Medicor 2017 #1 by Medicor MF Magazine

2017 #1 #1 2017

medicor medicinska föreningen’s

student magazine

In data we trust

Medicinska Föreningen going strong for 140 years

GAPMINDER:

Filling The Ignorance Gap

38 New to Sweden?

Tribute to Lennart Nilsson, Hans Rosling, Georg Klein

Prelude Dear Medicor readers, It is my pleasure to present you the first issue of Medicor 2017. First and foremost, a warm welcome to those of you who started their education at Karolinska Institutet this semester. As the new editor-inchief of the magazine, I share your excitement and anticipation since we all started a new journey. I must admit, I am lucky to be surrounded by meticulous and passionate people in the editorial team, as well as blessed to have the support of all Medicor family. Determined to carry the torch even further than previous teams, we aspire to publish a magazine that welcomes and inspires every student at Karolinska Institutet with a wide range of topics and a variety of perspectives. In a world where we are drowning in information, but starving for wisdom, it is important to remember and cherish those devoted their lives to make the world a better place. In this issue, Medicor features tribute to the three great men we lost in the past few months, whose work and wisdom is more important today than ever.

Photo by Matthjis Dorst for Medicor

With our undying gratitude to Hans Rosling, Medicor says farewell to him by commemorating his core values and carrying his legacy as “The Rosling”: telling it as it is, using facts to acknowledge the big picture. Therefore, we collected factful snippets of him and looked back at his 2013 Medicor interview from the eyes of then editor-inchief Gustav Drevin. We also rewind the life of Professor Georg Klein not just as the man who escaped from Holocaust and found a home here at KI, but also as a scientist and mentor. In addition, we honour Lennart Nilsson in his way, via photography. I would like to thank Helena Nordenstedt, Anna Mia Ekström, and Asli Kulane for sharing their memories of Hans Rosling, Eva Klein for opening up their family archives, and Saket Millind Nigam for his collaboration in getting a glimpse of Lennart Nilsson’s objective. As we observe the world getting increasingly immune to differences and ignorance is spreading in an alarming rate, the importance of having a transparent leadership is indisputable. We welcome the new MF president Max Kynning and vice-president Pontus Dannberg to shine light on the structural organization of MF and ways to get involved with the union in their new column. It is our duty as scientists, science advocates and factful citizens to raise our voice when policies are made disregarding scientific proof and insist on action. Therefore we hope you will march with us for science on April 22nd, 2017. Among other interesting articles, we take a closer look at the data manipulation issue in the post-truth era and discuss the effects of media on our perception and values. Don’t miss the tips on how to master small talk and make sure to take a look at the burger quest to pick your next taste stop. Last but not least, I would like to thank all Medicor contributors who bring this magazine to life. It is a great pleasure to work with all of you. I am happy to see that the Medicor team is continuously growing and evolving into something greater. I would like to take this chance to extend the invitation to talented new students who want to become a part of our team. Come and join us while we tell stories. Come and Tell Your Story.

Cover: Illustrated by Igor Cervenka Source photos: Georg Klein by Stefan Imreh, Hans Rosling by Gunnar Ask, Lennart Nilsson by Peter Hoelstad

Warm regards, Yildiz Kelahmetoglu Editor-in-Chief

Medicor Magasin Grundad 2006. Elfte årgången. Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 Ansvarig utgivare: Yildiz Kelahmetoglu Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm Nobels Väg 10, Box 250, 171 77, Stockholm Utgivningsplan 2017: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december. Kontakta Medicor: chefredaktor@medicor.nu www.medicinskaforeningen.se http://medicor.nu 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. Freelance material: Medicor retains the right to edit incoming material and does not take responsibility for unsolicited texts or pictures, and printing mistakes. The contributor agrees that, through published and signed Medicor material, their opinions do not necessarily represent those of Medicor or Medicinska Föreningen.

Overture KI CAMPUS

EQUAL RIGHTS FOR ALL STUDENTS AT KI

10 12

GOING STRONG FOR 140 YEARS MF PRESIDENT’S WORD:

ILLUMINATING THE UNION

SCIENCE 14 15

12 39

TWIN STUDIES FECAL MICROBIATA TRANSPLANTATION

DATA MANIPULATION

IMMUNOTHERAPY

FEATURE

Medicor pays tribute to three great men LENNART NILSSON GEORG KLEIN HANS ROSLING

GLOBAL FOCUS

CULTIVATION THEORY

GLASGOW EFFECT

GAPMINDER:

CULTURE

16 30

FILLING THE IGNORANCE GAP

34 36

SMALL TALK

NEW TO SWEDEN?

STOCKHOLM BURGER QUEST

STOCKHOLM CITY BIKES

41 COMICS

medicor Yildiz Kelahmetoglu • Editor-in-Chief | Joanne Bakker • Associate Editor Sibel Ilter • Editor of Campus | Veronika Kremer • Editor of Science | Zach Chia • Editor of Global Focus Joanne Bakker • Editor of Culture | Diana Cekatauskaite • Assistant Editor of Culture Joanne Bakker, Yildiz Kelahmetoglu • Layout Design | Gunnar Ask, Matthijs Dorst, Joanna Jangland, Martin Kjellberg, Ben Libberton, Oliva McCabe, Olivia Miossec, Linda Morgan, Saket Milind Nigam, Helena Nordenstedt, Fredrik Persson, Katarina Stojanovic, Isabelle Wemar • Photographers | Joanne Bakker, Benedek Bozoky, Diana Diana Čekatauskaitė, Zach Chia, José Damas-Fernandéz, Pontus Dannberg, Gustav Drevin, Tatiana Álvarez Giovannucci, Borislav Ignatov, Sibel Ilter, Veronika Kremer, Joanna Kritikou, Max Kynning, Ben Libberton, Ronan McCabe, Olivia Miossec, Laila Naqvi, Mauricio Barrientos Somarribas, Marianna Tampere, Isabelle Wemar, Teresa Fernández Zafra • Writers | Saket Milind Nigam, Zach Chia, Ben Libberton, Isabelle Wemar, Mina Saleem, Carmen Fourier, Caitrin Crudden, Roksana Khalid, Ronan McCabe, Anil Sharma, Alessondra Speidel • Proofreaders | Markus Karlsson • Comics Coordinator | Pedro Veliça, M. Plymoth • Comic Illustrators | GapMinder, Beyond Curie • Infographics

12/04 A SCALPELLA: SPRING CONCERT 19:00, Hjorthagskyrkan https://billetto.se/events/183932

13/05 VR SCIENTIFIC FESTIVAL KTH Royal Institute of Technology http://www.vrscifest.com

02-06/05 SPEX CORPUS KARROLINA Medicinska Fรถreningen, Solna medicinskaforeningen.se

KI CAMPUS

EVENTS 4

APR. 17 MAY 17

22/04 MARCH FOR SCIENCE Stockholm https://www.facebook.com/ events/1378276915526893/

Photo: Linda Morgan

21/04 JUBILEE PUB Medicinska Fรถreningen, Solna medicinskaforeningen.se

03/05 OPEN SCIENTIFIC SEMINAR SERIES Whole genome sequencing for diagnostics of rare diseases 14:30, Sjรถqvist Library C1:68, Karolinska University Hospital, Solna ki.se/labmed/calendar

23/04 VALBORGPUBRUNDAN Medicinska Fรถreningen, Solna medicinskaforeningen.se

06/05 BIOMEDICINE HOMECOMING EVENT Karolinska Institute, Solna https://www.facebook.com/ events/897138130428673/

Smörgåsbord By Teresa Fernández Zafra Climate Change Tracker Apps The development of technologies that allow tracking changes in climate is on the rise. The goal of such tools is to help governments and communities to predict natural disasters and to reduce the effects of climate change by improving prevention and emergency plans. RainMapper, for example, is a mobile app that oversees water precipitation all across the globe. This app was used to track the super typhoon Rammasun in Philippines, 2014. wgms Glacier app provides information about glacier changes with a satellite-based map. Both RainMapper and wgms Glacier apps are available for iOS and Android.

Our Ocean, Our Health Our Ocean, Our Health is a campaign created by the Sea Change project as part of the EUHorizon 2020. The ocean is an invaluable source of oxygen, it regulates the planet’s climate and it nourishes us with more than 140 million tons of food every year. Our current way of living is damaging the ocean’s natural balance which, as a result, compromises our wellbeing. Our Ocean, Our Health aims to raise awareness about the importance of the ocean in sustaining life on Earth by educating people about the sustainable actions needed to keep the ocean healthy. (Unesco)

Common waterrelated diseases: Diarrhoea Arsenicosis Cholera Fluorosis Intestinal worms HIV/AIDS Malaria Zika Thypoid

Turning feces into drinking water The Omniprocessor is a steam machine able to convert human faeces into drinking water and electricity. Even Bill Gates himself has tried it. As he described in his blog: “I watched the piles of feces go up the conveyer belt and drop into a large bin. They made their way through the machine, getting boiled and treated. A few minutes later I took a long taste of the end result: a glass of delicious drinking water.” This innovative machine was developed with financial help from the Gates Foundation to improve sanitation and access to clean water in poor countries. (GatesNotes)

97.5% of the earth’s water is saltwater. If the world’s water fitted into a bucket, only one teaspoonful would be drinkable. (water.org)

1.8 billion The number of people estimated to drink faecally contaminated water according to the WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation. (worldwaterday.org)

663,000,000 The number of people living without nearby water supplies, having to spend innumerable hours travelling or waiting to get access to safe water and/or being negatively affected by the use of contaminated water. (climate.nasa.gov)

17 The number of centimeters that the global sea level has risen during the last century. The rising rate this decade has been almost double of that of previous century. (unwater.org)

90 seconds Every 90 seconds an infant dies due to a water-related disease. (wateraid.org)

KAROLINSKA CAMPUS

Equal Rights for all students at KI By Equal Treatment Committee

Photos by Katarina Stojanovic for Medicor

Equal Treatment Committee (Likabehandlingsnämnden) (ETC) is a part of the Medical Students´ Association (Medicinska Föreningen, MF) and is a student-led committee. We work with both Karolinska and the student association to ensure equal opportunities for all students, regardless of their sex, gender identity or expression, age, ethnicity, religious or other beliefs, sexual orientation or disability. Our work includes raising awareness, driving change and supporting diversity. One of the issues that we are addressing is the hardship students face when reporting unequal treatment. We want to make it easier for students and staff to anonymously report all forms of discrimination and harassment without fear of persecution or judgement.

Milja Miettinen

Kelsi Smith

Victor Svedberg

Diana Kättström Third year Bachelor´s in Biomedicine student I have been a ETC board member since 2016. My involvement in issues of equal treatment and discrimination began in my second year of my studies when I witnessed the struggle of a close friend fighting for her right to equal opportunities. I believe that it is very important to ensure that students feel safe about reporting incidents anonymously and to continue to push for more ways that students can feel comfortable in coming forward if they ever do face harassment or discrimination.

First year Medical Student

First year Master’s in Public Health Epidemiology student

First year Psychology Student

I got involved with the ETC this year. Even a subtle discrimination can cause deep consequences in a person’s life so I feel it’s important to help those who have been targeted by it. My biggest hope is that everyone can feel safe and treated equally at our campuses, regardless of their diverse ethnicities, sexual orientation or possible disabilities.

I am the vice-chairperson of ETC. I strongly believe that diversity is one of our strengths as a society. Diversity and equal treatment goes hand-in-hand as our differences are something we all have in common and should be celebrated, rather than creating divides between us. I believe that as a global community of students at KI, we can set a wonderful example of what an equal environment is, and ensure all students and people are welcomed.

