Q&A with Holden Thorp: Finding Better Ways to Communicate Science
This month, Leaps.org had a chance to speak with Holden Thorp, Editor-in-Chief of the Science family of journals. We talked about the best ways to communicate science to the public, mistakes by public health officials during the pandemic, the lab leak theory, and bipartisanship for funding science research.
Before becoming editor of the Science journals, Thorp spent six years as provost of Washington University in St. Louis, where he is Rita Levi-Montalcini Distinguished University Professor and holds appointments in both chemistry and medicine. He joined Washington University after spending three decades at the University of North Carolina at Chapel Hill, where he served as the UNC's 10th chancellor from 2008 through 2013.
A North Carolina native, Thorp earned a doctorate in chemistry in 1989 at the California Institute of Technology and completed postdoctoral work at Yale University. He is a fellow of the National Academy of Inventors and the American Association for the Advancement of Science.
Read his full bio here.
This conversation was lightly edited by Leaps.org for style and format.
Matt Fuchs: You're a musician. It seems like many scientists are also musicians. Is there a link between the scientist brain and the musician brain?
Holden Thorp: I think [the overlap is] relatively common. I'm still a gigging bass player. I play in the pits for lots of college musicals. I think that it takes a certain discipline and requires you to learn a lot of rules about how music works, and then you try to be creative within that. That's similar to scientific research. So it makes sense. Music is something I've been able to sustain my whole life. I wouldn't be the same person if I let it go. When you're playing, especially for a musical, where the music is challenging, you can't let your mind wander. It’s like meditation.
MF: I bet it helps to do something totally different from your editing responsibilities. Maybe lets the subconscious take care of tough problems at work.
HT: Right.
MF: There's probably never been a greater need for clear and persuasive science communicators. Do we need more cross specialty training? For example, journalism schools prioritizing science training, and science programs that require more time learning how to communicate effectively?
HT: I think we need both. One of the challenges we've had with COVID has been, especially at the beginning, a lot of reporters who didn’t normally cover scientific topics got put on COVID—and ended up creating things that had to be cleaned up later. This isn't the last science-oriented crisis we're going to have. We've already got climate change, and we'll have another health crisis for sure. So it’d be good for journalism to be a little better prepared next time.
"Scientists are human beings who have ego and bravado and every other human weakness."
But on the other side, maybe it's even more important that scientists learn how to communicate and how likely it is that their findings will be politicized, twisted and miscommunicated. Because one thing that surprised me is how shocked a lot of scientists have been. Every scientific issue that reaches into public policy becomes politicized: climate change, evolution, stem cells.
Once one side decided to be cautious about the pandemic, you could be certain the other side was going to decide not to do that. That's not the fault of science. That’s just life in a political world. That, I think, caught people off guard. They weren't prepared to shape and process their messages in a way that accounted for that—and for the way that social media has intensified all of this.
MF: Early in the pandemic, there was a lack of clarity about public health recommendations, as you’d expect with a virus we hadn’t seen before. Should public officials and scientists have more humility in similar situations in the future? Public officials need to be authoritative for their guidance to be followed, so how do they lead a crisis response while displaying humility about what we don't know?
HS: I think scientists are people who like to have the answer. It's very tempting and common for scientists to kind of oversell what we know right now, while not doing as much as we should to remind people that science is a self-correcting process. And when we fail to do that – after we’ve collected more data and need to change how we're interpreting it – the people who want to undermine us have a perfect weapon to use against us. It's challenging. But I agree that scientists are human beings who have ego and bravado and every other human weakness.
For example, we wanted to tell everybody that we thought the vaccines would provide sterilizing immunity against infection. Well, we don't have too many other respiratory viruses where that's the case. And so it was more likely that we were going to have what we ended up with, which is that the vaccines were excellent in preventing severe disease and death. It would have been great if they provided sterilizing immunity and abruptly ended the pandemic a year ago. But it was overly optimistic to think that was going to be the case in retrospect.
MF: Both in terms of how science is communicated and received by the public, do we need to reform institutions or start new ones to instill the truth-seeking values that are so important to appreciating science?
HS: There are a whole bunch of different factors. I think the biggest one is that the social media algorithms reward their owners financially when they figure out how to keep people in their silos. Users are more likely to click on things that they agree with—and that promote conflict with people that they disagree with. That has caused an acceleration in hostilities that attend some of these disagreements.
