A call for revolution in US science, dino microbes in space, vaginas in the lab

US science is in a fix, so let’s fix it

“It’s as if the Pope and three leading cardinals held a press conference predicting the collapse of the Catholic church. These people know what they are talking about and we need to listen.” This from Incidental Economist Bill Gardner.

On the other hand, “This should be read as a mea culpa, given the authors’ roles in creating this problem in the first place,” a tweet from Jonathan Gitlin, policy wonk and occasional Ars Technica contributor.

Sandcastle and sand burial. Credit:  Xiaphias

Sandcastle and sand burial. Credit: Xiaphias

Both are talking about Monday’s editorial in PNAS, the highest profile call yet for revolutionary changes in the US system for supporting biomedical research. (Access to free PDF here.) The authors could hardly be more magisterial: Bruce Alberts (former president of the National Academy of Sciences and  editor of Science), Marc Kirschner (cell biologist, founder of Harvard’s systems biology department), Shirley Tilghman (molecular biologist, HHMI investigator, former president of Princeton), and Harold Varmus (Nobel laureate, former NIH Director, current NCI Director.)

Some of their proposals: Train fewer academic scientists. Convert the ones we are training from slave labor funded out of a lab’s grants to government training grants, which will help slow the flow. Train grad students for careers outside academic research. Turn postdocs into salaried staff scientists. Don’t pay faculty solely by grants either. Reform grant payments for institutional overhead. Reduce the competition to publish in the classiest journals. Reform the grant review process to stress innovative proposals and reduce the emphasis on translational research.

Nothing new and nothing doing

Two main points about this clarion call (aside from the fact that all four distinguished authors have contributed materially to potentiating the problems they now deplore): (1) There’s nothing new here; and (2) There’s very little chance the suggested reforms will come about.

The fact that the US is creating an oversupply of scientists has been known for decades, at least to those who will listen. An NAS report from a committee Tilghman chaired came out in 1998. I (and others) wrote about it in the 1980s. In their sharp summary and critique of the new paper, Beryl Benderly and Jim Austin note at Science Careers that a warning against a surfeit of scientists was part of that much-venerated modern roadmap for science, Vannevar Bush’s “Endless Frontier” report, in 1945.

I commend the subtly scathing Benderly-Austin post to your attention not just because it provides splendid context for understanding the editorial, but also because it lives at Science, published by the American Association for the Advancement of Science, surely the heart of the science establishment. (Disclosure: Beryl is an old, dear friend, and I have written for Jim Austin, but I’m quite sure I’d be paying the compliment even if that were not true.)

That dense tangle of vested interests

From their lips to God’s ear. Benderly and Austin are hopeful that the glamour of the editorial’s authors and the fact that it’s appearing in the Proceedings of the National Academy of Sciences could, at last, prompt people in positions to make changes to start making them. But, they also say, “The PNAS article authors do not provide a practical strategy for overcoming the dense tangle of vested interests and perverse incentives that protect the current system.”

An Australian sand castle 10 feet high. Credit: G. King

An Australian sand castle 10 feet high. Credit: G. King

And of course a practical strategy for overcoming the dense tangle of vested interests is exactly what’s needed. Can the prestige of Alberts, Kirschner, Tilghman, and Varmus tip the balance?

See John Timmer at Ars Technica for fine explications of of those vested interests. Timmer is not particularly hopeful. He points out that a seemingly obvious solution, more money for science, is not only not forthcoming but also would only intensify the problems, not solve them.

Pessimism seems warranted, since changing the system in the ways Alberts et al. suggest would gore oxen galore. Timmer points out that those who can make needed changes won’t like them and will resist. Moreover, implementing them will require cooperation from dysfunctional politicians, none more dysfunctional than the House Science Committee.

The stench of elitism and other objections

Here’s a smattering of additional commentary by scientist-bloggers who have thought about these issues a lot, and written a lot about them too.

Mike the Mad Biologist: “the grant review proposals are just daffy. I would argue we need more junior people closer to the research as well as non-academic researchers (i.e., from institutes and companies when appropriate) as reviewers.”

Ken Weiss at The Mermaid’s Tale, to which an HT for the sandcastle motif. Weiss says the problems are not only at NIH; some areas of the National Science Foundation budget may be cut as much as 20 percent in just one year. He advocates “a frank but non-partisan national discussion of what kinds of science and scholarship are most important and to phase in more funds for those and less for areas that, no matter how legitimate, are just less vital these days or less promising of major new discoveries.” Setting aside the near-impossibility of initiating a frank but non-partisan national discussion on any topic whatever, that sounds like the road to more translational and applied research. Quite different from the emphasis on basic science that Alberts et al. advocate.

Drip sand castle. Credit: Henry Mühlpfordt

Drip sand castle. Credit: Henry Mühlpfordt

Drugmonkey sees good things here, but. “What I don’t like about these proposals is the stench of elitism that encircles them. . . The alternative that is being proposed here is that we select good scientists at the beginnings of their careers and that is it. They get the money even if someone else has a better idea. . . The racket will be dominated by pedigree, you better believe it. Not good.

I have a bone to pick with those dinosaur-microbes-in-space stories

NASA plans to send a few dozen kinds of microbes to the Space Station to see, it is said, how they fare. The germ launch aboard the SpaceX Falcon 9 rocket has (of course) been delayed; it’s now scheduled for today (Good Friday, April 18, 2014.)

The microbes are said to have come from various publicity-attuned venues, one of which is Sue, the T. rex fossil that Chicago’s Field Museum periodically waves in front of reporters. Kim Bellware tells you about it at HuffPo.

At no point do any of the stories I’ve read make clear that this is not likely to be a microbe native to dinosaurs. It has been identified as the sticky-sounding Paenibacillus mucilaginosus. The researchers who did its genome say it is a growth promoter found in microbial fertilizers in China. Originally, apparently, a soil bug.

I am skeptical of this escapade. It lacks seriousness.

Tissue-engineered vaginas. No smirking allowed.

This one doesn’t lack seriousness. In fact, it’s a masterful example of bioscience geared to fixing a real-world medical problem, published in  a most respected journal (The Lancet), but also guaranteed to grab eyeballs.

In this research, tissue engineering has reached an apotheosis of sorts. It has achieved functioning vaginas grown in a lab. Well, functioning once they had been implanted in patients who lacked them.

Beginning eight years ago, researchers at Wake Forest Baptist Medical Center’s Institute for Regenerative Medicine took a bit of tissue from the vulvas of teenagers with a congenital deformity called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and grew the tissue into vaginas. (The syndrome, which results in an underdeveloped or missing vagina and uterus, is fairly common; NIH says it occurs in about 1 in 4500 newborn girls but is often not discovered until adolescence.)

Bahar Gholipour described the process in detail at LiveScience. It takes about six weeks to grow a vagina. “Once the organs were ready, doctors surgically created a cavity in the patients’ bodies, and stitched one side of the vaginal organ to the opening of the cavity and the other side to the uterus,” Gholipour says.

The patients have been followed for at least five years. The researchers report that the vaginas are functioning normally, including sexual intercourse.

At io9, Robert Gonzalez says the lab-grown vaginas may have other applications, for example in cancer and sex reassignment surgery. He is also looking forward to the lab-grown penis that he says is in the pipeline.

 

Category: Uncategorized | Tagged , , , , , , | Leave a comment

Eyes on the Medicare data dump: Cautions and cautionary tales

On Wednesday came the government release, finally, of Big Data on Medicare payments to medical practitioners for 2012. The beginning, one hopes, of release of many more years of data in aid of trend-spotting. Also, surely, some reining in of the grossest of these payments. Surely?

The data will keep science and medical writers busy for some time. You can find news about Wednesday’s massive Medicare data dump everywhere, but here’s Jordan Rau’s compact opener for Kaiser Health News: “The federal government published data tracing the $77 billion that Medicare paid to physicians, drug testing companies and other medical practitioners throughout 2012, and what services they were being reimbursed for. The data cover 888,000 different practitioners. More than 6,000 procedures are included, and the full database is so large that it requires statistical software to analyze it.”

At a Business Day post by Andrew Pollack and Reed Abelson there’s a link to the New York Times‘s interactive graphic permitting easy-peasy lookups of what individual practitioners got from Medicare by locale. The two docs who saved me from major surgery 3 years ago, and probably also saved my life, are not listed because they are not in private practice; they work in academic institutions and are salaried. Handsomely, I hope.

Big data can sometimes be misleading

Most writers focused, not surprisingly, on the most eye-popping payments. Heaven knows there were great riches to choose from. But many writers also dove a little deeper. At Wonkblog, Jason Millman listed the Medicare Top Ten multi-millionaires, but also explored what expenses they claimed. For 7 of the 10, a huge proportion of their reimbursements went for drugs administered on site. So I guess it’s not the poor beleaguered docs who are soaking the taxpayers after all. It’s the pharmas.

Rising Cost of Healthcare
A Business Day post by Denise Grady and Sheri Fink shows how the data can mislead. One example: a family medicine physician at the University of Michigan Health Services got $7.58 million in 2012 for more than 207,000 patients. Unbelievable, right?

Except, as it turns out, the doc directs a Medicare project involving 1600 primary care physicians, and the payments to them go through her office. So I did the math, which works out to well under $5K for each doc, with an average of 130 patients each for the year. At $36.62 per patient. Looks as if the University of Michigan Health Services, where I was once or twice a patient back in the last century, is a model of efficient and reasonably priced–cheap, in fact–medicine. Maybe I’ll go back to grad school after all.

