Make It Relevant

It can be difficult to teach students studying biology to appreciate the immediate relevance of understanding biology to their daily lives, and students may be disengaged in classes that stress mastery of fact-based material alone. Even students who claim to love biology may focus on a long-term goal of successfully applying to medical school or graduate school without recognizing the value of understanding biology in many areas of life. Others take biology courses solely to fulfill distribution requirements and are uninterested from the outset. It can be challenging to actively engage students who view biology as disconnected from their lives, since they may only want to be fed information toward their long-term goals.

About thirty years ago, I embarked on teaching a course called Biology and Public Policy at Bryn Mawr College to make clear how an understanding of basic biology helps students appreciate the impact of advances in biology in the public arena. Class size has ranged from twenty to forty students annually. Requiring only a semester of college-level biology, the course is open to all students, and classes often have a mix of biology and other science majors, as well as majors from other departments (including political science, environmental studies, anthropology, and philosophy). The nonscience majors bring different perspectives to class discussions. They might focus more on the public perception of the science behind an issue than on the biology itself. In turn, I push students with a stronger biology background to explain how public misperceptions of biology might lead to scientifically inappropriate policy decisions. The course aims to engage students with the real-world dilemmas of applying scientific information in policymaking and clearly communicating scientific ideas to the public. Misperceptions about science affect our lives—consider the current resistance, based on inaccurate information, to getting COVID-19 vaccines and wearing masks.

My initial motivation for creating the course was my own interest in science policy. I wanted to examine how scientific information enters into policymaking and the role that scientists might play in influencing policymakers. Most policymakers lack significant scientific training, and if they develop science-related policies without input from scientists, these policies might have unintended consequences. I also wanted to focus on the ethical challenges of biological advances to help students become more sensitive to the potential negative consequences of biological knowledge and methods. In 1991, I began teaching the class from the perspective of a concerned citizen with no particular expertise in political science, ethical philosophy, or science policy. Then I spent a sabbatical year in the mid-1990s as a program officer at the National Research Council (NRC), the research arm of the National Academies of Sciences, Engineering, and Medicine, and immersed myself in the process of providing scientific information and advice to the federal government and other entities. I learned that asking the right questions was critical in formulating sensible policy recommendations and that gaining the knowledge necessary to frame those questions can be a lengthy process.

Using a thematic approach, I focus the course on both arms of science policy: policy for science (funding and regulation) and science for policy (information to influence broader policy decisions). For each area, I use a well-defined case study as a springboard to explore the overarching theme. The themes and case studies are the funding of science, with a focus on the Human Genome Project (HGP); the question of whether science can self-regulate, with a focus on reproductive technologies and their lack of regulation; regulatory science, with a focus on the Food and Drug Administration and new drug development, using AIDS drug development as an example; science and uncertainty, with a focus on genetically modified organisms and electromagnetic fields and their (undetermined) risks of causing cancer; science in the national interest, with a focus on public health responses to bioterrorism and emerging diseases; and the limitations of science, with a focus on organ transplantation and euthanasia—in which policy issues transcend the science itself. I introduce relevant biological material with each theme, presenting the concepts needed to clarify how biological information influences the policy issues explored. I also describe the process of policymaking in context with the particular policy issue we are exploring. I pose questions and issues to students during these lectures and ensure every class has ample opportunity for discussion.

For example, I begin the exploration of funding of science and the HGP by presenting a perspective on funding mechanisms for science; these include funding from the federal (as well as state and local) government and funding from private sources, both corporate and nonprofit. I offer a historical overview of the development and goals of the HGP and how its funding differs from traditional funding mechanisms. I describe advances in molecular biology, gene manipulation, and genomic analysis so students can appreciate how government-funded basic research made the HGP possible and how the project has had significant returns for both science and society. For instance, technological advances in DNA manipulation led to the growing field of molecular medicine, as well as to the commercial applications of genome testing for ancestry tracing (such as 23andMe) and forensic genetic tracing of suspects in cold criminal cases. Class discussions then address issues of eugenics, genetic discrimination, and genetic privacy. Finally, I challenge the class to consider who should determine the priorities for funding given the finite budget available and whether limits should be placed on human genetic modification. Most students have never considered these implications of genetic advances; feedback suggests that many find exploring the issues revelatory and stimulating.

The last class of each topic is a student-led discussion. Student leaders create scenarios (town meetings, ethics panels, court cases) and assign roles or positions to classmates. For example, a discussion of federal funding of human germline gene therapy (which, in contrast to therapy that corrects a gene defect only in the affected individual, produces stable genetic changes that would be inherited by future offspring) might include students representing research scientists, physicians, parents who have a sick child, members of Congress, and bioethicists. Different class members take opposing positions as a given character and develop arguments to support them. Role-playing helps students overcome the unease they might otherwise feel taking a position that differs from their own. Assigning positions to students promotes consideration of different viewpoints, helping students avoid the tendency to agree with the positions of the most confident participants. Discussions often address additional ramifications, such as differing religious or cultural viewpoints, as students think through their positions. My role in these discussions is mostly to provide concrete information upon request, although I will on occasion heckle with extreme viewpoints to push the discussion forward.

