Spring 2015 Compiled

SPRING 2015
Lemurs & Racehorses:
A DISCUSSION ON SCIENTIFIC LEGACY

JACOB KIRSCHENBAUM
THE (A)SYMMETRIC
VITRUVIAN MAN
MAKE LOVE, NOT WAR: A

LESSON FROM BONOBOS
EHR: RESTRUCTURING US
HEALTHCARE
BEATRICE SENOCAK // 18
CASSANDRA PESTANA // 8
KAVIA KHOSLA // 26
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3/20/2015 5:24:45 PM
about
staff
president Rachel Occhiogrosso
editor in chief Eric Bai
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finance Connor Shinn
outreach Justine Palefsky
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science policy Lily Chan
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epublishing Rachel Occhiogrosso
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Sarah Lee
The Triple Helix is an independent, studentrun organization committed to exploring

the intersection of science and society. We
seek to examine the socioeconomic, moral
and environmental implications of scientific
advances, and to highlight the surprising ways
that science can affect our ideas of humanity.
The Triple Helix has an international scope,
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the National University of Singapore. You are
currently holding a copy of one of the Brown
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find a collection of articles written, edited &
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writers
Jacob Kirschenbaum
Sophia (Seon Yeong) Park
Miranda Norlin
Shannon McCarthy
Beatrice Senocak
Audrey Lee
Priya Patel
Kavia Khosla
Lucy Van Kleunen
Cassandra Pestana
Nicholas Mankiw
Logo design by Chen Ye 17.

Cover art by Kaley Brauer 17,
using images of bacteria species that
were propagated by Eli Block RISD 16.
THE TRIPLE HELIX || SPRING 2014
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Dear reader,
To properly convey to you how happy we are to
share this work is a lofty goal. Its unfortunate
that we cant include a snapshot gallery of
the writing meetings, design sessions, email
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our staff shared in putting this edition together.
The late nights and long hours are well worth
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Our publication is a most Tysonian work.
(Tysonian, of course, deriving from Neil deGrasse
Tyson, director of the Hayden Planetarium and
popular scientist extraordinaire - lets pretend
this is a word for a moment.) Like Dr. Tyson,
we want to share with you scientific matters
of such importance to us that we see no other
option than to write and illustrate this edition.
From hiding behind our smartphones to learning
from monkeys, we hope the ideas in these
articles inspire you to tell the world about the
things that are important to you.
The roots of The Triple Helix continue to spread
through the Brown community. The bright,
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recognized (as is our beloved North Atlantic whale
Churchill on page 33), and our blog continues to
gain readership. Our organization now involves
people of all talents and interests around College
Hill. Were thrilled to bring you their ideas and
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Managing Editor
FROM OUR
HEADQUARTERS
One important mission of the The Triple Helix is to get
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are a number of organizations that do this, but our
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scientific debates of our time.
Even as The Triple Helix continues to grow and expand

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It has been a privilege to serve with my dedicated
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Members, I thank you for your continued support
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Mirulda
CEO
SPRING 2014|| THE TRIPLE HELIX
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ii
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contents
SPRING 2015
8 MAKE LOVE, NOT WAR
12 ADHD
A Lesson From Bonobos

CASSANDRA PESTANA
Why Kids Today Cant Stay

Still
18 (A)SYMMETRIC VITRUVIAN MAN

An Overview of Brain
Lateralization and
Asymmetric Brain
Functionality
NICHOLAS MANKIW
BEATRICE SENOCAK
FEATURES
ON THE COVER
LEMURS AND RACEHORSES:

Jacob Kirschenbaum
23
26 EHR
Cognitive Human (Un)

Enhancement?
AUDREY LEE
Restructuring US
Healthcare through
Information Technology
30 BEHIND THE CONSENT FORM

What We Shouldnt
Miss From the SUPPORT
Controversy
KAVIA KHOSLA
34 A NEW AGE OF DECEPTION
How Technology is
Changing the Face of Lying
SHANNON MCCARTHY
50
40 NATURAL WORM CONTROL

The Potential Use of
Medicinal Plants
SOPHIA (SEON YEONG) PARK
46 LIP LIFT
MIRANDA NORLIN
Can Cosmetic Surgery

Increase Ones Happiness?
PRIYA PATEL
Exploring the Earthy Scent

of Wet Dirt
LUCY VAN KLEUNEN
To highlight the creative energy inherent in

the realms of art and science as well as the
importance and power of conveying scientific
concepts visually, we present Equilibrium:
a showcase of student artwork. This editions
series of Equilibrium pieces all come from
Mary OConnor 16. Look for these pieces in
between the articles!
iii
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Lemurs &
ARTWORK
Kaley Brauer 17
Eli Block RISD 16
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s & Racehorses:

JACOB KIRSCHENBAUM 17
Theres a New York Times article taped

on the door of my refrigerator, and its
been there for about seven years. Its
tucked away neatly in the bottom left
corner, outlasting all the report cards,
wedding invitations, and family photos. The piece of paper that was once a
pleasant off-white has turned a musty
yellow, and its corners have curled upwards so that, in order to read the article, I have to hold it down at the edges.
Its about a racehorse named Barbaro,
and I never let a day pass without stopping in front of the fridge to remind
myself of who he was.
Im sure you dont remember Barbaro. He was the centerpiece of one of
those fad news stories that held the
attention of our nations citizens back
in 2007. His struggle through a broken leg that culminated with a heartbreaking euthanizing struck a chord
with people around the country, and
Jeff Neumans Times article, Why We
Mourn Barbaro explains why we had
such a human reaction to the death of
a horse. The piece was almost tonguein-cheek, as Neuman compared Barbaros lack of both public scandals and
poor role modeling to the plethora of
such among our nations most beloved
athletes, concluding with, He trained,
ate and slept. He ran his races, gave his
best effort, accepted plaudits graciously, went back to his stall and prepared
to do it again the next time out. He
never fathered multiple offspring out
of wedlock. Alas [1]. For me, hes a re-
minder that greatness can be found in

the most ordinary and humble of lifestyles, and that sometimes, those unappreciated can bring us the most value if
we only give them a chance.
When I saw the title, Allison Jolly,
Who Discovered Female Dominance in
Lemurs, Dies at 76 in a recent Times
edition, I almost laughed out loud. Female dominance in lemurs is not only
one of the most oddly specific areas of
study, but also one that seems to have
almost no societal relevance, let alone
merit for memorial. As you can probably guess, I was wrong. Reading the
article out of curiosity, I immediately
saw Barbaro in Jolly. She was a racehorse of a scientist who, unlike her
colleague Jane Goodall, never became
a household name among Americans,
despite her groundbreaking research
in the field of evolutionary biology [2].
She was the first Western researcher
to explore Madagascar, and her work
provided important results on how we
understand evolution as a product of
environmental factors. Because Madagascar is an island that, geologically
speaking, recently broke off from Africa, it serves as a evolutionary time
capsule, or as Jolly puts it, the island
allows us to observe what happens
when time has broken its banks and
flowed to the present down a different channel [3]. Her most famous
fieldwork focused on the behavior of
lemurs and how their social organization compares to that of their mainland
counterparts giving us important

insights to the cogs of evolutions machinery.
As I dug deeper into Jollys legacy,
and I dont use that term lightly, I
found that she had published numerous books on Madagascar, exploring
all facets of the country and its inhabitants. She pushed the envelope for
women in science her entire life, especially as a publisher and writer of her
own work, yet, at the time of her death,
most people in the country probably
didnt know her name. Im not writing this to rant about why we mourn
Barbaro and not Jolly that would be
trite, and has more to do with media
influences and American social values
than anything else. I was curious to see
if Jolly really did leave a legacy, and as
I searched through her work, I began
to consider larger questions about scientific legacy in a more abstract sense.
If a scientist fails to leave a legacy, what
use was his or her work? More generally, if we cannot successfully record
our ideas and advancements into pages of history, what use is any scientific achievement? As such, I decided to
explore this notion of legacy and what
it means to leave one in the scientific
community. I use Jolly as a case study,
but the issues discussed have implications outside of Jollys life work. Why
choose Jolly? The answer has more to
do with her similarities with our good
friend Barbaro than anything else.
SPRING 2015 || THE TRIPLE HELIX
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DEFINITION OF LEGACY
What does it mean to leave a scientific
legacy, and how do we determine who
leaves one? Should we limit the group
to those who have won a certain award,
like the Nobel Prize? Or should the true
legacies be reserved for those who have
made their way into the mainstream
zeitgeist at some point in their lives instead of bringing Mozart to the masses, perhaps bringing Newton to the
neophytes? To answer these questions,
I sat down with someone who commands an undeniable scientific legacy, Browns very own Nobel Laureate
Leon Cooper.
From a pragmatic perspective, the scientist has to contribute to an ongoing
problem of the day, Cooper said. This
may seem like a moot point, since a scientist who works on a problem that is
not relevant, or has already been solved,
would certainly not be in consideration for a substantial scientific legacy.
However, there is a deeper truth to this
simple statement, as it implies that scientists have to be aware of the rest of
their community there is a degree of
awareness that a scientist must have in

order to leave a lasting legacy.
Conversely, the public also has to be
aware of the work, Cooper said, in
the most basic of ways. Whether the
researcher publishes his or her work
within the specific discipline the work
concerns itself with, or if the researcher chooses to publish a book for more
mainstream audiences, the work must
be made public in order to be considered something that contributes to an
individuals legacy. This makes the job
of researchers twofold do the work,
then communicate the ideas effectively.
The concept of a paradigm shift has
become essential to discussion of the
history of science ever since Thomas
Kuhn published his The Structure of
Scientific Revolutions. Kuhn argues
that scientific progress is driven by
periodic shifts of paradigm, which are
described as complete reformations or
refutations of once accepted notions or
methodologies. Going into my inter-
view with Professor Cooper, I planned

on focusing on this concept of a paradigm shift, and how it relates to scientific legacy. Contrary to my initial instincts, however, Cooper thought that
not all legacy-deserving work necessarily constitutes a paradigm shift: behind every major discovery or theory,
there are a thousand smaller pieces behind it. These smaller pieces of work
are just as important, and this is where
we find our Barbaro within a seemingly distinct conversation about scientific
legacy. Barbaros best quality his ability to put in hard work, day after day,
not always necessarily winning the
races or receiving the recognition he
deserved is precisely the quality that
scientists must possess if they hope to
leave a legacy. To contribute to solving
a problem of the day in a qualitatively
rigorous and socially contextualized
manner is all a scientist can do, and if
he or she is successful at it, like Jolly,
the work, can be remembered and utilized in later generations.
Behind every
major discovery or
theory, there are a
thousand smaller
pieces behind it.
Leon N. Cooper
PHOTO
Mike Cohea/Brown University
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QUALITY OF WORK
Of course, what defines qualitatively rigorous? Put simply, a scientists
work must have a certain merit to it to
be considered a contributor to a legacy, defined by an integration of outside
information and unification with more
general theories.
We all know that great work requires
collaboration, but behind this simple
mantra is a larger implication regarding scientific legacy if we remain
within our own area of expertise, why
would anyone else care? Researchers
must be able to integrate the work of
others in their own arguments in order to strengthen them and solidify
their legacy. Jolly does this throughout
her books, but perhaps the simplest
example is that of plate tectonics. Jollys books were written in the 1970s,
only about a decade after the geological community accepted the theory of
plate tectonics as valid. Her entire argument concerning the importance of
Madagascar as an evolutionary time
capsule hinges on the concept of plate
tectonics, as one must accept that Madagascar was once a part of Africa [3].
Her ability to utilize recent advancements in separate fields of study qualifies Jolly in this category, and shows
us how a multi-disciplinary approach
is often successful.
If youve ever been to a physics class, or
listened to Neil DeGrasse Tyson speak,
its hard to ignore the importance of
unification in science. The ability to
take specific work and apply it to larger, more general theories and concepts
is one of the main goals of scientific in-
quiry [4]. Not surprisingly, Jolly does

just that. Her work is not important
because we learned more about behavioral patterns of Malagasy wildlife, or
because she documented hundreds of
new species of plants and animals. Her
work is important because it changes
our understanding of a larger, more
general theory evolution this was
only accomplished because Jolly believed that her specific work had larger
implications, and she was able to make
those connections. To consider the social hierarchy of lemurs is almost unimportant if we fail to consider the corresponding hierarchies of primates on
other parts of the globe in the context
of their evolutionary timeline, which is
exactly what Jolly did [2].
CONTEXTUALIZATION
The ability to contextualize work contributes equally to a scientists legacy as
the merit of the specific work. To have
both a cultural and social understanding of ones work are pillars of scientific
contextualization, and therefore, ones
legacy.
If a researcher has no concept of how his
or her work affects the cultural identity of any specific society, or how his or
her work is related to this culture, how
can he or she expect people to remember his or her work? Herein lies the relationship between cultural awareness
and scientific legacy, and Jolly is certainly no exception to this rule, as you
probably guessed. Jolly carefully pulls
a thread of cultural relevance through
her tour de force, A World Like Our
Own, and, at points, reading the book
is less like reading a field journal and
more like reading a sociological analysis of Madagascar. Over the course of
the book, Jolly meets with various local scientists who aid her in her pursuit
of funding and support for her work,

including a Dr. tienne Rakotomaria,
who says, [Most people] know that
Malagasy nature is a world heritage.
We are not sure that [they] realize it is
our heritage [3]. Jolly clearly makes an
effort to convey to her reader the deeper personal and cultural issues that
arise when discussing conservation efforts and wildlife preservation, and she
captures this quality of her work most
succinctly in her dedication, where she
writes: For Richard,
who said, Tell the
whole story ecology
with people, not just
your animals [3].
Similarly, if a scientist cannot clearly determine what the social
implications of his or her
work are, he or she cannot hope to be remembered for very long.
The ability to make
Kirschenbaum.indd 5
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people understand why ones work is

significant is perhaps one of the most
important qualities a scientist can possess. In Jollys case, she, very early
in her book, is able to outline exactly
why her work is relevant, as she generalizes the questions she deals with in
her work: in the end, the question Is
conservation of nature worthwhile in
Madagascar? becomes simply Is conservation worthwhile? and the greater
question, If we destroy nature, can we
save humanity? [3]. Here, Jolly explicitly states why her work is not just
important to the people of Madagascar, but that it serves as a microcosm
of our global conservation efforts, thus
making her work important, relevant,
and contribute to her legacy.

Allison Jolly was an exemplary scientist in her ability to conduct high quality work and successfully contextualize
for the public. She was exceptional at
what she did, did it for some kind of
pure passion for the subject, and continued to work with a stalwart dedication throughout her life. These qualities should have merit in our society
people who are good at what they do
and then actually execute that skill to
the most exemplary degree should be
remembered. Thats why we mourn
Barbaro, and thats why we should
mourn Jolly. She never wrote a national bestseller, and she never hosted
People who are good at what

they do and then actually
execute that skill to the most
exemplary degree should be
remembered. Thats why we
mourn Barbaro, and thats why
we should mourn Jolly.
EDITOR
Hye In Sarah Lee
Cosmos. She never appeared as an

animated character on PBS educational programming, and she was never
interviewed by Jimmy Kimmel or Jon
Stewart. She observed, recorded, hypothesized, reasoned, questioned, concluded, and went back to her tent in the
middle of the Malagasy rainforest and
prepared to do it the next day. To satisfy concerns that her Madagascar legacy
is not apparent in our everyday lives,
one must look only at a certain animated movie franchise with Ben Stiller and Chris Rock, a franchise that has
grossed almost $2 billion worldwide
- almost none of which, unfortunately,
has been donated to conservation efforts in Madagascar. Alas.
REFERENCES
[1] Neuman, Jeff. Why We Mourn Barbaro. 2007 Feb 1.
[2] Vitello, Paul. Allison Jolly, Who Discovered Female Dominance in
Lemurs, Dies at 76. 2014 Feb 18. Available from http://www.nytimes.
com/2014/02/19/us/alison-jolly-76-dies-discovered-female-dominance-in-lemurs.html?_r=0
[3] Jolly, A. A world like our own: man and nature in Madagascar. New
Haven: Yale University Press; 1980.
[15] Cooper, Leon. Interviewed by Jacob Kirschenbaum. 17 March 2014.
[cited 21 March 2014]
[16] Weinberg, Steven. The Search for Unity. Daedalus. 106(4). p. 17-35
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PHOTOS
Kaley Brauer 17
MAKE LOVE,
NOT WAR:
A Lesson from Bonobos

CASSANDRA PESTANA 15
The human race, similar to our animal counterparts, is brimming with acts of violence, greed,
competition, and ruthlessness. The animal
kingdom often suggests that aggressive and
defensive behaviors are necessary for survival
and successful reproduction. However, is there
a more peaceful way to succeed evolutionarily?
Study of bonobo society suggests that there is.
Humans share 98% of their DNA with two species of the genus Pan: traglodytes (chimpanzees) and paniscus (bonobos). Surprisingly,
these apes are more closely related to us than
they are to gorillas, their more phenotypically
similar relative [1]. Despite their genetic similarity however, chimpanzees and bonobos are
polar opposites socially [2].
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Social Poles
Bonobos are known for their gregarious life-style, in which sexual behaviors, both hetero and homo, are common and serve many functions [3][4].
They lack a pronounced dominance
hierarchy, making for a nearly egalitarian society, although females hold
more influence over the group than do
males [5]. Excessive aggression is not
common among bonobos [3], but the

same cannot be said for their close relative the chimp.
Chimpanzees live in patriarchic societies in which aggression and violence
are not uncommon [3][6]. Theyve been
described as bloodthirsty killer-apes,
due to their involvement in war, tor-
ture, infanticide, and cannibalism [7].

