review

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.

DOES THE NAME DR. KRISANA KRAISINTU RING A BELL?

By | archive, review

A review of Cocktail: A Play about the Life and HIV Drug Development Work of Dr. Krisana Kraisintu by Vince LiCata and Ping Chong

cocktail.jpg

Truth be told, I don’t read plays very often, if at all. In fact, I’m ashamed to admit that I think the last one I read was back in high school long ago, and if I remember correctly had something to do with vampires – ironic in that vampires at the time were not so popular. But this play was about something I am interested in – medicine and social responsibility – and it was referred to by a friend, who also happened to be one of the authors.

Coincidentally, I read it on my way to Lagos, Nigeria, a place where access to medicine has its own battles. I was going to help facilitate a scientific training workshop, a workshop that would hopefully provide some knowledge to young biologists, many of which were hungry for ideas in their hunt for answers to malaria, HIV, tuberculosis, etc. On that flight, the similarity of scope of what I was reading and what I was heading off to was not lost on me.

In fact, it was much needed. It’s never easy to leave home, your family, for an extended period of time. More so, when you’re traveling to a place where the culture shock is expressed in the lack of the first world luxuries you’re used to. I needed to read the play – because in many ways, it reminded me of why I was going in the first place – that there was value in doing my small part.

To say that Dr. Krisana Kraisintu did a small part would be close to slander. Her actions have saved tens of thousands of lives, likely much more. She was responsible for directly going against governments, against pharmaceutical companies, against international laws even, to formulate and produced GPO-VIR. This is a generic fixed-dose combination of stavudine, lamivudine and nevirapine for treatment of advanced HIV infection, but more importantly represents the first generic HIV cocktail. To say that this took guts would be a great understatement.

Dr. Krisana: The fact that people are dying today from a treatable disease is not a hypothetical situation. Children are -

Brighton Miles Pharmaceuticals Executive 1 (BMP1): Ah, the children.

BMP3: The children!

BMP2: The children.

BMP6: The children.

BMP4: Always the children. (to BMP2) Breath mint?

BMP2: No thanks. You can’t fight the dying children.

BMP1: There’s no way.

BMP5: It just shuts off all useful discourse.

BMP2: It’s grandstanding, plain and simple. How do you trump a dying child?

BMP1: You can’t.

BMP3: You can’t.

BMP6: You can’t.

BMP4: It just shuts down the conversation every time.

BMP2: Why, if I had a nickel for every dying child…

BMP1: You’d be rich my friend, you’d be rich.

You learn this when you read the play, and in doing so you learn a little more about the biology of HIV, about the politics and economics of health. And in a way that a news report or textbook can’t emulate, you learn about the devastation of what a disease like HIV can do.

You also learn a little about Dr. Kraisintu, about what compels her to do what she does. In doing so, you are given a rare glimpse into the mindset of an individual who chooses to make many sacrifices for what they believe is right. This reminded me of another outstanding book, referred to me by no less than Stephen Lewis – Mountains Beyond Mountains: here, you lived within the head of Paul Farmer, another individual whose world is enveloped in activism. The parallels are striking and it makes me think that Dr. Kraisintu deserves to be up there with the likes of the Paul Farmers and Stephen Lewis’ of the world. It clear that they tick in the same manner, and it is both admirable and eye opening.

These are the perspectives you get when you read this play, and for that reason, I highly recommend you doing that. I haven’t actually seen the play performed. Not yet anyway. But wouldn’t that be something?

(To puchase from Amazon, please visit here)

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.

BOOK REVIEW: BROWNE’S “DARWIN’S ORIGIN OF SPECIES: A BIOGRAPHY”

By | archive, review

Much like David Quammen’s The Reluctant Mr. Darwin (2006) and Edward J. Larson’s Evolution: The Remarkable History of a Scientific Theory (2004), Harvard historian of science Janet Browne’s Darwin’s Origin of Species: A Biography (2007, ‘Books That Changed the World’ series, which also includes the Bible, the Qur’an, Smith’s Wealth of Nations , Plato’s Republic, Paine’s Rights of Man, and Marx’s Das Kapital) serves, I think, as a great introductory book on the topic of Darwin and evolution (for either lay persons wishing to become familiar with the topic or for undergraduate level courses in the history of science or biology). I wrote of Larson’s book before for a history of modern science course:

Edward J. Larson’s Evolution: The Remarkable History of a Scientific Theory is a wonderful compact book that does well to relate the social, cultural and political forces at work through the past two centuries of evolutionary thought. It is simple and broad, and Larson’s non-scientific prose adds to it being a great book for an introduction to Darwin, evolutionary theories, and the conflicts and successes the idea of evolution has endured.

