TB, a bacterial lung disease, infected an estimated 8.7 million people in 2011, according to the most recent statistics from the World Health Organization (WHO). While inactive in the majority of those infected, the active form is transmitted through air. The disease is a leading infectious killer worldwide. Second only to HIV/AIDS, it kills one person every ten seconds. In those afflicted, it leads to severe weight loss, chronic coughing – often of blood-stained mucus – and destruction of lung tissues. Dr. Madhukar Pai, a leading McGill tuberculosis expert, explained that the disease is not only physically debilitating, but also accompanied by social stigma and a heavy economic burden.

Multi-drug-resistant TB (MDR-TB) encompasses strains of the bacteria that do not respond to two critical drugs used to treat TB, isoniazid and rifampicin. When an individual is infected with the drug-resistant bacteria, physicians have to resort to ‘second-line’ drugs for treatment, which, according to Pai, have many side effects, are more expensive, and are not readily available.

“The regular drug-sensitive TB requires a standard six month treatment, [and] it’s not inexpensive, like three days of antibiotics,” he explained. “[For MDR-TB] that treatment lasts two years…even if you give all of this stuff for two years, about 50 per cent of patients are dead.”

In the past five years, a subset of patients has begun developing extensively drug-resistant tuberculosis (XDR-TB), which is resistant to even more drugs and has worse survival rates. Although the WHO has not yet formally adopted the term totally drug-resistant TB (TDR-TB), the strains identified in India and South Africa are believed by researchers to be unresponsive to all known drugs.

While the contexts of India and South Africa are very different, Pai says drug resistance in TB has similar “underlying drivers in both countries.” In India, the mismanagement of patients, which pushes them from physician to physician, has been identified as an important culprit in exacerbating TB. Poor diagnostics and fake drugs, which make up 10 per cent of the total TB drug supply in India, also leave patients receiving ineffective treatment.

The crisis is further complicated in South Africa, where nearly one out of every five adults lives with HIV. The presence of “extensively drug-resistant TB plus HIV” Pai says, “is a complete disaster.”

In recent years, a combination of efforts, including vaccination campaigns and national control strategies, have been implemented to fight TB by the South African government. However, the fight remains at a standstill as the casualties rise. The TB vaccine of choice BCG (Bacillus Calmette–Guérin), developed ninety years ago, is only partially effective.  The rise of drug-resistant strains has prompted greater efforts to develop improved vaccines against the disease in order to protect people before they’re infected, but these efforts have led to disappointment. In February, MVA85A, which was touted at the first new TB vaccine in a century, failed clinical trials.

Meanwhile, control efforts have given mixed results. Some reports suggest that India’s current strategy to defeat TB may actually be promoting more deadly drug-resistant strains. In an interview with the Wall Street Journal, Dr. Zarir Udwadia, whose research team discovered totally drug-resistant TB in India, criticized the country’s strategy as “a futile exercise [that will] serve to amplify resistance.”

One of these strategies includes giving the same standard regimen of drugs to anyone suspected of having TB, without checking for resistance, which would entail additional costs. For some patients, these regiments do not work and only heighten the presence of drug-resistant strains. Similarly, in Eastern European countries, poor management of TB has only aggravated the problem. Other strategies have included quarantining. Notably, in South Africa, when extensively drug-resistant tuberculosis broke out, many patients were involuntarily detained in prison-like hospitals.

“It doesn’t work. They broke out,” Pai said. “Keep on doing the wrong thing and you end up with drug-resistant bacteria that don’t respond to any interventions.”

The broadest effort to combat TB, the Stop TB Partnership, consists of 1,000 international governmental and non-governmental organizations. The project aims to provide treatment for fifty million people and prevent 14 million deaths by 2015.  However, the economic crisis has led some countries to reduce or stop contributing to TB prevention programmes.

On March 21, McGill University launched its International TB Centre in an event attended by experts from across Canada. Dr. Anne Fanning, researcher at the University of Alberta and the Chair of Stop TB Canada, described global efforts against TB, local efforts against TB particularly in Inuit communities, and scientific research as three areas that need serious attention.

“[All of this] needs the support of the government of Canada,” she emphasized.

Pai similarly believes that all countries need to take TB more seriously. He warned that the chronic underfunding of these programs across the world might only lead to compounded costs for everyone later.

