a sharper image: medical technology looking into the future of · 2019-12-10 · sahil doshi,...

SPRING 2013 | SYNAPSE | 1SSPRSS INGNN 202 1333 || SYNS APAPSPSEE ||| 11

Bionic EyeLetting the Blind See

Again

A Simple Paper Test

Improving Medical Diagnostics

Gun ViolenceIs Mental Health to

Blame?

Women’s Right to Know

Still fighting 40 years after Roe v. Wade

A SHARPER IMAGE: Looking into the future of medical technology

POLICY POLICY CLINIC AL TECH

2 | SYNAPSE | SPRING 2013

Looking into the future of medical technology

EXECUTIVE BOARD

GENERAL BOARDSAssociate Editors

Teja Alapati

Dara Bakar

Biruk Belele

Kartik Bhamidipati

Paul Blazek

Lucy Chen

Leonard Chiu

Kevin Huang

Monica Laskos

Design StaffArjun Bashyam

Biruk Bekele

Vicky Ro

Business Staff

Angela Huang

John Kim

Aman Singh

ADVISORY BOARDKent Bream, MD: Assistant Professor of Clinical Family

Medicine and Community Health, Hospital of the

University of Pennsylvania

Phyllis Dennery, MD: Chief of Neonatology and

Newborn Service, Children’s Hospital of Philadelphia

John Heon, PhD: Professor of English and Writing,

College of Arts and Sciences

Lisa Mitchell, PhD: Assistant Professor of South Asian

Studies, College of Arts of Arts and Sciences

Brendan Maher: Features Editor, NatureMark Pauly, PhD: Bendheim Professor of Healthcare

Management, The Wharton School

Philip Rea, PhD: Professor of Biology, College of Arts and

Sciences

Harvey Rubin, MD, PhD: Professor of Medicine, Penn

School of Medicine

Michael Topp, PhD: Professor of Chemistry, College of

Arts of Sciences

Nicholas Wilcox: Founder of SYNAPSE

MANY THANKS TOSAC, PubCo, The Philadelphia Inquirer, Dr. Carl June, Dr.

Paul Offit

EXECUTIVE BOARD

BACK: Praneet Mylavarapu, Farrah Alkhaleel, Megan Falls, Osama Ahmed, Changhee Han, Ellen Kim

FRONT: Niharika Gupta, Mallika Marar, Sahil Doshi, Kathy Liu, Amy Le

Sahil Doshi, Praneet Mylavarapu

Kathy Liu

Osama Ahmed, Farrah Alkhaleel,

Niharika Gupta, Changhee Han,

Mallika Marar

Megan Falls, Ellen Kim

Amy Le

Editors-in-Chief

Vice President

Editorial

Design

VP Finance

Elliot Melaney

Vihang Nakhate

Ben Nicholas

Nish Patel

Akiff Premjee

Indu Subbaraj

Nicholas Thomas

Chacha Wang

Dear readers,

In the last century, breakthroughs in medicine have gone hand in hand with technological progress. With advancements in prosthetics, drug delivery systems, surgical procedures, and medical interfaces, healthcare is largely driven by innovation.

To highlight the sweeping effects of modern technology on medicine today, SYNAPSE is presenting several unique articles that capture the theme of “A Sharper Image: Looking into the Future of Medical Technology.” At the vanguard of this change is the emergence of bionic eyes. We delve into the potential for these new retinal prostheses and how they might restore sight to the blind. Bringing these advancements to the clinical setting, we explore the evolution of medical diagnostics in developing nations and their potential for revolutionizing treatment. Furthering our dialogue on the impact of technology in the clinical setting, we discuss the possibility of machine learning to supplement the traditional physician practice. Finally, we examine the molecule of life, DNA, as a source of data storage. Exploring the verstaility of long-term molecular information storage opens up a new interface between medicine and computer science.

While the theme of our Spring 2013 Issue revolves around medical innovation, we also explore the role of healthcare in topical debates on gun violence and abortion to facilitate discussion among the student body. We hope you enjoy and engage with the wide spectrum of articles that we have put forth this issue.

As the seventh installment of SYNAPSE, we would like to extend our thanks to every member of the team, without whom this issue wouldn’t have been possible. We would also like to thank Nuvid Bhuiyan, Anand Gopal, Nicholas Wilcox, and Ashley Wu, for providing us with support and guidance during the transition of our team this semester.

Sahil Doshi and Praneet MylavarapuEditors-in-Chief

Interested in writing for SYNAPSE?

Go online to www.upennsynapse.com or

email [email protected] for more

information.

SPRING 2013 | SYNAPSE | 3

CONTENTS policy

clinical

technology

research

medicine & culture

GUN VIOLENCEIs mental health to blame? 4Osama Ahmed

NUTRITIONAL POLICYPromoting healthy eating habits 7Siyuan Cao

WOMEN’S RIGHT TO KNOWStill fighting 40 years Roe v. Wade

10Niharika Gupta

ARTIFICIAL INTELLIGENCEDoes AI have an application in medical practice?

13

Indu Subbaraj

IMMUNOINFORMATICSA new approach to vaccine

development15

Farrah Alkaheel

A PAPER TESTImproving medical diagnostics 17Shabnam Elahi

ON THE COVER

This issue’s cover photo was shot by Christian Hopkins, a freelance photographer and under-graduate student at the University of Pennsyl-vania, using a Canon MP-E 65mm macro lens. He used Adobe Photoshop to create the techno-logical overlay. The image was inspired by this issue’s theme, “A Sharper Image.”

For more SYNAPSE, visit our website: www.upennsynapse.com

CURING CANCERAssessing where we stand in cancer research

24

Kartik Bhamidipati

EMBRYONIC STEM CELLSWhen federal funding for research becomes controversial

26

Jenna Hebert

CHILDHOOD DEVELOPMENTThe importance of early education for a child’s future

29

Akiff Premjee

GENETICALLY MODIFIED FOODEvaluating AquaAdvantage® Salmon

30

Monica Laskos

BIONIC EYESRestoring sight to the blind

22

Peter Bittar

DNA DATA STORAGEDoes this biological molecule have a place in the new age of “big data?”

19

Lucy Chen

4 | SYNAPSE | SPRING 20134 | SYNAPSE | SPRING 2013

POLICY

What do the Aurora shooting, the Wisconsin Massacre and the Newtown shooting have in common? Apart from being some of the most

tragic cases of mass murder in the history of the United States, all three of them were perpetrated by people who were allegedly mentally ill and were driven to commit their heinous actions after being neglected by our mental health care system.1

In a country where gun violence claims the lives of more than 8,500 people every year and tragedies like Aurora, Wiscon-sin and Newtown happen far too frequently, people often oversimplify the complexity of what caused such tragedies.2 A case in point is the current contentious nationwide debate about the role mental illness plays in gun violence.

Efforts made by policy makers to ameliorate our mental health system in order to alleviate the problem of gun violence are welcoming prospects because the system is no doubt in need of urgent reform. However, the premise of mentally ill pa-tients bearing the brunt of the responsibility for gun violence is a premise that still needs to be viewed critically.

IS MENTAL ILLNESS TO BLAME FOR GUN VIOLENCE?

On Monday, January 13th, 2013, the widow of a U.S. Navy veteran who was killed in the Aurora shootings filed a law-suit against James Holmes’s psychiatrist Dr. Lynne Fenton for knowing that Holmes was dangerous yet not doing enough to protect the public by reporting him.3

While possibly a hyperbolic example of the extent of the blame being placed on mental illnesses—and on mental health practitioners for not diagnosing a person’s psychiatric predisposition towards violence—it is far from being an iso-lated incident. There are currently a plethora of medical ex-perts, bloggers and popular media outlets that are perpetuat-

BY OSAMA AHMED


ing uninformed opinions about such correlations.4 Surveys referenced in Scientific American also show that 60 to 80 percent of the public believes that those diagnosed with mental illnesses—schizophrenia in particu-lar—are more likely to perpetrate acts of violence.5 However, the fact of the matter is that not enough is known about such a correlation in order to make such definitive and ostracizing statements.

Many prominent mental health experts advise against drawing such con-clusions. Thomas Insel, the director of the National Institute of Mental Health, has blogged about this issue, noting that the vast majority of people with mental illnesses like schizophrenia are not violent and are more likely to be victims of violence rather than perpetrators.4 He also noted that when the issue of violence does precipitate, such individuals are much more likely to harm themselves than others.4 Peter Szatmari, the head of the department of child and adolescent psychiatry at McMaster Children’s Hospital, also added that “the vast majority of people that have mental health challenges are not violent, so it’s really important to sepa-rate those two as quite different phenomena”.4

Statistics also support the opinions of such experts. According to a study referenced in Scientific American in 2011, patients with severe mental illnesses only accounted for 3 to 5 percent of the 1,203,564 incidents of violent crimes that year.5,6 Unfortunately, the sensationalization of such correlations between mental illnesses and violence only serves to margin-alize an already stigmatized demographic even further.

AN INACCESSIBLE MENTAL HEALTHCARE SYSTEM

While we do not have enough evidence to directly link mental health to gun violence, the ongoing debate about gun violence following the shoot-ings has nevertheless raised important questions about the state of mental healthcare in America. Investigations of our mental health care system have lead to some alarming discoveries, which rapidly need to be ad-dressed. While the stigmatization of mentally ill patients should be avoid-ed, the recent debate over the state of mental healthcare in America is a welcome topic for discussion.

According to estimates made by the National Institute of Mental Health, every year approximately 26 percent of adults and 20 percent of children experience a diagnosable mental health condition. However, only less than 50 percent of people with such issues actually receive diagnosis and treatment.7 Untreated people are much more likely to have encounters with law enforcement agencies, and as such, they often end up in jails rather than mental health institutions. A study published by the Mental Illness Policy worryingly quantifies such phenomena, noting that it is so prevalent that there are estimated to be more mentally ill persons in pris-on than hospitals.8



Per capita expenditure on mental health services in 2010

THE KAISER FAMILY FOUNDATION/GRAPHIC

There are numerous reasons that explain this trend of mental health care inaccessibility. One such reason is the costs associated with seeing psychiatrists. Erlanger Turner, an assistant professor of psy-chiatry at the Virginia Commonwealth University School of Medi-cine, argues that while the Affordable Care Act makes the costs of seeking mental health more affordable, many families still have to decide between seeking mental health treatment or putting food on the table, thus ultimately making mental health care inaccessible, especially for low income households.7

A second explanation for a lack of mental health care ac-cessibility is the reduction in the number of government funded public psychiatric care beds nationwide, which limit the number of patients a hospital is able to accom-modate. There are currently 95 percent fewer psychiat-ric beds offered across the country than there were 50 years ago, making the num-ber of beds per population the same as it was in 1850.9 Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center and executive direc-tor of the Stanley Medical Research Institute, notes that a lack of beds significantly clogs up the system, leading to patients being neglected. He argues, “[Even] if the Pima Community College authorities had considered referring Jared Loughner (who shot Representative Gabrielle Giffords and others in Tucson in 2011) for evaluation, as they should have done, they almost certainly would have been told that no beds were available”.7 Without treatment fa-cilities, the prospects of treating mentally ill patients are futile at best.

A third reason for patients being denied mental treatment lies in in-voluntary commitment statutes (which are legal processes through which an individual with severe symptoms of mental illness can be court ordered to receive treatment) in many states that make man-datory treatment of severely mentally ill persons close to impos-sible. Many mentally ill people, especially those with bipolar disor-der or schizophrenia, are often unaware of their condition and do not seek help. Under current laws in many states, it is very difficult to involuntarily assess such individuals, even if they do seem to be potentially dangerous to society. Dr. Torrey notes this problem, say-ing that “the commitment statutes in states like Connecticut make it virtually impossible to evaluate and treat people like Adam Lanza until they have already demonstrated dangerous behavior. If Lanza’s mother did inquire about getting her son evaluated involuntarily (on his part), she would have been told that it would be very dif-ficult.”7 Unless these statutes are changed in order to give courts more power to refer people to psychiatrists, the most mentally vul-nerable segment of our population will not find its way into a men-tal health institution.

THE FUTURE OF MENTAL HEALTH CARE

As lawmakers sit down and discuss how to mold the mental health care system in the future, particular attention will need to be paid to two things. First, an effort will have to be made to decrease the stig-matization of mentally ill patients. In addition to shifting the bulk of the blame for violent crimes away from such people, policy mak-ers will have to reform the system in such a way that will maintain patient-psychiatrist confidentiality while simultaneously providing health workers with enough power to inform authorities of particu-

larly dangerous behavior. It has to be kept in mind, though, that despite such obligations to report dangerous behavior, psychiatrists cannot be expected to accurately and infallibly predict violent be-havior amongst their patients or bear the blame for not being able to do so.

