The Secret Lair

CC BY-NC-ND image from trepelu via Flickr

It is, perhaps, an understatement to note that we here in The Lair love mad science. We enjoy doing it, reaping the benefits when it works, and mocking those responsible (usually Minister Lynn) when it does not. This also lends us to pay a bit of attention when other people do mad science as well.

The big recent mad science news over the last few weeks has regarded two research teams that have been working to make the avian H5N1 influenza strain more easily transmissible among mammals. The fact that this research was done in the first place, and whether or not the full results of said research should be published, has sparked considerable public debate and a flurry of media reporting, both reasonable and terror-soaked.

The core issues is this: one type of avian influenza virus, know as the Highly Pathogenic Avian Influenza A H5N1, is present in birds in several regions of the world, and has rarely caused disease in humans because it is not easily transmitted from bird to human or person to person. The World Health Organization has been tracking human cases since 2003, and to date there have been 586 confirmed infections in humans resulting in 346 deaths, or a 59% death rate. A major concern has been the possibility that the virus might mutate to become more easily transmissible among humans, with the potential cause a highly lethal pandemic.

Recently, two teams of researchers tried to change the HPAI H5N1 in controlled laboratory conditions to be more transmissible among ferrets, which are a fair stand-in for humans in terms of observing influenza transmission and illness. The goal was to assess how easily such mutations might occur and what they would be, which could lead to improved vaccine development, assessment of drugs to treat this influenza, and develop plans to deal with a potential outbreak. The scientists were unsuccessful in directly manipulating the genes of the virus to produce the results they wanted, so they infected a ferret with the naturally occurring HPAI H5N1, isolated the virus from the ferret after the infection, and then infected another ferret with the virus. The intent was to see if the same viral sample would pick up mutations after as it “passed through” multiple ferrets such that it could be easily transmitted from ferret to ferret through the air. This was ultimately what happened.

The two teams presented their data at conferences last year, and then submitted formal papers to the journals Science and Nature for publication. Due to the fact that making a bad virus worse for humans raises the worry that bad humans may take the study results and try to do the same thing for evil ends, the studies were classified as Dual-Use Research of Concern, and sent to the National Science Advisory Board for Biosecurity for comment. The NSABB does not have the power to force the journals not to publish the studies, but can make recommendations; in this case, the recommendation was for publishing the studies but leaving key details out, such as the genetic sequences of the mutation mix involved.

This has raised a number of hotly debated questions. Should this research have been done in the first place? Is not publishing the full data prudent, to avoid bad people getting their hands on it, or is it fear-based science censorship that might set a precedent for preventing future infectious diseases studies from entering the public domain? My opinion is that this is not mad science but in fact important research to do, and the full papers should be published. Some specific thoughts on this:

• The biggest point of fear surrounds how lethal HPAI H5N1 is in humans. However, we do not have enough data to know whether the true death rate from the current virus in nature is really 60%. We do know that approximately 1 in 5 seasonal influenza cases are asymptomatic based on seroprevalence studies, which involve checking the blood of people who have had no symptoms of influenza for antibodies specific to the influenza viruses currently floating around in the population. As such, it’s conceivable that there are significantly more people running around who have had a milder or no illness to HPAI H5N1 and simply were never tested for it in the first place. Some seroprevalence studies have been done looking for asymptomatic people with antibodies to H5N1, and these have shown at least dozens of people who have been exposed but haven’t been seriously affected. That noted, given that the total number of confirmed human cases is a tiny sample size of 586, if further seroprevalence studies are done – which they should be – and discover even more people who didn’t get sick from the virus, that could dilute the 60% death toll dramatically.
• While the most grave concern is that HPAI H5N1 would become easily transmissible among humans and retain its high lethality, it is often the case in nature that when a pathogen genetically changes to become more transmissible, it becomes less capable of causing severe disease. This is a contributing factor as to why we have seen so few highly lethal influenza and other virus pandemics – the perfect storm of being highly transmissible, highly pathogenic, and having the staying power to last in the population for a long time is an exceedingly rare combination. Not impossible, mind you, but very rare.
• These studies involved ferrets, which are a good model for influenza in humans, but not perfect. One can extrapolate that increased ferret to ferret transmission would bode the same in humans, but that is not a direct correlation. Additionally, the severity of infections that a certain viral strain causes in ferrets doesn’t often correlate well with how severe human infections are with the same strain.
• HPAI H5N1 is a rubbish choice for a bioweapon. Terrorists are about stoking fear and making horrific symbolic statements, which can sometimes include personal maryrdom… but not the significant potential for killing everyone on their side in addition to their enemies. This is precisely what might happen if this viral was modified to be easily transmissible and got loose in the general population. There are far more effective, targeted weapons that would (quite sadly) be better choices.
• The labs, equipment, and expertise to do this kind of work without killing oneself in the process is not easy to come by. This type of work is a long, laborious process. Additionally, it seems unlike that publishing the full genetic sequence of this new virus won’t really help anyone create it. The general technique (repeatedly passing the virus through ferrets) is already known, even if the specific methods used aren’t publicly available. In the face of everything noted above, if someone had the knowledge and capability to create this virus on their own and was crazy enough to do so, they already have enough to go on to eventually succeed.
• The genetic sequence to the 1918 H1N1 virus was published in 2005, and samples of that virus exist in several labs across the world. So, there’s that. Which brings us back to the whole “influenza is a stupid choice for a bioweapon” thing.

