1#2013
medicor
2014 #1 medicinska fรถreningen i stockholm
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Opening up science 14 Nobel Laureate Sir Tim Hunt 25 MSF co-founder Johan von Schreeb 28
believE in yourself
says multifaceted neuroscientist Katarina Gospic
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Prelude The importance of unconventional stories. A year has passed since I started medical school here at
Karolinska Institutet. A lot of worries I had back then have changed, and I hope to continuously broaden my perspective of the world as life unfolds. Without having an official theme, an underlying thought of this issue is the strive for progress. We feature the inspiring neuroscientist, entrepreneur, and two-time TED speaker Katarina Gospic, a former KI medical student, as our cover story. Her one-hour radio talk, “sommarprat”, in the summer of 2013 was as motivational as it was enjoyable. She has valuable stories to tell, as a young woman, with an immigrant background, in the man-dominated culture of research and business. Let her spirit spur you to dare more.
We also provide you with an exclusive piece covering the 2001 Nobel Laureate Sir Tim Hunt’s revisiting lecture at Karolinska who is acknowledged for discovering the regulation of the cell cycle. Furthermore, I hope you take some time to enjoy our articles on how modern science is shifting its borders. The issue of making science more transparent is discussed in “Open Science”, while the analysis of the use of Big Data in monitoring global chronic disease provides an international perspective. We also make it personal. For instance, is your breakfast milk really that beneficial? We see an attitude shift in the arts. The greatly-acclaimed film Dallas Buyers Club has reminded people of AIDS in the early 1980’s. How art can be used to heal societal wounds, or at least attempt to console, is conveyed in the Utøya art project. Speaking of the unconventional – did you see that the Nobel Laureate balloon photo taken by Karolinska medical student Jingcheng Zhao has received over 635 000 views on Reddit? It would be interesting to see if more complex scientific concepts can be made more accessible to the broader public in a wittier fashion. I can only imagine how refreshing that would be.
Photo by Jincheng Zhao for Medicor
Another Karolinska profile you should read about is Johan von Schreeb, co-founder of Médecins Sans Frontières’s Swedish branch. He recently published his autobiography, where he deals with heavy moral and ethical questions as he tell us stories of the field missions he has performed. It is no mere recital of events, it is a deeper discussion about humanity, medicine, and power. We are happy to provide you with the extended answers to these matters in the issue.
Medicor Magasin Grundad 2006. Sjunde årgången. Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 Ansvarig utgivare: Gustaf Drevin Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm Nobels Väg 10, Box 250, 171 77, Stockholm Utgivningsplan 2014: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december. Kontakta Medicor: chefredaktor@medicor.nu www.medicinskaforeningen.se Frilansmaterial: Medicor förbehåller sig rätten att redigera inkommet material och ansvarar inte för icke beställda texter eller bilder, samt tryckfel. Upphovsman svarar för, genom Medicor publicerat, signerat frilansmaterial; denna(e)s åsikter representerar nödvändigtvis inte Medicors eller Medicinska Föreningens.
Sincerely, Gustaf Drevin Editor-in-Chief
Cover photo by Martin Kjellberg for Medicor 2
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1#2013
Overture 9 13 14
28
medicor
features
New MF Café Tired of the ridiculously high coffee prices at campus? Don’t worry, Medicinska Föreningen has opened a café, run by students, for students!
How important is breakfast Milk? What if the milk box text is not entirely correct about all the benefits that come with drinking milk? Let’s look into the negative effects of milk consumption.
open science Anti-conventional science - release your research papers for the broader community, not in closed-up journals!
Intervju: Johan Von Schreeb Kirurg, katastrofmedicinare och författare; KI:s docent Johan von Schreeb är en av landets mest respekterade namn inom global hälsa.
18 Katarina gospic: Young, driven, sharp
Former KI medical student Katarina Gospic is an entrepreneur, researcher, and neuroscientist, who dares to do her own thing.
16 25
KI Revisiting lecture: Sir Tim Hunt 2001 Nobel Laureate in Physiology or Medicine, Sir Tim Hunt, visited KI in March.
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Medical Yoga Yoga might have more benefits than helping you relax. We examine research behind the modern phenomenon of MediYoga.
UtøYA ART PROJECT How Utøya will turn into a memorial site for the 22 July victims.
medicor Gustaf Drevin • Editor-in-Chief | Oskar Swartling • Associate Editor | Andrey Pyko • Creative Director Ruslan Alam • Proofreader General | Vladimir Choi, Robert de Meijere • Executive Editors | Jin-Yu Lu • Treasurer Amanda Kaba Liljeberg, Sergio Scrò • Editors of Campus Issues | Iskra Pollak Dorocic • Editor of Science | Poya Livälven • Editor of the Arts Janne Andersson • Senior Advisor | Haroon Bayani, Sanni Kujala, Milou Öberg Sellersjö, Elena Lind Löwdin • Reporters | Touba Guerroumi • Illustrator Martin Kjellberg, Jingcheng Zhao, Maria Belikova, Florian Schober • Photographers | Sune Sun, Malaika Mikaelsson, Caitlin Jackson, Sara Babiker, Simon Peyda • Proofreaders Louise Forlin, Johanna Wolfsberger, Frida Segernäs, Ian MacLean, Susanna Charboti, Aitor Sánchez García, Nicolas Guyon, Nandini Rao • Writers
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Aperture
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Island of grief: “a cut within nature itself”
The mainland opposite to the island of Utøya will be made into an art and memorial piece, symbolising the scars that cannot be healed. For more on the Utøya art project, see page 35. Image by Jonas Dahlberg Studio , courtesy of KORO / Public Art Norway 5
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Smörgåsbord
636,000
views on Reddit
Nobel photo gone viral The Nobel balloon photo published in the previous issue of Medicor, featuring Laureates James E. Rothman, Randy W. Schekman, and Thomas C. Südhof, was immensely popular on Reddit, “the front page of the internet”. Over the course of two days, it garnered over half a million views. Medicor photographer Jingcheng Zhao has since been interviewed regarding the photo, which has since been re-published in several media, including KI-Bladet, Medicinsk Vetenskap, and Fotosidan.
A New Student Union at Flemingsberg campus Flemingsbergs Förenade Studentkårer (FFS), is a newly renovated co-operation association for the different student unions around Campus Flemingsberg. It now includes four organizations: Odontologiska Föreningen, Medicinska Föreningen, SöderS, and Tekniska Högskolans Studentkår. “Our aim is to participate in the development of campus Flemingsberg, to strengthen the cooperation between student organisations and strengthen interactions between students from the different universities in Flemingsberg”, FFS President John Håkansson remarks. About 500 new student apartments and a shopping centre are to be built in the campus area, with further student housing projects in the planning process. “... we as student representatives should speak with one voice for our students’ interests. This is best done under the umbrella of FFS” the president adds.
500
new student apartments
Your future A new MF career fair will take place at Karolinska Institutet, Solna campus, on May the 19th. Roughly 30 companies, NGOs and other institutions will take part at the fair and they will introduce themselves with the aim of recruiting KI students. Anyone who is interested in attending, the event will take place at Berzelius Väg 3 on May the 19th between 10:00 and 14:00. Drawing new borders On 18 March, Russia annexed the Crimea. The results of a referendum showed that almost the entire Crimean population wanted to leave Ukraine and become part of Russia. Many western countries have condemned the partition, while Moscow calls it percent legitimate under international law.
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Mysterious disappearance Malaysia Airlines flight MH370 has been missing since 7 March 2014. Major efforts to find remains of countries involved the plane in the sea near in the search Vietnam and Malaysia have failed. The possibility of a hijack or an act of terror has not been ruled out.
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1#2013
medicor
Karolinska
Right to health for all
A global perspective on non-communicable diseases
By Sanni Kujala Global Health: Right to health for
all seminar took place at Karolinska Institutet this March. Organised by FRU (The Association for Rehabilitation in Developing Countries) and Fysioterapeuterna, the seminar focused on the threat of non-communicable diseases (NCDs) in low and middle-income countries. Carl Johan Sundberg, professor of physiology at Karolinska Institutet, started off the seminar by emphasising the importance of physical activity in the prevention of NCDs. He explained how the increased standard of living in many low and middle-income countries has reduced people’s activity levels and led to stroke, heart disease and cancer topping the cause of death statistics. A disconcerting example of the rapid increase in NCDs comes from Tanzania, where Dr Julia Mbalilaki has studied cardiovascular diseases. The figures are grim, with a “frightening increase” in
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the average waist circumference of both rural and urban populations in ten years coupled with a decreased level of physical activity. The prevalence of metabolic syndrome is the same in young Tanzanians as it is in Swedish people in their sixties, said Mai-Lis Hellénius, professor and senior physician, who was presenting Dr Mbalilaki’s findings. “We really are in a hurry,” she admitted when talking about the need to develop preventive measures. Anders Nordström, Ambassador for Global Health at the Swedish Ministry for Foreign Affairs, made a strong statement in his talk for a shift from a focus on disease control and survival to health promotion. Rather than aiming at simply increasing life expectancy, he argued that the focus should be on maximising the number of healthy years a person will experience. To balance the disturbing facts about NCDs, the seminar audience were presented several health projects currently
run in different countries. Dr Kristina Kindblom talked about her research and experiences with physiotherapy and bodily knowledge in India and Karoline Beronius from Shifo presented eHealth solutions for improving child health services. Carl Johan Sundberg talked about the introduction of FYSS (Physical activity in the prevention and treatment of disease; a guide used to prescribe exercise to treat mental and physical illnesses) in Vietnam, where health care staff are currently trained in using the manual in their daily work. The different backgrounds of the speakers and participants at the seminar reflected the growing need for professionals from different fields to combine their expertise in the fight against non-communicable diseases that have become the invisible epidemic of our time.
