Following the people and events that make up the research community at Duke

Author: Zella Hanson

“News for the Rich, White, and Blue”: Nikki Usher on her new book and the state of American journalism

Sticky post
Erik Carter

News organizations are facing an economic crisis

In their battle for survival, they are “realigning their priorities in ways that favor audiences who are willing to pay.” And those who are willing to pay tend to be rich, white, and politically blue.

On November 3, as part of the DeWitt Wallace Center’s Fall 2021 Information Inequalities Speaker Series, author and University of Illinois associate professor Nikki Usher discussed her new book News for the Rich, White, and Blue: How Place and Power Distort American Journalism.

Usher began by explaining that as newspapers face “market failure,” only non-geographical news is in a position to survive. As news becomes a private good (The Washington Post, The Atlantic, and The New York Times come to mind), the result is inconsistent and unequal access to news. 

According to Usher, 1800 local communities lack any regular access to local news. Usher stated that political consequences result when news organizations pull back from places that don’t exhibit that aforementioned willingness to pay. 

She gave an example of one such consequence: many journalists had their “heads in the sand” about the rising tides of populism in rural America. As a result, they were blindsided when Trump won the election. But the win simply revealed what had been the case all along. 

The New York Times editor Dean Baquet acknowledged this after the election: “We’ve got to do a much better job of being on the road, out in the country… and remind ourselves that New York is not the real world.”

Usher said that another consequence of the delocalization of news is reduced trust: only 11% of Republicans say they trust the media a great deal or a fair amount. Additionally, when places lose news, they grow more polarized, with reductions in split-ticket voting. 

Usher said that she practices a kind of “gestalt scholarship,” employing the tools of ethnography and lived experience as well as quantitative data. She dipped into this side of her research, recounting a few anecdotes which represent the “materiality” of the loss of local news.

In 2018, the LA Times moved from its Downtown home, near Skid Row, to El Segundo. The move was not without controversy. In a 2018 editorial, an anonymous author wrote that “location matters, on both a physical and symbolic level, and… moving the headquarters far away from the local power base and the most important entities and stories the Times covers… is the wrong choice.” 

The Miami Herald’s old home got demolished in 2015. Now the newsroom is near the airport, across from a cow pasture. “It’s bad for the psyche for there to be no building to exist for people to see every day,” said an editor. (A recent bit of unnerving news regarding the future of the Herald and journalism at large.)

Usher then stated that newsrooms are “places of power” that are becoming “increasingly inhospitable places for those who are non-white and who lack financial resources.” 

In June 2020, The Philadelphia Inquirer’s top editor resigned after the publication of an article with the headline “Buildings Matter, Too,” led to a walkout by dozens of staff members. At the LA Times, Latinx journalists penned an open letter drawing attention to the fact that its 13% Latinx newsroom does not reflect its nearly 50% Latinx community. In Detroit, the disparity is even worse: an 80% Black population is served by a newsroom that is only 14% Black. 

In 1968, the Kerner Commission put down a series of recommendations to improve diversity, noting that the journalistic profession was “shockingly backward” in its absence of Black journalists. The American Society of News Editors set a target date for newsrooms to be at parity with the populations they represented: 2000. They’ve since pushed the deadline to 2025. 

It’s not looking good. That’s because, according to Usher, newsrooms aren’t hiring, and “when newsrooms don’t hire, they don’t hire minority journalists.”

Usher also touched on the “death of the working class reporter.” Increasingly, the only young people who are not deterred by journalism’s instability and lack of lucrativity are those who come from copious amounts of privilege. Add this to the inability of poorer students to pursue resume-building journalism activities alongside work-study jobs, and the preference of news outlets for the oft-wealthy students of elite universities, and one can see why “journalism is becoming a profession for the elite.” 

Usher said that when “newsrooms become bastions of privilege, [that’s] bad news.” Losing journalists who come from blue-collar backgrounds means losing the ability to “empathize” with a whole set of experiences.

Usher said that as news revenue goes increasingly digital, reliance on those willing to pay is even more pronounced, with “consequences for equity in access and geographically specific news coverage.” She referenced The New York Times, whose rise “mirrors the rise in inequality” of access to news. “They know they’re leaving people behind,” Usher said. She quoted Dean Baquet, who acknowledged that 98% of Americans “were now excluded from The New York Times’ journalism and might well have to do with substandard information.”

Usher also discussed “Goldilock newspapers” — not too big, not too small, but just right for survival according to the “upside-down logic” of digital advertising. The problem is that, as Mike Wilson of the Dallas Morning News put it, “the pursuit of digital subscriptions has honed our focus on what we’re covering” — sometimes to the detriment of local readers. As a result of this phenomenon, Usher has seen reduced coverage in places considered too low-income to get advertisers. In one instance, she saw a dismissal of concerns about ad- and malware clunking up the computers of those with inferior Internet access because “those people are less likely to subscribe anyway.” 

Where does this leave us? Usher identified a few potential solutions. She reiterated calls for more inclusive newsrooms, and added her own call for higher-ed financial aid reform so that lower-income students can have a fighting chance at pursuing journalism. She discussed the need for a “post newspaper consciousness” — to acknowledge that we cannot save the newspaper, but we can identify what journalism does best and save those “special parts.” 

She left the audience with a final recommendation: journalism should “embrace the partisan media system.” Usher clarified her position: the news media like The New York Times “hides behind a veil of neutrality,” when this is only an (unconvincing) illusion. “People want to see them advocate for social justice,” she said, and she agrees. Usher doesn’t think polarization is inherently bad “if it’s polarization toward social justice and breaking down systemic inequality.”

“There’s no use assuaging people who have given up and aren’t listening. And then you have lots of people unsubscribing because the phony neutrality was irritating them,” Usher said. For organizations like the Times, the veil of neutrality is looking like a lose-lose.

She advised them to “go for those who are still listening. And just own it.”

Post by Zella Hanson

School Segregation & Culture War: Color of Education 2021

Mary Hassdyk

Perhaps you’ve heard of the 1619 Project. A Pulitzer Prize-winning New York Times journalism project which sought to place “the consequences of slavery and the contributions of Black Americans at the very center of our national narrative,” the project has been controversial and is thought to have sparked the current debate over critical race theory in the classroom.

Its creator, Nikole Hannah-Jones, spoke at the Color of Education virtual summit on October 26. She discussed her journalistic research on systemic racial inequities in the education system, as well as the 1619 Project and the struggle over teaching race in the classroom.

Nikole Hannah-Jones

Hannah-Jones defined the public school as an “intimate place” where young members of society come together to “exchange ideas and culture, meeting across class and race.” The public school serves to create community, which, she stressed, is necessary for a healthy democracy. “A sense of community prevents polarization,” she said. “I know that a person who’s different from me still wants, fundamentally, the same things.” That gives us more of an opportunity to solve political problems without hostility. 

Instead, she often sees “segregated” low-income mostly-Black schools and “integrated” mostly-white schools, separated by a disturbing chasm of resources and opportunity. (She’s written about this in several Times pieces.) She remarked that “this bifurcation doesn’t serve our democracy and it doesn’t serve humanity.”

But that’s been a problem since before Brown v. Board of Education. What’s changed in the last few years, according to Hannah-Jones, is that in the wake of last year’s Black Lives Matter protests, there is now a “culture war” being waged over critical race theory. 

