2014 #4 medicormedicinska föreningen i stockholm 20 SEK

38 32 Insight with Nobel Prize winner Elizabeth Blackburn Edvard Moser THE FIGHTER Nadja Casadei never lets anything stand in the way of her goals

1 Prelude

All You Want For Christmas...

AS THE CHRISTMAS LIGHTS GLOW ALONG THE STREETS AND the snow lays gleaming at our feet, we gather together with family and friends that we so rarely our time spends. But there is some- thing more – we know that to open the Christmas gifts is what you’re really waiting for. And what better gift could there be than to find the latest issue of Medicor underneath the Christmas tree?

What a Christmas read you would find, because we tell the tale of what make up the positioning system inside our mind. We had the pleasure of talking to Edvard Moser some more, read the entire story on page 34. He’s not the only Nobel Laureate we Medicor got, Elizabeth Blackburn is interviewed on the Insight spot. She discovered the secret behind aging, gradually unfolding a story about telomerase that’s indeed engaging. Furthermore, we met with Nadja Casadei to talk about what makes her keep fighting every day. It is a truly inspiring interview about never giving up and letting absolutely nothing stop you.

For those of you who would prefer a lighter read, we have everything that you will need. If you ever wondered how Santa’s Photo by Jingcheng Zhao for little helper could get a nose so red, wonder no more and check Medicor Magasin out the “Julbord” spread. This magazine is filled with all that Grundad 2006. Åttonde årgången. you could wish, including articles from artificial meat to how to Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 survive the winter bliss. Ansvarig utgivare: Robert de Meijere Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm We hope you enjoy this last issue of the year and look forward to Nobels Väg 10, Box 250, 171 77, Stockholm seeing you again when the spring is getting near. Finally as always Utgivningsplan 2014: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december. Kontakta Medicor: [email protected] there are a lot of people we wish to thank, because without them www.medicinskaforeningen.se these pages would be blank. So from all of us to all of you: Merry Frilansmaterial: Medicor förbehåller sig rätten att redigera inkommet material och Christmas and a Happy New Year to! ansvarar inte för icke beställda texter eller bilder, samt tryckfel. Upphovsman svarar för, genom Medicor publicerat, signerat frilansmaterial; denna(e)s åsikter represen- terar nödvändigtvis inte Medicors eller Medicinska Föreningens.

Sincerely, Robert de Meijere Editor-in-Chief

Cover photo by Martin Kjellberg for Medicor

2 Overture

KAROLINSKA COVER STORY GLOBAL FOCUS

DID YOU JOIN THE EBOLA - THE NEW 8 CHASE FOR YOUR 22 BLACK FUTURE? On how the media and our politicians should learn Careers in Health and from the massive attention Science Exposition. surrounding the Ebola outbreak. THE BLACK GOLD 11 Frida Segernäs is ponder- mHEALTH ing on the coffee drinking 23 Mobile health applications at KI. Is it too much? and the need for evidence before widespread imple- 24 mentation. NOV2K 2014 12 Medicor’s Jessica De THE FIGHTER HEALTH CARE AND Loma Olson reports from the event where Science “WHAT DOESN’T 40 REFUGEES Fiction becomes Science KILL YOU MAKES James Salisi on on refugees’ Faction. rights. YOU STRONGER.” An inspiring interview with Nadja Casadei.

NOBEL THEME 30 An overview of the Nobel Prize. NOBEL SCIENCE

THE CURIOUS CASE 15 OF THE MIND INSIGHT Karolina Werynska on ELIZABETH the psychiatric condition 38 known as DID. BLACKBURN A career that will get you the Nobel Prize. ORGANIC FOOD – 16 WHAT IS THE POINT? Haroon Bayani goes though the arguments for consuming organic food. CULTURE THE HISTORY OF IN VITRO MEAT 44 18 CHOCOLATE? Medicor meets Mark Parvin Kumar tell us the Post, the creator of the story behind the most deli- world’s most expensive cious Christmas treat. hamburger. NAVIGATING THE COMPLEXITIES OF THE FEELING THE WINTER 34 BRAIN 46 BLUES? An interview with Edvard Moser, one of this year’s A guide to surviving the winners of the Nobel Prize in Medicine or Physiology, Swedish winter. and an in-depth look at the cells that constitute the po- sitioning system in our brain.

medicor Robert de Meijere • Editor-in-Chief | Oskar Swartling • Associate Editor | Andrey Pyko • Creative Director Ibrahim Rayyes • Proofreader General | Vladimir Choi • Executive Editor | Sergio Scro • Editor of Global Focus | Yasmine Djoumi • Producer Janne Andersson • Senior Advisor | Amanda Kaba Liljeberg • Editor of Campus | Iskra Pollak Dorocic • Editor of Science | Poya Livälven • Editor of Culture

Filippa Grönqvist, Vera Berg, Halima Hassan • Reporters | Martin Kjellberg, David Humphreys, Katarina Stojanovic, Maria Belikova • Photographers Gustaf Drevin, Yasmine Djoumi, James Salisi, Haroon Bayani, Karolina Werynska, Jens Magnusson, Parvin Kumar, Anna-Theresia Ekman, Frida Segernäs, Nicolas Guyon, Jessica De Loma Olson, Giulia Gaudenzi, Johanna Tauriainen • Writers | Fergal Horgan • Proofreaders | Mikael Plymoth, Jakub Lewicki • Illustrators 4 Aperture Mark Post holding the world’s most expensive hamburger made from cow stem cells. Medicor talked to him about the technology and ethics be- hind lab-grown meat. Read more on page 18. PHOTO BY: DAVID PARRY / PA WIRE

5 Julbord

Christmas-themed Science EVERY CHRISTMAS THE BRITISH MEDICAL JOURNAL PUB- lishes a series of articles with a twist. Be sure to check out the BMJ issue around Christmas time to get information on It has been why Rudolph’s nose is red, how James Bond’s drinking habits hypothesized would affect his physical and mental status, the genetics of magic and much more. that Rudolph’s red nose is the result of a parasitic infection of his respiratory system.

Ho Ho Ho In Canada the Canada Post uses “the characters H0H 0H0 as the postal code for letters to be sent to Santa Claus.

Knäckand other Christmas hazards CHRISTMAS IS A VERY STRESSFUL TIME FOR MANY, LEAD- USA ing to an increase of injuries around the festive period. Dentists experience an increased income of patients with A STUDY FROM THE UNITED detached fillings, cracked teeth and toothache, caused by States suggests there is no peak in “knäck” and other sweets consumed around the holidays suicides during the holidays. The but also grinding of teeth due to stress. Other common study, conducted over a 35-year peri- injuries are burns caused by boiling “knäck” or preparing od, saw no increase of suicides before, the Christmas dinner. Not even the Christmas tree is not as during, or after holidays. On the contra- harmless as it seems. Every year people are injured falling ry, before Christmas the rates of psychi- from unstable chairs when decorating their Christmas trees, atric visits actually decrease or falling down from lofts when looking for decora- in the US, debunking tions. The decorations themselves are a danger to the popular belief toddlers that bite into glass baubles or choke on that suicides are more toy-like decorations. So, in order to fully enjoy common during the the holidays without cracked teeth or band- holidays, especially dur- aged body parts, make sure to avoid stress and ing Christmas. It is be- excessive amounts of alcohol since these are lieved that this is due the most common causes of injuries. to an increase in social support during the holidays.

6 Julbord Sweden MANY PEOPLE GAIN WEIGHT DURING 3% fat. Herring, salmon and nuts are also Christmas and since obesity and cardiovas- healthy alternatives. But the healthiest sug- cular diseases are an increasing problem gestion would be to enjoy everything in in the Western world, many Swedes have moderation. Swedish studies suggest that become more conscious of what they eat. nocturnal feasting per se does not make you Traditional Christmas food can be quite fat, so enjoying a midnight “lussebulle” is fatty, but there are healthy alternatives. given green light. Luckily enough, the most popular dish for Christmas, the Christmas ham is one of the healthier alternatives containing only

Japan CHRISTMAS IS NOT WIDELY CELEBRATED in Japan, although some American cus- toms has been introduced. Christmas Eve is more similar to Valentine’s Day, a day for couples to spend time together and exchange gifts. Christmas eve, is also, the day for fried chicken. KFC and other restaurants serving fried chicken have their busiest day of the year on Christmas eve. Thanks to an extremely successful campaign in 1974, a bucket of Christmas Chicken is a must during the holidays. 7,000 Pieces of chicken fried in one KFC outlet in Tokyo on Christmas Eve. India ONLY 2.3 % OF THE INDIAN POPULATION ARE Christians, meaning that Christmas is a rela- 2.3% tively small festival in India compared to the of the Indian other ones celebrated. However, since the Indian population is about 1.2 billion, there population are more than 24 million Christmas celebra- are Christians tors in the country.

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Did you join the for your future?

Photo by David Humphreys & Katarina Stojanovic

As a Healthcare or Life Sciences student, you may not always know which career path to choose once you graduate. Perhaps you are not even aware of all the non-traditional career options available to you. Is your future really set in stone after you have completed your education? Think differently! On the 12th of November, a group of students held the biggest career fair that Karolinska Institutet had ever seen: CHaSE (Careers in Health and Science Exposition). CHaSE is a career fair targeted at all students and graduates in the health and life sciences. If you happened to join CHaSE you had the chance to find out what your future may hold.

THE CHASE “STARTUP” awareness towards alternative careers; 2) A WORLD OF OPPORTUNITIES In partnership with Medicinska Förenin- to bridge the gap between the academia Those who came to the fair had the gen (MF) and Karolinska Institutet, and and the privatized world; 3) to do that in chance to meet their dream company, on behalf of the Business Committee, a an interactive-stimulating environment. their future employer, to expand their group of 12 energized students gathered network and to improve their career around a table with the objective of or- THE DAY portfolio. If you joined the CHaSE, you ganizing a unique career fair. Many at- The 12th of November came fast. The may now have discovered that there are tempts to organize a major career fair Aula Medica was packed with 40 com- many other ways to shape your career had been made in the past and the team panies and organizations exhibiting their than the common tracks in academia. We was fully aware of the heavy task on its career prospects. The MF premises were all greatly hope that CHaSE will become shoulders. A brand was needed, and after the stage of a carefully selected panel of an annual event that keeps answering the a 6 hour brainstorming session on a cold speakers giving personalized advice to needs of students and professionals in March Saturday afternoon, the idea of the students, regarding their career as- our fields. CHaSE came up. “It’s catchy and reflects pirations. By inviting major life science the pursuit of your dreams” – one of the companies such as AstraZeneca, Roche CHASE YOUR FUTURE! team members said. It was set, CHaSE and SLL, CHaSE not only reached out A big thanks to the organizers who put was going to happen! to students but also already working CHaSE together: professionals. Particularly popular, the Cécile Zaouter, Christian Lind, Dan- “Personal brand”-workshop provided the iel Yen, Emelie Braun, Florian Meisgen, Discovery, networking visitors with the necessary tools to be Francesca Bignami, Lizan Kawa, Michael able to use social media to market them- Hagemann-Jensen, Moritz Lübke, Su- and interaction were the selves. A professional photographer took sanna M Bächle, Thibaud Richard, Tiago keywords of the day... the participants’ LinkedIn picture. Dis- Pinheiro. And also a big thanks to the vol- covery, networking and interaction were unteers at CHaSE. the keywords of the day, experienced by THE GOALS over 1000 visitors. Experience design was www.chasesthlm.se During the few months ahead, the CHaSE a key feature distinguishing CHaSE from team worked hard in defining its role and any other career fair. The Alice in Won- objectives. No business idea is to be suc- derland theme was picked as a mean for cessful if: 1) it’s not unique in its field; 2) discovery of the visitors’ opportunities. A it does not answer a well sought need. lounge with couches and a soccer table, It had to be big, it had to be unique and in which you could challenge AstraZen- it would have to answer the current re- eca for a game, were just some of the de- ality. Let’s face it (!): the traditional aca- tails making this day more interactive. demia pyramid is collapsing as we speak. So, CHaSE drew up its goals: 1) to create

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9 KAROLINSKA

Stepping up for Access to Health Care Time for students to take action!

