Does a 3-day fast reset your immune system?

I’ve been hearing new reports lately that sound an awful lot like pseudoscience: that fasting for an extended time, two days or longer, can reset your immune system and provide other health benefits. I first heard about this when a friend and colleague at Stanford University announced he was going on a 3-day fast. To explain, he pointed to a recent study, which I’ve now read.

Diet advice, including fasting-based diets, can be found all over the Internet, and much of it is nonsense, so I was very skeptical about these latest claims.

This time, though, there might be something to it. The scientific study that my colleague told me about was published back in June by USC’s Valter Longo, who studies aging and longevity. In this paper, Longo and colleagues described remarkable metabolic changes that occurred as a result of prolonged fasting. They found that fasting for 3 days or longer–drinking only water and eating less than 200 calories per day–can truly “reset” some components of your immune system. 

The research looked at both mice and humans. (It’s far easier to run the experiments in mice, of course, but we can’t always trust that the same effects will occur in humans.) In both species, fasting lowered white blood cell counts, which in turn triggered the immune system to start producing new white blood cells. White blood cells (or lymphocytes) are a key component of your body’s immune system.

Longo’s hypothesis is that fasting (or starvation) forces your body to “recycle a lot of the immune cells that are not needed” which explains the drop in the white blood cell count. Two of the key mechanisms are an enzyme called PKA and a hormone called IGF-1, both of which are reduced by fasting. Once you start eating again, your stem cells kick back into high gear to replenish the cells that were recycled.

The human part of the study was much more limited: a group of cancer patients fasted for 1, 2, or 3 days prior to chemotherapy. The idea is that fasting might reduce the harmful side effects of chemotherapy, particularly the immunosuppression caused by some chemotherapeutic drugs. These results are very preliminary: the patients are participating in a phase I clinical trial, which is designed to assess safety, not effectiveness. Nonetheless, the results indicate that a 3-day fast (but not a 1-day fast) was beneficial for these patients.

A key finding in this research is that you have to fast for several days to get any benefit: basically, you have to fully deplete your energy reserves (in the form of glycogen), and it takes your body at least 24 hours, and probably 48 hours or more, to do this. This is much harder than a 1-day fast, which many people do routinely. 

On the other hand, Valter Longo has compared the effects of periodic fasting to long-term caloric restriction, which has been shown to prolong lifespan in mouse and other animals. In a separate review article, Longo wrote: 
“Fasting has the potential to delay aging and help prevent and treat diseases while minimizing the side effects caused by chronic dietary interventions.”
Caloric restriction is extremely difficult to achieve for humans: you have to nearly starve yourself for years. Compared to this, an occasional 3-day fast should be a snap.

Caveats: fasting can be harmful, especially for people who have other health problems. If you’re seriously thinking of trying this, you should consult your doctor first. And this preliminary evidence, though encouraging, is primarily based on mice, not people. We might eventually learn that the benefits of fasting are outweighed by other problems. Fasting for more than two days isn’t easy, either: you’re going to get really hungry. 

Does a 3-day fast truly reset your immune system? Well, maybe not a total reset, but at least a mild refresh. The science suggests that, if you can do it, a prolonged fast for 2-3 days or longer may induce your body to clean out some old immune cells and switch on production of new ones. Stay tuned.

[An interesting aside: this study was lengthy and complex, and the authors apparently went to great lengths to satisfy the peer reviewers: the paper was submitted in October 2012, re-submitted after revision in December 2013, and finally accepted in April 2014. 18 months is a very long time.]

New York governor must decide today about law that protects doctors offering bogus treatments for Chronic Lyme Disease

Lyme disease is carried by tiny ticks; lower right above.
On Monday, the day this article appears, New York will get a new law that protects doctors who offer illegitimate therapies for a non-existent disease—unless Governor Andrew Cuomo vetoes it. The law is written to protect doctors who offer expensive treatments that provide no benefit, and it is being supported by advocacy groups who are thoroughly convinced that these treatments work.

What is this about? Lyme disease. A cadre of doctors has emerged in recent years who specialize in treating something they call Chronic Lyme Disease. They call themselves “Lyme literate,” and some of them have built their entire practices around CLD. Unfortunately for them, and sadly for their patients, this disease does not exist. 

First, I should be clear that Lyme disease is a real illness. It’s caused by a bacterium known as Borrelia burgdorferi, a small spirochete carried by ticks. (Aside: I was part of the scientific team that first sequenced this bacterium.) In most cases, Lyme disease responds well to a short treatment with antibiotics, and patients are fully cured. (See this excellent short video from Dr. Paul Auwaerter of Johns Hopkins School of Medicine.) Lyme disease ticks are really tiny, about the size of a poppy seed, and many people get bitten without realizing it. The ticks are carried by deer, and the disease has become more common as deer populations have exploded in suburban areas of the northeastern U.S.

Claims about "chronic" Lyme aren't new. As reported by Patricia Callahan and Trine Tsouderos in the Chicago Tribune back in 2010, 
“doctors around the country are telling patients with common medical problems such as back pain, poor concentration and fatigue that their ailments stem from a chronic form of Lyme disease that can evade standard treatment and wreak havoc for years. To fight what they believe is a persistent infection, the doctors often order months or years of intravenous antibiotics, which can cost tens of thousands of dollars.”
Long-term antibiotic usage doesn’t help, as multiple studies have shown (for example, Klempner et al. here and here). Even worse, it can create drug-resistant bacteria and other very serious, even fatal, complications.

But let’s not get distracted. The NY law is emphatically not providing support for Lyme disease patients, or funding new research into Lyme disease treatments. This law has one purpose: to protect doctors who want to use unproven, possibly dangerous therapies on unsuspecting or confused patients. Callahan and Tsouderos documented multiple cases where doctors told patients with other diseases—such as Lou Gehrig’s disease—that they had Lyme, and then treated them with expensive, unapproved drugs.

The New York legislature, apparently convinced by advocacy groups that chronic Lyme disease is real, passed a law whose sole purpose is to protect ill-informed doctors who want to use unproven (often expensive) therapies on sick patients. These groups are lobbying like crazy to convince Governor Cuomo to sign the law, claiming that it will protect Lyme patients. If anything, it will do the opposite. The law itself
“prohibits the investigation of any claim of medical professional misconduct based solely on treatment that is not universally accepted by the medical profession… including, but not limited to, the treatment of Lyme disease.”
So there it is: no funding for Lyme disease research or treatment. And the language is so broad that it protects almost any treatment, no matter how crazy—all the practitioner has to do is point out that the treatment is “not universally accepted.” An accurate name for this law might be the "freedom to experiment on unsuspecting patients act.”

Let's hope Cuomo rejects this law today. Otherwise, New York may become a haven for illicit, unscientific, and possibly harmful medical practices.

U.S. Education Department helps bail out for-profit college that lured students into bad loans

Talk about trying to fly under the radar: announcing a deal during Thanksgiving week is a sure sign that someone—in this case the U.S. Department of Education—doesn’t want you to notice.

