Biomedicine on Display

Thomas wrote a post yesterday on medical board games, which got me reminiscing about medical computer games. There is a long history of medical computer games, particularly within the simulation genre. Most noteworthy is the now extinct Bullfrog Productions’ wickedly funny Theme Hospital, which was published in 1997 by Electronic Arts. The game is a darkly humorous simulation, in which the player has to build a hospital, manage staff and attract patients. A similar game is the recently published Hospital Tycoon, published in 2007 by Codemasters.

Another sub-genre of medical games emerged from Japan with the succes of Trauma Centre: Under the Knife, released for the Nintendo DS in 2005. The game is a roleplaying game set in 2018, and features the struggle against a man-made disease called GUILT (Gangliated Utrophin Immuno Latency Toxin), which is distributed by a terrorist organization. The protagonist is a young surgeon, who learns he is a descendant of Asclepius, no less. The gameplay consists of a series of increasingly difficult operations (you can see what the gameplay looks like here), which the player has to complete to advance the story. The game has since spawned a number of follow-ups and clones.

Another series of games that deserve a special mention is the Life and Death-series, which dates back to the early years of DOS-gaming. Check out what a digitalised interactive brain surgery looked like in 1990 here.

There are a number of other medical games, but my personal favorite medically themed game (well, sort of medically themed) is the fantastic Psychonauts from 2005, in which the player has to delve into the psyches of a group of kids to stop a villain from tampering with their minds. A truly original and brilliant game, by any standards.

I have no doubt that we will see more medically themed games in the future, and particularly games along the lines of the protein-folding game Foldit (which has been mentioned on this blog before). Everyone, including scientists, are increasingly realising the co-creative potential of the participatory web, and there will no doubt be a rush to explore this potential.

Assume you have submitted a paper for the Bulletin of the History of Medicine or Museums & Society or some other fine humanities journal. Then imagine the editors write back to you saying that the anonymous reviewers just loved it and that the journal will accept it for publication in a forthcoming issue — on the condition that you also submit a Wikipedia page that summarizes your paper!

Sounds to me like a great vision for the future of public engagement with the humanities. And not at all unrealistic, because a precedent has already been set — by a science journal.

From now on, RNA Biology will require Wikipedia pages from all authors who submit their work to a new journal section that describes RNA molecule families. The journal will then send the pages for peer review before publishing them in Wikipedia (see Declan Butler, “Publish in Wikipedia or perish”, Nature News, 16 Dec. 2008).

The initiative is a collaboration between RNA Biology and the RNA family database (Rfam) consortium led by the Wellcome Trust Sanger Institute. According to the co-director of the Rfam database “the novelty is that for the first time it creates a link between Wikipedia and traditional journal publishing, with its peer-review element” — which he believes will boost the quality of the scientific content on Wikipedia (quoted in Butler’s piece).

It’s symptomatic that this initiative is taken by a science journal. Wikipedia has quickly been adopted by scientists of all categories, while humanities and social science scholars are so far more reluctant. Hopefully this will change soon. I bet at least one humanities journal will adopt a similar policy before the end of 2009.

When I was a kid I loved to play board games of all kinds (and hated to lose). But I don’t think I ever encountered any medical games. Turns out there are quite a few of them, however, some of which are probably best described as educational games.

Operation (1965) is a battery-operated game for kids from age 6 and older. In Medical Monopoly (1979) you play a doctor running a hospital, and if you are skilled at diagnostics and spending your funds wisely on acquiring the right kinds of drugs, organs for transplants, etc., you’ll get more patients.

What’s peculiar about Medical Monopoly — a game which allegedly is used by some school districts in the US to teach health care — is that the winner is the player who first fills the hospital with patients. Common sense would give credit to the player who first empties the hospital. But maybe the game only reflects medical hospital profit system business as usual, in which case it’s a pretty realistic training ground for living in the US.

