Semantron 2014

Semantron 2014

Contents

List of contributors

Diversity: editorÊs introduction

BODY

2

A cure for HIV? MILAD JEILANI

9

The cure for diabetes ALEX KOFFMAN

13

Designer babies MILO FABIAN

16

Embryonic stem cells DILEN PATEL

IDEA

22

Science and the riddle of consciousness FRANCIS AZNARAN

25

The riddle of consciousness BARNABY CULLEN

28

Colour experience: the example of Mary ALI NEDEN

31

The explanatory gap: physical facts and the facts of consciousness HARRY GOODHEW

34

Consciousness and the brain MAX NUGENT

37

Collective worship in schools TOMMY CURRAN JONES

41

Is bribery ever justifiable? DILLON HARINDIRAN

MONEY

47

If micro-finance wonÊt save them, what will? ARNAV KAPUR

52

The future of the NHS RUPERT WOOD

56

Income inequality in developing countries TAYLER YU

62

Should teachersÊ pay depend on their pupilsÊ examination results? DILLON HARINDIRAN

NUMBER

67

BachÊs use of alterations to Ritornello and Fortspinnung in the Allegro of Brandenburg Concerto No. 5 ED EDWARDS

71

Job promotion competitions JOSH ROBINSON

76

A clockwork universe? MARCO IOVINO

PAST

84 Why did Britain not follow FranceÊs revolutionary path in the late 18th and early 19th century? WILLIAM BEDDOWS

88

The British as Âabsent-mindedÊ imperialists OLIVER DANIEL

92

The collapse of the western Roman Empire NED TIDMARSH

97

The Venerable Bede and Imperial Rome SEB WAKELY

SOCIETY

101

A critique of democracy CHARLES APTHORP

104

Democracy and Liberalism WILL COOK

108

Liberty and modern society WILL SPENCE

112

China in Africa: friend or foe? WILL THOMAS

117

Intellectual property rights DARSHAN CHOHAN

WORD

ChaucerÊs The MillerÊs Tale and Postmodernism HENRY PAGE

122

GoetheÊs Die Leiden des jungen Werther and PropertiusÊ Monobiblos NIK NICHEPEROVICH

125

131

LorcaÊs death and writing in the Spanish Civil War GEORGE STANBURY

134

The Homeric hero ANDREW JONES

To ÂBe Again? Musings on KrappÊs Last Tape and A Kind of Alaska JOSEPH SPENCE

138

140

Sappho and Virgil PATRICK KING

Contributors

CHARLES APTHORP is taking a gap year but plans to apply to read History and Politics at Oxford next year.

FRANCIS AZNARAN is leaving to read Mathematics at Warwick.

WILLIAM BEDDOWS plans to apply to read History at Oxford next year.

DARSHAN CHOHAN is going to St. CatherineÊs College, Cambridge to read Law.

WILL COOK is off to Oriel College, Oxford to read PPE.

BARNABY CULLEN is in the Remove, and is a keen historian.

TOMMY CURRAN JONES is in the sixth-form, and is interested in humanities and social sciences.

OLIVER DANIEL is in the sixth-form, and is a keen geographer and historian.

ED EDWARDS is off to Gonville and Caius College, Cambridge to read Music.

MILO FABIAN is going to College, Oxford to read Biological Sciences.

HARRY GOODHEW is in the Remove and is mainly drawn to scientific investigation.

DILLON HARINDIRAN is taking a gap year, but will apply to read Economics and Management at Oxford.

MARCO IOVINO has decided to attend university in the USA. Next year he will be at Pomona College in California.

MILAD JEILANI will next year be studying Medicine at College, Oxford.

ANDREW JONES is going to The QueenÊs College, Oxford to study Classics.

ARNAV KAPUR will next year be studying Law at St. CatherineÊs College, Cambridge.

PATRICK KING is off to Magdalen College, Oxford to study Classics.

ALEX KOFFMAN will next year be studying Medicine at College, Oxford.

MAX LESLIE is going to Edinburgh to read Economics.

ROBERT LOOPUIT is in the sixth-form, and is interested in the law and history.

ALI NEDEN will next year be studying Classics at Durham.

NIK NICHEPEROVICH is in the sixth-form and is a keen classicist.

MAX NUGENT is in the Remove, and is a keen linguist.

DILEN PATEL is going to Imperial College to read Medicine.

JOSH ROBINSON is off to Warwick to read Mathematics.

JOSEPH SPENCE is the Master of the College.

WILL SPENCE is going to College, Cambridge to read HSPS.

GEORGE STANBURY is in the sixth-form and, while an enthusiastic linguist, is also interested in Psychology.

WILL THOMAS is in the sixth-form and is a keen geographer.

