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ADVICE FOR POTENTIAL GRADUATE STUDENTS

By | archive, commentary, impressions, pin-up

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We currently have room in the lab for more graduate students.

But before you apply to this lab or any other, there are a few things to keep in mind. First, be realistic about graduate school. Graduate school in biology is not a sure path to success. Many students assume that they will eventually get a job just like their advisor’s. However, the average professor at a research university has three students at a time for about 5 years each. So, over a career of 30 years, this professor has about 18 students. Since the total number of positions has been pretty constant, these 18 people are competing for one spot. So go to grad school assuming that you might not end up at a research university, but instead a teaching college, or a government or industry job. All of these are great jobs, but it’s important to think of all this before you go to school.

Second, choose your advisor wisely. Not only does this person potentially have total control over your graduate career for five or more years, but he/she will also be writing recommendation letters for you for another 5-10 years after that. Also, your advisor will shadow you for the rest of your life. People will always think of you as so-and-so’s student and assume that you two are somewhat alike. Finally, in many ways you will turn into your advisor. Advisors teach very little, but instead provide a role model. Consciously and unconsciously, you will imitate your advisor. You may find this hard to believe now, but fifteen years from now, when you find yourself lining up the tools in your lab cabinets just like your advisor did, you’ll see. My student Alison once said that choosing an advisor is like choosing a spouse after one date. Find out all you can on this date.

Finally, have your fun now. Five years is a long time when you are 23 years old. By the end of graduate school, you will be older, slower, and possibly married and/or a parent. So if you always wanted to walk across Nepal, do it now. Also, do not go to a high-powered lab that you hate assuming that this will promise you long-term happiness. Deferred gratification has its limits. Do something that you have passion for, work in a lab you like, in a place you like, before life starts throwing its many curve balls. Your career will mostly take care of itself, but you can’t get your youth back.

If, after reading this, you want to apply to this lab, we would love to hear from you.

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This piece was originally published at the SCQ in 2008

About Sönke Johnsen

"Sönke Johnsen is deep-sea biologist and visual ecologist at Duke University and still can't believe that his background in math, art, and writing got him a paying job, let alone one that lets him go down in submarines. In his spare time, he takes pictures (see here) and works with his daughter to unlock new levels on Mariokart Wii."

ASK NOT WHAT YOUR URBAN FOREST CAN DO FOR YOU…

By | archive, commentary, textbook

It’s time that we upped the ante on the level of public discussion on the urban forest. What is the urban forest you ask? Well it’s those pleasant remnant stands of forest that speckle the urban landscape, like Vancouver’s Stanley Park – but it’s also every other tree in the city, from that old oak tree on the front lawn to those pitiable and short-lived trees sprouting from the concrete downtown. Trees have been the recipient of a growing urban celebrity over the past years. I subscribe to Google News alerts, so whenever the words “urban forest” appear in a news article, I get an update. As these alerts were chiming away in my inbox in increasing abundance, I noticed that a solid 90% of the headlines were all hailing the benefits of trees for the city dweller. And I thought to myself, the other half of the story is missing.

First – why all the fuss? A lot of this celebrity can be attributed to the growing attention given to the urban forest by academic researchers. City forests, with all their idiosyncrasies, are attracting more and more researchers, who in turn are discovering more and more benefits of having trees in cities. An early example of this was the “View through a Window” [1] study, which showed that hospital patients with a window view of trees and natural settings recovered faster from surgery. Since then, research has uncovered a slew of other benefits selflessly provided by urban trees, from reducing crime rates in Baltimore [2] to increasing the value of homes in Finland [3].

The next critical point in the urban forest timeline came with the development of a computer model. The United States Forest Service created the i-Tree [4] model (suite of models, actually), which synthesizes scientific research into an off-the-shelf piece of free software that can be used by non-experts – usually city staff or community groups – to inventory their urban trees and actually put numbers and dollar figures to their value. Toronto recently conducted an analysis of its urban forest using i-Tree in 2008 [5], and found that the bare-bones replacement value of the urban forest is a whopping seven billion dollars. Moreover, they provide Torontonians with sixty million dollars in ecosystem services.

There are also some more esoteric benefits from trees that are steeped in the realms of the social sciences that I don’t fully comprehend. Trees provide place attachment and a sense of identity for people to their streets, parks, neighbourhoods, and city [6]. In Japan, people partake in Shinrin-yoku (literally, forest bathing), where they immerse themselves in the woods to reap the spiritual benefits [7]. Even though they cannot be as easily affixed with a dollar value in computer models, these psychological benefits that arguably all city residents experience, knowingly or not, are really where the rubber hits to road in terms of ecosystem services.

Amazing, right? Absolutely. So how can we blame the media for the fluffy and abundant coverage of city trees of late?

We can’t. But ending the narrative at this point paints an incredibly unbalanced picture of trees in the city. To the passerby it seems as though we have always had trees in the city, and just recently science came along and told us that they’re tops. Urban trees and the urban forest ecosystem, however, are far more complex (and frankly a little gloomier) than the happy-go-lucky altruists we are making them out to be.