Then I just found out (thanks to Jessica for the tip) about yet another medical educational board game. Contrary to most games Pandemic isn’t competetive, but co-operative. The players are supposed to help each other control outbreaks of diseases around the world and search for cures against them. If you play badly and don’t co-operate well, the diseases will win!

Jessica believes Pandemic could be used for serious educational purposes because it “does a really nice job of challenging players to effectively distribute resources and minimize losses in an unpredictable milieu”:

Players end up debating various tactics and strategies several turns in advance: for example, is it better to dispatch your scientist to a relatively remote but heavily infected area to prevent an imminent outbreak, or have her stay close to a research station to effect a cure? It all depends, since the game has mechanisms built in to keep things unpredictable while mimicking how epidemics of infectious disease can rapidly build on themselves and spiral out of control. Just as in real life, you’ll lose pretty quickly if you try to treat every single infection - you have to choose your battles and concentrate on long-term damage management. Because of that, I found myself wondering whether the game would work in a high school or college course dealing with public health policy, and decided it might - except it’s almost too difficult! (But then, so is public health policy).

Maybe it’s not advanced enough for students at the public health programme here at the University of Copenhagen — but on the other hand designing a more advanced epidemiological board game would be an excellent topic for a Bachelor’s thesis in public health.

Just a note about the new YouTube channel, which showcases videos created for the British Medical Journal (BMJ), one of the most influential and widely read general medical journals in the world. The channel is only three weeks old and the number of videos isn’t overwhelming yet (some interviews, mainly with leading experts on public health issues, like health equity and antibiotic resistance). But the channel could develop into an important progressive and semi-independent NGO-voice (it’s owned by the British Medical Association) on global health issues. So I’m vaguely positive. Wish DADL (the Danish Medical Association) could do something similar.

Mike Rhode’s post (on A Repository) about a nice little medical exhibit in the local history museum in Cookeville, Tennessee (see his many pictures here) reminds me about how many local museums around the world that have medical collections.

Mike’s post also makes me think about the kind of dilemma that the digital information society afflicts upon us.

On the one hand, it would be great to have online access to all medical collections and museums around the world, with links, of course, to Google Maps, loads of visitors’ pictures on Flickr and movies on YouTube, etc.. So that when I’m travelling I’m always prepared in advance for what there is to see.

But on the other hand, I would hate not to be able to be genuinely surprised now and then (like Mike was when he found this exhibit while visiting his inlaws). I mean, what’s the fun of being a medical museum tourist if you have seen everything online beforehand? I guess one can be surprised online and then get the experience confirmed IRL — but I prefer being surprised IRL. For example, in March I’m going to Navarra for a lecture, and I really don’t want to know if there is a medical museum in town — I prefer to be positively surprised when I’m there.

This must be a growing dilemma in the googlefied information society. Online reviews of restaurants take some of the joy of being genuinely surprised away, and so forth. Does someone know about a good analysis of this dilemma? Alex?

From all of us to all of you — we’re taking a few days off to enjoy a research-, exhibition-, acquisition- and blog-free zone.

As an icon of the Xmas season, we couldn’t resist bringing this pic:

Taken from Moist Production’s poster “Immaculate Confection”:

(thanks to Vanessa, Street Anatomy, for the tip)

I’m fascinated by how often scholars of science studies reinvent the wheel — because they are ignorant of other approaches to science than their own myopic perspective.

For example, I just stumbled over an otherwise excellent article — “Counting Corncrakes: The Affective Science of the UK Corncrake Census”, Social Studies of Science, vol 38, 377-405, 2008 — in which Jamie Lorimer, a postdoc at the Oxford University Centre for the Environment, discusses how emotions play a role in scientific work.

Lorimer observed, during his field work, how surveyors, researchers and their study objects were linked in a way that triggered “a variety of emotional responses among surveyors and researchers”. These “complex and multi-faceted” emotions, Lorimer suggests, provide “the vital motivations” that compel investigators to their work. And continues:

Although social studies of the field and laboratory sciences are beginning to concern themselves with the body, they have not yet fully engaged with the role of emotion in scientific practice. In Latour’s famous account of his trip to Boa Vista, for example, we hear little about what he and his research subjects were feeling at the time, what they enjoyed about their work and what they found frustrating. Perhaps this general reluctance to discuss emotion is a hangover from the radical symmetry and anti-ontological stance advocated by early actor-network theory, which effaced the specific skills and feelings of humans (Lorimer 2008, p. 398).