Critical race theory is an academic framework that examines the intersection of race with law and public policy. The theory is controversial: many fear the fundamental critique of the US legal and economic system that the theory ultimately implies. (In 2020, whereas white conservatives and more moderate liberals tended to blame fatal incidents of police brutality on “a few bad apples,” the viewpoint consistent with critical race theory is that “the problem is the barrel and the systems that produce it.”)

Laws banning the teaching of critical race theory have already been passed or are in the works in several states, including here in North Carolina, where Governor Roy Cooper recently vetoed a bill which sought to regulate the teaching of several race-related concepts, including whether “a meritocracy is inherently racist or sexist.”

There’s also historical revisionism, known pejoratively as ‘revisionist history’: the reinterpretation of orthodox views surrounding historical events, or, according to fellow Times contributor and historian Timothy Snyder, “the parts of history that challenge leaders’ sense of righteousness or make their supporters uncomfortable.” (Snyder says that in the US, “the ‘revisionists’ are people who write about race.”) 

Critical race theory ultimately requires some revisionism — to critically examine the intersection of race with the laws and policy of the current moment, we must critically examine how we got here, and that means taking another look at the US’ legal history, war history, even its history of infrastructure. Critical race theory is usually taught in college humanities classes. (Kimberlé Crenshaw coined the term in the 1980s, and her work is decidedly college level — I’ve read her here at Duke, but certainly not before.) But because critical race theory and revisionism are linked, it’s come to pass that any K-12 effort to teach about how racism has informed US history now gets labeled as “critical race theory” by adversaries of these efforts. 

Critical race theory has become a buzzword — and in many circles, it’s a bad word. These days, if a parent thinks you’re teaching critical race theory, you might soon find yourself without a job. (The summit required a passcode and was not recorded for fear that educators participating might be “outed as believers” in critical race theory and subsequently maligned.)

Along with educators in the Zoom comments, Hannah-Jones discussed this problem: teachers are getting accused of teaching “critical race theory”; the term is being used as a weapon and to imply wrongdoing; and it seems that parents, legislators, and even some educators don’t know what it actually means. 

Hannah-Jones asserted that this is “how propaganda works.” The term “critical race theory” is being used to produce fear and automatic condemnation, which distracts from the content of the theory and shuts down further (more rational) conversation. Hannah-Jones gave some advice to educators: “When a parent says, ‘I do not want my child to learn critical race theory,’ Ask them what they think that it is. They don’t know. And then you get to say, ‘Well, no, that’s history. Well, no, that’s anti-slavery.’ You get the point.”

Hannah-Jones explained that “as educators, you have to have these conversations with people.” Parents don’t necessarily know what their children are learning in school — and that can be a source of anxiety. So when “bad-faith actors are fear mongering, saying ‘Don’t you know what terrible things your kids are learning?’” it’s all too easy for parents to become distraught and distrust their child’s teacher.

Moving to discussing other issues in education, Hannah-Jones emphasized that schools are generationally deprived of resources, which is a problem that “can’t be fixed overnight.” She’s seen parents trying to advocate for their children and failing because they lack proximity to social, political, or legal power. “Maybe they can’t come to PTA because they’re a single mother, or they work at Popeyes — they get dismissed,” she said. “There’s no meeting with the superintendent. They can’t call the media in.” And when power dictates one’s ability to make change, the generational deprivation of resources can only continue.

Jayden Grant, a senior at Falls Lake Academy, asked Hannah-Jones how to ensure that these issues are addressed on the level of charter and private schools, which aren’t governed by the same policies. 

Hannah-Jones replied that she is fundamentally opposed to charter and private schools, viewing them as “undemocratic by design.” As such, “holding them accountable” is only possible through public advocacy, namely through the media. Students have the strongest voice, she told Jayden. They’re the reason these schools exist in the first place; it’s up to them to challenge policies or actions they see as unfair and make the public aware. 

On that note, Hannah-Jones brought the conversation back to the question of which version of our collective past will be taught in the K-12 classroom. Hannah-Jones said that based on the feedback she’s gotten and conversations she’s had, the 1619 project has inspired kids. It’s made them excited about history and learning in general. She denounced the neoliberal “privatization and commodification of education,” stating that often, parents wrongly view themselves as consumers. “We need to center kids in these discussions,” she said.

Hannah-Jones wrapped up the discussion with a call to action. She told the audience to “get angry” that authors like Ruby Bridges and Toni Morrison are being blacklisted, because “that is the same kind of thinking that’s led to the inequality we see now.” She claimed that “people wouldn’t be freaking out about the 1619 Project if it wasn’t having an effect,” but the Project is making waves, because “those who control the stories about who we are control the culture.” And the culture Hannah-Jones wants to see is one which sees the “least of us as just as deserving as anyone else.”

Professor Emeritus at UNC Harry Amana had the last word, saying that one cannot be an educator without being an optimist. That’s because, as an educator, you believe that “if people knew better, they would do better.” 

Maybe one day, we all will.

Post by Zella Hanson

Will the Humanities Save the World?

Lorenzo Gritti

The bad news about the energy transition, according to Dr. Matthew Huber, is that it’s not happening. At least, not at the scale we need it to. A June report stated that the share of fossil fuels in the world’s total energy mix is still about 80%, as it has been for several decades. “We still live in a system fueled by fossil fuels,” Huber said. 

Matthew Huber
Jennifer Wenzel

On October 18, Huber, author of Lifeblood: Oil, Freedom, and the Forces of Capital and a professor at Syracuse University, joined Dr. Imre Szeman, author of On Petrocultures: Globalization, Culture, and Energy and professor at the University of Waterloo, and Dr. Jennifer Wenzel, author of The Disposition of Nature: Environmental Crisis and World Literature and professor at Columbia University.

Moderated by Dr. Ranjana Khanna, professor and director of the John Hope Franklin Humanities Institute here at Duke, the panel discussion “What Can the Humanities Contribute to the Global Energy Transition?” explored the potential of humanities fields to help supplement perspectives offered by the sciences, teaching us about new ways of living for a greener world.

Imre Szeman

Khanna posed the titular question: what do the panelists think that the humanities have to contribute to the energy transition?

Huber responded that in dealing with climate disaster, the “critical issue of our time,” there’s a civic responsibility to engage with the “public and political struggle” for change.

Humanities scholars excel in the art of persuasion and argumentation, and they can use that in public forms, like the Op-Ed and social media. Whereas the public conversation is skewed towards economics and engineering, humanities scholars can emphasize the equally important political and cultural barriers toward the energy transition. 

Huber also called on history scholars to help recover the “deleted history” of what is politically possible.

“After four decades of neoliberalism we’ve forgotten what the public sector can actually do,” Huber said, “but when we remember the Soviet-style planned economy during World War II, and the New Deal, we recover that these large mass scale transformations have happened, and are possible,” Huber said. He also lamented that the social movements of today’s Left have become “atomized, neutralized, and largely ineffective” such that “students don’t believe in large-scale social change anymore.” With public history, activists can show how and why struggles of abolition have won in the past, and how that could be applied to the struggle for carbon abolition. 

