clarkson TB, Cefalu WT. The effects of hormone replacement therapy on carbohydrate metabolism and cardiovascular risk factors in surgically postmenopausal cynomolgus monkeys. Metabolism. 1996 Oct;45(10):1254-62. 12. Ande AB, Omu OP, Ande OO, Olagbuji NB. Features and perceptions of menopausal women in Benin City, Nigeria. Ann Afr Med. 2011 Oct-Dec;10(4):300-4. 13. Cover F, Virginia Kerns JKB. In Her Prime: New Views of Middle-Aged Women. 2 ed. Chicago, IL: University of Illinois Press; 1992. 14. Menopausal Hormone Therapy (MHT). [updated September 29, 2010April 25th, 2012]; Available from: http://www.womenshealth.gov/menopause/symptomrelief-treatment/menopausal-hormone-therapy.cfm. 15. Planning Your Future. [updated August 12, 2010April 25, 2012]; Available from: http://www.womenshealth.gov/aging/planning-your-future/. 16. Depression and Anxiety. [updated August 12, 2010April 25th, 2012]; Available from: http://www.womenshealth.gov/aging/mental-health/depression-anxiety.cfm. 17. Medication Safety. [updated August 12, 2010]; Available from: http://www. womenshealth.gov/aging/drugs-alternative-medicine/medication-safety.cfm. 18. Menopause [Internet] . Womens Health. 2010 [cited 2012 Sep 13]. Available from http://www.womenshealth.gov/menopause/images/shot-in-arm.jpg
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From Recklessness to Reclamation?: The Future of the Alberta Tar Sands

Sara Kinslow
n January 2012, President Barack Obama rejected TransCanadas application to build the Keystone XL pipeline, a 27,000-km pipeline which would have supplied the US with oil from bitumen tar sands in Alberta, Canada [1]. President Obama reasoned that he had not had enough time to assess the impacts and feasibility of the project. Many scientists feel the same, as even after several decades of industrial tar sands extraction in Alberta, the scientific community has not reached a consensus on the scope and magnitude of the relevant environmental impacts. Yet research presents evidence that greenhouse gas emissions, habitat loss, and pollution are all very real consequences of this industry. With TransCanadas reapplication earlier this year, the US still faces an important decision that, whichever way it goes, will set the tone for environmental discourse and priorities the world over. In the past, tar sands expansion has been approved without rigorous scientific oversight of ecological concerns and reclamation. The failure to appropriately and diligently track environmental impacts and effectively restore degraded land is a commentary on the ability of the oil industry to self-perpetuate through political and economic channels without the proper regard for biological and atmospheric ramifications. The Great Grayish Brown North Alberta, like most of northern Canada, is part of one of the largest remaining intact boreal forests in the world, a landscape interspersed with wetlands, which are considered threatened
ecosystems [2]. The area also contains at least 175 billion barrels of extractable reserves of bitumen, a viscous, gray tar-like hydrocarbon that can serve the same energy purposes as crude oil. Bitumen exists as an intermediate product of the bacterial activity that creates light crude oil, but this incompleteness means the energy content of bitumen is lower than other fossil fuels. With so many international players willing to pay upfront to secure another cheap fossil fuel source, projects expanded in the 1960s and have been outpacing environmental regulations and sustainability programs ever since [3,4]. Today, a handful of North Americas most powerful energy companies have transformed over 50,000 hectares of land for extracting, processing, upgrading, and transporting bitumen [4]. Bitumen is extracted from the ground by surface mining or in situ steam-aided gravity drainage (SAGD) [5]. Both require water and natural gas inputs to reduce viscosity and enable movement of the tar sands. Crude bitumen is transported downstream to upgrading facilities, which purify the tar sands into a usable form. The water-borne refuse is pumped into impoundments called tailing ponds, while the flowing bitumen is shipped off in tankers and pipelines to domestic and international markets. Approximately 1.3 million barrels of fuel are produced per day [4]. If the Keystone XL pipeline and similar projects are approved, the outflow from Alberta will increase to 3 million barrels per day by 2015 [3]. Established companiesSuncor Energy, Syncrude, and Totalare being joined by Shell, ExxonMobil, and international groups eager to

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capitalize on this economic opportunity [6]. It is worth noting the political advantages to the US of acquiring fuel from a neighboring country rather than overseas, as well as the short term jobs and economic returns. According to a spokesperson for the Canadian Association of Petroleum Producers, over 90% of extraction and processing is still to come [5]. If these and moose populations give anthropogenic edges a considerably wide berth when foraging [4]. Moose and beavers represent two species of cultural significance whose habitats are so affected by disturbances from tar sands that complete restoration is essentially impossible and species relocation equally impractical [4]. Blueberries, cranberries, and ratroot are also keystone species that are likely to be overlooked by restoration efforts [4]. For those areas that have been reforested, replanted forests are intended to be used for logging and timber, which means the biodiversity and ecosystem services provided by the region are being drastically reduced [8]. Also important are the tailings ponds and reclaimed wetlands. The Alberta tar sands operations are focused around the Athabasca River, which runs south to north between the Mackenzie River Basin, which supplies one-fifth of Canadas fresh water, and the Peace-Athabasca Basin [3,12]. Under the Alberta Environmental Protection and Enhancement Act of 1993, all OSPW must be held on site [13]. With over 23 square miles of tailings ponds, these are the single largest toxic impoundments in the world [3]. Tying up water resources in the ponds is necessary until they are properly treated and can be restored, but the ability for the Athabasca River to sustain healthy ecosystems and bitumen mining has been questioned [6]. A common method of reclaiming OSPW is the wet landscape, in which fluid tailings in mined-out pits are converted to wetlands. Once sand, oil, and water have settled into distinct layers, the pit can be dewatered and stabilized [8]. However, this process has taken decades longer than anticipated. One of the first tailings ponds, Tar Island Pond, was dug in the 1960s, added to until 1997, and was expected to be ready to restore in 2002. However, as of 2010, the process of settling had not finished sufficiently to allow dewatering. This pool of 30 years worth of chemicals has still not been properly handled [8]. As part of reclamation objectives, wetlands must be sustainable and functioning ecosystems [14]. The potential carcinogenicity of these impoundments should make regulation and testing a top priority. Yet the main oversight body for 30 years has been accused of catering to government and industry interests [3,6,15]. Studies on wet landscapes have demonstrated toxicity in microalgae and stress in fish populations [8,16]. One very telling study demonstrated that wood frogs, an indigenous species, showed decreased ability to persist in the younger wetlands [14]. On the other hand, older reclaimed sites were more comparable to undisturbed sites, indicating that the detoxifying services provided by wetlands may not be completely compromised. The main question is the timescale for detoxification, and this study indicates that restoring self-sustaining ecosystems may take decades. Regulation of habitat destruction and reclamation has been slow and retroactive. Strict tailings rules from the Alberta government were not passed until 2009, by which time hundreds of migratory birds had already died after confusing tailings ponds for water bodies [8,17]. Although newly-developed technology will expedite reclamation, the industry is plagued with chronic underestimates of the money and time required for restoration projects, yielding financial efforts inadequate
According to a spokesperson for the Canadian Association of Petroleum Producers, over 90% of extraction and processing is still to come
predictions are accurate, the environmental burden of pollution, water consumption, habitat destruction, and emissions is only going to increase. The US must consider the environmental data to decide once and for all whether continued reliance on fossil fuels is worth the degradation of one of the worlds most precious ecosystems. One Big Experiment Every tar sands processing project is required to restore 100% of land disturbed back to a natural state as close to predisturbance as possible [7]. However, reclamation legislation does not require boreal forests and wetlands to be as they originally were, nor does it set any specific time frame for reclamation processes [6]. As a result, there have only been attempts to reclaim 12% of total disturbed areas in four decades of development [8]. 70% of those lands belong to a single company, Syncrude, which is one of the oldest in the region [3]. Reclamation is happening immediately alongside industry and expansion in one big experiment that has seen neither planning nor regulation [8]. According to Gosselin et al., The environmental regulatory capacity of the Alberta and Canadian Governments does not appear to have kept pace with the rapid growth of the oil sands industry over the past decade [6]. Reclamation from tar sands activities is two-fold, requiring the creation of wetlands from oil-sands processed waters (OSPW) and tailings ponds, as well as re-forestation of non-aquatic systems. This means that, until restoration is complete, both wetland and boreal forest habitats will suffer prolonged degradation. The effects of tar sands mining on the Canadian boreal forest are most clearly expressed in NASA Observatory photographs of the region (see Fig. 1) that capture the extent of the disturbance [9]. The large polygons are the combined areas of mining pits and tailings ponds, yet the more benign SAGD, with its networks of pipelines rather than polygons of disturbance, has hidden environmental costs of habitat fragmentation, edge effects, and natural gas consumption [10,11]. Edges are created when the larger habitat matrix is cut through by human activity, changing the overall habitat dynamics. Fragmentation and edge effects have consequences for migration and movement, with evidence that both caribou
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to address real reclamation work [6]. Expected revisions to reclamation requirements in 2012 will have important ramifications for wildlife conditions both present and future [5]. Forecasts and Feedbacks Part of the protest surrounding tar sands stems from the carbonrich nature of bitumen that manifests itself in high emissions rates throughout its life cycle. The combined emissions of natural gas and bitumen throughout processing have significant climate change feedbacks that will only become more palpable as demand increases. Bitumen upgrading has emissions costs in sulfur, nitrogen, and carbon dioxide (CO2), releasing three times more CO2 than crude oil [3]. The oil sands industry is expected to account for 16% of Canadas carbon emissions by 2020 and 32% of natural gas demand in Alberta by 2017 [10]. Even with newer increases in efficiency and decreases in emissions from technology, the rate of production and upgrading offsets any potential negations, creating major roadblocks to achieving desired emissions cuts [6]. Suncor Energy, Inc., is already producing renewable energy elsewhere in Canada, but no attempts have been made to reduce emissions in this way [7]. One solution that has been suggested for counteracting carbon emissions is carbon capture and sequestration (CCS), which injects carbon from the atmosphere into the ground. In Alberta, the infrastructure already exists to make this feasible and $2 billion have been invested into research [10]. Unfortunately, this research has determined that the geology of the region is too porous to guarantee the security of large carbon stores, with leaks or plumes quite possible, rendering CSS an impractical solution for this area [3,6]. Both wetlands and forests are effective carbon sinks, but the rate of disturbance of these habitats outweighs restoration to the point where any real benefits of natural carbon sequestration will not be realized for years. So, tar sands operations send an overall net input of greenhouse gases into the atmosphere, playing into climate feedback systems. In turn, the effects of climate
References
1. News in brief. Nature. 2012 Jan 26; 481:414. 2. Turner RK, van den Bergh JCJM, Soderqvist T, Barendregt A, van der Straaten J, Maltby E, et al. Ecological-economic analysis of wetlands: scientic integration for management and policy. EcolEcon. 2000; 35:7-23 3. Nikiforuk A. Tar Sands- Dirty oil and the future of a continent. Vancouver: Greystone Books; 2008. 4. Garibaldi A. Moving from model to application: Cultural keystone species and reclamation in Fort McKay, Alberta. J Ethnobiol. 2009; 29(2):323-338. 5. Weinhold B. Albertas oil sands: hard evidence, missing data, new promises. Environ Health Perspect. 2011;119(3):a126-31. 6. Gosselin P, Hrudey SE, Naeth MA, Plourde A, Therrien R, Van Der Kraak G, Xu Z. Environmental and health impacts of Canadas oil sands industry. Ontario: Royal Society of Canada; 2010 Dec. 414. 7. Suncor Energy, Inc. 2011 Summary Report on Sustainability. Calgary, Alberta (CA): Suncor Energy, Inc.; 2011 July. 22. 8. Kean S. Eco-alchemy in Alberta. Science. 2009 Nov 20; 326:1052-5. 9. Aerial images of Alberta tar sands operations (NASA Earth Observatory) [image on the Internet]. 2011 Nov 11. Available from: http://earthobservatory.nasa.gov/ Features/WorldOfChange/athabasca.php. 10. Jordan SM, Keith DW, Stelfox B. Quantifying land use of oil sands production: a life cycle perspective. Environ Res Lett. 2009; 4:1-15. 11. Timoney KP, Lee P. Does the Alberta tar sands industry pollute? The scientific evidence. Open Conserv Biol J. 2009; 3:65-81. 12. Herbert CE, Weseloh DVC, MacMillan S, Campbell D, Nordstrom W. Metals and polycyclic aromatic hydrocarbons in colonial waterbird eggs from Lake Athabasca and the Peace-Athabasca Delta, Canada. Environ Toxicol Chem. 2010; 30(5):1178-83. 13. Giesey JP, Anderson JC, Wiseman SB. Alberta oil sands development. Proc Nat
change could manifest themselves in the decreased ability for wetlands to effectively detoxify OSPW or intense weather events severely impacting ecosystems already compromised by chemical contamination [14,18]. These are necessarily speculative considerations, but the majority of the available science on any environmental indicator pleads for improved understanding of both present dynamics and future scenarios. It is on this point that politicians and economists should pause; the breakneck speed with which tar sands operations are preceding is unsustainable, and coming to a safe stop will require solid science and regulation. Decisions from Downstream President Obamas rejection is one of the few times an Alberta tar sands proposal has not been approved. From an economic standpoint, the operations provide increases in income and employment to the area of Alberta, and governmental rhetoric of development and employment have garnered enough support to propel operations without long-term strategies [3,6]. The European Union (EU) is beginning to recognize the environmental risks of investing in bitumen, as evidenced by a recent failure of an EU committee to agree on a declaration that would shut Canadas oil sands out of European markets [19]. The US must also decide whether the promised economic returns are more important than the host of possible environmental consequences [20]. The Keystone XL Pipeline debate goes beyond the not in my backyard protests of the Midwest: the environmental impacts of the Alberta tar sands operations are having profound effects downstream, and as National Geographic photographer Garth Lenz said, we all live downstream in an era ofclimate change [21]. Sara Kinslow graduated from Brown University in 2012 with a degree in Environmental Science. She has been interested in environmental degradation and remediation ever since the Lorax lifted himself up and floated away. She hopes he will come back some day.
Acad Sci USA. 2010 Jan 19; 17(3):951-2. 14. Hersikern BD, Smits JEG. Compromised metamorphosis and thyroid hormone changes in wood frogs (Lithobates sylvaticus) raised on reclaimed wetlands on the Athabasca oil sands. Environ Pollut. 2010; 159:596-601. 15. Timoney KP, Lee P. Polycyclic aromatic hydrocarbons increase in Athabasca River Delta sediment: temporal trends and environmental correlates. Environ Sci Technol. Forthcoming 2012. 16. Debnest T, Turcotte P, Gagne F, Gagnon C, Blaise C. Ecotoxicological impacts of effluents generated by oil sands bitumen extraction and oil sands lixiviation on Pseudokirchneriella subcapitata. Aquat Toxicol. 2012; 112-113:83-91. 17. Schor E. Reclaimed dump sparks oil sands sustainability debate. NY Times [Internet] 2011 Aug 16; Business Day. Available from: http://www. nytimes.com/gwire/2011/08/16/16greenwire-reclaimed-dump-sparks-oil-sandssustainability-44003.html?pagewanted=all. 18. Gentes M, Waldner C, Papp Z, Smits JEG. Effects of oil sands tailings compounds and harsh weather on mortality rates, growth and detoxification effects in nestling tree swallows (Tachycineta bicolor). Environ Pollut. 2006; 142:24-33. 19. E.U. stalemate on dirty label for fuel from tar sands. NY Times [Internet] 2012 Feb 24; Global Business. Available from: http://www.nytimes.com/2012/02/24/ business/global/eu-stalemate-on-dirty-label-for-fuel-from-tar-sands.html?_r=1. 20. Canada. Oil sands benefits to the United States. Alberta: Government of Alberta. 2011 Sept. 21. Lenz G. The true cost of oil. Presented at Victoria Conference Centre, Victoria, BC. 2012 Ted.com/talks. Accessed 21 Feb 2012. 22. Canada. Reclamation. Alberta: Government of Alberta. 2012. Accessed from: http://oilsands.alberta.ca/reclamation.html. 23. http://earthobservatory.nasa.gov/IOTD/view.php?id=40997

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Born This Way? Why We Should Be Skeptical of the Science of Sexuality

