Tuberculosis

Richard A. Fluck, E. Paul and Francis H. Reiff Professor of Biology, Department of Biology, Franklin & Marshall College

Biology 102 is a first-year seminar at Franklin & Marshall College that uses the current world-wide tuberculosis epidemic, which the World Health Organization declared to be a global health emergency in 1993, to connect topics in molecular biology and biochemistry to key issues in public health policy. The basic science covered in the course includes the molecular biology and biochemistry of the tubercle bacillus, using DNA fingerprinting and molecular epidemiology to identify potential drug targets, the identification of suitable antigens for a vaccine, and the function of the immune system. The public health questions explored include the evolution of drug resistance, the synergy between tuberculosis and HIV, and contemporary disease control and prevention strategies.

A multidisciplinary approach is essential to understanding the problem of Tuberculosis. While there is an emphasis on the biomedical tools we have for preventing, diagnosing, and treating TB, these are studied in the context of the public health infrastructure that uses these tools. This requires that the course examine TB control and prevention from the perspective of anthropology, history, business, economics, ethics, law, and public policy.

The course is a discussion-based and writing-intensive seminar, organized around assigned readings, guest lectures, and semester-long group projects in which 3-4 students research topics related to real problems in TB control in 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. An example would be implementing a plan for TB education at local farm-worker camps. Undergraduate Preceptors, who assist students with writing and help lead class discussions, have been invaluable assets to the course, bringing their own specialized knowledge and skills to the process.

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.

Scientific Principle Public Policy Issue
DNA fingerprinting, molecular epidemiology Maintaining reference laboratories and an infrastructure and information network that permit sharing of data
Comparative genomics Developing strategies for drug and vaccine development
Cell biology of pathogenesis Public and private funding of basic research
Risk factors for infection and disease Targeted testing of high-risk groups (homeless persons, prisoners, and migrant and seasonal farm workers)
Contagion of an infectious disease Enforcing quarantine laws and other legal restraints on personal freedom
Function of the immune system Providing adequate resources for the diagnosis and treatment of tuberculosis in HIV-positive individuals, including special housing
Latency of tuberculosis infection Performing targeted testing and treatment of latent tuberculosis infection in high-risk groups (homeless persons, prisoners, and migrant and seasonal farm workers)
Vaccination Funding the development of a new vaccine and appropriate clinical trials; the ethics of clinical trials
Drug targets and drug development Forming public/private partnerships in drug development, including clinical trials
Drug toxicity Development, publication, and dissemination of treatment guidelines; the conduct of ongoing clinical trials
Drug resistance Sustaining a public health infrastructure that can ensure completion of an appropriate regimen and thus minimize the emergence of drug resistance

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.

The Course

A major priority in the design of this course is the engagement of students as scientists and citizens. This is accomplished through the variety of techniques described below.

Tuberculosis Syllabus

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Course Management

Leading Discussion

The one aspect of my teaching I would like to improve most is my ability to stimulate and lead classroom discussion. Bio 102, in contrast to
nearly all the other courses I have taught, depends very much on discussion, and I do not think that I facilitate discussion as well I should. In contrast, class discussions in my senior seminar at Princeton University in Fall 2001 (in which the subject matter was similar) were, for the most part, very stimulating. In the latter course, the students carried the discussion themselves on some days. It was truly a wonderful thing to see. I continue to work on this part of my teaching of first-year students.

Problems With Group Projects

In the first two iterations of Bio 102, students worked in groups of 3 or 4 on their semester-long projects. Each group produced a single document authored by all members of the group; all members of the group received the same grade for the paper. Each group decided among themselves, sometimes with advice from the preceptor or me, how to divide up the work and produce the papers. Some groups quickly came to consensus on
their topic, achieved a good division of responsibility, and got right to work on their projects. Other groups, however, did not work together well, for a variety of reasons: 1) they took a long time to reach consensus on a topic; 2) they never reached true consensus on a topic but proceeded nevertheless, with some members of the group going along reluctantly; 3) some members of the group did not do their fair share of the work-they did not attend group meetings, they were unprepared for group meetings, they did not do their “assignments” within the group. In the worst case scenario, the grade of every member of the group may suffer as the result of the unsatisfactory work of one member of the group. Alternatively, some members of the group must unfairly shoulder the work of the errant member.

With the help of my preceptor, I have tried to facilitate the group work as best I can, but my efforts have not always succeeded or have been too late to be of much use to the group. However, I ask all members of the group to evaluate each other near the end of the semester (See my response to II.E.1 below), and I take these peer evaluations into account when I grade each student’s “Class Participation,” on which 20% of the course grade is based.

This is an ongoing problem that I am addressing this summer as I prepare my syllabus for the Fall 2002 iteration of the course.

