The West African Ebola Outbreak As A Science Communication Challenge & Opportunity

I had the honor of speaking to a science communications seminar class at the North Carolina School of Science & Mathematics, recently described by Dave Dewitt at our NPR affiliate as, “[C]reated 35 years ago for serious NC students with grand aspirations. It was the first residential school of its kind in the country, and it’s public. The course catalog rivals many major universities, with classes in robotics, biomedical engineering, and astrophysics.”

Dean of Science, Dr. Amy Shenk, invited me to talk about the Ebola Virus Disease outbreak ongoing in west Africa in terms of its challenges to public science communication. I’ve put together my collection of stories written in my role as a contributor to the Pharma & Healthcare section of Forbes.com. With my training as a pharmacologist, I naturally focus on what drugs are in development to treat the potentially fatal disease. But what I’ve learned is that drugs have little use if a health system lacks infrastructure to even monitor blood or administer intravenous electrolytes.

General thought questions

What do you know about Ebola hemorrhagic fever (now called Ebola Virus Disease, or EVD)?

What were you thinking when news of the outbreak first broke?

What did you think about bringing infected U.S. missionaries to Atlanta for care?

What message might this send to the people of west Africa?

Where did science communication go wrong? Where did it go right?

 

For the following articles:

Which of these do you think have particularly high value (or low value!) in communicating the complexity of the Ebola situation to the general public.

Does the simple listing of facts lead to understanding, addressing legitimate concerns?

What ethical issues does the use of experimental Ebola drugs raise that present a general science communication opportunity?

Kroll Ebola articles at Forbes

Do We Have Any Drugs To Treat Ebola? – 29 July 2014

Should We Be Concerned About American Ebola Patients Coming To Emory Hospital? – 1 August 2014

Ebola ‘Secret Serum’: Small Biopharma, The Army, And Big Tobacco – 5 August 2014

FDA Moves On Tekmira’s Ebola Drug While Sarepta’s Sits Unused – 7 August 2014

Beware Of Fake Ebola Supplements – 14 August 2014

American Missionaries Cured of Ebola Infections; Brantly: ‘Today Is A Miraculous Day’ – 21 August 2014

How Will We Know If The Ebola Drugs Worked? – 26 August 2014

NIAID/GSK Ebola Vaccines To Enter US, UK Human Safety Trials – 28 August 2014

BioCryst to Launch NHP Ebola Drug Safety, Efficacy Studies ‘Within Weeks’ – 29 August 2014

WHO Ebola Drug Panel: Use Survivor Serum To Treat Ebola Victims – 5 September 2014

Gates Foundation Commits $50 Million To Ebola Containment Efforts – 10 September 2014

Cuba Responds To Ebola Crisis As Black Market For Convalescent Serum Emerges – 12 September 2014

CDC Ramps Up Ebola Worker Training In Advance Of Obama Announcement – 16 September 2014

 

Explaining the drugs, informed consent

Ebola, Experimental Drugs and Informed Consent: Should Those At Risk Simply Take The Doctors Orders? – by Elaine Schattner – 31 August 2014

 

Vaccines and public health – Another science communications challenge 

Final, somewhat unrelated issue on science communications relative to tomorrow’s NOVA documentary on vaccines: The need for humility in public health communications, by Dr. Brian Zikland-Fisher of the University of Michigan. The polarization of vaccine attitudes, regardless of scientific facts, requires a middle ground where people can have legitimate concerns addressed.

  • We must acknowledge that each parent has the right and the authority to make his or her own choices, and that it is our failing (either in the quality of our vaccines or the persuasiveness of our message), not theirs, if we have failed to convince them that vaccination is the better choice.

  • We must acknowledge that we have the best chance of convincing a skeptical public when we put the weaknesses of our arguments and the risks of our interventions front and center and acknowledge the fears that they evoke.

It may seem counterintuitive, but embracing humility may be the best thing we can do. Humility will build trust in those who believe (sometimes accurately) that we are not telling the whole story. Humility might resonate with those parents who genuinely want to do right by their children but have not been convinced by “the facts.”

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Boy howdy! We’ve hooked Superbug’s Maryn McKenna!