Hannah LeBlanc
n the past decade or so, several efforts to uncover the science of homosexuality have been published and received great media attention. From reports of gay animals to searches for the gay gene to the differences between gay and straight brains, there have been many reports in the popular media about the science of sexuality. Many gay rights advocates have found these studies useful in supporting a broader effort to demonstrate that homosexuality is natural, as opposed to a choice. However, there is good reason for skepticism. Many scholars have criticized the methodological and theoretical flaws of this work. Additionally, some LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) rights activists have condemned its underlying assumptionsnamely, that homosexuality requires biological justification. Furthermore, this science is predicated on a nature versus nurture paradigm that underestimates the mutual dependence of the social and biological aspects of human bodies, sexuality, and behavior. To overcome the problematic nature of current and past efforts in the science of sexuality, we need to radically transform the way we think about and research sexuality and the body to focus on the ways in which social and biological aspects of human bodies, behavior, and sexuality are always intertwined. Some gay rights activists support of science that seeks the biological basis of homosexuality is part of a larger political strategy that responds to accusations that homosexuality is a (bad) choice that represents a kind of morally lax lifestyle. The claim that queer people are born this way is used to garner support for gay rights by appealing to the notion that rights cannot be denied based on a biological difference [1]. Though this strategy is not the only approach used by LGBTQ rights movements, it has become a highly visible paradigm for questions around gay rights, and the science of sexuality is central to both sides of contemporary debate. Former Republican presidential hopeful Tim Pawlenty, for example, called on the dispute[d] nature of the science of sexuality in support of his anti-gay positions, and The Advocate responded with an op-ed by a prominent scientist of homosexuality [2]. The science of sexuality is thus seen to have increasingly high stakes for debates around LGBTQ rights. Flawed Science The science of sexuality deserves a bit more skepticism than it often receives. For one, Tim Pawlenty may be on to something. Closer inspection reveals that the foundation of these studies is
far less secure than it would initially appear. Queer theory scholar and activist Nancy Ordover, for instance, provides scorching critiques of some of the most prominent studies methodologies. For example, neuroscientist Simon LeVays famous study that claimed to find differences in the size of a hypothalamic nucleus in the brains of gay and straight men is wracked with problems in the way the researchers selected subjectsmost had AIDS, which could impact the nuclei in question, and 16 subjects were presumed heterosexual and in the way they measured the hypothalamus [1,3]. Another famous study by Dean Hamer (the same geneticist who weighed in on The Advocates op-ed, above) claimed there was strong evidence to support the existence of a gay gene [6]. Ordover again points out many glaring methodological problems with Hamers study, including the incredibly narrow selection criteria and the elimination of families he viewed as inconsistent with a genetic basis for homosexuality [1]. Moreover, as Ordover notes, most studies that contradict or fail to confirm a genetic basis for homosexuality go unpublished [1]. The science of sexuality has deeper theoretical flaws as well. These problems are thoroughly and convincingly critiqued by Barnard sociomedical scientist Rebecca Jordan-Young in her book Brain Storm [4]. Jordan-Young closely examines the scientific publications that are said to support a wider formulation of sexuality, called Brain OrgaReproduced from [15] nization Theory, to see how well they fit together to form a cogent whole [4]. Brain Organization Theory, perhaps the most accepted and familiar scientific notion of gender and sexuality, contends that the brain, like the genitals, is first organized by gonadal (commonly referred to as sex) hormones during fetal development and then activated by the later resurgence of these hormones during puberty, leading to sexually dimorphic brains and bodies. Jordan-Youngs detailed analysis reveals that the studies that claim to support Brain Organization Theory are often entirely contradictory, individual methodological problems aside [4]. For example, the criteria for who counts as homosexual or heterosexual vary widely across studies. In Jordan-Youngs words, one scientists homosexuals are another scientists heterosexuals [4]. A massive sociological study performed by Edward Laumann from the University of Chicago demonstrates that self-identification, fantasies, and behaviors rarely fully align, but studies often use only one of these different aspects of sexuality in classifying their subjects [4]. Thus, these studies assume a clean binary when one does not exist. This example is
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but one of the many theoretical and methodological problems that plague Brain Organization Theory and have led JordanYoung to conclude that there is little scientific basis to its claims. race and gender. These studies work under the assumption that the social and the biological are separate spheres: homosexuality is either a choice or it is natural. This formulation exaggerates the extent to which the biological is fixed and deterministic, deeply Homosexuality as Pathology underestimates the power of the social, and entirely ignores the Beyond flaws in the science, born-this-way politics are also way the biological and the social are always intertwined. Biology problematic because they rest on the notion that queer sexuality has many models for how ones social experience literally changes requires justification. As a recent New York Times op-ed points ones body, on both small and large time scales. Examples of out, this approach carries an unintended implication that the this phenomenon include neural plasticity (the putative basis of behavior of gays and lesbians needs biological grounding to learning and memory), bone growth, exercise, diet, epigenetics evade condemnation [5]. Furthermore, as Nancy Ordover argues, (non-genetic inheritable changes in gene expression), gene activation, biological causation theories of homosexuality are easily interpreted and evolution [7,8,9,10]. Furthermore, the social sciences and as disease instead of benign variation. Historically, medical humanities have an enormous body of work demonstrating belief in the biological bases of homosexuality has led to cruel the ways that naturalized categories like race, sex, and sexuality cures rather than to acceptance [1]. have been constructed and maintained While the born-this-way approach has through specific historical and cultural This homosexualitybeen effective in many arenas, claiming circumstances [11,12,13]. The science that homosexuality is based in biology of sexuality demonstrates a profound as-pathology bias seems does not fundamentally change the miscommunication between scientific to be built into the status of homosexuality in American and social ways of viewing human bodies assumptions underlying culture and assumes that queer people and behavior. need to justify their sexual desires and Thus, the main problem here is not the science of sexuality behavior in a way that heterosexual that the science of sexuality is scientifipeople do not. cally flawed and politically problematic In fact, this homosexuality-as-pathology bias seems to be though it is both of these things but that it reinforces the combuilt into the assumptions underlying the science of sexuality. mon belief that biology is fixed and outside the influence of social In Brain Organization Theory, sex (male or female) naturally and historical forces. This essentialist viewpoint is dangerous not gives rise to certain gendered behavior and identification (man only for those who support LGBTQ rights, but to anyone who is or woman), which gives rise to or includes certain sexual desires, interested in sexual, gender-based, and racial justice because it practices, and attitudes (desiring and having sex with women or assumes that complex contemporary social categories are instead men, being aggressive and dominant or passive and receptive). self-evident, fixed over time, and biologically deterministic. We Any non-alignment of these three categories say a woman who need to stop thinking in terms of nature versus nurture and start is more interested in a career than marriage or a man who desires thinking, and researching, the way the social and the biological another man is seen as an error in the normal pathway. Thus, are mutually constructing. This way of thinking goes beyond these studies that claim to support homosexuality as biologically the notion that human bodies and behaviors are affected by both grounded presuppose that heterosexuality (and certain kinds of social and biological causes nature and nurture but instead gendered behavior) are the natural default position. Furthermore, suggests that social and biological forces are highly entangled. the rigidity of all of these binaries closes off possibilities for people Rather than being born this way, we are at the center of a mulwhose gender or sexual behavior, or even sex organs themselves, tidimensional network of mutually informing social, historical, do not fit well into this either/or paradigm. and biological processes. Too bad it doesnt roll off the tongue. Nature Versus Nurture? These theoretical and political problems with the science of sexuality emerge from the more profound issue of viewing human behavior in a nature versus nurture paradigm, which has implications not only for the science of sexuality, but also for questions regarding
References
1. Ordover N. Science as Savior. American Eugenics: Race, Queer Anatomy, and the Science of Nationalism. City: Univ Of Minnesota Press; 2003. p. 5969. 2. Hamer D. OP-ED: Is It A Choice? A Scientists View. Advocate.com. 2011 Jul 14;1.1. 3. LeVay S. A difference in hypothalamic structure between heterosexual and homosexual men. Science. 1991 Aug 30; 253(5023):10347. 4. Jordan-Young RM. Brain Storm: The Flaws in the Science of Sex Differences. Cambridge: Harvard University Press; 2010. 5. Bruni F. Gay Wont Go Away, Genetic or Not. The New York Times [Internet]. 2012 Jan 28 [cited 2012 Mar 12]; Available from: http://www.nytimes.com/2012/01/29/opinion/sunday/bruni-gay-wontgo-away-genetic-or-not.html 6. Hamer DH, Hu S, Magnuson VL, Pattatucci AM, Hu N. A linkage between DNA markers on the X chromosome and male sexual orientation. Science. 1993 Jul 16; 261(5119):3217. 7. Bear MF, Connors BW, Paradiso MA. Molecular Mechanisms of Learning and Memory. In: Neuroscience: Exploring the Brain. 3rd ed. Baltimore: Lippincott Williams & Wilkins; 2007. p.761-791.
Hannah LeBlanc graduated from Brown University in 2012 with degrees in Gender and Sexuality Studies and Neuroscience. She is interested in the ways in which the human sciences and medicine consider social categories of difference, such as sex, gender, sexuality, and race. She can be contacted at Hannah_LeBlanc@brown.edu.
8. Bausto-Sterling A. The Bare Bones of Race. Social Studies of Science. 2008 Oct 1; 38(5):657-694. 9. Issa JP, Just W. Preface: Epigenetics. FEBS Letters, 2011 Jul 7; 585(13): 1993. 10. Burzynski SR. Aging: Gene silencing or gene activation?. Medical Hypotheses, 2004 Aug 12 ;64(1):201-208. 11. Omi M, Winant H. Racial Formation in the United States : from the 1960s to the 1980s. 2nd ed. New York: Routledge, 1994. 12. Fausto-Sterling A. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books, 2000. 13.. Foucault M. The History of Sexuality, Vol. 1: An Introduction. Trans Hurley R. New York: Vintage Books, 1990. 14. Butler J. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1999 15. Brain Basics: Genes at Work in the Brain [Internet]. National Institute of Neurological Disorders and Stroke. 2010 [cited 2012 Apr 20]. Available from: http://www.ninds.nih.gov/disorders/ brain_basics/genes_at_work.htm

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Engineering Tissue: A Cultural Revolution

Timothy Lim
he recent success of a Dutch team in cultivating strips of muscle from stem cells is the leading end of a string of breakthroughs in tissue engineering specifically geared for human consumption. Speaking at a science convention in Canada, the leader of the team Prof. Mark Post stated that artificial meat has the potential to reduce the environmental footprint of meat production by 60% and outlined plans to present the first artificially grown burger by the end of the year [1]. Posts statements allude to a profound change in how consumers think about the meat products they buy. Since the 1900s, the mechanization of meat production has increased the efficacy of the industry and its output. Somewhat a generational step behind, societies slowly recalibrate their value systems to their new reality of consumption. Preceded by the Animal Rights movement [2], todays appeal for the natural and organic represents an evolutionary shift in instilling a sense of morality into the laypersons consumption of food. Parallel to these social developments, advances in tissue engineering have succeeded from isolating and culturing stem cells to manipulating them into artificial organs [3]. It is at this confluence between the crest of a social wave and the quickly emerging field of tissue engineering that in vitro meat is poised to radically change how we live our lives. However, manuReproduced from [10] facturers wishing to produce and sell artificial meat face two distinct challenges: technical and social. The crux of the technical difficulty in engineering meat lies in the two different methods by which protein can be cultivated. The first, and so far, most effective method is based on proliferating embryonic myoblasts or adult skeletal muscle satellite cells upon a pre-fabricated scaffolding, such as collagen meshwork or micro carrier beads. These scaffolds are then grouped and stored in a bioreactor within which they provide a structure on which the cells can differentiate
into myofibers large enough to be cooked and consumed [4]. However, the proteins created from the scaffolding method are severely limited in their structural complexity. Thus, meats manufactured employing this technique will be largely confined to simple products based on processed meat such as hotdogs or hamburgers.
The crux of the technical difficulty in engineering meat lies in the two different methods protein can be cultivated
First developed by Benjaminson, Gilchriest, and Lorenzby in the 1970s for NASA astronauts [5], the second method relies on transplanting whole skeletal muscle explants onto petri dishes and culturing them to expand from their pre-existing natural structure. An advantage of this technique is that the explants already have the entire catalogue of component proteins, such as actin, needed for further proliferation and
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a workable scaffold from which to expand. The major disadvantage of this method lies in the management of cell growth beyond the existing explant. So far, researchers have not been able to effectively ensure that cells dividing from the explant receive the minimum amount of blood circulation needed with the majority of the colony becoming neurotic if separated for long periods of time from a nutrient supply [4]. However if a method is developed to effectively sustain the growth of explants, there is a high probability that structurally complex meat products, such as steaks, could be cultivated. totaling over $50 billion, devoted to agricultural subsidies, the first generation of companies attempting to release in vitro meat to the general public may have to face well-financed and politically entrenched opposition in the form of agriculture industry lobbyists. In contrast, the distribution of meat to consumers is much more unpredictable. The fact that a large proportion of the population does not know of the possibility of developing meat in vitro can be both a bane and a blessing for potential companies. Due to a lack of information and even results concerning testing, the general consumer will naturally be Reproduced from [10]. skeptical to such an alien method of agriculture. Furthermore, growing meat artificially poses great challenges to observant followers of Judaism and Islam due to their stringent dietary rules. Much religious debate has to occur on this topic before such a large population will take the leap of faith to eat meat that cannot be blessed because it has never been alive. As mentioned earlier, the development of in vitro meat is occurring at the same time as a popularization in organic food. From a marketing standpoint, organic food is relatively easy to advertise as it encourages consumers to return to our roots and live how we did before the advent of pesticides and other chemicals. While there is already a preconceived notion that natural is healthy, no such collective notion exists that artificial meat is inherently good in any way.
However if a method is developed to effectively sustain the growth of explants, there is a high probability that structurally complex meat products, such as steaks, could be cultivated
In addition, it must not be assumed that fully-grown protein tissues, regardless of the intricacy of their structures, will have all the nutrients found in natural meat. One of the most important features of bovine meat is the relatively high concentration of iron in the form of Fe(II) [6]. In their 2001 publication, Aisen, Enns, and Wessling-Resnick demonstrated a method of inserting and supplementing iron in cultured meat by binding iron to the plasma so that it becomes attached into the heme group in the subsequent myoglobin synthesis [7]. While such a procedure has already been proven for iron, no such mechanism has been developed for dietary minerals and vitamins, such as vitamin B12, that are not inherent in the production of myocytes. While it is conceivable that we will be able to understand every metabolic pathway for each nutrient in meat, the great challenge lies in devising a method to manipulate the synthesis of myocytes to incorporate all the nutrients. Posts team has garnered a favorable image in the media and other groups have received a mixture of both institutional and private incentives, such as the support of PETA with the animal rights advocacy group offering one million dollars to the first company that will bring lab-grown chicken meat to consumers [8]. However, proponents of in vitro meat potentially face direct opposition from the organized and politically powerful agriculture industry. With over 40% of the EU budget,
References
1. British Broad Casting Corporation. Lab Grown Meat is First Step To Artificial Hamburger. [Feb 19 2012]. Retrieved 9 March 2012. http://www.bbc.co.uk/news/science-environment-16972761. 2. Britannica. Ethics.Retrieved 9 March 2012. http://www.britannica.com/EBchecked/topic/194023/ethics. 3. National Science Foundation [U.S.A.] [2004]. The Emergence of Tissue Engineering as a Research Field. Retrieved 9 March 2012. 4. P.D. Edelman, D.C. McFarland, V.A. Mironov, and J.G. Matheny. Tissue Engineering. [May/June 2005]. 11[5-6]: 659-662. doi:10.1089/ten.2005.11.659. 5. Ellen Ternes. Paper Says Edible Meat Can be Grown in a Lab on Industrial Scale. University of Maryland. [6 July 2005]. Retrieved 9 March 2012.
While there is already a preconceived notion that natural is healthy, no such collective notion exists that artificial meat is inherently good in any way
While the technical issues with growing meat in vitro may seem intractable, they are not insurmountable and only require adjustments to a fundamentally working procedure. Cultivating a collective consumer conscience to buy the meat, however, will no doubt be the more difficult battle companies will have to face. Timothy Lim 15, has been following the progression of climate change activism for some time and the potential effects global warming. Thus far, economic and social policies have been tacit to say the least and he is interested in exploring how science might find an answer.
6. I. Datar, M. Betti. Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada. Possibilities for an in vitro meat production system. 20 October 2009. Retrieved 9 March 2012. http://www.sciencedirect.com/science/article/pii/S1466856409001222 7. Aisen et al. Chemistry and biology of eukaryotic iron metabolism. International Journal of Biochemistry and Cell Biology. 2009. Retrieved 9 March 2012. 8. Ketzel Levine. Lab-Grown Meat a Reality, But Who Will Eat It?. NPR. 8 May 2008. Retrieved 9 March 2012. www.npr.org/templates/story/story.php?storyId=90235492. 9. European Union 2010 General Budget. EU. 17 May 2010. Retrieved 9 March 2012. http://eur-lex.europa.eu/budget/data/D2010_VOL4/EN/nmc-titleN123A5/index.html. 10. http://www.thehandthatfeedsus.org/images/american-farmer-425x282.jpg

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Then and Now: What the Scopes Trial Can Tell Us About Contemporary Biology, Morality and the Law
Kate Nussenbaum
have been a victim of unusual and irrational thoughts, Charles Whitman wrote in 1966. The next day, he went on a murderous rampage, randomly shooting people at the University of Texas from the top of a bell tower killing 13 and injuring 32 [1]. Whitman acted of his own accord; he wasnt part of a terrorist group, nobody forced him to kill anyone that fateful day. But after he committed suicide, his brain was examined, per his request. His doctor discovered that Whitmans brain harbored a tumor the diameter of a nickel that pressed against his amygdala, a key brain structure that is involved in emotional regulation, especially of fear and aggression [1]. Whitmans story is not uniqueeach year many people with brain damage commit crimes, and often, like Whitman, the physical irregularities that may have played a role in their criminal actions come to light only after they have already broken the law. Indeed, violent crime is often an early sign of schizophreniaaccording to one study in the United Kingdom, 11% of a group of 1241 prisoners charged with homicide
suffered from schizophrenia, and over one-third of the group were characterized as psychiatrically abnormal [2]. A 1997 study by neuroscientist Adrian Raine shed more light on the physical underpinnings of violent behavior. In his study, Raine used PET scans, a technique in which a radioactive chemical is injected into the body to highlight active brain areas, to compare the frontal lobes of 41 people convicted of
98.1% of inmates on deathrow carry a set of genes that predispose them to violencepeople with these genes are four times more likely to commit violent crimes
murder or manslaughter with those of a control group. The criminal group was further divided into those who exhibited controlled, purposeful aggression to achieve a desired goal, and those who killed solely based on impulsive, emotionally charged aggression. The first group showed frontal lobe activity similar to that of the control group, whereas the second group showed significantly less metabolic activity in their frontal lobesevidence that their violent actions may have been spurred by a deficit in the executive control region of their brains [3]. Is the Legal System Moral? The question then, is how should the legal system handle these criminals? Should convicted criminals with frontal lobe dysfunction or brain tumors be treated less severely than their normal counterparts? Neuroscientist David Eagleman argues that biology places constraints on the idea of free will and these constraints affect everyone, not just people with obvious brain damage. He writes that genetics, to a large degree, determine the course of ones life. According to Eagleman, 98.1% of inmates on death-row carry a set of genes that predispose them to violencepeople with these genes are four times more likely to commit violent crimes [1]. All actions, including those of violent criminals, could potentially be traced back to biological roots, calling into question the justice of our legal system, especially as our understanding of those biological roots deepens.
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Currently, criminals can plea insanity in all but four states. In some, they can also plea diminished capacity. Pleading insanity equivalent to pleading not guilty, while diminished capacity is equivalent to pleading to a lesser crime [4]. For example, a convicted murderer who proves that he could not have intended to kill the person because he did not have the mental capacity capable to have such a specific intent could have his crime successfully reduced to manslaughter [5]. In thirteen states, defendants can also be deemed guilty but mentally ill. In that case, they must still serve full sentences but receive psychiatric treatment in jail, or in mental hospitals beforehand [6]. Today, juries are responsible for determining whether a convicted criminal falls under any of these categories. Scientific explanations for mental abnormalities can be the most convincing evidence for the diminished capacity or guilty but mentally ill states. Interestingly, a 1998 Washington Post article reported that less than one percent of defendants use the insanity defense, and of those, only one quarter are acquitted. According to Jonas Rappeport, the first President and first Medical Director of the American Academy of Psychiatry and the Law, so few defendants attempt the plea because proving insanity is very difficult [7]. Rappeport told the Post that even though defendants are rarely successful in pleading insanity, when youve got no better defense, thats the way to go [7]. But should it be easier for people with mental illness or brain tumors to be acquitted, or at least, to have their sentences reduced? As contemporary biology and neuroscience research begin to reveal more and more about human behavior, the question of its potential for limitless explanations arises. Is there any human behavior that biology cannot explain? And if not, what does that mean for the legal system? If each criminal action can be reduced to genetic probabilities and chemical reactions then should anyone be convicted of murder? Why should someone with a tumor be less responsible for his actions than someone without? Is there a
If each criminal action can be reduced to genetic probabilities and chemical reactions then should anyone be convicted of murder? Why should someone with a tumor be less responsible for his actions than someone without?
risk that more and more criminals will exploit the system and manipulate the meanings of current developments in biology to successfully persuade juries of some form of diminished capacity? Moreover, these new findings are morally problematic. On the one hand, most individuals believe in the notion of punishment for actions that negatively affect others. Not only does it appeal to our human sense of justicethe phrase an eye for an eye dates back to the Old Testament but the threat of punishment can serve to deter people from malevolent action. Society needs to be protected from people who act violently, regardless of the underlying cause of their aggression. On the other hand, if who we are and the choices we make are at least partially biologically programmed from our conception, then should we punish those who fail to win the great biology lottery? Repeating the Past The controversial idea that human action is nothing more than a product of biological mechanisms is not new. Indeed, it took center stage in the courtroom almost 100 years ago, in Dayton, Tennessee during the Scopes Trial. At that time, the desire to understand the human tendency toward violence was especially strong as people were grappling for a way to understand the cause of the First World War. The now infamous Scopes Trial occurred in the summer of 1925, after public school substitute teacher John Scopes purposefully broke Tennessees new law by teaching students the concepts of evolution. He did this so that he could play the defendant in the trial in which the American Civil Liberties Union planned to challenge Tennessees constitution. Famous politician William Jennings Bryan served as a key witness in the trial, bringing his fundamentalist Christian views to the stand, as well as enough media attention to launch Dayton into the national spotlight. Nobody cared much about the fate of John Scopes, but everyone wanted to see passionate arguers come to a head over one of the most Reproduced from [10] controversial topics of the time: evolution [8].