My 2007 book, Current Controversies in the Biological Sciences: Case Studies of Policy Challenges from New Technologies, coauthored with Jon F. Merz, a colleague in the University of Pennsylvania’s Department of Medical Ethics and Health Policy Department, uses themes and case studies to focus on both the process of developing science policy and its ethical ramifications. The challenge of finding appropriate readings for the class was one of our motivations for writing the book. While many excellent single-topic books are available, few sources cover many aspects of science policy. In addition, publications are aimed at audiences with differing levels of expertise. Our book serves as the core reading for the class, supplemented by many online postings of material to keep information current. Postings include articles describing scientific discoveries, policy recommendations from the NRC and other sources, opinion pieces, and news reports.

To move away from the biology-as-information mindset of some students, I assess students on how well they learn to communicate science to nonscientists. Students write three 1,200-word position papers with the goal of providing advice to legislators or other officials on laws and policies to be developed or supported that relate to the topics discussed in class. Most politicians are not scientists, so students must explain the science in lay terms. Students raise a policy issue, clearly explain the background science relevant to the issue, present both their position on the issue and arguments opponents might offer, and develop a coherent policy proposal. Students may submit rough drafts of their position papers and one revised paper during the semester. Students write a longer white paper as a final class assignment on a topic that we did not cover in class. These more in-depth papers, describing the science and policy challenges associated with the topic, do not require students to take a position on an issue, but many students do so. The emphasis on good writing produces noticeable improvement in student papers as the semester progresses. Some students struggle to develop a concrete proposal and need mentoring to develop an idea; students tend to try to solve an entire broad problem rather than argue a specific point. (I call this the “help stamp out things that need stamping out” approach, inspired by an old Peanuts cartoon.) Having to write within a strict word limit also forces students to refine their thinking. I push students not to resort to name-calling to criticize opponents of their proposal and to instead counter critics with logic, sensitivity, and tact. Several students have gone on to use their position papers as the basis for letters to legislators, and others have sought out career paths that included writing for nongovernmental organizations with interests in science.

Students often surprise me with the approaches they take in their papers, with many arguing positions that they do not personally support or that they even find to be abhorrent. One semester, an international student wrote a brilliant paper arguing that all people applying to immigrate to the United States should be screened for potential genetic diseases and barred from entering if the test revealed a serious illness or risk of illness. She incorporated authentic eugenics rationales in her paper. For example, she suggested that allowing genetically “defective” individuals to bear children would weaken the gene pool in the United States. When I later asked why she had chosen her position, she replied that she thought it would be an “interesting challenge.”

As I continued to teach the class, I discovered that some of the same obstacles to effective policymaking relate to several different class topics, and as we work through our class themes, I try to drive home these obstacles. First, if no one apparently cares about the issue, policymakers will ignore it. Raising awareness can happen in a variety of ways, including from a disaster, investigative reporting, and lobbying efforts. Exploring how issues become important is a useful lesson for students engaged in activism. Second, the ability to make effective policy is dependent on money. Funding limitations arise at every level of government, from local to international, and in virtually every issue we explore. How to make decisions that are both equitable and effective is a huge issue. Third, scientific information cannot drive decision-making alone. The complex interactions between politics, religious viewpoints and cultural frameworks, and past experiences all affect the policymaking process. Students often find these factors frustrating and want simple answers to complex questions. Learning to think otherwise is a valuable skill.

Addressing science policy is a moving target since each US election cycle might change the party in power. By setting a broad context in which to view science policy, I can guide the class to explore both common issues and those unique to the current political climate. Updating available course material and posting it to the course website is an ongoing process. I also encourage students to share materials that they find with me—and I post their contributions as well. The landscape of biological knowledge has changed dramatically over the past thirty years, with new discoveries and applications having immediate effects on topics explored in class. New technologies alter the questions of “what if?” to “what now?” Students need to address questions that have moved from theoretical to practical—and this makes the issues much more real and immediate.

While the course has a focus on US policy, I encourage students to also explore the impact of policy controversies in other countries. This enables international students who are less familiar with the United States to raise issues of science policy relevant to their home countries. Students have written eloquently about policy recommendations including regulation of surrogacy (in India), new drug approval (in Korea), and organ transplantation (in Iran).

Dealing with controversial issues in biology can create tension and resistance among students. I purposefully omit some topics, such as abortion, because the biology associated with the issue is not relevant to the core controversy. I make clear to students that they must be open to hearing viewpoints that might differ from their own and that all viewpoints are encouraged. I warn that some discussions might make students uncomfortable and suggest that if a topic is particularly personally painful (for example, assisted suicide for a student who had a family member commit suicide) they should talk with me privately. By being direct about expectations for class discussion, I have been able to avoid most (but not all) cases of student bullying or belittling. In recent years, the advent of the “call out” culture has made these stipulations all the more important. I also stress an awareness of racial disparities and past discrimination in many policy decisions. For example, the development of new drugs involves extensive clinical trials; in the past, these trials have failed to include people of color in the test population. This can lead to drugs that prove to be less effective for people of color.

