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Since March 4th, workers have fished 3,300 5,916 6,601 13,000 (03/18/13) dead, bloated pigs out of a river in Shanghai. Last week there was little information about where they were coming from, how they got there, or what they died from, only general agreement, as Bloomberg put it, that "nothing good comes from a dead-pig tide".

The Huangpu River feeds the drinking water supply for some of the city and although officials have so far assured citizens that the water is safe, and that they're taking water samples regularly, doubts persist.

If Pigs Could Fly

How the pigs got there is still a bit of a mystery. The carcasses are ear-tagged but officials can't decipher the tags, so they don't know the exact situation. Most likely, farmers dumped diseased pigs (some are infected with porcine circovirus) into the river at some upstream province. Despite the gruesome pig panorama, citizens are told not to fear the safety of pigs originating from the suspect provinces.

Piglets
via Wikicommons.

China produces half the world's pigs, five times what the U.S. produces. Pork is so central to the economy that pig price fluctuations effect the cost of living. This means that the large scale pig deaths over the past several months, albeit only tens of thousands in a pig population of millions, concern not only water drinkers and pork consumers but economists too.

When other food products befall catastrophe, the story may be different. When frosts freeze orange groves in Florida, for instance, producers warn consumers in the Northeast U.S. that orange juice prices might go up, that's it. Pig parts, however, are found in hundreds of products besides rinds and bellies and chops and loins. For instance, eighty percent of the U.S. heparin supply comes from pigs raised on farms in China, according to the director of Pharmacy at Boston Children's Hospital.

A few years ago, an epidemic of blue ear pig disease (porcine reproductive and respiratory syndrome virus (PRRSV)) ended up killing so many pigs that producers met the demand for heparin by adulterating the drug with a chemically similar substance. As the crisis unfolded, analysis detected oversulfated chondroitin sulfate that caused hundreds of severe allergic reactions and 175 deaths worldwide.

In the aftermath, journalists investigated the supply chain and found that the FDA had alarmingly little oversight into the production practices on pig farms in China. Since then, the FDA has increased its oversight. However, even last year, the Wall Street Journal reported that the FDA found contaminated heparin from fourteen more Chinese suppliers. The FDA put them on a watchlist with eight others.

They'd Fly Away?

In light of these investigations, consider that pigs provide material for many human life-saving technologies. A recent study describes the possibility of using porcine small intestine patches for pediatric patient cardiovascular reconstruction. Scientists are experimenting with porcine (and bovine) matrices for things like abdominal wall reconstruction.

Although some medicines, like insulin, are no longer made from pigs, the widespread use of pig parts in medicine often goes unacknowledged. Some religions forbid the use of pigs even for medical treatment, and some people get squeamish about pig body parts, according to designer Christien Meinderstsma in this Ted Talk. One Dutch heart valve company wouldn't send her their valve because they didn't want people associating their life-saving technology with pigs.

In her talk on the book, "Pig 05049", Meinderstsma highlights 185 products made with a pig she followed. A Greek cigarette uses pig parts to make a more "healthy", lung-like filter. Some frozen beef steak is made with beef bits glued together with pig fibrinogen or "meat glue". Some collagen injections for facial rejuvenation come from pigs. Pigs are also used to make soap, train brakes, fine bone china, and bullets (not silver, according to the picture...), and more than one hundred other things. They're amazingly ubiquitous, pigs, and floating in China's rivers too.

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Some related posts include Avian Flu In China (2005); Streptococcus suis in China (2005); a note on the heparin adulteration (2008) the H1N1 pandemic - (2009), and here.

Part III: "Do The Inuit Know Something That North Carolinians Don't?"

Polar bears are the largest carnivorous land mammal, yet they can look so cute in pictures -- fuzzy cubs playing in the snow, peering out with little black eyes -- or majestic adult bears floating on pieces of iceberg, fearsome yet vulnerable. Long part of the Inuit culture, the bears live on the polar ice and hunt seals - for decades, the Inuit hardly ever encountered polar bears. But these days they've become dangerous nuisance in villages. Scientists predict that two-thirds of the polar bears will be gone by 2050 due to rapidly melting sea ice. Concerned about their plight, conservation groups have taken them on as cause. Coca-Cola has made the polar bear a mascot as friendly-looking as Winnie-The-Pooh.

Polar Bear
by Louis Agassiz Fuertes (1920) (via Wikicommons, Public Domain).

In March, polar bear trade will be a subject of the 40th anniversary Convention of International Trade in Endangered Species of Wild Fauna and Flora (CITES). Scientists in the U.S., Russia and other countries argue the polar bear (Ursus maritimus) should be up-listed as "threatened to extinction", which would impose greater restrictions on trade. But the proposal has its opponents. Once the inconspicuous lone hunter roaming vast stretches of the deserted Arctic, the polar bear is now swept up in world politics.

In our last two posts, we compared the Inuit nations' acceptance of climate change to the attitude of North Carolinians in the United States. The state's leaders dogmatically deny science, then depend on federal and state money and technology to help them recover quickly after frequent hurricanes. The Inuit, on the other hand, can't order-up big Arctic snow-makers and magical Zambonis to build-up and resurface collapsing tundra. They've long been adapting to environmental changes, from DDT in their food sources to the effects of climate change that cause ice and fish and elk and berries to disappear before their eyes. Unlike U.S. politicians, the Inuit joined scientists in force last year to urge stricter carbon emission regimes at the Doha talks.

The Inuit refer to anyone south of the Arctic as a Southerner, as in: "Southerners tell us our food has mercury, slow down eating it... If our food is contaminated we will be affected, but we have little choice." To them, North Carolinians are southerners, most scientists are southerners, and in fact we're all southerners. Imploring us to change our carbon emitting ways, they'll say: "We cannot exist purely by making money, if we do not have our environment we do not survive..."

Southerners' Impositions

But it's not as it appears, a fairy tale about the wisdom of the doomed natives versus the cavalier ignorance of southerners, strip-mall blazing our carbon emitting ways across earth. As we pointed out about the Tuvulans in a climate change story years ago, it's never so simple. It's true, North Carolinans ask Congress to roll back the law that says buildings erected on beaches can't be covered by federal insurance; and it's true that the Inuit sometimes agree with scientists. But ask the Inuit about the polar bears.

Actually you don't have to, the Inuit will tell you. For background, in 2008 The US Fish and Wildlife Service put the polar bear on the Endangered Species list as a "threatened species" based on studies of polar bear population counts and rapidly melting Arctic ice. But the Inuit consider themselves custodians of the polar bears. Part of their heritage, the bears also feature in lucrative hunting businesses. The Inuit reject scientists' predictions of the polar demise. "Southerners often have a narrow perspective, based only on studies..", one man said. Others say the polar bears are endangered by the scientists themselves:

• "It's Southerners, meddling with caribou, polar bears and whales that endangers animals. This handling and tagging is what harms animals. Wildlife biologist are the ones endangering wildlife."
• "The bears are entering our communities because they can't hear. Helicopters are damaging their hearing and now they hunt by smell alone. That draws them into our villages."
• "Bears that are tampered with and handled or tagged will act aggressively, break into cabins and destroy snowmobiles."

Hungry Polar Bears

Males polar bears weigh 1,000 - 1,700 pounds (250-771 kg), so encounters in villages can be frightening. One man out on his snowmobile checking his fox traps one day, when, as it seemed: "a snowdrift alongside the trail reared up and became a large polar bear...". The bears will stalk children and kill sled dogs. Residents of Hall Beach, Nunavut, Canada grapple with this problem on a daily basis, as a local paper recently reported. The mayor explained that bears wander hungrily into towns when they smell walrus meat stored underground to age and ferment. After reading the article, citizens from other Inuit towns wrote in offering suggestions like building community storage lockers. One commented: "We are seeing bears everyday here also (Arviat). Lots of bear patrol and lots of rubber bullets. Put your meat caches away, pick up the seals from your yard. The bears will eventually move on."

Polar Bear Warning, Longyearbyen, Norway, via Wikicommons.

So while some Inuit blame the scientists for the disappearing bears, the presence of all the marauding bears has other Inuit doubting the scientists about polar bear population decreases.

In their insistence that polar bear populations are healthy, the Inuit are joined by people who don't accept the science on climate change. Denying the polar bear is in danger goes hand in hand with denying climate change, as in, the ice is not melting therefore the polar bears are not disappearing, or vice versa. Frequently, they'll say that populations have increased since the 1950's or 60's or 70's'. But scientists point out that polar bear counts back then were unreliable and that laws curtailing hunting helped sustain populations. In addition to making up their own polar bear counts based on mythical estimations of previous counts, they make up other "science" too. The say the polar bear will adapt, for instance, as if adapting was more like shedding a sweater than evolving over thousands of years.

It's fair to say that getting accurate counts of bears is challenging. The same features that allow bears to sneak up on seals and lunge at unsuspecting snowmobile riders also make them difficult to count by some methods. Last year the Nunavut government did an aerial survey that many claimed showed bear populations growing, and the Nunavut government also increased their hunting quotas. But they used different survey method from previous surveys, so no comparison could be made. Further adding to the complexity of it all there are 19 subpopulations of polar bears in five nations, not all equally imperiled.

