Medicor-2016-2

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1#2013 medicor
2016 #2
medicinska föreningen’s
22
Stockholm: A city of borders
12
Sexual and reproductive health
rights in crises
medicorstudent magazine
20
The gender gap in
academia
FINDING REFUGE IN
ACADEMIA
A young man’s
journey from war
to the lab bench
and beyond

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1#2013 medicor
Dear readers,
I am delighted to introduce you to the second issue of Medicor
2016!
The current Medicor team started working together in September
2015, right after the Kick-off event that was organized to capture
new talented students. Piece by piece we started forging a new
editorial team, to ensure that Medicor would continue to deliver
articles of high interest to our readers, highlighting current issues
happening not only at the university, but also in the Stockholm
area and worldwide. As June approaches, the current study
semester ends. For many of us, this also signifies the completion
of our study program here at KI. Some of us may continue onto
higher degree education, many may start working in their new
job position and others may be leaving Stockholm for exciting,
new opportunities. Several of our great editors and contributors
will leave the Medicor team to start new chapters in their lives.
It is for this very reason that this second issue of Medicor 2016
is so special - it offers us a chance to celebrate their fantastic
contribution one last time.
In this issue of Medicor 2016, we set the scene with an exclusive
interview with Dr Babatunde Osotimehin, the Executive Director
of the United Nations Population Fund (UNFPA), in which we
find out more about the sexual and reproductive health rights of
women in a crisis-prone world.
Along with other interesting articles, we discuss the possible exit
of Britain from the EU (i.e.“Brexit”), we take a closer look at the
gender gap in academia and we also provide useful advice on how
to beat procrastination – a subject that many students might find
useful as exams or project deadlines are approaching.
For our central theme, we dive into the challenges of refugee
integration. To this effect, we present two featured stories. First,
we dissect the increase in segregation that Stockholm has been
experiencing over the past decade and how it affects immigrants.
We then turn our attention to the story of Aram Ghalali, a
young refugee who, through steadfast determination, overcame
numerous obstacles to reach his dream of becoming a successful
researcher at KI.
I would like to end this editorial by wishing the best of luck to
all those Medicor contributors that will no longer be part of our
team. I will definitely miss you from the bottom of my heart and I
hope that you always remember that without you Medicor would
have not been possible. Thank you for your contribution and for
Telling your Story.
Prelude
Cover photo
by Simon Guérard for Medicor
PhotobyJingchengZhaoforMedicor
Medicor Magasin
Grundad 2006. Tionde årgången.
Utges av Medincinska Föreningen i Stockholm
ISSN: 1653-9796
Ansvarig utgivare: Teresa Fernández Zafra
Tryck och reproduktion: Åtta45, Solna
Adress: Medicinska Föreningen i Stockholm
Nobels Väg 10, Box 250, 171 77, Stockholm
Utgivningsplan 2016: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december.
Kontakta Medicor: chefredaktor@medicor.nu
www.medicinskaforeningen.se
http://medicor.nu
Frilansmaterial: Medicor förbehåller sig rätten att redigera inkommet material och
ansvarar inte för icke beställda texter eller bilder, samt tryckfel. Upphovsman svarar
för, genom Medicor publicerat, signerat frilansmaterial; denna(e)s åsikter represen-
terar nödvändigtvis inte Medicors eller Medicinska Föreningens.
Freelance material: Medicor retains the right to edit incoming material and does not
take responsibility for unsolicited texts or pictures, and printing mistakes. The con-
tributor agrees that, through published and signed Medicor material, their opinions
do not necessarily represent those of Medicor or Medicinska Föreningen.
Sincerely,
Teresa Fernández Zafra
Editor-in-Chief
Overture
9
Culture
Global Focus
FINDING
REFUGE IN
ACADEMIA
KI CAMPUS
Science
26
MF´S ACTIVITY PLAN 2016
medicor
Teresa Fernández Zafra • Editor-in-Chief | Radek J. Góra • Associate Editor |
Saket Milind Nigam • Executive Editor & Director of Photography | Jessica De Loma Olson, Joanna Kritikou, Alex Browne • Web Managers |
James Salisi • Editor of Global Focus | Sibel Ilter • Editor of Campus | Emily Clark • Editor of Science | Martha Nicholson • Editor of Culture
James Salisi, Vaso Basinou, Nira Nirmalathas, Teresa Fernández Zafra • Layout Design | Jingcheng Zhao, Katarina Stojanovic, Oliver Ljong, Simon Guérard, Néstor Vázquez
Bernat, Gustaf Drevin, Eric Wellme, Maria Belikova • Photographers | Jessica de Loma Olson, Joanna Kritikou, Radek J. Góra, Emily Clark, Benedek Bozoky, Maria López
Quiroga, Frida Hellström, Iris Peña Arriarán, Jakub Olczak, Gustaf Drevin, Se whee Park, Markus Karlsson, Diana Cekatauskaite, Halima Hassan, Iskra Pollak Dorocic, Parvin
Kumar, Mateusz Krawiec, Amy Jackson, Victoria Satchwell, Sarolta Gabulya • Writers | Mina Saleem, Anny Truong , Olivia Miossec, Daniela Kas Hanna• Proofreaders |
Mikael Plymoth • Senior Comics Coordinator | Anny Truong, Eveline Shevin, Emily Clark, Pedro Veliça • Comic Illustrators | Jakub Lewicki, Freepik.com, flaticon.com •
Infographics
Aram Ghalali tells us
about how he went
from being a refugee to
a sucessful researcher.
SEXUAL aND REPRODUCTIVE
health rights
studeNT SOCIETY FOR SURGERY
AND ANAESTHESIOLOGY
SCIENCE SNIPPETS
a giant leap for
humankind
GENDER GAP in ACADEMIA
SLEEP AND THE BRAIN
COMICS
SEGREGATION in sthlm
AVOID PROCRASTINATING
12
14
animal testing
brexit
26
18
19
20
22
32
33
GRADUATION TRAditions
health outcomes
measurement
34
42
37
38
40
22
18
33
38
12
24
32
19
37
science and the public23
DOCTORAL STUDENTS’
ASSOCIATION
17
can your birth date
predict your health?
24

4 5
Aperture
Explore the Outdoor
By Lauro Meneghel
Taken at Tyresta National Park, Sweden

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1#2013 medicor
medicinskaforeningen.se
EXAMINATION CEREMONIES
02-03
KI CAMPUS
EVENTS
JUNE.16
ki.se/en/cns/calendar
SEMINAR - BEHAVIOUR OF SICK AND
HEALTHY HUMANS
Mats Lekander
15
ki.se/en/news/ki-calendar
NOBEL CONFERENCE “CELL CYCLE
AND CELL DEATH IN DISEASE”
@ NOBEL FORUM
8
ki.se/en/news/ki-calendar
SEMINAR ON TISSUE IMMUNITY
Georg Gasteiger - Mainz Medical Centre
CMM, Karolinska University Hospital
30
Photo by Oliver Ljong for medicor
SOLVIK FIXING WEEKEND
07-10
GRADUATION DINNER & PARTY
04

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1#2013 medicor
Smörgåsbord
New blood test to detect liver cirrhosis
Digital information
stored inside DNA?!?
Reconstructing new
esophagus tissue
Fighting malaria
in Bhutan
Advances in heart
transplants
Cross-species transplantation pre-
sents a promising method to bypass the human
heart supply problem that patients face on the
waiting list. Porcine hearts transplanted into ba-
boons have survived for over two years so far,
report researchers from the School of Medicine,
University of Maryland. This is the longest pe-
riod noted, which could be achieved through the
new immune-suppressing therapy.
Markus Karlsson & Radek J. Góra
Detecting the liver scarring level in patients suffering from liver diseas-
es most often requires a biopsy, a procedure hardly safe from complications. Researchers at
Newcastle University proposed a promising way to simplify the process: When liver cells are dam-
aged, they release small amounts of cell-free DNA into the blood. By measuring
DNA methylation levels on genes, it may be possible to determine the stage of
liver cirrhosis in patients with non-alcoholic fatty liver disease. This could al-
leviate the patients and save costly health-care resources.
A critically ill patient had his esopha-
gus replaced with a stent. He refused, however, to
remove the stent for three and a half years due to the
fear of potential complications. Seven years after the
reconstruction and four years after the stents were
removed, the patient maintains a stable weight on
a normal diet, with no swallowing problems
whatsoever.
A team of computer scientists and electri-
cal engineers from University of Washington has proposed
one of the first complete systems to encode, store and
retrieve digital data using DNA molecules. The digital
data is chopped into pieces and stored by synthesiz-
ing a massive number of tiny DNA molecules, which
can be dehydrated or otherwise preserved for long-
term storage. The novel method of managing the
information can prospectively allow compa-
nies to keep their data that today would fill
a big box store supercenter in a space the
size of a sugar cube.
Tropical diseases are still a burden
to many countries in South Asia. The incidence
of malaria in Bhutan has been falling in the
past two decades, yet the government plans to
completely eradicate the disease by 2016. With
help of scientists from Australian National
University, trends and burden of malaria were
estimated. Researchers predict that the
major challenges the small Kingdom
must face in the future include ma-
laria importation from India, con-
tinued protection of the population
in endemic districts, and indoor re-
sidual spraying.