In the deal announced on November 20, a student debt collection company, ECMC Group, will buy 56 college campuses from Corinthian Colleges Inc., a for-profit university. Corinthian runs these campuses in 17 states under the names Everest College, Everest Institute, and Wyotech.

Corinthian, until recently a high-flying for-profit university, has flourished thanks to federal largesse: its students received Pell grants totalling over $400 million in 2012-2013, and it receives about $1.4 billion a year in federal aid.

All of this money supports a for-profit university (one of the Yugos of higher education) whose students have egregiously high rates of loan defaults and who often fail to complete their programs. These failure rates are a direct consequence of Corinthian’s strategy of targeting the poor and disadvantaged with “promises of jobs and good wages that would support their families.”

Just a few months ago, the Consumer Financial Protection Bureau (CFPB) sued Corinthian Colleges for its “predatory lending scheme,” claiming that 
“Corinthian lured tens of thousands of students to take out private loans to cover expensive tuition costs by advertising bogus job prospects and career services. Corinthian then used illegal debt collection tactics to strong-arm students into paying back those loans while still in school.”
After the CFPB announcement, the U.S. Education Department began restricting federal student aid to Corinthian schools, which Corinthian said would “put it at risk of failure.”  

Now, in a move that seems to undermine the actions of the CFPB, the U.S. Department of Education has brokered a deal to keep these schools in business, to be run by the Zenith Education Group, a subsidiary of ECMC Group, Inc. This action comes less than 3 months after the Education Department sent a letter to Corinthian denying its recertification application for federal student loans because 
“Everest Decatur [one of Corinthian’s colleges] created false placements and misrepresented Everest Decatur’s job placement rates to its accreditor in an attempt to maintain its eligibility for Title IV, HEA program funds.” 
About the takeover by student loan company ECMC, the New America Foundation’s Ben Miller, an expert on education policy, commented:
“You're talking about creating one of the 10 biggest nonprofit colleges on the fly with no educational expertise in place and doing so with an infrastructure of questionable quality. This type of transformation is unprecedented. Look at the biggest charter networks like KIPP. They started with one school and it took them years/decades to get bigger. So turning over something right away to operate at scale with such a vulnerable population and so-so educational offerings is an incredibly tough path to head down.”
Even if ECMC can run this operation, Corinthian and its various for-profit campuses have not demonstrated that they're worth saving. The U.S. government’s own Consumer Financial Protection Bureau has already sued Corinthian for over $500 million “to protect current and past students of Corinthian students …[and]… to halt these practices.” U.S. Congressman Steve Cohen (D-Tenn) called the deal with ECMC "a misguided use of federal funds," and added,
"When a school like [Corinthian] that has a checkered history is on the mat, throw in the towel. It's over." 
Well said. We don't need another mediocre, for-profit university recruiting students with promises of federally-subsidized loans and jobs that fail to materialize. Rather than propping up this failed enterprise, the Department of Education should simply let it fail. 

The top five cold remedies that do not work

A cure for the cold, from
One of my daughters caught a cold last week, and now she's given it to me. We’re giving ourselves the best treatment known to science: rest. But to judge from the products offered at our pharmacies, you’d think there were dozens of options to treat a cold. In local pharmacies and in the medicines aisle at my local grocery store, I’ve found row after row of colorful packages, claiming to relieve cold symptoms, shorten the duration of the common cold,” and more. 

Some of these medications actually do treat symptoms, but none of them cure a cold. But mixed among them—sometimes side-by-side with real medicines—I found several products that don’t work at all. 

How can a drug manufacturer get away with this? Simple: the products that don’t work are either supplements or homeopathic products. The manufacturers of both these types of “medicines” have successfully lobbied Congress to pass laws that exempt them from FDA regulation. Supposedly they aren’t allowed to make direct claims to cure or treat disease, but unless you read the wording on their packages very carefully, you’d never notice. (Note to older adults: bring your reading glasses to the pharmacy section!) 

Most important for consumers: if a treatment says it’s homeopathic, then its ingredients do not have to be shown effective. “Homeopathic” simply means that the ingredients are listed on the Homeopathic Pharmacopoeia, a list maintained by homeopaths themselves. And if it contains supplements or vitamins, they too are exempted from regulation by the FDA, under a law known as DSHEA

So next time you go searching for something to take for your cold, or for your child’s cold, here are the top 5 cold remedies you should not buy:

1. Zicam is a zinc-based remedy. Zinc is tricky, because there is some evidence to suggest that taking zinc right at the onset of a cold might shorten its duration a little bit, from 7 days to 6. But as Dr. Terence Davidson from UC San Diego explained, if you look at the more rigorous studies, the effect vanishes. Zinc turns out to have some worrisome side effects, too. Zicam's nasal spray and gel versions were linked to a serious loss of the sense of smell (anosmia), which led the FDA to issue a warning letter in 2009. Zicam responded by withdrawing the product for a time, but their website now says “A clinical link between the Zicam® products and anosmia was not established.“ Strictly speaking, this is correct, but there have been published reports suggesting a link, such as this one from 2009.*

Zicam’s website makes the misleading claim that “All of our Zicam® products are regulated by the FDA.” This is a common ploy of homeopathic drugmakers, claiming the FDA regulates them because the FDA could step in (as they've already done with Zicam) if consumers are being harmed. Unlike real drugs, though, Zicam has not been evaluated by the FDA for effectiveness or safety.

2. Airborne. You can find this in the cold remedy section many pharmacies (I did), but Airborne doesn’t cure anything. It’s a cleverly marketed vitamin supplement with no scientific support for any health benefits. How do they get away with it? Actually, Airborne paid $23 million back in 2008 to settle a class-action lawsuit over its advertising. They had been calling Airborne a “miracle cold buster.” According to the Center for Science in the Public Interest’s David Schardt, 
“Airborne is basically an overpriced, run-of-the-mill vitamin pill that’s been cleverly, but deceptively, marketed.”
After the lawsuit, Airborne modified their packaging, which now claims only that it “helps support your immune system.” This is one of those vague claims that supplement makers love, because it doesn't really mean anything. Airborne's products also now include a disclaimer that
 “These products are not intended to diagnose, treat, cure, or prevent any disease.”  
So what the heck are they doing in the “cold medicines” section of the store?

3. Coldcalm is a homeopathic preparation sold by Boiron, one of the world’s largest manufacturers of homeopathic remedies (including Oscillococcinum, an almost laughably ineffective flu remedy). It claims on the package to relieve cold symptoms. What’s in it? A dog’s breakfast of homeopathic ingredients, including belladonna, about which NIH says
Belladonna is UNSAFE when taken by mouth. It contains chemicals that can be toxic.” 
Another ingredient is pulsatilla, which “is highly toxic, and produces cardiogenic toxins and oxytoxins which slow the heart in humans.” Neither belladonna nor pulsatilla relieves cold symptoms.

Being homeopathic, these ingredients are highly dilute, but I think I’ll pass on Coldcalm.