City trees are actually subject to an appalling amount of stress, disregard, injustice, and blatant abuse. First off, the urban natural environment in general is degraded – without question – because we live in it and build things and pave surfaces and throw stuff out in it. We plant plants that shouldn’t be there, which become invasive. We introduce nasty critters and blights like the Dutch elm disease, Asian longhorn beetle, and most recently the emerald ash borer. We plant trees in compacted and degraded soils or tiny little concrete planters known by arborists as tree coffins. We chop off their limbs in a brutish manner to accommodate our utility lines. We gash their boles with lawnmowers, snowplows, and bicycle locks. We even vandalize trees! It’s just a hard-up life for John Q. Maple and Joe the Plumb Tree, trying to carve out a little piece of soil to call their own, make a living at providing us with ecosystem services, and raise a family of seeds.

All of these issues that face urban trees, and urban ecosystems in general, lead to a somewhat counterintuitive conclusion: the urban forest needs us. Unlike the tried, tested, and true forms of conservation in the hinterland where we can simply leave nature alone and it will mend itself of our transgressions, the urban forest ecosystem demands a new type of conservation; a new type of management. A seminal journal publication on urban forestry stated clearly that “sustainable urban forests require human intervention” [8]. So what does this mean? Let’s examine.

Enter Toronto, my hometown and the biggest city in Canada. Take a stroll for a moment along the Lower Don River trails; down the stairs at the pedestrian bridge in Riverdale Park and into one of Toronto’s key green features. The stately silver maples and graceful magnolias that lined your walk through the Victorian neighbourhood of Cabbagetown to arrive here are transformed abruptly into a dark and tangled wood, with ragged stands of gnarly old willows and bulging Manitoba maples, dripping with equal parts of invasive Virginia creeper and torn-up plastic bags.

Another key feature along the trail is a dense canopy of Ailanthus altissima, known somewhat ironically as the tree of heaven. This tree is also referred to as “Ghetto Palm” [9] because of its prevalence in unmanaged – and frequently poor – urban neighbourhoods. Before your arrival in Caggabetown, walk through some contrasting high-density neighbourhoods and look along building foundations, fencelines, and alleyway potholes and you will see the tree of heaven growing from mere cracks in the asphalt.

This species originally calls from China, and was brought first to Europe then to North America as an alluring ornamental wrought in the mysteries of the Orient. Its insatiable capacity for growth earned it the title tree of heaven, since it grew with such vigour towards the skies. This made it an ideal candidate for the harsh urban environment, where it showed utter disdain for the aforementioned assaults on city trees, and indeed flourished. However, the tree’s vigour soon became a problem. Its amazing capacity for growth meant that it could establish within naturalized, unmanaged forest ecosystems, like the Don Valley, and outcompete the region’s native tree species with ease. Moreover, the tree is allelopathic, meaning that it produces biochemicals that stop other (i.e., native) species from growing anywhere near it. The tree of heaven may be the poster child of urban forests without intervention.

Go a little farther north along the Don trail, underneath the majesty of the Bloor Viaduct, and you enter a sunny meadow. But in this seemingly appealing meadow can be found an unnavigable bramble of some of Ontario’s most notorious invasive plants: Japanese knotweed, garlic mustard, and endless fields of dog-strangling vine. Perhaps not coincidentally, this ecologically-marginalized meadow is also home to some of the City’s socially-marginalized homeless populations that inhabit camps just beyond the treeline.

Please don’t misinterpret me. These Lower Don trails are my favourite spot in the City precisely because, among many other benefits, they are so fascinating for the urban ecologist. And to be fair, incredible work on ecological restoration and management is indeed already in progress in the Don River Watershed at the hands of the Toronto and Region Conservation Authority [10]. What the Don does in the context of this story is provide a case and point that urban trees and forests are incredibly vulnerable, and left to their own devices to grow in the city will likely suffer. They demand varying approaches to management – human intervention.

The form of that human intervention is critical, however. There exist hidden vulnerabilities of the urban forest. These vulnerabilities are dangerous because of their relative invisibility, but perhaps even more so because they can manifest while we are trying to help the urban forest. In response to the aforementioned stream of news stories about the benefits of trees (which, to be fair are legitimately amazing), a natural reaction is to plant even more trees. But what would happen if all those planted trees were the same species? It would make the urban forest highly vulnerable to both existing and yet-to-be-introduced insects and diseases that eat and kill trees. These forest pests often target one species or one genus, so when the urban forest is composed largely of those species and genera, we lose them all at once! The most notable disaster of this kind was in the mid-1900s, when North American cities often planted nothing but elm trees along streets. Then the Dutch elm disease arrived, and it transformed these green-canopied, sun-dappled boulevards into barren and exposed tree-less streets. The unexpected horror that was felt by society in this instantaneous loss of their trees helped to birth the concept and practice of urban forestry in North America [11].

Now, what would happen if we planted all those trees in just one happy summer, and we planted so many trees that we didn’t need to plant more for a hundred years? Well, when all of those trees simultaneously enter their winter years and eventually succumb to the ravages of time, we again lose them all at once! Moreover, forests and urban forests alike are far more susceptible to falling over in storms with an over-abundance of old trees of the same age. And we will certainly be seeing a lot more storms in the coming decades. This latter scenario happens more frequently than logic would dictate. Everyone loves scotch. But imagine if distilleries only waited to start the next batch of twelve-year old single malt when the last batch ran out? That would be a pretty bleak eleven years.

As you are starting to guess, managing an urban forest is hard. Because of the long life of trees, the urban forest ecosystem, like all forests, is shaped by very slow processes, so management must have considerable foresight to avoid potentially delayed and disastrous effects. Management also needs to be intensive and continuous to combat all those tree injustices we talked about earlier.

