On June 21, a biosafety and ethical panel in the US approved the first clinical study using a genome-editing technology called CRISPR-Cas9. The study aims to create genetically altered immune cells to attack three kinds of cancer. Patients with multiple myeloma, melanoma, and sarcoma will be enrolled and treated with genetically modified T cells that, infused back into them, are expected to target and destroy tumor cells.
Genome editing technology is in the limelight and quite a number of articles in newsmagazines and newspapers have been published to inform the public of this new promising technology. It is difficult to say what messages have been really conveyed, apart from a generic wonder related to any new technology, notably in the field of life science.
The discovery of anti-CRISPR genes – which block the activity of specific CRISPR/Cas systems – in diverse groups of bacterial species has been almost ignored by general media. Yet, it is an important detail to understand the biological meaning of CRISPR systems. CRISPR and anti-CRISPR genes are part of the same host-parasite co-evolution and both participate in the rich and complex strategy of non-sexual genetic recombination. Changes are that the most important immediate consequences of studies on CRISPR systems could be in the microbiological field.
Scientific discoveries should be put in perspective in order to be understood. If one wants to convey the right message to the public, it is paramount to identify the landscape of a piece of new information, its context, and its relations with other scientific discoveries. Most journalists' comments on CRISPR are completely out of context, they seem to be fascinated only by science fictional potentialities, such as the theoretical possibility to edit human genes to eliminate "dangerous" genes and to improve human constitution.
Not only such a possibility is still remote – not the least because the relationship between phenotypes and genotypes is much more weak and nuanced that most "lay" people suppose - but the very concept of"human improvement" or "augmentation" is rather controversial. At the end of the day, overemphasizing genetic discoveries risks to produce false expectations and hopes, together with paranoid fantasies.
Experts and policy makers frequently advocate the adoption of a "principle of precaution" in relation with new genetic technologies. Maybe we should start using such a principle also when we inform the public.
Wednesday, June 29, 2016
Monday, June 20, 2016
Metaphors
This post is devoted to an article published on PLOS Translational Global Health. Written on the wake of the Orlando tragedy - in which 49 people dead and 53 were
wounded in a popular gay nightclub, shot by a gunman - the post is authored by James Michiel,
Senior Analyst at Emory University’s Rollins School of Public Health. The post
title is self-explicatory, "Public Health or Politics: The Recent History of America’s
Gun Epidemic and What Public Health Can (and Should) Do to End It". Michiel argues that "as public health practitioners
and researchers, we work to improve the health of the populations we serve. In
the case of gun violence, this must include building a consensus on the causes
of and remedies for this epidemic".
There is little doubt that gun control is an important issue and that
addressing gun violence should become a priority. Yet, this is not my focus.
The reason why I am interested in Michiel's post concerns the
metaphor that he uses, say, the description of gun violence
as an "epidemic".
The message that guns are like microbes, unavoidably conveys also the message that microbes are like guns. Saying "gun violence is an epidemic" implicitly tells people that microbes are as deadly as an AR-15 rifle, the semiautomatic weapon used in the Orlando carnage. Is this message correct? No, it is not.
Public health goal is hardly to eradicate infectious diseases, either in humans or in animals. Most microbes are helpful and humans and animals need them. Microbes existed well before humans appeared on the surface of the earth, and they will exist well after our species will be disappeared. Apart from very few infections, our goal is to control infections. The dream to cancel pathogens from our life is just a form of hubris.
What are the main consequences of this wrong message? They are at least two. First, this message gives the impression that public health authorities overemphasize risks connected to infectious diseases, which is the first step towards a slippery slope that drives to distrust. Second, this message reinforces the belief that infectious diseases result from an insult (the infection), which causes the disease in an individual. Not only this simplistic model is scientifically wrong, but it is the starting point of a misleading conception that turn infectious diseases into an individual business. Once such a wrong conviction is established, it would become quite difficult to convince people that vaccines, which are basically a community based intervention, are important.