4. UmckaUmcka is another homeopathic preparation that claims to “shorten the duration of common cold” and “reduce severity of cold symptoms.” Sounds pretty good—if only it were true. Umcka’s active ingredient is a plant extract called pelargonium sidoides, an African geranium. Interestingly, there have been a few experiments on this extract, some of which showed a small positive effect. However, a review of these studies reported that their quality was “very low," that all of them were conducted by Umcka itself, and that all of them were conducted in the same region of Russia. And remember: homeopathic preparations are so dilute that they contain little, and sometimes none, of the active ingredient.

5. Antibiotics. Okay, these are real medicine, and you can’t buy them over the counter at your pharmacy. But Americans take them in huge quantities to treat the common cold. The problem is, antibiotics don’t work for colds.

When my daughter told her friends she had a cold, they wanted to know why she didn’t go to the doctor. Of course, doctors can’t do anything about a cold, and going to a doctor’s office just puts other patients at risk. My daughter knows this. But her friends were astonished to hear that we never take her to the doctor for a cold. It turns out that most of them had been to doctors many times for colds, often coming away with a prescription for antibiotics. 

Antibiotics treat bacterial infections, not viruses. Taking antibiotics unnecessarily can be bad for you: besides wiping out your gut flora, it increases the risk that bacteria will develop drug resistance. Perhaps if we changed the name to "antibacterials," doctors would stop prescribing them for viruses.

I found Zicam, Airborne, Umcka, and Coldcalm for sale at Walgreens and Walmart. CVS and RiteAid don’t carry Umcka (good for them!) but do sell the others.

When you get a cold, you develop immunity to it and you won’t catch it again.We keep getting colds because they're caused by more than 100 different viruses, most of them nasty little buggers that continually circulate in our population. Each time you catch a cold, you’re getting a brand new one. The only consolation is that once you’re over it, you won’t get that one again.

So if you get a cold this winter, save your money. Stay home, rest and drink plenty of fluids. And I have it on good authority that there is one treatment for the common cold that’s inexpensive, widely available, and really, really works: chicken soup.

*In response to my inquiry, Zicam's manufacturer, Matrixx Initiatives, sent me some additional information. They pointed out that subsequent studies have not supported a link between Zicam and anosmia (loss of the sense of smell), and also that they permanently discontinued Zicam intranasal gel products ("Cold Remedy Nasal Gel and Cold Remedy Gel Swabs) in 2009, "despite the absence of any credible scientific data pointing to a potential link." They also argue that "the efficacy of zinc-based formulations is primarily a function of bioavailable dose" and that "Zicam products are formulated to ensure availability of the zinc." Arguing in favor of Zicam's benefits, they pointed to several studies that I'd already read, and I remain unconvinced and, as I pointed out above, Matrixx does not have to prove efficacy to the FDA because they are selling Zicam as a homeopathic preparation, which allows them to avoid FDA regulation.

“Shocking Report” on flu vaccines is neither shocking nor correct

Flu season is coming, and once again it’s time to get your flu shot (or snort, if you prefer FluMist). It’s not perfect, but the vaccine is your best protection against the influenza virus.

So I was surprised to stumble upon an article titled “Johns Hopkins Scientist Reveals Shocking Report on Flu Vaccines,” which popped up on an anti-vaccine website two weeks ago. Johns Hopkins University is my own institution, and I hadn’t heard any shocking new findings. I soon discovered that this article contained only a tiny seed of truth, surrounded by a mountain of anti-vaccine misinformation. Most of it focused on a report published in early 2013 by Peter Doshi, a former postdoctoral fellow at Hopkins.

First, as has already pointed out, Doshi is not a virologist or an epidemiologist, but rather an anthropologist who studies comparative effectiveness research. He never conducted influenza research at Hopkins. (He’s now an Assistant Professor at the University of Maryland’s School of Pharmacy.) Second, Doshi’s 2013 article was an opinion piece (a “feature”), not an original research article, and it did not report any new findings. Third, it is highly misleading to suggest (as the anti-vax article’s title does) that Doshi somehow represents Johns Hopkins University. At Johns Hopkins Hospital, the flu vaccine is required of all personnel who have contact with patients, as a good-practices effort to minimize the risk that a patient will catch the flu from a caregiver.

But what did Doshi’s article say? Even though it isn’t new, why are the anti-vaccine sites recycling it? His central argument is this:
“The vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.”
Let’s look at this statement. It’s almost obviously true: one only has to find a few overstated claims about the risks of flu, which isn't hard to do. But it’s also completely consistent to state that the vaccine is enormously beneficial and that the threat of influenza is very serious. See how that works? 

Doshi uses this slight-of-hand to suggest that the vaccine may not be beneficial at all. He never says this outright—instead, he just questions, again and again, whether the precise percentages reported in published studies are accurate. For example, he makes a big deal of a CDC announcement in 2013 that the vaccine’s effectiveness was only 62%. He casts doubt with phrases like 
“the 62% reduction statistic almost certainly does not hold true for all subpopulations”
which is almost certainly true, but is meaningless from the point of view of public health. Of course the vaccine doesn’t have the same effectiveness in everyone. The point is that it works most of the time. 

Doshi cites another study that showed a clear benefit for the flu vaccine, only to cast doubt on it with this argument: 
“No evidence exists, however, to show that this reduction in risk of symptomatic influenza for a specific population—here, among healthy adults—extrapolates into any reduced risk of serious complications from influenza such as hospitalizations or death in another population.”
Again, Doshi’s argument doesn’t prove that the original study was wrong, only that it doesn’t apply to everyone. But Doshi’s motivation, as evidenced by the relentlessly negative slant of his entire article, seems to be to convince people that the flu vaccine is bad.

Not surprisingly, the anti-vaccine movement has embraced Doshi (for example, here and here). And unfortunately, he seems to have accepted their acclaim: in 2009, he spoke at an anti-vaccine conference hosted by NVIC, a notorious (and misleadingly named) anti-vaccination group.

Perhaps even more disturbing is that Doshi signed a petition arguing that the HIV virus is not the cause of AIDS, joining the ranks of HIV denialists. He signed this statement while still a graduate student, so I contacted him to ask if he still doubted the link between HIV and AIDS. I also asked him if he supports flu vaccination, if he agrees with the anti-vaccine movement's use of his statements, and if he believes the flu is a serious public health threat.

On the question of signing the HIV/AIDS petition, Doshi responded that "Seeing how my name was published and people have misconstrued this as some kind of endorsement, I have written the list owner and asked for my name to be removed." (He declined to state directly - and I gave him the chance - that he agrees that the HIV virus causes AIDS.)

As for the flu itself, Doshi says "I don’t agree with CDC’s portrayal of influenza as a major public health threat." So he and I have a serious disagreement there. I asked if he agrees with the anti-vaccinationist who are using his writings to claim that the flu vaccine is ineffective, and he replied that while "ineffective" is "too sweeping," he has found "no compelling evidence of hospitalization and mortality reduction in [the] elderly."

