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On October 19, 1977, the apartheid government of South Africa banned The World, the Sunday World, and Pro Veritas, and 19 other people and organizations who stood with the Black Consciousness Movement.

The National Press Club called on people who were opposed to wear black clothes, ribbon or armband, and they refer to October 19th as "Black Wednesday."

Black Tuesday

South African media groups are now calling last Tuesday, November 22, 2011, "Black Tuesday".

The lower house of the South African Parliament controlled by the African National Congress (ANC) approved the Protection of State Information Information Bill in a 229-107 vote. The bill would allow the state to classify documents as secret because of "national interest". Anyone caught possessing such a document would serve 25 years in jail. The bill will be debated and voted at the upper house of parliament, the ANC controlled National Council of Provinces, before it goes to President Zuma to sign. [The Wikipedia page for South Africa's ruling political party the African National Congress (ANC) was temporarily "censored" in protest of the secrecy law, shown here]

When Governments Aim to "Own" The Media

South Africa's National Editor's Forum chairman, Mondli Makhanya, said the press corps were devastated
"watching the bill become law." As he put it:

"We never thought we would come here dressed in black to witness the Constitution of our country being betrayed by those who built it."

The motivations behind the bill are suspect. The wife of the ANC's State Security Minister Siyabonga Cwele has been convicted of running an international drug ring. Two years ago, we wrote on President Zuma's successful bid to get the National Prosecution Authority (NPA) to drop 16 charges against him related to several billion dollars of bribes for arms deals.

Recently, the Sunday Times reported that Zuma's government spokesperson Mac Maharaj sued newspapers reporting that 1.2 million French francs was paid to his wife to facilitate those arms deals. In the two years since ANC's Zuma was elected, allegations of this and that, like massive misuse of official funds have continued.

Hypocrisies of the Powerful

Perhaps there's no reason to ask then, if Zuma will sign the bill? Acronym Required has checked-in on the ANC's continued attempts to censor the vibrant South African media over public health issues over the years. Former President Thabo Mbeki expended hundred of thousands of spoken as well as written words typed into his weekly reports excoriating the media for covering the horrific conditions in hospitals, corruption, the lack of public infrastructure, the broken promises of his administration, and his twisted logic for not dealing with the AIDS crisis.

President Zuma seems to be taking it one step further by backing up rhetoric with more publicly forceful maneuvers. Last year we told parts of journalist Mzilikazi wa Africa's story of being kidnapped by the police as he was investigating ANC corruption in "South Africa'a Media Crackdown."

The officers who kidnapped wa Africa pestered him about why he was investigating ANC officers in the Mpumalanga province. They tried to extract his sources. They trumped up charges accusing him of fraud, forgery and passing forged documents that were later dismissed, and tried to force him to sign an admission of guilt. Under the new law, the documents that wa Africa received about the corruption and murders in Mpumalanga would be illegal for him to possess.

President Zuma has vigorously put down widespread outcry against the secrecy bill. He said that concerns were absurd and proclaimed the ANC to be a vigorous defender of the constitution. He has continually accused journalists of trampling the rights of others, who must "have recourse through legitimate institutions". As Zuma said in weekly address (August, 2010):

"The media has put itself on the pedestal of being the guardian. We therefore have the right to ask, who is guarding the guardian? All institutions, even parliament, has mechanisms in place to keep them in check."

Zuma accused the media, as did Mbeki before him, of not "reflecting the society it claims to protect and represent". Worst of all, he said, deploying the usual ANC strategy, the media defames the ANC party that worked so hard against apartheid. This isn't just Africa's problem, he pointed out, using Russia as an improbable example:

"Let us move beyond the hysteria, let the real debate begin. Our first point is that before looking at what they regard as external threats and perceived external threats, the media should conduct introspection first. During our State visit to Russia a week ago, Russian television was running a promotional jingle saying: 'How dependent is the independent media? Who pays for the news?'"

There's hardly a need to point out again, as we did last year, that using Russia, where investigative journalists and state critics regularly get murdered, to bolster professed ANC benevolence seems cynical and sinister.

Rebukes From Those Who Know

Many see the bill as a harbinger of more serious curtailments of freedom that the country has struggled to overcome in the 17 years since apartheid. Archbishop Desmond Tutu said in an address about the Chinese suppression of Tibetans that the current ANC government was worse than the apartheid government, when "at least you could expect to eat." He said that by now you should expect a South African government to be "sensitive to the sentiments of the constitution", and continued:

"You, President Zuma and your government, you do not represent me. You and your government represent your own interests. I am warning you, as I warned the [pro-apartheid] nationalists, one day we will start praying for the defeat of the ANC government."

A strong independent media (if there is such a thing), and investigative journalism are keystones to democracy, in South Africa, America, and everywhere else. A strong democracy is critical to science, to commerce, to health, to welfare, and to all of civil society. South Africa's Bill of Rights provides:

"freedom of expression, which includes freedom of the press and other media; freedom to receive or impart information or ideas; freedom of artistic creativity; and academic freedom and freedom of scientific research".