Regardless, scientists don't disagree about the species' fate. Ice that's disappearing faster than scientists predicted means that climate change will catch up with today's already shrinking polar bear populations. Scientists estimate that there are about 20,000 bears left. Each year about 600 are hunted by the Inuit in addition to what's taken by poachers.

Polar Bear Economics

With predictions that two-thirds of the population will be gone by mid-century, prices for polar bear hides have skyrocketed. Of course, as demand increases and supply decreases, the Inuit see opportunity.

In their quest to deal with the polar bears on their own terms, the Inuit have found some odd bedfellows, as people usually do in these situations. For example in Alaska U.S., when the U.S. Fish and Wildlife Service designated 187,000 square miles of land as protected critical habitat for polar bears, Alaska's native groups (not Inuit) joined oil and gas interests and the State of Alaska and successfully sued to stop the plan.

As for the Inuit, to protect their hunting interests, they vehemently oppose up-listing the bear in the CITES regime, contrary to what his recommended by the U.S., Russia, and other countries. They say: "the Inuit have been directly witnessing the effects of climate change in the Arctic...and are observing more Polar Bears than ever before..." Scientists dire predictions about polar bears, they say, are "claims not based on reality and fact but on misinformation and fear mongering." Joining them, the World Wildlife Fund doesn't support the CITES ban, calling it a distraction from the main goal of mitigating climate change.

In addition to protecting their hunting businesses their also trying to keep hungry bears out of their villages, with the help of some big companies. The town of Arviat, Nunavat (pop. 2,800) has built a fairly elaborate system for bear control. Electric fences help keep bears out of places like dumps and chained sled dog areas. The town pays someone to ride around the perimeter from October to December on an ATV from 12AM to 8AM every day to chase away polar bears. The program is a World Wildlife Fund initiative funded by Coca-Cola. The company has put millions of dollars into various polar bear conservation initiatives. So when it comes to climate science and economic self-interest, do the northerners and southerners have more in common then they would think?

You can look to the Olympics to see records broken, or you can experience everyday excitement records set by 2012 global temperature highs, flooding episodes, Greenland ice melt, weather catastrophe insurance losses, and millions of people displaced by extreme weather and climate change. Everyone's worried about this, despite what you hear - even the media.

Climate Change Media Fail?

The poor besieged media. As newspaper income plunges, papers continue to lay-off local reporters, publishers contract workers who mine US databases while based in the Philippines, and armed robbers attack journalists who still have jobs - even in the US. Now this: The Natural Resources Defense Council (NRDC), Media Matters, Huffington Post Green, and others accuse the media of ignoring the link between climate change and weather catastrophes. Said Media Matters:

Illustration by Neil Babra.
Used with permission.

"The major television and print outlets largely ignored climate change in their coverage of wildfires in Colorado, New Mexico and other Western states. All together, only 3 percent of the reports mentioned climate change..."

Huffington Post Green wrote:

"The media just might be starting to see the obvious link between climate change and extreme weather...Given the extreme weather we've been seeing lately, it's becoming (finally) clear to many journalists that we have a trend in our weather patterns"

It's true that many meteorologists don't believe human activity causes climate change. Perhaps it's a job-securing stance, since many work for large energy interests, although in 2010, three-quarters of meteorologists polled said they hesitate to talk of climate change because they fear "audience backlash".

Scientist Backlash

Also, let's not forget, scientists recently berated reporters who linked weather with climate change. And it was just 2005, when scientists were insisting people saying "climate change", not "global warming", because saying "global warming" could lead people to think that every time a snowstorm blew through there was no global warming. Reporters generally went along with this reasoning, which in the best case, added confusion and nuance in the face of tremendous anti-warming propaganda, and in any case, looked mightily like "doubt". Nevertheless, responsible reporters would stress after every hurricane, flood, or heat wave that no one event could be attributed "climate change". In July, 2010, for instance, Time wrote:

"Just as the record-breaking snowstorms of this past winter on East Coast didn't disprove climate change, a record-breaking heat wave doesn't seal the deal either. Weather and climate aren't the same thing. To use a World Cup analogy (which allows me to link to more Lego football, this time in German), it's as if the players on the soccer pitch represent the weather, and climate is the team manager."

If sports comparisons didn't click with you, a HuffPo reporter came up this:

"...think of weather as a one-night stand. Then climate would be raising the kid resulting from that night for the next two decades. One immediately leads to the other, but the two are completely different phenomenon. And that is why we have two distinct fields of study: meteorology and climatology."

Pick your analogy. As Jeff Masters of the Weather Underground summed it up when critiquing Al Gore's movie "The Inconvenient Truth": "I was glad to see that he didn't blame the heat wave on global warming--he merely said that more events of this nature will be likely in the future."

This is still the message, and it may seem clear as a cool autumn morning to you and me, but perhaps broadcasters, in their nightly frenzy of hair spraying, parka donning, and witness interviewing, view it as an unnecessary cluster of crazy-making detail and nuance. 30 second spots depend on very cut-and-dried events. Show yellow tape and police carrying evidence-bags. Say murder. Show smoke and flames. Say fire. Show devastating weather. Say global warming. No, say climate change. No, say it isn't necessarily climate change, but as scientists explain...

Worry For the Animals

So could we imagine this is why so many news shows default to saying "heat wave" while they turn the cameras on - zoo animals? For the past few years news shows have produced thousands of stories and pictures of tigers and sloths, elephants and porcupines cooling off in the heat -- cutely eating popsicles, playing in pools, and being attentively hosed down by zookeepers. Zoos make the incessant heat a selling point:

I suppose trying to get in cheaper by saying "global warming" would ruin the spirit of it. As the climate changes, one can find instructional videos on how to make "tiger popsicles" - frozen treats from various ingredients - real blood, real chicks, Gatorade, and water. All of this, plus more. Reporters who could focus our attention on impending calamities instead spin magical bedtime stories. As the Weather Channel reported recently:

"At the Houston Zoo a snow day offered heat relief for animals for the second summer in a row. TXU Energy provided the man-made snow while zoo keepers provided the fun by building snowmen for the elephants..."

Fun.

Redefining Nonfiction

Where to turn for science? While snowmen for the elephants passes as news, Discovery Communications, "the world's #1 nonfiction media company", recently re-aired an Animal Planet show about mermaids so convincing in its nonfictioness that the the National Oceanic and Atmospheric Administration (NOAA) first fielded a barrage "is it true?" phone calls, then felt compelled to issue a press release asserting that mermaids weren't real.

In response, Discovery Channel bloggers either defended the show as masterful theater "like the Blair Witch Project"; or baited readers: "The real question is, what do you believe?" Readers ate it up:

"I totally think this is real. not the magical mermaids we hear about from drunk sailors but the evolved kind. i am a christian and dont believe in the whole evolution thing, but what we have here is fact..."[sic]

The comment could be that of a child who won't let go of Santa (or someone aping a child), but theirs is an all-ages fantasy-reality mix-up. When adults experience derechos, or see walls of flame like nothing firemen have ever witnessed, they exclaim, "just like a movie!" When people hear about global cooling, or explorers "seeing mermaids" they want to own that "fact".

At Least This is Where we Focus our Despair

This summer's extreme weather hints that we're losing our cavalier climate wager. It's not only scientists who see the tangible repercussions of wantonly shoveling greenhouse gases into the atmosphere. Frequently, people show open concern about climate change. More people scorned Animal Planet's "Mermaids, Body Found", than declared undying faith in mermaid evolution. Recently, even some industry paid denialist-researchers seemed compelled to acknowledge long documented anthropogenic warming.

Perhaps we're collectively realizing that although the need for action on climate change may be a tough pill to swallow, there's no escape. Blood popsicles aside, there's not much to see at the zoo on very hot days. Zookeepers say the heat makes the animals "tired in the afternoon". Polar bears and sea lions slip into pools, while other animals are "allowed to return to their 'backstage bedrooms' to cool off".

Hopefully, although we fret over every poll reporting people's unexplainable trust of meteorologists, the same polls show that more people trust scientists - 74% - than any other source.

Overall, it seems that people are eeking away from climate denialism, which is good, because in the end, climate doesn't care whether we *choose* to believe physics and chemistry. Sea level still rises when North Carolina politicians outlaw it. Oceans continue to heat up when those same politicians 'compromise' with a moratorium on current science that local headlines call "a blend of science". So escape, as you will be invited to, to prince and princess fairy tales, to lands inhabited by unicorns, mermaids, and talking tigers, or to soothing climate tall tales. But remember, that science, wondrous as it is, doesn't "blend" with fairy tales like a scoop of protein powder in a mango ice cream milkshake.

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NOTES:

Thanks to Neil Babra, illustrator, writer, etc. for letting us use his illustration of "Life of Pi".

We read Yann Martel's magical book "The Life of Pi", on a train in India several years ago over a couple of sleepless nights. The movie, by director Ang Lee, will be released in November/December, 2012. The studio recently posted previews online.