By Anna-Theresia Ekman*

*Health Care in Danger Focal Point IFMSA-Sweden

HAVE YOU REFLECTED ON WHY HEALTH establishing the respect to human rights ranged our federations first Health Care care personnel are an actual target in and medical ethics. in Danger Sub Regional Training for Eu- conflicts and war zones? This is the harsh Access to health care is not only ropean students inviting experts of Inter- reality in many conflicts and it is believed threatened in armed conflicts. Parties national Humanitarian Law, medical field that the problem is increasing. In armed and other groups that do not acknowl- personnel and youth advocacy experts to conflicts, health care personnel are being edge the equal and inalienable rights meet students. During the spring term, targeted in attacks, ambulances are being within all humans are part of national and we welcome you to take part in our future denied access at checkpoints and phar- European decision making. The internal venture to step up for access to health macies are being raided. We as future disturbances in Ukraine are a reminder care. health care personnel can either adjust to that peace can be transient. Swedish am- How can we maintain access to health this development – or take a stand. bulance personnel are facing a more vio- care when violence and threats of vio- The International Federation of Medi- lent environment at the same time as per- lence are right at our door step? We need cal Students’ Associations (IFMSA) is sonnel in the emergency wards are being to find solutions and tools to be able to mobilizing students to take action. We are trained in self-defense in Stockholm. commit to the Human Right to Health, a global federation for medical students As part of the global movement, in armed conflict as well as non-combat who build a healthier tomorrow through IFMSA-Sweden has arranged activities zones. It is time for us as health care stu- local actions, student commitment and throughout the semester. We strengthen dents to step up and advocate the prin- advocacy. Supported by the International health care mandate to work as neutral ciples of the sanctity of health care, the Committee of the Red Cross, we have actors by informing of the Human Right right to health and to educate ourselves launched the project Health Care in Dan- to Health, International Humanitarian on Human Rights and access to health ger – Ethical Principles of Health Care in Law and medical ethics. We build capac- care. It is high time to speak up for the Conflicts and Other Emergencies. ity through symposiums, lectures, train- patient who seldom has the strength to Increased violence towards health ings and workshops. speak for herself. It is time to speak up as care personnel is a multifaceted area, In October, we arranged the Health the future care providers. where factors such as national security Care in Danger Symposium. We have ar- • polices, infrastructure, and implementa- tion of Human Rights needs to be taken into consideration. Given the complex nature of the threats, it is impossible for us to solve the problem ourselves. What we can do is to focus on part of the problem; the need of the patient and our professional ethic. Moa M Herrgård, the IFMSA Liaison Officer of Human Right and Peace, stress the importance of stu- dent action. Expecting conflict zones to be heaven is not realistic. The international society need to assure full implementation of ba- sic human rights in conflict zones. The access to health care is currently under threat due to violence towards health workers and facilities. They can call us naive and young, but IFMSA members have proven a capacity to address the obstacles to access to health and made a IFMSA Stockholm Local President Gustaf Drevin talks about the Health Care in Danger - Ethical Principles meaningful contribution. Let us do this in Conflict and Other Emergencies initiative (HCiD) during IFMSA Stockholm’s inspiration night in October. again, be leaders of behavioral change, re- Photo: IFMSA

10 KAROLINSKA The Black Gold Time to ponder on the coffee drinking at KI. Too much? Nah, just enough!

By Frida Segernäs

THE BLACK GOLD IS SOMETHING AL- eteria entirely on coffee. Viktor adds that year, and at the beginning and end of the most every student is depending on, and during the so-called exam periods, the terms they sell more coffee compared to because most of us haven’t got a car, it’s volume of coffee adds up a bit, meaning the rest of the time. This of course has not oil I’m talking about. The smell of that he will both bring his own coffee to do with the number of students actu- coffee when you enter any lecture hall at from home and buy some more at KI. No ally studying at the campus, and the very the Karolinska Institute is a warm wel- good for his finances, but maybe for the well known exam period at the end of come in the morning, and by the look of exam result. the terms. On a usual day the cafeteria most students, they need it. I wonder if In Sweden the average annual con- in Solna sells around 800 cups of coffee, the students at KI drink more coffee than sumption of coffee per person is 8,9 kilos, and on a busy day it can be up to 1500. We the rest of Sweden. which means 3,4 cups of coffee every day. can easily come to the conclusion that the Viktor Lind, medical student at KI, By talking to students at KI, I found that volume of coffee that is consumed at KI is one of many students who are carry- the ones who drink coffee often are above, on a regular day is massive, and that the ing a thermos in their bag alongside of and in many cases very much above, the staff working in the cafeteria get a good their books and computer. He explains average Swede. But the tea drinkers have work out through lifting about 120 liters that it’s because of the money, it’s simply their place at campus as well. If you add of coffee every day. too expensive to buy coffee in the cafete- those to the equation, I guess the school All though many of us are completely ria everyday. He has done some calculat- as a whole would match the Swedish av- sold on this delicious beverage, there are ing, and on a normal day with lectures erage. some things we don’t know about the he drinks about four large cups of coffee. Branka is working in the Sodexo caf- black gold we drink everyday. Therefore, That would sum up to 200 SEK a week, eteria in Jöns Jakob. She says that the con- I will now present some interesting facts and 1000 SEK a month, spent in the caf- sumption of coffee varies a lot over the about coffee, and also bust some myths.

DRINKING COFFEE = EXCESSIVE PEEING? A myth from the ‘70s says that coffee is a diuretic and if you I CAN’T SLEEP! drink coffee when it is hot outside you need to be careful A very common thought about coffee is not to become dehydrated. Coffee is not a diuretic if you are that it causes insomnia. Not every- drinking it regularly, and in a period of 24 hours there is no body knows that when drinking a cup difference whatsoever between a glass of water and a cup of of coffee, the caffeine is very quickly coffee. That means that a glass of water and a cup of coffee absorbed by the body and after 4-5 generate the same volume of urine if you see it in a one-day hours it is flushed out of the system. If you drink two or perspective. three cups of coffee on a daily basis, the effect from caf- feine is too small – therefore your insomnia is probably caused by something else. DEPRESSION? NO THANK YOU, I HAVE COFFEE. AVOID THE WINTER COLDS! If you are a coffee drinker the Coffee has a positive effect on our immune system. risk of being depressed is 20% This is because coffee contains more than a hundred less than a person who does kinds of antioxidants, which mildly stimulate the im- not drink coffee at all. This is mune system. Coffee contains about three times the caused by stimulation in the number of antioxidants compared to green tea. brain, which leads to an in- creased release of serotonin. I’M ADDICTED TO YOU… An addiction is very seldom a good sign. But the GETTING SOBER WITH COFFEE morning coffee, with the last sun in your face before For a while one of the most used ways to sober up if you Sweden turns into complete darkness, is very spe- had an alcohol problem was to drink coffee as a ”substi- cial. But of course, after a regular consumption of tute”. Research shows that this had an opposite effect, be- coffee for a long time withdrawal symptoms will ap- cause people drank both coffee and alcohol, which did not pear, if you suddenly stop drinking the daily dose lead to a reduction of alcohol consumption. Instead, the that your body is used to. But remember that effect was that people felt better after drinking coffee and morning coffee I talked about? At least for the number of car accidents actually added up when this me – it is totally worth the addiction! was a trend because drunk people high on coffee drove around.

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From Science Fiction to Science Faction; an inspiring symposium to unravel the mysteries

By Jessica De Loma Olson

HUMAN BEINGS HAVE A NATURAL TEN- year gathers some of the best scientists the most brilliant minds can share ideas dency to be creative, to explore their own from different fields. During the 20th and – Nobel Prize winner Edvard Moser par- imagination and to create universes that 21st of November all students, professors ticipated in last-year’s event – as well as are far from reality. Superheroes with un- and general public were able to enjoy create new possibilities and inspire fu- imaginable powers, alternative universes fascinating lectures about, to mentions ture generations. where anything is possible and incredible a few, regenerating the heart, creating Regenerating body parts, enhancing robots that overcome humans, are only Petri dish food and analyzing our upcom- humans and creating a map of our neu- a few examples. Jules Verne is popularly rons might seem like science fiction in- known for somehow predicting the fu- deed. And that was this year´s theme for ture. As a science fiction writer, he de- ...where some of the Nov2k: analyzing current discoveries that scribed futuristic machines and concepts, most brilliant minds not so long ago seemed like complete sci- such as submarines and videoconferenc- can share ideas – Nobel ence fiction, and understanding in what es, that seemed impossible in his time. direction we are going with these. During Humans have the incredible capacity of Prize winner Edvard this two-day event the public could enjoy being imaginative, speculating about the Moser participated in a multitude of sci-fi lectures, workshops future and of being creative to invent new aiming to stimulate our imagination in possibilities. But, are our scientific dis- last-year’s event... solving future upcoming challenges and coveries catching up to our imagination? an incredibly creative poster battle. This year’s Nov2k conference can help ing future. For 15 years in a row, and with Among the keynote speakers was provide insight to this question. the help of the Center for Gender Medi- Kenneth R. Chien, a professor at Karo- Nov2k is an event organized by gradu- cine and other postgraduate programs, linska Institute who delivered an inspi- ate students from Karolinska Institute this event aims to create a comfortable rational lecture on his field of interest: and Stockholm University that year after intellectual environment where some of cardiac regeneration. Science has always struggled against the fact that the heart is one of the organs incapable of regen- erating itself. However, Professor Chien’s talk alluded to a promising future as the field is gradually advancing towards the possibility of regenerating cardiac tissue. Choosing big challenges, recognizing when to take the right chance and having no fear at all, are the three main advices Chien gave his audience to conclude his inspiring lecture. From regenerative medicine to tran- shuman design, a lecture given by Ronald Jones, faculty at the Graduate School of Design at Harvard University. Humans are “fixed” all the time nowadays. From hearing aids to leg prosthesis, we can now not only preserve our lives but en- hance our abilities. Jones then motivates us to question ourselves to think if we are really crossing moral boundaries. Will

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Live 3D printing during Nov2k, Photos by Stephanie Wiegner normal humans someday not be able to speakers like David Schmidt, who de- for children that need a prosthetic hand compete against these improved transhu- nounced how science is producing paper and that might require several of them mans? If so, should we start putting lim- and not knowledge, reporting the “cherry throughout their growing period. its to our own creativity? “Can we create picking” process when selecting data. And last but not least, one of the best transhumans? Yes, but the real question is Other student speakers included Nina activities of the event: the poster slam. if we should,” explains Jones. Kaukua, who gave an insight to her re- Seven young researchers had three min- search focused on adult stem cells and utes each to defend their research and the possible regeneration of teeth, and make the public want even more. For this, ...this contributes to Matthias Lidin, with a speech titled “The they could pick any type of format to pre- what is known as “the Swedish lifestyle paradox”. Sweden is sent it but they all had to have one thing active couch potato probably considered all around the globe in common, it had to end with a cliffhang- as having a healthy and fit population. er. This initiative showed that science syndrome” However, recent studies show a differ- is not all about being static in a lab and ent perspective. Although only 9% of sharing knowledge in a plain and formal Relating to the need for analyzing our the Swedes say they never exercise, be- way. Science is much more than that. It is own abilities and their impact in the near ing one of the most active countries in passion. Endless hours in a lab that in the future, Kathryn Myronuk, from Singular- Europe, 21% of the population admitted end can be presented in some of the most ity University, showed the public around to sit more than 8,5 hours a day. Lidin ex- original ways possible. Arts and crafts, the exponential growth of technology. A plains that this means people in Sweden superheroes and superb actors had their paradigm shift in the use of robotics will have a tendency to workout and exercise spotlight for a couple of minutes during affect the current job positions available during concrete periods of time, but do that amusing morning. to humans. However, rather than worry- not mind sitting the rest of the day, maybe This year’s Nov2k was a stunning ex- ing about the possible non-desirable im- due to their work environment; this con- perience with an irresistible theme. Who pacts, Myronuk emphasizes that society tributes to what is known as “the active has never seen a superhero movie and should focus instead on how to overcome couch potato syndrome”. thought about those alternative worlds these limitations and start adapting to where anything is possible? With this this coming future. event the scientific community was re- Other keynote speakers that were Science is much more minded that almost everything is possi- invited to the event were Mark Post, re- ble as long as we can imagine it. Our re- sponsible for creating a new viable meat than that. It is passion. sponsibility as scientists is to let go of old source in the lab; Björn Högberg, who established concepts and to push the bor- uses DNA as Lego bricks opening the In addition to these incredible lec- ders of reality through our own creativ- doors to new possibilities for drug deliv- tures, participants also had the chance ity. These inspiring two days had the aim ery in the future; Ruth Ley, analyzing how to get in contact with 3D printing. Daniel to motivate science to blend conflicting genes can modulate our microbiome and Ljungstig, from 3DVerkstan, talked about concepts and to convert science fiction how this can affect our phenotype; and the different types of 3D printing that into science “factions”, one step at a time. Jesper Ryge, whose aim is to understand currently exist and all the possibilities Like every November, Nov2k will be back the brain’s circuits by modeling its com- and applications related to it. Have you next year with even more astonishing ex- plex network. ever imagined reconstructing a skull with periences for you with the will to inspire But Nov2k is not only about hearing what seems to be plastic puzzle pieces? the future of medicine and science. As brilliant scientists speak. Several events Or having a hand like the superhero Iron Carl Sagan said: “Imagination will often are organized to showcase the best among Man? It might sound foolish, but it is carry us to worlds that never were. But of the new generation of scientists. This now a reality. This “Iron Man” option is without it we go nowhere”. year it included exceptional student an affordable, practical and fast solution •

13 SCIENCE Science snippets By Jens Magnusson, Jessica De Loma Olson, Nicolas Guyon, Iskra Pollak Dorocic

LINKING THE BRAIN WITH THE GUT HALLUCINOGENIC BRAIN CONNEC- A recent hot topic in neuroscience is the TION effect of the microbiome – the bacteria Magic mushroom users usually report living in our intestines – on mental health. enhanced feeling of touch, more intense Research now suggests that the trillions colors, and synesthaesia, amongst other of bacteria found in the gut may have a hallucinations. Looking at new ways to profound impact on psychiatric condi- analyze how the brain is connected, re- tions such as autism and schizophrenia. searchers gave subjects a dose of psilocy- The microbiome seems to exert its great- bin, the active ingredient in magic mush- est impact on the brain earlier in life. In rooms, and placed them into an MRI one study, mice born by Caesarean sec- machine. They found dramatic changes tion (which results in an altered microbi- post-psilocybin, with increased integra- ome) were found to be significantly more tion between cortical regions that is not anxious and depressed. Another study present in the placebo subjects. This from 2013 discovered that the mice model hyperconnected brain could explain the for autism harboured a lower level of the changes in perceptions associated with common gut bacterium Bacteroides fragi- psilocybin. lis. Studies are ongoing to find concrete (G. Petri et al., Journal of the Royal Soci- mechanisms behind these correlations. Image credit: afgooey74 (Flickr) ety Interface, October 2014) (Nature News, November 14 2014)