Wednesday, June 15, 2016
Esprit de géométrie and esprit de finesse
On June 10, 2016 The New Yorker published a nice article on (mis)trust in science authored by Atul Gawande, a surgeon and public-health researcher. Dr Gawande' s central point is that mistrust in science is increasing and it is probably destined to increase. Why people mistrust science, he asks?
The first answer is straightforward: because they trust pseudoscience. The endless controversy on vaccine, vaccination and autism offers to Atul Gawande a good opportunity to reflect. Why do people believe against any evidence that vaccines may cause autism? Why is debunking that difficult? Why is misinformation that obstinate? Because there is a “backfire effect”, he argues. For instance, those who debunk false information tend to repeat too many times the legend, with the unexpected and paradoxical effect to reinforce it. They also providetoo many arguments instead of a few clear cut reasons. People are better convinced by silver bullets, while they have a natural tendency to suspect of long speeches. Ultimately – argues Dr Gawande – scientists tend to miscalculate the importance of world-views. True scientific theories are unnatural and counterintuitive. They challenge trivial experience and common sense. They demand intellectual honesty and efforts because they oblige the individual to re-frame his cognitive horizon, an operation that is always painful and demanding. So, people naturally tend to persist into their customary opinions.
There is, however, a second answer about the reason why people mistrust science. One could easily verify – argues Atul Gawande – that the more one is educated, the more is skeptical. The point is that education exposes people to science, but also leads "people to be more individualistic and ideological". In other words, by teaching people science, one often teaches them universal skepticism, and ultimately science itself becomes victim of such a skepticism.
In conclusion, Dr Gawande's argument is that people would naturally resist "scientific claims when they clash with intuitive beliefs", because abandoning conventional world-views is demanding and little rewarding. When, and if, they finally change their perspective, there is the inherent risk that they do not espouse a more scientific world-view, rather that they just become cynic. Teaching people scientific theories is thus worse than useless, is dangerous, if one does not teach them in the while also a new way of thinking. Science is "curiosity, inquisitiveness, openness, and discipline" and people can overcome mistrust in science only if they learn this basic lesson.
This lesson would be also a great conclusion for this post, if Dr Gawande did not partly disregard it. Unfortunately he did.
The New Yorker' s article starts with a reference to the heliocentric theory, taken as a clear example of counterintuitive scientific truth, which stands "in contrast to the wisdom of divinity and experience and common sense". Dr Gawande takes as granted that the heliocentric theory marked the dawn of a new era of progress and liberation from ignorance.
All those who know the history of science know that both geocentric and the heliocentric theories date back to ancient Greeks. The choice between one of them was due neither to common sense, nor to experience or religious beliefs.The main reason for opting for one of the two relied in their respective effectiveness in predicting stars' positions, planets' movement, and eclipses. In fact, none of them was more commonsensical or experience-based than the other. The geocentric theory had little to do with the trivial experience that the sun moves across the sky. In fact, the mature geocentric theory assumed that the sun orbited around two virtual points, called the eccentrics, and along two virtual spheres, the deferent and the epicycle. This very complex – and definitely counterintuitive - system allowed predicting stars' positions, planets' movement, and eclipses better than any other system, but it was rather cumbersome. The heliocentric system offered a greater ease of calculation, although it was less accurate and precise (and we know that Galileo had to trick his calculation in order to demonstrate his hypothesis, which is a great lesson for those who are still mesmerized by evidence-based science). In fact, scholars know that the scientific challenge was not whether either the sun or the earth was in the centre of the planetary system (actually, none of them is), but the principle of inertia and, consequently, the notion of movement.
A similar argument could be also developed about religious conflicts. Galileo was involved in a wider war to achieve cultural hegemony in Europe. Science and religion were marginally at stake. Heliocentric theories were just a pretext to fight a cultural battle between Reformation and Counter-Reformation.