We wrote about TXU in "TXU-Greenmail?"

We wrote about the hypocrisy of city officials who after a disaster denounce people who move into disaster prone areas, but before a disaster prevent precautionary measures like building moratoriums - for economic growth reasons, in FEMA and Disaster

We wrote about climate change awareness and communication in "Sea Change or Littoral Disaster?"; "Climate Change, Fueling the Debate", and many others.

We wrote about science TV programming in "Science Programming: Penguins and the Lethal Cannon"; and animals portrayed in media in Mongooses and Snakes - Combat Training; and "March On Penguins", and others.

Does International Public Health News Compel Us to Cheer Enthusiastically?

Everyone wants drugs to cure diseases. Everyone wants vaccines to prevent them. And in a world of urgent international public health problems, what is more publicly urgent then developing solutions for AIDS or malaria? Positive news on this front is always welcome, and in line with that, you don't win popularity points by sticking pins in up-beat public health reports, results, or clinical trial data. Popular science journalists generally talk about cool, politically neutral science, or slick technology, or brilliant research successfully advanced to save lives; they write about winning clinical trials that will end scourges, any scourge - cancer, AIDS, Hepatitis, obesity... Good news!

Cheerful news, like recent headlines highlighting research showing a vaccine for malaria that may be 55.1% effective. NPR headlines enthused "Vaccine Slashes Infection Risk By Half", whereas a more cautions USA Today said: "Malaria Vaccine May Have Potential to Save Millions".

The RTS,S/AS01 vaccine is a decades long effort, now a collaboration between The Gates Foundation funded PATH Malaria Vaccine Inititive (MVI) and GlaxoSmithKline (GSK). The partners recently published interim results in the New England Journal of Medicine (NEJM)² and presented their results to the media. By all accounts, the Phase III trials delivered very good news.

The Mosquito Drawing by M. R. Villarreal can be found at Wikipedia ¹

But What Does "May" Mean, in "May Save Millions"?

No one could say that Bill and Melinda Gates haven't changed the face of international public health. Mr. Gates leads a relentless campaign pushing the power of vaccines; he berates governments that don't vaccinate enough people; and he effectively leverages the media to deliver his messages. Last year the Gates Foundation held a fund-raiser hoping to collect $3.7 billion from governments and instead received $4.3 billion. As Global Alliance for Vaccination & Immunization's (GAVI) chief executive put it, "Bill was a little like a poker player who put a lot of chips on the table and scared everyone else off." Perhaps Gates is more a bridge guy, but point taken.

Given this, who would write-up the newest Gates Foundation news as, "a vaccine shown to be at best 44.9% ineffective in a half-done clinical trial"? No one. With the intense drive for upbeat news, I credit USA Today for their cautious "may save millions". But if you look more closely, for instance read the editorial accompanying the NEJM report³, or listen to scientists around the web and in journals like The Lancet ⁴, or pay attention the malaria researchers interviewed by "Nature News⁵, the caveats of this recent malaria study grab your attention:

1. First, there's the announcement itself. The data released is interim data; the full results of the malaria trial will be released in three years. Interim data releases are not unprecedented but past experiences, for instance with an AIDS vaccine, caution us against overly enthusiastic receptions for incomplete trials.
2. The interim results were reported for children aged 5-17 months, but the target age group is infants aged 6-12 weeks. In other words, these results don't address efficacy of the vaccine for the target group.
3. NEJM reported that at 12 months, the vaccine reduced episodes of malaria by 55.1%. However a US military scientist working with Sanaria, a competing vaccine maker, told Nature News that RTS,S actually offered only 35-36% protection 12 months after the vaccine. It appears that the efficacy of the vaccine might wane over time.
4. Although the reports noted reduced mortality, another scientist emphasized to Nature News that the data didn't support that announcement. Scientists hypothesize that the vaccine may just delay infection.
5. Although the vaccine reportedly cut severe disease in older kids by 47%, combining that data with the available data of the younger kids gave only a 34.8% decrease. This suggests the data for the target group of younger kids might turn out lower than reported in these interim results.
6. In addition, incidents like convulsions and meningitis might be more frequent in the vaccinated group.

These might not be showstoppers. For instance researchers hope that booster shots will improve efficacy. But what if in the end the much touted vaccine turns out not to be a vaccine but just another shot? Scientists and public health workers concern themselves with such non-trivial caveats. What's behind the apparently waning efficacy? How is the adjuvant effecting immunity? Science is exacting even when media reports are not. People also have underlying concerns about what's driving policy, science or the press releases?

Is Marginal Progress, "Success"?

Two of the people interviewed by Nature News are affiliated with Sanaria, a company that is also developing a malaria vaccine. Sanaria just released their own news of a Phase I malaria vaccine study testing the safety of a live attenuated virus. Nature interviewed the first author on the Sanaria study published by Science, as well as the CEO and last author on the Science study. They were complementary of the RTS,S effort, if somewhat critical on some points.⁶

It's worth noting the history of the Sanaria vaccine, to give context to the executives' comments and perspective. Like the RTS,S vaccine, Sanaria's vaccine is an extremely expensive, tricky, and laborious endeavor. The underlying idea for seems promising, but for starters technicians must painstakingly dissect out the salivary glands of mosquitoes in order to develop the vaccine.⁷ It's unclear how this can scale.

On top of the laboriousness of vaccine development, once the vaccine was made it didn't seem to work. In their first clinical trial, Sanaria injected 44 subjects. 42 people got malaria and 2 didn't, a 4.5% "success" rate. These subjects might have been better protected from malaria lounging in a malaria endemic region in mosquito-infested huts, but the Sanaria execs quickly pointed out that it wasn't the stunning failure it looked like, rather, it was a trial that "yielded positive results" -- as their press release put it (without including relevant numbers). The company is buoyed by such "success" and primed for the next controversial⁷ phase.

Because vaccines promise a silver bullet solution to disease, at the moment, every possible vaccine holds promise, since we have no viable one.

Sanaria's position as competitors doesn't invalidate their commentary on RTS,S (complementary as well as critical), since Sanaria executives voiced reservations shared by many others. An editorial in last week's "The Lancet indicated that the release of unorthodox partial results seemed to be more politically than scientifically driven. Diplomatically, The Lancet editors wrote: "although the latest findings are encouraging, we look forward to the full results of the RTS,S/AS01 trial in 3 years time."⁵

When There is No Treatment, What Does A More Effective "Treatment" Look Like?

Will the upcoming younger cohort data meet World Health Organization (WHO) goals of 'Protective efficacy of more than 50% against severe disease and death lasting longer than one year'? ⁵ This is an important question. Vaccine experts usually aim for 80% or more efficacy, and representatives for PATH say they hope to get there eventually. So then, does that make this vaccine a beta version?

Is all this media hoopla deserved for a beta version vaccine? A physician working in Africa distributing bed-nets warned against statements that might mislead people "to overestimate the impact of any single new intervention", in a comment at NEJM. Acknowledging this commenter also has vested interests doesn't detract from his message. 75% of the MVI/GSK study participants used bed-nets. But would people in real-life discontinue the more cumbersome bed-net efforts with a vaccine on the horizon? Will bed-nets still be funded with a 50% effective vaccine? A 30% effective vaccine? If you're a mom and your kid gets a vaccine that is 50% effective, what precautions do you then take to prevent infection? Does a 50-50 vaccine make your life better?

The tremendous investment in vaccines, both in terms of money and expectations, shouldn't slow other prevention and treatment efforts. But realistically, we don't have unlimited resources. It would be naive to think that the prolonged difficulty of vaccine development, the immense investment, and lack of a viable alternative don't influence funding and policy decisions.

Some of the problems scientists identified with this vaccine trial have persisted for years. In this 2006 book chapter recently released online, an economist analyzes RTS,S vaccine data of previous trials (PDF) (HT Nature News⁵). He reports on waning efficacy; and questions how the public health community decides which vaccine candidates merit further investment. 5 years later, as the latest trial barely noses over the 50% bar, we grapple with the same issues and questions he raised back then, but billions more dollars have been invested.

Which leads us to wonder whether mid-trial fanfare primes us react to whatever future malaria vaccine news comes along with knee-jerk positive determinism? What if the younger data shows only (say, hypothetically) 30% efficacy? Would we ever abandon the effort? As more and more money gets invested, do decision makers begin to act less rationally?

Media reports may boost stocks, may raise money and may discourage competitors, but in the end, the science behind the vaccine, the science that's supposed to underpin public health decisions, is fussy and complicated -- caveats matter. After all, you're asking people and governments to donate tens of billions of dollars, and you're promising 7 billion people that your vaccine will keep millions safe.

Tough Economy for an IPO?

Can we push for an end to malaria as if we were trying to put a computer on every desktop? Does this big money, big marketing, big media approach to public health that some find so jarring actually work? I'm not saying it doesn't. Perhaps it will become a more accepted way of developing medicines and vaccines. Maybe public health needs exactly this kind of paradigm shift.