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1#2013 medicor
Hi there!
Do you want to develop
science and health care?
At Innovation Office we help students with ideas within medicine and health. A mobile application, a care
program or a medical device – we have the competence to take your idea to innovation. All of our services
are available free of charge. Visit us in Aula Medica, Campus Solna or at ki.se/innovationoffice.
Photo:JingchengZhao
KI CAMPUS
By Frida Hellström and Iris Peña Arriarán
Photos by Katarina Stojanovic
Campus Huddinge
The southern KI campus, Campus Hud-
dinge, has so far had a pretty inactive stu-
dent life and the board seeks to change
this, with the help of the sections and Od-
ontologiska Föreningen (the student un-
ion for odontology students). With pubs,
social events, meetings and a grand open-
ing of the union facilities in Huddinge the
group is planning a great improvement
in local student life. MF is also a part of
Flemingsbergs Förenade Studentkårer
(FFS, a student union collaboration) who
currently work with questions of a com-
mon union house and the general social
life in Flemingsberg. In charge of the
Huddinge-group is board member Pontus
Dannberg.
Recruiting a General for Nobel
Night Cap 2017
Every fourth year MF has organized Nobel
Night Cap, which is a huge and exclusive
after party to the Nobel Banquet. Origi-
nally a tradition started by the students of
Stockholm it has now grown to a prestig-
ious event with a theme that is top secret
until the very last minute and it involves
the commitment of hundreds of students
every year. The party rotates between the
four big universities in Stockholm and the
board of MF hopes to produce another
great party when it is our turn again next
year. But for a Night Cap to happen, it
needs a General, and the planning of the
event needs to begin a year in advance.
Therefore the recruitment of the Gen-
eral is currently underway with a board
selected planning group who are in this
moment outlining the foundation and the
plans and for this great endeavor.
Recruiting more members and
improving our communication
A constant challenge for the union is to re-
cruit and keep its members, therefore the
board has two of its representatives, Anna
Petterson and Iris Peña Arriaran, that de-
vote most of their time towards coming
up with ideas to attract more members
and spreading information about what
the student union does and how one can
get involved and reap the great benefits of
the MF community. Right now they are in
the process of trying to find out what we
need as students and how MF can help us
get it, this can be everything from student
discounts and privileges to more student
influence and general information. KomU
are also involved in this work and their
job is to make sure all students at KI
know what’s going on at MF.
The Union House renovation
MF’s union house is located at Campus
Solna, just opposite Aula Medica and
next to the soon-to-be Biomedicum. With
the surroundings developing so quickly,
MF wants to improve with it to suit the
atmosphere. Kårhus 2018 is a renovation
project lead by board member and former
vice president Andrea Montano Montes.
The project is now in its planning and
fundraising – a renovation is estimated to
cost 20-25 million Swedish kronor – stages
with workshops and events. The plan is to
start the renovation on the 14th of Decem-
ber 2017, but there is a lot to do until then!
Studiebevakning
One of the jobs MF has is to make sure
students are represented everywhere (see
other article), and the board helps the dif-
ferent sections with this if necessary. The
students are also to be involved in recruit-
ing a new vice-chancellor, and thus have
appointed the representatives for the
Consultative College (Hörandeförsam-
ling) regarding the recruitment profile.
Most, if not all, of these students will also
be part of the Consultative College where
the members vote on the candidates for
the vice-chancellor position in October.
The MF Vision
As of two years MF has had a vision;
“Medicinska Föreningen is an open meet-
ing place characterized by interprofes-
sionality and friendship, where all stu-
dents can contribute, grow and prosper
through joy, creativity and passion” and
three central catchwords which we want
to live and work by: Diversity, Dedication,
Development. The board is now working
on implementing the vision in the organi-
zation and marketing it so that all mem-
bers are aware of what MF strives to be:
an open place for everyone to develop.
Every year we arrange a workshop day for
all the students at MF and KI to contrib-
ute to the Vision, learn what it means and
also to see how they themselves can in-
corporate it into their work at the student
union and become a part of the MF com-
munity. The Vision day will be held this
fall at MF (more information to come).
Student Health
Being the student union of a medical
institute such as KI requires a health fo-
cus among our members. The board is
working together with Studenthälsan to
improve students’ physical and psycho-
logical health. This includes all health
questions such as stress, alcohol use,
smoking, exercise and healthy, affordable
food options. •
In the last issue the readers were introduced to the
new board of Medicinska Föreningen (MF), but what
do they really do? The activity plan for 2016 is very
ambitious and the work has already started.
If you are interested in any of the
activities please contact us at:
styrelsen@medicinskaforeningen.se
How Medicinska Föreningen’s Board
is handling the challenges of 2016
“Medicinska Föreningen is an open meeting place characterized by interprofessionality and
friendship, where all students can contribute, grow and prosper through joy, creativity and passion”
9

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1#2013 medicor
KI CAMPUS
Interview by Radek J. Gora and Emily Clark Photos by Katarina Stojanovic
To celebrate World Health Day, Karolinska Institutet hosted an afternoon seminar to discuss the
protection of sexual and reproductive health rights (SRHR) of women and girls in a crisis-prone world.
With an impressive panel of speakers, the afternoon was kicked off by Dr Babatunde Osotimehin,
who, following a career as a medical doctor and Minister of Health in Nigeria, became the Executive
Director of the United Nations Population Fund (UNFPA) in 2011. We then heard from Professor Anna
Mia Ekström, head of the Global Health, HIV and SRHR research group at Karolinska Institutet; Per
Örneus, current Ambassador for Humanitarian Affairs; and Hampus Holmer, PhD and medical student
at Lund University.
Sexual and reproductive health rights
in crises
By Emily Clark
The scene was set by Osotimehin: conflict
and crisis are not new phenomena. In fact,
we are seeing increasing numbers of dis-
asters. So long as the underlying volatile
issues such as climate change,
religious tensions, poverty
and widening inequality exist,
we can expect to see conflict.
Camps that were initially built
for temporary respite have
sadly become all that many
children know as home.
Holmer brought up the ques-
tion, “What is health?”. So
much of health and ill-health
can be associated with how
and where we live, most of
which is outside of what we
would consider the health
system. We should not con-
sider SRHR in isolation; in-
stead we need a holistic ap-
proach. Örneus emphasized
the need for a longer-term
health systems view, as well as
looking at the bigger picture.
Osotimehin reflected on these
ideas later, asking, “Who owns
our health?”. Evidence sug-
gests that more exercise and
a better diet will improve our
health, yet arguably industry
drives many of our choices
that will impact on our health.
The UNFPA has many ways
in which it aims to improve
SRHR for women and young
children. It has established maternity
units, which has recently delivered their
5000th baby. So far, their maternal and
neonatal mortality rates are zero, high-
lighting what is possible with good quality
care despite ongoing trouble. They have
created safe spaces: physical spaces just
for women. They have listened to what
women want, for example by constructing
toilets that are within the safe space, obvi-
ating the need for a dangerous journey at
night time, outside, alone. They have es-
tablished centres for women to learn new
skills, to obtain assistance – whether it be
legal, psychological, or medical, including
contraception. “Pregnancy does not know
war or conflict.” The UNFPA strengthens
existing health systems, working closely
with local services providers to improve
sustainability.
Ekström discussed the topical
issue of migration. Migration
is a time of great vulnerability
for all, with difficulties in ac-
cess to knowledge - including
sex education, geographical
or financial access to health
care, language barriers, differ-
ent cultural and sexual norms,
stigma, and arduous journeys
representing just some of
these difficulties. Upon arriv-
ing in Sweden ongoing ineq-
uities exist as migrants have
higher mortality rates, and
later diagnoses of HIV. A basic
health screen involving tests
for syphilis, HIV, hepatitis B
and TB is available to all refu-
gees in Sweden, however, up-
take of this initiative is about
50%. Why? How can we im-
prove this?
Firstly, we must learn. We can
learn from the experience
of those in other settings. In
these tough financial times
with increasing demands, it is
imperative to implement the
best and most cost-effective
evidence-based interventi-ons.
Countries in conflict or in cri-
sis can little afford – in money,
in trust, in opportunity cost – to try what
doesn’t work. And, of course, it needs to
be contextualized. Underpinning any in-
tervention are the concepts of account-
ability, quality assurance, strong leader-
ship and policies, as well as education and
capacity building. Communication is key
– to bridge the gap between research and
“Pregnancy does not
know war or conflict.”
the people, research and policy-makers.
Mobile phone based technology has the
potential to reach many people very sim-
ply, and this should be embraced. Lastly,
the big issues need to be addressed. Pre-
vention of economic collapse, of con-
flict, prioritising women’s and children’s
welfare, building robust health systems
and infrastructure. As Osotimehin put it,
“Health belongs to the people.”
Medicor exclusive interview
with Dr Babatubde Osotimehin
Dr Babatunde was kind enough to speak
with us after the seminar so we could
pick his brains some more.
Sexuality is fundamental to our existence.
Yet, SRHR is often overlooked, overshad-
owed, ignored. “People don’t want to
talk about sexuality” – cultural norms
bear the responsibility here of sweeping
SRHR under the carpet, out of sight, out
of mind. Despite insufficient resources,
the UNFPA has been “able to bring vis-
ibility” to SRHR. Through connecting
with civil society and integrating and
engaging with students, the UNFPA has
helped shine the spotlight onto SRHR.
As the UNFPA looks ahead, challenges
loom. Their aspiration? Aiming to “reach
everybody and [leave] nobody behind”.
They think that concentrating on young
people, who number 1.8 billion, is a good
place to start. And certainly the impact of
supporting, caring for, and protecting just
this demographic group will be a signifi-
cant one. Girls in particular suffer during
war situations: one such example is the
use of rape as a weapon of war. It is im-
perative to be very clear on this: “…we do
not condone it and that the ones who are
caught, are penalised for it”. It is vital that
cases are reported, documented and that
offenders are prosecuted.
As we all know, prevention is better than
cure. How does the UNFPA employ this
adage in their work? Resilience building
is a concept which aims to “develop peo-
ple to learn to cope with crisis”. It is not
limited to conflict situations but is em-
ployed also for disasters such as flooding,
where, in the acute setting, the popula-
tion needs aid and food and shelter. But
building resilience involves prioritising a
long-term outlook and the “building [of]
systems to prevent flooding”, which will
avoid or reduce the need for such acute
interventions in the future.
Interventions should be contextualised
to improve success, engagement, and ac-
ceptability. Does the UNFPA ever struggle
with local customs? “We do, but we over-
come them”. The key is, as ever, down to
interpersonal relationships and commu-
nication: “you sit down on the floor, you
talk to people, you tell them what value
you are bringing”. It’s a process, requir-
ing time and ongoing discussion. Under-
pinning this dialogue is evidence for the
proposed intervention, and inspiring the
other party to realise the importance and
benefits to be had. Avoiding judgement is
imperative. What about deeply engrained
beliefs? The UNFPA identify and engage
gatekeepers, people who need to be on
board in order to reach the rest of the
community. Gatekeepers fulfil a vital role
of motivating the proposal, “champions
of the program”. Without this, there can-
not be sustainability.
What can we do, as students? “Reach out
to other students in the world” – students
of any kind. We should realise we are in
a very privileged position. We are able to
discuss ideas, challenge ideas, generate
new ideas, educate and empower people
all over the globe. We have access to all
sorts of research, evidence and statis-
tics. We can highlight issues so that they
become more prominent, we can “raise
awareness…raise resources…find solu-
tions”. Networking, and again, commu-
nication, is key. And the beauty is all of
this can be done from home. There is no
requirement to travel anywhere. Contact
people affected by the crisis, ask them
what they need, what they want us to do
to help. Ask them how we can best work
together. How can we put this issue in the
spotlight? What resources do they need,
and how can we obtain them?
Do not underestimate the opportunities
we have here, now. These global friend-
ships are “incredible and powerful”. •
“Health belongs to the
people.”
Dr Babatunde Osotimehin with, on the left, seminar moderators Caroline Olsson and Daniel Helldén. On the right in the back row: the panel
members Hampus Holmér, Professor Anna Mia Ekström and Per Örnéus. On the right in the front row, seminar organisers Karin Båge,
Sanni Kujala and Giulia Gaudenzi.

