Linking Science and Social Issues

What are the capacious civic questions or problems addressed in the course?

Bio 102 addresses the global tuberculosis epidemic, which the World Health Organization declared to be a global health emergency in 1993. Although
tuberculosis is a treatable, curable disease, more people died of tuberculosis last year than in any other year in history. At least 30 million people will die from tuberculosis in the next 10 years if current trends continue. Our shameful record in tuberculosis control and prevention is due in part to our lack of political will and hence our failure to develop and implement appropriate public policies to address the epidemic. Thus, a crucial component of our strategy to address the epidemic is to generate the political will to provide the necessary resources to fight the disease.

We also need better tools to fight tuberculosis. For example, the current "gold standard" diagnostic test-the tuberculin skin test-is more than 100 years old, and the widely used BCG vaccine is nearly 80 years old and largely ineffective. Moreover, we need new and better antibiotics that will kill the tubercle bacillus in less time than the drugs being used today (6-9 month regimens are commonly used today) and that can be used to treat multidrug-resistant TB and latent tuberculosis infection. There has been no new class of drugs for treating tuberculosis since the 1970s.

What basic science is covered in this course and how is it linked to public policy questions?

Developing these tools requires knowledge of the biochemistry of the tubercle bacillus and the identification of potential drug targets; knowledge of the molecular biology of the tubercle bacillus and identification of suitable antigens for a vaccine; and knowledge of the cell and molecular biology of the tubercle bacillus and how it can survive for decades in an immunocompetent host. In Bio 102, we discuss these problems in basic science and others: the evolution of drug resistance, the function of the immune system, and the synergy between tuberculosis and HIV. Thus, the future of tuberculosis control and prevention will depend on a better understanding of the biology of the tubercle bacillus, which is probably the most successful pathogen in human history.

As summarized in Table 1, Bio 102 affords students an opportunity to study the global tuberculosis epidemic from the multiple perspectives of biology, medicine, public health, public policy, and others.

What strategies does the course use to both advance science education and foster civic engagement?

First, I take a multidisciplinary approach to TB. In general terms, this means that my students and I study TB from both a biomedical perspective and a public health perspective. Thus, while we discuss the need for better tools for the prevention, diagnosis, and treatment of TB, we also discuss the need for an effective public health infrastructure that can use these tools. The latter requires us to study TB control and prevention from the perspectives of anthropology, business, economics, ethics, law, and public policy. A second strategy is the assignment of semester-long, group projects. As part of this project, students write 5 related documents-a memo that states their preference for a project, a pre-proposal, a proposal, a progress report, and a final paper. All but the first paper are written by a group of students; thus, students must discuss among themselves the key ideas, etc. Each of the documents (except the last one) is read by both the undergraduate preceptor and me; and we give the students extensive feedback, both written and oral, about their papers. My discussions with each group about its papers are some of the most
stimulating ones of the semester. Each group also presents its work to the rest of the class, who then have the opportunity to ask questions, challenge the writers' assumptions, and engage the writers in a discussion of their work. I also invite an outside "expert" to act as a discussant when students present their final reports to the class.

To ensure that students will report on topics consistent with the course's multidisciplinary approach, I provide a list of topics from which students can choose. The topics range from biology, to anthropology, to economics, to law, to public policy. Given the range of topics, the students teach each other about their topics when they report to the class. The projects invariably have policy implications. For example, a paper about multidrug-resistant TB must address the need for a public health infrastructure that can ensure completion of an appropriate drug regimen. In choosing, I pick topics that represent real problems in TB control and prevention. Thus, students know that they are not only learning about a real problem but that their findings could be used to do something about the problem, for example implementing a plan for TB education at local farm
worker camps. In the case of TB control and prevention, such doing inevitably involves public policy.

A third strategy I use to ensure that students wrestle with key ideas is to plan structured in-class discussions of assigned readings. To help students prepare for the discussions, I provide them study questions and ask them to discuss the questions with a small group (the composition of which varies from one assignment to another) before they come to class.

Finally, the fourth strategy takes advantage of the residential character of first year seminars at Franklin & Marshall College, which helps make this course work as well as it does. All students in the course live together on the same floor of a residence hall. Their proximity to each other facilitates group work and ensures that discussion of the course materials continues outside the classroom.