But even if a 40% or 50% effective vaccine is acceptable from a public health perspective, once this vaccine is developed, governments will still need to consider costs. In this economy, some ask, how much will governments shell out for a vaccine with a 50% efficacy rate? Can you and should we market vaccine with lots of pre-release fanfare to push governments towards buying the vaccine?

Asked about cost per vaccine, GSK wouldn't answer directly, but stressed how the company will reinvest all the proceeds to improve the vaccine. Shares of GSK rose slightly on the RTS,S vaccine news, and shares of biotech company Agenus which makes the RTS,S vaccine adjuvant rose from $.48 prior to the announcement, to $2.80 (which got Agenus re-listed by the SEC). All things that may influence decisions. However when questioned about the unconventional data release, PATH's MVI director didn't mention politics, billions of invested dollars, stakeholder expectations, or the saved Massachusetts biotech companies. He said: "we felt it was our scientific and ethical duty to make the results public when they become available."⁵

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¹ The mosquito drawing is by Mariana Ruiz Villarreal. It is the anatomy of a Culex pipiens, a vector for malaria. This image was selected as Wikipedia's Picture of The Day for 10 September 2010.

² The RTS,S Clinical Trials Partnership; First Results of Phase 3 Trial of RTS,S/AS01 Malaria Vaccine in African Children, October 18, 2011 10.1056/NEJMoa1102287

³White, N. F.R.S.; A Vaccine for Malaria October 18, 2011 10.1056/NEJMe1111777

⁴Editorial: The Lancet, Volume 378, Issue 9802, Page 1528, 29 October 2011, doi:10.1016/S0140-6736(11)61659-0

⁵Butler, D.; Malaria Vaccine Results Face Scrutiny: Published online 26 October 2011, Nature 478, 439-440 2011, doi:10.1038/478439a

⁶Epstein et al: "Live Attenuated Malaria Vaccine Designed to Protect Through Hepatic CD8+ T Cell Immunity": September 8 2011 Science 28 October 2011: Vol. 334 no. 6055 pp. 475-480 DOI: 10.1126/science.1211548

⁷ Kappe1, S., and Mikolajczak1, S.; "Another Shot at a Malaria Vaccine". Science 28 October 2011: Vol. 334 no. 6055 pp. 460-461 DOI: 10.1126/science.1213934

⁸ Farlow, Andrew.; "A Review of Malaria Vaccine Candidate RTS,S/AS02A", Chapter Three of The Science, Economics, and Politics of Malaria Vaccine Policy, a report written in 2005 and 2006 and published 14 April 2006 and January 2010. Department of Economics, and Oriel College, University of Oxford.

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We previously wrote about Phase II Clinical Trials of the RTS,S vaccine here. We wrote about US funding for malaria here and here; vaccine strategy here; malaria prevention here and here. We've also written frequently on international public health, including the development of a AIDS vaccine, here and here.

The Map

Acronym Required previously wrote about parents who self-vaccinate in lieu of getting vaccinations, a sort of barbaric hazing for this era's unlucky children. And while some people in the West shun vaccines because they think they're dangerous, people in Africa shun them because they suspect shots are a Western plot to kill them. The US shockingly fanned the flames of the vaccine avoidance trend when it faked a vaccine campaign in Pakistan in order to to get access to Osama bin Laden. Meanwhile, tragically, people continue to die because there aren't enough vaccines to protect them.

When people refuse vaccinations, we lose herd immunity; microbes have get a chance to mutate; and of course people get sick and die. The trend has contributed to large outbreaks of whooping cough, mumps, chicken pox, and measles world-wide, as well as polio, typhoid fever, meningitis and hepatitis A. Now there's a great map Vaccine-Preventable Outbreaks, put out by the Council on Foreign Affairs, so you can see the impact of this all.

(The vaccination map ranks as one of my favorite maps, as does Newspaper Map.¹)

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¹ Granted the UI's sometimes not entirely there

We previously discussed vaccinations in Maher's Mainstream Media Anti-Vaccination Campaign; The Wild Wooly Internet; Polio Vaccines, The End of a Scourge?; Vaccine Development For Developing Countries and others.

Mundane Data Breaches

Mistakes usually occur after a conflagration of seemingly small, quotidian errors. Often no one seems to own the problem, it's simply a "glitch". In our technological world, we're quite accustomed to glitches and large data integrity losses. We stick the newly issued credit card into our wallet before even knowing (or caring) about the details of why it was replaced.

Technology "glitches" are not to be trifled with though, they shut down metropolitan train systems, admit ~32,000 students instead of ~16,000, and compromise the most private data of 31,000 people, 100,000 people, 4 million people...They're just boring news.

In medicine, repercussions from computer glitches make train outages seem trivial. From August 2008 through February 2009, a computer glitch in the Veteran's Affairs record system tied patients to the wrong medical records, leading to incorrect dosing, delays in treatment, and other errors. A computer glitch in another case incorrectly cleared women of breast cancer after mammogram screens showed they actually had tumors.

Bodily Injury and Death

Imagine the most unimaginable "glitch" and it's probably already happened. In one, famous 1980's case (PDF), cancer patients undergoing radiation treatments from the Therac 25, manufactured by Atomic Energy of Canada (AECL), intermittently received radiation doses 100X the prescribed dose. The resulting radiation could burn through the torso and leaving a burn marks on the victim's back. The trauma from radiation trauma killed some patients within weeks.

An investigation of the Therac 25 history showed how multiple errors begot fatal injuries. The high doses occurred when a technician first entered an "X" to incorrectly select a certain dose of high beam photon mode; then "cursor up"; then "E" to correctly select a certain dose in the electron mode; then "Enter", all within 8 seconds. This accidental series of keystrokes activated the high beam instead of the low-beam, but the high beam diffuser wasn't in place, so intense radiation burned ears, breasts, groins, clavicles.

When it happened to one patient, the sound system between the treatment room and the operator wasn't functioning. He had been treated multiple times in the past, so knew something was wrong when as he lay on the table for treatment he suddenly heard unusually loud noises, saw a flash of light, and felt a searing burn. Pause. Then it happened again. The technician only learned something was wrong when the patient pulled himself off the treatment table and began banging on the locked door.

Because the burns happened infrequently, because the error messages were imprecise or oblique, and because technicians, engineers and managers couldn't believe the Therac 25 was malfunctioning, operators continued to injure patients until 1987. In a letter to one hospital physicist AECL explained that their machines couldn't be malfunctioning because of modifications that improved the "hazard rate" by "at least five orders of magnitude! With such an improvement in safety (10,000,000%) we did not believe there could have been any accelerator malfunction."

A glitch -- an "accelerator malfunction"? Or errors attributable to peoples' actions?

Errors Upon Errors

The persistence of medical physicists at several hospitals quickened Therac-25 problem solving, but clumsy safety processes, a reluctant manufacturer, and slow FDA action impeded resolution. In the final analysis, a long list hardware, software, quality assurance and process issues such as these, contributed to the injuries and fatalities:

• The hardware and software were built by two different companies and only tested when the system was installed in the hospital.
• Code wasn't independently reviewed.
• Some engineering errors permitted overrides after malfunctions, other errors allowed for safety check bypasses.
• The FDA hadn't thoroughly tested the Therac 25 (a medical device) because previous models had a reasonable safety record. But the Therac 25 had undergone numerous changes, for instance manual control systems transitioned to software controlled systems.
• The company recalled the machines at one point, but because the first patients didn't die, the FDA under-classified the severity of the problem. But an intense radiation beam to the head could result in a more lethal dose than another body part, so later incidents were fatal.
• The medical physicists and the FDA made recommendations to AECL. The company complied with some safety directives, but ignored others.
• Technicians incorrectly diagnosed issues, for instance in one case a problem was wrongly attributed to a switch. The company replaced the switches. The problem recurred.
• AECL wrongly told some institutions who reported incidents that theirs was the first report. So each hospital thought their case[s] unique.

Elusive Intangible Injury

In the Therac-25 case, each contributor -- a software programer, an engineer, a technician, someone in quality assurance, a safety officer, staff at the FDA, a company executive -- made a small mistake. Lawsuits, FDA investigations, out of court settlements, and eventually national media exposure brought the case attention. The entire compendium of errors in the Therac-25 case is so classic and dramatic that it's used as a case study. But what about computer glitches where less harm is done to fewer patients over a shorter period of time? Or what if so many are hurt - millions, say - that the plight of any one individual gets diffused? What if the evidence is unclear - there there are no burn marks on the front and back of the body?

Can injured patients be made whole? In Therac-25 cases, the lawyers of families of patients with terminal cancer argued that patients died sooner and suffered more because of their Therac-25 injuries.

What if doctors delay cancer treatment and the person dies an early death from breast cancer, as in the case we mentioned above? What can lawyers prove, how can victims be compensated? In the case where Veteran's Administration patients were matched with the wrong record, the VA denies that any negative outcomes. No harm reported, no harm done?

What about still "lesser" glitches, everyday database breaches?

Patients: Students of Misfortune?