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1#2013 medicor
KI CAMPUS
By Jakub Olczak and Gustaf Drevin Photo by Eric Wellme and Gustaf Drevin
Do you want to be a surgeon?
KirA - a student society for surgery and anaesthesiology
From war to robotic surgery
The Karolinska Institute was formed for a
single purpose: training war surgeons for
the 19th century Carolean wars stretch-
ing into Prussia, the Ukraine, and far into
Russia. They were barbers and crafts-
men and their methods urgently crude.
Today, surgery and anaesthesiology have
developed into complex sciences span-
ning from advanced practical techniques
to modern technology, requiring opera-
tors to be skilled, flexible, and updated.
No wonder so many medical students are
intrigued by surgery and anaesthesiology.
Premiere workshop
There are hundreds of vibrant surgical
student societies. Recently this trend has
come to Sweden and now Stockholm, as
Lund and Örebro have similar societies.
Also known as KirA, our organisation
provides medical students opportunities
to involve themselves in surgery and an-
aesthesiology. The suturing workshop on
April 19th was the premiere event, where
150 people were interested and ten partic-
ipants randomly selected. Six older stu-
dents were present to tutor groups of 2-3
beginners. A short lecture was also given
to ensure participants has basic theory
in minor surgery. Students were taught
wound physiology, local anaesthetics, and
suture techniques before teaching three
sutures. Students seemed very happy. Ju-
lia Ekman, a second-year student, says it
was “the excitement of learning basic but
useful techniques early in my education
and to get a foundation for future terms of
medical school” that made her interested.
She adds that “the workshop truly whet-
ted my appetite, and I am totally adding
‘suture kit’ to my birthday wish list!” KirA
hopes to provide at least five workshops
per term to cover the interest for such
practice.
Student interest
The authors have always felt that the
interest for different surgical special-
ties and anaesthesiology and critical or
emergency care rank extremely high in
the mind-set of medical students, already
from an early stage in our education. It
made sense for us to then perform a sur-
vey of this interest and investigate if the
numbers did support our intuition.
A whooping 551 medical students at Karo-
linska Institutet answered, and more
than 80% want to engage in some kind of
extra-curricular surgical or anaesthetic
activity and three-fourths consider sur-
gery or anaesthesiology as future careers.
We are happy to cooperate with IFMSA
Stockholm and Läkarsektionen in initiat-
ing KirA.
Tuesday April 19th, 20 medical students in scrubs took over the clinical practice centrum at Karolinska
Hospital Solna, as the newly created Student Society for Surgery and Anaesthesiology (Studentsällskapet
för Kirurgi och Anestesi, KirA) held its first ever workshop - a suturing tutorial. We have created KirA to fill a
void concerning opportunities for medical students to pursue specific interests already in medical school.
The interest for Studentsällskapet för Kirurgi och Anestesi’s first suture workshop was immense - 150 people registered but the
organisers could only select 15. Therefore, the spots were slumped using an online generator!
The tutor Lottie Phillips, fourth-year, says
she “would have loved to have been given
a chance early on to learn some basic sur-
gical techniques from and older student
who could say ‘hey, I know it seems far
off, but you will be there before you know
it.’ Being a tutor for KirA is a way to be
that student for somebody else.”
The three founding pillars
Our main vision is that medical students
can pursue their interests in different ca-
pacities, in order to establish a full-width
and realistic perspective of otherwise in-
deed over-romanticised specialties. We
have envisaged three founding pillars to
guide the society.
Firstly, KirA wants to showcase the ben-
efits or doing research by arranging stu-
dent-adapted journal clubs with some of
Sweden’s most prominent researchers in
surgery and anaesthesiology. Students of
any level can participate and no previ-
ous experience or knowledge will be re-
quired. Participants can expect to learn
how to read scientific articles, get inspira-
tion, and meet researchers.
The second pillar is anatomy, which is
often forgotten between the anatomical
and surgical semesters. This, of course, is
a more or less personal experience of the
authors... One aim is to create anatomy
booklets to complement atlases and lec-
tures.
The third and perhaps most attractive fea-
ture is our practical approach, where su-
turing can be complemented with work-
shops on keeping free airways, robotic
surgery, or advanced suturing techniques.
This concrete and hands-on approach is
what most students want, according to
our survey. We are happy to provide this
rewarding break in your studies!
Anaesthesia and global health
Apart from the founding pillars, two addi-
tional important elements make up KirA.
There has been an unfortunate divide be-
tween anaesthesiology and surgery, the
severity of which can depend on country,
culture, clinic, and level of care. Many stu-
dents are palpably positively surprised by
the thrill of anaesthesiology. KirA wants
students to tap into that underrated po-
tential and be introduced to this enabling
feature of modern surgery.
The second element is a global focus. Ap-
proximately 5 billion people lack access to
“safe, affordable, and accessible surgical
and anaesthetic care” (WHO, 2015) and
global surgery is the “neglected stepchild
of global health”. KirA hopes to bridge
this divide and emphasise that the inter-
national nature of medicine applies also
here.
The future
KirA has been in contact with and re-
ceived verbal support from the four sur-
gery course directors at the Karolinska
Institute. It has been encouraging and giv-
en KirA a sense of academic anchorage.
We, the authors of this article and found-
ers of KirA, intend to make KirA a stand-
ing committee and society for many more
medical students to come. One day, we
hope to meet younger future colleagues in
the corridor, saying they want to become
surgeons because they once joined a sur-
gical student society at their university.
We hope you want to join us in this vision
and promote surgery and anaesthesiology
at the Karolinska Institute with us. •
Surgical survey
A pre-launch survey engaging 551 medical
students at the Karolinska Institute showed
that despite a huge interest in these spe-
cialities, there is a lack of channels for ex-
pressing one’s interest or curiosity in surgery
or anaesthesiology.
Founders Gustaf Drevin (standing left) and Jakub Olczak (standing right) instructing students in basic minor surgery theory.
The workshop participants seemed to really enjoy getting a sneak peek on surgery, in the form of suturing.
Studentsällskapet för Kirurgi och Anestesi (KirA)
KirA is a surgically and anaesthetic society for medical students. Through KirA, you will enjoy
journal clubs, anatomy knowledge, and practical workshops related to surgery or anaes-
thesiology, sometimes with a global health touch. KirA cooperates with IFMSA Stockholm
and Läkarsektionen. Founders are fourth-year medical students Gustaf Drevin and Jakub
Olczak.
Contact: ordforande@sallskapetkira.se

16 17
1#2013 medicor
The reason many of us PhD students
chose to do science is because we enjoy
reading and learning. We like thinking
about complex problems, analyzing and
discussing them in our research groups.
But don’t think it’s only in the lab that you
can do these things. When I first joined
the student union I found that what they
do is maybe not so different from research
and science. In a quick read I introduce
how we function and what the purpose of
the Doctoral Students’ Association is. But
be aware! If you are a true scientist you
might end up joining us (to your supervi-
sor’s regret)!
The Doctoral Students’ Association
The Doctoral Students’ Association rep-
resents around 2100 PhD candidates, con-
stituting the biggest section of the main
student union at KI, Medicinska Förenin-
gen. Our main objective is to make sure
that the voices of students are heard and
are part of the decisions made at KI. We
therefore nominate or elect representa-
tives to the major boards, committees,
even to the highest body at KI, the senate
(konsistoriet). We have four representa-
tives sitting in the Board of Doctoral Edu-
cation, three in the Board of Research and
two in the senate, just to mention a few.
There is probably no other organ at KI
that has such a good representation in the
decision making as we do.
Luckily for us, Swedish universities in
general and KI in particular have a good
tradition of involving students. This has
helped us to continue to improve and
stay ahead. Those of us who have studied
abroad know this is not always self-evi-
dent. We are fortunate for having the op-
portunity to be partners with the faculty
improving the institute.
The Board Meetings
Every month we have a board meeting,
usually around 15 of us gather discuss-
ing student issues over a slice of pizza
and some soft drinks. Every meeting a
few new students find us. The reasons
they join vary, but many who come share
the belief that as students we also have
a responsibility to create a modern and
forward looking University. Some do this
simply by letting us know about problems
or issues they notice. Others go a step
further and will give suggestions on how
to solve them. Those who are especially
enthusiastic will join us and take part in
the discussions to find the best solutions.
What’s on the Agenda now?
In addition to the student representation
we have different workgroups with par-
ticular focal points. One workgroup is for
Clinical PhDs and another one aims to
organize social events, like pubs and par-
ties during the upcoming year. Finally, we
have the KID workgroup that will start to
reach out to students to discuss how to
improve it for its planned reintroduction
in 2018. We are also lucky to have a board
with a lot of different interests so each
can focus on different issues. Some are
passionate about international relations,
some are particularly keen on equality
issues while others are experts in KI’s
organization. This diverse board, with
different backgrounds and different in-
terests, creates a dynamic and enjoyable
atmosphere for discussions.
You might even learn something!
Student union work isn’t just fun but can
be rewarding too. Participating helps to
develop your soft skills, the way to inter-
act and discuss. You find out how the uni-
versity is structured, how decisions are
made and how you can influence them.
You learn to discuss and debate, and how
to present your arguments. You practice
how to communicate and to work in a
team to solve difficult and complex prob-
lems. Sounding like science yet?
What we do is not so different from
research - we identify problems, read up
on them, discuss them and finally try to
come up with ways to solve them. Our
“research group” (the Board) is enthusi-
astic and engaged, and is often willing to
stay late into the evenings to discuss and
debate about the decisions we make. Fi-
nally, as many research groups do, at the
end of a year of hard work we go for a
Christmas dinner as a reward for our ef-
forts. I hope that the next time will be full
of new faces! •
You are always welcome to join us
for one of the board meetings!
Contact us at:
dsa@medicinskaforeningen.se
For more info:
www.medicinskaforeningen.se/phd
By Benedek Bozoky
Photo by Néstor Vázquez Bernat
The science behind the
Doctoral Students’ Association
From left to right: Luliia Savchuk (BM), Eva Hesselmark (BM), Cheng Xu (BM), Frida Kalm, Paula Cermakova, Fei Yang (BM), Chenhong
Lin, Matilda Liljedahl (BM), Débora Masini (BM), Benedek Bozoky (Chair), Manideep Gupta Vemula (BM), Simone Setterberg (BM)
Not present: Javad Jafari (Treasurer), Susanne Neumann (Secretary). BM: Board Member
KI CAMPUS

