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Science Policy Around the Web – June 21st, 2019

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By Neetu Gulati Ph.D.

Image by Kathy Bugajsky from Pixabay 

Tech disorder? Smartphones linked to bizarre horn-like skull bumps

Two Australian researchers published a study inScientific Reports this year with an unusual discovery: people are growing horn-like bone spurs at the base of their skulls. They found these protrusions on around 400 adults aged 18 to 86, and larger growths were found among younger people. Bone spurs usually do not cause pain or require treatment, but if they become too large can become a problem.

While the study originally did not get much press, it has broken headlines recently after a BBC article covering how modern life is transforming the human body. The authors in the original research article hypothesized these bone spurs could be due to “sustained aberrant postures associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets.”

While the article has led to sensationalized media accounts, some experts have questioned the validity of the conclusions, saying the study lacks a control group and cannot prove cause and effect between the spurs and technology. Furthermore, there may be bias in the study because the subjects are people with enough neck problems to warrant visiting a chiropractic clinic, where the authors of the study work.

Regardless of the exact cause of the bone spurs, numerous cases of “texting neck” ailments and similar problems have occurred as technology use as increased since the early 2000s. Dr. David Geier, an orthopedic surgeon, commented that the study “isn’t going to convince people not to use their phone. But small changes like putting pillows under our laptops and holding the phone or tablet higher up and away from our laps can promote better posture.” Others, such as Dr. Evan Johnson, an assistant professor and director of physical therapy at the New York-Presbyterian Och Spine Hospital, commented that the bone spur “is a really big ‘So what?’ moment… The fact that you have this little bony projection in your skull, that means nothing.” It will be important to see if these projections get worse over time, to the point of leading to pain.

(Dr. Shamard Charles, NBC News

Type A blood converted to universal donor blood with help from bacterial enzymes

Donor blood plays a critical role in the healthcare system. However, there is a constant shortage of blood for transfusions around the world. Blood shortages are made more complicated because blood transfusions cannot be done with just any blood, the patient and donor blood types must be compatible or else the recipient’s body can have a deadly immune response to the donor blood. The immune system recognizes specific sugar molecules on the surface of red blood cells, which denote blood as one of the four types: A, B, AB, or O. Blood type O is coveted as universal donor blood, because it lacks these unique sugar molecules, also known as antigens, so they are not recognized as “foreign” in a patient’s body, even when given to people with other blood types. 

Now, researchers have discovered a way to convert type A blood to type O, using a combination of two bacterial enzymes to remove the “A-defining” antigens. Harvey Klein, a blood transfusion expert at the National Institutes of Health, commented on the work, “this is a first, and if these data can be replicated, it is certainly a major advance.”

Previous attempts by researchers to remove the A-defining antigens from blood have had limited success, because the enzymes used were not very efficient. In the most recent study, bacterial enzymes identified from a human stool sample removed the sugars in human blood efficiently using only tiny amounts of the enzymes. If these findings can be translated to practical application, the amount of universal donor blood could nearly double, as type A blood makes up approximately 1/3 of the blood supply. To get to that point, more work needs to be done to confirm that these enzymes are not altering anything else in the blood.

(Elizabeth Pennisi, Science)

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June 21, 2019 at 2:59 pm

Science Policy Around the Web – June 18th, 2019

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By Allison Dennis, B.S.

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Congress is debating-again-whether genes can be patented

The last time the U.S. government issued an official guidance on human gene patenting, it was from the Judicial Branch in 2013. By a unanimous decision, the Supreme Court ruled that two genes whose DNA sequence can be used to predict the probability of a patient developing breast or ovarian cancer, BRCA1 and BRCA2, could not be patented. Companies are still free to pursue patents manipulating or mitigating the effects of specific genes, but the ruling invalidated the patents held by Myriad Genetics for these two genes and opened the door for clinical labs to begin widely testing patient samples for mutations across a wide variety of disease predicting genes that might have otherwise been patented.

Insurance claims filed in 2004 indicate that only one in four women received a BRCA mutation test before being diagnosed with cancer. By 2014, more than 60% of these tests were administered diagnostically, allowing women confirmed to be at risk to pursue prevention and early detection of breast and ovarian cancer before developing either. The effect of the 2013 Supreme Court ruling to dramatically reduce testing costs in combination with technological developments and public health awareness have been attributed to this shift.

Now lawmakers in the legislative branch are weighing in. Senators Thom Tills and Chris Coons filed a bipartisan draft bill that would expand the types of inventions eligible for a U.S. patent to include previously restricted subject matter falling under “abstract ideas,” “laws or nature,” or “natural phenomenon,” which could be interpreted to include human genes. While Tillis has since made clear that it was “was never the intent” to again give companies ownership over single human genes, the changes could allow companies to limit examination of specific genetic variants like those most likely to cause disease. Supporters of the bill feel it is necessary to provide companies with sufficient intellectual property to incentivize their research into isolated natural products. Many point to less-restrictive patent codes abroad, which they feel put the U.S. at a disadvantage.  