Secondly, an effort needs to be made to improve the accessibility of the mental health care system at large. Whether by lowering costs, ameliorating insurance plans, providing more public psychiatric beds or amending laws, the sys-tem needs to be restructured in order to ensure that people who desperately need mental health treatment can access it easily.

Perhaps doing all of this at the end of the day might not dramatically lower gun violence. However, do-

ing so will still divorce us from our bias of inordinately blaming gun violence primarily on mentally ill people. It may also help fix a part of our healthcare system, which, despite having the responsibility of dealing with a quarter of our population, has been severely neglected in recent times and needs urgent attention.

References

1. Ablow, K. (2012, August 7). Did mental illness fuel Wisconsin massacre -- or was it terrorism? . Fox

News. Retrieved January 25, 2013, from http://www.foxnews.com/opinion/2012/08/07/did-mental-

illness-fuel-wisconsin-massacre-or-was-it-terrorism/

2. Rogers, S. (2012, December 17). Gun crime statistics by US state. The Guardian. Retrieved February

7, 2013, from http://www.guardian.co.uk/news/datablog/2011/jan/10/gun-crime-us-state7. Eric

L E., Collins, R., & Cracknell, B. S. (2008). Sensible approaches for reducing clinical trial costs. SAGE

Journals, 5(1), 75-84. Retrieved from http://ctj.sagepub.com/content/5/1/75.full.pdf

3. Coffman, K. (2013, January 15). Psychiatrist who treated accused Colorado gunman sued over

rampage. Reuters. Retrieved January 26, 2013, from http://www.reuters.com/article/2013/01/15/us-

usa-shooting-denver-idUSBRE90E11I20130115

4. Weeks, C. (2012, December 17). Newtown shootings underscore how confused we are about

mental illness and violence. The Globe and Mail. Retrieved January 26, 2013, from http://www.

theglobeandmail.com/life/parenting/newtown-shootings-underscore-how-confused-we-are-about-

mental-illness-and-violence/article6493787/

5. Arkowitz, H., & Lilienfeld, S. (2011, July 8). Deranged and Dangerous: When Do the Emotionally

Disturbed Resort to Violence?. Scientific American. Retrieved February 7, 2013, from http://www.

scientificamerican.com/article.cfm?id=deranged-and-dangerous

6. Crime in the United States by Volume and Rate per 100,000 Inhabitants, 1992–2011. (2011). FBI .

Retrieved February 25, 2013, from http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2011/crime-

in-the-u.s.-2011/tables/table-1

7. New York Times. (2013, January). Can Mental Health Care Reduce Gun Violence?. Room for

Debate - The New York Times. Retrieved January 26, 2013, from http://www.nytimes.com/

roomfordebate/2013/01/17/can-mental-health-care-reduce-gun-violence5. Begley and Carmichael,

“Desperately Seeking Cures,” Newsweek 155 (May 31, 2010)

8. Torrey, E. F., Kennard, A. D., Eslinger, D., Lamb, R., & Pavle, J. (2010, May). More mentally ill in jails than

hospitals. Mental Illness Policy . Retrieved January 26, 2013, from http://mentalillnesspolicy.org/NGRI/

jails-vs-hospitals.html

9. Torrey, E. F., Fuller, D. A., Geller, J., Jacobs, C., & Ragosta, K. (2012, July 19). No Room at the Inn: Trends

and Consequences of Closing Public

Psychiatric Hospitals. Treatment Advocacy Center. Retrieved January 25, 2013, from www.tacreports.

org/storage/documents/no_room_at_the_inn-2012.pdfwiley.com/doi/10.1111/1467-9310.00132/pdf


You Are What

You EatThe role of federal policy in addressing nutritional

concerns and promoting healthy eating habits.

adults, or about 11.5% of the adult population, have CVDs ranging from diseases in vascular tissue to stroke.3 CVD causes about one in every four deaths in the United States and is the leading cause of death in most developed na-tions.4 Extensive research has been conducted regarding the treatment and prevention of CVD, with nutrition emerging as one significant preventative measure.

In order to promote healthy eating in early adulthood years—such as in college—one must look to eating habits formed during childhood. Recent evidence shows that di-etary choices in childhood can have a significant impact on the trajectory of disease development.5,6 However, while the awareness of nutrition as a preventative measure in chronic disease is growing, the practice is still lacking. How does one address this discrepancy between awareness of nutritional benefits and the lack of healthy eating? In order to popularize the use of nutrition as a preventative measure against chronic disease, public health and government of-ficials are called upon to emphasize nutrition in childhood in both school and community settings to promote life-long healthy eating habits.

BARRIERS TO HEALTHY EATING

To devise an appropriate nutritional program, one must first consider the two largest barriers to healthy eating: awareness and access.7 Individuals need to be aware of what is considered nutritional. Current guidelines published by the U.S. Department of Agriculture are represented by My-Plate, which gives a pictorial representation of how a meal should be structured by displaying suggested portions on a plate.8 Along with MyPlate, dietary guidelines also rec-ommend moderation of foods that contain fatty acids,

Every year, after the daunting process of college applications and decisions comes the next biggest challenge of every student’s college career: facing the

“Freshman 15.” This rumored phenomenon describes the uncanny ability of college freshmen to gain weight during their first year at college, and it looms over freshmen minds as students venture into the world of buffet-style dining halls and late night Chinese take-outs. Yet in spite of the worry and consternation, the “Freshman 15” is actually largely fiction; but the practice of poor nutritional habits during college years is not.1,2 These practices encompass everything from skipping meals to high consumption of fast foods and low consumption of fruits, vegetables, and fiber.2

These dietary habits can have consequences that go far beyond college years. From cardiovascular disease to di-abetes, illnesses that stem from poor nutrition are grow-ing problems in the United States. Consider the example of cardiovascular disease (CVD). The Center for Disease Control and Prevention reports that 26.5 million American

BY SIYUAN CAO

(in Childhood)

26.5 million American adults, or about 11.5% of the adult population in the United States, have cardiovascular diseases (CVD), ranging from diseases in vascular tissue to stroke. CVD causes about one in every four deaths in the United States and is the leading cause of death in most developed nations.

al

MEGAN FALLS/GRAPHIC


sodium, and sugar.5 With increased attention directed toward healthy eating habits from doctors, websites, and even school lunch programs, there has been progress in overcoming the barrier of awareness as individuals, and particularly parents, become increasingly mindful of what is considered healthy.7

However, even with awareness of what is healthy, it remains difficult to overcome the barrier to access healthy foods, particularly in urban, low-income neighborhoods—the highest at risk for unhealthy eating and obesity.7 This bar-rier to access is composed of two major components. The first is a lack of financial and temporal resources.7 Healthy foods, such as fresh fruits and vegetables, are generally more expensive, and thereby increase the financial bur-den on families with limited incomes. In addition, meal preparation takes time—time that might not be available in neighborhoods where parents are required to work sev-eral jobs—leading to situations in which fast food and mi-crowave meals make up in convenience what they lack in nutrition. The second component is that of role models.7 Because children often look up to parents and caretak-ers, it can be difficult for children to follow healthy eating habits if their role models are unable to follow a healthy dietary regime themselves.

HOW CAN WE PROMOTE NUTRITIONAL EATING?

Nutritional programs should focus on addressing both barriers in order to promote early healthy eating habits.

These programs must thus be two-fold: at school as well as in the community. Schools need to focus on providing healthy meals and educating students. Recently, healthy school meal programs, like the Kansas LEAN School In-tervention Project, have been successful in reducing fat content in school lunches while maintaining caloric bal-ance.9 However, the success of these programs is still un-certain due to student preference for unhealthy foods and lack of continuity from school to home.10 Evidence is still in favor of school intervention programs. The Healthy Options for Nutrition Environments in School study showed that interventions have led to de-creased consumption of unhealthy outside foods and bev-erages brought from home when compared with control schools where there was no intervention.11 These interven-tion measures included discouraging unhealthy snacks at home, removal of unhealthy foods from school fundrais-ers, and increased communication of nutritional informa-tion to parents. Results show that school programs have the potential to target and reduce unhealthy eating.

But even more important is policy implementation at home, which must be done at the community-level. The key here is to make healthy foods more available to fam-ilies who are either unaware of the need for nutritional eating or are simply unable to access nutritional foods. One intervention conducted in a low-income urban area of Baltimore showed that increased inventory and more visible promotion of nutritious foods at local supermar-kets led to an increase in customers making healthy food choices.12 Public health programs should therefore focus on increasing the availability of healthy foods at afford-able prices and ensuring that the public knows where they purchase them.

EDUCATION VERSUS POLICY

While there are still barriers to healthy eating, interven-tions prove to be promising in promoting healthy eating. But how far should interventions go? Recall that New York Mayor Michael Bloomberg began his crusade last year to ban the sale of 16oz sodas in New York, citing the city’s increasing obesity rates.13 Amidst public outcry, the

Current nutritional guidelines from the United States Department of Agriculture recommend the meal structure above, along with moderation of foods that contain fatty acids, sodium, and sugar.

SOURCE: USDA

In light of the barriers to nutritional practices, perhaps the solution is not to limit food choice, but rather to encourage the choice of healthier foods through pro-grams designed to raise awareness and access.


References

1. Zagorsky, J. L., & Smith, P. K. (2011). The Freshman 15: A critical time for obesity intervention or media myth? Social Science Quarterly, 92(5), 1389-1407.

2. Huang, T. T. K., Harris, K. J., Lee, R. E., Nazir, N., Born, W., & Kaur, H. (2003). Assessing overweight, obesity, diet, and physical activity in college students. Journal of American College Health, 52(2), 83-86.

3. Heart Disease FastStats. (2013, January 9). Retrieved February 22, 2013, from Center for Disease Control and Prevention website: http://www.cdc.gov/nchs/fastats/heart.htm

4. Heart Disease Facts. (2012, October 16). Retrieved February, 2013, from Center for Disease Control and Prevention website: http://www.cdc.gov/heartdisease/facts.htm

5. World Health Organization, Food and Agriculture Organization of the United Nations. (2003). Diet, Nutrition and the Prevention of Chronic Disease (Technical Report No. 916). Retrieved from http://www.fao.org/docrep/005/ AC911E/AC911E00.HTM

6. Devine, C. M., Connors, M., Bisogni, C. A., & Sobal, J. (1998). Life-Course Influences on Fruit and Vegetable Trajectories: Qualitative Analysis of Food Choices. Journal of Nutrition Education, 30(6), 361-370.

7. Kelly, L. E., & Patterson, B. J. (2006). Childhood nutrition: Perceptions of caretakers in a low-income urban setting. The Journal of School Nursing, 22(6), 345-351.

8. Post, R. (2012). Putting MyPlate to Work For Nutrition Educators. Journal of Nutrition Education and Behavior, 44(2), 98-99.

9. Harris, K. J., Paine-Andrews, A., Richter, K. P., Lewis, R. K., Johnston, J. A., James, V., . . . Fawcett, S. B. (1997). Reducing Elementary School Children’s Risks for Chronic Diseases through School Lunch Modifications, Nutrition Education, and Physical Activity Interventions. Journal of Nutrition Education, 29(4), 196-202.

10. Cho, H., & Nadow, M. Z. (2004). Understanding Barriers to Implementing Quality Lunch and Nutrition Education. Journal of Community Health, 29(5), 421-435.

11. Coleman, K. J., Shordon, M., Caparosa, S. L., Pomichowski, M. E., & Dzewaltowski, D. A. (2012). The healthy options for nutrition environments in schools (Healthy ONES) group randomized trial: Using implementation models to change nutrition policy and environments in low income schools. International Journal of Behavioral Nutrition and Physical Activity, 9(80), 1-16.

12. Gittelsohn, J., Song, H.-J., Suratkar, S., Kumar, M. B., Henry, E. G., Sharma, S., . . . Anliker, J. A. (2010). An urban food store intervention positively affects food-related psychosocial variables and food behaviors [Abstract]. Health Education & Behavior, 37(3), 390-402.

13. Grynbaum, M. M. (2012, May 30). New York Plans to Ban Sale of Big Sizes of Sugary Drinks. Retrieved February 21, 2013, from The New York Times website: http://www.nytimes.com/2012/05/31/nyregion/bloomberg-plans-a-ban-on-large-sugared-drinks.html?pagewanted=all

14. [About Us]. (n.d.). Retrieved March 7, 2013, from Agatston Urban Nutrition Initiative website: http://www.urbannutrition.org/

Students participate in an Urban Nutrition Initiative fruit stand at Drew Elementary last year (the school is closed now). The “table” they’re using is the YUMM bike, the “Youth Urban Mobile Market,” which a crew of UNI’s seniors bikes around West Philly with selling fruit and smoothies.