The US HIPAA laws protect a person's medical data, file, or record from being accessed by an unauthorized person. Therefore someone couldn't enter your doctor's office, grab your paper record from the thousands stuffed floor to ceiling, and forward it on. Sometimes the law seemed overly strict. In the name of HIPAA, unmarried lifelong partners of hospitalized patients were forbidden from learning about their loved one's health.

Although HIPAA has provisions for electronic records, today's larger, more frequent mishaps leaves this regime seeming quaint. Consider the recent data breach at Stanford, where the emergency room records of 20,000 patients were posted on line. A New York Times article details how it happened. One billing contractor dealt with one marketing contractor, who interviewed one potential employee who leaked the data. The marketing contractor received got the data from Stanford Hospital, "converted it to a new spreadsheet and then forwarded it" to a job applicant, challenging them to

"convert the spreadsheet -- which included names, admission dates, diagnosis codes and billing charges -- into a bar graph and charts. Not knowing that she had been given real patient data, the applicant posted it as an attachment to a request for help on studentoffortune.com, which allows students to solicit paid assistance with their work. First posted on Sept. 9, 2010, the spreadsheet remained on the site until a patient discovered it on Aug. 22 and notified Stanford."

Would any of these patients know if they were harmed? What if they had some condition that an insurance company, employer, teacher or other would use to disqualify them as in this Stanford case? Will the class action lawsuit that's filed make them whole? What if someone recognized the value of such data and stole it, as in a recent Orlando, Florida case where hospital employees forwarded emergency room data for over 2,000 accident victims to lawyers? In the old days, hauling 20,000 patient files out of a doctor's office unobtrusively would be a challenge. Not so much with electronic data, all you need is a glitch.

HIPAA specifies that each responsible individual can be fined $250,000. Will the job applicant who outsourced her Excel Worksheet problem to StudentofFortune.com pay $250,000? The marketing contractor? The billing contractor? Stanford?

Often the public has no idea about medical injuries resulting from glitches, physical or otherwise, just as they didn't with the Therac-25. If someone dies, as in the Therac-25 case, perhaps the news will get out. But the more common the incidents, the more data is lost, the more are made to seem benign, the more harm is done, the less we learn about any particular incident.

You can read all this as a depressingly negative outlook on technology and health, but my view is different. Injuries and deaths due to vague "glitches" can be prevented by fixing small, but very tangible errors. The outsourcing of everything has increased the number of contractors, and with all these people, looser interpretations of rules and diffuse culpability. But it's not just contractors. Many employees are also very cavalier about data. Walk-in or call any major medical center and you will see glaring errors. Fixing such errors, attention to detail, and yes - support for regulatory oversight, can reduce harm.

A recent Financial Times article reported on a £1.6 million geoengineering trial launched by SPICE (Stratospheric Particle Injection For Climate Engineering) at a British Science Festival. In "Trial Seeks to Hose Down Warming Climate", Clive Cookson describes how the company aimed to test the feasibility of cooling the planet by creating atmospheric conditions that simulate volcanic activity. Beyond the trial:

"A full-scale global cooling system would cost more than £5bn and take two decades to install, said Hugh Hunt of Cambridge university, another team member. It would require 10 to 20 gigantic balloons, each the size of Wembley stadium, attached to ships distributed in the world's oceans and pumping 10m tonnes a year of material into the stratosphere.""

Geoengineering - How Far Have We Really Come?

Interesting enough. We often hear of plans for geoengineering. Certainly weather modification has been around for so long that when a Texas licensing board in charge of approving projects convened recently, one member suggested that the technology was so routine the licensing board should disband. Although we know generally about cloud seeding and futuristic geoengineering, we don't often hear about experiments with some of the more sophisticated climate technologies, which makes the FT article interesting.

But also interesting, was a letter to the editor in response to the article, published by the FT a couple of days later (Sept. 15). In it, the President of an American aerospace company wrote that the "trial" reported by FT was old news. He explained that injecting particulate matter into the atmosphere has "been in full swing at it for nearly a decade...", and continued "Dozens of aerospace, defence and technical companies like ours have been advising into the initiative for many years. He explained:

"...[a] series of tests to create a polymerised and ionised mixture of certain metals, including aluminium, barium, thorium and selenium, among other contents, was perfected and tested in US facilities. A joint public-private operation, initially called "Cloverleaf", was operationalised and subsequently supported by US state and federal weather modification legislature.

Throughout the continental US, dozens of tanker and other aircraft are daily applying thousands of gallons of aerosol nano-particulates that serve several objectives, including the purported ability to reflect UV radiation. Similar operations are being conducted in Canada and parts of Europe.[emphasis ours]

What the actual secondary effects of this operation are, including human health impacts, are currently unknown or undisclosed. The Bristol university team may be wise to "hose down" those facts as well. In the meantime, anthropogenic climate impact is in this regard, quite real indeed."

REALLY?

Before the Financial Times boldly printed this editorial, people firmly relegated "Cloverleaf Operations" to conspiracy theory territory. True, thousands of YouTube videos devote bazillions of hours to documenting "chemtrails" streaked across blue skies -- often accompanied by music of the producer's choosing, making them no less boring.

And true, hosts of crackling talk radio shows tell audiences that their guests will "risk death" if they divulge a huge secret government chemical spraying operation, and then of course their guest divulges the secret.

A search for "chemtrails" on YouTube actually turns up 29,200 results. I have to say, I had no idea this was as big as it is -- have you heard of this chemtrail thing? It's easy to ignore, unless, say, as I have experienced, one or more of your previously rational friends goes through some weird mid-life crisis, and with testosterone flagging (my theory), veers off bizarrely denouncing the rational in favor of numerology, Mad Hatter utterings, and chemtrails. How else would you know, unless you read the Financial Times editorial section?

Fact or Fiction?

Of course some people -- the subset who espouse chemtrails and read the Financial Times editorials -- were elated: "PROOF!", they crowed on their blogs. But try to find one other mention of such a program in any other respected publication -- one whose mission isn't to divulge "scary secrets your government's hiding from you". Given this, the Financial Times editorial seems like a rather casual airing of the news -- and it is news.

It must be true, you say, it's the Financial Times! Many people attest that the FT and its sister publication The Economist do an above respectable job covering science. I really like both publications, but they both publish quite a few "science" articles that are more or less press releases for some company's pie in the sky technology that you've never heard of and will never hear of again. Yes, they have some in depth coverage of science, and sometimes feature British science establishment luminaries like Paul Nurse, but frankly I think their coverage of economics, yachts, and watches is better. The original article on the water aerosol trial was sort of in this in the sky technology vein. But the theme got way more interesting with the editorial.

Existent or Not Existent?

The editorial was written by Mr. Matt Andersson, who signed as the CEO of a Chicago company called Indigo Aerospace. Indigo Aerospace is not listed in Hoover's, so it's hard to guess how much money he makes "advising into the initiative". Or maybe he didn't really mean in his letter that his company was running geoengineering programs but more literally that companies "like his" were. Or maybe his company does advise such initiatives.

Being curious, I easily learned that Indigo Aerospace used to be incorporated in Illinois, where they reportedly consulted to Booz Allen Hamilton, known for its military and government business. But as of May, 2011, Illinois lists the Indigo Aerospace Inc. as "involuntarily dissolved". So then is the corporate entity for which he signed as CEO not in existence anymore? This unfortunately throws doubt on his whole Cloverleaf assertion (at least to us). But why be judgmental? FT wasn't.

But we unfortunately don't know if the FT editorial is credible. If we were the FT editorial team we would do a bit more checking into this story -- really. Now we can only wonder: Do governments drastically change weather patterns, ruin sunsets, and subject us to chemical experimentation, and is this so ho-hum that we only read about it on conspiracy theorist sites, on Ron Paul 2012's blog, and in the editorial section of the Financial Times? It's potentially very interesting news people, more please. Or is it a conspiracy theory, as contended by every state agency, military organization, scientist, urban legend site, and news publication -- except for the FT? Mildly interesting but worthwhile noting. What do you wager?

Science Journalism Debauchery

Has anyone aside from science bloggers had so many rules imposed on them? OK, maybe science journalists. In the 1990's, when the debate over genetically modified (GM) seeds motivated the headline: "MUTANT CROPS COULD KILL YOU" (Express February 18, 1999), the British government attempted to correct the fear-mongering headlines. That didn't work, so to stem future journalistic liberties of that sort, the Parliament tried to subdue the culture that propagated such rumors.

They issued a a lengthy report warning of further journalistic depredation from "the approaching era of digital TV" and the "increasing ghettoisation". (No mention of the internet.) More journalists needed to be "scientists", they said, after surveying GM stories put out by all of eleven UK publications over two days. Only 17% of the stories were written by science journalists, they found, and not any of the commentary came from "science writers". The Science and Technology Committee of the House of Commons, the Royal Society, and SmithKline Beecham suggested punishing future misbehavior, especially for getting the facts wrong:

"media coverage of scientific matters should be governed by a Code of Practice which stipulates that scientific stories should be factually accurate. Breaches of the Code of Practice should be referred to the Press Complaints Commission."