Following two weeks of Congressional hearings, and a letter signed by 170 scientific organizations, nine nobel prize winners along with 74 leading physicians and scientists have weighed in by urging lawmakers to more carefully consider the proposed changes. The level of concern or eagerness expressed for the bill seems largely up to the interpretation of the reader, suggesting that much more work is needed for the bill to achieve its stated goal of reducing frustration and confusion generated by the Supreme Court rulings.

(Megan Molteni, Wired Magazine)

Federal Grants Restricted To Fighting Opioids Miss The Mark, States Say

Of the 70,237 drug overdose deaths captured by the CDC in 2017, nearly a third involved cocaine, psychostimulants, which include MDMA and methamphetamine, or both. The CDC cites “changes in the drug supply, mixing of substances with or without the user’s knowledge, and polysubstance use” as emerging threats. Yet the opioid-focused way grant money is allocated may be restricting the ability of states to adapt.

At the frontlines of the opioid epidemic are state officials dedicated to making the most of federal grants designed to offer struggling states a financial lifeline. For example in 2017, Arizona used funds from a State Targeted Response grant to train 9,197 individuals in Naloxone usage and purchase 8,798 Naloxone kits, allowing first responders to perform 5,649 overdose reversals. Many states are using the money to implement the hub-and-spoke model, first developed and demonstrated to be effective by Vermont, in which intensive addiction treatment is offered at a limited number of hubs connected by a local network of outpatient addiction programs and primary care physicians. Through this structure, the hub-and-spoke model can make at least one licensed mental health or addiction counselor accessible per 100 patients.

While the framework provided by the hub-and-spoke model may intuitively help address addiction beyond the specific use of opioids, they rely on Medication Assisted Treatment, an intervention that has only been approved for opioid addiction. Similarly the use of Novaxalone is only effective in reversing opioid overdoses, in the case of cocaine overdose it is ineffective. Additional research is underway to develop parallel treatments for other substances, but these efforts have been eclipsed by the national focus on opioids.  

In 2017, opioids accounted for less than half of the overdoses suffered in eleven states, including Pennsylvania, Texas, and California. This may point to the effectiveness in opioid specific treatment, but it also the persistent dangers of drug-use. Currently, the funding opportunities are insufficient to address the gaps in the mental health system needed to more completely help patients living with addiction. The pathways leading to drug-abuse, no matter the current drug of choice, may provide a common point of intervention resilient against the so called “emerging threats” of substance abuse.

However, similar to the shift seen as users transitioned from OxyContin to Heroin, public health fear that the next shift will turn to drugs not classified as opiods and therefore ineligible to be combated with the funds. In 2017, eleven states

(Carmen Heredia Rodriguez, Elizabeth Lucos, and Orion Donovan-Smith, Kaiser Health News)

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June 18, 2019 at 5:22 pm

The worst humanitarian crisis in the world: war, disease outbreaks and famine in Yemen

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By: Silvia Preite, Ph.D.

Source: Wikimedia

War and natural emergencies in low and middle-income countries often result in the weakening of health systems and relaxation of disease surveillance and prevention, leading to increased risk of infectious disease outbreaks. The over four-year civil war in Yemen continues today and, according to the United Nations (UN), has resulted in the worst on-going humanitarian crisis in the world. Hunger and the spread of communicable diseases affects the vast majority of the Yemeni population.

Overview of the ongoing war in Yemen

Before the start of the conflict in 2015, Yemen was already the poorest country in the Middle East, with debilitated health care systems and poor infrastructures. In March 2015, the Houthi movement took over the government in Sana’a (the capital). In response, a Saudi Arabia and United Arab Emirates-led coalition (supported by several other nations including the United States, the United Kingdom and France) started a military intervention in Yemen, with the intention of restoring the Yemeni government. Overall, this conflict resulted in devastation of agriculture, services, and industry in Yemen. Moreover, in more than four years of air strikes, over 50% of Yemeni hospitals, clinics, water treatment plants and sewage have been continuously bombed. The situation is further worsened by restrictions on food and medicines and limited access to fuel, leaving many essential facilities non-functional, including water sanitation centers. These conditions have led to extreme famine and spreading of diseases, including massive cholera outbreaks among the population. 

