An immigrant's tale: why we should welcome immigrants to the U.S.

1918 obituary for my grandfather.
This week I’m taking a break from science and choosing a more personal topic for my last column of the year. Many scientists wouldn’t be here if not for the opportunities offered by a new life in the U.S., and with so much anti-immigration talk in the news recently, I wanted to offer a counterpoint.

America is famously a land of immigrants. Some families came earlier than others, but most people in the U.S. today, including me, wouldn’t be here if some recent relative didn’t immigrate. Approximately 80 million people today are either immigrants or first-generation children of immigrants, and many more are 2nd or 3rd generation.

Despite the fearmongering of current Republican presidential candidate Donald Trump, immigrants are not and have never been the cause of America’s problems. On the contrary: immigrants have been the secret of our success. A true leader wouldn’t be afraid of them. (By the way, since when did candidates demonstrate their toughness by telling everyone to be afraid?)

The picture shown here is a newspaper obituary from the summer of 1918, showing my grandfather, Bernard Salzberg, after he was reported as killed in action in World War I. Bernard came to America as a 16-year-old boy, leaving his home in Lvov (part of modern-day Ukraine, though it was in Poland at the time) to find a better life here. He wasn’t yet a citizen when the U.S. declared war in 1917. As the obituary says,
“Salzberg could have avoided service, but instead … took out his first citizen papers before joining the American fighting forces in September 1917.”
Fortunately for me, the obituary was wrong in one critical detail: my grandfather was grievously injured by poison gas, but he didn't die. He survived and eventually came home, married, and had two children, one of whom was my father.

Both of my mother's parents were immigrants as well. They fled the pogroms in Poland in 1929 and 1930, barely in time to escape the Nazis. They arrived in the U.S. during the Great Depression, when jobs were scarce, and they never had much, but life in the U.S. was nonetheless far better than in their homeland. My immigrant grandparents could scarcely have imagined that their grandchildren would include doctors, scientists, lawyers, professors, and other productive members of society.

As a scientist, immigration affects me in another way. Our graduate education system attracts many of the best students from all over the world, especially in science and engineering. I first discovered this as a graduate student at Yale, when my fellow students came from Europe, Africa, China, and South America–and this in a graduate class with fewer than 20 students. In most U.S. science departments today, the majority of our graduate students are foreign-born, and we are delighted to get them. Many of these students remain here after graduation and become valuable members of society, creating much of the innovation that drives the U.S. economy. They stay because the U.S. offers opportunities that their own countries don’t. The U.S. is a far richer country today–not just economically but culturally, intellectually, and socially–than it would be if we closed our doors to immigrants.

I’m not saying we should open our doors to unrestricted immigration: we could be overwhelmed, as Germany and Sweden have been this year. But we should recognize that when immigrants come here to stay–when they want to join the U.S. and become part of our society, with all that entails–they contribute tremendously to the country.

We shouldn’t be afraid of immigrants: we should welcome them. Happy New Year, everyone.

Over-hyped claims that antidepressants cause autism and antidepressants

Over-hyped, overstated, and probably just wrong.

That's my summary of the latest high-profile study of autism, which reports that mothers who take antidepressants increase the risk of autism in their unborn children by up to 87%. The new study, which appeared this week in the journal JAMA Pediatrics, received widespread attention, both uncritical (Washington Post, Huffington Post) and more cautious (CBS News). But it was that 87% increase that caught most people's attention.

Many scientists, including me, read this news with skepticism. It seems particularly unlikely given that exactly two years ago, another large study reported exactly the opposite conclusion. The 2013 study, published in the New England Journal of Medicine, found that antidepressant use during pregnancy was NOT associated with an increased risk of autism. What's more, the 2013 study looked at exactly the same class of antidepressants, selective serotonin uptake inhibitors (SSRIs), as the new study.

So what's going on? Was the 2013 study just wrong? It seemed the only way to answer this was to read the new study, written by Anick Bérard and colleagues. Looking over the new numbers, my conclusion is that Bérard simply tortured the data until she got the results–and the press headlines–that they wanted. Let's look a bit more closely.

Bérard and colleagues looked at 145,456 children born in Quebec between 1998 and 2009. From this total, 4,724 were born to mothers who took antidepressants (SSRIs) at some time during their pregnancy. The number of children diagnosed with autism was 1,054, about 0.7% of all babies. Only 46 of the 1,054 were born to mothers who had taken antidepressants. The study's main results concerns mothers who took antidepressants in the second or third trimester: these women accounted for 2,532 infants, of whom 31 were diagnosed with autism.

If these numbers seem confusing, try focusing on just one number: 31. The study's main conclusion–and all the headlines–are based on those 31 children diagnosed with autism whose mothers took antidepressants in their second or third trimesters.

The key results are found in Table 2 of the study. Out of 9207 infants whose mothers took antidepressants one year before getting pregnant, 82 were later diagnosed with autism. Bérard et al. found that, after adjusting for various confounders, this group of infants had no increased risk of autism. Another group was infants whose mothers took antidepressants, in the first trimester: of these 4200 infants, 40 were diagnosed with autism. Bérard et al. computed that the adjust risk for this group was 16% lower than average. This difference was not statistically significant, though.

Finally, there's the third group of 2,532 children whose mothers took antidepressants during the 2nd or 3rd trimesters. 31 of these children were later diagnosed with autism, which worked out to an increase in relative risk of 87%.

The first thing to note here is that the increase is relative, not absolute. The overall risk of autism in this study, which was consistent with other studies, was 0.7%. An 87% increase works out to a risk of 1.3% – that's an increase of 0.6% in the rate of autism. This doesn't sound nearly so dramatic as 87%.

But keep in mind that this supposed increased risk of autism is based on just 31 cases. Digging a bit deeper, we find that the way these 31 children were diagnosed was not so clear: the authors wrote that
"Autism spectrum disorder was defined as a medical service claim or hospitalization with a diagnosis of ASD."
Apparently this means only that the children were evaluated for autism, as Dr. Alison Stuebe at The Huffington Post pointed out. Bérard et al. admit this in their paper, where they report that when they restricted their analysis to children whose diagnoses were confirmed by a psychiatrist or neurologist, the number of children with autism was smaller and the increased risk was not statistically significant. In other words, if they looked only at children with confirmed autism, their main conclusion would fade away.

You also might have noticed that Bérard divided the data up in multiple ways to look for an increase in autism: they looked at mothers who took antidepressants before getting pregnant, during the first trimester, and during the 2nd and 3rd trimesters. They don't report any findings for the 2nd trimester alone, or for the 3rd trimester alone, which would have certainly involved smaller (and probably less significant) numbers.

This raises a potentially fatal problem with the study: multiple testing. Whenever a study considers more than one hypothesis, the statistics must be adjusted to account for that. If you look for an effect in ten different ways, you're more likely to find something by chance alone, so you have to find a much stronger effect in order for it to be valid. (The web comic xkcd has a great explanation of this.) Bérard doesn't explain how many hypotheses she tested, but she does write that:
"No adjustment was made for multiple comparisons; hence, we cannot rule out chance findings given the number of comparisons made."
No kidding! Upon reading this, my main question was how the journal editors let them get away with this. I guess JAMA's editors like headlines, perhaps a bit too much.