Frans de Waal, ethologist and primatologist, concludes that the chimpanzee resolves sexual issues with power,
while the bonobo resolves power issues with sex [8]. So, which one can
humans best identify with? Or further, which relative should we identify
with?
Mock Man
It wasnt until 1916 that bonobos were
recognized as a separate species [1].
Chimpanzees, however, were named
more than a hundred years earlier in
1738 [9]. During this time, the chimpanzees aggressive and violent behavior served as reinforcing evidence that
violence is innate to human nature. In
fact, the word chimpanzee itself means
mock man [9].
Would societal understanding of human evolution today be different had

bonobos been discovered prior to
chimps? De Waal argues that reconstructions of human evolution might
have emphasized sexual relations,
equality between males and females,
and the origin of the family, instead
of war, hunting, tool technology, and
other masculine fortes [10]. Study of
bonobos should redirect our interpre-
tation of our own evolution and be

treated as newfound evidence that homosexual behaviors, female equality,
and promiscuity can be evolutionarily advantageous. The discovery of the
bonobo marks an expansion of awareness of our predispositions. We can
choose which relative we use to justify
our behaviors. We can choose which
ape deserves the name of mock man.
The Role of Homosexuality and Female

Influence in Controlling Aggression
Homosexuality has been classified as
a paradox, due to its inability to lead
to reproduction. It has therefore been
argued that homosexuality should not
exist [5][11]. This assumes that all sexual behavior exists for the sole purpose
of reproduction. However, the correlation between heterosexual sex and reproduction in humans is nearly zero
[12]. In other words, we have much
more sex than we do children, suggesting that sex serves as more than just
a reproductive mechanism, but could
perhaps be done for pleasure or for social bonding.
bonobos often participate in face-toface copulation. It is hypothesized

that the frontal orientation of the vulva and clitoris in female bonobos was
adapted for this position [5], allowing
for more personal, intimate, and pleasurable experiences than traditional
mounting positions. They also exhibit
a diversity of erotic contacts including
genital rubbing, sporadic oral sex, massage of anothers genitals, and intense
tongue-kissing between members of all
sex [5][4], implying that genital stimulation serves both hedonic and reproductive urges.
Further supporting this hypothesis,
Bonobo behavior further suggests that
homosexuality plays additional alternate roles in society aside from that of

pleasure such as reconciliation, mate
attraction, tension regulation, and social bonding [13]. Hohmann et al. find
that post-conflict genital contacts are
more common than pre-conflict, suggesting reconciliation is a motivator
for sexual behaviors. They also found
that rates of genital contacts increase
during contexts of high tension, such
as when food is present but scarce, and
that they are most common between females, enabling them to band together
and overcome the more individually
powerful sex.
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ARTIFICIAL
SISTERHOOD
In order to maintain significant amounts of control
and influence over males,
female bonobos use homosexual behavior to create a
sense of artificial sisterhood
[5][6]. These homosexual behaviors allow them to form close social relationships with which to promote cooperation against the physically stronger
males [14]. The feminist movement is
a human example of women coalescing for equal rights and opportunity.
It wasnt until women united through
social bonding and understanding
that they were able to overcome male
repression of their rights and capabilities as voters, workers, and influencers.
Homosexual behaviors are the basis of
this social bonding in bonobo society.
EVERLASTING ESTRUS
Female bonobos also protect their social standing against stronger males by
extending estrus (periods of high levels
of fertility) [6]. According to the amicable trade-off hypothesis, males are less
aggressive with females who are sexually attractive [15][16]. Since amicable
social relationships between males and
females of this species are critical for
mating success, males are encouraged
to reduce their levels of testosterone in
order to lower their levels of aggression and thus appeal to females though
peaceful interactions, such as grooming [15]. Therefore, the extension of estrus allows for the prolonging of male
cooperation and respect [4].
Similarly, it should be safe to argue
that if women refrain from loving and
10
reproducing
with men who
do not support
their rights as equal
human beings, then
those beliefs and traditions will wane
from society. Women,
like female bonobos,
should demand amicability, fairness, and
equality from their male
counterparts that want
to pass their genes and
traditions on to the next
generation.
AGRESSION UNCHECKED
Unlike that of bonobos, chimp social
structure is dictated by male aggression, suggesting that if females fail to
stand together or to be highly selective
in their choice for partners, aggression
will continue unchecked. Because female chimpanzees do not have the
same opportunities to stand up against
male dominance due to their inability
to socially bond in a significant way
[6], male aggression runs rampant
and dictates the social structure and
mating success [3][6]. Nathan W. Bailey and Marlene Suk hypothesize that
same-sex sexual behavior [in bonobos] provides the glue that establishes,
maintains, and strengthens social relationships [17]. Without this glue in
chimp society, female power is unable
to compare to that of males, enabling
males to continue imposing their decisions on females without their consent
or input.
WAYS TO ALLEVIATE
TENSION
Bonobos also successfully use different forms of sex to alleviate tension,
therefore maintaining low aggression
[4]. De Waal notes that anything that
arouses the interest of more than one
bonobo at a time tends to result in sexual contact [5]. Jealous males have been
observed chasing another male away

from a female and then reuniting and
engaging in scrotal rubbing. Similarly,
if a female hurts an unrelated juvenile,
the mother of that juvenile may react
instinctually by lunging at the aggressor, an action immediately followed
with genital rubbing between both females [5]. When two groups unexpectedly encounter each other they peacefully mingle and engage in mutual
sex and grooming. In these potentially
tense situations, bonobos partake in
kissing, genital rubbing, and copulation in order to reconcile aggressive behaviors and avoid competition or hostile encounters that could lead to injury
and destroy social peace [5][18]. When
faced with potential competition over
food resources, territory, or partners,
chimpanzees respond with increased
levels of testosterone, which lead to a
high-power motive, while bonobos
respond with increased levels of cortisol, which increases stress and results
in a more passive coping style [19]. Sexual acts, unlike violence, tend to reduce
stress and this hormonal difference is
what enables bonobos to instinctually
avoid conflict and violence.
Some may argue that bonobos are compulsive sexual beings and that homosexuality exists merely because they
are unable to control their urges. However, while bonobos engage in sexual
behaviors between most members of
the group, they do not perform acts of
incest [5]. Incestuous relationships lead
to the loss of genetic variation, which
can be detrimental to a species. This
suggests that although bonobos are
creatures of sexual tendencies, they still
obey the laws of evolution and avoid
evolutionarily disadvantageous sexual
behaviors that might be detrimental to
their gene pool. Together, these results
indicate that sexuality can serve as a
peaceful alternative to aggression for
resolving social tensions.
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War vs. Love

For chimpanzees, aggression is used to
settle power disputes and to gain control of important resources [19]. When
humans use violence to settle similar
issues, there are serious repercussions.
In his article in Time Magazine titled
Americas Medicated Army, Mark
Thompson claims that medication can
alleviate some debilitating and nearly
intolerable symptoms of combat and
operational stress injuries and helps

restore personnel to full functioning
capacity [20]. It has also been noted that the repeated deployments to
the warzones contribute to the onset
of mental-health problems, such as
post-traumatic stress disorder (PTSD)
[20]. The majority of humans appear
unable to cope with the guilt and
memories of violence and aggression,
without the help of therapy and drugs.

If this is true, and medication such as
Prozac is necessary for full function in
combat and recovery afterward, then
perhaps humanity should find an alternate way of settling disputes one with
less detrimental psychological consequences. Perhaps bonobos can teach us
a thing or two about love as a healthy
alternative to war.
Conclusion
Clearly humans can relate to both societies, as we demonstrate spiteful behaviors when angered and altruistic behaviors when empathizing [21]. Evolutionary biologists
and behaviorists today are working to learn more about
what pushes humans toward either extreme so that we
can find the key to a more peaceful existence for us all [7].
If there is evidence of a peaceful society in which males and
females live harmoniously, inevitable tensions are relieved
through affectionate behaviors, and sexual behaviors of all
References
sorts are accepted, then it must be possible for us to choose

to likewise make our society egalitarian and accepting. Not
only does the natural evidence exist, but it exists in one of
our closest living relatives. We can continue to emulate the
killer-ape, the chimpanzee, or we can learn from the bonobo and, as Martin Luther King Jr. once said, evolve for all
human conflict a method which rejects revenge, aggression
and retaliation. The foundation of such a method is love.
The choice is ours.
EDITOR
Hank Baker
[1] Duke University. What is a Bonobo?. [Internet] [cited on 2013 October 21] Available
from http://evolutionaryanthropology.duke.edu/research/3chimps/chimps-bonobos
[13] Hohmann G, Fruth B. Use and function of genital contacts among female bonobos.
Animal Behaviour 2000; 60: 107-120.
[2] Public Broadcasting Service. Chimps and Bonobos Evolution: Why Sex?
[Internet] 2001 [cited on 2013 October 21] Available from http://www.pbs.org/
wgbh/evolution/library/07/3/l_073_03.html
[14] Ralph T, Global Post. Study: Female bonobos have sexual relations with other
females to boost their status [Internet]. 2012 March 1 [cited 2013 September
25]. Available from: http://www.globalpost.com/dispatches/globalpost-blogs/
weird-wide-web/study-female-bonobos-homosexual-relations
[3] Sommer V, Bauer J, Fowler A, Ortmann S. Patriarchal Chimpanzees, Matriarchal

Bonobos: Potential Ecological Causes of a Pan Dichotomy, Springer 2011; 35:469-501.
[4] Stanford BS. The Social Behavior of Chimpanzees and Bonobos, Current Anthropology 1998; 39: 399-417.
[5] De Waal FB. Bonobo sex and society: The behavior of a close relative. Scientific
American 1995; 58-64.
[6] Furuichi T. Female contributions to the peaceful nature of bonobo society. Evolutionary Anthropology 2011; 20:131-142.
[7] Kirshenbaum S, National Public Radio. Do Bonobos And Chimps Offer A Path
To Understanding Human Behavior? [Internet] May 2012 [cited 2013 November 2] Available from http://www.npr.org/blogs/13.7/2012/05/07/152197388/
do-bonobos-and-chimpanzees-offer-a path-to-understanding-human-behavior
[8] Quammen D. National Geographic. The Left Bank Ape. [Internet] March
2013 [cited 2013 October 21]. Available from http://ngm.nationalgeographic.
com/2013/03/125-bonobos/quammen-text
[9] Infoqis Publishing Co. Information and Facts about Chimpanzees. [Internet]
2009 [cited 2013 October 21]. Available from http://www.chimpworlds.com/
[10] Waal F, The New York Times. Bonobo: The Forgotten Ape. [Internet] 1997 [cited 2013 October 21]. Available from http://www.nytimes.com/books/first/d/
dewaal-bonobo.html
[11] Pope SJ. Scientific and Natural Law Analyses of Homosexuality, The Journal of
Religious Ethics 1997; 25: 89-126.
[12] Benagiano G, Carrara S, Filippi V. Sex and Reproduction: an evolving relationship,

Oxford Journals 2009; 16: 96-107.
[15] Surbeck M, Deschner T, Schubert G, Weltring A, Hohmann G. Mate Competition,

testosterone and intersexual relationships in bonobos, Pan paniscus. Animal
Behaviour 2012; 83:659-669.
[16] Nature World News. Attractive Females Dominate the Social Circle: Bonobo
Study. [Internet] 2013 July 16 [cited 2013 October 21]. Available from http://www.
natureworldnews.com/articles/2986/20130716/attractive-females-dominate-
social-circle-bonobo-study.html
[17] Bailey NW, Zuk M. Same-sex sexual behavior and evolution. Trends in Ecology
and Evolution 2009; 24: 439-446.
[18] Hare B, Wobber V, Wrangham R. The self-domestication hypothesis: evolution
of bonobo psychology is due to selection against aggression. Animal Behaviour
2012; 83: 573-585.
[19] Wobber V, Hare B, Maboto J, Lipson S, Wrangham R, Ellison P. Differential
changes in steroid hormones before competition in bonobos and chimpanzees,
Proceedings of the National Academy of Sciences of the United States of America
2010; 107: 12457-12462.
[20] Thompson M, Time Magazine. Americas Medicated Army [Internet] June 2008
[cited 2013
November 2] Available from http://content.time.com/time/magazine/article/0,9171,1812055,00.html
[21] Whipps H, Live Science. The Evolution of Human Aggression [Internet] February 2009 [cited 2013 November 2] Available from http://www.livescience.
com/5333-evolution-human-aggression.html
Pestana.indd 11
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AD
ARTWORK
Kaley Brauer 17
Mary OConnor 16
12
Mankiw.indd 12
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DHD
Why Kids Today Cant Stay Still
NICHOLAS MANKIW 17
2 OPINIONS DOMINATE
the debate about the rising diagnosis in ADHD. One claims that
ADHD has become over diagnosed while the other claims that
ADHD has become better diagnosed.
AN UNCOMMON OPINION
is that societal changes have actually increased the
number of children with ADHD.
Mankiw.indd 13
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Attention-deficit hyperactivity disorder, or ADHD, is one of the most

common mental disorders in children and young adults. Estimates
based on epidemiologic surveys put the percentage of children with
ADHD around 5-10% [1]. ADHD was not always this recognized,
however, and there has recently been a rise in the diagnosis of the
disorder. ADHD was commonly thought to be in 3-7% of children.
Now a few select studies show that 15% of boys and 10% of girls will
receive an ADHD diagnosis by high school [2]. Most studies support
that 5-10% of children have ADHD [1]. People have different opinions on why there is this increase. The two most common ideas are
that the disorder is becoming better recognized or over diagnosed,
but both think there is not an actual rise in ADHD. The idea that
ADHD is over diagnosed has significant flaws and does not accurately acknowledge the people that struggle with the disorder. The idea
that ADHD is was previously underdiagnosed is correct that the disorder is becoming better recognized, but it is incomplete as it does not take into account changes in society which could
impact the number of people with ADHD.
Some background on ADHD is needed to understand the reasoning behind these opinions. ADHD has two general types:
inattentive and hyperactive. Its diagnosis is based on a series of questions to determine whether the patient displays the
symptoms of ADHD such as fidgetiness, difficulty remaining seated, forgetful, and impatience [1]. The clinician determines
whether the symptom is severe or not and uses these judgments to determine if the child has ADHD and its severity. On
the neurobiology side, people with ADHD are shown to have significantly smaller brain areas than that of those without
ADHD, specifically, the caudate nucleus, cerebellar vermis, globus pallidus, and the corpus callosum [3]. The caudate nucleus and globus pallidus contain a high density of dopamine receptors. The primary purpose of dopamine is to mediate
the reinforcement pathways in the brain, and the underlying problem for many people with ADHD is a problem with the
reinforcement pathways [3].
CONTRADICTORY OPINIONS ON ADHD

An opinion over-popularized by the
media about the rising diagnoses is that
ADHD is not actually that common or
not even a real disorder [2]. The main
basis for this opinion is the subjectivity in diagnosing ADHD and that for
a long time children with ADHD were
simply unruly children[10]. Since it is
based on the clinicians opinion rather
than on a strict test, a diagnosis is more
subjective than objective. According to
this opinion, drug companies use the
subjectivity to their advantage in order
to sell more ADHD medications [10].
An even more extreme view is that
ADHD does not actually exist, and the
14
wealthy created ADHD as an excuse

to give their children super drugs to
perform better in school. The problem
with this opinion is that it does not recognize the evidence that there is a neurological basis for ADHD. The media
has highly publicized this side of the
debate and latched onto a few inflammatory, inaccurate statistics.
The counter opinion is that ADHD was
previously underdiagnosed and that
people with a serious disorder were
unfairly labeled as deviant [1]. This
opinion is supported by epidemiologic
studies showing that around 5-10% of
the American children population has

ADHD. The 10-15% were simply small
pockets found in studies of limited
size. With regard to drug companies,
some believe that what they do in raising awareness about ADHD is actually
beneficial to the population. Without
this publicity, many children would go
undiagnosed and continue to struggle
[1]. The rising diagnoses are then not
something to be concerned about but
rather good news. This opinion has
many merits and is far more accurate
than the opinion that ADHD is overdiagnosed, but it overlooks certain arguments.
Mankiw.indd 14
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POSSIBLE FACTORS FOR A RISE IN ADHD

An uncommon and unstudied opinion
is that there are a growing number of
people with ADHD. This would have
to be caused by some change in society that has made it more conducive
towards ADHD.
The problem with supporting this
opinion is that ADHD is a heterogeneous disorder and as such there is no
single pathway towards ADHD [4].
Currently, researchers believe that genetics plays a significant role in a person getting ADHD [4, 5]. Specifically,
the dopamine transmitter gene, DAT1,
and dopamine receptor gene, DRD4,
are recognized to be the most common susceptibility genes. Mutations
in these genes is a contributing factor
to the decreased brain size in the caudate nucleus and globus pallidus, the
significance of which was mentioned
above. Even though there is a significant amount of evidence that ADHD is
genetic, not everyone with ADHD will
necessarily have these mutations and
not everyone with these mutations will
have ADHD.
Because of this, scientists still think that
ADHD is partially caused by environmental or social factors. Researchers,
however, cannot be sure if these factors
actually cause ADHD and its severity
or whether there is simply a correlation [4]. Some of these possible environmental factors are video game addiction, childhood anxiety disorders,
bullying victimization, and childhood

family dynamcis. Video game and
internet addiction directly correlate
with the severity of ADHD [6]. Video
games incentivize the player to get to
the next level or get another achievement, and the game then provides an
immediate reward when completed.
This activates a striatal dopamine in
the caudate nucleus release [6]. Continued video game use could reinforce
the pathway leading to severe ADHD
as well as video game addiction. It is
not clear whether video games actually
cause ADHD or whether people with
ADHD are attracted to video games as
they provide immediate gratification
[6]. Some childhood anxiety disorders
can lead to ADHD. Social phobia and
Separation Anxiety Disorder (SAD) especially show direct correlation with
later ADHD [7]. It is not clear exactly what the biological connection between social phobia and ADHD is.
Bullying victimization is also positively correlated with ADHD, but the
connection is not clear [8]. Scientists
hypothesize that it may be connected
through social phobia [8]. Early relationships between child and parent
affect the development of children and
have an impact on childhood ADHD.
It is true that childhood ADHD can put
strain on the parent-child relationship
exacerbating the situation [4]. Pathogenic care, severely negligible care, towards a child also can lead to Reactive
Attachament Disorder (RAD) which
has similar symptoms to and the same

treatment as ADHD [9]. All of these
environmental factors are related to
ADHD and rises in them could either
lead to or signal a rise in ADHD.
Four major environmental factors were
shown to affect ADHD video game addiction, other anxiety disorders, bullying, and changing family relationships.
More people are addicted to the internet and video games, mainly because
they have become more easily accessible. According to one study 14%
of children and 20% of adolescents
screened positive for excessive internet
use [6]. Compare this to the 10% of
children with ADHD and remember
that internet and video game addiction
correlated with the disorder. Video
games could potentially have caused
more people to have ADHD, or they
could have caused minor ADHD to become more severe and then more likely
to be diagnosed. The next two causes
closely tie into this idea. Both have
become prevalent due to the internet.
One study shows that 73% of Americans teens use social media which is an
18% increase from 2006. Social media
sights have been both a playground for
bullies and an anxiety producing factor
in some peoples lives [11]. Anxiety
can lead to ADHD. Bullying can lead
to anxiety and ADHD.
An uncommon and unstudied opinion is that there are

a growing number of people with ADHD. This would
have to be caused by some change in society that has
made it more conducive towards ADHD.
Mankiw.indd 15
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CONCLUDING REMARKS
The most commonly accepted cause by the scientific community is then that ADHD is becoming better recognized by clinicians and therefore people receive better diagnoses. But it
is also likely that the changes in the environment mentioned
above do have a negative effect on children and cause some
rise in ADHD.
REFERENCES
[1] Wozniak J. Interviewed by: Mankiw N W. November 2, 2013 [cited
November 11, 2013].
[2] ] Schwarz A, Cohen S. A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise [Internet].
March 31, 2013 [cited September 20, 2013]. Available from: http://www.
nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.html?pagewanted=all&_r=1&.
[3] Tripp G, Wickens J R. Neurobiology of ADHD. Neuropharmacology
2009; 57 : 579-589.
[4] Thapar A, Cooper M, Eyre O, Langley K. Practioner Review: What
have we learnt about the
causes of ADHD? J of Child Psychology and Psychiatry 2013; 54(1):3-16.
[5] Sharp SI, Mcquillin A, Gurling H. Genetics of attention-deficit hperactivity disorder
(ADHD). Neuropharmacology 2009; 57(7-8):590-600.
EDITOR
Jordan DeLoach
[7] Bittner A, Egger HL, Erkanli A, Costello EJ, Foley DL, Angold A. What
do childhood anxiety disorders predict? J of Child Psychology and
Psychiatry 2007; 48(12):1174-1183
[8] Unnever JD, Cornell DG. Bullying, Self-Control, and Adhd. J of Interpersonal Violence
2003; 18(129):129-147.
[9] Dahmen B, Ptz V, Herpetz-dahlmann B, Konrad K. Early pathogenic
care and the
development of ADHD-like symptoms. J of Neural Transmission 2012;
119(9):1023-1036.
[10] Stolzer JM, The ADHD Epidemic in America. Ethical Human Psychology and Psychiatry
2007; 9(2):109-116.
[11] Miller M, With increased social media use comes increased social
anxiety. 2013 Jul 3.
[6] Weiss MD, Schibuk H, Allan BA, Saran K, Baer S. The screens culture:
impact on ADHD.
Springer Open Choice 2011; 3(4):327-334.
16
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The (A)symmetric
Vitruvian Man:
An Overview of Brain Lateralization
& Asymmetric Brain Functionality
BEATRICE SENOCAK 15
Leonardo Da Vincis Vitruvian Man,
the iconic illustration of the Renaissance period, depicts two superimposed positions of a male body centered within both a circle and a square.
The illustration is named in honor of
Marcus Vitruvius Pollio, an influential Roman architect who considered
the human body to be an example of
architectural perfection and suggested
that the symmetries of the human body
should govern the way architectural
structures were built [1]. Although Da
Vincis drawing portrays the human
body as perfectly symmetrical on the
outside, this symmetry breaks down
18
on the inside, where the eye cannot see.