Of course an editor at the Independent responded describing how writers could conquer the facts but still mislead the reader. Thankfully, there's often a compelling counterargument. So in the end, the report's authors settled for a rather bland collection of guidelines dealing with Balance; Uncertainty; and Legitimacy.

And of course while the Parliament fretted about the fate of genetically engineered crops, over at News of The World...

Digital Science Journalism - Publishing Freedom

When science blogging came along it seemed to offer an alternative to the maligned mainstream media science journalism. But despite its growing stature, it too has been besieged by criticism. Some of this came from mainstream media, especially in the beginning.

But interestingly, while traditional science journalism often gets attacked from the outside, online science journalists indulge in lots and lots of self-flagellation. Perhaps this is to be expected from people who labor at the frontier of the often masochistic bench science, replete with high rates of experimental failure. Or perhaps self-criticism makes it easier for science bloggers to generate conversation? Work out their identities? Get traffic?

Of course there's much more to online science journalism then blogging, but I'm going to limit my comments to that. Acronym Required started about seven years ago, and from the rather echoey halls of 2004 science blogging, the medium exploded. Now it impressively fills some of the gaping holes in other science journalism.

We last commented on the state of "science" television programming in 2007 -- and why comment further? The science blogging world offers an amazingly vibrant alternative, filled with witty, reflective, analytical, smart, and generous writers -- especially considering the frequent debauchery of mainstream journalism. Which makes the persistent whine of self-criticism all the more puzzling. Is it some evolutionary thrust gripping science bloggers to impose governing rules on their peers?

This is especially amusing in the context of how blogs started, to augment search. Search itself started in a era that included the (albeit, totally unrealistic) perception of internet as free of boundaries, regulations, and governments. Consider this piece from early 1996:

"We are creating a world that all may enter without privilege or prejudice accorded by race, economic power, military force, or station of birth. We are creating a world where anyone, anywhere may express his or her beliefs, no matter how singular, without fear of being coerced into silence or conformity."

Radical, but the philosophy is actually alive and well among quite a few technologists today.

Search back then was pretty rudimentary, thus the role of blogs. To understand just how rudimentary, look at this old Yahoo page with its awesome user interface. (Accompanied by the great ad with a winking person who looks photo-shopped from two different faces, asking awkwardly: "So, My Yahoo! or yours?".)

My point is, the world in which blogging started was simple. For one, an early blog was often not much more than some geek saying -- "hey I found this cool site": link -- so I'm cool too, right? These "trusted links" made a prehistoric stab at "community" and "personalization" -- because who could trust something called the "World Wide Web", with its random collection of and unknown "links"?

Secondly, through innovation if not mindset, the Internet and blogging celebrated independence from tradition. As the internet expanded, many bloggers took to the medium in defiance of the exclusive world and onerous rules of offline publishing. The audience for blogs in the beginning was a very small group of internet users, frontiersmen strongly connected by their independence, who were by default "the community".

Page Views

As the originators of the real commercial internet intended, soon people realized they could make advertising money on the internet, and "pageviews" became an all important metric. The number of people publishing on the internet grew and bloggers were then advised to "keep it short". This advice about post-length was couched as insight about readers short attention spans. But it was as much about drawing pageviews and revenue. "Keep it short" and the unspoken "make us money" became compulsory over 'make it interesting'.

When Tumblr and Twitter arrived on the scene with truly short-form platforms, some of the same organizations then suggested that blogs could actually be a venue for "long-form" writing. Finally, just as the fashion industry moved away from dictating skirt lengths sometime in the 1980s, people eventually stopped dictating ideal post length. Of course they still told people what to do, they just moved on from making demands on post length.

To Join Or Not To Join

It's my impression that science bloggers find more rules to bandy about than others, but granted, I don't have enough data to swear that economists, say, are really more laissez-faire. I couldn't possibly document all the various rules that science bloggers have proposed for other science bloggers over the years, but to illustrate my point, I'll mention a few.

First there's the question of where to host your blog. Some insist that science bloggers should join a science blogging network. This came about when the number of online science bloggers reached a point where they could actually form a group. Those advocating joining offer compelling reasons -- traffic, exposure, "community". Now, the number of such science blogging "communities" has surpassed our ability to keep track of them. There are still pros and cons to joining of course, depending on your goals, technical abilities, impressions of the different online venues, how your schedule might accommodate blogging, etc. But your agreeable answer to join is existentially far more critical to a potential host than to you. After all, the hosts wouldn't exist without the bloggers.

Of course the notion of "online community" includes many possibilities. Communities can be collaborative, nurturing, educational - great; or, if you've observed them in action, joining such an online science community can be like joining the military, where participants -- "travel to exotic foreign lands, meet interesting and exciting people, then kill them."

Proving Your Worth

Once the blogger decides where to put their blog, a barrage of other considerations and demands will follow. For example, in 2007 bloggers for peer-reviewed research reporting (BPR3) emerged, proposing

"to identify serious academic blog posts about peer-reviewed research by offering an icon and an aggregation site where others can look to find the best academic blogging on the Net."

While interesting as a business aggregation proposal, the blog "Peer-To-Peer" diplomatically commented on the idea, saying it would be impossible for such an icon to assure the "quality of the blog post itself". Or, we might add, to insure the quality of the writer's analysis, the quality of the science journal, the quality of the science research, and so on.

Questions of ethics in science blogging are constant, carrying on from earlier discussions of ethics in blogging and science journalism. Way back in 2003, bloggers started wondering whether they should adopt journalists' standards. Perhaps journalism in 2003 was wrapped in mystique that shrouded realities like "MUTANT CROPS COULD KILL YOU", but the drumbeat of ethics has since trailed science bloggers. I can't see how this could be useful people have written strong arguments noting that blogging wouldn't exist if bloggers weren't ethical. Nor has the whole ethics thing really led to changed behavior as far as I can see, but those who push "ethics" will forever peer over our shoulders.

Still other people demand, as the Parliament did 1999, that science bloggers/journalists only blog about things they know. Quite a qualitative statement considering variations in breadth and depth of knowledge among both scientists and journalists. A comment here provides a good rebuttal to that idea. You could also reason that writing solely about what you know at any moment, like the biomechanics of kangaroo tendons, for instance, despite how interesting that may be to you, might be a good way to become a lazy, narrow minded, outdated, and one bored stiff writer to say nothing of your readers'.

Recently the subjects of anonymity and pseudonymity re-emerged and preoccupied many science bloggers. I'm not going to weigh down this post talking about that, except to note 1) that the discussion has largely revolved around the value and necessity of a particular type of individual authentication, and 2) that the discussion has largely ignored the politics and economics driving such individual authentication.

Other people try mark out precise roles for science bloggers/journalists. Science writers should be "educators", they say, or "explainers", or priests of "how things work". Each such suggestion is an invitation for extensive discussion and cogitation, and naturally other people will vehemently disagree with every proposal. So then why don't bloggers just do what suits them best? Or does the constant criticism and re-definition create "community" (and pageviews)?

Getting The Details Right

We've touched on some general instructions to bloggers about how to blog about science. There are more detailed demands too, aimed at all of science blogging and journalism, as the divisions between online and offline media blur. For instance:

• 2005: Don't use the word "Global Warming": Thus implored some scientists reasoning that people would confuse climate change with their local weather.

• 2006: Don't use big words: So lectured the film "Flock of Dodos: The Evolution-Intelligent Design Circus". The version I saw at Tribeca, 2006 highlighted words used by scientists in dialogue that were "too big", while characterizing Intelligent Design folks as small word people, i.e. comparatively approachable and understandable. It employed character assassination on all fronts by advising scientists to drop their testy, pompous attitudes, while basically infantilizing people who were religious. Some scientists took this whole thing to heart, overlooking how the movie slyly played to both audiences. People who knew the fairly simple polysyllabic words could be secretly smug that they knew the words when the definitions flashed on the screen like some weird spelling bee; and the other side of the audience could be smug about the portrayal of scientists as surly and smug.

• 2007: Don't publish on Fridays: The IPCC panel and hundreds of scientists took flack from the communication "framers" for publishing their 2007 report on a Friday (link accessed 04/11) because 'any veteran journalist would know better'. The same post chastised the report for lacking "drama" like portraying "polar bears on melting ice". The authors gave another paper kudos for "reframing the IPCC report" with a "corruption angle" that gave it "more legs". In other words, said the framers, don't be scientists or reporters be PR ringmasters.
• 2008 "Don't use the word "denial", "denialist", or "denier": Some scientists said that labeling climate change denialists as such was pejorative.

At the time, each of these instructions drew passionate discussions. But times change -- or don't change. Today it's fine to use "global warming" and "denialist". Science Friday still airs to large audiences on Fridays, and Science Magazine successfully publishes, Friday, after Friday, after Friday.