The senior author of the study, Anick Bérard, appears to have an agenda, as Slate's David Auerbach explained. Last year, she testified in a lawsuit against Pfizer, claiming that their antidepressant Zoloft caused birth defects. The judge in that case, Cynthia Rufe, threw out Bérard's testimony with the explanation that her methods were unscientific:
"Dr. Bérard’s opinions regarding Zoloft are only made possible by her departure from use of well-established epidemiological methods." 
Now, the fact that Bérard has previously testified in court cases doesn't prove that her current study is flawed, but it does indicate that she has a bias against antidepressants. This bias might explain why her study looked so hard to find an effect when the data don't seem to support it.

Finally, I should note that even if the new study is correct (and I doubt it), it completely ignores the risk of stopping medication for pregnant women with severe depression, as Dr. Alison Stuebe discussed at length at the Huffington Post. (Recall that the 2013 study I mentioned above found that there was no increased risk of autism in women taking SSRIs.) No woman should go off her medication based on this study, although I fear that the headlines from last week will have exactly that effect.

The top 5 supplements you should not take

Ginkgo trees lining a path.
Dietary supplements are big business. They are promoted for all sorts of health benefits, including weight loss, memory enhancement, body building, and cancer prevention. Many of the claims featured on websites and product packaging are not true, but that doesn’t seem to stop supplement makers from promoting them.

Unlike drugs, supplements are not regulated by the FDA. With drugs, the FDA requires that they be both safe and effective, but with supplements, they can only take action when products are tainted in some way, or when supplement makers cross the line and make specific claims about curing disease. When they do cross that line, all the FDA can do (in most cases) is issue a stern warning and tell them to stop making false claims, which has little effect. In an effort to educate the public, the FDA regularly issues warnings such as this one, telling consumers to “beware of products promising miracle weight loss,” but supplements continue to sell briskly.

Many of the best-selling supplements have little or no evidence to back up their claims, and the vast majority of people will not benefit from taking them. So here are the top 5 dietary supplements that you should not take:

1. Ginkgo biloba. Ginkgo biloba extract is made from the leaves of a beautiful tree that is native to China. It is widely advertised as a supplement that can enhance memory, stave off dementia and Alzheimer’s, and treat other conditions. I found it available from many vendors, including Target, Whole Foods, CVS, Walgreens, and others.

Alas for any hopeful consumers, ginkgo biloba doesn’t work, as scientific studies have repeatedly shown. A recent meta-analysis of 28 different trials looked at its effect on memory, executive function, and attention, and found that it had zero effect on any of these functions.

Nonetheless, web vendors such as continue to promote ginkgo as a treatment for dementia and Alzheimer’s, despite having received a warning notice from the FDA stating that their advertising violates the Food, Drug, and Cosmetics Act. The FDA letter, dating from 2010, stated that ginkgo biloba is “not generally recognized as safe and effective” for dementia or Alzheimers, but the Zooscape website still claims otherwise..

2. Garcinia cambogia. “Garcinia cambogia is hot,” says Consumer Reports. Also known as the tamarind fruit, garcinia cambogia is promoted as a near-magical weight loss treatment. It does contain a substance that was once thought to have promise in treating obesity, but it’s been studied in multiple trials, all of them negative. The first trial, in 1998, concluded that
“Garcinia cambogia failed to produce significant weight loss and fat mass loss beyond that observed with placebo.” 
According to Consumer Reports, multiple studies since then have all reached the same conclusion: it doesn’t work.

Garcinia cambogia’s popularity took off after Dr. Oz promoted it on his TV show in November 2012, where he called it a “revolutionary fat buster." This episode, which has now been removed from the Dr. Oz show website, was the subject of a U.S. Senate hearing led by Sen. Claire McCaskill, who sharply criticized Oz for promoting products that aren’t back by science. Said McCaskill, "I don't know why you need to say this stuff, because you know it's not true."

I had no trouble at all finding many sources for garcinia cambogia, all of them making strong weight loss claims. sells many brands, including Quality Encapsulations, which calls it a “powerful appetite suppressant” that will “block the formation of new fat cells” (there’s no evidence for this). A brand called Stay Healthy, also available from Amazon, claims you can “eat like a gorilla and lose belly fat fast!”

Sorry, but no: you can’t eat like a gorilla and lose weight. At least not like a healthy gorilla.

3. St. Johns wort is a flowering plant that some people use to treat depression. In this respect, it’s in a different category from the other supplements in this list, which are used for physical rather than psychological conditions.

A double-blind, randomized, placebo-controlled trial of St. John’s wort as a treatment for major depression was published in 2002. This type of study is the gold standard for science-based medicine, and produces the most reliable results. The conclusion was clear: St. John’s wort performed worse than placebo, and the authors concluded that St. John’s work is not effective for major depression.

This might have settled things, but studies continued, and in 2008 a review article came to a different conclusion, finding that St. John’s wort was better than placebo for major depression. Even more recently, a 2011 study looking at minor (rather than major) depression found, just like the 2002 study, that St. John’s wort offers no benefit.

Thus the evidence for St. John’s wort is confusing and contradictory. One thing that is clear, though, is that St. John’s wort can have dangerous interactions with other drugs. The NIH warns that
“Combining St. John’s wort with certain antidepressants can lead to a potentially life-threatening increase of serotonin, a brain chemical targeted by antidepressants. St. John’s wort can also limit the effectiveness of many prescription medicines.” (emphasis in original)
Despite these dangers, you can buy St. John’s wort anywhere: it took me mere seconds to find dozens of choices. If you’re thinking about trying it, follow NIH’s advice and consult your physician first.

4. Glucosamin and chondroitin. These two supplements have been promoted for years as a treatment for joint pain. Scientists have run many experiments to see if they work, and some of the experiments have been mildly positive, encouraging people to give them a try. Joint pain, especially in the knees, is very common, and we don’t yet have a real cure (unless you count knee replacement). (I have chronic knee pain myself, and I would love to find a pill that would cure it.)

To finally resolve the question, NIH conducted a large $12.5 million study called GAIT, which compared glucosamin, chondroitin, celecoxib (an NSAID), and placebo. The conclusion: the only treatment that worked was celecoxib (Celebrex). In a small subset of patients with moderate to severe pain, there was a hint of a benefit for glucosamine-chondroitin, but it wasn’t significant. For patients with mild pain, only celecoxib worked better than a placebo.

So the door isn’t completely closed for this supplement: it clearly doesn't work for mild pain, but for moderate to severe pain, it might offer a small benefit, although an NSAID is better.

Of course, there’s no hint of this uncertainty in the advertising I found. For example, Puritan’s Pride says their pill “nourishes joints to improve flexibility, supports connective tissue in and around the joints," and "promotes healthy cartilege." Of course, the very bottom of their web page has a disclaimer stating that "these products are not intended to diagnose, treat, cure or prevent any disease." Oh, so why exactly should anyone purchase them?

5. Echinacea. Echinacea is a flower, similar to a daisy, that is widely used to treat the common cold. Apparently this got its start when a Swiss herbal supplement maker was erroneously told that Native American tribes used it as a cure. Regardless of the source, the use of echinacea grew, and it has now been subjected to multiple scientific studies.