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This particular controversy over evolution was not about had those genes, could they use that information to free him or whether it was true; it was about whether it was in the best herself from the moral codes of society? Neuroscience evidence interest of society to teach the theory to public school students. does not offer a guide for how to act. Almost no one would In essence, Bryan believed that if children were taught that argue that a person with those genes should act violently, or their species had survived not because individuals had acted that a person with a brain tumor should go on a killing spree. cooperatively, but rather because they had outcompeted ev- But Darwins theory of evolution did not dictate that people eryone around them, they would turn into the savage beasts should fight to survive in an eat-or-be-eaten world certain science urged them to become. How can teachers tell students people, like Kellogg, just used that interpretation of his theory that they came from monkeys and not expect them to act like to understand a puzzling and violent war. Do warped intermonkeys? he asked [8]. Bryan also believed evolution would pretations of contemporary biology pose the same threat to challenge the Christian ideas of morality children learned society? If scientific evidence frees some criminals from the from their parents. full responsibility of their crimes, then are we providing the Many, like Bryan and Vernon Kellogg in his famous book public with the type of dangerous education Bryan feared Headquarters Night, argued that evolution provided a justification would crumble the moral foundations of society? for people to act violently, not a reason why people actually There are no certain answers to those questions, but hisdid. In his book, Kellogg described the mindset of a German tory suggests that the spread of scientific knowledge has no military leader during WWI, writing, If [Germany] wins, it correlation to the corruption of a human sense of right and will prove that she is on the right way, and that the rest of the wrong or our tendency toward violence. Battle and blood world, at least that part which existed in every ancient culture; we and the Allies represent, is on violence extends further back in There are no certain the wrong way and should, for time than the scientific study of the sake of the right evolution of biology. Warring tribes did not answers to those questions, the human race, be stopped and need Darwins theory to justify but history suggests that put on the right way or else their actions, just as ancient killers be destroyed as unfit [9]. Keldid not murder others because the spread of scientific logg did not believe that German they believed they had no conknowledge has no military leaders had evolved to trol over the course of their lives. act violently; he believed that they Though the scale of violence has correlation to the corruption thought their violent actions were grown over time, that trend is of a human sense of right not only justified, but actually almost certainly due to more deemed benevolent, by Darwins powerful methods, rather than and wrong or our tendency theory. more powerful justifications. toward violence Whether our understanding Moving Forward of biology will be able to reform What, then, would Bryan think of the current debate about how the law to the benefit of society remains uncertain, but it seems the law should punish criminals with neurological impairment? clear that educating the public about science will not corrupt Many found evolution troubling because they believed the societys moral codeif anything, it may allow us to refine it knowledge of our inherent, biological drives would deprive us and give people suffering from neuropsychological disorders of our humanity; people with similar mindsets may fear public a second chance. As the scientific communitys understanding knowledge of developments in neuroscience that also suggest of the biological foundations of violent action sharpens, it is that our biological underpinnings are responsible for many of imperative that the public not be shielded from their work. our actions. Perhaps neuroscience does not challenge religion The most humane and rational jury is one that is well-educated as obviously as evolution, and so it may not find as ardent on the motivations and mechanisms of human behavior. opponents. But as scientists use new tools to find biological explanations for human behavior that, like evolution, have the Kate Nussenbaum is interested in how science affects our views potential to be misinterpreted, does another public battle await? of morality and intends to concentrate in Cognitive Neuroscience Take, for example, Eaglemens set of genes that predispose at Brown University. She can be reached at kate_nussenbaum@ people to act violently. If a person found out at birth that they brown.edu
References
1. Eagleman D. The brain on trial. The Atlantic. 2011 July-August. 2. Anderson M. Mental illness and criminal behaviour: a literature review. Journal of Psychiatric and Mental Health Nursing 1997;4:243-250. 3. Seiden J. The criminal brain: frontal lobe dysfunction evidence in capital proceedings. Capital Defense Journal. 2004. 16 (2): 395-420. 4. Insanity defense [Internet] 2010 August 19 [Accessed 2012 Apr 4]. Available from: http://www.law.cornell.edu/wex/insanity_defense 5. Diminished capacity [Internet] 2010 August 19 [Accessed 2012 Apr 4]. Available from: http://www.law.cornell.edu/wex/diminished_capacity 6. Current Application of the Insanity Defense [Internet] 2012 [Accessed 2012 Apr 26]. Available from http://criminal.findlaw.com/criminal-procedure/currentapplication-of-the-insanity-defense.html 7. The insanity defense: a closer look. The Washington Post [Internet]. 1998 Feb 27 [cited 2012 Apr 26]; Available from http://www.washingtonpost.com/wp-srv/local/ longterm/aron/qa227.htm 8. Larson E. Summer for the gods. Massachusetts: Harvard University Press; 1998. 9. Kellogg, V. Headquarters nights. The Atlantic Monthly Press; 1917. 10. Anatomy of the Brain. [Image on the Internet]. 2004. [cited 2012 June 2] Available from: http://pubs.niaaa.nih.gov/publications/arh27-2/153-160.htm 11. Portrait of Charles Darwin as a young man. [Image on the Internet]. 2010. [Cited 2012 June 2] Available from: http://www.nlm.nih.gov/exhibition/darwin/ darwinprimages.html
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Operating Under the Influence: The Problem with Sleeplessness in the Medical Profession
Chloe OConnell
n the night of March 4, 1984, Libby Zion was admitted to New York Hospital with a fever, agitation, and strange jerking motions of her body [1]. Libby, a college freshman, had been struggling with depression, and her symptoms were attributed to a viral syndrome with hysterical symptoms [1]. Instead of investigating the strange jerking motions of her body, the doctors prescribed meperdine, which can cause fatal drug interactions with phenelzyne, Libbys antidepressant. As her condition worsened over the course of the night, the residents prescribed another anxiolytic drug, haloperidol, and put her in physical restraints. By 6:30 AM, Libbys fever had reached 107 degrees. One of the residents attending to her, who had left to tend to the 40 other patients he was covering that night, was called back in. But it was too late. Soon after, Libby died of cardiac arrest. Libbys father, a journalist in New York City, began an investigation immediately after his daughters death. At first, he blamed the doctors who had treated her. But when he learned about the shortage of personnel staffing in the hospital that night, he transferred his criticism to the institution itself. In an op-ed piece for the New York Times, he wrote, You dont need kindergarten to know that a resident working a 36-hour shift is in no condition to make any kind of judgment call forget about life-and-death [2]. He followed up the article by pressing charges against the hospital. The case became important not because of its final verdictthe jury found Libby and New York Hospital equally at fault because Libby had not disclosed that she had cocaine in her system. Rather, the case became important because it highlighted a growing problem in American medicine: doctors, particularly residents, were not getting enough sleepand people began to worry this was costing patients their lives. The New York State Health Commissioner set up a panel to make sure doctors and residents in the state were sufficiently rested. In 1989, the state made the commissions recommendations mandatory, setting concrete limits for the first time on the amount of time that residents were permitted to work. Residents were limited to an average of 80 hours of work per week, and shifts were to be no longer than 30 hours. Residents were also required to get a minimum of 10 hours off between shifts. In 2003, the Accreditation Council for Graduate Medical Education adopted these regulations nationwide, so that any teaching hospital that did not adhere to the guidelines would risk losing accreditation [3]. Initially, there was some resistance to these regulations. Some argued that rotating patients among multiple doctors
would worsen patient care. Others argued that experiencing the entirety of a patients illness was necessary for training purposes. And despite resistance from hospitals now facing the economic burden of having to hire a larger resident staff, they had no choice, and the rules went into effect. At the time, people wondered whether the rules had gone too far. 10 years later, the question has changed: did they go far enough? The gravity of sleep deprivation The age-old culture of sleep-deprivation in medicine is not without consequences for both patients and doctors. Medical residents, who frequently are asked to work more than 24 hours at a time, are at increased risk for depression, and those who are pregnant are at an increased risk of complications [4]. These 24-hour shifts also make residents twice as likely to get in a motor vehicle accident on their way home from
In a lottery-like economic decision-making game, subjects that had been awake for 23 hours were found to make riskier decisions for economic gains
work [5]. Patients suffer as well one recent study reported an 83% increase in complications when elective surgeries are performed by doctors who slept less than six hours between being on-call the night before and reporting to the hospital for the elective procedure [6]. After 24-hour shifts, physicians make 36% more medical errors than they do after 16-hour shifts and five times as many diagnostic errors [7, 8]. One famous study equated performance impairment after 24 hours of wakefulness to having a blood alcohol level of 0.10, well above the 0.08 legal limit for driving in most states [9]. Sleep deprivation is also linked to altered decision-making patterns. In a lottery-like economic decision-making game, subjects that had been awake for 23 hours were found to make riskier decisions for economic gains [10]. The authors then compared the activation of certain brain regions between the two groups using functional magnetic resonance imaging (fMRI). They found that activation in the ventromedial prefrontal cortex was increased in the sleep-deprived participants, and that this activation correlated with a bias toward risky

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gains. Sleep deprivation was also associated with decreased activation in the right anterior insula and the dorsomedial prefrontal cortex, which have been associated with a wide range of processes, including emotional and social awareness, as well as drug-seeking in rats [11, 12]. In well-rested participants, activation in these areas correlated with participants tendency to avoid negative risks, so the authors suggest that hypoactivation in the sleep-deprived participants reflected a decreased anticipation of negative consequences and therefore less aversion to negative risks. If the authors hypotheses are correct, this means that a surgeon who has been on-call the night before will have a different pattern of brain activation than one who is well-rested. This altered activation may make them less cautious when making risky decisions that involve the patients health. Steps Forward In light of these findings, accreditation agencies have recently made more changes to the structure of medical training to reduce sleeplessness within the profession. In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) amended the rules instated following the Libby Zion case and put further restrictions on the hours that residents are permitted to work. The maximum shift duration was decreased from 30 hours to 16 hours for first-year residents and to 28 hours for those beyond their first year [13]. The council required hospitals to provide sleeping facilities or safe transportation home after overnight shifts and stipulated that residents and faculty must be educated about fatigue and safety. However, the changes are so recent that there is no data on how they have affected the incidence of preventable adverse affects (PAEs) such as brain damage, infection, paralysis or any other complication resulting from a medical mistake. While these new requirements are an important step toward solving the problem of sleep deprivation in medicine, they come at a price. Again, the rules were enacted too recently for an exact assessment of their actual financial cost, but analysis by the ACGME prior to their enactment estimated that the changes would cost the healthcare system over $380 million [13]. According to the analysis, depending on how the changes are implemented, this figure could rise to over $694 million. However, this cost should be offset by the reduction in PAEs due to sleep deprivation. If PAEs are reduced by at least 2.4%, the policy changes will save money for the patients and their families who bear these cost burdens. For hospitals, however, the economic outcome is bleaker: implementing the rules will end up costing them money unless PAEs are reduced by at least 10.9%. Some argue that unless this 10.9% reduction is met, the economic reforms are not economically in the best interests of hospitals, and may end up hurting a medical system that is already struggling under the weight of its own immense costs. Yet others, including victims of a PAE and their family members, argue that no dollar figure can be put on a patients life. Furthermore, many of these victims and family members are asking, are these new regulations enough? Current Debate: Informed Consent A recent editorial published in the New England Journal of Medicine re-ignited the debate over sleep deprivation in medicine, endorsing the recommendation put forth by the Sleep Research Society that sleep-deprived surgeons should be required to obtain informed consent from patients before performing an elective procedureone that is not required as part of a medical emergency [14]. Under the recommendations, surgeons would be required to inform their patients of the extent and potential safety impact of their sleep deprivation, and the patient would be able to decide whether or not to re-schedule the procedure for another time. In light of the recent findings linking sleep deprivation and performance impairment, increased risk for surgical complications, and impaired decision-making, 80% of patients say they would request to reschedule if their doctor had been awake for 24 hours [15]. Like the regulations that followed the Libby Zion case, this idea has been met with considerable oppositionnot only from hospitals, who would lose money if surgeries were rescheduledbut also from surgeons themselves. According to an editorial submitted by the American College of Surgeons, mandatory disclosure will not fix the underlying problem,
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which is lack of awareness about our human limitations [16]. The editorial argues that other factors besides sleep affect performance, including marital difficulties and financial troubles. It also says high-caliber surgeons who are careful and committed to delivering quality care and are conscious of their own sleep-induced impairment will likely view mandatory disclosure of sleep history as oppressive and insidious [16]. The economic consequences of allowing patients to reschedule surgeries if their doctor is suffering from sleep deprivation are perhaps the largest deterrent to the instatement of mandatory-disclosure regulations. With the enormous costs of wasted scheduled operating room time and personnel, not to mention the financial cost to the physician and hospital, new regulations could push healthcare costs even higher. But that does not mean new regulations should be discounted entirely If allowing surgeries to be rescheduled as a result of surgeons sleep deprivation is not practical economically, possibly fixing the root of the problem, sleeplessness in medicine, is a better alternative. But this is also not economically feasible. A recent article in the American Journal of Surgery estimated that if the medical profession were to adopt the Aviation Industrys rigorous standards of limiting pilots work hours, the cost would come to approximately $1 million per patient life-year saved [17]. It would also require a 71% increase in the physician workforce, and a 174% increase in the number of residents in the American medical system. Although some say that the years of patient life and patient well-being gained are worth the cost, in reality, few people are willing to foot the bill. But that is not to say that there is nothing to be done. Recent studies on the nature of sleep and performance have suggested innovative sleep strategies, mainly polyphasic sleep patterns and naps, as alternatives to a full nights sleep.
References
1. Lerner BH. The case that shook medicine. Washington Post 2006 Nov 28. 2. Gracey DR Intern in the Promised Land. Bloomington: iUniverse; 2009: 86. 3. Lehrner BH. A life-changing case for doctors in training. New York Times 2011 Aug 14. 4. Veasey S, Rosen R, Barzansky B, Barzansky B, Rosen H, Owens J. Sleep loss and fatigue in residency training. JAMA. 2002; 288: 1116-1124. 5. Barger LK. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005; 352:125-134. 6. Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA 2009; 302:1565-1572. 7. Ladrigan CP, Rothschild JM, Cronin JW, Kaushar R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns work hours on serious medical errors in intensive care units. N Engl J Med [Internet].2004 [cited 2012 March 10]; 351:1838-1848. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa041406 8. Ladrigan CP, Rothschild JM, Cronin JW, Kaushar R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns work hours on serious medical errors in intensive care units. N Engl J Med [Internet]. 2004 [cited 2012 March 6]; 351:1838-1848. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa041406 9. Dawson D, Reid K. Fatigue, alcohol, and performance impairment. Nature 1997; 388: 235. 10. Venkatraman V, Huettel SA, Chuah LYM, Payne JW, Chee MWL. Sleep deprivation biases the neural mechanisms underlying economic preferences. J Neurosci. 2011; 31(10): 3712-3718. 11. Craig AD. How do you feel now? The anterior insula and human awareness. Nat Rev Neurosci. 2010; 10(1): 59-70. 12. Fuchs RA, Evans KA, Ledford CC, Parker MP, Case JM, Mehta RH, See RE. The role of the dorsomedial prefrontal cortex, basolateral amygdala, and dorsal hippocampus in contextual reinstatement of cocaine seeking in rats. Neuropsychopharmacology. 2005; 30: 296-309. 13. Nuckols T, Escarce JJ. ACGME Common Program Requirements: Potential cost implications of changes to resident duty hours and related changes to the training
One study examined the sleep patterns of 99 sailors completing double-handed and solo ocean sailing races [18]. The authors reported that most of the sailors spontaneously adopted polyphasic sleep and had few or zero adverse affects to the adjustment, although mean sleep time was reduced from 7.5 to 6.3 hours. Interestingly enough, reductions in sleep did not negatively impact race performance. In fact, performance was negatively correlated with total amount of sleep. Extremely short naps, or mini-naps, may be another way to minimize impairment in doctors performance without sacrificing too much valuable time to sleep. Naps of 20 minutes were found to alleviate sleepiness and enhance performance level after sleep deprivation [19], and naps as short as 6 minutes were found to enhance memory [20]. Even naps as short as a coffee or bathroom break may be helpful. Scientists in Japan recently reported that only three minutes of stage-two sleep was necessary to alleviate the performance deficits induced by one-and-a-half hours of lost sleep [21]. Sleeplessness in medicine is firmly ingrained in the structure of our healthcare system. Despite the potential consequences for patients health, changes to the system may not be economically feasible. It is difficult to imagine a solution that would not cripple an already-struggling healthcare system in which costs are expected to rise to around 34% of total US GDP by 2040 [22]. However, a deeper understanding of sleep itself may provide answers. This promising new research on sleep and sleep deprivation may yield economically practical solutions that could help us prevent deaths like Libby Zions. Chloe OConnell graduated from Brown University in 2012 with a degree in Human Biology: Brain and Behavior. She can be contacted at chloe_oconnell@brown.edu.
environment announced on September 28, 2010 [Internet]. 2010 [cited 2012 Mar 31]. Available from: http://www.acgme.org/acWebsite/dutyHours/dh_index.asp 14. Nurok M, Czeisler CA, Lehmann LS. Sleep deprivation, elective surgical procedures, and informed consent. N Engl J Med 2011; 363: 2577-2579. 15. Blum AB, Raiszadeh F, Shea S, et al. US public opinion regarding proposed limits on resident physician work hours. BMC Med 2010; 8:33. 16. Pellegrini CA. Sleep deprivation and elective surgery. N Engl J Med 2010; 363:2672-2673. 17. Payette M, Chatterjee A, Weeks WB. Cost and workforce implications of subjecting all physicians to aviation industry work-hour restrictions. Am J Surg 2009; 197:820-825. 18. Stampi C. Polyphasic sleep strategies improve prolonged sustained performance: a field study on 99 sailors. Work & Stress: An International Journal of Work, Health, & Organisations 1989; 3(1): 41-55. 19. Hayashi M, Watanabe M, Hori T. The effects of a 20 min nap in the mid-afternoon on mood, performance, and EEG activity. Clinical Neurophysiology 1999; 110(2): 272-279. 20. Lahl O, Wispel C, Willigens B, Pietrowsky P. An ultra short episode of sleep is sufficient to promote declarative memory performance. J Sleep Res. 2008; 17(1): 3-10. 21. Hayashi M, Motoyoshi N, Hori T. Recuperative power of a short daytime nap with or without stage 2 sleep. Sleep. 2005; 28(7): 829-836. 22. White House Council of Economic Advisers (CEA). The Economic Case for Health Care Reform [Internet]. 2009 [cited 2012 May 14]. Available from: http://www. whitehouse.gov/administration/eop/cea/TheEconomicCaseforHealthCareReform 23. Ganju A, Kahol K, Lee P, Simonian N, Quinn SJ, Ferrara JJ, Batjer, H.H. The effect of call on neurosurgery residents skills: implications for policy regarding resident call periods. J Neurosurg. 2011: 116(3); 478-482. 24. Dumont T, Rughani AI, Penar PL, Horgan MA, Tranmer BI, Jewell RP. Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction. 2011: 116(3); 483-486. 25. Image available from: http://www.publicdomainpictures.net/view-image.php?im age=2862&picture=asleep&large=1

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At a Crossroads: Evaluating Novel Treatment Options for Diabetes Mellitus

Lakir Dilip Patel
iabetes mellitus, a metabolic disease that affects insulin production and resistance, afflicts millions of individuals worldwide. Nearly 90% of diabetic cases are caused by a defect in insulin production and utilization (type 2), whereas the more severe form, type 1 diabetes mellitus (T1DM), results from complete loss of the insulin-producing B cells in the islet of the pancreas. Without insulin, the body cannot regulate blood glucose levels. Currently, no cure exists for either type of diabetes. Management of T1DM involves insulin therapy, usually in the form of a subcutaneous injection of insulin. Daily injections, however, carry with them poor patient compliance [1]. Injections may be missed because
with improved drug delivery systems that employ sustained release of therapeutics over time, thus requiring fewer administrations. A consideration of the effects on patient quality of life is critical in evaluating both therapies. Currently, patients can actively manage T1DM with insulin therapy; therefore, any new therapy must not only be more efficacious than insulin injections, but also present fewer complications and side effects. Therapies that can stabilize blood glucose levels while freeing the patient from the burden of daily medication will be the most successful. Islet Cell Transplantation Excitement regarding the prospect of islet cell transplantation peaked with the advent of the Edmonton protocol in 2000 [3]. Developed by an islet transplantation group at the University of Alberta in Edmonton, this procedure was the first to successfully transplant islet cells into several patients. This protocol was unique in that it used high amounts of transplanted islet cells as well as a combination of various immunosuppressants and antibodies to prevent rejection. The results of this protocol were promising: all seven of the first patients achieved sustained independence from insulin injections for the first year post-transplant. Longer follow-up periods, however, revealed loss of graft function, with more and more patients needing to resume insulin injections over time [4]. In light of this declining graft function, the promise of islet cell transplantation must be re-evaluated. The literature targets two areas of the protocol that can be improved to avoid loss of graft function: maximizing the number of viable islets and avoiding toxicity associated with immunosuppressive drugs [5, 6]. The current protocol involves obtaining islet cells from cadaveric donors. Making use of a living donor pool could both increase the supply of islet grafts as well as the potency of grafted islet cells, since the potency of cells from living donors is assumed to be far superior to that of cells from cadaveric tissue [3]. Furthermore, living donor sources allow for greater specificity in matching donors and recipients based on human leukocyte antigens (HLAs), the surface proteins used to mediate foreign body detection. Thus, the inclusion of living donor sources would help address two of the main issues miring current islet cell transplantations: donor shortages and immunosuppression. Although transplantation using living donor grafts appears to have significant potential, very few cases in which living donors were utilized have been reported. In order to verify the efficacy of living-donor transplantation, studies are needed to assess graft function and patient health in the long-term.
of patient forgetfulness, or intentionally omitted because of pain, embarrassment, or interference with daily activities [2]. Going forward, the medical and research communities have two options for improving T1DM treatment and management. The solution closest to a true physiologic correction of the diabetic state would be islet cell transplantation, which aims to restore the patients supply of insulin-producing B cells [3]. An alternative would be to improve current insulin therapies
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The need for protracted studies cast doubt on how rapidly transplant programs can incorporate living donor sources. Even if a large quantity of islet cells can be purified pre-transplantation, several obstacles inherent to the transplantation process exist. The current protocol for islet cell transplantation involves delivery of islet cells to the hepatic portal vein via catheterization. Implantation of islet cells at this site allows for delivery of insulin to the portal circulation, where naturally produced insulin would be delivered [7]. Interaction of islets with blood components at this site, however, triggers an instant blood-mediated inflammatory response, which can lead to the loss of nearly half the grafted islet mass [4]. Treatment with anticoagulation drugs such as heparin or anti-inflammatory agents both during and after transplantation can help avoid the loss of islet mass, but at the cost of increased risk of bleeding [8]. Given that islet cell transplantation is an allogeneic procedure (transplantation from a genetically non-identical donor), lifelong use of immunosuppressive drugs is necessary for patients. If one defines a successful islet cell transplantation as one that results in insulin independence, the reduced frequency of hypoglycemic episodes or increased patient quality of life can be misleading in light of a lifelong regimen of immunosuppressive drugs. Although stable glucose levels provide patients with a feeling of independence, the need for daily immunosuppression may affect their quality of life in equally palpable ways [9]. Immunosuppressant drugs can cause serious detrimental side effects, including toxicity. Current research has investigated islet encapsulation so as to hide surface HLAs and avoid the need for immunosuppression. When encapsulated, islet cell surface HLAs would not be recognized by the immune system, preventing the activation of an immune response. Although no patients have achieved insulin independence from encapsulated islets, clinical benefits have been demonstrated, such as the disappearance of hypoglycemic episodes [10, 11]. By reducing the size of the encapsulation unit, researchers hope for incorporation
Although islet cell transplantation presents the potential to physiologically cure T1DM, realizing this clinical outcome may be years away
of cells in sites with better functional exchange, leading to improved insulin delivery [12]. Encapsulated cells hold great promise, but, like many of the other innovations to islet cell transplantation, will probably remain at the research bench for the foreseeable future. Although islet cell transplantation presents the potential to physiologically cure T1DM, realizing this clinical outcome may be years away, as current studies indicate decline in graft cell function and loss of insulin independence. Combined with the need for lifelong immunosuppressant drugs, islet cell transplantation, in its current state, does not appear to be generating as much excitement as it did in 2000. With the rapid development of biotechnology and drug delivery, more viable treatments may arise with significant improvements for patient compliance and quality of life.
Drug Delivery Contemporary drug delivery methods for diabetes require daily injections of insulin. Insulin, a peptide hormone, like other protein-based drugs, is quickly degraded by stomach enzymes and thus cannot be taken orally. Novel drug delivery systems that encapsulate or shield insulin from stomach enzymes until the optimal time for drug delivery could allow for oral forms of insulin treatment. The benefit to such technologies is improved patient compliance: patients are more likely to adhere to a simple oral drug regimen as opposed to uncomfortable, inconvenient injections [13]. The premise for encapsulating insulin so it can be taken orally is straightforward. Shielding insulin within a biocompatible and biodegradable material will not only protect it from protein-degrading enzymes, but will also allow for controlled release of the therapeutic agent over time. Materials of choice among the research community are the biocompatible polymers PLGA [poly(lactic-co-glycolic acid)] and PLA (polylactide) [13, 14]. As byproducts of various metabolic pathways, the introduction of these polymers into the body via a PLGA or PLA-coated drug would not induce an immune or inflammatory response. Insulin therapies that incorporate such biocompatible polymers could prove to be both efficacious and low-risk. Current technology exists to fabricate polymer nanospheres, tiny spherical particles of polymer that are loaded with insulin [13, 14]. Ideally, these nanospheres adhere to the GI tract. Insulin would slowly be released as the polymer shell degrades into naturally occurring by-products. These technologies have demonstrated Reproduced from [17] bioadhesion and sustained release of insulin over ex-