URBAN NUTRITION INTIATIVE/PHOTO

New York City Board of Health subsequently approved Mayor Bloomberg’s ban, although a Judge recently halted it. In light of the barriers to nutritional prac-tices, perhaps the solution is not to limit food choice, but rather to encourage the choice of healthier foods through programs designed to raise awareness and access. An excellent example resides in West Phila-delphia: the Urban Nutrition Initiative (UNI).14 UNI has programs that contain lessons on everything from healthy snacking to healthy cooking. By bringing these lessons to both schools and the community at large, UNI is able to target both the students and their par-ents.

The road to healthy eating habits is a long and arduous one, especially in urban areas where awareness and ac-cess are limited. While the dangers of poor nutrition can be heard from doctors and other health experts, popular fast food chains pervade a different and often louder message. If evidence has so strongly favored healthy eating, why have people been reluctant to fol-low this new practice? The answer may lie within the habits developed during peak developmental years. As such, we should strive to consider what exactly we are consuming before we eat it. So, what did you eat today?


Still fighting 40 years after Roe v. WadeBY NIHARIKA GUPTA

Forty years ago, the Supreme Court decided in favor of Roe in Roe v. Wade, making abortion legal in all fifty states.

In the four decades that followed, abortion has remained a contentious issue on the national agenda, continuously challenged by conservative bills that restrict access to abortion. Despite the inability for “pro-life” and “pro-choice” office holders to find a middle ground, a Wall Street Journal poll found that 70% of Americans actually want Roe v. Wade to be upheld while only 24% want this landmark ruling to be overturned.1 In reaction to the exponential growth in anti-abortion activism, Sarah Weddington, the defense lawyer who argued for legalized

abortion in Roe v. Wade said, “We are not asking this court to decide that abortion is good, or that everyone should have one. We are asking this court to decide that that issue is one for the individual to decide, not the government”.2

Yet conservative policymakers are still chal-lenging the very right for women to make their own medical decisions with the Wom-en’s Right to Know Act, requiring women to wait an unprecedented twenty-four hours for an abortion and receive an invasive ul-trasound. Because the act opens a Pandora ’s box full of violations of patients’ rights, abor-tion activists are still fighting. Forty years af-

VICKY RO AND MEGAN FALLS/ GRAPHIC


CLAIMING MONOPOLY ON MORALS OR FEMINISM LEAVES LITTLE ROOM TO WITNESS A REAL DISCUSSION ON ABORTION

This new law would require mothers to have an ultrasound done whether she wants to watch or not.

WIKIPEDIA / GRAPHIC

ter Roe v. Wade, everyone is still searching for an honest debate.

WOMEN’S RIGHT TO KNOW ACT

Despite backlash from the transvaginal ultrasound bill wildly publicized in Virginia, Pennsylvania leg-islators are pushing for a similar bill. The Woman’s Right to Know Act (WRTKA) would force women to receive information about the gestational age and health of the unborn child and would require medi-cal professionals to follow guidelines when provid-ing abortion information.3 Outraged at such a bill, Tobias Barrington Wolff, law professor at the Uni-versity of Pennsylvania, commented that this bill requires “doctors to position the ultrasound moni-tor in the woman’s face whether or not she wants to watch it”.4 If the WRTKA is approved, Pennsylva-nia would join twenty-three other states that have a similar bill requiring these ultrasounds.5

Although close to half of the states have a form of the WRTKA, no policymakers have brought to at-tention the fact that restricting access to abortion is a violation of Roe v. Wade. Little of the debate has focused on what these restrictions really mean for reproductive rights and for the doctor-patient re-lationship. Conservative Pennsylvania State Repre-sentative Kathy Rapp, who introduced the Pennsyl-vania WRTKA in 2012, maintains that women will continue to be denied the opportunity to base their health care decisions on full information unless the bill is passed.6 However, Rep. Rapp fails to recognize that the WRTKA denies women the opportunity to make their own medical decision and forces doctors into following non-professional guidelines that will lead to complications and irreversible consequences.

ACCESS WITH UNDUE BURDEN

If ultrasounds are routinely performed among OB GYNS, why is there so much controversy over its use for this Act? Both the FDA and physicians red flag any procedure for non-medical purposes. Ul-trasound rays heats body tissues and may produce small pockets of gas called cavitation. The FDA states that though ultrasound imaging has an excel-lent safety record for over twenty years, the long-term effects are still unknown. Because of this con-cern, the FDA “discourages the use of ultrasound for non-medical purposes”.7

The twenty- four hour waiting period has created small ripples throughout the Pennsylvania com-munity but actually can have a significant impact. The twenty-four hour delay translates into an even longer wait, as women have to go through three ap-pointments at a reproductive health care provider before receiving an abortion, meaning at least a two week delay. Women at the end of their first trimes-ter could be forced into waiting until their second trimester, “when abortion procedures are more ex-pensive and more dangerous”.8 This concern is not shared by many Pennsylvania House Representa-tives, who do not see it as a major obstacle unless in context of other restrictions. Every restriction leads to another complication of reproductive rights.

CHALLENGING THE DOCTOR-PATIENT RELATIONSHIP

In an open letter to the House, Marilyn J. Heine, M.D., President of the Pennsylvania Medical Society (PAMED), described the most significant impact of the bill, “it would jeopardize open dialogue within physician-patient relationship”.9 PAMED’s Grass-roots Action Center has “sent ninety-nine messages to over sixty-seven House Representatives to keep intact the doctor-patient relationship”.8 The fact is doctors are being degraded into keeping their pro-fessional opinion from their patients. The most ac-tive medical professional groups in Pennsylvania re-


fer to the act as a “government approved script which may contain medically inaccurate and misleading in-formation”.4 But Pennsylvania doctors will assert they will continue to stand up for their patients’ rights.

HER OWN MEDICAL DECISION

Representative Rapp clearly misconstrues the bill as supporting women’s rights whereas it instead violates a woman’s basic right to make her own medical de-cision. Claiming monopoly on morals or feminism leaves little room to witness a real discussion on abortion. Concerned about patients’ rights, Execu-tive Director at Planned Parenthood Pennsylvania Advocates, Sari Stevens, believes that this act “seems to believe that women are not smart or informed enough to make their own medical decisions”.4 For most women, the choice of getting an abortion is heart-wrenching in itself. But degrading a woman

References

1. Weiner, R. (2013, January 22). Poll: On Roe v. Wade anniversary, majority think abortion should be legal. Washington Post. Retrieved from http://www.washingtonpost.com/blogs/post-politics/wp/2013/01/22/poll-on-roe-v-wade-anniversary-most-want-decision-to-stay/

2. Lapinski, V. (2013, January 22). Winning Roe v. Wade: Q&A with Sarah Weddington. TIME. Retrieved from http://nation.time.com/2013/01/22/winning-roe-v-wade-qa-with-sarah-weddington/

3. Gold, J. (2011, October 19). To Curb Abortions, Opponents Focus On The ‘Supply-Side’. National Public Radio. Retrieved from http://www.npr.org/blogs/health/2011/10/19/141526455/to-curb-abortions-opponents-focus-on-the-supply-side\

4. Democrats Use Ultrasound Bill As Rallying Cry. (2012, March 1). Politics PA. Retrieved from http://www.politicspa.com/democrats-use-ultrasound-bill-as-rallying-cry/32284/

5. Threats to Abortion Rights. National Abortion Federation. Retrieved from http://www.prochoice.org/policy/states/biased_counseling.html

6. Rapp, K. (n.d.). Support the Women’s Right-to-Know Act (House Bill 1077). PA State Rep. Kathy Rapp. Retrieved from http://www.reprapp.com/womenrtk.aspx

7. Ultrasound Imaging. (2012, June 6). US Food and Drug Administration. Retrieved from http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/ucm115357.htm

8. PA Abortion Control Act. (2013). Planned Parenthood. Retrieved from http://www.plannedparenthood.org/ppsp/pa-abortion-control-act-18387.htm

9. PAMED (2012, April 27). Your Voices Helped Delay Vote on Controversial Ultrasound Bill - Pennsylvania Medical Society. Pennsylvania Medical Society. Retrieved from http://www.pamedsoc.org/MainMenuCategories/Government/NewsfromHarrisburg/Womens-Right-to-Know.html

WIKIPEDIA / GRAPHIC

Conservative Pennsylvania State Representative Kathy Rapp introduced WRTKA in 2012 even though it vio-lates Roe v. Wade.

absent. Clearly the terms “invasive” and “non-med-ical” have not reached the ears of policy makers. Ev-ery conservative measure is being taken to strip Roe v. Wade from the life changing impact it had for all women. Forty years later, the fight continues.

into agreeing with the government’s medical opinion strips her status as a citizen capable of making an in-formed decision.

HER FIGHT

The search for a genuine debate begins again. Poli-cymakers hassle over morals or feminism, and re-inforce their arguments by quoting the basic rights of every human being. The real discussion about restricting access to abortion and what it means is


Artificial Intelligencein Medicine

BY INDU SUBBARAJ

CLINICAL

Tools of evidence based medicine are changing how medicine is practiced

If you have visited Student Health recently, you may have noticed that the doctor looked up your symptoms on a computer before giving you a diagnosis or treatment

recommendations. Such practice is an example of evidence-based medicine, a method that uses statistical analysis of medical data to reach fact-based conclusions, as compared to the older method of using intuition or personal observations.1 This concept is the foundation of many professions, including finance and marketing, but is a relatively novel concept in medicine. A surprising pioneer in the rule-based reasoning approach to medicine is WolframAlpha, a computational service known primarily for its purely mathematical calculations. In May 2011, WolframAlpha extended its realm to provide a reference tool for medical ailments.2 It has compiled survey data from the Centers for Disease Control and Prevention to provide an easy resource to identify not only symptoms that correlate with a disease but also statistics that provide users with a likelihood of having the illness, based on gender, race and age as well as a statistical breakdown of the usage of relevant drugs.2 This service only scratches the surface of tools that have been and continue to be developed to help doctors make diagnoses.

ORIGINS OF EVIDENCE-BASED MEDICINE

The advent of WolframAlpha’s resource is a snapshot of evidence-based medicine, an idea that has been around since its conception in 1972 but officially named only in 1992 by Dr. Gordon Guyatt.1 Evidence-based medicine has become increasingly widespread and technological tools known as decision support systems have played a large role in its implementation. These tools are designed to aid doctors in diagnosis. Many of the systems serve the basic purpose of providing access to a compilation of organized data that aids rule-based reasoning. However, extensive research per-sists with the aim of creating systems that not only provide a da-tabase but also analyze the data to produce predictions and sug-gestions. This application of artificial intelligence in medicine has gained momentum since the 1970s and according to Dr. Edward Shortliffe is “closely tied to the psychology and the modeling of logical processes by computers.”3 While the research and concep-tual validity of the systems are exciting, there has been much delay and controversy surrounding their implementation in clinical set-tings, primarily due to the hesitation and skepticism of physicians.

BASICS OF EVIDENCE-BASED METHODS Decision support systems rely on the data mining of knowledge bases, or stores of data, to create frameworks of information.4 Some of the applications that have been developed use only this descriptive model, based on a fixed data set, and are much like the WolframAlpha diagnosis application in providing an analysis of large amounts of data.3 Another type of application that is based on a descriptive model provides a statistical analysis about the steps to take after a diagnosis is made, rather than the diagnosis itself. Both of these are forms of rule-based reasoning; they pro-vide results based on “if-then” comparisons by using knowledge from the past to make conclusions about the problem at hand.5

An extension of these basic support systems is the promising development of artificial intelligence (AI) predictive diagnostic tools. Dr. Shortliffe calls such AI developments in medicine “ex-pert systems,” programs that, given data, can analyze and reach conclusions in a way similar to the reasoning process of human experts in the field.3 These intelligent decision support systems (IDSSs) have the ability to detect patterns and make deductions from the original data. They are built using a combination of data mining and artificial neural networks (ANNs). ANNs are “math-ematical models that simulate the structure and functional as-pects of biological neural networks;” they are the portion of the IDSS that allows learning and analysis.4 ANNs are com-prised of numerous con-nected processors that mimic neurons in the hu-man brain. The key com-ponent of an IDSS model is training the ANN. As-sociation rules are first applied to past cases to produce more general rules. These rules are the first pieces of information loaded into an artificial neural network in order to train it. The ANN can then analyze and make conclusions when presented with a problem, based only on the connections established from the given data. As the ANN is used more, it grows and learns, much like a human brain.5 The value of an IDSS lies in its ability to produce conclusions across knowledge domains, without external supervision.5

The value of an Intelligent Decision Support System lies in its ability to produce conclusions across knowl-edge domains, without external supervision.