In truth, the human body exhibits significant anatomical asymmetry. During
embryonic development, the heart experiences a slight turn to the left side
of the body, while the liver develops
on the right and the two lungs grow
into increasingly distinct structures [2].
Arguably, the most important example of asymmetry in the human body
exists in the brain. A brief examination
of the two halves of the brain also
known as the cerebral hemispheres
might initially cause one to consider
that these structures are mirror images
of each other. Indeed, the hemispheres

do not differ conspicuously in terms
of structural features and total tissue
weight. The distribution of brain tissue
across the left and right cerebral hemispheres, however, reveals that there exists points of asymmetry between the
two halves of this vital organ [3]. Such
asymmetries give rise to functions that
are associated with one side of the
brain over the other, and make certain
behaviors, including handedness and
language, invaluable starting points in
the quest for understanding the functionality of the human brain.
Senocak.indd 18
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Brain Lateralization
The phenomenon of brain lateralization describes the asymmetry between
the two hemispheres of the brain. As
a result of lateralization, certain functions controlled by the brain are localized to one hemisphere over the other
[4]. For example, in most people language-related functions are controlled
by the left cerebral hemisphere. The
dominance of the left hemisphere in
language, however, does not render
the right hemisphere insignificant in
contributing to this function. In fact,
the right hemisphere is thought to be
important for processing tone of voice,
humor, hesitation and figurative language [3]. The two hemispheres of
the brain are extensively connected
through a network of neuronal fibers
called the corpus callosum, so that neither hemisphere works alone to control
a function.
One of the most fundamental questions to consider while studying brain
lateralization is why the brain prefers
to organize itself such that neural networks controlling a certain function are
located in one hemisphere instead of
being spread out across the two hemispheres. Some neuroscientists argue
that lateralization increases the brains
efficiency and speed in executing functions, since communication within a
hemisphere takes place more quickly than communication between two
hemispheres, which involves sending
information across the corpus callosum
and then integrating input from both
hemispheres [5]. Current research in
the area of brain lateralization has also
focused on determining mechanisms
underlying the brains asymmetric organization. Recent studies have suggested that brain lateralization might
be driven by a collection of factors such
as hormones, gender, fetal orientation
in the womb, and genetic makeup [3].
Although there are extremely sophisticated ways of visualizing differences
between the cerebral hemispheres of
the brain and determining the functional outcome of these asymmetries,
much remains to be understood about
brain lateralization. The first step in
studying this phenomenon in humans
requires taking advantage of behaviors
known to be controlled by a dominant
hemisphere and therefore provide
clues about the asymmetric organization of the brain [3].
Lateralized Behaviors: Language and Handedness

LANGUAGE
As indicated earlier, the left hemisphere is typically the dominant hemisphere in controlling functions related
to language. This pattern of functionality was first discovered by the French
neurosurgeon Paul Broca in the mid1800s, who noticed that patients suffering from aphasia [4] the general term
for conditions in which normal speech
function is lost had tumors in the left
hemisphere of the brain.
Although language is often considered
to be dominantly controlled by the left
hemisphere, it can be lateralized to

the right hemisphere or be controlled
equally by both hemispheres as well.
One of the early ways of determining
a persons hemispheric language dominance was the Wada test, developed in
the 1950s. In this rather invasive procedure, a chemical called sodium amytal would be injected into the artery
supplying blood to the hemisphere
of the same side, inducing anesthesia
and disrupting speech function in the
hemisphere to which it was delivered
[3]. Considering the complications that
could arise from chemically anesthetizing one half of the brain, it has been
necessary to find ways of determining
language-related asymmetry in less invasive ways. One method of determining language dominance is the dichotic
listening test, in which experimenters
can deduce hemispheric dominance
of speech sound perception based on
which ear processes simultaneous auditory stimuli more accurately [3].
HANDEDNESS
Similar to language, handedness is also
an asymmetric behavior. While language lateralization is observed
in other species, such as passerine birds which produce
song under the control of
the left hemisphere [3], the
strong bias for one limb
over the other is uniquely
observed in humans, even
when compared to other primates [5].

Comparing the incidence of handedness in humans and chimpanzees
makes it likely that handedness in humans developed after the evolutionary
divergence of humans and their primate ancestors [5].
It is thought that the lateralization resulting in handedness occurs during
Senocak.indd 19
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THE PROBLEM WITH BEING

LEFT-HANDED
In the 19th century, an Italian physician by the name of Cesare
Lombroso attempted to investigate the biological basis of criminality. Not surprisingly, left-handed individuals bore the brunt
of Lombrosos so-called scientific evidence, which associated lefthanders with a more primitive state of mind. In 1903, Lombroso wrote that, left-handedness, united with many other traits,
may contribute to form one of the worst characters among the human species [8] adding, in early times, and still among people little civilized, such as Arabs the writing was preferably from
right to left, which is the habit until corrected [9].
Although Lombrosos work is denounced as pseudoscience in the
present day, until recently many researchers were seduced by the
association of left-handedness with pathological conditions. In
1977, psychologist Theodore Blau concluded that sinister children, as he called them, were more vulnerable to mental illness
and likely to experience academic and behavioral challenges [8].
Not so long after, neurologist Norman Geschwind wrote that
left-handed individuals lived shorter lives and experienced delays
in physical and mental development [8]. At the time, such claims
on left-handedness were considered to be grounded in scientific evidence and started a new trend in many American and British schools, where left-handedness was
increasingly considered a reflection of deviant personality. Often times, left-handed children were forced to
convert to right-handedness. Some methods of ensuring this conversion were particularly brutal, as they
involved restraining the childs left-hand so as to keep
it from being used [10].
ARTWORK
Mary OConnor 16
Anand Prahlad, tracing
of da Vincis Vitruvian Man
Although left-handedness is relatively less common

than right-handedness in the human population, the
percentage of left-handed individuals has remained
stable over the course of human existence, at roughly ten percent [2]. Archaeological analyses of cave
paintings and artifacts such as hunting spears have
confirmed the stability of this ratio [2]. While abnormal asymmetry of the human body can sometimes be
indicative of a serious underlying condition such as
dextrocardia, in which the heart is unusually situated on
the right left-handedness is no longer considered to be a
sign of an underlying pathology, but is accepted as a normal deviation from the usual asymmetry of human handedness [2, 11].
20
Senocak.indd 20
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the early stages of human development. The findings that embryos at

seven weeks after conception generally
have a more developed right hand and
that 92% of fetuses which sucked their
thumb in the womb preferred the right
thumb over the left one, support the argument that handedness develops early on [5]. One study found that lateral-
ization of handedness might be driven

by the LRRTM1 gene, implicating a genetic basis for right or left-handedness
[6].
Considering the vague principles of
brain lateralization, it would be logical to assume that handedness results
from the lateralization of the motor
networks responsible for controlling

hand movement [7]. Interestingly, the
motor networks associated with handedness do not display the prominent
left-right asymmetries that do language networks [3]. Handedness actually seems to be determined more so by
asymmetries of language areas than by
asymmetries of motor areas [7].
Language and Handedness: An Enigmatic Connection

Paul Broca, the neurosurgeon who
made the initial observations on language lateralization, also hypothesized that language dominance and
handedness were correlated, such that
a persons handedness was opposite
from the hemisphere controlling language [4]. Broca is famously quoted for
saying, We speak with the left hemisphere [5], and his ideas on lateralization gave rise to the Broca Rule, which
predicted that right-handed individuals had left-sided language dominance and vice versa. Although studies
have found that the correlate generally
holds true for right-handers, it breaks
down for left-handers. As it turns out,
many left-handed individuals actually
have left-sided language dominance,
and significant percentages exhibit either right-sided or bilateral
dominance [12, 13].
Although the correlation between lan-
guage and handedness is not perfect,

it allows scientists and doctors to look
at a persons hands and make knowledgeable predictions on the organization of this persons brain. Before the
development of techniques such as
fMRI, PET, Wada, and the dichotic listening test, neurosurgeons preparing
to perform surgery on a patient often
relied on the patients handedness as
an external clue to the organization of
their brain [4]. Unfortunately since not
every brain especially those belonging to left-handed individuals is governed by Brocas Rule, the hand-brain
link must be used with caution.
The Origin of the HandLanguage Link

Handedness and language are seemingly
unrelated behaviors,
which makes it surprising to observe
a relationship between
language
dominance
and
handedness. Theories on the origin of
the
hand-language
link indicate that these
functions might not be
all that unrelated after
all. One theory explains
the correlation by noting that both language
and
handiwork
require fine motor skills and
argues
that it would be more efficient for the

brain to control these similar functions
by having them located in one hemisphere [5]. Another theory suggests
that language a 200,000 year-old and
therefore relatively recent development in the scheme of human evolution [3] could be considered a parasitic system that invaded regions of the
brain initially involved in controlling
basic motor functions [14].
Theories attempting to understand
the origin of the relationship between
handedness and language dominance
have provoked much thought on the
evolution of verbal human language as
well. A third theory on the origin of the
language-hand link examines the role
of gesture in human speech and hypothesizes that verbal language might
Senocak.indd 21
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have evolved from a gesture-based

language [3]. Several observations
support this theory, such as the report that captive apes usually gesture
with their right hand while making
communicative sounds [3]. Studies of
individuals who are blind from birth
also found that these individuals use
gestures while speaking. For example,
one study found that blind and sighted individuals alike tilted a C-shaped
hand in order to gesture the pouring of
a liquid [15]. Such findings imply that a
gestural language might be hardwired
in the brain and that our current verbal language may have evolved from
a mode of language that once relied
primarily on gestures. Finally, a fourth
theory, also known as The Right Shift

Theory, argues that the connection between handedness and language dominance can be explained by gene which
increases the probability of left cerebral
dominance and left-handedness when
expressed [5].
Conclusion
The asymmetries between the two cerebral hemispheres of the brain seem to
govern complex human behaviors such
as language and handedness. Studying
the cause and effects of structural and
functional asymmetries in the brain can
shed light not only on the evolution of
the human brain, but also on how the
brain works and why, in some cases, it
does not work properly. Although it is
unlikely that left-handedness is an indication of problematic brain asymmetry, the relationship between language
EDITOR
Lucy Zhou
dominance and handedness might

be key in understanding disabilities
such as stuttering and dyslexia. Most
intriguing are accounts of patients reported to have developed speech impediments after being forced to convert
handedness, generally from left-handedness to the more socially acceptable
right-handedness [10]. It might be that
forced conversion disrupts the synergy
between language and hand areas of
the brain, thus resulting in a deterioration of language function [10]. The
References
[1] Stanford University. Leonardos vitruvian man [Internet]. [cited 2013

Dec 12]. Available from: http://leonardodavinci.stanford.edu/submissions/clabaugh/history/leonardo.html
[2] Klass P. On the left hand, there are no easy answers. The New York
Times (USA) [serial online]. 2011 Mar 06 [cited 2013 Dec 13]. Sect.
18 and Under. Available from: http://www.nytimes.com/2011/03/08/
health/views/08klass.html
[3] Toga AW, Thompson PM. Mapping brain asymmetry. Nat Rev Neurosci.
2003; 4(1): 37-48. doi:10.1016/10.1038/nrn1009.
[4] Holder MK. What does handedness have to do with brain lateralization
[Internet]. [cited 2013 Dec 12]. Available from: http://www.indiana.
edu/~primate/brain.html
[5] Papadatou-Pastou M. Handedness and language lateralization: Why are we
right-handed and left-brained? Hellenic Journal of Psychology [Internet].
2011 [cited 2013 Dec 13]; 8: 248-265. doi: 10.1080/1357650X.2011.615127.
[6] Francks C, Maegawa S, Laurn J, Abrahams BS, Velayos-Baeza A,
Medland SE, Colella S, Groszer M, McAuley EZ, Caffrey TM, Timmusk
T, Pruunsild P, Koppel I, Lind PA, Matsumoto-Itaba N, Nicod J, Xiong
L, Joober R, Enard W, Krinsky B, Nanba E, Richardson AJ, Riley BP,
Martin NG, Strittmatter SM, Mller HJ, Rujescu D, St Clair D, Muglia
P, Roos JL, Fisher SE, Wade-Martins R, Rouleau GA, Stein JF, Karayiorgou M, Geschwind DH, Ragoussis J, Kendler KS, Airaksinen MS,
Oshimura M, DeLisi LE, Monaco AP. LRRTM1 on chromosome 2p12
is a maternally suppressed gene that is associated paternally with
handedness and schizophrenia. Mol Psychiatry [Internet]. 2007 Jul
31 [cited 2013 Dec 13]; 12(12): 1129-1139. doi: 10.1038/sj.mp.4002053.
[7] Siebner RH, Limmer C, Peinemann A, Drzezga A, Bloem BR, Schwaiger
M, Conrad B. Long-term consequences of switching handedness: a
positron emission tomography study on handwriting in converted
left-handers. J Neurosci [Internet]. 2002 Apr 01 [cited 2013 Dec 13]; 22(7):
2816-2825. Available from: http://www.jneurosci.org/content/22/7/2816.
long.
22
lateralization of the
brain, it seems, reflects a balance of functionality assembled
under the guidance of millions of
years of human evolution.
[8] Konnikova, M. Sinister Minds: Are left-handed people smarter? The

New Yorker (USA) [serial online]. 2013 Aug 22 [cited 2013 Dec 13]. Available from: http://www.newyorker.com/online/blogs/elements/2013/08/
psychology-are-left-handed-people-smarter.html
[9] Kushner HI. The art of medicine: Cesare Lombroso and the pathology
of left-handedness. Lancet [Internet]. 2011 Jan 08 [cited 2013 Dec 13];
377(9760): 118-119. doi:10.1016/S0140-6736(11)60009-3.
[10] Kushner HI. Retraining left-handers and the aetiology of stuttering:
The rise and fall of an intriguing theory. Laterality [Internet]. 2012
[cited 2013 Dec 13]; 17(6): 673-693. doi: 10.1080/1357650X.2011.615127.
[11] Deep-Soboslay A, Hyde TM, Callicott JP, Lener MS, Verchinski BA,
Apud JA, Weinberger DR, Elvevg B. Handedness, heritability, neurocognition and brain asymmetry in schizophrenia. Brain [Internet].
2010 May 31 [cited 2013 Dec 13]; 133(10): 3113-3122. Available from:
http://brain.oxfordjournals.org/content/133/10/3113.long
[12] Knecht S, Drger B, Deppe M, Bobe L, Lohmann H, Flel A, Ringelstein EB and Henningsen H. Handedness and hemispheric language
dominance in healthy humans. Brain [Internet]. 2000 Aug 17 [cited 2013
Dec 13]; 123(12): 2512-2518. Available from: http://brain.oxfordjournals.
org/content/123/12/2512.abstract
[13] Khedr EM, Hamed E, Said A, Basahi J. Handedness and language
cerebral lateralization. Eur J Appl Physiol [Internet]. 2002 Jan [cited
2013 Dec 13]; 87(4-5): 469-473. doi: 10.1007/s00421-002-0652-y.
[14] Corballis M. The Gestural Origins of Language. American Scientist (USA)
[serial online]. 1999 [cited 2013 Dec 13]. Available from: http://www.americanscientist.org/issues/pub/1999/2/the-gestural-origins-of-language/5
[15] Iverson JM, Goldin-Meadow S. Why people gesture when they speak.
Nature [Internet]. 1998 Nov 19 [cited 2013 Dec 13]; 398 (6708): 228.
doi: 10.1038/24300.
Senocak.indd 22
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Cognitive Human
(Un)Enhancement?
AUDREY LEE 16
Suppose it is 2040 and the technology

to improve your ability to concentrate,
think critically, and retain information
is readily available. What do you do?
In its most general form, human enhancement refers to the use of medicine, technology, and techniques to improve the capacities of people beyond
what we would consider normal or
healthy [1]. More specifically, drugs
such as those used by college students
to improve general mental faculties,
including concentration, memory, and
critical thinking, fall into a more discrete category known as cognitive human enhancement. Cognitive human
enhancement refers to the amplification or extension of core capacities

of the mind through improvement or
augmentation of internal or external
information processing systems [2].
The development of cognitive human
enhancers has become increasingly
popular over the years, which can be
illustrated primarily by the prevalent
use of cognitive enhancement drugs,
such as Ritalin and Adderall. These
drugs increase academic productivity,
by improving our ability to concentrate and think critically. According to
recent surveys conducted across several college campuses, as many as 20
percent of college students have used