HUMAN POPULATION GROWTH MAKING FUNCTIONAL PANCREATIC β The UN estimates that there will be 10- CELLS 12 billion humans by 2100, a projection Some 387 million people suffer from dia- that fuels discussions about the environ- betes. The minority with type 1 diabetes, mental impact of overpopulation on our in which insulin-producing β cells gradu- planet. To build an evidence base for this ally die, could potentially be cured if the discussion, researchers used comput- cells could be replaced with new ones. ers to model population dynamics un- However, acquiring enough new, func- der different scenarios. They found that tional β cells is difficult. Now, a group of even with draconian one-child policies it researchers at Harvard University have would take centuries to decrease popula- developed a protocol to produce β cells tion size. Therefore, reducing overpopu- from patient-derived stem cells. The new lation is no “quick fix”; instead, our focus cells reversed symptoms when trans- should be on attenuating our environ- planted into diabetic mice, and the meth- mental impact in other ways. od, which is scalable for humans, could (Bradshaw et al., PNAS, November 2014) be a significant step towards curing type 1 diabetes. (Pagliuca et al., Cell, October 2014) Image credit: Anders Sandberg (Flickr) RESUSCITATING DEAD HEARTS Australian doctors at St. Vincent’s Hos- pital in Sydney have successfully trans- EVADING HIV planted the first dead heart by making it Around 1 percent of people infected with beat again in a special chamber. Despite HIV are asymptomatic, but the genetic what we would expect, it is possible to mechanisms behind this are still not un- resuscitate dead hearts instead of using derstood. Researchers have found a ge- live ones from brain-dead patients. This netic mutation that caused two men (one presumed miracle has been developed of whom was diagnosed HIV-positive 30 with the help of research from the Vic- years ago) to not show any clinical symp- tor Chang Cardiac Research Institute and toms. The virus was shut down as a result consists of a preservation solution and an of a modification of its genetic code due ex-vivo organ care system that can keep to a group of enzymes, usually repressed, the organ warm and functional; making it that causes further DNA changes. This possible to revive the heart even 20 min- could lead to future treatment whereby utes after the donor has died. It is hoped activation of these enzymes can disable this groundbreaking development will HIV even after infection has already been help reduce the problem of donor short- established. age. (Colson et al., Clinical Microbiology and (Victor Chang Cardiac Research Institute Infection, October 2014) - http://www.victorchang.edu.au)

Image credit: Brick red (Flickr)

14 The curious case of the mind

By Karolina Weryńska The Strange Case of Dr. Jekyll and Mr. Hyde (Wikimedia commons)

OUR BRAIN HOLDS MANY MYSTERIES: flecting the eternal fight between good to be the main one. The unconscious use some will kindle your interest and oth- and evil. Dr. Jekyll desperately tries to of “we” instead of “I” is also common. ers will baffle you completely. Let’s take suppress his worryingly vicious urges. He DID is often accompanied by epi- a peek at one of them. creates a serum that turns out to be rather sodes of amnesia and time distortion. “Kathy”, 29 years old, mother of three, surprising – instead of masking the evil The main identity (called “the host per- was brought to hospital by her husband inside, it transforms him into his ruthless, sonality”) is usually unaware of the split after overdosing on sleeping pills. violent alter ego, Mr. Hyde. Before long inside. The switch leaves behind memory Since the age of four, she was sexu- Hyde begins to dominate and take control lapses, which cannot be explained by ally abused by her father. That led her of Jekyll. forgetfulness. Although not common, to become “Pat”. At age nine, her moth- Emergence of the first additional communication between the personality er started having sexual relations with identity is usually triggered by early states is possible (e.g. older identities of- her. “Kathy” couldn’t accept that and so childhood trauma (sexual abuse more of- fering advice to the younger ones). More “Vera” emerged. At 14, she suffered from ten than physical). The terror is so mon- often, however, one identity is unable to yet another traumatic experience. She umental that the child cannot deal with recollect external information presented was raped by an older man (a close fam- the truth and represses the reality (“it to another. ily friend) and following this, “Debby” happened to somebody else”), thus creat- Without any biological correlates, appeared. When “Kathy” was 18 years ing a new personality state that is better there is no consensus on diagnosis or old, she ran away from home, and was prepared to process the traumatic event. treatment. It is known that people suf- ultimately forced by poverty into prosti- fering from DID are more vulnerable to tution, for which “Kathy” began calling hypnosis and therefore more prone to herself “Nancy”. Some time later “Debby” The number of identities suggestions. Indeed, hypnosis is often rejected “Nancy” and drove her to a sui- can vary from two to used in therapy sessions. The goal is to cide attempt. During assessment, “Deb- integrate all the personality states whilst by” was identified as the most dominant 100. Some disappear maintaining all the experiences of each of her identities. What is the diagnosis? with age, others remain alter ego. Dissociative identity disorder (DID, On a final note, DID can be viewed previously known as multiple personal- constant companions as an extreme version of what occurs ity disorder) is one of the most contro- deep inside. naturally in all of us. Nobody has a truly versial psychiatric diagnoses. Some con- “integrated” personality – we adapts to sider it to be connected with borderline The first switch is followed by a ten- new roles and change our behaviors in personality disorder, whilst others doubt dency to create new personality states in response to changes in our external en- its very existence. response to further trauma. The number vironment. In this light, we can think of DID is a psychiatric condition with at of identities can vary from two to 100. DID as the result when different aspects least two distinct identities that control Some disappear with age, others remain of an individual do not function properly behavior during different situations (one constant companions deep inside. together. is dominant, whilst the other emerges in Differences amongst identities are Our mind works in mysterious ways. specific situations). A classic example is often astounding. Not only do charac- This is just one condition, yet there are “Dr. Jekyll and Mr. Hyde”, portrayed in a ter traits change, but so does the tone of countless other personal peculiarities famous novella by Robert Louis Steven- voice, posture, and handedness – even creating separate worlds inside us, mak- son. It is a thrilling tale of the struggle sexuality and gender can be altered. Fur- ing each of us singular and unique. between two sides of one individual, re- thermore, the first identity doesn’t have •

15 SCIENCE

Image credit: Ksayer1 (Flickr) Organic food – What is the point?

By Haroon Bayani

IN THE LAST TEN YEARS, OUR CONSUMP- sensitization). Furthermore, analysis of In addition, a few words should be tion of organic food has increased tre- biomarkers and nutrient levels in serum, said about the environmental impact of mendously. While it can sometimes be urine, breast milk, and semen did not re- organic food, since a large portion of con- priced twice as much as non-organic veal any substantial disparities between sumers purchases it with the belief that it food, people are still willing to pay for it, organic and conventional food. When is more environmentally-friendly. We can justified by our presumptions that it is it comes to vitamin content, again, no reason that reduced pesticide use should healthier, more environmentally-friend- significant differences could be found. result in less pollution of Mother Earth. ly, and simply tastier. Nobody can argue Phosphorus levels, on the other hand, A meta-analysis published in Journal of with anybody’s individual taste, but there have been found to be higher in organic Environmental Management showed that is evidence to suggest that the first two food than conventional food. This, how- organic farming did indeed have a low- assumptions are not necessarily correct. ever, is not clinically relevant as one must er environmental impact per unit area First of all, what is organic food? be close to starvation in order to induce than conventional farming. On the other Here, it is defined as organic food one phosphorus deficiency. hand, mainly due to lower yields, organic finds in the supermarket or at small, ex- farming had a higher impact per product clusive shops, and not home-grown food, unit. Perhaps a mixture of both systems for which evidence is limited. Addition- Perhaps a mixture of is needed, depending on the demands of ally, it should be mentioned that organic both systems is needed, people and geography. food, unlike conventional food, is usually In conclusion, you should not by any grown without the use of pesticides, ferti- depending on the means stop consuming organic food if lizers, antibiotics, or hormones. The man- demands of people and you already do so. In some cases it tastes ufacturers of these products endorse the better, and in others it simply looks principles of fairness, care, ecology, and geography better. Despite this, one should not au- health. No wonder people relish them. tomatically assume that conventional Although it seems plausible that food Nonetheless, organic food does ap- food, whilst occasionally less tasty or at- without pesticides, etc. is healthier, there pear to be superior in one aspect. Pesti- tractive, is any less nutritious. Secondly, is no evidence showing that organic food cide contamination is remarkably lower one cannot easily judge whether or not is more beneficial for health when com- in organic food, which is not a surprise organic food is more environmentally- pared to conventional food. In September considering that no pesticides are sup- friendly, as the reality is more complex 2012, a systematic review was published posed to be used. That being said, does than one may think. And lastly, if you in Annals of Internal Medicine, synthe- this have any clinical relevance? No. The want the ultimate assurance, there is sizing 17 studies, of which three exam- levels of pesticide contamination in con- always the option of growing your own ined clinical outcomes. None of the latter ventional food are already far below the food. displayed a significant difference for al- maximum allowed safety limits. • lergic outcomes (eczema, wheeze, atopic

16 SCIENCE

Tricking our sense of taste By Jessica De Loma Olson

Image credit: Alisha Vargas (Flickr)

OF OUR FIVE COMMON SENSES, WE have been associated with differences in a glycoprotein naturally found in Synse- might think taste is at the bottom of our perception and tolerance for sweet tastes. palum dulcificum, otherwise known as list when considering their relative im- This could explain why sweets are a soft the miracle berry. This molecule binds to portance. If we had to lose a sense, almost spot of many people, whilst others simply sweet receptors on the tongue and when no one would think twice about discard- cannot stand them. exposed to sour substances, changes its ing our sense of taste. However, the rel- conformation and activates the wrong evance of taste for survival is well known sweet receptors. In this situation, sour is despite being often underestimated. If you have a sweet interpreted as sweet, opening the doors When humans were hunter-gatherers, tooth, you do not have to a universe of confusion for our taste it is likely our taste receptors were critical buds. to our survival. Unpleasant tastes are of- to feel guilty anymore... Sometimes, tricking our sense of taste ten associated with poisonous substances can involve much more than altering our or non-edible goods that should be avoid- Another aspect to this is our percep- tasting perceptions. The presence of bit- ed. This is the case for bitter substances, tion of bitter taste and resulting facial ex- ter receptors (TAS2R) has been docu- usually characteristic of alkaloids derived pressions. Remember that feeling of eat- mented in smooth muscle cells in the from plants that are poisonous, and sour ing broccoli? You would probably stick airways. Studies have shown how bitter ones, normally related to rotten food. your tongue out, wrinkle your nose, and substances can activate these receptors But our sense of taste does not only retract your upper lip. Now, think about to induce the relaxation of bronchial serve to warn us about potential dan- what face you would put on if you were muscles. Such discoveries could bring gers – it is also related to pleasure. The “grossed-out” by the look of rotten food. new therapeutic options to treat asthma, refreshing taste of freshly-picked vegeta- Feel familiar? The connection between showing us that there is more to learn bles or the juiciness of a piece of meat visceral disgust (induced by looking at about our senses than we know. can get any of us to salivate. And this is rotten food) and bitter taste has been This leaves us with a final question: no coincidence. Both our senses of taste widely studied. Both produce the same are we capable of manipulating our sense and smell initiate the process of diges- contraction of facial muscles and have of taste to suit our own purposes? Getting tion, which means that, as you start eat- been linked to the same neurological children to eat their vegetables or even ing, the stomach automatically becomes area, the anterior insular cortex. Even treating diseases such as asthma are only active even before the food gets to it, pre- though there seems to be an obvious con- some of the possibilities the future may paring itself for digestion. nection, the biological relevance of this hold. As long as our insatiable appetite Another interesting fact is our propen- remains unknown. for scientific discovery does not subside, sity towards sweets. If you have a sweet Many questions have yet to be solved, we inch ever closer to the taste of vic- tooth, you do not have to feel guilty any- but our interest in understanding this tory. more – genetics are behind this. Different sense is growing. During the process of • alleles of the gene Tas1r3, which codes for uncovering answers, there have also been one of the subunits of the sweet receptor, attempts to alter and trick it. Miraculin is

17 SCIENCE

In vitro meat: from science fiction to the future of food

By Iskra Pollak Dorocic

Medicor talks to the creator of the world’s ple, originated from industrial livestock. most expensive hamburger about the Prevalent bacterial contamination make technology and ethics behind lab-grown meat recalls common. A huge amount meat. of antibiotics is used on cattle, fuelling the rise of antibiotic resistance. Growing WOULD YOU EAT A HAMBURGER THAT meat in sterile facilities could avoid all of was grown from stem cells in a lab? Does these problems. it sound appetizing in any way? Chances During his talk, Dr. Post emphasized are you would say no. I thought so too that we do not actually need to consume until I spoke to Mark Post, the scientist animal protein in order to survive and behind the stem cell-derived hamburger thrive. Being vegetarian is a perfectly rea- unveiled last year. There are a number sonable option, nevertheless only 3% of of compelling reasons to support this Europe’s population chooses this alter- budding technology and they do not just native, and this proportion has remained include animal welfare. Dr. Post, who re- relatively even over the last 35 years. cently spoke at the Nov2k conference at Clearly, most of us prefer to keep eating Karolinska Institutet, says his main mo- meat, despite knowing that it’s not great tivations for this endeavor are “for the either for our health nor for the envi- Professor Mark Post with a burger potential societal impact that it has: on ronment. What’s more, global meat con- made from Cultured Beef food security, the environment and ani- sumption is projected to more than dou- Photo: David Parry / PA Wire mal welfare.” ble by 2050 due to the developing world’s The maintenance of livestock has an increasing ability to afford it. enormous environmental impact. Ac- kind of experiment in the walls of aca- So how is cultured beef actually demia. It is more of an industrial project.” cording to a 2006 UN report on food grown in the lab? The process begins security, livestock accounts for 18% of The next step is to make it into a com- with harvesting stem cells from a cow, mercial enterprise. “The investors are worldwide greenhouse gas emissions, specifically the muscle-precursor cells mostly due to the release of methane, a there, but the food companies are reluc- which are able to regenerate throughout tant. They are conservative.” The funding greenhouse gas which is 20 times more life. The cells differentiate and multiply a potent than carbon dioxide. This makes for the initial phase of development came trillionfold, then assemble into myotubes, partially from Sergey Brin, the co-found- the meat industry worse than the entire which are basically muscle fibres, each transportation sector in terms of emis- er of Google, who said he got into the idea less than 3 mm long. Muscle cells natu- for animal welfare reasons. He is the one sion. Going vegetarian would do a lot rally contract and relax, making the myo- more for the environment than swapping who picked up the €250,000 tab for the tubes form rings of muscle tissue through first lab-grown burger ever produced. in an SUV. this movement. These rings are then cut Not only that, the amount of land used At a much-publicized and broadcasted into strands, and 20,000 of the strands are event in London during August 2013, the for grazing takes up 26% of the habitable assembled into one burger. land on the planet, 70% of all land used world’s first “cultured beef” burger was for agriculture and 8% of global human presented to the world. It was cooked by water use. We are quickly running out of ...cells taken from one British chef Richard McGeown and tast- resources necessary to continue increas- ed by a panel including Josh Schonwald, ing livestock for a growing global popula- cow could produce 175 a food critic, Hanni Rützler, a nutritional tion – the global herd amounts to a stag- million burgers researcher, and Dr. Post himself. Dr. Post gering 60 billion land animals. describes the taste as being “not perfect In contrast, cells taken from one cow yet and we knew that. But it’s definitely The actual scientific process of in- getting there. It’s definitely better than could produce 175 million burgers. With vitro meat production is relatively sim- our current technology this would take any other meat substitute that I have tast- ple. “If I can do it, anyone can”, insists ed. I know it will be there when I can no 440,000 cows. The point would not be to Dr. Post. He envisions a future where one completely eliminate livestock, but to re- longer distinguish it from real meat.” could grow his or her own meat. To him The burger was made up entirely of duce their numbers drastically. the science behind it is quite trivial, and Current livestock farming practices cultured muscle cells, with an addition of very much in the realm of possibility to- powdered egg and breadcrumbs, which also facilitate the rise in epidemic virus- day. “It’s something that’s scientifically es. Both swine and avian flu, for exam- are used for binding even in regular burg- kind of boring. So you shouldn’t do this ers. Some beetroot juice and saffron was