It also gives anyone the right to:

"Any information held by the state; and any information that is held by another person and that is required for the exercise or protection of any rights."

Constitutional scholars lay out excellent arguments why this bill is unconstitutional², and the opposition party has said that if Zuma signs the bill, they would push for constitutional review in the Constitutional Court. Zuma's highly political evasion of charges against him, as well as other irregularities have shown that the judiciary and other institutions are increasing in the grip of the ANC. Snuffing out investigative journalism will accelerate that trend.

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¹ I should note that the move is not endorsed by smaller press who think that "Black Wednesday" should not be conflated with "press freedom" by major newspapers dependent on advertisers in their battle with the government over advertising spend. (Here's an article on that.)

² The website Constitutionally Speaking has an excellent discussion of this that I found unfortunately, after this was post was written. Go there for a thorough presentation of that scholar's reasoning and for the discussion that follows.

The 1987 movie Cry Freedom offers a look at a South African reporter muzzled covering the anti-apartheid movement and suspicious murder of activist-hero Steve Biko. I liked it when I watched it a couple of years ago, although I have to warn you that the mainstream media reviews called the movie a watered down version of the real story, with Robert Ebert saying it was: "sort of a liberal yuppie version of that Disney movie where the brave East German family builds a hot-air balloon and floats to freedom." I'm sure it would be fascinating to compare their harsh criticism of the movie to the MSM watered down coverage of years of South Africa's apartheid, but I'll leave that for another time.

We're big fans of Thanksgiving and usually try to write a post. This year we wanted to stick with our preferred genre and write about something undercovered or underloved in other media. In 2005 we wrote about that the myth that tryptophan causes post Thanksgiving meal sleepiness, a myth that is now pretty much a Thanksgiving Day media meme.. In 2007 we wrote about the origins of the domesticated turkey in "Thanksgiving - All Things Ottoman.

Happy Thanksgiving

We didn't want to write a Thanksgiving holiday-history story because whatever is not covered in 1st and 2nd grade is almost always politically freighted. Wanting to stay away from politics, we decided to write about food again, ironically inspired by politicians who are collectively deadlocked on multitudes of really important issues, but who nevertheless manage to muster up recipes to share with reporters. What in this world isn't political, I guess?

[Image is from Wikipedia Commons, and is licensed under Creative Commons 3.0 (CC by-SA 3.0)

We can't imagine where recipe sharing inclinations came from. Is this an old, lingering tradition from a time when everyone - churches, ladies groups, and neighborhood potluck groups - put out recipe books? I can't imagine announcing that for tonight's dessert we'll be enjoying Rick Santorum's "Apple Tarte Tatin"!!

But it seems popular. Last week, for instance, Representative Nancy Pelosi shared her chocolate mousse recipe -- a Thanksgiving Day tradition in her home. It has 1 pound of dark chocolate, 8 ounces of butter, 8 eggs, 4 tablespoons of sugar and 1/2 a cup of heavy cream. It's probably delicious -- The Hill has to whole recipe -- but you have to admit it's not exactly a heart-happy dessert.

Michelle Obama might disapprove, and the GOP would no doubt accuse her of excessive caloric spending. To model such thriftiness, I'm sure, Representative John Boehner (R-Ohio) told The Hill he was looking forward to his mother's turkey brine. And, he wouldn't give the publication the recipe.

What To Write

I don't know about turkey brine, so I looked on the Food Network, which has this. It's peppercorns, allspice berries, salt, rosemary, sage, and other sundry spices and herbs, plus vinegar. Don't knock turkey brine, A whopping 3,603 people endorsed it. Perhaps Mrs. Boehner's secret recipe is better, but I'd bet my party on 3,603 votes if I were going that way. Apparently one soaks their turkey in the brine before cooking. The whole process takes about 10 hours, so you have to be comfortable cooking on Congress-Time. Hopefully John's mom adds extra "sage" that is magically, surrealistically absorbed by anyone who eats/drinks it.

I didn't really realize the extent of this whole politicians' recipes thing until I came across internet caches of recipes from US governors, senators and congressman. Who knew? The internet is a wonderful, learning environment. Speaking of sage and wisdom, North Carolina Congressman Howard Coble had a truly brain related recipe called, actually, "Brains N'Eggs", which he described as a can of "brains in gravy", "preferably" Rose Brand, with bacon grease and eggs. His mother served it as a "not at all unusual" breakfast, that alas it can't be found in Washington D.C., he reported.

What To Write

Obviously you can please many people with chocolate mousse, and probably gross others out with pork brains, depends on what you're going for. Politicians also provide recipes of their heritage, like Olympia Snowe's "Baklava". Others donate recipe's reminiscent of their state like Senator John Kerry's "Massachusetts Cranberry Bread". Some offer what I think of as anti-cooking, like "microwave chicken": chicken, microwave, a bottle of (your favorite) salad dressing, and water.