Cholera outbreaks

Cholera is a bacterial disease leading to severe diarrhea and dehydration, usually caused by the consumption of contaminated water or food. World-wide, an estimated 2.9 million cases and 95,000 deaths occur each year. It has been estimated that cholera has affected more than 1 million people in Yemen, with more than 2000 deaths, becoming the worst cholera outbreak in the world. According to Médecins sans Frontières (MSF) (known in English as Doctors Without Border) and Physicians for Human Rights, hospitals, mobile clinics, ambulances, and cholera treatment centers continue to be bombed, despite the fact that they have been marked as medical centers and the GPS coordinates have been communicated to the Saudi coalition. In addition to cholera, as a consequence of dropping immunization rates, more than 3000 cases of measles have been reported. Cholera and measles can be prevented by vaccinations and proper health infrastructure. Global eradication efforts have been adopted over the years to eliminate these infections, making the spreading of these diseases in Yemen a significant setback. 

Humanitarian violations

The Fourth Geneva Convention concerns the protection of civilians during conflicts, and has been ratified by 196 states, including parties involved and supporting the war in Yemen. The air strikes on medical centers violate the principles of medical neutrality established by the convention that protects hospitals and health care workers from being attacked. Within the standards of this international law, there is also the right of free mobility of medical personnel within a conflict zone. In contrast, during the civil war in Yemen restrictions have been applied by all involved parties on the activity of medical staff, delivery of health care equipment, essential medicines and vaccines. 

Latest UN report on the Yemen crisis

According to the UN, an estimated 24.1 million people (80% of the total population) need assistance and protection in Yemen, and of those, 14.3 million are in acute need (need help to survive). More than 3 million people are currently internally displaced (IDP), living in desperate conditions in Yemen or elsewhere in the region. It is estimated that 20.1 million people need food assistance, 19.7 million people need basic health care services, and 17.8 million people lack potable water, sanitation and hygiene (WASH). 

Children

An estimated 7.4 million children are in need of humanitarian assistance. Severe children’s rights violations are taking place in Yemen, affecting more than 4000 children and including the risk of being armed and recruited in the war for the boys and child marriage for girls. An estimate of 2 million children are deprived of an education, with around 2,000 schools made unusable by air strikes or occupied by IDPs or armed groups. Upwards of 85.000 children under the age of 5 may have died from severe hunger or other diseases. Overall, according to the UN, at least one child dies every ten minutes in Yemen because of diseases that could be normally prevented, hunger and respiratory infections. 

Urgent need for plans and resolutions

Both famine and disease outbreaks are threatening the Yemeni population and their survival currently relies only on international aid. In February 2019, the United Nations and the Governments of Sweden and Switzerland converged in Geneva to face and discuss the “High-Level Pledging Event for the Humanitarian Crisis in Yemen”. The aim of this meeting was to request international support to alleviate the suffering of the Yemeni people, and they requested $4 billion to provide life-saving assistance. Up to now, 6.3% of the requested budget has been funded; it is encouraging to note that last year UN was able to raise almost 100% of what was initially requested through multiple world-wide donations. 

Along with new funding, the OCHA (UN Office for the Coordination of Humanitarian Affairs), argues that urgent action is needed to prevent any exacerbation of the crisis. The most urgent action to resolve this unprecedented, man-made, medical and humanitarian emergency should come from all the parties involved to end the war and allow the re-establishment of food imports and adequate health services.

As the world barely watches, with only intermittent attention given by the international media, the conflicts and emergency remain. Non-profit and humanitarian organizations (UNICEFMSFWFPSave the Children) have greatly aided the Yemeni population, despite challenging operational environments and the import and circulation restrictions. Moreover, when millions of people, including children, die from hunger and preventable diseases every day, the ethical responsibility of this disaster becomes global and concerns all of us. 

Global implications and future perspectives 

The on-going conflict in Yemen, illustrates how the support of research into innovative global-health solutions is highly needed. When the traditional healthcare system has collapsed and human rights are suspended, we need technologies which further support the victims of war-torn countries to achieve basic sanitary and health standards, beside disease monitoring and vaccination strategies.

We live in an increasingly interconnected world where outbreaks of neglected or re-emerging infectious diseases know no boundaries. Therefore, the consequences of conflicts and disasters in low-middle income countries pose a significant global threat and may affect even stable healthcare systems. Proper evaluation of the causes and consequences of infection outbreaks during the Yemeni conflict is therefore critical for two reasons: devise new strategies to more effectively control and prevent the spread in war-torn areas, and proactively encourage and support countries in regions of conflict to take the necessary measures to minimize the risk of similar humanitarian disasters in the future.

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April 11, 2019 at 4:29 pm

Science Policy Around the Web – March 12, 2019

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By Andrew Wright, BSc

Source: Pixabay

The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?

Diabetes is highly prevalent in the United States, affectingnearly 10% of the US populationand accounting for approximately 80,000 deaths every year. While the pursuit to reduce or mollify the societal and economic impact of this disease is undoubtedly necessary in a country where fully 39.8% of adults are obese, there are some who wonder if such efforts have slipped into problematic territory. 