CONTROVERSY SURROUNDING EVIDENCE-BASED MEDICINE When decision support systems and evidence-based medicine were first introduced, skepticism was high among doctors.6 They perceived the mathematical and technical basis of such an entity as intrusive and believed that it restrained the creativ-ity and versatility of their profession.6 These critiques stemmed from the notion that medicine is an art requiring years of prac-tice and one that is constantly evolving; many doctors were worried that introducing such mechanical systems would dis-courage innovation and result in “cookbook medicine.”6 Such an atmosphere would be especially harmful in situations with minimal past evidence since these systems base decisions on previous experience and trials.

Since the mathematical basis of these systems is beyond the realm of expertise of most physicians that would potentially use it, it has proven hard to convince them of the tools’ validity. Doctors have raised concerns on the limitations and accuracy of the approach, regardless of the amount of data. Moreover, due to unfamiliarity with these machines and the associated ev-idence-based approach, doctors would need to learn new skills and modify their practice; this proved to be an annoyance to many of them. 7

Although the level of acceptance by the medical community has increased over time due to advancing technology and a greater understanding of that technology, roadblocks still exist today, including legal and accuracy issues. Malpractice suits are an intricate legal problem even when they don’t involve man ver-sus machine scenarios. Introducing these systems further com-plicates the issue of legally classifying malpractice as a fault of the physician or a liability associated with using a machine.8 As always, evaluating the accuracy of the more complex support systems, like IDSSs, is very difficult as there is rarely a consen-sus of opinions, even among human experts. This issue reflects the core of the problem: medicine is not an exact science, un-like other fields that apply statistical analysis. Therefore, using mathematically based guidelines to make decisions in medicine seems counterintuitive to many physicians.

For example, consider the case of Dr. Daniel Merenstein, a fam-ily doctor who was medically trained in evidence-based medi-cine. In 1999, a healthy man over 50 years of age approached him for the possibility of a blood test to check for prostrate-specific antigen. This test has the potential to identify whether the patient has prostrate cancer. Dr. Merenstein compared the

advantages to the disadvantages of taking the test, including the arduous process of biopsies and further treatment the patient would potentially have had to endure. He told the patient that there was no statistical evidence that early detection of an ag-gressive form of prostrate cancer improved a patient’s chance of survival, and conversely, that early detection might simply reveal a very slow-growing cancer that required no treatment at all. The patient did not take the test. Unfortunately, several years later, it was discovered the patient had an aggressive and untreatable form of prostrate cancer and Dr. Merenstein was embroiled in a lawsuit. While Dr. Merenstein himself wasn’t deemed respon-sible, the residency program he trained at was and fined $1 mil-lion.9

An encouraging example of evidence-based medicine can be found in the prescription of anti-arrhythmia drugs to patients experiencing irregular heartbeats after a heart attack. Histori-cally, these drugs had been administered to all patients experi-encing the symptom, regardless of the severity. The aggregation and analysis of a large amount of data from randomized trials indicated that giving the drugs to patients with mild arrhythmia actually increases their risk of death. This evidence changed the practice of administering these drugs, thereby saving countless lives.9

Certainly, the controversy surrounding this new practice of med-icine and its associated tools is not without reason. Both sides have a case, and arguably, the only way to move forward is to agree on the approach that would best help patients. Over time, an increasing number of physicians have realized the potential benefits of these systems in aiding diagnosis. Moreover, as pa-tients become more informed about their illnesses using the in-ternet and tools such as WolframAlpha, they too will begin pos-ing questions in the dialogue. This added opinion will certainly fuel the debate, and it is an important opinion to consider: would you, as a patient, want doctors evaluating you on this mathemati-cal basis or not?

References:

1. Belsey, J., & Snell, T. (2009). What is evidence-based medicine?. Bandolier, Retrieved from http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/ebm.pdf

2. Morrison, T. (2011, May 24). [Web log message]. Retrieved from http://blog.wolframalpha.com/2011/05/24/new-medical-tools-to-explore-yoursymptoms/

3. Shortliffe, E. (1987). Computer systems to support clinical decision making. Journal of the American Medicine Association, 258, 61-66. Retrieved from http://bmir.stanford.edu/file_asset/index.php/768/BMIR-0181.pdf

4. Basu, R., Archer, N., & Mukherjee, B. (2012). Intelligent decision support in healthcare. Analytics, 33-45. Retrieved from http://www.analytics magazine.org/januaryfebruary-2012/intelligent-decision-support-in-healthcare

5. Khan, C. (1993). Artificial intelligence in radiology: Intelligence support systems. Manuscript submitted for publication, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, .

6. Timmermans, S., & Mauck, A. (2005). The promises and pitfalls of evidence-based medicine. HealthAffairs, 24 (1), 18-28. doi: 10.1377/hlthaff.24.1.18 Health Aff January 2005 vol. 24 no. 1 28

7. Ghali, W., Saitz, R., Sargious, P., & Hershman, W. (1999). Evidence-based medicine and the real world: understanding the controversy. Journal of Evaluation in Clinical Practice, 5(2), 133-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10471221

8. Greenberg M, Ridgely M. Clinical Decision Support and Malpractice Risk. JAMA. 2011;306(1):90-91. doi:10.1001/jama.2011.929.

9. Gorman, C. (2007, Feb 15). Are doctors just playing hunches?. Time Magazine, Retrieved from http://www.time.com/time/magazine/article/0,9171,1590448-1,00.html

Since the mathematical basis of these sys-tems is beyond the realm of expertise of most physicians that would potentially use it, it has proven hard to convince them of the tools’ validity.


Imagine a system where vaccines could be developed almost immediately for every new virus. Imagine if it only required an immunologist to make a simple search through a database to generate

the framework for an entirely new vaccine. The vaccine would then be tested and approved by a computer simulation of the immune system. No lab experiments, no trials, and no costly procedures. The field of immunoinformatics, a new discipline that compiles viral genetic data into many databases, offers an easier, financially feasible way to develop vaccines.

Vaccines have been developed and manufactured for much the same way since 1796, when Edward Jenner developed the first vaccine to prevent small pox.1 While vaccines have advanced immensely since then, there are still many problems that have arisen over the years. Pathogen mutation has made it very difficult for vaccines to stay effective.2 Once a pathogen mutates, the immune system must generate a new adaptive response. The only way to develop immunity to this newly mutated pathogen would be through a new vaccine.

ImmunoinformaticsA new approach to vaccine development

By Farrah Alkaheel

AR

JUN

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YAM

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Vaccines work by tricking the body into producing antibodies that bind to a specific protein on the surface of a pathogen. The proteins that antibodies bind to, often called epitopes, allow for the immune system to recognize and kill the pathogen.3 Therefore, scientists must map epitopes to develop vaccines. But the process is fraught with challenges such as laboratory analysis of pathogen gene products to map epitopes and experimental techniques that are both expensive and time-consuming.

As immunologists continue to tackle these problems, researchers have begun utilizing immunoinformatic tools for the development of relevant vaccines.

“Through the use of whole genome sequencing or exome sequencing, tumor specific mutations can be identified for each patient,” says Dr. Carl June, a leading researcher in immunotherapy at the University of Pennsylvania Perelman School of Medicine.4

According to Dr. June, these mutations are plugged into algorithms to predict whether the mutant peptides will bind to the patient’s HLA alleles. Then based on this information, a set of peptides can be produced and used as a patient specific cancer vaccine.

Immunoinformatic tools can also be used to test the effectiveness of vaccines. Recently,

References

1. History.com. (n.d.). Jenner tests smallpox vaccine — History.com This

day in history — 5/14/1796. History.com — History made every day —

American & World History. Retrieved March 31, 2013, from http://www.

history.com/this-day-in-history/jenner-tests-smallpox-vaccine

2. Korber, B., Montiago, L., & Yusim, K. (2006). Immunoinformatics

comes of age. PLoS Computational Biology, 2(6), e71. Retrieved

March 8, 2013, from http://www.ploscompbiol.org/article/

info%3Adoi%2F10.1371%2Fjournal.pcbi.0020071

3. Hendry, C., Farley, A., McLafferty, E., & Johnstone, C. (2013). Function of

the immune system. Nursing Standard, 27, 35-42. Retrieved March 8,

2013, from http://www.ncbi.nlm.nih.gov/pubmed/23427625

4. June, C. (2013, March 28). Email interview.

5. Tomar, N., & De, R. (2010). Immunoinformatics: an integrated scenario.

Immunology, 131(2), 153-168. Retrieved February 12, 2013, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967261/

6. Weiner, D. (2013, March 28). Email interview.

“Recently, computer algorithims have been developed to virtually simulate healthy immune systems.These algorithms could be used to conduct experiments by interpreting interactions between the different immune cells.”

computer algorithms have been developed to simulate healthy immune systems. These algorithms are able to conduct experiments by interpreting interactions between the different immune cells. In silico- as opposed to in vivo or in vitro- vaccination can then be conducted in these virtual immune systems and progress could be monitored for the effectiveness of the vaccine.5

However, “it’s too early to determine their value,” says Dr. David Weiner, Chair of Gene Therapy and Vaccine Program at the University of Pennsylvania Perelman School of Medicine.6 Such databases for immune system modeling are still in their infancy and more research needs to be conducted to know for sure.

Today, major uses of immunoinformatics are limited to epitope predictions, immune target selection and antigen design, according to Dr. Weiner.6 In the future, immunoinformatic tools could help test for potential drugs. By using a virtual immune system, cellular responses could be observed when the drug is administered in silico-. Further, more accurate immune responses could be predicted for certain drugs by personalizing the immune system model based on gender and age.6

Ultimately, immunoinformatics offers an exciting new method to approach vaccines, infectious diseases, and drug development.


A Simple

Paper TestBetter Medical Diagnostics in Developing Nations

Yet another episode of coughing had started. Jean stepped away from his work as his weak body shook with each gasping breath. Though these

sudden fits had now become a part of his daily routine, this time was different. His throat burned, his body ached, and his worn hands were now covered in blood.

Jean Dubuisson is a farmer living in a small village in central Haiti with his wife and children. Despite months of coughing fits and fevers, he did not seek medical care. After all, there was no clinic in his hometown and the closest medical facility was too far and too expensive. But once Jean started coughing blood, he knew that his con-dition was serious. He traveled to the closest clinic, where he was examined by a physician and given a prescription—a bottle of multivitamins.

As his condition continued to worsen, Jean went to another medical facility. It was there that he was finally diagnosed with the source of his symptoms, tuberculosis (TB). He was soon admitted into a rigor-ous TB treatment program, and in just a few months, he was cured of TB. Yet the disease’s year-long crusade on Jean’s body had left permanent scars. Though “cured,” Jean’s lungs were severely damaged, and he would always have difficulty breathing.1

Jean is one of many victims of poor medi-cal diagnostics. Although much of global health discourse has focused on treatment, the first step in any medical procedure is identifying the disease. Many developing countries such as Haiti lack adequate testing laboratories. In most of these regions, 38 percent of the population subsists on $1 a day, and the gross na-tional income per capita is $500 per year.2 As a result, healthcare budgets are often so preoccupied with costs of maintaining basic medical facilities and staff that sup-porting high-tech, costly testing facilities is not practical.

However, the availability of quality laboratory testing is crucial in the diagnosis of infectious diseases. Without

these resources, many clinics rely on educated guesses based on vague symptoms, which often results in mis-diagnosis. In a study conducted at a medical center in Kumasi, Ghana, 40 percent of patients who had been diagnosed with malaria were confirmed by lab results to actually have bacterial sepsis, a type of bacterial infection.3 Similarly, in Nigeria, half of the patients across several medical facilities were misdiagnosed with typhoid fever in the absence of laboratory tests.4 In this way, misdiagnosis can result in delay or failure to treat life-threatening illnesses.5

So how can low-cost, accessible healthcare diagnostic tools be provided? The most recent approach to this

problem has been “point-of care” diagnostics—bringing the lab to the patient. Although new technolo-gies such as all-inclusive lab kits and palm-held microscopes allow for portable on-site testing, they often cost up to thousands of dollars and require extensive training for use.6 Instead of taking this reductionist approach, Dr. George Whitesides, a chemist and professor at Harvard University, has proposed to start simple. How simple? Let’s start with a piece of paper.

Taking advantage of many useful properties of paper, Dr. Whitesides

has developed a small postage stamp sized sheet of pa-per that can test for a range of diseases including ma-laria, TB, and HIV. Furthermore, physicians, nurses, and aid workers can easily use this diagnostic method. A drop of blood or urine on this paper chip causes a rapid change in coloration and reveals a wealth of medical data. Then, by using a mobile device, a photo of this chip is taken and sent to a central database, which instantly interprets the data and returns the re-sults.7

Why paper? First of all, paper is cheap and abundant.

