Decisions, Decisions, Decisions.

I am often surprised by the sheer number of choices I have to make every day as a parent. While most of these are as simple as what to feed my girls for dinner, others carry life-long implications. For my children’s healthcare, though, my plan was simple: listen to their doctor, and do what the doctor says. Well, that simple plan flew out of the window on day one when their first pediatrician insisted that my twins were identical just because they had the same blood type. I realized that I would have to be their advocate, actively making decisions instead of blindly trusting the experts. This led me to the issue of vaccines. Vaccination to me was standard healthcare and not something I had ever questioned. However, with all the buzz about the safety or otherwise of vaccines and vaccine schedules, this also became a decision I had to make. Would I get my children vaccinated?

To make this decision, I had to get informed. I found that the consensus among credible sources such as the World Health Organization (WHO)  and the Centers for Disease Control and Prevention (CDC) was that vaccines are a safe and very effective  way to prevent or reduce the severity of several infectious diseases. Why then did several sources claim that startling numbers of people were injured or killed every year by vaccines?  Was there a genuine risk associated with vaccination?

If one word could capture my search for facts about severe vaccine side effects, it would be “frustration”. I found that credible sources often provided a very one-sided view on the issue: A lot of talk about the benefits of vaccines but not much information on any potential problems. This may stem in part from genuine difficulties in determining exact numbers. For instance, in the US, suspected reactions to vaccinations are reported to the Vaccine Adverse Event Reporting System (VAERS). Since this system is based on self-reporting, anyone- parents, doctors, nurses, or vaccine manufacturing companies- can file a report. Consequently, a particular incident may get reported multiple times. Moreover, there is no requirement for proof of a link between a vaccination event and the supposed side effect.

The VAERS only collects information on possible vaccine side effects. Parents seeking compensation for serious side-effects suffered by their children are able to file a claim with the  US Office of Special Masters of the U.S. Court of Federal Claims (often called Vaccine Court). Here, alleged cases of severe vaccine side effects are reviewed, and compensation is given as the court finds appropriate. In this system, successful petitions are not considered an admission that an illness or a condition was caused by vaccines, but simply that it may have been. Last year, out of the 887 cases tried in this court, 696 were awarded some compensation. Since there are specific guidelines as to what can be reported as a vaccine-related injury deserving compensation by the government, this number gives a good idea of what experts consider possible vaccine-related effects.

Genuine limitations or not, this defensive stance taken by health organizations is problematic. The existence of a vaccine court and a compensation system points to the fact that there may indeed be some cases of severe reactions to vaccines. The absence of easily-accessible numbers then gives the impression that the authorities are hiding something. I also noticed that my kids’ pediatricians and nurse practitioners did not readily provide information on possible serious reactions to vaccines. I was told to expect mild reactions such as a low-grade fever or a rash.  Interestingly, I readily found a lot of information from propaganda-based anti-vaccination websites. If credible information is not easily available or readily given to balance out the argument, it handicaps a person’s ability to make decisions based on facts. Doctors and researchers may not have all the answers on whether, why or how frequently genuine severe side effects of vaccines happen, but even this is worth communicating to the public. There is much value in an honest “we don’t know yet”. Such openness would build trust between the scientific and healthcare communities and the public.

As a scientist, the evidence in support of vaccines is clear. As a parent, though, things are less straightforward.  The odds of an adverse reaction may be slim, but that means nothing if your child is affected. I realize, though, that I regularly expose my children to all kinds of risks. For example, my daredevil daughter climbs around the playground with the speed and agility of a circus acrobat. “Look, Mummy, I’m a ninja!” she shouts as I have another near-heart attack just watching her. In the US alone, there are 200,000 serious playground-related injuries every year. Even more astonishingly, 150 children are treated in emergency rooms every hour for car crash-related injuries, which are the leading cause of death by injury in children 5-19. Yet there is no talk of banning playgrounds or cars. We simply work to make them safer for our children.