As the Climate Critic in the Green Party of Canada’s Shadow Cabinet, Dr. Imre Szeman drafted the Green Party’s proposal for the energy transition. He says that upon seeing the recommendation to end all production of fossil fuels, journalists asked Szeman, “Is this realistic? Here? Now?” They seemed to view such a change as “impossible — even though they might want it.”

Szeman argued that whether climate solutions are considered ‘realistic’ isn’t so much a question of cost, but of “our ability to conceptualize another way of being in the world,” which is where humanities fields come into play. He then posed a series of questions, including “What do we love about our current habits and behaviors? Who is culpable for the carbon dioxide in the atmosphere? How did we get here, and what does this say about our ability to get somewhere else?” He said that the role of the humanities in the energy transition is to answer all of these questions — and to remind us of the need to ask them in the first place.

Wenzel agreed, explaining that energy humanities can help us examine the literary and cultural narratives that shape our experience. She explained that fossil fuels enable a “chain of ease” wherein the primary mode of thinking about fossil fuels in everyday life is not thinking at all. She discussed the oil inventory activity she does with her students, where they account for the ubiquitous significance of oil in their lives. We develop an “embodied attachment” to the things that oil makes possible — the smoothness of plastic, the speed of auto, the smell of a butane stove. This leads us to an “impasse: we know where we stand, but we’re unable or unwilling to take action at the scale we know we need to.” 

Wenzel explained that the oil inventory was actually invented by the oil industry with an insidious intention — to get consumers to consider the indispensability of petroleum products in their lives “to produce wonder and appreciation.” She showed the audience an Exxon commercial, in which scenes of vast, interconnected energy grids play across the screen as a soothing voice tell us, “you don’t need to think about the energy that makes our lives possible. Because we do.

Wenzel emphasized that the effect of rhetoric like Exxon’s is to “ensure passivity.” The lesson? When we take stock of the impact of oil on our lives, how we use that information matters most. Climate activists must reclaim the oil inventory to “disrupt habits of mind” rather than entrench them.

Khanna noted that one of the humanities’ core methods is a “revelatory gesture of critique,” and asked the panelists what they thought about “moving past that initial gesture, toward some broader consensus for change.” 

Wenzel said that doing the work of the oil inventory is powerful, but “not the last move.” We must make other moves, and in terms of thinking about what we might do otherwise, we must take care to be “forward thinking, but deeply, critically, historically informed.”

Huber said that we need to interrogate the “politics that attach oil to life,” because it’s a strategy of moving politics away from work, production, and who decides its conditions. Production today feels invisible — it’s offshore, outsourced — so that we fail to ask questions about who’s controlling it, and to what effect. He called upon the 1930s, when a “radical politics of production was on the table,” and said that climate-conscious humanities scholars need to work to recover this history.

Szeman had one “next move,” in the words of Wenzel: to realize that oil companies in the US are private, unlike in much of the rest of the world. “There’s a decision made very early on” about how and in what quantities oil is to be used — a decision that could be amenable to change.

Khanna opened the panel to questions. One audience member asked about how to advocate for an energy transition in light of the fact that capitalism is ultimately responsible for much of the status quo and the damage it has caused. How can humanities scholars critique the status quo without critiquing capitalism to the point of suspicion from would-be supporters?

Szeman emphasized the need for recognition that there are some things that one can do in the political sphere, and some things one can’t. Even though the Green Party falls squarely on the political left, “we don’t explicitly criticize capitalism right off the bat, because that doesn’t seem like the winning position.” It’s important to give voice to discussions about change “to the extent possible within the official political sphere.”

Wenzel told the audience about giving a talk on energy humanities at the Pipeline Safety Trust conference. She had to “stand in front of the oil industry” — regulators, landowners, executives — which meant “thinking about which values and assumptions to share.” By establishing credibility, she could “make conversations about this problem, which implicates all of us, possible” — despite their different perspectives.

Huber contended that when the enemy is as abstract as the quasi-global system of capitalism, it can “induce paralysis.” He’s “not sure we can absolish capitalism on the time scale” necessary for the energy transition. He quipped that the earth is not dying, it’s being killed, and “those who are killing it have names and addresses.” Those people are the target, he said — just as in the abolition of slavery, when the target of struggle was the slave owning class, another oligarchical power representing about 1% of the population. Although he supports a systemic critique of capitalism, right now “we need to be more concrete. These people have names and addresses,” he reiterated.

Another audience member asked about how to “break down the concepts of beauty and pleasure” that support the current oil regime.

Huber discussed the need for “low-carbon luxury” and an investment in open green space as part of any Green New Deal. Climate politics has often been about “shame, fear, guilt, sacrifice,” he said, and “we’re not going to win on that.” A beautiful, pleasurable vision of the future is what’s needed to win people over.

Wenzel identified the role of literature in “collecting and borrowing” ideas of beauty, arguing that beauty is always constructed. To those who view renewable energy, like wind and solar, as an eyesore, Wenzel posed the question: “Are oil spills ‘beautiful’?” (Take a glimpse.)

Someone asked a question about science fiction’s ability to “dream futures into being” — what should humanities scholars aspire to read and write? 

Wenzel said that there are many ways to think about the future, and that apocalyptic renditions of science fiction are essentially “practicing for possible bad futures.” Huber agreed, stating that apocalyptic visions can be galvanizing — but there must be a positive vision that wins people over (he pointed to AOC’s “Message From the Future”).

Szeman said that utopian narratives tend to say more about the viewpoint by which a fictional world is considered a utopia than a “prescriptive way to get there,” and suggested that humanities scholars interested in fiction might consider creating more of the latter.

Revolutionary ideas were discussed during the two hours, and panelists acknowledged that humanities fields can’t do all of this work alone. 

Wenzel told the audience about a discussion she had with an economist from the Energy Policy Center. She’d said, “we’re interested in the non-technological obstacles to transition and non-technological tools to foster public demand for these changes. We want to understand why people remain so attached to the world that fossil fuels have created.” The economist said, “Right. We call that demand-side management.”

The audience laughed, understanding the frustration that often results from the disparate methodologies of science and humanities fields. Wenzel said she “felt a bit deflated” — but also learned a word she could use in future collaborations with economists and policymakers. 

The humanities have many valuable contributions to the energy transition: recovering histories, disrupting the status quo, crafting new narratives. But what’s important right now is communicating this. Wenzel left us with an instruction: “We need to learn to build bridges across different disciplines.”

This event was organized by the Energy Humanities Working Group in partnership with the Duke University Energy Initiative, Nicholas Institute for Environmental Policy Solutions, and John Hope Franklin Humanities Institute. Duke students or faculty members can join the Energy Humanities Working Group by contacting Dr. Tom Cinq-Mars (tom.cinq.mars@duke.edu).

Post by Zella Hanson

Back in Action: HackDuke’s 2021 “Code for Good”

If you walked across Duke’s Engineering Quad between 9AM on Saturday, October 23rd, and 5PM on Sunday, October 24th, the scene might’ve looked like that of any other day: students gathered in small groups, working diligently.

But then you’d see the giant banner and realize something special was afoot. These students were participating in HackDuke’s “Code for Good,” one of the most eminent social good hackathons in the country.