            Similar to how the introduction of pain as a fifth vital signhelped to unintentionally spur on the devastating opioid crisis, there is fear that the expanding diagnostic criterion of prediabetes could lead to the familiar territory of unnecessary treatment. For one, the risk of prediabetic patients developing diabetes from year to year is low: just under 2% according to the Centers for Disease Control (CDC).  At the same time the methods of treatment for prediabetes, designed to prevent progression to the full disease, are not particularly effective in achieving that goal. While a 2009 study demonstrated that exercise intervention or metformin, a common drug used to treat diabetes, did prevent some prediabetic patients from transitioning to full diabetes, methodological concerns have been raised with the authors’ results. One of the major issues is that the study used high risk patients at the upper end of the prediabetic spectrum, which is significant given that the American Diabetes Association (ADA) reduced the lower threshold of what counts as prediabetes around the same time. Of these “less” prediabetic patients, many never transition to the full disease. This suggests at the very least that treating these patients, especially pharmacologically, is not necessary or beneficial.

            Despite these issues being raised, there is a worrying trend of medical professionals doing just that. While no drug has been approved to treat prediabetes, doctors are continuing to treat prediabetic patients with diabetes drugs by prescribing them off-label at the recommendation of the ADA. Not only does this include metformin, which has its own difficult side-effects, but also several medications with “black box” labels that denote severe risks. Particularly when one considers that those who progress to full diabetes will be treated with these same drugs as their condition worsens, using them prophylactically is likely overzealous.

            Finally, there have been concerns raised about financial conflicts of interest, to which the medical and pharmaceutical industry are certainly not strangers. The companies behind the most prominent diabetes drugs have gifted millions of dollars to those in positions of influence at the ADA and other medical institutions. Perhaps as a result, while international groups such as the World Health Organization (WHO) have rejected prediabetes as a condition outright, the American medical community seems to be falling in line with the diagnosis. When top-down societal changes to reduce obesity may a be more effective means to reduce diabetes according to the WHO, the over-medicalization of prediabetes could ultimately do more harm than good.

(Charles Piller, Science)

Microplastic pollution revealed ‘absolutely everywhere’ by new research

With estimates that the ocean will have more plastic than fishby weight by 2050, it should come as no surprise that global plastic pollution is becoming rapidly untenable.  It is well understood that plastic does not biodegrade, but rather breaks down into increasingly smaller pieces know as microplastics. These pieces of plastic can become so small that they can be ingested by zooplankton, one of the fundamental building blocks of the marine food chain, which means they eventually make their way to the human digestive system.  

            While the problem was previously thought to be relegated to the worst polluted waterways and places like pacific vortexes (colloquially known as the “Great Pacific Garbage Patch”), recent studies have shown that microplastic pollution is so pervasive that pieces are found in every area tested. This includes freshwater bodies in the United Kingdom, groundwater supplies in the United States, the Yangtze river, off the coast of Spain, and in tap water around the world.

            The problem is not relegated to shallow water bodies either, with microplastics being found at the bottom of the Mariana Trench at levels of up to 2,200 pieces per liter of sediment. While these levels of contamination are undoubtedly perilous to wildlife, the affect they might have on humans is unclear. However, research from the National University of Singapore has demonstrated that microplastics harbor both bacteria that cause coral bleaching and those that cause gastroenteritis.  Further,  the possibility remains for chemicals contained in microplastics such as polychlorinated biphenyls (PCBs), which are carcinogenic, to cause deleterious health effects as chronic exposure leads to cumulative effects. What is clear is that without some method of reducing plastic pollution or monumental cleanup efforts, microplastics will become a troubling global burden in the years to come.

(Damian Carrington, The Guardian)

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March 12, 2019 at 4:53 pm

Intellectual property theft and its effects on US-China trade relations

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By: Neetu Gulati, Ph.D.

Source:Wikimedia

China and the US are currently in the midst of a trade war that, if not resolved my March 1, 2019, will lead to another increase in tariffs by the US. This trade war, which started over the US accusing China of stealing intellectual property from American companies, has already affected the economy of the two countries and could have global effects. The US has evidence that information including biomedical research breakthroughs, technological advances, and food product formulations have been stolen. In response to these illicit trade practices, the US imposed tariffs on Chinese imports, leading to the beginning of the trade war.

So how did we get here? 2019 marks forty years of diplomatic relations between the United States and China, which officially began on January 1, 1979. Since relations began, the two countries have benefited from ongoing trade, and China has become the largest goods trading partner with the US. Bilateral economic relations have increased from $33 billion in 1992 to over $772 billion in goods and services in 2017.  Despite strong economic ties, relations between the two countries have come under strain in recent years. The US State Department has identified concerns over military conflict in the South China Sea, counter-intelligence and security issues, and the trade deficit, among other issues. These issues came to a head in April 2018 when President Donald J. Trump issued a statement that China had stolen America’s intellectual property and engaged in illegal trade practices. In response, the US imposed additional tariffs on approximately $50 billion worth of Chinese imports. China then countered with tariffs on US imports, and thus a trade war between the two countries began.