At Medpage Today, John Gever consulted docs, who were mostly unhappy with the data release. Their comments ranged from “IT’S NONE OF YOUR BUSINESS WHAT I’M GETTING FOR MY SERVICES,” not really a reasonable reaction to expenditure of public money, to the perfectly sane worry that people would assume the figures reflect what the doc takes home, not gross receipts that must cover staff, overhead, and much else.

Charles Ornstein, a longtime journalist now at ProPublica, laid out several cautions on interpreting the data at Covering Health, the blog of the Association of Health Care Journalists. If a practitioner treats only Medicare patients, he points out, the payment may well be larger than one going to a doc who treats privately insured patients too. Or the doctor may provide services–cancer care, for instance–that are reimbursed at a high rate. Ornstein cautions, “Of course, there may be other reasons that raise questions of fraud, but don’t just assume that because a number is large, a doctor has done something wrong.”

Not seeing eye to eye

On the other hand, there are all those handsomely paid opthalmologists. The 17,000 eye docs, less than .02% of the total number reimbursed, took in 7% of Medicare reimbursements. $5.6 billion, $330,000 per.  Max Ehrenfreund sees opthalmologists through a glass darkly at Wonkblog.

The Pollack-Abelson Business Day post mentioned above features a
defense of opthalmologists. Sort of. It includes a splendid map showing the locales of those most reimbursed.

A billion of the $5.6 opthalmological billion goes for the macular degeneration drug Lucentis. $2000 per injection, often once a month. Most of which, the docs say, they pay to Genentech, Lucentis’s maker. Maybe so, but the docs profit handsomely. The post explains why. Among the reasons, big rebates from Genentech. And I love the tale of the docs who accumulate zillions of frequent-flyer miles by putting Lucentis orders on miles-bearing credit cards.

A Lucentis alternative for macular degeneration, also by Genentech, is off-label use of the cancer drug Aventis. It costs $50 per treatment. Even if Lucentis is better than Aventis–and none of the docs quoted in the post argue that it is–can it possibly be 40 times better?

Keeping my eye on opthalmologists

One does wonder if there’s something about opthalmologists. Here is a personal anecdote, so it’s not data. Well, two anecdotes, but still not data. I lost the sight in my right eye permanently when I was 35. Long story, so let’s move right along to many years later. In the last 10 years, two different opthalmologists in two different parts of the country have urged me to have surgery, offering hope of improving vision in that eye.

medicare card female

For a number of reasons, not least my own not-unskilled research, I know that the surgery they were proposing would not restore vision in that eye, not even partially. When I pointed this out, each of the docs shrugged, conceded that he couldn’t guarantee a satisfactory result, but urged me to consider surgery (by him) anyway. Cheeky. Breathtaking, actually.

Please also note that in each case surgery was a suggestion out of the blue from the doc. I had not come to his office seeking therapy for my bad eye; I was there for other reasons.  A driver’s license, in one case. These were sales jobs, pure and simple, urging a procedure that the salesmen knew to be useless.

Too bad for their bottom lines that the potential customer knew it too. But in this case the potential customer was unusually prepared. Her career was based on looking skeptically at medicine, and she had researched the topic herself. What about the 99.9999etc% of customers who lack that specialized armor? Who rely on physicians to give them medical advice untainted by self-interest?

If this had happened only once I would probably, um, have turned a blind eye; I happen to have one handy. But it has occurred two times, unprompted. That hints at a trend. I wonder what would happen if, as an experiment, I trundled from eye doc to eye doc? I have a hunch that at least some would suggest surgery. I very much hope that most would not. But when I think about Lucentis vs. Aventis, and frequent-flier miles. . . Maybe there is something about opthalmologists.

Medicare data summaries galore

Kaiser Health News is all over the story about the Medicare data release, with summaries of commentary from many mainstream media sources and links to the originals, plus several of its own posts too.

Wonkblog has summaries of commentaries (and links) too.

medicare parts

Department of blind outrage

Release of the Medicare payment data provides justifiable opportunities for dudgeon, none higher than that of Knight Science Journalism Tracker Paul Raeburn. The reason we did not have the data years ago, he explains, is that the American Medical Association has been fighting (successfully) to keep this use of taxpayer money out of the public eye since 1979. As Raeburn points out, the shock generated by these numbers makes it clear why the AMA was so dedicated to keeping it hidden.

He links to a number of pieces explaining the data, but observes, “I’m surprised that the role of the AMA in keeping the data secret hasn’t yet been hit hard in these publications. It’s stunning that it was able to keep this information secret for 35 years; I’m waiting for the legal story that examines how that happened.”

I second that, and how. I’d adore to see Linda Greenhouse turned loose on this story. It was a Federal court decision that freed the Medicare data, though, and I think she only does the Supremes.

One lovely tidbit: It was, believe it or not, the Wall Street Journal that pursued disclosure of the data down the years and won this legal victory for transparency, capitalism be damned. A number of sources have chided the New York Times for not giving the WSJ credit for its doggedness. The complaints were chronicled by Times Public Editor Margaret Sullivan.  She joined in, biting the hand that feeds her, but also slyly noted that the Washington Post, USA Today, and the Associated Press didn’t mention the Journal‘s role either.

Category: Uncategorized | Tagged , , , , , , , , , | Leave a comment

That climate change report, Jane Goodall’s birth, and Richard III’s death

 

Gloom and doom

As you probably know, the latest authoritative climate change report was released early this week to a world apparently too exhausted, or distracted, to take much interest in the upcoming calamities. Here’s the nut from Justin Gillis’s New York Times piece: “The report by the Intergovernmental Panel on Climate Change, a United Nations group that periodically summarizes climate science, concluded that ice caps are melting, sea ice in the Arctic is collapsing, water supplies are coming under stress, heat waves and heavy rains are intensifying, coral reefs are dying, and fish and many other creatures are migrating toward the poles or in some cases going extinct.”

Tweeted by @UrsulaWJ

Tweeted by @UrsulaWJ

The coverage, or rather lack thereof, infuriated Knight Science Journalism Tracker Paul Raeburn. He wants to know why reporters are not demanding government reactions to the report, especially US government reactions. “The boss [Prez Obama] says we can’t deny the reality that urgent dramatic action is necessary to preserve our way of life. His negotiator says the reality is that the U.S. will not fund most of any response with taxpayer dollars. Where is the press, which should be demanding to know what the reality is, or what the pseudo-reality inside the State Department looks like? Are we going to let these guys off the hook?”

Raeburn contrasts this absence of enterprise with coverage of The Mystery of the Lost Plane. “Every scrap of information about Malaysia Flight 370 is being scrutinized for hours by panels of analysts on cable news and across the Internet. Could we take just one or two members of the Malaysia 370 press corps and put them on climate change?”

At ImaGeo, one of the new blogs at Discover, Tom Yulsman focuses on a complex graphic from the report. He offers interpretations of the very busy image, which uses icons to show how climate alterations are affecting ecosystems around the world.  The hed on Annalee Newitz’s post at io9 forecasts famine and water riots, although her lede refers more sedately to water shortages. The tasks ahead, she says, will include genetic alterations of crops to increase drought-resistance and serious improvements to food and water security to defend them against violence. Her post includes a link to the PDF of the report.

Bad Astronomer Phil Plait’s summary even, oddly, manages to find a ray of hope in the report. If you feel like grinding your teeth some more, Plait also includes links to a few naysayers. But at Technology Review, John Reilly says we can’t just adapt to climate change because the effects will be so specific and local and therefore unpredictable. He complains, “the report is a compendium of things that might happen or are likely to happen to someone or something, somewhere. But what does this actually mean for me, or anyone who might read the report?”

Jane Goodall is 80

Jane Goodall’s 80th birthday was April 3. Tributes abound, of course, for the scientist/activist who stimulated worldwide curiosity about the lives and behavior of nonhuman primates, and who then abandoned her fieldwork with Tanzanian chimpanzees to campaign for more enlightened treatment of animals and the environment. It’s not an exaggeration to say that her work stimulated drastic changes in a number of scientific fields, for example animal behavior, primatology, psychology, evolutionary studies, and medical research.

Goodall with the toy chimp that was a birthday present 79 years ago.

Goodall with the toy chimp that was a birthday present 79 years ago.

See Henry Micholls’ long interview, reprinted at the BBC Futures site. National Geographic, a funder of Goodall’s work that doesn’t mind taking credit for it, has collected several tributes here. NIH Director Francis Collins also pays tribute, praising her for working to reduce the use of chimps in medical research. Maria Popova has collected some of Goodall’s writings on science and religion at Brain Pickings. Mary Bagley has put together a Goodall biography at Live Science.

Poor Richard

A bit of a Brit academic brawl has developed over those bones dug up from a parking lot in Leicester and claimed to belong to the much-reviled King Richard III, last of the Plantagenets. Richard was bloodily slain at Bosworth Field, in the 1485 battle that ended the decades-long Wars of the Roses, led to the Tudor regime, and ultimately produced England’s greatest monarch, Elizabeth I.

Richard is reviled largely because he has long been blamed for murdering his potential rivals for the throne, the little princes in the Tower of London. There is a good case that he probably didn’t. The charge of child murder against Richard may have been a political lie fostered by the Tudors. It has been promulgated to this day by a sycophantic William Shakespeare–and a long line of skillful actors thrilled at the chance to play one of the stage’s great villains. The case for Richard is laid out persuasively in Josephine Tey’s terrific detective story, The Daughter of Time.