Browne’s book better fits this description, for it adds more readable prose and unlike Larson’s book, does not contain a wealth of grammatical errors. Of course, at only 153 pages, Browne’s book hits some topics well (Darwin’s life and work) while passing over others quickly (creationism in the late 20th century). Unlike Quammen, Browne does discuss the Beagle voyage, then moves on to the period of Darwin’s work from 1836 to 1859, when On the Origin of Species was published. The remainder of the book tells of the influence (or lack thereof) that Darwin’s evolutionary theory has had on both the sciences and society. Now I will mention particular points in her book that I liked. Browne brings up the debate about whether or not Darwin delayed in publishing On the Origin of Species for fear of ridicule and criticism (from the religious folk). This debate in the history of science has been most recently discussed by Cambridge historian of science John van Wyhe ( “Mind the gap: did Darwin avoid publishing his theory for many years?” Notes & Records of the Royal Society 61 (2007): 177-205). Browne reiterates van Wyhe’s claim that “Darwin’s Delay” is a historical myth, and that instead of a delay Darwin was using the time for research (especially on barnacles) and experimentation – in essence, Darwin wanted to know that he had it right before he published his theory. Browne writes:

Nowadays, in the light of all that is known about his personality and correspondence, it seems feasible to suggest that a strong commitment to scientific accuracy and a proper sense of scientific caution were at least as high in his mind as any fear of the consequences of publication. (p. 50).

And:

Historians tend to smile at so much time spent on ingignificant organisms [8 years on barnacles] and call it a sideline, a delaying tactic in order that Darwin might avoid confronting the furore that would arise out of publishing his other more wide-ranging evolutionary views… What he found in barnacles, however, brought important shifts in his biological understanding, strengthened his belief in evolution and provided an essential backdrop to Origin of Species. (p. 54).

Browne also explains in several instances how Darwin did not single-handedly rid God from society or how he cannot be attributed to racism, eugenics, or genocide, as is often the case that creationists attempt to make. If Darwin and his work are responsible for these atrocities to humanity, they argue, then we must dismiss the theories. However, we never hear of anyone attempting to dismantle chemistry because of the consequences of the atomic bomb droppings on Hiroshima and Nagasaki. That humanity can apply science to its wishes for how they think the world ought to be should bear no claim on the validity of that science. As much as science changes based on new observations, evidence, etc., science is how we understand our world, a way of knowing. How we take that understanding and use it to change the world is different. Jared Diamond used geographical factors to explain how human races came to be where they are today (politically, economically, etc.) in Guns, Germs, and Steel. What Diamond misses, however, is that although whites historically have had scientific and technological advantages over the rest of the world because of the geography of where they lived, there was still a conscience human decision behind the acts of colonialism, slavery, genocide, etc., and this decision was based on a constructed division of savage versus civilized man. Many miss a similar point when it comes to Darwin – although people used his theories to support their racist, eugenic, and colonial actions, Darwin cannot be attributed to starting these lines of thinking.

Browne writes that “racism and genocide predated Darwin” (p. 128) and that “Darwin’s Origin of Species can hardly account for all the racial sterotyping, nationalist fervour and harshly expressed prejudice tot be found in the years to come” (p. 108). She notes, however, that On the Origin of Species became a tool to support this thinking: “there can be no denying the impact of providing a biological backing for human warfare and notions of racial superiority”(p. 108), or “evolutionary views, and then the new science of genetics, gave powerful biological backing to those who wished to partition society according to ethnic difference or promote white supremacy” (p. 128). In regards to the impact Darwin had on religion, Browne reminds us that “[a]nxious doubts, secular inclinations and dissatisfaction with conventional doctrines were launched among intellectuals long before Darwin came on to the scene” (p. 63). Also, Darwin’s theories hardly cast doubt on a literal belief in Genesis:

Learned biblical study since the Enlightenment had encouraged Christians increasingly to regard the early stories as potent metaphors rather than literal accounts. Biblical fundamentalism is mostly a modern concern, not a Victorian one. The real challenge of Darwinism for Victorians was that it turned life into an amoral chaos displaying no evidence of a divine authority or any sense of purpose or design. (p. 86)