What Lorimer says, is that the community of actor network theorists (ANTs), headed by Bruno Latour (a follower of Michel Serres), have effaced the emotional dimension of scientific work. And that he is now filling out this lacuna by introducing affect into science studies:

This paper has shown that affect plays a vital role in motivating field scientists, many of whom work long hours in challenging conditions for little material reward. They do it because they enjoy it; in Massumi’s (1996) terms affect provides the ‘vital glue’ that impels these human–corncrake interactions … it is likely that there is a clear topography of fun, awe or intellectual challenge that can be had in the field (Lorimer 2008, p. 398).

Well, the importance of affect may be new to some students of science studies. But the rest of us, especially we who read and write biographies and autobiographies of scientists, have known this for — yes, centuries! In fact, a focus on the affective dimension of science is one of the defining traits of the genre of scientific biography.

Lorimer’s article illustrate one of the dangers of intellectual movements like ANT — they form cognitively closed communities that become so absorbed in their own terminology that they don’t realize that there exist other analytical approaches to the world. And when they find lacunas in the construct they believe they have found out someting new. We may expect to see many post-ANT scholars reinventing lots of wheels in the years to come.

I’ve just learnt about a new interesting project called Material Beliefs, which takes emerging biomedical and cybernetic technology out of the laboratories and into public spaces. 

Material Beliefs focuses on technologies that blur the boundaries between the body and materials. They are also interested in how design can be used to stimulate discussion about the value of body-material hybridity. Rather than focusing on the outcomes of science and technology, they wisely see them as unfinished and ongoing practices.

Sounds like a project that we might be able to learn from.

Material Beliefs is based in the Department of Design at Goldsmiths (University of London) and is funded by the Engineering and Physical Sciences Research Council in the UK. See much more on their integrated website/blog here.

This week our museum staff is closing down the temporary exhibition ’Oldetopia‘, which opened back in October 2007 (14 month is a long time for a temporary show).

All the artifacts will be handed back — either to our own storage facilities or to our generous lenders. For example, a set of delicate surgical knives and other equipment that we used to show aesthetic surgery are carefully packed to be sent back to the plastic surgery clinic at the National Hospital here in Copenhagen.

Below, our conservator Nicole Rehné walks away with some stuffed poultry, the (animal) remains (no living animals were harmed in the exhibition!) of the pioneering endocrinological experiments performed by Danish medical doctor Knud Sand in the 1930s.

We intend to keep the stuffed ones in storage and are not at all thinking of repatriating them to the indigenous fowl population in the South East Asian jungles :-)

The wall texts are scraped off. They looked good — but it’s hard work to remove them without destroying the underlying wall-paper (many grateful thanks to the designer who kept the wall texts short). Here Sven Erik Hansen, our in-house physician and guest researcher, removes letters — first the consonants, then the vowels. While our administrator, Carsten, concentrates on the headlines:

Soon the next temporary exhibition will fill the ground level show rooms. From Wednesday 21 January and three months on you can see Design4Science. More about that later. 

(thanks, Bente, for letting me use the Danish original on Museionblog)

Just a comment triggered by the announcement for the 3rd annual graduate student conference at the Department of Comparative Literature, Stanford University, 10-11 April 2009 on the theme avatars, personae, heteronyms and pseudonyms.