The bones in the parking lot. Credit: University of Leicester

The bones in the parking lot. Credit: University of Leicester

In 2013 the parking-lot bones were declared to be Richard’s based on substantial historical and archaeological evidence and a study of mitochondrial DNA extracted from them. The new objections come from a couple of historians with no apparent genetics expertise. They are not saying the identification is wrong, only that it’s not 100% certain, according to Macrina Cooper-White at the Huffington Post.

Of course the identification is uncertain, but the evidence is pretty persuasive, including the genetic evidence. The University of Leicester has posted a detailed description of how the mtDNA study was done by looking at mtDNA in two living people who are descended from Richard’s mother through an all-female line. The description includes a long PDF detailing the genealogy of one of those descendants; the other participated in the study anonymously.

It would be a pretty strong story even without the DNA. The skeleton was buried in the spot where contemporary accounts said Richard had been buried. Radiocarbon dating traces the remains to around 1500; Richard died at the Battle of Bosworth in 1485. Osteology reveals that the man died at around age 30; Richard was 32. The body was wounded grievously in a way that suggests the assailants meant to defile it, as history recounts. A reasonable conclusion is that these are the remains of the last Plantagenet King of England.

They’re doing the complete genome of the bones too. That will of course include the Y chromosome. There is some hope that the Y will confirm that the bones are indeed Richard’s through study of genealogies of all-male descent from his forebears. But there are questions of paternity among those forebears. So whatever the Y chromosome seems to show, we can be sure that it will give rise to more disputes and there will be more to write about. I look forward to it.

Richard’s bones must endure one final Tudor humiliation. They are to be reburied in Leicester Cathedral, a domain of the Church of England. Richard was, of course, a Roman Catholic. The Church of England, you’ll recall, was invented as an aid to divorce decades after Richard’s death — invented by the second Tudor monarch, who was, in his way, as notorious as Richard. Henry VIII’s marital/spiritual flounderings made the wealthy Roman Catholic institutions on English soil ripe for rifling. Which is why the remains of the former Franciscan Greyfriars Priory, where history says Richard was buried, lie under a municipal parking lot.

Category: Uncategorized | Tagged , , , , , , , , , , , | 1 Comment

Science and data journalism at Nate Silver’s new 538

Nate Hate: What the fox doesn’t know yet

Science was supposed to be part of the mix when Nate Silver, the highest profile statistician in history, first announced his move last year. That move being, you’ll recall, that he was taking his 538 political blog away from the New York Times to ESPN and expanding it into the data journalism site. In the intervening months, though, announcements about his plans emphasized his traditional strongest interests, sports and politics. I thought maybe science had been dumped, or at least postponed.

Not so. The newly launched 538 does include science, although the choice of staff writers for the science section is . . . peculiar. There are no science journalists or science writers–so far, at least. The choice of topics has been strange, too.

Credit: DeviantART.com

Credit: DeviantART.com

Knight Science Journalism Tracker Paul Raeburn walks you through some of his objections to the science coverage, which he characterizes as tepid and sometimes silly and also tardy. Such as a piece on calories burned during sex (which, he points out, is a topic already covered by Woman’s Day.)

Raeburn saves his biggest guns for 538′s lead science item of that day, a very odd piece on how to evaluate health news that advises paying attention to your gut feelings about the validity of the story. That was particularly odd advice because it was written by Jeff Leek, an associate professor of biostatistics and oncology at Johns Hopkins and a blogger at Simply Statistics.

Raeburn takes this idiocy–by a statistician!–down easily, and the rest of the site’s opening science pieces as well. But there seems to be no answer to the question that baffled me too: Why would a news site that’s supposedly built on data journalism advise people to base judgements about newsworthiness on “gut feelings,” the antithesis of data?

The climate at 538

One of 538′s listed science contributors is Roger Pielke, Jr., a professor of environmental studies at the University of Colorado Boulder. He is thought of as a climate change skeptic in the sense I outlined here last year–one who acknowledges that global warming is happening but does not favor drastic measures to slow it down. This choice of Pielke, as you may imagine, had a lot of the climate folks foaming at the mouth.

Credit: birdclan.org

Credit: birdclan.org

At the Columbia Journalism Review’s Observatory, Alexis Sobel Fitts presents a critique of the 538 science section, including Leek’s piece. But it’s also a takedown of Pielke’s post, which argues that recent increase in the cost of weather damage is a function of increased infrastructure in vulnerable places and has nothing to do with climate change. Judith Curry, a climate scientist and sometime contrarian who blogs at Climate Etc. also considers 538 in general and Pielke in particular, taking exception to Fitts’s comments. Curry also includes links to and quotes from other critiques, pro and con.

538′s data journalism lacks data

Raeburn’s view that 538 so far lacks the data and analyses it claims to be about is shared by others. Mark Coddington, at the Nieman Journalism Lab, links to several critiques of the new 538; many voice that same objection. Most of these posts are not about 538′s science coverage, and some simply seem offended by the very idea of data journalism. Psychologist Adam Waytz, at the SciAm blog The Moral Universe, thinks what he calls “quantiphobes” resist expressing subjective subjects in objective terms. He says, “numbers make things more fact-like, and facts can evoke discomfort.” Scary.

The same objection was posted most pungently by Noah Smith, who says at Noahpinion,
“I’m a big Nate Silver fan, but let me join the chorus of people looking at his new “data-driven” blog site and saying “WTF?”. As far as I can tell, it’s barely data-driven at all! . . .
The problem with the new FiveThirtyEight is not one of data vs. theory. It is one of “data” the buzzword vs. data the actual thing. Nate Silver is a hero of mine, but this site is not living up to its billing at all.”

Smith’s is a detailed and persuasive blast at Pielke, noting that Pielke’s post contains no statistical analysis and doesn’t count costs that should be included, such as reinforcing buildings and relocating crops. Smith objects to other posts at 538 on economic subjects for the same reason: lack of data and data analysis.

The pregnant pause at 538

In adddition to Pielke, Silver has also hired University of Chicago health economist Emily Oster to write about science. Oster’s claim to fame is that she resented the arbitrary-sounding edicts of her obstetrician, such as limits on weight gain. The current advised limit of 35 pounds that so chafed her sounds delightful and doable to me. In my pregnant day, back in the last century, it was just 20 pounds. I didn’t make it.

Anyway, instead of dumping her doc and finding one less autocratic, Oster wrote a book, Expecting Better, that investigated whether there were scientific bases for the pregnancy shibboleths. Her most controversial claim is that there is no evidence that light drinking damages a fetus. (“Light drinking” she defines as 1 drink a day after the first trimester. Isn’t 1 drink daily the recommended limit for all women, pregnant or not?)

Her opening shot at 538 is about pregnancy too, taking on recent studies suggesting that acetaminophen during pregnancy can have long-term consequences for the children. One study suggests behavior problems and slow motor development at age 3, and the other attention-deficit hyperactivity disorder at age 7.

Oster argues that it’s difficult to get a good sense of the risks outlined in these studies because of the traditional way results are reported. She’s right. It’s a problem with many medical studies and a very useful point to keep hammering at. “For example, a 30 percent increase in risk on a baseline of 10 percent means an increase from 10 percent to 13 percent. A 30 percent increase in risk on a baseline of 1 percent is an increase from 1 percent to 1.3 percent. In terms of the number of people affected, these are quite different.” The reported risks of damage in the developmental study turned out to be much larger than the small ones in the ADHD study.

Credit: indervilla.com

Credit: indervilla.com

Nor were these randomized controlled trials, raising the question of whether acetaminophen-users are different from nonusers. At a guess, they had more pain, or at the very least lower pain thresholds. Oster wonders whether it was not the drug itself but whatever prompted using the drug that encouraged later ill effects. In the ADHD study the differences were significant; the users had more psychiatric diagnoses than the nonusers.

Also, she notes, the results in both studies could just be wrong. Her example comes from physics, the recent erroneous faster-than-light results. It struck me as an odd to choose a mistaken study from physics for comparison, since there are plenty of examples of errors in biomedical studies. Oster’s bottom line: “We have a tremendous amount of evidence that Tylenol is safe in pregnancy, and now a little bit of evidence that maybe there are some risks. We should, perhaps, be more cautious than before, but only a little.”

This piece is not difficult or technical writing–in fact there’s not much data in it, which seems to be the trend at 538. But it’s more than 1300 words long. An experienced science writer could have explored the same cautions about these studies more crisply, engagingly, and briefly. Half the length or less. Indeed, science writers do this sort of thing every day. It might have involved interviewing Oster or one of her colleagues plus some docs, but science writers do that every day too. And there are a not-insignificant number of science writers who could have done this analysis on their own.

So far, the pieces I’ve seen at 538 are not data-intensive analyses of the sort that Silver specialized in at the Times. I’m not sure who Silver thinks 538′s audience is, but it’s a rare reader–even among pregnant women–who will stick around to wade through 1300+ words. My summary above hit most of the important points and even included a couple of quotes from Oster’s piece. 310 words.

Oster seems to be on the staff, so presumably she will be writing about science often. I assume she will be extending her subject matter beyond pregnancy even though she wrote a book about it. A single topic seems a pretty narrow focus for a science section. Her hire is one way of dealing with the XX Issue, and it’s hard to think of a more XX Topic than pregnancy. But there are tons of other XX subjects loaded with potential for data analysis and commentary. They range from science about women–much to deride and pick apart there–to women in science, where there is much to mourn. OTOH, Oster is a health economist, so she probably won’t be writing only about women.

The future of 538

Having been through a number of startup pub launches myself, two of which have survived for decades, I caution against issuing final judgements about 538 in the first wretched days, or weeks, or even months. I can tell you from experience that if it looks as if the folks at 538 are making it up as they go along, that’s because they are. It’s what you do at a startup.

