Birth control news: Free contraception. Also: DIY abortion

birth control postcard villain

Birth control: science’s most important achievement
Effective birth control is, arguably, the most important human invention since language. Also the most important contribution of science to human welfare ever.

Discuss. But you’re going to have to work hard to convince me otherwise. For a few of the reasons why contraception matters so much (to men as well as to women and children), consult economist Sonia Orrefice’s recent post at The Conversation.

How to get free birth control

The government has just cracked down on insurance companies that haven’t been providing free birth control products as required by the Affordable Care Act (aka ACA–yes, the much-hated Obamacare.) The rules also apply way beyond Obamacare policies to other medical insurance policies, such as many offered by employers.

The US Department of Health and Human Services says insurance companies must offer women at least one of each of the 18 types of contraceptive options approved by the Food and Drug Administration. This includes not just the pill and intrauterine devices (IUDs) but also emergency (after-sex) contraception, sterilization, the patch, injectables, and other methods.

The right-wing Washington Times presents this news as just one more example of Obama’s imperial overreach (“HHS rewrites Obamacare rules: Orders free birth control for all”.) But of course free birth control (not to mention other no-copay women’s services) were always part of the ACA. The new regulations are simply very explicit about precisely what must be covered. The reason for such specificity is that a number of insurance companies have been weaseling out of that commitment.

Timothy Jost has a brief list of the 18 approved methods at the HealthAffairs blog, with a link to the PDF detailed list. You can also get the list here.

The new regulations apply only to birth control methods for women. Male sterilization and condoms are FDA-approved but are not on Jost’s list. If dependent children are covered on a woman’s policy, the free contraceptive services are available to them, too. The government’s detailed–very detailed–FAQ list is here.

The new regs don’t necessarily mean that women will be able to get a specific contraceptive free. As Phil Galewitz explains at Shots, “the plans may still charge fees to encourage individuals to use a particular brand or generic. For example, a generic form might be free, while a brand-name version of the drug can include cost-sharing, HHS said.” Also, the regulation doesn’t go into effect until the new plan year, which in most cases means not until next January.

However, a workaround from the government FAQs: “If an item or service is not covered but is determined medically necessary by the woman’s attending provider, there must be an easily accessible process for the woman to get that item or service.”

God is in the details. And  you can be sure that religious opponents of birth control will be looking for Him there.

The most effective birth control method is an IUD

They work really well, but intrauterine devices (IUDs) are not all that popular. Sarah Kliff’s Vox IUD FAQ notes that some of that foot-dragging is probably due to hangover bad press from the Dalkon Shield, an early ’70s IUD that injured hundreds of thousands of women and killed some of them.

Pelvic Xray showing IUD. Credit: Nevit Dilmen

Pelvic Xray showing IUD. Credit: Nevit Dilmen

Today’s IUDs are quite safe and keep sperm away from eggs far more reliably than anything else except sterilization, which is permanent. Although fewer than 10% of US women use IUDs, 40% of gynecologists do. Which tells you something.

The IUD’s great virtue is that it prevents pregnancy invisibly and automagically, but for only as long as the user wants it to prevent pregnancy. No daily pill, no weekly patch, no ducking into the bathroom to grease up and insert a diaphragm when opportunity knocks unexpectedly. With an IUD, get it and forget it. And when you’re ready to get pregnant, take it out.

See Kliff’s post for the few cons. All the approved birth control methods (and their risks) are compared and contrasted in the FDA chart here.

Although the IUD is cheaper than, say, the pill in the long run, a big barrier to IUD use has been the upfront cost. For one thing, inserting an IUD requires training, skill, and professional credentials.

At Salon, Valerie Tarico describes how her daughters paid $1200 each for hormonal IUDs, the reasons why this method has been so costly, and plans for making a new IUD, the Liletta, available more cheaply to low-income women. Find more details on the Liletta from Martha Kempner at RH Reality Check. The FDA approved it in March.

IUD adoption is growing, along with use of the other long-acting reversible contraceptive, the birth control implant, according to Madeleine Schwartz at Fivethirtyeight. Making them available free through the ACA is going to increase their popularity. Especially as word gets out about the statistics on effectiveness Schwartz quotes: “The IUD has a failure rate of less than 1 percent and is considered to be 45 times more effective than the pill and 90 times more effective than male condoms based on typical use.”

DIY abortion

Andrea Grimes is a Texas writer who recently reported at RH Reality Check on a wine-and-cheese gathering she threw for a few friends. It was not just a social occasion. The women were there to learn the World Health Organization’s protocols for safe self-induced abortion with the drug misoprostol.

It was something of a brave move. In Texas, Grimes explains,  assisting someone to obtain an illegal abortion is a felony (although, she says, “the law prevents pregnant people themselves from being prosecuted for attempting to induce an abortion on their own.”)

So Grimes proceeds carefully. “I let people know that the WHO information exists and that it is a medically sound, evidence-based protocol. I am always careful not to advise people directly to use miso; I don’t want to break the law, and neither do others who share the WHO protocols.”

Misoprostol is the second half of the conventional drug-based procedure known as medically induced abortion, commonly used for early abortion. Medication abortion is a standard medical procedure. It is not at all the same thing as emergency contraception, like Plan B, which is used to prevent fertilization shortly after unprotected sex.

The first half of conventional medically induced abortion employs mifepristone, RU-486, which is taken at a clinic or doctor’s office. Misoprostol is taken later, usually at home. Find a friendly description of standard medically induced abortion, including potential risks and side effects, at the Our Bodies, Ourselves site.  Or see the more straight description at WebMD.

But as the latest edition (2012) of WHO’s “Safe Abortion” explains, the two-pill process is only one approach to abortion. The second pill, misoprostol, can induce abortion by itself. (See, for example, the Executive Summary, p. 4.  The “Safe Abortion” PDF can be had free directly from WHO here, and also for free from the US National Library of Medicine here.)

Misoprostol is widely available because it has other medical uses. Some have nothing to do with reproduction–for example, preventing ulcers in people taking NSAIDS. It’s used in veterinary medicine too. In the US, misoprostol requires a prescription. But it is available over the counter in many other countries.

abortion DIY china misoprostol

Women on Waves cites studies showing that misoprostol-only abortions are successful 90% of the time and work best and most safely before 12 weeks of pregnancy. The site also has photos of what misoprostol tablets look like in several parts of the world.

There’s also news about the 2-drug form of medically supervised abortion. A study published in April in the journal Contraception described  new evidence-based protocols, conducted over 5 years with 13,000 women at Los Angeles-area Planned Parenthood clinics. The researchers  found that the protocols were more than 95 percent effective up to 63 days of pregnancy, according to Emily Crockett at RH RealityCheck.

The 63-day limit matters because the FDA has approved the two-drug medical abortion regimen only up to 49 days of pregnancy. The new protocols also used lower drug doses. At Medscape, doc Peter Kovacs found this pretty convincing, concluding “Several studies suggest that new protocols could be developed to extend the availability of medical termination services beyond 49 days’ gestation.”

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Torture and psychologists; picture the universe with Hubble and Webb telescopes

The worst bioethics scandal of the 21st century (to date)

We may have to wait until its own official independent report in June to know for sure whether the American Psychological Association really did collude with the Central Intelligence Agency and the Bush administration to put together a systematic program of torture. But the evidence so far is certainly, ah, suggestive.

It comes most recently from a report by folks Allie Conti at Vice calls “rogue psychologists and mental health experts.” (Peculiar word choice here, “rogue.” These are scientific and medical professionals deeply opposed to torture and any participation in it by scientific and medical professionals.)

The report details emails exchanged between APA officials and the CIA between 2003 and 2006. They show, John Bohannon says at Science Insider, that “The world’s largest professional organization for psychologists has maintained a surprisingly cozy relationship with the defense and intelligence community.”

A side note on torture basics

Torture is morally wrong, forbidden by law in several places, and against the Geneva Convention.

The science shows that torture is also worthless as a method for extracting information. People will say anything under torture, and do.

So the bottom line is that besides being vicious and an offense against humanity, torture is also a really really stupid waste of time, energy, and money.

Yet a baffling dogged belief in its utility persists. I explored all this in a post here at On Science Blogs last December when the Senate Intelligence Committee released its damning report on the CIA torture program. So I won’t summarize the evidence further here.