As a history of science student, I have learned to see how social, cultural, political, and religious factors contribute to science, and how science in turn can affect these institutions. A “rather modern combination of manufacturing affluence, gentlemenly social standing, religious scepticism and cultivated background,” Browne writes, “ensured that Darwin always had a place in upper middle-class society and the prospect of a comfortable inheritance, both of which served as very material factors in his later achievements” (p. 10). If factors about his life enabled Darwin to be the meticulous, detailed scientist (amateur or not) he was, then his science was influenced by the society in which he lived, for no one could “fail to notice the way that Darwin’s biology mirrored the British nation in all its competitive, entrepreneurial, factory spirit” (p. 67). Marx wrote to Friedrich Engels in 1862:

It is remarkable how Darwin rediscovers, among the beasts and the plants, the society of England with its division of labour, competition, opening of new markets, ‘inventions’ and Malthusian ‘struggle for existence’É in Darwin, the animal kingdom figures as civil society.

Browne also touches on smaller aspects about Darwin’s life and work that I find interesting. It is too often said that the first printing of On the Origin of Species sold out it’s first day (see Larson, p. 88). A reader would assume, then, that the public went out and snatched up copies of the book like they do now with the Harry Potter books. Browne corrects this assumption (as does Quammen (p. 174)) by stating on the very first page that it “sold out to the book trade on publication day” (p. 10). The importance of writing letters was crucial for Darwin in his gathering of information and facts for his developing theories:

Without this extraordinary correspondence… Darwin’s theory would have sunk. In this he was materially helped by the rapid development of the Victorian postal system, brought to a peak of efficiency by Rowland Hill from the 1840s and 1850s, and the expanding infrastructure of empire. (p. 88)

Browne would know, of course, of the importance of correspondence to Darwin, a sedentary naturalist. She worked on the early volumes of Darwin’s correspondence. She also gives a brief account of the work of Darwin’s colleague and friend, the botanist Joseph Dalton Hooker, who also made use of international correspondence. Hooker was a naturalist and administrator (of Kew Gardens) who was “aimed at the empire of botany” (p. 91). Hooker’s career attests to the connection between science and society, with Kew Gardens playing an important role in British colonial expansion ( economic botany or colonial botany). Forthcoming (2008) is historian of science Jim Endersby’s book, Imperial Nature: Joseph Hooker and the practices of Victorian science . Finally, I enjoyed the reference to the distinction between field and laboratory biology, which I read a little about when I did my paper on Darwin and his seed germination experiments. Browne has a way with words so that in a sentence or two she can sum up a concept for the reader:

By the last decade of the nineteenth century their aim was not to catalogue dead animals and plants but to understand the inner workings of living, breathing bodies – a self-conscious conceptual break from the past. This new attitude to biology reflected a major move away from observational natural history towards a more experimental, laboratory-based form of investigation, a move that can be seen taking place in almost all of the sciences at the time. Traditional natural history, of course, did not stop; it became sidelined, sometimes regarded as the province of amateur naturalists, or otherwise reconstituted as new sciences of animal behaviour, ecology and environmentalism. Like physics and chemistry, biology was becoming something that was primarily practised indoors, in a lab, under controlled conditions, and increasingly with the financial aid of government agencies. (p. 132)

Overall, I liked Browne’s book, better than Larson’s but not quite as much as Quammen’s. I would have preferred some consistency in the title of Darwin’s “one long argument.” Browne goes back and forth between Origin of Species, On the Origin of Species, or just plainly Origin. This is merely a minor detail, but I like consistency. Browne tells us that an illustration from Huxley’s Evidence as to Man’s Place in Nature is the “first pictorial representation of evolution” and “has since become as iconic as the double helix of DNA” (p. 97). Probably more iconic is Darwin’s illustration of a branching tree from one of his transmutation notebooks (notebook B, 1837), which predates Huxley’s image. Maybe Huxley’s is a picture whereas Darwin’s is a diagram, I don’t know. But even Darwin was not the first to draw a tree of life, for Lamarck had such a sketch in his Philosophie Zoologique (1809). (See Mark Wheelis, “Darwin: Not the First to Sketch a Tree,” Science 315 (February 2, 2007): 597. Unfortunately, Wheelis attributes Darwin’s tree to an 1868 notebook).

About Michael D. Barton

Michael D. Barton is an undergraduate in history at Montana State University-Bozeman. He plans to continue with a graduate program in the history of science, where he would like to research some aspect of Charles Darwin's life, work, or legacy. When he is not adding cool stuff to his blog, or reading for his classes, he spends time with his wife and 18-month old son.