Management needs to be inclusive – often over half of a city’s urban forest is situated on private residential property and subject to the whims of the homeowner, for better or for worse. This also means that city foresters can’t get their hands a notable chunk of the trees in their jurisdiction. Consequently, municipal governments can’t be expected to shoulder the whole burden of management. Outreach, educational material, by-laws, and incentive programs to engage homeowners and businesses in urban forest management are a must.

The complex ownership regimes of cities really put a stick in the spokes of sustainable management of the urban forest too. In those endless swaths of Canadian boreal forest that we typically associate with forestry, a single forest products company will manage hundreds of thousands of hectares of Crown forest. In the city, a single hectare of urban forest might be under the management (or mismanagement) of dozens of homeowners, small business, institutions, random pedestrians, and city arborists and foresters, all with differing values and objectives. This is complicated even further by the fact that the product being harvested is not timber, but psychological benefits and other such intangible amenities that care little for property boundaries. Lastly, urban forest management needs to transcend the various socio-political quandaries that we create in cities, like policy gaps and a lack of enforcement, development pressure and densification, insufficient municipal urban forestry budgets, and a flat-out lack of awareness.

These are my concerns, if we tell just one side of the story.

So remember, the next time you take a leisurely stroll through your neighbourhood, enjoy the view of the park out of your office window, dabble in some Shinrin-yoku, or enjoy any number of the ecosystem services city trees provide, please be sure to ask what you can do for your urban forest, because it needs you.

References:

1. Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224, 420-421.

2. Troy, A., Grove, J. M., & O’Neil-Dunne, J. (2012). The relationship between tree canopy and crime rates across an urban-rural gradient in the greater Baltimore region. Landscape and Urban Planning, 106, 262-270.

3. Tyrväinen, L. (2000). Property prices and urban forest amenities. Journal of Environmental Economics and Management, 39, 205-223.

4. http://itreetools.org/

5. City of Toronto. (2008). Every tree counts: A portrait of Toronto’s urban forest. Retrieved from http://www.toronto.ca/trees/every_tree_counts.htm

6. Jones, O., & Cloke, P. (2002). Tree cultures: The place of trees and trees in their place. London, UK: Berg.

7. http://www.shinrin-yoku.org/

8. Clark, J. R., Matheny, N. P., Cross, G., & Wake, V. (1997). A model of urban forest sustainability. Journal of Arboriculture, 23, 17-30.

9. Burkholder, S. (2012). The new ecology of vacancy: Rethinking land use in shrinking cities. Sustainability, 4, 1154-1172.

10. Toronto and Region Conservation Authority. (2009). Don River watershed plan: Beyond forty steps. Retrieved from http://www.trca.on.ca/the-living-city/watersheds/don-river/projects–plans.dot

11. Jorgensen, E. (1986). Urban forestry in the rearview mirror. Arboriculture Journal, 10, 177-190.

About James Steenberg

James Steenberg is a PhD student at Ryerson University in Toronto, where he studies forest ecology and sustainable management. When he got too old and fat to plant trees for a living in the Rockies he went to school and started researching and writing about them instead.

A moment of your time: about Bill C-398 and how Canadians can contribute to global health

By | commentary

Dear Canadians:

On wednesday, a very important piece of policy will be discussed in parliament.   It’s called Bill C-398 and it deserves our attention.  It seems that it has been challenging for some to see its merits, and so, I’d like to take moment to clarify what it’s all about.  It turns out that it’s not just important – the narrative is intriguing as well: it has a rich history of political intrigue; it is a story where viruses factor in prominently; it has a plot that involves armies of angry grandmothers; and above it all, learning about Bill C-398 can literally save lives.

Note, that the below piece is a re-edit of sorts, an update of a piece I wrote for Boing Boing that was an attempt to discuss that political intrigue.  And also note that there is some bias in my commentary – but I think this is natural.  There are obviously a variety of viewpoints involved and my own happens to disagree with those who choose to listen to corporate and political interests – more so when those interests rely on reasoning that is often spun a certain way to misrepresent useful facts. My bias happens to fall on the side of human dignity: something I think we should all spend a moment to contemplate, and something I think all Canadians would feel is a cause worth fighting for.

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“Access to life-saving medicines is not a luxury, but a human right.”

~Canadian HIV/AIDS Legal Network

To me, the above statement is one of those things that sound like a no-brainer. Put another way, if I were to ask you whether you thought a person’s income should determine whether they live or die from something like HIV/AIDS, then I think you would see that the answer is nothing but obvious. But here I am, in Canada, writing this post, because there is a very real danger that members of my government think that this isn’t such an easy decision after all – that maybe wealth and business interests do matter when dealing with such ethical choices, and that there is a hierarchy where certain lives are worth more than others.

Let me backtrack a bit, and provide a little context. I’d rather not write a rant, emotional and heart wrenching as this discussion can be – I’d prefer to rely on reason, and not on rhetoric. Yes, rhetoric helps, but reason and validity are much more powerful.  I want everybody to understand why this is an important issue, one that deserves coverage, and one that deserves our involvement. More importantly, I want everybody to understand why the right thing to do is obvious.

To start, let me mention the letters and numbers that make up the label, “Bill C-398.” Keep them in your head – at least for a moment. If you’re the sort that prefers hearing at least a quick definition, then this one might work:


“Bill C-398 aims to reform CAMR and make it easier for Canada to export affordable, life-saving, generic medicines to developing countries.”