“In today’s day and age there is no sense in thinking of global health as a problem that doesn’t bother us or affect us.” He said, “TB anywhere is TB everywhere.”

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Mendez, a trained neurosurgeon, explores humanity’s struggles through art, while seeking to alleviate it through medicine and technology. I sat down with Mendez prior to a discussion on his work on September 24, which was organized by former McGill professor, Dr. Norman Cornett.

In recent years, Mendez has made headlines by facilitating the adoption of remote-presence robots to provide specialist neurological consultation services in remote areas of Canada. Remote-presence robots allow physicians to operate in a clinic thousands of kilometers away, using a video game-like joystick to move a robot throughout. These robots can rotate 360 degrees, and have a monitor that shows a live-feed of the physician. In addition, they are equipped with high-resolution cameras and sound equipment, allowing for real time examination and interaction with patients. Despite the unusual experience of interacting with a robot, Mendez says that patients, family, and staff quickly adapt to this futuristic associate.

In Canada, as well as in Mendez’s native Bolivia, aboriginal populations – often located in remote areas – suffer disproportionately from lack of access to specialist care due to distance and climate. Mendez excitedly speaks about the potential to expand such services and take expertise to where it is needed most.
“To listen to the heartbeat of a baby in the mother’s womb thousands of kilometers away,“ Mendez said. “[to] determine which mothers are at risk.”

He views technologies such as remote-presence robot systems as a means of reducing disparity and providing equal access to medical care, even in remote areas such as the Canadian arctic. These communities, too, are quickly accepting and integrating technologies. Mendez describes a community in Northern Labrador that, after the province proved unwilling to purchase a remote-presence robot, came together to raise funds to do so independently.

Though he has helped found neurosurgical units Asia, Africa, and South America, Mendez’s interest in technology is not limited to the medical field. In another initiative, presently in its second year, children in Inuit communities in Northern Labrador are provided with laptops and put in touch with children from Nova Scotia and the Bolivian Andes.

“These kids can communicate with art, math, and music,” he said. “[This] instills in children the idea that, no matter who we are, our contributions have the same value.”

Mendez also emphasizes the importance of investing in cross-cultural exchanges. He described a school in the north of Canada where, for the first time, two students have entered 12th grade, and will be the first two high school graduates in several years. Communicating with graduating students in Nova Scotia via the laptops motivated these students to continue their education. In this way, the introduction of innovative technologies can provide services to people who lack access, and offer these communities a means for growth.

“The change will come from within,” Mendez said. “We can help provide the environment for the children to one day become the leaders of the future, and change their own communities.”

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According to the Food and Agriculture Organization of the United Nations (FAO), 1,500 edible insect species are eaten around the world. In Africa, Asia, and South America, insect dishes range from fried ants and candied grasshoppers to canned grubs and caterpillars. The eating of insects, however, is on the decline.

Robert Kok, an emeritus McGill professor in Bioresource Engineering, said, “A lot of people remember their grandparents consuming Mopani worms but don’t indulge themselves anymore.” “There’s a very strong modern cultural bias against eating bugs.”

The adoption of insects as food may not only help to alleviate the ethical issues and health concerns associated with eating meat, but also to reduce the negative environmental impact of meat production, including pollution and land degradation.

“Insects are animals and their flesh has pretty well the same composition as the flesh of our more commonly-consumed food animals,” said Kok. “So, if you eat their meat you get pretty well the same nutrition as when you eat chicken,” he continued.

It has been projected that, by 2050, food production must increase by 70 per cent to meet the needs of the growing world population. Livestock, which is notoriously internally inefficient at converting plant feed to protein, is unlikely to meet these demands.

Researchers such as Arnold van Huis, an entomologist in the Netherlands at the Wageningen University and Research Centre, have shown that many insect species efficiently convert plant feed to edible protein. While cows require 10 kilograms of feed to produce one kilogram of protein, locusts only need two kilograms of feed to produce the same amount of protein. Moreover, it’s been shown that insects release between 10 to 300 times less greenhouse gases such as methane than livestock.

“[Insect] materials could be used as food chemicals to make industrial foods and feed for fish farming, chickens, biodegradable plastics, et cetera.” Kok said. He noted, however, that the conversion efficiencies, costs, and environmental impacts are not fully clear since there have not been industrial insect farms to produce food for humans yet.

