Bioengineering in Society

This is the short version of a vision I have for the UW bioengineering department's strategic plan. I've posted the longer version in a comment.

Bioengineering is a term that includes many particular topics, but it is always associated with advances in medicine or biotechnology. Since its inception, the field has been synthetic. In the 1960’s, physicians and materials scientists collaborated to generate a solution enabling long-term kidney dialysis. The Teflon Scribner shunt led to Seattle’s prominence as renal failure treatment center and is but one example of ground-breaking interdisciplinary engineering work at the UW. Bioengineers may forget that it also set the stage for a situation in which a “God Committee” made decisions about which patients could receive the expensive dialysis procedure in a resource limited environment. In the end, federal health care policy was changed so that no renal failure patient would be refused treatment. The area of bioengineering that I believe should be tackled in the next 5-25 years is not a specific research program; it is the way that bioengineers think about their position in society.

As the bridge between basic biomedical research and practical implementation, bioengineers are uniquely positioned to think critically about the needs and expenses of the technology they are building. I believe that the best bioengineers will be able to integrate needs and opinions from society into the healthcare setting. They will be at the minimum competent communicators about issues in science, engineering and society.

My proposal is for the bioengineering department to deliberately invest in the dialogue among bioengineers about the social implications of the work they do. Several research strengths at the UW exist in the midst of important public discussions about science and society. Three of these are global health, stem cell research, and nanotechnology. Not only are there prominent researchers in each of these fields within or affiliated with the bioengineering department, but there are centers here focused on each of these topics. It is clear that faculty and students are committed to contributing to society in meaningful ways. The Grand Challenges in Global Health Care grant is an example that bioengineers at the UW are committed to the complex challenge of moving healthcare out of the resource intensive Western hospital environment into the home and beyond to developing countries.

I believe strongly that a deliberate effort to incorporate issues of social responsibility and public policy into science and technology would provide the foundations to develop individuals that will lead their fields in academia, the corporate sector and the public sphere. How would this be accomplished? I can imagine three techniques. The first is a prominent seminar series on campus focused on issues in engineering and society. Speakers must be qualified to discuss the social and political aspects of fields that they work with, not merely offer armchair analyses of public policy. Such a series could rotate between bioengineering related fields of global health nanotechnology, or stem cell science. Another technique – perhaps more effective but less prominent – at increasing knowledge and ideas about science and society is an ongoing discussion group that includes faculty and all levels of trainee. This could incorporate idealism, practicality and a breadth of ideas in a collegial environment that could engage student and teacher alike. The third, and perhaps most difficult implement would be a course focused on issues of engineering and society. Challenges here include finding the teaching resources, adding to an already heavy course load, and the artificiality of classroom discussion on social, ethical and political issues. Perhaps this would be best as a joint effort between departments. It will not be easy to incorporate concepts often relegated to liberal arts departments into a technical education, but creativity and dedication could result in significant gain. Bioengineers familiar with the global, social and political context of their work will be better prepared to tackle the current challenges in health care and lead us through the next century.

Here are some web resources for UW groups interested in science and society:

International Health Group:
http://depts.washington.edu/ihg/index.htm
Nanotechnology and Nanoscience Student Association:
http://students.washington.edu/nansa/index.html
Forum on Science Ethics and Policy:
http://www.fosep.org/

Reviewing Peer Review

peer: (pîr) n.
A person who has equal standing with another or others, as in rank, class, or age: children who are easily influenced by their peers.

peer: (pîr) intr.v.
peered, peer·ing, peers
1. To look intently, searchingly, or with difficulty. See Synonyms at gaze.
2. To be partially visible; show: The moon peered from behind dark clouds.

- definitions from dictionary.com


Is the system of scientific peer review ready for a paradigm shift? Peer review has long relied on the usage of the noun in common parlance, but perhaps that has been too limiting. Will scientists of my generation and beyond accept a broader definition? In a surprising move, one of the most respected names in scientific publishing is willing to permit open public comment on articles submitted for publication.