The upshot is that the arguments against publishing this work are based in inflated fears and bad assumptions, and such “research censorship” would have negative repercussions in the future for people looking to do work on infectious agents. The question of “Why would you make an already bad virus worse?” is an important one, and the answer is that when done in a controlled environment, it will give us vital information that will help our chances of survival if this ever occurs in nature. Indeed, this seems to have been the ultimate decision of influenza experts at the WHO, who decreed a few days ago that the studies will be published in full.

For more robust discussion of the issue, check out the special series of editorials on “The H5N1 Manuscript Redaction Controversy” at the excellent open-access journal mBio, including one for publication, one against, and one decidedly on the fence.

I’m just glad Minister Lynn isn’t involved. He’s still locked in Level 17 of The Lair’s Menagerie without Internet access. I think.

Scott Roche is a prolific guy. Every time I look at his tweetstream he’s publishing a new collection of stories, or is pushing the work he does with Flying Island Press, or is pimping a new column for the Nifty Tech Blog, or is telling the world about one of his podcasts, or…

You get the point. The man likes words. When he put out the call for reviews of his new book, Caveat Veritatem, I decided to take him up on the offer. Here is how he describes it:

Truth is a dangerous thing. A little of it goes a long way and it can come back to bite you. That’s why our society (and most societies I would imagine) encourage the polite, little lie. Thus my title for this anthology “Caveat Veritatem” or “Beware of the Truth”. Here are five stories that tell various truths, no matter the consequences for you or for the characters.

• “Vicious Cycle” – Wherein a leader is forced to choose between repetition and redemption.
• “X Marks the Spot” – Mark uncovers a long buried box that unlocks him. This is one of the prequel stories in my Children of Legend series.
• “Truth Is No Stranger to Fiction” – They say there’s some truth at the core of every story, even the most absurd ones. That comes back to haunt a publisher of such tales.
• “Tell Me Why” – Can love be outlawed in order to save humanity?
• “Hell Hath No Fury” – Don’t mess with Mother Nature or her defenders. Mike learns that lesson the hard way when both attempt to blow him and his experimental craft out of the air.

This collection is a quick read and a pleasing one. It’s a good introduction to the author’s style, which is strong on character, moderate on description,m and shot on flowery prose.  Roche spins a good story without wasting the reader’s time on details better left to their imagination. Each of these five stories has something to recommend it; the craft is strong here. The stories are all on the very short side, usually just a single scene, but his style and characterizations draw the reader in. Each tale had a strong core, but there was enough conflict to keep them interest and to keep the reader wondering what would happen next. When I finished, I found myself thinking about picking up some of his longer form works — I wanted more.

I have only one complaint: all of the stories feel like they end abruptly. Perhaps that’s part of the strategy (to leave the reader wanting more), or perhaps that’s simply how he crafts his short stories.  If I had a wish, I would ask for a little more catharsis at the end of each story.

Despite my quibble with the endings, I would and do recommend this book.  These five tales are the perfect length for a quick afternoon read and will leave the reader curious to see what other stories Roche has up his sleeve.

You can learn more about Scott Roche and his many projects at his website, http://scottroche.com.

Attention self-publishing authors. We want to review your books. 

We know how hard it must be to build publicity for your work. You don’t have a marketing department or a bottomless budget. You don’t have a major powerhouse…or perhaps even a small windmill…backing you up. All you have is your passion for the work. We respect that. We’d like to review your work.

We need to be clear…we will review your work fairly. If we see glory, we’ll crow about it. If we see major problems, we will point them out. We’re not promising sunshine and roses, but we are promising to give your work a fair shake and to assist in getting the word out there.