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2014-03-19 11:39:15
Karolinska
Uganda and Karolinska
How KI became entangled in the Ugandan anti-gay bill Slowly, countries worldwide are becoming more tolerant towards same-sex relationships and behaviour. Many restrictive and oppressive laws have been abolished in most countries of the world. However, in some, such as Uganda, the trend is completely opposite.
By Sergio Scrò During the past year, Uganda has been at the centre of international attention as a result of its controversial policy against homosexuals. The legislation, officially called the Anti-Homosexuality Act, specifically focuses on punishing homosexual behaviour, which is already illegal in Uganda. According to the Act, homosexual behaviour is divided into two categories: “aggravated homosexuality” and “offence of homosexuality”. The first category encompasses all same-sex acts involving HIV-positive individuals or involving minors. The second category is concerned with same-sex marriage and sexual intercourse between homosexuals in general. Both categories of homosexual behaviour are now punishable crimes in Uganda, carrying a sentence of life imprisonment.
The policy had been drafted by numerous MPs and is largely supported by the Ugandan community. It subsequently reached President Museveni’s desk on the 24th of February and was passed and signed into law the very same day. He had previously asserted that a law should be made to punish those who promote homosexuality and those who engage in homosexual acts; however, he was uncertain that someone should be punished for being born homosexual. He had wanted evidence that homosexuality could be inherent from birth before he signed the bill into law. Due to his concerns regarding this issue, Museveni led an investigation involving scientists from Uganda as well as from abroad. His goal was to determine whether homosexuality is a conseqence of the environment or of pre-determined genetics. Eventually, his team of investigators came across a paper written by Niklas Långström, Professor of Psychiatric Epidemiology at Karolinska Institutet. The article in question, “Genetic and environmental effects on same-sex sexual behaviour: A population study of twins in Sweden”, published in Archives of Sexual Behaviour in 2010, was written by Långström together with three other researchers from Sweden and the United Kingdom. The study investigated Swedish male twins with the aim of understanding whether the sexual behaviour of an adult was due to genetics (nature) or the environment (nurture).
The legislation in Uganda is based on a debate whether a person is born homosexual or if it is due to the environment in which one is raised. Illustration by Touba Guerroumi.
Museveni’s team misinterpreted the results of this study in order to justify the anti-gay legislation. He asserts that “the studies that were done on identical
twins in Sweden showed that 34%-39% were homosexual on account of nature and 66% were homosexual on account of nurture”. However, this statement is only half correct. The study explicitly considers nurture in a very different way than
investigators came across a paper written by Niklas Långström, Professor of Psychiatric Epidemiology at Karolinska Institutet that understood by Museveni. On careful reading of the article, it is clear that the environment (nurture) was defined by both twin-specific biological phenomena (e.g. infections, birth-complications and intrauterine conditions) and social experiences (e.g. twin-specific upbringing and peer influences). In fact, Swedish culture and common upbringing had no effect on homosexual behaviour, according to Långström’s study. Despite this flawed understanding of the science, the anti-gay legislation has been warmly welcomed by Ugandans – except for those in the LGBT community, who hide from the public eye and live in fear of arrest. A war has been unjustly declared against Uganda’s LGBT community for the crime of love, while real crimes such as rape, paedophilia, and homicide are largely ignored. In fact, the anti-gay legislation now means that punishment for a man loving a man, or a woman loving a woman, is harsher than that for child rape. The situation in Uganda is even more incredulous given that science has been distorted for the purpose of persecution.
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1#2013
medicor
Karolinska
KI students esTablish NGO Gayané Arustamyan and Judith Thanner
Last December a group of
Public Health Masters students took the initiative to set up their own non-governmental organization (NGO) under the name: Swedish Initiative for Global Health (SGH). The team, consisting of 10 multidisciplinary international students, worked together to establish the new NGO with focus on international health. Their primary objective is to create an NGO run by KI students for KI students. The team of students is motivated to establish cooperation with small charity organizations, with the ultimate goal to improve health in low and middle income countries. SGH has already built a long-term partnership with The Uganda Development and Health Associates (UDHA), a local NGO operating in Iganga district, which works primarily with maternal and children’s health. In this regard, UDHA is working hard to provide a safer environment for women during childbirth despite their limited financial resources. Giving birth at home in Iganga district is one of the leading causes of maternal mortality, infections and complications. Hence, providing a more hygienic environment at birth is a promising way to reduce avoidable deaths. Therefore, SGH’s main focus is to support mothers at birth by providing a sterile delivery kit, free of charge.
New student initiative:
Student-run café! By Sergio Scrò On Monday the 10th of March, a new Student café has been inaugurated at Medicinska Föreningen in Solna. It was an initiative of four medical students who wanted to create a new café for students, by students. The people behind the initiative (Aron Odbratt, Anna-Maria Wintler, Fredrika Fröjdh and Cora Sjökvist) and the students of KI, have long felt the need of having an affordable place where students could socialize after class and enjoying some coffee, fika, chat, read, study and so forth. The inauguration of the café has been a great success as many students were present and enjoyed food and drinks within the cosy atmosphere offered by the place. The creators of the café are working hard
in order to make the café a place where students can interact with each other as well as study. Different forms of entertainment, such as live music, will be created and promoted. In addition, a quiet zone to study or to do group work, while still enjoying the ambience of a student café. The student café at Medicinska Föreningen will be open Mondays and Wednesdays between 15:00 and 18:00. In the near future, there will also be plans to open up a kitchen in order to provide to extend the opening times and to provide dinner for those who want it. If you wish to get involved in the crew of the student café, please join the Facebook page: “MF café crew” or email: mfcafecrew@gmail.com
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Finally, the members of SGH have begun the process of fundraising to provide 2,800 delivery kits to Iganga district and will be volunteering in local health facilities during the summer break. If you are interested in volunteering or funding our project, please contact Sergio at: sergio.scro@ stud.ki.se
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Karolinska
One room. One bed. One patient.
Student opinion: With the building of the New Karolinska Hospital underway, Frida Segernäs reflects on the pros and cons of modern hospital conception and construction. By Frida Segernäs The New Karolinska Hospital (NKS)
is growing into a top modern university hospital that is costing tax payers billions of Swedish crowns. It is a large hospital with approximately 300 000 m2 and 7000 rooms, but only 729 patient beds according to Annelie Liljegren, medicial counsellor and active at the development department at NKS. Not to mention, the emergency cases will drop from 70 000 patients a year to 20 000. Thus I ask, where did all the space go? Single-bed rooms. Each patient is offered a single-bed room, including shower and toilet, which makes rest and sleep better. The primary reason for building single rooms is to decrease the risk of nosocomial infections by improving hygiene and performing medical procedures within the walls of the room. Another advantage is that relatives can stay the night in the extra beds provided in all rooms. However, how long will it take before NKS starts putting patients instead of relatives on that bed due to low capacity? And what about patients who may not have relatives nearby? Nurses are more present in multiple rooms, which makes it easier for patients to get company. On the other hand, single rooms can provide opportunities for more personal contact. A patient trapped in bed in a single room runs the risk of being isolated from everyone. With patients around, as there would be in a multiple room, you can talk about matters during the day that relatives cannot relate to. Also, if a patient falls out of bed, another patient would be able to press the emergency button as an
Illustration: Touba Guerroumi
act of humanity rather than merely being a bystander. According to Pia Wange, the director of business development at Linköping University Hospital (US), hospital visits are often too short for someone to feel lonely. However, they seem to have forgotten about the patients who have to stay longer. When I spoke with a 65 years old male patient with pancreatic complications, I found out he has been in the hospital for three months. He made a great friend in a multiple room, and they supported each other through the sickness, something which would not be possible in a single room. Change. Single rooms may need more nurses in order to keep all patients su-
MONEY
Cost a lot to build PERSONNEL More nurses required INTERACTIONS Lonely Fewer nurses around poor patient security
pervised. Is it better for patients to stay in single rooms, when Stockholm cannot provide nurses to monitor all rooms? Wange says we have to change the way we work to solve this, due to shortage of money for more staff. She adds it is going to be the same staff responsible for the same number of patients. In US there are one or two nurses for six-eight patients. After speaking to some doctors in Linköping, the impression is that there are often more patients than that. Logically it should be easier to monitor them in a multiple room. What are the challenges with changing the way of working with a staff that large? One room, one bed, one patient. I think this system will take some time to optimize.
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INFECTIONS
Decreased prevalence of infections SLEEP Better sleep - less pills PRIVACY Private bathrooms Easier to talk to relatives
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1#2013
medicor
Karolinska
KI graded “high quality”
A recent examination shows that three Swedish universities need to improve the quality of their professional health programmes in order to keep their graduation licence. In light of this, hopes are that measures will be taken to re-establish a high standard. By Amanda Kaba Liljeberg After a national inspection car-
ried out by the Swedish Higher Education Authority (Universitetskanslersämbetet, UKÄ) half of the medical educations were found to have poor quality of education. The universities of Gothenburg, Umeå and Uppsala were deemed deficient and will have one year to improve, or the universities will loose their license, as Karolinska Institutet, Linköping and Lund universities were approved. Örebro University was excluded from the examination since the education is still very new. The results are very gratifying for KI. We can establish that our medical program is among the best, when consulting the comments of the sub targets of the evaluation. We also received report on the diagnostic radiology nurse program, where we are considered Sweden’s best, as well as the nurse program, which shares the place of second best in the country, notes Jan-Olov Höög, Dean of Education at Karolinska Insitutet.