The organisers take the Sanskrit word avatāra as their point of departure (in Hindu theology, an avatar is a deity that descends into a lower realm, i.e., what Xians call an incarnation): ”How do we make ourselves visible, or readable, to the world at large? How do we portray or define ourselves­ to ourselves?”:

The virtualization of certain areas of our societies has provided new fora for experimenting with and reflecting on the images we construct and project, the personae we mimic and adopt, and the ways in which we interact with each other. That said, virtual culture may merely highlight issues that have emerged in different forms through visual art and literature both transnationally and transtemporally: for example, the use of gender-altering pseudonyms as a method of alternative self- representation; the adoption of myriad personae as a tool in artistic creation and performance; and the veneration of icons both religious and social.

Accordingly, the conference is proposed to deal with “the various descents, ascents, descendants and ascendancies of the avatar, as well as the various representational iterations of alternate or constructed personae, such as pseudonyms”, i.e. papers might include topics like:

• oracles and prophets
• icons as objects, icons as people
• masks
• poetic personae
• literary hoaxes; invented authors and their reception
• ghostwriters
• female writers with male pseudonyms and vice versa
• gender, performance, corporeality, drag, self-portraiture
• digital personae; dystopic/utopic movement toward the virtual
• archetypes (Jungian, etc.)
• “personality” or celebrity self-construction, “avatars” of human ideals, cultural “icon” worship, public personae and the culture of self-representation
• orality vs. textuality; textual history & hermeneutics
• hiding/obscuring vs. highlighting/exaggerating

For some reason it all reminds my of Richard Satava’s late 1990s notion of ‘medical avatar’. Satava — who had been in charge of the US Defense Advanced Research Project Agency’s (DARPA) combat care program and later their telemedicine project — had a vision of a multi-dimensional 3D-scanner representation of the whole body, which recorded all possible kinds of patient data — brain waves, blood flow, heartbeat, inner organ structure etc. — in real time:

The patient will walk through a doorway, like the security scanner at an airport, and we will get all the information we need from a true suspended hologram. You can actually feel the beat of the floating heart even though nothing is there

Forget about bloodless avatars in Second Life; Satava’s ‘medical avatar’ was a bloody realistic avatar. The head above (made by Alexander Tsiaras, founder and CEO of AnatomicalTravelogue) is taken from a critical paper by Claudia Reiche where it is accompanied by a quote from Satava:

What you are looking at here is bits and bytes. Zeros and ones. But it’s also a living, breathing, caring human being. This may well be a way to introduce the future to you.

Would be interesting to see if somebody will use the occasion of the Stanford meeting to follow the notion of ‘medical avatar’ through the last ten years of multidimensional medical imaging literature. If so, send an 500 words abstract to avatarsconference@gmail.com by 10 January.

The recently founded Nordic Network of Medical History (chaired by Astri Andresen in Bergen) is organising a three-day postgrad course on “Power, policies and health” (3 ects points), 11-14 May 2009, at the University of Copenhagen. The aim is to present

some theoretical and methodological approaches to the study of power and policies in the field of health, namely power studies (how to study the exercise of power and the processes of problematisation), relations between research and policymaking (when and how does research and policymaking interact), the anthropology of policy (analyses of how policy discourses ‘work’). Two methodological and design approaches are presented oral history as a means to study policy processes and comparative studies of health policies. Focus is on recent history.

PhD-students with different disciplinary backgrounds are invited to register. The number of participants is limited to 20. An important part of the course is discussion of participants’ projects (participants are supposed to submit short texts before the course begins). There is no course fee, and each participant will get a 800 DKK bursary per day to cover food and accommodation (but you’ll have to pay for travel). Faculty includes Virginia Berridge, Centre for History in Public Health, London School of Hygiene and Tropical Medicine; Susan Wright, Danish School of Education, University of Aarhus; and Signild Vallgårda, Department of Public Health, University of Copenhagen. Registration with Susanne Fray, s.fray@pubhealth.ku.dk. Further info here, or from Signild Vallgårda, s.vallgarda@pubhealth.ku.dk.

Two quotes from yesterday’s online media caught my interest as a historian of contemporary biomedicine:

First from an interview in yesterday’s Nature online with former Director of the National Institutes of Health (NIH), Elias Zerhouni:

The economic stimulus package is $500 billion, with $1 billion for science. It’s outrageous. This is the future of our country. So now we’re subsidizing the industries of the past at the expense of investments in the industries of the future. It’s almost an insult, frankly.