To understand how intellectual property, or IP, fits into the trade war, it is important to first understand what it is. According to the World Intellectual Property Organization, IP “refers to creations of the mind, such as inventions; literary and artistic works; designs; and symbols, names and images used in commerce.” More simply, IP is something created or invented through human intellect, but not necessarily a tangible product. These products often have important scientific implications, as the umbrella of IP can cover genetically engineered crops, newly developed technologies and software, and new therapeutics, just to name a few. IP is legally protected through means such as patents, trademarks, and copyright, which allow people to gain recognition and financial benefits from their creations. These protections are country-specific, and the US Patent and Trademark Office gives guidance about protecting IP overseas, including in China. The process of transferring IP from the creator to another entity, often for distribution purposes, is known as technology transfer. This process is at the heart of the accusation of theft of American IP.

According to a seven-month long investigation done by the United States Trade Representative (USTR), China’s unreasonable technology transfer policies meant they did not live up to the commitments made when joining the World Trade Organization. The report found that Chinese laws require foreign companies to create joint ventures with domestic Chinese companies in order to sell goods within the country. The investigation by USTR found that “China’s regulatory authorities do not allow U.S. companies to make their own decisions about technology transfer and the assignment or licensing of intellectual property rights.  Instead, they continue to require or pressure foreign companies to transfer technology as a condition for securing investment or other approvals.” By pushing for technology transfer, these laws opened up American companies to theft of their IP. Stolen IP has included things like software code for a wind turbine, genetically modified corn seeds, the idea behind a robot named Tappy, and even the formulation for the chemical that makes Oreo filling white.

Beyond stealing information for goods entering China, it is also possible that Chinese workers in the United States may be stealing IP and sending it back to their home country. For example, a Chinese scientist known as ‘China’s Elon Musk’ was accused by his former research advisor of stealing research done at Duke University and replicating it in China for his own gain. A former assistant director of counterintelligence at the FBI suspects that the Chinese scientist was sent by the Chinese government intentionally to steal IP. This was not an isolated incident, either. According to a report from an advisory committee to the National Institutes of Health (NIH), research institutions in the US may have fallen victim to a small number of foreign researchers associated with China’s “Talents Recruitment Program,” which the National Intelligence Council identified as an effort to “to facilitate the legal and illicit transfer of US technology, intellectual property and know-how.” This comes mere months after the NIH announced that it had identified undisclosed financial conflicts between US researchers and foreign governments. Without giving details of specific countries, NIH Director Francis Collins reported to a Senate Committee hearing that “the robustness of the biomedical research enterprise is under constant threat.” Nevertheless, these threats should not hinder the research enterprise. During a hearing in April 2018, House Science Committee Chair Lamar Smith remarked, “on the one hand, we must maintain the open and collaborative nature of academic research and development. On the other, we must protect our research and development from actors who seek to do us harm.”

The balance between research collaboration and theft is delicate. Information sharing is increasingly necessary as scientific pursuits become more interdisciplinary in nature, and can lead to more productivity in research. However, voluntary collaboration is different from unwilling or coerced transfer of ideas. The ability of US scientists and entrepreneurs to innovate and create new IP is an important driver of the American economy, and further allows for the ability to research new scientific pursuits. Not only does IP theft undermine the incentive and ability for Americans to innovate, it has had drastic negative effects on the American economy, with annual losses estimated to be between $225 billion and $600 billion according to a report put out by the IP Commission. These losses directly affect those who own and/or license IP, as well as those who are associated with these companies or individuals. This can then lead to downsizing or cutting jobs, further harming American science and technology industries. It is for this reason that the US responded so strongly against the evidence of IP theft.

In response to the accusations from the US, Chinese President Xi Jinping promised to resolve the “reasonable concerns” of the US regarding IP practices. The Chinese government announced punishments that could restrict Chinese companies from state funding support due to IP theft and at the G20 Summit in December 2018, the Presidents of the two nations agreed to a 90-day financial truce, which will end March 1, 2019. 

The two countries are currently working on a trade deal to end the escalating tariffs, which would lessen tensions between the world’s two largest economies. The US wants China to commit to buying more American goods and services, and to agree to end the practice of requiring American companies to give technology transfers in order to do business in China. Without hashing out details, China has agreed to increase imports of U.S. agriculture, energy, industrial products and services. Delegations from the two countries will meet again in mid-February in China to continue negotiating. Trump was optimistic that the two nations would be able to make a deal before the deadline, saying, “I believe that a lot of the biggest points are going to be agreed to by me and him.”  