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tended time periods (in various animal models), demonstrating the technologys efficacy [13]. The low risks associated with the biocompatible materials, in addition to patient-friendly characteristics such as oral delivery and sustained release (weekly or monthly administrations as opposed to daily), make nanoencapsulation of insulin an exciting therapeutic option that addresses several quality of life issues. Before the technology can be used in clinical settings, it must pass clinical tests and regulatory approval. Clinical trials for islet cell transplantation require experimentation over several years, in terms of quality of life implications. The burden of daily insulin injections contributes to most patients difficulty in adhering to current regimens [2, 9]. While patients may be cured from a medical standpoint, islet cell transplantation may not drastically improve their quality of life relative to current treatments. Oral drug delivery systems, on the other hand, free patients from the burden of daily medications while eliminating the pain often associated with injections [2]. Although not a cure in the medical sense, drug delivery systems improve upon current insulin treatment in an area that many patients are concerned with: day to day quality of life. Implementation of each technology into the healthcare delivery system requires that it be advantageous for both patients and providers. With regards to economic cost, both islet cell transplantation and drug delivery systems appear to be cost-effective [1, 15], rendering drug delivery systems, an outpatient procedure, easier to implement at the healthcare delivery level. Islet cell transplantation, although minimally invasive, is an inpatient procedure, and carries the associated surgical risks and cost of hospital days [4]. Ultimately, islet cell transplantation and drug delivery systems differ in the scope of treatment. Islet cell transplantation aims to correct the physiology of the diabetic state whereas drug delivery systems aim to improve upon current insulin administration regimens. Science and medicine constantly strive to discover cures for disease states that affect humans; however, assessing the quality of a therapy must also consider a patients quality of life. The promise of a cure for T1DM through islet cell transplantation warrants continued research in this field. As for the progression of T1DM treatment, drug delivery systems, tailored for patient compliance and comfort, appear to be a logical bridge between current therapies and the sought-after cure. Lakir Patel 13 is a Biology concentrator in the Program in Liberal Medical Education at Brown University. With an interest in biotechnology and physiology, he is excited about how technological advances will shape the medical community.
review. Diabet Med. 2010;27:812-822. doi: 10.1111/j.1464-5491.2010.03029.x 10.Wang T, Adcock J, Kuhtreiber W, et al. Successful allotransplantation of encapsulated islets in pancreatectomized canines for diabetic management without the use of immunosuppression. Transplantation 2008; 85:331337. doi: 10.1097/ TP.0b013e3181629c25. 11.Calafiore R, Basta G, Luca G, et al. Microencapsulated pancreatic islet allografts into nonimmunosuppressed patients with type 1 diabetes: first two cases. Diabetes Care 2006; 29:137138. doi: 10.2337/diacare.29.01.06.dc05-1270. 12.Basta G, Montanucci P, Luca G, Boselli C, Noya G, Barbaro B, et al. Long-Term Metabolic and Immunological Follow-Up of Nonimmunosuppressed Patients With Type 1 Diabetes Treated With Microencapsulated Islet Allografts. Diabetes Care 2011;34(11):2406-2409. doi: 10.2337/dc11-0731. 13.He P, Tang Z, Lin L, Deng M, Pang X, Zhuang X et al. Novel Biodegradable and pH-Sensitive Poly(ester amide) Microspheres for Oral Insulin Delivery. Macromol Biosci. 2012. doi: 10.1002/mabi.201100358 14.Kumari A, Yadav SK, Yadav S. Biodegradable Polymer Nanoparticles Based Drug Delivery Systems. Colloid Surface B. 2010; 75:1-18. doi:10.1016/j.colsurfb.2009.09.001 15.Beckwith J, Nyman J, Flanagan B, Schrover R, Schuurman H. A health economic analysis of clinical islet transplantation. Clin Transplant 2011;26(1):23-33. doi: 10.1111/j.1399-0012.2011.01411.x 16. Insulin Pen Picture [Image on the Internet]. 2008 [cited 24 April 2011]. Available from http://www.flickr.com/photos/pkuhnke/2429325444/in/photostream/ 17. Islet Cells Picture [Image on the Internet]. 2007 [cited 24 April 2011]. Available from http://www.flickr.com/photos/luzillo/411865960/
. . . the biotechnology sector appears to be rapidly developing new solutions to diabetes treatment
in order to yield significant data regarding long-term graft function, complications, and patient mortality. Novel drug delivery systems, however, can demonstrate efficacy of delivery of therapeutic doses of insulin and lack of toxicity on shorter time-scales, potentially leading to expedited FDA approval. With the development of biocompatible polymer nanospheres, the biotechnology sector appears to be rapidly developing new solutions to diabetes treatment. With the plethora of academic laboratories and private companies dedicated to biotechnology, competition and collaboration will surely drive innovation, yielding therapies that change the way the medical community manages diseases such as type 1 diabetes. Going Forward Through current insulin treatment regimens, patients can manage their type 1 diabetes and live relatively healthy lives. In order to supplant current insulin treatments, new therapies must improve efficacy and minimize side effects; otherwise, patients have little incentive to change their standard of care. While both islet cell transplantation and drug delivery systems promise better control of blood glucose levels, the two differ
References
1.Bakalar N. Microchip Implanted to Deliver Drug Shows Promise in Trial. The New York Times [Internet]. 2012 Feb 17[cited 2012 Feb 23]; Health: A1. Available from: http://www.nytimes.com/2012/02/18/health/research/microchip-implanted-todeliver-drug-shows-promise-in-trial.html 2.Peyrot M, Rubin R, Kruger D, Travis L. Correlates of Insulin Injection Omission. Diabetes Care 2010;33(2):240-245. doi: 10.2337/dc09-1348. 3.Atala A, Lanza R, Thomson J. Islet Cell Transplantation. In: Foundations of Regenerative Medicine: Clinical and Therapeutic Applications. Academic Press; 2009. p. 400-417. 4.Vaithilingam V, Sundaram G, Tuch BE. Islet Cell Transplantation. Curr Opin Organ Transplant. 2008;13:633-8. doi:10.1097/MOT.0b013e328317a48b 5.Soggia A, Hoarau E, Bechetoille C, Simon MT, Heinis M, Duvillie B. Cell-based therapy of diabetes: What are the new sources of beta cells? Diabetes Metab J. 2011;37:371-5.doi:10.1016/j.diabet.2011.05.007 6.Halban P, German M, Kahn S, Weir G. Current Status of Islet Cell Replacement and Regeneration Therapy. J Clin Endocrinol Metab. 2010;95:1034-1043. doi: 10.1210/ jc.2009-1819 7.OSullivan E, Vegas A, Anderson D, Weir G. Islets Transplanted in Immunoisolation Devices: A Review of the Progress and the Challenges that Remain. Endocr Rev. 2011;32(6):827-844. doi: 10.1210/er.2010-0026 8.Kort H, Koning E, Rabelink T, Bruijn J, Bajema I. Islet Transplantation in Type I Diabetes. BMJ. 2011;342:426-432. doi: 10.1136/bmj.d217 9.Speight J, Reaney M, Woodcock A, Smith R, Shaw J. Patient-reported outcomes following islet cell or pancreas transplantation in Type I diabetes: a systematic
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Farm Subsidies for Commodities Crops: the Need to Revamp Outdated Farm Legislation
Alexandra Peseri
Origins of the Farm Bill The destructive effects of World War I caused large-scale bankruptcy in Europe, which in turn caused major export markets in the United States to crumble [1]. This economic downturn occurred at the same time as US banks were not giving enough credit to farmers. Moreover, the dustbowl, which caused widespread soil loss, caused crop prices to drop dramatically. Crop prices were so low during the Great Depression that many farmers could no longer maintain their farms and went out of business [3]. Enter President Franklin D. Roosevelt with the New Deal, a plan designed to bolster the U.S. economy. A component of this legislation, The Agricultural Adjustment Act of 1933 (the AAA) was aimed at supporting farmers and was passed in 1938. It can be viewed as the first Farm Bill, as it essentially paid farmers not to farm on a certain percentage of their land, and called for the federal government to purchase excess grain [2]. Both provisions were successful in increasing the price of crops to a level acceptable to farmers, while maintaining affordability for consumers [4]. Moreover, the governments purchase of excess grain was a form of insurance it could be released if natural disaster were ever to destroy the countrys food supply [5]. Many of the New Deal programs, including the AAA, were meant to be temporary forms of relief, to be altered accordingly or altogether eliminated after the crisis had ended. In reality, these programs have not been reconstructed accordingly, so as to reflect the current state of the economy [3]. Subsidies, such as those set up during the New Deal, are a major component of the Farm Bill, a $284-billion piece of legislation that shapes how and what we eat and how farmland is used. A new bill is passed once every five to seven years. The influence of the Farm Bill on the U.S. agricultural system is far greater than many may realize, especially because farm policy is essential in aiding the countrys current economic recovery [6]. Although less than 1% of working Americans claim farming as an occupation, it is important for the remaining 99% of Americans not to forget that farms still cover most of our land, agriculture uses most of our water, and farmers produce most of our food [7]. Not only is the impact, regarding nutrition programs, food production, and the agricultural profession, of the Farm Bill felt within this country, but also by the global economy, because the United States is both a major exporter and importer of crops [3]. Goals of the Farm Bill The law serves to uphold the farming profession by providing crop insurance and protection against high foreign tariffs and subsidies, which have remained in place since Roosevelts relief legislation. The bill also aids in environmental conservation, ensures that poverty-stricken families do not go hungry, and works to maintain waste and water facilities in rural communities. This is done with funds directed to nutrition and food stamp programs [6]. While these are all seemingly valuable efforts, the existing provisions have not been updated to reflect changes within the agricultural sector, such as the growing fissure between salaries of industrial-scale farmers and that of smaller and local farmers. The former are taking in exorbitant profits thanks to government aid and at the expense of the latter [8]. Unfortunately, Congress has not re-molded the Farm Bill to reflect that the Great Depression is long over, and there has been a steady increase in many farmers incomes. This
Subsidies, such as those set up in the New Deal, are a major component of the Farm Bill, a $284 billion piece of legislation that shapes how and what we eat and how farmland is used
is largely because the prices of crops, particularly the ones that are subsidized, are climbing [1]. Herein lies the issue of bolstering large-scale farms at the expense of small-scale farms, or, more simply, helping the rich become richer and the poor become poorer. The Farm Bill is composed of fifteen different topics, called titles. Most prominent are Commodities, Conservation, Nutrition, and Competition. The first deals with commodities like wheat, corn, soybeans, cotton, rice, dairy, peanuts, and sugar. Producers of such crops receive income support, the most generous amounts of which are given to those who produce the first five. It also so happens that nearly 74% of these subsidies are given to the top 10% of producers, who are usually also the wealthiest 10%. In the year 2010, $6.4-billion in USDA funds was given to farmers of these commodity crops [6]. At the time when subsidies were first instituted, they were rightly provided to farmers of commodity crops, which could be stored and purchased by the government when prices fell too low. Today subsidies are still primarily directed to producers of commodity crops, even though they there is no shortage of food. Farmers with diversified farms are given no such safety net. Farmers of commodities are the same producers that have seen an increase in income,

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own or maintain grass-based pasture systems, and therefore do not benefit from this type of aid [1]. Recent and Future Farm Bills Some of the more recent farm bills have appeared promising, but could be significantly improved. That of 1996, passed under the Clinton Administration, was falsely promoted as the bill that would rid the country of subsidies. The bill did in fact eliminate many subsidies, but allowed for three major and enormously important exceptions. These were for dairy, sugar, and peanutsthree main commodities that significantly influence the countrys agricultural system [5]. The 2008 Farm Bill, known officially as the Food, Conservation and Energy Act of 2008, has been widely lauded by agriReproduced from [15] cultural and government organizations as a law that upheld the goals of the bill. American Farmland Trust, Capitol Hill Publishing Corporation, and the National Sustainable Agriculture Commission have all produced publications praising the legislation as extremely successful and innovative [11]. However, these high opinions are not held universally. Opponents argue that the very policies presumed to protect small and local farms are instead aiding in their demise. This is because the bill, like many preceding it, allows for owners of industrial-sized farms to receive the largest share of government subsidies and often use the funding to purchase more land, pushing aside smaller and newer farms [3].
and therefore, are not in dire need of such funds. They are generally the most industrialized and wealthiest farmers [3]. The Need for Policy Change If not all farmers continue to experience variable and sometimes low incomes, as they did during the Great Depression, then why not just make direct payments to the farmers who are truly struggling, rather than maintaining subsidies mostly to commodities crops? Direct payments are a type of subsidy that are more easily altered than other types of subsidies, such as price supports, export subsidies, and import barriers, such as quotas, tariffs, and regulations. Many farmers vouch for the subsidies that are not as easily altered because they are at lower risk of being cut. These kinds of subsidies also happen to be given most generously to the highly productive, wealthy farmers who do not actually need them, but fight to maintain their place in the Farm Bill [9]. Subsidies to commodities are less likely to be depleted by politicians over time, because they are not a direct part of the federal budget, and thus, cannot be easily cut. Direct payments, on the other hand, are more likely to be adjusted, as they are a component of the budget. Moreover, it is the wealthy commodity farmers that have the resources to lobby and promote the maintenance of subsidies over direct payments [10]. Federal government funds, in the form of subsidized feed, are allotted in inordinately greater amounts to the industrial animal sector, making little or no funding available to small farmers and farms that raise grass-fed cattle. Small-scale farmers rarely use purchased feed grain; instead, they grow their
Would eliminating all subsidies be a policy beneficial to America?

Would eliminating all subsidies be a policy beneficial to America? Free-market advocates point to New Zealand, which has gotten rid of all agricultural subsidies, as a prime example of success. Proponents of this model argue that the market should govern the way we deal with agriculture. New Zealand, though, produces crops and meats of mostly high quality, such as lamb, fruits, and nuts. Since these are all very valuable to begin with, it is fairly easy for the country to focus on further improving their quality, because an increase in quality will translate to a significant increase in profit margin. The United States, on the other hand, produces cheaper crops,
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such as cotton, corn, and grain. Increased quality of such crops would therefore only generate a marginal difference in profit. One reason why the U.S. subsidizes these crops, and not the fruits and nuts produced in the country is because the commodities do in fact feed much of the world. When looking to shift legislation concerning agricultural production, the U.S. therefore has a lot more to consider than New Zealand, whose crops have a far more limited global reach [3]. With the 2008 Farm Bill expiring this fall, and a less than desirable economy at present, the House Agriculture Committee is striving to formulate a piece of legislation that will fulfill the Farm Bills inherent goals of supporting the livelihood of farmers, ensuring nutrition for all citizens, and promoting fair markets and competition, amongst others, in a more cost-effective manner [12]. One particularly promising supplement to the 2012 Farm Bill is the Local Food, Farms, and Jobs Act. The Act was written by Congresswoman Chellie Pingree (D-Maine) and Senator Sherrod Brown (D-Ohio) and would secure an additional $100-million for local farming and infrastructure nationwide [13]. Pingree explained what the act entails at Providences 8th annual Local Food Forum, held at Brown University. As the keynote speaker, she highlighted the strong movement in Congress to cut back on commodity payments. This change could make a substantial difference for local farming and infrastructure, if even a small proportion of the existing $100-million, already a part of the Farm Bill, is directed towards their development. Such reallocation of funds is promising, and
One reason why the U.S. subsidizes these crops, and not the fruits and nuts produced in the country is because the commodities do in fact feed much of the world
Referencess
1. American Farmland. Farm Bill 101: What you need to know about the next farm bill. Washington, D.C.: American Farmland Trust; 2002. 2. Imhoff, D. The CAFO Reader: The Tragedy of Industrial Animal Factories. Berkeley and Los Angeles: University of California Press; 2010. 3. Peseri, Alexandra. Conversation with: Katherine, DeMaster. 2012 April 2. 4. National Public Radio [Online]. 2011 Sep 26 [cited 2012 Mar 9]; Available from:http://www.npr.org/blogs/thesalt/2011/09/26/140802243/the-farm-bill-fromcharitable-start-to-prime-budget-target 5. Living History Farm [Online]. 2003 [cited 2012 March 1]; Available From: URL:http://www.livinghistoryfarm.org/farminginthe30s/water_11.html 6. Cheit R. Week #4: USDA and Farm Subsidies [Unpublished lecture notes]. ENVS:1560: Sustenance and Sustainability: Exploring the Nexus of Agro-food Systems, Society, and the Environment. Brown University; lecture given 2012 Feb 28. 7. American Farmland. Farm Bill 101: What you need to know about the next farm bill. Washington, D.C.: American Farmland Trust; 2002. 8. United States Environmental Protection Agency [Online] 2009 Sept 10 [cited 2012 March 12]; Available from: http://www.epa.gov/agriculture/ag101/demographics. html 9. Babcock, B. Integrating Soil and Water Conservation into the Farm Bill [Online]. Center for Agricultural and Rural Development: Iowa State University [cited 2012
has the potential to trigger additional changes. Ideally the $16-billion directed to subsidies would be split more equitably amongst farmers, making for a more even playing field between conventional farmers and other types, such as local and organic, who are not currently receiving sufficient funding in the form of subsidies. Other promising supplements, in addition to the LFFJ Act, are being considered, and may be incorporated into the updated bill if enough public support is garnered for them, but only time will tell if the 2012 Farm Bill is a success. Whether or not the legislation is successful depends on how accurately it reflects the current economy of the United States, in which many commodities farmers are making comfortable incomes, and many small-plot farmers are in need of government support. Increased funding for sustainable agriculture, as well as incentives for farmers to implement technology that is less degrading to the land, as well as funding for new farmers, will make for a beneficial piece of legislation. Alexa Peseri is a sophomore at Brown University, studying Environmental Studies. She is interested in everything environmental, especially the areas of food and health. Her interest in the Farm Bill was piqued in the fall of 2011, when she attended the Local Food Forum, held at Brown University.
March 2]. Available from: http://www.card.iastate.edu/presentations/ 10. Sumner, D. Agricultural Subsidy Programs [Online] 2008 [cited 2012 April 20]; Available from: http://www.econlib.org/library/Enc/AgriculturalSubsidyPrograms. html 11. Eagle Publishing. 2008 Do Agriculture Subsidies Help Save Family Farms? Available from: http://archive.redstate.com/stories/featured_stories/do_agriculture_ subsidies_help_save_family_farms 12. Daukas, J. Success in the 2008 Farm Bill: A New Direction for Farm and Food Policy :[Internet]. American Farmland Trust; 2008 July 2 [cited 2012 Feb 28]. Available from http://www.farmland.org/programs/farm-bill/analysis/documents/AFT-2008Farm-Bill-brochure-August2008.pdf 13. Capital Hill Publishing Corp. In difficult financial times, we need a farm bill thats balanced. [Internet]. 2012 Mar 7 [cited 2012 Mar 10]. Available from: http:// thehill.com/special-reports-archive/1275-agriculture-march-2012-/214831-in-difficultfinancial-times-we-need-a-farm-bill-thats-balanced 14. Pingree, C. Local Food Forum; 2012 Feb 7; Providence, Rhode Island. 15. Image available form: http://cdn7.wn.com/ph/img/c8/ bd/70ea9e38556211fabb300b1c7abb-grande.jpg 16. Image available from: http://4.bp.blogspot.com/_tQ4TcqM2bVA/TTzbUsPO_WI/ AAAAAAAAAMg/3PnkYeT1pv8/s1600/Farm+Bill+Funding+Graph_Jan+2011.jpg