On the heels of the recruitment of Deborah Blum to ScienceBlogs, I am happy to welcome journalist Maryn McKenna to our neck of the ether.
Her inaugural post can be read here.
superbug-cover.jpgMcKenna’s blog is called Superbug, reflecting the title of her most recent book, SUPERBUG: The Fatal Menace of MRSA, and her general interests in infectious diseases and food safety. Her 2004 book, BEATING BACK THE DEVIL: On The Front Lines with the Disease Detectives of the Epidemic Intelligence Service (of the US Centers for Disease Control and Prevention), named among Top Science Books of 2004 by Amazon.com and an “Outstanding Academic Title” by the American Library Association.
More details from her biography indicate that ScienceBlogs has secured a remarkable and experienced writer:

As a newspaper reporter, she worked for 11 years at the Atlanta Journal-Constitution, where she was the only journalist assigned to full-time coverage of the Centers for Disease Control and Prevention. She reported from the Indian Ocean tsunami and from Hurricane Katrina, as well as from Southeast Asia, India, Africa and the Arctic, and embedded with CDC teams on Capitol Hill during the 2001 anthrax attacks and with a World Health Organization polio-eradication team in India.
Previously, she worked for the Boston Herald, where stories she co-wrote on illnesses among veterans of the first Persian Gulf War led to the first Congressional hearings on Gulf War Syndrome, and at the Cincinnati Enquirer, where her stories on the association between local cancer clusters and contamination escaping a federal nuclear weapons plant contributed to a successful nuclear-harm lawsuit by residents.
Maryn has been an Ochberg Fellow of the Dart Center for Journalism and Trauma at Columbia University; a Media Fellow with the Henry J. Kaiser Family Foundation; and a Knight-Wallace Fellow at the University of Michigan. She has also served short fellowships at Harvard Medical School and the Casey Journalism Center on Children and Families at the University of Maryland. In 2006, she was an inaugural Health Journalism Fellow of the East-West Center in Honolulu and is now an Associate of the Center and teaches other journalists in its programs in Asia.
She is a cum laude graduate of Georgetown University, has a master’s degree with highest honors from Northwestern University, and is the recipient of numerous journalism awards.

McKenna is clearly not your ordinary writer.
McKenna Manhattan Bar Leadville.jpgBut, of course, I cannot let her welcome message go without some levity. My eye was captured by a photo on McKenna’s website with her in front of The Manhattan Bar in Leadville, Colorado, generally considered the highest, continually-occupied municipality in the continental United States. Their Facebook page is here.
Situated on US Highway 24 that becomes Harrison Street in Leadville, The Manhattan Bar is just across from the famed Delaware Hotel in this boomtown established by the Silver Rush of the late 1870s and 1880s that then collapsed when the silver standard backing US currency was repealed in 1893.
If you’ve driven from Denver to any scientific conferences in Aspen, hiked Colorado’s highest peak, Mt. Elbert, ran or biked any Leadville race, or taken your lab for whitewater rafting down the headwaters of the Arkansas River, chances are that you have driven past The Manhattan Bar.
Gotta respect a talented writer who acknowledges with reverence one of Colorado’s greatest treasures.
Welcome, Ms. McKenna!
And, as always, you can continue to follow Maryn on Twitter @marynmck
Photo credit: Shamelessly taken from McKenna’s website entirely without her permission.

