the Zika article, a meta review

Sunday September 18, 2016

I did not record total time spent working on the article. The only thing I could tell is that I used approximately 40% of the total time working on that article for finding and reading sources, both in published journal article form and also news from online news outlets. Approximately, the whole feat took about a week.

distribution of time spent

Previously, I would spin up 3 different word documents when writing an intense, long article. 1 document for collecting resources and defining its function, another article for outlining and sketching the draft with a bunch of bullet points, and another article for actually writing the full article. It worked for me until recently I felt that such kind of flow would create a disjointed feeling between resources and the actual draft.

I begged for a change. This time, a single article to rule them all.

Commencing such writing feat commands preparation. Drafting from scratch is hard, hence I would sort to imitate other’s way of writing a general overview about Zika. I referred to a rundown by The Telegraph “What is Zika, where did the virus come from and what happens if I catch it?” to help me with the outline. After figuring out the information that deemed important for a complete rundown, I commenced to the next stage.

Then I started out by writing sections I wanted to have in this article. This was the foundation I laid. By figuring out how many sections I wanted to have, I would be able to structure my thoughts and my points, segregating contents into their appropriate sections, and making notes on what kind of information I would like to have. To demonstrate, here’s how I do it:

Zika in Southeast Asia draft

I populated the initial draft with sections and points on what I should cover. And then, little by little I expanded each bullet points. Most of the time, I ended up expanding bullet points until I felt they were sufficient enough to be glued together into coherent sentences. This process was iterated virtually for every bullet points. Along the way, I added and removed points to make sure that the article has a flow that makes sense, although “making sense” here is subjective to one’s view.

With my previous writing style, I would processively progress from top to bottom. With my recently refreshed writing style, I would be gunning the article with total disregard of order. If I got stuck at section #2, I didn’t let the writer’s block to sing an aria. Instead, I would let my murderous intent to lift the block by quickly shifting to next section. At first, it scared me because the draft looked like swiss cheese with a lot of holes.

If it was not because of the assistance from my friends, the workflow would seem like dancing on a creaking floor. I invited Afiq Asri because I look him up as a scientist with a decent amount of knowledge in epidemiology. He’s like a person at the frontline when a region is experiencing an epidemic. While I could understand texts in molecular microbiology without struggling to breathe, I am running short of insight when it comes to dealing solving puzzles of an outbreak. I know the micro things, but not quite on macro stuff.

Syafiq Lomotech is always my go-to proofreader. I regard him as a person well-versed in lots of things, and able to ask the good questions when it comes to clarifying the ambiguous. Whenever my writing doesn’t make sense, he would step in and ask for clarification. Thanks to him, I had reworded couples of sentences, adding and removing few others that made the article jumpy and incoherent. I also had Tarmizi Halim, and he pointed out few correct Bahasa terms for molecular biology and structural proteins.

The more the better, right? I invited Nadhirah Nazaruddin. Despite her busy schedule with clinical residency, she had invested her time to help me out. She assisted by submitting comments and recommendations on words I should be using so that I did not confuse the public. I also had Nurul Aqilah to assist me in the process. Well actually, she volunteered herself to provide assistance, and I was happy to have her as a part of the team. Like Nadhirah, she helped me with the language, and by using her knowledge on physiotherapy she corrected few terms about the physical rehabilitation for patients suffering from GBS.

I had to left out a section. This section was aimed at advanced readers with the interest to know more about the research areas associated with Zika, an attempt to provide the illustration on how scientific community is dealing with Zika virus. Well, let’s talk about it here then. There are few areas we could explore when dealing with Zika. First, we could discuss Zika’s genetic composition and its molecular characteristics. This is all about molecular virology. The second area would be discussing its infectivity and what would the results if it infects humans or other animals, and then understanding the progress of the infection if our immune system failed to clear Zika out of the body. With the knowledge from the previous two sections, we could now devise the plan for designing the vaccination strategies, and engineering (preventive measure, pre-infection) and antiviral drug to stop viruses from amassing in number (curative measure, post-infection). Last but not least, we need to talk about the efficacy of the vaccine/antiviral drug to assess its effectiveness, and what we could do to make it better and cheaper. By “better”, it should induce lifelong immunity without a booster. By “cheaper”, poor countries should afford it.