What does the science say? In 2003, a randomized, placebo-controlled, double blind trial published in JAMA – again, these are the gold standard for scientific evidence – found that echinacea was not effective for treating colds in children aged 2-11, and that it appeared to causes rashes in some of them. Another study, also a randomized, placebo-controlled, double-blind trial, looked at college students, and found again that echinacea didn't work for them either: "echinacea provided no detectable benefit or harm in these college students who had the common cold." More recently, a 2014 review concluded "Echinacea products have not here been shown to provide benefits for treating colds."

Not surprisingly, though, everyone sells echinacea. The NatureMade brand just says "supports immune system health" (a vague claim that the FDA doesn't restrict). Puritan's Pride's label says the same thing. The Dr. Oz website doesn't sell echinacea, but an article there by Tod Cooperman claims that "echinacea can help you get over a cold faster and reduce symptoms." Zooscape is even bolder: it sells an echinacea tea that it advertises with the phrase "colds and flu be gone!"

Save your money. If you have a cold, echinacea won't help. I have it on very good authority, though, that chicken soup works wonders.

[For a list of the top vitamins you don't need, see my 2014 article on that topic.]

Feds arrest dietary supplement makers for fraud

In the largely unregulated world of dietary supplements, it's like the Wild West. Dramatic claims abound, most of them unsupported by evidence, and it's hard to know if any of them can be trusted. Supplement manufacturers claim their products cure cancer, Alzheimer's disease, arthritis, and more. They promise miraculous weight loss results, nebulous "boosting" of your immune system, and anti-aging benefits.

Once in a while, though, they get caught. This week the U.S. cracked down hard on several of the more egregious offenders, announcing indictments against half a dozen supplement makers, including criminal charges against one.

It's about time. Consumers everywhere should applaud these actions and encourage more. Here's what happened.

On Tuesday, November 17, the U.S. Justice Department indicted USPlabs, a major supplement manufacturer whose products include Jack3d and OxyElite Pro. The Justice Department alleged that USPlabs "doctored packaging, labeling, and other paperwork to defraud others about what the product was." Further, the indictment points out that USPlabs claims that their products are made from natural plant extracts, when instead, as one USPlabs defendant put it:
"lol stuff is completely 100% synthetic."
The fraud runs even deeper: according to the Justice Department, after an outbreak of liver injuries associated with OxyElite Pro, in which some consumers needed liver transplants to save their lives,
"they [USPlabs] promised the FDA and the public that they would stop distributing the product at issue. They didn’t. Instead, they undertook a surreptitious, all-hands-on-deck effort to sell as much of the product as they could."
The criminal indictment, which led to the arrest of six USP employees and consultants, is just one of a sweeping set of actions over the past week. The Justice Department also filed six civil cases against other supplement makers for illegally claiming their products could cure diseases. The allegations include:

  • Clifford Woods LLC illegally sold Taheebo Life Tea, Germanium, and Organic Sulfur as treatments for Alzheimer's and cancer.
  • Optimum Health (aka Lehan Enterprises) illegally sold a product called DMSO cream for arthritis and cancer.
  • Regenica Worldwide (aka Vivaceuticals) illegally sell their RegeneSlim as a disease cure, and in addition RegeneSlim contains DMAA, an unsafe food additive under the federal Food, Drug and Cosmetic Act, but does not declare DMAA as an ingredient.

Just to be clear: none of these violations have yet been proven in court. But to be even more clear: none of these products treat or cure cancer, Alzheimer's, arthritis, or any other disease.

In addition to the DOJ actions, the Federal Trade Commission indicted three more supplement manufacturers for illegal advertising claims (that's the FTC's purview). One indictment, against Chrystal Ewing and her two companies, Health Nutrition Products LLC and Classic Productions LLC, alleged that:
"In ads for W8-B-Gone, CITRI-SLIM 4 and Quick & Easy diet pills, the defendants featured bogus weight-loss experts. Citing fake scientific studies, the defendants also deceptively claimed to have clinical proof that consumers would experience a 'RAPID FAT meltdown diet program' that lets them shed five pounds in four days with one pill, or up to 20 pounds in 16 days with four pills."
Needless to say, none of those products deliver the results they claim.

It's a jungle out there. As the FTC's Jessica Rich said, "People looking for a dietary supplement to improve their health have to wade through a swamp of misleading ads. Be skeptical of ads for supplements that claim to cure diseases, reverse the signs of aging or cause weight loss without diet or exercise.”

It appears that major supplement retailers such as GNC have dropped USPlabs like a hot potato: I couldn't find OxyElite Pro on any of their sites. However, despite the indictments and arrests, USPlabs is still marketing OxyElite Pro on their own site, where they tout it as the "#1 Selling Fat Burner", with a long list of other claims. What about the liver toxicity cited by the Justice Department? The OxyElite website claims:
"OxyELITE Pro shows no side effects in well over 99% of its users. In fact, USPLabs and GNC have stated that there’s been over a billion servings of Jack3d and Oxy ELITE Pro safely taken with no problems!"
The FDA apparently disagrees: in March of this year, they issued a Medication Health Fraud notice that OxyElite Pro contains a hidden drug ingredient, fluoxetine. Fluoxetine is a type of selective serotonin reuptake inhibitor (SSRI), used for treating depression and other conditions. According to the FDA,
"SSRIs have been associated with serious side effects including suicidal thinking, abnormal bleeding, and seizures. In patients on other medications for common conditions (aspirin, ibuprofen, or other drugs for depression, anxiety, bipolar illness, blood clots, chemotherapy, heart conditions, and psychosis), ventricular arrhythmia or sudden death can occur."
Caveat emptor: these supplements might contain harmful ingredients. There's only one safe way to take supplements: ask your physician. Unless your doctor specifically recommends one, stay away. You'll feel better and your wallet will benefit too.

Get your wolfsbane here! Cures headaches, only $16 a bottle

Homeopathic drugs contain some pretty strange ingredients. These drugs (or perhaps I should call them potions) come in ordinary-looking packages, apparently designed to look just like real medicine, but they are not. Inside the bottles are concoctions of a wide variety of plant extracts and other substances, almost none of them effective for what’s written on the package.

This week I was browing the headache remedies at CVS, and I encountered a treatment I hadn’t seen before: Nova Headache Complex. It’s an expensive homeopathic remedy, advertised at $16.29 for a 50-ml bottle.

Because homeopaths and their treaments are unregulated, Nova can sell this stuff without having to prove that it has any effect at all on headaches. We can thank Congress for that: ever since 1938, when a homeopathic member of Congress passed the first law protecting them, homeopathic manufacturers have been allowed to forgo any testing to show that their products are safe and effective. And who decides what is homeopathic? The homeopaths themselves.

So: what does Nova’s Headache Complex contain? According to the package, it contains Aconitum Napellus 12X, Bryonia 12X, Cactus Grandiflorus 4X, Chelidonium Majus 6X, Cimicifuga Racemosa 6X, Sanguinaria Canadensis 6X, Spigelis Anthelmia 6X, Thuja Occidentalis 6X. Let's look at just the first of these.