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February 7, 2019 at 9:39 pm

Saving the Chesapeake Bay – Home to 18 million people

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By: Hsiao Yu Fang, Ph.D.

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Source: Flickr

The Chesapeake Bay is the largest U.S. estuary, where freshwater from rivers and streams flows into the ocean and mixes with seawater, making it a rich environment with abundant wildlife. Every year, the Bay produces 500 million pounds of seafood. The entire Chesapeake Bay watershed, which includes six states (New York, Pennsylvania, Maryland, Virginia, West Virginia, and Delaware) and the District of Columbia, is home to 3,600 species of plants and animals and more than 18 million people. Importantly, the actions of these 18 million people directly affect the health of the Bay. To quote the movie Finding Nemo, “All drains lead to the ocean.” Due to the combination of water-born nutrient pollution that comes from human-produced waste and runoff from cities and farms, the Bay has been listed on the country’s “impaired waters” list for decades. Thankfully, recent policy measures to regulate the environmental impact of human activity on the Bay have shown profoundly promising results that with further efforts could fully restore the health of the Bay.

At one point, the conditions of the Chesapeake Bay seemed almost irreversible. Years of population growth and pollution led to a significant decline in animal species, affecting commercial and recreational fishing as well as tourism. Scientists have shown that about one-third of the nitrogen in the Chesapeake comes from air pollution. Pollution in the air emitted from power plants and vehicles is carried over long distances via weather conditions and eventually deposits into the Bay’s waters. As air pollution can travel thousands of miles, the region over which air pollutants are capable of impacting the Bay is known as the airshed; this area is about nine times as large as the Bay watershed. Excess nitrogen and phosphorus pollution in the Chesapeake cause a biological chain reaction that results in “dead zones” – areas with minimal amounts of oxygen. This phenomenon worsens in the summer, when heat and pollution fuel algae blooms, blocking sunlight and depleting life-sustaining oxygen underwater. Aquatic life including fish, crabs, and oysters suffocate in these areas of the Bay affected by dead zones. The Bay used to yield tens of millions of bushels of oysters. Today the annual catch has fallen to less than one percent of historic records.

There have been several attempts through the years to restore the Bay. The Clean Water Act of 1972 reduced industrial pollution to the Bay, though it fell short of its promises of transforming the Bay into “fishable, swimmable” waters. In 1984, the six states within the Bay watershed embarked on another cleanup plan, which again failed to show lasting improvements. In 2010, the Chesapeake Clean Water Blueprint was established, which is the largest water cleanup plan ever managed by the US government. Using the powers granted by the Clean Water Act, the Environmental Protection Agency (EPA) issued new pollution limits for nitrogen, phosphorus, and sediment feeding into the Bay. Subsequently, the six Bay states and the District of Columbia announced formal plans to meet the EPA limits by 2025. What makes the Blueprint unique compared to previous failed attempts is that it will impose penalties on states that fail to act.  Each state is required to reach two-year incremental milestones of pollution reduction. Ideally, once the Blueprint fully achieves its goals, the Bay should no longer be on the impaired waters list.

Almost a decade has passed since the restoration efforts of the Chesapeake Clean Water Blueprint began, and already the Bay shows the potential for becoming a transformative environmental success story. Today, the Bay appears more resilient and capable of adapting to excess pollution loads. Recent studies have shown that the Bay is beginning to replenish oxygen in its waters; repairing what were once underwater dead zones. The Chesapeake Bay Foundation’s (CBF) 2018 State of the Bay Report’s Habitat Indicator Scores show that the resilience of the Bay, quantified as the growth of underwater grasses and resource lands, is slowly increasing from their 2016 levels, despite the record-breaking summer storms of 2018.

While progress has been made in restoring the Bay, more is needed. Bipartisan support from the federal government and from federal-state collaborations is essential to the Bay’s further recovery. The Bay’s overall health remains fragile and additional improvement is not assured. In fact, CBF’s2018 State of the Bay Report released this month showed a decline in the Bay’s health for the first time in a decade. This was due to extreme storm-related weather conditions in 2018 that carried high concentrations of nitrogen, phosphorus, and debris into the Bay.

The Chesapeake Bay’s health has vital impacts on people’s health, jobs, and access to clean drinking water. The forests in the Bay watershed produce safe, filtered drinking water for 75 percent of the watershed’s residents, which is nearly 13 million people. If more action is not taken now, the future cost of inaction will be more dire and expensive than current restoration efforts. The Chesapeake Clean Water Blueprint might be the best and last chance to restore the Bay. Simple, individual actions like conserving water and energy in our daily activities, volunteering in stream and river cleanups, and contacting local representatives and advocating for the importance of protecting the Bay can also go a long way towards contributing to the well-being of the Bay. “Treasure the Chesapeake” is not just a slogan on a license plate – these words underlie a great environmental recovery project, as well as a potential model for water pollution clean-up projects around the world.