KADATH: A VISION INTO THE AGE OF NANITES

By | archive, journal club, review

Many science fiction writers have developed tales regarding mankind’s attempts to surmount the forces of nature that separate man from God. These works often portray the human species as a newcomer to Earth and as a brash and shortsighted community working feverishly towards its own demise. The history of this story has its modern roots in the late 1800s with the Transcendentalism movement in New England. Writers such as Edgar Alan Poe and Herman Melville, as well as their counterparts in England such as Mary Shelley, began examining the human spirit’s desire to conquer nature in their literature and the ramifications such an undertaking could entail. Throughout the 20th century, Moby Dick and Frankenstein’s monster have been replaced with robots and nanotechnology, but the underlying story remains; will mankind’s zealous pursuit for knowledge result in his rightful ascension to the throne of God or will nature whisk away his noisy, but insignificant existence? Kadath in the Cold Waste, a short story written in 1995 by Edward Keyes, tackles one of the newest facets of scientific progress, nanotechnology. The accuracy of the nanotech applications which Keyes describes, as well as the tone in which he writes, elucidates his view regarding nanotechnology as the next possible key in mankind’s pursuit of divinity.

Kadath in the Cold Waste follows the story of a young boy named Gavin who lives on a Martian colony in the year 2103. The Martian colony that Gavin lives on is home to the last surviving human population: an escape mission from Earth to avoid a plague which caused the extinction of humankind from the face of the planet in the year 2045. Gavin observes the Earth, in association with a mentor Dr. Johan, from the surface of Mars using telescopes. On a routine observation, Gavin notices an enormous metal ring in orbit around the circumference of Earth. Gavin and Dr. Johan are astonished as the discovery means that not only did humans survive the plague, but they are advanced enough to construct such an awesome piece of architecture. They steal a ship from the colony, as any sort of communication attempt with Earth is forbidden by the local leadership, and set off for Earth.

En-route, a small metal ball attaches to the hull of their ship and begins eating its way through the thick plastic composite. Gavin and Dr. Johan don space suits before the hull is breached, but the metal glob soon attacks and kills both of the characters. However, Gavin immediately regains consciousness and comes to discover that the metal clump that killed both himself and Dr. Johan was actually a cluster of nano-machines called Nanites, and upon consuming his brain, actually mapped and digitally duplicated its structure inside of a computer program. Gavin finds himself in a virtual existence, but one that is in every sense as real as what he had known while physically alive. Gavin learns that the plague that had caused the extinction of mankind from Earth was actually the result of self-replicating Nanites consuming and assimilating the minds of humans into their computer world. Gavin is guided throughout the computer world by a Kadathan named Calvin, a resident of the computer world who had been assimilated years before during the original Nanite outbreak. Calvin enlightens Gavin on the benefits of being a digital entity, from instant access to any knowledge available, to generating anything one wishes simply by commanding it.

The computer program, powered by the large metal solar collecting ring in orbit around Earth, links every mind that it has assimilated to every other mind into a large single entity called the collective. Gavin is able to meet with people by accessing their simulated location in the program, and he is escorted at his wish to the site where the original creator of the Nanites, Dr. Meredith, lives. After meeting with Dr. Meredith, who expresses great regret about the devastation that he unleashed upon the mortal world, Gavin decides that he would like his biological body reassembled and to be provided with a shuttle back to Mars. The computer system complies and reassembles Gavin, granting his request. However, upon being removed from Kadath, it is revealed that the entire existence that Gavin had known prior to being converted into a digital form was already a part of the system, but just a simulation to study the minds of people who were unaware of being part of the collective. The actual Martian colony that had existed years before had long since been destroyed before Gavin came into existence.

Kadath in the Cold Waste touches on many aspects of nanotechnology, including how it may be applied to assist humans in the future. Nanotechnology is characterized by the manipulating and manufacture of materials less than 100nm. By compacting everyday items into these proportions, large cumbersome objects can be streamlined and integrated into more efficient forms. An early example of this process is seen as Gavin and Dr. Johan wear small re-breathing and water collection devices while on the shuttle to Earth. Although nanotechnology isn’t explicitly mentioned regarding these tools, the idea of having microscopic devices that can perform functions like converting exhaled carbon-dioxide back into oxygen is precisely what nanotechnology may be able to accomplish. Devices such as water filtration systems that use nanotechnology to purify contaminated water are already on the drawing board for companies like KX Industries, the developers of Brita water filters.