I became interested in the ETC after going to an open board meeting. I think the work the ETC does is important and want to contribute to it to ensure it has a solid foundation in the Medical Students´ Association and at KI.

CAMPUS WHY JOIN ETC?

HOW TO JOIN ETC?

As a student-led organization we are totally dependant on ambitious and engaged students who are willing to dedicate their time to working with important student issues but also bring our attention to the issues that need to be addressed. By joining ETC you will be part of discussions, meetings and other activities organized by ETC. To ensure that our work brings benefit to all study programmes at KI we encourage students from every year and programme to join us!

There are different ways you can participate in ETC and contribute to our work. One way is to join our board and become a driving force behind changes towards a more welcoming and equal student environment at KI. Another is that you can become a general member where you can also greatly contribute to improvements at KI, through volunteering during planned activities.

Joining ETC may also bring you benefit when applying to exchange programmes, masters programmes or doctoral studies as participation in student-led organizations shows ambition and initiative.

If you are interested to be a part of ETC or have great ideas that would promote equality, please contact us via email lbn@medicinskaforeningen.se. For updates on our work and progress, please like our Facebook page: @mf.etc.lbn!

MAKE YOUR VOICE HEARD!

Come to our open board meeting the 29th of March at 6 p.m. to discuss what we can do to create a more equal environment at KI and MF. We encourage an open, frank discussion about what could be improved, or what you believe is positive at KI. You can find out more about the ETC as well and express interest in joining us. We will be serving free pizza! Welcome! •

Ensuring Equality and a safe campus: Tips from Equal Treatment Committee • • • •

It is always you who decides whether an action or a behaviour is unwelcome Talk to someone if you have been discriminated against, harassed or victimised so that you can get support Always report discrimination, harassment and victimisation Be an ally to others by speaking up and taking action against all forms of discrimination, harassment and victimisation

As the chairperson of ETC for 2017, I feel passionately about working for an equal environment at KI and in the student’s association. Discrimination, harassment and victimisation is happening around us all the time and I think that it’s our duty to try to reduce it and promote equal treatment. I would like the committee to grow bigger and for MF and KI to put more work into creating an equal environment for all students.

Micaela Gonzalez Second year Medical Student Chairperson of ETC

CAMPUS

Medicinska Föreningen going strong for 140 years By Isabelle Wemar

Medicinska Föreningen (MF), the student union of KI, is celebrating its 140th anniversary. And like any other 140-year old, MF demands a lot of attention. It’s past office hours when I head to the Medicinska Föreningen reception in Solna. The board members are still hard at work, when I arrive for my interview. Leading the student union is no small task; in fact, the president and vice president both have taken a break from their studies to focus solely on MF. Eager to find out more about MF, I sit down with president Max Kynning, vice president Pontus Dannberg, and board members Katarina Stojanovic, Johanna Hagman, and Linnéa Dalman. First things first – what is the mission of MF? Max: “Our interest lies with the well being of the students of KI, whether we arrange social events, plan the welcome reception for new students, or organise lectures and seminars. We administer the activities of our organs and committees, for example Programutskottet which hosts the weekly Friday pubs, and the International Committee which works towards bringing international and Swedish students closer.” Pontus: “Unlike student unions at other universities, MF encompasses all medical

programmes at KI, which is quite unique. I think this is one of the best things about Medicinska Föreningen, because this allows for an interprofessional exchange and creates a stronger feeling of community between the students.” How did you get involved with MF, and why should others do so too? Max: “I joined Medicinska Föreningen in my first year and got engaged in Programutskottet. Through that I got to meet so many awesome people that I would not have met otherwise, and from then on I was hooked.” Katarina: “MF is hands down the best place for meeting people outside of your class, and I think that is really important, to gain a bigger perspective and greater understanding for your colleagues in your future career. Once you graduate, you are going to be around people with vastly different educational backgrounds, so why not begin now?” Johanna: “The more students that are involved in the union, the more social exchanges will happen!” Pontus: “To me, MF is not only a meeting place, but also a place for learning. During my time at the union, I have learnt how to handle a bar, plan events for hundreds of

guests, and tend to an economy – things I had not tried before.” This is a very special year for Medicinska Föreningen, what do you have in store? Linnéa: “We are going to host a jubilee pub on the 24th of March, where special anniversary drinks will be available. We are also going to release the tickets to the Spring Ball then, which is going to be a huge, luxurious event packed with performances, award ceremonies as well as speeches from famous KI people, and amazing food.” Wow, I really would not want to miss out on that. How do I keep myself posted? Max: “The best way to get informed is through our page ‘Medicinska Föreningen i Stockholm’ on Facebook. Be sure to check out our website ‘medicinskaforeningen.se’ as well, where you will find a calendar with all scheduled events.” With that, the clock strikes six and while I gather my things up to head home, the board members are only beginning their meeting. •

Photo: Isabelle Wemar for Medicor

The current board of Medicinska Föreningen Front row: Linnéa Dalman, Bethel Tesfai, Klara Arvidsson, Johanna Hagman, Sammy-Jo Geara, Matilda Kjellander. Back row: Sandra Carlsson, Pontus Dannberg, Nina Aurell, Max Kynning, Katarina Stojanovic, Ghonchehgol Assadi. 10

JUBILEUMSVÅR 2017

ANNIVERSARY-BALL RELEASE-PUB BIRTHDAY-PUB 22/4 24/3 21/4 Release of tickets to the ball, The anniversary-beer and the anniversary-cocktails

Ball at Medicinska Föreningen for the celebration of the 140tjh anniversary

Celebration of the 140th anniversary at the Friday-pub 11

CAMPUS

Illuminating the Union MF President’s word

The Council is the highest deciding body of MF, where main policies, budgets and higher positions within MF and Karolinska Institutet are elected. The Council meets three to four times per semester and consists of up to 29 members. The elections for the Council are held digitally each autumn in October where the members are directly elected for a full year, starting from November. In its first meeting, the Council elects the president and vice president of MF, along with the board. It also elects the student representatives in KIs executive boards (board of higher education, doctoral education and research) at this meeting. The board of MF, led by the president and vice president, operates MF’s everyday work, ranging from strategic planning and addressing issues within MF, to questions regarding the staff. The board consists of students from several programs, and is concerned with several main topics. This year the topics are; increasing membership, solidarity, campus Flemingsberg, student influence, organization and communication. Other than these different focus points, we try to facilitate and promote new ideas and projects from our members. These commitments (the Council and the board) are maybe not the optimal stepping stone to get involved in MF. Usually involvement starts in one of our sections, committees or societies. These have a more focused purpose and aim, are more easily grasped and are therefore more suitable for a first involvement. The sections, one for each educational program, focus primarily on student in12

Council (Fullmäktige) Board (Styrelsen)

Staff (Personal) Councils (Råd)

Sections (Sektioner)

Societies (Kårföreningar)

fluence and in some cases on social activities. The nursing section (SSEK), for example, has a group called Festis which organises social events such as bowling nights and pub-crawls. The committees focus on an aspect of the student social life. There is a committee for the sports activities (IdrU), for the reception (MU), the pubs and the parties (PrU), the administration of the union house (FU), the cultural life (KU), the communication (KomU), our future careers (NU), as well as committees for equal treatment and internationalization. The societies, while not directly a part of MF, offer an experience unlike most other. We have our skit groups (Spex) who perform and entertain, our choir (A scalpella) and string orchestra (Stroket) for those with the talent for it. We also have

Committees (Utskott & Nämnder)

a brass band (Blåslaget) and dance group (Dragplåstret). Fighting for the rights of the LGBTQ population, Queerolinska is a pristine opportunity to effect changes. These groups of students are a terrific way to get new experiences and gain new friends. If you are interested in getting involved, we sincerely hope that you do not hesitate to contact either them directly or us. A first thank you, of many to come.

Max Kynning & Pontus Dannberg President & Vice President Medicinska Föreningen ordf@medicinskaforeningen.se vordf@medicinskaforeningen.se

Photo: Johanna Jangland for Medicor

Medicinska Föreningen (MF) has always been a home away from home for us, as it has for many students over the past 140 years. Unfortunately, the same cannot be said for all. Over the years, we have heard quite a few students complain that MF is not welcoming or open to changes. The feeling that MF is not transparent and hard to understand is something that we hope to change this year. Some of these are, in our opinion, misconceptions while others are true. In this new column we aim to highlight relevant and larger issues and to further increase the understanding of MF. In this first issue, we address how MF is organized and, maybe more importantly, how one goes about to get involved.

SCIENCE

Science Snippets By Joanna Kritikou

NEW ARTIFICIAL INTELLIGENCE ALGORITHM IS AS ACCURATE AS DOCTORS…

ORGANISM WITH SYNTHETIC DNA CREATED

…at identifying skin cancer. Researchers at Stanford University created an algorithm that was provided with a library of 130.000 images of different skin lesions, representing over 2.000 different diseases. They then trained it to visually diagnose the conditions and identify potential cases of cancer. The algorithm was put to the test against 21 expert dermatologists and was able to match the performance of the doctors with impressive accuracy. (Nature, January 2017) Photo: AJC1, Flickr

TREATING ALZHEIMER’S AND REGENERATING ROTTEN TEETH? A drug which is normally given to Alzheimer’s disease (AD) patients has been found to repair cavities by stimulating the naturally occurring stem cells in teeth, which are able to rebuild bony tissue. The drug was tested on mice, by treating cavities with a biodegradable collagen sponge soaked in the AD drug (named Tideglusib). Over time, the sponge degraded and was replaced by newly synthesized dentine - indicating a natural repair mechanism by the tooth’s own stem cells. (Scientific Reports, January 2017)

If you ever took Biology, you probably know about the bases A, T, C and G. Now, a lab has made two new bases, X and Y. These new bases, which do not exist in nature, have been inserted into bacteria and can give rise to stable organisms with the help of a little genetic engineering. After a few attempts back in 2014, the group now finally got stable organisms after adding a molecule that moves the artificial nucleotides across the cell membrane more efficiently and by using CRISPR-Cas9 to destroy flagged cells that do not have the synthetic bases. (PNAS, December 2016)

IS THE MAN COLD REAL?