Participants have to “build something, not just an idea,” said Anita Li, co-director of HackDuke. Working in teams, students develop software, hardware, or quantum solutions to problems in one of four tracks: inequality, health, education, and energy and environment.

Participants can win “track prizes,” where $2,400 in total donations are made in winners’ names ($300 for first, $200 for second, $100 for third) to charities doing work in that track. There are other prizes too. Sponsors, including Capital One, Accenture, and Microsoft give incentives: if participants incorporate their technology or use their database, they’re qualified to win that sponsor’s prize (gift cards, usually, or software worth hundreds of dollars).

This year, Duke’s department of Student Affairs sponsored the health track, in hopes that participants might come up with ideas that could help promote student wellness here at Duke. “It’s a great space for thinking about these issues,” Li said.

Li told me they had more than 1,000 registrations, though there’s always a little less turnout. HackDuke is open to all students and recent graduates, so that “you get to see these cool ideas from everywhere.”

Just under half of this year’s participants were from Duke, almost 10% hailed from UNC, and the rest were from other universities across the US and the world. 30 percent of participants were women — a significant increase from the last HackDuke covered by the Research Blog, in 2014. 

This year is “particularly interesting,” Li said, because of the hybrid model. Last year, everything was virtual. This year, about 300 (vaccinated) students attended in person, making HackDuke one of the few Major League Hacking events with an in-person component this year. With the hybrid model, talks, workshops, and demos are all livestreamed so that no one misses out.

Some social events also had online elements: you could zoom into the Bob Ross painting session as well as the open mic, which Li said quickly turned into karaoke night. The spicy ramen challenge was “a little harder over Zoom.”

I came across Sydney Wang and Ray Lennon, along with teammate Jean Rabideau, as they were building a web app called JamJar for the Education Track contest. In the app, students give real-time feedback to teachers about how well they’re understanding the material. There are three categories: engagement (you can rank your engagement along a scale from “mentally I’m in outer space” to “locked in), understanding (“where am I?” to “crystal clear”), and speed (“a glacial pace” to “TOO FAST!”). Student responses get compiled and graphed to show mean markers of understanding over time. 

Lennon said he’s participating because “this is the best way to learn: to be thrown in the fire and have to learn as you go.” Wang felt the same way. She’s new to coding, and feels like she’s learning a lot from Lennon.

Like Lennon and Wang, many participants see HackDuke as an opportunity to learn. There are technical workshops where participants can learn HTML and CSS. There are talks where speakers discuss working in the coding and social good sector. The CTO of change.org, Elaine Zhou, flew to Durham to speak to participants about her experience. So there’s a networking opportunity, too — participants can meet people like Zhou doing the work they want to do, and professors and company representatives who can help them on their journey to get there.

There were challenges. Staying hydrated was one: by Sunday morning, they’d gone through seven cases of water, 16 cases of soda, and three cases of red bull. “It takes a lot of liquids,” Li said. And then there’s sleep — or lack thereof. When Li was participating in her freshman year, she slept for about three hours. Many people pull all-nighters, but “nap sporadically everywhere,” Li said. “It’s like finals season, with everyone knocked out.” She saw a handful of guys sleeping on the floor in Fitzpatrick. She gave them bed pads. 

Li’s love for HackDuke is contagious. She loves to see participants focusing on social good and drawing on their awareness of what’s happening in the world. “People are thinking about things that are intense; they’re really worrying about issues facing certain communities,” Li said.

At HackDuke, people really are coding for good.

Post by Zella Hanson

Restoring the “Sacred Link”: Water Rights in Australia

(Jenny Evans/Getty Images)

For 223 years — ever since Britain established its first Australian colony in 1788 — indigenous Australians have exercised resistance to colonial plundering and exploitation. One thing colonizers have plundered and exploited is water — water that is “cultural, spiritual; water for our people, water for our country,” according to Tati Tati Elder Brendan Kennedy.

As part of the Fall 2021 Global Environmental Justice Speaker Series — part of a student-led Environmental Justice course here at Duke — on October 6th, Dr. Bruce Lindsay, the Senior Lawyer at Environmental Justice Australia (EJA), discussed indigenous water rights in Australia. 

Because the Australian constitution is “silent on key issues” of land and water use, throughout the 19th and 20th centuries, water use was regulated according to English riparian rights in conjunction with English common law. Under this colonial law, whoever owned the land on which water flowed had the right to that water. 

Dr. Lindsay argued that Australian law was designed according to the “gross fantasy of the empty continent.” Upon the premise that Aboriginals simply did not exist, colonizers proceeded accordingly — buying and selling land that was already occupied and under aboriginal custodianship. Because Aboriginals didn’t own land in a way recognized by the law, they were “marginalized and excluded” from decisions about water infrastructure and allocation “while degradation [went] on around them.”

Dr. Lindsay and the EJA work primarily with aboriginal communities and organizations in the Murray Darling Basin. The Murray Darling Basin is the largest river Basin in Australia, hosting 90% of the population, 70% of irrigated land, and providing 40% of agricultural production. A precious resource amidst Australia’s hot, semi-arid climate, the Basin has been the site of major conflicts over water since the early 19th century. 

The Murray Darling faces a problem called “over allocation,” which means that more entitlements for water use have been issued than can be sustained at their full value. By the 1990s and 2000s, over-extraction had led to drought and unprecedented water shortages, and the ecosystems supported by the Murray Darling Basin were “on the verge of ecological collapse.” The Australian government passed the Water Act of 2007 and the Basin Plan of 2012 to bring the Basin to a “healthier level” and “ensure that the Basin is managed in the national interest” as they saw fit. 

To highlight the tension between the Australian legal view and the Aboriginal view, Dr. Lindsay read the Aboriginal anthropologist Deborah Bird Rose’s definition of country. According to Australia’s indigenous people, country “gives and receives life… is lived in and lived with… is a proper noun… is a living entity with a yesterday, today and tomorrow with a consciousness, and a will toward life.” For Aboriginals, the flow of water should support this notion of cultural wellbeing and “genuine coexistence.” But according to Dr. Lindsay, Australian law (being a “pillar of the settler state”) does not currently provide for “life, ecosystem health, and spirit except for where it intersects with the utilitarian purpose.” Thus, Dr. Lindsay believes that the law needs a massive upheaval in order to be reconciled with the indigenous vision.

The EJA is currently working with Aboriginal communities on one such upheaval: the “cultural flows” concept of water management. Cultural flows necessitates reallocation and redistribution of water rights by the Australian government in order to increase Aboriginal control and authority over water. To restore life to country, reverse environmental catastrophe, and revitalize their economic health and culture, Aboriginals hold that there must be a change from the current model where water is understood as something to be continually exploited. Such a change is not without historical precedent: in New Zealand in 2017, the government granted the Whanganui River legal status as a living entity, so that New Zealand law now views harming the Whanganui tribe and harming the river as equivalent. 

Ultimately, the EJA hopes to implement the cultural flows framework across the Basin. They’re starting by working with the Tati Tati First Nations community to implement cultural flows in the Margooya Lagoon. Because this requires the Victorian government to deliver the rights to manage water there, the EJA must work with both Australian law and the Aboriginal view. Dr. Lindsay claimed that they don’t have to be mutually exclusive. The EJA seeks to find the intersection where water as a public good to be managed in the public interest can also be water managed for the good of country and the health of the community. Thus, the EJA aims to advocate for policy that enables that mutually beneficial outcome.