18 also added to enhance colour and make meat is the feedback he gets. “This sub- In order to start producing more com- the meat look more natural. The main ject requires a lot of public debate. And plex types of meat, such as steak, a few difference from a regular burger is that for that you need to engage, there is no engineering obstacles still need to be the cultured burger contains absolutely way around it.” When asked how he feels solved. A thick steak would need a vas- no fat, as it is pure muscle. Still, the panel about being the face of this new technolo- culature in order for the cells to receive members were sympathetic and praised gy and all the publicity surrounding it, he sufficient oxygen and nutrients. Another the burger’s texture for its ‘realness’ and laughs, “I’ve been in medical research for goal is to eliminate serum (which comes ‘whole mouth feel’. 25 years and there has never been a medi- from animals) from the culture media Dr. Post says that the public reaction cal journalist interested in that work. And used to feed the cells as they are grow- has mostly been positive. “Most people now all of a sudden they are interested in ing – this would make the procedure even understand that there are issues with something that seems almost trivial to more cruelty free. And then of course meat production. And any alternative me.” there is the cost. It will need to substan- that you present they look at it favorably.” tially decrease to ever be plausible com- In the UK, 68% of people on the street say mercially. they support the technology. In the Neth- “This subject requires a Looking to the future, the develop- erlands, 63% feel the same, and 50% say lot of public debate.” ment of cultured meat looks bright. Who they would buy in-vitro meat in the su- knows, maybe in a few years we’ll be en- permarket if it were available. “The real Dr. Post has been working as a tis- joying some guilt-free hamburgers. And initial scare has faded somewhat, because sue engineer with an expertise in build- even if not, in-vitro meat is provoking a lot of people have been writing about ing blood vessels, and meat engineering some necessary dialogue on the subject it, and most people now know what it is. started out more as a side project. “I of future technologies as well as the is- Which is actually pretty amazing.” Beside wasn’t really looking to get into a new sues with mass production of meat. Bon education, the other obstacle is just pure type of tissue, or new type of tissue engi- appetit? habit. Dr. Post thinks once people get ac- neering, but I just very much like the ap- • customed to the idea there will be little plication.” Growing in-vitro meat proved obstacle in getting cultured meat into to be much more achievable compared to kitchens. “Making it accessible makes it for example growing functional organs less ‘frankenstein-ish’. “ for transplantation. “I like the idea to According to Dr. Post, the best part start achieving your goal with tissue en- of talking to the public about cultured gineering at an earlier stage.“

19 GLOBAL FOCUS

Worlds AIDS Day 2014 at Karolinska Institutet

By Halima Hassan

The Human Immunodeficiency Virus and this is the primary aim of activists. result majority of people today are very (HIV) targets and weakens the immune Though it goes without mention that uninformed with regards to the disease. system in infected individuals. Acquired activists should have a good theoretical Professor Anna Mia Ekström, Depart- Immunodeficiency Syndrome (AIDS) is basis of the issue they wish to change. ment of Public Health Sciences, Karolin- the final stage of HIV infection and peo- Therefore the idea of researchers as ac- ska Institute, spoke about how there is ple with AIDS have severely damaged im- tivists is ideal. still ignorance among the young and old mune systems which places them at risk alike about HIV. Some people are still un- for opportunistic infections and some Is it the responsibility sure about the various ways in which HIV cancers. Currently there is no cure for the can be transmitted and whether its safe to disease however effective treatment with of scientists to have sex with an infected individual. antiretroviral drugs (ARVs) can control condense their findings, Furthermore, this reduction in HIV the virus, lowering the risk of develop- related activism appears to have led to a ing AIDS and allowing patients to enjoy avoiding complicated lack of interest in the issue by young sci- healthy and productive lives. terminology, before entists, the media, politicians and funding sharing? bodies. Professor Kristina Broliden, part THE CENTRAL THEME OF THE WORLD of the department of Medicine, Karolin- AIDS day conference that took place at However, the unfortunate reality to- ska Institute, explained how it may be the Karolinska this year was the idea of re- day is that HIV related activism is not as lack of funding within HIV research that searchers as activists and speakers with dynamic as it once was. Ophelia Haany- is repelling young scientists from pursu- different roles within the HIV commu- ama, author and Senior Advisor to the ing a research career in this field. Addi- nity were invited. The key factor that un- Swedish NGO Noah’s Ark, explains that, tionally, Haanyama argues that it is also derlay the immense and unprecedented realistically, “activism has to be at the partly the fault of the current HIV scien- progress made in respect of the response same impact, the same noise as the prob- tists and the media, rather than the gov- to HIV and AIDS, compared to other lem at hand.” HIV remains a global pub- ernment for allocating little money to the public health issues, is activism. The lic health issue however a lot of progress field, “Researchers and HIV workers are current Ebola epidemic has, if anything, has been made in the past 30 years; many part of the reason for the lack of interest conveyed to us the necessity for strong of the initial complaints of the activists, in HIV because we have somehow com- lobbyists within our research communi- such as the need for drugs with fewer side municated that the problem is sorted.” ties. It is difficult to achieve much within effects, have been addressed. As a result A counter that arises when discussing global health without putting pressure of the progress, over time, the movement the notion of scientists as activists is that on the policy makers to achieve change, waned in terms of activity. However as a science should ideally be neutral. Dr Pia Engstrand, who works at the Ministry of Foreign Affairs, argues that there is actu- ally no such thing as neutral research. All funding bodies have vested interests in the projects they are funding. Although some scientists may find it difficult to engage directly in activism, they can still aid change by sharing their information. Engstrand argues that better information sharing between researchers and policy makers is the key to more effective re- sponses to public health issues like HIV. Ideally there should be a constant flow of information between the scientists and policy makers in order for the best deci- sions to be made. A relating issue also discussed at the conference was the accessibility, in terms

20 GLOBAL FOCUS

Photos by Chantal Marchini of presentation of information and writ- things, better patient-provider interac- ality, around the globe? How can health ing style, of research results to the policy tion, changes in the way clinical trials are workers and the industry sustain millions makers and public. Is it the responsibility conducted and a reduction in the cost of of people on antiretroviral drugs for long of scientists to condense their findings, drugs. Buse argues that that although “it periods of time? Haanyama believes that avoiding complicated terminology, be- would be a wonderful world if academics before addressing these issues there are fore sharing? Ekström stated that to some could become activists, it is more realis- some basic but important barriers that extent researchers should also consider tic to focus on some incremental steps need to be addressed. Firstly, the HIV themselves public health informants. Re- that can be taken to support activists and health care strategy used should be tai- searchers and academics are ultimately to provide them with incentives to better lored to the region and community being the experts and they should try to convey engage in policy processes by improving targeted. For example the issue for many what they know and find in layman terms activist-researcher partnerships.” Buse African communities affected is access so as to easily engage with policy mak- wants researchers and activists to be bet- to hospitals or health care agencies to re- ers and collaborate with activists. Its only ter allies as this may be the best way to ceive drugs, let alone continually taking through such a coalition that the great- bring about more evidence based, social- drugs. “Healthcare efforts need to be lo- est change can be observed. Ekström be- ly progressive policy. “Align yourselves as calized, strategic and specific. Everything lieves that scientists need to improve the researchers more closely to activists so doesn’t work for everyone.” For this, way results are communicated and should they can bring about change for all.” Ekström comments that what is needed try to make themselves more accessible is research into developmental corpora- to the everyone. After all, “science is tions and implementation strategies so funded on tax payers money therefore we “it would be a wonderful health care officials know exactly what have a responsibility to share... We cant world if academics works and where. just leave it to the public health officials could become The HIV response has come far since to communicate to the general public.” the 1980s when it first gained momentum. Broliden counters with a slightly differ- activists...” It has resulted in the development of bet- ent argument: “some scientists are inter- ter drugs for those infected and today disciplinary and others prefer staying be- Though finding ways of improving there also exists many support groups. hind the microscope and generating data. partnerships between the key players in Though not as publicized as it once was, Maybe we should focus on doing what the HIV agenda is important, its also vi- it is necessary that the pandemic is for- we are good at.” Broliden believes that tal that the current efforts carried out to gotten in the mist of the many other glob- though every scientist should be availa- address the epidemic are reviewed and al health issues. People are still dying all ble to answer questions and be accessible improved if necessary. All the invited around the world from this disease, pri- to policy makers if need be, not everyone speakers at the conference agree that the marily from a lack of access to treatment. should have to; particularly if communi- real focus should be on HIV prevention The need for policies which are evidence cation is not their strength. through education and treatment. This based and tailored to specific HIV com- The keynote speaker at the confer- idea of treatment as prevention came munities is also an issue today. It is vital ence was Dr. Kent Buse, Director of Stra- from the observation that infected indi- that relationships between policy makers, tegic Planning and Special Advisor to the viduals with low viral load, as a result of scientists and activists improve, in order Executive Director at UNAIDS. His talk treatment with anti-retroviral drugs, have to observe further progress with issues focused on ways to improve communi- a 96% reduced risk of transmission. How- such as access to treatment. Stronger alli- cation between scientists, policy mak- ever with this action plans comes many ances between these three groups within ers and activists. Through activism, the problems. How can this ‘treatment as the HIV community is the key to one day HIV movement achieved, amongst other prevention’ plan be implemented in re- ending the battle with HIV. • 21 GLOBAL FOCUS

Image credit: European Commission DG ECHO (Flickr) Ebola – the new black

By Haroon Bayani

IN SEPTEMBER, AT THE UN GENERAL malaria, lower respiratory tract infec- drastic measures. If the officials did not Assembly, President Barack Obama tions, diarrhoeal diseases, and tuberculo- warn the public in time, there probably voiced the three most significant global sis. A greater sense of perspective would would have been more casualties. Un- threats. In third place came the extremist better serve the public perception of in- fortunately, Ebola has already led to sig- group Daesh (also known as ISIS or ISIL), fectious diseases. nificant economic losses in sub-Saharan spreading terror and slaughtering inno- countries, even those without any cases. cents in the Middle East. In second place Tourism and mining are two sectors that came “the Russian aggression in Europe”. If people took obesity have seen dramatic declines in revenue. In first place, however, came none other as seriously as they It should be mentioned that without than the notorious Ebola virus disease, the actions taken, many more lives would which has spread to over three African did Ebola, perhaps have been lost. Even though things could states, killed under 20 000 so far, and it would not be so have been done better, the threat of Eb- has taken the life of one American citi- ola as a pandemic seems to have been zen. However, when compared to other prevalent. averted, at least for now. Furthermore, a diseases, it is not as horrendous as one vaccine is currently being developed by might think. My point is not to undermine the cas- the British pharmaceutical company GSK First of all, let us have a glance at the ualties, nor am I claiming that the Ebola and the US National Institute of Allergy development of Ebola. Researchers be- epidemic should be neglected. It is a dis- and Infectious Diseases. The Ebola out- lieve that a two-year-old boy in Guinea ease with a high mortality rate, and thus break has also exposed the fragile infra- was the index case, back in December should be taken seriously and eliminated structure and allegations of corruption 2013. Several of his female relatives be- as soon as possible. However, we must within affected countries – issues that are came ill and displayed similar symptoms, not disregard other serious health threats much more deep-rooted. Nonetheless, and later died. The virus spread when the around the world. Apart from the infec- Ebola is only one of many pressing health initial cases infected people, spreading tious diseases mentioned, there is a more issues that the world has to deal with. My it to other villages. Since it took several urging disease – a ticking bomb if I may hope is that our future politicians and the months before the authorities recognized say so – the obesity epidemic. Now im- media take these other concerns as seri- it as Ebola, it spread easily across borders agine if the media, our politicians, and ously as the Ebola epidemic. to neighbouring countries. As of the 2nd President Obama panicked about that • of December, approximately 7000 people one. Would that not be helpful? If people have died of Ebola. Whilst it may seem took obesity as seriously as they did Eb- too high a number for some, in reality ola, perhaps it would not be so prevalent. it is not even a fraction of the casualties At the same time, the hype surround- caused by the major infectious diseases. ing Ebola has possibly done more good Those that kill more than Ebola (deaths than harm. As a result of the ensuing numbering in the millions) include HIV, panic, many countries felt obliged to take

22 GLOBAL FOCUS

Image credit: Sean MacEntee (Flickr) mHealth Evidence first before widespread implementation By James Salisi