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January 23, 2019 at 3:54 pm

Conspiracy Theories and Ebola: How a US Federally Funded Research Facility in the Heart of Sierra Leone’s Ebola Outbreak Acerbated Local Misconceptions about Ebola

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By: Caroline Duncombe

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An inherent distrust follows what one does not understand; scientific endeavors if not explained properly are easily misunderstood. From climate skeptics to CERN’s 666 logo, the world is wrought with conspiracy theories surrounding science. The role of conspiracies should not be underestimated or neglected, especially since such theories are interspersed with layers of truth. Usually conspiracies reside harmlessly on the edge of the web, but during the Ebola outbreak in Sierra Leone an unaddressed rumor resulted in fatal consequences. Rumors revolving around a Tulane University research facility located in Kenema Government Hospital prompted a breakdown in relations between the local populations and international health care workers. This mistrust led to the refusal to permit blood draws for diagnostic purposes during the critical initial stages of the Ebola outbreak. By underestimating the importance of cultural and religious symbolism surrounding scientific research U.S. federal funding agencies, laboratory researchers, and private companies made a crucial mistake. By analyzing this curious conspiracy theory, scientists, funding agencies, and health practitioners can learn from past mistakes and become more aware of the impact of research beyond pure scientific pursuit.

Background

            On May 24th, 2014,a young woman miscarried in Kenema Government Hospital. Given the recent outbreak in nearby Gueckedou, Guinea, Ebola was suspected. A day later, the same hospital reported the first confirmed case of Ebola in Sierra Leone. Soon after, Kenema became a hot zone – the entry point for the Ebola virus to spread throughout Sierra Leone and eventually the world. The repercussions of the Ebola outbreak extend well beyond the 11,310 death count in West Africa to economic, social, medical, and cultural spheres.

The Kenema Government Hospital was not a typical Sierra Leonian public hospital. In fact, the hospital was well-equipped, with the only Lassa fever isolation ward anywhere in the world. The lab dated to 2005, when Tulane University received a $10 million grant from the U.S. National Institutes of Health to study “Diagnostics for Biodefense against Lassa fever”. Since previous investigations of sporadic Lassa fever outbreaks were based out of Kenema, the natural choice for the establishment of first-rate laboratory infrastructure was Kenema Government Hospital.

As the years passed, the Tulane research laboratory acquired more grants and partnerships. One of the principal collaborators was the private for-profit company, Metabiota, which received grants from two U.S. Department of Defense (DoD) agencies – Defense Threat Reduction Agency and Biological Engagement Program – to primarily study the pathogenesis of Lassa fever, a ‘US bioterror threat’. Due to stipulations in NIH grant funding, the substantial amount of money flowing into this “shiny new” research laboratory could not be applied to assisting patients in the “dilapidated, cramped, and poorly resourced Lassa ward only some 50m away” (Bausch). During the Ebola outbreak, the Lassa laboratory’s focus shifted to Ebola, continuing research until the NIH did not renew funding in 2014, primarily due to safety reasons.

The Conspiracy Theory

Following the 2014 outbreak, a conspiracy theory circulating throughout Sierra Leone, essentially claiming that the U.S. created Ebola, or a Lassa-Ebola hybrid, and either intentionally or accidentally released this bioterror weapon from the U.S. NIH and DoD-funded research facility at Kenema Government Hospital. While such a rumor lacked credible evidence, there were specific circumstances surrounding the policies of the research outpost that fed into the narrative – truths that should have been addressed through culturally sensitive policies.

Four main factors converged into a superstitious and suspicious narrative about the Lassa research laboratory. First, by branding the Lassa research facility with a bioterrorism component, the project assisted in drawing out a natural conclusion that bioterror weapons were also present in the laboratory. Tulane University’s initial grant application in 2005 framed Lassa virus as a US biosecurity threat through key words such as “Diagnostics for Biodefense” and “LASV as a biological weapon directed against civilian or military targets necessitates development of… diagnostics.” The framing of the diagnostic development laboratory in terms of a biodefense strategy against the NIAID Category A classification was not an accident, but rather a necessity to gain funding. As Annie Wilkins puts it “whether the prospect of weaponization is regarded as sensationalism or a real concern, all researchers are aware of the utility the bioweapons threat has in obtaining funding.” By emphasizing biodefense and collaborating with the U.S. DoD via Metabiota’s funding stream, a natural linkage between the work of the research outpost and bioweapons developed.