Photo: Marissa Anderson, Flickr

A new study claims that it seems that viruses may actually be evolving to infect men more severely than women. The theory behind this is that it is advantageous for a virus to infect, but not necessarily harm, a woman because she has a greater chance of passing the virus on to her child. That pressure is absent in men so the virus can basically go all out on the male host and cause greater harm. The researchers used mathematical modeling and showed that there was, indeed, selective pressure in order to produce a lower mortality rate in women. (Nature Communications, December 2016)

A NEW HUMAN ORGAN HAS BEEN DISCOVERED

PRO-EDUCATION GENES DECREASING

A new organ, called the mesentary (greek for “midgut”), has finally been classified. Leonardo da Vinci gave one of the first descriptions of it back in the day, but until around 2012 it was thought to be a series of separate structures keeping the intestines attached to the abdominal wall. By using complex microscopy, researchers were able to confirm that the structures are all interconnected and appear to be part of one overall structure. The mesentery has now been added as an organ to the famous Gray’s Anatomy textbook. (The Lancet, November 2016)

The desire to pursue a post-secondary education has long been thought to have a genetic component. Scientists have previously identified a cluster of genes that, if contained in the genome, might predispose someone to stay in education a little while longer. However, a new study shows that this gene group may be becoming less common. The study conducted in Iceland reported that pro-education genetic variants appeared increasingly less between 1910 and 1975 than ever before. (PNAS, December 2016) Photo: Alan Levine, Flickr

SCIENCE

Twin studies

NASA breaks new ground for genetic research By Marianna Tampere Photo: NASA

For so many of us, the essence of happiness lies in the taste of a piece of good chocolate. However, my friend doesn’t much care for it. Could this, almost criminal, dislike of chocolate be explained by genetics? Indeed, scientists have been puzzled by the origin of complex human traits ranging from personal behavior to the occurrence of diseases since early civilization. Twins can be valuable subjects to pull apart and study our inherent and environmentally influenced characteristics. Identical or monozygotic twins share all of their genes. In contrast, fraternal or dizygotic twins share about 50 percent of their genes, like any other siblings do. Studying twins is the most accurate way of finding out how human traits are inherited. Victorian scientist Francis Galton was one of the first to note the value of twins for studying hereditary traits. He was highly interested in the effects of “nature versus nurture”, a term coined by himself. However, his interpretations from twin studies led him to the dark belief that genetic qualities of the human race could be improved by selective breeding, and thus to the rise of “eugenics”. Nowadays, largescale twin registers serve as a grand platform to study complex traits and diseases. The Swedish twin registry managed by Karolinska Institutet contains extensive information about 85,000 twin pairs and has approximately 30 ongoing research projects. When astronaut Scott Kelly landed on Earth last March, breaking the US record for the longest time spent in space, he also set a landmark for twin studies. Scott and Mark Kelly are identical twins and astronauts, who came up with the idea of an unprecedented experiment to figure out how extended space travel affects the human body. During the study, between 2015 and 2016, Mark was on Earth and Scott 14

was in space. Biological samples were taken from the Kelly brothers before, during and after the space flight, allowing for the most thorough molecular profiling of human beings ever, done by ten research groups. Preliminary results from the study are truly exciting to the scientific community.

“The greatest importance of the study is to show that we can do it.” “Almost everyone is reporting that we see differences”, said Christopher Mason, a geneticist at Weill Cornell Medicine in New York City, in a report in Nature. Researchers found that Scott’s telomeres, protective caps at the end of chromosomes, grew longer during the spaceflight and returned to original length after landing on Earth. They discussed that physical activity and special diet might have counteracted the damaging effects of space travel. An independent study including ten astronauts has been initiated by NASA on telomere length to figure out what the results really mean. Mason’s research team reported around 200,000 RNA molecules to be differentially expressed between the twins. A closer look

will reveal if a “space gene” was activated during the spaceflight. The fact that the Kelly brothers are just two people poses a challenge for the scientists trying to untangle natural variations from real effects of space travel. Despite the limitation of having only one twin pair, the current study generates an enormous amount of new knowledge about the human body’s response to gravity-free life. Science team member Andrew Feinberg said at the NASA Human Research Program’s annual workshop, highlighting the success of omics in science: “The greatest importance of the study is to show that we can do it.” Knowledge obtained from the Kelly study will be of great significance for Mars journey preparations. As a mission to Mars will likely last for three years, it is crucial to understand the challenges that humans may face on the way. Numerous twin studies have led us to important discoveries. And what about chocolate? You guessed it – twins helped us to figure out the genetics of taste preferences, too!•

More details about the project: Instagram: @stationcdrkelly, @nasa Web: www.nasa.gov

The power of poop

SCIENCE

Treating disease with fecal transplants By Laila Naqvi and Veronika Kremer

Transferring stool from a healthy into a sick person – a fecal transplant – may sound gross, but it cures almost all patients with a life-threatening infection. The mechanism? A bacterial makeover. Fifty to seventy-five percent of a human is non-human. We share our bodies with a vast number of bacteria, archaea, and viruses – the human microbiota. The human gut alone hosts up to 1,000 bacterial species that encode five million genes - the microbiome - and play a vital role in health and disease. The recent development of low-cost, high-throughput DNA sequencing has sparked a boom in research of the human microbiome. The gut microbiota has not only been shown to govern energy metabolism and fend off pathogens, but also to ‘train’ the immune system and communicate with the brain. From obesity over cancer to bad mood, there is hardly any disease or condition where the microbiota has not been implicated in. Altering the numbers or the composition of gut microbiota can have severe consequences. Overuse of broad-spectrum antibiotics can wipe out beneficial bacteria, allowing pathogenic, often antibiotic-resistant, bacteria, such as Clostridium difficile, to overgrow the intestine. The life-threatening C. difficile infection (CDI) affects approximately 500,000 patients in the US annually. The toxins secreted by the bacterium destroy intestinal cells, causing watery diarrhea. Failure of standard antibiotics in CDI progressively

destroys most of a patient’s gut microbiota, leading to indefinite recurrence of CDI and 30,000 deaths per year in the US. Scientists have recently re-discovered the power of poop – the therapeutic effects of fecal microbiota transplantation (FMT). In 2013, The New England Journal of Medicine published the first randomized controlled trial comparing FMT with the antibiotic vancomycin for patients with recurrent CDI. The trial ended early when doctors realized that less than 30% of vancomycin-treated patients recovered, while 94% of patients receiving FMT did, relatively free of adverse events. Since then at least 27 studies have confirmed the efficacy of FMT against CDI. One mechanism of FMT’s therapeutic effect is that beneficial bacteria from the healthy donor outcompete C. difficile and create an environment unfavorable for its growth. To treat diseases with feces is not a new idea. In 4th century China, “yellow soup” – a fecal suspension – was used to remedy severe diarrhea. In 1958, stool transplants entered ‘modern medicine’ and successfully cured life-threatening intestinal infections, but were treated with great skepticism and only turned to as the last resort. Now, FMT has largely been em-

braced by the medical community. Over the past years, the treatment has become more refined, thus reducing the ‘gross factor’: Donors are being rigorously tested for pathogens, and the fecal microbiota is turned into an odorless suspension that can be stored in a frozen state or, more recently, packaged into a pill. The success of fecal transplants against CDI makes a compelling case for their use against other diseases associated with a dysfunctional microbiota (obesity, autoimmunity, inflammatory bowel disease, cancer, and neurological disorders). However, FMT trials have yielded mixed results. The effects of FMT are harder to predict or to explain in non-CDI conditions as their causes often are not fully understood. Even though FMT is not a panacea, the simplicity of this treatment has led to proliferation of ‘do it yourself’ protocols for desperate non-CDI patients. Because of a lack of rigorous screening for pathogens and understanding of donor selection such practices are potentially risky and ineffective. However, since the promise for FMT is huge, and the patients impatient, mechanistic insights need to be generated quickly to develop new curative therapies.• 15

SCIENCE

In Data We Trust By Diana Čekatauskaitė

Anyone who has tried to plot data knows how enormous the temptation is to exclude, or even “improve” that one value that does not quite fit in. The reasons behind this urge are usually innocent: when the graphs are prettier, it is easier to draw conclusions and convincing one’s target audience of the significance of the findings. The findings that took months (or even years) and thousands (or even millions) of kronor to achieve. The findings that are “self-evident” anyway. Or so they seem. Playing around with data to a variable extent has been researchers’ bread and butter for ages; however, it is only recently that the issue has received muchneeded attention. In 2011, 50 papers by one star social psychologist from The Netherlands were retracted due to “falsified data and made-up experiments”. The scandal amounted to a decade of work, involved as prestigious journals as Science and, unsurprisingly, struck an enormous blow to the field’s reputation and credibility. But one does not need to look overseas: the widely covered Macchiarini case at Karolinska Institutet taught everyone a valuable lesson. The malpractice becomes obvious once uncovered, but it takes time.

“In a culture governed by the principle ‘publish or perish’ scientists’ positions and funding are only secured by success.” Meanwhile, in a day-to-day life of a researcher, there is still a fair amount of subjectivity behind quite common practices as, for example, excluding evident outliers in data sets. This makes the line between a simple discard-as-noise and full-blown research fraud seem somewhat blurred. And, apparently, when there is money and power involved – even more so. JAIL TIME FOR… MIXED-UP SAMPLES? Decreased integrity of the field and diminished trust in science in general, misallocated funds and positions – these are 16

all-too-real ways fraud causes damage. In addition, the self-inflicted harm to the researcher is no less severe. In July 2015, biomedical scientist Dong-Pyou Han from Iowa State University was sentenced to nearly five years in prison, followed by three years of supervision upon release, and a fine of 7.2 million US dollars (approx. 65 million kronor). Han tampered with data in a series of HIV vaccine trials, sponsored by grants from the US National Institutes of Health, by spiking rabbit blood samples with human antibodies. In this way, he made the vaccine seem effective in inducing immunity to the virus in rabbits. According to the researcher’s letter to the university, the reason behind this was seemingly something as trivial as unnoticed sample mix-up years ago he tried to conceal. It is rather unusual, however, for a scientist to be sentenced to jail. Han’s case could have ended with a ban to receive federal funding for three years, the highest penalty to junior researchers, had it not drawn the attention of a US senator who took the case public for subsequent criminal prosecution. This raised quite a few questions on the uneven penalization researchers face for scientific misconduct, as well as to what extent the public should be involved in cases like Han’s.

The percentage of researchers who were aware of misconduct yet did not report. (according to surveys)

BELIEVING IN ARTIFACTS Another high-profile case of research misconduct adds one more layer of complexity to the underlying reasons: the case of Yoshiki Sasai, once one of the most renowned developmental biologists in Japan, and his mentee Haruko Obokata. They were aiming at creating one of the greatest scientific breakthroughs of the 21st century: stimulus-triggered acquisition of pluripotency (STAP) – a simple method to transform ordinary cells into pluripotent stem cells by subjecting them to profound stress. The concept was promising everything from millions of dollars and rewriting textbooks, to a Nobel Prize. After Obokata, ‘the rising star of science’ and the owner of the so-called ‘golden hands’, finally got Nature to publish her two papers early 2014, other researchers tried to reproduce her findings.

“Decreased integrity of the field and diminished trust in science in general are all-too-real ways fraud causes damage.” Unsurprisingly, when all of them failed to demonstrate the cell reprogramming with the proposed technique, her papers were soon retracted, causing an enormous public uproar. Obokata was ordered to replicate the data under extreme scrutiny and 24-hour video surveillance, which she failed to do. Nevertheless, she never admitted to having committed fraud, and after withdrawing herself from the public eye to be treated for depression, released a memoir in which she states she was

Photo credit: Peter Knutson

made a scapegoat. Her mentor Sasai committed suicide a couple of months after the papers were retracted. He reportedly left Obokata a note saying: “Be sure to reproduce STAP cells.” WHATEVER YOU ARE READING IS PROBABLY FALSE Although the examples mentioned here are scandalous extremes, quite a few meta-studies report worrisome numbers of fraud in daily research. For instance, several surveys have shown that the percentage of researchers who were aware of misconduct yet did not report it was over 40%. The numbers for reproducibility – one of the pillars of the scientific process– were even worse. In 2012, the research division of the pharmaceutical company Amgen tried to reproduce 53 widely-cited papers on cancer drug development. Only 11% of them could be validated – 6 out of 53 papers. Epidemiologist John Ioannidis went even further and published a paper titled “Why Most Published Research Findings Are False” in PLoS that argues most published findings have a high probability of being incorrect. He used mathematical models to illustrate how science is heading towards obscurity, due to not only blatant manipulation but sometimes also inadvertent flaws, such as various biases in combination with the perception of statistical significance, as well as today’s scientific process itself.