Additionally, Kok believes that North Americans are unlikely to embrace insects anytime soon. Nonetheless, mass production and the use of insect parts in food chemicals such as chitin, oils, and protein presents an opportunity to introduce insects into our diets.

Though crickets are not on the shelves of grocery stores yet, you can get a taste of chocolate covered ants at the Montreal Insectarium. Additionally, local markets and internet sites have also begun to sell insects for human consumption. Daniella Martin, an advocate for entomophagy, hosts a web-based show called Girl Meets Bug. This show provides a host of recipes for those who would like to add “Fried Scorpions” and “Cabbages, Peas ‘n’ Crickets” to their menu.

“To me, edible insects represent a whole new culinary world to be explored, one which has the potential to be highly eco-friendly and maybe even help solve hunger problems,” Martin said. “Insects are historically and globally popular, easy to raise, very nutritious, and usually quite tasty. What’s not to like?”

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Derek Ruths, an assistant professor of Computer Science at McGill who teaches COMP 189, a course on Computers and Society, explains that forecasting the future of the internet is difficult because these changes will be accompanied by society’s changing ideas and expectations about privacy and regulation.

“Ten years ago people would have thought Facebook, the idea of putting all that information online, was ridiculous. But somehow society has changed,” he said in an interview with The Daily.

The rise of networking sites like Twitter and information warehouses such as Wikileaks has been attributed to civil uprisings that have occurred across the world. The 2009 protests in Moldova were dubbed by the media as that country’s “Twitter Revolution.”

However, some, like Malcolm Gladwell, the author of the New Yorker article “Why the revolution will not be tweeted,” have argued that the internet plays a peripheral role in social uprisings, such as those that took place in Moldova and Iran. Ruths, while agreeing, stated that the role of the internet may expand in future uprisings.

“Large parts of the population [are] not online, and we don’t have a good understanding of how to use [the web] yet,” he said. It may then be the case that once the social theory around the use of the internet is developed, future online networks will become not a reflection of, but a basis for social movements.

However, while society is figuring out new ways to harness the power the internet, legislators across many countries have been moving toward enacting regulatory measures on the web.

In an address to students at George Washington University on February 15, the United States Secretary of State Hillary Clinton called for “ground rules to protect the World Wide Web.” International treaties in the future might follow the example of Finland, where, in 2009, broadband access was made a legal right. In Egypt, where the government retains control over internet service providers (ISPs), some 88 per cent of internet traffic was shut down within tens of minutes for a period of five days this month in response to the wave of protests in that country. The establishment of international ground rules and penalties may serve to discourage nations from restricting access to the internet.

On the other hand, with increasing regulation we may also see the establishment of tighter controls, similar to China’s “Great Firewall.” In the U.S., senators have introduced the “Protecting Cyberspace as a National Asset Act of 2010,” a controversial bill that if enacted, will grant emergency powers over the internet to the president, potentially including “kill switches” or legal control over ISPs in times of emergency. Ruths pointed out that with threats such as spam, viruses, worms, and denial-of-service (DoS) attacks, concerns about the lack of rules and regulations concerning the internet are legitimate and must be addressed. However, he expressed some reservation about the regulations that are being enacted. “It’s not clear that people who are the decision makers in this have the technical knowledge to sort of think about the actual options and their implications.”

Along with governmental regulatory bodies, the market is proving to be a powerful force in shaping the future of the internet. One of the battle fronts, the “net neutrality” dispute, has pitted ISPs against content providers. Many ISPs are seeking to implement tiered networks that will charge content providers to deliver different levels of services. ISPs maintain that tiered networks will allow for better delivery of services and innovation, while content providers argue that their implementation will allow ISPs to discriminate between data, and threaten web freedoms and openness.

On another front, many ISPs are looking to regulate internet usage at the user level. Recently the Canadian Radio-television and Telecommunications Commission ruled in favour of regulation by allowing telecommunications companies to charge usage-based fees – as opposed to the current monthly flat rate. After a wave of petitions and protests, Prime Minister Stephen Harper and the Minister of Industry are set to reverse the ruling.