The second factor was out of the control of Tulane University: A suspicious coincidence. Due to its proximity to Guinea, laboratory capacity, and fluidity in movement across the Sierra Leone-Guinea border, the first confirmed case of Ebola in Sierra Leone occurred in Kenema Government Hospital. Although there potentially were other cases of Ebola in Sierra Leone, none of the primary health care clinics in the area had the laboratory capacity to officially diagnose Ebola. A natural speculation ensued: what are the chances that the one Biodefense laboratory in Sierra Leone, where the hemorrhagic Lassa fever virus was located, was also the site of the first confirmed case of a “new” bioterror threat that also causes hemorrhagic fever, Ebola? Money draws attention, and the money flowing into this singular laboratory was substantial when compared with other public hospitals in Sierra Leone. For reference, the Sierra Leone Ministry of Health and Sanitation allocated U.S. $20 million budget to run the entire national health system in 2009.

Third, a nurse from Kenema Government Hospital claimed to an audience at a fish market that “the deadly [Ebola] virus was invented to conceal “cannibalistic rituals”. The statement and an already distrustful community culminated into a riot at the hospital on July 25th, 2014. Such a case further cemented the people’s suspicions that the laboratory was “stealing” the blood of Sierra Leonians. Even though collecting blood is necessary for diagnostic tests, there are many deeply held cultural beliefs about blood in Sierra Leone, and many people are reluctant to participate in blood test as a result.

Fourth, the research facility suspiciously and suddenly shut down right at the beginning of the outbreak without much explanation to the community. Additionally, many of the Sierra Leonian staff who could have addressed the suspicions about the facility pre-outbreak have since died while bravely combatting Ebola. All of these factors accumulated into the conspiracy theory that actors involved with the bio-defense grant and the US government created a bioterror weapon and unleashed it on West Africa.

Policy Considerations

The accumulation of these factors demonstrate the importance of cultural sensitivity and awareness when implementing scientific research policies. In 2018, Tulane University and a variety of partners received a new $15 million federally funded grant to study how Ebola and Lassa survivors fought off the diseases. Hopefully, the researchers are opening this facility with a new awareness and increased precautions on the spiritual and social baggage they bring to Kenema. This is especially important when considering the potential for further stigmatization of Ebola survivors if called to Kenema Government Hospital for research or treatment purposes.

There are several policy considerations that could alter the course of this conspiracy and help acclimate the community to both the presence of a well-equipped laboratory and blood draws for diagnostic purposes. Research institutions should refrain from using vocabulary such as “biodefense” and “bioweapon” to describe the purpose of research. A clinician in the Lassa ward pointed out that “The average Sierra Leonian won’t see Lassa Fever as a bioweapon threat. Only in the Western world do they see it like that.” Since the potential for contracting Lassa and Ebola is an everyday reality for Sierra Leonians, research initiatives on such diseases should be spoken about in terms of their potential for public health. Additionally, universities seeking to do medical research should consider the cultural significance of their location, and contemplate ways, including shifting location, that might reduce any negative connotations. Engaging influential spiritual leaders in productive information partnerships could also assist in assuaging local concerns.

Policy considerations should also be contemplated by grant funding institutions like the NIH and DoD. First, grant stipulations should integrate a layer of flexibility for distributing certain supplies and resources for patient care. Second, the NIH and DoD should be cognizant of their bias in funding grants that are written in terms of biodefense interests of the US, especially when related to countries where such a ‘bioweapon’ is an everyday reality. This is especially important because such bias incentivizes deleterious narratives that invokes cultural, social, and medical consequences.  Lack of funding for neglected infectious diseases that only burden developing countries by the US is a complex and important issue that will require deep structural changes – and would require another blog post to contemplate. Yet, a simple solution would be to require scientific grant applications to contain a section in which the applicant considers the cultural and social impact of the work within the community of interest. In addition, community outreach with intentional dialogue on assuaging concerns about sensitive research activities should made be mandatory.

The conspiracy theory exacerbated the already high level of mistrust in Western interventions during the outbreak. As the Washington Post emphasizes, the lesson from this case study is “that winning the trust of communities at risk is absolutely indispensable to limiting the impact of the inevitable next Ebola epidemic in West Africa.” Hopefully, the Tulane University research center in Kenema Government Hospital has learned from past mistakes, and seeks to engage the community and douse suspicions against their research upon re-opening the laboratory this year. Conspiracy theories usually integrate truth with speculation. The traditional method of ignoring such theories or flat out denying (as was the case with Tulane University) may have detrimental consequences as seen during the Ebola outbreak in Sierra Leone. The power in a conspiracy theory is not necessarily its truth, but it’s power to persuade people that it is true. And as scientists who are often focused on the facts, we often have a hard time understanding that concept. When doing research, it is crucial to be cognizant of the social perception of science and attempt to build bridges between gaps of understanding on cultural practices and scientific endeavors.

 

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Written by sciencepolicyforall

January 17, 2019 at 6:34 pm