Case dismissed in vaccination libel case against Amy Wallace and Dr. Paul Offit

Writer Amy Wallace just tweeted and posted to her blog the fabulous news that a pending libel case against her and physician Paul Offit has been dismissed.
Amy Wallace was the author of the centerpiece article in a Wired magazine feature on how antivaccination activists create fear and confusion by distorting and misrepresenting facts about vaccines. This article “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” was discussed in detail here back in October.
Two days before Christmas one of those individuals, Barbara Loe Fisher (also Arthur), filed a $1 million claim that Dr. Offit had libeled her in Wallace’s article by saying, “She lies,” in reference to Ms. Fisher. Condé Nast, the publisher of Wired, was also named in the suit.
Orac at Respectful Insolence wrote a very detailed post a week later explaining how Loe Fisher and other anti-science activists use the threat of legal action to suppress criticism since they can’t rely on the science.
While dismissed, this legal action has certainly created financial and emotional distress for Ms. Wallace who, unlike Dr. Offit, had no experience in dealing with the level of hostility that can be dished out by the antivaccination movement. As a freelance writer, Ms. Wallace probably also lacks the financial backstop that Dr. Offit has. In effect, I am concerned that a writer like Ms. Wallace, who wrote one of the best articles in recent memory on the antivaccinationist movement, will never take another assignment on such an issue because it is just not worth the aggravation. Even prior to the suit, Wallace noted that she had never before received such hateful letters and e-mails on any other topic in her 25 years of writing professionally. Much of the opposing correspondence made lewd sexual comments about Ms. Wallace rather than engage in a debate about the content of her article.
If my prediction is true, Orac is correct: the simple threat of legal action can be used to suppress criticism of anti-science and pseudoscience nonsense that threatens society (unlike taking a heavy metal-laden supplement product that harms only the user, withholding vaccines from children compromises herd immunity in society.)
On the other hand, this episode may embolden Ms. Wallace and encourage other writers to speak more extensively on the house of cards that lies behind antivaccinationists faulty assumptions on causality and search for true causes of autistic spectrum disorders.

Chronic illness discussion continues with Dave Munger on living with AIDS

I’m always pleasantly surprised when a topic generates enthusiastic reader feedback, particularly when comments come from long-time readers who share experiences I never knew they had or, in some cases, comment for the first time.
The topic this time was a simple reflection on my current bout of pneumonia and my being taken aback by how debilitating it has been mentally. It’s taken me two days just put put together these few sentences of what will essentially be a referral post.
A very thoughtful commenter posed a question to me about what does it mean to be “really sick.” What is long-term impairment? When are you “too sick” and “healthy enough?” When does chronic illness stop being debilitating and how do you get others to understand that sometimes you may look healthy outwardly but are still suffering inwardly.
So, while I was reading up on these topics I turned to the excellent new blog, The Daily Monthly, by Dave Munger, formerly the co-author of the psychology blog, The Cognitive Daily. Dave’s new blog is an exciting new project whereby he will select a topic each month that he will explore in depth and breadth daily. For February 2010, Dave has tackled AIDS in America, launching with the story of his friend Charles, an old high school friend and best man at his wedding who is today living with AIDS.
I mention this story not only to draw your attention to Dave Munger’s exciting new project but also because yesterday’s post touched on some of the topics we’ve discussed here about chronic illness. The final three paragraphs of the post speak of “looking sick” vs. “being sick” and make me think more about the struggles that the chronically ill face in proving to employers and HR departments that they are actually disabled or otherwise unable to do their jobs:

It’s one of the paradoxes of HIV/AIDS. If you do a good job fighting it, you end up looking like someone who’s not very sick. Even Charles, who hasn’t been healthy enough to work a 40-hour week for years, still gets strange looks from bus drivers when he flashes his “disabled” bus pass.

I’ll be back with some of the discussions you started here but I strongly encourage you to go over and bookmark Dave Munger’s, The Daily Monthly. For this month, begin here with Dave’s introduction to Charles.

Meditations on those with chronic illnesses

I have just a couple of thoughts today that I offer to the reader not for sympathy but, rather, for scientific observation and reflection.
I’ve been dealing with a case of bronchitis that became pneumonia. I tried to teach through it, do grant reviews, finish a book chapter, etc. but was finally ordered by my pulmonologist to recuperative bedrest at home for approximately four weeks.
When told I’d be confined to bed for a month, I thought that it would be great – that I’d get two papers and a grant renewal done and still have plenty of time for blog posts I’ve been wanting to get to, finish writing a couple of songs to take to the studio, get all the tax documents together, maybe learn a little CSS and webpage design and get around to a hosted personal website for the domain I’ve had for a year, etc.
After 10 days now, I’ve really done nothing more than read for short periods and sleep for long periods, with energy only for one blog post, a paragraph or two on a paper, and arranging for my classes to be taught. Twitter works, though, as 140 characters is about the limit. To be really sick – to the point of not being able to concentrate for more than 10 min – is a foreign concept. And I’m not actually *really* sick like other folks with chronic illnesses, cancer, etc.
To be unable to make your body do what you want it to is frustrating enough, especially when your little girl wants to go play in an infrequent snowfall of significance.
But I find it remarkable that an illness having nothing to do with the CNS can wreak such havoc on cognition, concentration, and motivation.
Some people might think, “wow, you’ve had 10 days to do *anything* you want,” but it blows me away that 10 days have passed and I’ve done jack shit.
So today, my heart goes out to all of those who suffer with chronic illnesses every day. You have my admiration and respect.