More on those emails

Bohannon says the report and the emails, dug up by New York Times reporter James Risen, appear to contradict the APA’s previous assertions about its relationship with the CIA and the Bush administration. They were provided to Bohannon by Nathaniel Raymond, a human rights researcher at Harvard University. He told Bohannon in an email: “The APA’s complicity in adapting its ethics to countenance psychologist involvement in researching and monitoring torture is the worst bioethics scandal of the 21st Century to date.”

At Mind Hacks, Vaughan Bell is not so even-handed as Bohannon. The emails, Bell says, reveal that “the US security agencies have been handing out key contracts to high profile psychologists on the basis of shared political sympathies rather than sound scientific evidence. The result has been a series of largely ineffective white elephant security projects that have cost hundreds of millions of dollars.”

The Times published the report to accompany Risen’s piece.  Most recent blogging seems to be based on Risen’s piece, but The Guardian’s post by Raya Jalabi also links to a PDF of the report and contains a lot of detail from it.

Hubble's 25th birthday photo shows Westerlund 2, a giant young cluster of about 3000 stars. You can fly through the image to the cluster in 40 seconds at EarthSky. http://earthsky.org/space/fly-through-hubbles-25th-anniversary-image

Hubble’s 25th birthday photo shows Westerlund 2, a giant young cluster of about 3000 stars. You can fly through the image to the cluster in 40 seconds at EarthSky.
http://earthsky.org/space/fly-through-hubbles-25th-anniversary-image

The Hubble at 25: a hero’s journey

Begun in expectation of lofty accomplishment, brought low by miscalculation and shame, then cleverly mending the mistake and finding ways around the obstacles, going on to accomplish so much more than had been imagined. That’s the classic hero’s tale, a mainstay narrative for the human psyche. And it’s the true story of a most magnificent human achievement, the Hubble Space Telescope.

The On Science Blogs planned celebration of the Hubble Space Telescope’s 25th birthday a couple weeks ago got postponed because of happenings here on Earth, like the Nepal earthquake and human-caused earthquakes here in the US. So here, a belated birthday tribute to a pretty spectacular success story for Homo sap.

When the Hubble was launched in 1990, its scientists were horror-struck to find that human error had made the telescope nearly blind, yielding only fuzzy views of the universe. More painful still, the mistake was revealed to the whole world at one of those disastrous backfiring press conferences that NASA manages to generate every so often. This one was worse, much worse, even than the revelation of the “arsenic bacteria” of 2010-11. Ian Sample recounts the the Hubble’s horrible but ultimately happy history at the Guardian, and so does Corey Powell at Discover’s Out There. It took astronauts 5 separate Space Shuttle missions to fix the Hubble, but in 1993, they did it.

Photographing the Universe in the future

The Hubble has taken more than a million images. The New York Times has put together a glorious selection, annotated by astronomers.  There’s a selection of quite different Hubble images in the slide show at SciAm. Editor Lee Billings calls them “far more humble” than the usual, but together they led to key discoveries about the universe.

Surely the most famous Hubble image is the one called the Pillars of Creation. Joseph Stromberg and Joss Fong have annotated and explained the image at Vox.

The pillars of creation. Credit NASA and European Space Agency

The pillars of creation. Credit NASA and European Space Agency

The Hubble will be dead soon. With the Space Shuttle gone it can no longer be repaired. In a few years it will shatter into blistered fragments in the Earth’s atmosphere as it plunges into the ocean.

The Hubble’s successor, much touted, is the James Webb Space Telescope, supposed to look even farther–and further–back toward the Big Bang. Now planned to launch in 2018, it is years behind schedule and of course billions over budget. Hank Campbell’s gloomy assessment is at Science 2.0. Campbell says the Webb is only 75% complete, the easiest 75%. It should, he argues, have been cancelled years ago and the money put to better use.

We can hope, I guess, that the Webb will turn out well after all. That it will become another hero’s tale, another rousing narrative of adversity overcome, a Hubble-like tribute to human accomplishment. But it doesn’t sound promising, does it?

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Earthquake in Nepal: science, media, health risks in dispute

Perched as it is, smack in the Himalayas, that great climbing wall heaved up by the titanic tectonic shoving match the Earthly regions we call India and China have been waging centimeter by centimeter for many millions of years, Nepal will always be shattered by earthquakes.

Red circle shows the location of the main earthquake that struck Nepal on April 25, 2015. Orange circles show locations of aftershocks. Circle size indicates intensity of the shock. Credit: United States Geological Survey (USGS)

Red circle shows the location of the main earthquake that struck Nepal on April 25, 2015. Orange circles show locations of aftershocks. Circle size indicates intensity of the shock. Credit: United States Geological Survey (USGS)

We still don’t know how calamitous was the one that hit Nepal last Saturday. But there are dire predictions.

DotEarth’s Andrew Revkin has been reporting estimates from one highly respected expert who says there may be more than 50,000 deaths all told, with a minimum of 25,000. Another, though, tells him that the Nepal government’s estimate of 10,000 is more likely. The post includes many details about the scientific basis for these estimates, plus a Q&A and a map of shaking intensity of the shocks far more detailed than the simpler USGS maps accompanying this post.

In an earlier post, Revkin discussed an alternative scenario, possible reasons why the death counts so far have been significantly lower than predictions made before the quake. At SciAm, Christina Reed posted another expert interview that also emphasized how both deaths and damage were looking as if they might be less awful than originally feared.

Updated satellite map of aftershocks and the primary shock of the 2015 Nepal earthquake (25th April 21:30 UTC+5:30). Credit: United States Geological Survey (USGS)

Updated satellite map of aftershocks and the primary shock of the 2015 Nepal earthquake (25th April 21:30 UTC+5:30). Credit: United States Geological Survey (USGS)

Becky Oskin reports at LiveScience that some experts say more shocks are still to come because the big one didn’t release all the seismic pressure trying to explode beneath the Himalayas. The ground has already moved about 10 feet near the capital Kathmandu, but there may be up to 50 more feet to go, according to one.

At Achenblog, Joel Achenbach mulls over the fact that, although earthquake prediction is enormously useful in a general way, particular earthquakes are still very often a surprise–occurring at different times and places and strengths than expected. What are the implications–for Japan, for California, for Virginia?

Achenbach is hopeful that, thanks to recent efforts at making Nepal more earthquake-aware, the toll there will be less bad than some fear: “I’d like to think that science and communication can make a huge difference when it comes to disasters.”

The multimedia earthquake

Mountain communities like Nepal are subject to what Richard Bissell and Thomas Kirsch call “a trifecta of risk”: a seismologically active landscape, hillsides prone to slide and avalanche, and, often, poverty that precludes construction of earthquake-resistant structures.  Carl Engelking has posted YouTube drone footage of earthquake destruction in Nepal at Drone360.

Credit: Nirmal Dulal

Credit: Nirmal Dulal

Folks at the American Geophysical Union have of course jumped into action. At Dan’s Wild Wild Science Journal, Dan Satterfield has collected links about earthquake science and videos. At the Landslide Blog, Dave Petley has posted a running series of pieces (and videos) reporting on the earthquake’s impact.

Josh Fischman has geologic details of the continuing struggle between the landmasses that created the world’s highest mountains in infographic form at SciAm. At the SciAm blog Rosetta Stones, Dana Hunter has collected many links, including information about contributing to relief efforts.  Relevant past pieces from SciAms of yesteryear have been collected here.

Medical matters in Nepal now

People have begun to behave as if the immediate crisis is over, but now there will be worries about coming health risks. The Centers for Disease Control and Prevention is telling US residents not to go to Nepal unless they must. But there’s not much blogging yet about medical matters.

Engineer Abhishek Yadav was at home in Kathmandu when the earthquake hit last Saturday. He described the chaotic scene for the BMJ blog. Older structures dissolved into clouds of dust, but so did newer ones; there are building codes, but they are widely ignored. Some private hospitals closed after the government ordered free medical care for all. Predictably, medical supplies ran out, power was shut down.

Credit: Krish Dulal

Credit: Krish Dulal

Doc Paul Auerbach has gone to Nepal to help with medical efforts, and the BMJ blog is also running his postings.  At Live Science, Rachael Rettner talks to UNICEF about what to expect. Including the central question of clean water.

Department of earthquake pessimism

Trolling for free graphics to illustrate this post, I stumbled into this US Geological Survey’s more-or-less real-time (one day) map of earthquakes around the world. Yikes.