As charming as "Flock of Dodos" was - do big words really make science/scientists extinct? If we believe that message, should we then be discouraged that in 4 years, the Flock of Dodos trailer has 13,376 views on Youtube, while Hoax of Dodos, the Discovery Institutes pathetically best response, has almost as many -- 11,405 views? OK true, the "Pulled Punches" video (cut scenes from Flock of Dodos) has 18,605 views. But for perspective on what 18,605 views means on YouTube, the video "Emma Watson Punches Interviewer" (Jan 19, 2006), has 4,159,895 (all view numbers as of 05/11). Despite the fact that "Punch" is a catchy keyword to put in your comparatively boring science video, what does all this mean for science and science journalism?

"Blogging" is Worthy

What if none of these rules and instructions make science blogging "better", whatever better is? What if people still deny climate change for example, no matter what the facts and no matter what manner we convey them? While pursuing better communication is incredibly important, as is presenting ideas compellingly, how much of science knowledge lost by miscommunication is really any responsibility or fault of scientists and journalists (online or offline)? How much should be attributed to the political inclinations, personal distractions, and various passions of our audiences?

In reality most science journalists have zero time to write stories, whether or not they have generous deadlines. Those stories must always be very compelling just to get read. The extreme example of this fact, illustrated by a UK journalist, applies to most writing:

"You are writing to impress someone hanging from a strap in the tube between Parson's Green and Putney, who will stop reading in a fifth of a second.

We may not like this. We may wish readers didn't prefer reading science only when it's infused with sex or violence or something that 99% of the population have some opinion on. We may wish that journalists really comprised some "fourth estate", or could make a difference, or could educate readers. What if science writers could just all write about their own fascinating interest, rather than about something dictated by advertising? And what if the audience would just read, and not worry about about ethics, badges of legitimacy or whether education was happening as they read?

But until science journalists make a lot more money or have a lot more time, that won't happen on any large scale basis. But most science bloggers write for free or pittance. And if you write mostly for free on a blog, shouldn't you just write? Or does it have to be for some higher purpose (agreed upon by the consensus of one of many "communities")? Because wasn't that the whole purpose of blogging?

Science bloggers should keep in mind what their up against. The lifeblood of mainstream media consists of headlines the likes of this week's "GM Blunder Contaminates Britain With Mutant Crops", about "Frankenstein" crops.

So I'm sure whatever you write, dear blogger, will stand up just fine. And until "offline" journalism reaches different standards, can we stop insisting/demanding/pleading that bloggers "ARE journalists too"? Maybe science blogging could stand on its own apart from journalism if the community of science bloggers trusted themselves.

• Cell Phone Warnings

  Recently, the World Health Organization's (WHO) International Agency for Research on Cancer (IARC) put the risks of cancer associated with cell phones in a 2B group: Possibly carcinogenic to humans, based on their analysis of available studies. From greatest to lowest risk the classifications are Group 1: Carcinogenic to humans, Group 2A: Probably carcinogenic; Group 2B Possibly carcinogenic; Group 3: not classifiable as to carcinogenicity; Group 4: Probably not carcinogenic.

  Scientists and journalists responded to this with their own interesting and sometimes quirky analyses. Many said the new information made them feel safe about cell phones and pointed out that the 2B group included the coffee. Others said they were concerned about the new classification, and focused on the fact that the 2B group includes DDT. And others argued in more complicated ways, things like - since DDT only affects eagles' eggs, they felt ok about cell phones. Some people reasoned that they know with certainty that tobacco is carcinogenic, and cell phones aren't in that category. How do people decide how to judge risk?

  Because logically, of course, some of this reasoning breaks down. It's not clear what people mean when they announce they'll take a risk with cell phones *because coffee is a possible carcinogen too*. Most likely they haven't read the research on the possible/maybe/sometimes connection between coffee and bladder cancer (the deciding factor for IARC on coffee). No, they're not thinking *bladder cancer*, they're thinking they'll take their chances with cellphones since they drink coffee all the time. But possible/maybe/sometimes isn't really reassurance.

  Some people say that since cell phones have been in use for 15 years or so, we would know if they caused cancer. But the use patterns were different, as were the strength of signal. And recall that cigarettes were only widely acknowledged to be carcinogenic in the 1950's and 1960's, when people had been smoking for hundreds of years. Then it took decades for that research to be acted upon. And people still smoke, no matter how clear it is that smoking causes cancer. At the present stage of cell phone research, we might not even know enough about physics and physiology to understand how cell phones cause or don't cause cancer. It adds up to a lot of unknowns.

  But still, everybody wants an answer. So do journalists and bloggers feel compelled to try to give one? This is sort of funny since no one really knows yet. But science journalists should understand how research works and the inherent uncertainty and risks and the unpredictability of evolving health research. So why feel compelled to provide an answer? Personally, (see, because we can't help ourselves) I think there's enough research that I won't walk around with my cell phone in my front pocket or stick a little mini cell phone inside my ear all day and night. And I hate to say this but I really do want to see more non-industry research. But that's based on what I know of the research, science, economics, and politics.

• Our Ancestors' Social Groups...Two Million Years Ago

  Scientists looked at the teeth of two million year old fossils and found that female hominids were more likely to leave the area they were born in, whereas males were more likely to stay closer to the cave they were born to...Oh wait, that's not catchy. We should say something like this: "Ancient male hominids had 'foreign brides'", or, hominid men "like[d] their man caves", they were "mama's boys" or were "homebodies"? See, all the good ones are taken. But by all means, lead anachronistically to catch the reader's attention.

  "Foreign Brides"? Really? It's not cool enough that scientists figured out how to analyze the teeth of our human ancestors from 2 million years ago in order to determine their possible social group structure? ¹

  Using newly evolved laser technology, Copland et al profiled the strontium mineral levels in the teeth from Australopithecus africanus and Paranthropus robustus, and from modern plant and animals around two caves in South Africa. Strontium moves up the food chain from plants to animals, and accumulates in developing teeth until about the age of eight. Scientists can analyze radioactive strontium levels in teeth for instance, and compare them to surroundings bedrock to determine birthplace. In this study, the two caves were within a band of dolomite bedrock in South Africa and non-dolomite geology surrounds this band. Researchers designated the dolomite band as local, and the non-dolomite regions further afield (~3 - 30km), as non-local.

  The teeth from both species were previously found to be similar in size, but importantly, females typically have smaller teeth than males. So the investigators found that females of the Australopithecine more likely had teeth with non-local strontium profiles, and the males teeth more likely to have a strontium profile reflecting their dolomite home turf. A probable explanation is that the females left the social structure they were born in to. This conclusion is supported by the pattern of female dispersal in our nearest ancestors, chimpanzees and bonobos. By comparison, in gorillas and other primates to whom we're not related, males tend to leave their natal group.

  ¹ Copland et al; Nature 474, 76-78 (02 June 2011) doi:10.1038/nature10149

In our last post we riffed off column in the New York Times titled "Medicine of the Move" (earlier titled "The Body Politic"), where Gail Collins opened with the statement: "sometimes you just want to tell the medical profession to make up its mind". Granted, we conceded, medicine and science can seem confusing. We described in Part I how medical profession recommendations come from science research, which the press can make appear contradictory. As an example, we showed differences between caffeine/diabetes research as presented in the media, compared to the research presented in the original source. We walked through different experimental protocols that would appear to show different results to the unpracticed reader. Finally, we emphasized that although headlines make ordinary science progress into "news" every day, a small research step reported in the "news" should not be confused with a public health recommendation.

As for public health recommendations, yes, doctors change them. But is it that the medical profession that "can't make up it's mind"? After all, medical advice comes from science research studies. Maybe it's scientists who can't make up their minds? In this post I'll explain why people puzzle me when they often complain that doctors/scientists "can't make up their minds". Secondly, I'll explain why I believe this popular notion is actually dangerous.

Would the World Be Better if The Medical Profession Didn't Evolve?

My first point I'll pose in the form of a question -- would the complainers rather that science and medicine be static than dynamic? Lets take the subject of Collins' NYT column that dealt with hormone therapy for female menopause.

First, lets look briefly at medical history. Hormone therapy came of age in the 1960's, a half a century ago. For perspective, let's look at an accelerated time frame. A century ago, doctors didn't understand that bacteria caused food poisoning. Doctors who admitted patients for so-called "ptomaine poisoning" could wash out patients' mouths, insert tubes in their stomachs, feed them milk, and wring their hands as they watched people stricken with food-borne bacterial infections die. Fifty years later, things had progressed. By mid-century, scientists understood bacterial infections and how they could be treated with antibiotics.

Medicine in the 1950's and 1960's saw the advent of the polio vaccine, the development of ultrasound to see babies inside the womb, and treatment of chronic kidney failure by hemodialysis. In 1960 and 1961 scientists along the East Coast of the US learned that the Hepatitis A virus was caused by shellfish contaminated with raw sewage. In the 1950's and 1960's doctors made major advances in cardiac surgery so they could repair congenital heart defects in babies. Such repairs became feasible when doctors realized that they could use a patient's relative as a live "heart and lung machine". From that 'proof of concept' technology advanced to machines that could keep patients oxygenated during heart surgery. As you can imagine, the first "heart surgeries" were risky business, and are new procedures in every field of medicine, especially surgery. The 1950's and 1960's brought major improvements to medicine, but in fits and starts. Mid-century, post WWII was the era when hormone therapy became popular.