~Canadian HIV/AIDS Legal Network

If you’re thinking that this is a Canadian thing, then think again. Other rich countries are watching how Canada will behave. There’s always a few in Europe, and apparently even China is curious. In the U.S., the topic appears to be quenched, but the behaviour of the Canadian government could catalyze dialogue. And if you’re not from a rich country? Well, you might actually have lives that will be affected by it, millions of lives even.

Here’s the problem in a nutshell: the developing world is heavily burdened with a variety of diseases, many of which are causing massive numbers of suffering and deaths.

This is understandably big. It’s a huge global challenge, and there are many reasons for why it exists and why it is difficult to both comprehend and fix. However, the presence of effective medicines is not one of the reasons. There is medicine out there that can help, and there is also a flow (sometimes slow) of discoveries that make these medicines better and more effective. In the case of HIV/AIDS, there are drugs that essentially turn the disease from a death sentence to something that is chronic and manageable. I can’t overstate how significant that piece of information is: it tells us that people do not have to die from HIV/AIDS.

So what’s the issue?

The issue is control without regard for doing the right thing: This is essentially about patents. It’s not that patents are bad, but rather that patents can be bad. As you probably already know, patents are a service provided by government to protect an inventor, such that the inventor has an element of control over how their innovation/product gets used. This is generally a good thing, because ultimately it provides order to a process that would get very chaotic very quickly should the patent not exist. However, sometimes the inventor isn’t the best person to make decisions about control. Sometimes, the inventor doesn’t have the best information to take stock of a situation, or sometimes there might be a moral argument where monetary performance should not take precedent. In other words, sometimes, there are special circumstances where you could say it is reasonable that this control is tweaked.

To illustrate this, here are some hypothetical (and not so hypothetical examples):

1. Your country has experienced a massive storm, perhaps one named after a character in Grease, and it has hit the East coast very very hard.  Many folks are still without power and water, but there is technology that would be incredibly useful to mitigate this. However, your resources are already stretched and this technology is too expensive at the scale that is required in such an emergency.

2. Someone has declared war on your country. To defend yourself, you would like to utilize a particular product. Unfortunately, it is under a cost prohibitive patent and therefore out of reach.

3. There are markets where your life saving drug is not being sold because no-one can afford them anyway. However, the drug (which could be a matter of life and death for millions) could be made at a cost (i.e. a generic) that makes it accessible in these markets, but if and only if, the patent over them is adjusted.

Here is my point. In all of the above cases, you would like to live in a civil society where the government can step in and forcibly change the patent, because in every case, there is an element of morality involved. And guess what – governments can do this and they do! It’s called a “compulsory license,” and they exist for this very purpose.

In fact, even the WTO is on board with this idea. They recognize that in some circumstances, such as those pertaining to global health, there needs to be an understanding that using such compulsory licenses is both necessary and an obligation. In fact, if you have a hankering for the legalese that outlines this for patents over essential medicines, you need only look up info on the Doha Declaration.

Canada actually took this to heart with a bill that came into force in 2005. Often referred to as “Canada’s Access to Medicine Regime” (or CAMR), it was an effort to put into action, the principles and details provided by the Doha Declaration. It was a way to try and enact compulsory licenses for the home production of generic drugs so that more accessible drugs could be produced. It was a good gesture.

Unfortunately, this initial attempt was flawed. The process was simply way too complicated, contingent on an army of legal expertise to navigate, which was all the more problematic because many of the actors involved did not have the means or access to do this. Indeed, the bill seems to contain a paradox in it, in that it can be interpreted as logically impossible to use. If you look closely, there’s a “you can’t do B until you do A” and a “you can’t do A until you do B” error in the details (see question 9 in this document for more details).

It was also very inefficient in that when a compulsory license was negotiated, it was always a one time affair, a one order affair, with specific amounts that could not be changed despite possible reassessment of needs, only good for one country, etc, etc, etc. Indeed, in the years that the law has been available, it has pretty much sat idle (I believe there has still only been one successful case where drugs were actually made and delivered, which provided ample evidence to demonstrate that this process was difficult at best). In fact, if someone were to asked me how difficult things are, the best description I could come up with, is that is it “catastrophically high maintenance.”

Which (finally) brings us to “Bill C-398.” This bill is basically “the edit.” Its sole purpose is to address the things that made the previous bill so ineffective, and at its heart it allows a more streamline and efficient way to issue these compulsory licenses so that production of these generics is more feasible.

No brainer right?

“Oh, but it’s not that simple,” they say. “There are many counter arguments,” they say. Only these counter arguments tend to sound like this:

Q: Shouldn’t we focus on other aspects of the problem. Like health infrastructure, or public education for HIV?

A: Hmmm… Let me get this straight. A government can only do one thing at a time? Nevermind the fact that passing this bill doesn’t actually cost the taxpayers anything. If anything, research has suggested that the foreign aid that we do provide will likely have greater bang for its buck.

Or maybe something like this:

Q: Wouldn’t these changes effect the pharmaceutical company’s bottom line, which in turn will effect R&D funding, and drive the home costs of medicine up?

A: The language is pretty clear in that these are generics that can only be sold in certain markets. These markets happen to constitute a very small percentage of pharmaceutical revenues (we’re talking single digits here). Oh yeah, plus you get royalties from doing this anyway. Also, there’s nothing stopping you from making your own generic version, so that you can enter the market yourself. Indeed, all research and current evidence would suggest a possible gain in bottom line. Plus, the R&D argument is totally a red herring. If that were so crucial, it might help if you spent less on PR and the like. Sneaky.