Doshi’s argument against the flu vaccine boils down to this: the vaccine is much less than 100% effective. This is undeniably true, and the research community makes no secret of it. In fact, many of us have repeatedly called for more research into better vaccines, in the effort to create a vaccine that is not only more effective, but that (like most other vaccines) only needs to be taken once for lifetime immunity. We’re just not there yet. Meanwhile, though, the annual flu vaccine is usually effective: a recent study showed, for example, that it reduced children’s risk of ending up in a pediatric intensive care unit by 74%.

So get your flu shot (or snort) now, before flu season hits, because it takes a couple of weeks for your body to develop immunity. By getting immunized, you’ll not only increase your chances of getting through the winter flu-free, but (because you won’t spread the flu to others) you might also save someone whose immune system would be overwhelmed by influenza. 

Should the government allow scientists to create new super-viruses?

Let's suppose a bunch of scientists proposed to take one of the most infectious human viruses—influenza, say—and turn it into a super-bug. Is this a good idea?

Or to put it another way: should scientists be artificially mutating viruses so that they have the potential to become a worldwide pandemic?

Right about now you might be asking: is anyone actually doing this, and if so, what on earth are they thinking?

And yet, several of the world's most prominent influenza researchers have been engaged in exactly this enterprise for several years now. They call their work "gain of function" experiments, because they manipulating viruses to give them new (and very dangerous) functions.

I wrote about this last year, after a group led by Ron Fouchier at Erasmus Medical Center in the Netherlands and Yoshihiro Kawaoka of the University of Wisconsin announced, in a letter to Nature, that they were going to create a new strain of H7N9 influenza virus that had the potential to turn into a human pandemic. Sure enough, just a few months later, Fouchier published results showing they had done just that, although they reported that their newly engineered strain had only "limited" transmissibility between ferrets (the animal they used for all their experiments).

Fouchier and Kawaoka had already done the same thing with the deadly H5N1 "bird flu" virus, causing a huge outcry among scientists and the public. As reported in Science magazine almost three years ago, Fouchier admitted that his artificially mutated H5N1 was "probably one of the most dangerous viruses you can make."

And yet he did it anyway—and then did it again, with H7N9.

Many other scientists were and are extremely concerned about these experiments, which some of us consider dangerous and irresponsible. This past July, a large group of scientists known as the Cambridge Working Group (of which I am a member) released a statement calling for a hiatus, saying:
"Experiments involving the creation of potential pandemic pathogens should be curtailed until there has been a quantitative, objective and credible assessment of the risks, potential benefits, and opportunities for risk mitigation, as well as comparison against safer experimental approaches."
Just two days ago, the U.S. government responded, announcing that it was going to take a serious look at whether creating these superbugs is a good idea. The Office of Science and Technology Policy (OSTP) is creating two committees to "assess the potential risks and benefits" of these experiments, particularly those involving the influenza, SARS, and MERS viruses.

Until the committees come up with recommendations, the government is halting any new funding for these experiments and asking for a voluntary "pause" on existing work.

Not surprisingly, Fouchier and his colleagues have argued that their work has benefits; that it has "contributed to our understanding of host adaptation by influenza viruses, the development of vaccines and therapeutics, and improved surveillance." Yet these arguments are tenuous at best. Fouchier and company have failed to show that the mutations they found in ferret experiments are likely to occur in the natural course of human outbreaks, which means that using their viruses for vaccine development would be a huge mistake.

And to claim that creating super-viruses in the lab will lead to "improved surveillance" is, frankly, laughable. Surveillance means getting out in the field and collecting samples from sick people. Gain-of-function laboratory experiments have basically nothing to do with surveillance.

Harvard's Marc Lipitsch has been one of the prominent voices arguing against this line of research, writing just last week that the scientific benefits of these experiments are very limited, for reasons detailed in his article. Lipitsch is also one of the founding members of the Cambridge Working Group.

According to the announcement from The White House, the first committee to evaluate the merit of these experiments will meet in just a few days, on 22 October. Meetings will continue throughout the winter, with recommendations expected sometime in the spring of 2015.

We have enough problems with influenza, and now with Ebola too, without scientists creating incredibly deadly new viruses that might accidentally escape their labs. Let's hope that the OSTP does the right thing and shuts down these experiments permanently.

How to stop Ebola: ban air travel from West African countries

Countries in which Ebola virus has appeared in the past.
I never thought I’d find myself agreeing with Louisiana governor Bobby Jindal. But this week, Governor Jindal called for a ban on air travel to the U.S. from the countries where the epidemic is present. He’s right: a flight ban is the best way to keep Ebola from spreading. 

In the world of infectious diseases, we often hear the phrase that the next epidemic is “one flight away” from the U.S. That’s truebut we don’t usually know where that flight will originate, so we can’t simply ban all flights to the U.S. from everywhere. With Ebola, though, we know the source: the epidemic is confined to Liberia, Sierra Leone, and Guinea. 

As the Ebola crisis has grown in West Africa, the need to stop its spread has grown ever more urgent. The number of cases is now over 20,000, and the CDC estimates that by January, Liberia and Sierra Leone will have 1.4 million people with Ebola infections. These are frightening numbers.

The Ebola virus has no treatment and no cure, although some promising research is under way (as I’ve written about previously). According to the WHO, the Ebola fatality rate is 50%. This makes it one of the deadliest diseases known to affect humans.

And now, alarmingly, Ebola has appeared in the U.S., in an airplane passenger who traveled from Liberia to Texas. This one individual has exposed as many as 114 others, all of whom are now being followed by the CDC.

In a press briefing yesterday, CDC Director Tom Frieden offered this reassurance:
We know how to stop outbreaks of Ebola.  In this country, we have health care infection control and public health systems that are tried and true and will stop before there's any widespread transmission.  The core of that, the way to stop Ebola in its tracks is contact tracing, and follow-up.”
Dr. Frieden is correct that we can stop an outbreak, if we can find everyone exposed and quarantine those who might be infected. But he dismissed the notion of simply banning travel: 
“Although we might wish we could seal ourselves off from the world, there are Americans who have the right of return.  There are many other people who have the right to enter into this country.”
I'm not arguing that we should “seal ourselves off from the world." (Nor, I suspect, is Governor Jindal.) We are arguing to seal off just three small countries in West Africa, until the epidemic passes. This would not be a difficult ban to implement and enforce. For Americans who wish to return from those countries, we can require a quarantine protocol, which the CDC already has in place at many airports. As Jindal said:
"How exactly would stopping the entry of people potentially carrying the Ebola virus be counterproductive? This seems to be an obvious step to protect public health in the United States.”
CDC Director Frieden also revealed yesterday that in the month of September, screening at airports in African countries has turned away 77 people who had signs of possible Ebola infection, including 17 in the month of September. Although Frieden used this example to illustrate the effectiveness of CDC’s screening program, it also shows that sick people are trying to board planes to the U.S. As the outbreak grows, it will grow increasingly difficult to keep all Ebola-infected passengers—who don't show signs of infection for several days—off those planes.

Director Frieden is correct that we can stop outbreaks of Ebola here, because we live in a modern country with good infection control systems. But prevention is better than control. So much as I hate to admit it, Bobby Jindal is right: we need a travel ban if we want to keep the Ebola virus out of the U.S.