Dr. Lindsay ended by recalling his earlier point of reconciling Australian law with indigenous vision. He stated that a “broader set of changes” need to occur in order to really bring justice to Aboriginal communities. Although the Australian High Court’s passing of the Native Title Act of 1993 ostensibly ended riparian rights by recognizing “native title” (the aboriginal traditional ownership of land “according to their own laws and customs”), native title is a “limited device” as far as water rights. Indigenous Australians have native title rights over 30% of the Australian continent, but own only 0.01% of water entitlements. Because state governments have a large role in reallocation, cultural flows projects would have to proceed on a case-by-case basis.

What Dr. Lindsay really hopes to see is a legal mechanism other than native title that will grant legitimacy to aboriginal traditional ownership. He recalled the Uluru Statement from the Heart. It states:

“[Our] sovereignty… has never been ceded or extinguished. How could it be otherwise? That peoples possessed a land for sixty millennia and this sacred link disappears from world history in merely the last two hundred years?”

Uluru Statement from the heart


How could it be? Sadly, the fact that only 0.01% of water entitlements are owned by indigenous Australians indicates that the sacred link of traditional ownership has disappeared — at least in the legal sense. So this is the ultimate goal of Dr. Lindsay and the EJA’s work with indigenous communities: to restore this sacred link.

Post by Zella Hanson

Cemetery, Community, Classroom: Collaborating to Honor the Dead

Open Durham

The institutional neglect and indignity faced by many African Americans during and after the Jim Crow era in the South didn’t end when their lives did. In a panel hosted by the Duke Office of Durham & Community Affairs on Sept. 10, a community leader, Duke professor, and undergraduate student discussed some of the work they are doing to combat the marginalization of Durham’s deceased in Geer Cemetery, two miles from Duke’s campus. 

Debra Taylor Gonzalez-Garcia, President, Friends of Geer Cemetery

Founded on land purchased from Frederick and Polly Geer by John O’Daniel, Nelson Mitchell, and Willie Moore in 1877, Geer Cemetery is the final resting place for over 3000 of Durham’s African American citizens. As Maplewood Cemetery was segregated, from 1877 until the opening of Beechwood cemetery in 1924 Geer served as the only cemetery for the African American dead. Lacking public funding and under fire from the health department for overcrowding, Geer Cemetery closed in the 1930s and, in the absence of a plan for its continued upkeep, fell into a state of disrepair

President of Friends of Geer Cemetery Debra Taylor Gonzalez-Garcia provided a brief history of Geer Cemetery. 

The nonprofit Friends of Geer Cemetery was formed in 2003 by “concerned citizens and neighbors” and has worked to “restore the cemetery’s grounds and research its histories” under their mission statement “restore, reclaim, respect.” According to Gonzalez-Garcia, work consists of maintaining the cemetery grounds, repairing headstones, writing life stories, and advocating for recognition. 

Friends of Geer Cemetery has accomplished a lot in terms of restoration: in 2004 the cemetery was unrecognizable, with broken headstones, overgrowth, and sunken burials. Today, with the help of Keep Durham Beautiful, Preservation Durham, and other volunteers, the entire cemetery can now be easily viewed.

The organization also continues to work tirelessly toward their other objectives, reclamation and respect. By mining local records, research volunteers have created a database which includes approximately 1,651 burials, but efforts are ongoing. 

Gonzalez-Garcia expressed excitement about the organization receiving grant funding for an archaeological survey. “[The survey] will help us to map out burials, because currently, there is no map,” Gonzalez-Garcia said. “We aren’t sure where people are buried.” 

The community leader discussed how efforts to reclaim Geer Cemetery bring about questions that reckon with white supremacy in general. “We’re not told stories of the African Americans who built Durham,” Gonzalez-Garcia said. “Why do we know so much about Washington Duke, and nothing of Augustus Shepard? Why should Maplewood still exist and not Geer Cemetery?” 

Adam Rosenblatt

Associate Professor of the Practice in International Comparative Studies Adam Rosenblatt expressed his interest in how care for the dead is “bound up with human rights and social justice.” This interest is personal: he has his own graveless ancestors who disappeared in the Holocaust. He expressed his passion for educating others about “places of mourning in our midst” through “community-engaged” scholarship.

Along with Gonzalez-Garcia, Rosenblatt sponsored a Story+ program at Duke entitled Geer Cemetery: Labor, Dignity, and Practices of Freedom in an African American Burial Ground. With the help of sponsors and a graduate mentor, Duke undergraduates Nyrobi Manuel, Kerry Rork, and Huiyin Zhou researched the cemetery closely in order to “uncover the stories of ordinary citizens and add these stories back into the historic narrative about Geer.” The researchers produced three unique, interactive digital projects which will contribute to the Friends of Geer Cemetery’s online platform for education and outreach. 

Rosenblatt discussed one challenge the Story+ engaged with: What really constitutes a human subject? The IRB’s definition doesn’t include the dead; there’s no IRB protocols for researching the dead and their stories. Many archives disappear entirely, or are fragmented.

Nyrobi Manuel

Nyrobi Manuel, a Duke undergraduate, was one of Rosenblatt and Golzalez-Garcia’s mentees. Manuel took Rosenblatt’s course “Death, Burial, and Justice in the Americas” and says the course inspired her to dig deeper into African American death practices. Through the Story+, Manuel researched John C. Scarborough, who established the fifth-oldest Black-owned funeral home in the country. She produced a project entitled “Scarborough and Hargett Funeral Home: Dignified Death and Compassion in the Black Community.” 

Manuel discussed her findings. Many funeral directors became important figures in their community, and John C. Scarborough was no different. A philanthropist and important community member, he helped to establish Scarborough Nursery School, North Carolina’s oldest licensed nursery school.

What’s always drawn Gonzalez-Garcia to Geer Cemetery is its “quiet beauty” and sense of connection. Though her ancestors are buried in Virginia, where she’s from, Geer Cemetery seeks to tell stories of African Americans through “emancipation and reconstruction: throughout history.” Geer is special because it seeks to tell the story of her “blood relatives” while also celebrating the history of Durham, which, she said fondly, is “my community now.”

Introducing: The Duke Space Initiative

NASA

Engineers, medical students, ecologists, political scientists, ethicists, policymakers — come one, come all to the Duke Space Initiative (DSI), “the interdisciplinary home for all things space at Duke.”

At Duke Polis’ “Perspectives on Space: Introducing the Duke Space Initiative” on Sept. 9, DSI co-founder and undergraduate student Ritika Saligram introduced the initiative and moderated a discussion on the current landscape of space studies both at Duke and beyond.

William R. & Thomas L. Perkins Professor of Law Jonathan Wiener began by expressing his excitement in the amount of interest he’s observed in space at Duke. 

One of these interested students was Spencer Kaplan. Kaplan, an undergraduate student studying public policy, couldn’t attend Wiener’s Science & Society Dinner Dialogue about policy and risk in the settlement of Mars. Unwilling to miss the learning opportunity, Kaplan set up a one-on-one conversation with Wiener. One thing led to another: the two created a readings course on space law — Wiener hired Kaplan as a research assistant and they worked together to compile materials for the syllabus — then thought, “Why stop there?” 