18 19
1#2013 medicor
Science Snippets
Ancient retrovirus lurking in
human DNA Retroviruses insert their
genome into the cells they infect, which
can sometimes be germline cells. These
cells pass on their DNA to the next gen-
eration…and the next…and the next.
Usually, these retroviral sequences or
“genomic fossils” are no longer capable of
producing any sort of infectious particles.
Intriguingly, however, one such retrovi-
ral fossil (called HERV-K) was recently
found “alive” in humans and is therefore
potentially capable of replication despite
being millions of years old. Studying this
might give clues as to how to deal with
the not-yet-fossilized retroviruses, like
HIV. (PNAS, March 2016)
HIV you’re (edited) out!
The CRISPR/Cas9 technique of genomic
editing has now been used to excise HIV
DNA that has been incorporated into
cellular DNA of CD4+ T cells. Current
antiretroviral drugs can stop the virus
from entering the cells, but once the virus
has placed its DNA they are of little help.
Researchers used a modified CRISPR/
Cas9 system to allow recognition of spe-
cific DNA sequences positioned within
the HIV-1 promoter. They were able to
show that removal of these sequences
completely eliminated viral production,
without any genotoxicity to host cell
DNA, and reduced viral replication.
(Scientific Reports, March 2016)
One step closer to understand-
ing men’s emotions Researchers have
discovered that testosterone reduces con-
nectivity in brain regions responsible for
feeling empathy. Women’s brains were
imaged by fMRI while they were asked to
associate an emotion with certain images.
The inferior frontal gyrus region became
specifically activated, suggesting that it
plays a role in empathy. After this, the
same women performed the experiment
after an administration of testosterone.
They took significantly longer to iden-
tify the emotions being expressed in the
picture, indicating that the hormone did
impair their capacity for empathy. (Psy-
choneuroendocrinology, March 2016)
Did a comet start life on Earth?
Were the building blocks of life on Earth
created here or were they brought by
comets or meteorites? Most of the organ-
ic compounds have been found in mete-
orites, comets, and interstellar dust. But
the sugar ribose, which forms the back-
bone of RNA, has never been detected.
A recent experiment that mimics the
conditions of a comet hitting a planet re-
sulted in the formation of a large variety
of organic compounds, including ribose
and other sugar molecules. This finding
strengthens the idea of comets being the
kick-starters of life on Earth.
(Science, April 2016)
Fighting big bugs with small
particles Antibiotic resistance is an
increasing issue as superbugs (antibi-
otic resistant microbes) are emerging.
One recent player in the fight against
superbugs is nanoparticles, which are a
million times smaller than a millimeter.
More specifically, nanoscale quantum
dots were used to kill multidrug resist-
ant superbugs. These can be activated
by light once in the body. Toxicity in the
nearby tissue can be controlled because
the quantum dots upset the balance of
chemical processes in the bacteria with-
out harming human cells. (Nature Mate-
rials, January 2016)
The evolutionary history of
Malaria The parasite Plasmodium fal-
ciparum is thought to have killed 438,000
people in 2015. There are several other
members of the Plasmodium family. So
why is this one so deadly? By comparing
its genetics to species of malaria found in
wild chimpanzees, a recent study aimed
to uncover the reason for the increased
infectiousness of human Plasmodium fal-
ciparum. It was found that it uses a much
higher number of genes to infect red
blood cells and that two invasion sites in
particular had an extremely high diver-
sity compared to the chimp parasites.
(Nature Communications, March 2016)
By Joanna Kritikou
Science
Photo credit: Chris Jupin (Flickr)
Photo credit: Jim Gathany (CDC #5814)
Photo credit: Kanijoman (Flickr)
After several successful space con-
quests, the next big venture for space
agencies around the world is to figure out
how humans can conquer Mars. This mis-
sion, called Mars One, has a launch date
set for the year 2024 and preparations
are already well under way. The possi-
bility of human settlements on Mars is
all the more exciting and very plausible
now after the discovery of water on the
surface of the red planet. A major ques-
tion is what biological changes occur as a
result of extended human space flight. It
is estimated that a Mars mission will take
around two and a half years in total, with
approximately one year spent flying in
zero gravity for the trip to and from Earth.
After all, there is little point in making
such a trip if we couldn’t survive it, or if
we were affected so detrimentally on a
physical level by the journey alone. This
is where the astronaut Scott Kelly and his
twin, retired astronaut Mark Kelly, come
into play. They suggested organizing and
taking part in a study to help answer this
particular question, and their genetic sim-
ilarity provides an excellent opportunity
for science.
NASA and the Russian space agency,
Roscosmos, have some understanding of
how human bodies adapt to spaceflight:
this comes from the many tests and analy-
sis performed on all returning astronauts.
One of the most interesting observations
from earlier space excursions relates to
vision. A survey of the returning astro-
nauts revealed that 29 percent of shuttle
astronauts and 60 percent of station as-
tronauts reported worse vision while in
flight. “Many became farsighted or expe-
rienced blurriness, possibly because the
shape of the eye flattens with pressure
changes in the skull,” NASA reports.
The proposal from the Kelly twins of-
fers a particularly exciting advantage as
they are identical twins. As well as be-
ing genetically the same, they have both
had very similar trajectories in life. Hav-
ing one of the twins spend time in space
while the other remained on earth gives
scientists an ideal experimental set up:
Mark Kelly, the retired astronaut acts as a
biological control, to which data acquired
from Scott Kelly will be compared to
upon his return from space. As well as all
the physical and physiological changes,
the advantage of any twin study is that
changes at the genomic level can also be
tracked and analyzed.
On March 1st 2016 Scott Kelly, along
with astronaut Mikhail Kornienko, re-
turned after 340 days on the International
Space Station (ISS). This is the longest
period of time that a US scientist has
spent in space. This mission is not over
just because the flight landed. There will
be weeks, even months, of data collec-
tion continuing post-flight, and samples
that are still on the ISS will need to be re-
turned to Earth. So far, the main findings
are that Scott Kelly looks great; year-long
missions are not the limit; and this mis-
sion was successful largely because of the
close coordination between the Russians,
the US and all the partners.
However, some of the results from this
twin study may never see the light of day.
The Kelly twins are having their entire
genomes sequenced, and if they discover
sensitive medical information they do
not want shared, such as susceptibility to
certain diseases, those results may not be
published.
It is safe to say that though the re-
sults of this mission will contribute sig-
nificantly to the preparations for the Mars
One mission in 2024, there will have to be
more long duration missions before the
final takeoff. This twin study will pro-
vide invaluable information about the
differences between the human body in
space compared to Earth and many of the
results may even aid scientists in under-
standing more about disease susceptibil-
ity and treatment on this planet. In this
regard, the outcome of this mission will
not only help humankind take that step
towards exploring another planet but the
results may help us achieve a better life
here on Earth, our first home. •
A twin study in space
Preparing for the next
giant leap for humankind
Science
By Halima Hassan
“It would be nice to learn that
there are no genetic effects
of long-term space flight, but
I somewhat doubt that to be
the case.” —Scott Kelly
their genetic similarity
provides an excellent
opportunity for science
some of the results from this
twin study may never see the
light of day
For more information and
updates on this study check:
www.nasa.gov/twins-study/
research
Photo: NASA Johnson
Spacewalk (Flickr)