NO COUNTRY FOR UNSUCCESSFUL SCIENTISTS Although the risks of being caught for scientific misconduct are increasing due to technical advances, the fact that there are still people willing to take a chance with data manipulation is a red flag in itself. It indicates that the current system of how science is done, rated and financed has inherent flaws, with one of them being intolerance to failure. In a culture governed by the principle “publish or perish”, scientists can rarely afford to throw away months of research, as their positions and

“Amgen tried to reproduce papers on cancer drug development. Only 11% of them could be validated – 6 out of 53 papers.” funding are only secured by success. It seems that the system itself encourages an ostrich-like behaviour, trying to ignore or cover up “mistakes. As seen in Han’s case, the consequences can be severe. In addition, the “worth” of a scientist in terms of employability, the likelihood to receive funding among other things, is often measured by the number of publications in high-impact journals, such as Na-

ture, where Obokata was trying to get published. With an acceptance rate of around 8%, the journal welcomes only the most revolutionary work, a practice already seen as destructive by some. Nature has been recently criticized for resembling a commercial enterprise that prioritizes jaw-dropping titles over genuinely important and good work. The current obsession with publications in certain journals could have made some researchers more likely to skew or have a distorted view of their data in order to publish there, while less captivating but nonetheless important studies struggle to ever make the cut. Finally, in times when ‘post-truth’ - Oxford Dictionary’s word of the year - is causing the value of a fact to diminish, it is even more disappointing to realize that the scientific community is not immune to that either. Truth, however, is central to the mission of the medical and scientific research. So, how do we restore trust in research integrity? There is no simple way, and many stakeholders, including funders, publishers, and not least the academics themselves must engage to establish solutions to improve transparency and accountability of research. Physics Nobel Laureate Peter Higgs said in an interview that he “could not have predicted the Higgs Boson in today’s academic climate”. Isn’t that a call for a time-out to figure out how to avoid replacing Higgses with Obokatas? •

SCIENCE

Drive responsibly

Photo: Flickr

How CAR-T cells are becoming safer and more efficient By Borislav Ignatov

Anti-cancer therapy using T cells modified to express chimeric antigen receptors (CARs) is becoming increasingly recognized as a powerful new tool in the therapeutic arsenal in oncology. However, despite the great promise this approach holds, recent failures in human trials have raised concerns over its safety. More and more people are now asking why some trials have failed, what we can learn, and how to improve CAR-T cell therapy. May 7, 2016 proved to be a grim day for futurists and tech enthusiasts. While driving in auto pilot mode on a highway in Florida, a Tesla Model S car crashed into an 18-wheeler truck killing the 40 year-old driver. The news quickly went viral – a promising new technology has malfunctioned and as a result a life was lost. Later in the same year, the field of cancer immunotherapy was partially thrown in disarray by a car crash of its own.

“CAR-T cells are viewed as the poster child for personalized cancer therapy.” In a clinical trial led by Juno Therapeutics, CAR-T cells led to brain swelling in three leukemia patients and their subsequent death. CAR-T cells are genetically engineered patient-derived T cells that possess a receptor composed of the variable fragment of an antibody on their cell surface, fused to an intracellular signaling domain. These receptors recognize a specific antigen on the surface of cancer cells and help the T cells find and kill tumors. 18

This cancer immunotherapy approach has shown promising effects in numerous pre-clinical models and encouraging results in clinical trials, especially in blood malignancies. CAR-T cells are viewed as the poster child for personalized cancer therapy due to the fact that the patients’ own cells are modified to target an antigen their own cancer expresses. An advantage of this therapy over small molecules or antibodies is that it represents a so-called “living drug”. This makes for longer-lasting effects of the CAR-T cells compared with those of a molecule that is short-lived due to excretion or natural decay. At the same time, CAR-T cells have the potential of immune surveillance or even immunological memory. This would, in theory, ensure not only the destruction of primary tumors and observed metastases, but also the elimination of metastatic cells too small to be detected. Undoubtedly, CAR-T cells hold a great potential in providing clinicians with a powerful tool against cancer and improving patients’ outcomes. Experts in the field warn, however, that there are still important lessons to be learned and that we should take cautious steps ahead, as attempts at long jumps may result in dis-

aster. The Juno failure was particularly alarming because it came from a relatively small cohort of around ten patients. The main suspect in the incident, however, was thought to be fludarabine – a chemotherapy given alongside the T cell transfusion, rather than the CAR-T cells themselves. Unfortunately, when the trial was resumed later the same year with an improved clinical protocol, two more deaths occurred and further treatments were postponed indefinitely.

“An advantage of this therapy over small molecules or antibodies is that it represents a socalled ‘living drug’ ” This sad news, combined with the announcement from the pharmaceutical giant Novartis that it was dissolving its own CAR-T cell division, had cast a thick shadow over the future of what appeared to be one of the most promising new therapies in the anti-cancer arsenal. People became skeptical of the concept and were worryingly asking: Is T cell modification safe? This important question, however, needs to be addressed in a more complex

SCIENCE Photo credit: Peter Knutson

context as safety is dependent on a multitude of factors: Can the approach used to modify the T cells turn them dangerous in the long run? Is the antigen the CAR-T cells recognize also present in normal tissues? How long can the T cells persist in the body once the tumor cells have been eliminated? T cell engineering should not be viewed as a rigid process going from cell modification to treatment, but rather as a molecular tool to shape the recognition and response of the cells. Our ability to genetically engineer T cells and use them to fight cancer will always be limited by our fundamental understanding of biology and the way the immune system works. Therefore, expanding our basic knowledge is essential to make these therapies safer and more precise. In the Juno trial, it is suspected that the targeted antigen was also expressed in small quantities in the brain of the patients, which led to the attack on healthy tissues. While such reactions are highly undesirable, to say the least, and may occur as a result of how the receptor was engineered, they can also depend on how much antigen is expressed by the tumor compared to healthy tissue. The latter may not be apparent before the treatment commences and complications arise, even after previous rigorous testing. The good news is that scientists are already on the move to make sure genetically engineered cellular therapies will become safer and more reliable. One concept that is currently under investigation is the introduction of a “kill switch” into these cells. The inclusion of a “suicide gene” in the engineered cellular genome prompts the cells to undergo apoptosis

once a specific substance is injected into the patient. If done in a timely manner, this should prevent the intensification of adverse events and protect the patient’s healthy tissue from further damage. The big disadvantage with this method is that one is essentially trying to alleviate the side effects of a very expensive therapy by killing it, potentially still leaving viable cancer cells in the patient. Not everyone views this approach as an “all or nothing” scenario, and perhaps one could adjust the dose to stop the destruction of healthy tissue while sparing a part of the engineered T cells to kill off tumor cells.

“We should always remember that big shadows are frequently cast by bright lights.” The opposite concept, an “on switch”, also seems very lucrative and is being explored. In this scenario, the antigen recognizing domain and the signaling domain are uncoupled from each other and can only be connected and thus function, by the introduction of a small molecule. Without it, the cell will be able to recognize the antigen, but not get activated to kill. This allows for time and dose dependent control of the CAR-T cell function. Some groups are also exploring the concept of intentionally making the receptor binding site imperfect so it would need the presence of an additional soluble molecule to successfully connect with the antigen. Another approach to make these therapies more specific is the introduction of additional receptors that allow the

CAR-T cells to be active only within the tumor. A group in Baylor College of Medicine, Houston, Texas has engineered cells CAR-T cells primed against pancreatic cancer. Alongside the CAR, the T cells were also equipped with a special receptor that allowed them to proliferate only within the tumor microenvironment. The mouse experiments showed that once the tumor was eliminated, the CAR-T cell population also started diminishing. Despite the bumps along the road, scientists and clinicians are not giving up on this promising cutting edge therapy. Currently, two big efforts to modify T cells using CRISPR technology are about to commence in China and the United States. New and better designed CAR-T cells are in the pipeline of several biotechnology and pharmaceutical companies. But the large push forward would be meaningless without the more personal success stories. Stories like that of 2 yearold Layla Richards from Great Britain who was the first person in the world to receive a lifesaving CAR-T cell therapy and is now leukemia free 18 months after. As our fundamental knowledge of cancer and the immune system deepens and our techniques of more precisely targeting tumor cells and sparing healthy tissue improve, Layla’s case may be turned from a viral news story to a game changing treatment for thousands of patients. We should learn from the recent and any future failures and always remember that big shadows are frequently cast by bright lights. And the future of engineered cellular therapies against cancer seems bright indeed. •

FEATURE

Making the invisible visible Have you ever wondered what it looks like when malaria parasites infect red blood cells? Photographer Lennart Nilsson (19222017), who passed away this January, did. He captured that perfectly timed moment as well as many others during his long and fruitful career. Nowadays, his images can be found all across Karolinska Institutet. Photography Lennart Nilsson produced documentary and portrait photography, but he became world-famous for his pioneering work in medical photography. His highly acclaimed images of human fetuses was published in the magazine “Life” and in his book “A child is born”. The series was one of the opening exhibits at Stockholm´s Fotografiska Museet in 2010, for which Nilsson was invited to cut the ribbon. Lennart Nilsson experimented with photographic and microscopic techniques to visualize medical research and “make the invisible visible”.

Professional Career at KI Joining KI in the 1970s, he collaborated closely with scientists there - bridging science and art as well as research and society. KI has honored Nilsson for his contributions by appointing him Honorary Doctor of Medicine in 1976 and by granting him the Karolinska Institute Jubilee award in 2010. The Swedish government gave Nilsson an Honorary professorship in 2009. From 1998 onwards, KI has distributed the Lennart Nilsson Award with the aim of promoting education, training and research within the medical, biological and engineering sciences through the use of images. The KI Library holds several copies of his most famous books for those interested in more of his fantastic work. To honor his work, Fotografiska Museet is displaying a small selection of the “A child is born” series again from February 6 to April 2 - so don´t miss out on that! •

Photo: Saket Milind Nigam for Medicor Text: Joanne Bakker

FEATURE

GEORG KLEIN 1925 - 2016 Photo: Gunnar Ask

A life driven by curiosity By Benedek Bozoky During his life, Georg lived through a world war, escaped a communist regime, built up a world leading research institution where cutting edge research was done for decades and inspired a generation of successful scientists before passing away at 91 years of age.

n 1944, he was still a 19-year-old Jewish-Hungarian teenager in Budapest. The Nazi’s had taken control of the country and began the deportation of the remaining Jewish population of Hungary. By then the news had reached them about the horrors of the concentration camps, but many refused to believe it. Jews had been part of the country for generations and fought and died for their country during WWI. Few would have imagined what the nation allowed to happen. But the reports, brought to light by two escapees from Auschwitz, were too detailed to be untrue. Going against the mainstream, as he often did, Georg de22

cided he wasn’t going to board the trains headed for the concentration camps. And so, while in one of the rounding-up camps heading for the trains, risking his life, he miraculously escaped through a door that hadn’t been guarded.

“He survived the war, but watched old friends turning their backs on him, and a nation failing to protect its people.”

After the war, Georg started his medical studies and during a summer night by the lake Balaton, he met Eva, the most beautiful girl he had ever seen (as he would often retell the story). Shortly after they married, she became his lifelong partner not only in life but also in science. By coincidence and a series of unlikely events, which included paying off a train conductor, running out of money and receiving help from the Polish Jewish community (who they had never met before), Georg and Eva escaped from by now communist Hungary and moved to Stockholm. Here they finished their studies and started their research careers. To-

FEATURE Photo: Klein archive

• M.D. Karolinska Institute, 1951 • Professor of Tumor Biology and Head of Department of Tumor Biology, Karolinska Institutet between 1957-1993 • Published over 1385 papers in cancer research. • Published 14 books about his life, science, literature and philosophy, including “Jag återvänder aldrig” (I will never return), Pietà and “Resistense” (Resistance). • Georg Klein died on 10 December 2016 at the age of 91.