BY SHABNAM ELAHI

A drop of blood or urine on this paper chip causes a

rapid change in coloration and reveals a wealth of medical

data. Then, by using a mobile device, a photo of this chip

is taken and sent to a central database, which instantly in-terprets the data and returns

the results.

ELLEN KIM / GRAPHIC


The chip can be easily produced from napkins, toilet paper, or any other paper derivative. And while most blood tests in-volve needles and test tubes, which are difficult to dispose of, these paper chips can simply be burned.7 Most importantly, paper is naturally able to soak up and move fluids.

Dr. Whitesides’ paper-based model relies on two simple com-ponents: a sample to be tested and a reagent that changes col-or in response to the sample. Using this idea, Dr. Whitesides has developed many varieties of the paper test. The most ba-sic model is the 1D lateral flow prototype. The 1D model is comprised of a single sheet of paper on which a printed wax-outlined channel system directs the fluid to different testing zones, tiny areas on the sheet containing reagents that can change color. For instance, a drop of blood at one end of the sheet can rapidly wick and diverge into separate channels, each leading to different testing zones.

A more extensive 3D model, which can test for thousands of factors, has also been developed. This model is composed of alternating layers of wax-patterned paper and adhesive tape. The channels are etched across each sheet just as in the 1D model, but they also move vertically into adjacent sheets via pores in the adhesive tape that separate the layers. Thus, a sample that is added to the topside of the test will travel through separate channels that direct the fluid across the lay-ered sheets and into certain test zones at the bottom layer of the chip.8

The wax-patterned paper used in the 1D and 3D models can be produced by running paper through a solid wax printer, which imprints a specific waxed design using black wax as

the toner. While the wax printer itself costs $800, a single print-er can produce 10 million tests per year, at a low cost of 0.1 cents per chip. Despite the low cost, however, some aspects of the production process still need to make the transition from laboratory to industry. In more complicated systems like the 3D model, the sheets and tape still require manual layering. Furthermore, in both models, the reagents must be added by hand via pipettes to the different test zones.

Dr. Whitesides’ work in paper diagnostics has inspired him to start the nonprofit organization, Diagnostics For All (DFA). The organization focuses on efficient, low-cost paper testing for application in areas such as liver function, child nutrition, and agriculture. With a $10 million grant from the Bill and Me-linda Gates Foundation, DFA has developed a liver function test and in March 2012, the organization began its first series of clinical trials with this test in Ho Chi Minh City, Vietnam.8 The results of these clinical trials will determine when these paper tests can be readily used in developing countries.

Liver function is important to monitor, as extensive antiret-roviral therapies and the overmedication of TB drugs can be extremely toxic to the liver. Dr. Whitesides’ liver function test is an example of a 3D paper test that conducts three impor-tant assays: AST (aspartate transaminase), ALP (alkaline phos-phatase), and total serum protein. As an example, AST is an enzyme released when liver cells break down. With a simple finger prick, a drop of blood is applied to the top of the paper chip. As the blood spreads across the top sheet, red and white blood cells are filtered out so that only plasma can flow into the channels leading to the AST test zone, as well as the two other test zones. In order to assess the levels of AST, the AST test zone contains cysteine sulfonic acid. AST binds to and re-acts with cysteine sulfonic acid to produce sulfite ions. Since the test zones contain methyl blue printed over pink test wells, they are purple under standard conditions. However, once the methyl blue reacts with sulfite ions, it becomes colorless; this transforms the test wells from a deep purple to a pink hue.7 Therefore, if the test wells were transformed to a pink hue, this would signify that liver cells were breaking down.

For now, Diagnostics For All is relying on grants from non-profit organizations such as the Bill and Melinda Gates Foun-dation to develop its different paper tests. However, the organi-zation hopes to someday establish its own independent source of revenue in order to continue developing low-cost diagnostic tools. Some future commercialized products include paper tests for athletes in which a drop of sweat can determine their electrolyte levels and simple over-the-counter cholesterol fin-gerprint tests.7

Without doubt, misdiagnosis and a lack of adequate laboratory testing are two of the major challenges in addressing global health issues. While paper-based microfluidic devices have been successful in testing for a variety of diseases and indica-tors, they are not without limitations. For instance, testing for viruses often involves DNA replication and cycles of repeated heating and cooling, both of which are beyond the capabilities of paper tests. Furthermore, many argue that the underlying

A representation of the 1D lateral flow prototype shows the different channels along which a sample could diverge.

MEGAN FALLS/GRAPHIC


References:

1. Farmer, Paul. The Consumption of the Poor. Boston, USA: SAGE Publications, 2000. 184-212. Print.

2. UNICEF. Monitoring and statistics. Available at: http://www.unicef.org/statistics. Accessed 22 January 2005.

3. Evans JA, Adusei A, Timmann C, et al. High mortality of infant bacteraemia clinically in- distinguishable from severe malaria. QJM 2004; 97:591–7.

4. Ngwu BA, Agbo JA. Typhoid fever: clinical diagnosis versus laboratory confirmation. Niger J Med 2003; 12:187–92.

5. Petti, Cathy A. “Laboratory Medicine in Africa: A Barrier to Effective Health Care.” Laboratory Medicine in Africa . (2006): n. page. Print.

6. McNEIL Jr., Donald. “Far From Any Lab, Paper Bits Find Illness.” New York Times. 26 Sep 2011

7. George Whitesides: A lab the size of a postage stamp. Film. 15 Feb 2013. http://www.ted.com/talks/george_whitesides_a_lab_the_size_of_a_postage_stamp.htm

8. Martinez, Andrew, Phillips, Schott, and Whitesides, George. “Three-Dimensional microfluidic devises fabricated in layered oaoer and tape” PNAS (2008): 105: 19606-19611

health care systems and infrastructure of developing coun-tries cannot be sustained by pieces of paper. While there is much work to be done in reducing the global disparities in medical diagnostics, Dr. Whitesides has taken the first step in an entirely new direction by demonstrating that complex issues do not always require complex solutions.

TECHNOLOGY

BY PETER BITTAR

While research has yet to find a definitive cure for blindness, promising new technology offers patients a chance to see again

BIONIC EYESSeeing into the Future of Blindness

For 20 years, Barbara Campbell was blind. Today, she can locate her bus stop, see the light from her apartment building, and even

watch Rod Stewart perform on stage, all thanks to a retinal implant. Ms. Campbell, along with 100,000 Americans like her, has retinitis pigmentosa, a condition in which a person’s retinal cells progressively deteriorate until he or she cannot see at all. Yet, with the FDA’s recent approval of retinal implants, developments in medical devices promise to alleviate Ms. Campbell’s condition as well as other retinal diseases.1

THE SCIENCE OF RESTORING VISION

With at least 1.3 million legally blind people in the United States, correcting visual impairment is a great challenge in medical science.2 The causes of blindness are diverse; it can occur when any part of the optical pathway is impaired.3 In a healthy eye, light first passes through the cornea—the outer layer of the eye— before being focused by the lens onto the retina. Within the retina, photoreceptors are activated by light and stimulate the optic nerve. The optic nerve then transmits electrical signals to the brain where an image can be formed thereby

BIRUK BEKELE/GRAPHIC


“How happy that made me. Not only to see the sillhouette of my son, but to hear that voice coming and saying, “Yea it’s me, Dad. I’m here and I love you.” — Argus II trial patient

completing vision. Of particular interest to the medical field is blindness caused by damage to the retina, which accounts for 50 percent of all blindness cases.3 Retinal impairment can be caused by diseases such as retinitis pigmentosa or a similar condition known as age related macular degeneration. In both of these diseases, patients experience a loss of photoreceptors, the main light-detecting cells. Consequently, their vision is severely impaired or even non-existent in advanced stages of the diseases.4 Due to the proliferation of these kinds of retinal conditions, there has recently been a push to develop corrective devices to combat these diseases. One of the leading advancements in the field is retinal prostheses, i.e. bionic eyes, which are able to aid a dying retina and restore sight to the blind.

In the last few decades, scientists have developed a variety of medical devices to serve in place of damaged or destroyed body tissues, from pacemakers for those with heart conditions to cochlear implants for the hearing impaired. In a similar fashion, retinal implants were developed to replace or assist retinal cells damaged by retinitis pigmentosa or macular degeneration. Two kinds of retinal implants are currently under development: subretinal and epiretinal implants. In subretinal implants, a thin plate (50-100μm) with thousands of light sensitive diodes is placed under the retina.4 When light strikes the eye, the photodiodes act as synthetic photoreceptors in order to generate a current that is transferred to electrodes that stimulate remaining retinal cells. On the other hand, epiretinal implants are not directly stimulated by light. Instead, they are activated by an external camera, either worn on a pair of glasses or embedded in the lens of the eye, which sends a signal to an array of electrodes on top of the retina. The electrode array then directly activates the optic nerve and sends a signal to the brain.3

PRACTICALITY AND PRICE The question that remains is whether these implants can feasibly work. As of the time of this writing, while a handful of subretinal implants are currently in development, none have yet been approved for sale. One epiretinal implant, however, has enjoyed a little more success. In March 2011, after 20 years of development, the Argus II® epiretinal prosthesis developed by Second Sight Medical Products won EU approval for sale in the European Economic Area and became the first retinal prosthesis available on the world market.5 More recently, the FDA approved the Argus II for sale in the United States on February 14, 2013.1 The device only has a resolution of 60 pixels, one-hundredth of the pixels of a TI-83 calculator, but phase 2 clinical trials have shown that out of thirty subjects with severe retinal degeneration, 96% of subjects were able to localize objects such as utensils on a table and 57% were able to discriminate motion.6 After the four hour surgery needed for implantation, some patients could identify large numbers or even read large print words. According to Dr. William Maisel, chief scientist at the FDA’s Center for

Devices and Radiological Health, for the 1300 individuals who will develop retinitis pigmentosa each year, the device is the “difference between night and day.”

One member of the study spoke of his 17 year old son. “How happy that made me,” he said. “Not only to see the silhouette of my son, but to hear that voice coming and saying, ‘Yeah, it’s me, Dad. I’m here and I love you’.”7

Still, these results do not come without a price tag. In Europe, where the implants are already on the market, the device costs about $100,000 and the surgery itself costs $16,000.8 The US version of the device will likely cost upwards of $150,000. However, the Second Sight team is optimistic that US insurers will cover the cost of the device.1

According to Dr. Amanda Starc, Assistant Professor of Health Care Management at the University of Pennsylvania, it is likely that the prosthesis would be covered by Medicare Part A since it requires an inpatient procedure. Whether private insurers would cover the device, however, is more ambiguous. Still, they should be apt to pay for the procedure given that the number of patients receiving the treatment is not very large.9

Moreover, there could be health risks associated with the procedure as well. Of the 30 patients in the Argus II clinical trial, 11 experienced negative effects, some as severe as retinal detachment and erosion of the cornea (the clear outer covering of the eye). To address these concerns, the team has made many substantial device modifications, and even with all the potential risks, the FDA advisory panel still unanimously voted to recommend approval, judging that the benefits of the prosthesis outweighed its risks.1 The costs may seem steep, but for those like Ms. Campbell, the benefits can truly be life changing.

LOOKING FORWARD Although the retinal implant is a huge breakthrough in mitigating blindness, it is not the final frontier for retinal prostheses. The team behind the Argus II is working on implants with hundreds of electrodes that could provide enough visual data to enable patients to recognize faces and read large print. They are also developing a video camera that could be installed inside an artificial lens to remove


the need for an external camera as well as use the eye’s normal movements.10 Aside from the Second Sight team, a group at MIT led by Dr. John Wyatt is developing a system that could have 400 electrodes - a significant improvement over the Argus II’s 60 electrode device. Additionally, a team headed by Dr. Daniel Palanker at Stanford University has proposed testing a subretinal implant consisting of a collection of 5000 photovoltaic cells. These wireless cells would be stimulated by pulses of infrared light from a glasses-mounted detector, but more importantly, the device could theoretically yield a resolution that is ten times better than that of other devices. Palanker’s team hopes to begin clinical trials in France in the next year.11, 12

Bionic eyes are set to make their American debut over the next couple of years with the Argus II system. With promising projects occurring worldwide, curing blindness no longer seems to be a science fiction fantasy. Within the next few decades, we may be able to achieve resolutions that are able to emulate normal sight and work with the eye’s natural mechanisms to essentially cure blindness for thousands of Americans and millions elsewhere in the world. It is feasible that one day, retinal prostheses may be as common as pacemakers and cochlear implants, making blindness a thing of the past.

