To Make Science Engaging, We Need a Sesame Street for Adults
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
In the mid-1960s, a documentary producer in New York City wondered if the addictive jingles, clever visuals, slogans, and repetition of television ads—the ones that were captivating young children of the time—could be harnessed for good. Over the course of three months, she interviewed educators, psychologists, and artists, and the result was a bonanza of ideas.
Perhaps a new TV show could teach children letters and numbers in short animated sequences? Perhaps adults and children could read together with puppets providing comic relief and prompting interaction from the audience? And because it would be broadcast through a device already in almost every home, perhaps this show could reach across socioeconomic divides and close an early education gap?
Soon after Joan Ganz Cooney shared her landmark report, "The Potential Uses of Television in Preschool Education," in 1966, she was prototyping show ideas, attracting funding from The Carnegie Corporation, The Ford Foundation, and The Corporation for Public Broadcasting, and co-founding the Children's Television Workshop with psychologist Lloyd Morrisett. And then, on November 10, 1969, informal learning was transformed forever with the premiere of Sesame Street on public television.
For its first season, Sesame Street won three Emmy Awards and a Peabody Award. Its star, Big Bird, landed on the cover of Time Magazine, which called the show "TV's gift to children." Fifty years later, it's hard to imagine an approach to informal preschool learning that isn't Sesame Street.
And that approach can be boiled down to one word: Entertainment.
Despite decades of evidence from Sesame Street—one of the most studied television shows of all time—and more research from social science, psychology, and media communications, we haven't yet taken Ganz Cooney's concepts to heart in educating adults. Adults have news programs and documentaries and educational YouTube channels, but no Sesame Street. So why don't we? Here's how we can design a new kind of television to make science engaging and accessible for a public that is all too often intimidated by it.
We have to start from the realization that America is a nation of high-school graduates. By the end of high school, students have decided to abandon science because they think it's too difficult, and as a nation, we've made it acceptable for any one of us to say "I'm not good at science" and offload thinking to the ones who might be. So, is it surprising that a large number of Americans are likely to believe in conspiracy theories like the 25% that believe the release of COVID-19 was planned, the one in ten who believe the Moon landing was a hoax, or the 30–40% that think the condensation trails of planes are actually nefarious chemtrails? If we're meeting people where they are, the aim can't be to get the audience from an A to an A+, but from an F to a D, and without judgment of where they are starting from.
There's also a natural compulsion for a well-meaning educator to fill a literacy gap with a barrage of information, but this is what I call "factsplaining," and we know it doesn't work. And worse, it can backfire. In one study from 2014, parents were provided with factual information about vaccine safety, and it was the group that was already the most averse to vaccines that uniquely became even more averse.
Why? Our social identities and cognitive biases are stubborn gatekeepers when it comes to processing new information. We filter ideas through pre-existing beliefs—our values, our religions, our political ideologies. Incongruent ideas are rejected. Congruent ideas, no matter how absurd, are allowed through. We hear what we want to hear, and then our brains justify the input by creating narratives that preserve our identities. Even when we have all the facts, we can use them to support any worldview.
But social science has revealed many mechanisms for hijacking these processes through narrative storytelling, and this can form the foundation of a new kind of educational television.
Could new television series establish the baseline narratives for novel science like gene editing, quantum computing, or artificial intelligence?
As media creators, we can reject factsplaining and instead construct entertaining narratives that disrupt cognitive processes. Two-decade-old research tells us when people are immersed in entertaining fiction narratives, they loosen their defenses, opening a path for new information, editing attitudes, and inspiring new behavior. Where news about hot-button issues like climate change or vaccination might trigger resistance or a backfire effect, fiction can be crafted to be absorbing and, as a result, persuasive.
But the narratives can't be stuffed with information. They must be simplified. If this feels like the opposite of what an educator should be doing, it is possible to reduce the complexity of information, without oversimplification, through "exemplification," a framing device to tell the stories of individuals in specific circumstances that can speak to the greater issue without needing to explain it all. It's a technique you've seen used in biopics. The Discovery Channel true-crime miniseries Manhunt: Unabomber does many things well from a science storytelling perspective, including exemplifying the virtues of the scientific method through a character who argues for a new field of science, forensic linguistics, to catch one of the most notorious domestic terrorists in U.S. history.