Some long-serving productive politicians like former Senator Edward Kennedy never dished out recipes to the media. A Rockefeller gave out four. Others who were only very briefly in office must have entered with a recipe in hand, like Sarah Palin and her Alaska Crab Wrap Sandwich, which, if I weren't allergic to crab, I might like her best for.

Ignoring all good evidence, Californians ousted Governor Gray Davis in favor of Governor Schwarzenegger, who was obviously too busy with other household chores to write recipes for reporters. Davis got served up lemons and gave the press his Lemon Chicken recipe.

Happy Thanksgiving

So back to our unchosen subject. We're weary of pumpkin pie, we've done turkey, cranberries are all bogs and antioxidants, what's left? We could talk about the turkey dinner where they actually go and feed the turkeys? Hmmm...Brussels sprouts? The thing about Brussels sprouts is nobody writes about them because they're only slightly more popular, I wager, than canned pork brains scrambled with eggs and grease.

Nobody knows where Brussels sprouts originated, unlike the excellently documented domesticated turkey. Most people agree they don't come from Belgium but some say their actually a centuries old source of "Flemish national pride". It seems like when it comes to Brussel Sprout's, everyone's making something up. A few say they originated in Rome where they were thought to make people smarter. Maybe they were popularized in WWI, maybe they came to Louisiana when the French immigrated, maybe they're the most disliked British vegetable...on and on.

But they are considered healthy for many reasons, like because they contain sulfoaphane and indole-3-carbinol and a lot of research finds they have anti-cancer properties.. They look pretty cool on the vine. And to eat? Curried? Roasted?

Best wishes to all and Happy Thanksgiving to those readers who have a holiday.

A US Court blocked the FDA from requiring cigarette warnings on boxes this week, calling the graphics "emotion-provoking images...". U.S. District Judge Richard Leon decided in a Washington court yesterday that tobacco companies shouldn't have to display images of diseased lungs or a cadaver bearing chest staples on an autopsy table, because this would "unconstitutionally compel speech." Nor should companies have to print 1-800-QUIT on cigarette boxes.

I guess what he's saying is that cigarette companies have the right to package fantasies up in the tobacco they manufacture, fantasies of how cool smokers are, that blithely omit the disease and death their product metes out. The FDA, on the other hand, has no right to present the more accurate side of the story.

You know that smoking causes cancer, heart disease, vascular problems. Did you know that smokers have 7 times the risk of abdominal aortic aneurism (AAA) than non-smokers? You probably know about second-hand smoke. Did you know about third hand smoke which stays in home and hotel walls and ceiling tiles for 30 or 40 years, affecting the health of not only present but future occupants?

The judge says the images on cigarette boxes crossed the line between "factual information" and "government advocacy". The line is "frustratingly blurry", he says, but he sees it.

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 would 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? 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; listen to scientists around the web and in journals like The Lancet ⁴; or heed 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 the main question the trial seeks to answer.
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 after 12 months. 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 it 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, who was complementary of the RTS,S effort, if critical on some points.⁶

The history of the Sanaria vaccine is also an interesting, expensive, and laborious endeavor. The underlying idea seems promising, but for starters, technicians dissect out the salivary glands of mosquitoes to develop the vaccine.⁷

In the first trial, Sanaria injected 44 subjects. 42 people got malaria and 2 didn't, a 4.5% "success" rate. Although those subjects might have been better protected from malaria lounging in a malaria endemic region in mosquito-infested huts, Sanaria 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 the success of their trial and primed for the next controversial⁷ phase. At the moment, every possible vaccine holds promise, since we have none.

Their 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. Does that make this vaccine a beta version?

Is all the 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 the vaccine routes, 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 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). 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.

It's a well known strategy they say. But how well known is it if Wikipedia doesn't even have an entry? It goes like this. Say you're the owner of a dog who's just bitten someone. If you're a chuff, churl or cretin -- or you may say, your average defensive citizen -- you deny it via the so called "Four Dog Defense". Here's how one lawyer explained it to the St. Petersburg Times in 1997 ¹:

1. First of all, I don't have a dog.
2. And if I had a dog, it doesn't bite.
3. And if I had a dog and it did bite, then it didn't bite you.
4. And if I had a dog and it did bite, and it bit you, then you provoked the dog."

The St. Petersburg Times article wasn't actually about a dog, but about the landmark tobacco cases. And the tobacco industry played it something like this, as you may know:

1. Smoking definitely doesn't cause cancer, there's no evidence it causes cancer.
2. There's no consensus on the evidence; smoking may cause cancer but second hand smoke definitely doesn't.
3. Mice may get cancer but mice are not humans, cigarettes are not additive.
4. People choose to smoke -- and who are we to impose on people's constitutional rights? - etc.