20 21
1#2013 medicor
Science
Not long after winning the Nobel
Prize in 2014, neuroscientist May-Britt
Moser took part in the BBC program No-
bel Minds. As the lone woman at a round-
table discussion she, along with the other
prize winners, discussed her scientific
discoveries and their implications for the
world. However, it was only Dr. Moser
who was singled out and questioned
about how she managed to balance her
career and having children, not her male
counterparts. Why is it that in this day
and age, when gender equality should be
the norm, that women are greeted by sur-
prise at having successful careers and be-
ing parents? And why are women still un-
derrepresented at top levels of academia?
It’s tempting to think that gender dis-
crimination is a thing of the past, especial-
ly in a progressive country like Sweden.
While it’s true that the fight for equality
has made great strides over the last dec-
ades, current statistics and experimental
studies on the issue show that the playing
field is still not even.
Let’s first look at the situation at Karo-
linska Institutet. There is a peculiar gen-
der gap at both the student and professor
level – albeit an opposite one. Women
make up the majority at KI, both as stu-
dents (a whopping 70% of KI students are
female), as well as staff (62%). But look-
ing at the highest-level professor posi-
tions, women make up only 28% of the full
professors at KI. In the United States, the
numbers look similar, with 21% of science
professors being female despite equal
numbers of PhDs between the genders.
Several explanations for this gender
gap are commonly offered – women sim-
ply aren’t as interested in working their
way up the career ladder as men are, per-
haps due to still sharing a disproportion-
ate burden of family obligations. Or is
there a glass ceiling that makes it difficult
to break through due to both overt dis-
crimination and unconscious gender bias?
There’s no simple answer to that
question. Shirley Tilghman, president
of Princeton University, aptly explained
to Nature, “I don’t think there’s a single
obstacle, I think there’s a whole series of
phenomena that add up.”
Interestingly, research has shown that
women are just as ambitious as men when
they begin their careers. Michelle Ryan,
a professor of social and organizational
psychology told the Guardian, “We’ve
done the surveys for numerous profes-
sions, and whether it’s police officers, sur-
gical trainees, or women in science, men
and women have absolutely equal levels
of ambition and want to make it to top in
equal numbers. But while men’s ambition
increases over time, women’s decreases.”
Gender bias, based on stereotype as-
sumptions, starts early. Males are pre-
sumed to be better at math and science,
even if test scores suggest otherwise. At
the University of Washington, 1,700 biol-
ogy undergraduates were asked to rate
their fellow students based on compe-
tence. The male students rated their fe-
male peers lower, even if they were equal-
ly competent based on their grades. They
judged other men higher than women
who had better grades and equal amounts
of class participation, and the study
showed that a woman would need to get a
grade of A to acquire the same prestige as
a man getting a B.
This attitude continues in higher aca-
demia. One of the first studies to shine
light on the uneven playing field of aca-
demia was performed right here in Swe-
den, and published in 1997 in Nature.
The study tried to figure out why, despite
graduating in even numbers, male PhD
holders ended up in professorships at a
much higher rate than their female coun-
terparts. It turned out that postdoctoral
funding grant decision by the Swedish
Medical Research Council gave women
significantly lower competence scores,
despite the female applicants having the
same scientific productivity as the males
(as measured by publications and cita-
tions). A female applicant had to be 2.5
times more productive than the average
male applicant, at time of applying for
postdoc funding, to receive the equivalent
competence score – this would amount to
3 extra papers in Nature or Science!
A more recent investigation into aca-
demic funding in the United States, based
on 2015 NIH funding outcomes, shows
slightly more encouraging numbers. Even
though men apply for more grants than
women, the number of grants awarded is
proportional in most cases. One interest-
ing exception is the NIH Early Independ-
ence Award, which requires institutions
to nominate applicants. In this case men
are overrepresented, showing that men
are more likely to be supported and pro-
moted by their institutions at the crucial
early stage.
It’s difficult to study gender bias in the
real world – there are many factors to be
controlled for and no two candidates are
identical when applying for a position or
grant. In a clever experiment published in
2012 in PNAS, researchers sent out iden-
tical CVs for a lab manager position to
scientists at 6 different US universities
– the only difference was one CV had a
male name on top, while the other a fe-
male name. The result was striking - pro-
fessors were more likely to mentor “John”
and were willing to offer him US$3,730
more in pay per year than “Jennifer”. Both
male and female professors showed this
discrimination against female applicants,
underlining that both men and women ex-
hibit an unconscious gender bias.
In addition to gender bias, there
seem to be psychological factors at play.
Women consistently underestimate their
abilities, perhaps due to internalizing the
gender stereotypes, and display a confi-
dence gap compared to their male peers.
In one of the most replicable psychology
experiments, men both overestimate their
abilities and subsequent performance
on a variety of tests by up to 30%, while
women underestimate both. The actual
test scores do not statistically differ.
Women also more frequently feel
the “impostor syndrome”, where a high-
achieving individual believes she or he is
not smart enough to deserve the success
they have attained, and will eventually be
exposed as a fraud. When a person holds
back due to a lack of confidence, they
do not pursue opportunities. “Success, it
turns out, correlates just as closely with
confidence as it does with competence”,
write Katty Kay and Claire Shipman, au-
thors of a book on this topic.
When it comes to salaries, most fields
report lower pay for women doing the
same job as men. Linda Babcock, a profes-
sor of economics at Carnegie Mellon Uni-
versity and the author of Women Don’t
Ask explains, “men initiate salary nego-
tiations four times as often as women do,
and when women do negotiate, they ask
for 30% less money than men do”. The
The gender gap in academia
By Iskra Pollak Dorocic
Infographic by Jakub Lewicki
pay gap of female to male American scien-
tists is 18%. Additionally, it has been shown
that when women enter a male-dominated
work field in large numbers, the pay for the
whole job sector drops.
Clearly women are negatively impacted
by their lack of confidence and negotia-
tion skills in the workplace. But what hap-
pens when women do behave assertively?
They may suffer a whole other set of con-
sequences, ones that men don’t typically
experience. Iris Bohnet, author of What
Works: Gender Equality by Design, writes,
“what is celebrated as entrepreneurship,
self-confidence, and vision in a man is per-
ceived as arrogance and self-promotion in
a woman”.
Using data from 14 million student re-
views on the Rate My Professors site, re-
searchers found that people tend to think
more favorably of men than women in the
work place. Men are praised for the same
things women are criticized for, and re-
views are more likely to focus on a wom-
an’s appearance or personality and on a
man’s skills and intelligence.
Given that most of us, male and female,
display cognitive and often unconscious
gender biases, how do we make the aca-
demic workplace fairer and more equal?
One way is to become more aware of the
issues and consciously question why we
judge individuals the way we do. But more
realistically, a solution is to de-bias institu-
tions and organizations instead of just the
individuals. Iris Bohnet, author of a book
on the subject, proposes we “create policies
and institutions that work for real human
beings with their limitations, for example,
cognitive biases, including prejudice”. For
instance, making the review process for
publications, grants, and job applications
blind - by removing the names during the
evaluation process - could eliminate the
variable of judging the applicant by their
gender, as well as other irrelevant factors.
Things do seem to be changing. The
gender gap has been decreasing over the
decades due to increasing number of wom-
en pursuing PhDs, though at a slower pace
than expected. In 2012, the Swedish govern-
ment stipulated that at least 47% of newly
hired professors at KI should be women. A
2015 study in PNAS showed faculty mem-
bers prefer female candidates for tenure-
track jobs in science and engineering over
males, at least on paper (the results were
based on surveys, not actual hiring).
Making academia fairer and more ac-
cessible to the most competent people,
regardless their gender, race, sexual ori-
entation and otherwise, will ultimately
benefit us all. After all, science has no lack
of problems to solve, and adding different
perspectives to the process can only be an
advantage. •
Science

22 23
1#2013 medicor
Science
We dedicate roughly a third of our lives
to sleep, a universal characteristic highly
conserved through many species - from
flies to humans. Despite its undeniable
restorative and reinvigorating powers,
its evolutionary costs are high: during
sleep we are vulnerable and subjected to
“predators”; we don’t eat, drink, socialize
or reproduce.
However, we know little to nothing of
what really happens in the brain once
we fall asleep, but do not fret! Recent re-
search led by Lulu Xie, from University of
Rochester Medical Center in New York,
suggests that sleep drives toxic waste out
of the adult brain.
Their work, published in the journal Sci-
ence, studied volume fluctuations in the
brain’s cerebrospinal fluids (CSF) dur-
ing wake and sleep cycles. The brain, as
opposed to the rest of the body, lacks a
working lymphatic system to dispose of
metabolic waste. In turn, it has a “glym-
phatic system” which allows for CSF to
recirculate around the brain flushing
away the toxic waste produced as the re-
sult of brain’s activity, and accumulated
in-between cells throughout the day.
The scientists measured mice brainwave
activity to confirm the sleep or wake con-
dition. They then marked mice CSF using
fluorescent traces injected into the brain
and observed, in real time, the “glymphat-
ic” CSF volume variations. It was found
that mice CSF volume fraction changed
from 14% during wake state to 23% dur-
ing sleep. These results suggest that the
higher volumes of CSF during sleep per-
mit the brain to effectively remove neuro-
toxic waste.
Dr Lisa Genzel, of the University of Edin-
burgh’s Centre for Cognitive and Neural
Systems, whose focus is human sleep and
memory research, said: “It’s fascinating! It
seems that sleep is like the metabolic reg-
ulating machine of the brain. This study
opens a promising research field”.
Many diseases, such as stroke or demen-
tia, are associated with sleeping prob-
lems. Future therapies could target brain’s
metabolic role by helping to dispose of its
neurotoxic waste products. Furthermore,
most neurodegenerative diseases, such as
Alzheimer’s and Parkinson’s, are associ-
ated with “misaccumulation” of protein
aggregates and metabolic waste products
that harm brain cells.
Researchers investigated how efficient
the glymphatic flushing system was at dis-
posing of these noxious substances. They
radiolabelled amyloid beta, a protein
linked to Alzheimer’s progression which
builds up in the brain when we are awake,
and observed its clearance rate. Results
showed that clearance rate of amyloid
beta during sleep was twice as fast as dur-
ing waking. Dr Genzel also said: “We pre-
viously knew that sleep is important for
memory consolidation, but now this new
research also shows that sleep plays a role
in basic metabolic processes, which may
also be linked to Alzheimer’s disease”.
These findings offer an explanation for
sleep’s remarkable restorative functions,
which may be due to the 60% CSF vol-
ume increase during sleep, facilitating the
clearance of neurotoxic metabolic waste
accumulated during the day and keeping
neurodegenerative diseases at bay. So re-
member, don’t forget to flush! •
By Maria López Quiroga
Photo: Sleeping is needed to facilitate the clearance of neurotoxic metabolic waste. Henri Rousseau, “The Sleeping Gypsy” (1897)
Sleep is to the brain
what flushing is to the toilet
By Diana Čekatauskaitė
Science feat. the Public
or Science vs. the Public?
Photo:ScienceNewsCycle;“PiledHigherandDeeper”byJorgeCham
Two unrelated stories epitomise the growing divide between what is proven
and what is not.
Science
Fake Correlation -
Real Consequences
1998: The Lancet publishes a study by
Wakefield et al. that argues for the pres-
ence of a link between the MMR vaccine
and development of autism. Regardless of
the fact that it was a correlational study
consisting of merely 12 patients, its find-
ings were presented and understood by a
large part of the society as a causal rela-
tionship. This led to mass hysteria, fuelled
by sensationalism in media, and feeding
into people’s lack of comprehensive un-
derstanding of the research.
The paper was retracted (although only in
2010) after Brian Deer’s investigation for
The Sunday Times revealed that Wake-
field was apparently paid an exorbitant
amount of money to conduct the study
to dissuade people from using the MMR
vaccine, and vaccination in general. All at-
tempts to replicate the study - the largest
had a sample size of more than 1.2 million
children - argued exactly the opposite.
But after 18 years of arduous work to dis-
credit the fraudulent researcher, vaccina-
tion rates are still in decline in developed
countries. Why?
Not-So-Golden Rice
2000: Science publishes a paper on genet-
ically engineered rice that produces beta-
carotene (vitamin A precursor), designed
to overcome the shortage of dietary vi-
tamin A. Vitamin A deficiency results in
blindness and other illnesses, which are
said to be responsible for ~2.5 million pre-
ventable deaths per year. In 2013, protest-
ers, allegedly encouraged by Greenpeace,
vandalized the Golden Rice field trial in
Philippines because the rice was geneti-
cally modified (GM). As of 2016, not a sin-
gle country has grown Golden Rice com-
mercially.
In addition, the public outcry after one
death of a patient after attempted treat-
ment of a rare metabolic disorder with
GM adenovirus resulted in halting all
human-gene-therapy experiments for sev-
eral years. It is staggering to see the differ-
ence between the scientists’ expectations
of the benefits of the genome-editing
techniques, and the connotations and fear
the GM acronym has in the general public.
Even researching transgenic organisms
has somewhat become a taboo with strict
regulations. But why?
Science and the Public:
it’s complicated
While looking for answers to these
“whys”, the most striking thing to realize
is the “gulf of mutual incomprehension…
but most of all lack of understanding”
between the two camps of ‘sciences’ and
‘humanities’ the society has been divided
into, as warned by C. P. Snow in his fa-
mous Rede Lecture. While scientists are
not always the best communicators of ide-
as, science cannot exist for its own sake,
without the public. Therefore, it is alarm-
ing that it was so easy to spark such panic
and shake the trust in one of the most im-
portant scientific inventions of all time,
leaving an unpleasant impression that the
trust between the camps was not exactly
there in the first place. Why is that?
The fear the general public has comes from
miscommunication and a lack of tools to
assess scientific claims critically. This cre-
ates a fertile ground to profit from claims
with no scientific basis, while disproving
them is expensive and inefficient. Even
though there have already been attempts
to implement interdisciplinary education
to close the gap, yet the faster science pro-
gresses, the bigger role the gap has. It is
now time to try the public with CRISPR
– an extremely precise gene-editing tool
that can possibly change the genetic line-
age of mankind. Here come the benefits,
the risks, the moral issues, and everyone,
not only scientists, have to get involved.
The question we all need to ask ourselves
now is how to ensure that CRISPR avoids
the GM fate. •