Does a standing desk lengthen your lifespan?

Standing desks are all the rage lately. These desks allow you to stand up while working on your computer. Some standing desks can be raised and lowered, so you can alternate during the course of the day between sitting and standing. The principal argument for these desks is that they provide health benefits.

Proponents of standing desks claim, plausibly, that they give you more energy and improve posture. The CDC has found that standing desks (or “sit-stand” desks) reduce upper back and neck pain and improve moods. At, Joseph Stromberg reported that standing desks reduce the risk of obesity and type 2 diabetes. And a 2012 Australian study found that prolonged sitting increased the risk of death. In other words, standing up more and sitting less can help you live longer. All this makes me want to stand up right now.

The newest claim is that standing up lengthens your telomeres. If true, this would provide a mechanism to explain how standing up might lengthen your life. The new study, led by Swedish scientist Per Sjögren, appeared this month in the British Journal of Sports Medicine.

Telomeres are special DNA “caps” on the ends of everyone’s chromosomes. As we age, these caps gradually get shorter, and if they get too short, the cell dies. They function as a kind of molecular clock, telling a cell when it’s old. A substantial body of scientific evidence shows that if you can maintain telomere length, cells—and their owners—will live longer.

But how could merely standing more, or sitting less, shorten our telomeres? Being skeptical, I read the paper.

Here’s what Sjögren and colleagues did: several years ago, they conducted a study measuring the effect of exercise on weight, cholesterol levels, and a few other characteristics. That study included 101 people, all 68 years old. They randomly chose 49 people (14 men, 35 women) to study the effect of exercise on telomere length. They used blood samples taken 6 months apart, both before and after the exercise regimen. This was all completed back in 2011.

Previously, they reported that there was no difference in telomere length between the “exercise” group and the control group. So how can they publish a new study that seems to reach the opposite conclusion? It turns out there isn't a new study at all, but a re-analysis of the original data.

In the early study, the exercise program did have some significant effects: it increased the amount that people walked around by 1663 steps per day, and decreased their sitting time by 2 hours per day. However, people in both groups spent less time sitting over the course of the study. So the scientists re-analyzed the data and looked at telomere length as a function of four more measurements. For one of these measures, change in sitting time per day, telomere length was reduced enough that the relationship showed a p-value of 0.02.

Unfortunately for Sjögren, this new finding is based on just 12 individuals. That's a tiny number for a scientific study. And when I looked at the key figure in the paper, it’s pretty clear that the effect depends critically on just 2 of those 12 individuals who had both reduced sitting time and longer telomeres. Take those 2 people out, and the effect vanishes. The authors admitted that
“The study sample is small and we cannot rule out that the findings are a chance phenomenon.”
We've seen this sort of thing before: a small study with a minimally significant effect. Usually these types of results never get replicated. As much as I’d love to believe I could lengthen my telomeres by standing up a bit more each day, this rather implausible findnig is simply unconvincing. It’s based on a sub-group of only 12 people—and furthermore, this is a re-analysis of previous data, which feels an awful lot like cherry-picking. If there is any effect, it’s very small.

Nevertheless, other studies do show health benefits from spending more time walking and less time sitting. A daily walk probably confers the same benefit as a standing desk, but a standing desk isn’t a terrible idea either. Just don’t count on it to lengthen your telomeres.

Should we test all women for breast cancer-causing mutations?

In this week’s Journal of the American Medical Association, famed geneticist Mary-Claire King argues that all women over age 30 should be tested for cancer-causing mutations in the BRCA1 and BRCA2 genes. King, who made the original discovery of the link between BRCA1 and breast cancer, is one of the world’s leading experts on how mutations in these genes cause cancer.

But her proposed new universal testing policy, which fellow Forbes contributor David Shaywitz calls “audacious,” goes far beyond what other experts recommend. Earlier this year, the highly regarded U.S. Preventative Services Task Force (USPSTF) recommended testing BRCA genes only in women with a family history of breast or ovarian cancer. 

Although there’s no question that King is an expert on BRCA gene testing, I think she’s gone much too far with her latest proposal. She has the science right, but she is far too optimistic about how her recommendation would actually play out. The policy might save some lives, but it would also cause a great deal of pain.

First, it’s worth explaining why King thinks universal BRCA testing is a good idea. In her JAMA article, King and colleagues describe a new study they conducted in Ashkenazy Jews that showed, somewhat surprisingly, that 
“50% of families found to harbor BRCA1 or BRCA2 mutations had no history of breast or ovarian cancer that would have triggered clinical attention." 
In other words, under current policy guidelines, 50% of people who have a damaging mutation in one of these genes will not have their genes tested. Many of them will eventually get breast or ovarian cancer—as King explains, women with harmful BRCA1 mutations have a 60% risk of cancer by age 60, and for BRCA2 the risk is 33% by age 60. That’s a very high risk, though it’s important to keep in mind that many women with these mutations will never get cancer.

With modern DNA sequencing technology, any large-scale genetic BRCA testing program is likely to uncover thousands of mutations that have no harmful effects, and thousands more whose effects are simply unknown. (Aside: each BRCA gene spans about 80-90 thousand nucleotides of DNA, and each of those letters can mutate in 4 ways, changing into one of the other 3 bases or just being deleted. This means there are at least 400,000 mutations possible in each gene, not counting larger deletions. A colleague and I published an article in 2010 describing one such BRCA test.) King is clearly aware that such reporting these mutations to patients would only sow confusion, and she recommends that:
“Testing for BRCA1 and BRCA2 should focus solely on unambiguously loss-of-function mutations with definitive effect on cancer risk…. A VUS [variant of unknown significance] can increase confusion and compromise clinical management; for population-based screening, these variants should not be reported.”
Herein lies one of the biggest problems with King’s idea. We don’t have universal agreement on which mutations have no significance, and even if we did, most physicians are not experts on cancer genetics. In our lawsuit-prone medical culture, there exists an unfortunate tendency to over-treat and over-report everything. 

Thus I fear that if we had wider BRCA testing, clinical labs would report all mutations back to physicians (how could they not?), and physicians in turn would report everything to the patients. The result would be that millions of women would be told "you have a mutation in BRCA1, and we don't know what it means." What's a patient supposed to do with that?

The other problem is that the only treatment to prevent breast and ovarian cancer is surgery to remove a woman’s breasts and ovaries. We don’t have a pill you can take, or lifestyle changes you can adopt, that will dramatically reduce your risk of hereditary cancer. But unlike a cancer diagnosis, the discovery of a BRCA mutation does not mean you have cancer. It simply means you have a risk, possibly a high risk, of getting cancer at a young age. We know from decades of research that people are not very good at evaluating risk. We tend to over-estimate the danger of events that seem very dramatic or visible to us, as cancer is to many people. 

By King’s own estimates, widespread BRCA testing would detect cancer-causing mutations in 250,000 to 415,000 women in the U.S. This estimate assumes the test doesn’t have false positives, which it almost certainly would. All of these women would then be faced with an extremely difficult dilemma: should they have both their breasts removed, or live the rest of their lives in fear of breast cancer? 