Four Dogs Launched a Thousand Ways

"Four Dogs Defense" might to you sound more like a Kung Fu movie, but once introduced, you'll recognize it more often then you'd like. Some people describe the Four Dog Defense as a trial lawyer's adage, but the tobacco industry used it for decades to successfully deflect charges that cigarettes cause cancer. Despite volumes of documents proving of their deception in the form of the tobacco papers, the same companies today mount the same defense, albeit with diminishing success.

You might also be familiar with this strategy not only because of tobacco, but asbestos, lead, bisphenol A or any number of chemicals or "benign" products (sugar, alcohol, etc.) currently on the market.

The Natural Resources Defense Council (NRDC) used the "Four Dog Defense" to frame their recent investigation: "The Delay Game: How the Chemical Industry Ducks Regulation of the Most Toxic Substances". The report compellingly describes tactics the industries used to stall regulation. It focuses on three chemicals, trichloroethylene (TCE), formaldehyde, and styrene, which have been on the market for decades despite proof they cause morbidity and mortality.

NRDC describes how vested industries spend millions of dollars demanding the EPA conduct new science reviews, how the industries demand "independent" assessments and hire "independent" scientists to do favorable studies; and how they dispatch lobbyists to "influence" politicians and the EPA. Thus, toxic chemicals like formaldehyde, lead, atrazine, TCE stay on the market thanks to a collection of vested interests preventing the EPA from acting on well established science.

Of course for every move that industry makes to stall the EPA - demanding studies, suing, producing biased studies, and publicizing contrarian views aimed to confuse and stall regulation - the EPA and tax payers pay mightily to defend science. Circularly and ironically, taxpayers who already paid for the research to make their living environment healthy, then pay for defense when industry and lobbyists to attack that very science. The taxpayer pay for these attacks on science and the EPA (that the Tea Party and GOP so dearly want to abolish), both with our money and our health.

The TCE Story

This four dog defense strategy has kept trichloroethylene (TCE) on the market for decades. TCE is a solvent used for metal degreasing, commonly for cleaning airplane parts. It's also used in household items such as paint removers, glues, correction fluid, electronic equipment cleaners, rug cleaners, and adhesives. TCE is linked with leukemia, cancers, developmental defects, and problems with the male reproductive system, the immune system, liver, kidney and nervous systems.

TCE is found in hundreds of Super Fund sites, places like like Lawrence Livermore National Laboratory, and military bases. Many of these sites are not giant dumps somep other place in America but right in our communities. When a new housing development gets built in the vicinity of some high stature physics lab in an expensive suburb, for instance, the EPA describes how TCE can contaminate air that gets into homes and water. TCE leaches from the soil into water supplies, evaporates into the air, and poisons humans by any means of ingestion.

And what happens when homeowner's get sick? The four dog defense continues. The effects of TCE on human health were detailed in Jonathan Harr's 1996 non-fiction book A Civil Action.

A Civil Action

As Harr recounts, a large number of people began to die in Woburn, Massachusetts, in what public health officials identified as a leukemia cluster. Three companies, including W.R. Grace and a tannery owned by Beatrice Foods, dumped TCE onto land and it leached into the water supply. During discovery before the trial, companies' defense lawyers deposed the plaintiffs, grilling them on the details of their daily lives. As Harr describes in his book, they produced exhaustive inventories of products used in each plaintiff's house, what they ate, drank, cleaned with...

"five hundred brand-name household products -- cleaning agents and detergents, rug shampoos, cosmetics, nail-polish removers, insect repellents, paints, lawn fertilizers, cold remedies, cough syrups, herbal teas, coffee, even peanut butter."

The goal-oriented lawyers are relentless:

"Do you eat peanut butter?" one of Facher's young associates asked Anne Anderson.
"No," said Anne.
"Did you ever eat peanut butter?"
"I guess everybody living has probably tried it," replied Anne.
"Do your kids eat peanut butter?"
"Well, the same jar has been sitting there an awfully long time, so I guess we don't eat much"
"What kind is it, plain or chunky?"
"Plain, smooth," said Anne."
"You made your children peanut butter sandwiches?"
"They ate some, when they were small"
"When you say, 'some,' could you quantify that?" One or two sandwiches a week for the children?"

Peanut butter can contain aflatoxin, a carcinogen.

As Harr writes, Jan Schlichtmann, lawyer for the plaintiffs, knows that the defendant's lawyers are trying to dilute the evidence in order to develop uncertainty about the origin of the cancers. When at 5:00PM, he requests that the defense lawyers to end their deposition, they ignore him and continue their questioning.

"Do you eat bacon?...(Bacon contains dimethylnitrosamine, a carcinogen.) How often? How many slices? Do you fry it or bake it? Do you have Teflon pans (Teflon is made of a resin containing acrylonitrile, a carcinogen.) How often do you use them? Do you chew sugarless gum? (Saccharin, a carcinogen in mice.) How often? Do you pump your own gas?..."

It continues with each plaintiff, over the next three weeks -- do you bathe, shower, wear deodorant, own a cats, have plastic shower curtains, drink beer, smoke? Each activity or product contains certain carcinogens, passes on certain risks...