Although the medical educations at Karolinska Institutet, Linköping and Lund universities were rated ”high quality”, none received the highest rating of ”very high quality”. Areas that we need to improve on include education about medical care organization and health economy. We are good at inter-professional education, but we can be even better. An enormous amount of work has been done to put our education in the frontline. In a couple of years, KI’s nurse education has progressed from being questionable to being reviewed as one of the best, says Jan-Olov Höög. The evaluation establishes that all universities have high or very high quality in the most central parts of the education, such as diagnosing and treating common diseases, as well as displaying ethical and professional attitudes. The faults, that have rendered three of the universities’ quality insufficient, are in teamwork and cooperation with other professions in health and medical care.
An examination by the Swedish Medical Association (Läkarförbundet), where recently graduated medical students were asked for their opinion on their education, shows similar results. 90% of the students say they have been well prepared to work as doctors. However, in questions about how prepared they are for working together with other professional groups, only the students at Linköping University are really satisfied. In the February issue of Läkartidningen, Marie Wedin, chairwoman in the Swedish Medical Association, recognises the fact that there is a lot to be done to improve the quality of the Swedish medical educations, also with the institutions that passed UKÄ:s evaluation. Nevertheless, she writes that she is convinced the universities under critique will improve and not loose their license. With thoughts for the future, she adds that hopefully this evaluation will raise the interest to modernise and improve our medical educations.
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Increased pay for PhD students
PhD students can now afford two more square metres of living space. Johanna Wolfsberger
students came in effect in Sweden. Before, most of Karolinska Institute’s PhD students were receiving doctoral grant (utbildningsbidrag, UBB), which corresponds to SEK 15 500 before taxes, for two years before the university employed them. The new regulation provides that doctoral students are employed on a doctoral studentship (doktorandstjänst) already after one year, enjoying the same social benefits as all other employees, including the higher salary of minimum SEK 24,100 before taxes with increases over time. KI’s Doctoral Students’ Association (Doktorandsektionen) DSA is working on the complete abolition of the UBB as it stands
for worse social welfare access for the students. DSA Chairman Arash Hellysaz says ‘the law is a step in the right direction’. Interestingly, as the new regulation results in higher costs for the supervisor, a decrease in the number of doctoral students at KI would be inevitable. However, Arash Hellysaz says that although DSA is expecting a drop down in numbers of newly admitted PhD students, it is only partly connected to the changes in law. The main factor is rather that the capacity of students is reached. The maximum capacity has been pushed for years, with too many students per supervisor making it hard to keep the quality of education. Certainly, students that have applied before 2014 might be dis-
Illustration: Touba Guerroumi
With first of January this year a new law regarding the employment of doctoral
pleased as the law has no retrospective function, while many prospective PhD students are highly delighted about the new law. The higher income definitely will make the option to receive a doctoral education at KI even more attractive.
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karolinska Science
Science snippets By Vladimir Choi, Iskra Pollak Dorocic, Susanna Charboti, Johanna Wolfsberger
3 years
The length of time a child has been free of HIV, after being born to an HIV-positive pregnant woman in Los Angeles. Anti-retroviral drugs were administered during delivery and throughout the first hours of the newborn’s life. Results presented at an AIDS conference in Boston indicated that the treatment had effectively eliminated the virus from the baby’s body. This is the second case of seemingly-permanent suppression of HIV, and whether this might be a medical breakthrough remains to been seen. The Guardian, 5 Mar 2014
Swiss student exchanges at risk The Horizon 2020 research programme and Erasmus+ student exchange are now endangered following a referendum that invalidated a freedom-of-movement agreement between the EU and Switzerland. This could affect visiting students going to or coming from Switzerland, which has particularly-strong research in computer, health, nano-, and material sciences. You can now forget your regular chocolate delivery from your Swiss corridor mate. BBC News, 17 Feb 2014 HIV virus and a cell. Credit: NIAID
30,000 years The age of a virus that was dug up from the Siberian ice and revived. Amazingly, the virus became infectious after thawing, making it the oldest-known active virus. Fortunately, it only targets amoebae, but the researchers suggest that as the ice on Earth melts, the return of other ancient viruses could emerge as a new risk to human health. Legendre et al., PNAS, Mar 2014
Pithovirus sibericum, from the Siberia. Courtesy: Julia Bartoli & Chantal Abergel, IGS, CNRS/AMU
300,000 petabytes
Randomness of hereditary disease Why do identical twins, who share the exact DNA, develop different diseases? Until now, it has been believed that the gene from your mother and that from your father are utilized to the same degree. A new KI study has shown that random chance decides which copy of the gene is expressed, making gene activity more dynamic than previously believed. This may explain why identical twins don’t always look exactly the same, and why certain individuals develop a hereditary illness while their relatives do not. This study used a new technique that made it possible to analyze gene activity from single cells, instead of pooling together thousands of different cells. Deng et al., Science, Jan 2014
A pill to stop metastasis? Metastasis is the primary cause of death from cancer. Recently, an Austrian research group found a way to overcome natural killer (NK) cell inhibition, leading to the depletion of metastatic cells in mice. This breakthrough in activating the innate immune system to target cancer cells is generating hope of a “pill” against metastasis in humans. Cancer Research UK, 20 Feb 2014
The amount of data generated by the brain in one year. Keep in mind: one petabyte = just over 1 million gigabytes. The New York Times, 25 Feb 2013
Image credit: Flickr account pennstatenews
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1#2013
medicor
Science
The dark side of milk There is no doubt that drinking milk is of great benefit. It is a natural source of several vital vitamins, minerals, and fats. By drinking large amounts one may decrease their risk of osteoporosis and even colon cancer - or so we believe. By Haroon Bayani
It is true that some types of milk, such as breast milk, are essential for the newborn, but the milk from a cow is not. In fact, it may even be less beneficial than one might think. Whilst studies done by the dairy industry show several health advantages of milk, a few others, made by independent research groups, claim otherwise. By drinking milk, we may in fact be increasing, not decreasing, our risk of osteoporosis. Why have we been taught otherwise? The dairy industry turns over several billion euros every year and the profits from milk alone are vast. Because the dairy industry is so lucrative, there is no reason to stop, and nor should they. As long as the producers benefit from it and the farmers continue to be occupied, it is not a problem. Nevertheless, it is problematic when producers exaggerate the health advantages of milk, even though they may not be true. Furthermore, the matter becomes even more complicated when these dairy companies work as cooperative lobby groups to influence food agencies and legislators across Europe. Influencing policy makers in turn affects the recommendations that are set by the agencies and the EU. When ordinary consumers, who rely on these recommendations, are given incorrect or biased information – what is the purpose of such institutions? Fortunately, there are studies not financed by the dairy industry that show that milk may not be as beneficial as previously thought, and in fact may even have some adverse effects.
The dairy industry turns over several billion euros every year First of all, it is true that cow’s milk contains large amounts calcium and phosphorus. It is also a good source for
Is milk really that good for you? Illustration: Touba Guerroumi
vitamins such as vitamins D, B12, etc. Nevertheless, when it comes to calcium, it is comparatively difficult to absorb. As a cation, it would form insoluble compounds with anions in the food, most commonly phosphorus. Consequently, the high content of phosphorus in milk impedes calcium absorption. According to a 1999 study published in the Journal of Nutrition, the net absorption of calcium from milk is rather small. Additionally, the risk of attaining osteoporosis does not decline with increased milk consumption. A 2013 meta-analysis involving several countries confirmed this fact in Osteoporosis International. It also showed that the countries with the lowest consumption of dairy products have the lowest incidence of osteoporotic fractures. This was confirmed by a 1997
long-term study in the American Journal of Public Health that indicated no correlation between higher consumption of milk and reduced risk of osteoporosis. It suggested that, around the age of 20, consuming dairy products correlates with a slightly higher risk of hip fracture at old age. That being said, cow’s milk can be valuable in some cases. For example, after losing a tooth, milk is one of the best fluids to conserve it in before going to the dentist. Milk has various health benefits and it is a good source for many vital vitamins and other nutrients, but in terms of osteoporosis, the downsides appear to outweigh the benefits –one might be better off finding more suitable sources of calcium. One should always think twice about health claims and use common sense to decide what to consume.
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Science
Open Science
Nobel Laureate Peter Higgs recently revealed that he would not have found his eponymous boson in today’s “publish or perish” research culture. The prospect that we could be missing out on worldchanging research is a scary one. What could the scientific community be doing wrong? By Nicolas Guyon and Nandini Rao In today’s academic world, limited space in reputable journals and scarce funds for research have professors and students struggling to make a name for themselves. Whoever is winning, it is clearly not science. A number of fraudulent studies – undoubtedly brought about by pressure on scientists to produce research that will catch the attention of publishers – have been exposed over the last few years, tarnishing the reputation of the scientific tradition. It would seem that the modern world of research is a hostile environment that breeds anxiety, encourages deception, and worst of all, strips science of its noble intention to improve and expand human knowledge. So what does Open Science have to do with all of this? Strictly speaking, since the scientific revolution, science has mostly been open. The rise of journal publishing in the 17th century allowed for transmission of knowledge to most parts of the world. Today, however, unhealthy levels of competition are encouraging isolation and opaqueness where there should be connectivity and cooperation, according to Célya Gruson-Daniel, a founding member of the HackYourPhD collective aiming to bring more transparency into current practices of research. In a TEDx talk she gave in June 2013, Gruson-Daniel
unhealthy levels of competition are encouraging isolation and opaqueness where there should be connectivity and cooperation discussed how she believes Open Science can release some of the pressure on academics and instead foster an environment of openness that would, at the end of the day, make us better scientists. If researchers could publish their work in a way that is widely available to everyone, using tools already existing on the internet (blogs, wikis, etc.), the potential for knowledge sharing and interaction would be enormous. First, Open Science aims to make science more transparent and better documented. A research paper is a summary – it cannot substitute for raw data, protocol and experiment details. Open Science can provide the infrastructure for researchers to shed light on the totality of their process, so that their work can be interpreted and replicated in the future. If a project were to be dropped, negative or seemingly insignificant findings could be published in blogs or other low threshold publications. Today, negative results are often dismissed and much of the knowledge created during research projects simply disappears. Second, Open Science is powered by the need to better manage and preserve scientific data. Nature News recently reported that 80% of data generated in the last two decades has been lost due to bad archiving. Storing data in online archives will encourage new collaborations, as well as the use of pre-existing datasets.