This dilemma was famously on display last year, when actress Angelina Jolie revealed in a New York Times article that she’d had a double mastectomy, after discovering that she carried high-risk BRCA mutations. Jolie’s mother died from cancer at the age of 56, and she explained in her article that as a result of the surgery, “ I can tell my children that they don’t need to fear they will lose me to breast cancer.”

King’s proposal is audacious, and it’s well worth debating. But without a better treatment option, telling hundreds of thousands of women that they have a high risk of breast and ovarian cancer carries a potentially enormous cost, both physical and emotional, for these women. Rather than putting huge numbers of women under the surgeon’s knife, we should instead double or triple our investments in research on treatments that may eventually make surgery unnecessary. 

Do high voltage power lines cause cancer?

This could be a very short article. I could just write “no, power lines don’t cause cancer"—but that wouldn't explain why so many people believe otherwise. And it won’t help people who are thinking about buying a home that has power lines nearby. So let’s look at this question a bit more closely.

For the past century or more, humans have been surrounding ourselves with an ever-growing array of electrical devices. All of these devices create electrical or magnetic fields, often called EMFs. There’s no doubt that our exposure to EMFs has increased dramatically in modern times. Not surprisingly, many people have worried that this is a bad thing. The belief is so pervasive that NIH has at least two websites devoted to this topic, one by NIEHS and one by NCI, as does the Medical College of Wisconsin. Realtors have created webpages to inform home buyers about how power lines might affect the value of their home. Not surprisingly, you can easily find companies on the Internet that will sell you devices (such as SafeSpace and EMFshield) to protect your body from the supposed perils of EMF.

People worry especially about high-voltage power lines, probably because they are carried by very large, highly visible structures that look vaguely threatening. This fear seems to have started with a 1979 study in which Nancy Wertheimer and Ed Leeper reported a correlation between high-voltage power lines and childhood leukemia in the area around Denver, Colorado. Wertheimer's results spurred numerous studies in the years since. A review of the evidence in 1995 pointed out that
“There is no known mechanism by which magnetic fields of the type generated by high voltage power lines can play a role in cancer development. Nevertheless, epidemiologic research has rather consistently found associations between residential magnetic field exposure and cancer.”
Scientifically, the question at the time was, were these associations real or coincidental?  If they were real, what’s the mechanism? Clearly, further studies were needed. Well, twenty years later, the data are in: power lines do not cause cancer.

In 2002, the WHO commissioned a huge (339 pages) and very thorough report on all the types of electrical and magnetic fields on the planet and how these EMFs might effect our health. Among its findings were:
“There is little experimental or theoretical evidence that mutations could be directly caused by ELF [extremely low frequency] magnetic fields…. There is little evidence that ELF electric or magnetic fields can cause malignant transformation of cells in culture.”
The final conclusion of the WHO commission was that
“Static electric and magnetic fields and extremely low-frequency electric fields are not classifiable as to their carcinogenicity to humans (Group 3).”
Group 3 means we don’t have any positive evidence that EMFs cause cancer. The only lower category, Group 4, would mean we have evidence that electromagnetic fields do NOT cause cancer, but such evidence is very difficult to produce. In other words, they concluded that the evidence didn't support a link, but more studies might yet find something.

After the 2002 report by the WHO, a study in 2005 raised the alarm again. In that study, Gerald Draper and colleagues claimed to find an association between the distance to the nearest high voltage power line and childhood leukemia. Draper found that living less than 200 meters from these power lines (in England and Wales) raised the risk of leukemia significantly compared to living at least 600 meters away.

The scientific reaction to the Draper study immediate and highly critical. Hepworth and colleagues pointed out that the results did not support a causal role for electromagnetic fields (which were not measured), but at best a geographic correlation. Kheifets and colleagues demonstrated out that the effect disappeared when the control groups were analyzed differently. Other critiques quickly emerged as well: a sign that science was working to self-correct, as it often does. But Draper’s study was widely reported, while the criticisms were not. The critiques, though, paint a compelling picture that Draper’s work was seriously flawed.

One of the most recent studies is from 2013 by Elliott et al. who looked at over 50,000 cases of cancer, including leukemia, brain cancer, breast cancer, skin cancer, and others. They found no increased risk for any of these cancer types and concluded
“Our results do not support an epidemiologic association of adult cancers with residential magnetic fields in proximity to high-voltage overhead power lines.”
This debate sounds very familiar. Many false hypotheses, such as the notion that vaccines cause autism, or that acupuncture can reduce pain, show the same pattern: a few small studies produce weak positive evidence, but then larger, better studies fail to back them up. Proponents always call for more studies, but if the effect is real, it doesn't disappear when you do a bigger study. If anything, the effect should appear stronger.

A major problem that the EMF alarmists have, which none of the proponents have ever answered, is one of mechanism: how is the very weak EMF from a power line supposed to cause cancer? Multiple theories have been suggested: maybe EMFs affect the movement of magnetic particles within cells, or alter the voltages across cell membranes—but as the editor of BMJ, Geoff Watts, put it in his response to the 2005 Draper study:
“Evidence to support these and other ideas is at best thin and at worst non-existent.”
So no, electrical power lines do not cause cancer. But they're still ugly. We should bury them all underground.

The 3 Dumbest Products Sold By Whole Foods Market

Whole Foods "Whole Body" products.
I have a love-hate relationship with Whole Foods Market. On the one hand, I love their fresh produce, their baked goods, and many other food choices there. On the other hand, they seem to have embraced anti-science positions in the interest of keeping everything “natural.”

Before describing what they do wrong, let’s start with some things they get right. Their seafood sustainability policy supports fishing practices that allow wild fish populations to survive. This is a shining example that other stores would do well to follow, if we want to preserve remaining stocks of wild salmon, tuna, swordfish, and other fish. Whole Foods stores now mark each fish with a sustainability rating shown as a bright-colored label next to each fish. Bravo!

Whole Foods also offers chicken and beef that was raised humanely, following animal welfare standards that they clearly describe on their website and in their stores. For those who care about the way farm animals are treated, this is a valuable option.

But in some areas of the store, especially their “health” section, Whole Foods wades deep into pseudoscience,  So here are the three of the most egregious examples.

1. Whole Foods sells homeopathic medicines that are little more than snake oil. They make claims for health benefits, both on their shelves and on their website, that are based on little more than magical thinking. For example, they sell “homeopathic flu remedies” claiming that “when taken at the first sign of sickness, these can provide temporary relief of symptoms including fever, chills, and body aches.” This is simply false: no homeopathic treatment has ever been shown to be effective at treating flu symptoms. (I’ve written about homeopathy in more detail here and here.)

It’s ironic that on the one hand, Whole Foods proclaimsWe've long believed that consumers have a right to know what's in your food”. But when it comes to homeopathic remedies, they neglect to inform consumers that these remedies do not contain the ingredients on the bottle at all. That's because homeopathic preparations are so diluted that not a single molecule of the original substance remains. Even more absurd, though, is that even if they weren't diluted to nothing, most homeopathic ingredients have never been shown to have any health benefits to begin with.

