TALK for the March for Science

TALK for the March for Science, Santa Fe, New Mexico April 22, 2017

With thanks to my friend Elena Giorgi, who helped make it happen, and Josip Loncaric who took my picture, and A Bone Martinez, who kindly taped it -- see the link at the end if you are interested.

 

I’m going to start this talk with some time travel. Many of you have embarked on time travel yourselves, by exploring family trees, or by genetic testing to discover your roots in your DNA, reaching back to try to imagine the world of your ancestors. But there is one profound difference in their lives that is very hard us to imagine. And it is not the lack of cell phones. It is this: throughout the arc of human history, people were intimate with death in a way that we are not.

When a new baby is born into our families, our expectation is that, of course, we will get to see that little one grow up. That children will outlive their parents.  This is not the way it’s always been. This is a gift that science gave us.

So, our first stop in our journey through time: Catalhoyuk, in present day Turkey. We will go back about 7,000 years, and stop there. (People were just beginning to figure out how to brew beer, so let’s not go back any further.) 1000 years of burials in Catalhoyuk tell this story to the scientists who can read the bones: 

       - 40% of babies died before the age of 5. 

       - Only 1/10 people made it to 40 years old.

       - Please raise your hands if you (like me) are over 50 and willing to admit it.

We’re all right out – because nobody, nobody at all, lives to 50 years old. 

OK, let’s fast forward to ~1730, London. Now, not only is beer on tap, but we can get a good cup of coffee and some lively political debate in the local coffee house. A gentleman named John Marshell is busy compiling the Bills of Mortality, he’s documenting the cause and age of every death in London, death by death. 7000 years have come and gone, but surprisingly little has changed:

       - Things are worse for London’s babies, ~45% won’t make it to 5, nearly half die.

       - If you do make it past childhood, the odds are better: 20% make it to 50 years, a few people even make it to old age.

So what were all these young Londoner’s dying of? If we peer over John Marshell’s shoulder, we’ll get a grim glimpse: most often, it’s infectious disease. The Kings Evil (TB), worms, “the purple and spotted fevers”, infected teeth...   Death by infected teeth? I don’t know about you, but I’m ready to high tail it outta’ the 18^th century.

So lets come home. Our time. Our place. Our America, 2017. Age of miracles and wonder.

       - Our babies almost always get to grow up; only ~6 out of 1000 don’t make it.

       - Heart attacks and cancer are the leading killers, diseases of old age.   95% of us live past 50. On average, we get 79 years of life.

What has changed?  Clean water. Antibiotics. Vaccines.

But something more subtle as well.

Louis Pasteur, the man whose experiments led to the acceptance of the germ theory of disease said, “Chance favors only the prepared mind”.

So another change in our times: Through science, we collectively have a “prepared mind”. We discover new disease outbreaks swiftly when they arise. And we have clarity of purpose when we discover something new and dangerous. We isolate the bug that causes the outbreak, figure out how it’s transmitted, how to treat it, and how to vaccinate against it. Recent decades have brought us nightmares: Ebola, SARS, Zika, HIV, drug resistant TB, and Hanta virus (in New Mexico). And we respond. Sometimes the science is very difficult.  Still, we respond.  Your tax dollars pay for America’s response; I think it’s a good deal.

My life’s work focuses on HIV vaccines. To this day, I’m motivated by witnessing first hand a turn around in the expectation that children should get to outlive their parents. I watched helpless as two dear friends of died of AIDS in the 1990s.  They died in their 20s. One was my next-door neighbor growing up, Kevin. The sweet little boy I had babysat had grown into a fine, funny and generous man. HIV took him. The other was my housemate for 5 years, Brian, one of the most extraordinary scientific minds I’ve ever encountered.  AIDS kills in many ways. Brian’s beautiful mind was lost to AIDS dementia; it was the one thing he feared the most. My friends’ deaths were slow and hard.  Their brave moms were by their sides constantly to help them endure the pain of the last months of their lives. These memories I hold in my heart: these wonderful men, their beautiful families, what they suffered, what was lost.

AIDS was discovered in 1981. It was 16 very long years before we figured out how to treat it with good success. But still, even now, HIV infections are never cleared.  Antiretroviral therapy is hope and life. But it is also expensive and arduous: a lifetime of 3 drugs a day, drug resistance can evolve, the drugs can have hard side effects, and too many people still don’t have access to treatment.

The HIV pandemic is not over, but is no longer news, so it falls away from our attention. The WHO estimates 37 million people are living with HIV, that there are over 2 million new infections, and over a million AIDS deaths, each year. The sorrow of million deaths is impossible to comprehend. When I try to begin to understand it, I remember that every one of them is someone’s Kevin, someone’s Brian. In the US, the CDC estimates 1.2 million people are living with HIV. A working vaccine would turn this epidemic around. How? Now, for some science.

Your immune system has the remarkable ability to distinguish “self” (that would be you) from “non-self” (that would incoming infections). When you get a new infection, your immune system goes into battle, but it takes a while to ramp up. Meanwhile the new pathogen begins to take hold, uses your body to copy itself, and as a conduit to infect others.  When you survive and clear an infection, some of your immune response lingers, harbored as memory cells. These memory cells are poised and waiting to protect you. If you’re ever exposed to that same pathogen again, your immune response will be swift, potent and precise.

The way a vaccine works is by using an inactivated pathogen, or just a fragment, some bit, that doesn’t get you sick, but can still trigger an immune response. Vaccines leave behind the memory cells you need to protect yourself, should you later encounter the real and dangerous pathogen.

We still don’t have an HIV vaccine; it is a particularly difficult challenge. HIV infects the immune system itself. It is highly variable, different in every single infected individual. Still, we are making steady progress, and I’m hopeful about it.

Finally, some thoughts about Trump’s proposed 20% cut to the NIH budget. Much of the human health research done in our country is seeded through the NIH. It keeps us at the cutting edge of medical advances. It is how we fuel innovation, and how we train the next generation of scientists. A 20% cut will close the door on many promising research directions that are currently underway. Momentum will be lost.  

Remember the words of Dr. Pasteur, “Chance favors only the prepared mind”. Our national science programs are our collective “prepared mind”. We need to attend to the health of our people, and the health of our planet; science enables that. Thank you all for doing your part today, for Standing With Science. Never take your citizenship for granted, learn about the issues, seek truth, and then VOTE! 

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Time travel, courtesy of Christopher Will in his book Yellow Fever, Black Goddess

AIDS stats were taken from the WHO and CDC Websites, 2017