24 25
1#2013 medicor
Do you believe in as-
trology? If your answer
is YES you belong to the
30% of Swedes that swear
on the predictive power of
horoscopes. If you belong
to the remaining 70%, do
not read this article: it may
challenge your thinking.
There may be compelling
scientific evidence sup-
porting the notion that the
month we are born plays an
important role for diseases
we are likely to develop.
Scientists at the Colum-
bia University investigated
whether a person’s birth
month has anything to do
with risk of getting a par-
ticular disease. ‘’Every time
we go to the doctor data
is being recorded about us
by the Hospital and we can
use these medical records
for research’’ says Nicholas
Tatonetti, the lead research-
er. ‘’We had a very large
clinical data set, approxi-
mately 1.7 million patients,
and we examined 1600 dis-
eases for birth month de-
pendencies’’1.
What they
found is pretty stagger-
ing: 55 diseases, including
asthma, cardiomyopathy
and attention deficit hyper-
activity disorder (ADHD),
were strongly linked to the
patients’ birth month. For
example, people born in
early spring (March/April)
seemed to have higher risk
for developing a heart con-
dition, while people born in
early autumn (September/
October)were more prone
to respiratory problems.
Those born in early winter
appear to be at higher risk
for neurological and re-
productive diseases. Octo-
ber and November are the
months with the highest
overall disease risk, while
on the other hand May ap-
pears as the ‘’safest’’ month
to be born. Finally some-
thing positive about being
a Gemini! But before you
get overly excited that your
zodiac sign guarantees
protection, or worried that
your November-born child
will develop ADHD, it is
important to realize that al-
though there is a strong as-
sociation, the birth month is
not the only risk factor and
definitely not the most cru-
cial one. “The risk related
to birth month is relatively
minor when compared to
more influential variables
like diet and exercise. The
point of the research wasn’t
to scare people off giving
birth in certain months, but
ra-ther to use the mass of
data available to uncover
new disease risk factors, ”
Tatonetti explains1
.
If your birth month
plays a significant role in
the diseases you are likely
to develop during your life-
time does that mean that
astrology holds the key to
human health? And when a
new moon occurs in Aries
will it have physiological
effects on Capricorns? The
answer is that our health
has nothing to do with the
Can your birth sign predict
your health destiny?
By Vaso Basinou
The anatomical-astrological human by Limbourg brothers
I have thoroughly investigated the matter and
frankly I wish I had not. As it turns out, people
born in winter time are more susceptible to
mood disorders. And as a Scorpio, I had to
admit: There is some science behind our bad
reputation as the darkest sign in the zodiac!
Science
1
Press release: Data Scientists Find Connections Between Birth Month and
Health: http://newsroom.cumc.columbia.edu/blog/2015/06/08/data-scientists-
find-connections-between-birth-month-and-health
2
Forster and Roenneberg (2008) Human Responses to the Geophysical Daily,
Annual and Lunar Cycles:http://dx.doi.org/10.1016/j.cub.2008.07.003
3
Press release: Babies’ biological clocks dramatically affected by birth light
cycle: http://news.vanderbilt.edu/2010/12/babies-biological-clocks-dramatically-
affected-by-birth-light-cycle/
4
Press release: Astrology and celebrity: Seasons really do influence personality:
http://www.eurekalert.org/pub_releases/2015-05/uoc-aac051315.php
Sources
moon or the position of the
planets. It is associated with
changes in light, humidity and
temperature occurring dur-
ing the different seasons of
the year. It is not about which
month you are born in, but
more accurately it is about the
season you were born in. Sea-
sonality affects many aspects
of our biology even in indus-
trialized societies, where we
have control over light, tem-
perature and food availabil-
ity. It is really remarkable that
even in isolation of these envi-
ronmental influences, humans
still have seasonal rhythms of
births and susceptibility to ill-
nesses, which are related to
the month of conception2.
The effects of seasonal
changes on health are so pro-
found that people in ancient
times seem to have been fully
were aware of it. ‘’To investi-
gate medicine properly, this is
what one should do’’ Hippo-
crates states. ‘’First, to careful-
ly consider the seasons of
the year and what they
yield ... for know-
ing the changes
of the seasons,
the risings and
settings of the
stars, [the physi-
cian] will be able
to tell beforehand
what sort of a year is
going to ensue’’. At that
time astrology and astron-
omy served the same purpose:
to provide a measure of time.
Later, astronomy employed
scientific methods to predict
cosmic phenomenon and the
two disciplines diverged. We
know, after all, that planets are
not made of magical stuff, and
the moon has hardly any influ-
ence on small volumes of wa-
ter, like lakes, let alone on the
56 litters of water contained in
an average human body.
So, what it is about sea-
sons that influence our health?
Several assumptions point to
the levels of maternal vitamin
D and exposure to seasonal
pathogens. But perhaps the
most compelling explanation
came from a research group
at Vanderbilt University. “Our
biological clocks measure the
day length and change our be-
haviour according to the sea-
sons. We were curious to see
if light signals could shape the
development of the biological
clock,” said Douglas McMa-
hon, the principal investiga-
tor3
. We all possess internal
time-measuring devices that
are called biological clocks.
What they do is to provide a
representation of the external
time and fine-tune our physi-
ology to the demands of daily
light/dark cycle. This is what
regulates our sleep/wake cy-
cle, body temperature, feed-
ing/fasting cycle, hormone
production and metabolism.
The way our biological clocks
tell the time is by receiving
light information through
the retina which can directly
‘’tune’’ our master clock
found in the hypothala-
mus. If our internal
clock is well-tuned
to the external
time, then we
can be sure that
our physiologi-
cal functions
will also run on
time. However, if
there is a mismatch
between internal and ex-
ternal timing, problems will
appear. That’s where the birth
season comes into play.
The McMahon team found
that perinatal exposure to dif-
ferent light periods of a day
(called photoperiods) has
strong effects on the stability
of our biological clock in lat-
er life. In brief, they exposed
newborn mice in three differ-
ent photoperiods: a 12 hour
light/12 hour dark schedule
(corresponding to spring/
fall), a 18 hour light/6 hour
dark schedule (correspond-
ing to summer), or a 6 hour
light/18 hour dark schedule
(corresponding to winter).
Mice were then switched into
a different photoperiod en-
vironment and almost all of
them were able to adjust their
clocks accordingly. All but one
group: mice raised in the win-
ter schedule had an unstable
biological clock that could not
adapt to the different photo-
periods (summer or spring/
autumn).
“This exaggerated re-
sponse to a change in season
is strikingly similar to that of
human patients suffering from
seasonal affective disorder,”
McMahon commented. “We
know that the biological clock
regulates mood in humans. If
an imprinting mechanism sim-
ilar to the one that we found in
mice operates in humans, then
it could not only have an effect
on a number of behavioural
disorders but also have a more
general effect on personality,”
3
In a follow up study, they
demonstrated that the peri-
natal winter photoperiod in-
duces changes in the function
of serotonin neurons that lead
to increased depression and
anxiety-like behaviours.
In a nutshell: Someone
born in dark winter is at a
higher risk for developing
psychological disorders com-
pared to someone born in a
sunnier month. Building on
that, people born in spring and
summer are shown to have
higher levels of hyperthymic
temperament—a tendency to
be excessively positive4
. And
a hyperthymic temperament
can sometimes be assisted by
the fun of reading how magic
your day is going to be when
the Venus is occurring on the
second house of Leo. Despite
the fact that there is no sci-
entific reason for believing in
horoscope prognosis, we can
still enjoy the power of selec-
tive perception when it comes
to things that matter to us.
‘‘Faith is to believe what you
do not yet see’’ wrote Saint
Augustine and pointed that
’’reward of this faith is to see
what you believe’’. •
October and November are the months with
the highest overall disease risk, while May
appears as the ‘’safest’’ birth month
Our
health
has nothing to
do with the moon
or the position of the
planets. It has to do
with the season
we were
born in
If our internal clock is well-tuned to the exter-
nal time, then we can be sure that our physi-
ological functions will also run on time

26 27
1#2013 medicor
A young man’s journey from war
to the lab bench and beyond
Story by Iskra Pollak Dorocic and Parvin Kumar
Photography by Simon Guérard
Finding Refuge
in Academia:

28 29
1#2013 medicor
T
he migrant crisis is a geopolitical
event unlike any other in two gen-
erations. Hundreds of thousands
of refugees mostly from Iraq and Syria
have arrived on the shores of Europe and
much can be done to help them - both
indirectly through diplomacy and aid
or directly through welcoming and in-
tegrating refugees. Whilst the ongoing
crisis has garnered a spotlight on the col-
lective plight of refugees, less is known
about the personal narratives of those
who made the demanding journey over
land and sea. Perhaps if we got to know
them a little better we would understand
what this crisis means to our own human-
ity. Amidst the tragedies, could there be
a glimmer of hope for a resolution? We
think there is a story set so deep in all of
this that it could perhaps be an inspira-
tion for our times.
As a teenager, Aram fled his homeland
and took an arduous journey spanning
a whole continent – across Iran, Turkey,
then Greece, Albania, onwards to Italy,
France, Germany, Denmark, and finally
Sweden. The journey took several years
and multiple stops, traveling solely by
foot and sometimes train. Sound familiar?
These days it’s a recognizable story heard
in the news – hundreds of thousands of
refugees from Syria and other war-torn
regions are desperately trying to make it
to Europe to find a peaceful life.
But the story of Aram Ghalali is not
one you’ll find in the newspapers today.
Though he took the same path, Aram ar-
rived in Sweden in 1998 when he was 15
years old. His family fled their home in
Kurdistan, Iraq after their father and a
number of other relatives were killed and
their house confiscated. Was it easier to
arrive as a refugee in Europe then? “No,
I think it is easier now. There were clear
borders between the countries then. So
it was difficult”, explains Aram as we
chat at Jöns Jakob on a cloudy February
afternoon. Today he is 33 years old and
holds a PhD degree from Karolinska In-
stitutet, where he now works as a cancer
researcher at the Institute of Environ-
mental Medicine. Although we often hear
the beginning of these kind of narratives,
we rarely hear the outcomes and stories
of successful adaptation.
Aram’s story is one of overcoming
great difficulties and setbacks, but per-
severing despite them. A major life goal
was to study science and become a medi-
cal doctor, and since arriving in Sweden
Aram tirelessly worked towards that goal.
It was not without obstacles. At first, he
did not speak Swedish nor have proof
of previous studies and grades. “When I
wanted to study science, the teachers told
me this is impossible, because only abso-
lutely the top students in Sweden go into
science”, explains Aram. The other immi-
grant students around him were sent to
trade schools, to become mechanics and
electricians. But Aram was stubborn and
managed to convince his high school’s
guidance counselor to give him a chance
to go into the science track. He was given
one month to listen in on math and phys-
ics classes and take a qualifying exam.
Aram passed with flying colors. This cru-
cial moment started his path to a career
in science.
Once again, the road was not easy, but
Aram’s hard work and determination led
him toward his goals. “I wanted to be a
doctor. At this time I did not have any
papers, no citizenship from any country.
In my Swedish residence permit it said
my identity could not be confirmed be-
cause I came with no papers.” Aram got
accepted to King’s College in the UK but
due to lack of papers he was not able to
get a UK visa. Instead, he went to Mälard-
alen University College in Eskilstuna and
obtained an impressive total of 5 different
degrees in science and engineering.
All the while, Aram’s goal was to study
at Karolinska Institutet. He describes vis-
iting KI for medical school interviews,
“I saw the roads on campus, called No-
bel road and Berzelius road... It was sort
of a holy land. I got the feeling of some
sort of spirit of KI and I thought one day
I need to study here, I mean I HAVE to
study here.” Finally, he found himself at
KI for a Master thesis research project,
which eventually led to a PhD position in
cell biology. These days Aram’s research
focuses on environmental factors influ-
encing different types of cancer, asthma
and inflammation.
Tragedy cannot be the
end of our lives.
We cannot allow it to
control and defeat us.
- Izzeldin Abuelaish
Cover Story
“ “
Although we often hear
the beginning of these
kind of narratives, we
rarely hear the outcomes
and stories of success-
ful adaptation.

30 31
1#2013 medicor
“For me, science is not something that
you own”, explains Aram . He draws in-
spiration from issues facing his commu-
nity, such as the high incidence of certain
types of cancer in Aram’s hometown in
Iraq, due to the use of chemical weapons.
“I think the knowledge I learned here at
KI is something I should somehow give
back to society and humanity.”
Between 1987-1988, vast areas of Iraq
were subjected to repeated attacks of
chemical weapons. The town of Halabja,
close to Aram’s hometown, was attacked
with a mixture of both blistering sulphur
mustard and organophosphorus nerve
gases which killed and injured thousands
of civilians. Aram explains, “Most farm-
ers have now returned to their previously
poisoned farms and villages. Physicians
and oncologists in this region are alarmed
that the cancer risks in this population are
very high. They observe that very young
individuals die of large, aggressive, rap-
idly metastasizing tumors.” Clearly there
is a need to scientifically determine the
danger to the population living in the
affected region. “I plan to analyze soil
samples from exposed areas for chemi-
cal weapons and to identify toxicological
effects of compounds remaining in the
soil. I hope that the results can be used
for cleaning up, and for deterring political
leaders from using these gases.”
Aram’s passion for human rights does
not end with science. He also founded a
non-profit organization called War in my
playground, which has members in sever-
al countries. The organization’s goal is to
provide children affected by the current
conflicts in Iraq and Syria with necessi-
ties to increase their educational oppor-
tunities. The organization delivers teach-
ing materials such as books, pencils and
notebooks, as well as toys to bring some
joy to kids living in refugee camps. “We
believe that a happy childhood is a uni-
versal right”, explains Aram.
An overarching theme emerges out of
our conversation with Aram – his aware-
ness of a specific type of mindset to over-
come obstacles: “I think it’s all about your
mentality, your way of thinking.” Aram
argues against determinism, the percep-
tion that our intelligence or attitude are
something we are born with and are un-
changeable. “There are some who have a
welcoming attitude towards challenges,
persevering when they encounter set-
backs and see criticism as a chance to
learn more. They do not have the same
view of intelligence, but consider it some-
thing that is developed by hard work and
new skills.” His philosophy about life re-
flects the psychological quality of resil-
ience, the ability to adapt in the face of ad-
versity, as well as personal responsibility.
However, Aram is also quick to point
out that circumstances are important
as well. He credits his success to people
along the way who have helped him out,
such as his high school guidance counse-
lor as well as his PhD advisor at KI, both
of whom gave him a chance to continue
his scientific quest. When asked what he
hopes for other immigrants coming to
Sweden today, Aram answers: “The wel-
come that I got. I could flourish in this
system, and I hope they get it as well.”
How difficult is it for a newly arrived
immigrant or perhaps a refugee, in a simi-
lar situation as Aram, to continue on to
higher education? On the one hand, uni-
versities want to attract international stu-
dents and staff, as this bolsters their repu-
tation. Maria Olsson, Senior Officer and
Program Manager at the KI International
Relations Office told us, “every year sev-
eral hundred exchange students study
at Karolinska Institutet and one-third of
the students come from other countries.
These students bring fresh perspectives
and help to create an internationally ori-
ented workplace and study. By attracting
internationally competitive employees,
students and partners strengthen and im-
I think the knowledge I
learned here at KI is
something I should
somehow give back to
society and humanity.
– Aram Ghalali
“ “
Cover Story
prove the exchange of knowledge, which
in turn further increases the quality of the
operations.”
One issue is the problem of accredi-
tation that newly arriving students face.
We asked Maria Olsson whether any pro-
grams exist to help immigrants, including
refugees, who may be highly qualified
but do not have the proper papers or ac-
creditation when they apply. “No, unfor-
tunately not,” she replied. However, “KI is
the national coordinator for a fast track to
get immigrants into our professions. That
is, for those who already have a medical
degree (from another country)”. Unfortu-
nately, the situation still stands that many
highly educated immigrants who arrive in
Sweden will spend a lot of time and ef-
fort requalifying for higher education and
relicensing their degrees - if they ever
manage to do so. According to a report by
the UN Refugee Agency (UNHCR), 86%
of Syrian refugees reaching EU shores in
2015 had completed secondary school, and
half of those were University educated.
In light of this situation, Swedish reg-
ulators are stepping up efforts to recog-
nize the academic merit of refugees and
expedite their return to work. Migration-
sverket, for example, has reallocated re-
sources to the burgeoning asylum appli-
cations. Regular applications have been
halted or delayed and effort is being made
to match incoming refugees to vocations
that are best suited for their interests and
educational level. The European Union,
since the beginning of 2015, has launched
the EU Science4Refugees initiative. The
initiative is aimed at “helping refugee sci-
entists and researchers find suitable jobs
that both improve their own situation and
put their skills and experience to good use
in Europe’s research system.” Such initia-
tives would be welcomed by refugee sci-
entists and academics who would benefit
from getting work and being recognized
by society.
History is dotted with luminary exam-
ples of refugees who have gone on to ex-
cel in their chosen vocations and become
world leaders. The former American sec-
retary of state Madeleine Albright and her
family were refugees that fled the war in
Czechoslovakia to the United States. En-
rico Fermi the “architect of the nuclear
age” was an Italian theoretical and experi-
mental physicist who fled fascist Italy to
join the American War effort against the
Nazis.
Now we have heard the trials and
tribulations of one Iraqi academic war
refugee who has come through to realise
his dream of pursuing scientific research.
Through pure grit and determination
every obstacle Aram faced became a step-
ping stone toward his dream of higher
education and research. But he couldn’t
have done it alone, a welcoming and sup-
portive society was just as important for
his successful integration. If we were to
take a leaf from Aram’s story it should be
the one that pertains to his mindset. The
mindset to adapt to change and overcome
challenges.
We live in times marked by cultural,
economic and technological shifts. Many
challenges we face as a society stem from
these shifts and upheavals. One way to
adapt is to discard the belief that our per-
sonality is immutable and adapt to meet
the challenges that we are posed. How we
act as students, researchers and doctors
will set an example for the society at large
and how society responds to the migrant
crisis will be judged by historians for dec-
ades to come. By refining our attitudes to
the migrant crisis we could redefine the
outcome for Europe and the hundreds
of thousands of refugees. How do we
strengthen Europe - so that it continues to
be a sanctuary of peace for the hundreds
of millions who reside here? The answer
probably lies in the courage at the heart of
the individual citizen. Perhaps if we find
the courage to give them a home they will,
as did Aram, gift us a dream. •
“I saw the roads on
campus, called Nobel
road and Berzelius
road... It was sort of a
holy land”
Aram’s passion for
human rights does not
end with science.
“I think it’s all about your
mentality, your way of
thinking.”
How we act as students,
researchers and doctors
will set an example for
the society at large