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The Sounds of Science

Selen Senocak
Prelude After a concert in Carnegie Hall, an admirer approached the renowned violinist Jascha Heifetz. Upon being complimented on the beautiful sound of his violin, Heifetz is said to have bent down, put his ear against the violin case and remarked that he couldnt hear anything at all [1]. Although there is no doubt that Heifetz was an extremely talented violinist, his blundering admirer suggests that a musicians performance is affected to a certain degree by instrument quality. Throughout his career, Heifetz owned several very select violins, such as the 1714 Dolphin Stradivarius and the 1731 Piel Stradivarius [2, 3]. Can these acclaimed violins take any credit for the virtuosos flawless performances? Introduction For centuries now, luthiers have attempted to reproduce instruments rivaling those created by Antonio Stradivari. Recently, scientists have joined in on this quest. Stradivaris instruments, in particular his violins, are known for their exquisite sound quality; however, what gives these violins such a reputation remains a mystery. A Lifetime of Instruments Antonio Stradivari was born in 1644 in Cremona, Italy. By his early twenties, he had set up shop in Cremona and begun building instruments independently. Over the course of his life as an artisan, Stradivari made over 1,100 instruments, including violins, violas, cellos, harps and guitars. Some 600 of these instruments survive today, The Messiah being one of the most famous violins in the world [4]. There have been many attempts to solve the secret of Stradivaris violins. It was once suggested that the luthier built instruments using wooden beams of ancient cathedrals or that he would soak the wood in urine [5]. However, none of these theories had any firm, scientific grounding, and the production of Stradivari violins ended with the great masters death in 1737. Subsequent efforts to solve the puzzle of Stradivaris mystifying violins focused on a study of the geometry of these instruments [6]. It was later understood, however, that the geometry of a violin is in fact easily reproducible. The complex three-dimensional structure largely based on the Golden Ratio is not necessarily what gives an instrument its distinctive tone [6, 7]. Thus, scientists turned from examining the architecture of the plates and shifted their focus to the material these plates were made from. The missing piece of the puzzle, it seemed, was hidden within the wood. A Stradivarius Song The difference in sound produced by a Stradivarius and a contemporary violin is democratic in its subtlety. A recent blind testing of Stradivarius violins revealed that a majority of concert violinists could not discriminate between a Stradivarius and a modern violin [8]. Does this mean that Stradivarius fame
is a product of imagination? Charles Sherba, Concertmaster of the Rhode Island Philharmonic and Professor at Brown University, does not think so [9]. While listening to two recordings of Tchaikovskys Violin Concerto one played on a Stradivarius, the other on a contemporary violin Professor Sherba could hear a very clear difference between the two recordings. On a separate occasion, after playing on Arthur Grumiauxs Stradivarius he also had a flashback to the time when he had heard Grumiaux play Bachs Violin Concerto on the radio many years prior [9]. The secret of Stradivarius thus remains very real to Professor Sherba. A Good Violin? The perceived sound of an instrument depends on countless factors, many of which are subjective. Oftentimes, violin appraisers do not consider the quality of sound to be a determinant of instrument value. Instead, the violins brand, condition, and time and place of making are of importance [9]. What a violinist looks for in an instrument, however, is quite different. For a violinist, choosing a violin is an entirely subjective process. The instrument will eventually become the musicians voice, one that must have the right dosage of brilliance,
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projection, mellowness, and complexity [9]. Since different types of performances require specific tones, there is also no single ideal violin. For example, a concerto violin must have a distinct sound so that it does not blend with the orchestra. However, the same violin might be overpowering in a chamber group [9]. Some violinists actually own several violins to cater to the needs of a particular composition. A Stradivarius might be used to produce a bright and brilliant sound, whereas a Guarneri another type of Cremonese violin might be chosen for a darker effect [7]. Resonance Essentially, a good concert violin is one with a high capability of resonance. Resonance is a physical phenomenon whereby the amplitude of sound waves is increased, thus resulting in a louder and fuller sound [10]. When a violinist bows across the strings, these strings begin to vibrate. The energy of the vibrations is then transferred from the strings of the violin to the belly and back through a structure named the bridge. The belly and back are composed of plates that not only have a large surface area, but also have the ability to resonate. Some parts of these plates vibrate much more easily at certain frequencies than others [11]. The especially resonant areas on a violin plate can be found using Chladni Patterns [12]. Placing a violin plate on a loudspeaker and sprinkling it with small particles, such as sand or salt, can determine these patterns. When the loudspeaker is turned on, the particles on the plate move around and form specific patterns according to the frequency of the sound [12]. Chladni Patterns provide important feedback to the luthier during the process of violinmaking. Symmetrical Chladni Patterns are an indication of symmetry in the shape and thickness of the violin plates [12]. This symmetry is necessary for the production of an even, resonant sound. One of the ways of mathematically representing the ability of an instrument to radiate sound is with the radiation ratio [13]. This value is calculated by dividing the speed of sound waves travelling through the instrument by the density of the material making up the instrument. A violin with a larger radiation ratio is believed to be one with superior resonant capabilities [14]. The Maunder Minimum Considering the supposed importance of the radiation ratio and wood density, it is interesting to look at dendrochronological findings from Stradivaris time. Stradivari lived in a time when wood might have been less dense [4]. To understand the reason for this, it is necessary to travel back in time to relive the coldest period of the Little Ice Age. The Little Ice Age was a time when temperatures dropped in many areas around the world, especially in Europe and North America. The coldest period of the Little Ice Age known as the Maunder Minimum took place between 1645 and 1715. During this period, temperatures dropped by an average of 1-2 degrees Celsius [15]. It is now known that the Maunder Minimum was caused by a quiet Sun [16]. Every eleven years or so, the Sun completes a solar activity cycle, during which the number of sunspots rises and falls in a distinctive pattern. These temporary spots on the photosphere result from an increase in the Suns magnetic activity. During the Maunder Minimum, there was an almost complete absence of sunspots [16]. Stradivari was born a year before the start of the Maunder Minimum. This means that the trees he used during the Golden Period of his violinmaking (from 1700 to 1720) must have grown during the coldest time of the Little Ice Age. In harsh conditions, trees tend to grow more slowly. The rings that make up the pattern of the wood are narrower and the wood itself is less dense [4, 10]. One hypothesis proposes that this low density wood used by Stradivari resulted in the production of such unique musical instruments [4]. The hypothesis that Stradivaris excellence in violinmaking was a result of the Maunder Minimum is a fairly bleak one. Does this mean the opportunity to create such exquisite instruments has been lost forever? In a recent study, Swiss and German scientists found consolation from a most unexpected species: fungi [14]. The study revealed that certain fungal species, Pysisporinus vitreus and Xylaria longipes, cause the decay of wood and decrease its density without affecting the speed of sound travelling through the wood [10]. This degradation was thus seen to significantly increase the radiation ratio and improve the acoustic qualities of the wood samples [10]. Violins lHpital With scientific evidence pointing to the importance of wood density in instrument quality, radiologist Berend C. Stoel and violinmaker Terry M. Borman decided to measure the density of Stradivarius violins and compare them to that of modern violins [17]. Measuring the density of a complex three-dimensional structure usually involves dunking the object under water and observing the change in water levels. Fortunately, Stoel and Borman thought of another method: they took the instruments to Mount Sinai Hospital in New York City to be CT scanned.

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. . . the determinant of sound quality in a violin is the intricate patterns of different densities of wood making up the plates
After analyzing the CT scans, Stoel and Borman came up with an unexpected result: the density difference between the rings of wood was much less in the Cremonese violins than in the modern ones [17]. This implies that the determinant of sound quality in a violin is the intricate patterns of different densities of wood making up the plates. To give an example in support of this idea, violinmaker Dennis McCarten finds that the ideal type of wood to work with is composed of narrow summer and winter grains. For the production of a quality instrument, this wood must be used in a way that the summer grains widen as they radiate out from the central axis of the instrument [7]. The Chemistry of Sound Despite Stoel and Bromans findings, Joseph Nagyvary, Professor of chemistry and biophysics at Texas A&M University, argues that hypotheses concerning wood density are not all that sound. Nagyvary, who has been conducting research on this topic since 1975, believes that the quality of Stradivarius violins comes from the chemicals used in the treatment of wood [18]. Through several different methods of analysis, Nagyvary and his team determined the presence of chemical molecules in the wood of the Stradivarius violins, such as barium sulfate, borate, and zirconium silicate [6]. These chemicals are not naturally found in untreated wood and they were not detected in the wood of the tested modern violins. Electron imaging also showed that the ash of Stradivarius violin wood had a much higher degree of heterogeneity than that of the
References
1. Ball P. Old violins reveal their secrets. Nature [Internet]. 2008 Oct [cited 2012 Apr 04]. Available from: http://www.nature.com/news/2008/081002/full/news.2008.1147. html 2. Loaning of Stringed Instruments [Internet]. Nippon Music Foundation; 2010 [cited 2012 Apr 04]. Available from: http://www.nmf.or.jp/english/instrument/instruments. html 3. Stradivarius Violin Tracker [Internet]. 2010 [cited 2012 Apr 04]. Available from: http://www.theviolinsite.com/violin_making/strad-violins.html 4. Burckle L, Grissino-Mayer HD. Stradivari, violins, tree rings, and the Maunder Minimum: a hypothesis. Dendrochronologia. 2003; 21(1): 41-45. 5. Wright L. String Theory. Scientific American. 2003 Dec; 290(1): 22. 6. Nagyvary J, Guillemette RN, Spiegelman CH. Mineral Preservatives in the Wood of Stradivari and Guarneri. PLoS ONE [Internet]. 2009 Jan [cited 2012 Apr 04];4(1). Available from: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal. pone.0004245 7. McCarten DJ. Interviewed by: Senocak B. 16 Mar 2012. 8. Sample I. How many notes would a virtuoso violinist pay for a Stradivarius? [Internet]. [Place unknown]: The Guardian; 2012 [cited 2012 Mar 11]. Available from: http://www.guardian.co.uk/music/2012/jan/02/how-many-notes-violinist-stradivarius 9. Sherba, C. Interviewed by: Senocak B. 19 Mar 2012. 10. Schwarze FWMR, Spycher M, Fink S. Superior wood for violins wood decay fungi as a substitute for cold climate. New Phytol. 2008 Sep; 179(4):1095-1104. 11. Wolfe J. Violin Acoustics: an introduction [Internet]. [Place unknown]: The University of New South Wales School of Physics; [cited 2012 Mar 11]. Available from: http://www.phys.unsw.edu.au/jw/violintro.html
commercial violins [19]. Nagyvary suggests that Stradivari treated his wood by boiling it in an aqueous mixture of chemicals such as zinc, copper, chromium, and iron. Generally, wood must be put away to dry for about 7-10 years before its moisture content falls below 10% [7]. After this point, it becomes suitable for violinmaking. The chemical treatment described by Nagyvary and his team could break down the hemicellulose molecules in the violin wood, thus decreasing wood moisture and density [18]. Despite his criticism of hypotheses concerning wood density, Nagyvarys findings thus support the idea that wood density is the key in solving Stradivarius mystery. Finale In the face of science, technology and hefty grants, Stradivari continues to prevail. One possibility that seems to have been overlooked is that Antonio Stradivari might have just been an extremely talented violinmaker. An ...element of genius is evident says Dennis McCarten of the artisan he studied so thoroughly during his training [7]. He was just in the right place at the right time, and he did it really well. Chemicals and wood density aside, Mr. McCarten can very vividly imagine Stradivari as he worked in his shop where several generations of violinmakers found a space to share their knowledge and joy of building musical instruments. Whatever turns out to be the truth about Stradivaris violins, it is mysteries like this mysteries that even science struggles to solve that add a touch of spice to our lives. So for now, let us just close our eyes and listen to the music. Perhaps this way, the final piece of the puzzle will be easier to hear. Beatrice Senocak, from Istanbul, Turkey, is a pre-medical student studying Neuroscience at Brown University. With a passion for writing and music, she hopes to become an accomplished cellist in the future. She would like to thank Dennis McCarten (McCarten Violins), Professor Charles Sherba (Brown University) and her editor, Rudy Chen (Brown 15), for their help in putting together this article.
12. Wolfe J. Chladni patterns for violin plates [Internet]. [Place unknown]: The University of New South Wales School of Physics; [cited 2012 Mar 11]. Available from: http://www.phys.unsw.edu.au/jw/chladni.html 13. Norton M, Karczub D. Fundamentals of Noise and Vibration Analysis for Engineers. Cambridge: Cambridge University Press; 2003. 14. Whitfield J. Rot offers fresh sound for violin makers. Nature [Internet]. 2008 Jun [cited 2012 Apr 04]. Available from: http://www.nature.com/news/2008/080616/full/ news.2008.894.html 15. Fagan BM. The Little Ice Age: How Climate Made History, 1300-1850. New York: Basic Books; 2000. 16. Chilly Temperatures during the Maunder Minimum [Internet]. [Place unknown]: Nasa Earth Observatory; 2006 [cited 2012 Mar 11]. Available from: http:// earthobservatory.nasa.gov/IOTD/view.php?id=7122 17. Stoel BC, Borman TM. A Comparison of Wood Density between Classical Cremonese and Modern Violins. PLoS ONE [Internet]. 2008 Jul [cited 2012 Apr 04]; 3(7). Available from: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal. pone.0002554 18. Towie N. The key to Stradivaris tone, Nature. Nature [Internet]. 2006 Nov [cited 2012 Apr 04]. Available from: http://www.nature.com/news/2006/061127/full/ news0061127-7.html 19. Nagyvary J. The Chemistry of a Stradivarius. C&EN. 1988 May; 24-31. 20. Image available from: http://commons.wikimedia.org/wiki/File:Five%2BStradivar i%2Binstruments-gifts%2Bfrom%2BWhittall%2B480.jpg 21. Image avilable from: http://commons.wikimedia.org/wiki/File:Hallelujah_ score_1741.jpg
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Can Social Media Create Social Change?