With an ever-changing landscape, the future of the internet remains unpredictable. However, Ruths encourages the public to inform itself about these critical issues, and, cautiously optimistic, remarked “there’s some rough times ahead for sure… [but] I find it hard to believe that we’re going to end up in a very dismal scenario.”

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As a discipline that brings together health care and information science, health informatics is involved in setting up resources like search engines that doctors can use to retrieve clinical data. These tools can be grouped into two categories – information retrieval systems (IRS) and clinical decision support systems (CDSS).

Pierre Pluye, a physician and associate professor in the Department of Family Medicine at McGill University, investigates these electronic resources. He explained how IRS provide a way to filter the staggering amount of available information down to only the most relevant.

“There are 57 million abstracts on Medline [an online biomedical database]. Physicians do not have time [to read every single one]… because basically you would have to read 24 hours a day, seven days a week just to keep updated,” said Pluye.

CDSS differ from IRS in that they provide patient-specific information. Clinicians can use calculator-type programs that look at a patient’s history to determine their likelihood of contracting diseases or experiencing medical complications.

Still, the existence of such readily available information can create tension in the clinical setting. The digital diagnoses sometimes conflict with the clinician’s assessment and experience. But Pluye points out that physicians are under no obligation to incorporate new information into their practice.

“All physicians know tools like Medline…[but] a study by researcher Marc Berg found that often physicians will turn the tool off when they disagree with it,” said Pluye.

At other times, recommendations provided by digital support systems clash with peer or hospital policies.

“You have to talk to your peers, your group, consult with them, ask, ‘Do we want to do this?’” Pluye said.

While some studies have indicated that decision support systems improve practitioner performance, these tools have yet to be adopted on a larger scale, and clinicians still seem skeptical. A 2005 report in the Journal of the American Medical Association stated that effects of these decision-making systems on medical outcomes are still inconclusive.

Pluye makes certain to note, however, that clinicians are much more likely to use technology to look up comparable medical research rather than to base a clinical decision on the results.

“There is something appealing about the myth of automatic medicine. The patient enters the room, you enter the information, and results appear,” Pluye said. “It’s not like that at all. There are very few decision support systems…. In daily practice, people use the information retrieval systems.”

Recently, artificial intelligence technologies have been developed to aggregate relevant data faster, and to learn from patient histories and diagnoses to improve future results. How the field of medicine and the role of physicians will accommodate and adapt to this new technology remains to be seen.

With more patients using online information sources, and physicians using electronic knowledge resources, the dynamic of physician-patient relationships has changed. Pluye, however, saw no threat to the future of the profession. Instead, he pointed to the stronger communication between patients and physicians that will follow new technological developments.

“Do you prefer a clinician that supposedly knows everything? Do you prefer to meet and share negotiations with a clinician?” Pluye said. “Whatever the machine, or the book, or your brain says, the issue is compliance. With such tools you can have better communication with patients.”

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Internet Service Providers (ISPs) act as the intermediary information carriers between users and web sites. In recent years, in what has become largely a battle of revenues, ISPs have sought to implant tiered network infrastructure and charge web sites – or content providers – for services.

Large content providers, such as Yahoo!, eBay, and Google, receive much of their revenues from new applications and advertising. Their wealth depends in large part on the masses of visitors to their site. Dr. Muthucumaru Maheswaran, a computer science professor at McGill, explains that the ISPs, who make it possible for sites like eBay to have so many visitors, want a piece of the revenue pie.

“The people who actually make the networks are anxious because they’re not sharing that wealth,” he said.

Content providers, however, argue that ISPs would use tiered networks as a way to extort money for preferential services to those willing to pay.

As such, in recent years legislation has been drawn up across Europe and North America to address net neutrality. Its proponents support the current system, described as the end-to-end model. Vint Cerf, one of the pioneers of the Internet and a senior executive at Google, describes the net-neutral Internet as a network where data is transported without discrimination in regards to its source, origin, or content.

Others argue against net neutrality because it has constrained, and will likely continue to constrain, innovations in the information transfer techniques that allow the Internet to thrive. Without the competition that a non-neutral net provides, ISPs have little incentive to develop better ways to send information whizzing around the planet.

Maheswaran describes the Internet as an evolving ecosystem, and says that new regulations could hurt or help it. Yet he remains partly skeptical that regulation would benefit the net as a whole.