When the draft was in progress, Aqilah pinged me asking would it better if the article was broken down into smaller chunks. I considered that option before writing it, but I had to give up the idea of making smaller chunks. While it is good for making the article easily digested for public consumption, but there few things I did not want to happen. First, say that I had 3 separate pieces of the Zika article, those 3 pieces would have to be shared independently of each other on social media. People would find the first part, but that might not guarantee they would find another 2 pieces. On top of that, it would be harder for me to track unique shares and likes if there were to be 3 separate pieces. By having the whole thing in a single article, it would make it easier for anyone to cite if the article ended up being a valuable resource on Zika.

comments on the Zika draft

The struggle to write scientifically accurate is a real pain, and I am glad I could feel the pain before I am up for my Ph.D. studies. During the course of completing it, I referred to at least 26 web resources and articles from news outlets. If I were the choose the important web resources, I would say the ones from CDC contributed a significant portion. But web articles alone won’t cut it. Around 29 published scientific papers were also being my reference points. My strategy was quite aggressive this time. Most of the papers I obtained (some through a certain science hub) were subjected to intense highlighting with Adobe Acrobat Reader. Some of the phrases from the scientific papers were directly translated into Bahasa. With the combination of these 2 methods, I found myself really productive at threshing out information from the dense papers.

Zika resources and assets

The completion of Zika article opened up few suggestions on what I should be doing next. It is for the public’s benefit. I have this thought to write about HIV, ranging from its history to the success on clinical trial RV 144 (the Thai Trial) of ALVAC-HIV prime and AIDSVAX booster. While there is an antiviral drug for HIV known as the AZT (Zidovudine, a nucleoside analog), designing a vaccine against HIV looks a lot like an impossible engineering because HIV mutates so fast. Some groups had come up with the strategy to use CRISPR/Cas system to remove the chromosomally integrated part of the HIV, however with a sad success. Here’s the link to ALVAC-HIV podcast by TWIV. Also, I think I want to discuss a bit about the needle-sharing program.

The next option would be writing about the unrestrained use of antibiotics has negatively impacted our future with a quite grim race that we might have little chance of winning. Bacteria are going stronger over time. We share the fault because of our indiscriminate and excessive use of antibiotics has given birth to superbugs. If this concept seems alien, let’s look at it in real time.

I feel a bit pissed off seeing pseudoscience products being marketed as cancer-killing treatment. First off, there is no single product that could target all kind of cancers. Secondly, each type of cancer has a bunch of different profiles. Third, the scientific community is still struggling to learn the underlying biologies of all kinds of cancers, because cancers are just plain hard nail down. Writing this sounds fun, but I don’t see myself quite fit to do this at this time. Cancers always find a way to get us befuddled because of its repertoire spans a very long horizon, and the beauty of their acting never ceases to bewitch us, over and over again.

Perhaps the main contender on my next list would be discussing the issue of immunization and vaccination. I am thinking to approach this discussion by writing it in 2 parts. Part 1: the human immune system would cover the fundamental basis of our human immune system. I intend to do the classic approach. Discussing the innate and adaptive immunity, the role of immune cells in adverting incoming crisis and invading pathogens. Part 2: vaccination would cover the application of knowledge from human immunology. In this part, I would like to go through the history of variolation, Edward Jenner’s story pioneering the smallpox vaccine, Salk and Sabin’s story with the polio vaccine, and 1979 smallpox success story. I would like to take this chance refute few misconceptions, for example, immunity through breastfeeding, contents of the vaccine, and few other things. I anticipate this one would be a handful to handle.

My only regret is that I spent too much time reading than writing. Apparently, the more I read the more I was confused with that I already understood. However, the thrill of collaboratively penning this freakishly big article is an achievement I will forever be proud of.

This whole article is a meta review of my long-form article on Zika, published on Amanz Media in Bahasa.