Illustration: Nirupa Rao
Third, Open Science makes science available and understandable to anyone who is interested. Science is currently too removed from society. Since taxpayers fund
How you can be an open scientist: - Share your articles pre-publication using tools such as SlideShare or figshare. Open them to commentary and try collaborative writing. - Document data and share it, post-publication, in an open labbook on a blog or wiki. - Use open data for your research – there is plenty available online. With data-mining, you can obtain results without spending unnecessary time or money. - Use open-source software. From citation tools like Mendeley to statistical platforms like R, there are numerous options out there. - Consider publishing OA and do not judge journals by their impact factor. In fact, some publishers such as PNAS give discounts to KI researchers for publishing OA. - Deposit copies of published articles in online repositories (KI has one) and social networks like ResearchGate. - Publicize your daily routine as a researcher through blogs and non-scientific articles. Include the community in your experiments – through collecting or analysing data, for example, using Foldit or Test My Brain. - Crowd-fund your research on platforms such as Geekfunder or Petridish.org. - Join HackYourPhD (hackyourphd.org) or Open Science Sweden.
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Science
Illustration: Nirupa Rao
most public research, they have the right to access results. This could also have positive consequences when it comes to influencing decisions on public policy. In short, Open Science advocates for a world where researchers will be judged on the strength of their contribution to the scientific community rather than the reputations of the journals they have published in. Much has already been accomplished using this new approach. Open Access (OA) journals, such as PLOSOne, open databases and collaborative platforms are allowing scientists to work together in a way unlike anything we have seen before like never before. New economic models to support research, such as crowd-funding, are emerging. The Open Science movement is not without its challenges, however. Novel publication formats must first be recognised and credited by scientists themselves, as well
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80% of data generated in the last two decades has been lost due to bad archiving as funding authorities, before their full potential can be realised. The system is still based on journal impact factors, and OA journals currently cannot compare with the likes of Nature, Science and Cell. Currently, scientists must pay to have their articles published openly, as a means of covering publication costs and making access free of charge for readers. Besides being a deterrent to researchers, this has led to predatory publishing – the acceptance of articles without discretion, in order to make money.
of information and thus a need for curation – a role currently taken on by journals. Increasing the scale of science will also make verification of discoveries more difficult. Misinterpretation and abuse of scientific data by the public (or even other scientists) could negatively impact the progress and regulation of science. Admittedly, opening science is an uphill task. In order to work, it needs the support of the entire scientific community. If this happens, it could be the beginning of the next scientific revolution.
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Open Science also means that huge amounts of data will suddenly become available, leading to a potential overflow
2014-03-19 11:39:57
Science
MediYoga
Bringing relaxation into healthcare By Milou Öberg Sellersjö From a Traditional Eastern per-
spective, the positive effects of yoga (Sanskrit for “unification”) result from a still and conscious mind. Recently in the Western world, we have been very keen to find out how yoga affects our physical and mental wellbeing. However, its integration within healthcare requires deeper understanding by the scientific world and wider society. This is where MediYoga comes in. As a gentle form of yoga that focuses on relaxation and deep breathing, it incorporates postures from Kundalini, which has roots in Hinduism, tantra and meditation. The aim of MediYoga is to use yoga as a therapy program in healthcare and evaluate its effects, taking it to a new level. Tibetan monks have been practising yoga and meditation for over 5000 years. The psychologist Carl Jung travelled to India
use yoga as a therapy program in healthcare... taking it to a new level
and held five famous lectures in Kundalini Yoga, integrating Yogi Philosophy into his own theories about self and the collective unconscious. Göran Boll, the founder of MediYoga, discovered yoga as an 11-year-old while reading about martial arts. In 1993, Boll underwent training as a teacher and became the leading instructor in the Kundalini Tradition in Stockholm. He understood that more evidence-based research on yoga is needed so that its benefits can be accessible to everyone in Sweden. Initial research in the field takes us back to 1924 in Kaivalyadhama Yogic Hospital in India. Seventy-four years later, the first study examining the daily practice of yoga was done in Sweden by Karolinska Institutet, examining its effect on back pain. Regular practice of yoga gave significant results, reducing pain, anxiety and stress. Conducted at Danderyds Hospital ten years later, the “Cardiac Arrest” study counts as the most important in the history of MediYoga, leading to its implementation as regular treatment for all patients. The participants of the class range from patients with early-stage can-
cer to those who are severely ill. Studies have now assessed MediYoga’s effect on blood pressure (Svedala primary care 2010-2011), sleep (Danderyds Hospital 2011-2012), stress (Nora primary care 20112012), and heart conditions (Danderyds Hospital 2011; Huddinge Hospital 2012).
How can we boost our parasympathetic system in order to gain better reprieve from our hectic lives? Based on an Eastern tradition of mantras (singing), mudras (hand position), drishti (gaze) and asana (posture), MediYoga uses Western concepts in its framework. In the body, yoga affects both the endocrine and nervous systems, in particular, the autonomic nervous system – an interplay between the sympathetic “fight and flight” and parasympathetic “rest and digest” responses. “Our species survived thanks to the Sympathicus, and it helped
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us through a lifetime of fight against cave bears,” describes Anders Engqvist, during the training of new MediYoga instructors. Today, most of us do not have cave bears in our daily lives but rather, other stress-inducing factors: “…in many situations it looks like we live our lives like it does not matter how we live our lives, which ends up in mental and physical burnout, diseases, chronic stress and fatigue.”
the mind that everything is alright, and that there is no need to stress. Singing “Om” before and after every class acts as a conditioned stimulus that turns on the parasympathicus with regular yoga practice. MediYoga has been shown to lower blood pressure, modulate insulin levels , boost the immune system, and most importantly, induce a repair process of the whole body, affecting stress, pain, sleep, digestion and hormone secretion.
How can we boost our parasympathetic system in order to gain better reprieve from our hectic lives? According to MediYoga teaching, deep breathing and yoga practice can focus a person’s attention and relax the mind. Deep breathing lets in more oxygen into the body, reassuring
In 2007, one study on yoga was published every month. Today, three to four articles are being released each week, of which 10-15% directly relate to MediYoga. The interest in the field is expanding rapidly and the results have so far been positive. Since 2007, 1200 people in Sweden and 300 in Norway have been educated about MediYoga. The aim now is to expand its reach to everyone who needs it. Göran Boll daringly adds: “you’ll probably get superpowers too.”
MediYoga has been shown to lower blood pressure, modulate insulin levels, boost the immune system...
Above: The medical path of yoga is well-integrated with the Kundalini Chakra energy system, in which different parts of the body are connected to endocrine glands, lymph nodes, and organs. Practising yoga steers both the physical and mental aspects of well-being in a positive direction. Illustration: Touba Guerroumi Opposite: Göran Boll practises MediYoga with two students, one of whom is Medicor writer Milou. Photo: Florian Schober
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Katarina Gospic Neuroscientist, MD, PhD, author, entrepreneur, TED speaker
Storytelling by Poya Livälven Photography by Martin Kjellberg
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KI Profile
“ Spring
The way I work is that I am always myself I do my own thing.
has
finally
arrived
in
Stockholm. The wind blows with the last of its cold, as winter slowly loosens its grip on the city. I am sitting on the grass, squinting at the sun. It is so easy to get distracted from our normally stressful lives where I am situated right now. Here in Vanadislunden I can hear the birds singing - it is an oasis in the centre of urban Stockholm. I am aware of so many things in my surroundings, I can feel the grass tickling my hands, I can feel the sunlight on my face and I feel alive. Our brains are such an interesting, and at the same time, mysterious structure – responsible for perception and cognition throughout our lives. But sometimes it feels like our society is ahead of our bodies, our brains are not really made for the cosmic amount of stimuli that is forced upon us. The theme of the day is the brain. Let us head back to why I am in Vanadislunden. I am waiting for what people would call a prodigy; waiting for Katarina Gospic, the thirty-year-old, renowned neuroscientist, medical doctor, entrepreneur, author and medial figure. Maybe you have seen her TED talk, read one of her books or listened to her “sommarprat” (summer talk) in SR P1. I am supposed to interview her today – a bit nervous because I have no idea who I am about to meet. I walk toward the intersection Frejgatan/ Tulegatan and I see a woman approaching me with a smile on her face. I have my own prejudices about these kinds of ultra-productive people in science; that they are square and only interested in their own area – maybe difficult to bond with. But I will soon be proven wrong. We decide to take a walk in the busy streets of the city while casually chatting about the big and small things in life. Her
dedication stems from her passion for development. “[…] it is really what I believe is the best part of life – to learn new things, to grow, to continuously make things better ”. She really is a woman of her word – at the age of 17, she did a project at KI as a part of her high school education, and since then she has worked in several different labs. After high school, she attended medical school at Karolinska Institutet, studied physiology and also started her doctoral studies – all simultaneously. As some sort of response to my reflexive way of saying that I feel inferior in her presence, she says that “[…] when I was accepted into medical school I felt that this was what I had been fighting for my whole life. Now I did not need to have full points on a test, I could just learn for the sake of learning”. We pass a busy intersection and in that moment we stop speaking due to the overwhelming sounds from the surroundings.