Ritalin or Adderall to study, write papers and take exams [3]. Furthermore,
as stated by research conducted by the
National Institutes of Health, almost
350,000 prescriptions for the alertness
drug Modafinil are being written in the
United States every year, even though
the only condition for which it was approved until recently was narcolepsy,
which affects only about 135,000 people [4]. The large difference between
the number of prescriptions being
written for this cognitive enhancer and
the number of people with the condition for which this drug is used to treat
Lee.indd 23
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indicates that Modafinil is being used

for reasons other than its intended
purpose. The possibility of being able
to take a drug to improve mental functioning is slowly becoming a reality,
and as the prevalence and availability
of cognition-enhancing drugs becomes
more apparent, it is important to engage in the multifaceted ethical debate
surrounding cognitive enhancement.
How does a healthy human body respond to a drug meant to treat an illness? One facet of the complex debate
surrounding the use of cognitive human enhancement is safety. By interfering with natural human capabilities,
many side effects and unforeseen consequences may result, especially because cognitive enhancement involves
altering a humans ability to organize,
think, or concentrate. According to a
study conducted by the National Institutes of Health on cognition-enhancing drugs, these substances may be
accompanied by deleterious side effects, including toxicity and physical or
psychological dependence [4]. These
risks can become amplified through
the long-term use of the drug, which
is usually necessary in order to achieve
and sustain the desired enhancement
effect. Further health risks associated
with cognitive enhancers become apparent through the lack of safety data
available surrounding the use of these
drugs. While the Federal Food, Drug,
and Cosmetic Act requires manufacturers to show that drugs are safe for
their intended purposes, the act does
not consider the health consequences
that may result when a drug is used
for a reason other than its intended
purpose [4]. Even though cognitive
Another aspect that must be considered is the social implications of using

such drugs. In considering the social
effects of taking cognitive enhancers,
think about our competitive society.
Consider the limited places in prestigious schools or the high-stakes multitasking of modern work life [5]. In this
increasingly ambitious culture, the
freedom not to enhance may be difficult to maintain [6]. Furthermore, it is
important to note that the more effective cognitive enhancements prove to
be, the more pressure people will feel
to use [these cognitive enhancements]
to gain or retain socioeconomic advantages [4]. Will the pressures to perform well and succeed in everyday society eventually coerce us towards the
recreational use of cognitive human
enhancers? Another potential societal
consequence associated with the use
of these drugs is the fear of a cognitive arms-race in which people might
[spend] significant resources merely

in order to keep up with the Joneses
[2]. If the recreational use of cognitive
enhancers becomes common practice,
members of society may find themselves expending an excessive amount
of resources in search of the best enhancements. The use of such drugs
may create a society in which those
who do choose to cognitively enhance
themselves begin to compete with others who are also cognitively enhanced,
thus creating this cognitive arms-race.
Further social implications involve
socioeconomic status and the cost of
using cognition-enhancing drugs. Because the cognitive-enhancing drugs
for the sole purpose of enhancement,
rather than the treatment of an illness,
is viewed as a privilege, it is likely that
those who are unable to afford these
drugs will remain unenhanced, while
those who are able to afford these same
drugs will become enhanced. The cost
of these enhancers creates a barrier that
could exacerbate the disadvantages
already faced by people of low socioeconomic status in education and employment [6]. By making these cognitive enhancers available to the public,
there is the possibility of increasing
the opportunity gap between the
rich and educatedand the poor and
less educated [8] as it becomes apparent that there are some who can afford
such drugs, and those who are unable
to. Through the use of these drugs and
the resulting opportunity gap, the
playing field for jobs and future careers
becomes unleveled. This opportunity gap will only continue to increase
through the amplified use of cognitive
human enhancements, creating a further divide between differing socioeco-
As the prevalence and availability of cognitionenhancing drugs becomes more apparent, it is

important to engage in the multifaceted ethical
debate surrounding cognitive enhancement.
PHOTO
Kaley Brauer 17
24
enhancers may have the ability to be

beneficial to standard human cognition
when taken in the absence of illness,
there is still uncertainty surrounding
the consequences of taking a drug to
treat a condition that is not considered
an illness. While all drugs and technologies have risks, from a public health
point of view, an acceptable ratio of
risks to benefit is far different when
people have a life-threatening illness as
opposed to when [people] have milder symptoms or when they are well
to begin with [5]. When drugs that
are meant to treat illnesses are used to
improve normal human cognitive capabilities, the health and safety risks
associated with abusing these drugs
become important concerns.
Lee.indd 24
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STATISTICS
Full-time college
students, ages 18 to
22, are more than
twice as likely as
non-college students
of the same age to use
Adderall.
In 1991, there were 1

million prescriptions
for Adderall and other
stimulants; In 2010,
there were 15 million
prescriptions for Adderall
and other stimulants.
nomic classes. Is it possible that a pill

has the potential to create a society in
which socioeconomic status plays such
a large role in your future success?
A third major aspect of cognitive enhancement stems from the authenticity
of human ability. Some argue that the
use of cognition enhancers reflects our
values and our sense of self [6]. Part
of this philosophical view considers
self-improvement by improving natural human capabilities and then categorizing these enhancements as traits
that can be bought or sold through the
use of cognitive enhancements. This
commodification of enhanced human
traits, such as the improved ability to
critically think, concentrate or remain
alert, raises philosophical concerns surrounding the sale and purchase of unnatural human capabilities. Is it moral
to purchase the ability to concentrate
or memorize information in an attempt
to exceed normal human cognitive
1 in 3 Adderall
abusers are
between the
ages of 12
and 17.
function? The philosophical viewpoint

on the use of the cognitive enhancements also explores the difference
between ones true self and ones enhanced self. Are these enhanced traits
acquired through the form of a pill less
genuine than the natural capabilities
given to us as humans? As cognitive
enhancements become more and more
prevalent and available, [people]
fear that there will be a strong temptation to seek chemical magic bullets
for solving problems better addressed
by other means [7]. The idea that the
ability to critically think and memorize
information, which was once achieved
through hard work and persistence,
can now be achieved through a pill undermines our natural capabilities. The
philosophical reservations surrounding the use of cognition-enhancing
drugs also extend beyond the tangibility of enhancement and examine the internal, personal debate that stems from
a persons use of cognitive enhancers.
References
[1] University of Oxford. Human Enhancement [Internet]. 2013. Available
from: http://www.fhi.ox.ac.uk/research/human_enhancement
[2] Nick Bostrom. Cognitive Enhancement: Methods, Ethics, Regulatory
Challenges [Internet]. 19 Jun 2009. Available from: http://www.nickbostrom.com/cognitive.pdf
[3] The New York Times. The Adderall Advantage [Internet]. 2005 Jul 13.
Available from: http://www.nytimes.com/2005/07/31/education/edlife/
jacobs31.html?pagewanted=all&_r=0
[4] Maxwell J Mehlman. Cognition-Enhancing Drugs [Internet]. 2004 Sep.
Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690227/
Common cognitive
human enhancers, such
as Adderall and Ritalin,
have been used without
a prescription by about
5% of U.S. college
students.
Considering the authenticity of natural

knowledge does achieved excellence
[have] a higher worth than talent that
is bought? [8].
Cognitive human enhancement and
the ethical debate surrounding this
topic can only be completely engaged
by considering the various different
approaches that make up the ethical
debate. Through the distinct lenses of
safety, social implication and philosophy, the question surrounding the use
of cognition-enhancing drugs becomes
far more complex. In order for members of society to fully understand the
diverse aspects that have created this
ongoing debate, the different facets of
the debate and each of their contributing consequences must be clear. Say
the time does come for you to consider
making use of these cognition-enhancing drugs. Now what will you do?
EDITOR
Hye In Sarah Lee
[6] University of Pennsylvania Center for Neuroscience & Society. Cognitive
Enhancement [Internet]. 2013. Available from: http://neuroethics.upenn.
edu/index.php/penn-neuroethics-briefing/cognitive-enhancement
[7] Allen Buchanan. Cognitive Enhancement and Education [Internet].
2013. Available form: http://tre.sagepub.com.revproxy.brown.edu/
content/9/2/145.full.pdf+html
[8] Nick Bostrom and Anders Sandberg. Cognitive Enhancement [Internet].
19 Jun 2009. Available from: http://download.springer.com/static/pdf/814/
art%253A10.1007%252Fs11948-009-9142-5.pdf?auth66=1384457408_caeb31267a569d66ec98839865d8e9bd&ext=.pdf
[5] Steven E. Hyman. Cognitive Enhancement: Promises and Perils [Internet].

24 Feb 2011. Available from: http://www.sciencedirect.com.revproxy.
brown.edu/science/article/pii/S0896627311001097
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3/20/2015 4:36:14 PM
INTEGRATING
INFORMATION
IN EMR
and Recent Breakthroughs in
Health Information Technology
KAVIA KHOSLA 16
Knowledge is power, and information
undeniably fuels our society. Big data
not only supports research and informs
policymakers, but now it could be the
solution to Americas healthcare woes.
The last few years have brought to light
important discussions about the future
of healthcare in America. The Recovery
Act of 2009, which created HITECH
(Health IT for Economic and Clinical
26
Health Act), the Affordable Care Act

of 2010, and recent breakthroughs and
setbacks in the genetics industry make
information in health one of the biggest
priorities in the US. All these endeavors to reach accountable and efficient
health care rely heavily on electronic
health records (EHR).
Americas healthcare system is ineffi-
cient and unsustainable; it is an irrefutable fact. Even now, the United States
lags behind every developed nation
in the quality of healthcare provided
for the amount of money spent, which
at this point is 17.7% of the US GDP.
Genetics and personalized medicine
have been noted as possible solutions.
The goal of personalized medicine is
to tailor care to each patient by using
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EHR eliminates errors in providing health care by

making information more accessible, supporting
clinicians in decision-making, and keeping an organized
database for management of the quality of care.
genetic information to predict individual response to treatments rather than

prescribing generic fixes to variable
conditions. In turn, the US would significantly cut healthcare costs by participating in preventative and personalized care [11]. Given the prospects,
there is not a proper infrastructure
for this kind of care yet. Patients must
participate in their care along with the
doctor in order to harness the power
of personalized medicine. Information besides genetic information, like
extensive behavioral and medical history, must be documented and accessible to the patients health provider.
In general, personalized care involves
participatory health care, patient involvement, or patient-centeredness
[12], all of which are not present in our
health system at the moment but can
be achieved through electronic health
records. In this way, EHR is both a new
system and an infrastructure for newer
systems like personalized healthcare.

Until the last three years, paper-based
records prevailed in our health system.
Information had a physical location,
only accessible to a select few people
involved in the care of the patient. In
addition, paper based records are disorganized and portions are often misplaced. This negatively impacts the
care of the patient, but also prevents the
US from gathering all this data as big
data to conduct research and track the
quality of care [1]. EHR eliminates errors in providing health care by making information more accessible, supporting clinicians in decision-making,
and keeping an organized database
for management of the quality of care.
Studies since the 90s have corroborated the enormous benefits of this method of health information exchange. The
rate of patient readmission, medication and diagnosis errors, and duplicate testing decreases significantly in
networks connected by an electronic
health system [1].
A new wave of technology like EHR
depends on three stages: infrastructure,
software service companies, and the
consumer applications that proceed.
The advents of the electronic health record in the US emerged in the 1960s,
but it was almost wholly a private undertaking without proper infrastructure or help from the federal government [5]. Our health system produces
mass amounts of information, and until recently no mass storage system
existed that could conveniently and
securely hold it. Until recently, cheap
and convenient mass storage was not
feasible. Since the last five years, however, even the average American citizen uses Amazon, Dropbox, and other
cloud storage systems on a daily basis.
According to Jeff Smith, co-founder of
Prospect Health (November 2013), this
cloud storage infrastructure is what
makes the EHR system a plausible endeavor.

Software companies such as Epic realized the potential of this infrastructure
and have become the leaders in electronic health software. This phase of
the technology wave, though well on
its way at the moment, must be carefully watched. As noted earlier, EHR was
a largely private undertaking when it
was first invented. This gave rise to the
present situation, in which EHR systems advance within the context of private institutions and are unable to usefully exchange information amongst
each other. This phenomenon, called
interoperability, has been the largest hindrance to meaningful use of
the EHR system. In 2009, HITECH set
aside over 27 billion dollars to incentivize the widespread and meaningful
adoption of EMR [4]. The goal of this
law is to integrate and make accessible
all the information that is put into the
EHR systems. Only then can we ensure
a cost effective process of emergency
care, multi-provider care, and research.
This is a momentous year in public
policy and health technology, not only
because of the Supreme Court ruling
on genetic patenting, but also because
Stage 2 of HITECHs Meaningful Use
will go into effect in 2014. Similar to the
Supreme Court ruling, a key purpose
of Stage 2 of HITECHs Meaningful
Use clause is to increase the flow of
Khosla.indd 27
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information in the American healthcare system. The goal in this case is to

increase quality and accountability of
care across the board.
As stated earlier, the invention of EMR
within the US was a private undertaking, and therefore encouraged fissured development of different EMR
systems. Most health providers have
their own unique EMR system, which
ensures a lack of interoperability between the providers systems [7]. HITECH tackled this issue by making the
meaningful use clause. The phrase
meaningful use has become famous
in the Health IT industry, as the clause
within HITECH dictates the regulations under which a provider or health
vendor must adopt an EMR system in
order to get incentive money. Stage
1 of Meaningful Use engaged many
more professionals with the EMR by
offsetting the costs of implementing it.
However, hospitals and physicians are
not naturally inclined to share the information that they put on their EMR
for multiple reasons (some doctors
have reported hesitance in disclosing
discharge reports for fear of insulting
the patient) [9]. To address this, Stage 2
mandates that anyone receiving incentive money for their EMR system must
have certain policies in place that make
28
the exchange of information with their

patients and other providers efficient.
For example, one stipulation reads,
Over 50% of requesting patients must
receive electronic copy of their health
information within 3 business days [of
the request] [9]. Meaningful use must
be monitored carefully in order to
complete the second phase of the EHR
technology wave, formation of leading
software companies that will pave the
way for use of the technology.
The last phase in the EHR wave is the
production of applications that will
work in the framework of this established software. As noted earlier, many
advantages of the EHR system have
been researched and systematically
proven. Most of these benefits are seen,
however, when a clinician or hospital
interacts with the system rather than
passively replacing the paper based records with an electronic one [1]. Lack
of interaction is a major problem in
transitioning to a completely electronic
system.
Numerous barriers in getting doctors
to not only accept, but also interact
with the EMR have made the transition
from paper to EMR inefficient. Clinicians were, and often still are, hesitant
to accept the new system from both
an economical perspective and out of

convenience. For one, doctors are accustomed to physically handling all
the notes about a patient in order to
make a diagnosis or analyze their status. The lack of tangibility of the EMR
often leads to a tendency to keep both
paper and electronic records, actually increasing the amount of time that
a doctor must put into records [2]. In
order to record the progress of doctors
visits, the physician would also have to
type up notes during the visit, which
makes the interaction feel less personal
[2]. Lastly, most of the EMR systems in
hospitals thus far have lacked free-text
abilities. As Pam Khosla, MD (November 2013) explains, the EMR data entry
process often looks like a flowchart
of drop boxes, in which the physician
must select binary answers to complex
medical questions. Just in the past five
to seven years, a significant number of
technologies came out attempting to
solve these problems. New software
now includes speech to text features
or programs that can translate free text
progress notes into EMR reports [3, 4].
Nevertheless, there is little research to
corroborate the advantages of these
technologies, and some articles even
concluded that they make no difference at all. In order to successfully implement the EHR system throughout
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The Obama administration has fronted nearly 30

billion dollars 44,000 to 60,000 dollars per eligible
health provider to cover the costs of adopting
EMR systems through HITECH
health provider centers in America,
private and public support must be
provided to generate the proper applications.
The Obama administration has fronted nearly 30 billion dollars 44,000 to
60,000 dollars per eligible health provider to cover the costs of adopting
EMR systems through HITECH [4].
This has been a large step forward
for EMR infrastructure, increasing the
EMR use rate from 17% to 44% between
2008 and 2012 [5, 6]. The law requires
that all health providers implement an
EMR system by the year 2016 or face

penalties. Private investment has been
historically low in healthcare information technology, but with the demand
for electronic records and efficient
healthcare tools, this trend is likely to
shift [7]. Big data in healthcare is a tremendous gain for pharmaceutical companies, insurance companies, doctors,
and other intersecting industries. Companies can use large amounts of patient
information to model their products
and services more effectively. Clinical decision support tools are being
developed for doctors to guide their
REFERENCES
treatment practice based on large data

sets. Doctors also look forward to live
streaming of medical imaging such as
echocardiograms and other emergency care imaging that would save time,
money, and many lives. Given the endless possibilities of healthcare information technology at the moment, private
investment is sure to reach these areas
of the industry. When it does, we may
finally see the beginnings of quality,
accountable healthcare in the United
States.
EDITOR
Methma Udawatta
[1] Hersh W. The Electronic Medical Record: Promises and Problems.

J Am Soc Inf Sci. 1995 [cited 2013 Nov 20];46(10):772-776. Available
from: http://skynet.ohsu.edu/~hersh/jasis-95-emr.pdf
[7] The IBM Center for the Business of Government. Dr. Farzad Mostashari on
Nationwide Interoperability [Online video]. 2013 Sep 13 [cited 2013 Nov
20]. Available from: http://www.youtube.com/watch?v=Qxz04PQzVWk
[2] 2Makoul, G, Curry R, Tang P. The Use of Electronic Medical Records. J Am

Med Inform Assoc. 2001 [cited 2013 Nov 20];8(6):610-615. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130071/#__ffn_sectitle
[8] Blumer T. Politicos Purdum: Obama Had to Lie to Pass ACA because
the Public Couldnt Handle Unpleasant Truths. 2013 Nov 17 [cited
2013 Nov 20]. In: Blumer T. NewsBusters [Internet]. Available from:
http://newsbusters.org/blogs/tom-blumer/2013/11/17/politicos-purdumobama-had-lie-pass-aca-because-public-couldnt-handle-un
[3] Johnson S, Bakken, S, Dine D, Sookyung H, Mendonca E, Morrision

F, Bright T, Vleck T, Wrenn J, Stetson P. An Electronic Health Record
Based on Structured Narrative. J am Med Inform Assoc. 2008 [cited
2013 Nov 20];15:54-64. Doi: 10.1197/jamia.M2131
[4] Shea S, Hripcsak G. Accelerating the Use of Electronic Health Records
in Physician Practices. N Engl J Med. 2010 Jan 21 [cited 2013 Nov
20];362:192-195. Doi: 10.1056/NEJMp0919140
[5] Lohr S. The Miracle of Digital Health Records, 50 Years Ago. 2012 17
Feb [cite 2013 Nov 20]. In: Loh S. The New York Times: Bits [Internet].
Available from: http://bits.blogs.nytimes.com/2012/02/17/the-miracleof-digital-health-records-50-years-ago/?_r=2
[6] Hospitals, Physicians Make Major Strides in Electronic Health Record
Adoption [Internet]. Robert Wood Johnson Foundation. 2013 July 8.
[cited 2013 Nov 20]. Available from: http://www.rwjf.org/en/about-rwjf/
newsroom/newsroom-content/2013/07/hospitals--physicians-makemajor-strides-in-electronic-health-re.html
[9] Levins, H. Video Excerpt: Farzad Mostasharis Talk at LDI Health Policy
Seminar [Internet video]. 2013 Sep 15 [cited 2013 Nov 20]. Available
from: http://ldi.upenn.edu/about/news/2013/09/14/video-excerpt-farzad-mostashari-s-talk-at-ldi-health-policy-seminar
[10] Centers for Medicare & Medicaid Services. Stage 2 [Internet]. [Updated
2013 Nov 07; cited 2013 Nov 20]. Available from: http://www.cms.
gov/ Regulations-and-Guidance/Legislation/EHRIncentivePrograms/
Stage_2.html
[11] Kmiecik T, Sanders D. Integration of Genetic and Familial Data into
Electronic Medical Records and Healthcare Processes. Northwestern
University. 2009 Feb 02 [cited 2013 Nov 20]. Available from: http://
www.surgery.northwestern.edu/ docs/KmiecikSandersArticle.pdf
[12] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428816/
soon ill be a very old man and very old men dream of summer
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Beyond
The Consent Form:
WHAT WE SHOULDNT MISS FROM