But what kills me, is that even if there is a reasonable and say unforeseen cause for concern, the Bill has a freaking “sunset clause” which is basically something that gives all parties a “we’ll see how it goes, in case it’s not working” escape route.

All to say, that because of this kind of political and big pharma semantics, there is a very real likelihood that the Bill will die (perhaps in the next few days when it is up for a second reading).  This would be an interesting commentary on the values of our government, although there is already a rich backdrop to this political story.

You should know that this is a Bill that had a previous incarnation two years ago.  It once lived in the country calling itself Bill C393, and it was one of those few Bills passed by the House of Commons where party lines were clearly broken.  Unfortunately,  during that time, the Conservative Senate stalled their vote to make it law, and they did this because they knew that there was an opportunity to “save face” with their industry interests by avoiding the issue altogether.

This was the frustrating part, and I have to admit, my trust in Canadian politics really took a hit.  Here, certain members of Senate, a place that traditionally falls in line with the vote of the House of Commons (because that is, after all, the democratic element of decision making), stalled discussion on this Bill 4 times over 4 days, and in doing so, Bill C-393 got killed by association when a new election was called.

To put this in perspective (and to use internet vernacular), let me just say that this horrific series of events represented a political facepalm of the highest possible order. In fact, we invented a term for it: we called it a #megafacepalm.

And so here we are with another attempt. This is the essence of why you should care about BILL C-398. But what can you do?

Well, for starters, you can lend a hand by speaking out. Retweet this blog post, write about it yourself. You should definitely send an email to Prime Minister Harper and a few of his key Members of Parliament by using this ridiculously easy petition. If you’ve got something meatier to say, how about copy pasting this entire list of emails, and let the Canadian government know how you feel. If you’re not Canadian, do these things anyway, and then make this issue pertinent in your own country. This is an urgent matter, and for Canadians, there is only so much time to advocate. It’s really an amazing chance for Canada to lead the way.

You can also immerse yourself in this cause and get as much information as possible. You can check out organizations such as the Canadian HIV/AIDS Legal Network, which has all sorts of great documents including this informative myth versus fact sheet.

If you’re a university student, you can check out your local UAEM chapter. If you’re a Grandmother, you can hear what Grandmothers Advocacy Network have to say. Better yet, check them all out, or join these groups and volunteer your time.

There is also a twitter campaign in progress.  Flood the feed with hashtags like #C398, #fixCAMR, #medicinesforall, #cdnpoli and tweet out your support with phrases like:

“Please vote YES to Bill #C398 on Wed! We need to #fixCAMR and improve #accesstomedicines! #cdnpoli”

“Have you signed the petition in support of #accesstomedicines yet? Go to www.medicinesforall.ca! Let’s #fixCAMR & pass #C398!”

If you think the idea of Bil C-398 above seems reasonable and just, please do whatever you can. Because through it all, you should never ever forget: “Access to life-saving medicines is not a luxury, it is a human right.”

About David Ng

David (@ng_dave) is Faculty at the Michael Smith Labs. His writing has appeared in places such as McSweeney's, The Walrus, and also as an occasional blogger at boingboing.net. If you're looking for a graphic for your next science talk, he encourages you to check out his blog, popperfont.net.

LET ME TELL YOU ABOUT JOHN MICHAEL GRIFFIN, JR.

By | archive, commentary, impressions

- FROM THE ARCHIVES -

wtcgriff.jpg

Griff, as he was known in high school, was a friend of mine.

In fact, late in the first half of our lives, he stood up for me physically and philosophically, for being a science geek. Truth is, John’s endorsement was the first time I was ever deemed cool for wanting to be a scientist.

It is also 10 years ago, that Griff died an engineer and a hero in the collapse of one of the World Trade Center towers.

We lost touch almost twenty years before, but his kindness and generosity formed not only a cornerstone of the scientific life I have today, but resonates in the person and father I have become as well.

At a northern New Jersey Catholic high school, in a predominantly Irish town, being a gangly Polish boy from two towns over was not the formula to cultivate one’s popularity or self-preservation. Excelling and throwing the curve in biology and chemistry classes didn’t help either, nor did being a David Bowie fan in a place where Bruce Springsteen was revered. That’s probably where my nickname, “Zowie,” came from – the name of the glam rocker’s first child.

Worse, I had skipped a grade in elementary school, and being a year behind physically, was not compatible with self-defense during high school gym class.

So, it was sometime in junior year, when scoundrels had me cornered and slammed against the wall, books thrown down the hallway, that a simple gesture saved me. John, already well on his way to his adult height of 6′ 7″ or 6′ 8″, stepped in and said, “Hey, lay off of Zowie. He’s goin’ places.” And with that, the beatings stopped.

John and I were soccer fans. At that time, soccer hadn’t taken off in the States but I was a huge player and had met John at Giants Stadium where I had season tickets (Section 113, row 7, seat 26) for the relocated New York Cosmos. At just $4 a ticket, I could afford a season’s pass to see some of the greatest international soccer stars of the late 20th century: Germany’s Franz Beckenbauer, Italy’s Giorgio Chinaglia, Yugoslavia’s Vladislav Bogićević;, and, of course, Brazil’s Pelé.

John’s family were long-time Giants season ticket holders and probably got their Cosmos season tickets (three rows behind me) through some sort of promotional giveaway. I recall that John was surprised that a science dork like myself would be cool enough to come to soccer games alone – my father dropping me off outside the gates so he could go home and watch his beloved football on TV. But we Jersey boys did love soccer, even though we were at a school where American football and basketball reigned supreme. Many Saturday and Sunday afternoons were spent at the massive stadium during soccer’s American heyday of the late 1970s, when crowds would reach 50,000 – 75,000 strong.