Too Many Oral Reports Linked to the Projects

In the first two iterations of Bio 102, oral reports to the class accompanied the proposal, progress report, and final projects give the class, preceptor, and me ample opportunity to ask questions and to suggest improvements in the papers.

Group Work on Discussion Questions

Before each discussion class, I send discussion questions to groups of students and ask them to prepare responses for discussion. I change the composition of these groups from one assignment to another.

Peer Led Class

Each semester, the preceptor leads one of the class discussions. The preceptor consults with me about the topic, chooses the readings, prepares
discussion questions for the class, and leads the discussion. I have enjoyed these classes very much because they allow me to play more the role of an observer (though I do participate in the discussion myself). Both my preceptors have done superb jobs in leading discussions.

Guest Teachers

Dr. Lee Reichman (Professor of Medicine; Professor of Preventive Medicine & Community Health; Executive Director, New Jersey Medical School National Tuberculosis Center; Newark, NJ) visited the class in both 1999 and 2000. He gave a public lecture, met with the entire class for 80
minutes, and then met with groups of 3-6 students throughout the day to discuss their projects and answer questions. Dr. Reichman’s visits have occurred at around the time that the students were writing their progress reports. Thus, each group knew their topic well and, at the same time, had many questions for Dr. Reichman. For the students’ final oral reports, I also invited “discussants,” i.e., other faculty, physicians, community health care workers, to hear the reports and respond to them.

In Fall 2002, I plan to invite a broader array of local health care workers to meet with the class.

Evaluating Learning

Classroom Participation and Attendance

Your individual contributions to the class-making and responding to oral presentations and participating in class discussions-will be an important part of this course. Thus, your participation in class will be the basis for 20% of your course grade. Moreover, you will fail the course if you have more than two unexcused absences from class.

Research and Writing Projects

You will write 6 papers (described below), beginning with a short one (a memorandum) and ending with a project report. Mr. Fragale and I will describe each assignment in class, and for most assignments, there will be assigned reading in Pechenik. I will also give you an evaluation form for each assignment.

These forms will function as a check list (Did you format the document properly, submit the appropriate documents, etc.?) and will also describe the criteria by which Mr. Fragale and I will grade your papers.

Except for the pre-proposal and final project report, you will submit each paper twice, first to Mr. Fragale and then to me. Mr. Fragale, using the evaluation form as a guide,will read and mark your paper and return it to you with suggestions for revision. You will then revise the paper along the lines suggested and submit the paper to me, along with the version you submitted to Mr. Fragale and his comments. I will then read and grade your revised paper. Neither Mr. Fragale nor I will mark every mistake, every infelicity, every poorly cast sentence in your papers. Rather we will try to identify, on the basis of the paper you have given us, your strengths as a writer; and we will give you a few pointers on how you can become a better writer. If we believe it appropriate, we will refer you to the Writing Center (KEI-316; ext. 3866) to work on specific aspects of your writing. At the Writing Center you will also find a number of books and useful (and free) handouts on punctuation (e.g., the semicolon, the colon), grammar (e.g., idioms, passive voice, parallelism), and writing papers (e.g., writing introductions). The Center also publishes a book, Model Student Essays, that you may find useful for this and other courses. The Writing Center tutors are very busy, so you should make an appointment if you wish to work with one.

Papers are due at the beginning of class on the dates listed in the Schedule of Classes (see below). For some assignments, I will also ask you to submit a digital version of your paper. You can do this by dropping a copy of it in the Submissions folder for this course on the Curriculum Server. Having access to these digital files will make it easier for me to combine the reviews into a single document for you. For example, I will use such electronic documents to combine all of your book reviews into a single document, which I will then make available to you via the Distribution folder for this course on the Curriculum Server.

On the dates on which most papers are due to me, you will also make an oral presentation to the class in which you summarize-not read-your paper. These presentations will serve at least two functions. First, they will give you opportunities to develop and practice an important skill. Second, they will enable you to tell the rest of us about your project, which will be of general interest to all of us as we work to understand tuberculosis and which may be of specific interest to students working on other projects.

Every paper must have an Acknowledgments section in which you identify the individuals who helped you prepare the paper and the specific ways in which they helped you, for example, discussing ideas, proofreading, editing, helping in the library, etc. The College holds its students to the highest standards of intellectual honesty and prescribes harsh penalties for academic dishonesty, including plagiarism. It is your responsibility to be sure that work you submit conforms to the College’s guidelines, as described in The Catalog.