THE SUPPORT CONTROVERSY
SOPHIA (SEON YEONG) PARK 14
The letter filed by the Federal Office for Human Research Protections (OHRP) against the
Surfactant, Positive Pressure, and Oxygenation
Randomized Trial (SUPPORT) presented in
March 2013 has been the most contentious issue in the neonatal research community in 2013
[1]. Yet, the case somewhat passively closed
when OHRP withdrew its proposed sanction
in June of the same year [2, 3]. OHRP initially
accused the SUPPORT investigators and affiliated institutions for their failure to fully inform
the studys risk to parents of enrolled subjects
during the consent process, but with its pullback, charges against the SUPPORT researchers and ethics committees that approved the
consent form were lifted and no further action
30
were to be taken for the time being. However,

even though OHRP withdrew, a controversy
remained unresolved. Rather, continued disputes in the bioethics community exposed key
limitations of the current system that must
not be silenced or overlooked, such as a need
for reassessment International Review Board
(IRB) standard with consideration of possible
conflicts of interest (COI) and establishment of
standardized verbal consent process that can
ensure a thorough communication between investigators and patients.
The SUPPORT was a nation-wide NIH-funded
randomized clinical trial conducted from 2005
to 2009 at twenty-three U.S. hospitals, enrolling
Park.indd 30
3/20/2015 4:41:28 PM
of 1314 premature babies [4]. The study

aimed to determine an optimal level of
oxygen treatment for premature infants. In their preterm, infants do not
have a fully-developed respiratory system and requires an external oxygen
supply. While oxygen supply may help
infants continue to develop, high level
of oxygen may lead to excess growth
of retinal blood vessel and cause blindness, a symptom known as retinopathy
of prematurity (ROP). In order to find
an optimal oxygen concentration that
can minimize predicted eye damage
and maximize survival rate, the study
randomly assigned enrolled infants
into one of the two treatment groups
of higher oxygen level (91-95%) and
lower oxygen level (85-89%), both level ranging within the standard of care
(85-95%) [4].
gen treatments were unknown, and

that was precisely what the SUPPORT
study aimed to illuminate. At the current stage, doctors at Neonatal Intensive Care Units (NICU) are prescribing
the treatment based on the uncertainty.
The SUPPORT study intended to improve such limitation in current understanding and to establish a reliable,
evidence-based clinical treatment. The
result of the study was clearly fruitful,
and will help improve the quality of
medical care and save many premature babies lives at NICU in the future.
However, at the time when the study
was being implemented, the researchers and physicians understanding of
the outcomes of either range of oxygen
supply was limited, and therefore, it
had been impossible to warn patients
about the risk.
OHRP letter criticized the SUPPORT

study consent form for failing to fully
identify potential risk involved in the
research. According to the OHRP investigation, majority of the SUPPROT
study consent forms did not note that
the higher oxygen group had a greater
chance to develop ROP and lower level
involved higher mortality. Death was
not mentioned as a risk in any of the
forms, although it was perceived as a
possible outcome by many investigators. Instead, the forms assured that
there is no predictable increase in
risk expected by the enrollment of the
study [1].
In response, con-SUPPORT bioethicists

Alice Dreger, a bioethics professor at
the Northwestern University, pointed
out that considering that the aim of
clinical treatment was not to cure, but to
find the difference between two groups
[6]. At least, the hypothesis was expecting that one group would receive more
damage compared to the other group.
If one group were anticipated to be less
benefited, the possible side effect must
have been addressed. The side effects
that an inadequate oxygen treatment
would generate, such as ROP, higher
mortality and neurodevelopmental impairments, were known at the beginning of the study, but were not mentioned in the consent forms. However,
these side effects should have been
stated, as it is logically predictable that
a less benefited group would be affected by those.
SUPPORT researchers and NIH officials defended against the OHRP letter,
asserting that: (1) the associated risk,
such as higher possibility of ROP for
higher oxygen group and higher mortality for lower oxygen group, was not
known at the beginning of the study,
and (2) the risk involved in the study is
also risk perceived by standard of care,
and there was no additional risk of
the research treatment [5].
The first main point of the defense
is that, in the beginning of the study,
consequences of either range of oxy-
Also, SUPPORT critics claim that by

assigning premature infants into either
of the treatment groups, investigators
were limiting what those babies may
receive, and therefore it does involve
an additional risk [7, 8]. If the babies
had not been enrolled in the study,
they would have been treated with
physicians discretion depending on
their condition, receiving an oxygen

supply ranging anywhere in 85-95%.
However, if they are enrolled in the
study, their treatment is more strictly
restricted into either higher or lower
range, and their individual conditions
would not be considered to adjust the
treatment level. Yet, it should be also
considered that there remains a room
for dispute regarding whether physicians discretion would necessarily be
beneficial, as those would be a guessbased treatments in essence, not an evidence-based ones fully confirmed by
RCT.
The second defense point put forth is
that the consent forms do not contain
any flaw, as both higher and lower oxygen treatment groups correspond to
the oxygen supply range approved in
the current standard of care, and any
side effects expected by the study treatment may also be resulted by the very
process of the standard of care. David
Magnus, a bioethicist at Stanford University, argued that such side effects
can be defined as a minimal risk,
and it is not unethical that the consent
forms did not fully specify each of the
risks [9].
On the other hand, con-SUPPORT bioethicists take a different stance regarding the minimal risks [1]. They argue
that risks such as death and blindness
would be too severe to be simply unacknowledged. By not addressing
such risks, investigators would not be
fully informing patients of the risk as
comprehensively as they claim. While
explanation provided by SUPPORT
defenders is logical, there is a room for
disagreement about whether serious
illnesses such as blindness and death
could be allowed to be unmentioned to
the parents of enrolled infants.
The repeated rounds of criticism between SUPPORT critics and defenders
have clearly revealed conflicting perspectives of each side. Each side put
forth its own interpretation and logics with conflicts of interests (COI). In
PHOTOS
Kaley Brauer 17
Special thanks to Mark Brauer
Park.indd 31
31
3/20/2015 4:41:28 PM
August 2013, HHS public hearing was

organized with an aim to address unresolved doubt and to provide opportunity to communicate difference between
two sides, and both side had chance to
explicate themselves [10]. However, it
hardly seemed they reached a negotiation point, with many of arguments
being elaborate reiterations of above
points. This undue tension created by
continued disputes is to be resolved,
and the focus should be on how to supplement the drawbacks of the current
system exposed by this controversy, as
trying to define whether and who to
penalize would only result in further
polarization of the bioethical community.
The first point to consider is a possible
need for verbal communication or education process stipulation. During the
HHS public hearing, Sharissa Cook, a
mother of one enrolled infant, stated
that she was not fully informed about
the study when she gave her consent
[10]. Had I known the full extent of
the study, I would not have given my
consent, Cook recalled. She added
that the investigators compensated
her ability to make an informed decision by being not forthcoming with
the information, and argued that the
information should be presented so
that a person of any education level
can understand. She also criticized that
the title gave a false impression, stating
32
that the name of the study, SUPPORT,

is an inducement to participate.
While it is unlikely that the SUPPORT
investigator intentionally misguided
parents of infants, Cooks experience
highlights potential communication
error during the consent process resulting in consenters misunderstanding, which could imply a fundamental
problem of the current consent process. Numerous studies had already
frequently addressed limitation in the
consent procedure [11, 12, 13]. Oftentimes, patients have a poor retention of
information that they received during
the consent procedure [11]. It is also
a probable that the patients are intimidated by a long list of protocol and
simply rely on experts description,
and signing the consent form as a
matter of ticking boxes [13].
The reason for this would be far from
individual investigators moral failure.
With the time and resource constraints
faced, the consent process at the current stage is inevitably liable to human
error.
As the complex protocol is passed
down, verbal education during the
consent process could be abridged at
individual investigators discretion,
while brochures written in professional languages are incomprehensible to
laypeople. It would be unreasonable
and impossible to seek consent for
every detail, but bias that could be introduced when choosing details to actually tell during the limited time may
introduce conflicts.
In order to prevent possible miscommunication during the consent process, the ways to effectively inform
patients from varied background
should be accommodated. A research
by Shukla et al (2012) found out that
a visual aid (DVD) and lower reading
grade level brochure helped greatly
to patients understanding, so such
could be recommended to be prepared
at the beginning of the study [12]. To
accommodate patients with different
levels of interests, materials of varying
degrees of specificity could also be prepared. Dr. Onora ONeill, a professor
at Newnham College, UK, suggested
that amount and level of information
given to be dictated by patients, not
physician. It would help reduce misunderstandings if the consent forms are
examined by a group of non-medical
professions before getting approved.
Evidently, such solutions will involve
more spending, and could be compromised when considered realistically.
Cost-benefit consideration needs to be
weighed in. However, if applied appropriately, constructing guideline on
materials and building available information bank would serve as an effective means of communication to build
Park.indd 32
3/20/2015 4:41:29 PM
trust between patients and researchers.

Second, IRB standard may need to be
reestablished. The concern of many
SUPPORT critics was that none of the
23 institutions raised questions to this
controversial, if not flawed, consent
form. This also takes us back to the
criticisms that have been previously addressed: the current IRB policies
and procedures are somewhat lax and
allows a room for biases. According to
the study by Vogeli et al., in an anonymous survey of 296 IRB chairs, onethird responded that their policy did
not require voting members to disclose
industry relationship, and one-fourth
answered that they did not defined a
course of action in case IRB member
with COI is acknowledged [14]. Although the possible COI has seldom
been covered in the SUPPORT discussion, it is obvious that it could have
been present at both institutional and

individual levels. In order to improve
the clarity of voting process and promote self-awareness among IRB members, clearer guideline for COI standard in IRB should be accommodated.
While repeated claim and dispute may
oblige temporal delay and additional
spending, protecting the rights of study
subjects should always be a prior issue.
Drawbacks exposed by the SUPPORT
dispute should not be overlooked or
silenced, as it will clearly bear a larger
implication in both medical research
and bioethics community. Considering
this is a nation-wide study supported
by a national agency with major media
attention, it will serve as an important
precedent and may affect numerous
other smaller-scaled research studies.
The obvious flaws of the consent process exposed at the current state must
REFERENCES
[1] Public Citizen. The Surfactant, Positive Pressure, and Oxygenation
Randomized Trial (SUPPORT) Analysis of the Complete Protocol and
Complete Consent Form [Internet]. 2013 [cited Dec 18 2013]. Available
from: http://www.citizen.org/documents/2124.pdf
[2] Public Citizen. Human Research Protections under Federalwide Assurance (FW A) 5960 [Internet]. June 4 2013 [cited Dec 29 2013]. Available
from: http://www.citizen.org/documents/2111_ohrp_retraction_support_4_2013.pdf
[3] U.S. Patient Protection Agency Drops Plan to Sanction Leaders of
Infant Study [Internet]. Science Mag. June 6 2013 [Cited Dec 28 2013].
Available from: http://news.sciencemag.org/people-events/2013/06/u.s.patient-protection-agency-drops-plan-sanction-leaders-infant-study
[4] SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal
Research Network. Target Ranges of Oxygen Saturation in Extremely
Preterm Infants [Internet]. NEMJ. Available from: http://www.nejm.
org/doi/full/10.1056/NEJMoa0911781
[5] Drazen JM, Solomon CG, Greene MF. Informed Consent and Support
[Internet]. NEJM. May 16 2013 [cited Dec 30 2013]. Available from:
http://www.nejm.org/doi/full/10.1056/NEJMe1304996
[6] Dreger AD. FAQ on the SUPPORT study controversy [Internet]. [cited
Dec 29 2013]. Availabel from: http://www.alicedreger.com/support.html
[7] Subject to question [Internet]. Nature. 21 August 2013 [cited Dec 27
2013]. Available from: http://www.nature.com/news/subject-to-question-1.13573
be addressed to identify the cause and

to productively discuss possible preventions.
It is hopeful that Kathy Hudson, the
deputy director of NIH who initially
fully endorsed the NIH-funded SUPPORT study, offered to award grant
supplements to investigate this case
[10]. With NIH support, it would be
possible to reexamine and evaluate
strengths and weaknesses of current
system and research process. Although
the specifics of NIH inspection is not
yet determined, the grants should aim
to create a productive outcome, such as
readjusting IRB regulation standard,
clarifying COI standard, and creating
a realistic verbal consent process specification if necessary. At the very least,
the focus should be on diagnosing systemic flaws, not emphasizing on individual moral defects or punishment.
EDITOR
Russell Shelp
[8] Hoffman J. Watchdog Halts Action on Researchers [internet]. June 5 2013
[Cited Dec 28 2013]. Available from: http://www.nytimes.com/2013/06/06/
health/watchdog-halts-action-on-researchers.html?_r=0
[9] Magnus D, Caplan AL. Risk, Consent and SUPPORT [Internet]. NEJM.
May 16 2013 [cited Dec 29 2013]. Available from: http://www.nejm.
org/doi/full/10.1056/NEJMp1305086
[10] United States Department of Health and Human Services. Matters
Related to Protection of Human Subjects and Research Considering
Standard of Care Interventions [Internet]. 2013 [cited Jan 2 2014].
Available from: http://www.hhs.gov/ohrp/newsroom/rfc/Public%20
Meeting%20August%2028%202013/supportmeetingtranscriptfinal.pdf
[11] Sahin N, Oztrk A, Ozkan Y, Demirhan Erdemir A. What do patients
recall from informed consent given before orthopedic surgery? Acta
Orthop Traumatol Turc. 2010;44(6):469-75.
[12] Shukla AN, Daly MK, Legutko P. Informed consent for cataract surgery:
patient understanding of verbal, written, and videotaped information.
J Cataract Refract Surg. 2012 Jan;38(1):80-4.
[13] ONeill O. Some limits of informed consent. J Med Ethics. 2003
Feb;29(1):4-7.
[14] Vogeli C, Koski G, Campbell EG. Policies and management of conflicts
of interest within medical research institutional review boards: results
of a national study. Acad Med. 2009 Apr;84(4):488-94.
Park.indd 33
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3/20/2015 4:41:33 PM
ARTWORK
Kaley Brauer 17
Mary OConnor 16
34
McCarthy.indd 34
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A NEW AGE OF
DECEPTION:
How Technology is Changing the Face of Lying
SHANNON MCCARTHY 15.5
Our words used to vanish. Before Blackberry

and Facebook, social interactions floated away
nearly as fast as they appeared, leaving only
a memory. As Cornell researcher Jeff Hancock explained in his TED talk, The Future
of Lying, humans have evolved to interact
without a record because there never was one
[1]. However, relatively new text based technology, including text, instant message, and
Twitter now put our daily interactions into
writing, into a record. Our conversations stack
neatly in email inboxes and Facebook feeds,
ready to be searched and verified at any time.
Technologys record of our conversations is just one of the many ways

technology is changing the way we
interact and subsequently the way
we lie. Technology has changed
every corner of our interactions,
from finding a date to finding a job,
from emailing a college to texting a
friend. Subsequently, the medium
and dynamics of our interactions
have altered, so our lies must also
change.
McCarthy.indd 35
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MAINTAINING FRIENDSHIPS
Technology has changed the way
friends interact. Text messaging, phone
calls, Facebook, Snapchat and a host of
other technological innovations make
us constantly accessible to our friends
[2]. We can be contacted almost anytime and anywhere. Therefore, in order to maintain our friendships, while
maintaining a shred of privacy, people
have started using what is now termed
the butler lie [2].
Butler lies are lies meant to preserve
the relationship with a friend that initiated unwanted social interaction by
calling at a horribly inconvenient time
[2]. Butler lies are employed to avoid a
new conversation, smoothly end an existing conversation or belatedly explain
an instance of bad communication [2].
For instance, a Facebook chat conversation with a good friend is dragging
on and you are unbelievably bored.
You do not want to offend your good
friend, so you may say Oh, sorry, Ive
got to go, the boss is coming. This lie
gracefully ends an unwanted conversation without damaging the friendship.
Therefore, these lies act as technological butlers, buffering us from the outside world, just like the servants for
whom they were named [2].
avoid conversation, while preserving a

friendship [2]. Therefore, the butler lie
grants us an excuse for inaccessibility,
while maintaining our friendships [2].
Further, butler lie have arisen from our

constant accessibility and are enabled
by the ambiguity of technology [2]. Using bad cell reception or a dead phone
battery as an excuse for not answering
someone only works when there is ambiguity in the interaction [2]. That is,
using the I left my phone at home excuse would not work if the other person knew that their text message had
been opened.
Given this positive function of the butler lie, Hancock advises against ambiguity reducing features of technology,
such as the Facebook seen by feature
or the blanket availability status in
most instant messaging interfaces [2].
Hancock instead proposes features that
would better facilitate selectively ending conversations, such as an IM availability status that can be personalized
for different people online, a feature
that has actually been implemented by
Facebook after the release of Hancocks
paper [2].
While deception usually triggers a host

of negative emotions, Jeff Hancock, the
researcher who coined the term butler lie, actually claims that these lies
can be a positive force [2]. He reasons
that technology within our friendly social interactions, is meant to foster relationships [2]. Butler lies work toward
this same goal [2]. Most people only
lie with motive, and the motive of the
butler lie is to gracefully and delicately
Ultimately, the Butler lie can be considered a positive form of lying. While
its never particularly good to lie, the
Butler lie protects both our friendships
and our privacy. Therefore, while technology may be spurring us to lie, these
lies are not necessarily bad.
GETTING A JOB
Aside from managing friendships,
technology has transformed other ordinary activities, including getting a job.
Job-hunting has moved to the internet
with websites like CareerBuilder, Monster, and LinkedIn, a social networking
site for professionals, largely replacing
the traditional paper and ink resumes
of ten years ago. Just like technology
changed the way we lie to friends, so
has it changed the way we lie while
job-hunting.
The motivation for lying while
job-hunting, whether in paper or online, is the same; applicants want to appear as qualified as possible, but also
need to present themselves as honest,
since nobody wants to hire a liar [3].
The primary difference between tradi36
tional resumes and online resumes is

the number of people that can access
them [3]. Almost anyone with internet access can view a public LinkedIn
profile, while only select people chosen
by the applicant get to see a traditional printed resume [3]. More potential
viewers means a higher possibility of
being caught in a verifiable lie, such
as exaggerating responsibilities from a
previous job [3]. This increased chance
of being caught decreases the motivation to tell verifiable lies [3].
As a result, LinkedIn resumes are more
truthful in areas important to employers, including prior work responsibilities, but contain more lies concerning
other, non-verifiable aspects of the application, such as the applicants hob-
bies outside of work [3]. Conversely,

traditional resumes had more deception related to their responsibilities,
but less deception in their interests [3].
For example, an applicant with a public LinkedIn profile may not list extra
responsibilities under her previous
employment section, but may say she
reads the New York Times every morning instead of the reality in which she
rolls out of bed with just enough time
to get to work. Conversely, a traditional
applicant is more likely to lie about his
previous jobs, which fulfills his need to
self-enhance and makes him less likely
to embellish his hobbies.
Both these lies make the resume more
appealing and account for the chance
of being caught in a lie [3]. Thus, the
McCarthy.indd 36
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public aspect of LinkedIn profiles, enabled by technology, alters the type,

but not necessarily the frequency of
lies [3].
This finding can be considered a victory for technology. By increasing the
exposure of our resumes, LinkedIn has

effectively decreased the amount of deception in areas that are more important to employers, making applicants
more honest where it counts. Presumably, if applicants are more honest in
their applications in the areas that mat-
ter, then the more qualified applicants

will get the jobs they deserve instead of
being beaten by applicants who edged
them out with exaggerations. Subsequently, while technology has changed
the way we lie to our employers, this
change may very well be for the better.
by of an independent judge and finally