John had a gift to make anything fun and to make anyone laugh. I recall sitting with him in a ski lodge in Amsterdam, NY, as I was recovering from frostbite during an ill-prepared class trip ski weekend. He pulled me into an imaginary board game with a napkin dispenser, where he pretended each napkin contained a message as to how to proceed during each turn.

John was a physical caricature, handsome but goofy, self-effacing but self-confident, and possessed of a clever and caustic wit, which he carried into professional life and fatherhood. No one was safe from John’s good-hearted and bombastic comedy routines.

Now, my memories of John seem half a life away, from the impromptu high school graduation party he called at my house to his pride at finishing his engineering degree and managing facilities for a million-square foot building in Manhattan. Perhaps he protected me as a kid because he knew that way deep down, he, himself, was destined to become an engineering geek. As well as the hero, protecting the lives of others in a very real way.

On the glorious fall morning of 11 Sept 2001, I was fixing coffee for my wife when the newsreader on my pager announced that a jet had struck the south tower of the World Trade Center.

I had missed my recent 20-year high school reunion and had not known that John had only months before been appointed director of operations at the WTC.

I did not learn until two weeks later that John had facilitated the escape of dozens of workers, handing out wet towels so people could breathe on their way down the stairs. In the book 102 Minutes by New York Times writers Jim Lynch and Kevin Flynn, John is immortalized in the corroborated account of the elevator rescue of 72-year-old Port Authority construction inspector, Tony Savas.

When he returned to 78, Greg Trapp saw a group of three Port Authority employees at work on the doors to the elevator where Tony Savas, a seventy-two-year-old structural inspector, was trapped. Trapp peered into the small gap and saw him, a man with thinning white hair, seemingly serene. One of the workers grabbed a metal easel, wedging the legs into the opening, trying to spread the doors from the bottom, where they seemed to have the greatest leverage. But their efforts had the opposite effect at the top of the doors, which seemed to pinch tighter.

At that moment, John Griffin, who had recently started as the trade center’s director of operations, came over to the elevator bank. At six feet, eight inches tall, Griffin had no problem reaching the top of the door to apply pressure as the others pushed from the bottom. The doors popped apart. Out came Savas, who seemed surprised to find Griffin, his new boss, involved in the rescue. Savas seemed exhilarated, possessed of a sudden burst of energy, rubbing his hands together, or so it seemed to Trapp.

“Okay,” Savas said. “What do you need me to do?”

One of the Port Authority workers shook his head. “We just got you out-you need to leave the building.”

No, Savas insisted. He wanted to help. “I’ve got a second wind.”

Both men perished soon after in the tower’s collapse.

John’s wife, June, the former June Maarleveld and sweetheart of the class behind us, was quoted in New York Times, Portraits of Grief:

“He was at the back of about 30 people they were evacuating,” his wife, June Griffin, related from the accounts of survivors. “He had been in fires before — he should have gotten out.”

Mrs. Griffin speculated that her husband, instead of running for the exits, headed for the fire control center, where his training as a fire safety officer would have directed him. “He was an engineer,” Mrs. Griffin said. “He must have thought, `Buildings don’t just fall down.’”

It’s unfortunate but leaving New Jersey and running on the tenure-track treadmill in a biomedical career caused me to lose track of a great many friends, and in some ways, to stop appreciating life even. Since John’s death, we’ve all found a little more time in our schedules to make time for one another. As the father of a little girl conceived in the months after the terrorist attacks, I try to respect June’s privacy and send little gifts for the girls every so often. I cannot imagine how they and nearly 3000 other families deal with the most public of tragedies that came to roost among those at the start or in the prime of their adult lives.

I finally worked up the guts to go to Ground Zero five years ago for the first time since the attacks. Despite all the bickering about what the memorial should look like, there was already some small memorial area set up in the interim. John’s name sits at the top of one column of names on placards commemorating those who died there. And I so dearly wish that I had attended our high school reunion to thank John for his friendship during my formative years.

Instead, I keep a makeshift memorial to him, constructed at my old lab, that now sits outside my office and greets me every day. I also keep some other reminders: John’s picture, a photo of the Waldwick, NJ, memorial to John and all the firefighters who perished, a personal note from June with some of the best marital advice I’ve ever received, among others.

Some great minds have said that facing death often gives people the license to finally live their lives.

I am fortunate to have been touched by a soul who needed no such reminder.

About davidjknoll

David J. Kroll, PhD is an adjunct associate professor of medicine at Duke University Medical Center, of pharmacotherapy and medical journalism at the University of North Carolina at Chapel Hill, and is a President’s Teaching Scholar of the University of Colorado. He enjoys each of these titles because none of the aforementioned institutions actually pays him a dime. He notes that fully half of his finest trainees have been Canadian women. Despite his love for Canada, David currently swelters in Durham, NC, with his wife, Heather S Shaw, MD, and their daughter, Phoebe Talbot Kroll.

SHOULD EVERYONE HAVE ACCESS TO LIFE SAVING MEDICINES?

By | archive, commentary, review, textbook

If you’re a reader from Canada, don’t forget to check out aidsaction.ca. Here, you can look up your candidates and send off an email to support the Call to Action to reform Canada’s Access to Medicines Regime and help save lives!