While the pre-trial "discovery" of "A Civil Action" drags on, people continue drinking TCE polluted water and breath TCE polluted air.

"Roland Gamache was dying of leukemia by the time his second deposition began. Neither he nor his wife could admit this to each other. But the lawyers all knew. In early October, Gamache did not have strength enough to get out of bed...."

And while these leukemia victims answer inquiries by lawyers working on behalf of TCE dumpers, somewhere else in the world, in another room, at another polished bird's eye maple conference table, lawyers for a different chemical or product question different plaintiffs about their possible exposure to solvents -- have you ever glued anything (glues contain can TCE)? Walked by the old Naval base in the next block?

In the end the Woburn case didn't repair the TCE victims, nor did it motivate universal action on TCE. But law schools use the book as a case study to instruct future lawyers prosecuting (as well as defending) the makers of toxic chemicals. As you can imagine then, with this sort of defense fully proven to work, people injured from environmental toxins have a difficult time getting remedy from the courts.

The Doggy-Dog World of Politicians

Given the tenacity and success of the four dog defense, it was against great odds that after decades years of stalling, not only by industry and lawyers, but by politicians, White House administrations, and the Department of Defense and Department of Energy, the EPA released its final IRIS assessment of TCE last week.

The EPA's last assessment of TCE came in 1987, almost a quarter of a century ago. In 2001 the EPA calculated that based on research to that date, TCE was 5-65 times as toxic as previously thought, especially to children. It can be found in 761 Superfund sites. Since the Department of Defense and Department of Energy would be responsible for cleaning up many of the sites, the agencies fought vigorously to prevent EPA action. OMB reports that DOD action against the rule cost taxpayers a million dollars.

The EPA's path to updating the Toxic Substance Control Act (TSCA) was tortuous, likewise for the the EPA's completion of the IRIS assessments for the backlog of chemicals with suspected or proven health affects. The EPA is struggling to overcome a failed strategy of depending on industry to produce safety profiles of chemicals, which hasn't adequately safeguarded our health. (Acronym Required started reporting this here in 2005, decades into the battle ²). But progress is hindered - as you can see, industry mounts gargantuan hurdles against the EPA.

Even once people are somewhat convinced that a chemical such as bisphenol A is toxic, lobbyists for industry deploy the four dog defense. This is long after the media loses interest, long after the public tires of hearing about it, long after the environmental groups start in on their next agenda, and long after most politicians drop the issue (now that they're not getting calls from their constituents).

As we speak, politicians that we (you) voted for, "working in our interest" actively fight against the EPA's IRIS assessments and against EPA moves to strengthen TSCA. Their most successful claim against regulating chemicals that cause the loss of life and impede people's ability to work? That the "stringent" rules will "cost jobs". Politicians are lawyers after all, so they know the four dog defense perhaps better than we or Wikipedia.

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¹ "Can This Man Tame Tobacco?" David Barstow St. Petersburg Times April 7, 1997

² Acronym Required wrote about TSCA in of posts a couple of posts about Teflon in 2005; in a few posts on Europe's REACH, for instance The EU on Chemicals: More Strife Across the Pond?; a here and in many posts about bisphenol-A.

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.

New Scientists Who Don't Do Science

Every so often, actually with disturbing frequency, claims about the underlying cause of autism spring up like fungii in manure after a rain. It's practically required that claims of this genre be built on false premises or make invalid conclusions, like this week's link between internet use and autism. Oxford personality Baroness Susan Greenfield breathed life into this rumor in an interview with New Scientist, then defended herself by saying provocatively: "I point to an increase in the internet and I point to autism, that's all." But where's the evidence, and why is this stuff being published?

Greenfield's been at this for a while, "popularizing science" for decades, and recently "popularizing science" at the cost of science itself. In 2008 she warned the children's brains were being destroyed by technology in a book reviewed in the Times:

"As it happens, her new book, ID: The Quest for Identity in the 21st Century, digresses all over the place in little flash floods of maddening provisos and second thoughts. It's as if she dictated it while bouncing on a trampoline, fixing an errant eyelash and sorting her fraught schedule on a BlackBerry."

Back in 2009, before the UK's Royal Institution fired Lady Greenfield, she argued that the total immersion in "screen technologies" was linked to a "three-fold increase in prescriptions for methylphenidate" (prescribed for attention deficit disorder). She told the paper that people were losing empathy and becoming dependent on "sanitized" screen dialogues, just like packages of meat in supermarkets had replaced "killing, skinning and butchering an animal to eat".

Had you ever thought of the internet like that? No? Science popularizing has that power. I'm not deriding science popularizers, I'm criticizing the practice of distorting science. Greenfield's analogies opened up new worlds of understanding for Guardian readers too. 254 people commented, some sarcastically:

• "That's exactly what my mum said about reading The Beano."