I felt that this was what I had been fighting for my whole life According to Gospic, the interest of research, neuroscience and academia started at an early age – a product of her environment and early ingenuity. Having a father from Croatia and a Swedish mother is a contributing factor according to her. “There was a never-ending friction between the two cultures, in the most positive way of course, because it stimulated questioning, nothing was taken for granted […]”. Also the Croatian War of Independence in the early 90’s, made her aware of the fact that that there are always two sides of a coin, of a story. Swedish media reported one thing while her relatives told another.
That is something she has always brought with her, in her daily life and in research because “[…] the world is more complex than black or white”. She also mentions that it is important to question things in neuroscience because the results can have different implications depending on what you compare certain data to. My nervousness is slowly letting its grip slip from me, and the conversation flows much better as we randomly choose streets to wander on. As a young woman in the academic hierarchy, she has also taken many different roads and been questioned. Traditionally, the higher academic positions have been more male-dominated, but Gospic believes that age and not necessarily gender also contributes to being questioned. “Friction” is a word she loves to use describing these subtle conflicts between generations and ideas. “It is where
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opposites meet that the ‘cool’ happen, if everybody are men in their 50’s, people who have taken exactly the same ways in life, shared the same experiences, then all hitherto thoughts won’t be challenged. I think it is something fundamental in having these ‘frictions’ to create something new”. My thoughts immediately go to the philosophic idea of dialectics, that states that an idea, a thesis will create a challenging idea, an anti-thesis, and together they will merge and create a new idea – the synthesis. These tensions between the thesis and anti-thesis are mostly subtle but sometimes they blow up into open conflicts, something that Gospic experienced when she was about to receive her doctoral degree; another ‘player’ entered the game and took the edge of her “victory”. Protests were made from her side, but they were all in vain. “[…] for me it
is extremely important with fair play, if you work hard, you should receive recognition for it”. Interestingly enough, a part of her research has been about our congenital ability to feel injustice due to processes in our amygdala. When she finally received her doctoral degree in 2011, she decided working full-time with her company Brainbow Labs, which she started earlier. The reasons why she left the academic world for her company, at least for now, are dependent on many factors. “The reason I wanted to start it was because I wanted to implement research in our society due to the fact that we do not live as we learn. Neither us, that do the actual research, nor other people in society. But the real injustice is in the fact that the knowledge is not available to everyone. I think it is really strange because your taxes go to research and I believe that you should have the best possibilities of acquiring it and ap-
medicor
ply the research in your life, which benefits health, performance and well-being”. Now she holds lectures in leadership and decision-making for both private and public actors to spread her ideas. A sudden cold wind makes us both shiver and we hasten our pace. Her lectures and courses focus on ideas that the general mentality in our society has increasingly shifted from a quality thinking to quantity thinking. A successful researcher is one who produces a lot of papers and not necessarily one who makes a contribution of great significance. The eminent physicist and Nobel
...mentality in our society has increasingly shifted from a quality thinking to quantity thinking 21
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KI Profile
Extras: Katarina Gospic Full name: Katarina Anna-Maria Gospic Degree: M.D, M.Sc, Ph.D. Date and place of birth: February 6, 1984, Stockholm Hobbies: Exercising, travelling Music: ”Anything that is happy” i.e. Ai Se Eu Te Pego by Michel Teló Languages: Swedish, English, German, and Croatian Website: www.brainbowlabs.com Latest book: Den sociala hjärnan (2014) Publications at a glance:
Limbic Justice - Amygdala Involvement in Immediate Rejection in the Ultimate Game. Effects of oxazepam on affective perception, recognition, and event-related potentials. Emotional perception modulated by an opioid and a cholecystokinin agonist.
laureate, Peter Higgs, discusses this in an interview in The Guardian. He states that: “I wouldn’t be productive enough for today’s academic system”. Gospic believes that creativity takes time – it is important to fail and use trial and error. She raises an example where a class of children are given the task to draw a watch on a paper, if you first give them one minute to do it – they all look pretty much the same as all need the same foundations. But if you instead give them ten minutes to do it the results will be much more diverse and creative. Creativity takes time. Research and studying is another aspect of Gospic’s life that has taken a lot of time. According to scientists, it takes about ten thousand hours to master a skill, and she has spent over thirty thousand hours on neuroscience. How does one keep the focus and motivation during such a long time span? You can make an analogy to the craving of ice cream on a warm and sunny day – you will do anything to taste it. With the sunshine on our faces, the ice-cream analogy really makes you want to take a bite. Even though she has been busy, she has managed exercising and adapting a healthy life style. “A healthy mind in a healthy body” is her motto and she laughs saying it because it sounds cliché. Since her childhood she has been doing gymnastics and it has been really important to her, staying fit, because otherwise it would have been impossible to reach her level of expertise. As a way of collecting her knowledge and making it public, she is also the author of two books in the genre of popular science: “Den sociala
hjärnan” and “Välj rätt! : en guide till bra beslut” (Eng: “The social brain” & “Make the right choice! : a guide to good decisions”). These are two books that combine the top-notch knowledge of the brain and apply them to our everyday lives.
the most important thing is to dare, dare being brave and dare being yourself Due to her books, research and sociable personality, she has received a lot of media attention. Regularly invited to hold lectures, she has been seen in Swedish Television and heard on Swedish Radio. She has turned into a role model and a source of inspiration for many – especially young people in science. On the topic of what kind of role model she wants to be, she answers that she is happy and honoured that people find her inspiring. “The way I work is that I am always myself – I do my own thing. And every time one does that, there are people that think that ‘it will all go to hell’, that ‘you are crazy’ […] that is not important for me. The way I look at it is that I have one life, I want to try my chances and take the fantastic opportunities in this country – I only want to see what I can do with them. And how others see me is up to them, if it is positive, I appreciate it, but if it is negative, it is their problem and not mine.” Gospic believes that it is dangerous to become too dependent on what others think of you; there is a risk that you will lose your spirit and ultimately yourself. You should do what you love, regardless
how others see me is up to them, if it is positive, I appreciate it, but if it is negative, it is their problem and not mine
I want to try my chances and take the fantastic opportunities in this country of what other people say. Now the surroundings are more familiar and we are back in Vanadislunden – yet there is a long steep way to the top of the hill – our final destination. Gospic can proudly say that she has never moved an inch from being afraid of what other people think. This is the secret behind her success. Her next step is developing her company and her entrepreneurship. For instance, she wants to apply neuroscience to even more concrete parts of our lives i.e. architecture. Her key concepts of health, performance and well-being will be implemented of course. The future for her is, or as she calls it, her “life research”, is doing things that have never been done before – to try and develop leadership skills in different institutions around the world, so that everyone can reach the peak of their potential. As we reach the peak of the hill, warm, tired and a bit sweaty, I ask her if she has anything she wants to add. She really is a woman of words – she has a way of formulating them, making difficult concepts easy to grasp. Her last words before our ways part are the following: “I think that the most important thing is to dare, dare being brave and dare being yourself. And it is more difficult than it sounds sometimes because there are powers working against you, then you have to build such a strong personality that you can follow your moral, your lusts and the things you want to do.” Suddenly I sense a lump in my throat and an anxiety I have never felt before starts building up. It is an existential anxiety and I feel small on the top of Vanadislunden while gazing out on the rooftops of Stockholm. I realise that I have not always lived my life to the fullest, being afraid of others judging me for who I am. But in the long run – what do I have to lose? “Because that is what people regret on the brink of death – that they lived the life that was expected from them and not the life they really wanted. That would be damn boring; if you on your deathbed realise that you had this chance and did not do what you wanted with it.”
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Nobel Revisiting Lecture
From sea urchins to the Nobel Prize:
Sir Tim Hunt By Iskra Pollak Dorocic
Looking towards the future, Sir Tim noted that one of the big questions left to answer is how cells actually know when to enter mitosis. Photo: Maria Belikova
In 2001, Sir Tim Hunt was awarded
the Nobel Prize for Physiology or Medicine, along with Sir Paul Nurse and Leland H. Hartwell, for identifying the regulation of the cell cycle. His breakthrough discovery of the cyclin molecule came in the early 1980s at Wood’s Hole Institute in Massachusetts, USA. Subsequently, Sir Tim has led a research group at the Cancer Research UK Institute, has been a member of the European Research Council’s Scientific Council, and was knighted by the Queen in 2006. Sir Tim recently gave a “Nobel Revisiting” lecture in a packed Nobel Forum, and we also had the privilege to speak to him afterwards. During the lecture he introduced his lifelong scientific quest by explaining that “a biochemist’s obsession with how things are turned on and off has always been what interested me.” He continued to describe in detail his discovery of molecular “switches and latches” and their role in the control of mitosis. The images of dividing cells on the screen were startlingly beautiful and eerily dramatic, showing one of the most fundamental processes of life. Sir Tim noted that the process of cell cycle regulation, illustrated so elegantly in most biology textbooks today, nevertheless took a long time to figure out. During our interview following the lecture, Sir Tim fondly reminisced about his extraordinary finding that earned him the Nobel Prize. He explained that the dis-
covery came from a humble source – sea urchin eggs. The idea developed over the five summers he spent at Wood’s Hole, but with minimal progress. One day, after attending a lecture by a visiting scientist, he was inspired to conduct a “simple experiment” and thereafter ran back to the lab to repeat his experiment and examine the data carefully. This was his eureka moment: “Sure enough, I soon had
a phenomenon on my hands which I was pretty sure was connected with cell cycle control. It was a very rare case where a chance observation turned out to be significant, and nobody else thought it was theoretically possible.”