2. Whole Foods has an anti-GMO policy, adopted across all their stores, that ignores the science of GMOs. They announced last year that they would label all products in their stores to indicate whether they contained Genetical Modified Organisms. They also have announced that they are trying to eliminate GMOs from their shelves. 

Why is Whole Foods opposed to all GMOs? Their answer is simply: 
Crops are currently modified to survive herbicide treatment, produce their own pesticides and resist certain diseases.“
This answer is a true statement, though it does not describe all GMOs, nor does it explain why we should avoid them. For example, golden rice is a form of rice that’s been modified to contain more vitamin A than regular rice - a modification that is designed to prevent blindness in children, particularly in poor, rural regions where rice constitutes a major part of the diet. Golden rice has even been blessed by the Pope. Is Whole Foods opposed to this form of GMO?

And what’s wrong with engineering a crop to resist disease? Some foods would basically disappear from our shelves if we didn’t have disease-resistant versions. For example, the Hawaiian papaya was nearly wiped out by a virus until, in one of the first uses ever of genetic modification, plant scientists created a resistant variety. This saved the industry, and the papaya itself has exactly the same nutritional value it had before.

I suspect that Whole Foods (and many anti-GMO types) are mostly opposed to Monsanto’s Roundup Ready GMO crops, which are modified to allow farmers to use more of Monsanto’s herbicides. I can sympathize with that position - but not with opposing all uses of GMO technology. That’s throwing the baby out with the bathwater.

3. Whole Foods won’t sell the pain relievers aspirin and ibuprofen, because they’re not “natural." Instead, their Whole Body department sells a wide range of nutritional supplements, for which they make claims such as this
“Not sure which supplement to choose? Grab a full-spectrum wellness or immune support formula. These combinations of herbs, vitamins, minerals and antioxidants are specifically designed to effectively improve overall wellbeing and enhance immune support.“ 
That’s just gobbledygook, but it's carefully worded to avoid FDA regulations. The phrase "enhance immune support" is a common go-to phrase for supplement makers, because it sounds science-y. Not only are supplements mostly useless, but taking megadoses can actually harm you. And there’s no scientific reason to think that “natural” products are better for you. After all, snake venom is 100% natural.

In contrast, ibuprofen and aspirin really work - but you can't buy them at Whole Foods. I continue to shop at Whole Foods for their many excellent food selections. But for anything medical, I shop elsewhere.

South Carolina lawmaker wants to force Creationism down students' throats

Well, it’s happened again. The great state of South Carolina has demonstrated that when it comes to ignorance of science, its legislators take a back seat to no one. They must have been jealous of Kansas, Louisiana, and Texas.

Last week, SC legislator Mike Fair, a Republican, proposed a new standard for teaching high school biology that encourages teachers to teach alternatives to evolution, by which he means creationism. He's been working on this for months; last spring he tried to pass a law that would have required students and teachers to construct arguments against evolution. After failing to get that through his committee, he has proposed a new law that says
“evolution is continually open to and subject to experimental and observational testing.”
Except of course that's not what he really means.

Let’s be clear: Mike Fair doesn’t want evolution to be taught in public schools. Instead, he wants to force students, using the power of government, to adopt his conservative Christian views, which teaches that God created all living things just as they are today, about 6000 years ago (or 4000 years, depending on who you ask). 

Fair has a history of trying to dumb down the teaching of science.  Back in February, he blocked the state education oversight committee from using the phrase “natural selection” in the state science standards. Speaking to the (SC) Post and Courier, Fair said 
“To teach that natural selection is the answer to origins is wrong. I don't think it should be taught as fact.” [Mike Fair, S.C. legislator]
Ignorant barely begins to describe this statement. Mike Fair clearly doesn’t have the faintest grasp of biology or genetics. He’s the last person that anyone should want to weigh in on science standards. His behavior goes far beyond mere ignorance, though: not only is he wrong, but he wants to use the power of the state to impose his religious views, under the guise of science, on every student in South Carolina’s schools. No wonder South Carolina is perennially ranked near the bottom of the country in public education. 

I have a confession to make. I grew up in South Carolina and went through the public schools there, from kindergarten right through high school. I met lots of guys like Mike Fair: popular, plays on the football team, student body president. These guys are usually bullies (we've all seen the movie), and that’s just what Fair is demonstrating now: he wants to bully every teacher, and every child, into listening to his ignorant views of science. I’ve no doubt that if Fair could require prayer in every school — Christian prayer, that is — he’d do that too. I grew up surrounded by this kind of nonsense, but I didn't speak up then because I would have been ostracized. Well, I'm speaking up now. 

Fair and his colleagues in the Republican-dominated S.C. House of Representatives argue that no, they aren’t forcing teachers to teach creationism — they just want to teach the controversy. Equally appalling is the position of the S.C. Superintendent of Education, Mick Zais, who agreed with this sentiment, saying: 
"We ought to teach both sides and let students draw their own conclusions."
No, you shouldn't. There is no scientific controversy about evolution. Evolutionary theory is based on an enormous edifice of facts, with literally tens of thousands of scientific papers providing evidence to support it. There is no competing theory out there.

Ironically, three years ago Fair introduced a bill to prevent the imposition of Islamic-based Sharia law in South Carolina. He justified this by saying 
A growing concern is the immigration of people who are accustomed to their religion and their civil laws being inextricably connected. For those newcomers to our state, this bill will be helpful to them as they are assimilated into our culture maintaining complete freedom to worship as they please."
Reading this sent my irony meter way into the red zone. Let me see if I understand: Mike Fair doesn’t want religion and civil laws to be “inextricably connected” — but he does want to require that public, state-funded schools teach his religious view of the creation myth. I guess what he meant to say is that it’s okay to mix religious fundamentalism and civil law, as long as it’s Mike Fair's brand of Christian fundamentalism.

South Carolina doesn't need its own set of science standards, nor does Texas, Louisiana, or Kansas. The laws of science don't change when you cross state lines or national borders. Allowing politicians to set science standards is a recipe for disaster, and is one reason why the U.S. continues to lag the rest of the world in science education—as South Carolina has once again demonstrated.

Robert Kennedy's Anti-Vaccine Craziness

Robert Kennedy is obsessed with the notion that vaccines cause autism. He’s particularly obsessed with the discredited idea that thimerosal, a preservative used in some vaccines, causes autism. Now Kennedy is about to publish a new book on this topic, and he’s promoting it both in the press and, as described in today’s Washington Post, in the halls of Congress. He’s recently had personal meetings with U.S. Senators Barbara Mikulski and Bernie Sanders to try to convince them to take action based on his claims. Why is it that a scientifically unqualified anti-vaccine advocate can get a private audience with a U.S. Senator? Because he’s famous, that’s why.

Robert F. Kennedy Jr. is part of the most famous family in America. He’s the nephew of a former president and the son of a former senator and Attorney General, both tragically assassinated in the 1960s. Another uncle, Edward Kennedy, was a U.S. Senator for Massachusetts for decades. He gives hundreds of speeches a year, mostly on environmental issues, and he’s been an influential figure in the environmental movement.