The Editor-in-Chief of Nature, Philip Campbell, writes on the Nature website that,

Nature's peer review process has been maintained, unchanged, for decades. We, the editors, believe that the process functions well, by and large. But, in the spirit of being open to considering alternative approaches, we are taking two initiatives: a web debate and a trial of a particular type of open peer review.

The trial will not displace Nature's traditional confidential peer review process, but will complement it. From 5 June 2006, authors may opt to have their submitted manuscripts posted publicly for comment.

Any scientist may then post comments, provided they identify themselves. Once the usual confidential peer review process is complete, the public 'open peer review' process will be closed. Editors will then read all comments on the manuscript and invite authors to respond. At the end of the process, as part of the trial, editors will assess the value of the public comments.

This is intriguing. When presented with this news, many scientists I have spoken with do not believe it. It just seems so different than what we are used to doing. From my perspective, there are several potential benefits to this, and some detractors. Let’s start with the detractors.

Peering into Peer Review is Poor because:

• It’s bad for the social structure of science. At large scientific meetings, the most powerful individuals in the field – the guys and gals who review grants and receive awards – are not as criticized on their science as much as junior colleagues. When a comment is made that could be perceived as a personal attack, there is a real potential of retribution. On the flip side of this, the more democratic the review process gets, the greater the potential for reviews to become popularity contests. Any scientist can tell you the last time she heard a speaker legitimize a finding because the researcher was from Boston or San Francisco.
• More than 90% of Nature’s submissions are rejected. That means there could be a large body of evidence presented to the public arena that is not formally addressed by citation. If ideas for experiments, and dare we say, marketable products, are submitted to Nature but rejected, is that information in the public domain?
• Messing with a well-established system will throw the socio-economic foundations of the practice of science out of order to the extent that the current system of funding science will be unstable and scientists will not be able to keep their labs up and running. Maybe this seems a bit of a doomsday scenario, but this is just a blog. What’s the harm in a little doom?
• The system works, and it works well.

Peering into Peer Review has Potential because:

• Peer Review is a taxing system on researchers. It takes half a day to properly review an article. Scientists are bombarded with requests to review papers, and after the top scientists refuse (due to over-commitment), reviewers can end up reading papers on the periphery of their expertise. Permitting the scientists who are most concerned with a topic to self-select themselves as reviewers will increase the quality of reviews.
• Petty requests and personal attacks in reviews have no place in science. We might expect that a named reviewer will not make comments such as “more information could be drawn from slides dipped in weak grape juice” than the hematoxylin and eosin stained tissue sections in the submission’s figures. I will concede a bit of sour grapes here – this was taken from one of my own reviews – but the point is still valid. Public statements are typically less subjective than anonymous ones.

However this turns out, I am interested in the potential for improving the practice of science. In the least, the activity of reviewing peer review may result in a better mechanism of how science is communicated.

Update

Note: This is the concluding entry in a series of posts related to my experiences in quarantine. Remember the mumps outbreak? King County Public Health was concerned that I was a vector, but...

The PCR was negative,
So I am back at the lab.
Instructed to keep a distance,
And avoid crowded spaces.

They drew some more blood yesterday.
Called "convalescent serum."
What? Convalescent? I feel fine!
Parotid stone passed Monday.

So much for mumps quarantine poems.

Check out MJ's comment on "the role of quarantine." It makes good points about the differences between H5N1 and SARS in terms of incubation time and the usefulness of quarantine. With mumps' 12-25 day period, I suppose it is more like SARS than bird flu!

It looks like public health is overcoming the mumps outbreak in Iowa:
Check this Chicago Tribune article.

Deconstructing Pandora's Quarantine

The myth of Pandora seems to me a useful metaphor for understanding the kinds of issues I hope to discuss on this blog. My current experience with quarantine is a good first exercise. Using the Pandora's Box story as a guide, I will try to name the evil spirits of a given situation and identify the hope that can reconcile them. Why not just call them plusses and minuses? I guess that just doesn't seem as interesting to me.