Meanwhile, the busy USGS has updated the US danger-zone map to reveal that the riskiest places at the moment are mostly in the heartland. At ScienceInsider, Eric Hand says that the new map shows for the first time that there are 17 areas in 8 states with frequent induced earthquakes, thanks to the oil and gas boom.

New map highlights US earthquake risk zones. Blue boxes indicate areas with induced (human-caused) quakes. Credit: USGS

New map highlights US earthquake risk zones. Blue boxes indicate areas with induced (human-caused) quakes. Credit: USGS

“So far, most induced earthquakes have done no more than rattle windows. But a few have been big enough to damage buildings, and now USGS says that it can’t rule out the possibility of a magnitude-7 temblor, which would cause widespread damage.”

Let me muster some departing optimism. Hand also reports that, in addition to pleasing thee and me, the drop in oil prices is closing some potentially dangerous production sites.

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Homo sap is now a GMO. Shall we edit the genes of human embryos?

Well, the rumors that scientists in China have been messing around with fully predictable genetic engineering of human embryos, discussed here at On Science Blogs a month ago, turn out to be true. Fully predictable hell has broken out. More will, predictably, follow.

The good news is that, despite a considerable amount of previously reported success with the gene editing technique known as CRISPR/Cas9 in cell lines and even in living creatures, these early attempts on human embryos ended up a mess. It’s good news because that failure may give us a bit of breathing room to figure out what should be done about genetic tinkering with an embryo that will affect that person-to-be’s descendants. Or, more practically, whether anything can be done, given that these new technologies are (relatively) cheap and simple to use, and portable.

The researchers, at Sun Yat-sen University in Guangzhou, took care to short-circuit ethical objections by doing this early work in 86 human embryos fertilized imperfectly during in vitro fertilization, embryos that could not survive and would normally have been thrown out. Their target was the gene for ß-thalassaemia. Mutant versions of the gene are responsible for a range of inherited blood disorders and can be fatal.

The procedure worked properly in only a handful of cases. Most of the time the new genetic material inserted itself in the wrong place in the genome. The process also created mosaics: embryos where the desired change was present in only some of its cells, not in all. It is not known how using embryos that were abnormal to begin with affected the outcome.

Despite this unsettling start, in principle there is no obvious reason why, eventually, normal human embryos cannot be edited successfully, as has been done in monkeys. I wrote about the monkey work here more than a year ago.

Sister macaques Ningning and Mingming were the first primates whose genomes have been monkeyed with using CRISPR/Cas9 technology. The work was reported in February 2014. Credit: Cell, Niu et al.

Sister macaques Ningning and Mingming were the first primates whose genomes have been monkeyed with using CRISPR/Cas9 technology. The work was reported in February 2014. Credit: Cell, Niu et al.

The new paper appeared in the Springer journal Protein & Cell and is open-access. Why, you ask, not in Nature or Science, which loooooove hot papers? These top journals do want hot papers, they do, but apparently don’t want them as hot as this one. Both journals turned it down–on, it is said, ethical grounds.

Is this an unethical paper? I’d say no, for reasons I’ll get to in a moment.  My guess is that the journals just decided they didn’t need the hassles the paper is inviting. The published paper’s metadata shows that Springer took only one day to decide otherwise. On April Fool’s Day, in fact. Try not to read anything into that date.

Protein & Cell‘s Impact Factor can be guessed at by noting that the paper was published April 18 but appears, astonishingly, to have languished unnoticed and unheralded for a few days. Does Springer have a PR department? Or is it just . . . shy?

Rounding up blog posts about the new human gene-editing paper

The paper has generated an extraordinary amount of media attention, much of it repetitive.  At Ars Technica, John Timmer provides a straightforward and mostly straight science account of the work described in the new paper and the technical problems it emphasizes. Tia Ghose explains some of the technical difficulties the researchers ran into–and potential solutions–at LiveScience. Ghose also notes rumors that several other labs are at work on human embryo editing.

Critics fall mostly into one of two camps. Some want no genetic work done on human embryos period, especially work that could affect future generations. Others would like to find ways to make preliminary exploratory research on human gene editing acceptable but hold off–for how long is not clear–on any attempts to apply this work to embryos intended to survive. The Chinese work, carried out on crippled embryos that would otherwise have been discarded, seems to me be an example–and, by those criteria, perfectly ethical.

Rob Stein, at Shots, focuses on critical assessments of the work, emphasizing how the failures the Chinese describe demonstrate that human embryo editing is far from any clinical applications. Genome Web summarized several other negative comments.

Razib Khan urges everybody to calm down at Gene Expression, noting that the failures mean that human embryo gene editing is far from being a consumer product. He says the real danger will be something like “a government or society [that] isn’t bound by normal human ethical standards, and begins to basically treat their population like livestock. As is usually the case the major issues looming are not scientific, but have to do with human volition.”

At The Loom, Carl Zimmer’s explainer begins with the new Chinese paper. But the post is really a walk through the history of attempts to fix human disease with genetic engineering, linking to a number of Zimmer’s past pieces for amplification.

Homo sap becomes a GMO

Chris Gyngell’s post at Practical Ethics comes down squarely in favor of human germline editing on grounds that it offers immense potential benefits. People who oppose it Gyngell dismisses as emotional rather than rational.

Gyngell argues that the scientists who have called, respectively, for a germline editing moratorium in Nature and a pause in Science fail to show why “general concerns about this technology warrant such extraordinary disapproval, while the same concerns in other technologies are ignored.” Why, Gyngell wants to know, does germline editing deserve special attention?

Because, Paul Knoepfler responds sternly, germline editing involves “experimentally de novo creating designer babies with gene edits that the resulting genetically modified people could then pass along to future generations forever with unknown consequences.” Knoepfler is a stem-cell researcher and passionate blogger who has come up with his own plan that would permit germline gene editing to go forward as research but stop short of attempting to bring a genetically modified baby into existence.

Wired’s Nick Stockton has collected comments from scientists and ethicists who have been involved in the Nature and Science commentaries calling for human germline editing to stop altogether or at least slow down. These commentaries were discussed here at On Science Blogs last month.

Hank Greely, of Stanford Law School, a co-author of the Science call for a pause in the research, told Stockton he thinks the Chinese researchers have nothing to be ashamed of. But the fact that the work was doable, however imperfectly, “makes it even more urgent to have a societal conversation about how far to go.”

I love the flag-waving self-absorption of Wired’s hed, “America Needs to Figure Out the Ethics of Gene Editing Now,” with its implication that it is this country’s job to make ethical rules on gene editing for the world. It’s going to be hard enough to make rules for the US. Doing human embryo research with government money is against the law here, but there are no restrictions whatever on what companies and other private organizations can do.

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Concussion, TBI, human evolution, Neanderthal DNA, blogging news

Concussion, traumatic brain injury, and life’s hard knocks

Search “concussion” in the media and you’ll come away thinking hard knocks to the head are chiefly a problem for kids and football players (or kid football players.) Last fall the blog of the Dana Foundation, which focuses on brain research and education, called it the “NFL Concussion Crisis.”

But as Fred Powledge points out at NPR’s blog Shots, concussion is a far more serious problem for old folks, of whom he is one. They have the highest rates of traumatic brain injury-related hospitalizations and deaths.

Powledge’s is a very personal account of his very personal concussion, which landed him in hospitals for two weeks last fall and is still irritating his life today. Recovery from concussion is s-l-o-w. A writer, he complains particularly about a frustrating increase in typo production.

This MRI of a human brain reveals injury (in red) to the brain’s coverings following mild head trauma. Credit: Lawrence Latour, NIH.

This MRI of a human brain reveals injury (in red) to the brain’s coverings following mild head trauma. Credit: Lawrence Latour, NIH.

Christie Aschwanden’s post at Fivethirtyeight is–predictably since the new home of Nate Silver’s data journalism enterprise is ESPN–about concussion in football. But she points out that “we still don’t have a way of definitively diagnosing concussion. Do we even know what a concussion is?” (Side note: This is an opportunity to point out that Aschwanden has recently joined Fivethirtyeight as lead science writer, boosting the site’s science-writing cred at least 538% after last year’s inauspicious start, described here at On Science Blogs.)

What concussion is is what it is now called formally: TBI, traumatic brain injury–or, in Powledge’s case, MTBI, mild traumatic brain injury. Although when it happens to you, he notes, MTBI doesn’t seem so mild. Not that the rename resolves much of concussion’s mystery, since what happens after depends on the severity and frequency of the blows that cause it, and what parts of the brain are traumatized, and the person affected’s general state of being.