I expect they’ll get better. Maybe they’ll even figure out how to do data journalism, which would be a boon for everybody. One commentary I read suggested that 538 badly needs a news editor. More than 1, I should think. There’s a lot of work to do.

Category: Uncategorized | Tagged , , , , , , , , , , , , | 1 Comment

INFLATION and the origin of the Universe(s)

“Then nearly 14 billion years ago expansion started.”

Woo-hoo! They’re dancing in the streets over how the Antarctic telescope BICEP2 has just provided the first actual data supporting the inflationary theory, the idea that the universe expanded spectacularly immediately after the infinitesimal point that was the Big Bang. Bad Astronomer Phil Plait says the news is “very esoteric—probably the most layered and complex announcement I’ve ever written about.” So be prepared, it’s Cosmology 2014.

The BICEP2 telescope at twilight, which occurs only twice a year at the South Pole. Credit: Steffen Richter/Harvard University

The BICEP2 telescope at twilight, which occurs only twice a year at the South Pole. Credit: Steffen Richter/Harvard University

The slightly bipolar general response among the knowledgeable is encapsulated by, among others, physicist Max Tegmark, writing at a SciAm Guest Blog, “if the BICEP2 discovery holds up, it will go down as one of the greatest discoveries in the history of science.”

We’ll get to the cautions in a moment, but note that Tegmark’s brief pro forma bow to scientific skepticism is swamped by his wholehearted embrace of the findings. And he is by no means an isolated case. Nearly all the blogging acknowledged perfunctorily that the data need confirming, but there seemed to be few true doubters.

Hints last week, the story this week

After an enormous amount of preliminary speculation over the weekend, finally a press conference last Monday. Matthew Francis explains on the wing at Ars Technica, “we’ve detected the first direct evidence of the inflationary phase of the Big Bang, in which the Universe expanded rapidly in size.”

“Rapidly” hardly begins to cover it. “Inflation is a bit of a mind-bender, I’ll admit. It started just about  10-35   or so seconds after the bang. To give you a better idea of how short a time interval that is, we’re talking 0.00000000000000000000000000000000001 seconds! And it only lasted until about  10-32  or so seconds later,” Plait says. (At 13.7 Cosmos & Culture, Adam Frank issues a correction. He got the number of zeroes wrong. It’s 34, not 35. I cut-and-pasted the number Plait used, so please direct your complaints to him or to Slate’s copy-editing department.)

The imprint of the Big Bang: B-mode polarization (the swirls) of light coming the first fraction of a second after the birth of the Universe itself. Credit: BICEP2 Collaboration

The imprint of the Big Bang: B-mode polarization (the swirls) of light coming the first fraction of a second after the birth of the Universe itself. Credit: BICEP2 Collaboration

As explained at Symmetry, the data depict the first images of gravitational waves, ripples in space-time.  The violence of post-Big Bang inflation was such that it literally made waves. The observations of the cosmic microwave background—a faint glow left over from the Big Bang, were made by the #BICEP2 telescope. (BICEP is the muscular acronym for the Background Imaging of Cosmic Extragalactic Polarization experiment; the telescope is situated near the South Pole because the seeing is so good there.) The post contains links to the papers and technical details and notes that a paper has been submitted to Nature.

How to explain the near-inexplicable

Knight Science Journalism Tracker Faye Flam has followed this news since last week, describing how the media, mostly the print media, have been explaining this very big story that is nearly impossible to explain. On Monday she told of the hubbub following last week’s “maddening” press release from the Harvard-Smithsonian Center for Astrophysics, which promised Big News on Monday. Later that day she critiqued post-press conference pieces from several publications, including the New York Times, Nature, Scientific American, the AP, and other sources.

In her Wednesday post, headed “How to write a lede about a phenomenon most readers have never heard of, the discovery of which backs an important theory most people know nothing about” she declares the winner to be Joel Achenbach at the Washington Post. She deconstructs what he did and why it was exactly the right thing to do.

For your education, here’s what Achenbach did: “In the beginning, the universe got very big very fast, transforming itself in a fraction of an instant from something almost infinitesimally small to something imponderably vast, a cosmos so huge that no one will ever be able to see it all.

“This is the premise of an idea called cosmic inflation — a powerful twist on the big-bang theory — and Monday it received a major boost from an experiment at the South Pole called BICEP2. A team of astronomers led by John Kovac of the Harvard-Smithsonian Center for Astrophysics announced that it had detected ripples from gravitational waves created in a violent inflationary event at the dawn of time.”

Sean Carroll (the physics one, obviously) has posted on this news a number of times, but this particular link will bring you to some meditations on the discovery plus a clip of his explanatory interview Tuesday on the NewsHour. Very clear, and then Gwen Ifill asks him what practical value this finding will have in everyday life. His response: None.

So refreshing to hear a scientist defend the urge to satisfy mere curiosity about how the universe began. Among his musings in the post itself: “We tell stories about how the universe works, but we don’t simply tell any old stories that come to mind; we are dramatically constrained by experimental data and by consistency with the basic principles we think we do understand.”

And now, the multiverses

We get a nice, clear history of the theory-building in the decades before BICEP2, plus a brief summary of the findings and some implications, from Tom Levenson, who blogs at The Inverse Square. One of those implications is “That the idea of a multiverse — other patches of space time that underwent an inflationary episode to form island universes of their own — has now gained a boost (if one patch of space-time can inflate, so could others)….”

Formation of multiverses. This illustration depicts a main membrane out of which individual universes arise; they then expand in size through time. Credit: Moonrunner Design http://news.nationalgeographic.com/news/2014/03/140318-multiverse-inflation-big-bang-science-space/

Formation of multiverses. This illustration depicts a main membrane out of which individual universes arise; they then expand in size through time.
Credit: Moonrunner Design
http://news.nationalgeographic.com/news/2014/03/140318-multiverse-inflation-big-bang-science-space/

At National Geographic, multiverses are the central topic of Dan Vergano’s post. He observes, “in the models favored by the BICEP2 team’s observations, the process that inflates a universe looks just too potent to happen only once; rather, once a Big Bang starts, the process would happen repeatedly and in multiple ways . . . That means every kind of cosmos is out there in the aftermath of the Big Bang, from our familiar universe chock full of stars and planets to extravaganzas that encompass many more dimensions, but are devoid of such mundane things as atoms or photons of light.”

Multiverses are not an easy idea to get your brain around, but they help explain some cosmological puzzles, Vergano says. Such as why the universe we live in is a universe we can live in, a universe organized around laws of physics that permit biochemistry and so forth, and which makes possible life (or at least life-as-we-know-it.)

Chronic naysayer John Horgan, at SciAm’s Cross-Check, rejects multiverses on grounds that the hypothesis is both unscientific and immoral. Unscientific because multiverses “are totally imaginary and by definition can never be observed.” On immorality, he quotes himself reviewing Brian Greene’s 2011 book The Hidden Reality: “First, at a time when we desperately need science to help us solve our problems, it’s irresponsible for scientists as prominent as Greene to show such a blithe disregard for basic standards of evidence. Second, like religious visions of paradise, multiverses represent an escapist distraction from our world.”

The inflationary skeptics: Let us hope it is not a trick

The most potent skeptic is probably Horgan because his objections are couched in largely nontechnical language and so can be comprehended more widely. At that same Cross-Check post, he writes that he hopes the gravitational wave findings turn out to be true, “because cosmology and physics desperately need a jolt of energy.” But until several conditions are met, he remains doubtful about the inflationary theory.

The first of his conditions is, of course, confirmation of the BICEP2 data by other sources. Sean Carroll told Gwen Ifill that a number of groups will be releasing data on this point in the next couple of years, so we should know whether others agree with the BICEP2 findings pretty soon. Or don’t. Among other things Horgan wants to know is what mechanism drove this vast inflation and why only inflation can account for the gravitational wave findings.

Another skeptic is cosmologist Peter Coles, who blogs at In the Dark and has posted about the BICEP2 findings a number of times. I am too unlettered in this field to have an opinion about his critiques, except to note Coles saying he would place only an even-money bet that what BICEP2 has found is in fact a cosmological signal. He commends the researchers and likes the fact that they have posted their paper and data for all to peer review. He also praises social media’s response and links to the Facebook discussion of BICEP2. I haven’t studied it, but it looks pretty technical. Doesn’t sound like Facebook at all.

Still, Coles says, while the BICEP2 results are interesting, “it is far too earlier [sic] to even claim that they are cosmological, let alone to start talking about providing evidence for or against particular models of the early Universe. . .  this is a measurement of such potential importance that I think we have to set the bar very high indeed when it comes to evidence.”

Even a developer of inflation theory, Andrei Linde, is not entirely convinced. At the New Yorker, Andrea DenHoed presents a video of Linde being told by one of the BICEP2 researchers that the telescope is backing up his theory. Linde says, “Let us hope it is not a trick. I always live with this feeling. What if I am tricked? What if I believe in this just because it is beautiful? What if . . .”

Category: Uncategorized | Tagged , , , , , , , , , , , , , , | Comments Off

Coke v. WHO on sugar & obesity, gene therapy v. HIV, Obama & Obamacare v. Galifianakis, David Wright v. Office of Research Integrity

 

They’d like to teach the world to drink Coke

The National Press Foundation recently sent out an invitation to a webinar for journalists next week, something it does occasionally. The ostensible topic is science reporting. But “science reporting” turns out to be just a cover for a public relations campaign on behalf of Coca-Cola.

coca cola

I know this because Knight Science Journalism Tracker Paul Raeburn rose wrathfully to beg writers not to attend and to urge the Foundation to cancel the webinar. As Raeburn pointed out, not only is the session sponsored by Coca-Cola, both the speakers–the only speakers–have been supported by Coke and have used their professional positions as academics to work against public health efforts such as taxing sugar-sweetened beverages and posting calorie counts on menus. “But why on earth is a journalism organization allowing Coke to use its cred to legitimize this webinar? This is a scandal.”