an accuracy score given by a person
trained to code for accuracy [4]. This
study suggested that women lie more
than men with their profile pictures
[4]. They further demonstrated that
womens profile pictures often misrepresent them by showing pictures
of themselves with significantly better
hair or skin tone or even older pictures
in which they look noticeably younger
[4]. Like with text, misrepresentation
seems to be frequent. However, photo

misrepresentation differs in that it is
not particularly subtle [4].
GETTING A DATE
Technology has also changed the way
people meet and date, as is evident
in the long and dizzying list of online
dating sites available. By changing the
medium of meeting romantic partners,
technology has also affected the way
we lie in dating.
Prospective daters face the same challenge as online job applicants. They
want to enhance themselves and appear attractive, yet they also want to
appear authentic and honest [4]. Balancing these two motives affects their
lying [4]. Unsurprisingly, recent studies have found that online daters lie in
both the text and photos of their profiles [4, 5]. Two studies have recently
been released on online dating lies.
Further, these more overt photograph

lies activate a process called equivocation that relieves the internal tension
between self-enhancement and authenticity in photographs that usually prevents people from lying [4]. For example, when a women posts a picture of
herself in which she looks better than
The first study focused on the accuracy of the text portion of profiles [5].
In this study, researchers had online
daters rank how accurate their profiles
were, and then the researchers collected physical measurements to verify the
profiles [4, 5]. The study demonstrated
that lying in the text portion of profiles
is frequent, but subtle [4, 5]. Therefore,
while a 510 accountant may not have
claim to be an astronaut, he may have
say that he is 6 feet tall. Therefore, daters balance their lies in text by making
them frequently, but subtly, so as to increase attractiveness without deterring
from authenticity [4, 5].
In the second study, a team of researchers, led by Jeffery Hancock and Catalina Toma focused on lies within profile
pictures. They ranked the accuracy of a
small pool of online dating profile pictures using first a self-reported accuracy, second an accuracy ranking given
McCarthy.indd 37
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she normally does, she doesnt necessarily feel that she is being unauthentic
because she is able to justify the picture
as real in the sense that the picture may
look like her on a special occasion [4].
Equivocation, therefore, reduces the
bad feeling of lying because the liar is
able to convince herself that her wildly inaccurate picture looks like herself
sometimes. This in turn makes it easier
for her to misrepresent herself in her
profile picture [4].
Overall, lies were found to be frequent
in both text and pictures, which suggests at least some preference for
self-enhancement at the
risk of losing authenticity [4, 6]. This trend
aligns with the
hyperpersonal
models
concept of selective
self-presentation [5, 6]. This
hyperpersonal
model, originally
proposed by Joseph Walter
in 1996 outlines that
online interactions
encourage
selective
self-presentation,
or the favorable presentation of
yourself, because the medium is slow

and highly editable [5, 6]. However,
the hyperpersonal model also suggests that the communication through
technology also discourages selective
self-presentation because lying could
jeopardize future face-to-face interactions [5, 6]. By applying this model to
online dating, daters are encouraged
to deceive in their profiles to enhance
their self-presentation to get a date, but
are tempered by the reality that their
lies could negatively impact the relationships they are starting [5]. Selective self-presentation, the careful and
strategic presentation of oneself, exists
in online dating within both textual interactions and profile pictures perhaps
because the highly editable nature of
online dating sites compared to meeting people through other means [4].
While technology did not create selective self-presentation, it has provided
a greater opportunity to give into the
impulse to self-embellish [6]. Within
dating, the need to present oneself as
attractive, yet honest may always have
been there, and online interactions
have only made the urge to submit to
selective self-presentation greater by
making it easier to do. Within dating,
this new deceit has the potential to be
disastrous because there are no positive ramifications as with online applications and the Butler Lie. Further,
finding a romantic partner is significantly more important than finding a
job, which makes these misrepresentations all the more dangerous. It is one
thing when a lie lands you a bad job, it
REFERENCES
[1] Jeff Hancock: 3 types of (digital) lies.
TEDTalks. Youtube Video. http://www.
youtube.com/watch?v=nn5k4snG3rA
[2] Hancock J, Birnholtz J, Bazarova N,
Guillory J, Perlin J, Amos B. Butler Lies:
Awareness, Deception and Design. CHI
2009;517-526.
is an entirely different matter when a

lies lands you a bad spouse.
Technology has shaped the way we deceive one another in both a positive and
a negative way. We now use butler lies
to preserve friendships and our privacy. We are honest about our responsibilities and a little more deceitful about
our interests to appear more qualified
to potential employers, which is a positive shift in our lying habits. Finally,
we lie to possible romantic partners
both in text and in our photographs to
present ourselves in the best possible
light, a change that seems dangerous
and frightening. Further, the striking
aspect of these changes imposed by
technology is that our motives have remained stable.
Before computers, tablets and blackberries, people still wanted to keep friends,
get a job and meet their dream guy or
girl. Technology has only changed the
rules of the game. It has made us nearly constantly accessible to our friends,
which requires mild deception to preserve both our friendships and our privacy. It has threatened our old, more
vulnerable lies about responsibilities
in traditional resumes and forced us to
selectively self-present in more unverifiable ways. And it has slowed down
dating initiations from actual conversations to virtual profiles, which gives
daters more opportunity to manipulate
how they present themselves. In the
end, we still strive for the friends, the
jobs, and the dates, and only the course
has changed.
EDITOR
Hank Baker
[3] Guillory J, Hancock JT. The Effect of Linkedin on Deception in Resumes.
CyberPsychology, Behavior and Social Networking 2012; 15 (3); 135-140.
[4] Hancock JT, Toma CL. Putting Your Best Face Forward: The Accuracy
of Online Dating Photographs. Journal of Communication 2009; 59;
367-386.
[5] Toma CL, Hancock JT, Ellison NB. Separating Fact from Fiction: An
Examination of Deceptive Self-Presentation in Online Dating Profiles.
Personality and Social Psychology Bulletin 2008; 34 (?); 1023-1036.
[6] Walther JB. Computer-mediated communication: Impersonal, interpersonal and hyperpersonal interaction. Communication Research
1996; 23; 3-44.
38
McCarthy.indd 38
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Eq4.indd 2
3/20/2015 5:21:59 PM
Natural
Worm Control
THE POTENTIAL USE OF MEDICINAL PLANTS IN SYSTEMS

FOR THE CONTROL OF WORMS IN RUMINANTS
MIRANDA NORLIN 17
WHATS WRONG WITH CURRENT SOLUTIONS?

The infestation of livestock with intestinal parasites is a leading cause of poor productivity and
economic loss worldwide [1, 2, 3]. Whether
production is limited by death of the
animal, loss of weight, or decreased
production of milk or fiber, these
worms are bad for the animal and
for the farmer who needs to profit from it. The predominant method of
control and elimination of these parasites is the
administration of chemical formulas, or anthelmintics, which kill the parasites and leave the host, at least
in theory, free of worms. The exclusive use of these
40
drugs is, however, rapidly becoming ineffective

and unsustainable and so worms are a growing problem, especially for farmers raising
sheep, goats, and other small ruminants
in the developing world. Cost, availability, and environmental impact
are three issues that make continued
use of conventional anthelmintics untenable.
These drugs are already prohibitively expensive for
most farmers in developing nations. To compound this,
most modern formulas are oil-derived compounds. As
oil-reserves are depleted world-wide, the availability of
oil-derived compounds is bound to decrease and their
Norlin.indd 40
3/20/2015 4:51:21 PM
price to go up [4]. Even today it is very

difficult for many small-scale, rural
farmers to obtain conventional chemical anthelmintics. In Pakistan, for instance, many farmers cannot afford
these drugs or are sold substances that
have been diluted to a subtherapeutic
(ineffective) level [5]. Because the price
of proper treatment is often greater
than the animals worth, farmers will
often dilute the drug or not complete
the full course of treatment [5, 6, 7]. Not
only is this course of action ineffective
in the short term, but it also aggravates

the issue of the worms growing resistance to these drugs.
The rapidly decreasing efficacy of anthelmintics is approaching a point of
crisis. Resistance, the decreased response in a parasite population to a
drug that is normally effective, cannot
be reversed [8], and is inherited [2].
Many scientists are focusing on finding
replacements for now ineffective drugs
and strategies to avoid the evolution of
resistant worms in the first place. Although it is possible to reduce the rate
at which worms become resistant, the
efficacy of the drugs currently used will
only continue to decrease. In the face
of synthetic anthelmintics rising cost,
environmental impact, and declining
ability to control worms, researchers,
veterinarians and farmers are investing
more effort in determining the potential of medicinal plants to help control
these parasites [ 3, 6, 7, 9].
WHY MEDICINAL PLANTS?

Medicinal plants have been used in traditional medicine around the world for
centuries, but only recently has there
been significant interest in their scientific validation. As synthetic dewormers become less effective and organic
and sustainable farming practices become more popular, the identification
of medicinal plants that are effective
anthelmintics is increasingly important [10]. Medicinal plants make more
environmentally friendly drugs than
the petrochemicals that are commonly used, and sustainable growth, harvesting, and processing of such plants
could provide a cheap and local source
of medication. The use of some plants,
like the legume Lespedeza cuneata, is
made even simpler because it has been
found to be effective when provided as
forage or dried in hay [11, 12, 13]. Some
challenges, however, remain: most
plants are not available year round;
some of the formulations traditionally
used are difficult to prepare; there are

gaps in our knowledge about their efficacy, safety margins, and side effects;
and standardization is often very difficult to achieve [5]. Yet their study is
worthwhile. Much of the hesitation to
use medicinal plants stems more from
the current lack of knowledge [7] than
from doubts about their intrinsic therapeutic worth. By establishing what
plants are valid treatments, how they
are best administered, in what doses
they should be used, and what potential side-effects or toxicity may be associated with them, researchers would
provide a usable therapeutic tool that
can be incorporated with conventional
dewormers, pasture rotation protocols,
antiparasitic vaccines and proper nutrition to create comprehensive parasite managements systems [6, 7, 8].
IDENTIFYING AND VALIDATING

MEDICINAL PLANTS
The preliminary step to any research is,
of course, to identify plants of interest.
Fortunately centuries of trial and error
have established, in the form of traditional botanical knowledge, a body of
information that can guide researchers
towards species that contain anthelmintic active compounds. Surveys and
conversations with indigenous tribes
and old timers can furnish research-
ers with a starting group

of plants that can be narrowed by comparison to
previously tested plants
before research is carried
out. The results of such
surveys and screening
can be applied broadly,
but it is important, when
assessing the worth of
FAMACHA ANAEMIA GUIDE

This guide indicates how to identify ruminants that have been infested with Haemonchus contortus, a parasite that mainly
affects their hosts by sucking blood and
causing anemia and other blood loss related
symptoms. By looking at the ocular mucus
membranes of the animals, infection can be
easily identified.
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medicinal plants as a long-term solution, that such evaluation is made on a

more local basis. Medicinal plants will
be cheaper and more sustainable than
petrochemicals, but only if the plants
can be grown relatively locally and
are a hardy species. One study in the
Netherlands, for example, investigated the anthelmintic action of a papaya
seed extract. The results were limited
but even had the extract been effective
it couldnt have been a viable solution
for Dutch farmers as the price of import would be prohibitive [4]. Rather,
efforts should have been focused on
searching for a plant that grows, or can
easily be grown, locally.
A good illustration of such a search
might be found in a case study of my
familys property in the mountains of
Western North Carolina. Several years
ago I chopped down a large number
of Ailanthus Altissima in an attempt
to clear part of a pasture for hay. This
is a fast-growing, tree with a pungent
smell that is invasive in WNC [14]. A
strong smell indicates that a plant has
a high concentration of aromatic secondary compounds, chemicals which
frequently possess insecticidal or medicinal qualities, so I looked it up again
when searching for plants that might
have anthelmintic compounds [3]. A.
altissima is indeed commonly stripped
of its bark, along with others in the

genus Ailanthus, for use as an anthelmintic in Indian traditional medicine
[15, 16]. The potential of plants that are
already invasive in an area should be
especially noted as their use for medicine would turn a liability into an asset.
Once a plant has been identified, research, on worms in an incubated dish
or (in vitro), should be done to cheaply
and efficiently screen for anthelmintic
activity [1], or, in cases like this where
such activity has already been documented, to investigate the best way to
administer the secondary compounds
and most effectively extract them. The
best method will depend on the relative bioavailability, compound stability, safety, and cost of production of
each method of administration [17].
In some cases, this method may be involve less processing if directly feeding
the plant in question is medicinally effective. Research on worm infested livestock (in vivo) should be carried out to
determine whether feeding whole plant
parts controls worms and to determine
the appropriate dose, dosing protocol,
and safety margins of the treatment in
whatever species of animals are of interest. Ailanthus excelsa, a close relative of A. altissima, is listed in a review
of potential antifertility agents [18], so
special attention should be paid to the
safety, or rather, risks, associated with

A. altissimas use in breeding stock.
Plants that show anthelmintic potential
should also be compared to others in
the same area that might be effective.
Ailanthus shows good potential as an
option for anthelmintic treatment in
North Carolina and some other states.
Elsewhere however there might be
other equally or more viable options.
In Texas, for instance, Melia azedarach
is also classified as invasive [19]. This
plant is also originally indigenous to
India and studies have found that its
leaves and seeds contain anthelmintic
compounds [19, 20, 12]. Where anthelmintic compounds are most concentrated in the two plants is significant.
In places where both plants are invasive, M. azedarach would be the better choice as leaves and seeds can be
more sustainably harvested than bark,
whose careless or frequent harvesting
can result in the death of the tree [7].
Although in the case of invasive plants
this issue is less significant, (farmers
might, in fact, be eager to reduce the
population of the invasive species) the
location of secondary compounds is
important, especially if the plant concerned is slow growing, as it is unwise
to wipe out the plant from which one is
obtaining medicine.
PLANT PREPARATION AND COMPOUND EXTRACTION

Methods of plant preparation to obtain
a usable medication vary in ease, costliness and effectiveness and are also relevant to our choice of plant [7]. Some
secondary compounds may need to be
extracted and administered dissolved
in a solvent. The active secondary compounds in M. azedarach offer a good
example of the variance in how different solvents work to extract them and
facilitate their action. Maciel et. al. tested extracts of M. azedarach leaves and
seeds using hexane and ethanol, and
chloroform and ethanol respectively.
For both leaves and seeds the LC50,
or concentration necessary to kill half
of the worm population treated, of the
42
ethanol extracts was significantly lower in almost

all cases than the LC50 of
the hexane and chloroform
extracts [19]. For this case,
and for these secondary
compounds, ethanol is the
better solvent. A study by
Eguale et. al. investigating
the potential anthelmintic activity of Coriandrum sativum
offers an explanation of the varying
effectiveness that might be applicable. When testing C. sativums effect
against adult larvae in vitro they found
that the hydro-alcoholic extract was
more effective than the aqueous one.
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Most anthelmintics work against adult

parasites by being absorbed through
their skin so they offer as a possible explanation the fact that hydro-alcoholic
substances are absorbed more readily
[22]. The solvent that is used to extract
secondary compounds affects the price
of producing medicine from a plant
and the ease with which extraction of
secondary compounds can be carried
out determines whether they might be
processed locally with simple equipment [6]. A plant whose compounds
can be extracted using water and a pot
would obviously be a cheaper alternative than one whose compounds are
only soluble in some other substance
that would need to be manufactured.
One of the benefits of using plant extracts is that it is significantly easier to
determine and control the dose administered. A purified extract of only the
active secondary compound[s] would
allow even more precise dosing but
in many cases the precise active compound has not been identified or the
plant contains multiple chemicals that
work together to efficiently kill parasites.

In these cases we cannot make a purified extract and so a crude infusion
of the plant would be the next easiest
to standardize. Using non-purified
compounds raises its own issues as
research must be done to determine
how different growth conditions affect
the plants concentration of secondary
compounds [10]. In several studies of
Albizia anthelmintica researchers have
found that the plants anthelmintic activity varies greatly depending on how
the treatment is prepared and where
the plants are from. Arid areas seemed
to be associated with more concentrated secondary compounds and thus
more pronounced medicinal action [7].
The least controllable, but at times
quite effective, way to administer compounds is by allowing stock free access
to an anthelmintic plant. Cichorium
intybus, Lespedeza cuneata, and Lotus
corniculatus have all been found to affect worm load in animals grazing free-
ly on them [11, 12, 13, 23]. All of these

plants are high in condensed tannins,
compounds whose anthelmintic properties are widely accepted. How they
act, however, is still unclear. Studies
seem to indicate that it is a combination
of direct action [8, 11] against nematodes and their ability to protect protein
by binding to it in the rumen [the initial
digestive chamber of 4-stomached
ruminants] and releasing it later in the
digestive process where it is absorbed
[8, 11, 24, 25]. A positive correlation
exists between supplemental protein
and increased immune reaction against
worms [2, 8, 24, 26]. Overdosed, tannins can reduce nutritional uptake [26]
but it appears possible to find a balance where the positive effects in elimination of parasites is greater than any
negative impacts [24, 25].These plants
might also reduce worm load because
they are higher off the ground than
grass and limit the re-ingestion of faeces and the parasite eggs they contain.
WHAT IS SAFE AND EFFECTIVE?