NED TIDMARSH is going to St. PeterÊs College, Oxford to read History.

SEB WAKELY teaches Classics at the College, and is known for his sunny disposition.

RUPERT WOOD is in the sixth-form and is an economist.

TAYLER YU is going to study History and Economics at College, Oxford.

Diversity: editorÊs introduction

Neil Croally

A school should be many things. Semantron attempts to embody that prescription. There are essays here from students and from staff, on subjects from literature to Physics, History to Medicine, Economics to Mathematics. Many of the essays, though not all, are based on the Extended Essay produced by students in their last summer holiday at the school. These too – in their subject matter, of course, but also in their formatting and referencing – are various. I have not attempted to impose the sort of order most publishers would require.

Why not?

These essays are not the work of Semantron . More important, it is good to see how minds develop. I hope that the contributors to this issue will, at some point, look back at their work published here and say ÂOh! ThatÊs what and how I was thinking then.Ê Five of the essays in the section Idea were written to compete for prizes in the Erasmus Competition. Ali NedenÊs essay won third prize. Dillon HarindiranÊs essay on teacherÊs pay won the Staton Prize, which is awarded by RegentÊs Park College, Oxford.

PART ONE

BODY

1

A cure for HIV?

Milad Jeilani

The Human Immunodeficiency Virus (HIV) has plagued the human race for over three decades, and has risen to become one of the deadliest diseases in human history, claiming a staggering 1.6 to 1.9 million lives each year. 1 For years the Âcure for HIVÊ has been on the lips of the most prominent scientists, yet to this day it manages to elude us. But we havenÊt given up hope yet. After all, it took 105 years after the discovery of the typhoid bacterium to develop a vaccine for typhoid. But the time lag is getting shorter. It only took 16 years from the discovery of the hepatitis B virus to the development of a vaccine. 2 Still, there is renewed hope after recent success concerning the now famous ÂBoston patientsÊ: two HIV-positive patients that received bone-marrow transplants, leaving them apparently cured of HIV. HIV is a lentivirus, and like all viruses of this type, it attacks the immune system. The name ÂlentivirusÊ literally means Âslow virusÊ because they take such a long time to produce any adverse effects in the body: it can take up to 15 years for the first signs of HIV infection to appear. 3 In fact, it is so well hidden that the only thing that gives it away is the presence of antibodies against HIV in the blood. However, this does not mean that all is well in this dormancy. There are two types of cells of the immune system that are infected by HIV: CD4 lymphocytes – the regulatory cells of the immune system, and macrophages – these ingest foreign proteins and flag them for the immune system. During the silent phase, some 100 million virus particles are destroyed daily, while simultaneously about 2 billion CD4 1 [Student BMJ, The worldÊs deadliest virus , 2013] 2 [Aidsmap, Why is it so hard to make a vaccine against HIV? , 2013] 3 [AIDS.gov, Stages of HIV, 2009] The virus

lymphocytes (5% of the total population) are destroyed by the virus each day and need to be replaced. 4 Such is the extent of the viral onslaught that after a number of years the replenishment of the CD4 lymphocytes fails to keep up with the virus, resulting in a profound depression of immune function. Furthermore, once this immune function has been compromised, the individual is left to the mercy of opportunistic infections. These are bacterial, viral, fungal or protozoan infections that usually do not cause disease in a healthy host, but which take advantage of weakened immune systems, and can cause devastating illnesses. 5 The Centres for Disease Control (CDC) have developed a list of more than 20 opportunistic infections that are considered as AIDS-defining infections. These include PCP (a rare form of pneumonia), KaposiÊs sarcoma (a tumour), Tuberculosis and Wasting Syndrome. 6 Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic infection, life expectancy falls to about 1 year. 7 Another problem with treating HIV is that itÊs a retrovirus. After infecting a body cell, a retrovirus turns its own RNA genome into DNA and then integrates this DNA into the host cellÊs DNA. 8 The virus then lies dormant within the cell indefinitely – for as long as the cell is alive. In this state, the virus is known as a latent virus. It is invisible to the immune system and anti-retroviral drugs (ARVs), because these only kill viruses that are actively replicating. The latent virus can 4 [Schoub, AIDS and HIV in perspective , 1999] 5 [AIDSMEDS, Opportunistic Infections (OIs) , 2011] 6 [AIDS.gov, Opportunistic Infections , 2009] 7 [AIDS.gov, Stages of HIV , 2009] 8 [Global Health Forum, Why we canÊt (yet) cure HIV , 2009]