We must also appeal to the audience's curiosity. We know curiosity is such a strong driver of human behavior that it can even counteract the biases put up by one's political ideology around subjects like climate change. If we treat science information like a product—and we should—advertising research tells us we can maximize curiosity though a Goldilocks effect. If the information is too complex, your show might as well be a PowerPoint presentation. If it's too simple, it's Sesame Street. There's a sweet spot for creating intrigue about new information when there's a moderate cognitive gap.
The science of "identification" tells us that the more the main character is endearing to a viewer, the more likely the viewer will adopt the character's worldview and journey of change. This insight further provides incentives to craft characters reflective of our audiences. If we accept our biases for what they are, we can understand why the messenger becomes more important than the message, because, without an appropriate messenger, the message becomes faint and ineffective. And research confirms that the stereotype-busting doctor-skeptic Dana Scully of The X-Files, a popular science-fiction series, was an inspiration for a generation of women who pursued science careers.
With these directions, we can start making a new kind of television. But is television itself still the right delivery medium? Americans do spend six hours per day—a quarter of their lives—watching video. And even with the rise of social media and apps, science-themed television shows remain popular, with four out of five adults reporting that they watch shows about science at least sometimes. CBS's The Big Bang Theory was the most-watched show on television in the 2017–2018 season, and Cartoon Network's Rick & Morty is the most popular comedy series among millennials. And medical and forensic dramas continue to be broadcast staples. So yes, it's as true today as it was in the 1980s when George Gerbner, the "cultivation theory" researcher who studied the long-term impacts of television images, wrote, "a single episode on primetime television can reach more people than all science and technology promotional efforts put together."
We know from cultivation theory that media images can shape our views of scientists. Quick, picture a scientist! Was it an old, white man with wild hair in a lab coat? If most Americans don't encounter research science firsthand, it's media that dictates how we perceive science and scientists. Characters like Sheldon Cooper and Rick Sanchez become the model. But we can correct that by representing professionals more accurately on-screen and writing characters more like Dana Scully.
Could new television series establish the baseline narratives for novel science like gene editing, quantum computing, or artificial intelligence? Or could new series counter the misinfodemics surrounding COVID-19 and vaccines through more compelling, corrective narratives? Social science has given us a blueprint suggesting they could. Binge-watching a show like the surreal NBC sitcom The Good Place doesn't replace a Ph.D. in philosophy, but its use of humor plants the seed of continued interest in a new subject. The goal of persuasive entertainment isn't to replace formal education, but it can inspire, shift attitudes, increase confidence in the knowledge of complex issues, and otherwise prime viewers for continued learning.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]
Tiny, tough “water bears” may help bring new vaccines and medicines to sub-Saharan Africa
Microscopic tardigrades, widely considered to be some of the toughest animals on earth, can survive for decades without oxygen or water and are thought to have lived through a crash-landing on the moon. Also known as water bears, they survive by fully dehydrating and later rehydrating themselves – a feat only a few animals can accomplish. Now scientists are harnessing tardigrades’ talents to make medicines that can be dried and stored at ambient temperatures and later rehydrated for use—instead of being kept refrigerated or frozen.
Many biologics—pharmaceutical products made by using living cells or synthesized from biological sources—require refrigeration, which isn’t always available in many remote locales or places with unreliable electricity. These products include mRNA and other vaccines, monoclonal antibodies and immuno-therapies for cancer, rheumatoid arthritis and other conditions. Cooling is also needed for medicines for blood clotting disorders like hemophilia and for trauma patients.
Formulating biologics to withstand drying and hot temperatures has been the holy grail for pharmaceutical researchers for decades. It’s a hard feat to manage. “Biologic pharmaceuticals are highly efficacious, but many are inherently unstable,” says Thomas Boothby, assistant professor of molecular biology at University of Wyoming. Therefore, during storage and shipping, they must be refrigerated at 2 to 8 degrees Celsius (35 to 46 degrees Fahrenheit). Some must be frozen, typically at -20 degrees Celsius, but sometimes as low -90 degrees Celsius as was the case with the Pfizer Covid vaccine.
For Covid, fewer than 73 percent of the global population received even one dose. The need for refrigerated or frozen handling was partially to blame.
The costly cold chain
The logistics network that ensures those temperature requirements are met from production to administration is called the cold chain. This cold chain network is often unreliable or entirely lacking in remote, rural areas in developing nations that have malfunctioning electrical grids. “Almost all routine vaccines require a cold chain,” says Christopher Fox, senior vice president of formulations at the Access to Advanced Health Institute. But when the power goes out, so does refrigeration, putting refrigerated or frozen medical products at risk. Consequently, the mRNA vaccines developed for Covid-19 and other conditions, as well as more traditional vaccines for cholera, tetanus and other diseases, often can’t be delivered to the most remote parts of the world.