“Never too serious about himself, or what he had accomplished, but always humble, down to earth and with a good bit of self-humor.” gether they would help to start the field of tumor immunology, laying the groundwork for today’s successes in immune therapies against cancer. Their many discoveries included the tumor suppressor genes and figuring out the immune systems protective mechanism against cancer cells. I stumbled into Georg’s office nearly 60 years after he had moved to Stockholm. As a young medical student, I had met enough professors to know that their arrogance and self-image is typically correlated with their success. By then Georg had amassed many distinctions: hundreds of publications from pioneering research,

Georg and Eva Klein during a conferment ceremony for doctoral students together with their son Peter.

students who would become deans, and rectors at KI, countless honorary doctorate degrees and author of over 10 books. Meeting Georg you wouldn’t have expected it. His door was open for everyone and he spoke with the same humbleness to all. During our group meetings and celebrations, Georg would entertain us with stories from his incredible life. They ranged from the times he chaired the Nobel committee, to the times he met the king of Sweden. He would tell us about his core beliefs to do good science: to always share your findings with the field and to create a good and open collaborative environment even with your competitors. He never allowed us to keep any research to

ourselves, but always urged everyone to discuss and share their findings. From all the stories my favorite is about a Midsummer night’s eve he worked all night in the lab. Back in the 60’s, the department was receiving frozen tumor samples from Africa. They arrived in the late afternoon, so the staff stayed for the evening to process the material. As it happened, one of the batches was to arrive on Midsummer eve. Because of the holiday he couldn’t ask anyone to stay late, so he volunteered for the job. Georg spent little if any time in the lab, and so it was no surprise to himself or anyone in his group that all the samples were ruined, 23

FEATURE

despite him working all night. Still, as the night went on, he felt happier and happier. By the time, he was driving home in the morning he was ecstatic. Why? He realized later that his joy came from skipping the celebrations that he otherwise would have had to attend and pretend to enjoy. The story might sound silly and irrelevant to most. But it reminds me of how he was. Never too serious about himself, or what he had accomplished, but always humble, down to earth and with a good bit of selfhumor. University education can often feel unmotivating for us students. Studies that once started out of an interest and curiosity for a subject, tend to turn into monotone learning to pass one exam after another. At the finish line, we are happy to forget about the trouble we had getting there, and move on to leave academic life behind us. When I met Georg, this all changed for me. He never told me, or anyone else in the group what experiments to do, or when and how much to work. He never taught me any lab technique or how to perform data analysis. What we did was to discuss science, and also art, literature and psychology. Instead of telling his students what to do, he instilled in them a curiosity to understand. As it has already been formulated, I will rely on the quote by Antoine de Saint-Exupery, “If you want to build a ship, don’t drum up people to collect wood and don’t assign them tasks and work, but rather teach them to long for the endless immensity of the sea”. 24

“Instead of telling his students what to do, he instilled in them a curiosity to understand.” I think more than anything, this is the reason why so many people hold Georg in such high regard, and why I am most thankful to him. It is also why so many of his students have become such exemplary people. They understand that true science comes from the curiosity to learn about the unknown, and instead of teaching only the tools for science, they try to pass on the interest and passion for finding things out as well.

Photo: Fredrik Persson

Two weeks before he passed away, Georg was still coming to the lab daily together with Eva. At 91 years, with a bad hip, and weak from a chronic infection he refused to stay home. It was the final proof of his determination to keep learning, driven by his curiosity. And how could he have stayed away from the lab, the department he once built? Where he had created a research environment that would sprout world leading research for decades, and where scientists would learn to become leaders in their fields. Where he had found a home after a terrible war in an international research environment that wasn’t bound by borders or ideologies and where he helped guided young students, including myself, towards a stimulating field of science and research. •

Lumos Maxima

FEATURE

By Gustaf Drevin

Jedi master. Data visionary. Rock star. Pop star. The one who made data sing. Magician.

raise and admiration from all over the world poured in after Hans Rosling’s passing on February 7th. I was not alone to cry that evening. My high school class had watched his TED Talks in Theory of Knowledge (philosophy) class back in 2009. My world view and career hopes changed after that. He did not render anybody indifferent. Such was his being, the everlasting first impression. Medicor’s story is tightly tied to this wonderful, wonderful scientist. He was the cover story dream come true in our 2013 re-launch. A group of students set out to recreate Medicor with global and educational value. Hans fit perfectly for the cover interview, which we have made available online (see Photo: Martin Kjellberg for Medicor the text box). We talked about students’ You probably have your own Hans role in global health and respecting the knowledge and skills of your colleagues Rosling story. Many of us health science students have him to thank for our career in poorer countries. choices. Maybe you chose epidemiology I remember laughing at fellow stu- because he made numbers relevant to dents who accompanied Hans to a stu- social change, pursued medicine because dent ball but were disappointed that he you found inspiration in his professional had talked about global health through- story, or became a global health enthuout the evening. His unique fervour and siast after better understanding how the intensity was no façade nor dramatis world is interconnected. personae. It is too easy to simplify Hans As the world seemingly take turns for into a pedagogically optimised juxtaposition of humour and seriousness. But, the worse, our generation have to assume he relentlessly fought the persistent ig- the legacy of firm-handed factfulness, norance. My current mentor, Johan von incessant inquiry into the state of the Schreeb, recalled how they jokingly had world, and uncompromisingly standing given Hans blinkers for his 50th birthday, up for the extremely poor. because he always worked on a myriad Admittedly, this is a daunting task. of problems simultaneously, while his But we are fortunate to enjoy an updated friends would say he needed to focus. worldview, standing on the shoulders of Hans wanted to remain an educator, a man who would spellbind us by wavrather than a larger-than-life Time Maga- ing his solidified laser beam or titanium zine hero. He lambasted people who ro- hip implant like a wand illuminating the manticised poverty. He repeatedly berat- darkest corners of ignorance. A man ed the otherwise internationally revered whose patronus was a constellation of editor of The Lancet, Richard Horton, brightly coloured Legos and bub- bles, orwhen he said that global health is his life ange, red, blue, green, and yellow against philosophy. Because, factfulness entails a light-blue backdrop. letting evidence, not predetermined opinions, govern your actions. Together with No, Hans Rosling was not just a Jedi masOla Rosling and Helena Nordenstedt, he ter, rock star, nor just a simple magician. knew how to present datasets in order to He was so much more. change mindsets. He was so often right He was our Dumbledore. • and we were quite often unenlightened.

HANS ROSLING 1948 - 2017

“

“…This goes on for 15 minutes, until Gustaf finally gets the chance to interrupt him: “It’s issues like this that we want to share with the students at KI, and therefore we’d love to have an interview with you.” Gustaf looked like his heart stopped. And I think mine might actually have. After what seemed like an hour, we hear “Sure”. “Sure”!?! What? Hans Rosling just said yes to an interview!”

”

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You can find the 2013 Medicor interview with Hans at: https://medicor.nu/hans-rosling-onwhy-we-should-care-about-globalhealth/

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For a personal account of Medicor’s first meeting with Hans, please visit Jingcheng Zhao’s blog post “Shooting a Portrait of Hans Rosling for a Student Magazine Cover”: https://petapixel.com/2013/06/10/btsshooting-a-portrait-of-hans-roslingfor-a-student-magazine-cover/

FEATURE

Snippets of Hans By José Damas

ince the word ‘viral’ was taken away from medicine by the entertainment industry, space for science narrowed. Most of the space on the internet, social media, and television are kidnapped by fantasy and reality shows, with tons of memes and cats in between. We cannot blame the entertainment industry alone. Science itself retreated from the public space, like a teenage boy, closed the door of its room while it grew up, and found itself behind paywall subscriptions worth thousands of dollars per year. Behind this whispered war, a revolution began. “Vive la résistance! Shout out loud from TED!”. Many scientists took the opportunity to bring science closer to the public through TED Talks. Hans Rosling appeared for the first time in the TED world in 2006 with his hit performance ‘The best stats you’ve seen’. Only time can tell how much the game changed in public health sciences after that. Global health field finally got its hero. Even before the TED talks, he already had a prolific career within public and global health sciences. Nothing to prove, but a lot to teach. To the field, Hans was a hero and teacher. But for others, he was also a friend, a close colleague, a mentor, a relative, and a physician. This is Hans, the man beyond the TED Talks, as remembered by his colleagues and friends. INFORMATION IS NOT NECESSARILY KNOWLEDGE “He would ask you a lot of questions, to make you feel uncomfortable. He would not tolerate lack of information, he would ask for your sources, examples. He would push you to make you think. I think that in the end when people left the room, they felt so good because now they felt they knew the information properly.” JOB APPLICATIONS WITH HANS “When we started to work together, me as a postdoc, we were discussing my salary and he said, ‘I will pay you 5000 SEK per month.’ I replied, ‘What? I will earn more at the hospital!’ (laughs) and he told me, ‘Why are you worth more? Why should you earn more than a person in Nigeria? Your colleagues in Nigeria earn 5000 SEK doing the same job. Money is money.’ “ Anna Mia Ekström Clinical Professor in Infectious Diseases Epidemiology, KI. Worked with Hans for over 15 years.

THERE IS ALWAYS ROOM FOR FACTS “He was really warm, he always remembered and asked about your family. But he was really rational, he would use facts and data to give personal advice.” (…) “One day he asked me about when I will have kids. ‘Have you thought about getting a kid? Look at the fertility rate of the country, it is going down, you should have a kid.’ ”

HISTORY WILL BE KIND TO HANS “He was really serious about the whole situation (the Ebola outbreak). He told me that he spent some evenings listening to Winston Churchill’s speeches to get some motivation. He said, ‘This is the feeling that I’m having right now, this is how serious it is, this is WWII, but our enemy is easier because we know who the enemy is, it is not people against people, it is people against the virus.’ ”

NOT YOUR TYPICAL DINNER NIGHT “He was really funny and unexpected. He would run randomly and jump a fence. One day in a restaurant at dinner he tried to swallow some knives.”

Helena Nordenstedt: Assistant Professor in Global Health, KI. Worked with Hans for over 3 years, especially during the Ebola outbreak. ‘PLEASE, NO TOUCHING’ “While were in Liberia for work, we were not allowed to touch anyone in that month we were there for the risk of spreading the Ebola virus. I was sitting on my first evening after I had arrived, not touching anyone, with my plate… and then all of the sudden I heard a voice with a Swedish accent, ‘HELENA, YOU ARE HERE!’ and there was Hans. I was so happy to see a familiar face, to see someone I knew, that I jumped on him and I hugged him, and he stayed completely rigid, stiffened, not hugging me back, when normally he hugged everyone… And I thought, why is everyone so quiet in the room? There was a complete silence in the room all of a sudden, and it took me a few seconds to realize ‘Oh, I broke the rule… they are going to send me home, I touched someone.’ ” (She was not sent back home.)

FEATURE UNDER THE UPPSALA SUN ‘He told me that plane flights are the only times when he sees movies, and he told me that he always watches B-quality chick flicks. He really liked them. He would tell me, “Helena! I just saw this movie, it was great… I cried and I laughed so much.’ ” THE BIG BANG HANS “Hans used to talk a lot! He teaches and talks, and teaches and talks; and he also listens, but generally talks quite intensely. We were going back to Sweden and arriving in the middle of the day to Sweden after a fourday conference, and I had been listening to him happily for all these days, but we were on the night flight from the US and the day we arrived in Sweden I was supposed to do the night shift in the hospital. I was thinking, ‘I need to get some sleep! How can I make him make him quiet for some time? I can’t listen to him anymore’. But how do you tell you say to Hans to shut up? So, I managed to persuade him to watch my favourite TV series – The Big Bang Theory – and he really liked it! He saw like four episodes straight, and I thought ‘Yes! Some silence, I can get a little time of my own.’ ”

Asli Kulane: Assistant Professor in International Health. Programme Director for the Masters in Global Health and Erasmus Mundi. Worked with Hans for 15 years.