MOBILE HEALTH APPLICATIONS However, the state of evidence for In terms of evidence, Tomlinson et (mHealth) have been touted as a low-cost mHealth effectiveness is still dismal to al cites the model published by the Soci- tool to improve health. This is mainly be- justify investing in them. A systematic ety for Preventions Research to expound cause of mobile phone ubiquity and wide- review of mHealth interventions by Car- on the necessary steps that proponents spread use, especially in low- and middle- oline Free and colleagues found modest of mHealth interventions should take in income countries. It is estimated that by benefits in outcomes for provider sup- order to support scale-up. The follow- the end of 2014, 4.55 billion people world- port interventions on diagnosis and man- ing should be completed before coun- wide will use mobile phones. In fact, agement, and SMS reminders. In con- try-wide implementation or scale-up is there are countries like the Philippines trast, the review also found reductions started: “two high quality efficacy trials, where there are 1.5 times more mobile in correct diagnoses using mobile tech- two high quality effectiveness trials, fol- phones than people and India where nologies compared to gold standard. In lowed by dissemination research that has there are more mobile subscribers (564.73 addition, a systematic review by Gerald established that the intervention can be million) than people who had access to Bloomfield and colleagues found insuf- delivered with fidelity being tested, as proper sanitation (366 million). ficient evidence to support the effective- well as information about the interven- Mobile phones are flexible tools for ness mHealth use for non-communicable tion’s costs.” communication, education and research diseases in Sub-Saharan Africa. Efficacy trials are tests set in ideal and many health experts support its use conditions while effectiveness trials are in public and personal health. A techni- tests set in real-life conditions. According cal report by Alain Labrique and col- ...evidence for mHealth to Tomlinson and colleagues there are leagues published in 2013 described 12 effectiveness is still currently no mHealth interventions that common mHealth applications in a new dismal to justify meet the standards for scale up. Thus, framework to use such applications as they recommended innovative research health systems strengthening innova- investing in them designs such as multi-factorial strategies, tions across the reproductive health con- which can take advantage of many simi- tinuum. These mHealth applications are Nevertheless, the scarcity of evidence lar pilot projects to design and test small client-education and behavior change has not stopped the development and im- sets of factors with multi-factorial design; communication, sensors and point-of- plementation of mHealth interventions randomized controlled trials, which are care diagnostics, registries/vital events in many parts of the world; even if the the standard of testing clinical benefits; tracking, data collection and reporting, majority of these projects do not move and data farming, which can take advan- electronic health records, electronic beyond the pilot stages and the commu- tage of the enormous amount of mobile decision support, provider-to-provider nities that they are run in are left hanging. data usage that are already available to communication, provider work planning This situation has prompted experts such gather the evidence for mHealth scale-up. and scheduling, provider training and as Mark Tomlinson and his colleagues to education, human resource management, call for a systematic approach for search- • supply chain management and financial ing for evidence to support the scale-up transaction and incentives. In developing of mHealth in a paper published on PLOS countries, hundreds of pilot projects have Medicine, an open-access medical jour- been started and ended, with only a lim- nal. ited number progressing to large-scale implementation.

23 THE FIGHTER Story by Filippa Grönqvist & Vera Berg Photo by Martin Kjellberg

COVER STORY

What doesn’t kill you “ makes you stronger.

he athlete that added another cat- with a big smile. After buying a quick status. She wrote: “Cancer. Do you know egory of sports to her seven. By breakfast we start the interview. She is what that is? An Achilles tendon rupture winning the fight against cancer very open when she starts telling us her was nothing. Today I got the answer of Tshe once again proved to herself and the story. my fatigue during summer. I got cancer world what one can accomplish with a Already at the age of 18, she was con- in the lymph nodes. This might be my determined mind-set. Eight months have sidered one of Sweden’s leading athletes most challenging journey but my attitude passed since her last treatment of chemo- in heptathlon. This would end abruptly is still the same: I will be back. But please, therapy. Today, she aims to compete in on October 17th 2013. She had recently hold my hand, because this time I am the upcoming Summer Olympic Games. recovered from an achilles’ tendon rup- afraid.” She was determined to survive, We decided to meet Nadja at Bosön, a ture and for several months, she had no other options were plausible. After sports camp as well as her second home. been suffering from fatigue and a gastric updating her Facebook status the phone She enters the cafeteria full of energy and ulcer. During her training she felt tired did not stop ringing. Media, friends and and lactic acid easily built up. Having family wanted to know that she was well done several tests at the doctor’s on the and to give her strength and faith. morning of the 17th, she was sitting with her boyfriend Gunnar at a café when she received the phone call that no- ...when she received the body wants to receive. Her doctor phone call that nobody told her the results from the tests showed signs of lymphoma. She wants to receive. repeated the word “lymphoma” in disbelief. Immediately, Gunnar, Nadja had been shaking all day fol- her boyfriend, started googling, lowing the shocking phone call. She did and the word “cancer” was the not stop until she had heard her dad’s only thing she saw on his screen. calm voice and encouraging words on the Suddenly, people, cars, everything phone. He said what he always says, “Eve- moved in slow motion, and several rything will be all right, Nadjis. You will hours later she found herself in get through this. I promise.” another café. The next morning she was hospital- The first thing she did when ized. Despite the circumstances, she felt she came home was to call her safe, as if nothing could kill her among all family and update her Facebook the doctors and nurses that were taking

26 care of her. She dreaded the bone marrow both the stomach and the throat. The di- overwhelming feelings and letting other biopsy, but it passed easier than she had agnosis of aggressive cancer was bad, but people worry for her. expected. But the fear came, along with she told us that it at least was susceptible Nadja, who never was keen on eating the unknown. Waiting for the test results to chemotherapy. pills took 13 pills for breakfast and another was exhausting, and the first night alone The problem with chemotherapy, Na- 18 for dinner. Just swallowing all of them in the hospital was a nightmare. dja said, was that one has to become re- took more than an hour. The workouts ally sick before one can get better. With she had planned on doing soon became all her energy, Nadja was sure she would walks because her body was unable to do “Everything will be be able to exercise even during the treat- much more. Working out was so physi- all right, Nadjis. You ment. She asked her doctor how often cally demanding that on the days that she she would be able to exercise and they did so had to sacrificed as she was unable will get through this. I looked at her as if she was stupid. She to do anything but sleep afterwards. The promise.” was, however, convinced that she would workouts still helped her fight the cancer, be able to pull it off. Had they ever treat- both physically and mentally. She felt like Nadja suddenly reacts to someone ed an elite athlete? “No, wouldn’t think a warrior. passing by calling her name and the in- so?” But as the chemotherapy started, her terview is paused for a moment while confidence in making it through without The workouts still she and her friend chat for a little while. major difficulties was gone. She, who did When they are done she continues telling not vomit, even after the most exhausting helped her fight the us about what happened after the tests race, suddenly found herself feeling like cancer, both physically were finally done; it was one week later, a helpless little child. Finally she realized and to announce the results six people in that she was mortal. and mentally. She felt white clothes entered the room. Her first Since Nadja is a person with an in- like a warrior. thought was “this is not good”, and her quisitive mind, her blog helped her a lot boyfriend who was sitting relaxed on the during her struggle with the disease. By Today, she is cancer-free, but will not couch in the room, seemed to be think- sharing her thoughts she could let others be declared completely cured for another ing the same thing as he sat up straight think for her, and could get away from be- five years. as soon as the procession came in. The ing overwhelmed by a lot of thoughts at a Lymphoma, as Nadja described it, is a thought crossed her mind that she might time. Now, looking back, she sometimes lottery. She has never been drinker or a actually die, but it was more of a calm re- gets scared. She describes the social me- smoker, but has lived healthily her entire alization than a shock. They told her that dia as a process for her to handle the life. Yet, fate picked her cells to go crazy. she had an aggressive form of cancer in

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This might be my “ most challenging journey but my attitude is still the same: I will be back.

Today she is still the same Nadja, but of top athletes that have been diagnosed stead of as just ‘another patient’, although more worried. Life is uncontrollable and with lymphoma as well as suffered from she feels excluded since finishing her she is constantly aware of time, never an Achilles tendon rupture are scarce. treatment. Thoughts and speculations do feeling safe, knowing that what she has Even fewer have planned on participat- not get answered and she emphasizes the today might be gone by tomorrow. She ing in the Olympic Games on top of that. importance of having a knowledgeable says she has neither clue nor control. She Nadia, however, is about to change things medical person to call. knows this new feeling will stay with her, Undoubtedly, Nadja has high ambi- Nowadays she dedicates a lot of time and the only way to get by is to accept it tions and she realizes that reaching her inspiring others in all kinds of difficult and learn how to live with it. goals will not be a piece of cake. Plan B is situations to keep on fighting for their not a failure yet irritating, she describes. sake even though the odds might be bad. Design is something Nadja has a desire Using her blog and lectures she reaches ...the only way to get by to work with in the future, and her lat- out to these people in hope of becoming is to accept it and learn est project is a book. The book will be a source of inspiration. She emits light released in February and consists of a and warmth, and her winning mentality how to live with it. collection of her blog entries and photos is limitless. A year ago she was diagnosed created during her illness. with cancer and today she is more alive She is also a lot more indecisive re- than ever. The heptathlon became an oc- garding her training. Her mind-set had tathlon. always been “what doesn’t kill you makes Today, the hospital • you stronger” and to work out until ex- department at haustion was the best thing she could do. Today, she is scared; the things that Karolinska Sjukhuset exhaust her might actually kill her. Al- feels like home to her. though she is motivated, there is an un- certainty concerning how her body will She described the care during her ill- respond to the training. Challenges are ness as “fantastic”. Today, the hospital something she always has liked and to department at Karolinska Sjukhuset feels compete in the Olympic Games in Rio like home to her. The hospital staff was de Janeiro 2016 is the goal. The number always present and saw her as Nadja in-

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29 THE GHOSTS OF NOBEL PRIZES PAST

By Yasmine Djoumi

Hurrying down the empty hospital ward, I could not help but notice the steady beeps of a heart monitor, the shuffling feet of a patient with a prescription in his hands or the wailing of a newborn baby. Objects, treatments and new ways of thinking which we now take for granted were once major breakthroughs in medical and human history. A select few were awarded the most prestigious award of them all. Let us now take a stroll down memory lane and revisit the ghosts of Nobels’ past.

INSULIN INSULIN IS A PEPTIDE HORMONE PRODUCED BY THE ISLET cells of the pancreas. Its role includes regulation of blood sugar concentration and metabolic pathways. Its absence or 1923 dysfunction gives rise to Diabetes Mellitus. In the early 20s Frederick G. Banting, a Canadian scientist, had an idea of how to isolate a large fraction of the islet cells of the pancreas without the death of the subject; in this case dogs. He travelled to his friend and colleague John J. R. Macleod with the request to carry out his research in Macleod’s lab. Skeptical ORGAN AND CELL TRANSPLANT at first, Macleod agreed and supplied Banting with 10 dogs and JOSEPH E. MURRAY, AN AMERICAN PLASTIC SURGEON, two medical students to assist him. Banting wanted only one, performed on the 23rd of December 1954 the world’s so the students tossed a coin and the winner was Charles Best. first successful renal transplantation between the During the summer, Banting and Best carried out their ex- identical twins Ronald, who was healthy, and Rickard, periments and by the end of the summer, they were able to who was dying of renal failure. The operation lasted extract an exudate from the islet cells which they supplied to for 5.5 hours. The use of immunosuppressive medicine a diabetic dog named Marjorie who survived for the whole was not needed in this case because of their identical length of the summer. Upon Macleod’s return they showed him genes. This surgery opened up the doors to the field of their results and were granted more dogs and research money. transplantation surgery. At that point, it took 6 weeks to isolate the insulin. In order Murrey shared 1990’s Nobel Prize with E. Don- to speed up the process, Banting suggested they try with fetal nall Thomas, who discovered that cell transplantation calves instead, which worked perfectly. On January 11, 1922, the from the bone marrow - a so called hematopoietic first insulin sample was given to a 14 year old boy, dying of dia- stem cell transplantation - could cure Leukemia. Don- betes, named Leonard Thompson at Toronto General Hospital. nall’s studies showed that hematopoietic stem cells While it was Banting and Best that carried out and discov- could proliferate and become new blood cells. His ered insulin, it was Banting and Macleod who received the No- methods also reduced the impact of a condition called bel Prize in 1923. In the spirit of camaraderie, Banting shared graft-versus-host disease. Donnall carried out this re- his prize money and the glory of the discovery with Best. search from the 50s to 70s at Fred Hutchinson Cancer Research Center. Donnall’s results went on to be used by several doctors around the world. One of them was John Ker- sey, who performed a bone marrow transplant on 16 Although a lot has been discovered and a lot year old Dave Stahl, dying of Birkitt’s lymphoma. Dave of Nobel Prizes have been awarded, there is still alive today and is currently the longest living is an immense pool of knowledge waiting to lymphoma transplant survivor. be unleashed. And while the Nobel present is about the brain’s own GPS, one cannot help but wonder what Nobels’ future might bring. 1924 ELECTROCARDIOGRAPHY IN THE BEGINNING OF THE 20TH CENTURY, it was known that the beating rhythm of the heart involved electrical currents. Unfortunately, they had no proper way of cal- culating these currents without putting elec- trodes directly on the heart. Willem Einthoven 1930 developed a new string galvanometer, a thin BLOOD GROUPS filament passing between very strong elec- tromagnets. When current passed through, IN THE EARLY 1900S, AUSTRIAN SCIENTIST the electromagnetic field would cause the Karl Landsteiner, discovered the so called string to move. Light would cast a shadow on ABO-system, a collective name for the vari- the moving roll of photographic paper pro- ous blood types. During that time, it was al- ducing a continuous curve corresponding to ready known that the mixing of blood from the movements of the string. The original ma- two individuals gave an agglutination. During chine needed a water cooling system for the Landsteiner’s experiments he found that magnets, 5 people to operate it and weighed blood transfusion between people with the over 270 kg. Instead of patches of electrodes, same blood type gave no destruction of blood limbs were submerged into tanks of salt solu- cells, whereas the opposite happened with tions. Einthoven received the Nobel Prize in transfusions involving different blood types. 1924 for his invention and went on to describe Landsteiner called the different blood types various cardiovascular disorders. for A, B and C, referring to the type of antin- gen present on the surface of the red blood cells. C is now known as the O or 0 (zero) to signify the absence of both A and B antibod- 207 people have ies. For his pioneering work, Landsteiner has recived the Nobel Prize been called the father of transfusion medi- cine. in medicine since 1901 The first successful blood transfusion was performed by Reuben Ottenberg at Mount Si- nai Hospital in New York.