To understand the scope of the challenge, consider this: In the U.S., more than 984 million doses of Covid-19 vaccine have been distributed so far. Each one needed refrigeration that, even in the U.S., proved challenging. Now extrapolate to all vaccines and the entire world. For Covid, fewer than 73 percent of the global population received even one dose. The need for refrigerated or frozen handling was partially to blame.
Globally, the cold chain packaging market is valued at over $15 billion and is expected to exceed $60 billion by 2033.
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Freeze-drying, also called lyophilization, which is common for many vaccines, isn’t always an option. Many freeze-dried vaccines still need refrigeration, and even medicines approved for storage at ambient temperatures break down in the heat of sub-Saharan Africa. “Even in a freeze-dried state, biologics often will undergo partial rehydration and dehydration, which can be extremely damaging,” Boothby explains.
The cold chain is also very expensive to maintain. The global pharmaceutical cold chain packaging market is valued at more than $15 billion, and is expected to exceed $60 billion by 2033, according to a report by Future Market Insights. This cost is only expected to grow. According to the consulting company Accenture, the number of medicines that require the cold chain are expected to grow by 48 percent, compared to only 21 percent for non-cold-chain therapies.
Tardigrades to the rescue
Tardigrades are only about a millimeter long – with four legs and claws, and they lumber around like bears, thus their nickname – but could provide a big solution. “Tardigrades are unique in the animal kingdom, in that they’re able to survive a vast array of environmental insults,” says Boothby, the Wyoming professor. “They can be dried out, frozen, heated past the boiling point of water and irradiated at levels that are thousands of times more than you or I could survive.” So, his team is gradually unlocking tardigrades’ survival secrets and applying them to biologic pharmaceuticals to make them withstand both extreme heat and desiccation without losing efficacy.
Boothby’s team is focusing on blood clotting factor VIII, which, as the name implies, causes blood to clot. Currently, Boothby is concentrating on the so-called cytoplasmic abundant heat soluble (CAHS) protein family, which is found only in tardigrades, protecting them when they dry out. “We showed we can desiccate a biologic (blood clotting factor VIII, a key clotting component) in the presence of tardigrade proteins,” he says—without losing any of its effectiveness.
The researchers mixed the tardigrade protein with the blood clotting factor and then dried and rehydrated that substance six times without damaging the latter. This suggests that biologics protected with tardigrade proteins can withstand real-world fluctuations in humidity.
Furthermore, Boothby’s team found that when the blood clotting factor was dried and stabilized with tardigrade proteins, it retained its efficacy at temperatures as high as 95 degrees Celsius. That’s over 200 degrees Fahrenheit, much hotter than the 58 degrees Celsius that the World Meteorological Organization lists as the hottest recorded air temperature on earth. In contrast, without the protein, the blood clotting factor degraded significantly. The team published their findings in the journal Nature in March.
Although tardigrades rarely live more than 2.5 years, they have survived in a desiccated state for up to two decades, according to Animal Diversity Web. This suggests that tardigrades’ CAHS protein can protect biologic pharmaceuticals nearly indefinitely without refrigeration or freezing, which makes it significantly easier to deliver them in locations where refrigeration is unreliable or doesn’t exist.
The tricks of the tardigrades
Besides the CAHS proteins, tardigrades rely on a type of sugar called trehalose and some other protectants. So, rather than drying up, their cells solidify into rigid, glass-like structures. As that happens, viscosity between cells increases, thereby slowing their biological functions so much that they all but stop.
Now Boothby is combining CAHS D, one of the proteins in the CAHS family, with trehalose. He found that CAHS D and trehalose each protected proteins through repeated drying and rehydrating cycles. They also work synergistically, which means that together they might stabilize biologics under a variety of dry storage conditions.
“We’re finding the protective effect is not just additive but actually is synergistic,” he says. “We’re keen to see if something like that also holds true with different protein combinations.” If so, combinations could possibly protect against a variety of conditions.
Commercialization outlook
Before any stabilization technology for biologics can be commercialized, it first must be approved by the appropriate regulators. In the U.S., that’s the U.S. Food and Drug Administration. Developing a new formulation would require clinical testing and vast numbers of participants. So existing vaccines and biologics likely won’t be re-formulated for dry storage. “Many were developed decades ago,” says Fox. “They‘re not going to be reformulated into thermo-stable vaccines overnight,” if ever, he predicts.