WIKIHANS “He once said, ‘I know about 200 countries, while other people know about 200 kinds of wines, while I only know two kind of wines.’ ” WHAT GOES AROUND… COMES AROUND “Hans wanted exchange between countries. When you talk to many people, you get the idea that low and middle income countries are going to get something from high income countries, that we are filling a system, doing capacity building. But he saw the two directions, he would say ‘Having international students here will improve our Swedish students’, the interaction was very important to him. It was a two-way street. He defended that a lot.” HANS BLESSED THE RAINS: “One of the things that surprised me is that I knew that he had lived in Africa and that he had worked there for a long time. But one day he told me, ‘You’re not the only one from Africa. I’m also from Africa, I was born in Africa.’ ” ALWAYS GO FOR THE EXTRA MILE: “Even on PhD courses, he would use props to explain. The first time that I was in a lesson with him I was like “What is this professor doing with that?” He came with a bucket and half a kilo of popcorn for illustrating how many people needed water and food. So, everything he did on the TED Talks, he had done before in the classroom. He brought toilet paper, Lego pieces/bricks, etc. For him, it was not about what kind of props he used, it was about ‘Am I reaching them? Am I making them understand these facts?’ ” •

“ For him, it was not about what kind of props he used, it was about ‘Am I reaching them? Am I making them understand these facts?’ ”

THE PACIFIER “One day, in a PhD gathering, we did karaoke, everybody had to sing and we were cheering for him, ‘Come on, Hans. It’s your time to sing.’ And he sang ‘Twinkle, Twinkle Little Star’ in Swedish. And somehow people connected, everyone knew that song in their native language and before you know it, this PhD gathering became a day care party, with everyone singing Twinkle, Twinkle Little Star.”

Photo: Jingcheng Zhao

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GLOBAL FOCUS

Cultivation theory: how media shapes our worldview By Zach Chia

Photo: Pixabay

Something nice and sweet trends on social media… a commenter types - “faith in humanity restored”. Many others rush to like the comment. Something tragic takes place, many people die… the onlookers read the news and sigh “what has this world come to…” Many others react by changing their social media profile picture. The Cultivation Theory, which was first developed in 1976 by George Gerbner and Larry Gross, studies the longterm effects that media, particularly television, have on our world view. The fundamental idea is that our perceptions of the world are shaped by the amount of time we spend exposed to media – the more time spent watching television, the more it encompasses our reality. While the concept of Cultivation Theory began as a study of the long-term effects of television viewing, newer modes of Cultivation Theory have begun to include long-term consumption of other forms of media. One of the conclusions of the Cultivation Theory is the phenomenon known as Mean World Syndrome. Gerbner showed that the amount of time one spends watching television is directly proportional to how unforgiving and intimidating one thinks world is. As we see more violence on television, we come to overestimate the violence in reality. However, this doesn’t only apply to viewing televised violence. In the immediate aftermath of the Malaysia Airlines plane accidents in 2015 (MH 370 and MH17), the 24-hour news cycle had wall-to-wall coverage of the crash and every stage of

the investigations. The airline reported a loss of approximately 97 million USD that quarter (almost double compared to preceding year), and has since been restructured with a loss of 6000 jobs, along with an uphill trudge towards changing the fear of flying with Malaysia Airlines. Yet, the risk of death from flying is 1 in 7 million, comparatively low to the risk of death from cycling, which is 1 in 88,000.

(2007) summarised neuroimaging and behavioural evidence to argue that negative memories convey more details that positive ones. Furthermore, evolutionary biologists, such as John Garcia, have hypothesized that the power of negative events is vital to our survival as a memory of a negative experience allows us to avoid the same negative stimuli.

Why does the news media peddle such violent and tragic stories? Essentially stories that generate emotions draw viewers in. News about the end of the world sells more effectively than news showing improvements in life and conditions. Viewership numbers matter because the more people tune in to a station or medium, the more effectively companies can advertise in the space allocated to them on that channel. This may not be something solely under the umbrella of management and marketing, but also concerns psychology and biology.

The current president of the United States has been observed to watch a lot of FOX News, which has the tendency to portray the world as made up of moral absolutes and peddle an “us-versus-them” worldview. On more than one occasion, the current president of the United States has claimed that there are “a lot of bad dudes out there” and more recently, he claimed an immigrant-caused incident in Sweden that no Swedish resident could identify.

In their seminal work, Baumeister and colleagues (2001) argued that there is clear evidence for bad events having a stronger impact than good events on human psychology. In a review, Kensigner

But does all this matter?

In the era of alternative facts and fake news, understanding the concepts of Cultivation Theory, Mean World Syndrome and their biological and psychological relevance is more pressing than before.•

GLOBAL FOCUS

Photo: Pixabay

The Glasgow effect: the power of vulnerability By Ronan McCabe Glasgow, the largest city in Scotland - the cultural hub of the country. Emerging from the 20th century, and characterised by heavy industry, the city now also hosts an exciting music, arts and nightlife scene, drawing from its rich and deep-rooted traditions. But the city has a darker side – a mystery that has plagued epidemiologists for a number of years. Glasgow has the lowest life expectancy in Western Europe. When compared to other post-industrial cities (e.g. Liverpool and Manchester), there remains an unaccounted for ‘excess’ in poor health outcomes. Socio-economic deprivation, the foremost driver of poor health in any population, does not offer adequate explanation. Even adjusting for behavioural (e.g. smoking, diet, exercise) and biological (e.g. blood pressure) risk factors does not elucidate the reason for this difference. It cuts across disease, age, gender, and social standing. For example, after controlling for confounding factors, premature mortality (<65 years) in 2010 was observed to be 30% higher in Glasgow than in both Liverpool and Manchester; a similar comparative study with the 30

Northern Irish city of Belfast corroborated these findings. This excess in mortality is infamously, and colloquially, known as the ‘Glasgow Effect’.

“What lies at the heart of the Glasgow effect, how is it being addressed, and what lessons can be learned?” According to epidemiologists, the concept of socio-economic ‘vulnerability’ is the key to understanding the Glasgow Effect. This concept could be understood as the balance between the exposure to detrimental factors (e.g. socio-economic deprivation) and the ability of the population to cope with this exposure. If in the

face of this exposure the ability to cope is lost, then the population will be more vulnerable to poor health outcomes compared to a population whose ability to cope remains. It is thought that the Glasgow population’s ability to cope has been fragmented and eroded. With the loss of social coping mechanisms an excessive socio-economic vulnerability has been created, which compared to other cities, such as Manchester, has led to higher mortality. But why is Glasgow particularly vulnerable? The answer is thought to lie in social, economic, and physical changes, that occurred in the years following the end of World War II. •

GLOBAL FOCUS These changes are thought to have compounded the effects of historically high levels of socioeconomic deprivation that had already existed there before. These changes included, for example, the creation of New Towns. Built in the surrounding countryside, the original intention was to ease the over-crowdedness of the city and resolve the health and economic problems of the time. However, during a delay in planning from 1946 to 1950, the original intention was subverted by a new notion of ‘modernisation’ which sought to increase economic growth through focusing the New Towns on lighter and higher skilled industries. This had the effect of being ‘socially selective’; swathes of the population moved from the city but only those who aligned with the New Towns’ economic criteria. Thus, sections of the population, particularly skilled and young people who are considered less vulnerable to detrimental exposures moved to the new towns, leaving behind a city that was seen to be waning economically at the time.

responsible for the detrimental policies of that era, became deeply unpopular amongst the Scottish electorate. However, due to the ‘democratic deficit’ little could be changed as the Scottish vote was drowned out in elections. The result was a defeated and disenfranchised population, with a lost sense of agency over the events of daily life; the psychological toll of this has been noted by epidemiologists, particularly the role of agency and in mental health. The 1980s left a bitter taste in the mouths of the Scottish electorate. Following the British Conservative party’s loss in 1997, it retained only one out of the 59 Scottish seats. Although 56 of 59 Scottish seats are currently held by the independ-

“The concept of socio-economic ‘vulnerability’ is the key to understanding the Glasgow Effect.” This move left behind those considered more vulnerable, like workers and families of workers in heavy industry with lower-incomes. The policy of the UK Government during the 1980s, almost thirty years after the start of New Towns, is thought by epidemiologists to have worsened the situation. These policies included the heavyhanded de-industrialisation of Glasgow’s heavy industry, the erosion of trade unions, and a reduction in available/affordable housing through a decrease in the financing of state funded homes. The result was high unemployment and increased inequalities. Glasgow was not the only place in the UK that faced such policies, but it is thought to have suffered more due to inadequate local response falling short of providing the buffering effect seen in other cities. Linked to the political circumstances of the 1980s, researchers in the field also contend with the relationship between vulnerability and the concept of the ‘democratic deficit’. Scotland has 59 seats out of 650 in the UK parliament; the entirety of the Scottish electorate could vote a certain way and still see a majority government elected that is in no way representative of that vote. The Conservative party, which formed the UK government from 1979-97, and who were

Photo: Olivia McCabe

The Finnieston crane: a relic of Glasgow’s industrial past ence supporting Scottish National Party, the British Conservative party once again forms a majority government. As UK politics become increasingly divergent (Brexit) to the political leanings of the Scottish electorate, the ‘democratic deficit’ is being felt, fuelling a desire for independence that is unabated since narrowly

losing an independence referendum in 2014. From the work of public health bodies such as the Glasgow Centre for Population Health, the understanding of vulnerability and its relation to health and wellbeing is gaining ground. This has led to the formation of various charities and organisations that have made the enhancement of social coping mechanisms their focus. One of these is the GalGael Trust which has provided a means of social cohesion, solidarity, and purpose. It has notably achieved this through the community led building of Birlinn; these boats, of Norse influence, provided the backbone to the Gaelic culture of Scotland’s west coast until around 300 years ago. The GalGael Trust states that through this they have created a ‘cultural anchor’ for members of Glasgow’s population; both a reference to the shipbuilding industries that suffered heavily under the UK Government of the 1980s, and the sense of community that to this day is integral to the Gaelic culture which now mainly resides on the Western Isles of Scotland. The Scottish population exhibits this excess in poor health outcomes, albeit to a lesser extent than Glasgow. What this shows – with the Glasgow Effect being a major component – is the extreme end of what social medicine and public health has been discussing for years: that health and wellbeing are not just dependent on the quality of the health care system, or specific health interventions. Rather, society’s function as an interlinked system, as an interconnected whole, plays an important part. In Scotland this has led to public health initiatives such as the AfterNow project, which encompasses a number of facets of modern society, exploring how they impact health, while advocating change on a systems level. Perhaps most importantly, the Glasgow Effect may exemplify a defining notion in public health this century. Looking beyond Scotland’s shores, with the global rise in health issues such as addiction, mental illness, obesity, and a general loss of wellbeing, the concept of vulnerability may apply on a wider scale. Several unanswered but high-priority questions arise with this observation: is exposure to detrimental factors increasing in daily life? Has the ability to deal with these exposures been decreased? Often focus is placed on what has been gained in modern society, but do we sufficiently consider what has been left behind in its wake? •

GLOBAL FOCUS

Filling the ignorance gap By Zach Chia In October 2016, a comment was published in The Lancet, titled “Global health seems to have entered into a post-fact era, where the labelling of numerators is incorrectly tweaked for advocacy purposes.” The article was written by Helena Nordenstedt and Hans Rosling from KI. Their comment was written in response to a percentage that had made its way in the first report of the International Accountability Panel of the UN’s Global Strategy for Women’s, Children’s and Adolescents’ Health. In the report, the panel mentions that 60 % of maternal deaths took place in a humanitarian setting, implying that a lot of resources should be put on humanitarian settings in reducing maternal death. This number first appeared in 2015 and was quoted in major public health documents. Nordenstedt and Rosling were puzzled by this data…how is this possible? Now that it had made its way to international governmental documents they had investigate this. What they found was shocking. 60 % was a crude extrapolation. All maternal deaths in the 50 most vulnerable countries in the

world were considered as deaths in humanitarian settings and divided by the total number of maternal deaths in the world. Using a more logically sensible estimate (calculating only people who are receiving humanitarian aid as people in humanitarian settings), Nordenstedt and Rosling measured the percentage of maternal deaths in humanitarian settings to be closer to 17 %.

