Monday, April 24, 2017

Reading Henrietta Lack as Pornography?

This commentary was originally posted 9/15/15.  I am reposting it because of the airing of the HBO Movie, The Immortal Life of Henrietta Lacks starring
Oprah Winfrey, on April 23, 2017. 


How does an award winning book that reads like a detective story and an exposes racial and ethical issues in medicine in the US – so timely when threats to our personal privacies proliferate – get called “pornography” and almost gets banned from Tennessee’s Knox County High School?

The book – The Immortal Life of Henrietta Lacks (2010), written by science writer, Rebecca Skloot.  I’m sure you’ve read it - the story of how a sample of cervical cancer cells was taken from a poor Black woman, Henrietta Lacks, as she was being treated for cancer. Lacks’ cells were used to create the first known human immortal cell line for medical research. The central problem - Ms. Lacks never gave permission for her cells to be kept and used. In fact, for decades her family had no idea that her mother was immortalized among scientists as “HeLa.”

Last week it was reported a mother in East Tennessee did not want her 15 yr. old son to read the book as part of his assigned summer reading, calling it “pornographic” and “too graphic.”    In fact, the mother is trying the get the book banned from Knox County High School.

Not surprisingly online media have had a field day with this – Slate, Huffington Post, and other parents in the Tennessee school district – calling it  “modern-day book burning,” “provincialism,” and “censorship.”

Sure enough.  But for me this incident with the Mom shouts out low health literacy in the US – the serious problem and reality of children and adults learning very little and understanding less about their bodies, how they work, and how to keep them healthy.

In Skloot’s book there is a powerful scene when the author is speaking with Lack’s oldest son, Lawrence (now 64), trying to explain the amazing biological legacy that his mother’s cells have created – the advances in medical treatment that resulted.  Skloot draws a circle with a dot in the center to represent a cell because she realizes that the son, like at least half the adults in the US, lack the most basic of health and science concepts – understanding what the building blocks of life are – cells.

The low health literacy of millions of adults in the United States has been called a “silent killer” (Zarcadoolas, Pleasant & Greer, 2006). The data documenting low health literacy is overwhelming. More than 30 years of evidence demonstrates that a significant portion of the U.S. adult population has difficulty accessing, understanding and using information about health.  Roughly 80 million adults in the U.S. have either basic or sub-par health literacy. And we’re not any better with science.  

       Between 5 and 15% of the public qualify as scientifically literate.  Only 18% can be considered an attentive science public. This includes – the fundamental scientific concepts, scientific process, scientific research, technology and scientific uncertainty and that rapid change in the accepted science is possible.
To make it a bit more graphic:
       Most know Earth travels around the Sun. √
       But few can successfully define molecule. X
       Most don’t understand the scientific process- hypothesis/testing/evidence. X
       About 60% know antibiotics don’t kill viruses. X
       More than 50% believe the earliest humans did live at the same time as dinosaurs. X

I’m not shocked at this Mom’s actions. Like most she’s likely looking out for her child. 
But I’m left seeing once again, the seemingly intractable legacy of the poor health and science literacy that is epidemic among us.


Tuesday, April 18, 2017

Menopausal Rats: not in my backyard


You’ve heard the joke.  What’s going to survive a nuclear holocaust?
      Answer:  Rats and Twinkies.
Twinkies aside, there’s no arguing through all recorded history rats have been wherever humans have been. Bringing with them public revulsion, disease and public outrage. In modern times urban residents in poorer neighborhoods and especially public housing have been beleaguered by rats that have overrun their homes.  Turn on a kitchen light at night or dare to walk out into a hall or down to the laundry room. Rats: Disgusting, frightening, threatening, demoralizing, maddening.

Wired Magazine and The NewYork Post both reported this week that NYC and the De Blasio administration are turning to a new rat solution.  Based on research done by scientists formerly at Univ of Arizona, the biotech company Senetech claims they have a way to use a chemical compound, not to poison and kill rats, but to simply make them infertile.

“Our non-lethal compound is placed in a liquid bait that brings rats back for seconds, thirds and more. They happily help themselves until over a few weeks both the males and the females become infertile. Otherwise they continue to lead normal lives without any observable side effects.”

Sophomoric jokes aside, what caught my attention about this new rat solution was the not surprising reaction of some residents living in public housing.
“Why are they ‘testing’ this on us?”
“How do they know it’s safe for us?”

A comment on the NY1 story read:
“Is this safe for humans or not? If it is, then go right ahead and spray away, but if its not, you shouldn't be using it in subways where Humans are exposed. I had to wait 20 minutes for my subway train this morning - signal problems again.” 

New Yorkers’ concern and early outrage makes sense.
Coupled with the long and shameful history of non-consented medical testing on minority, disadvantaged and disabled populations in the US, there is another powerful factor that will cause people to be suspicious and concerned about this new rate solution being tried in their housing projects.

At least 50% of adults in the US have low health literacy.
Only about 20% have adequate science literacy.
So familiarity with medical concepts, how the body works, medical and health terms are unclear to millions as are the basics of the scientific process, clinical testing and the public health and safety infrastructure of this country. 

I went to a quick source of information – WIRED Magazine’s coverage of the rat program. ( I knew it would take me a lot longer to read an EPA report.)

When you unpack the important facts behind the story (here I took content from both WIRED and NY Post) and do so with an eye to what science and health literacy/knowledge people would need to understand what Senestech is going to do, it becomes clear that folks are saying WHY TEST THIS IN MY BACKYARD?

Here’s what you find. 
Key facts reported in media on the left, the science or health concept/knowledge it assumes/requires the reader/resident to have, in the middle, and the likely effect on the consumer/resident, on the right:

Fact Reported in Media
Type of Science Literacy Required by Resident/Consumer
If you have low health literacy or science literacy
(at least 50% of adult in the US have low health literacy. About 20% are science literate
NIH grants - The city first ran trials of ContraPest in subway stations back in 2013 as part of an NIH grant project.

Knowledge about grant process and efficacy and safety testing
You miss that the pesticide, ContraPest, has already been tested.  You may think its safety is going to be tested in your house/neighborhood
NYC will now engage in a large-scale test of the technology

Process of testing – from smaller pilot testing to large field testing

In SenesTech’s first trial a few years ago, rat populations near subway stations went down by 43 percent.

Process and phases of testing
Significance of the 43% decline in rat population
With low numeracy skills the percentage may not communicate the treatments effectiveness.
The Environmental Protection granted approval for use of ContraPest on brown and black rats, the most prevalent in New York.

Understanding the role and value of federal testing and credentialing.
How do we know this is safe for me and my family?
The chemical treatment, ContraPest, works by attacking oocytes, the egg precursors that every female mammal is born with.

Basic reproduction anatomy.

Contraception is likely to work better than poison because if rats are poisoned and killed off this leaves food and shelter for more rats to thrive.

Animal behavior, competition for food supply

The chemicals in ContraPest break down in the rat liver within 30 minutes, so they don’t pee or poop it out into the water supply.

Function of liver; meaning of a chemical being “broken down” in the liver; ContraPest does not work like poisons that do not break down in the liver
How can this be safe for me and my kids and family?

The active ingredients are metabolised by the rat’s body in 10 minutes, which means that any predator that eats it is not affected, and the compound quickly breaks down into inactive ingredients when it hits soil or water.

Meaning of “metabolized”  and “inactive ingredients”
This stuff stays around forever and can poison my kids.  It can’t be safe.

If public health and housing officials want a program to succeed assisted by an engaged, trusting public then more needs to be done to communicate these fundamental concepts and facts before the intervention is implemented in neighborhoods.