Quarantine

Evil

• Endangered Individual Liberties
• Lost Productivity
• Economic Hardship

Hope

• Public Safety
• Time to Recover from Illness
• Increased Personal Time

In reality, this demarcation is oversimplified. If one is genuinely infected with a dangerous disease, most people would agree that public safety and the need to recover from the illness would trump any of the negatives of quarantine. What I would really need to do is categorize my thoughts not for quarantine in general, but for quarantine in the context of an otherwise healthy and functioning individual experiencing one nuisance sign of a potentially dangerous disease that surfaced in a rare outbreak that had a few cases in a state where he recently traveled.

Day 3 (Economics)

Day three of the waiting game feels much as the first. The weekend is not sush a bad time to be forced apart from society. My wife and I typically spend the time with each other, and if we leave the house, it is for a hike or such. We each typically go into lab for a good chunk of one day, and that is where she is right now. Now facing Monday, I have realized the challenge this will be if this goes on for another week (the nine day period expires Friday.)

This brings me to another point: economic productivity. I wonder what the effects of a widespread quarantine for H5N1 avian flu would have on the economy. I'm no economist, but I would imagine that any effects from lost work would hit the poor first and hardest. Do employers make any allowance for workers on quarantine? Is that something the government is prepared for in the reports recently issued about the possible pandemic? Who's responsibility is it to keep food on the table when the breadwinner is quarantined?

The Role of Quarantine

So I'm Quarantined...

Institute of Medicine member Marty Cetron opens a published discussion about quarantine as follows: "By utilizing quarantine and isolation as public health tools we are in many ways battling twenty-first century pathogens with a fourteenth century toolbox." The public control of disease is not new. A sizeable number of empirical prescriptions exist in the book of Leviticus that control and reduce the spread of disease. Individual and community health still play a very important role in contemporary Jewish culture. Quarantine as first applied in bubonic plague infested Europe referred to a forty day isolation period.

Having been under quarantine for about 24 hours of an expected 9 day period, I am glad that the Washington and King County health boards no longer stick to that duration. I am already feeling the tension between individual liberty and the public good. This manifests in its own disease: cabin fever. I have repeated to many that, "I believe in public health," and still stand by that statement. In my opinion, public health departments should have even greater reign over the health risks that we confront daily. I would like to see some public authority take more control of school food, for example. (Hooray for the curb on sweet drinks at school!) My condition however falls within the imminent threat category of public health. Perhaps it will help me better think about the real and potential quarantines issued in response to SARS or H5N1 bird flu.

Let me clarify my situation with mumps, in case any of you are worried about me or about yourselves! The public health officials I have spoken with report that a significant number of the mumps cases in Iowa occurred in individuals who had received two MMR vaccines. The MMR vaccine is not without controversy. A report by Dr. Andrew Wakefield published in Lancet in 1998 documented increased numbers of kids with Crohn's disease and autism. Even though this article was retracted, numerous parents - particularly in Great Britain - refused to immunize their children with MMR. This episode is a particularly good one illustrating a dysfunctional relationship between biomedical science and the public, but that is for another entry... Regarding the vaccine's efficiency, the common report is that the MMR is 90-95% effective at producing protective antibodies. Let's say I received 2 MMRs as a child (the standard regimen, confirmed by my mom), a booster shot before high school at age 13, and a booster at age 22 before medical school. By my calculations, that would put my chances of seroconversion between 99.99% and 99.9994%. This is not even close to the risk of infection we would see with a SARS or bird flu outbreak. That puts my experience in quarantine in a different category than its infectious colleagues, but does not refute the legitimacy of my experience.