We are sure to be hearing more about concussion in older folks over the next couple of years. That’s because Hillary Clinton, now age 67, suffered TBI after a fall in 2012. She spent 3 days in the hospital and, Lenny Bernstein reports at To Your Health, is fully recovered. But the episode will certainly surface as the 2016 Presidential election campaign roars on. I’m expecting rumors of permanent brain damage.

Why is the human skull so hard? Bro science knows.

The subject of concussion permits me an excuse to drag in a favorite topic, paleontology, specifically the evolution of the human skull. At his blog Laelaps, Brian Switek tackles two University of Utah researchers who have argued that “Hands evolved to punch faces. Faces evolved to take punches.” Switek points out that the idea that hands can be weapons, therefore they evolved to be weapons, is a post hoc fallacy common in arguments about evolution.

He notes that the researchers didn’t look for signs of broken facial bones or blunt-force trauma on skulls of early humans like Australopithecus, nor did they “try to model how early human skulls would have reacted to the stresses of an incoming fist. The entire argument is simply that australopithecine skulls look like they could take a punch. . . This is bro science – dudes pummeling each other driving human evolution.”

Pardon me while I take a moment to happy dance around the delicious notion of bro science.

Switek also notes that although early humans like the Australopithecine Lucy were bipedal, their hands were anatomically rather like those of their tree-living ancestors.

i.e., they couldn’t make fists.

Pow, right in the kisser!

I also want to drag in this Charles Choi report at Live Science on the oldest sample of Neandertal DNA, dated at around 150,000 years ago. Not a complete genome, or at least not yet.

Nothing to do with concussions, although it does involve a human skull.  This is basically an excuse to run this extraordinary photo of the still-buried Neandertal, known as Altamura Man, who supplied the DNA. He is encrusted in calcite formations.

The skull of Altamura Man, a Neandertal buried in an Italian cave and dated at about 150,000 years BP. The rest of his body is encased in calcite formations. Credit: Italian Ministry of Cultural Heritage

The skull of Altamura Man, a Neandertal buried in an Italian cave and dated at about 150,000 years BP. The rest of his body is encased in calcite formations. Credit: Italian Ministry of Cultural Heritage

McKenna moves

Speaking of professional moves by really good science writers, Maryn McKenna, she of Wired’s Superbug blog and many other professional highlights, has moved to Phenomena, the mini-blog network at National Geographic. Her new blog, Germination, sounds as if it will still be mostly microbial. The focus, she says, will be on “public health, global health, and food production and policy—and ancient diseases, emerging infections, antibiotic resistance, agricultural planning, foodborne illness, and how we’ll feed and care for an increasingly crowded world.”

 

HealthNewsReview rebirth and relaunch

And while I’m up and announcing novelty, the venerable HealthNewsReview, veteran vetter of medical journalism, is celebrating its 9th anniversary with a spiffy web site redesign and relaunch. Gary Schwitzer’s introductory post recaps some history.

HealthNewsReviewers have analyzed nearly 2000 medical news stories so far in the blog’s almost-decade. You will probably not be surprised to learn that only 14% of them deserved 5 stars, but I guess it’s somewhat encouraging that only 4% of them got 0 stars.

A particularly helpful–and terrifying–new feature is the decision to take on press releases as well as articles. This makes terrific sense, since so many so-called science and medical articles simply rehash the release, and often just reprint it verbatim–frequently without acknowledging that it is a release and sometimes even having the chutzpah to add a staffer’s byline. Schwitzer explains the reasoning for adding analysis of releases here, summarized neatly under the hed “News releases can lead media like sheep – hiding key problems.”

Exhibit A is a multi-author bashing of a University of Wisconsin release on use of a prostate cancer drug to slow memory loss in women with Alzheimer’s disease. The verdict: “Misleading to the point of deception . . . Yet it appears that journalists and other web producers bit on the bait and followed the lead of the news release unquestioningly.”

Oy. Scary. But much needed.

 

About back-patting bloggery

Linking to posts by friends and colleagues is common among bloggers, including some famous and highly regarded science bloggers, naming no names. I’ve been blogging about blogging weekly for nearly 6 years, but have been pretty restrained in this practice.  If I do say so myself, and I do. However, this makes two weeks in a row. Last week it was Joel Shurkin’s fine Inside Science series on the discouragements of Alzheimer’s disease research. This week it is Fred Powledge’s insightful account of his concussion, aka mild traumatic brain injury, at NPR’s Shots.

Some readers will have noticed that Fred Powledge and I have the same last name.  That’s no accident. Full disclosure: Fred Powledge is my first husband.

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Alzheimer’s disease update: gloomy

The great plague is coming

The lede on Joel Shurkin’s three-part post on Alzheimer’s disease and other dementias at Inside Science is stark and discouraging: “The great plague is coming. After 100 years of research and billions of dollars spent around the world, we still have no protection and there is none on the horizon.”

Full disclosure, Joel and I are old friends and colleagues. But I am being completely objective when I tell you that he is an exceptional science writer with a venerable record, and that this series is an enormously useful explainer about what’s going on (and not going on) with research on this most horrifying of the diseases of aging.

One reason for the laggard pace is that there is still no consensus about how Alzheimer’s develops. Researchers have long been at war over which process is more important for destroying the brain in Alzheimer’s, the tau protein tangles or beta amyloid plaque accumulation in the brain.

My nonquantitative impression is that beta amyloid has captured majority opinion. But the partisans of tau are neither cowed nor silent, and what seems like a significant new Mayo Clinic paper comes down on that side too.

It reports that studies of 3600 postmortem brains show that dysfunctional tau protein drives cognitive decline and memory loss. And it argues that beta amyloid, the other toxic protein that characterizes Alzheimer’s and builds up as dementia progresses, is not the primary culprit. Tau tangles first appear in the brain stem sometimes as early as childhood, whereas beta amyloid is found later in the cortex, a decade or more before cognition declines are obvious. Accumulations of both, the researchers say, probably occur in parallel, “eventually resulting in incompletely understood crosstalk between the pathologies.”

Writing at In The Pipeline about the new paper arguing that pathology from tau is more important than beta amyloid, Derek Lowe points out that, even if the finding holds up, it’s always possible “that amyloid-centric approaches could still be of benefit (just as it’s possible that amyloid still is the real driver of the disease state). But neither of these are sure things. Alzheimer’s has no sure things.”

Alzheimer’s therapies

As Joel Shurkin explains, drug therapies currently used for Alzheimer’s are pretty close to useless. A certain excitement has attended a new experimental drug from Biogen, an excitement especially among investors, who have driven Biogen’s stock price up significantly.

At the HuffPost Science Blog, Howard Fillit, of the Alzheimer’s Drug Discovery Foundation, calls Biogen’s baby a (sigh) breakthrough. It reportedly reduces amyloid plaques in the brain and improves cognitive function. Note that so far there is only is a very early study involving just 166 patients. The drug, called aducanumab, is not a pill. It’s a monoclonal antibody vaccine that must be administered intravenously, probably once a month.

In another In the Pipeline post, Lowe tries to be hopeful about the drug, but honesty forces him to pick some nits. He notes that every other antibody trial has failed, and it will be years before Stage III clinical trials can tell us whether aducanumab can really make a difference in Alzheimer’s.

At HealthNewsReview, Alan Cassels picks more than a few nits, not impressed with media coverage of the Biogen breakthrough and deeply skeptical of any therapy focusing on getting rid of amyloid plaques. “Alzheimer’s drug discovery has sadly experienced an almost universal failure rate of preclinical and Phase I, II, and III testing,” he says, reproducing a startling infographic from a 2010 Nature journal to demonstrate the point.

This recent infographic from Nature Reviews Drug Discovery suggests how badly Alzheimer's drugs have done compared with other pharma efforts, Cassels points out at HealthNewsReview. The funnels illustrate the average number of compounds needed at each stage of drug development in order to get one drug approved. http://www.healthnewsreview.org/2015/03/journalists-fire-another-silver-bullet-at-alzheimers/

This recent infographic from Nature Reviews Drug Discovery suggests how badly Alzheimer’s drugs have done compared with other pharma efforts, Cassels points out at HealthNewsReview. The funnels illustrate the average number of compounds needed at each stage of drug development in order to get one drug approved.
http://www.healthnewsreview.org/2015/03/journalists-fire-another-silver-bullet-at-alzheimers/

The graphic is so startling that I’m reproducing it here (and providing a link to a more legible version) to demonstrate how much more effort has gone into Alzheimer’s drugs than into drug therapies for other diseases–with essentially nothing to show for it. Given the billions in public money expended, Cassels says, you’d think there would be a taxpayer revolt.