Also wrathful is Gary Schwitzer at the HealthNewsReview, where he critiques science and medical journalism. He quotes Raeburn at length, pointing out also that for four years HealthNewsReview has been on the National Press Foundation’s case for these fairly naked PR moves on behalf of its sponsors. He’s written several times about the fact that the Foundation has taken money from Pfizer for seminars on topics such as cancer, where the pharma has a big financial stake.

Sugar, sugar. I just can’t believe it’s true.

Sugar–denigrations of it, that is–is a topic on other recent blogs too. Nearly every week, actually. It’s always a favorite with Marion Nestle at Food Politics. This time she’s writing on the World Health Organization’s call for comments on its proposed guidelines for intake of added sugars. WHO advocates that added sugars account for less than 10% (50 grams) of daily calories; 5% (25 grams) would be even better.

Nestle’s post is particularly sweet and juicy because it fills us in on the politics and lobbying behind why this same guideline never made it into the dietary recommendations WHO issued a decade ago.  The reason is not very complicated. A can of Coke or Pepsi contains about 40 grams of sugar.

Noting that the comment deadline is March 31, Nestle says, “WHO must either think that the research basis of the 10% sugar guideline is much stronger now . . . or that the political landscape has shifted so far in the direction of reducing sugar intake that governments will ignore industry groups this time. I’m not so sure.  I think WHO needs all the help it can get with this one. Submit comments here.  Now!”

It’s possible that Nestle may not be giving changes in the anti-sugar political landscape enough credit. Scott Clement, at the Washington Post blog The Fix, reports that the new NBC/Wall Street Journal poll found that twice as many poll respondents think sugar is the biggest health risk than those that fear marijuana most. OTOH, neither group was a big percentage of the sample. Only 8% were most worried about pot, while just 15% listed sugar as the biggest health risk. Half the respondents were most worried about tobacco and a quarter about alcohol.

Obesity? What obesity?

Obesity? What obesity?

At the PLOS blog Public Health Perspectives, Lindsay Kobayashi doesn’t mince words either: “Refined sugar is one of the worst things found in the Western diet.”  She urges favorable comment to WHO by the end of this month too. Kobayashi also takes the oddly optimistic view that the WHO guidelines might be “a stepping stone for health policy and the food industry to move forward together in reducing refined sugars in processed foods.”

Sure they will. Gail Collins tells us that part of the federal school lunch law taking effect this year will ban candy and soft drinks from school premises, including vending machines. So you can see why the sugar people are in a panic, and why Coke has seized an opportunity to lobby journalists.

Gene therapy for HIV and selling Obamacare

There’s a possibility for gene therapy for HIV infection involving one of the new gene-editing techniques, zinc-finger nucleases. I wrote about it at the Genetic Literacy Project earlier this week.

The post also mentions a couple of developments announced at the annual Conference on Retroviruses and Opportunistic Infections. For example, there’s been another apparent cure of a newborn involving heavy doses of antiretroviral drugs. CROI is a pretty jam-packed conference, but you can catch up quickly on HIV developments if you consult Paul Sax’s Really Rapid Review at his NEJM blog HIV and ID Observations.

Sax concludes with that clip of President Obama gamely pitching Affordable Care Act insurance to Zach Galifianakis on the latter’s mostly lame online mock interview show Between Two Ferns. In case you missed it, my review is that it’s mildly amusing in a couple of spots, especially the finale, but not worth 15 minutes of your time. Or Obama’s, either.

Galifianakis and Obama

Nice to know, though, that those highly desirable Millennials have a different view of Galifianakis. The interview was, for a time, the biggest source of referrals to healthcare.gov. No word yet on whether the youths stayed to actually buy policies, thus contributing to the actuarial demands of cheaper health insurance. Mother Jones has what it calls “This Week’s Must-Read” piece describing how the interview came to be.

Integrity at the Office of Research Integrity

A few days ago, Adam Marcus reported at Retraction Watch that the head of the Office of Research Integrity had resigned his post last month for reasons that were undisclosed and mysterious. The ORI monitors alleged misconduct by scientists funded by the National Institutes of Health and the Public Health Service. It reports annually, ususually listing about a dozen findings of misconduct. These include cases of fabrication, falsification, and/or plagiarism.

Now we know why David Wright quit, in his own words, because Science‘s Jocelyn Kaiser has obtained a copy of his letter of resignation. It appears at ScienceInsider.

David Wright. Credit: ORI

David Wright. Credit: ORI

It’s a doozy. Most of his job, Wright said, was “spent navigating the remarkably dysfunctional HHS bureaucracy to secure resources and, yes, get permission for ORI to serve the research community.  I knew coming into this job about the bureaucratic limitations of the federal government, but I had no idea how stifling it would be. What I was able to do in a day or two as an academic administrator takes weeks or months in the federal government.”

His beef is with the Office of Assistant Secretary for Health Howard Koh at the Department of Health and Human Services, ORI’s supervising agency. Kaiser explains, “He writes that ORI’s budget was micromanaged by more senior officials, and that Koh’s office had a ‘seriously flawed’ culture, calling it ‘secretive, autocratic and unaccountable.’ For example, he told Wanda Jones, Koh’s deputy, that he urgently needed to appoint a director for ORI’s division of education. Jones told him the position was somewhere on a secret priority list of appointments. The position has not been filled 16 months later, David Wright notes.”

Ivan Oransky has followed up at Retraction Watch by linking to Kaiser’s post. Several intriguing comments. Wright says he’s been told that his job is to make his superiors look good and to be a team player. He also questions whether a very political agency like OASH is the proper home for a regulatory agency like ORI. And there’s lots more, including his plan to publish his daily log.

The journalist in me is salivating. The citizen in me is in despair over how much ammunition these stories are about to hand over to the enemies of government. No longer will they need to invent victims of Obamacare and the school lunch program. The truth is likely to be awful enough.

Category: Uncategorized | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 4 Comments

Giant virus, contamination, Svante Pääbo and the Neanderthal Genome, and Sydney Brenner on funding and scientific publishing

 

That giant virus

OK, sure, I know, Pithovirus, that giant virus they thawed out of the 30,000 year-old Siberian permafrost, is a pathogen specific for amoebas, blah blah blah. But I can’t help wondering what else is going to turn up as the warming Earth releases creatures from the melting of ice frozen many thousands of years ago.

Pithovirus. Credit: Julia Bartoli & Chantal Abergel

Pithovirus. Credit: Julia Bartoli & Chantal Abergel

And I’m not alone. Carl Zimmer mentioned the possibility in his Matters column. Last year a different giant virus was found in a human patient with pneumonia. Vincent Racaniello gives details of this case at his Virology Blog.

At Climate Progress, Ari Phillips is worried too.  And, he notes, so are the researchers themselves, although they are mostly concerned about more recent pathogens that might resurface as the frozen tundra thaws, very serious pathogens such as smallpox.

Pithovirus, the new giant virus, really is a giant, 1.5 micrometers, 25% bigger than any virus previously found. As big as some bacteria, visible in an ordinary microscope. And it’s not like most viruses in other ways, either. It’s got a DNA genome, but it’s small. Pithovirus doesn’t reproduce in typical viral fashion by taking over the cell nucleus, as Ed Yong tells us at Nature News. It violates the usual viral profile in other ways, too. The standard in present-day viruses is to smoosh up the genome to make it as tiny as possible. This guy lets its DNA sprawl, although there is still lots of empty space in its baggy body.

For a primer on giant viruses, see Marcia Stone’s post at Small Things Considered from last November. The existence of these creatures, she says, requires redrawing the Tree of Life.  There’s an argument that giant viruses may be descended directly from lifeforms that existed before the fabled LUCA, the hypothetical last universal common ancestor of all cellular life presently on Earth.

Contamination

Zimmer quotes a researcher not involved in the Pithovirus work as speculating that the find might not be genuine after all, that the sample might have been contaminated with young viruses. Since I’m a virological ignoramus, I won’t argue that point, except to note that in that case why does Pithovirus seem to be unlike any other virus ever seen?

However, I don’t want to distract from the fact that contamination of samples can be an enormous problem in many fields of research. Contamination is on my mind because I have just reviewed Svante Pääbo’s new memoir Neanderthal Man: In Search of Lost Genomes for the Genetic Literacy Project.

Left, H. neanderthalensis. Right, Svante Pääbo   Credit: Frank Vinken

Left, H. neanderthalensis. Right, Svante Pääbo Credit: Frank Vinken

This engaging book is obsessed with contamination, although that’s not obvious at first. It briefly describes how the grand old man of ancient DNA became a scientist. It also, as you may have heard, describes Pääbo’s life as a bisexual, although that’s brief too, and the very antithesis of salacious. The memoir is all about sex, but it is not sexy.

Instead, Neanderthal Man is devoted–and devoted is definitely the word–to the years-long ancient DNA project to sequence the Neanderthal genome. Pääbo and his far-flung team did that to an accuracy that exceeds most of the contemporary genomes being sequenced today. The sequencing project was about sex in the sense that its real aim was to discover the aftermath of sex: whether bits of the Neanderthal genome survive in us.