I believe I am serving what is called a voluntary quarantine. I do not believe I am under any legal obligation to stay home. My doctor says it is okay to go jogging and biking, as long as I do not engage in close contact with others. My wife has already been exposed, so it is okay for me to live in the same place as her – thank goodness! From the statistical data above, I am very inclined to believe that I neither infected or infectious. I wonder what percentage of quarantined individuals in a SARS or H5N1 will actually be sick, and how many will endure the quarantine unaffected (& bored). Another aspect of an epidemic outbreak would be fear of infection. Perhaps if I was really afraid of getting sick, I would not mind as much a forced absence from work and play. If I could telecommute to do experiments, I guess this situation would be very different. Until I figure that out, I will have to put off my studies for a week.


For members of the academic community, see the full transcript of the discussion these quotes are extracted from in the Journal of Law, Medicine & Ethics, Winter 2004 v32 i4 pS83(4). This proceedings includes a number of important topics ranging from the need for quarantine, how it should be enforced, and the mechanism by which state legislators put quarantine laws in place.

Do the Mumpty-Mump

So, maybe you are wondering why I am posting so much the first day after going live. The hidden motivation for this blog is THE MUMPS. Don't worry - I am sure that I do not have the mumps. Three MMR vaccines should account for that. I do have a very swollon parotid gland. I think it is due to a salivary stone. Anyway, the CDC has suggested that the states take conservative measures to contain subsequent outbreaks. So here I am at home until further notice - notably a PCR for viral load and IgM measurements. If they are clear, I could be back in circulation by Tuesday or so, but maybe not until Friday. Which sucks.

While writing this I was contacted by the Public Health folks - the PCR machine crashed. I wonder what that means. Did the thermal cycler fall off the table? I told the person that called that I was willing to give the reaction a go. Just send the primers over. I could go into lab after hours to run it, in case I really do have the paaramyxovirus. Are you allowed to run diagnostics on yourself, anyway? What are the ethical implications of that decision? I guess that means the first tests won't get done until Monday, which means they will want me to stay home longer... In the meantime, I am supposed to look out for orchitis.

Creationism is Pagan?

Here's one from the intersection of Science and Religion:

Vatican Astronomer Guy Consolmagno was in Glasgow yesterday to deliver a lecture, and The Scotsman picked up the story. Some interesting nuggets came out of the article.

Brother Consolmagno stated that "Knowledge is dangerous, but so is ignorance. That's why science and religion need to talk to each other." This he supported with an analogy describing creationism, whose supporters want it taught in schools alongside evolution, as a "kind of paganism" because it harked back to the days of "nature gods" who were responsible for natural events.

The article ends with the following statement:

"Religion needs science to keep it away from superstition and keep it close to reality, to protect it from creationism, which at the end of the day is a kind of paganism - it's turning God into a nature god. And science needs religion in order to have a conscience, to know that, just because something is possible, it may not be a good thing to do."

Something about this resonates with me. I wonder what it is...

Introductions

Dear Readers,

What you will find here in the next few months will be my ideas related to several interests that can be categorized as topics in science and society. These include:

• Stem Cells - This is my current topic of research.
• Religion and Science - I am both a scientist and religious: what does that mean?
• Science as a Tool for Sustainability and Economic Development - The hope for Pandora.
• Public Understanding of Science - Just who do they think scientists are?
• History and Philosophy of Science - My way of figuring out what it means to be a scientist.

Some of you are familiar with the Forum on Science Ethics and Policy. Much of what I write has been influenced by my role in that organization. I would encourage you to check out the resources available on their website. Hope for Pandora is an opportunity for me to write my own ideas independent of my connection to FOSEP.

I have started this blog for several reasons. These include:

1. To generate a conversation about science and society.
2. To contribute interesting and meaningful content to the digital community.
3. To improve my own writing and argument skills.
4. To learn more about what others think about science.
5. To encourage scientists to think critically about how their work fits into society.