Photo: Maria Belikova
It was a great honour to hear Sir Tim speak live, and certainly inspiring that his passion for research has not dimmed after all these years.
Looking towards the future, Sir Tim noted that one of the big questions left to answer is how cells actually know when to enter mitosis. “It’s very nice actually, when there are still things we don’t know, because it means that those of you who still have your careers in front of you have some good problems to work on. Having good problems to work on is no easy matter, let me assure you.” He urged young students and researchers to expand their horizons and expose themselves to new things, in particular, to think beyond particular techniques or systems, and not be afraid of branching out.
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Photo: Gustaf Drevin
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Global Focus
From Mapping (Autocatalytic Spaces), artwork by Darlene Charneco
Medical hotspotting
How Big Data is tracking chronic disease patients By Ian MacLean
How did crime in New York City
drop by 60% since the mid-1990s? The concept was simple – find out which streets had the most crime, then apply police resources to those areas (hotspots). This inspired Dr Jeffrey Brenner, a young primary care physician who, after becoming involved in a homicide case, decided to apply this technique to healthcare in Camden, New Jersey, one of America’s most impoverished cities. Thus began medical hotspotting. Chronic conditions such as diabetes and heart disease are some of the most expensive conditions to treat, especially when they worsen to the point where emergency treatment is required. As a result, prevention and access to healthcare are key to improved patient outcomes and cost control. Brenner outlines some ways of how medical hotspotting can intervene in such cases before they become too costly: 1. Bring the care to the people that need it the most. Nurse practitioner-led clinics are held in buildings or neighbourhoods that have a high percentage of high-cost patients. 2. Follow up patients where they live. Outreach teams follow up patients at their homes or shelters, as directed by care coordinators. 3. Gain a deeper understanding of the patient’s condition. Healthcare coaches or patient advocates have emerged in a role
that is part social worker, part healthcare provider. 4. Provide greater flexibility in scheduling. Making more same-day appointments available aims to redirect traffic from the emergency department to general practitioners/family doctors. A key component to these measures is the willingness with which hospitals and clinics give up their proprietary data to medical hotspotting teams. Outliers with excessively-expensive inpatient stays, a high number of emergency admissions, or development of late-stage complications are targeted. So far, Dr Brenner and his supporters have been optimistic, finding significant savings and improvement in patient outcomes. Like-minded innovators have adapted medical hotspotting to other settings in the US and abroad. Cincinnati Children’s Hospital is sending teams to assess asthma patients’ homes for compatibility with the treatment plan. A Stanford University-affiliated clinic has opened with the goal of providing focused, aroundthe-clock availability for patients with serious chronic problems, involving home visits and coaching for self-care. A pilot study initiated by Boeing cut medical costs of its employees by 20% as a result of reducing emergency department visits and hospitalizations. Several clinics in Saskatoon, Canada have begun
an emergency department wait-time reduction program to identify high-cost patients, many of whom are homeless, suffering from addiction or mental health issues. Other Canadian provinces, amid healthcare budgetary cutbacks, are considering using the technique to identify patients who easily fall through the gaps in the system. However, there are fears that the healthcare system will intrude even further into people’s lives, and concerns about data privacy will likely persist. Benefits may also take a long time to be realized, thus discouraging hospitals and clinics from making the initial heavy investment. Hotspotting may also not be an obvious choice in countries that already place a higher emphasis on community and preventive care than the US. While health systems differ and local epidemiology varies according to geographical location, there remains a worldwide need to address inequalities by improving patient outcomes and reducing costs. Lessons can always be learned from innovations that cross boundaries and are not afraid of making a difference where it counts.
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Global Focus
Nutritional labelling “More immunity than Berlusconi” What are food labels telling us? By Aitor Sánchez García
eco
Labels on our foods send us messages that
drastically influence our food choices, but are these claims always fair? The European Union (EU) has strict regulations concerning nutrition and health claims. A nutrition claim refers to an inherent beneficial nutritional property, such as “low fat” or “high in fibre”. It must follow strict quantifiable criteria as detailed in the Annex of Regulation (EC) No 1924/2006. For instance, “low fat” may only be stated when the product contains no more than 3 g of fat per 100 g, and “source of protein” requires that at least 12% of the energy value be derived from protein. Furthermore, a health claim goes beyond this by stating health benefits that can result from consuming a given food, such as reinforcement of the body’s natural defences or enhancement of learning ability. Health claims are also subject to authorisation under Regulation EC 1924/2006 before they can be printed. Recently, “new function” health claims based on newlydeveloped scientific evidence have also been allowed on a case-by-case basis, following submission of a scientific dossier to the European Food Safety Authority (EFSA) for assessment. These are highly valued in the food industry due to their potential to increase the sales and reputation of a product. Despite these regulations, some companies pursue morally-debatable strategies in order to acquire the right to use those claims. For example, some brands are al-
lowed to advertise health claims merely by adding small quantities of vitamins or minerals to their product, then state that the product helps “maintenance of your immune system” or contributes to “normal macronutrient metabolism”. At Swedish supermarkets, you may be amused to find labels such as “more immunity than Berlusconi”, “forget your doctor’s number”, “summer holidays bottled” or “look good naked”. These practices reveal that in spite of legal frameworks to regulate food labelling, there will always be gaps. In the US, the Food and Drug Administration (FDA) has three categories of claims: health, nutrient content, and structure/function. Nutrient content claims encompass those that add standalone adjectives such as “free”, “high”, “low” to a quantity (e.g. “only 200 mg of sodium”) as well as comparative adjectives such as “more”, “reduced”, or “lite”. The FDA makes a distinction between claims that are specific to a bodily function or structure and those that affect a health or disease-related condition. Although health claims are subject to premarket review and authorization, structure/function claims are not. Furthermore, the FDA does not regulate statements that relate a category of foods (e.g. fruits and vegetables) to generic statements about health, which it considers “dietary guidance”.
These practices reveal that in spite of legal frameworks to regulate food labelling, there will always be gaps. No matter which side of the Atlantic you are on, the answer seems to lie in education and critical thinking. Understanding the effects that foods have on our bodies may not be as easy or enjoyable as eating a meal, but we should all be wary of expecting sudden and dramatic improvements in our health as depicted on the label. Keep in mind: extraordinary claims require extraordinary proof.
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Johan von Schreeb
“
Det går inte att sitta hemma och prata om medmänsklighet när jag har möjlighet att praktisera den.
Text: Oskar Swartling och Gustaf Drevin Foto: Martin Kjellberg
Många studenter inom de medicinska yrkena uttrycker att de drömmer om att åka för att arbeta humanitärt, där ideella organisationer som Läkare Utan Gränser (MSF) står högt i kurs. Föreställningarna är många. Kirurgen, katastrofläkaren och Karolinska Institutet-docenten Johan von Schreeb är Sveriges kanske mest erfarne inom just internationell katastrofmedicin. Första uppdraget genomfördes redan som vikarierande underläkare. Idag är han känd för att ha varit med och grundat MSF:s svenska gren.
I von Schreebs nyutkomna autobiografi, Katastrofdoktorn (2013), krossas många naiva illusioner och myter om humanitärt arbete, då författaren tar oss till några av de minst glamourösa platserna på jorden, såsom ett post-sovjetiskt Afghanistan, Sierra Leone i inbördeskrig och ett jordbävningsdrabbat Haiti. Genom att sprida insikterna om vad det internationella medicinska arbetet egentligen kan handla om, hoppas von Schreeb krossa förlegade myter och skadliga inbillningar folk tenderar ha kring den humanitära gärningen. 29
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Det finns många myter om vad det här med katastrofinsatser handlar om, som jag tror baseras på våra föreställningar om hur världen ser ut. Karolinska Institutet har många internationella profiler på campus, men Johan von Schreeb är en av de mer multifacetterade av dessa. Katastrofdoktorn är inte bara en skildring av många av de händelser och platser von Schreebs arbete tagit honom till, istället är det ett verk där författaren stundtals tar ställning mot sig själv, för att istället ifrågasätta sitt arbetes bevekelsegrunder. I mosaiken av alla de händelser, tankar och funderingar uppdragen resulterat i möts konst och vetenskap, ett möte där vetenskapens stelhet luckras upp och en ny bild av medicinen åskådliggörs. Verket är en personlig resa, en färd genom gott och ont, där moralen granskas, synas och omvärderas. En resa där läsarens invanda föreställningar frontalkrockar med den råa verkligheten. Kontoret Johan von Schreeb sitter i är mindre än man kan förvänta sig. Byggnaden är stor, fyrkantig och steril; lite småtråkig. Karolinska Institutets Institution för Folkhälsovetenskap består av tetragonal betong och långsmala, raka korridorer. Visst står det någon exotisk, snidad träfigur på något bord här eller där när man traskar förbi de vitmålade väggarna och de små kvadratiska kontoren, men formgivning är ingen stor utgiftspost. I en av korridorerna sitter kirurgen och författaren Johan von Schreeb. Ett av Sveriges mest respekterade namn inom global hälsa, samt ett välkänt namn internationellt. Då, 1989, reste von Schreeb och dennes fru Susanne till Zendadjan, Afghanistan, för att arbeta på det regionala sjukhuset. Idag är han välrenommerad docent vid Institutionen för
...hänge sig åt minnen och hur jag uppfattade att det var.