If the book is mostly about doing the Neanderthal genome, doing the Neanderthal genome was mostly about contamination–or, rather, trying to bypass contamination. That meant fishing genuine Neanderthal DNA out of a soup of DNA from other creatures, bacterial and human–extraneous DNA that had, over 40,000-plus years, soaked into every Neanderthal bone they worked on.

Before I read Neanderthal Man, I thought I knew something about contamination of ancient DNA. In fact, though, I had no clue. No matter how well informed you are about genetics, Svante Pääbo will teach you things.

Funding

Neanderthal Man also got me wondering about the role of the funding process in smoothing the way for good work, innovative work. Pääbo works at the Max Planck Institute for Evolutionary Anthropology in Leipzig; in fact, he helped design it. The Max Planck Society funds a staggering 82 such institutes, most in Germany.

In organization the Max Plancks are a bit like the Howard Hughes Medical Institutes–designed around individual researchers who have enormous freedom, and part of that freedom is freedom from having to write grant proposals.

The principle is the same even though the funding sources are different.  HHMI’s money came originally from the estate of a very rich man. Most of the Max Planck budget “is derived from the coffers of the public sector,” which I assume means German taxpayers. Even so, when Pääbo found he needed $5 million more than originally planned to pay for additional sequencing, the money was forthcoming. (In fact, as I recall, the Society gave him more.)

Obviously there is no such possibility with public money here in the US. But there are costs, certainly, to the government funding system we’ve developed here. The Nobel laureate Sydney Brenner rails against some of them in an interview much blogged-about this week.

Sydney Brenner delivering his Nobel Prize banquet speech, 2002. Credit: Hans Mehlin

Sydney Brenner delivering his Nobel Prize banquet speech, 2002. Credit: Hans Mehlin

Brenner argues that with present-day funding practices, Fred Sanger, who won two Nobel Prizes, would not have been able to support his work on the biochemistry that underlies most of today’s biological research. That’s  because he went a decade between publications. Bioinformaticist Mick Watson disputes that at Opiniomics, arguing that if he was working today, Sanger’s findings would have been handed over to a private company  “where the technology would be developed free of the pressures of academic research.” Seems to me there would be plenty of pressure at a private company, although of course not pressure to publish.

Brenner has proposed a funding alternative that he calls the Casino Fund, organized along the HHMI/Max Planck lines of support for an excellent individual researcher who then puts together lab and team to suit. Every organization that gives money to science should take 1% of it and write it off, Brenner declares. “You give it to people like me, to successful gamblers,” he argues. But “all the business people stand up and say, how can we ensure payback on our investment? My answer was, okay make it 0.1%. But nobody wants to accept the risk.”

Brenner also has a lot to say about the scientific publishing industry, none of it complimentary. For takes on this, largely in agreement with him, see Retraction Watch (and many comments), In the Pipleline, and the Mermaid’s Tale.

 

Category: Uncategorized | Tagged , , , , , , , , , , , , , , , , , , , | Comments Off

Obesity and Calico Cats

 

Obesity on the decline?

Is this the best news of the week? The news that obesity in little kids has gone down dramatically here in the US? Researchers at the government’s National Center for Health Statistics claim, in a JAMA paper, that obesity from age 2 to 5 has fallen from 13.9 percent in 2003-04 to 8.4 percent in 2011-12.

Greet these data with little glad cries, and hope madly that these kids, and those who come after, can continue to maintain healthful weight as they navigate through the crises of life. But absorb also the fact that it’s at best a dent in the obesity statistics. As the paper points out, obesity hasn’t declined in other age groups.

Also, read analyses from Zachary Goldfarb at Wonkblog, which I am pleased to report continues its focus on data even though Ezra Klein and (some of) Co. have departed for their ambitious explanatory news startup.

In another post, Goldfarb points out the disheartening news that the decline among young kids does not show up in all ethnic groups: black and Hispanic little kids are still often fat. It’s the white kids who are less so. “We’re celebrating the fact that for all kids ages 2 to 5 childhood obesity has declined from 13.9 percent to 8.4 percent over 10 years. Yet, 11.3 percent of black children ages 2 to 5 and 16.7 percent of Hispanic children that age are obese. Just 3.5 percent of white children ages 2 to 5 are obese.”

At Covering Health, the blog from the Association of Health Care Journalists, Joe Rojas-Burke explores some potential reasons for this divide, which range from income disparities to lack of exercise (due in part to the lure of video games.)

The JAMA report attributed the decline largely to government programs. These include food stamps (which have of course just been cut) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), plus new nutrition and physical activity standards for early child care programs,  Other factors include a reduction in smoking during pregnancy and in TV  fast-food ads targeting children.

And, of course, Michelle Obama’s “Let’s Move” program, along with similar efforts by professional groups. I don’t know how deliberate the timing was, but the Obama administration has just announced restrictions on the marketing of junk foods and sugary drinks on school campuses.

Credit: fbotero

Credit: fbotero

Is breast best for obesity?

Also on the list of factors that may have contributed to the decline in obesity among kids 2 to 5 is increased support for breastfeeding mothers. Reducing the risk of obesity is just one of the benefits that has been attributed to breastfeeding.

Surfacing this week, however, is another paper that casts doubt on the now-conventional wisdom that Breast Is Best. It was published in the journal Social Science & Medicine, and uses a clever technique for getting around the confounding effects of race and income that make studying the effects of breastfeeding messy.

In addition to comparing subjects from general populations who had been breastfed versus those who had not, the researchers compared subjects in the same family, one of whom had been breastfed and the other not.

In her blog comments on the paper, Amy Tuteur, the Skeptical OB, concluded, “Simply put, looking within families takes ethnic, cultural and socio-economic factors out of the picture. When you do that, you find no difference between breastfed and bottlefed children.” The research compared subjects on a number of outcomes, including obesity.

The paper is very long, and Tuteur’s analysis is useful because it picks out a few salient points and helpful charts. But keep in mind that Tuteur’s skepticism has long extended to strong claims for the benefits of breastfeeding. She tells us at the outset that she believes “although the benefits of breastfeeding are real, they are small and restricted to relatively unimportant risks like colds or episodes of diarrheal illness during the first year of life. To hear lactivists tell it, however, breast milk has super powers and women who do not breastfeed are bad mothers.”

You will not be surprised to learn that this Feb. 26 post has already attracted hundreds of comments. I haven’t read them, but will wager that many are not complimentary. Lactivists.

What causes obesity?

At the PLOS blog Obesity Panaea, Travis Saunders attributes the growth of obesity in children to four factors he says he’s pretty sure about: Sugar-sweetened beverages, sedentary behavior (especially screentime), lack of sleep, and adult obesity. He says the data on other possibilities are either weak or in conflict. These possibilities range from the the obvious (like diet), to the less so (like gut microbes and a lack of breastfeeding.)

Since he’s convinced it’s a factor in obesity, I wish he’d said more about lack of sleep, which is a theory I don’t know much about and haven’t the time to delve deeply into at the moment. OK, sleeping less means more time to eat, perhaps especially if lack of sleep is due sedentary pursuits like late-night TV. But there must be more to it than that, right?

Nature and nurture in obesity

At about the same time as the CDC paper, another JAMA journal, Pediatrics, also weighed in on childhood obesity. It published studies of genetic variation in satiety responses, aka appetite, in non-identical twin youngsters. An accompanying editorial, apparently written from the Department of Duh, concluded that these genes vary among individuals.

The papers prompted fulmination from David Katz, editor of the journal Childhood Obesity, in a post at HuffPo. He argues that gene studies are pretty much irrelevant to solving the problem of childhood obesity, pointing out that people had pretty near the same genes a few decades ago, when childhood obesity was much rarer.

It’s a long post with a convoluted and repetitive analogy between appetite genes and genes for gills–don’t ask–but there’s no arguing with his conclusion: “Can we really justify the lunacy of a culture that studies genes looking for variation in satiety responses, while engineering foods to undermine satiety responses?”

Hot news and not news about coat color genetics in calico cats

The Christian Science Monitor thinks that inactivation of one of the X chromosomes, which happens in all mammals but no other animals, and which Mary Lyon discovered in 1961, is new news.

Unfortunately, the New York Times picked up the Monitor story and treated it as new news, too. Now that this misleading factoid has appeared in the Newspaper of Record, it will no doubt be promulgated as a 2014 discovery forever in term papers, and cribbings of term papers, not to mention encyclopedia articles and probably several books.

I suspect this happened because it involves cats and pictures of cats, irresistible eye candy that seem to result in brain freeze and abandonment of professional responsibilities.

X inactivation is the reason for fur color in tortoiseshell and calico cats. The X chromosome is turned off at random in mammalian females. Some cells reflect Dad’s X and some Mom’s. Fur color genes are on the X chromosome. If each parent has a different color variant, the result in furry offspring is mixed coat color. (A calico cat’s white patches are not really white, they are unpigmented as a result of a different gene.)

The real news about calico cats

The reason I know that this is old news is that I wrote about it in 2009, in one of two features on epigenetics I did for BioScience. It was not new news then, either, far from it. But it’s an intriguing everyday example of the random effects of X inactivation and its resultant genomic imprinting, an epigenetic process. I used it for the same reason the Monitor and the Times did: it is striking, and it involves cats and the opportunity for cat photos.

Calico cats. Credit: tanakawho http://www.flickr.com/photos/28481088@N00/380418201/

Calico cats. Credit: tanakawho
http://www.flickr.com/photos/28481088@N00/380418201/

Cat coat color has been under investigation for more than a century. After Mary Lyon’s discovery of X inactivation in 1961, the reason for tortoiseshell and calico coats was clear. In 1999, Lyon herself–by then one of the few Grand Old Women in genetics–made it her opening example in one of her final papers, a brief primer on X inactivation she wrote for Current Biology.