• "I hear it gives you cancer as well""

Guardian readers know how to take a piss. But Oxford's Greenfield knows how to get publicity. So her 2009 headline followed and preceded myriad other claims, all to scare people about technology. To her latest, scientists online responded briskly, with vitriol, meaning that in terms of popularity, Greenfield had a field day. We've been following false arguments about autism for a few years, so we wanted to look more closely at how Greenfield's latest claim about the internet causing autism differs from the claim that television caused autism that we covered back in 2006. For one, back in 2006 they actual did research -- well, economics research.

But Who Needs To Do Research When They'll Print the Stuff You Make Up?

Maturing her arguments of 2008-2009, Greenfield now adds autism to the mix, upping the ante by playing not just to fuddy-duddy technophobes but to all parents and their worst nightmares. One day the child seems fine, then something mysterious happens and the child is no longer themselves. What happened? Doctors and scientists have no clinically actionable idea. Greenfield knows.

Perhaps it makes life easier for some autism suffering families to attribute changes in their child to some outside agent. It's also common to say that a crime has been perpetrated by people from another state or town or country. We've seen autism blamed on vaccines, television, rain...Uncomplicated agents that can be controlled by parents are especially attractive - TV. But where's the evidence? When the New Scientist asked that, Greenfield replied:

"There's lots of evidence, for example, the recent paper "Microstructure abnormalities in adolescents with internet addiction disorder" in the journal PLoS One...There is an increase in people with autistic spectrum disorders. There are issues with happy-slapping, the rise in the appeal of Twitter - I think these show that people's attitude to each other and themselves is changing."

How nimbly she links computer use, with "internet addiction disorder" (IAD) -- not recognized by US psychiatrists; with brain change; with behaviors; and even with attitudes - facile. But the paper didn't say anything about attitudes; didn't prove "addiction", didn't prove detrimental brain changes, didn't prove behavior changes.

Can You Compare the Cognition of Chinese 19 Year Olds Playing Games 12 Hours A Day To 1 Year Old Cooing Babies?

The PLoS One paper deserves more comment than I'm going to devote here. To note, though PLoS One depends on the community for peer review, and although this paper has over 11,000 views (14/08/11), not one person has peer-reviewed - "rated" - the paper. Nevertheless, it's cited all over the internet as proof that "internet use" does bad stuff to the brain, take your pick - "shrinks it", "wrinkles it", "damages", "contracts", "re-wires" it... But the paper is not about "internet use". It's about on-line gaming.

The PLoS One authors write that the research is particularly important to China because unlike in the US, in China, IAD is recognized, and is cited as a big problem. The Chinese vigorously treat the "disorder" with strict treatment regimens including until 2009 shock therapy.

The authors used addiction criteria (i.e. "do you feel satisfied with Internet use if you increase your amount of online time?"), and asked the subjects to estimate how long they had had the addiction. They then used brain imaging to show that brain changes correlated with self-reported duration of online game playing. There were 18 subjects, 12 males average age 19.5 years, and presumably 6 others (females?) who the authors do not characterize.

The subjects played online games 8-13 hours a day. I can't evaluate the data, I don't know enough about voxel based morphology. But I'm not surprised someone "playing online games" 8-13 hours a day, 6.5 days a week for 3 years is different than the controls, who were "on the internet" less than 2 hours a day. Likewise, I would expect a soldier engaged in street patrol in Afghanistan 10 hours a day, 6 days a week for three years to be different than someone who walked their dog around the block in sunny suburbia 3 days a week for the last month. (If I were in a joking mood I'd say that kids playing online games 13 hours a day 6 days a week must have extraordinary abilities to actually still be in college.)

Even if you believe in IAD, the authors acknowledge the study's limitations. They say they don't prove IAD caused changes; don't prove that the subjects brains weren't different to begin with; acknowledge the "IAD duration" measurements (self-assessment) are crude; and the data aren't rigorous to conclude negative changes.

None of these caveats slowed Greenfield, who cited this paper and linked it to all sorts of unrelated things. But autism is NOT related. Wikipedia describes what she calls "Happy-slapping" as an outdated British fad", evidently more a media fad than a scary phenomenon - it's not related to autism. There's nothing inherently sinister about using Twitter - it's not related to autism.

Greenfield trained as a neuroscientist. Does she not know this stuff? In 2003, she mocked people who attributed anything to "scary technology." So why is she now popularizing the opposite message? Her PLoS One example is nothing more than pulling some study out of thin air and linking it to her own machinations about technology. Claims such as hers provide ripe fodder for quacks, crazies and zealotry.

How Does Technology Change Us? Research Shows Beneficial Effects in Online Gamers

Here's the second instance of "proof" Greenfield gives in the New Scientist interview, and note that again cites an academic paper and links it incongruously to her own made up stuff. She says:

"...A recent review by the cognitive scientist Daphne Bavelier in the high-impact journal Neuron¹, in which she says that this is a given, the brain will change. She also reviews evidence showing there's a change in violence, distraction and addiction in children."