Gary Schwitzer follows up by thrashing CBS for its reports on “promising” “silver bullets” for Alzheimer’s that are apparently not Biogen’s bullet. Although as Schwitzer points out, it’s hard to tell from the pieces themselves, which lack essential information of this sort.

And can we please  PLEASE stop with the silver bullets? Guys, the correct cliché is  magic bullets. M-A-G-I-C. The association to silver bullets is the Lone Ranger, not disease therapies.

Diagnosing Alzheimer’s

This disorder takes a very long time to work its evils. Even if good treatments are developed, they are likely to be useless unless they can be applied early enough to halt brain disintegration. Even slowing Alzheimer’s down could contribute significantly to making life less miserable for patients and their families–not to mention saving billions of health care bucks.

Joel concludes his series with a focus on prospects for good ways of diagnosing Alzheimer’s (and other dementias) before–ideally long before–the brain becomes a wreck. There are two main approaches, he says: imaging and biomarkers.

Functional magnetic resonance imaging can apparently see bad proteins like amyloid and tau in living brains. Testing spinal fluid–not fun at all for the patient–can detect the proteins too. Brit scientists have developed a blood test they claim can predict, with 87% accuracy, development of Alzheimer’s disease within in a year among people with mild cognitive impairment. A reliable blood test would be an extraordinary advance.

The test with the most potential, Joel says, is known as A4, and studies on it are just beginning. The researchers will recruit 1100 high-risk but presymptomatic subjects, using PET imaging to try to find evidence of amyloid in their brains. The drug they’re testing, solanezumab, is said to reduce amyloid.

But wait, there’s more. At the NIH Director’s Blog, Francis Collins has just enthused over saracatinib, a not-very-effective cancer drug that AstraZeneca had shelved. Yale researchers have resurrected saracatinib and are studying it for potential utility in Alzheimer’s disease.

Alzheimer's brain pathology illustrated using fluorescent microscopy, which reveals both the Tau protein neurofibrillary tangles (flame-shaped structures) and amyloid plaque pathology (rounded structures.) The warmer colors indicate amyloid accumulation in living brains. Credit: Mayo Clinic

Alzheimer’s brain pathology illustrated using fluorescent microscopy, which reveals both the Tau protein neurofibrillary tangles (flame-shaped structures) and amyloid plaque pathology (rounded structures.) The warmer colors indicate amyloid accumulation in living brains. Credit: Mayo Clinic

And then there are the researchers who say ultrasound treatments fully restored the memories of 75% of its study subjects.

Who were mice.

Cassels assures us that no, this is not an item from The Onion.

At Neurologica, though, the normally skeptical Steven Novella sounds borderline excited about the ultrasound work, which he hails as a novel and noninvasive treatment. He leavens this unusual stance, though, with his native caution. He warns journalists that mice are not people, and mouse models of Alzheimer’s are not perfect duplicates of human disease because they are definitely associated with amyloid accumulation. Which is, as we have seen, still in dispute for humans.

I guess Novella hadn’t read John Timmer’s post at Ars Technica. Timmer tells of a similar experiment that reversed Alzheimer’s symptoms in mice.

Using a cellphone.

That’s not an Onion item either.

How to prevent Alzheimer’s disease

If reliable diagnosis and successful treatment are long-distance prospects at best, what of preventing this brain-destroyer?

You’ll be relieved to know that, according to some, it’s easy-peasy.

At HuffPo, Carolyn Gregoire reports that the MIND diet cuts your Alzheimer’s risk by 50%. MIND co-mingles the Mediterranean Diet and the DASH hypertension diet: heavy on whole grains, fruits, vegetables, no red meat, etc., plus a glass of wine.  At Big Think, Natalie Shoemaker is into leafy greens for Alzheimer’s prevention.

And then there’s exercise. Deric’s MindBlog notes that the “modest” effects of exercise aren’t really so modest: substantial reductions in all-cause mortality and a 35% or more reduction in risk of cognitive decline in the nondemented.

At Science of Us, Melissa Dahl brings us news of Klotho’s ability to protect against the symptoms of Alzheimer’s (even, reportedly, among people with evidence of the disease in their brains at autopsy.) You’ll be wanting to know what Klotho is. An anti-aging protein, sometimes acting as a hormone.

And how do you get more Klotho? Aerobic exercise!

And finally, caffeine reportedly reduces beta amyloid plaque accumulation in the brain.

Needless to say, the evidence that these nostrums can prevent or treat Alzheimer’s disease ranges from rickety to near-invisible. OTOH, they probably won’t hurt. And of course we should all be eating right and exercising and drinking coffee anyway.

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More herbal supplement regulation? Plus scientific April Foolery

REGULATION OF HERBAL SUPPLEMENTS IS A SCAM. BUT YOU KNEW THAT.

Steven Novella reports at Neurologica on a nice piece of investigative science journalism about government (non)regulation of the supplement industry at the Canadian Broadcasting Corporation.

CBC researchers created a fake treatment for fever and pain in children and submitted paperwork to the Canadian government for a Natural Product License. This part is particularly wonderful: the centerpiece of the application was pages copied from a 1902 homeopathic reference book. It took five months, but the government approved the fantasy product as “safe and effective.”

Novella’s inarguable point in this juicy and readable post is that the Canadian government has issued “a license to lie to the public about a health product.”

That situation is not much different in the US, of course. But I wonder ever so tentatively if there’s a chance that we might possibly perhaps be creeping slowly toward improved regulation of the $33 billion supplement industry.

Two reasons. No, three reasons.

First, GNC moved quickly to become first of four giant retailers to settle and seek to rise above recent accusations of selling herbal supplements lacking the herb claimed on the labels. The headline accusations came a few weeks ago after investigations by the New York State attorney general.

GNC has promised what Anahad O’Connor at the NYT Well blog called “sweeping new testing procedures on its herbal products that far exceed quality controls mandated under federal law.” GNC is saying it will use DNA barcoding–shorthand for firmly identifying plants by the specific DNA characteristic of the species–to make sure what’s on the label is what’s in the bottle.

DNA barcoding is the type of testing the New York investigations used to argue that the claimed herbs were absent from the supplements it tested. There seems to be a legitimate question about whether this is the right kind of test to use on some kinds of supplements–for example, extracts, which are so heavily processed as to destroy DNA. I wrote about the DNA barcoding problem here at On Science Blogs a few weeks ago.

In fact, that’s what GNC claimed at first, that its extracts were perfectly kosher but, because of processing, DNA-free. So I’m puzzled about why all of a sudden the company is vowing to use DNA barcoding to demonstrate its virtue.

snake-oil-bottle-cropped-label

Pieter Cohen, Harvard Med, is a longtime critic of the supplement industry but told me that DNA barcoding is not always the right test. He told Julia Belloz at Vox that it’s about time a supplement purveyor is making sure the label accurately describes the content. “What’s amazing is that it has taken 20 years for a major retailer to say they will fully respect the law.” OTOH, the agreement does nothing, he points out, to make sure that what’s in the bottle is safe and/or does what it promises to do.

Note that GNC’s vows apply only to its own store brands, not other brands it sells. This is quite a smart marketing move. If it can burnish its reputation as the trustworthy place to buy supplements, that will help justify the often-higher prices it charges.

Second, the list of state attorneys general that have joined with New York in asking Congress to investigate the herbal supplements industry has now grown to 14. Not that anything will come of it. Particularly with this Congress. But it’s a place to start, the beginnings of a ToDo list, and, I hope, a way of keeping this issue in the news.

Medicine-free medicine

The third reason I am slightly hopeful about cleaning up the supplements industry is that  the US Food and Drug Administration will soon be holding a two-day meeting (Webcast!) on regulation of homeopathic products.  It’s come one, come all as speakers, so expect a circus.

And what are homeopathic products? Let’s just say that there would have been no point in the New York State attorney general’s office testing any homeopathic product to see if it contained its claimed ingredients. That’s because homeopathy’s proud boast is that homeopathic medicaments are diluted so severely that nothing is left other than what Novella calls “mysterious vibrations or implausible and highly fanciful water chemistry.” (This from a delightful 2009 post defining homeopathy.)