2

also reactivate itself, and begin replicating once more. This is why an infected individual cannot stop taking ARVs, since some of the latent viruses will inevitably reactivate. This latent ÂreservoirÊ, along with the extensive damage to the immune system is the major barrier to the eradication of HIV. 9 At the moment, the best treatment available is highly active anti-retroviral therapy (HAART), which consists of a combination of at least three ARVs. There are six classes of ARVs. 10 Each of the first five classes are a different enzyme inhibitor, which block the action of certain enzymes used by the virus to infect a host cell, e.g. they stop conversion of RNA into DNA, or the manufacture of proteins required to maintain cell structure. 11 CCR5 antagonists are the final and most important class. These act to dampen the sensitivity of the CCR5 receptor – a protein on the surface of white blood cells. 12 Although it seems illogical to attack your white blood cells – the very cells fighting off the virus, studies have shown that the CCR5 protein is used by the virus to enter and infect host cells. 13 Thus, by shutting off the CCR5 protein, these antagonists reduce the ability of the virus to infect cells. In fact, people who have a mutation called the ÂCCR5- ∆ 32 mutationÊ do not have any CCR5 proteins on their white blood cells, and so have natural immunity to HIV. 14 Clearly, HAART is a sophisticated programme of treatment for HIV sufferers. And in high-income regions such as North America, Western Europe and Australia, HAARTÊs impact has been dramatic. Opportunistic infections are now uncommon, and average life expectancy is at an all time high at 63 years, which is only 13 years below 9 [PLOS Pathogens, Rapid Quantification of the Latent Reservoir for HIV-1⁄ , 2013] 10 [Patient.co.uk, Antiretroviral Agents , 2012] 11 [Aidsmap, Integrase Inhibitors , 2013] 12 [Wikipedia, CCR5 , 2013] 13 [Wikipedia, Receptor Antagonist, 2013] 14 [FoundCare, What is HIV antiretroviral treatment?, 2013] HAART

that of the general population in these regions. 15 However, HAART is not without disadvantages. In regions most affected by HIV, sufferers are unable to afford the costly HAART cocktails, and partial treatment often proves to be a poor alternative. 16 HAART medications also receive criticism due to their schedules. Often confusing and easy to forget, such regimens may be risky since missing a time-tabled ingestion can have serious consequences on efficacy. Also, as with any potent, lifelong therapy, side effects are common, including bone problems, liver damage, diarrhoea, nausea and more. 17 One of the first major breakthroughs in combating HIV came off the back of years of painstaking research and a large helping of luck. Timothy Ray Brown, the ÂBerlin patientÊ, was diagnosed with HIV in 1995 and with leukaemia (a cancer of the blood) in 2006. Brown had already undergone chemotherapy, but needed a bone marrow transplant. His doctor, Gero Hutter, suggested they seek a donor with the CCR5- ∆ 32 mutation, which gives the carrier natural immunity to HIV. 18 Hutter theorized that a transplant from such a donor could make the recipient resistant to HIV also. No one apparently had tried this, and his idea received mixed reaction from other doctors. But within weeks, tests showed promise that Brown was cured – the virus in his blood had dropped to undetectable levels, and the cancer had disappeared. However, researchers in California recently found traces of HIV in his tissues, leading to speculation that the virus had returned. 19 Mr Brown and his doctors dismissed the The Berlin patient 15 [NHS, What is the life expectancy for someone with HIV? , 2013] 16 [HIV Positive Voices, Highly Active Antiretroviral Therapies (HAART) For Treating HIV , 2013] 17 [Live Strong, The Side Effects of HAART , 2010] 18 [Huffington Post, Timothy Ray Brown, ÂBerlin PatientÊ, And His Doctor Are Convinced⁄ , 2012] 19 [Daily Mail, First man believed cured of AIDS says the disease is gone forever⁄ , 2012]

3

findings, saying whatever traces of HIV remained were dead.

The Boston patients

This summer, two anonymous HIV sufferers, known as the ÂBoston patientsÊ, are said to have been cured. The key to their ÂcureÊ is the bone marrow transplants they underwent three and five years ago respectively. Normally, doctors wouldnÊt recommend such a drastic procedure for HIV alone – the treatment carries a 20% risk of death – but both patients had life-threatening lymphomas (a type of blood cancer), complications of their HIV. The bone marrow transplants successfully treated both the cancer and the HIV infection. For years after their transplants, the Boston patients remained on ARVs. But for three and five months now (at the time of writing: half-way through August 2013), they have been off their medications, and the virus remains at bay. 25 Nevertheless, doctors will need to follow the men closely for at least a year, because the virus may be hiding out in latent reservoirs. 26 If the men stay healthy, they will be the third and fourth patients ever to be cured of HIV, after Timothy Ray Brown and the baby in Mississippi. 27 The Boston patients are the most promising development yet on our way to finding the cure for HIV. Researchers and doctors are excited about the news, especially since the Boston patientsÊ treatment differed from that of Brown in one key way – Brown was given stem cells that were predisposed to resist HIV infection due to CCR5- ∆ 32, while the stem cells that the Bostonians received had no such resistance. Their doctors believe that the transplanted cells must therefore have been protected from infection by the antiretroviral drugs taken during cancer treatment. 28 The finding is very important for people with HIV who also need blood-cell transplants, but the treatment is unlikely to 25 [New Scientist, Double good news from HIV front line , 2013] 26 [Nature, Stem-cell transplants may purge HIV , 2013] 27 [Nature, InfantÊs vanquished HIV leaves doctors puzzled , 2013] 28 [Bloomberg, Stem Cell Transplants Clear HIV in Two Patients in Study , 2013]