The unfortunate irony seems to be that the efficacy of immunization may be the one factor inducing increased complacency, as most new parents have no personal experience with widespread outbreaks of preventable infectious diseases. Deadly outbreaks seem to have disappeared, along with our fear of them. However, if we stop vaccinating our children, these diseases will return.

I still cringe just a little bit when my kids get their shots, but I know that we have made the right decision for them. Whether or not I get my own booster shots on time is a different question! 

My little ninja

The Value of a Great Dad

I grew up convinced that my father knew everything. As a young child just learning to add, I would give him what I called “very hard math” to do, asking him to add up all the numbers from 1 to 10. I still wonder how he managed to keep a straight face at my amazement at his mathematical abilities, considering his engineering background. As my questions became more complex with time, so did his answers, and these displays of knowledge took on new meaning for me. In my mind, if someone who had all the answers to life’s questions believed in me and my abilities, what was stopping me from believing in myself? If he was right about everything else, he must also be right about me being able to achieve anything. I once asked “Daddy, if I ever wrote a book, would you buy one?”. He didn’t laugh or ask what on earth I would write about, but immediately said “I would buy the first one”.  Those simple words meant the world to me.

A father’s particular brand of parenting is often overlooked and highly underrated. When conducting research for his book on fatherhood, author Paul Raeburn noted that about half of all research on child psychology did not even mention a father’s input or perspective. However, fathers have a lot to offer their children beyond a paycheck and strict discipline. Research shows that children with loving and attentive fathers have better self-esteem and a more positive view of the world. Spending time with Dad also increases empathy, an effect that lasts into adulthood (surprisingly, spending time with Mom had a much lower influence on this). Additionally, though depression in mothers negatively affects child development, having a sensitive, caring father significantly reduces these effects on a child.

As with mothers, fatherhood is also marked by biological changes.  There are measurable differences in the brains of fathers when compared to non-fathers, and fathers display strong brain activity when they hear their children cry. Fatherhood is also marked by a reduction in testosterone and an increase in prolactin and oxytocin. However, there is a catch: Unlike in mothers where these hormonal changes occur naturally during and after pregnancy, in men these changes only happen when fathers take an active part in childcare. This means that for men, close interaction with their children, starting as early as possible, is critical to a strong father-child bond. It may seem unfair that mothers have a biological head start, but considering the importance of a great dad, the efforts invested into this relationship are definitely worth it.

I haven’t written that book yet, but I did give my father a copy of my thesis when he visited for my graduation. I later saw him carefully place it in his hand luggage with all his other valuables, and in that moment, I had arrived.

Happy Fathers’ Day to all fathers and father figures out there, to my husband, who is everything from story-teller to princess to horsie, and whose congratulatory high fives already make his girls beam with pride, to my brother, who is hands down the best diaper changer I know, and  to my Daddy, who taught me that my best was always good enough. Your confidence in me still gives me courage to take on the world.

My Daddy and Me                                                                              My Girls and their Daddy

The Biology of Motherhood

Mothering is a universal concept associated with all that is strong, kind and loving. All my life I have heard stories of the feats that my grandmothers accomplished to help their children succeed, and I have seen the sacrifices that my own mother has repeatedly made for her family. I have watched with admiration the efforts that mothers, some in very difficult situations, put in every single day to make life better for their kids, never complaining and never growing weary, and the idea of me being that model strong mother to anyone has always been intimidating. What if my maternal instincts didn’t kick in, and I didn’t intuitively know what my kids needed? What if I didn’t have what it took to be the stuff of legends?

Mother’s intuition is advertised as a magic sauce, a secret ingredient that turns women into moms. It makes sense, though, that something so important would have a strong biological component to it. As researchers study the changes that occur during pregnancy and soon after birth, we are learning more and more about how the state of pregnancy itself prepares a woman for motherhood. A lot of maternal behavior is regulated by changes in the levels of hormones in an expectant mother. For example, oxytocin, a hormone known to give the feeling of happiness, is produced in women during pregnancy and soon after birth. High levels of oxytocin make mothers more attached to their children, more attentive and more in-tune with their children’s needs, and a mother’s oxytocin levels increase as she interacts with her child. Oxytocin also increases in babies as they interact with their mothers, creating a feedback cycle that cements the mother-child bond.  The effects of this hormone are not limited to biological mothers, though, as the oxytocin feedback cycle also helps strengthen the attachment between foster and adoptive mothers and their non-biological children.