Over the last two centuries, the life expectancy of the human race has increased overall. In 1800 the worst life expectancy in the world was from Yemen at 20 years old, in 2013 the worst performing country was Sierra Leone at 45. On the other end of the scale, Sweden had the highest life expectancy in 1802 at 40 and in 2013, Japan had the world’s highest life expectancy at 83 years old (life expectancy in Sweden was 82 in 2013).

Chasing rigorous facts and arguing for a fact-based world had been a passion of Hans Rosling in the last decade of his life. The need for facts (plain and simple) cannot be understated in a ‘post-fact’, ‘alternative fact’ world. In fact, Rosling was ahead of the curve when it came to a factbased world. We live in a world flooded with facts, but we swim in a whirlpool of ignorance.

While far from perfect, child mortality of children younger than 5 years old in Sierra Leone (the worst performing country) has fallen from 514 deaths per 1000 born in 1901 to 182 in 1000 as of 2012. The fall in Japan (the best performing country) is even more dramatic, from 362 deaths per 1000 children in 1862, to 2.8 deaths per 1000 children as of 2012.

And that ignorance arises from assumptions. The non-profit foundation Gapminder seeks to challenge our assumptions with real facts.

The data from Gapminder Tools is not there to make us feel good, but to clear up misconceptions. Let’s use it. •

What do these facts show? “[A] world where most things improve; a world that is not divided.”

INCOME LEVELS

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About Gapminder

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Gapminder has continued and extended Trendanalyzer with an improved version called Gapminder Tools.

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HEALTH & INCOME OF NATIONS IN 2015 This graph compares Life Expectancy & GDP per capita for all 182 nations recognized by the UN.

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They set to work by creating a statistical visualization software called Trendanalyzer, that combined officially collected statistics and allowed an individual to plot them using interactive graphs.

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Gapminder was founded in 2005 and led by Hans Rosling, his son Ola Rosing and his daughter-in-law Ana Rosling-Rönnlund (together with a board of directors).

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a free fact-based worldview

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DATA SOURCES—INCOME: World Bank’s GDP per capita, PPP (2011 international $), with a few additions by Gapminder. X-axis uses log-scale to make a doubling incomes show same distance on all levels. POPULATION: Numbers from UN Population Division. LIFE EXPECTANCY: http://www.healthdata.org/— The interactive verison of this chart is available at www.gapminder.org/tools which lets you animate historic data for hundreds of indicators. LICENSE: Our charts are freely available under Creative Commons Attribution License. Please copy, share, modify, integrate and even sell them, as long as you mention: ”Based on a free chart from www.gapminder.org”.

Graphic: GapMinder Foundation

CULTURE

City Bikes: the good, the bad and the ugly By Olivia Miossec According to a Danish study, every kilometer you cycle, society gains around 2,1 kronor, but every kilometer you drive, it loses 1,5 kronor. I know. These numbers are quite abstract and probably do not resonate with you. So how about this; with every cyclist gained in a city, a subway or bus commuter is lost. If you have experienced and barely survived the T-bana or bus at rush-hour, this should have you jumping for joy (if not directly onto a saddle). Bikes promote health and exercise, curb pollution and fluidify traffic. These are some of the reasons why, for the past decade, in a desperate effort to drag its citizens away from the steering wheels or underground tunnels, a thousand or more cities have implemented bike-sharing systems. The concept of bike sharing is simple: government-funded bikes can be found all around the city, docked to ‘smart’ stations. All you need then is a credit card or bike pass to rent the bike for a few hours. How it all began

The history of bicycle-sharing, not surprisingly, begins in the Netherlands with Luud Schimmelpennink. As a political statement against the system, he introduced ‘white bikes’ in 1965 across the city of Amsterdam. Anyone could use these (and hopefully bring them back) at no cost. The government, always the party poopers, confiscated the bikes, putting an end to the project. Then, in the mid-1990s, a second generation of bike-sharing was born. It was Copenhagen, again not surprisingly, which implemented the first official, government-supported bicycle-sharing system, where you rented a bike against a deposit of a few coins. The one weakness of this system: having too much faith in people’s decency. Indeed, due to anonymity as well as the low cost of

Photo: Tony Webster, Flickr

the deposit (about the same amount you would give for a supermarket caddy), most of the bikes got stolen. A third generation of bike-sharing programmes came about in the late 90s and early 00s in Germany and France. These introduced ‘smart’ docking stations where credit or subscription cards could be inserted to release the rental bike. This removed anonymity and increased accountability. You could still run away with one of their bikes, but now they could retaliate with your personal and credit card details at hand. It was however only after the implementation of the largescale, successful and thus trendsetting Velib’ program in 2007 in Paris, that bikesharing programmes became widespread across the world. Despite being french and wanting to give all the glory to

my nation, I must give credit where credit is due; the man behind both the Copenhagen and Paris bike-shares was the one and only Dutch bicycle superstar Luud Schimmelpennink; the father of all bike-shares.

Stockholm City Bikes

So what about Stockholm in all of this? Whilst not as famous as the Netherlands or Copenhagen, our city is extremely bicycle friendly. If you look down at the ground as you walk, you will note that the bike paths are larger than the pedestrian ones. You may have also experienced the heart stopping woosh of bicycles as they zoom past you at reckless speed on the sidewalk. When you yourself are on the bike (and realize cyclist are no less aggressive than when you were a pedestrian), you will almost never have to share the road with cars, the bike paths being extensive and frequent. As for the bike-sharing system, in 2006, the Stockholm City Council implemented the ‘City Bikes’, a system similar to what can be found in Paris, London, Copenhagen or even Beijing. It is the result of a partnership between the city of Stockholm and the outdoor advertising unit Clear Channel Communication (the reason for the colourful advertising placed upon the bike’s wheels). The bikes are available from April to October, from 6am to 10pm and subscriptions are either 3-days (165 SEK) or season-long (300 SEK). The maximal rental period is 3 hours. The technology-savvy city has also developed an app which provides information on station location and bike availability.

CULTURE one card. This could elevate bicycles to a competitive alternative to buses for commuters emerging from the depths of subway lines. Goodbye bus number 3 commute to KI, hello City Bike ride. Stockholm City Council has also declared that they will increase time availability for biking and the length of the season, as well as the choice of subscription types. They are thus addressing the bigger flaws within the system.

Photo: Olivia Miossec

Room for improvement

‘City Bikes’ are far from perfect, but no programme is. Paris has too few bike lanes. London only allows 30 minute long rides and Barcelona’s BiCing programme is only available to citizens and residents. What about Stockholm? As of 2018, the current contract will expire. Stockholm City Council and the traffic office are thus working to develop and improve the current system. So, what exactly is in dire need of change? First things first. City Bikes have 150 docking stations and around 1500 bikes. The stations are therefore spaced far apart from one another and finding a station emptied of all its bike is too frequent an occurrence. Cough *Karolinska* cough. More than once, I ended up locking my City Bike to a pole and limiting my fika, visit or swim to less than three hours - because there was simply no station within a 20 minute radius of my location. There are also some popular or practical areas such as Djurgården or central station which simply lack bicycles. Another important issue is the brevity of the bike rental season: City Bikes only run from April to October. I know that the Stockholm winter seems interminable but it’s not five months long either. We don’t live in Narnia. So how about extending the season a few more months, or even the whole year? From the cosy seat of the bus, I have witnessed many commuters biking in the coldest, darkest days of winter. Of course, this confirms my belief that Stockholmers are just a tad bit insane. But should we not reward and encourage insanity if it promotes health and gives me more seating space on the heated bus? Continuing on the theme of time-frame: bikes are not available after 10 pm. You know what else is not available after 10 pm? Subways and buses!

The most troublesome flaw is the bikes themselves. Have you tried biking up a hill with these bikes and their so called three ‘gears’? I have died so many times halfway up the most ridiculously small hills. This type of bike may work in flat lands such as Copenhagen and Amsterdam – but just the hill between Gamla Stan and Slussen is reason enough to consider a few more gears and a better mechanism.

“City Bikes have 150 docking stations and around 1500 bikes.” Whilst this article may seem only to cover my personal grievances, a recent 2017 survey of a thousand City Bikes users commissioned by the programme confirms what I have laid out above. The most important changes needed were bike volume, geographic availability and longer hours, closely followed by newer bikes and a year-round season.

So what now?

To solve these problems, the City Council must study other cities for inspiration. Which they have. Copenhagen and the Netherlands have already been visited. But how about hopping on a plane to Paris and witnessing the programme that launched a thousand programmes. Paris has around 1800 stations, located every 100 meter, and 200000 bicycles. Whilst you may argue Paris is a tad bigger and its population ever so slightly denser than Stockholm, this difference remains a considerable one. The Stockholm council has vowed to increase the number of stations and thus increase connectivity and availability. The aim is to implement a bike station at every T-bana exit and to combine your City Bike and SL subscriptions onto

Whilst these are considerable changes, more can still be done to elevate City Bike to a decent alternative to other forms of public transport. For this, we can look towards Copenhagen, a city which officially now has more bikes than cars on its roads. Indeed, always a city of innovators, Copenhagen implemented the first ever motorized bike-sharing system in 2013. Is this what City Bike is missing? On one hand, Stockholm cyclist are aggressive, lawless individuals and providing them with a motor would be a murderous enterprise. It would also be counter-productive to one of the greater goals of cycling: health and fitness. Indeed, a study with beta testers in 2013 in Copenhagen showed that, given the opportunity to not cycle at all and let the motor do the work, the testers proved to be as lazy as expected. On the other hand, it could open bicycle transport to a higher number of individuals, and thus fulfill another important goal: getting rid of cars and thus, pollution. Another innovative idea is a rewards system, with free credit for leaving your bike at certain locations which usually lack bicycles (cough *Karolinska* cough). This could improve availability and reduce the need to shuttle the bikes around the city.