Adela Wu
That Fateful Spring Its not over yet, Mubarakthe fight for Egypt continues!, Stop a Massacre from happening in EgyptCairo turning violent TODAY scream a few of many Facebook events during 2011 [1,2]. Not only did these user-created events broadcast snippets of the Egyptian Arab Spring, but they were able to muster thousands of users for a single cause. Contrary to popular belief, February 2011 did not mark the first time social media played a role in the development of these protests. In March 2008, Egyptian activists created a Facebook group named the April 6 Youth Movement to support low-wage laborers in Mahalla [3]. Within days, 70,000 users joined, and, just weeks after its inception, the first ground protests erupted [1]. A few years later, the demonstrations reached a boiling point in Cairo. When asked to comment on social medias significance in promoting the revolution, one activist proclaimed, We use Facebook to schedule the protests, Twitter to coordinate, and YouTube to tell the world [4]. Facebook, Twitter, and YouTube provided a trio of forces to translate decades-worth of resentment towards Egypts president, Hosni Mubarak, into unified anti-government protests collectively known as the Arab Spring. Even individually, their reach is impressive. Twitter hosts 175 million accounts, and, last year, about 140 million tweets were sent per day [5]. Facebook should soon hit one billion profilesnearly one-seventh of the global population [6]. The world is shrinking exponentially as social media quickly connects individuals around the globe. With this ease of networking comes a proliferation of shared information. People now receive content not just from traditional sources but also through peers, setting a new precedent for the way news is distributed. With escalating police violence resulting in protestor Khaled Saids brutal death as well as arrests of key activists, such as Google marketing executive Wael Ghonim, the frustration among Egyptians came to a head early in 2011. Social media helped fuel these flames as Facebook groups and Twitter feeds exploded with cries for revolt and justice. Ghonim declared that to liberate a government, give [the people] the Internet [7]. Social media was considered to be such a vital element of the Arab Spring that the government regarded the Internet as a serious threat. In the wake of mounting demonstrations against Mubarak, the Internet was unplugged on January 28, 2011, in an effort to stem the distribution of rallying cries online [8]. However, does Mubaraks fear of social media testify to its ability to enact social change? The Internet blockade failed to stop the protests, leading one to question whether the true driving force was actually web-based [9]. Despite the disappearance of social media outlets, people still managed to communicate meeting places with each other, and the number of protestors rallying in the streets and city centers actually surged [9]. The Internets far reach and presence in everyday life 46 THE TRIPLE HELIX Fall 2012
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appear to create a solid platform for social change. However, while social media can rapidly garner general support, its effectiveness at generating long-lasting social change is still uncertain. On the Internet, where anonymity reigns and misinformation is rampant, quick publicity can trivialize the ideals touted by social movements. Even when widespread attention is achieved through social media, directing this spotlight to
On the Internet, where anonymity reigns and misinformation is rampant, quick publicity can trivialize the ideals touted by social movements
promote positive change may result in unwanted attention in other areas. Social media is only the beginning, a tool for a greater enterprise. What social media can do for social change depends on more than the Internets ability to access and harness millions of users for a cause. In the end, social media played a specific role in these demonstrations, but it did not encompass the events. Can Social Media Transcend the Web? Social media may only be effective regarding issues that concern its arena. The Stop Online Privacy Act (SOPA), and its Senate counterpartthe Protect IP Act (PIPA), were introduced in late 2011. Should the bills have passed, any websites formerly outside of U.S. legislation suspected of exchanging pirated intellectual property would have come under U.S. jurisdiction, essentially creating an unprecedented censorship policy in America. The controversy surrounding these bills provoked widespread criticism, especially when popular websites directly pushed for action. Tumblr, a microblogging service with over 13 million unique visitors and 48 million active blogs, plastered an ominous message on its main page, calling for users to contact state representatives and reveal the gravity of the bills unconstitutionality [10]. Reddit devoted its entire site to information about SOPA, and Wikipedia censored its own content for 24 hours on January 18, 2012, during the largest online protest in history [11]. People reacted to these online protests, and politicians noticed. Shortly after the Internet backlash, both SOPA and PIPA were shelved in January 2012 for further, undated revisions. Its nice to see a campaign like this when the average person knows something is up and calls his representative, stated a lawyer who actively fought the legislation [12]. The success of anti-SOPA/PIPA demonstrations reveals the In 2012, The Triple Helix, Inc. All rights reserved.
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ternets power to spread information and unite people for a common cause. Yet, it is possible these protests only worked because the Internet itself was at stake. The goals of the antiSOPA/PIPA protests are clear-cut when compared with Egypts Arab Spring and other historical and contemporary social demonstrations against government corruption and economic practices. Egyptian protestors were forced to grapple with complex and debatable issues whereas the bills were focused, written propositions without much room for open interpretation. Websites and web-users saw the free use and sanctity of the Internet threatened and proceeded to fight back via the most reasonable and convenient venue possible: the World Wide Web. While social media aided the cause by grabbing attention, SOPA/PIPAs abuse of power was stopped by millions of calls and messages sent to politicians and coordinated efforts by websites to self-censor in protest [13]. Even though the Internet helped lay the groundwork, in a later phase, the movement shifted its focus to encouraging citizens to contact their Congressional representatives. This transition illustrates a fundamental question underlying social medias efficacy outside the Internet. Dilution of Ideals As seen in the anti-SOPA/PIPA protests, social media easily generates support and awareness, but this popularization risks diluting the core ideals of a movement. Since August 2011, the Occupy Wall Street movement has grown to inspire occupations in cities, campuses, and communities throughout the nation [14]. We are the 99 percent...We are getting nothing while the other 1 percent is getting everything, proclaims a blog entirely devoted to displaying user-submitted photos of the 99 percents woes, complaints, messages, and hopes [15]. On Twitter, rallying cries such as #occupywallstreet and #occupytogether are widely circulated among users [16]. With help from quirky Internet memes, culturally relevant electronic images or blurbs, the phrase 99 percent and the movements original moniker, Occupy, evolved into catchy slogans used more as punch lines and gag reels than to promote economic equality [17]. Occupy has prefaced many parodies, such as the trending Twitter topic OccupySesameStreet as well as Occupy Red Robin on the animated show South Park. The Occupy Move-
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ment itself has become a farce, losing its significance as its name is haphazardly plastered on unrelated subjects [16]. This trivialization dilutes the original platform, sidetracking the movement from its original goals. Activists are also wary of attributing the Occupy movements support solely to social media. A student protestor, Matthew Presto, states thats the way a lot of revolutions tend to be framed, as if it were a spontaneous burst [14]. The Internet has lent great momentum by generating awareness about protestors concerns, but the roots of the entire movement cannot be reduced to an Internet fad. Though people on the Internet identified with the Occupy movements message of equality and fairness, the movement survived and grew because people left their computers and demonstrated on-site through rallies and semi-permanent settlements [14]. A call for change can only be sustained through active effort. Accessibility vs. Truth Easy exposure to news comes at a price. A recent example of a viral Internet sensation under scrutiny was the charity Invisible Childrens KONY2012, a 30-minute video on Joseph Kony, leader of a guerilla army, and the abduction of Ugandan children. Within a week, the YouTube clip garnered 76 million views, and the Facebook link was shared 2.24 billion times [18]. KONY2012 quickly became a ubiquitous stamp for the entire campaign, leading to a dramatically heightened visibility for the foundation. However, the very breadth of this videos audience raised questions about Invisible Childrens financial and social responsibilities. The abuses in Uganda have occurred for over twenty years, and Invisible Children itself has been operating since 2005so why was all this attention directed to this issue only now? KONY2012 drew its onslaught of criticism first from
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scholars skeptical of the videos veracity. Jason Russells documentary presented only one Caucasian mans perspective on a nations ongoing struggles with handling human rights abuses, and his personal view was released as a cry to expose a ruthless criminal. It seemed that, in order for a half-hour clip to appeal to different demographics on the Internet, its portrayal of the subject matter must be diluted. Ethan Zuckerman, from Massachusetts Institute of Technologys Media Lab, lamented if we want people to pay attention to issues we care about, do we need to oversimplify them? [19]. Vocal detractors have also called the entire KONY2012 campaign a bigoted form of contemporary white mans burden [20]. To them, the film merely presents a patronizing view of Uganda. After presenting a condensed summary of Joseph Kony and his child soldiers, KONY2012 invited viewers to help by simply sharing the video. On the surface, the premise appeared admirable, since it capitalized on social medias free ability to expose and spread information. However, KONY2012s goal to end such abuses through raising awareness ultimately failed when it never attempted to educate viewers more deeply about the human rights problems in Uganda [20]. When the first skeptics started to question the videos content, Kony was not the only one getting exposed. In an ironic turn of events, Russell and his foundation have come under fire as a result of KONY2012s widespread circulation. The Visible Children blog established itself soon after KONY2012s release, collecting numerous figures about Invisible Childrens dubious financial practices and transparency. For example, the blogs first post revealed that the charity only contributed 32% of its annual funds to direct services in 2011 [21]. The basis of Invisible Childrens strategy was also attacked, as people reacted strongly to seeing unnecessarily large sums of money used for productions like KONY2012. People wondered if the charity spent too much on making
References
1. Facebook. Its not over yet Mubarak...The fight for Egypt continues! Feb 12, 2011. Available from: https://www.facebook.com/events/199296513414409/?ref=nf. (accessed 11 Mar 2012). 2. Facebook. Stop a Massacre from happening in EgyptCairo turning violent TODAY. Feb 2, 2011. Available from: https://www.facebook.com/ events/147742325282805/. (accessed 11 Mar 2012). 3. April 6 Youth Movement. Frontline. WGBH Educational Foundation. Available from: http://www.pbs.org/wgbh/pages/frontline/revolution-in-cairo/inside-april6movement/. (accessed 11 Mar 2012). 4. Howard, P. The Arab Springs Cascading Effects. Miller-McCune. Feb 23, 2011. Available from: http://www.miller-mccune.com/politics/the-cascading-effects-of-thearab-spring-28575/. (accessed 11 Mar 2012). 5. Twitter. #Numbers. Available from: http://blog.twitter.com/2011/03/numbers.html. (accessed 10 Mar 2012). 6. Hunter, C. Number of Facebook Users Could Reach 1 Billion by 2012. The Exponent Online. Jan 23, 2012. Available from: http://www.purdueexponent.org/ features/article_8815d757-8b7c-566f-8fbe-49528d4d8037.html. (accessed 10 Mar 2012). 7. Prettyman, K. Egypts Social Media Revolution. Deseret News. Feb 11, 2011. Available from: http://www.deseretnews.com/article/700109077/Egypts-social-mediarevolution.html. (accessed 29 Mar 2012). 8. Naib, F. Online Activism Fuels Egypt Protest. Al Jazeera. Jan 23, 2011. Available from: http://www.aljazeera.com/news/middleeast/2011/01/2011128102253848730. html. (accessed 11 Mar 2012). 9. Alexander, A. Internets Role in Egypts Protests. BBC News. Feb 9, 2011. Available from: http://www.bbc.co.uk/news/world-middle-east-12400319. (accessed 29 Mar 2012). 10. Tumblr. Protect the Net. Available from: http://www.tumblr.com/protect-the-net. (accessed 12 Mar 2012). 11. Fight for the Future. The January 18 Blackout and Strike. Available from: http:// sopastrike.com/numbers/. (accessed 12 Mar 2012). 12. Yu, R. SOPA Protest Gets Intended Effect. USA Today. Jan. 18, 2012. Available
JHU
films and media instead of direct services in Uganda. KONY2012 highlights the Internets power to disseminate informationwhether for good or for bad. While KONY2012 was immensely popular, Invisible Children failed to direct this publicity for substantive change and positive effect. Not only did KONY2012 incite negative attention toward the foundation, but, in the interest of maximizing its potential audience, the video oversimplified many critical issues for accessibilitys sake. Armchair Activists and the Need for Action Social media connects people with each other and with news around the world. The convenience of sharing through social media creates an unprecedented contemporary culture of exchanging knowledge. However, this proliferation of information becomes overwhelming if users are not cognizant of how to use and understand the content. Accuracy of information itself is also endangered by misrepresentations and oversimplification on the Internet. In this context, social medias true influence on sustaining a cause beyond gathering support is still undetermined. Social movements certainly benefit from popular awareness and support, but real social change requires engagement beyond a few button clicks and a copied-and-pasted link. Social media has the potential to act as a catalyst for change but not until its users apply the knowledge gained from shared content in live, real-world situations. On-site campaigners behind Occupy Wall Street, protestors in the Arab Spring, activists in Uganda are the ones attempting to enact true, sustainable social change. It is the people, not social media, who translate awareness into action. Adela Wu is an undergraduate student at Brown University studying neuroscience and English.
from: http://www.usatoday.com/tech/news/story/2012-01-18/SOPA-PIPA-protestreaction/52641560/1. (accessed 12 Mar 2012). 13. Paul, I. Were SOPA/PIPA Protests a Success? Results are In. PC World. Jan. 19, 2012. Available from: http://www.pcworld.com/article/248401/were_sopapipa_ protests_a_success_the_results_are_in.html. (accessed 29 Mar 2012). 14. Sledge, M. Reawakening the Radical Imagination: The Origins of Occupy Wall Street. The Huffington Post. Nov 10, 2011. Available from: http://www. huffingtonpost.com/2011/11/10/occupy-wall-street-origins_n_1083977.html. (accessed 13 Mar 2012). 15. Tumblr. We Are the 99 Percent. Available from: http://wearethe99percent.tumblr. com/. (accessed 13 Mar 2012). 16. Amidon T. Occupy Trademark: Branding a Political Movement. The CCCC-IP Annual; c2011. Available from: http://culturecat.net/files/2011CCCCipAnnual. pdf#page=32. (accessed 29 Mar 2012). 17. Ellis L. The 99 Percent Solution. Mother Jones. Mother Jones and the Foundation for National Progress; c2012. Available from: http://motherjones.com/media/2012/01/ occupy-wall-street-internet-memes-timeline. (accessed 13 Mar 2012). 18. KONY 2012: Proof of the Positive Power of Social Media or its Danger? The Social Skinny. 2012. Available from: http://thesocialskinny.com/kony-2012-proof-of-thepositive-power-of-social-media-or-its-danger/. (accessed 15 Mar 2012). 19. Rosen R. Why We Should Take Heart from the Backlash Against KONY2012. The Atlantic. Mar 9 2012. Available from: http://www.theatlantic.com/technology/ archive/2012/03/why-we-should-take-heart-from-the-backlash-againstkony2012/254231/. (accessed 29 Mar 2012). 20. Fisher M. The Soft Bigotry of KONY2012. The Atlantic. 2012 Mar 8; [cited 2012 Mar 29]. Available from: http://www.theatlantic.com/international/archive/2012/03/ the-soft-bigotry-of-kony-2012/254194/. (accessed 29 Mar 2012). 21. Tumblr. We Got Trouble. Available from: http://visiblechildren.tumblr.com/ post/18890947431/we-got-trouble. (accessed 29 Mar 2012). 22. Healy J. Occupy the Next Level: Four Ideas for the Movement. November 21, 2011. Available from: http://joshhealey.org/2011/11/21/occupy-that-next-level/.

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DIGITAL HIGHLIGHTS
Highlights from the Blog

Articles featured here are selected from The Triple Helix Online. To read the full aricle, browse more subjects, and join the conversation on the web, visit triplehelixblog.com.
Criteria for Habitable Planets and Implications for Earth

by Sunny Parmar, Georgetown University
The search for extraterrestrial life has always been one of our greatest fascinations with the universe. . . How successful has this search been in actually finding an Earth-like planet? And what can we do when we do find such a planet? The article goes on to describe criteria for habitability and consider these questions.
Biological and Psychological Effects of Human Space Flight

by Isabelle Boni, University of Chicago
While important innovations have come out of space exploration, technology is also being developed to minimize the various strains associated with space travel. The conclusion affirms that space travel is worth its costs: With all these possible outcomes in mind, is it still worth it to send astronauts into space? Given the redeeming scientific boons of space exploration and progress made in solving problems related to it, the answer is, increasingly, yes.
Leaf it to Me: Biomimicry and the Ar cial Leaf

by Prathima Radhakrishnan, University of Chicago
Using a Virus to Treat Cancer

by Ayush Midha, The Harker School
Although the potential of using viruses against cancer was first discovered two centuries ago, recent research has revived interest in the potential of this particular treatment method: With more research and testing, the oncolytic virus has the chance to revolutionize medicine by not only being the most effective treatment of cancer, but also the most improbable treatment.
A fresh, optimistic look at environmentalism centers on the development of the artificial leaf as an example of the potential of technology to pave the way to a brighter future: By mimicking natures design principles, engineers and scientists are creating products that are perfectly adapted to solve problems we face today. . .we can save nature by paying her the greatest complement: imitation.
Paramedics: A Danger to Patients?

Some question the effectiveness of the endotracheal intubation (ETI), a technique in which the paramedic inserts a tube down by Monica Kumaran, The Harker School a patients throat in order to use it as an airway adjunct, while Considering the difficulties and assets of nuclear energy, others vouch for its effectiveness amongst paramedics. More the conclusion states that If the world is to switch more of training and better instruction may be necessary to ensure its energy to nuclear sources, governments and businesses the risks of ETI is far outweighed by its effectiveness. involved in the industry must increase transparency and accountability. Until then the future use of bioremediation will have to become a way for society to clean up nuclear Scan the code with a smart mistakes of the past, not further nuclear energy in the future. phone to visit the blog now!
Nuclear Energy: The Future of Bioremedia on
by Michael West, George Washington University
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UCHICAGO
On the Origin of Knowledge: an Evolutionary Enquiry into the Structure of Perception

Taylor Coplen
umans are terrible observers. If a laboratory instrument introduced as much bias as we do, it would be tossed out immediately. We fabricate significant patterns from meaningless data. We see faces everywhere, from pieces of toast to Mars [1]. And every classic rock song, when played backwards, seems to reveal some hidden, often satanic, message. There is little doubt that the human mind plays an active role in structuring perception, but it is unclear how fundamentally active this role is. The way we receive information from the external world has traditionally been a topic of purely philosophical concern. However, a consideration of the evolutionary process that shaped the human brain offers an explanation for the specific structure of our perception. Empiricists assert that the mind is originally lacking in ideas and accrues them through experience. In this theory of knowledge, the mind is likened to a tabula rasa (blank tablet), or in the words of John Locke, white paper, void of all characters, without any ideas [2]. Other philosophers hold that the mind has innate ideas, which precede the individuals experience. Immanuel Kant famously championed this position. Kant argued that concepts like space, time, and even causality are pure intuitions of the human mind, which we impose upon our experience of the sensible world [3]. According to Kant, these conceptions form a cognitive framework, which makes experience possible by structuring
falls into the realm of evolutionary biology. An epistemological inquiry, centered upon an evolutionary understanding of the human being, reveals two insights: 1) that we are born with these innate concepts that structure our experience, and 2) that these concepts are themselves the product of experience
In the same way that our respiratory system structures the way that we receive oxygen from the environment, our complex neurological system dictates the way that we receive information
sensory information. As such, this knowledge must predate the individuals experience. However, the origin of this a priori framework is obscure, and Kant says very little about how we come to possess such concepts. If we consider all mental activity as the product of physical cognitive mechanisms, then it seems that this inquiry into the origin of our cognitive framework
in a general sensethe experience of our biological ancestors. By the latter half of the 18th century, the epistemologies of European philosophers could be categorized as either empiricist or rationalist. The rationalists, residing primarily on the European continent, regarded reason as the primary source of knowledge [4]. Alternatively, the empiricists, most of whom were British, argued that experience was the principle source of knowledge [5]. Most epistemologists of the time fit neatly into one of these two categories, until the writings of the Scottish empiricist, David Hume, spurred Immanuel Kant to produce his magnum opus, The Critique of Pure Reason, in which he rejected both of the competing schools. Kant suggested reason as a solution to the skeptical arguments proposed by Humes empiricism. The resulting theory was referred to as transcendental idealism. Often likened to the Copernican Revolution in philosophy, transcendental idealism argues that causality, space, and time are a priori intuitions, which the human mind imposes upon our perception of the sensible universe [6]. Thus, drastically more significance is placed on the role of the observer. According to transcendental idealism, concepts like space and time can never be learned through experience because the individual must possess these concepts in order for experience to be possible.

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In order to understand why these concepts must be innate to allow for experience to take place, consider the alternative: a mind devoid of innate ideas, the aforementioned tabula rasa. If a subject were born without an innate idea of space, one may assume that he or she could derive this idea by identifying objects and considering their physical relation to each other. However, the idea of space must be presupposed in order for the notion of one objects relation to another to even be conceivable. The concepts of time and causality can be considered in a similar hypothetical situation and the conclusion is always the same: the way that we experience the external world is made possible only if these concepts are presupposed. These innate concepts can be thought of as way for the mind to structure incoming sensory information. Without this structuring framework, the individual would simply receive incoherent stimuli rather than useful, organized information about the external world. Yet despite the obvious necessity of this cognitive framework, its origin remains obscure. One major obstacle that has hindered this investigation is the mystery surrounding the mind. Many philosophers in the past have struggled with the perplexing relationship between the mind and body. Today, however, modern neuroscience has provided considerable evidence that indicates that all mental phenomena are the result of a physical structure [7]. Though the claim that the mind is the product of physical matter is still disputed, there is enough supporting evidence to accept this position as a premise for the following argument. In humans, all sensation, thought, emotion, and desires are the direct product of neurological activity [8]. This discovery is essential to forming a complete understanding of our innate cognitive framework. In order to understand the structure of our perception, we need only understand the origin of the structure of our central nervous system, specifically the brain. The brain, like all the physical mechanisms that comprise the human body, developed gradually over time through the process of natural selection [9]. Thus, as we trace the evolutionary development of the brain we will be simultaneously witnessing the development of the framework that structures our perception. Let us first consider the notion of experienceso intimately related to any theory of knowledge. For Hume and other empiricists, experience is the aggregate of cognitions acquired through the individuals perception of the external world. While experience clearly requires a subject, there is no reason that it should be considered as restricted to an individual. For if I could somehow transmit my observation of an object directly to another being by minutely altering the structure of his or her brain to precisely reconstruct my mental image, there would be no way to identify the true observer in any epistemological sense. We would both have acquired the exact same knowledge. Though this example seems like science fiction, the point is Reproduced from that experience can [10]. be transferred from one individual to another by replicating physical conditions of the brain. Experience, in a more general sense, can be transferred from o n e individual to another, encoded in complex patterns of deoxyribonucleic acid, DNA. When a mutation alters a Reproduced from [16] physical characteristic of an organism, the alteration can either positively or negatively contribute to its fitness. The structure of the organisms neurological system determines the way it perceives. Physical manifestations of the organisms genetic structure will either be passed on to the next generation or perish with the organism; the outcome is determined by the organisms interaction with its environment [10]. If, for instance, an organism is biologically structured in such a way that it is unable to perceive a potential predator, it will most likely
Our specific neurological structure, and thus the structure of our perception, is the product of many evolutionary trials and errors
not survive to reproduce and thus this perceptual structure will die out. Our specific neurological structure, and thus the structure of our perception, is the product of many evolutionary trials and errors. As information is useful for the survival of an organism, it is a commodity shaped by the process of natural selection. In the same way that our respiratory system structures the way that we receive oxygen from the environment, our complex
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neurological system dictates the way that we receive information. To gain knowledge of the external world, an organism requires some biological structure that can receive stimuli and trigger a reaction in the organism. For instance, an eyespot apparatus is an organelle found in many unicellular organisms [11]. Simple photosensitive proteins react to incoming photons and produce chemical messengers, which allow the organism to determine the direction of the light and move accordingly [12]. Though this is one of the most primitive forms of perception, the organism can now distinguish between two states of the external world: light and dark. This rudimentary process of
When organisms become capable of storing multiple pieces of information, memories are structured in sequence so that when the organism recalls each memory there is a sense that one memory took place before the other
to stimuli, organisms become capable of constructing primitive memories [14]. Organisms with the ability to sense change in the external world and record these changes have the rudiments necessary to produce the groundwork for our conception of time. When organisms become capable of storing multiple pieces of information, memories are structured in sequence so that when the organism recalls each memory there is a sense that one memory took place before the other. Thus humans, with extremely complex neurological systems capable of storing countless memories, have an innate temporal intuition, which allows us to structure our experience in chronological order. While this example is particular to the structure of temporal perception, the structure of spatial or causal perception can be considered in a similar way: as a gradual succession of increasingly complex perceptual structures. The process of evolution by natural selection can sufficiently account for the specific structural framework of our perception. Once we accept that our thoughts, sensations, and perceptions are the product of the physical structure of our brain, which is in turn the product of natural selection, this conclusion is inevitable. In a certain sense, the experience of our biological ancestors, i.e. their interaction with the environment, is the determining force that shaped the outcome of our cognitive structure. The bias that our particular type of perception introduces is the vestigial baggage of evolution, which was at one point in our evolutionary history conducive to survival. Taylor Coplen 15 is a Philosophy & History, Philosophy and Social Studies of Science and Medicine (HIPS) double major at the University of Chicago.
10. Williams, George. Adaptation and Natural Selection. Princeton : Princeton University Press, 1966. 11. Kreimer, G. The green algal eyespot apparatus: a primordial visual system and more? 2009. 12. Hegemann P Vision in microalgae, 1997. 13. Stanley B. Klein, Leda Cosmides, John Tooby, and Sarah Chance Decisions and the Evolution of Memory: Multiple Systems, Multiple Functions, 2005. 14. Chrisantha T Fernando, Anthony M. Liekens, Lewis E. Bingle, Christian Beck, Thorsten Lenser, Dov J Stekel, and Jonathan E. Rowe Molecular Circuits for Associative Learning in Single-Celled Organisms, 2008. 15. http://www.flickr.com/photos/cblue98/7254347346/ 16. http://www.flickr.com/photos/question_everything/2921759515/ 17. http://www.flickr.com/photos/truthout/4521676743/
perception involves chemical messengers that cause an almost instantaneous response in the organism. Further evolutionary modification in more complex multicellular organisms causes these chemical messengers to make permanent alterations to the organism so that the information can be accessed and utilized at a later time [13]. By making physical alterations in response
References
1. NASA Unmasking Mars http://science.nasa.gov/science-news/science-atnasa/2001/ast24may_1/ 2. Locke; An Essay Concerning Human Understanding, New York: Prometheus, 1995 2:1:2. 3. Kant, Immanuel. Critique of Pure Reason. Cambridge: Cambridge University Press, 1998. 4. Cottingham, John, Rationalism, London: Paladin Books, 1984. 5. Priest, Stephen. The British Empiricists. 2nd. New York: Routledge , 1990. 6. Kant, Immanuel. Critique of Pure Reason. Cambridge: Cambridge University Press, 1998. 7. John C. Eccels Evolution of Consciousness 1992. 8. Armstrong, D.M. A Materialist Theory of the Mind, London: Routledge; 1993. 9. Striedter, Georg. Principals of Brain Evolution. Sunderland: Sinauer, 2005.