Another facet of nano-technology was portrayed as Gavin and Dr. Johan prepare sensors to be deployed into the atmosphere of Earth before they discard their space suits and walk upon its surface. The sensors were designed to detect and inform Gavin and Dr. Johan of harmful toxins that may have accumulated in the air since humans left Earth. The technology of sensing chemicals on the nanoscale is on the forefront of nanoscience today. Currently proposed methods of this detection use highly sensitive nanotube electronic devices that are able to form very specific interactions with biological proteins (Chen 2003). These devices are being engineered to detect antibodies as well as other proteins in order to increase the accuracy and speed of disease diagnosis. This use of nanotechnology as a method for chemical identification is portrayed very realistically, as the use of such nano-sensors has already shown promise in biological settings.

The Nanites that attack and assimilate the two characters also has roots in current nanotechnology research, but Keyes develops this aspect of the science with an ominous tone and perhaps with some literary license. These self-replicators were able to supply themselves with building materials for replication by disassembling portions of biological structures and reassembling them into forms identical to themselves. The original catastrophic outbreak of Nanites in the story involved self-replicators being programmed to evolve and then being released into the environment. This “grey-goo” scenario, uncontrolled self-replication of nanomachines, is plausible, but current research points out that steps can be taken that can prevent self-replicators from becoming uncontrollable. Chairman of the Institute for Molecular Manufacturing Neil Jacobstein and law professor at the University of Tennessee Glenn Reynolds have collaborated on a paper titled Foresight Guidelines for Responsible Nanotechnology Development, which provides guidelines for government, professional and industrial nanotechnology use.

The focus of the paper revolves around specific actions that can be taken to avoid a situation where self-replicating nanomachines become out of control. They propose many insightful ideas that would limit both the ability of nanomachines to replicate as well as the designing of such machines. They suggest setting industrial guidelines which limit not only the displacement of self-replicators, but also the schematics of their design. This would create a sort of barrier to disallow self replicators access to the outside of a lab setting, including in the hands of potential terrorists. They also suggest limitations be set for the amount of onboard instructions that selfreplicators can possess. By remotely controlling the data needed for self-replication, with radio signals for instance, a safety switch is put in place which gives a great deal of power to human operators over nanomachines. I believe that the Kadath in the Cold Waste also overlooks the overwhelming complexities in writing a program which mimics evolution to the degree that would result in a sense of self-awareness in machines. Nanomachines would most feasibly be programmed like machines of today: with instruction sets designed to carry out focused tasks with great efficiency. A great deal of time and energy can be saved by developing numerous nanomachines for specific tasks than one nanomachine for a multitude of tasks. This trend is evident in modern forms of mass production involving automated systems.

In addition to physical characteristics of nanomachine implementation, Kadath in the Cold Waste examines the ethical and moral ramifications of integrating technology and biology. Gavin notices many things about being digital that were not present in his human form, such as the ability to access past memories instantly and with perfect clarity. The physical characteristics of metal surpass the biological brain’s ability to store and access information. Kadathan entities are able to do interesting things once free from the tether of biology, including the ability to communicate while avoiding the immense drawbacks of verbal communication. Gavin experiences others thoughts as well as their emotions just as they were being felt by the other individual. The ability to convey complete thoughts allows Kadath to be a very ethical place where the misunderstandings created across class and cultural lines are dissolved through education and complete human to human communication.

Gavin also relishes new forms of art in which the experience of emotions are coupled with unimaginable sensory stimulations such that he found himself, “experiencing the raw emotive concepts of the piece, at the level of thought and thought alone.” It was interesting to see a contrasting perspective to the general notion that integrating machines into a human body would detract from emotional experiences as well as the moral gain that experiencing such emotions could impart on the viewer. Gavin’s guide points out how much better art is when any possible barrier between the artist and his or her audience is removed, something that integrating nanotechnology into the brain may accomplish. The piece of art that Gavin experienced was written by a non-human source, which also has provides interesting insights into the ability of mankind to communicate directly with other biological forms in nature such as animals. The thought patterns of animals were valued and assimilated by Nanites into the collective, as these minds provided an even greater amount of information on which the Kadathan society was built. Keyes provides a balance to the negative aspects of nanotechnology by portraying unique and positive ethical and moral gains that may be available once the limitations of biology are overcome.