If you are interested, please contact Chris Miller: ctmiller /at/ thesecretlair.com. 

I have spoken about beards in this place on several occasions, and at great length. But to truly understand the noble value of the crackling virility hedge, one does not need copious words or vast descriptors. For the true worth of the face-mane can be summed up by five simple virtues:

1: *Tenacity*

2: *Wisdom*

3: *Liberation*

4: *Passion*

5: *Wanderlust*

And so it came to pass that this is known as the Holy Quintinity of Beardly Virtue. You have been enriched by this knowledge. Please go about your day a better person for it.

Image via Wikipedia

First, let me congratulate my fellow Overlords and Mad Scientists on the successful deployment of the weather control satellite. During the last week I have personally witnessed a wide variety of climatic and atmospheric conditions: pleasant spring jacket temperatures, deep autumnal fogs, even snow and freezing rain. I was particularly impressed by the localized micro-monsoon. However, may I request that you conduct future tests elsewhere? As entertaining and informative as it has been to observe this variety of meteorological effects from the comfort of my personal lodging, some of the specific applications of the technology have posed challenges to my assigned minions. (While I personally subscribe to the theory that adversity is good for their development, I have been informed by HR that this management approach is not conductive to their continued positive engagement.) As a result, might I recommend an alternate target, perhaps Manchester (http://www.manutd.com/Splash-Page.aspx).

CC BY-NC-SA image by blackrvn via Flickr

Hogwarts School of Witchcraft and Wizardry motto: Draco dormiens nunquam titillandus (Never tickle a sleeping dragon)

Johns Hopkins University motto: Veritas vos liberabit (The truth shall make you free)

As previously noted, my intent for the next meeting of The Secret Journal Club was to take on a challenge from a certain Overlord on the topic of weight loss. However, I’m delaying that until next time so that I can take a look at one of the more interesting geek-related peer reviewed articles to come out of the august institution that is Johns Hopkins. This can only be “The new and improved learning community at Johns Hopkins University School of Medicine (JHUSOM) resembles that at Hogwarts School of Witchcraft and Wizardry”, published in the journal Medical Teacher in 2007.

Medical Teacher is a peer reviewed journal that focuses on training in the health professions, and “provides accounts of new teaching methods, guidance on structuring courses and assessing achievement, and serves as a forum for communication between medical teachers and those involved in general education”. Sadly, the publisher has locked the full text of this article behind a paywall. From the abstract:

Background: In July 2005, a learning community was created at Johns Hopkins University School of Medicine to foster camaraderie, networking, advising, mentoring, professionalism, clinical skills, and scholarship—The Colleges. The cultural and structural changes that emerged with the creation of this program have resulted in JHUSOM bearing a resemblance to J. K. Rowling’s fictional Hogwarts School of Witchcraft and Wizardry.
Aims: This manuscript will describe the similarities between these two revered schools, and highlight the innovations and improvements made to JHUSOM’s learning environment.
Description: The intense, stressful, and lengthy professional training required to achieve competency in the practice of medicine and in the practice of witchcraft (albeit fictional) have meaningful parallels.
Conclusion: The supportive learning environment at these two schools should afford the next generation of graduates to have an even more enriching experience than those who have come before them.

This sounds like a fun and cute comparison, but my initial reaction was: what’s the academic point? As if anticipating this question, the authors listed the following as “Practice Points”:

• Changes that optimize the learning community of a medical school are likely to enhance the educational experience of both students and physician–teachers.
• Personal and professional growth of medical students is most likely to occur in supportive and encouraging environments.
• Literature, beyond just medical literature, can be a valuable source of information that promotes reflection on our medical practices.

What follows is a delightfully written series of thoughts that compare the changes made to the JHUSOM in 2005 to the structure of Hogwarts as depicted in the Harry Potter novels. The authors clearly are fans of and well-versed in the Potter mythos, and their enthusiasm for both that and medical education shines through. They choose to compare the two institutions across the following points:

Joining the ranks – Hogwarts students on matriculation are excited by learning a new language, skillset, and obtain wizard robes and special equipment when they start. If you substitute “white coat” for “wizard robes”, the description is the same for medical students.

Dividing the whole into four – The four Houses of Hogwarts are named after “the four greatest witches and wizards of the age”:

“Helga Hufflepuff is remembered for her loyalty and justice, Godric Gryffindor for his daring, nerve, and chivalry, Rowena Ravenclaw for her wit and desire to learn, and Salazar Slytherin for his cunning.”