Once a plant has been confirmed as
an anthelmintic and different administration methods have been tested,
more research is essential to establish
dose guidelines and safety margins.
Many people would tend to assume
that because the substances in question
are either plants or plant derived they
are natural and thus safe [27]. In
fact, plants can have very adverse and
sometimes lethal effects and very small
safety margins and so need to be tested
for safety both for the animal receiving
them and for the consumer of that animals products [6].
This article discusses a number of species that are, or are potentially, effective but this adjective hasnt been
quantified. This is another of the tasks
that must be accomplished before the
place of medicinal plants in worm control can really be defined. The European
Agency for the Evaluation of Medicinal
Products and the FDA concur that, for
an anthelmintic to be labeled as effective against a species of worm, it must
eliminate at least 90% of the worm load
[28]. Very few medicinal plants meet
this standard, but this is no cause for
dismissal. In some cases the use of
sub-optimal solutions is justifiable
from a purely economic standpoint. It
is possible that incomplete elimination
of worms is still sufficient to reduce
their impact on production to a negligible level [26]. In others, it is simply
a matter of something is better than
nothing in rural and undeveloped areas where commercial dewormers are
either unavailable or prohibitively expensive [7]. But farmers, veterinarians
and researchers are becoming increasingly aware that gastrointestinal parasite control is not a one-shot, one-drugfix-all problem. Rather it is a challenge
that must be met by the development of
many diverse and sustainable methods
that can be integrated into customized
systems for each farm. Such a system
would account for the animals raised,
the locality and the general production
set up, and the management practices
[6, 7, 8]. There is no doubt that the use
of anthelmintic plants will be an essential component of any such system. It is
therefore vital that researchers continue to identify species and conduct research that will allow medicinal plants
to be safely and effectively used to their
full capacity.
ARTWORK
Eric Bai 15
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...gastrointestinal parasite
control is not a one-shot,
one-drug-fix-all problem.
REFERENCES
[1] Eguale T, Tadesse D, Giday M. In vitro anthelmintic activity of crude
extracts of five medicinal plants against egg-hatching and larval
development of Haemonchus contortus. J Ethnopharmacol. 2011
Sep;137(1):10813.
[2] Wolstenholme AJ, Fairweather I, Prichard R, von Samson-Himmelstjerna G, Sangster NC. Drug resistance in veterinary helminths. Trends
Parasitol. 2004 Oct;20(10):46976.
[3] Kamaraj C, Rahuman AA, Elango G, Bagavan A, Zahir AA. Anthelmintic
activity of botanical extracts against sheep gastrointestinal nematodes,
Haemonchus contortus. Parasitol Res. 2010 Dec 14;109(1):3745.
[4] Lans C. Validation of ethnoveterinary medicinal treatments. Vet Parasitol. 2011 Jun;178(3-4):38990.
[5] Iqbal Z, Jabbar A, Akhtar MS, Muhammad G, Lateef M. Possible Role
of Ethnoveterinary Medicine in Poverty Reduction in Pakistan: Use
of Botanical Anthelmintics as an Example. Journal of Agriculture &
Social Sciences. 2005;1(2):18795.
[6] Hammond JA, Fielding D, Bishop SC. Prospects for Plant Anthelmintics in Tropical Veterinary Medicine. Vet Res Commun. 1997 Apr
1;21(3):21328.
[7] Grad JT, Arble BL, Weladji RB, Van Damme P. Anthelmintic efficacy
and dose determination of Albizia anthelmintica against gastrointestinal
nematodes in naturally infected Ugandan sheep. Vet Parasitol. 2008
Nov; 157(3-4):26774.
[8] Shalaby HA. Anthelmintics Resistance; How to Overcome it? Iran J
Parasitol. 2013 Mar; 8(1):1832.
[9] Assis L., Bevilaqua CM., Morais S., Vieira L., Costa CT., Souza JA.
Ovicidal and larvicidal activity in vitro of Spigelia anthelmia Linn.
extracts on Haemonchus contortus. Vet Parasitol. 2003 Nov; 117(1-2):439.
[10] Hrdegen P, Hertzberg H, Heilmann J, Langhans W, Maurer V. The
anthelmintic efficacy of five plant products against gastrointestinal
trichostrongylids in artificially infected lambs. Vet Parasitol. 2003 Nov;
117(1-2):5160.
[11] Min BR, Pomroy WE, Hart SP, Sahlu T. The effect of short-term consumption of a forage containing condensed tannins on gastro-intestinal
nematode parasite infections in grazing wether goats. Small Rumin
Res. 2004 Mar; 51(3):27983.
[12] Joshi BR, Kommuru DS, Terrill TH, Mosjidis JA, Burke JM, Shakya
KP, et al. Effect of feeding sericea lespedeza leaf meal in goats experimentally infected with Haemonchus contortus. Vet Parasitol. 2011
May; 178(1-2):1927.
[13] Shaik SA, Terrill TH, Miller JE, Kouakou B, Kannan G, Kaplan RM,
et al. Sericea lespedeza hay as a natural deworming agent against
gastrointestinal nematode infection in goats. Vet Parasitol. 2006 Jun;
139(1-3):1507.
EDITOR
Hye In Sarah Lee
[15] Kundu P, Laskar S. A brief resume on the genus Ailanthus: chemical
and pharmacological aspects. Phytochemistry Reviews. 2009 Nov 12;
9(3):379412.
[16] Lavhale M, Mishra S. Nutritional and therapeutic potential of Ailanthus excelsa - A Review. [Internet]. 2007. Available from: http://www.
phcogrev.com/text.asp?2007/1/1/105/59636
[17] Rochfort S, Parker AJ, Dunshea FR. Plant bioactives for ruminant health
and productivity. Phytochemistry. 2008 Jan; 6(2):299322.
[18] Kumar D, Kumar A, Prakash O. Potential antifertility agents from plants:
A comprehensive review. J Ethnopharmacol. 2012 Mar; 140(1):132.
[19] Maciel MV, Morais SM, Bevilaqua CML, Camura-Vasconcelos ALF,
Costa CTC, Castro CMS. Ovicidal and larvicidal activity of Melia azedarach extracts on Haemonchus contortus. Vet Parasitol. 2006 Aug;
140(1-2):98104.
[20] Kamaraj C, Rahuman AA, Bagavan A, Mohamed MJ, Elango G, Rajakumar G, et al. Ovicidal and larvicidal activity of crude extracts of
Melia azedarach against Haemonchus contortus [Strongylida]. Parasitol
Res. 2010 Feb 23; 106(5):10717.
[21] Akhtar M., Iqbal Z, Khan M., Lateef M. Anthelmintic activity of medicinal plants with particular reference to their use in animals in the
IndoPakistan subcontinent. Small Rumin Res. 2000 Oct; 38(2):99107.
[22] Eguale T, Tilahun G, Debella A, Feleke A, Makonnen E. In vitro and in
vivo anthelmintic activity of crude extracts of Coriandrum sativum against
Haemonchus contortus. J Ethnopharmacol. 2007 Apr; 110(3):42833.
[23] Marley C., Cook R, Keatinge R, Barrett J, Lampkin N. The effect of
birdsfoot trefoil [Lotus corniculatus] and chicory [Cichorium intybus]
on parasite intensities and performance of lambs naturally infected
with helminth parasites. Vet Parasitol. 2003 Feb; 112(1-2):14755.
[24] Nguyen TM, Binh DV, rskov ER. Effect of foliages containing condensed
tannins and on gastrointestinal parasites. Anim Feed Sci Technol. 2005
Jun;121(1-2):7787.
[25] Terrill TH, Dykes GS, Shaik SA, Miller JE, Kouakou B, Kannan G, et
al. Efficacy of sericea lespedeza hay as a natural dewormer in goats:
Dose titration study. Vet Parasitol. 2009 Jul; 163(1-2):526.
[26] Githiori JB, Athanasiadou S, Thamsborg SM. Use of plants in novel
approaches for control of gastrointestinal helminths in livestock with
emphasis on small ruminants. Vet Parasitol. 2006 Jul; 139(4):30820.
[27] Githiori JB, Hglund J, Waller PJ, Baker RL. The anthelmintic efficacy
of the plant, Albizia anthelmintica, against the nematode parasites
Haemonchus contortus of sheep and Heligmosomoides polygyrus
of mice. Vet Parasitol. 2003 Aug; 116(1):2334.
[28] Messenheimer J. EFFECTIVENESS OF ANTHELMINTICS: General
Recommendations VICH GL7.
[14] USDA, NRCS. 2013. The PLANTS Database [http://plants.usda.gov, 17

November 2013]. National Plant Data Team, Greensboro, NC 274014901 USA.
44
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Lip Lift
Can Cosmetic Surgery
Increase Ones Happiness?
PRIYA PATEL 16
As cosmetic surgery becomes cheaper
and safer, the number of cosmetic surgery procedures performed is increasing. In 2011, 14.7 million documented
cosmetic surgeries were performed of
which 4.4% occurred in South Korea,
making it the seventh largest producer of cosmetic surgery worldwide [1].
Per capita, South Korea had the largest number of procedures performed,
with 13.3 procedures done for every
1000 citizens [2]. The most common
surgical procedures in South Korea
are Lipoplastya removal of stomach fat, Breast Augmentation, Blepharoplasty- a reshaping of the eyes, and
Rhinoplasty a resculpting of the nose,
in that order. South Koreas cosmetic
surgery industry is growing and fuel-
ling a homogenized standard of beauty

throughout East Asia[1]. This surge in
cosmetic surgery has many contributing factors: societal pressures to be
beautiful, an idea that beauty can be
attained through hard work, and perhaps the idea that beauty and happiness are intrinsically linked together.
For modern Korean women, being conventionally beautiful means having a
small face, large eyes, and a high, sharp
nose. It is no surprise that blepharoplasties and rhinoplasties are among
the most common surgical procedures,
as they enlarge the eyes and modify
the nose, respectively [3]. Many plastic surgery clients look to Koreas actresses and Kpop stars for inspiration.
They want to look like Shin Min-a or

Kim Tae-hee, actresses with large eyes,
pointy noses and slender jaw lines [4].
These women aspire to beauty standards that seem somewhat arbitrary-where do these standards come from?
Numerous research papers that talk
of golden ratios that exist in attractive female faces. For example, it has
been proven that the most attractive
ratio between interocular distance- the
distance between the eyes- and total
face width is .45[5]. However, many of
these studies use Caucasian women as
their subjects, and therefore, are most
certainly biased [5,6]. There has been
one study showing that ethnically Korean women have statistically differ-
PHOTOS
Kaley Brauer 17
46
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Researchers have hypothesized human emotion to

be a sort of feedback loop, wherein expression of an
emotion amplifies the experience of that emotion,
rather than just being a consequence of it.
ent facial ratios than North American

white women. In this study, ethnically Korean women were categorized
as either average or attractive by
other Korean women. The attractive
Korean women had facial proportions
that were much closer to those of the
average North American white woman. This outcome is deeply unsettling.
The judges of attractiveness were
themselves, ethnically Korean, but
their definition of beauty was highly
biased in favor of women who shared
facial proportions with North American white women [7]. This suggests a
homogenization of beauty standards.
Globally, it appears that there can only
be one beautiful, and it is this beauty
that many of the consumers of cosmetic surgery strive for.
Regardless of where beauty standards
have come from, they are present and
difficult to escape. Although the origin
of rigid ideals of beauty are difficult
to trace, the motivations behind conforming to these standards are easy
to comprehend. Its hard to stay competitive in service jobs in Korea if one
hasnt had some of these procedures,
as job applications can require a headshot submission. Effectively, a persons
attractiveness is judged alongside his
or her professional qualifications [2].
In this environment, it is difficult to
not conform to the cosmetic surgery
standards, lest one sabotage his or
her future employment opportunities.
Procedures like blepharoplasty are
thought to make the face look more

alert and inviting [8]. For service sector
employers, then, it would make sense
to want employees to appear as attentive and attractive as possible. The vast
pool of cosmetically enhanced potential employees in South Korea makes
it almost unwise to not have some sort
of procedure done to align oneself with
the accepted beauty standard. Being
beautiful is not so much a luxury as a
tool for survival.
In addition to the common procedures,
like blepharoplasty, rhinoplasty and
jaw reshaping, a new surgery has come
into the forefront- a variation on Valentine Anguloplasty, or smile surgery,
that is supposed to make the patient
seem more pleasant and inviting. Within this past year, the company Aone
has patented its own version of Valentine Anguloplasty, named Lipt, as
a combination of the words lip and
lift. Valentine Anguloplasty, historically, has been used to try and correct
a drooping, downturned mouth. Aone
claims that it corrects the downward
turned mouth by actually changing the
muscle balance of the mouth. This is
supposed to yield longer lasting results
than traditional anguloplasties consisting only of skin excisions [9].
In typical western cosmetic surgery, the
correction of an excessively drooping
mouth is done by injecting the muscle
with botulinum toxin (often referred to
as Botox), and soft tissue implants.
Soft tissue implants are materials used

as fillers for certain facial structures
[10]. However, the botulinum/implant
combination, though longer-lasting
than soft tissue implants alone, has a
finite longevity, and the patient must
have consistent remolding of the implant and re-injection of botulinum
toxin. Aone boasts a longer, more permanent solution to downturned mouth
corners through Lipt. Aone does not
highlight the potential neurological
and social effects of Lipt, and how
changing facial expression can directly
impact a persons mood.
The Lipt procedure involves cutting
a part of the modiolus, a disk-shaped
group of muscles located at the corners
of the mouth, thereby weakening the
muscles that cause a person to frown.
Frowning is induced by the contraction
of the depressor anguloris muscle located in the modiolus, and weakening
it can cause a more naturally upturned
mouth. Can this perpetual, subtle
smile actually make someone happier?
Beyond the seemingly obvious happiness that comes from feeling more attractive, Lipt has the potential to neurologically improve the moods of its
recipients, simply by making frowning
more difficult. According to one study,
women who were unable to frown due
to a botulinum toxin injection of their
corrugator muscles (which are located
above the eyes) tended to report better
moods, and tended to show fewer negative emotions than those women who
Patel.indd 47
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BEFORE
were able to fully frown. Researchers

have hypothesized human emotion
to be a sort of feedback loop, wherein
expression of an emotion amplifies the
experience of that emotion, rather than
just being a consequence of feeling it. If
someone cannot express negative emotions with his or her face, then that person feels less negativity [11].
The idea that the facial expression and
the emotion share a causative, as well
as a correlative relationship has been
tested since the late 20th century, with
researchers Adelmann and Zajnoc observing that patients forced to smile
found cartoons to be funnier. Then researcher Jonathan Cole observed that
patients with facial paralysis caused by
a genetic disorder, Mobius syndrome,
were also much less able to feel common emotions. Furthermore, increased
corrugator activity has been linked to
anxiety and other disorders [12]. This
link between expressing emotion and
feeling it has been used as far as to attempt to treat depression. One study
showed that nine out of 10 depression
patients injected with botulinum toxin in the glabellar frown lines, located
at the inner corners of the upper eye,
AFTER*
did not show depression signs upon

follow-up [11]. These results indicate
that expression is integral to feeling
and that humans faces are not merely
facades, but rather an integral part of
emotional responses.
The inability to express an emotion
does not only affect the person making
the expression; third-party observers
can interpret an emotional expression,
regardless of how the maker of the
facial expression intends to be seen.
In one study, people who could not
frown due to injection of botulinum
toxin were photographed making the
same facial expressions before and after their injections. Participants were
able to rank the pre-injection photos as
more angry or sad than the post-injection photos. The after photos were
described as expressing more happiness and less anger, fear, and sadness
[13]. The injection of botulinum toxin
involuntarily restricted the frowning
facial expressions in the photographed
participants of this study, and the subjects viewing the photos could grade
the intensity of emotion accordingly.
Then if someone were to put forth a
perpetually happy face, even uninten-
tionally, observers would notice.

Further adding to the impact of a facial expression, there is also research
to indicate that an observer undergoes
an involuntary amygdallar reaction to
emotions expressed by others. Even
before there is a conscious interpretation of a facial expression, the brain
responds. In one research experiment,
fearful, happy and neutral faces were
shown to participants, and there was
significant amygdala activity in response to emotive faces as opposed to
neutral faces. Clasically, amygdallar
responses are associated with fear, but
this study showed that the left anterior
amygdala was also stimulated when
observing a happy facial expression
[14]. This shows that human brains
have an involuntary, measurable, response to displayed emotions, and that
the mood people convey to the world
has a real and neural effect on others.
A surgery like Lipt can make a person
always appear slightly smiling, and
looking happy all the time can subtly
cause others to feel happiness. If Lipt
can induce an improved mindset in patients and the people they interact with,
then perhaps this surgery is a positive
* NOTE: These are merely a photoshopped example as opposed to actual before and after pictures.
48
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A surgery like Lipt can make a person always

appear slightly smiling, and looking happy all the
time can subtly cause others to feel happiness.
thing- a way to spread brighter moods.

To some, the increasing demand for
surgically attained beauty is troubling.
Cosmetic surgery is seen as a sign of
vanity or shallowness. There are people who openly criticize South Koreas
beauty standards on popular websites
like BuzzFeed [15, 16,17] , while simultaneously ignoring what beauty means
to South Koreans. Beauty, however

members of a society choose to define
it, can have a profound influence on
people, both subjectively, and objectively. There is a neurological correlation between the faces one makes and
sees and how happy a person feels [10].
Maybe the desire to look beautiful, always smiling, or always bright-eyed
and alert doesnt stem from person-
REFERENCES
[1] International Society of Aesthetic Plastic Surgery. ISAPS International
Survey on Aesthetic/Cosmetic Procedures Performed in 2011 [Internet]. 2011. [cited November 13, 2013]. Available from: http://www.
isaps.org/files/html-contents/Downloads/ISAPS%20Results%20-%20
Procedures%20in%202011.pdf
[2] Lee, Heesu, Bloomber Businessweek. Perfecting the Face Lift, Gagnam
Style [Internet]. October 10, 2013. [cited November 12, 2013]. Available
from: http://www.businessweek.com/articles/2013-10-10/plastic-surgery-lifts-south-korean-tourism
[3] Stone, Zara, The Atlantic. The K-Pop Plastic Surgery Obsession [Internet].
May 24, 2013, [cited November 12, 2013]. Available from: http://www.
theatlantic.com/health/archive/2013/05/the-k-pop-plastic-surgery-obsession/276215/
[4] Kim V. CNN Travel. Welcome to the Plastic Surgery Capital of the World
[Internet]. August 9, 2012 [cited November 13, 2013]. Available from.
http://travel.cnn.com/seoul/visit/ideals-beauty-plastic-surgery-capital-world-389581
[5] Pallett PM, Link S, Lee K. New golden ratios for facial beauty. Vision
Research 2010; 50:149-154.
[6] Cunningham MR, Measuring the physical in physical attractiveness:
Quasi-experiments on the sociobiology of female facial beauty. J Personality and Social Psychology 1986; 50(5):925-935.
[7] Choe KS, Sclafani AP, Litner JA, Yu G, Romo T. The Korean American
Womans Face Anthropometric Measurements and Quantitative Analysis
of Facial Aesthetics, JAMA Facial Plastic Surgery 2004; 6(4):244-252.
[8] Haddrill M. Eyelid Surgery for a More Youthful Appearance [Internet].
May 2013. [cited November 12, 2013]. Available from http://www.
allaboutvision.com/cosmetic/blepharoplasty.htm
al vanity. Perhaps wanting to present

a surgically-altered, conventionally
beautiful face to the world is an attempt to bring happiness to oneself
and others. While some may argue that
going under the knife is excessive, or
that the standards of beauty are narrow and unforgiving, no one can deny
the legitimacy of the desire to spread
happiness.
EDITOR
Methma Udawatta
[9] Mouth Corner Lip Surgery (Smile Lipt) .Aone Plastic and Aesthetic
Surgery[Internet]. [cited November 12. 2013]. Available from: http://
eng.aone.ac/
[10] Carruthers J, Carruthers A. Aesthetic Botulinum A Toxin in the Mid
and Lower Face and Neck. Dermatologic Surgery 2003; 29(5):468-476.
[11] Finzi E, Wasserman E. Treatment of Depression with Botulinum Toxin
A: A Case Series. Dermatologic Surgery 2006; 32(5):645-650.
[12] Adelmann PK, Zajonc RB. Facial Efference and the Experience of
Emotion. Annual Review of Psychology ; 40:249-280.
[13] Teichmann B, Schroder U, Sprengelmeyer R, Ceballos-bauman, Ao.
Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness,
and fear. J American Academy of Dermatology 2003; 49(2):213-216.
[14] Breiter HC, Etcoff NL, Whalen PJ, Kennedy Wa, Rauch Sl, Buckner
Rl, et al. Response and Habituation of the Human Amygdala during
Visual Processing of Facial Expression. Neuron 1996; 17(5):875-887.
[15] Perez A. Buzzfeed. I Wasnt Beautiful Enough to Live in South Korea
[Internet]. May 31, 2013[ cited November 12, 2013]. Available from:
http://www.buzzfeed.com/ashleyperez/i-wasnt-beautiful-enough-tolive-in-south-korea
[16] Broderick R. Buzzfeed. Plastic Surgery that Forces you to Smile Uncontrollably Is All the Rage Among South Korean Women [Internet].
August 28, 2013 [cited November 12, 2013]. Available from http://www.
buzzfeed.com/ryanhatesthis/plastic-surgery-that-forces-you-to-smileuncontrollably-is-a
[17] Odell A. Buzzfeed. Has Plastic Surgery Made These 20 Beauty Pageant
Contestants Look the Same? [Internet]. April 24, 2013. [cited November
12, 2013]. Available from: http://www.buzzfeed.com/amyodell/hasplastic-surgery-made-these-20-korean-beauty-pageant-cont
Patel.indd 49
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EXPLORING THE
Earthy Scent
OF WET DIRT
LUCY VAN KLEUNEN 17
Maybe youve never heard of geosmin, but you know it well. An organic
compound produced by soil bacteria,
geosmin is responsible for a scent that
is recognizable, ubiquitous, and evocative that of your grandmothers garden or canoe trips; the earthy flavor of
beets, spinach, mushrooms, and catfish
[1][2]. Geosmin, which is Greek for
earth odor, is one of the molecules
responsible for the characteristic smell
of moist soil [3][4]. Most humans can
smell geosmin in concentrations as low
as 0.7 parts per billion, meaning that if
you poured a teaspoon of geosmin into
the equivalent of 200 Olympic-sized
swimming pools, you would still be
able to smell it [1][2].No one knows
for sure where this sensitivity has come
from, but some have speculated that it

could relate to prehistoric survival, developed as a way for our ancestors to
find sources of water [1]. David Cane,
a biochemist a Brown University, has
been interested in this organic molecule for a long time. His exploration
of the biochemical origins of geosmin
has both opened doors to a comprehensive understanding of soil ecology
and helped solve a practical problem
faced by many municipalities that of
drinking water purification.
Geosmin is produced by a variety of
microbes, cyanobacteria, and fungi
including S.coelicolor. a species of filamentous dirt bacteria [5]. In 2007,
Cane and a team of Brown University
biochemists discovered the sequence

in the S. coelicolor genome responsible for producing geosmin. This gene
triggers a mechanism by which a single protein within the bacteria produces the compound in a two part reaction
[6]. This was the first work done on the
mechanism of geosmin biosynthesis
since the 1980s [7].
Amongst soil bacteria, S. coelicolor has
been one of the most widely studied
genetically, and was completely sequenced in 2002[8]. Scientists like Cane
have been able to identify the genes
connected to many of the processes
within the bacteria that create organic compounds. Many of these compounds are of potential therapeutic
PHOTOS
Kaley Brauer 17
50
Kleunen.indd 50
3/20/2015 4:54:43 PM
SEE THAT DOT TO THE LEFT?