But on the thimerosal issue, Kennedy has gone completely off the rails. He authored a and Rolling Stone article (jointly published) nearly ten years ago that claimed not only that thimerosal-containing vaccines cause autism, but that “the government” knew about it and had been covering it up. Kennedy wrote then that
The story of how government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public is a chilling case study of institutional arrogance, power and greed.”
Alarming-sounding stuff. The article is full of dramatic claims like this one. The only problem is, it’s all false.

I’ve been writing and speaking about the anti-vaccine movement for years, including articles in 2009 and 2010 on three landmark vaccine court rulings. As I explained back then:
Why was thimerosal introduced into vaccines? Well, early vaccines were administered from multi-dose bottles, in which bacteria could grow. In one particularly disastrous incident in 1928, 12 children in Australia died from staph infections after getting the diptheria vaccine from the same multi-dose bottle. After the introduction of thimerosal, bacterial infections caused by vaccination virtually disappeared.”
In the late 2000's, a special vaccine court conducted three lengthy hearings in which the anti-vax advocates were asked to present their best cases. One of the cases focused specifically on the question of whether thimerosal in vaccines cause autism. In that case, the judge concluded:
“The numerous medical studies concerning the issue of whether thimerosal causes autism, performed by medical scientists worldwide, have come down strongly against the petitioners’ contentions. Considering all of the evidence, I find that the petitioners have failed to demonstrate that thimerosal-containing vaccines can contribute to the causation of autism.”
As a lawyer, Kennedy should be able to understand this. The science, which Kennedy apparently does not understand, leads to the same conclusion: in study after study, scientists have found no link between thimerosal and autism, or any other kind of neurological disorder. And as RFK Jr knows, thimerosal was removed from childhood vaccines in the U.S. over a decade ago, and the rate of autism diagnosis continued to rise. This fact alone contradicts his major claim. 

What was shocking to me, the first time I heard Kennedy talk about thimerosal in vaccines, was how absolutely certain he is that he is right. Today's Washington Post article describes a man who remains utterly convinced, despite the mountain of evidence against him.

After Kennedy's article appeared, scientists responded quickly and convincingly, pointing out its numerous flaws and distortions. tried to fix the problem, issuing five corrections before throwing up their hands and removing the article entirely from their website. Rolling Stone also took down the article. Salon’s editor-in-chief wrote an apology, saying 
I regret we didn’t move on this more quickly, as evidence continued to emerge debunking the vaccines and autism link. But continued revelations of the flaws and even fraud tainting the science behind the connection make taking down the story the right thing to do .”
Kennedy has steadfastly refused to admit any errors, ever. As of today, his own website still displays the original article, without even the small corrections that had made. He’s been embraced by the anti-vaccine movement: he gave a keynote talk at their annual conference, Autism One (prompting this response from one well-known science blogger), and he even spoke at one of Jenny McCarthy’s “Green Our Vaccines” demonstrations.

As Keith Kloor wrote today in his online column at Discover, Kennedy has not only failed to convince the world that he’s right (and the entire scientific community is wrong), but he doesn’t really care. He told Kloor that “if I die poor, then I go down fighting for what’s right.” (This despite the ridiculousness of the notion that the wealthy Kennedy family will ever be poor.)

By ignoring the scientific evidence that shows that thimerosal and vaccines have no link to autism, Robert Kennedy has placed himself firmly in the camp of conspiracy theorists and cranks. He’s also demonstrated breathtaking arrogance. He believes that despite his lack of scientific training, he knows the truth that every scientist who’s studied this issue has missed. 

Even worse, Kennedy is using his fame to spread anti-vaccine misinformation, which has contributed to an alarming rise in the number of infectious disease outbreaks here in the U.S., including major outbreaks of measles and whooping cough. Though I doubt he will listen to me (he’s ignored everyone else), Kennedy needs to take a hard look at the harm he’s causing to defenseless children, the elderly, and cancer patients, and anyone else with a weak or compromised immune system. His advocacy of bad science will cost lives, if it hasn’t already.

When I've heard Kennedy talk about environmental topics, where I agree with him almost completely, I’ve been impressed by his passion and his seeming command of the issues. But having heard him speak about thimerosal and vaccines, I now realize that he’s a dangerous idealogue, willing to distort the truth so thoroughly I can’t believe a word he says. The only solace I can take from today’s Washington Post article is that Senators Mikulski and Sanders don’t believe him either. Both of them brushed him off. Next time, they shouldn’t bother giving him an audience.

Stop teaching calculus in high school

Math education needs a reboot. Kids today are growing up into a world awash in data, and they need new skills to make sense of it all. 

The list of high school math courses in the U.S. hasn’t changed for decades. My daughters are taking the same courses I took long ago: algebra, geometry, trigonometry, and calculus. These are all fine subjects, but they don’t serve the needs of the 21st century. 

What math courses do young people really need? Two subjects are head-smackingly obvious: computer science and statistics. Most high schools don’t offer either one. In the few schools that do, they are usually electives that only a few students take. And besides, the math curriculum is already so full that some educators have argued for scaling back. Some have even argued for getting rid of algebra, as Andrew Hacker argued in the NY Times not long ago.

So here's a simple fix: get rid of high school calculus to make way for computer programming and statistics.

Computers are an absolute mystery to most non-geeks, but it doesn’t have to be that way. A basic computer programming class requires little more than a familiarity with algebra. With computers controlling so much of their lives, from their phones to their cars to the online existence, we ought to teach our kids what’s going on under the hood. And programming will teach them a form of logical reasoning that is missing from the standard math curriculum.

With data science emerging as one of the hottest new scientific areas, a basic understanding of statistics will provide the foundation for a wide range of 21st century career paths. Not to mention that a grasp of statistics is essential for navigating the often-dubious claims of health benefits offered by various "alternative" medicine providers. 

(While we're at it, we should require more statistics in the pre-med curriculum. Doctors are faced with new medical science every day, and statistical evidence is the most common form of proof that a new treatment is effective. With so much bad science out there (just browse through my archive for many examples), doctors need better statistical knowledge to separate the wheat from the chaff.) 

Convincing schools to give up calculus won’t be easy. I imagine that most math educators will scream in protest at the mere suggestion, in fact. In their never-ending competition to look good on a blizzard of standardized tests, schools push students to accelerate in math starting in elementary school, and they offer calculus as early as the tenth grade. This doesn’t serve students well: the vast majority will never use calculus again. And those who do need it - future engineers, physicists, and the like - can take it in college. 

Colleges need to adjust their standards too. They can start by announcing that high school programming and statistics courses will be just as important as calculus in admissions decisions. If just a few top universities would take the lead, our high schools would sit up and take notice.

We can leave calculus for college. Colleges teach calculus well, and 18-year-old freshmen are ready for it. Every major university in the country has multiple freshman calculus courses, and they usually have separate courses designed for science-bound and humanities students. Many students who take high school calculus have to re-take it in college anyway, because the high school courses don’t cover quite the same material. 

Let’s get rid of high school calculus and start teaching young students the math skills they really need.