Kadath in the Cold Waste directs the reader to consider the shortcomings to society that may occur with nanotech integration. Keyes portrays the cummultive thinking of the construct as limited by many of the same things that make it so powerful. All of the individuals that are in the system are linked to each other in a way best described in the story as dreamers dreaming a common dream. However, new thoughts and different perceptions no longer exist between individuals, and this limits uniqueness of ideas. For this reason that above all, Kadathans value the people that are most different. The very reason for Gavin’s creation into an existence that kept him ignorant of being in the system was to benefit from his unique ideas. This process of sewing and harvesting thought patterns from people like a crop disregards the moral rights of people to exist as free entities. By generating people in a computer program, the true essence of human creativity is inherently undermined. I feel that although Gavin didn’t know about being in the system, the fact that he was still “wired” to it limits the successfulness of such an experiment. His ideas were still produced through a computer program and that alone under minds the concept of uniqueness.

However, this has some interesting implications considering that one could just as easily argue that real human thoughts are generated from the hardware that is our brain, and that this hardware is a result of the hardware that our parents possessed and “programmed” us with. Being connected to a huge number of other people also presents shortcomings that Gavin must wrestle with. As a member of the construct, he is susceptible to sharing his thoughts and ways of thinking with anyone whom wishes to access them. He feels violated that not even his thoughts can be kept private in a system that relies on the cumulative thoughts of everyone to exist. Inequities surprisingly still exists in Kadath as the speed at which Kadathans think is based on the physical computer that exists on Earth and its allocation of processor power to individuals. The more that an individual’s ideas are valued in Kadath, such as those of engineers and physicians, the more processor power is allocated to their minds compared to others whom are deemed less important. Its surprising how a community of such individual to individual interconnection could have what I believe to be the greatest ability to separate have and have-nots; the capability to limit the ability to think.

What I believe to be the most interesting and scary ethical and moral infraction on mankind created in the age of the Nanites was touched on with some of Gavin’s first thoughts upon regaining consciousness in the digital world when he considered, “…what kind of afterlife is this?” By becoming digital, Gavin becomes effectively immortal. He can no longer perish unless he chooses to be erased from the system and therefore commit suicide. By denying the right to die of natural causes and live a life governed by the laws of nature compared to the artificial laws of a computer program would have strong negative religious consequences for individuals that were also denied the choice whether or not to be apart of that system in the first place.
Kadath in the Cold Waste identifies both plausible and creative uses for nanotechnology in everyday circumstances, while also developing some very unique ethical benefits and shortcomings of nanotechnology use. Kadathan society evolved out of mankind’s desire to pursue a complete dominance over the laws of nature. By doing so, Keyes shows that mankind’s new role of God may cost too high of a price for its benefits, possibly even the right to be human.

Citations:

1. Edward Keyes, Kadath in the Cold Waste.. Available online. (December 1995)

2,. Neil Jacobstein, “Foresight Guidelines for Responsible Nanotechnology Development.” Draft Version 6 Unpublished. (April 2006)

3. Robert Chen et. al, “Noncovalent functionalization of carbon nanotubes for highly specific electronic biosensors.”

About davidfinnessy

David Finnessy is a junior pursuing a biology degree at the University of Wisconsin Madison who was going to write a factual boring blurb about himself until he realized that nobody else did. He wishes that he had something clever to say like everyone else, but finally last week Wednesday while studying for organic chemistry, he wrote over the last bit of brain space that was associated with humor in order to memorize carboxylic acid derivatives. He would apologize in full if he had not over-written his conscious last year in preparation for a physics test.

TO TALK OF THE WORLD OF BODIES

By | archive, commentary, review

bodyworlds.jpg

(BodyWorlds 3 is currently in Vancouver
at Science World, until January 14, 2007)

I had a train-wreck experience about Gunther von Hagens’ Body Worlds. I had previously heard nothing about the man, his work, or the show before we headed out to see it at Chicago’s Museum of Science and Industry, but one of my sources inside the museum world had mentioned that there had been a fair amount of controversy surrounding both von Hagens and the exhibit.

The exhibit was divided into anatomical systems: locomotive, nervous, cardiovascular, and digestive, plus a kind of gallery of awe—bodies in motion, human bodies and elements thereof placed in their jaw-dropping context. This last contained some interesting violations of the exhibit design, which seemed to lump together what should have been a gallery of the reproductive system and human ontogeny/development.

The basic design of the exhibit was to place glass cases centrally with a variety of full-body specimens placed around the edges. The cases were designed for two lines of visitors to view simultaneously from each side. This was absolutely necessary in terms of human-flow issues. However, the specimens were not always oriented in an equal opportunity way, so it was possible to have chosen poorly in terms of the side you viewed.