“Regulations…might actually hurt breakthrough ways of deploying applications and using applications,” he said.

Yet another concern in the net neutrality debate are antitrust issues and censorship. Some believe that the existence of a tiered network might foster an environment where independent media becomes unable to compete with large publishers, because large companies could pony up the cash for information highways to their sites. Small sites, on the other hand, would be in the information back country.

Such censoring has taken place in the past. In 2006, the Canadian branch of the phone corporation Telus blocked a site set up by the labour union during a labour dispute. Similarly, in other countries, ISPs have been compelled by governments to censor content. Without appropriate neutrality legislation here in Canada, ISPs may censor content that conflicts with their interests in the same way Telus censored the union.

Some argue that new regulations are not needed because, as long as antitrust legislations allowing competitive marketing are in place, the user has a range of choices. Such competitive ISP marketing exists in Europe. However, this poses a problem in places like Canada and the U.S., where there is little competition between Internet service providers. Without healthy competition, the few Canadian companies who control these services could band together to draw as much money out of Internet users as possible, and harm consumers as a result.

Many ISPs argue for tiered networks as a way of dealing with heavy weight content delivery on the Internet. Currently, information-heavy content, such as high–definition television, is not delivered via the net. Yet according to Maheswaran, a tiered system could allow such content to be Internet accessible.

“This is where the real need for tiered network might emerge. In the near future, everything might emerge into a digital network, and ISPs would have a huge role to play,” he said.

Many of the solutions that have emerged to preserve net neutrality have focused on legislation. The most important thing, argues Maheswaran, is that no sites disappear because of a non-neutral net.

“It is very important for us to make everyone aware of what kind of information is out there, so the bias is minimized and somebody doesn’t tell you whatever you are looking for does not exist,” he said.

Maintaining perfectly symmetric and neutral content delivery systems, while ideal, may prove to be too costly in the long run. However, a more sophisticated scheme in which neutrality is the topmost layer, while the network itself is adjusted to fit increasing demand, might work best.

In terms of the current conflict between content producer and distributors, as Maheswaran duly points out, “It looks like a debate that could go on forever.”

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On February 12, millions across the world celebrated Charles Darwin’s 200th birthday. Darwin’s journey on the HMS Beagle and his explorations have formed what Dr. Andrew Hendry, professor of biology at McGill University, calls “the foundations of all modern biology.”

In his 1859 landmark work, On The Origin of Species, Darwin described evolutionary development and the transformation of species through the process of natural selection. Darwin’s unorthodox ideas proved controversial at the time of their publication.

As Dr. Ehab Abouheif, professor in the Department of Biology at McGill, describes, “When you undergo a paradigm shift, it is always turbulent, always controversial, and always difficult.”

At the time, Darwin was not aware of the mechanisms of heredity and genetics – processes which would later be reconciled with Darwinian evolution in a unified theory.

“All of the advances of the last 150 years have pretty much just fleshed out his basic fundamental idea. We know many more details than he did, but the basics are the same,” explains Hendry.

Those details include a good knowledge of the genes that encode for development, and the field of epigenetics – the study of heritable changes in gene function that are not changes in DNA sequence.

“Where before, many people had in essence discarded the idea that acquired characters can be inherited, the new challenge is to understand how they fit into Darwin’s scheme,” says Abouheif.

Hendry also points out that in addition to genetics, another major shift in evolutionary biology has been understanding evolutionary time. “Darwin thought evolution took place slowly, but we now know it can often take place on short time scales. Evolution is occurring around us right now,” Hendry says.

“Fundamentally, Darwin put us in our proper place,” Hendry says “We are a part and product of the natural world, not something that has some dominion over it. This makes us realize that we have, to take better care of what we have and that we need to find a way to maintain a more harmonious integration with the natural world.”

Abouheif agrees. “When a theory has really significant, deep and meaningful impact, its influence only continues to grow,” he says.

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Although peer-to-peer file sharing and anonymous personal web sites have given people a way to leak sensitive information in the past, whistleblowers have run high risks of being discovered, because information travel routes can often be easily traced. Wikileaks overcomes this problem by using advanced cryptographic techniques and an internet protocol called the Onion Router.