This is my first foray into blogging. It is inspired by the Prometheus Science Policy Blog and the ScienceBlogs which I recommend you peruse for interesting content. I want Hope for Pandora to focus on weighing opposite sides of a debate. The goal of consensus may be just out of reach, but a humble approach at the discussion table may land us closer. I look forward to any comments, ideas and critiques you have for me. I will be honored by your participation in this community.

Pandora's Box

One lovely evening, while dancing on the green, Epimetheus (Prometheus's brother) and Pandora (a gift of the gods to man) saw Mercury, Jupiter's messenger, coming towards them. His step was slow and weary, his garments dusty and travel-stained, and he staggered beneath the weight of a huge box which rested upon his shoulders. Pandora, in a whisper, begged Epimetheus to ask Mercury what gift he bore. Epimetheus complied with her request, but Mercury evaded the question and asked permission to deposit his burden in their home for safe-keeping. Mercury was too weary to convey it to its destination that day, and promised to call for it shortly. He placed the box in one corner of the dwelling and departed, refusing all hospitable offers of rest and refreshment.

Mercury had but crossed the threshold when Pandora insisted in having a peep at the contents of the mysterious box. Epimetheus was warned by Prometheus of interfering with the gods' business, told her that her curiosity was dangerous, and left the house hoping she would join him in the fresh air.

Left alone with the mysterious casket, Pandora became more and more inquisitive. The box was of such fine workmanship that it seemed to smile and encourage her. Around the box a glittering golden cord was wound, and fastened on top in an intricate knot. Pandora felt sure she could unfasten it, and reasoned that it would not be indiscreet to untie it if she did not raise the lid. Repeatedly she heard Epimetheus call for her to join them outside; yet she persisted in her attempt. She was just on the point of giving up in despair, when the refractory knot yielded to her fumbling fingers, and the cord, unrolling, dropped on the floor.

Pandora had fancied that sounds like whispers originated from the box. The noise now seemed to increase, and she listened closely to the lid. Imagine her surprise when she distinctly heard the soft cries of, "Pandora, dear Pandora, have pity upon us! Free us from this gloomy prison!"

Pandora's heart beat so fast and loud, that it seemed for a moment to drown all other sounds. Should she open the box? Just then a familiar step outside made her start guiltily. Epimetheus was coming, and she knew he would urge her again to come out, preventing the gratification of her curiosity. She quickly raised the lid to have one little peep before he came in.

Now, Jupiter had malignantly crammed into this box all the diseases, sorrows, vices, and crimes that now afflict humanity; and the box was no sooner opened, than all these ills flew out, in the guise of horrid little winged mothlike creatures. These little insects fluttered about, alighting, some upon Epimetheus, who had just entered, and some upon Pandora, pricking and stinging them unmercifully. They then flew out through the open door and windows, and fastened upon the merrymakers without, whose shouts of joy were soon changed into wails of pain and anguish.

Epimetheus and Pandora had never before experienced the faintest sensation of pain or anger; but, as soon as these winged evil spirits had stung them, they began to weep. The two quarrelled for the first time in their lives. Epimetheus reproached his wife in bitterest terms for her thoughtless action; but in the very midst of his vituperation he suddenly heard a sweet little voice entreat for freedom. The sound proceeded from the unfortunate box, whose cover Pandora had dropped again, in the first moment of her surprise and pain. "Open, open, and I will heal your wounds! Please let me out!" it pleaded.

The tearful couple viewed each other inquiringly, and listened again. Once more they heard the same soft voice; and Epimetheus bade his wife open the box and set the speaker free, adding that it would be difficult to add to the evil consequences.

It was well for Pandora that she opened the box a second time, for the gods, with a sudden impulse of compassion, had concealed among the evil spirits one kindly creature, Hope, whose mission was to heal the wounds inflicted by her fellow prisoners.

Lightly fluttering hither and thither on her laced wings, Hope touched the wounded places on Pandora's and Epimetheus' skin, relieved their suffering, and quickly flew out of the open window embarking on a quest to heal the downcast spirits inflicted by the previous release.