But I think the other problem is that we haven’t found a way to explain things to people when it’s not a crisis. So, for example, a strong indicator of whether someone who might otherwise be vaccine hesitant decided to get their vaccine is if they understood how vaccines worked before the pandemic started. Because if you're trying to tell somebody that they're wrong if they don't get a vaccine, at the same time you're trying to explain how it works, that's a lot of explaining to do in a short period of time.
Lack of open-mindedness is a problem, but another issue is that we need more understanding of these issues baked into the culture already. That's partly due the fact that there hasn't been more reform in K through 12 and college teaching. And that scientists are very comfortable talking to each other, and not very comfortable talking to people who don't know all of our jargon and have to be persuaded to spend time listening to and thinking about what we're trying to tell them.
"We're almost to the point where clinging to the lab leak idea is close to being a fringe idea that almost doesn't need to be included in stories."
MF: You mentioned silos. There have been some interesting attempts in recent years to do “both sides journalism,” where websites like AllSides put different views on high profile issues side-by-side. Some people believe that's how the news should be reported. Should we let people see and decide for themselves which side is the most convincing?
HS: It depends if we're talking about science. On scientific issues, when they start, there's legitimate disagreement about among scientists. But eventually, things go back and forth, and people compete with each other and work their way to the answer. At some point, we reach more of a consensus.
For example, on climate change, I think it's gotten to the point now where it's irresponsible, if you're writing a story about climate change, to run a quote from somebody somewhere who's still—probably because of their political views—clinging to the idea that anthropogenic global warming is somehow not damaging the planet.
On things that aren't decided yet, that makes sense to run both. It's more a question of judgment of the journalists. I don't think the solution to it is put stark versions of each side, side-by-side and let people choose. The whole point of journalism is to inform people. If there's a consensus on something, that's part of what you're supposed to be informing them about.
MF: What about reporting on perspectives about the lab leak theory at various times during the pandemic?
HS: We’re the outlet that ran the letter that really restarted the whole debate. A bunch of well-known scientists said we should consider the lab leak theory more carefully. And in the aftermath of that, a bunch of those scientists who signed that letter concluded that the lab leak was very, very unlikely. Interestingly, publishing that letter actually drove us to more of a consensus. I would say now, we're almost to the point where clinging to the lab leak idea is close to being a fringe idea that almost doesn't need to be included in stories. But I would say there's been a lot of evolution on that over the last year since we ran that letter.
MF: Let's talk about bipartisanship in Congress. Research funding for the National Institutes of Health was championed for years by influential Republicans who supported science to advance health breakthroughs. Is that changing? Maybe especially with Sen. Roy Blunt retiring? Has bipartisanship on science funding been eroded by political battles during COVID?
HS: I'm optimistic that that won't be the case. Republican Congresses have usually been good for science funding. And that's because (former Sen.) Arlen Specter and Roy Blunt are two of the political figures who have pushed for science funding over the last couple decades. With Blunt retiring, we don't know who's going to step in for him. That's an interesting question. I hope there will be Republican champions for science funding.
MF: Is there too much conservatism baked into how we research new therapies and bring them to people who are sick, bench-to-bedside? I'm thinking of the criticisms that NIH or the FDA are overly bureaucratic. Are you hopeful about ARPA-H, President Biden’s proposed new agency for health innovation?
HS: I think the challenge hasn't been cracked by the federal government. Maybe DARPA has done this outside of health science, but within health science, the federal government has had limited success at funding things that can be applied quickly, while having overwhelming success at funding basic research that eventually becomes important in applications. Can they do it the other way around? They’ll need people running ARPA-H who are application first. It’s ambitious. The way it was done in Operation Warp Speed is all the money was just given to the companies. If the hypothesis on ARPA-H is for the federal government to actually do what Moderna and BioNTech did for the vaccine, themselves, that's a radical idea. It's going to require thinking very differently than the way they think about dispersing grants for basic research.
MF: You’ve written a number of bold op-eds as editor of the Science journals. Are there any op-eds you're especially proud of as voicing a view that was important but not necessarily popular?
HS: I was one of the first people to come out hard against President Trump['s handling of] the pandemic. Lots of my brothers and sisters came along afterwards. To the extent that I was able to catalyze that, I'm proud of doing it. In the last few weeks, I published a paper objecting to the splitting of the OSTP director from the science advisor and, especially, not awarding the top part of the job to Alondra Nelson, who is a distinguished scientist at black female. And instead, giving part of it to Francis Collins. He’s certainly the most important science policy figure of my lifetime, but somebody who’s been doing this now for decades. I just think we have to push as hard as we can to get a cadre of young people leading us in Washington who represent the future of the country. I think the Biden administration leaned on a lot of figures from the past. I’m pushing them hard to try to stop it.