Wolfsbane flowers
Aconitum napellus is a lovely flowering plant, commonly known as monk’s hood or wolfsbane. If that sounds ominous, it should: wolfsbane contains several highly poisonous compounds. It's listed at #3 in the top 10 deadliest plants at Zitbits, which explains:
"When ingested, an intense burning feeling in the limbs and abdomen is immediately felt. In large doses, death can occur in as little as 2-6 hours. Only 20ml of pseudaconitine is needed to kill an adult human. Its name comes the mythology that it was thought to keep away werewolves, hence ‘wolfsbane’."
Wolfsbane has been used as a poison for thousands of years, going back to Roman times. Many young readers will remember it as the main ingredient in a deadly potion in the Harry Potter books. Coincidentally, exactly one year ago, a gardener in England died after accidentally brushing against some wolfsbane flowers.

Yikes! How can they sell this stuff? Well, luckily for consumers, the 12X refers to an extreme dilution, in this instance equal to 10 raised to the 12th power, or 1 part in 1 trillion. The only reason people don’t die when they take Nova's Headache Complex is that there’s essentially no wolfsbane in it.

Fortunately, most homeopathic “drugs” don’t contain any measurable amount of their active ingredients. That’s because homeopaths think that the more you dilute a substance–even to the point where not a single molecule remains–the more potent it is. This laughably foolish notion flies in the face of modern chemistry, biology, and physics, but homeopaths believe it anyway.

What about the other ingredients? All of them are plant extracts, several of them also poisonous (including black cohosh and bloodroot). To avoid extending this discussion for many more pages, suffice it to say that none of these plants have been shown scientifically to cure headaches.

Nova Headache Complex does contain one real ingredient: 20% alcohol. That’s quite a lot, much stronger than beer or wine.'s Yvette d'Entremont demonstrated on YouTube how one can easily get drunk from a few bottles of these homeopathic products. (She used CVS's homeopathic constipation cure, which fortunately has no effect at all on constipation.) This revelation prompted NBC4 in Los Angeles to investigate why CVS was selling alcohol to minors.

Back to our headache "cure": fortunately, over-the-counter medicines such as ibuprofen, aspirin, and acetaminophen work very well for most people. If none of these work for you, drinking an alcohol solution laced with wolfsbane (or, to be more accurate, laced with nothing) won’t help either.

The FDA is currently considering whether or not to modernize its regulation of homeopathic remedies. They’ve held a hearing and solicited public comments. Interesting, the Federal Trade Commission weighed in, arguing that the FDA's current lax rules “may harm consumers and create confusion for advertisers.” I’m skeptical that the FDA will step in any time soon, but one can always hope.

Meanwhile, CVS will sell you wolfsbane for headache pain, but I hope that none of the bottles contain the deadly poisons listed on the label. If nothing else, at least you get a shot of overpriced alcohol.

Putin muzzling science in Russia: a return to the Soviet era?

Vladimir Putin looking skeptically at a scientist.
In a surprising development this past week, Russia has notified all scientists at Moscow State University (MSU) that they must submit their research papers to the state security service before they will be permitted to publish them. Nature News reports that Russia is imposing this policy on universities and research institutes throughout the country.

Perhaps this should not be a surprise. Vladimir Putin has steadily imposed ever greater restrictions on the media, to the point where most Russians are not even aware that Russian-backed fighters shot down Malaysia Airlines Flight MH17 last year. This new move towards censorship is just one more step towards imposing Stalin-esque restrictions on all Russians. Requiring scientists to submit their manuscripts to the security services will severely cripple their ability to publish anything even remotely novel or interesting. Why take the chance?

Mikhail Gelfand, a prominent scientist in my own field of bioinformatics, told Nature that:
“This is a return to Soviet times when in order to send a paper to an international journal, we had to get a permission specifying that the result is not new and important and hence may be published abroad.”
Exactly: Putin is returning Russian to the bad old days of the repressive USSR, when the state controlled all media and ordinary citizens were afraid to speak. For now, a few scientists were willing to speak to Nature, but we shouldn't be surprised if even those voices are silenced in the future.

In a bit of absurdist theater, under the new policy Russian scientists who write their papers in English (as is commonly required for publication) must translate them into Russian, because the security service personnel (apparently) cannot read English. I doubt too that the Russian security services have the expertise to understand even a fraction of the papers that they are demanding to see.

Russia has a long history of scientific innovation across all fields of science, particularly mathematics and physics. Under the repressive Soviet regimes of Lenin, Stalin, and their successors, many Russian scientists fled to the West, where they could work without fear of being thrown into a gulag. The U.S. and Europe–and the world–benefitted greatly from their expertise.

Russia’s scientific output has been lagging in recent years, according to an article in Nature earlier this year. There have been a few bright spots, though, such as (in my own field) the recently-created Dobzhansky Center for Genome Bioinformatics at St. Petersburg State University, which has already published some outstanding papers. Now I wonder how long that new center will last.

Ironically, the famous geneticist Dobzhansky, after whom the new St. Petersburg institute is named, left Russia as a young man in 1927 and moved to the U.S., where he went on to do his groundbreaking work in evolutionary biology.

Putin’s obsession with power and control might be an opportunity for the rest of us. Here’s a call to Russian scientists: follow Dobzhansky’s example and come to the U.S. We may have our flaws, but you can publish your work freely, and you can even write a blog criticizing the leaders of your university, or your former university's football policy, or your political leaders.

Football is still corrupting our universities. It needs to go.

(In which I again take on the football-industrial complex, and get myself in trouble with fans.)

It's happening again. The University of Maryland is about to pay millions of dollars to its football coach so they can fire him a year early, and proceed to hire a new football coach and pay him millions of dollars. All this at a time when the university is desperately strapped for cash, after years of hiring freezes, salary freezes, and unpaid furloughs for its employees.

What's truly astonishing is that U. Maryland did exactly the same thing just four years ago, and it has been a complete disaster. Here's how I described the scenario in 2011, when I was still a professor there:

  • Pay $2 million to buy out the old coach, Ralph Friedgen, and hire a new one, Randy Edsall who will presumably boost attendance and revenue.
  • Hire Edsall for $2 million per year, who then produced a losing season (2 wins, 10 losses), leaving games with even lower attendance than before.
  • Because football is still losing money, get rid of 8 other varsity sports.

Yes, they really did eliminate 8 other sports in order to invest more in football. Here's what they cut: men’s cross-country, indoor track, outdoor track, men’s swimming and diving, men’s tennis, women’s acrobatics and tumbling, women’s swimming and diving, and women’s water polo.

None of this produced any tangible benefits, either financial or academic.

Now let's look at what U. Maryland is about to do now, after several embarrassing blowout losses this season:

  • Pay $4.7 million to buy out the current coach, Randy Edsall. That's $2.1 million for the rest of this season and $2.6 million for next year. 
  • Hire a new football coach and pay him at least as much as the old coach.
  • Continue to impose unpaid furloughs and pay freezes on academic staff across the board.
Wow, this investment in football really seems to be working for U. Maryland.

What the heck is the U. Maryland president, Wallace Loh, thinking? 

Loh originally hired Edsall just a month after he (Loh) joined the university. One might attempt to explain this as a rookie error made by a new president. But this time he has no such excuse.