On to a better future

Whilst I may appear harsh on the Stockholm bicycle-sharing programme, it is only because it is the system I know best. Stockholm also happens to be an ever-changing city (have you noticed Hagastaden lately?!), which constantly builds and innovates. It also has a hilarious rivalry with Copenhagen, the current cycling royalty. There is therefore no reason for 2018 not to be the year City Bikes goes from decent to amazing. And hopefully from then on, it will be city officials and traffic offices from other countries who will fly to Stockholm for ideas and inspiration. •

Infographics: Amanda Phingbodhipakkiya for March for Science

via Beyond Curie Project, https://www.beyondcurie.com/

CULTURE

Connecting through words: the power of conversation By Mauricio Barrientos Somarribas and Tatiana Álvarez Giovannucci Have you ever met somebody for the first time and felt it was impossible to get the conversation to flow? We have all been there, and some of us tend to struggle with this more than others. But even for those of you who normally feel at ease chatting with people, have you ever wondered: how good are you really - at the art of conversation? What is a conversation, anyway? The Merriam-Webster dictionary defines a conversation as an “oral exchange of sentiments, observations, opinions, or ideas”. Conversations allow us to peer into the minds of other human beings, to get a glimpse of their reality. This implies that improving our ability to engage other people and discuss various subjects can help us open our perspectives and enhance our understanding of the world. However, to improve our conversational skills, we must first understand how conversations unfold. The infamous small talk A casual conversation will usually begin with some small talk. Small talk is a type of conversation in which “the social function is more important than the content being discussed”. This implies that the conversation will revolve around common topics that all participants will feel comfortable discussing and will likely have something to say about. As our definition suggests, the implicit rules and functions of small talk depend on the sociocultural context. In the USA and Latin America, for example, people will easily engage in small talk with friends and strangers alike. It wouldn’t take long for a Spanish or Italian person to start chatting about culture, food or politics. In contrast, in countries like Sweden or Finland, small talk with strangers is not so common; it might disturb their privacy. Even in more familiar settings, people will respectfully take turns and wait for the person talking to finish their idea. Some people even consider small talk unnecessary, since it usually implies that the topics discussed lack depth or meaning. So the question arises: would we fare better in a world where conversations 38

were limited to those with a specific purpose? The answer is probably no: small talk plays an important role in facilitating social interaction in our daily life. It allows us to sense the general state of mind of people in our environment before engaging in a more functional conversation. It enables us to meet new people: e.g. foreigners might have a hard time approaching locals (and therefore, integrating) in places where small talk is infrequent. It is during these first interactions that we get a feeling for the person and his/her interests. Small talk also helps maintain a cordial environment at work, fills up space to avoid uncomfortable silences and finally, for recreation: some people just really enjoy talking.

But not all talk is created equal Despite its many uses, the downside of small talk is that it alone cannot build genuine connections with others. It rarely addresses feelings or strong opinions; personal or conflicting topics such as politics or religion are usually avoided. And even when we do have something to share, we easily surrender to small talk many times because it allows to escape from an uncomfortable truth: people

judge and disagree. Unfortunately, the fear of confronting our disagreements, learning to negotiate and reaching agreement is reflected in phenomena like Brexit or the rise of Trump: people are not willing to understand each other. Social media does not seem to help: why bother talking to somebody who disagrees with you when the phone in your pocket offers hundreds who agree? A study in the late 90s led by psychologist Arthur Aron showed that an intimate conversation of 45 minutes can lead to a feeling of close connection between strangers. The study paired unrelated persons and handed them a predefined set of questions that both individuals had to answer. The questions were designed to be personal, and ranged from easy (“Would you like to be famous? In what way?”) to more complex and intimate (“Of all the people in your family, whose death would you find most disturbing? Why?”). It was found that couples discussing the personal questions developed a sense of closeness that was not present in a control group that engaged in small talk. The study concluded that selfdisclosure and reciprocity are key factors to achieve the effect of connection. Where that newlyacquired closeness can lead is uncertain - perhaps it was only a nice dinner, but it could also become a close friendship or even a long-lasting relationship. One thing is for certain: you will probably learn something new, or feel something different. Perhaps that person will no longer feel like a stranger, and that feels good somehow. Meeting and truly connecting with other people through conversation can be a rewarding experience. However, if we introduce ourselves and start directly

CULTURE

Photo: Chris Blakeley, Flickr

with something like ‘Hey, I just met you, but my dog died and I have never felt more alone’ we will more likely end up in an awkward situation. So, how do we learn to have more frequent and better conversations? We looked for advice from more experienced buddies and found the following to be the key exercises to train your conversational muscle.

THE ROUTINE Warm-up Starting a conversation with a stranger has many challenges. And for many of us, the thought of having to endure the small talk phase is not really appealing. Why do we hate it so much? Catherine Blyth, author of the book “The Art of

Conversation” believes it is not really because of the banal nature of the topics discussed, but because of how silly it makes us feel. That self-awareness. Talking to a person we barely know, constantly switching topics to avoid an awkward silence, all while trying to simultaneously maintain both their and our interest in the conversation demands tons of energy. It’s best to just relax! Be genuine and change the focus from what we should say next, to what they are saying. Work out If we made it through the warm-up phase, we will probably start to feel more comfortable. Adventure time! Break some barriers and jump into deeper, more meaningful topics. To keep the conversation flowing: be present and listen sincerely. We take this for granted, but it is actually a skill to develop. This requires keeping our ears open (and more importantly, a wide open mind) to really understand what the other means rather than politely waiting for them to finish to make our point. Be genuinely interested, ask follow-up questions and comment from your own insight, but don’t make it about yourself. When facing people of opposing worldviews, be respectful: if you want someone to consider your point of

view, why would you be inflexible about theirs? If both sides avoid attacking each other, we might get surprised. This is especially relevant nowadays, to reduce unnecessary divisiveness among us. Argue facts with facts, and be willing to admit when you don’t know. A discussion is not something that you win, but a place where you learn and grow as a person. Finally, we should also take care of being understood. Three essentials: honesty, brevity and clarity. Radio journalist Celeste Headlee said it clearly in her fabulous TEDtalk: ‘Good conversation is like a miniskirt: short enough to retain interest but long enough to cover the subject’. TAKE HOME MESSAGE People’s realities are worlds apart, which often leads to disagreements and misunderstanding. Improving our conversations can help us understand other people and perhaps reveal what it is what we share that makes us human. •

Illustrations: Chris DeLorenzo (instagram)

CULTURE

New to Sweden?

Tips on how to fit in the Swedish culture

By Laila Naqvi Upon leaving the aircraft, I knew it was the beginning of another new adventure. If you are an international student like me, who loves to travel the world and takes education partly as an excuse, then you know that the adrenaline rush of discovering another land is indescribable. The process of trying to resettle, readapt, familiarize and reconstruct life is undeniably satisfying. Swedish universities rank amongst the top and are therefore a popular choice for knowledge seekers. Once in Sweden, the next step is not only to dive into your studies but also try to assimilate into the culture. Here, we give advice for incoming wanderers on how to do this. First, one should forget the stereotype that Swedes are extremely reserved and dislike making conversation. I agree that they might not initiate a talk, and you sometimes might get a passive vibe from them. You should not let that discourage you, because once you get the ball rolling, you will realize how friendly Swedes are. Only by getting to know the locals can you genuinely understand the social norms. My suggestion is to try to learn the Swedish language as soon as you arrive. Little by little, you will start to enjoy comprehending your environment and becoming almost a local. Once you have Swedish friends, you will get to know their lifestyle as well. You will soon learn to be extremely punctual, so don’t forget to keep track of the time when you get those invitations for Fika meetings! Food, music and sports are the best mediums to get a true sense of an unfamiliar culture. It’s a way to connect without having to speak, so even if you are not a fan of communicating through a newly-learned language, try out Swedish food, listen to their top hit singles and get fit by doing some sports. Fortunately, the international committee at Medicinska Föreningen (MF) has us covered by organising several programmes for the sake of integration. Language @ KI is for anyone interested to learn Swedish, with categories divided into beginner, intermediate and advanced. In the Tandem Project, students from different countries are matched to other applicants based on their language interests to connect and learn about each other’s language and culture. The Coffee hour is a relaxed social gathering from 4 PM at KIB (Solna Campus) on Thursdays with a weekly theme to kickoff a conversation.

Cooking@ KI is a great initiative for foodies who want to connect with a culture through its flavour. This project organises several cooking events during the semester with themes based on cuisines, so keep an eye open for the Swedish evening. Idrottsutskottet, the sport committee of MF, organises several sports events such as sports day, marathons and ski trips. There are also many initiatives to meet people outside of KI, which is hard enough as it is, especially if you are stuck in the lab all day. An example is ‘Kulturkompis’ (literally ‘culture buddy’). This project with the slogan “Make friends through culture” couples newcomers and Swedes to go (for free) to cultural events together. Another platform is ‘MeetUp’, a great way to meet people who have the same interests as you. There are groups as specific as ‘French speakers who want to learn Swedish’. The final tip will be to go shopping. You will soon notice that everyone dresses quite formally even for a casual day out. Swedes are known to have a modern, sophisticated style with dark monotone colours and basic patterns, perfectly matching the blessed Swedish weather. Wearing a similar outfit, you will at least look like the Swedes: fake it until you make it! And if all else fails, at least learn to practice the concept of ‘lagom’, where everything is appropriate and not necessarily perfect. With that said, make the best out of your time whilst you are here, and take away an ‘experience’ with you rather than a short-term stay. •

Stockholm burger quest

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By Ben Libberton

Photo: Freepik

With this high level of interest from the public, Yemi decided to take the website beyond the aggregate statistics and began visiting different burger joints to make video blog posts in an effort to describe what makes the perfect burger. His videos’ focus is on the first bite impression, as the burger “has to be the star”. So, according to the Burger King, what makes a good burger?

It’s the quite simple, but often overlooked burger-to-bun ratio. You should have a good bite of soft, but lightly toasted bun with every bite of burger. No burger hanging over the side, and especially no mini-burger on a giant bun. The acid test is when you’re finishing up: does the last piece in your hand have two chunks of soft, toasted bread and a nice chunk of meat? If yes, then you have eaten a good burger. Congratulations! Now, a good burger and a great burger are different things. We are talking about taking the elements of good burger, and making them exceptional. Let’s start with the bread. Soft and lightly toasted are a must, as is the size, and don’t forget the burger-to-bun ratio. However, to make it great, the bread should be fresh and, if possible, homemade. It should be soft and fluffy with a thin, crispy layer all around the outside from a light toasting on the grill. “When you have bread like this, you can’t get it wet”, says Yemi. One of the big sins he sees in burger restaurants is soggy bread. The first cause is an oily burger. “A great burger cannot be oily,” explains Yemi. “A great burger usually has a combination of meat, either lamb, beef or pork, and it just melts in the mouth without having excess grease. You should eat a burger with your hands and you don’t want to be wiping them every time you touch it.” The second cause of soggy bread is all the “wet stuff” that we see adorning our burgers. “Put tomato, lettuce and anything wet on the side, give the customer the option to include it but don’t force them,” explains Yemi. While the burger has to be the star, it not just about the meat, the restaurant it-

self has a part to play. The decor, the beer selection, the fries, and the music all have an impact on how much you’ll enjoy your burger eating experience. Yemi has put together a top 3 of the best burger places in Stockholm. 1. Barrels Burgers and Beer High quality burgers in a great environment. 2. Phil’s Burgers Always a solid choice, Phil’s will never let you down. 3. Bun Meat Bun For high quality, fast-food burgers on the run. What’s that, no Flippin’ Burgers? “Flippin’ is the best,” says Yemi referring to statistics for Flippin’ Burgers on his website. “But I haven’t been yet, so I can’t confirm it. I will get there, but next on the list is Vigårda in Vasastan”. Photo by Ben Libberton

Yemi Afolabi is a standup comic, a writer, a Hyper Island student, a gamer, but most importantly, he is a man who loves burgers. His talents for spotting a good burger were forged in the crucible of the New York burger scene when he was growing up, meaning when it comes to finding the perfect patty, he’s a tough man to please. Since moving to Stockholm 5 years ago, Yemi has noticed a steady increase in the number of burger establishments in the city. In late 2016, he started a website to aggregate the ratings of Stockholm’s various burger restaurants. “The website was a school project for Hyper Island,” explained Yemi. “We had to design a page that used data from the web. I love burgers and gaming so I decided to combine those two to make a burger rating site in the style of an 8-bit video game. The response has been great; people either come up to me with new recommendations or ask for suggestions”.

If you have any suggestions for Yemi or you want to ask him for recommendations, he’s not a hard man to find. He performs regular stand-up comedy gigs around the city. For more info, check out Yemicomedy.com. For the most up-to-date burger stats, check out CoderComic.Github.io. • 41

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