In conclusion, Dr Gawande is certainly true when he describes the reason why people mistrust science - and there is a lot to learn from his article - yet scientists would be more credible if they avoided the most trivial commonplaces. Science is chiefly esprit de géométrie, but without a bit of esprit de finesse it could hardly survive.
The first answer is straightforward: because they trust pseudoscience. The endless controversy on vaccine, vaccination and autism offers to Atul Gawande a good opportunity to reflect. Why do people believe against any evidence that vaccines may cause autism? Why is debunking that difficult? Why is misinformation that obstinate? Because there is a “backfire effect”, he argues. For instance, those who debunk false information tend to repeat too many times the legend, with the unexpected and paradoxical effect to reinforce it. They also providetoo many arguments instead of a few clear cut reasons. People are better convinced by silver bullets, while they have a natural tendency to suspect of long speeches. Ultimately – argues Dr Gawande – scientists tend to miscalculate the importance of world-views. True scientific theories are unnatural and counterintuitive. They challenge trivial experience and common sense. They demand intellectual honesty and efforts because they oblige the individual to re-frame his cognitive horizon, an operation that is always painful and demanding. So, people naturally tend to persist into their customary opinions.
There is, however, a second answer about the reason why people mistrust science. One could easily verify – argues Atul Gawande – that the more one is educated, the more is skeptical. The point is that education exposes people to science, but also leads "people to be more individualistic and ideological". In other words, by teaching people science, one often teaches them universal skepticism, and ultimately science itself becomes victim of such a skepticism.
In conclusion, Dr Gawande's argument is that people would naturally resist "scientific claims when they clash with intuitive beliefs", because abandoning conventional world-views is demanding and little rewarding. When, and if, they finally change their perspective, there is the inherent risk that they do not espouse a more scientific world-view, rather that they just become cynic. Teaching people scientific theories is thus worse than useless, is dangerous, if one does not teach them in the while also a new way of thinking. Science is "curiosity, inquisitiveness, openness, and discipline" and people can overcome mistrust in science only if they learn this basic lesson.
This lesson would be also a great conclusion for this post, if Dr Gawande did not partly disregard it. Unfortunately he did.
The New Yorker' s article starts with a reference to the heliocentric theory, taken as a clear example of counterintuitive scientific truth, which stands "in contrast to the wisdom of divinity and experience and common sense". Dr Gawande takes as granted that the heliocentric theory marked the dawn of a new era of progress and liberation from ignorance.
All those who know the history of science know that both geocentric and the heliocentric theories date back to ancient Greeks. The choice between one of them was due neither to common sense, nor to experience or religious beliefs.The main reason for opting for one of the two relied in their respective effectiveness in predicting stars' positions, planets' movement, and eclipses. In fact, none of them was more commonsensical or experience-based than the other. The geocentric theory had little to do with the trivial experience that the sun moves across the sky. In fact, the mature geocentric theory assumed that the sun orbited around two virtual points, called the eccentrics, and along two virtual spheres, the deferent and the epicycle. This very complex – and definitely counterintuitive - system allowed predicting stars' positions, planets' movement, and eclipses better than any other system, but it was rather cumbersome. The heliocentric system offered a greater ease of calculation, although it was less accurate and precise (and we know that Galileo had to trick his calculation in order to demonstrate his hypothesis, which is a great lesson for those who are still mesmerized by evidence-based science). In fact, scholars know that the scientific challenge was not whether either the sun or the earth was in the centre of the planetary system (actually, none of them is), but the principle of inertia and, consequently, the notion of movement.
A similar argument could be also developed about religious conflicts. Galileo was involved in a wider war to achieve cultural hegemony in Europe. Science and religion were marginally at stake. Heliocentric theories were just a pretext to fight a cultural battle between Reformation and Counter-Reformation.
In conclusion, Dr Gawande is certainly true when he describes the reason why people mistrust science - and there is a lot to learn from his article - yet scientists would be more credible if they avoided the most trivial commonplaces. Science is chiefly esprit de géométrie, but without a bit of esprit de finesse it could hardly survive.