U. Maryland is by no means alone in its misguided emphasis on football. In 2012, the University of Florida announced it was eliminating its Computer Science program while simultaneously increasing the football budget. The ensuing outcry (spurred in part by my Forbes blog) convinced the administration to back down, but at the time they saw no irony in their plan to cut science education and spend more on football. 

Listen, sports fans: football is not the reason we have universities. Universities exist to provide education, no matter what the (sometimes rabid) football boosters may say. Some American universities (hello U. Chicago!) do extremely well without having a team at all. Outside the U.S., universities have no major sports programs at all–the students enjoy sports, as all young people do, but the universities focus on what they do best.

Yes, I know the arguments on the other side. “Football makes a profit,” some claim. To that I would say, so what? Universities could make a profit running a casino too – should they do that?

But just for the sake of argument, let's accept the premise that football is profitable. Great! In that case, we can spin off the teams as private corporations, and let them pay to use the university logos, stadiums, etc. The teams can pay the players, as any professional team must, and the students and alumni can continue to cheer on "their" teams, just as residents of Baltimore cheer for "their" professional, privately owned Ravens team. 

Let's face it: university administrations are simply not equipped to run a major sports and entertainment business, which is what college football has become. The spectable of U. Maryland spending $4.7 million simply to buy out its current football coach, when the university is desperately trying to save money for its core mission, demonstrates how corrupting the influence of football has become.

Even worse is the shameful abuse of the players, who serve as unpaid laborers while their coaches make millions. "We give them a free education," administrators and coaches respond. Yeah, right. College football is a multi-billion dollar industry, in which the athletes at the center of the game are prohibited from taking any money. Just pay them, and they can decide if they want to pay tuition with their own money.

If we make college football private, everyone wins. Universities keep their football revenue, the fans get their team, and the university no longer has to pretend that it's educating its unpaid football players. We could even set up the system so that players were given a proper academic scholarship after their playing days were over, which for most of them is just a few years. And perhaps best of all, the players would earn the paychecks they deserve. 

Otherwise, expect me to write another article in about five years, in which I will describe yet again how the University of Maryland (or some other school) is paying millions of dollars to buy out the contract of their football coach, while the school's academic mission is ignored.

Don't eat dirt

Don't eat dirt. It's bad for you.

This might seem like a head-slappingly obvious piece of advice, but there have been a slew of reports in recent years suggesting just the opposite.  Here are a few headlines:

  • "Eating Dirt: The benefits of being (relatively) filthy" in Scientific American
  • "Eating Dirt: It might be good for you" from the ABC News website
  • "Eating dirt can be good for the belly, researchers find" from Science Daily, summarizing a 2011 anthropological study in the Quarterly Review of Biology
  • "The old and mysterious practice of eating dirt, revealed" at, describing a documentary film, Eat White Dirt, released last year.
And there's even a blogger who claims that dirt is "the missing superfood."

These articles describe a custom in which women, especially pregnant women are advised to eat dirt or clay, which some people claim offers health benefits. The ABC News story quotes a Georgia woman saying about the clay she eats, "The good stuff is real smooth. It's just like a piece of candy."

There's even a name for this practice: geophagy, or "earth eating." The NPR story claims this practice goes back millenia. Of course, ancient humans tended to die before they reached the age of 40, so I'm not sure I want to imitate their dietary practices.

Dirt is not the new superfood. Quite the contrary: dirt is the home of some nasty parasites, including a type of worm call toxocara, which can make you extremely ill. These worms are invisible to the naked eye–you can't see them crawling around–but they can cause devastating disease and even death.

This came to my attention last week in a case report in the New England Journal of Medicine (written by Dr. Steven Feske and colleagues) about a 38-year-old pregnant woman who was admitted to Massachusetts General Hospital with back and neck pain, vomiting, and headache. She was initially treated and released, but 11 days later,
"...she began to hyperventilate and her vision went black from the periphery to the center. The symptoms lasted for approximately 2 minutes and were followed by spots in her visual fields, headache, neck pain that radiated to her arms, nausea, and dizziness."
Mass General ran extensive tests, and her brain MRI showed lesions "suggestive of multiple strokes." Given all her symptoms, her physicians suspected that she was infected by a parasitic worm (a helminth or nematode) caused by eating dirt or clay. The patient was originally from Guatemala, where nematode infections are common, and where dirt-eating during pregnancy is encouraged in some areas. As they explain in the NEJM article:
“According to a tourist brochure from the Christian shrine in Esquipulas, Guatemala, 'In Guatemala, eating clay tablets combines healing, devotional reminders, blessings from Our Lord of Esquipulas, good fortune, and pregnancy nutrition.' ” 
Some of the tests came back positive for Toxocara, a parasite roundworm. Only then did the patient reveal that she had been eating dirt, but not from Guatemala, which she had not visited in several years. She had eaten dirt from a neighbor's yard in Massachusetts.

Fortunately, there is an effective treatment for Toxocara infection, and the patient recovered and delivered a healthy baby.

The roundworms that cause toxocariasis are commonly found in dirt in the U.S. They are transmitted by dogs, who spread them around through their feces. Pretty disgusting, right? A variety of other nasty parasites are transmitted through soil, including other kinds of roundworms, whipworms, and hookworms.

So don't eat dirt. It's not good for you. Really.

Donald Trump shows his anti-vaccine craziness, and Ben Carson's response is worse

Donald Trump used the latest Republican debate as an opportunity to express wildly inaccurate anti-vaccine claims, embracing the thoroughly discredited position that vaccines cause autism. This claim has been exhaustively debunked, by countless scientific studies and by reports from the Institute of Medicine and the CDC. It started with a now-retracted 1998 study by one of the great villains in medicine, Andrew Wakefield, who continues to push his fraudulent views despite having lost his medical license.

Trump's comments were nutty and dangerous, but Ben Carson's response was, in some ways, worse. Carson had the chance to set the record straight, and because of his medical credentials, he could have been effective. He failed.

Trump has been an anti-vaxxer for years, so his comments were not surprising. Science blogger Orac posted a 2007 Trump quote that almost exactly mirrors what he said in the debate.

What was much more surprising, and deeply disappointing, was the response of candidate Ben Carson, who until last year was a pediatric neurosurgeon at Johns Hopkins School of Medicine. (Note that although I too work at Hopkins Medicine, I've never met Dr. Carson.) Carson did point out vaccines don't cause autism, but then he made a series of false claims that come right out of the anti-vax playbook.

When the moderator asked Carson to respond to Trump's anti-vaccine rant, Carson had a golden opportunity to do some real good: he could have corrected the record and pointed out the real harm that comes from anti-vaccination misinformation. Instead, he said things like this:
“Vaccines are very important, certain ones, the ones that would prevent death or crippling. There are others, a multitude of vaccines that don’t fit in that category, and there should be some discretion in those cases.”
Forbes bogger Tara Haelle has already explained the grievous error here: all our vaccines prevent death.  Carson's claim is simply false, and it's shocking that a highly trained physician would make this statement, on a national stage, without knowing the facts. What Carson should have said–but didn't–was this, from the Every Child By Two organization:
"Each and every vaccine added to the list of recommended immunizations will save the lives and/or reduce the number of disabilities of children in the United States. With the introduction of every new vaccine, rates of both disease and deaths have fallen across the country."
Carson then dug himself even deeper into the anti-vaccine camp with this claim:
"But it is true that we are probably giving way too many in too short a period of time."
This claim is right out of the anti-vaccine playbook: it was the basis of the "too many, too soon" campaign launched by Jenny McCarthy's Generation Rescue, the country's leading anti-vaccine activist group. In fact, the vaccine schedule is very safe, and misinformation like this trope leads to parents withholding vaccines from their children, which in turn can cause sickness, disability, and death.