MF: I want to circle back to the erosion of the public’s trust in experts. Most experts are specialists, and specialists operate in silos that don’t capture the complexity of scientific knowledge. Are some pushbacks to experts and concerns about the perils of specialization valid?
HS: You're on the right track there. What we need is more respect for the generalist. We can't help the fact that you have to be very specialized to do a lot of stuff. But what we need is more partnership between specialists and people who can cross fields, especially into communication and social sciences. That handoff is just not really there right now. It's hard to get a hardcore scientist to respect people who are interested in science, education and science communication, and to treat them as equals. The last two years showed that they're at least as important, if not more so.
MF: I’m grateful that you’re leading the way in this area, Holden. Thank you for sharing your thoughts and your work.
Sexually Transmitted Infections are on the rise. This drug could stop them.
Sexually transmitted infections (STIs) are surging across the U.S. to 2.5 million cases in 2021 according to preliminary data from the CDC. A new prevention and treatment strategy now in clinical trials may provide a way to get a handle on them.
It's easy to overlook the soaring rates of gonorrhea, chlamydia, and syphilis because most of those infections have few or no symptoms and can be identified only through testing. But left untreated, they can lead to serious damage to nerves and tissue, resulting in infertility, blindness, and dementia. Infants developing in utero are particularly vulnerable.
Covid-19 played havoc with regular medical treatment and preventive care for many health problems, including STIs. After formal lockdowns ended, many people gradually became more socially engaged, with increases in sexual activity, and may have prioritized these activities over getting back in touch with their doctors.
A second blow to controlling STIs is that family planning clinics are closing left and right because of the Dobbs decision and legislation in many states that curtailed access to an abortion. Discussion has focused on abortion, but those same clinics also play a vital role in the diagnosis and treatment of STIs.
Routine public health is the neglected stepchild of medicine. It is called upon in times of crisis but as that crisis resolves, funding dries up. Labs have atrophied and personnel have been redirected to Covid, “so access to routine screening for STIs has been decimated,” says Jennifer Mahn, director of sexual and clinical health with the National Coalition of STD Directors.
A preview of what we likely are facing comes from Iowa. In 2017, the state legislature restricted funding to family health clinics in four counties, which closed their doors. A year later the statewide rate of gonorrhea skyrocketed from 83 to 153.7 cases per 100,000 people. “Iowa counties with clinic closures had a significantly larger increase,” according to a study published in JAMA. That scenario likely is playing out in countless other regions where access to sexual health care is shrinking; it will be many months before we have the data to know for sure.
A decades-old antibiotic finds a new purpose
Using drugs to protect against HIV, either as post exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP), has proven to be quite successful. Researchers wondered if the same approach might be applied to other STIs. They focused on doxycycline, or doxy for short. One of the most commonly prescribed antibiotics in the U.S., it’s a member of the tetracycline family that has been on the market since 1967. It is so safe that it’s used to treat acne.
Two small studies using doxy suggested that it could work to prevent STIs. A handful of clinical trials by different researchers and funding sources set out to generate the additional evidence needed to prove their hypothesis and change the standard of care.
Senior researcher Victor Omollo, with the Kenya Medical Research Institute, noted, “These are prevention interventions that women can control on their own without having to seek or get consent from another person,” as is the case with condom use.
The first with results is the DoxyPEP study, conducted at two sexual health clinics in San Francisco and Seattle. It drew from a mix of transgender women and men who have sex with men, who had at least one diagnosed STI over the last year. The researchers divided the participants into two groups: one with people who were already HIV-positive and engaged in care, while the other group consisted of people who were on PrEP to prevent infection with HIV. For the active part of the study, a subset of the participants received doxy, and the rest of the participants did not.
The researchers intentionally chose to do the study in a population at the highest risk of having STIs, who were very health oriented, and “who were getting screened every three months or so as part of their PrEP program or their HIV care program,” says Connie Celum, a senior researcher at the University of Washington on the study.
Each member of the active group was given a supply of doxy and asked to take two pills within 72 hours of having sex where a condom was not used. The study was supposed to run for two years but, in May, it stopped halfway through, when a safety monitoring board looked at the data and recommended that it would be unethical to continue depriving the control group of the drug’s benefits.