Tuesday, June 7, 2016
The Yata Mirror
The G7 Ise-Shima Vision for Global Health is a joint declaration released on May 27, 2016, by the seven world leaders during the G7 Summit, held in the Shima Peninsula in Japan. Two important issues have been raised by the declaration.
The first important point concerns the emphasis put on an integrated biodefense approach. Ultimately, this approach is based on the idea of combining military, security and public health efforts creating a unified field of competence and governance to contrast biological threats from different sources, including bioterrorism, biological incidents, and naturally occurring outbreaks. Still more important, the document identifies two main funding mechanisms, 1) the Contingency Fund for Emergency (CFE), which is a specific, replenishable, funding mechanism created in May 2015 by the WHO, which has been now fully endorsed also by the G7 Summit; and 2) a new instrument just developed by the World Bank, the Pandemic Emergency Financing Facility (PEF), which offers financial coverage in the event of an outbreak to low income countries and to qualified international agencies. The PEF covers outbreaks of infectious diseases, including new Orthomyxoviruses (new influenza pandemic virus A, B and C), Coronaviridae (SARS, MERS), Filoviridae (Ebola, Marburg) and other zoonotic diseases (Crimean Congo, Rift Valley, Lassa fever).
A second important point addressed by the Ise-Shima Declaration concerns Antimicrobial Resistance and the “One Health Approach”. The document endorses the "One Health Approach" in human and animal health, agriculture food and the environment, and call for an integrated collaboration between G7 ministries of health, environment, and agriculture. In addition, the document solemnly declares the "effectiveness of antimicrobials as a global public good and prioritize efforts to preserving such effectiveness through appropriate and prudent use of antimicrobials both in humans and animals". The United Nations usually considers clean water, safe environment, peace, economic stability, etc. as global public goods. Adding to this list the " effectiveness of antimicrobials" is an important policy decision, which promises to have significant future impacts (one of them is already evident from the Ise-Shima Declaration, which formally bans the use of antibiotics for growth promotion in animal husbandry and preserve the use of antibiotics only for therapeutic reasons in human and veterinary medicine).
So, is everything ok with the Ise-Shima Declaration? Almost.
The Shima Peninsula, which hosted the G7 Summit, is famous for housing one of Shinto's holiest sites, the Ise Grand Shrine. In the restricted part of the sanctuary – the sancta sanctorum – there is a sacred mirror (Yata no Kagami), which is believed to represent the Truth. The Mirror was given directly to the Emperor from Amaterasu, the Maiden of the Sun. The legends tells that the Goddess was once involved in a fight with her brother, the God of the sea and storms, Susanowo. At the end of the combat,Amaterasu, angry, hid herself in a cavern, leaving the world in the dark. Other Gods played then a pantomime with dancers to appease her, putting a mirror at the entrance of the cavern to allow the Goddess to see the show from inside. Not onlyAmaterasu saw the show, amusing herself, but she also saw her splendid beauty reflected by the mirror. So the Yata Mirror saved the world from darkness, because the Goddess returned outside. Finally, the Mirror was given to the Emperor. For more than one thousand and seven-hundred years (the mirror dates back to the 3rd Century), only the Emperor and the sanctuary priests were allowed accessing it. On the reverse of the mirror, there was a secret inscription used for centuries as a seal of enthronement for newly appointed Emperors of Japan. Only after World War II, it became possible to study this inscription, which was amazingly made of 37 letters of Brahmi, Hebrew and early Japanese script. They include the Hebrew name of G-d, the Chinese Yang symbol, the early Hindu symbol for Aum, and a mysterious inscription, maybe in Latin letters and Arabic numbers.
Truth, light, mirror, power, secrecy, God: could one find a deeper, and nicer, symbol, to describe the countless nuances of human communication? Yet, communicational aspects are totally missed in the Ise-Shima Declaration and this is - at least to me – it's main fault. It's really a damage, because most issues raised by the document would make still more sense if they were framed within a wider context, also including public health and risk communication. Might Amaterasu, the Goddess of light, enlightens our rulers and teach them that each profitable human enterprise starts with good communication.