“I wish I had my beta-blockers handy.” James Whyte Black’s comment when told that he had won a Nobel Prize, 1988 referring to the drug he discovered for the treatment of heart disease. 1990

HELICOBACTER PYLORI CHRONIC GASTRITIS AND PEPTIC ULCERS ARE A MAJOR HEALTH PROBLEM IN the world, affecting inhabitants of rich as well as poor countries. Today, we know that peptic ulcers are not only caused by an overproduction of gastric acid, but also by the gram negative Helicobacter Pylori bacteria. According to the World Health Organization, H. Pylori is the cause of 92% of cases diagnosed with gastritis or peptic ulcers. Barry J. Marshall and Robin Warren, two Australian scientists, discovered in 1982 H. Pylori in biopsies from patients diagnosed with ulcers. The general dogma at the time was that no bacterium could live in the conditions of the hu- man stomach due to its low pH. Marshall and Warren concluded that the bacte- ria they found must be the cause of the non-curative chronic ulcers. Alas, they were met with criticism and became the laughing stocks of the whole scientific community. But Marshall did not give up. He was so convinced of his findings that he had to prove it to the world one way or the other, so he decided to drink a beak- er full of Helicobacter. To the surprise of the gastroenterologists of the world, Marshall, previously healthy, was after a few weeks diagnosed with peptic ul- cers. This discovery now made a chronic disease into a highly curable one. His 2005 stunt not only stunned his colleagues. Some thought he was mad while others called him a cowboy, but the Abbott Company chose to commemorate his feat by making it into a comic strip. Marshall and Warren shared the Nobel Prize in 2005.

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THE NOBEL PHYSICS LITERATURE By Amanda Kaba Liljeberg By Poya Livälven

THIS YEAR’S NOBEL PRIZE IN PHYSICS IS I AM IN GAMLA STAN ON A CHILLY, BUT winner of the Nobel Prize in literature awarded to Isamu Akasaki, Hiroshi sunny autumn day. While I am walking 2014. The hour is at hand and with only Amano and Shuji Nakamura, for the in- down the streets of cobblestone, a cold seconds left we grab our cell phones and vention of efficient blue light-emitting wind makes me shiver and I tighten my prepare them for taking pictures while diodes, which has enabled bright and scarf around my neck. Today, a colleague professional photographers stand beside energy-saving white light sources. from Medicor and I are supposed to wit- us with their mighty system cameras. The white light we see in light-emit- ness the delivery of the Nobel Prize in The time is now 1 p.m. and the bois- ting diodes, or LED lamps, can only be literature in Börshuset, the seat of the terous atmosphere from before is gone created by a triad of colors; green, red Swedish Academy. We head toward with the wind. Everyone gazes at the and blue. Green and red diodes were in- Stortorget, and slowly, a large, timeworn door handle that slowly turns downward. vented in the 1960s and are created in the and yellow building appears in front of The door opens and Peter Englund, wear- same way, with a technique that however our eyes. Fast, we find the discrete side ing a suit, proudly enters the room and does not work in the production of blue entrance of the building for press person- announces the winner to the rhythmic diodes. For three decades scientists tried nel. There are hordes of huge cars from clatter of the camera shutters. He looks to figure out a way to create blue diodes, different news media on the outside and across the room and announces that Pat- until the work of Akasaki, Amano and Na- the streets of Gamla Stan that usually rick Modiano is the winner of the Nobel kamura finally paid off. dwell with tourists and street artists at Prize in 2014. A sense of relief and sur- The LED lamps are more efficient this time of the day is now the site on prise washes through the room. Who is than regular light bulbs, as they shine which the eyes of the literature world lay this Patrick Modiano? The winner was brighter and need much less electricity to their gaze. not part of the fancied candidates, but do so. Since the LED lamps are so energy- My colleague and I enter the build- when you hear the reasoning behind giv- efficient, they can be powered by solar ing and find our way to Börssalen where ing him the award, you really appreciate power. In the parts of the world where the world press is positioned. The at- their choice; the Nobel Prize in Literature access to electricity grids is not possible, mosphere is tense and anticipatory. Eve- for 2014 is awarded to the French author this makes a big difference and the in- rybody is busy finding the best spot for Patrick Modiano “for the art of memory vention of LED lamps could increase the photography and filming. People whisper with which he has evoked the most un- quality of life for over 1.5 billion people. and gossip about whom they think will graspable human destinies and uncov- In addition, LED lamps last longer, up win; will it be Ngugi Wa Thiong’o, Assia ered the life-world of the occupation”. to 100,000 hours compared to the light Djebar or Haruki Murakami? We success- Just as fast as the press was gathered they bulb’s lifetime of 1,000 hours. With saving fully manage to find our place close to vanish with these final words. The room the Earth’s resources as well as diminish- the famous door, from which the perma- is emptied and life in Gamla Stan is re- ing material consumption, this invention nent secretary of the Swedish Academy turned to normal. Now Börshuset is wait- truly is revolutionary. •will enter the room and announce the ing for next year’s 15 minutes of fame. •

...for the art of memory with which he has evoked the most ungraspable human destinies and uncovered the life-world of the occupation “ - The Nobel Prize in Literature for 2014 is awarded to the French author Patrick Modiano

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PRIZES 2014 CHEMISTRY ECONOMY By Ibrahim Rayyes By Halima Hassan

THE 2014 NOBEL PRIZE IN CHEMISTRY plistic terms, STED microscopy utilizes THE 2014 PRIZE IN ECONOMICS HAS BEEN has been jointly awarded to Eric Betzig, two different laser beams; one that ex- awarded to Jean Tirole, a French eco- Stefan W. Hell and William E. Moerner cites fluorescent molecules to glow and a nomics professor, for his work on market for their work in the “development of su- second one that quenches the fluorescent power and regulating competition. Tirole per-resolved fluorescence microscopy”. glow in all but one nanometre-sized area. had been working since the early 1980s Dating back to the latter half of the By scanning over a larger area, a super-re- on regulation in economics, with a par- 19th century, a resolution of 0.2 microme- solved image can thus be obtained. As the ticular focus on ways to control the domi- tres had been established as the physical name implies, single-molecule microsco- nance of major companies. limitation of light microscopy. Although py involves repeatedly activating a minis- His studies covered a wide range of it has been enough to provide us with tre- cule, but different, subset of fluorescent areas within the economic sciences in- mendous insights into structures of cells molecules at a given time and thereafter cluding the banking industry, pay and and tissues - amongst other things - since superimposing the images. By having a credit card fees. These areas have become its invention, seeing smaller organelles distance greater than 0.2 micrometres be- increasingly important in recent times as has been an impossibility. Delving deeper tween the fluorescent molecules, a super- governments have privatised former pub- into the microenvironment of the organic resolved image is thus generated. lic monopolies such as telecoms, water world has required the use of the electron It is noteworthy to add that the use of and electricity. One of Tirole’s many con- microscope. With the use of fluorescent fluorescent molecules still provides the tributions to the field of economics is the molecules, Betzig, Hell and Moerner possibility of studying cells in their living introduction of game theory in industrial have, in effect, overturned this limitation state. Thus, with the use of fluorescence organization. This has allowed econo- of light microscopy. microscopy, looking at cellular processes mists and policymakers alike to regulate More specifically, this year’s Nobel such as neuronal synapses, transcription large firms more efficiently and fairly. His Prize recognizes the exploitation of flu- and translation as they occur in real time theories have been particularly helpful orescent molecules using two different has now become very possible. Truly, in ‘asymmetric information’ situations, principles; stimulated emission depletion these pioneering principles have helped where the regulators do not have access (STED) microscopy and single-molecule evolve microscopy into nanoscopy and to the same knowledge as the firms they microscopy, with the former being devel- the extent of knowledge that will result are regulating. oped by Stefan Hell whereas the latter from this awaits to be seen. Tirole’s theories have proved im- has been made possible by the independ- •mensely important; they have been im- ent works of Betzig and Moerner. In sim- plemented by many competition regula- tors worldwide. Therefore it comes as no surprise that the Nobel committee describe Tirole as “one of the most influ- ential economists of our time.” Tirole’s selection for the prize was not controversial. On the contrary, it was met with much praise. “Most people thought he’d get it at some point,” com- ments Mark Armstrong, a professor at Oxford University. Tirole felt proud after receiving the award but emphasised that his win could not have happened without help from others: “It’s also being with the right people, in the right place, at the right moment. And, you know, it’s team work too.” • - The Nobel Prize in Literature for 2014 is awarded to the French author Patrick Modiano The Nobel Prize in Chemistry 2014 was awarded jointly to Eric Betzig, Stefan W. Hell and William E. Moerner “for the development of super-resolved fluorescence microscopy”. Photo by David Humphreys

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Photo by Gustaf Drevin Navigating the complexities of the brain By Iskra Pollak Dorocic Infographics by Jakub Lewicki

s Edvard Moser stepped off the decades, starting with the discovery of the memory trick still used today, where plane from Trondheim – bliss- the “place cells” in 1971 by O’Keefe, who one imagines walking through a specific fully unaware that the 150 emails demonstrated that very specific brain space, such as a house, and associates Aand 75 text messages on his phone were a cells are active only when one is in a spe- each phrase or number to be remem- sign that this day would be like no other cific location. The Mosers added to this bered with a specific object or location – he was on his way to give yet another in 2005 with their discovery of the “grid in the house. This trick allowed them guest lecture. But as soon as he entered cells”, which generate the coordinate to memorize long speeches and recite the terminal in Munich, the news came system used by the brain for exact posi- them effortlessly while mentally walking via a congratulating representative. The tioning. Both cell types were initially dis- through the imagined space. Today, par- unsuspecting Dr. Moser finally realized covered in rats, but have since also been ticipants in memory championships use that he had just won the most prestigious shown in humans. this strategy to memorize exceptionally prize in science - the Nobel Prize in Phys- long strings of numbers, or the order of iology or Medicine. What they found took cards in multiple decks. “I’m terribly grateful, it’s absolutely So it was obvious that memory and fantastic”, said Dr. Moser to the Nobel them completely by navigation are somehow linked in the spokesperson who contacted him short- surprise. brain. The first person to coin the term ly thereafter. “I didn’t even know it was “cognitive map” was Edward Tolman, a today, I really didn’t even think about it. Medicor had the privilege to speak to mid-20th-century psychologist and ada- So even more pleasant when it’s such a Dr. Edvard Moser over the phone just a mant anti-behaviouralist. He observed surprise.” few weeks after the announcement. rats navigating through a labyrinth and Edvard Moser, alongside his lifetime realized the animals must have been scientific partner and wife May-Britt Mo- forming an internal representation of ser and their ex-supervisor John O’Keefe, LINKING MEMORY AND SPACE the external environmental in their mind received this year’s prize “for their dis- For over two and a half millennia, sci- and using it to find their way through the coveries of cells that constitute a posi- entists and philosophers alike have con- maze. But how exactly is this cognitive tioning system in the brain”. The trio templated the ways in which our minds map represented in the brain? How do described the specific cells in our brains create internal maps of the environment the cells in our brains, the neurons, code which are responsible for mapping the and enable us to navigate through space spatial orientation? space around us and giving us a sense of – tasks crucial for survival. The ancient In the late 1960’s the American-British where we are. The research spans several Greeks were the ones who developed neuroscientist John O’Keefe was just em-

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barking on a promising academic career As the animal at University College London (UCL). He moved through was interested in how brain activity di- particular rectly controls behaviour, and decided spots in the to record the activity of single neurons box, specific located in the hippocampus of rats while neurons fired, not they moved around an enclosed environ- unlike the place cells in ment. The hippocampus also happens the hippocampus. But in contrast to be the structure where memories are to the place cells, these entorhinal cells formed in our brains. Neurons commu- fired in other places too. They seemed nicate with each other via tiny electrical to form a pattern. “The discovery was a currents, and it is possible to record the longer process”, says Edvard Moser. The electrical activity of a brain cell using researchers first had to make changes to small wires, called electrodes, implanted the recording setup, in order to recognize into the brain. O’Keefe discovered that the pattern produced by the neurons. only certain neurons became active “We found quite early on that the cells in when the animal was in a particular the entorhinal cortex have a special firing spot in its box. So the same neu- correlate. Each of them have many firing ron was active each time the rat fields that are very regular.” The pattern was in the middle of the box, that emerged was one of many hexa- and another specific neuron gons placed on top of each other as the fired each time the rat moved animal moved through the environment, to the left corner, and so basically forming a honeycomb pattern. on. O’Keefe coined these “But then to see that this was really the special hippocampal cells hexagonal pattern, we had to increase “place cells”, and proposed through space. The Mosers took this skill the size of the recording environment so that the hippocampus generates different with them and started their own labora- then you could really see how these fir- cognitive maps which are represented by tory in their native Norway. It was there ing positions were spaced in relation to collections of specific neurons active in in 2005, that they made the seminal dis- each other. So I would say that it was a different environments. Effectively, the covery of “grid cells”. Aiming to figure process that took place over maybe half brain forms a memory of a particular out the control mechanism for O’Keefe’s a year, where we became more and more place based on the combination of place place cells, the Mosers first looked up- certain that it was a hexagonal pattern. cells that are active in the hippocampus. stream of the hippocampus, in an area And of course there were those really ex- called the entorhinal cortex. This region citing moments, but it wasn’t really one sends prominent inputs to the hippocam- single moment.” REVEALING THE HIDDEN pus, and thus also to the place cells. Not There is a certain elegance and unu- PATTERN much attention had previously been paid sual simplicity with this pattern of grid May-Britt and Edvard Moser spent to the entorhinal cortex, but the Mosers cell activity. It turns out that the hexago- some time in O’Keefe’s UCL laboratory decided to implant their electrodes into nal geometry is an optimal configuration in 1996, as part of their post-doctoral this particular structure and record while that allows for maximal spatial resolution research. This is where they learned the animal moved around its environ- and energy conservation of the system. how to record single-cell activity in ment. What they found took them com- This unexpected simplicity is a scien- rat brains while the animals moved pletely by surprise. tist’s dream, especially in brain research