Who To Blame?

Based on recent findings about the risks associated with hormone therapy, women and doctors now hesitate before turning to hormone therapy. Collins, who developed breast cancer that she attributes to hormone therapy, ended her NYT column with this: "Actually, I don't blame anyone. Except maybe the guy who wrote that "Feminine Forever" book." She's referring to an early hormone therapy proponent and author, gynecologist Dr. Robert Wilson. Today, the book's title sounds suspiciously pseudo-medicine but it probably sounded different to women in the 1960's, half a century ago. At that time of "women's liberation", Wilson chastised the predominantly male medical community for being callous to women. A 1966 Time Magazine article described Mr. Wilson's complaints about doctors:

"physicians generally dismiss post-menopausal changes as part of the 'natural' aging process. Their attitude, [Dr. Wilson] suggests tartly, stems from the fact that "most doctors, being male, are themselves immune to the disease." As he sees it, the menopause is "castration," and [Wilson] asks whether his colleagues would tolerate so casually a similar fate in themselves.

So in the era of women's liberation, Wilson accused men as standing-by while women were one day bra-less free spirits, and the next day "castrated" at the youthful age of 50. Which is why in 1966, as Time Magazine wrote:

All over the U.S., women in their 40s and 50s are going to doctors and demanding "the pills that will keep me from growing old." Women in their 60s and over are asking for "pills to make me young again." In each case, what they are really asking for are doses of hormones to slow down or reduce the ravages of age.

Now, a half a century later, science studies are finally catching up with individual accounts and showing that some of the risks people had always worried about with hormone therapy could not be ignored. But for the last half a century some women got terrifying first hand knowledge of risks they probably had no had no idea they were assuming. Breast cancer is one of the most publicized concerns, with studies showing 8 in 10,000 women per year contract breast cancer who wouldn't have without hormone therapy. In addition, women who take estrogen and progestin risk more strokes, blood clots and urinary incontinence.

To be fair, there are associated decreases in the incidence of colorectal cancer and hip fractures with hormone therapy. Many women benefited and swore by hormone therapy. But the problem was, no woman nor her doctor could predict which risk vs. benefits bucket she might fall into. That's always the hardest part, predicting risk given very few knowns and a vast number of unknowns. Today scientists continue to do research in order to try to find a way that women can glean the benefits of hormone therapy but not incur the risks.

As hormone therapy fades in popularity it may seem intuitive to damn whoever made it popular. Perhaps hormone therapy was in part a cultural movement that's gone the way of hippies? Not quite. Half a century later, women's liberation is less of a cultural driving force in the United States, but women of all ages take take other risks, for instance with plastic surgery. Decades from now, this too might look silly. But now, there's all sorts of rational urging that not only to stay young looking, but to keep a job, to stay in the job market, women must stay looking youthful.

Moving away from the NYT column, if you want to cast blame, there lots of targets. Profit making companies -- pharmaceutical, insurance and media -- all distort public health knowledge. Much has been said about each of these industries. But people should just as well blame the human body for not making medical science easier and more predictable. Genetic variation assures that people can react differently to the same treatments. The same medication that cures one person, will do nothing for another, and in rare cases will kill another.

Many women never incurred any negative outcomes from hormone therapy. Scientists are still working to understand why. Doctor try to apply that knowledge for patients' health. Fortunately for all of us, scientists and doctors don't give up, therefore science and medicine continue to evolve. People who think change is a curse, who infer therefore that this progress is a curse should spend some time perusing old medical journals.

The Logic of Blaming Scientists

Medicine and science do change in half a century, true, and that's a good thing. But even if you're looking at science or medical progress over a short time span, does saying medicine/science can't make up its mind make sense?

Isn't it a little like saying "the press can't make up its mind"? After all, science research is almost always translated for the public by the press. So do "science columnists" like John Tierney at The New York Times behave in concert with journalists/data movers like Julian Assange at WikiLeaks? Can these journalists ("sources", to some) be lumped with TV personalities or "citizen journalists" at the Huffington Post? With twittering science journalism professors? Sure, you can clump together professionals if that feels convenient, but in an honest moment no one would compare the entire cohort of "scientists", "doctors", or even "journalists" to a school of ten thousand sardines flitting hither and thither through the sea until they expire in Santa Barbara harbor from depleting all available oxygen.

Just as absurd, the statement that science or medicine "can't make up its mind" presses the illogical notion that scientists collude in order to present the disparate or outlying findings that you immediately find looking across any subject's vast body of research. I'm sure scientists would love to be gifted with such inordinate non-existent powers over research grants, graduate student experiments, science publishing, reviewers, etc. in order to collude, but the universe is not so magical.

Clearly, these ideas about scientists' ignorance or malevolence do not make sense, but that does not stop their spread. And while the NYT lede was perhaps tongue in cheek, the very common sentiment that scientists can't tell what's really going on in all the conflicting research leads to more insidious behavior. This is our second point.

Fostering Dangerous Attitudes about Science and Medicine

Propagating the myth that scientists and doctors present "conflicting" results, and "can't make up their minds" leads citizens to exasperation with research. Few acknowledge how it's all filtered through the press. Fewer still peruse the even the summary, called an "abstract", of original studies, most of which are publicly available online (for instance health at Pubmed).

In this way, the commonly expressed sentiment that scientists change their minds can become in essence a self-serving excuse for apathy: 'How can I take care of my health when scientists and doctors can't even make up their minds?' As the subtitle of the NYT article puts it: "It's very difficult to be a civilian in the world of science." Oh, woe are we. But ironically, by blaming scientists/doctors, citizens resign themselves to fate and thus open themselves to manipulation.

So second to pointing out the fundamental essence of science and medicine that advances at a rapid pace, fortunately for us, I suggest that the myth that scientists can't make up their mind is insidiously destructive because it enables manipulation of the public in matters of science and medicine.

Take personal health. If people believe they are helpless, they're less likely to try and understand the science that effects them, less likely to do research, and less likely ask questions of doctors. Distrust of allopathic medicine can also lead people to ignore doctors, to turn to "woo-woo" theories, or to become susceptible to relentless pharmaceutical advertising and absurd press headlines aimed at readers. It's fine to criticize woo-woo science, as many scientist do, taking on homeopathy, acupuncture, anti-vax, chiropractic, chrystals, etc.; but scientists and critics are intellectually blinkered if they do that without acknowledging the anti-science industry that gives these sorts of "healers" their power.

Once people have fully accepted the premise that scientists and doctors "can't make up their minds" on health, it's a small step to convince them that science can't make up "it's mind" on anything else either.

Are climate scientists predicting an Ice Age or Global Warming cry shills for energy "business as usual" (BAU) such as fossil fuel lobbies? And now half the US population doesn't believe in climate change, a situation that doesn't bode well for any species. I simplify of course, people also choose not to believe in climate change because they don't see anything they can do about it. But often that learned helplessness starts with a false indictment of scientists. As in personal health, the false indictment that scientists really don't know anyway is self-serving because it breeds fatalistic apathy.

The apathy leads to further victimization by those who work most effectively when citizens don't pay to close attention. Not only do people believe they can't do anything about global warming, they justify their stance by saying the scientists don't know what's happening either. This becomes the perfect atmosphere for severe policy moves like the destruction of the EPA. Polluted air and water disproportionately effect the elderly, poor, and very young who can't protest, but in the end it will effect everyone. Propagating distrust in science by claiming science can't make up it's mind creates the perfect apathetic breeding ground for such radical policies.

To conclude, I heartily disagree with the idea the medicine or science can't make up it's mind. First, too often people confuse press headlines with medical advice derived from many research studies, each of which is only a building block to public health recommendations. As medical history shows, it's these changes, commonly called progress, that has expanded our lifespan (albeit with risks). It defies logic to say that scientists collude to create conflicting results. Most importantly, the popular idea that science or health professionals "can't make up their minds" feeds a learned helplessness that in turn opens citizens to further manipulation.

(Whose responsibility is it to make sure that people understand science research? In the end, it's of our responsibility. Unlike many others, I don't agree that it's up to the scientists' to educate the general public. But that's the subject of another post.)

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¹ Pointing out that the media can distort the actual results of studies for the sake of a headline, we asked why, for instance, the lead author would be quoted in this Science Daily study saying "We have known for many years that people with or at risk of Type 2 diabetes should limit their caffeine intake", when the author's actual science journal study (M.-S. Beaudoin, L. E. Robinson, T. E. Graham. An Oral Lipid Challenge and Acute Intake of Caffeinated Coffee Additively Decrease Glucose Tolerance in Healthy Men. Journal of Nutrition, 2011; 141 (4): 574 DOI: 10.3945/jn.110.132761) reported correctly that studies have found a "negative correlation between long- term coffee consumption and type 2 diabetes risks"? See? Study says one thing, news report on the study says another.