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30 MINUTES, 70 FATES.

You don’t know it, but as I write this piece, there is some serious procrastination going on. My attention span is weak and sidetracked constantly by a variety of diversions, and if you must know, it’s taken me close to half an hour to write these first two sentences. Still, one could argue that none of us are strangers to procrastination, and 30 minutes is relatively short – only a minor instance of time in the grand scheme of things.

But a lot can happen in thirty minutes. Earlier, I had been looking over some 2009 UNAIDS statistics, and noting the numbers issued in the report. They are all very big, big enough certainly to require the pressing of buttons on calculators. More to the point, I learn that during my thirty minutes, approximately 70 people died from HIV/AIDS in Sub-Sahara Africa. That’s 1.3 million victims each year – in Sub-Sahara Africa alone. Many of these were parents leaving orphans, and many were young children just leaving. Most troubling, however, is the fact that all of them suffered their fate with a loss of dignity.

Why do I say this? I say this because people shouldn’t have to die from HIV/AIDS. There are good medicines out there, and they can control the disease. In fact, for those in the developed world, HIV/AIDS is now considered a chronic disorder, not a death sentence. If you are diagnosed, you are no longer forced to take a shortcut to demise. You can still have a long life, you can still be productive, and you can still live with dignity.

Unfortunately, this wasn’t an option for those who passed away. For them, the medicines were out of reach. They were simply too expensive. And from this, you come to realize a cold hard fact in this narrative: that the fate of a person living or dying from HIV/AIDS is determined by their income. This statement is fairly straightforward, with no mincing of words, or confused rhetoric. But for most, it feels fundamentally wrong, and yet, it is a simple reality of how the world works today. Why it works in this way, however, is complicated.

IT’S ABOUT CONTROL

Imagine yourself an inventor. And you have invented something that many people want. Not only that, but you spent a significant amount of time and money on the way there. Naturally, you want to make sure you protect your innovation. You want to make sure that you are not only compensated for your work, but that you are rewarded accordingly – handsomely even. This is where government can step in: they can protect you, and they can do this by setting rules on intellectual property. They grant patents, which allow you to control your invention, and control how others can or cannot use it. The government sees obvious value in this, because the fact of the matter is that innovation needs help sometimes.

This, basically, is how the pharmaceutical industry works. They are inventors, and their product is medicine. Research and development costs are significant, both in terms of money and in terms of time, mostly because many of the things they invent do not work out in the end. They get patents, and are compensated and rewarded accordingly – relatively speaking, the pharmaceutical industry is rewarded very handsomely.

This is because there is a market for such things: whether we are talking about antiretroviral drugs for HIV or Viagra for life style needs, in the developed world, people want these drugs (and in some cases, need these drugs), and are willing to pay for them. They do this, because they can, often with help from health care providers and government. The supply and demand is there, and the pharmaceutical industry knows how to play this game. You, the reader in the developed world, make the market.
Because things are so handsome, the pharmaceutical industry has a vested interest in maintaining the status quo. They don’t want to lose any semblance of control, even if, apparently, lives are on the line. They are very good at protecting this control – their lobbying influence is very strong indeed, and they do this with zeal although sometimes by misrepresenting facts.

GENERICS CREATE NEW MARKETS.

Herein lies the challenge: that for drugs against HIV/AIDS, there is this other market. Furthermore, this is a market that needs the medicine desperately: the aforementioned 70 individuals are included here, although it is too late for them. However, it is also a market that is generally not part of the game. We can say this, because of two points:

1. This market doesn’t count because they cannot afford the drugs.

2. This market doesn’t count because they are not part of the pharmaceutical industry’s bottom line.

Consequently, a lot of very clever people have suggested that a way to get around this challenge, this challenge of access to medicine, is to set up ways to produce generic drugs. This is essentially where outside companies can be granted the right to copy the drug and produce it at much lower costs. Just to clarify, the cost of drug production is generally a very small fraction of the final price tag. Anyway, the argument here, is that these rights would be very specific, in that generics could only be sold under strict circumstances such that the status quo is unaffected in wealthy markets. A good example of this, is to simply say that generics can only go to developing markets, can only go to places like Sub-Sahara Africa, since they already do not factor into the industry’s bottom line. Furthermore, the inventors can stipulate royalties, so that they still get compensated for opening up these markets. In fact, in the best situation, the inventors would even produce their own generics.

For a variety of reasons, the pharmaceutical industry has not been keen on this idea, and has done much to make generic production as laborious and slow as possible. Ideally, they would be a willing participant in discussions with generic producers, and bargain fair terms so that these cheaper drugs can be made. Unfortunately, this rarely happens and when it does, it tends to be on an older palette of medicines, things out of date for rich people like us, which may be less effective for a variety of reasons (side effects, efficacy, convenience).

Because the pharmaceutical industry generally does not want to play, the notion of “compulsory licenses” has been pushed to the forefront. I’ve written about these in the past, and they deserve a repeat mention.

THE GIST OF A COMPULSORY LICENSE*.

Compulsory licenses assume that, sometimes, the inventor isn’t the best person to make decisions about control. Sometimes, the inventor doesn’t have the best information to take stock of a situation, or sometimes there might be a moral argument where monetary performance should not take precedent. In other words, sometimes, there are special circumstances where you could say it is reasonable that this control is tweaked.

To illustrate this, here are some hypothetical (and not so hypothetical examples):

1. You are a company that recently received your patent, so that now your drug is being sold for $1500 instead of the previous $10 pricetag.