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where the complexity often seems over- The Mosers are not your typical No- involved and some I’m more involved in. whelming. Discovery of patterns starts bel winners. The humble Norwegians But basically we run the group together, the journey to understand the computa- defy stereotypes of old, white-haired we have one common goal, one set of key tion underlying a complex process, in this scientists who made their groundbreak- questions which we want to investigate”, case, spatial navigation. ing discoveries many decades ago. Ed- says Edvard Moser about working with vard and May-Britt Moser are youthful- his wife. “It’s an advantage in the sense The Mosers are not looking 50-somethings, who not only hike that we are complementary, and that she the mountains surrounding their home in has strengths that are somewhat different your typical Nobel Trondheim, but also volcanoes around from mine, so if you put those together winners. the world – in fact, they got engaged on we become stronger than just the sum of top of Mount Kilimanjaro in Tanzania. us.” “What is fascinating about studying Edvard is known to wear his red Con- the positioning system, is that it is a sim- verse sneakers at conferences, showing “The Human Brain ple form of cognition that is kind of away off his laid-back style – both physical but project is somewhat from sensory receptors and also far away also personality-wise. In fact, he seems a from the motor neurons. I often say that bit overwhelmed with the attention since more controversial, it is in the middle of the brain.”, says Mo- receiving the Prize. “For sure I enjoy it, there’s a big resistance ser. Indeed, since the entorhinal cortex as long as it does not become too much, receives no direct sensory input, unlike I enjoy it”, he replies when asked how he in Europe.” say, the visual system (which receives in- is handling all the attention. “The days Despite the advancement in our un- formation from the retina) the hexagonal are very chaotic because there’s so many derstanding of the mind, many mysteries pattern is created internally. “Why that thing that I need to do, many interviews still abound. Moser considers, “There are is interesting is that unlike most other and all these preparations for the things many questions still unanswered, we are functions in the brain that are computed in Stockholm, that’s part of it. I would just grasping the surface on understand- in the association cortices, this one has a assume that it comes back to a bit more ing how higher brain functions come very clear correlate in the outside world, normal after New Year.” about. Let’s say cognitive functions: how which is the position of the animal. So it’s Both Edvard and May-Britt grew up very easy to measure and can then be re- on islands off the coast of Norway in non- lated to the computations that are taking academic families. When they met as un- place [inside the brain].” dergraduates at the University of Oslo, they discovered their mutual interest in TWO MINDS, ONE GOAL brain and behaviour, and through unre- It really takes special minds to unlock lenting motivation ended up in the lab of the brain the way the Mosers did. Dr. Per Andersen. At the time he was study- Cori Bargman, distinguished neurobiol- ing neurons in the hippocampus, and was ogist and head of the $100 million BRAIN initially apprehensive about pursuing the initiative, tweeted not long after the No- project the Mosers had in mind. bel Prize announcement, “Lesson from Since the beginning, the Mosers O’Keefe and the Mosers: the brain is worked as a team. “We share our in- stranger than you could imagine. Yet by volvement in all projects, but there are intelligent observation, you can under- some projects where May-Britt is more stand it.”

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we think, how we plan, how we make de- against involvement in neuroscience, be- nological advances. He continues, “be- cisions, all that. By and large, there is a lot cause that is what everyone wants. But cause there are many fancy technologies we still don’t know for many of the higher the way it is done and maybe the focus but it’s even more important to actually functions.” on the collection of a lot of data, while it’s find the problems that you really want to Indeed, brain research has recently not always clear how knowledge is going solve. Sometimes one has to do more ad- been gaining momentum. Within the last to come out of all this data.” venturous things if you really want to get year, both the EU and the US invested far, and that always involves some risk.” substantial amounts of funding in re- “My advice to young searching the mind and its many disor- ders. The EU initiated the €1-billion Hu- researchers would FROM MICE TO MEN man Brain Project, while the US followed be...” Place and grid cells have more recently suit with the BRAIN initiative. When also been shown to exist in humans, not asked how he sees these large initiatives, The Mosers have a common labora- just in rats, the model that O’Keefe and Moser replied, “The BRAIN initiative in tory at the Kavli Institute for Systems the Mosers first investigated. This has po- the Sates is a very good document, they Neuroscience, with a large number of tential relevance in Alzheimer’s disease, have formulated key questions that can PhD students and post-docs. “My advice where both the hippocampus and en- be addressed with some really new and to young researchers would be try to find torhinal cortex are affected early on. The upcoming techniques and technologies.” a question that really interests you, that functional deficits in these regions trans- For the EU project, Dr. Moser reserves hasn’t quite been solved yet, and go for late into devastating spatial memory loss, some skepticism, “The Human Brain that using new technologies that have where patients gradually fail to recognize project is somewhat more controversial, come - but don’t forget the question”, says their environment and even loved ones. there’s a big resistance in Europe. Not Moser, referring to the many recent tech- Understanding the basic mechanisms behind spatial navigation will help shed insight into the cognitive decline seen in such neurodegenerative disorders.

...have shed light on a very fundamental function of our minds.

It is still early days in our understand- ing of the brain. John O’Keefe alongside May-Bitt and Edvard Moser have shed light on a very fundamental function of our minds. Past Nobel Prizes have hon- oured other essential findings in neuro- science, particularly in the visual, olfac- tory and memory systems. This year’s winners can rest assured they have added to the progress of understanding one of the greatest mysteries of the universe – our brains. •

I didn’t even know it was today, I really didn’t even think about it. - Edvard Moser realizing that he had just won the Nobel Prize

“ 37 INSIGHT

Insight is Medicors feature with the pur- pose to shine light on some of the differ- ent occupations and branches within the medical field. Each edition feature an interview with a selected person and a presentation of his or hers specific area of specialization. The intention is to in- spire and to give students some insight into some lesser known career paths and specialties.

Elizabeth Blackburn Professor of Biology and Physiology and a Nobel laureate.

By Halima Hassan

THE NOBEL WEEK DIALOGUE IS AN AN- do of molecular biology tends to be that gaging in, for example, mindfulness and nual event that takes place in Stockholm things are very universal in life and things healthy eating habits can have positive where previous Nobel laureates are in- are not going to be profoundly different. effects on telomeres; reducing the rate at vited to discuss a particular theme. This I sensed that this [finding] was going to which they shorten. These are early find- years event was focusing on aging and be pretty fundamental. The question then ings however provide insight into the sort attendees included Professor Elizabeth was, we had no idea how this was going to of behaviors which possibly contribute to Blackburn. Blackburn won the 2009 play out in humans.” Today we know that the aging process. “All that telomeres give Nobel prize in physiology and medicine telomere length underlies the prolifera- us is a quantifiable, molecular, concrete for co-discovering the enzyme telomer- tive capacity of a cell and telomere short- readout that gives you some kind of a han- ase. Telomerase catalyzes the replenish- ening, as a result of reduced telomerase dle, statistically speaking, on [aging].” ment of DNA stretches found at the ends activity with each cell division, is associ- of chromosomes called telomeres, which ated with the aging process and many age SOCIAL REALITY AND TELOMERE otherwise shorten whenever a cell di- related diseases. However many factors MAINTENANCE vides. Telomere length is an indicator of besides aging can contribute to telomere “[There has been] telomere research systemic aging, with shorter lengths being maintenance such as chronic stress and looking at people in chronic stressful life associated with chronic diseases of aging lifestyle. situations: those with socio-economic and earlier mortality. I met with Professor problems, people in war-torn countries, Blackburn prior to the dialogue to discuss HEALTH(Y) BEHAVIORS AND refugees... We see the effects of traumatic her work. TELOMERE MAINTENANCE events on children relating to how short “Everybody has external stressors, there their telomeres are when they are middle THE NOBEL WORTHY DISCOVERY is nothing that can be done about this. aged. There are a lot of things we have to AND ITS IMPLICATION It turns out that giving people tools to start thinking about.” A paper from the “It was pretty clear that right from the get cope with these, when you look at people Blackburn lab looked the impact of dis- go you needed something to maintain the who have the ability to manage how they crimination and racial bias on telomere ends of DNA.” perceive stress, they do better in terms length in African-American men. Results The Blackburn lab has sought to, and of their telomere maintenance.” Studies suggested that “multiple levels of racism, continues to seek, the full extent of a role from the Blackburn lab and others focus- including experiences of racial discrimi- telomerase and telomeres play in a cel- ing on the external factors which have an nation and the internalization of negative lular processed besides aging. “The cre- impact on telomere length show that en- racial bias, operated together to accelerate

38 INSIGHT

biological aging among African-American men.” When discussing these findings Blackburn commented “...we all know that [these] social [attitudes] have ill effects; we know that this is not good for people and their health. But to see it hit people in this way, I think, well this is a way of mak- ing a message come through very clearly. We know concretely that this is happen- ing. In so many ways it speaks to you.”

FUTURE Future research into telomeres should study the molecular mechanisms which mediate changes in telomere length. “Part of my lab is [currently] focusing on trying to understand the very elaborate molecu- lar ‘dance’ involving the telomere ends, telomerase and the telomere binding pro- teins. Really trying to elucidate all the molecular details.” Should clinicians start monitoring pa- tient telomere length? Blackburn notes that “monitoring [of telomere length] is like weighing; that single piece of infor- mation, is useless without context,” but along with patient data could, in the fu- ture, aid prognosis and provision of suit- able care. “A study looked at depression and its correlation with bladder cancer in a co- hort of patients. They found that those with depression had almost two times the likelihood of dying from the cancer. [Later it was also found that] if their telomeres where in the lower portion of length dis- tribution, in addition to being depressed, their odds of dying increased by 5 fold.” The Blackburn lab are working hard to elucidate everything there is to know Photo: Maria Belikova about telomeres and considering how critical this area of science is, I believe there is chance this lab will be recognized by the Nobel committee once more. •

’09 Nobel Prize in Physiology or Medicine ’01 Appointed a ’07 Named one of TIME Magazine’s 100 Most Influential People member of the President’s Council ’98 President of the American Society for Cell Biology on Bioetichs ’75 PhD from the University of Cambridge ’70 Bachelor of Science

39 GLOBAL FOCUS

Health care and Refugees an issue of rights and responsive policies

By James Salisi

“WORKING WITH REFUGEES CHANGES for the UNHCR and its partner agencies tecting the refugees and providing for your perspective about the challenges of to respond adequately protect them un- their basic needs, in partnership with health care and the priorities related to til stability and lasting solutions to the UNHCR and international humanitarian health policies,” said Jad Shedrawy, a first causes of displacement have been found. organizations, the adequacy of protection year student in the Master’s Programme and the danger of being returned are still in Public Health at Karolinska Institutet THE RIGHT APPROACH BUT issues that need to be addressed. (KI). Before starting his studies at KI, INADEQUATE POLICIES Shedrawy worked as a field officer at the In principle, the approach to the ref- REFUGEES: HISTORICAL United Nations High Commissioner for ugee emergency response and to health BACKGROUND Refugees (UNHCR) Office in Lebanon. care in this situation is based on rights Going back to the history of refugee Refugee camps provide temporary and community participation. Therefore rights helps in understanding the im- relief from armed conflicts, famines or the granting of refugee status is impor- portance of these rights in places where insecurities but are inherently unsustain- tant as this defines access to all the rights these are not granted. The Convention able without aid from outside or from of refugees that the UNHCR and host Relating to the Status of Refugee in 1951 the communities that they are in con- countries that signed the 1951 convention defines a refugee as “any person who, tact with. The refugees are vulnerable to are obliged to provide. However, granting owing to a well-founded fear of being infectious diseases, malnutrition, poor refugee status to displaced population persecuted for reasons of race, religion, sanitation, post-traumatic stress disorder, takes circuitous routes in some countries. nationality, membership in a particular and violence against women and chil- For example, in Turkey, displaced popu- social group or political opinion, is out- dren. Thus, it is important for humani- lation were initially labeled as “guests” side the country of his nationality and is tarian organizations and the UNHCR to then later on modifying the term as “un- unable or, owing to such fear, is unwilling prevent situation in refugee camps from der temporary protection” without clari- to avail himself of the protection of that deteriorating. fying what exactly these terms mean, country; or who, not having a nationality “As most of our work as healthcare according to Birsin Filip in an article pub- and being outside the country of his for- professionals focuses on preventing and lished on Global Research website about mer habitual residence as a result of such delaying progression of diseases, with a the plight of Syrian refugees in Turkey. events, is unable or, owing to such fear, is huge emphasis on emerging antibiotic unwilling to return to it”. resistance, when I switched to field work The 1951 Convention and its 1967 Pro- with refugees, I realized that much more ...the adequacy of tocol promulgated the rights of refugees basic needs should be gratified and my protection and the which include access to courts, access to knowledge could be oriented in a way danger of being returned primary education, right to work, provi- that lead to even more disease prevention sion for documentation, including a ref- and drug misuse than my clinical work,” are still issues that need ugee travel document in passport form Shedrawy explained. to be addressed. and prohibition of expulsion or return Indeed, health care in refugee camps or refoulement. Protection of and assis- poses a special challenge to government, tance to the refugees are the objectives of policy-makers and service providers. It is Recently, the United Nations Relief granting these rights. The access to these a key component of protection according and Works Agency (UNRWA) sounded rights of displaced individuals will be ef- to UNHCR. In addition to water, sanita- the alarm on the plight of Palestine refu- fectively barred if governments vacillate tion and shelter, healthcare determines gees from Syria who have suffered from on the status of the displaced crossing the wellbeing and sometimes survival closing of borders and a series of forced their borders. of refugees according to Médicins Sans returns from neighboring countries. In Frontières (MSF) manual on Refugee addition, many Palestine refugees have HEALTH CARE IS A KEY COMPONENT OF PROTECTION Health. irregular status in other countries such as Lebanon and Egypt, which bars them At the heart of protection is the access to However, deeper issues of rights and primary care. Refugee health care is fo- status confront displaced populations, from accessing social services and civil documentation. cused on primary care and is an integral even those in refugee camps, around the part of the relief and assistance extended world that need to be addressed in order Although host governments to some degree take on the responsibility of pro- to displaced populations. Plans for health