Folkhälsovetenskap, och arbetar deltid som allmänkirurg. Han är dessutom medgrundare av MSF:s svenska gren, dess före detta ordförande och efter flera uppdrag i fält så klart en av dess mest erfarna läkare. Berättelser, erfarenheter och existentiella funderingar från fält har nu mynnat ut i Katastrofdoktorn, ett verk baserat på dagboksanteckningar, minnen och tankar som utvecklats under arbetet. För von Schreeb har skrivandet haft flera syften. Han berättar att ”det kändes som att det fanns väldigt mycket berättelser kvar som inte var nedtecknade och det fanns ett behov för min egen skull.” Tonen i rösten tyder på att det inte är första gången han talat om varför han skriver. Vidare, menar han att ”det har varit väldigt roligt att få skriva såhär, till skillnad från det mer akademiska”, och han förklarar att han egentligen inte är en akademiens man, utan snarare en mer kreativ själ som låter sig styras av känslan av att göra gott för sig själv. ”Man kunde helt hänge sig åt minnen och hur jag uppfattade att det var.” von Schreeb skyler inte detaljerna, men är inte ute efter att chocka, glorifiera eller sensationalisera arbetet i katastrofområdena. Istället är han självkritisk och ställer sig svåra moraliska frågor längs med vägen. ”Det måste vara högt till tak och debatten ska vara högt i tak. Självkritik är en viktig komponent och något som odlas inom MSF”, säger han och antar en personlig och filosofisk position i författarrollen. Från denna position tycker han sig kunna fundera över moralen, normerna och värdena vi lever utefter, utan att bli nedtyngd av någon organisations fotboja ”Jag var lite för ung för att skriva en memoar”, skrattar han med självdistans. ”Därför tycker jag det var mer av en reseskildring. Inte bara en reseskildring
...exemplen från Rwanda och Kambodja, [då är det] lätt att man låter makten berusa en ute i världen, utan också en reseskildring inom mig själv.” Skrivandet blir således ”en bearbetning och något slags bokslut över det jag har varit med om och fått se” indikerar han. Samtidigt har von Schreeb genom detta uttryck kunnat ”ställa svåra frågor till mig själv.” Det fyllde således även en terapeutisk roll i och med att det erbjöd ett sätt att formulera de sinnelag som ansamlats under alla fältuppdrag. ”Det har funnits mycket tröst i skrivandet”, säger han eftertänksamt. ”Man skapar ett alter ego i skrivandet.” Den kreativa processen i skrivandet gav alltså von Schreeb möjlighet att ”sätta ord på känslor och tillstånd, få lite distans till mig själv.” Således skapar han ett nytt perspektiv på tidigare erfarenheter, då orden får ta form i löpande text. ”Jag har alltid speglat mig själv väldigt mycket – inte kanske så mycket i att läsa det jag skrivit, utan just i själva skrivandet. Att jag blir av med saker och ting. Att jag lyckas sätta ord på känslor och på tillstånd.” Som exempel nämner han, med ett plötsligt allvar och ny tyngd i orden, ”de fall i Rwanda där jag hade patienter som dog på operationsborden. De bär jag med mig hela tiden. Att bära dem med mig tvingar mig hela tiden att ifrågasätta mig själv, att inte bli högmodig.” I boken åskådliggör och krossar von Schreeb många outtalade, och uttalade, föreställningar som alltför många personer bär på. ”Många av de människor jag mött verkar ha en bestämd uppfattning om vad jag varit med om”, berättar han. Många har nog trott sig veta vad det egen-
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Johan von Schreeb tänker efter och väljer sina ord noga. Viss kritik går att urskilja vid flertalet tillfällen, även om han är vältalig nog att linda in budskapet. “Många av de människor jag mött verkar ha en bestämd uppfattning om vad jag varit med om.”
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Kontoren personerna vid Institutionen för Folkhälsovetenskap sitter i är ganska små, men upplyses väl av rektangulära fönster. Trots fyrkantigheten och det begränsade utrymmet, känner man sig aldrig instängd.
tligen innebär att arbeta internationellt i krissituationer. ”Det finns många myter om vad det här med katastrofinsatser handlar om, som jag tror baseras på våra föreställningar om hur världen ser ut.” Att författa Katastrofdoktorn öppnade en kanal för att krossa dessa inbillningar om ”Albert Schweitzer, den här ’hjälten’, vita doktorn som kommer och ställer saker och ting till rätta.” Istället får läsaren följa människorna, bakom myterna, som utför arbetet i fält. Man blir en del av personliga konflikter, tveksamma beslut, ångest, oro och omöjliga val. Detta skrivs med en oglamourös ton som bidrar till att på ett nyktert förfarande förmänskliga myten om ”katastrofläkaren”. Han betonar hur han inte ville ”skriva om sig själv som en hjälte – tvärtom.” Poängen med verket är snarare att få förklara ”hur svårt det kan vara och vilka utmaningarna är” med att arbeta i fält, i utsatta områden. Samtidigt är det för honom klart att man ”med passion snarare än skuld kan förändra”, ett tänkande som agerar antidot mot cynism.
varje berättelse ska ha något mer att berätta
Det kanske mest framstående på det mer personliga planet är när von Schreeb förklarar hur förhållandet till familjen påverkas av fältarbetet. Det var så klart svårt att särskilja ”det här personliga och privata [och förstå] var gränslinjerna går någonstans”, menar han och ställer sig den retoriska frågan: ”hur mycket kan man lämna ut sina barn, i sammanhanget?” Samtidigt går det inte alltid att förklara allt, för medan von Schreeb menar på att han verkligen velat ”våga vara ärlig”, har han varit tvungen att ibland ”dra gränsen för att skydda andra, och kanske också sig själv.” Starka föreställningar är som upplagda för elaka misstolkningar och tokiga missförstånd. Boken är en ärlig återberättelse om vad det katastrofarbetet innebär. Samtidigt det är något mer än enbart en samling historier från fält. Det är en djupare analys av mänskligheten och en bit av samtidshistorien. ”Varje berättelse ska ha något mer att berätta”, menar författaren själv. Reseskildringen är mer intern än extern och huvudbudskapet bör för läsaren vara slående. ”Istället för att skapa myten om sig själv, måste man avliva den. Framförallt när man är med och jobbar med sådana här saker, är det otroligt lätt att bli upphöjd till någon slags hjälte.” Han talar istället om ”fadersmordet; att när någon
sticker upp för mycket, blir de utsparkade med en kniv i ryggen. Det tror jag ligger i hela organisationens framgång. Att det inte blivit en sekt.” Genom verket får läsaren intrycket av att författaren rannsakat sig själv i jakt efter sin egen roll i mänskligheten. Liknelsen med Joseph Conrads chef d’oeuvre Mörkrets Hjärta ligger närmast till hands, och von Schreeb citerar just denne i inledningen. Det verket följer en skeppares sökande efter elfenbenshandlaren Kurtz uppför Kongos floder i sekelskiftet mot 1900-tal. Längs vägen bestörtas huvudkaraktären av slaveriets grymheter och maktmissbrukets utbreddhet i ett Afrika under kolonisering. ”Hela det tänket har ju varit någon slags övergripande tanke”, säger von Schreeb och drar parallellen till hur människan, i brist på ett fungerande samhälle med interhumana regler och värden, kan utsättas för sammanbrott av såväl moral som etik. Han skriver poetiskt hur ”[d]et är i miljöer fjärran från kritiska röster som ett blint maktutövande frodas. På platser där människan lämnats ensam med sin svaghet”. Man bör i situationer som dessa vara på sin vakt mot sin egen morals korrumpering: ”som grodan man lägger i kokande vatten, som hoppar ur med en gång
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Recension av: Katastrofdoktorn
D
Extra: Johan von Schreeb
et Johan von Schreeb inte visste var att när han och hustrun Susanne korsade gränsen till Afghanistan, i slutet av den sovjetiska ockupationen, var att hans syn på läkarrollen och livet skulle förändras grovt. Efter att ha gömt sig hos Mujaheddin-ledare, med filtar som kamouflage för att undkomma patrullerande helikoptrar, når de sjukhuset i Zendadjan, där han som ensam och oerfaren kirurg obarmhärtigt konfronteras den nya vardagen. ”Hela upplägget är så fjärran mot vad jag är van vid. Jag måste tänka annorlunda för att vara till nytta här. Frågan är bara hur? Och hur mycket kan man kompromissa?” Frågorna och tvivlen på den egna förmågan samlas på hög, samtidigt som behovet av hjälp är enormt och privatlivet långsamt distanserar sig. Situationen på sjukhuset är ohållbar och säkerhetsrisken ökar, men de kan inte själva bestämma när de ska återvända till Sverige. Varje dag genomför han amputationer och andra livräddande operationer utan tillräckliga resurser.
Född: 24:e maj 1961 Yrke: allmänkirurg (25%), docent, författare Inriktning: internationell katastrofmedicin Exempel på publikationer:
Timing and type of disaster severity data available on Internet following the 2010 Haiti Earthquake. Time for order in chaos! A health system framework for foreign medical teams in earthquakes. Early Hospital Mortality among Adult Trauma Patients Significantly Declined between 1998-2011: Three Single-Centre Cohorts from Mumbai, India.