The first important point concerns the emphasis put on an integrated biodefense approach. Ultimately, this approach is based on the idea of combining military, security and public health efforts creating a unified field of competence and governance to contrast biological threats from different sources, including bioterrorism, biological incidents, and naturally occurring outbreaks. Still more important, the document identifies two main funding mechanisms, 1) the Contingency Fund for Emergency (CFE), which is a specific, replenishable, funding mechanism created in May 2015 by the WHO, which has been now fully endorsed also by the G7 Summit; and 2) a new instrument just developed by the World Bank, the Pandemic Emergency Financing Facility (PEF), which offers financial coverage in the event of an outbreak to low income countries and to qualified international agencies. The PEF covers outbreaks of infectious diseases, including new Orthomyxoviruses (new influenza pandemic virus A, B and C), Coronaviridae (SARS, MERS), Filoviridae (Ebola, Marburg) and other zoonotic diseases (Crimean Congo, Rift Valley, Lassa fever).
A second important point addressed by the Ise-Shima Declaration concerns Antimicrobial Resistance and the “One Health Approach”. The document endorses the "One Health Approach" in human and animal health, agriculture food and the environment, and call for an integrated collaboration between G7 ministries of health, environment, and agriculture. In addition, the document solemnly declares the "effectiveness of antimicrobials as a global public good and prioritize efforts to preserving such effectiveness through appropriate and prudent use of antimicrobials both in humans and animals". The United Nations usually considers clean water, safe environment, peace, economic stability, etc. as global public goods. Adding to this list the " effectiveness of antimicrobials" is an important policy decision, which promises to have significant future impacts (one of them is already evident from the Ise-Shima Declaration, which formally bans the use of antibiotics for growth promotion in animal husbandry and preserve the use of antibiotics only for therapeutic reasons in human and veterinary medicine).
So, is everything ok with the Ise-Shima Declaration? Almost.
The Shima Peninsula, which hosted the G7 Summit, is famous for housing one of Shinto's holiest sites, the Ise Grand Shrine. In the restricted part of the sanctuary – the sancta sanctorum – there is a sacred mirror (Yata no Kagami), which is believed to represent the Truth. The Mirror was given directly to the Emperor from Amaterasu, the Maiden of the Sun. The legends tells that the Goddess was once involved in a fight with her brother, the God of the sea and storms, Susanowo. At the end of the combat,Amaterasu, angry, hid herself in a cavern, leaving the world in the dark. Other Gods played then a pantomime with dancers to appease her, putting a mirror at the entrance of the cavern to allow the Goddess to see the show from inside. Not onlyAmaterasu saw the show, amusing herself, but she also saw her splendid beauty reflected by the mirror. So the Yata Mirror saved the world from darkness, because the Goddess returned outside. Finally, the Mirror was given to the Emperor. For more than one thousand and seven-hundred years (the mirror dates back to the 3rd Century), only the Emperor and the sanctuary priests were allowed accessing it. On the reverse of the mirror, there was a secret inscription used for centuries as a seal of enthronement for newly appointed Emperors of Japan. Only after World War II, it became possible to study this inscription, which was amazingly made of 37 letters of Brahmi, Hebrew and early Japanese script. They include the Hebrew name of G-d, the Chinese Yang symbol, the early Hindu symbol for Aum, and a mysterious inscription, maybe in Latin letters and Arabic numbers.
Truth, light, mirror, power, secrecy, God: could one find a deeper, and nicer, symbol, to describe the countless nuances of human communication? Yet, communicational aspects are totally missed in the Ise-Shima Declaration and this is - at least to me – it's main fault. It's really a damage, because most issues raised by the document would make still more sense if they were framed within a wider context, also including public health and risk communication. Might Amaterasu, the Goddess of light, enlightens our rulers and teach them that each profitable human enterprise starts with good communication.
Wednesday, June 1, 2016
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