2. Your country has experienced a series of anthrax scares. The company that holds the patent for the most effective drug against infection from the offending bacterium, sees an opportunity, and decides to jack up the price.

3. Someone has declared war on your country. To defend yourself, you would like to utilize a particular product. Unfortunately, it is under a cost prohibitive patent and therefore out of reach.

4. There is an impending nuclear power plant meltdown, and there is technology that would be incredibly useful to mitigate radiation contamination and poisoning. However, your resources are already stretched because of the utterly horrific effects of a 9.0 Richter Scale earthquake, and this technology is too expensive at the scale that is required in such an emergency.

5. There are markets where your life saving drug is not being sold because no-one can afford them anyway. However, the drug (which could be a matter of life and death for millions) could be made at a cost (i.e. a generic) that makes it accessible in these markets, but if and only if, the patent over them is adjusted.

Here is the point. In all of the above cases, you would like to live in a civil society where the government can step in and forcibly change the patent, because in every case, there is an element of morality involved. And guess what – governments can do this and they do! It’s called a “compulsory license,” and they exist for this very purpose.

In fact, even the WTO is on board with this idea. They recognize that in some circumstances, such as those pertaining to global health, there needs to be an understanding that using such compulsory licenses is both necessary and an obligation. In fact, if you have a hankering for the legalese that outlines this for patents over essential medicines, you need only look up info on the Doha Declaration.

FIGHTING IT: ACCESS TO MEDICINE REGIMES.

So at the end of the day, advocates like myself feel that compulsory licenses are a way to save lives. And so we push for laws that enable their existence in the global health front. These are often called “Access to Medicine Regimes” and a few countries already have them in place. In many respects, they are an example of innovation themselves, since there are two challenging criteria they are designed to meet: (1) that cheaper life saving drugs are made available to poorer countries; and (2) that the pharmaceutical industry can still keep their status quo in richer countries. Many, like the law in Canada, don’t seem to be working, and so there is a movement to try and fix it. Like, any good exercise, this has been done under expert review, and the new Canadian law (called Bill C-393) looks pretty good. It meets the two criteria.

Unfortunately, there is some serious push back from the Canadian pharmaceutical industry. They lobby government and do so with counter arguments that have already been addressed by this expert peer review, such that many have been calling the pharmaceutical industry unethical: that their reasons for fighting are based on misinformation. Most of their arguments appeal to those that value ownership, that their properties, inventions, and monopolies are in danger because of careless policy, but that could not be farther from the truth. They simply don’t want to lose any semblance of control. Despite these tweaks being carefully scripted to protect their business interests, the pharmaceutical industry still regards them as a starting point to a “possible” loss of control. Because of this excessive anxiety, they fight and they fight and they fight. For those interested in endings, this one is severe: Bill C-393 was killed.

Sometimes, they fight in other ways. In the case of Free Trade Agreements between the European Union and India, one of the battles over generic drugs concerns the issue of “data exclusivity.” This is a technical term that essentially says that even if a patent is not holding things back, a company still can halt the process. Here, a bulletin recently released by Doctors Without Borders describes it well:

Data exclusivity (DE) is a backdoor way for multinational pharmaceutical companies to get a monopoly and charge high drug prices, even when their drug has been found to not deserve a patent, or the patent has expired – DE would apply to all drugs.

If India accepts DE, the agency in charge of approving medicines for use in the country would not be allowed to register a generic version of a medicine for a period of time – usually 5 to 10 years. To register a generic, producers rely on the clinical trial data provided by the originator company to show the drug is safe and effective. All the generic has to prove is that it is identical to the originator product. But if DE were in place, the originator company’s clinical trial data would be protected by ‘exclusivity’ and generic producers would therefore have to submit their own safety & efficacy data to register the generic medicines. This would oblige them to repeat clinical trials—something that would take years and be incredibly expensive, not to mention unethical, as it would involve withholding a drug that has already proven to be effective from some of the participants in the trial.

And so things drag, time passes, and minutes, days, and years are wasted. To call this delay an act procrastination sounds too contrite. I can certainly think of stronger words.

TO CONCLUDE…

In the end, it boils down to the following nugget: Do you think access to life saving medicine is a human right? Or at least, if you think that previous statement is too overreaching, do you think it is something that is worth more than the pharmaceutical industry’s perceived fear of loss. I sincerely hope so: At the very least, maybe more dialogues will be sparked, and a good place to start is down below in the comments.

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To get involved there are a number of places I can recommend. Firstly, an informal blog collective has been set up to discuss these issues in a more layman and easy to read manner. This blog is called “My Rights Versus Yours” and includes a cast of students and academics who are involved in various aspects of the Access to Medicine cause. We aim to have posts that deal with the various issues at stake including pieces about both the science and policy involved. This is a new blog, but we are hopeful that many will find it both useful and enjoyable to read. You can follow the blog on twitter or better yet, partake in its first Global Health Carnival. If you’re a Canadian reader, I strongly urge you to check out aidsaction.ca particularly the page which asks our candidates to endorse and support the reform of Canada’s Access to Medicines Regime. Timing is crucial here, as a Federal election looms. If nothing else, just make sure you vote.

About David Ng

David (@ng_dave) is Faculty at the Michael Smith Labs. His writing has appeared in places such as McSweeney's, The Walrus, and also as an occasional blogger at boingboing.net. If you're looking for a graphic for your next science talk, he encourages you to check out his blog, popperfont.net.