Let me show you what Carson could have done. Six years ago, Bill Maher–one of the most left-wing talk show hosts in the media, and an anti-vaxxer himself–was interviewing former Republican Senate majority leader Bill Frist, who is also an M.D. Here's what happened:

Dr. Frist interrupted Maher and said "wait, this is important," and proceeded to school Maher on how vaccines save lives. I wasn't a big fan of Frist, but he did a fantastic job here. Carson, in contrast, just pandered to the audience, and to Trump.

The moderator also asked Rand Paul, the other M.D. among the candidates, to respond to Trump's anti-vax claims. He too repeated the anti-vaccine trope that he "ought to have the right to spread my vaccines out a little bit." This is nonsense as well: Paul does have that right, and no one has ever proposed taking it away. It's bad medicine, though, and as doctor, Paul should know better. He failed as well.

It's far more harmful to the public when a high-profile doctor makes anti-vaccine statements than when a blowhard like Trump makes them. Dr. Ben Carson and Dr. Rand Paul should both know better.

Jellyfish proteins: modern snake oil for brain health

Watching ABC's World News Tonight this week, I saw an impressive-looking ad for a pill that claimed to improve memory and cognition. The ad showed several adults, all looking very happy, presumably because they didn’t forget where they left their keys. In appearance, it looked like many of the drug ads that run on the evening news in the U.S. these days.

The ad described a product called Prevagen, which is sold as a supplement, not a drug. This is a critical distinction: supplements are almost completely unregulated, unlike real drugs. The FDA isn’t allowed to regulate supplements and their claims, thanks to Congress and the 1994 DSHEA law.

I was curious about what this memory pill could be. The Prevagen ad, website and packaging make a number of very strong claims, scientifically speaking. The biggest claim is that Prevagen improves memory*, something pretty much everyone would like. The website also includes the more specific claim that “Prevagen can improve memmory within 90 days.*” The package adds that Prevagen “supports healthy brain function*, [a] sharper mind*, and clearer thinking.*"

How can they make these claims if they aren’t true? Simple: every claim has a little asterisk (*) next to it. If you scroll all the way to the bottom of the Prevagen webpage, you’ll find what that means:
“*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”
Behind this blanket escape clause, supplement makers hide all kinds of unsupported claims. Thus Quincy Biosciences–Prevagen's manufacturer–can state that “Prevagen significantly improves learning,” add the asterisk, and voila! the FDA can’t touch them, as long as they don't make a claim to cure a specific disease.

And by the way, they also claim that “Prevagen improves the quality of sleep.*” There’s that asterisk again.

So what is Prevagen? It’s a pill that contains a protein called apoaequorin, which is found in a species of jellyfish that glows in the dark. These jellies produce two proteins, apoaequorin and green fluorescent protein (GFP), that help them fluoresce. It’s an amazing biological system, and the three scientists who discovered GFP were awarded the 2008 Nobel Prize in chemistry.

How (you might be wondering) this can be sold as a dietary supplement? After all, we don’t eat apoaequorin, and isn’t a supplement supposed to be related to something we normally eat? It sounds more like a drug. The FDA agrees with me–I’ll get to that below.

Despite Quincy Bioscience’s claims, I see no reason why eating this protein would have any effect at all on brain function. First of all, it’s not even a human protein, so it's unlikely to work in humans. Second, even if it did work in humans, eating it would not deliver it to our brains, because it would be almost certainly be broken down in the stomach. And third, the connection between this protein and memory is complex, so simply having more of it is not likely to improve memory.

Prevagen isn’t cheap, either. If you order direct from the company, a month’s supply of pills will cost you $66 with shipping. There’s even an “extra strength” version, though I cannot see how twice as much of an ineffective pill will be twice as effective. On the other hand, two times zero does equal zero.

I wrote to ask the president of Quincy Bioscience, Mark Underwood, if his company is claiming that Prevagen will provide any benefits to people suffering from dementia or Alzheimer’s. He didn’t answer that question, but he did respond that “our scientific basis for the claims we make related to Prevagen are on pretty solid ground.” He was careful to qualify this first, though, writing that
“Prevagen is intended to assist people with mild memory issues related to aging. Prevagen is not a pharmaceutical, nor is it approved by the FDA for the treatment of any neurodegenerative disease (Alzheimer’s, Parkinson’s, etc.).  We do not wish to confuse mild memory loss related to aging with Alzheimer’s disease or dementia in our advertising.”
I also asked Underwood if he could provide any peer-reviewed studies supporting his company's claims. He sent me several studies, but none of them was peer-reviewed: they include company-sponsored studies that are unpublished, and one published abstract from 2011, in the Journal of Alzheimer’s and Dementia. Abstracts, though, are not peer-reviewed: they are short summaries typically presented in oral form at conferences, and sometimes published (as this one was) in special supplements to journals. This abstract seems to be the basis of the claim on Prevagen’s website that “Prevagen was tested in a large double-blind, placebo-controlled study using computers to assess brain performance. 218 adults over 40 years old participated in the three month study. Prevagen significantly improved learning and word recall.*” (Note the asterisk again.)

Prevagen’s claims should be easy to test. If Prevagen really does improve memory, then it would be relatively cheap to run large, well-controlled studies on randomized subjects, and I’d expect to have seen multiple studies published since 2011. But because Prevagen is being marketed as a supplement, Quincy Bioscience doesn’t have to prove anything. They just have to be careful not to cross the line in their advertising.

I asked Ted Dawson, the Abramson Professor of Neurodegenerative Diseases at Johns Hopkins School of Medicine, what he thought of Prevagen’s claims.
“It is hard to evaluate Prevagen as to the best of my knowledge there is no peer-reviewed publication on its use in memory and cognition,” said Dawson. “The study cited on the company’s web site is a small short study, raising concerns about the validity of the claims.” 
Treating dementia, Alzheimer’s, Parkinson’s, and other age-related brain disorders is truly difficult. If you want to see what real scientists (not supplement maker) are doing to try to stave off or cure dementia, here’s a short video narrated by Dr. Dawson:

Dr. Mark Sager, a scientist at the Wisconsin Alzheimer’s Institute and a Professor at the University of Wisconsin, has been quoted saying that he does not recommend Prevagen “primarily because there’s no evidence that it does any good.” He recommends adopting a Mediterranean diet instead, which does have some scientific evidence to support it.