Celum presented these preliminary results from the DoxyPEP study in July at the International AIDS Conference in Montreal. “We saw about a 56 percent reduction in gonorrhea, about 80 percent reduction in chlamydia and syphilis, so very significant reductions, and this is on a per quarter basis,” she told a later webinar.
In Kenya, another study is following a group of cisgender women who are taking the same two-pill regimen to prevent HIV, and the data from this research should become available in 2023. Senior researcher Victor Omollo, with the Kenya Medical Research Institute, noted that “these are prevention interventions that women can control on their own without having to seek or get consent from another person,” as is the case with condom use, another effective prevention tool.
Antibiotic resistance
Antibiotic resistance is a potentially big concern. About 25 percent of gonorrhea strains circulating in the U.S. are resistant to the tetracycline class of drugs, including doxy; rates are higher elsewhere. But resistance often is a matter of degree and can be overcome with a larger or longer dose of the drug, or perhaps with a switch to another drug or a two-drug combination.
Research has shown that an established bacterial infection is more difficult to treat because it is part of a biofilm, which can leave only a small portion or perhaps none of the cell surface exposed to a drug. But a new infection, even one where the bacteria is resistant to a drug, might still be vulnerable to that drug if it's used before the bacterial biofilm can be established. Preliminary data suggests that may be the case with doxyPEP and drug resistant gonorrhea; some but not all new drug resistant infections might be thwarted if they’re treated early enough.
“There are some tradeoffs” to these interventions, Celum says, and people may disagree on the cost of increased resistance balanced against the benefits of treating the STIs and reducing their spread within the community.
Resistance does not seem to be an issue yet for chlamydia and syphilis even though doxy has been a recommended treatment for decades, but a remaining question is whether broader use of doxy will directly worsen antibiotic resistance in gonorrhea, or promote it in other STIs. And how will it affect the gut microbiome?
In addition, Celum notes that we need to understand whether doxy will generate mutations in other bacteria that might contribute to drug resistance for gonorrhea, chlamydia or syphilis. The studies underway aim to provide data to answer these questions.
“There are some tradeoffs” to these interventions, Celum says, and people may disagree on the cost of increased resistance balanced against the benefits of treating the STIs and reducing their spread within the community. That might affect doctors' willingness to prescribe the drug.
Turning research into action
The CDC makes policy recommendations for prevention services such as taking doxy, requiring some and leaving others optional. Celum says the CDC will be reviewing information from her trial at a meeting in December, but probably will wait until that study is published before making recommendations, likely in 2023. The San Francisco Department of Public Health issued its own guidance on October 20th and anecdotally, some doctors around the country are beginning to issue prescriptions for doxy to select patients.
About half of new STIs occur in young people ages 15 to 24, a group that is least likely to regularly see a doctor. And sexual health remains a great taboo for many people who don't want such information on their health record for prying parents, employers or neighbors to find out.
“People will go out of their way and travel extensive distances just to avoid that,” says Mahn, the National Coalition director. “People identify locations where they feel safe, where they feel welcome, where they don't feel judged,” Mahn explains, such as community and family planning clinics. They understand those issues and have fees that vary depending on a person’s ability to pay.
Given that these clinics already are understaffed and underfunded, they will be hard pressed to expand services covering the labor intensive testing and monitoring of a doxyPEP regimen. Sexual health clinics don't even have a separate line item in the federal budget for health. That is something the National Association of STI Directors is pushing for in D.C.
DoxyPEP isn't a panacea, and it isn't for everyone. “We really want to try to reach that population who is most likely going to have an STI in the next year,” says Celum, “Because that's where you are going to have the biggest impact.”
The Friday Five: The plain solution to holiday stress?
The Friday Five covers five stories in research that you may have missed this week. There are plenty of controversies and troubling ethical issues in science – and we get into many of them in our online magazine – but this news roundup focuses on scientific creativity and progress to give you a therapeutic dose of inspiration headed into the weekend.
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Here are the promising studies covered in this week's Friday Five:
- How to improve your working memory
- A plain old solution to stress
- Progress on a deadly cancer for first time since 1995*
- Rise of the robot surgeon
- Tomato brain power
And in an honorable mention this week, new research on the gut connection to better brain health after strokes.
* The methodology for this study has come under scrutiny here.