Tia Ghose explains what the work the Monitor was reporting on is really about at LiveScience. It’s a new method for visualizing genes whose activity is shut down in individual cells. The report comes from a paper delivered at the Biophysical Society meeting last week.

Ghose’s piece includes a nice very basic explanation of X inactivation and its results, using cat coats as an example because that’s the example the researchers used. But Ghose notes correctly that the reason for tortoiseshell and calico coats has been known for 60 years.

Blame the researchers?

So maybe we should blame the researchers for giving the Monitor the impression that the reason for calico cats was their discovery? Or was it just that the Monitor writer, Sudeshna Chowdhury, made rookie mistakes: reporting on unpublished work and getting no outside comment. And apparently not reading up on background either.

I don’t know what the Times‘s excuse was. I guess the opportunity to include a cute cat item in its weekly roundup was irresistible. Another item to file under the heading Too Good to Check.

Ghose’s is the piece to read. But it will not, of course, be the one engraved in tablets of stone, even though it is clear about the science and also gets an important episode in the history of genetics right.

Listen, I’m a lifelong cat lover, but it is not the case that when a researcher waves cats in front of a reporter, the reporter must salivate.

Category: Uncategorized | Tagged , , , , , , , , , , , | 1 Comment

The systematics post about fecal transplants and climate change

This is not scatology

Hard to resist the lure of scatology when writing about fecal transplants, especially if one is a lifelong smart-ass. But this lifelong smart-ass will try, if only to differentiate what I write about this startling-sounding and still novel approach to curing disease. Differentiate it, that is, from the coy self-conscious naughtiness other bloggers have brought to the table.

Clostridium difficile. Credit: Centers for Disease Control and Prevention

Clostridium difficile. Credit: Centers for Disease Control and Prevention

Hard also to imagine that anyone within the sound of my voice doesn’t know that a fecal transplant is just what it sounds like, the transfer of feces from a healthy person into a sick one. And that it has been awesomely successful–an unheard-of 90% cure rate–against Clostridium difficile, which is also just what it sounds like, a difficult bacterium that is difficult to get rid of, debilitating, and sometimes fatal.

Last May, the US Food and Drug Administration, alarmed at the unregulated swift adoption of fecal transplants, not just for C. diff infection but experimentally for other conditions, announced that it was regulating human feces as a drug. This meant that docs must file an Investigational New Drug (IND) application before performing a transplant. The point was to make transplants safer and standardize the treatment. But the paperwork was a hassle and an annoying and time-consuming delay in getting a cure to suffering patients.

The result: uproar and, after six weeks, an exception made for C. diff treatment. However, as a commentary just published in Nature has observed, FDA’s fecal transplant regulatory policy is complicating research into its use in other conditions, such as inflammatory bowel diseases and obesity. Both of these–and other disorders–have been linked by researchers to derangement of the billions of microbes that reside in the human gut and are necessary for life.

The researchers propose that FDA look upon the feces used in transplants not as a new drug but rather as a tissue product. Or perhaps FDA should even devise a new classification, as the agency has done for blood. Those moves, the authors say, “would keep patients safe, ensure broad access and facilitate research.” Regulating feces as tissue would require careful record-keeping and screening for communicable diseases, which are, they say, exactly the safety precautions needed for fecal transplants.

That step would also permit studies of long-term safety of feces transfer. At the moment, safety–especially long-term safety–is a big question mark. The researchers acknowledge that there are potential risks with fecal transplants, for example transfer of disease organisms along with microbes that fight disease.

Stool banks

Two of the authors have helped launch what they call a stool bank. In its first 3 months of operation, the nonprofit OpenBiome, working under the FDA compassionate exception for C. diff, has supplied more than 100  treatments to a dozen hospitals. Other hospitals are developing their own stool banks.

Current treatments consist of minimally processed fecal material whose microbial residents are–this is a bit scary–unknown. But the researchers say progress is being made on identifying specific good guys. “Knowledge gleaned from transplantation of natural systems could inform the design of synthetic communities tailored to treat specific diseases,” they say, and these products could then be regulated appropriately as drugs.

This proposal to regulate feces as tissue is brand new, and of course it remains to be seen how FDA will react, and how quickly. But the proposal was greeted with little glad cries by Jonathan Eisen, the Davis evolutionary biologist, who blogged, “it kind of blew my mind.”
Eisen’s blog, The Tree of Life, is one of the better sources for keeping up with microbe research.  Christine Gorman also wrote about the paper at the SciAm editors’ blog Observations.

 

Pseudoscience reports on the Shroud of Turin and astrology

Knight Science Journalism Trackers Paul Raeburn and Faye Flam both vented on the topic of pseudoscience this week.

Paul noted with approval a post at Achenblog, the blog of Washington Post science writer Joel Achenbach, a dazzling writer that I don’t read much now that the Post is paywalled. Achenbach expatiated on a HuffPo post with the incomprehensible but irresistible hed “Shroud of Turin Formed by an Earthquake? Scientists Say Face of Jesus Image Caused By Neutron Emissions.”

Achenbach used the piece to argue that self-interest, rather than lofty goals like educating the public, is what drives good science writers to get it right. If they prove untrustworthy, readers will abandon them. Paul agrees. Me too.

Meanwhile, Flam zeroed in on a National Science Foundation poll that found, once again, that most people know zilch about science, that many reject the theory of evolution (“only a theory”), and that astrology is widely believed to be based on solid science.

My first thought, when I encountered the NSF survey a few days ago, was that the respondents were hazy about the word “astrology,” and that many confused it with astronomy, which they knew to be scientific. Flam thought so too, and found some research to back it up. But she also found research suggesting that respondents didn’t confuse the two terms, or maybe that they thought astrology and astronomy meant the same thing.

So much for the confusion hypothesis; no comfort there. And a comment posted on Flam’s post is even more disheartening. The comment links to a 2011 survey of college students showing that respondents didn’t confuse astrology with astronomy, and that most believed the stars and planets affected their lives. Here’s the best part: the survey respondents were all astronomy students.

 

The Washington Post swears off treating health press releases as news

We are accustomed to news aggregation sites, even science sites, reprinting press releases as if they were news stories. Hey, it’s a lot cheaper than putting together original material.

But it was a jolt to learn, also from Tracker Paul Raeburn, that the Washington Post‘s Health & Science section had also succumbed to routinely treating this promotional material as news. Not even rewriting releases and adding a quote or two from an outside source, another common practice, but just reprinting them.

Paul complained, and within a few days the Post altered the practice. The new policy (actually, I trust, a return to the old policy) now is: No more releases masquerading as news. Wow. Not often a blogger gets to change the world, not to mention change for the better the science and health information available to hundreds of thousands of people.

It does invite a question, though, about how the practice got started in the first place.

 

"Angry hot planet" (Image: Green Party)

“Angry hot planet” (Image: Green Party)

Kickstarting climate change reporting

Six freelance journalists are trying crowd-funding to underwrite their reporting on climate issues, according to Bud Ward at the Yale Forum on Climate Change and the Media. The journalists are calling their project Climate Confidential and are trying to get support from 800 people by March 8. They had raised some $9000 from 300 people by February 20.

Doing the math, that works out to about $4000 per journalist and about $500 per story. Which seems a modest enough stipend. So modest, in fact, that I’m wondering how they can manage. Apparently they intend to produce a sort of insider newsletter that will go to their supporters under various subscription models. A full year prepaid will be $55.  There are lots of entrepreneurs who have built successful newsletter businesses, especially in and around Washington, DC. But they charge an awful lot more than $55 per sub.

I see that the Tracker has also picked up this news from the Yale Forum. But my post didn’t come via the Tracker. HT to Fred Powledge. Also, Happy Birthday.

 

The climate is changing

Last summer I wrote about my sense that the climate-change debates had mostly moved away from outright denial of global warming and were focusing more on arguing about the right policies, if any, for coping.

I won’t pretend it was an original thought. Dot Earth’s Andy Revkin has returned to it once more, recounting a talk by political scientist David Victor of the University of California, San Diego. Victor proposes a systematics of opponents of action against climate change.

Victor divides them into three groups: shills, skeptics, and hobbyists. It’s not denialism at all, he says. “Instead, what we are seeing is what psychologists call “motivated reasoning” —people hear about something they abhor and they find reasons to justify their dissent. Believing that the science is “uncertain” is one of those reasons.”

I know what shills are, viz Fox News, and in my post I described a variety of skeptics with different positions on regulation. “Hobbyists” is a delightful term, but it’s not terribly descriptive. It suggests to me that Victor thinks some climate warriors are simply in it for entertainment. Am I surprised? I am not. That’s what Internet trolls do too.

Category: Uncategorized | Tagged , , , , , , , , | Comments Off

Science at the Sochi Winter Olympics, plus the Latest on Gene Editing

olympics logo

The Sochi Olympics: Geology, ecology, and climate

Something I’ve been wondering, and Bob Costas & Matt Lauer & Co. haven’t been telling me, is why the devil Sochi, a summer resort town?

Well, because, Seattle resident Dana Hunter tells us at SciAm’s Rosetta Stones, Sochi is a lot like Seattle. Um, Seattle? Mild, rainy winters? For the Winter Olympics?