The human nose is so sensitive to geosmin that if that dot was geosmin
and every page of this magazine was part of one large body of water, we
would still be able to smell the geosmin. In fact, even if the magazine was
twenty times larger, wed still be able to smell it.
use. Dirt bacteria such as S. coelicolor

are responsible for the production of
anti-tumour agents, immunosupressants and over two-thirds of all natural antibiotics currently available [9].
Although a rise in adaptive microbial
resistance to these organically produced drugs has reduced their popularity, biochemists have continued
this research in order to understand
the processes that can lead to antibiotic production [10]. It was during such
pharmaceutical research that Cane and
his team unexpectedly discovered the
source of dirts odor. The practical application of this discovery is not immediately apparent- the earthy geosmin
scent is often positively associated with
fond memories of rainy soccer games
or camping trips. However, when one
thinks of finding the same smell in a
glass of water, the potential relevance
of the discovery becomes clear.
There is no consensus in the biochemistry community as to why we now
find a taste that does not alert to any
toxicity unpleasant [11]. This preference can become a big problem for
municipalities which have experienced
blooms of cyanobacteria, commonly
called blue-green algae [12]. During
summer months, when high phosphorous and nitrogen concentrations spur
these blooms in reservoirs, water systems receive complaints from users
about musty and dirty tastes in their
water attributed to geosmin produced
by cyanobacteria . Although drinking
geosmin is not harmful for humans,
cities do not want to provide their con-
stituents with dirty-tasting water. This

compound can become a significant
contaminant in very small quantities
due to our sensitivity to the scent [12].
In order to address this problem, Cane
and other researchers developed an
easy methodology for testing water
for the presence of geosmin. Because
the geosmin-synthesizing gene is now
known, they found they could use simple PCR technology, which can detect
the presence of a specific chain of genes
[13]. There are plans to turn this water
test into a field kit that cities can use to
test their reservoirs [11][14]. In October
of 2011, Brown submitted a patent application for this method [15].
The most significant use for this fieldkit is in early detection of geosmin contamination. If cyanobacteria blooms
are allowed to spread for a long time,
removal techniques become costly and
inefficient. Sprinkling granular activated carbon to absorb the bacteria or
setting up biofilm-containing sand filters can relieve the problem, but both
methods are highly dependent on contact time and water quality [12]. Oxygenating the source water using ozone
both kills oxygen-hating anaerobic
bacteria and pushes surface-dwelling
cyanobacteria into the depths where
they die due to lack of sunlight [16].
While this method can be cost-effective in long run, it involves initial high
capital investment [12]. Some bacteria
can use geosmin as a fuel source and
thus organically deplete the level of
these compounds, but this has only
been successful so far in controlled laboratory situations [17]. Amongst these

methods, there is no procedural solution, and often blooms are contained
by some combination found through
trial and error [18].
In addition to water treatment facilities, the troubles of geosmin decontamination can also affect the fishing and
wine industries. Geosmin contamination in a fish farm can mean several
days of purging off-flavored fish with
clean water before marketing, inflicting considerable financial losses on the
aquaculture industry [17]. Similarly, if
a few tiny drops of geosmin find their
way into a fermenting wine barrel,
makers must rush to salvage their supply, often using grape seed oil as a type
of solvent for the geosmin. This too,
can prove to be an inconvenient and often inefficient technique [1]. In both situations, Canes genetic field test would
allow for earlier detection and isolation
of geosmin contamination.
In 2008, Cane and the team compared
geosmin production in cyanobacteria,
which is the usual culprit for geosmin
contamination in water, to that in S.coelicolor, the bacteria they originally
analyzed. They found that in both species of bacteria, virtually the same biochemical reaction was catalyzed to produce geosmin. This production was the
result of a single mutation in both bacterias the DNA sequences that were of
similar length. In fact, when they studied this production in still other bacteria species, they noticed that their geo-
Kleunen.indd 51
51
3/20/2015 4:54:47 PM
smin producing genes were also very

similar. Amongst the geosmin synthesis genes in cyanobacteria, S.coelicolor,
and various other geosmin-producing
organisms, there were correspondingly high levels of sequence conservation
over all 730-740 amino acids. All species that produce geosmin do so in virtually the same way- with the same genetic sequence and virtually the same
catalyzed enzymes [14].
This genetic similarity becomes an important tool for solving the pesky problem of contamination source detection
in reservoirs. Before any decontamination methods are even tried, industry
officials must identify the source of the
contamination. Cyanobacteria blooms
are often difficult to isolate to a particular area, and furthermore cannot
always be attributed as the sole cause
of soil-taste in water [11]. Dr. Susan B
Watson of the Canada Centre for Inland Waters in Burlington, Ontario, is
an expert on the ecological and socioeconomic effects of source-water toxins
and blooms. Her research has shown
that in many cases of geosmin contamination, cyanobacteria were not even
present in high quantities [19][5]. Geosmin can find its way into reservoirs
from a number of sources, including
other bacteria or even biofilm buildup on water-channeling pipes [5]. This
means that methods such as filtration,
which specifically target blue-green
algae, will not necessarily stop the water from smelling like soil. To further
complicate source identification, considerable expertise is required to identify geosmin-producing cyanobacteria
microscopically [19]. As techniques to
52
distinguish between species of bacteria

have become more advanced and classification has become more rigorous,
many species identified as geosmin
producers by early studies have since
been renamed, leading to confusion
[19].
The geosmin-detecting PCR test can
help solve this problem. Along with
being able to detect geosmin contamination in early small quantities, these
tests have the additional advantage
of being able to differentiate amongst
geosmin producing species. For those
running the water systems in small,
often rural, municipalities, containing
geosmin contamination can become
extremely frustrating and costly. The
PCR test that Cane has helped develop
assists cities in two ways. First, it helps
them detect geosmin contamination
earlier. Then, it helps them identify
its cause, thereby taking the guessing
game out of containment strategies.
With such a tool, municipalities could
easily take regular tests across their
reservoirs in order to pinpoint, monitor, and contain the presence of geosmin-producing microbes.
Unfortunately, according to Professor
Cane, it is not feasible to use the genetic discovery to bioengineer non-geosmin-producing bacteria or alter the
genetic signature of cyanobacteria in
reservoirs. There would be no way to
efficiently treat a lot of water to specifically target and deactivate certain gene
proteins in a wide variety of bacteria.
Because the water would need to remain potable, any such method would
also need to be screened for possible
toxic effects. Removing the bacteria,

genetically engineering them to not
produce geosmin, and then introducing them back into the environment
could have unknown ecological effects.
Instead, understanding the mechanism
by which geosmin is produced can
lead to development of early detection
methods, such as the PCR test, that can
more easily identify and target a source
of geosmin production- such as a cyanobacteria bloom- before it becomes a
huge problem [11].
Despite the significant practical applications of his discovery, what Cane
finds most fascinating about his work
is its potential for revolutionizing our
fundamental understanding of soil
ecosystems. Because the gene sequence
that causes geosmin production has
been highly conserved across a wide
variety of bacterial species, it must be
important. In other words, as the bacteria evolved and differentiated, the geosmin-creating gene stayed virtually the
same. This reaction must then have an
evolutionary or environmental function [11].
So far, this function has not been definitively identified. A common theory is
that species, including humans, have
developed high sensitivities to geosmin in order to aid their own survival.
Professor Keith Chater, in an article in
The Guardian after his team at the John
Innes Centre in Norwich independently discovered the function of the geosmin-producing genetic sequence,
speculated that camels could follow
the geosmin scent to find water in the
desert and that geosmin-producing
Kleunen.indd 52
3/20/2015 4:54:50 PM
bacteria could be spreading the scent

in order to find hosts, like camels, to
carry their spores [20]. Neither part of
this theory, however, has been backed
by any empirical data. Geosmin has
also been proposed as a chemical land
mass homing signal for anadromous
[migrating] fish, and there has been
some circumstantial evidence for geosmins attraction of worms and eels [5]
[11]. Now that the genetic sequence
controlling geosmin production has
been discovered, experiments can be
performed in which the genetic code
of a typically geosmin-producing bacterium is altered to limit geosmin production. This bacterium could then be
monitored in various controlled and

natural environments to determine the
ecological function of the mechanism
that produces the smell [11].
Beyond the potential for these interesting applications, the biochemistry
community has also found this discovery significant as an interesting scientific problem in itself [11]. The protein
that completes geosmin production is
shaped like a dumbbell in which one
side completes half of the reaction and
the other completes the second. This is
the first bifunctional enzyme found for
the production of the type of terpene,
or class of organic molecule, to which
REFERENCES
[1] Howes Laura. Geosmin. Royal Society of Chemistry. [Internet]. [cited
2013 Oct 21].
Available from: http://www.rsc.org/chemistryworld/podcast/CIIEcompounds/transcripts/geosmin.asp
[2] Halifax Regional Municipality. Geosmin Frequently Asked Questions.
[Internet]. 2013 Oct [cited 2013 Oct 21]. Available from: https://www.
halifax.ca/hrwc/Geosmin_FAQ.html
[3] Cotton, Simon. Geosmin. Uppingham School. [Internet] 2009 Aug
[cited 2013 Oct 21]. Available from: http://www.chm.bris.ac.uk/motm/
geosmin/geosminh.html
[4] Trojan Technologies. Taste-And Odor-Causing Compounds in Drinking
Water. [Internet]. 2005 [cite 2013 Oct 21]. Available from: http://www.
engamerica.com/uploaded/Doc/Trojan_ECT_Facts.pdf
[5] Juttner F, Watson SB. Biochemical and Ecological Control of Geosmin
and 2-Methylisoborneol in Source Waters. J Applied and Environmental
Microbiology [Internet]. 2007 July[cited 21 Oct 2013]; 73(14):4395-4406.
Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1932821/
[6] Coyle Ann. Brown Chemists Explain the Origin of Soil-Scented Geosmin. Brown University News.[Internet]. 2007 Sep 16 [cited 2013 Sep
25]. Available from: http://news.brown.edu/pressreleases/2007/09/
origin-soil-scented-geosmin
[7] Meganathan R.What Causes the Characteristic Smell of Soil? Northern Illinois University Department of Biological Sciences. [Internet].
2013 [cited 2013 Oct 21]. Available from: http://www.bios.niu.edu/
meganathan/smell_of_soil.shtml
[8] Bentley SD, Chater KF, Cerdeno-tarraga AM, et al. Complete genome
sequence of the model actinomycete Streptomyces coelicolor A3(2). J
Nature [Internet]. 2002 May 9 [cited 21 Oct 2013]; 417:141-147. Available
from: http://www.nature.com/nature/journal/v417/n6885/full/417141a.
html
[9] Sanger Institute. Streptomyces coelicolor. [Internet]. 2013 Apr 03 [cited 2013 Oct 21]. Available from:http://www.sanger.ac.uk/resources/
downloads/bacteria/streptomyces-coelicolor.html
[10] Pearson Education- infoplease. Production of Antibiotics. [Internet].
2013 [cited 2013 Oct 21]. Available from: http://www.infoplease.com/
encyclopedia/science/antibiotic-production-antibiotics.html
geosmin belongs. The team is still piecing together the biochemical puzzle
posed by this completely unexpected
mechanism in the geosmin-producing reaction [13]. Whether at this deep
academic level, in the practical problem of drinking water purification, or
in broad theoretical questions about
the role of scent in soil ecology, there
is much more to the smell of dirt than
worms and mud-pies. The next time
you step outside on a rainy day, take a
moment to appreciate the fresh earthy
scent which greets you. It is proof that
right under your feeta fascinating reaction is taking place to produce geosmin, natures mysterious perfume.
EDITOR
Malio Kodis
[11] Cane David. Interviewed by: Lucy Van Kleunen. 2013 Oct 15 [cited
2013 Oct 21].
[12] Microbac Laboratory Services. Geosmin and MIB and Resulting Taste
and Odor Problems in Finished Drinking Water. [Internet]. 2011 [cited 2013 Oct 21]. Available from: http://www.microbac.com/uploads/
Technical%20Articles/pdf/Geosmin%20and%20MIB%201.pdf
[13] Research at Brown: The Directory of Research and Researchers. David Cane. [Internet]. 2012 [cited 2013 Oct 21]. Available from: https://
research.brown.edu/myresearch/David_Cane
[14] Giglio S, Jiang J, Saint CP, Cane DE, Monis PT. Isolation and Characterization of the Gene Associated with Geosmin Production in Cyanobacteria.
Environ. Sci. Technol [Internet]. 2008 [cited 2013 Oct 21]; 42:8027-8032.
Available from: http://pubs.acs.org/doi/pdf/10.1021/es801465w
[15] Cane D, Giglio S, Jiang J, Saint CP, Monis PT. Methods of Detecting
Sources of Microorganism Contamination. United States Patent Application 0250604, Oct.2011.
[16] Clean-Flo. A Natural Method of Reservoir Restoration. [Internet] 2013
[cite 2013 Oct 21]. Available from: http://www.clean-flo.com/systems/
reservoir-restoration/
[17] Guttman Lior, van Rijn Japp. Isolation of Bacteria Capable of Growth
with 2-Methylisoborneol and Geosmin as the Sole Carbon and Energy
Sources. J Applied and Environmental Microbiology [Internet]. 2011
[cited 2013 Sep 25]; 78(2): 363-370. Available from: http://aem.asm.
org/content/78/2/363.full
[18] New Hampshire Department of Environmental Services. Cyanobacteria
and Drinking Water: Guidance for Public Water Systems. [Internet]
2009 [cited 2013 Oct 21]. Available from:http://des.nh.gov/organization/
commissioner/pip/factsheets/dwgb/documents/dwgb-4-15.pdf
[19] Environment Canada. Dr. Susan B. Watson. Government of Canada.
[Internet]. 2013 Aug 29 [cited 2013 Oct 21]. Available from: http://www.
ec.gc.ca/scitech/default.asp?lang=En&n=F97AE834-1&formid=20E3A
86D-215C-45C8-8942-C21E20E8EDA6&xsl=scitechprofile
[20] Simons, Paul. Camels act on a hump. theguardian. [Internet]. 2003
March 5 [cited 2013 Oct 21]. Available from: http://www.theguardian.
com/science/2003/mar/06/science.research/print
Kleunen.indd 53
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Lemurs & Racehorses:

A DISCUSSION ON SCIENTIFIC LEGACY

MAKE LOVE, NOT WAR: A

The Triple Helix is an independent, studentrun organization committed to exploring

Logo design by Chen Ye 17.

THE TRIPLE HELIX || SPRING 2014

Even as The Triple Helix continues to grow and expand

SPRING 2014|| THE TRIPLE HELIX

8 MAKE LOVE, NOT WAR

A Lesson From Bonobos

Why Kids Today Cant Stay

18 (A)SYMMETRIC VITRUVIAN MAN

LEMURS AND RACEHORSES:

Cognitive Human (Un)

30 BEHIND THE CONSENT FORM

34 A NEW AGE OF DECEPTION

40 NATURAL WORM CONTROL

SOPHIA (SEON YEONG) PARK

Can Cosmetic Surgery

Exploring the Earthy Scent

To highlight the creative energy inherent in

THE TRIPLE HELIX || SPRING 2014

(3) Table of Contents.indd 4

THE TRIPLE HELIX || SPRING 2015

A DISCUSSION ON SCIENTIFIC LEGACY

Theres a New York Times article taped

minder that greatness can be found in

counterparts giving us important

SPRING 2015 || THE TRIPLE HELIX

awareness that a scientist must have in

view with Professor Cooper, I planned

THE TRIPLE HELIX || SPRING 2015

quiry [4]. Not surprisingly, Jolly does

of funding and support for her work,

people understand why ones work is

and contribute to her legacy.

People who are good at what

Cosmos. She never appeared as an

THE TRIPLE HELIX || SPRING 2015

A Lesson from Bonobos

THE TRIPLE HELIX || SPRING 2015

common among bonobos [3], but the

ture, infanticide, and cannibalism [7].

Would societal understanding of human evolution today be different had

tation of our own evolution and be

The Role of Homosexuality and Female

bonobos often participate in face-toface copulation. It is hypothesized

Further supporting this hypothesis,

Bonobo behavior further suggests that

homosexuality plays additional alternate roles in society aside from that of

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observed chasing another male away

THE TRIPLE HELIX || SPRING 2015

War vs. Love

operational stress injuries and helps

without the help of therapy and drugs.

sorts are accepted, then it must be possible for us to choose

[3] Sommer V, Bauer J, Fowler A, Ortmann S. Patriarchal Chimpanzees, Matriarchal

[12] Benagiano G, Carrara S, Filippi V. Sex and Reproduction: an evolving relationship,

[15] Surbeck M, Deschner T, Schubert G, Weltring A, Hohmann G. Mate Competition,

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THE TRIPLE HELIX || SPRING 2015

SPRING 2015 || THE TRIPLE HELIX