In 2005, JHUSOM created four Colleges that the students are randomly assigned to, and identify with over the course of their training. These are named for extraordinary physicians of the past:

• Dr. Florence Sabin, the first woman to rise to the rank of Professor at JHUSOM, and the first woman to become a member of the National Academy of Sciences
• Honorary Dr. Vivien Thomas, surgeon and scientist who made significant contributions to the Blalock–Taussig shunt to treat ‘blue baby’ syndrome, and mentor to numerous Hopkins surgeons for cardiac surgical techniques
• Dr. Daniel Nathans, who won the Nobel Prize in Medicine for his discoveries in genetics and molecular biology
• Dr. Helen Taussig, a pediatric cardiologist and Professor at JHUSOM, who was also instrumental in developing the Blalock–Taussig shunt, and excelled clinically despite losing her hearing

The physical setting and surroundings – Both Hogwarts and Johns Hopkins Hospital are vast, sprawling structures with imposing portraits of former instructors on the walls and are quite easy to get lost in. Of course, the portraits at Hopkins don’t talk and the staircases don’t move.

Valuing diversity – Both institutions cherish diversity in their students and instructors, both in terms of race/ethnicity and background interests.

Learning together – Both the Houses of Hogwarts and the Colleges of JHUSOM serve as close-knit learning groups for their members from year to year.

Grading system, coursework structure, and reprimands – In general, the systems are similar, although the Hogwarts structure is far more punitive, with half of the Hogwarts grades carrying a negative connotation (Outstanding, Exceeds Expectations, Acceptable, Poor, Dreadful, and Troll) compared to only one that does in the JHUSOM (Honors, High Pass, Pass, and Fail). Additionally, the freedom of the Hogwarts instructors to remove points from a House or assign all manners of detention to students is (fortunately, perhaps) nonexistent at the JHUSOM. Both have detail sets of curricula that are competency based, such that students are not allowed to attempt advanced techniques before mastering basic ones.

Social events and competition – If only JHUSOM had quiddich… students could fly around on ensorceled stethoscopes, chasing after a winged prescription pad… nevermind. Although inter-House competition is a crucial part of Hogwarts life, this is far less emphasized with the JHUSOM Colleges. That noted, the Colleges do annually compete against each other in athletic events, as well as mingling in at various social events.

The roles of the faculty – Both institutions have core faculty of various specializations assigned to each House/College for leadership, mentoring, and running different specific courses.

Interaction between older and younger students – Hogarts and the JHUSOM have dedicated space assigned for studying and socialization specific to each House of College. Additionally, emphasis at both is place on contact building with students of different years and alumni.

The article concludes by assessing why the structures at both institutions work well:

Both involve prolonged professional training at schools that are committed to the growth and development of their students. The new Colleges program at JHUSOM represents a substantial investment that is changing the learning environment for the students and faculty members alike. The ‘house model’ of the Colleges program at JHUSOM appears to be more wide-ranging than other medical school formats that have been previously described, in that faculty members are called upon to be advisors, mentors, teachers, evaluators, role models, social-event planners, and community anchors or pillars for the student body.

The authors also examine how the meaningful relationships such an environment provides can allow the students to learn better, as well as to specifically foster a better sense of professional humanism and compassion. From the broader context of medical education, they contend:

The new organizational structure at our medical school, which resembles other institutions of learning that have taken on the ‘houses format’, including Hogwarts, is a structure that allows each medical student to receive individualized attention from a faculty advisor who will be with them for the duration of their training experience. Future research will determine how this progressive attention influences the growth and development of medical students and affects their careers in medicine.

Apart from being an enjoyable read, I am forced to go back to my initial question: what was the academic point of publishing this? To me, the answer is half a cheat – discussing the changes to the JHUSOM itself would have been dry, but adding in the Hogwarts comparisons makes such a discussion far more entertaining. The ultimate goal of the article is an excellent one, namely to show that a restructuring of how traditional medical school education (a thing that is sorely needed on many fronts) from a social perspective ultimately provides a better experience for students and better doctors to the world at large.

The fact that the educational model J. K. Rowling has crafted in her novels is being proven successful in the medical educational world is merely enchanted icing on the cake. Also, the fact that six of Rowling’s books are cited along with academic articles from such places as the New England Journal of Medicine in a peer-reviewed medical publication is also decidedly cool.

Reference: Stewart, R., Barker, A., Shochet, R., & Wright, S. (2007). The new and improved learning community at Johns Hopkins University School of Medicine resembles that at Hogwarts School of Witchcraft and Wizardry Medical Teacher, 29 (4), 353-357 DOI: 10.1080/01421590701477423