Extending stability outside the cold chain, even for a few days, can have profound health, environmental and economic benefits.
Instead, this technology is most likely to be used for the new products and formulations that are just being created. New and improved vaccines will be the first to benefit. Good candidates include the plethora of mRNA vaccines, as well as biologic pharmaceuticals for neglected diseases that affect parts of the world where reliable cold chain is difficult to maintain, Boothby says. Some examples include new, more effective vaccines for malaria and for pathogenic Escherichia coli, which causes diarrhea.
Tallying up the benefits
Extending stability outside the cold chain, even for a few days, can have profound health, environmental and economic benefits. For instance, MenAfriVac, a meningitis vaccine (without tardigrade proteins) developed for sub-Saharan Africa, can be stored at up to 40 degrees Celsius for four days before administration. “If you have a few days where you don’t need to maintain the cold chain, it’s easier to transport vaccines to remote areas,” Fox says, where refrigeration does not exist or is not reliable.
Better health is an obvious benefit. MenAfriVac reduced suspected meningitis cases by 57 percent in the overall population and more than 99 percent among vaccinated individuals.
Lower healthcare costs are another benefit. One study done in Togo found that the cold chain-related costs increased the per dose vaccine price up to 11-fold. The ability to ship the vaccines using the usual cold chain, but transporting them at ambient temperatures for the final few days cut the cost in half.
There are environmental benefits, too, such as reducing fuel consumption and greenhouse gas emissions. Cold chain transports consume 20 percent more fuel than non-cold chain shipping, due to refrigeration equipment, according to the International Trade Administration.
A study by researchers at Johns Hopkins University compared the greenhouse gas emissions of the new, oral Vaxart COVID-19 vaccine (which doesn’t require refrigeration) with four intramuscular vaccines (which require refrigeration or freezing). While the Vaxart vaccine is still in clinical trials, the study found that “up to 82.25 million kilograms of CO2 could be averted by using oral vaccines in the U.S. alone.” That is akin to taking 17,700 vehicles out of service for one year.
Although tardigrades’ protective proteins won’t be a component of biologic pharmaceutics for several years, scientists are proving that this approach is viable. They are hopeful that a day will come when vaccines and biologics can be delivered anywhere in the world without needing refrigerators or freezers en route.
Jamie Rettinger was still in his thirties when he first noticed a tiny streak of brown running through the thumbnail of his right hand. It slowly grew wider and the skin underneath began to deteriorate before he went to a local dermatologist in 2013. The doctor thought it was a wart and tried scooping it out, treating the affected area for three years before finally removing the nail bed and sending it off to a pathology lab for analysis.
"I have some bad news for you; what we removed was a five-millimeter melanoma, a cancerous tumor that often spreads," Jamie recalls being told on his return visit. "I'd never heard of cancer coming through a thumbnail," he says. None of his doctors had ever mentioned it either. "I just thought I was being treated for a wart." But nothing was healing and it continued to bleed.
A few months later a surgeon amputated the top half of his thumb. Lymph node biopsy tested negative for spread of the cancer and when the bandages finally came off, Jamie thought his medical issues were resolved.
Melanoma is the deadliest form of skin cancer. About 85,000 people are diagnosed with it each year in the U.S. and more than 8,000 die of the cancer when it spreads to other parts of the body, according to the Centers for Disease Control and Prevention (CDC).
There are two peaks in diagnosis of melanoma; one is in younger women ages 30-40 and often is tied to past use of tanning beds; the second is older men 60+ and is related to outdoor activity from farming to sports. Light-skinned people have a twenty-times greater risk of melanoma than do people with dark skin.
"When I graduated from medical school, in 2005, melanoma was a death sentence" --Diwakar Davar.
Jamie had a follow up PET scan about six months after his surgery. A suspicious spot on his lung led to a biopsy that came back positive for melanoma. The cancer had spread. Treatment with a monoclonal antibody (nivolumab/Opdivo®) didn't prove effective and he was referred to the UPMC Hillman Cancer Center in Pittsburgh, a four-hour drive from his home in western Ohio.
An alternative monoclonal antibody treatment brought on such bad side effects, diarrhea as often as 15 times a day, that it took more than a week of hospitalization to stabilize his condition. The only options left were experimental approaches in clinical trials.