32 33
1#2013 medicor
By Mateusz Krawiec
About the “Alternative” Diet
Animal Well-Being and Animal
Experimentation
Global Focus
I
t has been nearly half a year since I began my transition to being a person with more respect towards the lives of other beings
– a vegan. After having been influenced by many anti-animal cruelty messages from social media, I decided it was the time to
cut the suffering of fellow living creatures. According to the Vegan Society, a vegan is a person seeking exclusion of all forms
of exploitation and cruelty to animals for food, clothing, or any another purposes. However due to my current stand on animal
testing I find it difficult to ascribe myself, by the strictest definition, the title of vegan.
Throughout the times the food reper-
toire has changed, and populations have
adapted to varying cuisines, e.g. from
hunting, to growing one’s own food and
later shopping at local markets or gro-
cery stores.
Despite recent reports that vegetable
products may have higher greenhouse
gas emission per calorie compared to
meats, the animal industry taken as a
whole remains on the top of the ladder
of the food production carbon footprint.
This reason combined with the con-
temporary advancement in agricultural
methods, and additional knowledge such
as the suffering of animals or the carci-
nogenic effects of red meats, are now
leading people to turn to new dietary al-
ternatives.
There are as well individuals taking
progressive steps to eliminate animal
products from usage in everyday items
such as jackets or pillows, but also in the
world of animal testing.
However, one has to realize that the
current research methods are not as ad-
vanced (yet) as one would like them to
be. For a direct example, 94 of the total
104 Nobel Prize winners in the category
for Physiology or Medicine had their
work depend directly on animal tests.
Without it, they, and we as humans,
would have not been able to achieve the
highly regarded advancements benefit-
ing a modern-day world.
If you think that other animals’ lives are
as worthy as human ones, I do respect
that, but I doubt that everyone is going
to agree. Imagine that you yourself, or
somebody close to you falls to the hands
of a severe condition. The only way to
improve your or their state, and possibly
find a revolutionary treatment for this
condition, would involve animal testing.
Would you still say no to it?
Take for example the Swedish Animal
Alliance group (sv. Djurrättsalliansen)
launching a petition against malaria vac-
cine testing on primates at KI. Had ma-
laria been a common problem in this
country, would there be such high sup-
port for this movement?
As a student pursuing a program in med-
ical sciences, I myself have had previ-
ous experience with animal testing. And
trust me, holding the life of another be-
ing in your hands as it helplessly takes
its last breath is not a pleasant feeling at
all. On the other hand, one comes to ap-
preciate the sacrifice that has to be made
in order to generate new knowledge.
What should be really taken into con-
sideration is that ongoing animal testing
can actually be beneficial in creating a
future, cruelty-free research. By allowing
research to progress, one has the chance
to create a greater basis for computer-
aided models of animal testing. One of
such models is being developed by the
EU’s NOTOX project, which focuses on
designing algorithms that mimic the pro-
cesses taking place in living organisms.
When it comes to taking sides and part-
ing oneself to a specific label, we have to
take into consideration that the world is
not always black and white. Being aware
of the serious issue of animal manipula-
tion should not be taken lightly. How-
ever, not everything can be resolved at
once. By slow progress we could adapt
to non-animal diets and move to a phase
of animal cruelty free research, each at
their individual steps. •
UK votes on EU Membership
By Amy Jackson
Prior to announcing the referendum, the
UK Prime Minister, David Cameron re-
negotiated Britain’s position within the
European Union. The new deal focussed
on four key areas: in-work benefits; child
benefits; the Eurozone and exemption
from the treaty motto of “ever closer un-
ion among the peoples of Europe”. Whilst
Cameron was not able to achieve all of his
aims, protracted negotiations have culmi-
nated in a deal that Cameron has heralded
as giving the country “special status” in
the 28-country bloc.
The announcement of the referendum has
led to the creation of multiple campaign
groups, highlighting the level of division
within, as well as between, political par-
ties. In theory, the Labour party, SNP,
Plaid Cymru and the Lib Dems have stat-
ed they favour staying in the Union, the
UK Independence Party to leave, whilst
the Conservatives have chosen to remain
neutral. However, in reality the decision
has transcended party lines, with politi-
cians on both sides of the debate. Cam-
eron has seen close allies, such as Boris
Johnson and Michael Gove, join the cam-
paign to leave the EU highlighting the di-
vide at the top of Government.
Whilst the support received by the ‘Brex-
it’ campaign has shocked many, there
is no definition of what a Brexit would
look like. Leaving the EU would remove
the UK from the common market, which
means that goods, services and people
would no longer be able to move across
the bloc freely. Additionally, the UK
would no longer have to adhere to legisla-
tion created in Brussels after a two year
cooling off period. The UK would be re-
quired to negotiate a new bilateral agree-
ment with the EU, which would leave the
country dependent on the wishes of the
Union.
Those in favour of leaving the Union ar-
gue that membership has eroded the UK’s
sovereignty and ability to make its own
decisions. It has been argued that as one
of the richest countries in the bloc, the
UK has borne significant costs of mem-
bership. The current migrant crisis has
exacerbated the concerns of those wish-
ing to leave the EU, fearing that the UK
will be at the whim of decisions made in
Brussels regarding the admittance of mi-
grants.
The campaign to remain in the EU has fo-
cused on the economic benefits of being
part of the common market, and the need
to be part of a larger bloc in order for the
small island to have a place on the world
stage. If the UK votes to remain in the EU,
the new deal negotiated by Cameron will
still need to be put to vote in the Euro-
pean Parliament.
The increased popularity of the UK In-
dependence Party in the 2015 General
Elections gave the first glimpse of the at-
titudes towards Europe. According to the
journal The Week, opinion polls show
both sides are receiving an even split of
the vote- demonstrating just how close
the decision could be. The rejection of an
EU- Ukraine partnership in the Nether-
lands this week has been touted as a sign
of events to come in the UK referendum.
The opinion polls were famously wrong
in the days preceding the 2015 General
Election, with shock across the country
as results were released. The resulting
apprehension is pushing both campaigns
to do all they can to convince citizens of
their arguments. However, with the ref-
erendum still two months away, anything
could happen and it remains extremely
uncertain just how the UK will vote. •
O
n Thursday 23rd June, Britain will hold a nationwide referendum on its membership of the European Union. Individuals
over the age of eighteen will be asked to vote for or against remaining in the EU in the first time since 1975 that member-
ship has been put to a common vote.
Referendum on possible Brexit to take place in June
From: www.livescience.com/32860-why-do-medical-researchers-use-mice.html
Jeff Djevdet (Flickr)

34 35
1#2013 medicor
Global Focus Global Focus
Working towards common-sense
outcomes measurement
By Victoria Satchwell
T
he BMJ Health Outcomes Summit
brought together a small but com-
mitted group of participants from
research and industry to consider the way
forward for the burgeoning discipline of
health outcomes measurement. It offered
a snapshot of current challenges facing
this important field and coincided with
the International Forum on Quality and
Safety in Healthcare held in Gothenburg
from 12-15 April.
Health outcomes measurement aims to
capture the effects of healthcare interven-
tions on patient and population health.
Its focus is empirically verifiable infor-
mation about the relationship between
what is done in the healthcare setting and
the results of those actions. Unlike other
medical research, where the effects of
drugs or surgical procedures are exam-
ined, outcomes research understands ‘in-
tervention’ more broadly to include not
only treatments and services but also the
structures and processes of care, and the
way that care is organized.
Outcomes studied include clinical param-
eters such as blood pressure, survival or
hospitalization days but increasingly focus
is being directed towards broader ques-
tions about the ultimate impact of care
and the value that patients experience
as a result of that care. Good outcomes
measures are more likely to approximate
what we understand as the fundamen-
tal purpose of healthcare - health. One
such measure, Quality Adjusted life Years
(QALYs), aims to reflect a patient survival
and health related quality of life. Other
measures are based on patient responses
and may reflect a patient’s experience of
an illness, what worries them most about
their condition, its affect on their life and
functionality or their satisfaction with
care.
Health outcomes measurement informs
several important health system process-
es. It forms the cornerstone of healthcare
quality improvement and can be used to
hold providers accountable both to pa-
tients and regulators. Perhaps most im-
portantly, outcomes measurement con-
tributes to evidence-based medicine, and
the establishment of guidelines for care.
In the case of standardized outcome
measures, the common language that
these measures provide to healthcare
practitioners facilitates transnational
conversations and learning opportuni-
ties. Within the paradigm of Michael Por-
ter and Elizabeth Teisberg’s ‘value-based
healthcare’, outcomes measurement is
seen as tool to re-orientate care towards
improving value for patients and redefine
the nature of competition in healthcare.
Within a value-based purchasing system,
outcomes measurement informs an in-
dividual’s choice between practitioners,
facilities or procedures, and provides
health-insurers and public-payers infor-
mation to aid in healthcare purchasing
decisions.
Growth in the field of health outcomes
research represents the awakening of
healthcare providers to the need to eval-
uate the results of their activities, and
a recommitment to the common sense
understanding at the heart of healthcare
- that what matters is the outcomes that
patients experience. As such, this area of
research is a response both to the call for
evidence-based practice and comparative
effectiveness assessments, and the con-
cern that mounting healthcare expendi-
tures have not delivered increased value
for patients.
The BMJ Health Outcomes summit cen-
tered on questions related to the scalabil-
ity of outcome measures, the transfer-
ability and adaptation of measures to fit
local circumstances, what makes a good
measure, and whether measures capture
what they should.
Keynote speaker, Marc Berg, an advisor
at KPMG, introduced the challenge of
measuring value as a problem that really
hasn’t been solved. He aimed to orientate
the group’s thinking within the somewhat
messy waters of patient-centered out-
comes measurement and to ground this
thinking in what might be described as a
common-sense approach.
It is a paradox of outcomes measure-
ment that healthcare providers are often
value for patients than a gauge of ward
hygiene or whether a physician attended
the delivery.
Performance within silos may very well
contribute to quality of care but is in no
way an obvious determinant of whether
a patient experiences value. The argu-
ment is for outcomes that reflect the ul-
timate objectives of a function that may
span silos rather than an outcome that
tells us how a silo is performing. This ar-
gument highlights the point that asking
the right question is key to meaningful
outcome measures.
A shift in thinking towards outcomes
that span the cycle of care draws focus
to the question of which data sources
are key and where money and the time
of healthcare professionals is being un-
derinvested. Marc points out that you
often don’t need very much data to con-
struct measures that both matter to pa-
tients and that feel relevant to the work
of the healthcare professionals that will
be capturing this data and using these
measures to improve care. •
By DALY_disability_affected_life_year_infographic.png: Planemad derivative work: Radio89 via Wikimedia Commons
A shift in thinking towards outcomes that span the cycle of care draws focus
to the question of which data sources are key and where money and the time
of healthcare professionals is being underinvested
The BMJ Health Outcomes summit centered on questions related to the scal-
ability of outcome measures, the transferability and adaptation of measures to
fit local circumstances, what makes a good measure, and whether measures
capture what they should.
By Chris Sampson via Wikimedia Commons
drowning in measures that describe indi-
vidual aspects of care but know very little
about the quality of care experienced at
the level of the patient.
Marc describes how the separation of
healthcare into various departments and
specializations, and an eagerness within
each unit to demonstrate its own value re-
sults in fractured health outcomes meas-
urement that fails to reflect the journey of
the patient through the care cycle. Within
healthcare management, the metaphor of
silos is commonly used to illustrate the di-
vision of healthcare activities into distinct
jurisdictions and to consider the effect of
these divisions on care.
Because quality of care is a product of
the interaction between the activities of
these silos, and often occurs at the inter-
sections or where providers collaborate,
health outcomes measurement must work
to transcend ‘silo-ization’.
In order to understand value experienced
by patients, Marc suggests a shift in focus
away from silos and towards care func-
tions. He points out that from the patient’s
perspective there are a limited number of
care functions that a health system deliv-
ers and that the outcomes associated with
each of these functions are distinctive.
For example, for the function ‘chronic
care’, patients are more interested in
whether a provider successfully prevents
deterioration than their waiting time when
they come for a visit. For the function ‘pre-
natal and maternity care’, a healthy baby
and healthy mother is a better measure of
By Silhouette_Mr_Pipo.svg: Nevit Dilmen (talk) via Wikimedia Commons

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