But the Bavelier et al review says something different. The scientists specifically warn that no research predictably links brain changes to behavior like violence, distraction or "internet addiction" to technology - TV, video games. The authors cite studies showing the research remains too confounding, as they say in their conclusions:

• "the interpretation of these studies is not as straightforward as it appears at first glance"

• most reports tabulate total hours rather than the more important content type, therefore are "inherently noisy and thus provide unreliable data."

• technology use is "highly correlated with other factors that are strong predictors of poor behavioral outcomes, making it difficult to disentangle the true causes of the observations"

• Perhaps "children who have attentional problems may very well be attracted to technology because of the constant variety of activities."

Bavelier et al stress that the effects are unpredictable, for instance "good technology" like the once ballyhooed Baby Einstein videos can turn out to have zero or negative effects. Conversely assumed "bad technology" can be good. They write:

"action video games, where avatars run about elaborate landscapes while eliminating enemies with well-placed shots, are often thought of as rather mindless by parents. However, a burgeoning literature indicates that playing action video games is associated with a number of enhancements in vision, attention, cognition, and motor control."

This point from Bavelier et al is quite interesting because it appears to contradict the general conclusions of the PLoS One authors we cited above concerning online gamers -- assuming the study subjects played comparable games. Exploring these different results is potentially more interesting than a rhetorical sleight of hand tossing a science study citation in to falsely bolster gobbledygook.

To wit, the studies Greenfield uses don't support her points. That technology's effects are still unpredictable is widely acknowledged. Greenfield herself used to promote a computer program called MindFit which claimed to improve mental ability. The game didn't work. But it also didn't make kids pick up knives and murder each other. It's hard to understand Greenfield's motivation for denouncing technology as anything other than provocation.

Greenfield says: "It is hard to see how living this way on a daily basis will not result in brains, or rather minds, different from those of previous generations." But "hard to see" isn't science. A "brain", is not a "mind", nor is it "behavior", nor an "attitude". That's not to say brains don't change, or that technology couldn't affect us. Brains show changes during many activities, often temporarily. It's just to say that technology is not inherently, as she called it, "chilling".

I Point to Television and I Point to Picnics, To Family Dinners, To Teens Doing Charity, To Children Building Sand Castles on Sunny Days

As she is now vilifying the internet as a physiological change agent, Greenfield previously claimed that television changes the brain deleteriously. Now she dismisses the notion. When New Scientist asked her: "What makes social networks and computer games any different from previous technologies and the fears they aroused?" she responded:

"The fact that people are spending most of their waking hours using them. When I was a kid, television was the centre of the home, rather like the Victorian piano was. It's a very different use of a television, when you're sitting around and enjoying it with others..."

Nice image, the innocent television, like the innocent Victorian piano. Happy family times of the Victorian Era, singing around the piano, food aplenty, spirits flowing, enlightened, goal oriented well adjusted children unhindered by repressive social situations. Oh wait, it wasn't always like that? We learn more about the good 'ole days by venturing dangerously out on the internet where you can find the following first hand accounts:

Isabella Read, 12 years old, coal-bearer, as told to Ashley's Mines Commission, 1842: "Works on mother's account, as father has been dead two years. Mother bides at home, she is troubled with bad breath, and is sair weak in her body from early labour. "I am wrought with sister and brother, it is very sore work; cannot say how many rakes or journeys I make from pit's bottom to wall face and back, thinks about 30 or 25 on the average; the distance varies from 100 to 250 fathom. I carry about 1 cwt. and a quarter on my back; have to stoop much and creep through water, which is frequently up to the calves of my legs."

Sarah Gooder, 8 years old, trapper, as told to Ashley's Mines Commission, 1842: "I'm a trapper in the Gawber pit. It does not tire me, but I have to trap without a light and I'm scared. I go at four and sometimes half past three in the morning, and come out at five and half past. I never go to sleep. Sometimes I sing when I've light, but not in the dark; I dare not sing then. I don't like being in the pit. I am very sleepy when I go sometimes in the morning."

Greenfield's current glorification of TV defies the fact that TV has been roundly implicated for causing all sorts of unsocial behavior and not only by Greenfield before she changed her mind.

The Autism TV Link: "Why Not Tie it To Carrying Umbrellas?"

In 2006 Acronym Required used a study by economists linking autism and television to write a satirical ten step tutorial on how to publish bad science and get lots of media attention for it. The authors proved that a theories popularity, if brought to the attention of a non-critical media was independent of clearly stating no link between autism and television in your study. You didn't even need to be a scientist.

After reviewing those economists' work, Joseph Piven, director of the Neurodevelopmental Disorders Research Center at the University of North Carolina, weighed in on the autism television-watching idea, asking the Wall Street Journal "[W]hy not tie it to carrying umbrellas?" And so the researchers did! And in 2009, in "It's Back! The Rain Theory of Autism", we described how the same researcher group that blamed autism on televisions decided that it wasn't television causing autism, but rain.