Interview with Dr Ada Yonath, a 2009 Nobel Laureate in Chemistry

Last week in Stockholm (and Oslo), the 2009 Nobel Prize winners were gloriously hosted while giving their lectures and receiving their medals and diplomas. In Chemistry this year, the Nobel was shared by Venkatraman Ramakrishnan, Thomas A Steitz, and Ada E Yonath for their studies on the structure and function of the ribosome, a remarkable nucleoprotein complex that catalyzes the rapid, coordinated formation of peptide bonds as instructed by messenger RNA. My post on the day of the announcement in October was designed to counter the inevitable (and now realized) criticisms that the prize was not for “real” chemistry.
Thumbnail image for BallE09_5253g.jpgOnly ten days later, we in the NC Research Triangle area were very fortunate to host Dr Yonath at the North Carolina Biotechnology Center for the Symposium on RNA Biology VIII, sponsored by The RNA Society of North Carolina.
Among the many noteworthy speakers was Dr Greg Hannon from Cold Spring Harbor Laboratory, a scientist who some feel was overlooked for the 2006 Nobel Prize in Medicine or Physiology, one where Andrew Fire and Craig Mello were recognized for RNA interference and gene silencing.
NC Biotech’s Senior Director of Corporate Communication, Robin Deacle, kindly invited me to an audience with Dr Yonath and two science reporters following Dr Yonath’s lecture. As you might suspect, I was quite honored to visit for awhile with the woman who defied the naysayers and successfully crystallized a bacterial ribosome, then used X-ray crystallography to determine its structure below three angstroms resolution. The fact that she also used natural product antibiotics to stabilize ribosomal structure added to my magnitude of admiration.

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Southern Colorado Science Update #1: Alamosa Salmonella outbreak report released

The region of southern Colorado on either side of the Sangre de Cristo Mountains is quite special to the Pharmboy family. The high plains to the east and San Luis Valley to the west are sparsely populated, stunningly beautiful with a veritable mine of geological treasures, and are unlikely to be built up in the PharmKid’s lifetime. In fact, most counties down there have fewer people now than they did in 1900.
It is also rugged and you can easily die out there. Which gets you in touch with what matters.
Sangres.com sheepwestpeak01.jpgBighorn sheep and West Spanish Peak outside of La Veta, Colorado, about 60 miles east of Alamosa
For the blogeratti, the most informative blog I’ve discovered about the San Luis Valley is SLV Dweller. However, I still haven’t found a dedicated blog for the east side, but Sangres.com has the most comprehensive information available for the Scenic Highway of Legends area.
So, you can see why I might enjoy paying attention to news out yonder. Plus, stories that emanate from out there often have an interesting science slant, suitable for consumption by ScienceBlogs readers.
In March and April 2008, 442 people in the town of Alamosa, Colorado (2008 pop. 8,745), were sickened with Salmonella bacteria that was traced to the municipal water supply. Epidemiological estimates are that over 1,300 residents may have been striken. One death was reported. The story made national US news back then and we posted some details back then. I wrote then that “like many bacteria that enjoy the gastrointestinal tract, Salmonella causes diarrhea but can be fatal in small children, the elderly population, or anyone else with a compromised immune system.”
Alamosa’s water supply system had in the process of being upgraded, in part due to new state controls on arsenic content, but it was still operated under a water disinfection waiver from the state. Over 100 Colorado municipalities were absolved from chlorination requirements especially, in the case of Alamosa, where the water source came from deep artesian sources and would be unlikely to be contaminated like lake or stream sources. However, according to Kyle Clark at 9News in Denver, 76 of these waivers have been revoked.
In a report released last week, state officials have formally cited animal waste contamination in a deteriorating concrete storage tank as the likely cause. Seems that the inside area stays at about 65-75°F year-round. Alamosa is often the nation’s icebox (it’s 7°F/-14°C as I write) and all manner of birds and mammals take refuge wherever they can. The USGS National Wildlife Health Center describes that Salmonella is frequently shed in the feces of such animals and is often a cause of avian transmission at birdfeeders. (I also noted a couple of years ago that pet turtles are often the source of domestic Salmonella infections in kids.)
David Olinger in The Denver Post wrote that the Alamosa outbreak resulted from a “‘perfect storm’ of woes.”