Wiener and Kaplan, together with Chase Hamilton, Jory Weintraub, Tyler Felgenhauer, Dan Buckland, and Somia Youssef, created the Bass Connections project “Going to Mars: Science, Society, and Sustainability,” through which a highly interdisciplinary team of faculty and students discussed problems ranging from the science and technology of getting to Mars, to the social and political reality of living on another planet. 

The team produced a website, research papers, policy memos and recommendations, and a policy report for stakeholders including NASA and some prestigious actors in the private sector. According to Saligram, through their work, the team realized the need for a concerted “space for space” at Duke, and the DSI was born. The Initiative seeks to serve more immediately as a resource center for higher education on space, and eventually as the home of a space studies certificate program for undergraduates at Duke. 

Wiener sees space as an “opportunity to reflect on what we’ve learned from being on Earth” — to consider how we could avoid mistakes made here and “try to do better if we settle another planet.” He listed a few of the many problems that the Bass Connections examined. 

The economics of space exploration have changed: once, national governments funded space exploration; now, private companies like SpaceX, Blue Origin, and Virgin Galactic seek to run the show. Space debris, satellite and launch junk that could impair future launches, is the tragedy of the commons at work — in space. How would we resolve international disputes on other planets and avoid conflict, especially when settlements have different missions? Can we develop technology to ward off asteroids? What if we unintentionally brought microorganisms from one planet to another? How will we make the rules for the settlement of other planets?

These questions are vast — thereby reflecting the vastness of space, commented Saligram — and weren’t answerable within the hour. However, cutting edge research and thinking around them can be found on the Bass Connections’ website.

Earth and Climate Sciences Senior Lecturer Alexander Glass added to Wiener’s list of problems: “terraforming” — or creating a human habitat — on Mars. According to Glass, oxygen “isn’t a huge issue”: MOXIE can buzz Co2 with electricity to produce it. A greater concern is radiation. Without Earth’s magnetosphere, shielding of some sort will be necessary; it takes sixteen feet of rock to produce the same protection. Humans on Mars might have to live underground. 

Glass noted that although “we have the science to solve a lot of these problems, the science we’re lagging in is the human aspects of it: the psychological, of humanity living in conditions like isolation.” The engineering could be rock solid. But the mission “will fail because there will be a sociopath we couldn’t predict beforehand.”

Bass Connections project leader and PhD candidate in political science Somia Youssef discussed the need to examine deeply our laws, systems, and culture. Youssef emphasized that we humans have been on Earth for six million years. Like Wiener, she asked how we will “apply what we’ve learned to space” and what changes we should make. How, she mused, do prevailing ideas about humanity “transform in the confines, the harsh environment of space?” Youssef urged the balancing of unity with protection of the things that make us different, as well as consideration for voices that aren’t being represented.

Material Science Professor, Assistant Professor of Surgery, and NASA Human System Risk Manager Dr. Dan Buckland explained that automation has exciting potential in improving medical care in space. If robots can do the “most dangerous aspects” of mission medical care, humans won’t have to. Offloading onto “repeatable devices” will reduce the amount of accidents and medical capabilities needed in space. 

Multiple panelists also discussed the “false dichotomy” between spending resources on space and back home on Earth. Youssef pointed out that many innovations which have benefited (or will benefit) earthly humanity have come from the excitement and passion that comes from investing in space. Saligram stated that space is an “extension of the same social and policy issues as the ones we face on Earth, just in a different context.” This means that solutions we find in our attempt to settle Mars and explore the universe can be “reverse engineered” to help Earth-dwelling humans everywhere.

Saligram opened up the panel for discussion, and one guest asked Buckland how he ended up working for NASA. Buckland said his advice was to “be in rooms you’re not really supposed to be in, and eventually people will start thinking you’re supposed to be there.” 

Youssef echoed this view, expressing the need for diverse perspectives in space exploration. She’s most excited by all the people “who are interested in space, but don’t know if there’s enough space for them.”

If this sounds like you, check out the Duke Space Initiative. They’ve got space.

Post by Zella Hanson

Trust in Gynecology: The Impact of Race & Socioeconomic Status in Women’s Health

Nikki Mahendru’s mother didn’t go to the gynecologist for 45 years — and when she did, she regretted it. Ms. Mahendru felt “decades of anxieties and hesitancy reduced to five minutes of brisk interaction with her provider,” and left convinced that the “realm of women’s health was just not for her.” According to Nikki, a Duke University undergraduate, her mother’s “trust in the system was lost.” 

Mahendru joined Dr. Megan Huchko, the director of the Duke Center for Global Reproductive Health, and Dr. Chemtai Mungo, a Fogarty Global Health Fellow and OB-GYN doctor, on the Center for Global Women’s Health Technologies’ October 20 panel “Impact of Race and Socioeconomic Status in Women’s Health and Gynecology.” The panel was moderated by Ashley Deans and Alexandria Da Ponte.

Mahendru went on to detail an experience she had in the clinic with Carmen, a patient who spoke only Spanish and was also new to the gynecologist. The medical translator and Mahendru learned her story: she had been in pain for a year but had kept quiet due to money problems, had worked most of her life to send her kids to college, and was learning English via Rosetta Stone. With the details of Carmen’s story and an “equitable working relationship,” Mahendru and the translator could relay Carmen’s previous history to her provider. But Carmen’s provider knew only of her condition. 

Mahendru thinks gynecology done right has the potential to help women love their bodies and take care of their health, but gynecologists must earn the trust of their patients: “Acts of listening help bridge disparities.”

Dr. Huchko stated that throughout history, a male-dominated healthcare landscape saw the depiction of menses as ‘dirty,’ terms like ‘hysteria,’ and an overall lack of female control. The “father of gynecology” James Marion Sims exploited Black women in his development of the field, using unanesthetized slaves as subjects of experimentation. In general, Dr. Huchko sees a trend: “The lessening or decentering of women in women’s health corresponds to more discrimination.” In addition to the decentering of women, Dr. Huchko said that structural and individual factors “produce outcomes that prevent women from getting the care they need.” Like Mahendru, she identified trust as a central issue.

Dr. Megan Huchko, MD, MPH, is the director of the Duke Center for Global Reproductive Health

Dr. Huchko cited an experience in which she bore witness to the unattended consequences of racial bias in medicine. In Niger to repair women’s fistulas, which occur due to lack of postpartum care, Dr. Huchko felt she was attending to the downstream symptom of a much broader issue. She felt uncomfortable when the urogynecologist on her team ignorantly praised Sims without acknowledging his problematic history. Then, she saw this ignorance firsthand. 

Making a false assumption about the nature of the case, Dr. Huchko’s team chose to operate on a woman with a mass in her bladder. During the surgery, they realized the mass was a malignant tumor. With an unbiased eye and a complete exam and workup, this would have been clear. But because the team was looking at these women as “one-dimensional,” a woman with stage 4 cancer was subjected to a very invasive surgery that worsened her quality of life. 