The nice thing about making up "science" or just leveraging your status for narcissistic purposes, is that you can change, chameleon-like, at will. If your aim is to generate a headline in mainstream media rather than research, it doesn't matter what the science says. Most people don't remember headlines from one day to the next and they aren't that curious to dig further.

I believe a natural response to Greenfield's wild claims is humor and sarcasm, the same response the Guardian readers had. To Greenfield's latest foray, Carl Zimmer started an amusing twitter exchange with this: "I point to the increase in esophageal cancer and I point to The Brady Bunch. That's all. #greenfieldism".

A string of #greenfieldisms followed, like "@carlzimmer I point to Alzheimer's and I point to cheese doodles. That's all. #greenfieldism". (Of course this territory is risk ridden, because of the prevalence of actual real random "studies" like the one about mice who eat fast food and get Alzheimer's.)

When challenged, Greenfield didn't back down, instead she spewed forth with more analogies, like a clogged toilet if test-flushed. Asked for a response to the fact that there's not evidence claiming detrimental effects of technologies, she scoffed that you wouldn't see effects for 20 years. With just as absurd a distracting non-sequiter she once asked someone who challenged her on the technology-is-bad assertions if they denied smoking causes cancer.

Flexible "Theories" Make For Good Publicity for Scientists, For Newspapers...

I think it's cathartic, funny and educational to diffuse Greenfield's claims with humor. Wicked-fast coordinated Twitter de-bunking of such people is of course useful and could be made even more useful. Unfortunately the issues aren't always as simple as a Greenfieldism. And debunking the rhetoric of individuals seeking publicity on the backs of science is only one angle.

I think it's important to note that it wouldn't be news if there weren't ready and willing news outlets. The New Scientist printed all her assertions about links between technology, brain structure, autism, and behavior. They didn't ask questions. They didn't challenge. They didn't say: wait, isn't autism diagnosed at ages 2-4? Who's propping their 6 month old up in from on the computer to play war games? Why?

The Guardian, like most papers, publishes articles that range in quality. A Guardian comment on the 2009 article about Greenfield's theories, that called the article "absolute nonsense", and wrote I am surprised that the Guardian has published this..."sloppy journalism"..."absolute drivel", pulled in 160 "approve" votes, far more than any other comments. So even if readers hate the article, they'll still read it. Media succeeds because of advertising and hundreds of comments translates to how many hundreds of thousand of hits?

The media is quite capable of selective coverage. They ignore important scientific, political, and economic stories that they consider politically sensitive. But is anti-science coverage ever "censored"? Not if it can drive traffic, and sell ads - provide economic benefit to media outlets.

But to what extent can we accept this concession to the market if it gives us in return uncritical readers, uncritical patients, and uncritical citizens? Does it create an atmosphere amenable to medical quacks? Might it prime a population to be more receptive to political efforts to curb real free speech via social media technologies? Too bad so many potential critics (even bloggers) are involved with or depend on mainstream news outlets, which makes them understandably hesitant to bite the hand that feeds (or might feed) them.

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¹ Bavelier, D., Green, C.S., & Dye, M. (2010). Children, wired - for better and for worse. Neuron. 67, 692-701, Volume 67, Issue 5, 692-701, 9 September 2010 Copyright © 2010 Elsevier Inc. All rights reserved. 10.1016/j.neuron.2010.08.035

Acronym Required writes frequently on the diffusion and distortion of science in politics. We've written about individuals mixing religion with science, art with science, for instance here

The Pharmaceutical Research and Manufacturers of America (PhRMA) says it costs $1.3 billion to bring a new drug to market, and researchers dispute the lobby's claim. Could the ponderous costs of clinical trials, increasing regulation, a burgeoning FDA, and a litigious society keep driving drug prices up?

Perhaps we should we go back to simpler times, like 1895:

"The Cost of Making Antitoxin In the District:

Health Officer Woodward appeared before the Commissioners on the 10th inst., and submitted the following estimate for the suppression of contagious diseases: For the production of antitoxin for the treatment of diphtheria:

• twelve horses at $40 each, $480;
• maintenance of twelve horses at $10 each per month, $1200;
• bacteriologist, $1,800;
• materials and apparatus, $320;

Total: $3,800."

-The Journal of the American Medical Association Vol. XXIV, January 19th 1895: Miscellany.

It was the horses, obviously, driving costs up. Or perhaps they overestimated the cost of horses to support resistance to cheaper imports and generics, and to justify raising drug prices...

• 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 DTT. And others argued in more complicated ways, things like - since DTT only affects eagles' eggs, they felt ok about cell phones. Some people reason that they know with certainty that tobacco is carcinogenic, and cell phones aren't in that category. Do people merely construct rationales to coincide with the intensity of their cell phone use?

  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 individua physiologies to understand how cell phones cause or don't cause cancer. There's lots 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 and bloggers should especially understand a bit about 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.

• 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