I’m not the first person to raise questions about Prevagen. In 2012, a class action lawsuit was filed against them in California, in which the plaintiffs argued that the Prevagen didn’t work and that the advertising campaign was false and misleading. Earlier this year, another class action lawsuit against Quincy Bioscience argued that Prevagen’s active ingredient, apoaequorin, "is completely destroyed by the digestive system.” And in 2012, the FDA sent Quincy Bioscience a warning letter (see it here), pointing out that the company was marketing Prevagen as a drug, not a supplement. The FDA stated that:
"Apoaequorin is not a vitamin, mineral, amino acid, herb or other botanical, or dietary substance for use by man to supplement the diet ... nor is it a combination of dietary ingredients. Therefore, the synthetically produced apoaequorin used in your Prevagen products is not a dietary ingredient as defined in section 201(ff)(1) of the Act.... Accordingly, your Prevagen products could not be marketed as dietary supplements even if they were intended only to affect the structure or function of the body and not for use in the cure, mitigation, treatment, or prevention of disease."
Somehow, though, Quincy continues to sell Prevagen as a supplement. Their website claims they are the #1 selling brain health supplement in the U.S. today.

The appeal that Prevagen is making to consumers is a very old one: basically, they want you to think that if a protein is used in your brain, then eating that protein will make your brain healthier (even though apoaequorin is not a human protein). By this argument, I could package up hundreds of different proteins (perhaps thousands–the brain is a complex organ) and sell them as “brain food” This simplistic principle has been used for centuries in folk medicine: it’s the reason why some people think that eating the body parts of bears and tigers will make them more virile. But eating tiger organs doesn’t make you more like a tiger. It's a form of magical thinking, and there's simply no science to support it. In short, it's just wrong.

Human health isn’t that simple. You don’t acquire the properties of the food you eat. Eating chicken won't make you fly, and eating tuna won't make you a fast swimmer. Eating jellyfish proteins (Prevagen's main ingredient) won't improve your memory, nor will it allow you to emit green fluroescent light. There's no magic brain food, or supplement, that will make you smarter. But you can be a tiny bit richer by not spending your money on ineffective supplements.

Jurassic World fact check: can we clone dinosaurs?

One of this summer’s biggest hits was the movie Jurassic World, which earned a record $209 million on its opening weekend back in June. It's so popular that it’s still showing in theaters now, more than two months later.

Like its predecessors, the fourth movie in the Jurassic Park series features a theme park filled with dinosaurs that were created by cloning dinosaur DNA. In the movie, the dino DNA was collected from mosquitos preserved in amber, which (in the fictional movie world) had sucked the blood of dinosaurs 65 million years ago.

The success of the movie spurred to conduct a poll, asking Americans if they believed it was currently possible to create dinosaurs from DNA found in fossils. 28% said yes.

It makes for a fun story, but is there any science behind it? Well, yes and no.

Can we clone a living organism entirely from scratch, just from its DNA sequence alone? Yes! Not only can we do it, but it has already been done. Genome scientists Craig Venter and Hamilton Smith, both former colleagues of mine, achieved this at least twice, creating bacteria by synthesizing the necessary DNA and then “booting up” a new bacterial cell, which went on to replicate itself and grow into colonies of brand-new bacteria. Very impressive work, although bacterial genomes are quite small, only a few million nucleotides long.

Moving up a step, just last year, Hopkins scientist Jef Boeke (who is now at NYU) and his team synthesized an entire yeast chromosome. Yeast are single-celled like bacteria, but they're eukaryotes, evolutionarily closer to humans and dinosaurs than bacteria. Eukaryotes keep their DNA sequestered inside a nucleus, which in turn makes them way harder to clone from scratch. Synthesis of the remaining yeast chromosomes is under way, and it’s entirely feasible that we’ll have artificial yeast in just a year or two.

As of today, though, no one has even come close to synthesizing a multi-cellular creature like a dinosaur–or a chicken, or a frog, or a human. But in principal, it is possible to create a living animal just from its DNA, though it might take a few more decades to do it.

So yes, we might someday create animals from DNA. But dinosaurs? Alas, this half of the Jurassic World question gets a big “no.”

The problem is, despite the compelling story in the movie, there is no dinosaur DNA left on the planet. None at all, despite what you might have read. Dinosaurs went extinct about 65 million years ago, mostly likely because of a massive asteroid impact in the Yucatan peninsula, and DNA simply doesn’t last that long.

But wait, you might ask: what about all these stories about Neandertal DNA, or woolly mammoth DNA, or other ancient species? These studies are true and are very exciting. Scientists have reconstructed the genome of our Neanderal relatives from very old bones, around 30,000-40,000 years old. We can extract DNA from bones that old, although the DNA is badly degraded. I worked on an ancient DNA project myself, using an 11,000 year old mammoth thigh bone to reconstruct part of its genome. We were able to recover quite a lot of mammoth DNA from that bone.

Other work on ancient samples has demonstrated that in the most extreme conditions, where the bones have been continuously frozen in the Greenland ice sheet, DNA may survive as long as 1 million years. However, dinosaurs lived in temperate climates where DNA degrades far more quickly, and virtually all dinosaur DNA was probably gone within a few thousand years after the dinosaurs became extinct.

(By the way, that same YouGov poll that asked about cloning dinosaurs also asked "Do you believe that dinosaurs and humans once lived on the planet at the same time?" 40% of Americans said yes, demonstrating once again that Americans are woefully misinformed about evolution and the history of the planet.)

So alas, a mosquito that sucked the blood of a Tyrannosaurus rex, and then got swallowed and preserved in tree sap, would not yield any T. rex DNA for present-day cloning experiments.

This doesn’t mean we’ll never have a Jurassic Park, but if we do, we’ll have to guess at what that dino DNA looked like, perhaps using the DNA of birds. Perhaps, though, we should focus on saving the species we have left, which we are rapidly wiping out, before worrying about reviving long-lost dinosaurs.

Scott Walker takes $250 million from the University of Wisconsin, gives it to billionaire sports team owners

Just two months ago I wrote about Wisconsin Governor Scott Walker's dual attacks on his state's flagship university. Walker, who is currently running for the Republican nomination for President, is moving to eliminate tenure for professors at the University of Wisconsin, while at the same time implementing an enormous $250 million budget cut.

This week we learned a new reason why Gov. Walker cut that $250 million: he wants to give it to wealthy hedge fund managers to build a new basketball arena for the Milwaukee Bucks.

No kidding. I can only imagine what my colleagues at the University of Wisconsin are thinking.

On Wednesday, Walker signed a bill that would spend $250 million of taxpayers' money to build the new arena. Last year, the team was purchased by two billionaire hedge fund managers, Marc Lasry and Wesley Edens. In what's become a standard ploy, the new owners threatened to move the team if they didn't get a new arena.

As the Washington Post reported on Thursday, one of the team's other owners is Jon Hammes, one of Walker's top campaign fundraisers. Hammes' son recently donated $150,000 to a pro-Walker super PAC. For the Hammes, this must seem to be a pretty good return on investment: $150K plus some fundraising work in return for $250 million. (Obviously, Walker will deny that there's been any quid pro quo. But he's been working on this deal for months: according to the Milwaukee Journal-Sentinal, he included $220 million in state money for the arena in his budget back in February, but state lawmakers took it out.)

The libertarian Cato Institute denounced the public financing of the arena, according to the New York Times. Other Republicans are furious with Walker because one of the team's co-owners (Lasry) is a major supporter of Hillary Clinton's campaign.

When I wrote about Walker's attacks on the University of Wisconsin in June, I was mystified by why he would go on the offensive against an institution that his state should be incredibly proud of–and that provides countless benefits to the state and the nation. It seemed petty and vindictive, and it still does.