Frédéric Mégret, a Law professor at McGill and the Canada research chair in the Law of Human Rights and Legal Pluralism, explains that punishment has been a major concern of potential whistleblowers.

“Some people give information only to the extent that [their identity] remains confidential because they would otherwise put themselves at strong risk.”

For whistleblowers, the risk of being discovered can be extreme. Mordechai Vanunu, a nuclear technician, has spent 18 years prison in Israel, much of it in solitary confinement, due to what he revealed about the existence of an Israeli nuclear weapons program in 1986. Dr. Mégret says that the ease and anonymity of Wikileaks could greatly increase the number of people willing to leak information.

“Anonymity, assuming it works, plus easy technological access could encourage a lot of people, from all levels…to do things they wouldn’t do otherwise,” he says.

In its short lifetime of a year and a half, Wikileaks has received an astonishing 1.2 million documents. The documents range from the classified schematic design of the atomic bomb “Fat Man” detonated over Nagasaki in 1945, to records of misconduct in the FBI and multinational financial companies, to a secret 110-page document showing investigations of massive corruption and billion dollar money-laundering schemes in the Kenyan government.

Understandably, Wikileaks is not universally loved. Angry and embarrassed groups have brought many lawsuits and injunctions against it. In February of 2008, Wikileaks released internal documents from the Julius Baer bank in Zurich. The documents showed trade secrets from the bank, including methods used to help clients evade taxes by siphoning funds to trusts in the Cayman Islands. The Swiss bank filed a lawsuit against the American domain registrar of wikileaks.org, arguing a violation of privacy by a disgruntled ex-employee, and as a result the wikileaks.org domain was shut down.

After two weeks of uproar from civil liberties organizations, the injunction was overturned, because blocking the site violated the U.S. first Amendment on Freedom of Speech. An Electronic Frontier Foundation (EFF) senior staff attorney emphasized this in a press conference.

“Attempting to interfere with the operation of an entire web site because you have a dispute over some of its content is never the right approach. Disabling access to an internet domain in an effort to prevent the world from accessing a handful of widely-discussed documents is not only unconstitutional – it simply won’t work,” he said.

The onslaught of well publicized legal attacks like this one has only fueled the web site’s popularity, and resulted in more leaked documents. In December, the site released a 238-page military manual detailing the inner workings of Guantanamo Bay. The document, not classified but for internal use, had been legitimately requested by the American Civil Liberties Union (ACLU) many times since 2003, but had remained undisclosed.

In early March of this year, Wikileaks released documents detailing alleged propaganda and harassment activities of the Church of Scientology between 1986-1992. A few days later it released an 88-page report from 2003, which detailed the FBI’s surveillance tools for phone calls made via networks like the internet.

Dr. Mégret notes that due to the pivotal role of whistleblowers in passing on information about the Holocaust and the machete buildup prior to the Rwandan genocide, more international laws have sought to protect dissidents. Yet policies, he says, are still largely geared toward protection of the state.

“There is no systematic thinking about the role that individuals might have in helping enforce international law by denouncing situations kept secret by governments,” he explained.

Although the massive response to Wikileaks shows that it’s a needed resource – and that current whistleblower protection laws are insufficient in many countries – the openness of the site makes it susceptible to misuse. Although the site aims to serve as a forum and repository of documents that reveal illegal behaviour, users can publish documents that reveal anything from the private lives of celebrities to the passports of politicians.

Mégret notes that while documents such as the health records of celebrities might be of interest to the public, posting them on a web site would be a violation of privacy laws in many countries.

“The distinction between ‘significant public interest’ involving wrongdoing,” he says, “rather than something that is simply interesting, is important.”

The open nature of the site also makes it difficult to authenticate documents. Critics of the project have argued that the site may serve as a breeding ground for fabricated documents and perpetuation of false information. However, the developers of Wikileaks reply that their site offers a forum for “a worldwide community of informed users and editors who can scrutinize and discuss leaked documents.”

If such doubts prove to be unfounded, the long-term effect that Wikileaks might have on the way governments and corporations behave could be significant. The site has the potential to bring more accountability and transparency to organizations whose doors have traditionally been closed. Although the birth of the Wikileaks project has been dramatic, its maturation will likely be even more exciting.

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