It does raise a definitional question also, at least for me: can a homeopathic product fairly–or legally–be classified as an herbal supplement if the whole point is that it contains no herb?

You might think that the FDA is starting with an easy target: what could be more vulnerable than a medicine that claims to be medicine-free? But you would be wrong. This is not fringe stuff.

Case in point: a homeopathic asthma medication not only sold at Target, but sold under the Target house brand with the (in this case ironic) name of Up&Up. Is this a record for expensive bottled water: $127.92 per pint?

target homeopathy med

See the post by Scott Gravura at Science-based Medicine for many details. Gravura points out that homeopathic asthma meds are also available at Walgreen’s and online. (The Walgreen’s item bests Target’s bottled water price: $184 per pint.) Gravura’s link to an online site for an asthma med goes to Amazon, but as I write the link lands on the dreaded Error 404 Not Found.

Only a couple weeks ago, FDA issued a warning against OTC homeopathic asthma medications.  Perhaps Amazon is better at keeping up with the news than Walgreen’s is.

And I guess this is the place to note that both Target and Walgreen’s (along with Walmart) were among the four big retailers outed in the NYState AG investigation. These three have yet to say much of anything, let alone attempt to get out in front of the accusations as GNC is doing so smartly.

APRIL FOOLISH?

Was anybody, even an eighth grader, fooled by this week’s zoology paper in Nature? The one arguing that, thanks to global warming, dragons are on the way back? Even though it was co-authored by so legendary a biological scientist as Robert M. May? Even though the cover date of the journal issue was April 2, not April 1?

I doubt it. But at the SciAm editor’s blog Observations, Lee Billings calls for a moratorium on the scientific publishing tradition of April Fool jokes. Billings argues that the tradition fosters distrust of science.

Billings’s prime evidence is an undoubtedly searing personal experience. As a kid, Billings accepted as gospel a Discover magazine article about a purported new elementary particle as big as a bowling ball, wrote a report about it in 8th grade, and got an A. (So much for science literacy among Middle School teachers in Greenville, SC.)

Attempting a repeat performance the following year in a freshman science class–led, I am relieved to report, by a teacher who seemed to have some grasp of the subject–Billings was humiliated beyond recounting when the teacher pointed out the April cover date of the Discover issue.

Of course such an experience would be more than devastating to the tender unformed psyche of a high-school freshman. I’m not sure it’s enough to convince me that scientific April Fool’s jokes should be banned because some people don’t get the joke.

OTOH, science April Fool efforts are sometimes so abstruse as to let few readers–even sophisticated SciAm readers–in on the joke. SciAm Editor Phil Yam last year put together a brief history of the magazine’s April foolery that included some examples.

It’s also true that April Fool items, science and otherwise, are often lame and perhaps should be done away with on grounds that, by and large, they are just not funny. Larry Husten tells us at JWatch about a JAMA Internal Medicine paper proffering data to back up the adage that an apple a day keeps the doctor away. Regular apple eaters had fewer doctor visits than those who were, um, less regular.

Although–this is, I concede, pretty cute in a very specialized way–when subjected to multivariate analysis, the Apple Effect turned out to be nonsignificant.

 

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Do AA and other 12-step programs work? Does breastfeeding raise IQ?

Do 12-step programs for addiction treatment work?

Are 12-step programs like Alcoholics Anonymous and Narcotics Anonymous effective treatments for addiction? That long-time dispute has just popped up again, prompted mostly by an Atlantic article with the click-worthy title “The Irrationality of Alcoholics Anonymous.”

Gabrielle Glaser’s central argument is that there are other addiction therapies that work, but the 12-step programs are just not based on science. It’s a reasonable point historically. For one thing, many 12-step studies have tended to ignore a crucial problem in research design: selection bias. It’s reasonable to think that people in AA, NA, etc joined because they were especially motivated to quit. Members are probably not a random sample of addicts.

alcoholics anonymous

But Jesse Singal’s riposte to Glaser at Science of Us argues semi-persuasively that there may be recent data showing that 12-step programs can be effective.

Glaser emphasized the equivocal nature of the science collected in the 2006 meta-analysis in a Cochrane review, which found “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.” Singal seems to interpret that as saying the programs were not effective, but of course that isn’t what the Cochrane folks said (or, it appears, what Glaser was saying either.)  They said effectiveness had yet to be demonstrated. The quality of previous studies was often questionable, and it was also hard to compare them.

New evidence that AA works?

Singal quotes doc John Kelly thus: “There’s quite a bit of evidence now, actually, that’s shown that AA works.” Kelly is an addiction specialist at Mass General and Harvard Med and one of the authors of  a new Cochrane review to be published in August.

But the Singal post has problems too. It does not, for instance, take up drug therapies for addiction: methadone, naltrexone, etc. That leaves me in the dark about their effectiveness. I gather that 12-step programs in general don’t approve in principle of substituting one drug for another and so don’t want their participants to be using “therapeutic” drugs.

In talking about the newly revealed success rate, Kelly seems to be emphasizing research not on 12-steps themselves but on 12-step facilitation programs. Acronymed TSF, these programs sound something like prep courses for AA. Kelly claims these (plus a 12-step) have been shown to have up to a 20% advantage over one alternative treatment, cognitive behavioral therapy.

The lead author of the 2006 Cochrane Review, Stanford doc Keith Humphreys, will also be an author on the upcoming revisionist paper. He posted on his updated views about a strengthened scientific basis for AA etc last June at WonkBlog. This post, however, also was about the effectiveness of TSF, not 12-step programs by themselves with no introductory TSF boot camp.

Are 12-step facilitation programs the new AA?

But since TSF programs are not themselves regular 12-step sessions, I find these claims confusing. Is TSF a new, improved AA? Can measuring the effects of TSF plus a 12-step sojurn legitimately serve as what the clinical trials folk call “surrogate endpoints?” Is a TSF required for 12-step success, or does it simply increase the success rate? (Or, of course, neither, but both Kelly and Humphreys appear to rule that out.)

What Humphreys concludes is that TSF followed by 12-step participation is as effective as any other professional therapy. That may be good news, but it is also not an evaluation of the plain old AA, NA, etc. that millions of hopeful recoverers count on.

Also, a not unimportant point: the TSF pre-interventions require a therapist. Classic TSF is a three-month program. Humphreys also praises a mini-TSF, a “brief, structured introduction to AA,” without defining “brief.” A three-month stint run by a therapist will cost at least several hundred dollars, and even a brief one will cost something.

Contrast that with the ubiquitous–nearby and frequent–12-step sessions, which are free. Although you are supposed to contribute for the coffee. You can’t beat that for accessibility.

Glaser points out that the question of what works has taken on new urgency because Obamacare requires insurers and Medicaid to pay for substance abuse treatment. I wonder if that fact might help speed up reliable efficacy research. It would be nice to spend that money on stuff that works. Patients trying to get clean would probably prefer that too. Most of them.

Or, assuming that it turns out there is good evidence that 12-step programs can work, with or without TSF prep sessions, is it possible to do a better job of moving that information into physicians’ offices? Not to mention their brains? Along with the data on other approaches like cognitive behavior therapy and meds?

We are, we are being told, entering the age of Personalized Medicine. Surely time to lay out the smorgasbord of addiction therapies with attached price tags and data on what works.

Does breastfeeding increase adult intelligence and income?

The media loved the idea that breastfeeding improves intelligence. And, even better, that a breastfed baby earns more in adulthood. Who wouldn’t?

There have been other studies saying breastfeeding raises IQ (and some that say not). The New England Journal of Medicine‘s JWatch has made its past comments on these studies available free. But this new study, from Brazil and published in The Lancet, attracted so much attention because it went on for more than 30 years, which made it seem particularly persuasive.

Even venues where one might expect critical consideration reported with little analysis. The New York Times health blog Well, for instance. Vox’s Julia Belluz, an unusually skeptical eye, was pretty accepting of the Brazil study too. (Although a few days later she was writing about why you shouldn’t believe what you hear about exciting new medical studies, a series of cautionary tales for journos if there ever was one.)

There is much to praise in this ambitious long-term study. Spare a thought just for the amount of work involved over decades. At the Guardian’s Brain Flapping blog, Dean Burnett’s critical take begins with praise: “It’s a well-designed study which tries to take into account as many variable and confounding factors that could distort the results as possible.” Burnett’s critique leans heavily on the fact that IQ was measured with the always-controversial Wechsler Adult Intelligence Scale.