In the Argus II system, an epiretinal implant is placed on the inner layer of the retina. An external camera attached to a pair of glasses transmits image information to the implant. Once the implant receives an image, it functions like a photoreceptor and stimulates retinal ganglion cells that form the optic nerve.

References

1. Belluck, P. (2013, February 14). Device Offers Partial Vision for the

Blind. New York Times.

2. Nuckols, B. (2009, March 26). Fewer than 10% of legally blind

Americans read Braille. USA Today.

3. Zrenner, E. (2002, February 8). Will Retinal Implants Restore Vision.

Science, 295(5557), 1022-1025.

4. Hossain, P., Seetho, I. W., Browning, A. C., & Amoaku, W. (2005,

January 1). Science, Medicine, and the Future: Artificial Means for

Restoring Vision. British Medical Journal, 330(7481), 30-33.

5. Second Sight. (2012, October 1). FDA Panel Recommends FDA

Approval for Second Sight’s Argus II Retinal Prosthesis System.

Retrieved February 12, 2013, from Second Sight: http://2-sight.eu/

landing-spot-fda-panel

6. Humayun, M. (2012, April). Interim results from the international trial

of Second Sight’s visual prosthesis. Opthamology, 119(4), 779-788.

doi:10.1016/j.ophtha.2011.09.028.

7. Reinberg, S. (2013, February 14). FDA Approves ‘Bionic Eye’ to Help

Against Rare Vision Disorder. US News and World Report.

8. Sifferlin, A. (2013, February 15). FDA Approves First Bionic Eye. Time.

com.

9. Starc, A. (2013, February 27). (P. Bittar, Interviewer)

10. Wickelgren, I. (2006, May 26). A Vision for the Blind. Science,

312(5777), 1124-1126.

11. Palanker, D. (n.d.). Restoration of Sight to the Blind. Retrieved

February 21, 2013, from Daniel Palanker Lab Page: http://www.

stanford.edu/~palanker/lab/retinalpros.html

12. Santini, J.-L. (2013, February 6). Bionic eye gives hope to the blind.

AFP. Retrieved from http://www.google.com/hostednews/afp/

article/ALeqM5jsEbMsFV4St6ETctGQzBDV4kALXA?docId=CNG.2976

27187ac691191764bcf1ddcc7aea.2e1

Photoreceptors in the

retina are activated by

the light stimulating the

optic nerve.

Light passes

through the cornea and

reaches the lens where it

is focused onto the retina.

The pupil controls how

much light enters the eye.

The optic nerve transmits

electrical signals to the

brain where they are

interpreted and vision

is achieved.

The Process of Vision

50 percent of blindess

cases are caused by

damage to the retina

but the development

of retinal implants

provides hope for

these patients.

BIRUK BEKELE/GRAPHICS


DNA has always been used to store data—genetic data, that is. The color of your eyes, the shape of your nose, and the size of your feet are all determined by the DNA you inherited from your parents. But what about other forms

of data, such as books, movies, and music? Since the technology revolution, there has been an unending search for better forms of data storage—ones that are greater in capacity and smaller in physical size. Could this search end with a tiny biological molecule that already exists within all of us?

The structure of DNA has continually evolved through time, having been used for over three billion years as the genetic code in all life forms. DNA is composed of four basic units: the nucleotide bases adenine, guanine, cytosine, and thymine. Characterized by a double helix structure, DNA strands are wound and packaged into chromosomes that are stored in the nucleus of each cell. Certain specialized proteins make copies of DNA through a replication process, while others transcribe DNA into RNA, which in turn can be translated into the wide array of proteins in the body.

The New Double-Helical Hard DriveUsing DNA to store more than just genetic information

. . . . . . |B|i|n|a|r|y| text file. . . . . . .. . . . . . 100111010011110101011101001. . . . . .

. . . . . .|01110|21012|20100|12212|01102|01100|. . . . .

. . . . . .|GATCA|TGCAT|GGCCC|ATTGA|TCTTA|GAGTT|. . . . .

. . .

1. Binary/text file

2. Base-3 encoded

3. DNA-encoded

4. DNA fragments

Alternate fragments have

reverse complemented

file information

BY LUCY CHEN

ELLEN KIM/GRAPHIC


“I have a dream...”

“To be or not to be,

that is the question...”

DNA effectively serves as the hard drive for each cell, storing all the genetic information necessary for it to function correctly. Scientists have noted parallels between the way genetic information is stored in DNA and the way digital data is stored in binary code, which uses 0s and 1s to encode information. For example, each letter you read on this page is stored on a hard drive in binary code as a string of eight numbers.

Now scientists are looking into storing digital data in physical strands of DNA, as opposed to hard drives. As published in a Nature study in February, researchers from the European Bioinformatics Institute in England have created a novel method to use DNA as an accurate, practical method of data storage.1 These researchers successfully translated binary code into a sequence of DNA bases that can be artificially synthesized and stored in a test tube. While there have been other attempts at using DNA to store data—most notably by a group of Harvard researchers led by geneticist George Church last Fall—this study stored a record amount of data by developing a method of data translation that dramatically reduces the number of errors, an issue that had plagued previous experiments. 2

In this storage method, each DNA base represents an eight-number string of 1s or 0s from binary code. For example, the letter “H” would be encoded in DNA as bases GTGTA. Binary code is first translated into ternary code, which uses 0, 1, and 2. This ternary code is then translated into DNA bases. The latter step is dynamic, meaning that the identity of each base depends on the previous bases. This helps ensure that there are no strings of multiple identical DNA bases, which in turn serves to decrease the error rate during the synthesizing process. The string of DNA bases is then created in chunks, each with information about its location in the larger string. As a further precaution, each base is actually encoded in four different chunks to provide extra copies in case of errors. The effectiveness of this method was tested using a DNA sequencing machine, which reads the newly created DNA and can confirm that the intended sequence was in fact accurately synthesized.

Though researchers are satisfied with the scientific methodology of storing data in strands of DNA, the actual implications for digital data storage are still unclear. Using DNA to store data has clear benefits in that it can store a lot of information in a very small space. Currently, there is estimated to be three billion trillion bytes of digital data in the world, which if stored in DNA, could all fit in the back of a pickup truck.3 In addition, DNA lasts for a very long time, as proven by our use of fossils to determine the genetic makeup of animals that have long been extinct.

However, there are several challenges to using DNA as a data storage medium for everyday use. Ideally, DNA should be stored in a cold, dry, dark space. In addition, DNA sequencing, the method by which the DNA data can be read, can take up to three weeks. Moreover, at an estimated $12,400 per megabyte, the process is expensive and can only be carried out in specialized labs. It is worth noting however, that the price of DNA sequencing has dropped one-hundred-fold in the last decade, and further price drops would certainly make using DNA to store data more feasible.

Although it is unrealistic to think that DNA would ever replace your laptop’s hard drive, there are still applications of DNA data storage worth considering. Scientists recommend using DNA for storing data that needs to be kept long-term, namely, over 50 years. This could be especially useful for government records and archival data that would need to be kept safe for a long time and that does not need to be accessed frequently. Undoubtedly, more research needs to be done to make the process simpler. For now though, DNA has been used to store all 154 Shakespeare sonnets, an MP3 of Martin Luther King Jr.’s “I Have a Dream” speech, and Francis Crick and James Watson’s paper on the double helical nature of DNA—along with the code itself that the researchers used to convert bytes to bases.

Currently, there is estimated to be three billion trillion bytes of digital data in the world, which if stored in DNA, could all fit in the back of a pickup truck.

References:

1. Goldman, N., Bertone, P., Chen, S.,

Dessimoz, C., LeProust, E. M., Sipos,

B., & Birney, E. (2013). Towards

practical, high-capacity, low-

maintenance information storage

in synthesized DNA. Nature. http://

www.nature.com/nature/journal/

vaop/ncurrent/full/nature11875.

html?WT.ec_d=NATURE-20130124

2. Sample, I. (2013, January 23).

Shakespeare and Martin Luther

King demonstratepotential of

DNA storage. (Guardian News and

Media Limited) Retrieved February

1, 2013, from The Guardian: http://

www.guardian.co.uk/science/2013/

jan/23/shakespeare-sonnets-

encoded-dna

3. Test-tube data. (2013, January 26).

(The Economist Newspaper

Limited) Retrieved March 1, 2013,

from The Economist: http://www.

economist.com/news/science-

and-chnology/21570671-archives-

could-last-thousands-years-when-

stored-dna-instead-magnetic

ELL

EN

KIM

/GR

AP

HIC


Cancer is not just one disease. Instead it refers to the range of possible cancers, each of which progresses differently and responds to treatment in distinctive

ways. Although we have varying levels of success in treating each type of cancer, a universal cure—especially one that does not involve surgery or chemotherapy—eludes us. When cancer spreads to the entire body in a process called metastasis, countless patients have no option beyond consigning their lives to a hospice. However, we are at a major turning point in the history of cancer medicine where we know enough about the disease and have also developed new technological advances that will allow us to treat all types of cancer more effectively. Right now, two major potential treatment options are on the horizon—immunotherapy, a treatment that has grown more refined, and the new “quadruple helix” inhibition. Yet there exist two key barriers that keep us from finding the universal end-game treatment for all cancers—a lack of both research funding and technological innovation. If we can surmount these economic and technological barriers, we may be well on an expedited path to a cure.

THE SCIENCE BEHIND CANCER

Cancer research took off in 1971, a time when researchers realized that the more we found out about cancer, the more complex it seemed to be.1 Humans are made up of thousands of DNA segments called genes, which control everything from producing digestive enzymes to letting cells know when to divide. When the DNA gets damaged, the error is called a mutation. Mutations happen spontaneously or can be caused from outside forces such as X-rays and chemicals. The culmination of these mutations can cause major disruptions in the gene. What drives the proliferation of cancer is the presence of mutations in two particular genes—oncogenes and tumor suppressors. Oncogenes are genes that have the potential to cause cancer but only when mutated; when mutated, these genes cause cells to proliferate beyond their normal lifespan. A tumor suppressor normally prevents a cell from proliferating, but when mutated, it cannot stop the cell from turning into a cancerous cell. A third factor, called miRNA, plays a role in cancer proliferation by changing which genes are expressed. There are also physiological complications to cancer. Each separate tumor houses a completely different genetic population of cells that becomes more heterogeneous as time goes on. A 2009 Cambridge University breast cancer study investigated the nuances of variation in cancer by mapping out the abundance of entire gene displacements.2 Not only do small DNA changes accumulate, but also entire gene-segment locations do. Because there is so much

BY KARTIK BHAMIDIPATI

variation in cancerous cells, it is hard to successfully target just one gene or one protein associated with cancer in any potential drug.3

POTENTIAL CURES

Amidst the web of complexity that is cancer, there lies a chance that we find a universal weakness. From all that we have discovered, we know that a personalized approach to treatment is required. With such genetic variability from person to person, it only makes sense to treat each patient as an isolated case. The most promising treatment as of late has been the concept of immunotherapy—using a body’s own antibodies, specifically killer T cells, to combat the foreign cancer. Dr. Carl June at the University of Pennsylvania is investigating this phenomenon with a $1.1 million research project to treat pancreatic cancer. The project uses engineered Chimera Antigen Receptor (CAR) T-cells that bind to cancer and proliferate to keep killing.4 Last year, he published astonishing results for a leukemia trial where a majority of patients remained leukemia-free even after two years. In addition, the treatment had almost no noticeable side effects, generating hope that a new and highly-effective treatment has been found.

A more recent technological development revolves around the four-stranded “quadruple helix” associated with cell replication. Quadruple helices are irregular four-stranded DNA in highly replicating cells. Researchers at the University of Cambridge have concluded that the peaks in appearance of the quadruple helix at the moment of replication indicate that it has an integral role in replication and cell division.2 The relationship between the quadruple helix and cell replication is important since the cause of and spread of cancer can largely be attributed to the rapid and abnormal division of cells. Oncogenes generally drive the uninhibited replication of cancer, and quadruple helices

“Anyone who runs a cost-benefit analysis of spending, if looked at through a purely objective lens, would not be able to justify spending so much on cancer research. But as a society, we have to look beyond that—we have to realize how incredible the payoff would be if we had a cure for a disease that has plagued us for decades.”

The Quest for a Cancer CureWe are close to a cure, yet technological and economic barriers keep us from it.

RESEARCH


have been shown to exist in abundance during the replication phase of DNA. The researchers have therefore put forward the hypothesis that by using synthetic molecules to isolate these quadruple helices, we could potentially stunt cancerous cell division. We already have antibody protein inhibitors for the helices. The challenge that remains is finding a way to target the helices only in cancer cells; by doing so, we can halt cancer cell division altogether. Exploration of this pathway has only recently begun, but we are well on our way to making significant breakthroughs in this area.