Yeah, but that’s good, because it’s pleasant walking-around weather for the thousands of visitors (it hit 60 the other day), and the indoor venues are, duh, indoors, so it doesn’t matter where they are built, and the Caucasus mountains are less than an hour away for the snow sports. Not that real snow is so plentiful there this year; for real snow you have to go to Georgia (the US one). And the Carolinas. Although I guess that blast has turned to ice by now. Which is worse. Oh, and the Midwest. And the East. And especially the Northeast.

Anyway, Hunter’s post is largely about the risks involved in constructing all the venues in a spot where the building sites are wetlands, and flooding and earthquakes and landslides are a big risk.

Also snow slides, although this year it’s all artificial snow, which apparently is not so slidy. This news, doubtless also relevant for decisions about ski waxing, is from another Sochi geology post. It’s by Eva Amsen at The Finch + the Pea.

One of the reasons Russian President Vladimir Putin lobbied so hard to get the Olympics for Sochi was to turn the nearby Caucasus mountains into a trendy spot for a winter sports resort. Putin must be one of those global-warming deniers. (I’ve written about deniers here.)  At Climate Progress, Ari Phillips explains that Sochi will be out of the winter sports business by mid-century. Along with many other formerly cold and snowy locales.

This DigitalGlobe satellite image shows the 2014 Winter Olympics event slopes in Sochi, Russia. This image was collected Jan. 2, 2014. Credit: DigitalGlobe.  HT to Megan Gannon at LiveScience http://www.livescience.com/43149-sochi-winter-olympics-seen-from-space.html

This DigitalGlobe satellite image shows the 2014 Winter Olympics event slopes in Sochi, Russia. This image was collected Jan. 2, 2014. Credit: DigitalGlobe. HT to Megan Gannon at LiveScience 

The Sochi Olympics: Blog roundups

Scientific American is aggregating its Olympics-related blog posts under the heading Science at the Sochi Olympics here.  Among them are the Dana Hunter post mentioned above and the Judy Stone post on disease, below. Some others, Hilda Bastian at Absolutely Maybe on the attraction to risky winter sports, David Wogan at Plugged In on what happens to Olympics cities after it’s all over, and several Olympics posts from yesteryear.

LiveScience is congregating its posts at Winter Olympics 2014.  Some topics: Weather and climate of course, effects of altitude on speed skaters, which winter sports burn the most calories.

 

Big news at the Scientific American Blog Network

In other SciAm Blog Network news, very important news, there is at last a new blog czar for the network. He is Curtis Brainard, who invented The Observatory, the regular blog-style report on science journalism at the Columbia Journalism Review. Given his record, Brainard is the perfect pick for this demanding job, which has been vacant since the uproar last fall over former czar Bora Zivkovic’s behavior with women, which I wrote about at the time, and its electrifying effect on the science blogging community.

Knight Science Journalism Tracker Charlie Petit reports that Brainard, having been at the job only a few weeks, isn’t yet sure what changes he wants to make. Managing the existing stable of 40 bloggers must be a job and a half all by itself.

Charlie also quotes Brainard thus, “I think blogs provide a broader and deeper exploration of the sciences than has ever really been available to consumers of news and information.” About that, Brainard is quite right. Out of the chaos the Internet has visited on the publishing business has emerged, mirabile dictu, a Golden Age for science writing and science journalism, and much of it–maybe even most of it–is coming from science blogs and science bloggers. There are thousands, and I have been dipping into them every week here at On Science Blogs since 2009. Whew.

The Sochi Olympics: At the PLOS blog network

In addition to this post, you shouldn’t miss Travis Saunders’s Obesity Panacea explanation of how women’s ski jumping was barred from the Olympics until this year because “the folks who run the International Ski Federation were also worried that ski jumping might cause a woman’s uterus to move and/or fall out and/or burst.”

At Neuroanthropology, Daniel Lende shows us the startling brain design of John Fairbairn’s helmet for the Skeleton competition. Given the recent attention to the risks of concussion in sports, this design is a bit unsettling. And for the Skeleton competition? Maybe he’s thumbing his nose at fate?

The Sochi Olympics: Physics, chemistry, and math in winter sports



 

The National Science Foundation has collaborated with the educational arm of NBC to produce 10 short videos explaining the physics, engineering, chemistry, design and math involved in winter sports. They cover slopestyle, half-pipe, speed-skating apparel, recovery from injury, the science of ice and snow, bobsled, alpine skiing, the physics of figure skating, and how movement in all these sports relates to robot design. Find all the videos here.

Above, the video about my favorite Olympic sport, figure skating. It features Ashley Wagner, Gracie Gold, Meryl Davis and Charlie White and Evan Lysacek, who declares: “What does figure skating require? Everything.”

 

The Sochi Olympics: Olympic diseases

At Molecules to Medicine, Judy Stone has a long post on how big gatherings like the Olympics are a boon for infectious organisms. The only mass assemblage more disease-friendly than the Olympics, she says, may be the Hajj, the annual pilgrimage to Mecca. There was influenza at the Salt Lake City Winter Olympics in 2002 and measles at the Vancouver Winter Olympics in 2010. Measles spread far into British Columbia, affecting especially indigenous people in remote areas.

No mention in that post of NBC Olympics impresario Bob Costas’s pink eye, which forced him to give up the throne to Matt Lauer. “As a practical matter, I simply couldn’t do my job because my eyes had become so blurry, watery and sensitive to light,” Costas said in a statement released by NBC. Conjunctivitis has many causes; docs have said his is probably viral. At LiveScience, Rachael Rettner explains why pink eye is so contagious.

Credit: YouTube screen grab VIA LiveScience

Credit: YouTube screen grab VIA LiveScience

And see Star Lawrence at HEALTH’Sass for a literally colorful description of what pink eye feels like and what the green glop it produces looks like, plus the word on treatment and prevention. The take-away on prevention: Stay away, far away, from people with pink eye. I bet public health folks are emplaning to Sochi even as we speak to study its spread. Star’s conclusion, based on personal experience, “This is gross, but not the end of the world.” Costas might disagree; as I write he has not yet returned to his Olympics post.

 

Sochi Winter Olympics: Political science

It’s not possible to write about Sochi and the Russian Olympics and Vladimir Putin without mention of international politics and human rights. At the anthropology blog Savage Minds, anthropologist Elizabeth Cullen Dunn explains, via a history of Russia’s centuries-long record of genocide in this region, that she won’t be watching Putin’s Olympics. That record includes the recent ethnic “cleansing” of 26,000 people in the South Caucasus. Sochi itself was a site of Russian genocide against hundreds of thousands of Circassians in 1864. Dunn says, “Like Hitler at the 1936 Olympic games, Putin hopes to use the Olympic moment to showcase his grip on power.”

At 13.7 Cosmos & Culture, NPR’s group science blog, Barbara King writes about Olympics issues of social justice: Russian laws and discrimination against gay and transgender people and also animal rights issues.  Helen Jefferson Lenskyj, at The Conversation, describes the anti-gay propaganda and discrimination in Russia and mocks Putin’s defense of the anti-gay laws as a demographic strategy to encourage a higher birth rate. Putin and the International Olympic Committee, which insists that sports and politics are separate, she calls a perfect match for each other.  The Washington Post’s political blog The Monkey Cage promises explanatory posts on Russian politics for the next week or so.

 

Sister macaques Ningning and Mingming are the first primate GMOs whose genomes have been monkeyed with using CRISPR/Cas9 technology. Credit: Cell, Niu et al.

Sister macaques Ningning and Mingming are the first primate GMOs whose genomes have been monkeyed with using CRISPR/Cas9 technology. Credit: Cell, Niu et al.

How to rewrite genomes, our own included

These adorable monkeys are the first primate species to be genetically modified by a new technique called the CRISPR/Cas system. When I tell you CRISPR/Cas has generated unprecedented buzz among researchers, I hope you will understand that this is not hype.

The potential applications of the system are pretty-near unprecedented too. Genetic modification of any animal, any plant, and any microbe. “Smart bombs” that could destroy antibiotic-resistant disease bacteria without harming the good guys in your microbiome. The ability to study groups of genes to learn how they function together, which could identify real risk factors for complex disorders ranging from schizophrenia and autism to heart disease.

And, of course, direct human applications. Precisely targeted gene therapy. Preimplantation genetic diagnosis. Genetic enhancement. And attendant moral issues.

No, none is these things is possible at the moment, and yes, there is a distance to go. But the CRISPR/Cas system has been embraced by hundreds of researchers around the globe. And, oh yes, it’s simpler and cheaper than any other current gene-editing system.

You can find lots of details on these and related matters in my piece on the CRISPR/Cas system, last Tuesday’s column at the Genetic Literacy Project. For example, this gene-editing system is based on one evolved by microbes nearly 3 billion years ago.

 

Happy Valentine’s Day from On Science Blogs

Cutaneous Hearts, Each Distinctive and Unique Shown are a café au lait macule (A), lentigo (B), nevus spilus (C), halo nevus (D), acquired nevus (E), congenital nevi (F-J), hemangioma (K), salmon patch (L), acne excoriée (M), and a venous insufficiency ulcer (N). Credit: JAMA Dermatology.  http://archderm.jamanetwork.com/article.aspx?articleid=1787841

Cutaneous Hearts, Each Distinctive and Unique
Shown are a café au lait macule (A), lentigo (B), nevus spilus (C), halo nevus (D), acquired nevus (E), congenital nevi (F-J), hemangioma (K), salmon patch (L), acne excoriée (M), and a venous insufficiency ulcer (N). Credit: JAMA Dermatology.

 

Category: Uncategorized | Tagged , , , , , , , , , , , , , , , , , , | Comments Off