The whole-body specimens were on low platforms and most had no barriers between them and the visitor. They were placed well away from the wall, although many people didn’t seem to be taking advantage of this – the ability to view them from every angle was essential as each dissection was carried out from head to toe and front to back.

One serious oddity regarding the physical set up involved the last gallery, where the reclining pregnant figure, along with several embryonic and fetal specimens, were curtained off from the rest. This area also merited its own ostentatiously placed guard. I had no idea if it was originally envisioned in this way or if there was a story behind the separation. Whatever the reason, it’s disconcerting.

The pregnant figure was the culmination of a series of fetal development specimens beginning with the very early embryonic stages. The first of these was 99% uterus, where I was privy to a amusing, yet disappointing, discussion between two (20-ish, female) visitors:

“Look! You can see the tiny fingers!”

“Even this early!”

(They were Fallopian tubes to those of us not abused by bad biology education).

Other than the last gallery, the layout was stunning. The first two full-body specimens were relatively simple dissections revealing the depth and complexity of the muscular arrangement of the appendicular skeleton. For me, these were nothing particularly new. At this point in my life, I’ve dissected or supervised the dissection of probably 30 human cadavers and 20 different primate species. In learning and teaching anatomy (and the two are difficult to disentangle), there is a physical emphasis on geography and a theoretical emphasis on system. In the lab, you master the landmarks from every conceivable view, reducing the body to manageable regions. In the lecture hall, you ignore the distance between physical structures and try to master coordinated systems. To have the two entire systems juxtaposed in correct geography was one of the biggest “Ah ha!” moments of my intellectual life. It was also a profoundly moving experience. As P. Z. Myers so eloquently put it: “I am beautiful on the inside.”

Like the “Ah ha” moment, the next exhibit took a few minutes to sink in. It was an articulated skeleton with ligaments but no other flesh, reaching out toward the figure in front of it—the musculature of the same individual, arranged in the same pose.

Most of the full-body specimens at the exhibit were equally anatomically informative and artistically challenging. The “Chess Player” dissection brought me back to my first day in the lab as a student. The supervisor had prepared a similar laminectomy dissection (removal of the spines of the vertebrae and the top arch of the spinal canal to reveal the spinal cord and nerves emerging at each vertebral level). Each dissection group came through for a tour. Mine had three anthropology students and one med student who lasted about 2 seconds before face planting.

Med student mockage aside, the “Chess Player” was a fantastic piece, bringing the processes of intellect and motion together in a way that is often missing from hands-on dissection classes. (For example, at Pritzker, the brains of the cadavers had been removed for use in the dedicated neuroanatomy class, divorcing movement from thought.)

The thoroughness of representation and the depth of perspective contained in the specimens was astounding. My fingers ached to think of the painstaking work. Every conceivable view is represented somewhere, either in the cases or the full-body specimens. The juxtaposition of diseased and healthy specimens alongside those showing medical intervention (artificial joints, valves, arterial stents, etc.) was also highly effective. I was blown away, both as a scientist and consumer of art, by the arterial specimens. The arteries were filled with red polymer and the rest of the flesh and bone was dissolved away, leaving the three-dimensional structure rendered in the bold lines of the main vessels tapering into the incredibly delicate capillaries at the skin’s surface.

Amid the cases and specimens, there were floor-to-ceiling banners with classical anatomical drawings and other artwork regarding anatomical research, and some containing text reflecting on death, the body, and being human by scientists, artists, philosophers, etc. Some of the drawings were amusingly reflective of their period (e.g., a muscular diagram of a young man standing near, for some reason, a hippopotamus), but all really add to what von Hagens seems to be trying to do.

That is, to continue in the tradition of constructing forceful, persuasive images of and ideas about the authentic, natural glory of being human.

At the end of the galleries was a guest book and a blow-up of a completed donation form from someone who was determined to donate his body as a result of seeing the exhibit. I didn’t spend much time at the guest book after seeing an entry that simply said “It was kinda sick,” and another asserting that this “isn’t really for kids or toddlers.” I’d dispute that, having been fascinated by anatomy from a very young age. Personal opinion aside, there were numerous images about the exhibit and the lobby had clips from it running on televisions. If anything, the museum went overboard in trying to give parents ample information to judge whether the exhibit was appropriate for their children or not.