BARRIERS TO A CURE

We have the knowledge to win the battle—the only barrier is the lack of tools and resources. There exists a paradigm: we continue to pump more money into cancer research but cancer death rates have only decreased at an inverse rate, if at all. A frontrunner in his field, Dr. Ronald DePinho wants to challenge that assumption. He runs a lab at the MD Anderson Cancer Center in Houston, Texas, that is trying to launch a new war on cancer with a two-pronged approach—earlier detection in the short term and personalized genetic treatment in the long term. The problem is funding. According to Dr. DePinho, “We’re [resource-depleted] as a community. There’s been a 19 percent decline in NIH funding over the last 10 years. This is significant, precisely at a time when we have an increased incidence of major diseases, including cancer … and so you’re on a sinking ship. And what you’re doing is you’re trying to slow the rate of sinking through

efficiencies and managing the system”.5 There simply is not enough funding, whether private or public, for cancer research, which makes it one key barrier to a cure.

We have come so far in terms of technology, yet we still face technological barriers that prevent us from reaching a cure. The most significant recent development is cancer genome sequencing, which allows us to sequence the entire genome of a tumor. The power of cancer genome sequencing lies in the heterogeneity of cancers and patients. Cancer genome sequencing will allow clinicians and oncologists to identify the specific and unique changes a patient has undergone in developing his cancer. Based on these changes, a personalized therapeutic strategy can be developed. The problem, however, is that gene sequencing technologies are still too expensive to be of practical use. The truth is that we do not have a killer technology yet. An effective cure requires more than just effective drugs; it requires the use of advanced technology, such as nanotechnology, to target cancer cells specifically, where blood circulation is generally limited. We also have other avenues—some have even suggested the use of cryogenics to freeze and eliminate tumors. We have only scratched the surface of the technological front, and we have a long way to go in building these technologies.

The public has complained for years that we keep pumping money into cancer research with no results to show for it. Anyone who runs a cost-benefit analysis of spending, if looked at through a purely objective lens,

would not be able to justify spending so much on cancer research. But as a society, we have to look beyond that—we have to realize how incredible the payoff would be if we had a cure for a disease that has plagued us for throughout history. In the long run, the benefits far outweigh the costs. For that reason, cancer funding should be fully supported in the coming years to overcome the technological barriers and reach a cure that is within sight.

References

1. Gorski, D. (n.d.). Science-Based Medicine » Why haven’t we cured cancer yet?. Science-Based Medicine. Retrieved February 13, 2013, from <http://www.sciencebasedmedicine.org/index.php/why-havent-we-cured-cancer-yet/> Quadruple helix DNA find key to cancer cure? - Times Of India. (2013, January 23).

2. Nature 462, 1005-1010 (24 December 2009) | doi:10.1038/nature08645; Received 20 July 2009; Accepted 5 November 2009

3. Popular Mechanics - Automotive Care, Home Improvement, Tools, DIY Tips. Retrieved February 13, 2013, from <http://www.popularmechanics.com/science/sciences-greatest-unsolved-mysteriescure-for-cancer#slide-2>

4. GRADY, D. (2011, September 12). Immune System, Loaded With Remade T-cells, Vanquishes Cancer - NYTimes.com.The New York Times - Breaking News, World News & Multimedia. Retrieved February 10, 2013, from http://www.nytimes.com/2011/09/13/health/13gene.html?pagewanted=all&_r=0

5. Zakaria, F. (2012, December 10). Are we close to beating cancer? – Global Public Square - CNN.com Blogs. Global Public Square - CNN.com Blogs. Retrieved March 10, 2013, from http://globalpublicsquare.blogs.cnn.com/2012/12/10/are-we-close-to-beating-cancer/

6. Hadhazy, A. (n.d.). Will We Find a Cure for Cancer? - Science Mysteries in the 21st Century - Popular Mechanics.

7. Featured Articles From The Times Of India. Retrieved February 13, 2013, from <http://articles.timesofindia.indiatimes.com/2013-01-22/science/36483391_1_cancer-cells-dna-human-genome>

8. “Nano-Technology Provides New Cancer Treatment Options | Cancer Blog.”Cancer Social Network, Directory and Educational Hub | Know Cancer Community. Know Cancer , n.d. Web. 8 Mar. 2013. <http://www.knowcancer.com/blog/nano-technology-provides-new-cancer-treatment-options/>.

9. Science Daily. (2012, April 18). Cellular ‘Glue’ Resists Breast Cancer. Retrieved February 13, 2013, from <www.sciencedaily.com/releases/2012/04/120420105543.htm> Smith, O. (n.d.). The Human Genome Project: Hype meets reality – Respectful Insolence.

10. ScienceBlogs - Where the world turns to talk about science. Retrieved February 13, 2013, from http://scienceblogs.com/insolence/2010/06/14/thehuman-genome-project-hype-meets real/

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020

1971: Src, the first oncogene is discovered. President Nixon and congress declar a war on cancer by passing the National Cancer Act.

1981: p53, the first known tumor suppressor gene, is discovered.

1990’s - Scientists develop a weath of information as technology is developed to measure gene expression for thousands of genes simultaneously. Researchers gain further insight on miRNA, a molecule that controls gene expression.

1907 : Physicians form the American Assocation of Cancer Research, recognizing the dangers of cancer.

1941: Pharmacologists Louis Goodman and Alfred Gilman find that chemical agents could suppress lymphomas initiating the development of Chemotherapy.

Key Moments in Cancer

BIRUK BEKELE/GRAPHIC


A cure for blindness through the regeneration of retinal cells. An unlimited supply of nerve cells to replace those damaged in spinal cord

injuries. New treatments for diabetes and Parkinson’s. A way to study human development without putting human volunteers at risk. Researchers believe that these visions are just the tip of the iceberg for the potential medical applications of stem cells. Stem cells are undifferentiated cells that can be induced to develop into any of the 220 types of cells in the human body—they can be used to replace damaged tissue and thus serve as the foundation of regenerative medicine.1

Unfortunately, stem cell research has been plagued by controversy. The most promising types of stem cells are embryonic stem cells (ES cells), which are derived from the cells of the zygote that result from the union of the sperm and egg.1 Many Conservatives and religious groups, particularly members of the Catholic and Protestant churches, strongly object to ES cell research because they believe that an embryo is not “a clump of cells” but a real human being.2

There have been strict regulations on federal funding of ES cell research since 1996, even before the first human ES cell was isolated in 1998. Federal law from 1996 to 2001 prohibited financing of studies involving human embryos based on the idea that taxpayers should not have to support such controversial research. The Bush administration allowed for some funding of studies that were using existing lines of ES cells, but these restrictions still severely limited the amount of research that could be done.3 In 2009, the Obama administration made an executive order to allow federal funding for ES cell research as long as state or private money provided the actual embryos. However, the case of Shirley v. Sibelius challenged this decision before it could take effect, arguing that taxpayers should not support any research endeavor that involves destroying human embryos.

The Beginning of a New Age for Stem Cell Research

Lifting the ban on federal funding promises a brighter

future for regenerative medicine

BY JENNA HERBERT

Remarkably, the people who appealed Obama’s decision in this case were respected scientists themselves, illustrating that the divide is not as simple as science versus religion. James Shirley is an adult stem cell researcher at the Boston Biomedical Research Institute. Theresa Deisher, Shirley’s co-plaintiff, is a cellular physiologist and the chief executive of AVM Biotechnology, a company devoted to developing therapies using adult stem cells. Adult stem cells are undifferentiated cells found throughout the human body that can be used to replace tissue such as blood, bone, and cartilage. In fact, Deisher’s discovery of stem cells in the adult heart is considered one of the most important findings in stem cell research.2

Shirley and Deisher’s quest to “emancipate human embryos from research slavery sponsored by the NIH” culminated in their bringing the case to the Supreme Court.4 On January 7, 2013, however, the high court officially refused to hear the appeal, thereby finally allowing the NIH to fund ES cell research. Under the new guidelines, once ES cells have been obtained with the donor’s consent from surplus embryos in fertility clinics, the NIH is permitted to provide funding to use those ES cells for research.4

While Deisher and Shirley failed to win in the Supreme Court, they were successful in helping to deter scientists from ES cell research and forcing them to develop

“Remarkably, the people who appealed Obama’s decision in this case were respected scientists themselves, illustrating that the divide is not as simple as science versus religion.”


alternative research methods. Because of uncertainty about funding and the ethical baggage associated with human embryos, many researchers have turned to induced-pluripotent (iPS) cells. These are mature cells that have been “reprogrammed” to their embryonic states. While differentiated cells are typically very stubborn about reverting back to being blank slates, physician and stem cell researcher Shinya Yamanaka discovered which genes must be turned on in order to make these cells “forget” their identities, an accomplishment for which he won the Nobel Prize in 2011. He and his team successfully induced the first differentiated human cell into a pluripotent cell in 2007.1 Since then, research into iPS cells has exploded. While they avoid the issue of aborting human embryos, the real appeal of iPS cells is the possibility of giving a patient tissue derived from his or her own cells, providing a perfect genetic

match and avoiding the issue of potential rejection by the immune system.5

So what’s the problem? While iPS cells eliminate the need for embryonic stem cell research entirely, they are not nearly as well-behaved or well understood as ES cells. For one, iPS cells never truly forget their differentiated states. Epigenetic markers, such as acetyl and methyl groups that can influence gene expression, accumulate as a cell ages, and their effects are difficult to reverse. In addition, the genes that are needed to reprogram a cell are inserted via plasmids, circular DNA molecules

“Because of uncertainty about funding and the ethical baggage associated with human embryos, many researchers have turned

to induced-pluripotent (iPS) cells. These are mature cells that have been “reprogrammed” to their

embryonic states.”

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that can be transferred from one cell and integrated into another cell’s genome. This in turn has raised concerns about the plasmids entering into the genome in the wrong location and inactivating tumor suppressor genes or activating cancer genes.1 Moreover, iPS cells tend to accumulate mutations while being reprogrammed, which requires that each cell be evaluated. The resulting process of producing iPS cells is thus inefficient. Paul Knoepfler of the UC Davis School of Medicine told Forbes Magazine, “Considering their relatively short existence, we know a great deal about human iPS cells in a general sense, but as a field we know surprisingly little about how they will behave specifically in a clinical setting.” Jalees Rehman of the University of Illinois, Chicago, explains that embryonic stem cell research is necessary to better understand how cells differentiate and, in turn, perfect the process of reprogramming cells. He explains, “I usually ask the postdocs and Ph.D. students in my lab to always study

ES cells and iPS cells side-by-side, whenever possible”.6 By better understanding ES stem cells and how ES stem cell therapy works in the body, most scientists are hoping to eliminate the need for ES cells altogether, along with the ethical burden that comes with it.

Robert Lanza, chief science officer for Advanced Cell Technology, remarked, “We’re obviously delighted with the Supreme Court’s decision. However, it’s a shame it took this long to put this lawsuit to rest, not to mention the potentially life-saving research it held up or slowed in the process”.6 Advanced Cell Technology has had promising results in using ES cells to treat macular degeneration and macular dystrophy, diseases that are responsible for vision loss. The company has even successfully produced new eye cells to repair the retina. Researchers such as Candace Kerr, a professor at the Center for Stem Cell Biology and Regenerative Medicine at the University of Maryland, are “excited and relieved” by the decision about ES cell research funding. According to Kerr’s UMD faculty profile, her research focuses on using embryonic stem cells as a model for understanding early human development and the mechanisms involved in cell differentiation. Her lab is also working on developing therapies for spinal cord injuries through the regeneration of damaged cells. Kerr turned to iPS cells because of uncertainty about funding. She is eager, however, to start running experiments with ES cells, which she finds much easier to develop into neurons than iPS cells.5 While the general hope is that iPS cells will make the use of ES cells obsolete, the increased flexibility with which scientists can work with ES cells offers promising insight into stem cell research.

In the past few decades, scientists have been able to unlock the secrets of how the human body works at the cellular and molecular level, putting together the pieces of the puzzle as to why things go wrong and how to fix them. These discoveries have promising implications for treating devastating diseases. As the science advances, however, it will be a difficult balancing act for scientists and politicians to determine where to draw the line between promoting progress and

addressing the conflicting opinions that inevitably arise.

1868: German biologist Ernst Haeckel uses the

term “stem cell” to describe a zygote for the

first time

1981: Embryonic stem cells isolated in mouse.

1996: Dickey-Wicker Amendment prohibits

federal funding of research involving human

embryos.

1998: First human embryonic stem cell

isolated.

2001: George W. Bush imposes new guidelines

on federal funding of stem cell research,

allowing financing of studies that used ES cells

from a small number of existing lines of

embryos.