The hormone prolactin, popularly known to control milk production in mothers, is also involved in making new brain cells during pregnancy. These brain cells are involved in increasing a mother’s sense of smell, which helps her bond with her baby. (Is this why mothers are often the first to smell a poopy diaper, or does everyone else pretend to have an inferior sense of smell just so that mom always gets to do the diaper changes? I’m eagerly awaiting the results of that study!). Surprisingly, testosterone, a hormone very strongly linked to masculinity, also affects maternal behavior. High testosterone in mothers increases vigilance and attentiveness,  both of which are hallmarks of mother’s intuition . Obviously, then, the desire to love, protect and care for our offspring is encoded in our DNA. Yet, biology can only take us so far. The decision to give the best of ourselves to our children is one that mothers everywhere make constantly, and this is well worth celebrating. 

A little over three years in, I can’t pretend to know much about mothering. I make mistakes every day. Yet I wake up every morning determined to do the best I can, and I’m starting to believe that this is what motherhood is all about. Happy Mother’s Day to everyone who is mothering in any way, and especially to my own Mummy, to whom I owe a thousand apologies and a debt of gratitude which I can never repay. I still haven’t met anyone I’d rather have as my mother.

My mummy and me.

A CRISPR World

Every once in a while, scientists make a phenomenal discovery that truly transforms their field.  For biomedical research (and therefore for the world, as I like to think), no recent discovery has spread as fast and as widely as the CRISPR/Cas9 method of gene editing (making precise changes to specific regions of DNA). This technique is currently so popular that it has scientists and non-scientists alike genuinely interested in its prospects in terms of improving research and healthcare. Being the resident family biologist, I often get asked what all this “crispy” talk is about (note to my dear brother: the joke is only funny once!). Here is my standard introduction to this future Nobel prize-winning technology:

For several decades, scientists have studied the function of specific regions of DNA by causing damage to those regions and examining the effects of the damage on individual cells, organs or the whole organism. While methods used for these kinds of experiments have been improving steadily, the discovery of the CRISPR/Cas9 system is a huge leap forward. The CRISPR/Cas9 system was first identified as a natural method by which some bacteria protect themselves from other microorganism, such as viruses, which attack by injecting their DNA into the bacteria. Without getting too technical, there are two parts to this system: the CRISPR (clustered, regularly interspaced short palindromic repeats) complex, which can recognize a specific sequence in the foreign DNA and bind to it, and Cas9 (CRISPR-associated protein 9), a protein which destroys the foreign DNA by cutting it up, keeping the bacteria safe.

In the lab, scientists can modify this system to target and cut specific regions of DNA in any organism. When a cell’s own DNA is cut, though, its natural response is to try to fix the damage. However, the ways by which these cuts are fixed are not perfect, and mistakes are often made where bits of DNA are added or left out of the fix.  This disrupts the function of the targeted region of DNA, and researchers can then observe the result of these mistakes to learn more about the function of the affected region.

Why all the fuss about CRISPR, you ask? From first-hand experience, CRISPR is significantly more accurate and efficient than previous techniques. To illustrate, the difference between some existing methods and CRISPR is like the difference between asking a six-year-old to find and correct a single spelling mistake in an encyclopedia, and giving the same task to an English professor. Another significant advantage of this system is its adaptability. CRISPR success stories have been reported for organisms ranging from fungi to fish, which is why scientists are universally excited about it. Moreover, the components of the system are cheap, easy to get, and easy to use, making it a viable option for almost any lab. Being able to disrupt a region of DNA is great, but the system has further been modified  so that researchers can also increase, decrease or even change a gene’s function almost at will, and herein lies the immense power of the CRISPR/Cas9 system.