I’ve also searched around a bit to get a sense for the controversy over the exhibit. I’m surprised by the vehemence of reactions and the wide variety of objections being raised. Many take issue with von Hagens’ claim that his techniques and specimens are art (something he seems to be downplaying these days), relegating him, at most, to the status of craftsman (a distinction and demotion, I note, peculiar to Westerners who view art as a recreational excess, rather than something that exists in the middle of real life).

At least two authors of this type of criticism seem to have been so determined to sneer that they missed relatively straightforward scientific and artistic messages inherent in some of the pieces. For example, one was intensely critical of the “gimmick” of “Rearing Horse with Rider,” in which the human figure holds his own brain in one hand and his mount’s in the other. The viewer can approach closely enough to get the full effect of the horse’s immensity and just as that’s sinking in, the eye is drawn to the human brain positively dwarfing the horse’s.

Others insist that the so-called artistic placement obscures the anatomical information, citing, for example, the “Drawer Man” and the figure carrying his own skin like a coat. The former wasn’t included in this exhibit, so I can’t comment, but I thought that the volume of the skin relative to the individual’s musculature was both visually striking and informative.

Another seemed to think that the main point of the exhibit was to emphasize the similarity of human flesh to food. Although I find that an overly simplistic interpretation, I actually think that’s a message worth sending.

People are usually intrigued and repelled in equal measure when they hear that I used to teach anatomy.

“Well what does it look like?”

“Kind of like chicken or pork”

“Ew! That’s disgusting! We don’t eat muscle!”

A few years ago, I had a student share a story from his wife’s Girl Scout troop. They were working on a cooking unit with some whole fryers. One of the 11-year-old girls suddenly shrieked “Ew! They look like animals!”

But the largest category of criticism I found comes from those who feel that the exhibit denigrates humans by defiling corpses. Many deny that any information is conveyed. Others insist that von Hagens has no desire to convey information, only to shock. He has been called unbalanced, pornographic, psychotic, cold, calculating, and opportunistic. The words scientist, knowledge, and information frequently appear in sarcastic quote marks.

Other critics shift the focus from von Hagens to that which questions the motives of those who donate, often with pitying, contemptuous, or disbelieving tones. The specimen of the pregnant woman figures prominently in these critiques, demanding pity for her husband and loved ones, all the while insisting that she could not have known what von Hagens had in mind.

I’m not trying to pull rank, but I think it’s safe to say that I’ve put more thought into death and rituals of death than the average person. The tone of this criticism rankles, but doesn’t surprise me. It implies that individuals either have no right to determine what should happen to them after death, or that the idea of “informed consent” is a complete fallacy regarding one’s own physical remains. It’s particularly grating that the shrillest, most absolutist of these are devoid of any real consideration or appreciation for the plethora of different ways in which human groups treat the dead.

In my cultural anthropology class, I try to introduce the idea of the “Tao of Humanity” by drawing on Herodotus’ story about King Darius bringing Greeks and Indians together to talk about their rituals for the dead. The point is not that we eat or bury them, but that there is no human group that simply ignores the fact that death represents an individual and collective loss.

Bioarchaeologists have gone along for the culture-historical, processual, post-processual ride in trying to determine whether mortuary archaeology is telling us about the living, the dead, or neither. To pretend that those of us living in the Western world today have some kind of clarity on the subject is sheer hubris.

That said, there are some serious allegations that all of the specimens were not obtained via voluntary, informed consent. There have been reports in the German media that some of the corpses were victims of execution in Chinese prisons. The evidence does not seem to be especially robust, but it’s difficult to find a treatment of it that contains any facts, let alone dispassionate reporting regarding them.

All critics, regardless of the nature or orientation of their issues with the exhibit, seem convinced that von Hagens has nothing more in mind than cheap thrills and exploitation. It is very difficult for me to reconcile these simplistic condemnations with the richness of my own experience of it (and the apparent richness of the experience not just of my companions, but of the vast majority of the visitors there at the same time we were). I feel like I absorbed very little of what was available for the taking, and it’s somewhat depressing that so many seem to have been able to reduce it to so little.

About christinemalcom

Christine Malcom is a physical anthropologist working in Southern Coastal Peru. She teaches archaeology, cultural anthropology, medical anthropology, human evolution, and primatology classes at various places in the Midwest. She has also worked as a bioinformaticist, editor for various scientific journals, and Gal Friday to the executive director of a women\'s networking organization. She is a recovering theater/film nerd, who has replaced these vices with cooking, knitting, singing (badly), playing guitar (worse), writing, and smoking (but not inhaling) various forms of pop culture.