2007: First successful reprogramming of

differentiated cells when Yamanaka identified

the transcription factors necessary to revert a

cell back to its embryonic state.

January 2009: First human clinical trial, using

oligodendrocytes (type of cell found in the

brain and spinal cord) derived from human ES

cells.

March 2009: Obama lifts Bush administration’s

restrictions on funding, increasing the number

of ES cell lines available for research.

2009: Deisher and Sherley sue the Department

of Health and Human Services, Kathleen

Sibelius, and Francis Collins, the director of the

NIH.

August 2010: Shirley vs. Sibelius case shuts

down federal funding of ES cell research for 17

days.

September 2010: NIH funding permitted

again, but uncertainty about the future of

funding remains.

2013: Supreme Court lets the ruling that the

NIH can provide funding stand.

ARJUN BASHYAM/GRAPHIC

References

1. Shevde, Nirupama (2012). Stem Cells: Flexible Friends. Nature, 483 (7387). Retrieved from: http://www.nature.com/nature/journal/v483/n7387_supp/full/483S22a.html.

2. Wadman, Meredith (2013, February 9). Stem Cells: The Crusader. Nature, 470. Retrieved from: http://www.nature.com/news/2011/110209/full/470156a.html

Kerr, C. Candance L. Kerr (UMD faculty profile). Retrieved from: http://medschool.umaryland.edu/facultyresearchprofile/.

3. Stem Cell Research Gets a Reprieve (2013, January 20). New York Times, p. A20. 4. Wadman, Meredith (2013, January 7). High court ensures continued funding

of human embryonic stem-cell-research. Nature. Retrieved from: http://www.nature.com/news/high-court-ensures-continued-us-funding-of-human-embryonic-stem-cell-research-1.12171#/related-links.

5. Baker, Monya (2013). Court lifts cloud over embryonic stem cells. Nature, 493 (7432). Retrieved from: http://www.nature.com/news/court-lifts-cloud-over-embryonic-stem-cells-1.12215

6. Farrell, John (2013, January 8). Scientists relieved as Supreme Court passes over case against embryonic stem cell research. Forbes. Retrieved from: http://www.forbes.com/sites/johnfarrell/2013/01/08/scientists-relieved-as-supreme-court-passes-over-case-against-embryonic-stem-cell-research/.


MEDICINE AND CULTURE

The Critical Nature ofEarly Development

Over forty years ago, a young girl named Genie was discovered in an isolated cell. She was locked up, abused and denied both light and human contact

for years. Thirty years earlier, another little girl, Isabelle, was also hidden away and not given any care. Because of this isolation, both girls were unable to learn about and experience the world around them. The only difference between the two girls was that Isabelle was discovered at the age of six while Genie was fourteen before she was found and helped. What were the consequences? Isabelle was able to pick up language within a year and function properly in school while Genie was only able to reach the language capabilities of a two-and-a-half year old.1 The difference didn’t lie in the two girls’ cognitive abilities. Isabelle was found in time for early childhood development (ECD), a crucial stage where she could learn and develop at a much greater level than Genie, who was starting puberty and could no longer reap the benefits of growth that ECD offered.

Whenever early childhood development is discussed, it is essential to understand the work of Jean Piaget, a pio-neer psychologist in this field. It is from his work that we learned about the different stages of child development and the ideas of schemas.2 Through conducting experiments on his own children, Piaget discovered that there are four stages of cognitive development: sensorimotor, preopera-tional, concrete operational and formal operational. The general cognitive trend a child undergoes starts with the child assessing the world through his or her physical senses. Soon thereafter, the child is capable of rational think-ing and eventually abstract thinking. Along this path, the child develops other characteristics such as lan-guage, impulse control, and the ability to follow rules.

Another one of Piaget’s contributions to the field was his concept of schemas, organized patterns for thought in the brain that works in three steps: assimilation, ac-commodation, and equilibration.3 When a child learns what a cat is, they are going through the process of developing a schema. First, they use their schema of what a cat is to assess a second cat that they see. This process is called assimilation and if the second cat

fits their original schema, they have correctly identi-fied it. However, problems may arise. If the child sees a dog, they may confuse it for a cat because of similar features such as four legs, a tail, and fur. In this situ-ation, the child must alter their schema of what a cat

is to differentiate it from a dog. The adjustment of a schema is called accommodation. Finally, equilibra-tion is what allows cognitive development to con-tinue. A time when their minds can be molded and enabled to process new information. The mechanisms of schemas and ECD are essential for young chil-dren because they impact children during the criti-cal period, a time during which they can be molded and can take in multitudes of information. This criti-cal period is what distinguished the fates of Isabelle and Genie. Isabelle was still in her critical period

How the quality of early education can affect a child’s future

BY AKIFF PREMJEE

Promoting early childhood education will not only benefit a child’s development, but will also help prevent future issues such as teen pregnancy and violent crime.

Assimilation

Equilibration

New situation

Disequilibrium

Accomodation

ELLEN KIM/GRAPHIC


Since September 2010, AquaBounty Technologies (ABT) has been awaiting FDA approval for AquAdvantage® Salmon to be made available for public consumption.1 Created by combining genes from chinook salmon and

ocean pout with those of the Atlantic salmon, AquAdvantage® Salmon grows to market size in half the time that natural Atlantic salmon does. ABT declares that AquAdvantage® Salmon “are identical to other Atlantic salmon” in every other way.1

The idea of a GM fish is not as far-fetched as it seems; we have been eating GM plants for years. In 1994, the Flavr Savr tomato was the first GM produce to be introduced in the US.2 Since then, GM corn and soy have become a common part of the diet of many Americans. GM foods show a lot of promise, as does the AquAdvantage® Salmon. But are we being too hasty in approving the fruits of this relatively young field of research?

AquAdvantage® Salmon, is it too soon?

Risk-Benefit Analysis of Genetically Modified Food

BY MONICA LASKOS

when she was found and could thus take in more information to develop, whereas Genie was well past her critical period, preventing her from reaching her full cognitive potential.

To prevent children from going down the path that Genie experienced, it is imperative that policy makers put an emphasis on ECD. ECD is necessary to promote areas such as language, cognition, behavioral development, and social skills. President Barack Obama believes that it is vital to support ECD. In his State of the Union address this year, Presi-dent Obama laid out a plan for investment in high quality preschool programs for every child in America.4 Promoting early childhood education will not only benefit a child’s development, but will also help prevent future issues such as teen pregnancy and vio-lent crime. In Philadelphia, the Early Childhood Development Center through People for People Inc. as well as support from the Children’s Hospital of Philadelphia are prime in-stitutions that exemplify Obama’s mission. With the new national policy, ECD programs can expand even more and benefit more children. Though these implementations will take time, the foundations they will lay will be crucial for the the development of society.

References:

1. Jackendoff, R. (1994). Patterns in the Mind: Language and Human Nature. United States of America: BasicBooks. 2. Cherry, K. An Overview of Early Childhood Development. Retrieved March 11, 2013, from http://psychology.about.com/od/

developmentalpsychology/ss/early-childhood-development_5.htm 3. McLeod, S. (2009). Jean Piaget. Retrieved March 11, 2013, from http://www.simplypsychology.org/piaget.html4. Obama , B. The White House, Office of the Press Secretary. (2013). Remarks by the President in the State of Union

Address Washington, D.C.: Retrieved from http://www.whitehouse.gov/the-press-office/2013/02/12/remarks-president-state-union-address

ELLEN KIM/GRAPHIC


The Future GM Foods Promise

GM foods are defined by the World Health Organization as food that is produced by “organisms in which the genetic material has been altered in a way that does not occur naturally”.3 There are numerous reasons to produce GM foods: they can be cheaper, faster to grow, or more environmentally-friendly.1 They might be less susceptible to pests or diseases, as in the case of corn that has been genetically modified to contain Bacillus thuringiensis (Bt), a bacteria that kills caterpillars without adversely affecting humans.4 Some plants have even been engineered to provide more nutrition in developing nations, such as Golden Rice which contains more Vitamin A than its non-engineered counterparts.5 There has even been research done on creating vaccine-carrying plants; tobacco and bananas are top contenders for the task.6

Cautions from Experts

The possibilities presented by GM foods sound wonderful and futuristic. Still, we need to keep in mind that GM foods have only been on the market since 1994. Science takes time, and there has been a lot of concern that because GM foods are a relatively new endeavor, there may be risks associated with them that scientists have not yet come across. Some scientists and spokespeople at the Veterinary Medicine Advisory Committee Meeting on AquaAdvantage® Salmon claimed that there is insufficient evidence of the safety of such foods.7 Darrell Rogers, Campaigns and Communications Director of the Alliance for Natural Health, took issue with the fact that “rather than develop an appropriate evaluation method, the FDA is currently proceeding to approve the [GM] fish through a process of reviewing a new animal drug; clearly this is inappropriate”.7 At the same meeting, Michael Hansen, a senior staff scientist for the Consumers Union, asserted that AquaAdvantage® Salmon should not be approved “because of insufficient data of poor quality. We need more rigorous studies using better experimental design, more sophisticated or sensitive methodology with a large enough sample size to perform a power analysis to make adequate conclusions”.7

Experts think that more time and better methodology should be employed to ensure that GM foods are safe to eat. There is no excuse for shoddy science when it comes to the health of millions of consumers. Thankfully,

there has been movement towards ensuring the safety of GM foods—a 2012 literature review of studies on rodents that were fed GM food over long periods of time concluded that GM foods did not affect the test subjects any differently than would natural foods.8 More information about the safety of GM foods must be collected in order to satisfy the cautions raised by experts.

Wary Consumers

Consumers themselves are also skeptical of GM foods. They do not always trust monetarily involved parties to be ethical in their scientific studies. For example, Monsanto, a commercial seed company, has been filing patent infringement lawsuits against farmers who have had their crops contaminated by Monsanto’s GM seeds.9 A more serious concern is that foods are not required to be labeled as containing GM ingredients making it difficult to determine whether one is eating GM food.10 Additionally, consumers are concerned about GM food accidentally mixing with other species of plants and animals. Outcrossing, or “the movement of genes from GM plants into conventional crops […] as well as the mixing of crops derived from conventional seeds with those grown using GM crops”3, has the potential to bring crops that should not be consumed by humans, for one reason or another, into supermarkets. These issues need to be addressed before people become comfortable with GM foods.

ABT declares that AquAdvantage(R) Salmon

“are identical to other Atlantic salmon” in every other way.

There are numerous reasons to produce GM foods: they can be cheaper, faster to grow, or more

environentally-friendly.

References

1. Press Room. Retrieved from http://www.aquabounty.com/PressRoom/

2. Bruening, G. & Lyons, J. M. (2000, July). The case of the Flavr Savr tomato. California Agriculture, 54, 4, 6-7. doi: 10.3733/ca.v054n04p6 or http://ucanr.org/repository/CAO/landingpage.cfm?article=ca.v054n04p6&fulltext=yes

3. 20 questions on genetically modified foods. Retrieved from http://www.who.int/foodsafety/publications/biotech/20questions/en/

4. Bessin, R. (1999) Bt-Corn: What it Is and How it Works. University of Kentucky College of Agriculture. Retrieved from http://www.ca.uky.edu/entomology/entfacts/ef130.asp

5. Biofortified rice as a contribution to the alleviation of life-threatening micronutrient deficiencies in developing countries. Retrieved from http://www.goldenrice.org/

6. Giddings, G., Allison, G., Brooks, D., & Carter, A. (2000). Transgenic plants as factories for biopharmaceuticals. Nature Biotechnology, 18, 1151-1155. doi: 10.1038/81132 or www.nature.com/nbt/journal/v18/n11/full/nbt1100_1151.html

7. United States. Food and Drug Administration.(20 September 2010). Veterinary Medicine Advisory Committee Meeting: AquaAdvantage Salmon. Available: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/VeterinaryMedicineAdvisoryCommittee/UCM230471.pdf

8. Snell, C., Berhneim, A., Bergé, J., Kuntz, M., Pascal, G., Paris, A., & Ricroch, A. (2012). Assessment of the health impact of GM plant diets in long-term and multigenerational animal feeding trials: A literature review. Food and Chemical Toxicology, 50, 3-4, 1134-1148. Retrieved from http://dx.doi.org/10.1016/j.fct.2011.11.048

9. EcoWatch. (2013, January 7). Family Farmers Continue Fight in Landmark Lawsuit Against Monsanto. EcoWatch. Retrieved from ecowatch.org/2013/farmers-fight-monsanto/

10. Harmon, A., & Pollack, A. (2012, May 24). Battle Brewing Over Labeling of Genetically Modified Food. New York Times. Retrieved from http://www.nytimes.com/2012/05/25/science/dispute-over-labeling-of-genetically-modified-food.html


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