40 GLOBAL FOCUS

Image credit:Sharnoff’s Global Views (Flickr)

care interventions are based on needs, the 51.2 million individuals who were dis- As 2014 draws to a close, the UN risks and vulnerabilities. These determi- placed from their home because of per- refugee agency may yet see another re- nants change as the situation that forci- secution, conflict, generalized violence, cord high in the number of displaced bly displace people and/or the situation or human rights violations - the highest persons as conflicts in several regions of in camps stabilize. level of displacement on record. the world have escalated. The capacity In the acute phase, UNHCR and its of UNHCR, humanitarian organizations, partners focus on measles immunization, and governments receiving refugees nutritional support, control of commu- ...UN refugee agency is being stretched to the limit. In fact, nicable disease and epidemics, imple- may yet see another UNHCR spokesperson Melissa Fleming mentation of the reproduction health warned of winter crisis for almost a mil- measures and public health surveillance. record high in the lion displaced people in Iraq and Syria, During this phase, primary health care number of displaced thus prompting the agency to call for fulfills the basic needs of the refugees increased funding and for foreign aid to and contributes to the attainment of the persons... enable it to handle not only this immi- UNHCR mandate to provide protection nent crisis but also the other concerns in to the displaced. The services are even- The displacement of populations is refugee camps in the Horn of Africa, Li- tually expanded to include treatment of often drawn out for years and puts the beria, Mali, South Sudan, and the region cardiovascular and chronic diseases and refugees in desperate situations. For ex- surrounding Syria. cancers. However, the protracted nature ample, scattered in Syria’s neighboring The 1951 Convention and its Protocol of some conflicts preclude immediate countries, such as Turkey, Lebanon, Iraq may have been adequate in the years im- return to normalcy and puts on hold the and Egypt, are more than three million mediately after it was ratified but needs to rebuilding of health systems that could Syrians displaced by the armed conflict be revisited to respond adequately to the respond to the long-term needs of the dis- that started in 2011. Their numbers have changes in the nature of displacements placed populations. Additionally, provid- steadily increased over the years and around the world. Governments need to ing health care to displaced populations are straining the resources of the com- rethink the policies that govern granting where their status is in question becomes munities that have accepted them. Refu- refugee status for displaced populations increasingly difficult for humanitarian gees with enough resources flee to other and pool more resources to respond to organizations. countries such as Sweden to start a new acute phases of refugee emergencies and life but the vast majority of them have no to find lasting solutions to causes of dis- PRESENT CHALLENGES option but to stay in refugee camps or placement around the world. By the end of 2013, the UNHCR reported find temporary shelter in the region until • 16.7 million refugees. They were part of there is peace in their home country.

41 GLOBAL FOCUS

Building the Ebola Training Centre at Karolinska Institutet

By Giulia Gaudenzi

DURING A WEEK IN OCTOBER SEVERAL students and teachers from the Industrial Design program from Stockholm’s University College of Arts, Crafts and Design joined forces with the Centre for Global Health at Karolinska Institutet to build a simulated Ebola treatment center. Just in few days an empty sport facility located at ECDC (European Centre for Disease Control and Prevention) be- came a realistic medical camp to train fieldworkers. The training facility fol- lows Médecins Sans Frontièrs guidelines, making it it as realistic as possible, even Photo by Giulia Gaudenzi with heaters in place to simulate working in hot conditions. The facility was built with continuous interaction between the Industrial Designers and Interior Architect students with the medical staff HONORARY ACKNOWLEDGEMENT – BUT TO at Karolinska who have been recently in WHAT EFFECT? West Africa, and other experts. Often architecture can help in disas- ter relief. Architects are system thinkers, By Gustaf Drevin trained in producing ideas or solutions INFLUENTIAL TIME MAGAZINE MADE PUBLIC ITS ANNUAL PERSON by applying their technical, social and of the Year on December 10: ”The Ebola Fighters” – such a significant environmental knowledge. choice. “A crisis like the Ebola epidemic in Few stories have inspired us students of the medical sciences as West Africa requires a system of rapidly have those pouring out of western Africa lately. These people answered deployable and modular isolation and the call when nobody else did, treated when nobody else dared to, and treatment units” and say Dzenis Dzihic, died when the rich countries did not care. architecture graduate student from the But remember; expatriates made up a small percentage, as virtu- Royal Institute of Technology doing re- ally all deaths of healthcare workers in the outbreak have been national search on mobile and modular hospital staff. Western media, the United Nations, and even the WHO, should units to be used in a crisis. “In the current remain under heavy criticism for lagging behind in the fight against the Ebola-crisis there is a need to quickly virus. take care of a large number of patients The disease rages on. While Karolinska Institutet’s former Profes- in a short span of time in a specific re- sor Hans Rosling has tweeted that there is “[n]o longer a virus hunting gion of the world – which already suffers humans. Now we hunt the virus!”, many experts warn that while the from poverty and lacking infrastructure”. increase is slowing, the absolute number of people affected each month “There is a lot of potential for a archi- reaches a constant level. tects to work on improving and optimiz- Imagine the forcefulness of this virus establishing itself as endemic ing these facilities”. •in the region. We are relieved that “The Ebola Fighters” stepped in. Imagine how many lives they have saved in western Africa and have indirectly saved for the future. However, the work is not over, and these “fighters” have probably not yet paid their last sacrifice to the cause. This is maybe why the choice of “The Ebola Fighters” as TIME Magazine’s Person of the Year is so important. •

42 43 CULTURE

The history of chocolate By Parvin Kumar

Photo: John Loo (Flickr)

heobroma Cacao, food of the gods, degrees north and south of the equator. and dried in the sun. Now they are ready hardly an exaggeration. Chocolate is Today several African countries lead the to change hands: from cocoa farmers to a delicious and popular food group. production in cocoa. The cacao flower is Oompa Loompas at the chocolate factory. TIf you’re not in agreement consider your- pollinated by a gnat midge and hence the The beans are first sieved and cleaned to self uniquely extraordinary, mysterious or cacao bean is conceived. From pollination remove unwanted non-chocolate making incomprehensible. Perhaps you’d rather to the maturation of the pod it takes about entities. The beans themselves are then wax lyrical about coffee. I grant you that. 6 months. The plant flowers perennially winnowed to remove hulls then ground But now let’s talk about chocolates. Choc- and so it is common to find a plant with into a paste or made into chocolate liquor. olate loving is a cosmopolitan affair. You flowers and pods that have varying states The Dutching process uses alkali salts to can imbibe the thick warm liquid as an- reduce the bitterness of cocoa and extract cient American cultures did or eat it as a a tangible mass. The paste or cocoa mass candy, a relatively modern and European But now let’s talk is mixed with other ingredients to give us affair. Some have rules for how they eat about chocolates. the holy trinity of chocolate: dark, milk the creamy blocks. One such routine as Chocolate loving is a and white. The world of chocolate mak- follows: Break a small piece. Let it rest on ing is complex with many technical and your tongue. Feel it melt away with your cosmopolitan affair. chemical steps between the beans of the troubles. Theobroma Cocoa is indigenous cocoa pod and the truffles which you pur- to the luscious tropical forests of Amer- of maturity. The farmer is very careful to chase at a master chocolatier in Switzer- ica. We have the Mayans and the Aztecs make sure that a pod is fully ripe before land. It is a common travesty that choco- to thank for discovering the food of the harvesting as this determines the quality late is much more accessible to the rich Gods, but Linnaeus a Swede to thank for and the taste of the derived cocoa prod- world even while the beans come from that particular appellation. Today the ucts. Harvest is done by hand as it has lesser developed agrarian economies. It is crop is grown in most of the world’s trop- been for many centuries. The harvested often that the farmer who grows the crop ics and spurs a multibillion dollar trade. pods are smashed with a machete and then for its monetary value has little knowl- On the production end you could be a prepared for fermentation and roasting. edge of what a chocolate bar tastes like. cocoa farmer, a chocolate maker, a choco- The roasting ensures that unwanted ger- The first people to experiment with latier, a food scientist, an Oompa Loompa mination does not ensue and the fermen- the beans of the cocoa tree were the Ol- or a cocoa climatologist. On the consump- tation melts the pulp away from the cocoa mecs of modern day Mexico. They brewed tion end; well, there’s the rest of us. beans but not before imparting their fla- a drink from the beans which was thought Cocoa production occurs in the tropi- vor to the cocoa beans. Next the enriched to be invigorating. The Mayans and the cal regions of the world about 10 to 20 and fermented beans are laid out on flats Aztecs of central and North America 8th

44 CULTURE

Theobroma cacao, Photo: Malcolm Manners (Flickr)

They considered it a food of the divine “realm... century AD offered hot chocolate in chal- foam one must give it room to subside, of the humoral medicine system. As in the ices to the Gods in gratitude. They con- and go down bit by bit. This drink is the Mesoamerican cultures it was mainly a sidered it a food of the divine realm that healthiest thing, and the greatest suste- drink that was afforded and consumed by had been bequeathed as a gift to human- nance of anything you could drink in the the elite and thus was a symbol of status. ity. Archaeological evidence suggests that world, because he who drinks a cup of The consumption of solid chocolate bars cocoa was creatively taken together with this liquid, no matter how far he walks, and candy was made possible only after honey, cornmeal, vanilla, chili and the can go a whole day without eating any- the Dutching process was invented by dried flowers of Mesoamerican trees. One thing else.” Van-houten. This paved the way for mak- anonymous spanish colonial of the Amer- ing everything chocolaty from Snickers to icas describes how the Aztechs made a The value of this drink to cure hunger was chocolate cakes. The rest as they say is chocolate drink. perhaps the basis for its use as a currency. history. The following list gives us an idea of how • The value of this drink the beans were traded with other com- to cure hunger was modities of value. perhaps the basis for • 1 good turkey hen=100 cacao beans its use as a currency. • 1 turkey egg=3 cacao beans • 1 fully ripe avocado=1 cacao bean “These seeds which are called… cacao are • 1 large tomato=1 cacao bean ground and made into powder, and other small seeds are ground, and this powder The Spanish Colonials were the first to is put into certain basins… and then they introduce chocolate as a beverage to Eu- put water on it and mix it with a spoon. rope. They used the term chocolatl a mar- And after having mixed it very well, they riage between the Mayan word for hot change it from one basin to another, so ‘chocol’ and the Aztec word for water ‘atl’. that a foam is raised which they put in a The reason for this was that the word Ca- vessel made for the purpose. And when cao sounded similar to the term for feces they wish to drink it, they mix it with in romance languages. In the 16th and 17th certain small spoons of gold or silver or century Europe, hot chocolate quickly wood, and drink it, and drinking it one became a drink to improve health. In the must open one’s mouth, because being Baroque era it was a prescribed medicine

45 CULTURE Feeling the winter blues? A guide to surviving the Swedish winter By Johanna Tauriainen

ave you felt a bit down lately? Had the feeling that you would like to at- tend an activity but refrained since it is too cold outside? Do you feel an increased need to sleep? Do you have problems adjusting to the fact that Hthe sun sets at 15:00? Well, the Swedish winter has arrived and it is truly long, dark and cold. This time of year many residents in the Northern countries ex- perience the winter blues. The major cause of the winter blues is the lack of sunlight, which decreases our production of melatonin, a hormone that regulates the sleep cycle and that usually reaches its highest levels during nighttime. The dark also affects the levels of serotonin, a neurotransmitter, known to be involved in depression. During December and January our levels of serotonin reach their lowest levels, adding to the winter blues. The lack of sunlight also affects the circadian rhythm that, in part, is influenced by sunlight, causing many people to feel an increased need for sleep. Many of us experience the winter blues, but ap- proximately 12 million people in Northern Europe suffer from actual depression during the winter, a disorder appropriately termed SAD (Seasonal Affective Dis- order). In these cases medical attentions is required. Luckily, not all of us suffer Photo: Seth Sawyers (Flickr) this bad, but the darkness and the cold can make anyone miserable, so Medicor has compiled a guide for how to survive the Swedish winter.

KEEP WARM FAKE IT ‘TIL YOU MAKE IT TO SUMMER If the cold is what’s getting to you, there are easy solu- Arrange a summer party. Prepare summer-themed food and tions. Invest in high quality winter clothes like woolen drinks and have a dress-code for summer clothes (though, on socks, long johns, winter boots, a warm hat and gloves, the way there you might need to put on your long johns). Make a and a winter jacket. It won’t help against the darkness, but playlist of summer songs and for a couple of hours, get reminded you will never freeze again. of those summer feelings. Visit a beach volleyball hall – it’s like visiting an indoor SUNLIGHT beach! Even if you don’t enjoy volleyball, many halls also have a Lack of sunlight is the major factor caus- restaurant part where you can hang out after enjoying the feel- ing the winter blues. So whenever possi- ing of walking bare-foot on warm sand. ble, try to soak up some daylight. Going for a walk during lunchtime is a good INDOORS ACTIVITIES idea. Another suggestion is to take up Turn the darkness into something positive! Light candles, in- ice-skating or cross-country skiing or vite your friends for dinner, watch a movie or find a TV-series any other winter activity. This will re- to follow (preferably one that will last through the winter). quire snow and some appropriate clothes, Cuddle up on the sofa underneath a warm blanket with a cup of but once you get the hang of it, you’ll actu- hot cocoa and enjoy a good book. Enjoy long baths or treat ally keep pretty warm even though the temperatures are yourself to a spa visit to get your mind off the win- low. These activities not only give you an opportunity to ter blues. Arrange a glögg (Swedish mulled get some sunlight but also some physical exercise, which wine) party and warm yourself with is proven to decrease depression. a bit of glögg and ginger- If you are not one for sports, gather up some friends bread cookies. and channel your inner child – go sledding, arrange a snowball fight, build a fortress out of snow. Preferably bring a large thermos with something hot to drink to keep warm. If you cannot find true sunlight, there are artificial al- ternatives. Light therapy is commonly used to treat Sea- sonal Affective Disorder. In Stockholm, several light café’s offer light therapy. The treatment consists of hanging out Finally, if none of in a room with special lights, mimicking sunlight, for 1-2 these things work, do hours, while having tea, reading a book or even doing yoga. The exposure to light is said to make up for some as the Swedes do – of the lack of sunlight and might thus help those suffering book a trip to Thailand from the winter blues. for a week or two of 46 sunbathing. CULTURE The Elephant By Mikael Plymoth

47 Tell your story

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