Second from a post on yesterday’s Medgadget about a European Union (EU) funded project that aims to develop a microchip that can do DNA analysis for clinical applications:

This is one of the examples of pan-European cooperation that we constantly see over the wires, that never seem to make it past EU’s bureaucratic directives … It seems to us that an average 10 person startup from Silicon Valley tends to deliver results better than multinational projects run by Brussels.

Both quotes remind me how direly we need historical studies of the long-term interaction between medical science/tech development and economic policy.

A History of Genetics Day will take place at the John Innes Centre, Norwich (UK) on 9 September 2009. An international line-up of historians of science will speak, including

• Robert Olby: William Bateson and the establishment of the John Innes Horticultural Institution
• Marsha Richmond: Institutionalizing Mendelism: Women in the John Innes Workforce
• Donald Forsdyke: William Bateson’s contributions to evolutionary theory
• Ted Porter: Biometry and the question of blending inheritance
• Oren Harman: Evolutionary chromosomes: C. D. Darlington and Cytogenetics
• Jenny Marie: Genetics in 1930s Britain: a context for genetics at the John Innes Horticultural Institution and the Plant Breeding Institute
• Soraya de Chadarevian: Genetics in the atomic age
• Mike Gale: From Plant Breeding Institute to Crop Genetics
• Keith Chater: Focus and diversity in the history of bacterial genetics
• Sabina Leonelli: Arabidopsis, the botanical Drosophila: from thale cress to model organism

The conference will be accompanied by a historical exhibition drawing on the John Innes Foundation Historical Collections. More info here.

In his most recent exhibition, French artist Christian Boltanski has set up a small recording studio where visitors can donate their heartbeats to the vast archive of the heart that the artist is currently building. Ultimately, the collection of heartbeats is to be stored on the uninhabited island of Ejima in Japan, which belongs to the art centre Benesse Art Site Naoshima.
There, it will be possible to access for anyone who feels the urge to listen to the heart of a beloved deceased, that is to say if the person in question was a donor, or simply contemplate over fugitive life. In more than one sense, Les archives du coeur is a continuation of Boltanski’s by now lifelong exploration of the ephemerality of human existence, or what the artist calls “small memories” as opposed to the kind of memories that make up our common historical references. The theme of irreversible loss, fading remembrance and eternal oblivion, which pervades works such as the The Children of Dijon (1986) and The Dead Swiss (1990) – see image below - is once again addressed here.

Those familiar with Boltanski’s work will also recognise his use of photographic portraits and naked light bulbs, albeit this time they’re not combined. Instead the portraits are sampled into one big projection, which shows fragments of faces shifting in furious speed. The light bulb in its turn, throws its swaying dim light over a dark room with nothing else in it except for the vigorous throbbing of a pulsating heart. What attracts most attention however is undeniably the possibility of donating one’s heartbeat to the archival record. This is carried out in a special room that is made to resemble a consulting office.

A white-coated “clinician” instructs you about the procedure, and after giving your informed consent the recording can take place, earphones on your head and stethoscope to your heart. Because it deals with a culturally emblematic organ as the heart, Les archives du coeur poses questions about contemporary biomedical archives, biobanks and databases in an oblique way. Can I be sure that my heartbeat will stay on Ejima and not be used in new inconceivable artforms? The exhibition is on until the 14th of December at Magasin 3 in Stockholm.

Here’s an interesting opportunity for bloggers specializing in medical and health communication. The NIH Office of Medical Applications of Research is organizing a three-day course on ”Medicine in the Media: The Challenge of Reporting on Medical Research“ in Bethesda next June — free registration, meals and lodging are provided (but you have to pay for your travel). There are only 50 spots and competition for these courses use to be formidable. Course agenda here, application form here. Deadline is 30 January!

(thanks to Jessica for the tip)