CRISPR/Cas9 technology is so enticing, however, that this sometimes sends scientists down its path when other methods may actually be better for a specific experiment. Sadly, if journal and grant reviewers want to see CRISPR, then CRISPR you must use. Also, the CRISPR system is not flawless, and there are concerns about damage being caused to other sections of DNA that were not targeted.  Moreover, as everyone jumps onto the CRISPR bandwagon, overenthusiasm to publish findings whether for or against the use of CRISPR technology makes room for some sloppy science.

If you’re not in biomedical research, you’ve probably still heard about how scientists are going to use CRISPR to make designer babies and genetically modified foods that will either save or kill us all. How true are these claims? Well, CRISPR does make gene editing much easier, meaning that some things that were not feasible before are now possible. For example, some success has already been reported in using CRISPR technology together with IVF (in vitro fertilization) to fix a heritable disease in human embryos. This application of CRISPR technology is still in its preliminary stages, and we cannot expect that it will bring about an end to all genetic diseases as CRISPR is most useful under specific circumstances. However, for potential parents who are carriers of, or even affected by a heritable genetic disease, this technology  brings to them the hope of having a healthy biological child. How do we define “disease”, though, and when does something go from being a disease to just an undesirable trait? Where do we draw the line, and who draws that line? Does a government or regulatory body have the right to decide for everyone? I don’t know if anyone has the right answers to these questions or any others that will come up as this technology further improves. However, as with all other major advances in science, we must expect and trust scientists to thoughtfully weigh the ethical questions behind their work, and to act in the best interest of humanity.

Big advances in science are always exciting, and from all indications the CRISPR/ Cas9 technology still has numerous uses which we haven’t even begun to study. Thus, until the next big discovery rolls along and takes the world by storm, everything’s getting a little CRISPR.

Beyond Nature

My three girls look nothing like me. Whether or not this will change over time is an open question, but for now they are three different versions of their father. From time to time, though, as I watch them grow, I catch glimpses of myself in their behavior and even in their tastes in food, and this makes me wonder what other aspects of myself lie within their DNA. Our understanding of how DNA (deoxyribonucleic acid) works is improving everyday as new research findings are published, and as researchers link disease after disease to specific genes, I can’t help but worry that I may have passed on something harmful that will show up at some point in their lives. Luckily, the story of life is more complex than just DNA.

For many centuries, long before the discovery of DNA, psychologists and biologists alike have debated over how much of who we are is controlled by the environment. This “nature versus nurture” debate has now gotten much more intricate as it has expanded to include the influence of external and internal environments on how our DNA is read and interpreted by our bodies. With all the new information available to us today, it is easy to focus on the genetic basis of life. However, studies looking at the links between our DNA and specific conditions make it clear that the role of our environment cannot be overlooked. For example, recent research shows that about 50% of the factors that influence intelligence are inherited. This means that half of the factors controlling intelligence are NOT inherited. In fact, it has also been shown that especially for children, education, nutrition, and even a peaceful, nurturing home environment all contribute to intelligence. Similarly, the heritability of depression is at about 38%, meaning that 62% of factors leading to depression are under the control of our environment.

Several studies conducted on the heritability of diabetes put this number between 25-80%. These same studies are quick to point out, however, that the effects of genetics versus those of living in the same environment are not completely separable.  Researchers agree, though, that the interplay between the environment and genetics is crucial to the development of this condition. Similarly, interactions between genetics and the environment are responsible for heart disease and   asthma. Obviously, there are some illnesses that are purely inherited, and knowing your family history is important as it tells you what conditions you may be at an increased risk for. Still, it is nice to know that by trying to live a healthier life physically, mentally and emotionally, I can influence whether or not I develop certain conditions and to what extent.