Memo

In your memo, you will list the five available projects in your order of preference, with #1 being your first choice; describe the reasons for your choices; and tell me what strengths (language skills, database knowledge, organizational skills, related prior experience, etc.) and interests (interest in the topic, career goal, etc.), that you will bring to the project. The choices for projects are:

  • TB in children
  • DOTS Plus in the treatment of MDR-TB
  • TB in migrant workers (This project will include a modest field component in Lancaster County).
  • TB education needs among community health organizations in Lancaster (This project will be primarily, though not exclusively, a field project in Lancaster City).
  • Anti-TB vaccines

Book Review

On Sept. 14, you will choose a book related to this course in the F&M Library. On that date, you will also learn about writing book reviews. You will then write a review of the book you have chosen. In addition to submitting the usual paper copies of your review on Oct. 5, you should also place a copy in the Submissions folder for this course on the Curriculum Server. I will combine the reviews and distribute them to the entire class. One of your goals in writing this review is to tell the rest of us about the potential value of the book for the class projects, in particular which project(s) it might be most useful for.

Website Review

On Oct. 5, you will choose a web site related to this course and then become familiar with the site. On Oct. 17, each of you will describe your site in a brief presentation (less than 5 minutes) to the class. One of your goals in giving this review is to tell the rest of us about the potential value of this web site for the class projects, in particular which project(s) it might be most useful for.

Project

Working in teams of three (or four), you will prepare four documents on the topic to which you have been assigned.

The first will be a pre-proposal. This document, which is due to both Mr. Fragale and me on Sept. 28, should have a title page, about 2 pages of text (this and all other documents should be double-spaced), and a Literature Cited section. The text should include an introduction, a thesis statement or a statement of your objectives, and your plans for developing the thesis statement or meeting your objectives.

The second document will be a proposal for your project. The proposal will include an Introduction and background, in which you will describe the general topic that your team is addressing; the specific topics that you will address; the resources (books, papers in the literature, web sites) that you have identified; a Literature Cited section; a timetable for your work; and a plan for how you will meet your objectives. The last item should include a description of how you will divide responsibilities among the members of your team, how often and when you will meet to work on your project, and how the actual document will be written. The text of this paper (excluding Literature Cited) should be 6-8 pages. On the due date, your team will make a 15 minute oral presentation. An additional 10 minutes will be allotted for questions and discussion. Among other things, the oral presentations should inform the rest of us about your progress and help the other four teams better understand the place of your and their projects in the overall scheme of the course.

The third document will be a progress report for your project. The progress report, which you should consider as representing 50-75% of your final paper, will include an Introduction and background; supporting text; a description of what remains to be done (read, summarized, written); your plan for how you will finish the project; and a Literature Cited section. The text of this paper (excluding Literature Cited) should be 10-14 pages. On the due date, your team will make a 15 minute oral presentation. An additional 10 minutes will be allotted for questions and discussion. Among other things, the Q&A following your presentation should help you clarify what remains to be done on your project.

The fourth document, your project report, will include and Introduction and background; supporting text; a conclusion; and a Literature Cited section. The text of this paper (excluding Literature Cited) should be 14-18 pages. On the due date, your team will make a 25 minute oral presentation. An additional 15 minutes will be allotted for questions and discussion. For the oral presentations, I will invite a discussant to participate in the response to your paper. The discussants will be F&M faculty, physicians, or public health officers.

Evaluation of Team Members

By Sunday, December 3, you should send me an email in which you succinctly evaluate the contributions of your collaborators to the project.

Grading

Memo – 25 Points

Book Review – 50 Points

URL Review – 20 Points

Project –

Pre-Proposal – 40 Points

     Proposal – 50 Points

     Progress Report – 90 Points

     Project Report – 125 Points

Class Participation – 100 Points

Total – 500 Points

Background and Context

BIO 102, A first-year seminar covering tuberculosis from several perspectives: the molecular biology and chemosensitivity of Mycobacterium tuberculosis, the pathology and epidemiology of tuberculosis, social and historical perspectives on the disease, and public policy issues at Franklin and Marshall College, P.O. Box 3003, Lancaster, PA 17603-3118.
Richard A. Fluck, E. Paul and Francis H. Reiff Professor of Biology, Department of Biology, dick.fluck@fandm.edu, Phone: (717)392-6648.

Note – For in depth information on the background and context of tuberculosis in our world today, please peruse Richard Fluck´s essay “Why Study Tuberculosis in 2000?” found in the Syllabus PDF file on “The Course.”

Related Resources

Below you will find related news articles, bibliographies, web sites and SENCER documents related to the Power of Water

SENCER Resources

Below are resources from SENCER documents and publications related to the Power of Water Course

Backgrounders

Reinventing Myself as a Professor: The Catalytic Role of SENCER by Terry McGuire

Ektina, E. and Mestre, J.P. 2004. Implications of Learning Research for Teaching Science to Non-Science Majors, 1-26.

Tuberculosis: Ancient Foe, Modern Scourge by Richard A. Fluck (PDF)

Outside Resources

Please utilize Richard A. Fluck’s essay entitled “Why Study Tuberculosis in 2000”, found on page 1 of the course syllabus, for more information.

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