Early research
"When I graduated from medical school, in 2005, melanoma was a death sentence" with a cure rate in the single digits, says Diwakar Davar, 39, an oncologist at UPMC Hillman Cancer Center who specializes in skin cancer. That began to change in 2010 with introduction of the first immunotherapies, monoclonal antibodies, to treat cancer. The antibodies attach to PD-1, a receptor on the surface of T cells of the immune system and on cancer cells. Antibody treatment boosted the melanoma cure rate to about 30 percent. The search was on to understand why some people responded to these drugs and others did not.
At the same time, there was a growing understanding of the role that bacteria in the gut, the gut microbiome, plays in helping to train and maintain the function of the body's various immune cells. Perhaps the bacteria also plays a role in shaping the immune response to cancer therapy.
One clue came from genetically identical mice. Animals ordered from different suppliers sometimes responded differently to the experiments being performed. That difference was traced to different compositions of their gut microbiome; transferring the microbiome from one animal to another in a process known as fecal transplant (FMT) could change their responses to disease or treatment.
When researchers looked at humans, they found that the patients who responded well to immunotherapies had a gut microbiome that looked like healthy normal folks, but patients who didn't respond had missing or reduced strains of bacteria.
Davar and his team knew that FMT had a very successful cure rate in treating the gut dysbiosis of Clostridioides difficile, a persistant intestinal infection, and they wondered if a fecal transplant from a patient who had responded well to cancer immunotherapy treatment might improve the cure rate of patients who did not originally respond to immunotherapies for melanoma.
The ABCDE of melanoma detection
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Clinical trial
"It was pretty weird, I was totally blasted away. Who had thought of this?" Jamie first thought when the hypothesis was explained to him. But Davar's explanation that the procedure might restore some of the beneficial bacterial his gut was lacking, convinced him to try. He quickly signed on in October 2018 to be the first person in the clinical trial.
Fecal donations go through the same safety procedures of screening for and inactivating diseases that are used in processing blood donations to make them safe for transfusion. The procedure itself uses a standard hollow colonoscope designed to screen for colon cancer and remove polyps. The transplant is inserted through the center of the flexible tube.
Most patients are sedated for procedures that use a colonoscope but Jamie doesn't respond to those drugs: "You can't knock me out. I was watching them on the TV going up my own butt. It was kind of unreal at that point," he says. "There were about twelve people in there watching because no one had seen this done before."
A test two weeks after the procedure showed that the FMT had engrafted and the once-missing bacteria were thriving in his gut. More importantly, his body was responding to another monoclonal antibody (pembrolizumab/Keytruda®) and signs of melanoma began to shrink. Every three months he made the four-hour drive from home to Pittsburgh for six rounds of treatment with the antibody drug.
"We were very, very lucky that the first patient had a great response," says Davar. "It allowed us to believe that even though we failed with the next six, we were on the right track. We just needed to tweak the [fecal] cocktail a little better" and enroll patients in the study who had less aggressive tumor growth and were likely to live long enough to complete the extensive rounds of therapy. Six of 15 patients responded positively in the pilot clinical trial that was published in the journal Science.
Davar believes they are beginning to understand the biological mechanisms of why some patients initially do not respond to immunotherapy but later can with a FMT. It is tied to the background level of inflammation produced by the interaction between the microbiome and the immune system. That paper is not yet published.
Surviving cancer
It has been almost a year since the last in his series of cancer treatments and Jamie has no measurable disease. He is cautiously optimistic that his cancer is not simply in remission but is gone for good. "I'm still scared every time I get my scans, because you don't know whether it is going to come back or not. And to realize that it is something that is totally out of my control."
"It was hard for me to regain trust" after being misdiagnosed and mistreated by several doctors he says. But his experience at Hillman helped to restore that trust "because they were interested in me, not just fixing the problem."
He is grateful for the support provided by family and friends over the last eight years. After a pause and a sigh, the ruggedly built 47-year-old says, "If everyone else was dead in my family, I probably wouldn't have been able to do it."
"I never hesitated to ask a question and I never hesitated to get a second opinion." But Jamie acknowledges the experience has made him more aware of the need for regular preventive medical care and a primary care physician. That person might have caught his melanoma at an earlier stage when it was easier to treat.
Davar continues to work on clinical studies to optimize this treatment approach. Perhaps down the road, screening the microbiome will be standard for melanoma and other cancers prior to using immunotherapies, and the FMT will be as simple as swallowing a handful of freeze-dried capsules off the shelf rather than through a colonoscopy. Earlier this year, the Food and Drug Administration approved the first oral fecal microbiota product for C. difficile, hopefully paving the way for more.
An older version of this hit article was first published on May 18, 2021