What, then, is my most important contribution to my children’s lives? Probably not their DNA. Creating a healthy environment for them to grow and thrive, helping them develop good eating habits, teaching them to value themselves and others, and to be kind, and showing them that they can make a difference in the world are all just as important, if not more important than genetics.  Our DNA is an inheritance given to us without our consent, one which we pass on to our children without asking for permission. Luckily, we have a significant amount of control over the external factors that influence our make-up, and we can help build the best versions of ourselves, and of our families, upon the foundations laid by our DNA.

Back to the Bench

I have been surrounded by science from the day I was born. I grew up with a father who would answer my simplest childhood questions with elaborate scientifically-accurate descriptions, and though most of his efforts were sadly wasted on my younger self, I learned that there was a fascinating world out there just waiting to be explored. When I was a little older, I would spend hours reading my brother’s high school biology text book, captivated by descriptions of animal development. One of my happiest days was when that book became mine, and I no longer had to sneak around to read it. Biology has always been my main interest, and I pursued this through graduate school and to the postdoctoral level. Less than two years into my postdoc, however, I found myself with two adorable babies in my arms and a fellowship that would not cover the cost of childcare. For the first time in my life, I turned away from science as my new loves took precedence.

Surprisingly, I found out that it is quite common for women in the sciences to step away from their hard-earned careers to focus on their families. Also common is women taking less research-intensive (and therefore less time-consuming) jobs to improve their work-life balance. According to the United Nations Educational, Scientific and Cultural Organization (UNESCO) Institute for Statistics, an average of 53% of undergraduate students worldwide are female. However, only 44% of doctoral students and 29% of career researchers are women.  Should a woman be able to decide that she would prefer to be home with her kids? Absolutely. Should such a decision be forced upon a woman because of lack of support from her workplace? Absolutely not. If a profession that relies so heavily on ingenuity to make progress is losing a significant percentage of its workforce, can you imagine how many questions relevant to our health, the treatment of diseases and the advancement of science are going unanswered?

Fortunately, many institutions are catching up to the times and providing, or at least attempting to provide, support for scientists who just happen to be parents. In the United Kingdom and Australia, the Athena SWAN charter sets guidelines for institutions trying to close the gender gap in the sciences, among other fields. This charter makes several practical suggestions to improve work-life balance, such as limiting work activities to business hours so that parents can participate in all official events.  Recently, some government funding in the UK is being tied to institutions following the guidelines set by the Athena SWAN charter, and this has been a big incentive for organizations to speed up their progress in dealing with matters of gender equality.

The American Association of University Women (www.aauw.org) has been committed to supporting women in academia for over a century, and has over the years expanded its focus to include women and girls at all stages of scientific discovery. The AAUW provides funding for science education and research, does advocacy and public policy work, and even conducts salary negotiation workshops so that women are ready to demand fair wages when they get a job offer. UNESCO has also set up several initiatives to support women in science, including teaming up with the L’Oréal Corporate Foundation to recognize women excelling in their fields and to provide awards to fund their research.

Some institutions and foundations have from time to time asked focus groups to help identify areas of support for women. One particularly interesting suggestion is that institutions should allow researchers who become parents to use funds from grants to pay for childcare or to hire extra help in the laboratory if needed. Several institutions are also adopting policies that allow both women and men to take a total of one (unpaid) year off to take care of family commitments. The landscape for women in science is gradually changing. 

My stay-at-home-mom years were short-lived, though, and now with three little girls I found my way back to the bench. I have found that with children waiting at home, I can’t work late nights or weekends, and my vacation schedule is controlled by whether or not my children’s daycare center is open. I may not be able to work the long hours that I used to, but now I make every second count. I find that I am better at planning my experiments and more efficient at carrying them out, though sometimes this means skipping lunch on particularly busy days. I am relieved to find that while my priorities have changed, my love for research has not. I used to walk around the lab with experiments on my mind and a song in my heart, and that is still true. But now, from time to time I suddenly break into a smile when I remember something one of my daughters said. Granted, biomedical research is interesting, but having a 3-year-old say “Mummy, can you kneel down so I can ride you?” is priceless.