Dr. Huchko experienced a similar lack of structural competency during her residency, where colleagues openly racially profiled people and overtly discussed disparities in pain tolerances among different ethnicities. Since then, “things have changed,” and she embraces this new culture of “being patient centered, exploring our own biases, and [having] zero tolerance for racial profiling.” She stresses the need for personal education and accountability alongside systemic change. Eventually, this will lead to women feeling “respected, seen, and heard.”

Coming to the US from Kenya, Dr. Mungo quickly came to appreciate the “sheer magnitude” of structural racism and its impact on health and healthcare. Dr. Mungo explained that “mutually reinforcing systems of disadvantage” for people of color, such as food deserts, are both the result and cause of healthcare disparities and result in enduring legacies of disadvantage.

Dr. Chemtai Mungo, MD, MPH, is a Fogarty Global Health Fellow and OB-GYN doctor

Dr. Mungo also observed that with healthcare in the US being so economically driven, the best care is often directed at those with racial and socioeconomic privilege. When she worked in a high resourced (read: white, wealthy) hospital, access to uterus-saving equipment such as interventional radiology meant that she only did one hysterectomy in four years. Doctors at the hospital also came in on weekends to get a person with cancer into the OR immediately.

Now, working with a “safety net hospital,” Dr. Mungo sees a stark difference. With non-existent interventional radiology and more part-time, “less invested” employees, Dr. Mungo has done three hysterectomies (for obstetric hemorrhage) in three years — a 75% increase — and sees patients with time-sensitive conditions wait much longer before surgery. This “separate and unequal access to resources” is a cause for concern. 

Dr. Mungo also stressed the need to make practices “safe places” for patients of color by increasing minority representation. Dr. Mungo explained that while Black physicians make up only 5% of doctors and 3% of faculty, there is strong evidence that patients who are cared for by someone of their own race or ethnicity have better outcomes. “We live in a racist society,” Dr. Mungo stated, “so we need specific anti-racist policies.” 

Dr. Mungo also acknowledged that healthcare providers work within “templates” like 15 minute appointments, and posed the closing question, how can we make patients feel safe and heard within the constraints of modern medicine? 

Answering questions from the audience, Dr. Mungo and Huchko discussed medical algorithms that are based on race, like the VBAC calculator and GFR. 

Dr. Mungo indicted these algorithms as “an example of how institutionalized some [racial] biases are.” There is “no concrete evidence” on why these corrections for race — which typically act to reduce the probability of success for a procedure or favorability of an outcome — exist. Dr. Mungo would urge providers “not to stop at, ‘well, African Americans have an increased risk of diabetes.’ Ask why. Have them explain food deserts… and structural and environmental racism.”

Dr. Huchko stated that giving aspirin throughout pregnancy reduces preeclampsia, and is thus traditionally offered based on risk factors for preeclampsia, like low socioeconomic status and African American race. Sometimes, healthcare providers may not be able to address these risks without the acknowledgement of race as a risk factor. Dr. Huchko is right, African American women are at a higher risk for preeclampsia, and ignoring this correlation would probably do more harm than good. 

But per Dr. Mungo’s appeal, providers must interrogate these associations more deeply — and be ever anti-racist in their efforts — if they are to create the safe spaces and trusting relationships that Mahendru, Dr. Huchko, and Dr. Mungo each hope to see.

By Zella Hanson

“Do No Harm to Whom?” Challenge Trials & COVID-19

DAVIDE BONAZZI / SALZMANART

Imagine: you wake on a chilly November morning, alarm blaring, for your 8:30 am class. You toss aside the blankets and grab your phone. Shutting the alarm off reveals a Washington Post notification. But this isn’t your standard election headline. You almost drop your phone in shock. It can’t be, you think. This is too good to be true. It’s not — a second later, you get a text from the SymMon app, notifying you of your upcoming appointment in the Bryan Center.

A vaccine for COVID-19 is finally available, and you’re getting one.

This scenario could be less far-fetched than one might think: the Centers for Disease Control and Prevention has told officials to prepare for a vaccine as soon as November 1st. To a country foundering due to the economic and social effects of COVID-19, this comes as incredible news — a bright spot on a bleak horizon. But to make a vaccine a reality, traditional phase 3 clinical trials may not be enough. What are challenge trials? Should they be used? What’s at stake, and what are the ethical implications of the path we choose?

At Duke Science and Society’s “Coronavirus Conversations: The Science and Ethics of Human Challenge Trials for COVID-19” on Aug. 24, Kim Krawiec of the Duke School of Law posed these and other questions to three experts in health.

Dr. Marc Lipsitch, Director of the Center for Communicable Disease Dynamics at the Harvard School of Public Health, began by comparing traditional phase 3 trials and challenge trials. 

In both kinds of trials, vaccines are tested for their “safety and ability to provoke an immune response” in phases 1 and 2. In phase 3 trials, large numbers (typically thousands or tens of thousands) of individuals are randomly assigned either the vaccine being tested or a placebo. Scientists observe how many vaccinated individuals become infected compared to participants who received a placebo. This information enables scientists to assess the efficacy — as well as rarer side effects — of the vaccine. 

Marc Lipsitch

In challenge trials, instead of random assignment, small numbers of low-risk individuals are deliberately infected in order to more directly study the efficacy of vaccine and treatment candidates. Though none are underway yet, the advocacy group 1Day Sooner has built a list of more than 35,000 volunteers willing to participate.

Dr. Cameron Wolfe, an Infectious Disease Specialist, Associate Professor of Medicine, and Clinical Expert In Respiratory and Infectious Disease at the Duke Medical School, provided an overview of the current vaccine landscape.

Cameron Wolfe

There are currently at least 150 potential vaccine candidates, from preclinical to approved stages of development. Two vaccines, developed by Russia’s Gamelaya Research Institute and China’s CanSinoBIO, have skipped phase 3, but are little more than an idiosyncrasy to Dr. Wolfe, as there is “minimal clarity about their safety and efficacy.” Three more vaccines of interest — Moderna’s mRNA vaccine, Pfizer’s mRNA vaccine, and Oxford and AstraZeneca’s adenovirus vaccine — are all in phase 3 trials with around 30,000 enrollees. Scientists will be watching for a “meaningful infection and a durable immune response.”

Dr. Nir Eyal, the Henry Rutgers Professor of Bioethics and Director of The Center for Population-Level Bioethics at Rutgers University, explained how challenge trials could fit into the vaccine roadmap.

According to Dr. Eyal, challenge trials would most likely be combined with phase 3 trials. One way this could look is the use of challenge trials to weed out vaccine candidates before undergoing more expensive phase 3 trials. Additionally, if phase 3 trials fail to produce meaningful results about efficacy, a challenge trial could be used to obtain information while still collecting safety data from the more comprehensive phase 3 trial.

Nir Eyal

Dr. Eyal emphasized the importance of challenge trials for expediting the arrival of the vaccine. According to his own calculations, getting a vaccine — and making it widely available — just one month sooner would avert the loss of 720,000 years of life and 40 million years of poverty, mostly concentrated in the developing world. (Dr. Eyal stressed that his estimate is extremely conservative as it neglects many factors, including loss of life from avoidance of child vaccines, cancer care, malaria treatment, etc.) Therefore, speed is of “great humanitarian value.”