...det handlar om balansen mellan de begränsade resurserna och att hela tiden förstå att man verkar i ett större sammanhang. – men, om man långsamt värmer vattnet så hoppar den inte ur, utan, plötsligt är grodan död.”
otroligt lätt att bli upphöjd till någon slags hjälte ”Det är kanske det, de exemplen från Rwanda och Kambodja, som när man funnits i situationer att det är lätt att man låter makten berusa en. Framförallt när man är i en miljö där fattigdom är utbrett, där många inte gått i skola. Man är satt i ett sådant enormt överläge gentemot dem.” Samtidigt är han tydlig med att man inte fullt kan förstå de drabbade man behandlar. ”Jag varit noga med att påpeka att jag ju inte vet hur det är att vara katastrofdrabbad.” Än en gång tar han således den betraktandes synvinkel. ”Annars finns det många som uttalar sig om [katastrofutsattheten] och det är likadant att uttala sig om att vara fattig. Jag vet ingenting om fattigdom. Jag har ingen aning.”
regler och hur alla uppkomna känslor skakar om det fundament som ens liv vilar på. Det är ingen vacker skildring, utan en sann berättelse. ”Det handlar om, snarare än att rädda världen, andra saker som på intet sätt är mindre spännande och utmanande – det handlar om balansen mellan de begränsade resurserna och att hela tiden förstå att man verkar i ett större sammanhang.” Det är ett gemensamt engagemang som kan förändra. Men detta arbete får inte glorifieras. Som von Schreeb skriver: ”Jag tror inte på superhjältar. Det finns ingen därute som kan fixa det. Vi måste själva gå från ord till handling.”
När von Schreeb kommer hem från Afghanistan försöker han åter komma in i den svenska vardagen. Livsparadigmet, hela hans raison d’être, är nu förändrat. ”När jag senare är på väg att möta min mamma för att äta lunch sveper en helikopter fram över hustaken. Jag kastar mig in i närmaste port och tar instinktivt skydd.” Något saknas. Han återvänder flertalet gånger till fältarbetet, resor till hemska situationer i bland annat Rwanda, Sierra Leone, Kambodja och Haiti. Katastrofdoktorn, inte bara som en ärlig återberättelse av samtidshistorien, är en filosofisk resa över såväl internationella som personliga gränser; ett varningens finger för den humanitärt drömmande, och ett hyttande finger för den oinsatte tyckaren.
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I Katastrofdoktorn skildras ett klimat där personliga värderingar prövas, hur sunt förnuft ibland inte överensstämmer med 33
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Teaterrecension: Intensiven Av Elena Lind Löwdin Pjäsen ”Intensiven” på Stockholms
stadsteater handlar om de svåra val läkare ställs inför när det gäller vård av mycket sjuka barn. Handlingen utspelar sig under ett par varma sommarveckor och cirklar kring några föräldrar till patienter på barnintensiven samt vårdpersonalen som arbetar där. Föreställningen skildrar hur barnkirurgen förmedlar svåra besked till barnens föräldrar som alla har sina egna sätt att reagera inför det oerhörda, med ilska eller med sorg. En av föräldrarna kan inte acceptera att läkarna har gjort allt de kunnat för hennes tvååriga dotter som har svåra hjärnskador; hon kontaktar kvällstidningarna och kräver dessutom att hennes dotter ska flyttas till ett annat sjukhus. Det går att dra paralleller till det omskrivna fallet med narkosläkaren på Astrid Lindgrens barnsjukhus som för några år sedan anklagades för att avsiktligt ha gett en svårt sjuk prematur flicka en överdos narkosmedel med avsikt att påskynda döden. Läkaren har nu fått upprättelse: Åtalet baserades på ett felaktigt uppmätt värde tiopental i ett postmortalt
taget blodprov, ett värde som långt överskred en tekniskt administrerbar dos. För 20 år sedan förlorade pjäsens författare Mia Törnqvist själv sin dotter som var två månader. ”När jag läste om barnläkarfallet för några år sedan, så tänkte jag, att även om mina sympatier helt låg hos barnläkaren, så tänkte jag att jag kan jag förstå mekanismerna bakom. Vad det är som gör att man som förälder anmäler, eller drar igång något över huvud taget, och det är för att man inte kan acceptera det som har hänt”, säger hon i en intervju med SVT ABC. En annan av mammorna i pjäsen känner att det räcker med operationer för hennes dotter som fötts med stora organmissbildningar och att det vore bättre för barnet att bli av med alla slangar och få somna in. Till en början vill kirurgerna försöka att operera, men de inser så småningom att det inte går att göra något mer utan att utsätta flickan för onödigt lidande som ändå inte skulle leda någon vart. Kanske är det så att läkarna i grunden vill driva utredningen vidare och sätta in nya åtgärder? Det kan tyckas lättare att fortsät-
Foto: Eva-Maria Rundqvist
ta med insatserna än att backa, men då väcks frågan om det är etiskt att utsätta ett litet barn för detta. Teaterprogrammet har ett förord av läkaren och författaren P C Jersild och på de sista sidorna finns Läkarförbundets etiska regler tryckta. ”Intensiven” är en teaterföreställning som tar upp svåra och angelägna frågor om vad som är ett värdigt liv och när beslut om behandlingsbegränsningar behöver tas. Beslut som läkare ställs inför i sin kliniska vardag. Det är också en stark skildring av situationen för barnens föräldrar. När man ser ”Intensiven” är det omöjligt att förbli oberörd.
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Film review: Dallas Buyers Club By Johanna Wolfsberger The Jean-Marc Vallée-directed movie about an AIDS pa-
tient struggling to get treatment has been receiving a lot of attention lately, winning three Oscars and two Golden Globes, amongst others. The film, which is based on true events, tells the story of a Texan rodeo, Ron Woodroof, who is newly-diagnosed with HIV. When the doctor tells him that he has thirty days left to live and that he cannot provide him with drugs, Ron does not accept his fate but instead seeks treatment from a doctor in Mexico. Back in Texas, he meets a transgender, Rayon, who is also infected with HIV. Together, they start the Dallas Buyers Club, which enables AIDS patients to pay a monthly membership fee and give them unapproved medications in return, thereby outsmarting the Food and Drug Administration (FDA), at least for some time. At the beginning of the HIV epidemic during the 1980’s, the pharmaceutical industry in the US needed to conduct drug trials before gaining approval from the FDA. With no pre-existing treatment to compare with, half the patients received experimental drugs, whilst the other half only took placebo, and thus unknowingly left to their impending death. Meanwhile, the patients treated with the drug experienced severe side effects. Ron Woodroof was not content with this regulation. He wanted to live. Staying in the hospital and hoping that the pill he was swallowing every day contained the active ingredient was not an option for him. Instead, he smuggled drugs over the border in huge amounts to also help others with the same fate.
Photo Credit: Anne Marie Fox / Focus Features
Both Matthew McConaughey, who played Ron Woodroof, as well as supporting actor Jared Leto, playing Rayon, won an Oscar for their outstanding performances and dedication. I highly recommend this movie. It sheds light on a hidden side of society and reveals the powerful effect that being selfconscious about mortality can have on how one lives his or her life.
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Utøya becomes art
Image by Jonas Dahlberg Studio, courtesy KORO / Public Art Norway
“A cut in nature itself” By Louise Forlin This is the concept for the memo-
rial that will be constructed in remembrance of the day that plunged a whole world into chock. On 22 of July 2011, 77 individuals lost their lives in the terrorist attack on Utøya and in Oslo. First a bomb was set off in a government quarters, causing 8 people to lose their lives. And thereafter, 69 people were killed in the shootings on Utøya Island. The 69 victims at Utøya were mostly adolescents from the Arbeidernes Ungdomsfylking (the Norwegian Social-Democratic Youth League) who were there for a summer camp. To commemorate the lives that were lost, the Norwegian Government decided that a memorial site would be created in the two places where the attack took place. The design of the memorial has been chosen through a competition, and on the 27th of February, they announced the Swedish artist Jonas Dahlberg as the winner. His winning proposal is divided into two parts. The first one, called “Memory Wound”, will be made in the headland
across the water of Utøya and will literally be a cut through the ground. “A cut within nature itself reflecting physical and emotional experience of abrupt and permanent loss” is how the artist describes it himself. The excavation will be 3.5 meters and extend below the water line, thus making it impossible to reach the end of the headland. In his competition text, Dahlberg explains that “it reproduces the physical experience of taking away”
The second part of the memorial will be constructed at Government Quarter in Oslo. Firstly, a temporary memorial walk will be constructed. This later will be replaced with a permanent memorial, in the shape of an amphitheatre. The stone, trees and plants removed when creating the cut at Utøya will be transported to Oslo, where it will be used as the foundation for both the temporary and permanent memorials.
Visitors will be guided to the memorial site by a five-minute pathway that eventually will become a tunnel, leading to the dramatic cut in the landscape. On the stone wall facing the visitors, the 77 names of those who died will be inscribed.
Like the stone, that will be carved away from the land, the lives that were lost on that tragic July day can never be replaced. The memorial will serve to honour the survivors who managed to escape, as well as the bravery of rescue crew and the volunteers. It will forever remind us of what can happen if we allow the wrong ideals to take root in our society, and it is up to all of us to prevent anything from this ever happening again.
like the stone, that will be carved away from the land, the lives that were lost on that tragic July day can never be replaced
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