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UCSD
Disease and Differentials Why Paying Attention to Math Might Save the World
Chirag Krishna
icture yourself in differential equations 101. Swimming in eigenvalues, Laplace transforms, and matrices, you wonder where these might have any measurable application, besides modeling water flow out of tanks. You suspect that what youre learning might only help you solve esoteric math problems- none of which you would ever look at, anyway. But before you drop your textbook, consider that
process, with a plethora of variables to consider[1]. This classic epidemiological approach is neither simple nor entirely applicable to diseases that lack vaccines. In such cases, epidemiologists often turn to mathematical modeling- applying differential equations to model and account for disease phenomena. The predictive power enabled by the use of mathematical modeling has already yielded major results, not least of
these differential equations might have a more significant role than you thought. In recent years, math has played an increasingly important role in epidemiology- the study and characterization of how, when, and why diseases spread. An epidemiologist typically traverses afflicted regions, collects data, and analyzes casesoften a slow and arduous
which are improved preventative measures for diseases such as malaria and dengue. Model construction and validation have also influenced health policy decisions- in the case of HIV, researchers used a mathematical model to predict that a focus on immune-based therapies would more effectively combat the disease [2]. In this way, mathematical modeling
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has greatly enhanced the practice of global public health. But how is it that that an amalgam of variables, numbers, and equations can coincide to create such tangible impact? The history of using math to combat the spread of disease dates back to the 18th century. Daniel Bernoullis smallpox valuable qualitative information regarding particular diseases. For example, a recent epidemiological study of the H1N1 virus incorporated a mathematical model into its analysis, revealing a basic reproduction number value greater than 1 [7]. Consequently, researchers concluded that the transmissibility of the virus is greater than that of the seasonal flu. As such, they were able to recommend several prophylactic measures to combat H1N1, such as investigations of transmissions in schools and households, and careful analysis of electronic patient records [7]. Modern applications of mathematical modeling are numerous and diverse, and are largely based on the original work of Bernoulli, Kendrack, and McKermick. In 1967 The World Health Organization implemented a smallpox eradication program, influenced largely by the mathematical malaria model created by Sir R.A. Ross [8]. And as recently as March of this year, scientists in Cuba have developed models to characterize the distribution and risk factors associated with Dengue, a tropical disease that is the main agent of hemorrhagic fever [9]. Like many other neglected tropical diseases, there is no vaccine for Denguetreatment is largely limited to insect vector control. Not only do the models allow scientists to study the spread of Dengue in real time, but they also account for the distribution of the Aedes mosquito, the main causative agent of Dengue [10]. Also notable is the flexibility of the parameters incorporated into the models- for example, Hartley et al incorporated parameters reflecting seasonal variability of the Dengue virusthus enabling them to predict the time at which infection would be most potent [10]. The development of these mathematical models can also prove, to the extent that their assumptions are accurate, that current methods of control or treatment are ineffective. In
The results of these theoretical models are evidenced by the current collaboration of experts in medicine, biology, mathematics, and ecology as they use progression data to organize a treatment plan and preventative measures
model, developed in 1766, utilized ordinary differential equations to describe the progression and impact of smallpox over time. Patients were inoculated with a small amount of smallpox at birth; Bernoullis model described their survival rate as a function of time. The results of the study showed that the life expectancy of variolated patients increased by approximately 10% [3]. While the results of Bernoullis experiment and the validity of his model have been challenged, he set a groundbreaking precedent for future epidemiologiststhe translation of a public health initiative into an analytical math problem, with a tangible result that could affect policy. From a mathematical perspective, Bernoullis use of ordinary differential equations and a set of basic parameters relating infected individuals to healthy ones is a recurrent principle in modern epidemiological modeling [4]. Of course, Bernoullis work was only the first of many epidemiological models- computational epidemiologists have achieved much since the publication of his seminal paper. In 1927, Kendrack and McKermick developed the first SIR (susceptible, infected, recovered) model to predict the number of infected patients over time [5]. The model was used in studies of the London and Bombay plagues, as well as cholera [5]. Furthermore, their work led to the development of the basic reproductive number R0, a parameter representing the number of secondary infections resulting from a primary infection. The basic reproductive number is arguably one of the most important epidemiological parameters, and is clearly a direct byproduct of mathematical modeling [6]. Simple analysis of the reproductive number has provided researchers with
mathematical and computational analysis may be some of the only ways to aggressively combat these conditions through the development of more feasible and effective treatments
2003, Derouich et al proved that vector control, the primary method of Dengue prevention, can only delay the spread of Dengue using a mathematical model based in stability analysis. By incorporating this method, these researches were able to graph the Dengue infection in a given population as a function of time [11]. The ability of these models to do so is reflective

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of one of their main advantages- their use can quantitatively assess the progression of disease without gathering data and manually tracking the progression. The results of these theoretical models are evidenced by the current collaboration of experts in medicine, biology, mathematics, and ecology as they use progression data to organize a treatment plan and preventative measures. Its important to understand that computational and classical epidemiology are by no means discrete fields. They are integrated; the development of equations to model an outbreak are grounded in the data collected from the classical approach. What is clear is that there are significant differences between the two approaches. The use of mathematical modeling confers a degree of efficiency that the classical approach can never attain. This translates into the ability to infer information, such as a particular immune response, that could take years to discern through the observation of an afflicted group. Another important function of these models is that theyre able to predict the outcome of a particular treatment, regardless of whether or not a vaccination strategy currently exists. This characteristic seems particularly potent given the number of diseases that currently lack any sort of treatment- for example, mathematical analysis of neglected tropical diseases, such as Chagas Disease or African Sleeping Sickness, could hold great promise. The fact that such diseases are endemic to areas with poor infrastructures further frustrates successful vaccination strategies. As such, mathematical and computational analysis may be some of the only ways to aggressively combat these conditions through the development of more feasible and effective treatments. Furthermore, the advent of large scale computing enables quick and extensive model calculation- many variables and parameters can be incorporated and changed [12]. As a result, epidemiologists have the ability to simulate many different policy scenarios without manually redefining cases and their characteristics. But while the predictive power of mathematical modeling is strong, the method is not without flaws. The use of a mathematical model, epidemiological or otherwise, relies on certain assumptions about the target space. For example, the Kendrick-McKermack SIR model assumes, among other points, a fixed population and an absence of inherited immunity. If, however, the assumptions of the epidemiological model are incorrect, the mistakes naturally lead to incorrect outcomes. Additionally, these models strive to only incorporate the most important characteristics of a disease. Even with large scale computing, they cannot capture every quality pertaining to a disease- such data can only be gathered through the classical epidemiological approach of monitoring afflicted individuals and forming comparison groups. However, the salient point is that the use of mathematics to model the spread of disease has surpassed the classical approach on grounds of efficiency and computing power. Perhaps the largest advantage is its ability to analyze disease in the absence of vaccination strategies. Given the pervasive nature of disease, especially those that affect countries lacking basic infrastructure, it would seem prudent to rely on the results of these models to influence health policy. The precedent has been set by Dengue researchers, and it remains to be seen whether epidemiologists will endorse a similar approach on an even larger scale. Broadly, the current use of math models in epidemiology is evidence that the life sciences are moving towards integrating their techniques with advanced computation. The fact that math is being applied to such great effect in epidemiology, and in other fields such as pharmacy and medicine, should serve as motivation to incorporate more advanced mathematics into life science courses at collegiate level. The application of complex math models to biological phenomena suggests that greater integration of math into a students collegiate education, particularly those grounded in the life sciences, is integral if students are to tackle present and future diseases. So if you happen to be enrolled in differential equations 101, pay attentionyou just might learn how to cure the next epidemic that rolls around. Chirag is a second-year student studying Bioinformatics at UCSD. He is interested in neglected tropical diseases, pharmacology, and epidemiology.
References
1. U.S. Department of Health and Human Services Centers for Disease Control and Prevention. Principles of Epidemiology in Public Health Practice Third Edition An Introduction to Applied Epidemiology and Biostatistics. [homepage on the Internet]. 2012 [cited 2012 Mar Date]. Available from: http://www.cdc.gov/training/products/ ss1000/ss1000-ol.pdf 2. Hove-musekwa SD. The Role of Mathematical Modelling in Epidemiology with Particular Reference to HIV/AIDS, [homepage on the Internet]. 2006 [cited 2012 Mar Date]. Available from:, DIMACS Web site: http://dimacs.rutgers.edu/Workshops/Diseases/ slides/slides.html 3. Tabak J Probability and Statistics The Science of Uncertainty, New York : Facts on File, Inc.; 2004. 4. Dietz K, Heesterbeek JA. Daniel Bernoullis epidemiological model revisited. ScienceDirect. com [database on the Internet]. 2002 [cited 2012 Mar Date]. Available from: http://www. sciencedirect.com/science/article/pii/S0025556402001220 5. Weisstein EW. Kermack-McKendrick Model. [homepage on the Internet]. [cited 2012 Mar Date]. Available from: http://mathworld.wolfram.com/Kermack-McKendrickModel.html 6. Johnson T. Mathematical Modeling of Diseases: Susceptible-Infected-Recovered (SIR) Model. [monograph on the Internet]. 2010 [cited 2012 Mar Date]. Available from: University of Minnesota, Morris, Web site: http://www.morris.umn.edu/academic/math/Ma4901/ Sp09/Final/Teri-Johnson-Final.pdf 7. Fraser C, Donnelly CA, Cauchemez S., et al Pandemic Potential of a Strain of Influenza A
(H1N1): Early Findings. Science [serial on the Internet]. 2010 [cited 2012 Mar Date].;324(5934) Available from: http://www.sciencemag.org/content/324/5934/1557.full?sid=642959de2968-4d85-8006-31053edd9dff 8. Brauer F. Mathematical epidemiology is not an oxymoron. BMC Public Health [monograph on the Internet]. [cited 2012 Mar Date].;9 Available from: http://www. biomedcentral.com/1471-2458/9/S1/S2 9. Immunization, Vaccines and Biologicals. Report of the meeting of the WHO/VMI Workshop on Dengue modeling 25-26 August 2010. [monograph on the Internet]. 2010 [cited 2012 Mar Date]. Available from: World Health Organization, Web site: http:// whqlibdoc.who.int/hq/2011/WHO_IVB_11.02_eng.pdf 10. Hartley LM, Donnelly CM, Garnett GP. The seasonal pattern of dengue in endemic areas: mathematical models of mechanisms. ScienceDirect.com [database on the Internet]. 2004 [cited 2012 Mar Date]. Web site: http://www.sciencedirect.com/science/article/pii/ S0035920302903718 11. Derouich M, Boutayeb A, Twizell EH. A model of dengue fever. BioMedical Engineering OnLine [serial on the Internet]. 2003 [cited 2012 Mar Date].;2(4) Web site: http://www. biomedical-engineering-online.com/content/2/1/4 12. Roberts FS. Computational and Mathematical Epidemiology, Science Careers [serial on the Internet]. 2004 [cited 2012 Mar Date]. Web site: http://sciencecareers.sciencemag. org/career_magazine/previous_issues/articles/2004_02_06/noDOI.13665861607928732511 13. http://commons.wikimedia.org/wiki/File:CDC_7959_Ochlerotatus_japonicus.jpg
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UC DAVIS
Time to Remove Your Wisdom Teeth!?

Michelle G. Tran
volutionists postulate that the diets of our more primitive ancestors were largely based on hard grains, seeds, and other forms of vegetation. As such, early humans were adapted to their lifestyle, sporting larger jaws and more teeth to aid in grinding down tougher vegetation. However, the advent of cooked foods was followed by a reduction in jaw size, and turned wisdom teeth into a redundant structure; those unfortunate enough to be a part of the 85% of human beings who still develop wisdom teeth must contend with smaller jaw bones and superfluous teeth [1]. Thus, wisdom teeth need to be removed, especially if they become impacted and dont grow out properly Or so they say. Dental literature has long been trending towards less invasive approaches when dealing with wisdom teeth, but one study found that the incidence of dentists recommending tooth extractions has stayed the same [2]. In 2000, Britains National Institute of Clinical Excellence (NICE) stated that the practice of prophylactic removal of pathology-free impacted third molars should be discontinued and that surgical removal of impacted third molars should be limited to patients with evidence of pathology [3]. So why are third molar extractions still commonplace? Somewhere along the line, there is a disconnect in the information that flows from researchers to practitioners to patients. The redundancy of third molar extractions can be seen even from older studies. According to researchers at the University of Florida, half of the wisdom teeth that are diagnosed as impacted will end up developing normally, and only 20% of truly impacted teeth may become diseased. But every year, Americans spend more than $3 billion on third molar extractions in return for over 11 million days of pain [4]. Almost 4 million people dont actually need this surgery, and thousands of people have to suffer complications that are associated with removing wisdom teeth [5]. These complications include hemorrhaging, soft-tissue infection, paresthesia (pins and needles), and more [6]. Accordingly, the American Public Health Association opposes prophylactic removal of third molars, which subjects individuals and society to unnecessary costs, avoidable morbidity, and the risks of permanent injury [7]. Furthermore, a study conducted by Yonsei University and Ewha Womens University showed that a lack of third molars is linked to condylar fractures, or breaks in the hinge joint of the jaw [14]. The frequency of condylar fractures in those who removed their wisdom teeth was 50% higher than in those who retained their wisdom teeth. This discovery is one among many that establishes how wisdom teeth may not be as vestigial as many claim. And what about increased odds of pathology? Another study by Lysell et al. found that
an average dentist considers cyst formation and root reabsorption as significant risks [16]. But in regards to impacted third molars, the prevalence of cyst formation is about 2-4%, and that of root absorption is less than 1% [16]. Thus, there is research that refutes the necessity of third molar extractions. However, this is in direct conflict over what is being disseminated by dentists. Although more conservative dentists do not recommend extracting healthy third molars [8] and some suggest that they can help shoulder the impact of tooth loss, most dental practitioners will still support wisdom tooth extraction [9]. This is because wisdom teeth can be blocked by succeeding teeth, and are difficult to clean. Impacted wisdom teeth can also lead to gum infection and extensive tooth decay, and must be removed [10]. Removal may also be advisable to prevent pericoronitis and cysts, which are detrimental to nearby tissue or bone. Since most dentists recommend it, most people also believe that third molar extractions are mandatory. This view can be seen in personal blogs and forums, where those considering tooth extractions post their inquiries. Responders usually offer words of encouragement and push for extractions, parroting the reasons provided by health professionals [11]. However, there are a handful of respondents who deviate from the norm, and profess to retaining their wisdom teeth with no difficulties [12]. Other uncommon posts include skeptics who post questions such as, Do wisdom teeth really need to come out, or is my dentist trying to hustle me? [13]. There are also people who purport that wisdom tooth extraction is wholly unnecessary, and those with more extreme views compare dentists to communists and mafia groups. Notably, many of these dissenters underwent wisdom tooth extractions and experienced unfavorable complications. Others base their opinions on hearsay. And so, it is as if the community of researchers, doctors, and patients are sequestered on their own islands with differing viewpoints on the same issue. Thus, information concerning third molar extractions is not necessarily available to everyone. Information from researchers is usually found exclusively
Do wisdom teeth really need to come out, or is my dentist trying to hustle me?
in specialized journals, of which the general public does not frequent. However, this is merely an external observation. Informational discrepancies may stem from internal shortcomings: inconsistencies within research or in a failure to draw

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UC DAVIS
concrete conclusions [17]. For example, the American Association of Oral and Maxillofacial Surgeons (AAOMS) examined statistics and written sources to gain a better perspective on the wisdom tooth debate, but ended up with mixed results. After pooling the results of several studies, they reported that the presence of impacted third molars negatively affected the periodontium, or supportive tissues, of adjacent second molars. But in the second part of their paper, the AAOMS focused on literature concerning the extraction of impacted wisdom teeth, and found that removing third molars was harmful to the periodontium, or supportive tissues, of neighboring molars [18]. Thus, the stance that AAOMS takes on wisdom tooth removal remains ambiguous. The conflicting conclusions of their paper only serve to demonstrate how information from primary sources can be quite muddled. Such inconsistencies may only serve to confuse dental practitioners and oral surgeons, hindering their ability to do what is best for patients. This was seen when Almendros-Marques et al. [16] conducted a study to gauge how dental specialists decide when to remove wisdom teeth. Four dental specialists were presented the records of forty patients with impacted but asymptomatic third molars and asked for a diagnosis. Overall, the participants rated that 95% of the third molars should be extracted, and seemed to put special consideration into the patients age and third molar impaction type. These factors seemed to feed into concerns that included unpredictable eruption, damage of adjacent teeth, infection, and the crowding out of other teeth. However, all of these concerns are not exactly evidence-based. As previously stated, the aforementioned conditions are often associated with wisdom teeth, but are not very common [6]. These well-intentioned but possibly misguided associations are then passed down to the patients. But what about the not-so-well-intentioned dentists? Money could be another reason for dentists and oral surgeons to push for extractions. The cost of extracting wisdom teeth depends on the complexity of each case, but extraction
References
1. Robinson RJ, Vasir NS. The great debate: do mandibular third molars affect incisor crowding? A review of the literature. Dental Update 1993; 20(6):242-246. 2. Zadik Y, Levin L. Decision Making of Israeli, East European, and South American Dental School Graduates in Third Molar Surgery: Is There a Difference? J of Oral and Maxillofacial Surgery 2007; 65:658-662. 3. Guidance on the Extraction of Wisdom Teeth. London: National Institute for Clinical Excellence; 2000. 4. Stanley HR, Alattar M, Collett WK, Stringfellow HR, Spiegel EH. Pathological sequelae of neglected impacted third molars. J of Oral Pathology & Medicine 1988; 17:113-117. 5. Huang GJ, Rue TC. Third-molar extractions as a risk factor for temporomandibular disorder. The J of the American Dental Association 2006; 137:1547-1554. 6. Friedman JW, The Prophylactic Extraction of Third Molars: A Public Health Hazard. American Journal of Public Health 2007; 97(9):1554-1559. 7. APHA: Policy Statement Database. [database on the Internet]. 2008 [cited 2012 Apr 17]. Available from: American Public Health Association, Web site: http://www.apha. org/advocacy/policy/policysearch/default.htm?NRMODE=Published&NRNODEGU ID=%7b40FCA601-747E-4190-936B-BBB2DB8CDD36%7d&NRORIGINALURL=%2 fa dvocacy%2fpolicy%2fpolicysearch%2fdefault.htm%3fid%3d1371&NRCACHEHINT= NoModifyGuest&id=1371&PF=true 8. Carr A. Wisdom teeth removal: When is it necessary? - MayoClinic.com. [homepage on the Internet]. 2011 [cited 2012 Apr 13]. Available from: http://www. mayoclinic.com/health/wisdom-teeth-removal/AN01961 9. What good are wisdom teeth, anyway? [homepage on the Internet]. 2007 [cited 2012 Apr 17]. Available from: http://www.teethremoval.com/complications.html 10. Bloom N. Wisdom Teeth @ Norman Blooms Dental Practice. [homepage on the Internet]. 2010 [cited 2012 Apr 15]. Available from: http://www.bloomdental.com/
An impacted wisdom tooth Reproduced from [19]
of a single tooth can range from $100 to $400. The total annual profit that oral surgeons and general practitioners make from wisdom tooth extraction exceeds $3 billion dollars [6]. Thus, money could be a reason for dentists to push for extractions. There are weaknesses within and between all levels of the informational flow. On one hand, information at the primary source is ambiguous. With some follow-up, confusing experimental results may be cleared up. On the other hand, something as simple as better communication can allow people to make their own informed conclusions about wisdom teeth, and possibly save themselves from unwarranted expenses, groundless suffering, and adverse health issues. As people are becoming more and more health conscious, it is imperative to root out obscurity and misinformation lest the public be forced to deal with the consequences. Michelle Tran is a Cell Biology major at University of California, Davis. As someone who aspires to become a doctor, she values the importance of communication and understanding. She became interested in the topic of wisdom teeth after her dentist prompted her to undergo the extraction process.
services/wisdom.html 11. Hacker S. Wisdom teeth. [homepage on the Internet]. 2005 [cited 2012 Apr 18]. Available from: http://birdhouse.org/blog/2005/03/08/wisdom-teeth/ 12. Flap R. [homepage on the Internet]. 2005 [cited 2012 Apr 15]. Available from: http://flapsblog.com/2005/05/07/wisdom-teeth-removal-often-unnecessary/ 13. Katala. Do wisdom teeth really need to come out, or is my dentist trying to hustle me? [homepage on the Internet]. 2008 [cited 2012 Apr 18]. Available from: http://ask. metafilter.com/105996/Do- wisdom-teeth-really- need-to-come-out-or-is-my-dentisttrying-to-hustle-me 14. Zhu SJ, Choi BH, Kim HJ, Park WS, Huh JY, Jung JH, Kim BY, Lee SH. Relationship between the presence of unerupted mandibular third molars and fractures of the mandibular condyle. International J of Oral and Maxillofacial Surgery 2005; 34:382-385. 15. Lysell L, Brehmer K. Judgement on removal of asymptomatic mandibular third molars: influence of the perceived likelihood of pathology. Dentomaxillofacial Radiology 1993; 22:173177. 16. Almendros-Marques N, Alaejos-Algarra E, Quinteros-Borgarello M, Berini-Ayts L, Gay-Escoda C. Factors influencing the prophylactic removal of asymptomatic impacted lower third molars. International J of Oral and Maxillofacial Surgery 2008; 37(1):29-35. 17. Mettes DTG, Nienhuijs MMEL, van der Sanden WJM, Verdonschot EH, Plasschaert A. Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults. The Cochrane Library 2010; 2008(4):1-16. 18. White paper on third molar data. American Association of Oral and Maxillofacial Surgeons. [serial on the Internet]. 2007 [cited 2012 Apr 15]. Available from: www. aaoms.org/docs/third_molar_white_paper.pdf 19. Weisheitszahn2. [homepage on the Internet]. 2005 [cited 2012 Jun 21]. Available from: http://commons.wikimedia.org/wiki/File:Weisheitszahn2.JPG
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UCHICAGO
The Mysterious Function of the Female Orgasm