So, have we found the cure for HIV? Well, the CCR5- ∆ 32 mutation is present only in people of European descent, and then only in 4-16% of these people. 20 Furthermore, donors have to be of the same blood group as the patient. In fact, Hutter repeated the procedure in 2008 with 12 other people who had both HIV and cancer, but some were too sick to undergo treatment, and others couldnÊt find matching donors or ran into other roadblocks. 21 Scientists hope to investigate other avenues for a more reliable remedy. Separately, the International Maternal Paediatric Adolescent AIDS Clinical Trials (IMPAACT) Group is trying to replicate the Berlin patientÊs cure by giving CCR5- ∆ 32- mutated blood from umbilical cords to children with HIV. 22 The trials mark a change for the field: so far, most research worldwide has focused on adults. In 2012, the National Institute of Allergy and Infectious Diseases (NIAID) spent US$18 million on HIV cure research in adults, and just $45,000 on children. Yet 3.3 million children worldwide have HIV. 23 Children have been an afterthought in the fight against HIV, but the immune system of the child might be more easily manipulated to allow a cure. This was highlighted in March 2013, when it was announced that a baby in Mississippi who received treatment for HIV within 31 hours of birth stopped medication at 18 months without the virus rebounding. 24 Paediatric treatment

20 [Wikipedia, CCR5 receptor , 2013] 21 [Huffington Post, Timothy Ray Brown, ÂBerlin PatientÊ, And His Doctor Are Convinced⁄ , 2012] 22 [Nature, InfantÊs vanquished HIV leaves doctors puzzled , 2013] 23 [Nature, Bid to cure HIV ramps up , 2013] 24 [abcNews, Mississippi Baby Born With HIV ÂFunctionally CuredÊ, Doctors Say , 2013]

4

be used more generally because the risks from transplants are high.

programmes (injecting drug users can exchange used needles for new ones, in order to discourage sharing and re-use); and sexual abstinence. The pharmaceutical side of prevention includes: condoms; vaccines which would protect uninfected individuals from contracting HIV (although no effective vaccine has yet been produced); and finally circumcision (removal of the foreskin from the human penis). A 2009 study done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38–66% over a period of 24 months. 31 The WHO recommends considering circumcision as part of a comprehensive HIV programme in areas with high endemic rates of HIV, such as sub- Saharan Africa, where studies have concluded it is cost-effective against HIV. The apparent success with the Boston patients has caused a surge in optimism that a cure could be imminent. Nevertheless, 30 yearsÊ experience of struggle against HIV means we must accept that a viable cure for most HIV patients may still be a long way off. With an estimated thirty-three million people 32 currently living with HIV, for the foreseeable future it seems we cannot give up on a multi-faceted approach, combining education, diagnosis, treatment and prevention. 31 [Wikipedia, Circumcision , 2013] 32 [World Health Organization, Fast Facts on HIV , 2013]

Perhaps the Berlin and Boston cases should not be viewed too optimistically. Their ÂcuresÊ have come at a high price – intensive chemotherapy and life-long immuno- suppressants and still a significantly lower life expectancy. Alternatively, if we simply improved our HIV testing strategies and detected HIV earlier, we could keep patients healthy and improve their chances. One in four of those in the UK who are living with HIV are not aware they are infected. 29 In developing countries in particular, the problem of treating HIV is compounded by the prejudice and abuse often directed at sufferers. The consequences are wide- ranging, including being shunned by family and community, poor treatment in healthcare and psychological damage, leading to negative attitudes towards HIV testing and treatment. Also, despite reductions in the price of drugs, treatment reminds expensive to buy and to administer. Some activists are worried that the focus on treatment is detracting from prevention. 30 HIV prevention encompasses social as well as pharmaceutical strategies: requiring people to change their behaviour in order to gain protection from HIV. The social side includes sex education; needle exchange 29 [Lipkin, Professor W. I., 21 st Century Challenges , (Lecture). 2011] 30 [de Waal, AIDS and Power: why there is no political crisis – yet , 2006] HIV prevention

5

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