Another useful discussion strategy has been for me to take a view that differs from the mood of the discussion. If students respond vehemently to me, I have no problem with that. In a student-led town meeting discussion on how to respond to the presence of power lines producing electromagnetic fields near a school, I took the position of a (childless) resident who adamantly refused to pay more taxes to remediate the situation. Members of the class argued with me about my attitudes. I am, however, careful to keep as neutral a stance as possible when introducing issues; student feedback in the first few years of the class sometimes expressed concerns that I seemed to imply that a particular viewpoint on a topic was the only acceptable one, which was not my aim.

One of the biggest challenges for me has been managing class size. The class was capped at forty-two (the seating capacity of the classroom) when I first offered it and reached this number almost every year. It was difficult to fully engage the class at this size, and I split the class into two sections for student-led discussions. While this made each group more manageable, the arrangement deprived students of the opinions of those not in their section. Some students were reluctant to ask questions in class, feeling intimidated by the number of individuals in the classroom. The heavy load of reading papers also proved burdensome, since I provide detailed feedback on each paper.

Recently, Bryn Mawr and Haverford College created a joint minor in health studies, which expanded offerings in other departments tied to public health issues. Subsequently, my class size dropped to between twenty and twenty-five students, with dramatic effects. Student participation in daily classes markedly rose. More reticent students were more eager to contribute to discussions. And I found that reading and commenting on student papers became much more manageable!

In the past year, when teaching remotely because of the COVID-19 pandemic, I found that a flipped course allowed class times to be used effectively for discussion. Students viewed short, prerecorded lectures prior to classes, and we spent Zoom sessions exploring student questions and issues arising from lecture material. Student-led discussions took place in blog form, with scenarios posted online and students responding in writing from a particular assigned role or position. Much to my surprise, these asynchronous discussions successfully engaged the majority of students. Students who were reluctant to weigh in on discussions in person were more comfortable adding to the course discussion blog.

In one notable outcome of my course, students have expanded their interest in public health and careers in public health. Many former students have told me that the class was a major reason they changed their career goals. Current students seek summer internships in areas of public health or conduct supervised field work for academic credit in areas of public health and bioethics. I served as an adviser to several students who developed independent majors in public health, since Bryn Mawr doesn’t offer this major. Graduates have completed or are pursuing master’s degrees in public health or bioethics or combined medical and master’s degrees.

Bryn Mawr has a commitment to teach all students in all disciplines the skills for written communication. My course fell outside the lab-course-based structure the Department of Biology established to fulfill this requirement. Nevertheless, a central focus of the class was to reinforce the idea that the ability to communicate science to the public is a critical factor in becoming a scientist. I also believe that exposing students to issues in ethics and policy from the beginning of their training as scientists is important. In team-taught introductory biology, my colleague and I developed a multipart in-class case study on cancer, which first covered the molecular biology of cancer and aspects of molecular genomic analysis and then moved on to ethical considerations associated with decisions on testing and treatment, cost of medications, and related matters. We also had students write short reflections on the metaphor of cancer treatment as a “war” and the ethics of such an approach.

The Department of Biology requires all senior majors to research and present an original piece of work, and those students who are not engaged in supervised laboratory research with a faculty member take thematic senior seminars, limited to about ten students. My iterations of these seminars in the past dozen years have taken a broad-based approach to a topic, allowing students to write theses that can cover basic science, clinical applications, or policy matters. My most recent senior seminars demonstrate that biology student consciousness has shifted to include an awareness of broader societal issues. A seminar on the biology of cancer I taught in spring 2019 produced theses ranging from single-cell genome analysis of breast cancer and strategies for immunotherapy to analysis and policy to improve utilization of mammography by immigrant South Asian populations and recommended policies to limit access of minors to tanning booths. My fall 2020 seminar (taught remotely) on science and society focused on vaccines. Student theses covered such topics as developing vaccines against the parasitic disease leishmaniasis, studying children’s immune system responses to rationalize the current recommended vaccination schedule, and conducting a clinical trial to determine the effectiveness of cash incentives to increase utilization of the human papilloma virus vaccine. An international student wrote about the challenges of distributing COVID-19 vaccines worldwide and the need for international cooperation.

I would not have taught my Biology and Public Policy class for this long if I didn’t find it stimulating. I have learned to move beyond the “just the facts, ma’am” style of my own training to approach biology far more holistically. My interactions with students are focused on the mutual exchange of ideas and opinions. I frequently engage in hourlong discussions in my office with individual students who want to more deeply explore something from class. Encouraging students to consider the implications of biological advances has been extraordinarily rewarding. The response of students to this broader approach has reinforced my belief that all biology students should be required to engage in some study of policy and ethics. Perhaps the next generation of research scientists might be able to avoid some of the abuses of the past.

Acknowledgments: I thank Peter Brodfuehrer for helpful comments on this essay; Tamara Davis, my co-instructor in Biological Exploration I, for working with me to bring ethics and policy into our course; and all my biology colleagues for support in developing policy-related materials for the department. I thank the many students who enrolled in Biology and Public Policy over the years for their feedback, which helped me improve the course and make it more relevant to their interests.