Dr. Wolfe added that because phase 3 trials rely on a lot of transmission, if the US gets better at mitigating the virus, “the distinction between protective efficacy and simple placebo will take longer to see.” A challenge study, however, is “always a well defined time period… you can anticipate when you’ll get results.” 

The panelists then discussed the ethics of challenge trials in the absence of effective treatment — as Krawiec put it, “making people sick without knowing if we can make them better.”

Dr. Wolfe pointed to the flu, citing challenge trials that have been conducted even though current treatments are not uniformly effective (“tamiflu is no panacea”). He then conceded that the biggest challenge is not a lack of effective therapies, but the current inability to “say to a patient, ‘you will not have a severe outcome.’ It varies so much from person to person, I guess.” (See one troubling example of that variance.)

Dr. Eyal acknowledged the trouble of informed consent when the implications are scarcely known, but argued that “in extraordinary times, business as usual is no longer the standard.” He asserted that if people volunteer with full understanding of what they are committing to, there is no reason to assume they are less informed than when making other decisions where the outcome is as yet unknown. 

Dr. Lipsitch compared this to the military: “we are not cheating if we cannot provide a roadmap of future wars because they are not yet known to us.” Rather, we commend brave soldiers (and hope they come home safe). 

Furthermore, Dr. Eyal asserted that “informed consent is not a comprehensive understanding of the disease,” lest much of the epidemiological research from the 1970s be called into question too. Instead, volunteers should be considered informed as long as they comprehend questions like, “‘we can’t give you an exact figure yet; do you understand?’”

Agreeing, Dr. Wolfe stated that when critics of challenge trials ask, isn’t your mission to do no harm?, he asks, “Do no harm in regards to whom?” “Who is in front of you matters,” Dr. Wolfe confirmed, “that’s why we put up safeguards. But as clinicians it can be problematic [to stop there]. It’s not just about the patient, but to do no harm in regards to the broader community.”

The experts then discussed what they’d like to see in challenge trials.

Dr. Wolfe said he’d like to see challenge trials carried out with a focus on immunology components, side effect profiles, and a “barrage” of biological safety and health standards for hospitals and facilities. 

Dr. Eyal stated the need for exclusion criteria (young adults, perhaps age 20-25, with no risk factors), a “high high high” quality of informed consent ideally involving a third party, and access to therapies and critical care for all volunteers, even those without insurance. 

Dr. Lipsitch stressed the scientific importance of assessing participants from a “virological, not symptom bent.” He mused that the issue of viral inoculum was a thorny one — should scientists “titrate down” to where many participants won’t get infected and more volunteers will be needed overall? Or should scientists keep it concentrated, and contend with the increased risk? 

Like many questions pondered during the hour — from the ideal viral strain to use to the safest way to collect information about high risk patients — this one remained unanswered. 

So don’t mark November 1st on your calendar just yet. But if you do get that life-changing notification, there’s a chance you’ll have human challenge trials to thank.

Post By Zella Hanson

Vaping: Crisis or Lost Opportunity?

Wikimedia Commons

Whether you’re doing vape tricks for YouTube views or kicking yourself for not realizing that “USB” was actually your teenager’s Juul, you know vaping is all the rage right now. You probably also know that President Trump has called on the FDA to ban all flavored e-cigarettes to combat youth vaping. This comes in reaction to the mysterious lung illness that has affected 1,080 people to date. 18 of them have died.

At Duke Law School’s “Vaping: Crisis or Lost Opportunity” panel last Wednesday, three experts shared their views. 

Jed Rose, a professor of psychiatry and behavioral sciences and director of the Duke Center for Smoking Cessation, has worked in tobacco research since 1979, focusing on smoking cessation and helping pioneer the nicotine patch. Rose also directs Duke’s Center for Smoking Cessation.

According to Rose, e-cigarettes are more effective than traditional Nicotine Replacement Therapy (NRT). A recent study found that e-cigarettes were approximately twice as effective as the state-of-the-art NRT in getting smokers to quit combustible cigarettes (CCs). This makes sense because smokers are addicted to the action of puffing, so a smoking cessation tool that involves inhaling will be more successful than one that does not, like the patch.

Rose also took issue with the labeling of the current situation surrounding vaping as an “epidemic.” He called it a “crisis of exaggeration,” then contrasted the 18 deaths from vaping to the 450 annual deaths from Tylenol poisoning

Even in the “pessimistic scenario,” where e-cigarettes turn out to be far more harmful than expected, Rose said deaths are still averted by replacing cigarettes with e-cigarettes. 

The enemy, Rose argued, is “disease and death, not corporations”, like the infamous (and under-fire) Juul. 

James Davis, MD, an internal medicine physician and medical director for the Center for Smoking Cessation, works directly with patients who suffer from addiction. His research focuses on developing new drug treatments for smoking cessation. Davis also spearheads the Duke Smoke-Free Policy Initiative.

Davis began by calling for humility when using statistics regarding e-cigarette health impacts, as long-term data is obviously not yet available. 

Davis did present some known drawbacks of e-cigarettes, though, stating that e-cigarettes are similarly addictive compared to conventional cigarettes, and that a whopping 21% of high school students and 5% of middle school students use e-cigarettes. Davis also contended that “When you quit CCs with e-cigarettes, you are merely transferring your addiction to e-cigarettes. Eighty-two percent [of test subjects who used e-cigarettes for smoking cessation] were still using after a year.” 

However, according to Davis, there is a flipside. 

Similar to Rose, Davis looked to the “potential for harm reduction” — e-cigarettes’ morbidity is projected to be only 5-10% that of CCs. If the main priority is to get smokers off CC, Davis argues e-cigarettes are important: 30-35% of CC smokers say they would use an e-cigarette to quit smoking, where only 13% would use a nicotine patch. 

Furthermore, Davis questioned whether the mysterious lung disease is attributable to e-cigarettes themselves — a recent study found that 80% of a sample of afflicted subjects had used (often black-market) THC products as well.

Lauren Pacek, an assistant professor in psychiatry and behavioral sciences at Duke, examines smoking in the context of addiction and decision-making.

Pacek stated that flavored electronic nicotine delivery systems (ENDS) are important to youth: 61-95% of current youth ENDS users use flavored products, and 84% of young users say they would not use the products without flavors. So, banning flavored ENDS would ostensibly reduce young adults’ use, potentially keeping them off nicotine entirely.

However, Pacek pointed to the importance of flavors for adult users too: the ones that are purportedly using ENDS not for recreation or social status (as young people have been known to do), but for smoking cessation. Many former CC smokers report that flavored ENDS were important for their cessation. By banning flavored ENDS, the products look less appealing, and smokers are more likely to return to much more harmful cigarettes.  

So where do we go from here? 

Pacek did not take a concrete stance, but said her “take-home message” was that policymakers need to consider the impact of the ban on the non-target population, those earnest cigarette smokers looking to quit, or at least turn to a less harmful alternative. 

Rose also did not offer a way forward, but made clear that he does not support the FDA’s impending ban on flavored e-cigarettes and thinks the hysteria around vaping is mostly unfounded.

Davis did not suggest a course of action for the US, but as leader of Duke’s Smoke-Free Policy Initiative, he certainly suggested a course of action for Duke. The Initiative prohibits combustible forms of tobacco at Duke, but does not (yet) prohibit e-cigarettes. 

By Zella Hanson

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