He also wonders how this widely-praised study will increase the already heavy pressure on new mothers to breastfeed. This concern he bolstered with personal experience: his wife’s breastfeeding instructor, a health care worker, vilified women who considered formula feeding.

What’s wrong with the Brazil study of breastfeeding and intelligence?

Adrienne LaFrance based her Atlantic criticism largely on details of the study–especially that so many of the study subjects enrolled in 1982–5914 of them–were, as population researchers say, “lost to follow-up.” After 30 years, only 3493 were still available. That’s perhaps understandable in such a long-term study, but it does raise questions about the data’s validity.

She points out other difficulties too. Accounts of breastfeeding practices were collected years after the births, and were based on self-reports by the mothers. Self-reports are intrinsically subject to question.

“And even if breastfed babies really do grow up to have higher IQs and make more money, how do we know it’s because they were breastfed?” LaFrance asks. Although social class differences in breastfeeding practices seem to be less important in Brazil than in many other countries, it still is the case that nursing mothers tend to be better off and more educated than mothers who don’t (or can’t) breastfeed.

breastfeeding

There were other reported adult differences between those breastfed as babies and those who were not. The researchers compared babies who were breastfed for a month or less with those who were breastfed for a year or more. The differences were statistically significant, but not enormous. The income difference amounted to a little over $100 per month at today’s exchange rate, and as with IQ can perhaps be explained by other advantages in the breastfed. Breastfed children stayed in school longer, but less than a year longer. Also, IQ differences amounted to less than 4 points on average.

LaFrance concludes, “And though breastfeeding may play a role in how a kid turns out, 30 years of parenting surely has more to do with what kind of adult a baby becomes.”

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Apple Watch ResearchKit ethics, NYT flubs cellphone risks, scientists urge halt to human genome work

An Apple all day keeps the doctors monitoring you 24/7

I wasn’t paying much attention to the miasma emanating from last week’s Apple presentation, which seemed to consist entirely of The Watch and its astonishing pricing. So the news about Apple’s ResearchKit came to me in an uncommon way: in an office visit with my cardiologist, who is quite excited about the app’s clinical research possibilities.

He’s not the only one; there’s real giddiness about extracting Big Clinical Data 24/7 from people whose digital devices are their constant companions, all but surgically implanted. Theral Timpson of Mendelspod summed it up thus, “It’s an all out open source platform for medical research that has open science folks drooling.”

apple_research_kit_2.0.0

I guess ResearchKit is the logical endpoint of FitBit and other manifestations of the mania for self-monitoring. ResearchKit will pull health data (with permission, Apple hastened to assure us) from people’s iPhones, Apple Watches, and maybe other devices, and deposit it with research projects. It’s open source, so at Wired Marcus Woo says it could be available eventually for non-iThings, but no firm word on that yet.

Woo quotes researchers as saying the fact that there are millions of iPhone users will rule out selection bias in the studies, but also points out that Apple device users are on the whole young, white  and Asian, and affluent. He notes, “Not exactly representative.”

ResearchKit is already around in 5 pre-Watch apps available for the iPhone, so if you’re eager to be a research subject, you don’t have to wait until April. At Stanford Medicine, one of Apple’s A-list collaborators in ResearchKit, Becky Bach blogged at Scope that they were pretty darn excited about MyHeart Counts.  Alan Yeung, MD, an app architect and medical director of the Stanford Cardiovascular Health Department, rhapsodized about the potential for a million downloads, for doing much larger population studies than in the past, and also for significant improvement of data accuracy because it’s being gathered automagically.

On March 18, Scope’s Kris Newby reported proudly that nearly 28,000 people had consented already to provide their data to the MyHeart Counts study on cardiovascular health.

Seems to me ResearchKit might also lower the cost of research. Or maybe I mean it will shift the cost, of data collection at least, to research subjects. MyHeart Counts is at least a free app, but to participate in the research people will have to buy expensive devices like iPhones and Apple Watches and also pay carriers to provide service in perpetuity to send the data to researchers. I concede that the purchases will permit them also to make phone calls, text, do Facebook, play Sudoku, set an alarm, check their stocks, etc. But still.

The other four apps already in existence include mPower, a diagnostic tool for Parkinson’s disease that uses the iPhone touch screen to measure hand tremors and the mic to assess voice tremors. Plus apps for research on asthma, diabetes, and breast-cancer treatment recovery.

Bioethics and ResearchKit

The most extensive take on the research ethics issues that ResearchKit poses comes from an unexpected (to me) source: The Verge. Arielle Duhaime-Ross is concerned, for one thing, about participation by minors without parental consent. She reports that she was able to lie about her age to the Asthma Health app. This apparently is also possible with mPower and the breast cancer app Share the Journey.

The post also explores the obvious issues of privacy and confidentiality. Apple proclaims proudly that it will not see your data, but keeping data anonymous will also be a challenge for the research projects that receive it. One of the researchers admits to Duhaime-Ross up front that there’s no guarantee that a research subject couldn’t be outed.

The Bioethics.com blog is concerned enough about ResearchKit’s bioethical aspects to have posted a link to a Time piece that suggests ethical issues may arise beyond the obvious privacy and confidentiality concerns. For example, will richer institutions be able to attract patients away from trials that might make sense for them but have less funding and can’t provide an app?

At Ars Technica, Jonathan Gitlin thinks the Food and Drug Administration may have something to say about ResearchKit too, although no such potential barrier was mentioned during the Apple festivities launching it. Not every mobile health app is a candidate for regulation, he says, but FDA does have oversight of diagnostic devices, and apps like mPower are offering diagnosis. (And, it strikes me, mPower and its ilk could be a godsend to hypochondriacal obsessives, who will keep pushing the touch screen in search of tremors.)

 

The International New York Times wonders whether an Apple all day will bring doctors to stay

Not often you see a New York Times piece on science and medicine so thoroughly trashed as the one whose original (and, thanks to intervention by the NYT science department, short-lived) hed read: “Could Wearable Computers Be as Harmful as Cigarettes?”

The science-and-medicine blogosphere roared “NO!”, including the Times‘s own Public Editor Margaret Sullivan (who may, btw, be the best NYT Public Editor ever. She bravely and consistently cuts her employer not much slack.)

The many problems with the piece may well be traceable to the fact that it appeared in the Disruptions blog/column, which runs in the Style section. These departmental divisions are irrelevant to readers, but my hunch is that they may still prevail, hangovers from the dead-tree days, in the editing process.

Meaning that the column, by technology writer Nick Bilton, simply didn’t get the kind of going-over that would have happened in Science or Health. It appears also that Bilton, who may know all there is to know about Silicon Valley, has little background in the squishy and long-disputed medical subjects he tackled here, chiefly the cellphone-as-potential-health-risk saga.

He added insult to that injury by quoting only the infamous (among health writers) Joseph Mercola. “Why is the New York Times turning to Joseph Mercola as an expert on cancer risk?” thundered Kevin Lomangino at HealthNewsReview, pointing out that Mercola is an alternative medicine doctor who believes cancer is caused by root canals.

At Collide-a-Scape, Keith Kloor characterizes Mercola as “an osteopath who is notorious for his many unsubstantiated medical claims, some of which have drawn a warning from the U.S. Food & Drug Administration.” Orac, at Respectful Ignorance, presents great detail and several links about the colorful health advice career of Joe Mercola.

At Risk Science, Andrew Maynard walks you through the evidence on cellphone risk, concluding that a 2011 report from International Agency for Research on Cancer (a WHO body)  “found tentative evidence that very high use of cell phones might possibly lead to an increase in the relatively rare conditions glioma, and acoustic neuroma.” Not, in short, at all comparable to health risks from cigarettes.

apple watch gold

Maynard then turns to possible danger from the Apple Watch, which was presumably the viral-topic-of-the-moment reason Bilton decided to do his piece. As Maynard points out,  watches are different from phones because they are not held near the brain and they don’t emit high-power radio waves. “In other words, there is exactly nothing about a wrist-based wearable that, from the IARC report, would suggest that it could cause cancer.  Nothing.”

 

Decision day for designing future humans

Should we tinker with the genes of our descendants? It’s been a debate topic for half a century or more. Always an intriguing question to mull over in the comfortable absence of good ways of doing it.