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Sir John Crofton, TB combination therapy pioneer – a long and admirable life

Sir John Crofton.jpgDenise Gellene in the New York Times is reporting this morning that Scottish physician, Sir John Crofton, passed away on 3 November at age 97.
Crofton is best known for implementing a combination drug regimen to treat tuberculosis, the insidious lung infection with Mycobacterium tuberculosis which decimated the US early last century and still kills 2 million a year worldwide. The concept of using drug combinations to increase individual drug potency and slow the emergence of resistance is now a mainstay of therapeutic approaches for cancer, HIV, and other infectious diseases.
Gellene reports that Crofton first investigated streptomycin for TB shortly after the drug’s discovery and isolation at Rutgers by Selman Waksman and his then-graduate student, Albert Schatz. Waksman was sole winner of the 1952 Nobel Prize in Physiology or Medicine, with the oversight of Schatz ranked by Scientific American among the top 10 Nobel snubs.
Crofton’s original 1950 letter to the British Medical Journal on use of intermittent doses of streptomycin can be seen in this PDF.
Incidentally, the revered German physician, Robert Koch, was awarded the 1905 Nobel Prize in Physiology or Medicine for the discovery of M. tuberculosis. His medical microbiology criteria, known as Koch’s Postulates, became the rubric for establishing causation of an infectious agent.

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Wired posts Amy Wallace love/hate mail compiled from Twitter feed

Just a quick follow-up from our last two posts about Amy Wallace’s article, “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” in Wired magazine about vaccine developer Dr Paul Offit and the anti-vaccination movement:
Wired has now compiled Wallace’s tweets from the last two days into blog-readable narrative.

Only a week after Wired published “An Epidemic of Fear”, we’ve received more reader responses than any other story in memory. Journalist Amy Wallace has received hundreds of messages, weighing in on all sides of the issue, and posted some of those comments on her Twitter feed.

Readers Respond to “An Epidemic of Fear,” Part 1
Readers Respond to “An Epidemic of Fear,” part 2
To be fair, putting Amy’s tweets together was originally the idea of Sydney-based IT blogger, Bastard Sheep (part 1, part 2; the illegitimate sheep also twitpic’d last night a screen shot of his blog traffic before and after these posts).

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Venkatraman Ramakrishnan, Thomas Steitz, and Ada Yonath win 2009 Nobel Prize in Chemistry

Welcome visitors coming from a recommendation by Dr Carmen Drahl at CENtral Science, the blog of the American Chemical Society’s Chemical & Engineering News (C&EN):

Terra Sig has a fantastic post about the chemistry prize. The money quote: “If I see electrons being pushed around, it’s chemistry.”

Thank you for the kind words, Dr Drahl. New readers, feel free to weigh in down in the comments as to your take on this year’s Chemistry prize.


The 2009 Nobel Prize in Chemistry has been awarded to three amazing scientists who elucidated the chemical bond-by-chemical bond action of the cell’s protein synthesis organelle, the ribosome. Each of the three laureates employed three-dimensional, X-ray crystallographic structures and naturally-occurring antibiotics to dissect the mysteries of the ribosome, making tremendous advances in our knowledge on the least understood process of the central dogma of molecular biology: protein synthesis.

Yes, friends: this year’s Nobel Prize in Chemistry would not have been possible without the awesome power of natural products and the contributions of my natural products chemistry colleagues who provided Ramakrishnan, Steitz, and Yonath with the chemical tools for their work.

Literally dozens of these antibiotics are used clinically around the world and I guarantee that if you possess the relative wealth to have an internet connection to read this, you have taken at least one of these antibiotics.

Tetracycline? Check. Erythromycin or azithromycin? Check.

The scientific background on the 2009 Nobel Prize in Chemistry (PDF) is, as always, the best place for advanced students to start reading about the context of the scientific achievements of the three laureates. These are terrific, underappreciated, and meticulously constructed review articles, and this one by Måns Ehrenberg is no exception. Page 14, for example, provides a detailed list of the antibiotics that target the small and large ribosomal subunits of bacteria.

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