Claire Wilson
any contemporary sexologists claim that deeming the female orgasm mysterious is the result of cultural reluctance to learn and communicate about it. Indeed, it remains uncertain whether the estimated 5-10% of women who report never experiencing orgasm are truly incapable or simply lack sufficient information and comfort with their sexuality to achieve one [1]. Nevertheless, it is clear that the female orgasm is a more complex process than its male counterparts push-button response. Physical and nonphysical factors combine to create a more nuanced experience in womenone that, unlike the male orgasm, may be so subjective that it cannot be empirically measured. Such complexity leads many to wonder why the female orgasm even exists, as its evolutionary significance is unclear compared with the male orgasms explicit connection to reproduction. Theories entitled everything from byproduct to cryptic choice to sperm upsuck have been proposed, but only by achieving a thorough understanding of how female sexuality functions may we better comprehend why it has become what it is todayand use this insight to better manage womens sexual health.
Physical and Psychological Mechanisms In the extensive 2004 review Womens orgasm, five researchers compiled a comprehensive overview of the physical processes at work during arousal, orgasm, and the post-orgasmic refractory period. As with the male erection, female sexual arousal is marked by increased blood flow to the genitalia. While the vagina at rest resembles a collapsed tube, several factors cause it to lengthen and expand during arousal. The outer third of the vagina, designated the orgasmic platform, rises in anticipation of penetration. In a process referred to as vaginal tenting, the cervix and uterus draw up and away from the vaginas rear wall. This creates a sunken, balloonlike distension somewhat isolated from the cervix in order to delay deposited sperm from passing directly through the uterus and into the fallopian tubes [2]. During orgasm, powerful striated muscles that surround the vagina begin producing rhythmic contractions, each about 0.8 seconds apart. Early researchers of orgasmic function in women believed that the stronger the orgasm, the greater the number of contractions and, thus, indirectly the longer the duration of orgasm; subsequent comparisons of physiological recordings and subjective reports, however, have not
Reproduced from [9]

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UCHICAGO
conclusively found a relation between these contractions and individuals judgments of intensity. In addition to contractions of the orgasmic platform, uterine contractions may cause the cervix to lower into the seminal pool, resolving the obstacles against sperm transport posed by vaginal tenting. However, contractions may fall short as an objective indication that an orgasm has been experienced, given some womens reports of orgasm when no contractions were observed [2]. Unlike males, in whom plasma concentration of oxytocin rises steadily throughout sexual activity, females experience a dramatic release of this hormone into the bloodstream during orgasm. Oxytocin plays a physiological role in reproductive functions (childbirth, for one) and may be involved in such behaviors as empathetic responses and pair-bonding. Activation of the cingulate cortex and medial amygdala in the brain has also been observed, perhaps indicating a role for dopamine, a neurotransmitter involved in reward systems like those activated by addictive drugs [1]. Orgasmic releases of the hormone prolactinassociated with lactation and feelings of sexual gratification in generalalso double in concentration for women and remain so for up to an hour after climax. Blood flow to the genitals changes dramatically throughout arousal Theories of Evolution A controversial 2005 review, The case of the female orgasm: Bias in the science of evolution, revived the once popular conception of the female orgasm as an evolutionary byproduct of its male counterpart, rather than the result of adaptive necessity. That
...the female orgasm is far more individual and variably experienced than males more straightforward version
men can achieve orgasm so much more reliably than women may mean that female orgasms are just the product of both sexes developing from the same embryological structure, much like how males develop nipples without any gender-specific need for them [4]. Despite its theoretical logic, analyzable evidence for the byproduct theory remains scarce. For example, a 2008 paper examined variability in clitoral length versus that of the penis. The authors explained their rationale that relatively high variability in traits was evidence of a lack of selection for functionality [4]. The study did in fact find clitoral length to be much more variable than penile length, seemingly implicating that the clitoris has not adapted to evolutionary pressures like the penis; but this conclusion quickly provoked two retaliations in the same journal. The first primarily refuted the interpretation that the erratic reliability of female orgasm is a sign of nonadaptation, pointing out that ease and frequency of orgasms may not reveal anything about their adaptive value [5]. The second attacked the measure of genital size as an indicator of orgasmic reliability altogether. Its authors even replicated the study measuring volume instead of length, yielding no significant difference between the sexes and revealing just how unreliable reporting variability in size can be [6]. Others have also expressed doubt over the byproduct theory. For example, one researcher criticized the putative link between variability and selectivity, pointing out that nonadaptive male nipples are less variable in size than their adaptive female counterparts [7]. Another attacked its conception of evolutionary pressures, as The current adaptiveness of an adaptation is a separate concern from its evolved purpose... [8]. But these debates over what exactly constitutes an evolutionary byproduct in the first place are better handled with evidence, like that found in a handful of twin studies conducted during the past decade. The authors explained that if female orgasm is a byproduct of both sexes shared developmental origins, genetic contributions to orgasmic function should be correlated for biologically related males and females; and according to survey data from a staggering 10,000 subjects, no such significant correlation was found [7]. Alternative theories as to the evolutionary origin of the female orgasm have thus been reasserted. One hypothesis states that females greater difficulty in achieving orgasm provided
Non-genital stimulation, dreams, hypnosis, and even mental concentration have all been shown to produce orgasm in certain women, highlighting the critical role of the brain and psychology in female sexual response
and reaches its highest rates for about 10-30 seconds directly after orgasm. In combination with late uterine contractions, post-orgasmic releases of prolactin are thus hypothesized to serve as a terminal event for female sexual response, much like ejaculation for males [2]. Beyond its physical mechanisms, female orgasm has been shown to be quite variably determined. Non-genital stimulation, dreams, hypnosis, and even mental concentration have all been shown to produce orgasm in certain women, highlighting the critical role of the brain and psychology in female sexual response. In a similar vein, a recent study that collected data on exercise-induced sexual pleasure found that women who responded to the online survey reported orgasms in absence of sexual fantasy and without clothing-related clitoral pressure or friction [3]. Coupled with other reports of women who valued their subjective identification of orgasm over any objective observations, it appears that the female orgasm is far more individual and variably experienced than males more straightforward version [2].
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UCHICAGO
incentive for taking multiple mates among pre-human ancestors; this promoted confusion over their offsprings biological sires and consequently entrusted their care to the whole of the society [8]. Others argue that unreliable orgasms may bond females to those males capable of eliciting them, especially given the potential pair-bonding effects of orgasmic releases of oxytocin [7]. Many cryptic choice theorists furthermore believe that the inconspicuous nature of the female orgasm may aid in selecting which partners sperm make it to the egg. For instance, one study found that males body symmetrya trait indicative of stable genespredicted frequency of orgasm in their female partners [8]. The humorously titled upsuck theory, moreover, posits that female orgasm facilitates the transport of sperm through to conception [2] or serves to retain deposited sperm after eliciting orgasm longer than ejaculates that did not elicit orgasm [1]. All taken together, byproduct theory must contend with evidence that the female orgasms infrequency might reflect many less straightforward functions than those of male orgasm: covertly selecting, possibly on the basis of males genetic caliber, which partners will get called back, which partners sperm will fertilize an egg, or which partners sperm will be kept long enough to have a chance. Implications and Conclusion Ultimately, any insight into the development and function of the female orgasm holds potential benefits for the management of modern womens sexual health. Increased understanding of the physical and nonphysical processes behind the production of orgasm provides hope for the amelioration of psychological pressures placed on females who have difficulty achieving orgasm, from unfounded expectations to false inferences about the failure to meet them. With respect to its evolutionary significance, the suggestion that the female orgasm evolved as a mechanism for subtle discrimination carries a salient implication for maternal contributions to the human species: in effect, though the male sex drive may have played the major role in ensuring that future generations exist, female psychology may have had a major role in deciding what they are like. On the other hand, the validation of byproduct theory would alleviate much stress surrounding female sexuality, redefining failure to achieve orgasm as an entirely natural baseline from which each woman may proceed as she sees fit. Regardless, whether it facilitates pair-bonding with a single partner, incentivizes sex with many, or serves no specific purpose at all, the female orgasms existence at least reveals one basic truth about human behavior: we have evolved more complex social relationships than the basic male + female =
References 1. Puts DA, Dawood K. The evolution of female orgasm: adaptation or byproduct? Twin Research and Human Genetics, 2006 June;9(3):467472. 2. Meston CM, Levin RJ, Sipski ML, Hull EM, Heiman JR (2004). Womens orgasm. Annual Review of Sex Research, 2004;15:173-257. 3. Herbenick D, Fortenberry JD. Exercise-induced orgasm and pleasure among women. Sexual and Relationship Therapy, 2011 Nov;26(4): 373-388. 4. Wallen K, Lloyd, EA. Clitoral variability compared with penile variability supports nonadaptation of female orgasm. Evolution & Development, 2008;10(1):1-2. 5. Hosken DJ. Clitoral variation says nothing about female orgasm. Evolution & Development, 2008;10(4):393-395.
offspring model of species perpetuation. Research into female sexual function continues to show how diverse and nuanced it is, illuminating the necessity for more open communication and individualized care for womens sexual health. Increased awareness of the ways in which sexuality operates for males and females is thus essential to understanding the differences between us and deriving more enjoyment from our intimate interactions. Claire Wilson 14 is an English and psychology double major at the University of Chicago. She is an avid follower of research into sexual health and behavior and hopes to pursue a career in sexual psychology.
6. Lynch VJ. Clitoral and penile size variability are not significantly different: lack of evidence for the byproduct theory of the female orgasm. Evolution & Development, 2008;10(4):396-397. 7. Zietsch BP, Santtila P. Genetic analysis of orgasmic function in twins and siblings does not support the by-product theory of female orgasm. Animal Behaviour, 2011;82:1097-1101. 8. Thornhill R, Gangestad SW. Human female copulatory orgasm: a human adaptation or phylogenetic holdover. Animal Behaviour, 1996;52(4):853855. 9. http://www.flickr.com/photos/penumbrapics/2947689682/in/photostream/ 10. http://www.flickr.com/photos/lezarderose/1227708362/sizes/l/in/photostream/ 11. http://www.flickr.com/photos/nalbertini/7036568793/in/photostream/

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CORNELL
Reading the Labels: Off-label Drug Prescription

Hillary Yu
espite evidence that the drug produces little change in quality or duration of sleep, Seroquel has long been used to treat soldiers with insomnia. The inconsistency in effectiveness is less surprising given that Seroquels intended use, as labeled and approved by the federal Food and Drug Administration (FDA), is as an antipsychotic drug for the treatment of various mental illnesses. Seroquel does possess slight sedative properties, but its overall inability to produce significant improvements in a patients sleep and, instead, ability to cause a harmful and potentially fatal irregular heartbeat, must be taken into serious account [1]. Although off-label prescribing is fairly common approximately one in every five drug prescriptions in the United States is issued for off-label use knowledge of the process behind the practice is not [2]. The term off-label use refers to any instance in which a drug is taken for some purpose other than its FDA-approved use. Classes of drugs commonly prescribed for off-label use include anti-seizure drugs for depression or nerve pain, and antidepressants for chronic pain, ADHD, or bipolar disorder [3]. Although the practice of prescribing drugs for use in ways not approved by the FDA may seem illicit, it is entirely legal. The FDA stops untested and unsafe products from entering the prescription drug market, but has very little jurisdiction over distribution once those drugs are approved, have entered the market, and are available for sale. The only form of regulation, in a sense, for off-label prescribing is contained in the condition that drug companies are restricted from promoting the off-label uses of any of their drugs, to either doctors or consumers. There is an intricate balance in off-label prescription and use. On one hand, the ability to prescribe drugs off-label affords physicians flexibility in tailoring prescriptions to match
patient needs. As Dr. Steve Hughes, Associate Director for Medical Services at Cornell Universitys Gannett Health Center, explains, when a patient has not had success with the tested medication, off-label drug prescribing allows a clinician to try a similar medication with a different side-effect profile,
...when a patient has not had success with the tested medication, offlabel drug prescribing allows a clinician to try a similar medication with a different side-effect profile, increasing the chances of success
increasing the chances of success [4]. The overall rationale for the legality of off-label prescribing lies in the idea that, as those who interact regularly with their patients, doctors should retain the ability to exercise their judgment in determining what drugs should be prescribed to whom. In many cases the relative freedom given to doctors in this area has been beneficial for example, as scientific studies emerge with results on new drug benefits, physicians can proactively adopt new practices for their patients without having to wait for the FDAs approval process. The concerning news is that ambiguity and misunderstanding often obscures offlabel use. A 2006 study in the United States showed that alarmingly, 73% of off-label drug uses were found to have little to no scientific support [5]. For many drugs that are commonly prescribed off-label, physicians also often mistakenly believe that the alleged off-label benefits of the drugs are actually approved by the FDA. A 2009 mail survey by Chen et al. revealed that 41% of surveyed physicians erroneously believed at least one drug paired with a common off-label treatment was FDA-approved. An example of one such drug-indication pair is, again, Seroquel. Not Reproduced from [3] only is Seroquel prescribed off-label for
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CORNELL
insomnia, but it is also used off-label to treat dementia with agitation, even though the supporting evidence for its medical effectiveness is inconclusive [6]. In situations where little scientific support for success exists, prescribing drugs off-label is costly, both in finance and health. When drugs are used off-label without any real evidence for their efficacy in treating a medical issue, the placebo effect can mask the ineffectiveness of the medicine, resulting in a substantial financial cost to the patient who pays for the drug without the benefit of an actual improvement in health. If a drug is acting as a placebo, a patient may also incur unnecessary health costs through any harmful side-effects. Although off-label prescribing is not always detrimental, such studies as the one co-authored by Dr. Yank indicate that for the practice to be truly safe and patient safety is or should always be a primary concern for doctors and physicians extensive research on drugs commonly used off-label must occur on a larger scale. It is also the responsibility of physicians and even patients themselves (to the best of their extent) to find out as much as they can from peer-reviewed scientific papers or the website of the FDA itself, before agreeing to prescribe or take an off-label drug. Furthermore, specifically regarding the ethical implications of off-label prescription, physicians who Reproduced from [10]. continue to prescribe ineffectual drugs in the face of emerging studies should be held accountable. Even now, resources exist that allow physicians to check the current, available drug information; the Healthcare business department of Thomson Reuters offers a resource called DRUGDEX, which not only contains information on over 2,300 drugs, but also allows physicians Reproduced from [3] to compare offlabel indications (in medicine, an indication is a legal reason allowing a certain test, drug, surgery, or procedure to be used). As science advances, the medical field will only be more reliant on the use of medicine in treating humanitys myriad health issues. The technology exists for appropriate studies to be carried out to test both the effects of new drugs and the efficacy of using current drugs for novel purposes; although testing is often expensive, there is a strong ethical reason for us to discover as much as possible about the costs and benefits of different drug uses. Given the right evidentiary support, off-label drug use will not only be legal, as it technically already is, but also ethical and beneficial. Hillary Yu is a sophomore pursing a double major in government and biological sciences with a concentration in ecology and evolutionary biology.
A study conducted by Dr. Veronica Yank of Stanford University on the recombinant factor VIIa (rFVIIa or more commonly, NovoSeven) reveals these costs of off-label prescribing. NovoSeven, a recombinant procoagulant, was first approved in 1999 by the FDA to treat hemophilia-afflicted patients. By 2008, however, only 3% of in-hospital use of the drug was for hemophilia; the other 97% of in-hospital use consisted of off-label usage in cases involving cardiovascular surgery and trauma [7]. Published in spring 2011, the findings of Dr. Yank and her colleagues on the widespread off-label use of NovoSeven indicate there is no evidence the drug actually improves the chances of saving lives when used in an off-label context. Instead, NovoSeven increases the risk of blood clots and strokes [8]. When it is taken into consideration that investigators estimate the cost of the drug to be $10,000 per dose [7], it is clear that financial, as well as health, costs can be high when the off-label uses of drugs fail to undergo stringent scientific study.
References
1. Levin A. Concern raised over antipsychotics use for sleep problems. Psychiatric News 2011 Sep;46,17: 21. 2. Stafford RS. Regulating off-label drug use - Rethinking the role of the FDA. N Engl J Med 2008; 358:1427-1429. 3. Shoppers guide to prescription drugs number 6: Off-label drug use. Consumer Reports [Internet]. 2007 [cited 2012 April 27]; Available from: http://www. consumerreports.org/health/resources/pdf/best-buy-drugs/money-saving-guides/ english/Off-Label-FINAL.pdf 4. Stone, H [citing Hughes, S]. 05 Jul 2012. Re: Question for The Triple Helix.
5. Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med 2006;166:1021-1026. 6. Chen DT, Wynia MK, Moloney RM, Alexander GC. U.S. physician knowledge of the FDA-approved indications and evidence base for commonly prescribed drugs; results of a national survey. Pharm Drug Study 2009; 18:1094-1100. 7. Avorn J, Kesselheim A. Editorial: A hemorrhage of off-label use. Ann Intern Med 2011;154:566-567. 8. Yank V, Tuohy CV, Logan AC, Bravata DM, Standenmayer K, Eisenhut R, et al. Systematic review: benefits and harms of in-hospital use of recombinant factor VIIa for off-label indications. Ann Intern Med 2011;154:529-40.

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ACKNOWLEDGMENTS
The Triple Helix at Brown University would like to sincerely thank the following groups and individuals for their generous and continued support: The Brown University Undergraduate Council of Students (UCS), The Undergraduate Finance Board at Brown University (UFB), Katherine Bergeron, Dean of the College, And participating members of the Faculty Review Board: Anne Hart Beth Anne Zielinski Daniel Weinreich Gary Wessel Karen Marie Haberstroh Katherine Smith Kathryn DeMaster Samuel Greenblatt
If you are interested in contributing your support to The Triple Helixs mission, whether nancially or otherwise, please feel free to visit our website at thetriplehelix.org. 2012 The Triple Helix, Inc. All rights reserved. The Triple Helix at Brown University is an independent chapter of The Triple Helix, Inc., an educational 501(c)3 non-prot corporation. The Triple Helix at Brown University is published biannually and is available free of charge. Its sponsors, advisors, and Brown University are not responsible for its contents. The views expressed in this journal are solely those of the respective authors.
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Message from the CEO

Mridula Nadamuni Chief Executive Officer

Message from the CPO and EEiC

2012, The Triple Helix, Inc. All rights reserved.

THE TRIPLE HELIX Fall 2012 5

Nuclear Sovereignty: Radioactive Waste Dumping and Native Lands

Reproduced from [21]

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THE TRIPLE HELIX Fall 2012 7

8 THE TRIPLE HELIX Fall 2012

2012, The Triple Helix, Inc. All rights reserved.

Acupuncture: The Mysterious Needle

Reproduced from [19]

Reproduced from [22]

10 THE TRIPLE HELIX Fall 2012

2012, The Triple Helix, Inc. All rights reserved.

The simple answer is that there is no proven answer

2012, The Triple Helix, Inc. All rights reserved.

THE TRIPLE HELIX Fall 2012 11

Megastructures: Architectures Solution for the Issues of Urban Sprawl

12 THE TRIPLE HELIX Fall 2012

2012, The Triple Helix, Inc. All rights reserved.

Reproduced from [13]

2012, The Triple Helix, Inc. All rights reserved.

THE TRIPLE HELIX Fall 2012 13

Reproduced from [12]

14 THE TRIPLE HELIX Fall 2012

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Reproduced from [9]

16 THE TRIPLE HELIX Fall 2012

2012, The Triple Helix, Inc. All rights reserved.

Algae May Be the New Electrode in Psychiatric Research

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18 THE TRIPLE HELIX Fall 2012

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The Future of Vaccinations: From Jet Injectors to Edible Vaccines

20 THE TRIPLE HELIX Fall 2012

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Reproduced from [11] References

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THE TRIPLE HELIX Fall 2012 21

Dying to Feel Young: Re-contextualizing Menopause in America

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THE TRIPLE HELIX Fall 2012 23

From Recklessness to Reclamation?: The Future of the Alberta Tar Sands

Reproduced from [23]

24 THE TRIPLE HELIX Fall 2012