Now there are good ways. Gene-editing techniques in particular make it possible to modify the next generation’s genomes, and so future generations as well. In any species. Including Homo sap. These techniques, known as germline modification, are (relatively) cheap and simple. In other species they have also been remarkably effective.

So the discussion is, suddenly, theoretical no more. We know that for sure, because lots of scientists are yelling “STOP!” Or at least “Pause!”

The latest shout comes via this week’s Science (March 20). Attention will be paid because the assembled authors are luminaries. Jennifer Doudna, an inventor of CRISPR, one of the gene-editing methodologies that have bumped this formerly hypothetical question to the top of the ToDo list. David Baltimore, Nobel laureate and former president of Cal Tech. George Church, whose Harvard lab is a hotbed of genetic innovation, including germ line gene editing–the editing of genes in sperm, eggs, and early embryos, changes that will be passed on to future generations. Bioethicists R. Alta Charo and Hank Greely.

And several other notables–including, intriguingly, Paul Berg. A Nobel laureate too, Berg was an organizer of the historic 1975 Asilomar conference, which brought together scores of scientists and a few lawyers to draft guidelines for dealing with the (then) brand-new prospect of being able to directly modify genomes. At that point, the potential risks were unknown.

Asilomar is a fine analogy for what scientists are calling for now. Some kind of summit meeting. Some kind of guidelines. Some kind of policy. And, faint hope, some way of making it apply to labs all over the world.

Recalling what Berg said in a 2008 look back at Asilomar reveals what the new paper is about: “[T]here is a lesson in Asilomar for all of science: the best way to respond to concerns created by emerging knowledge or early-stage technologies is for scientists from publicly-funded institutions to find common cause with the wider public about the best way to regulate — as early as possible. Once scientists from corporations begin to dominate the research enterprise, it will simply be too late.”

In this case, though, scientists from private enterprise are also alarmed, writing last week in Nature to urge a research moratorium. I covered that development, and a lot of background on current efforts at human germline genetic engineering, in my weekly post at the Genetic Literacy Project for last Tuesday (March 17). Scientists in China, it is rumored, have already submitted papers reporting success with modifying the germlines of early human embryos.

germ cell gene editing

Gretchen Vogel describes differences between the commentaries in Nature and Science, and names other concerned scientific groups, in what I think is an open-access piece at Science.  She quotes Church on human germ line gene editing, “What is the scenario that we’re actually worried about? That it won’t work well enough? Or that it will work too well?”

Seems pretty obvious to me. Both.

 

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A century of Einstein’s general #relativity, life on a Saturn moon, sugar industry influences dental research

Everything’s relative

Einstein’s paper on general relativity was published in 1915. The paper didn’t appear until December of that year, but there’s already been some celebratory centennial doings. Science published a special issue last week, and it looks as if the contents are open-access, free to read.

At Last Word on Nothing, Richard Panek wonders whether the fact that one of the more important side effects of general relativity, the idea that gravity distorts space and time, has appeared in two mass-market movies (Interstellar and A Brief History of Time) means that this formerly mind-blowing idea is today widely accepted. Is it a ho-hum factlet now part of mainstream human thought? Or do many of us still need an introduction to space curvature and time dilation?

Einstein's theory of general relativity predicts that massive objects warp the space-time around them. NASA's Gravity Probe B found that the space-time around Earth is indeed curved by our planet, and twisted by its rotation. Credit: NASA

Einstein’s theory of general relativity predicts that massive objects warp the space-time around them. NASA’s Gravity Probe B found that the space-time around Earth is indeed curved by our planet, and twisted by its rotation. Credit: NASA

Speaking strictly for myself (an English lit major who, bizarrely, managed to sneak into grad school to study genetics because it seemed, well, kinda interesting), a physics brush-up never hurts.

Fortunately, one is available from Mike Wall at Space.com, who points out that General Relativity was a radical idea that has held up remarkably well under a century of intense scrutiny. Wall notes that scientists are using it today to study black holes, neutron stars and other celestial phenomena. Also “researchers will keep trying to unify general relativity with quantum mechanics, to marry the world of the very large with that of the very small.”

If successful, Wall says, this would produce the “grand and longed-for ‘theory of everything.'” In her centennial take at LiveScience, which describes attempts to get general relativity to break down, Tanya Lewis looks forward to a ToE too.

Life on Enceladus, a giant of a tiny moon?

Now this is cool. Or, rather, warm. Enceladus, one of Saturn’s many moons, is a ball of ice maybe 30 miles thick, but underneath the ice is liquid water. And, a new paper asserts, at the bottom of this ice-encased ocean are hydrothermal vents. And you know what hydrothermal vents could mean. Which is why, of a sudden, Enceladus has become a place to look for life.

The evidence is indirect and even a little weird, inferred from nanoparticles of silica adrift in the space around the moon and detected in Cassini spacecraft images. The particles form one of Saturn’s rings (the E ring), but it appears their source is Enceladus.

The blue "stripes" on Enceladus spew ice particles and minerals that are incorporated into Saturn's E-ring. Credit: Cassini Imaging Team, SSI, JPL, ESA, NASA

The blue “stripes” on Enceladus spew ice particles and minerals that are incorporated into Saturn’s E-ring. Credit: Cassini Imaging Team, SSI, JPL, ESA, NASA

One of the few ways minuscule silica particles just like this can exist is if minerals dissolved in hot water come suddenly into contact with cold water. This causes them to precipitate. Icy geysers shoot up 200 km from Enceladus, and they can blast the particles out into space to eventually encircle the giant gas planet.

The geysers are cold, but the silica nanoparticles couldn’t exist if they weren’t created first in hot water. So, the scientists reason, there must be hot water (at least 90 degrees C.) on icy Enceladus.

Such hydrothermal vents would be colder than most vents on Earth. But there is an Earthly precedent, the cooler Lost City vents in the mid-Atlantic. Lots of life there anyway. Scott Johnson explains the chemistry and geology at Ars Technica.

How can tiny Enceladus, only ~ 250km around, have hot springs? One standard explanation is tidal friction from mighty Saturn, which heaves and squeezes all its dozens of moons, and keeps Enceladus’s ocean liquid. But the researchers told Susanne Dambeck at the SciLogs Lindau blog that they think Saturn’s kneading action isn’t enough to explain the degree of heat that must be present on Enceladus. At Vox, Joseph Stromberg suggests maybe the additional heat comes from radioactive decay of isotopes.

If you want to know more about those plumes of ice and water vapor shooting up from Enceladus, Deepak Dhingra reports on several recent geyser papers at the Planetary Society guest blog.

Sugar, sugar

In 1998, the attorneys general of 46 states settled their lawsuit for recovery of tobacco-related health care costs against the four largest US tobacco companies. The companies agreed to pay more than $200 billion in just the first 25 years, and more in perpetuity.

States handled this windfall stupidly in many cases, mortgaging their shares of future payments to investors for pennies on the dollar and in some cases sticking themselves with billions in future debt, according to ProPublica.

Maybe they’ll have a chance to be smarter next time, with the sugar industry. That’s if dentist Christin Kearns has her way. Kearns is the first author of a paper PLOS Medicine published this week. Drawing on a recently unearthed trove of official documents and memos, the paper shows that, beginning late in the 1960s, the sugar industry influenced the National Institutes of Health’s National Institute of Dental Research to largely ignore the role of sugar in tooth decay.

“The documents reveal a virtual capture of the NIDR by an affected industry,” said Michael F. Jacobson, executive director of the Center for Science in the Public Interest, in a guest post at PLOS’s Speaking of Medicine blog. “The sugar industry convinced the U.S. National Institutes of Health (NIH) that studies that might persuade people to cut back on sugary foods should not be part of a national plan to fight childhood tooth decay,” Jocelyn Kaiser said at ScienceInsider.

This paper, Kearns told Lisa Aliferis at Shots, is only the beginning. There are lots more documents to be discovered, lots more sugar industry tactics to be disclosed. Litigation is “certainly a possibility.” A good possibility, it looks like, since one of her co-authors is Stanton Glantz, the American Legacy Foundation Distinguished Professor of Tobacco Control and head of the Center for Tobacco Control Research and Education at UCSF.

Meantime, the World Health Organization has just officially released its recommendation to eat less sugar, less than 10% of daily calories. Said Marion Nestle at Food Politics, “The last time WHO tried to issue the 10% of calories advice in 2003, it got clobbered by lobbyists. This time, lobbyists didn’t succeed.  This is progress.”

Credit: Rodale News

Credit: Rodale News

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