But the money cut from the University of Wisconsin, $250 million, exactly matches the state's contribution to the new arena for the billionaire hedge fund owners of the Milwaukee Bucks. It's now obvious what Scott Walker's priorities are.

Birth control pills have dramatic anti-cancer benefits

Women now have a surprising new reason to go on the pill.

Birth control pills have been around since the 1960s, when they offered women a revolutionary degree of control over their reproductive capabilities. Over the years, the formulation of "the pill" has changed, but it remains one of the most widely used, and most effective, forms of pregnancy prevention.

This week, a very large new study in The Lancet Oncology reported that use of birth control pills provides a significant, and surprisingly large, reduction in the risk of endometrial cancer. The benefit lasts for decades–women who used the pill in the 1960s have the same reduction in cancer rates as women who took it more recently. This is very good news for women.

The new study combined data from 36 earlier studies covering a total of 27,276 women with endometrial cancer and 115,743 without it. The authors–a large group called the Collaborative Group on Epidemiological Studies on Endometrial Cancer–have been working for ten years to collect and analyze this massive data set. Overall, they found that the risk of endometrial cancer in women who had used the pill was only 69% of the risk in women who had never used it. The benefit increased with longer usage: for every 5 years on the pill, women had a 24% reduction in the relative risk of cancer.
Relative risk of endometrial cancer (red line) based on how many years a woman used birth control pills. From "Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27,276 women with endometrial cancer from 36 epidemiological studies", published online 4 August 2015 in The Lancet Oncology.

Endometrial cancer is the most common gynelogical cancer, accounting for 6% of all cancers in women. The National Cancer Institute estimates that in the U.S., 54,870 women will be diagnosed with endometrial cancer in 2015, and 10,170 will die.

To put the benefit of birth control pills in numeric terms, the new study reports that:
"In high-income countries, 10 years use of oral contraceptives was estimated to reduce the absolute risk of endometrial cancer arising before age 75 years from 2.3 to 1.3 per 100 women."
The benefit is even larger for women who used the pill longer: after 15 years the risk of cancer drops to 1%. The authors estimate that over the past 50 years, the pill has prevented 400,000 endometrial cancers in western Europe, the U.S., and Australasia, including 200,000 in the past decade.

The policy implications of this new study are profound, and likely to be controversial. Women have long struggled to control their reproductive rights, and in many countries access to the pill is still very limited. Even in the U.S. the fight for access to birth control continues: just last year, the Supreme Court ruled in favor of a private corporation, Hobby Lobby, that claimed it had religious objections to providing birth control as part of its health care coverage. (Never mind the absurdity of the notion that a corporation could claim to have religious views.)

Now there's a new and very different reason to provide birth control pills as part of health care coverage. Time will tell whether this dramatic cancer prevention benefit will trump the objections of those who want to deny women access to the pill.

Congress passes a colossally bad idea for science funding

When was the last time anyone in Congress passed a truly good idea? I can’t remember.

But they do manage to come up with bad ideas, and sometimes these ideas make their way into laws, causing no end of harm.

This month, two U.S. Congressmen have come up with the idea to offer prizes rather than grants for scientific research. They were inspired, according to a story in Science magazine, by DARPA’s prize competitions for robotic vehicle design, as well as the private XPRIZE competition.

Now Congress wants the National Institutes of Health to give out prizes for biomedical research. They've tucked this idea into the 21st Century Cures Act, a bill funding the NIH and FDA that was passed by the House of Representatives on July 10. Congressman Todd Young of Indiana and Andy Harris of Maryland amended the bill to require NIH to create a new prize competition.

This is a staggeringly bad idea. Why? Where do I begin? Well, first of all, biomedical research costs money–lots of money. Everyone I know in biomedical research, in which I’ve been working for 25 years, needs money before they make their discoveries. A prize at the end is nice, but you can't do anything if you can't pay for equipment, supplies, and (perhaps Congress will be surprised to learn this) people’s salaries.

Flawed though it may be, the current U.S. funding system works pretty well: scientists write up their ideas as proposals, NIH or NSF convenes panels of experts to review those proposals, and the best ones (more or less) get funded.

A prize, on the other hand, is awarded after the work gets done. If this is how we’re going to fund science, then very little good work will get done. Only rich people, or rich companies, will be able to compete for prizes in biomedical research. That's how science worked in the 1800s and before, when the only way to do science was to find a wealthy patron, or to be wealthy yourself. Not surprisingly, things moved slowly back then.

But wait, it gets worse. These NIH prizes will be decided by a small committee, in a setup that will be ripe for corruption. According to the new bill, the committee will have 9 members:
  • The NIH Director
  • 4 members appointed by the NIH Director
  • One member appointed by the Speaker of the House
  • One member appointed by the majority leader of the Senate
  • One member appointed by the minority leader of the House
  • One member appointed by the minority leader of the Senate
This just gets worse and worse. There’s no way that 9 people, even if they’re all great scientists, can choose the best idea from among all areas of biomedical research. This is why NIH convenes hundreds of scientific review panels every year to do peer review: they need experts who understand the specifics of the research.

These 9 people will be responsible for giving away $80 million per year in prizes. In the scientific world, that's a huge program. Look at it this way: the Nobel committee gives out five prizes of $3 million each, or $15 million per year. If this passes the Senate, Congress will have created a prize that is 5 times larger than the Nobels, to be handed out by a yet-to-be-named committee of 9.

But this committee is fraught with problems: 5 out of 9 members will be political appointees, with no requirements that any of them have any scientific or medical training. And because the Director of NIH is a political appointee, one could argue that all 9 are political appointees. What's more, the appointments will last for 5 years, making them truly powerful committee members who will be unaccountable to the public or to anyone else.

One thing is certain: the prize committee members will be flooded with lobbying efforts to sway their choices. This sounds a lot like how Congress works; or rather, how the ugly underbelly of Congress operates.

But wait: there's more! The House bill says that these competitions are open to
“any person … without regard to the person’s place of incorporation, primary place of business, citizenship, and residency.” 
In other words, NIH will give these prizes to foreign citizens–and companies! So apparently they will take some portion of NIH's budget, and instead of awarding it in grants to U.S. scientists, they will give prizes to companies in, say, Russia.

Don’t get me wrong: I think science should be supported in every country around the world. But each country has its own system, and the NIH is by far the most important source of funding for biomedical science in the U.S. We just can't afford to have NIH give out prizes to the entire world. Competition for grants is already fierce, with fewer than 20% of scientific proposals being funded today. Did I mention that this prize competition is a terrible idea?

Here's another little gem: the bill allows the NIH Director to outsource the administration of the prize competition to a private company, who can take 15% of the money for itself. Was a private contractor involved in writing this bill? I’m guessing some company is already making plans to siphon off precious research funds running these competitions–and I wouldn't be surprised if they had a hand in drafting the bill.

The 21st Century Cures Act has some great things in it, such as an extra $1.75 billion per year for NIH over the next 5 years. Many people, scientists and non-scientists alike, would like to see that happen. But Section 1002, Prize Competitions needs to be deleted when the Senate takes this up.

We could certainly do a better job allocating scarce funds to biomedical research in the U.S., but setting aside a large sum to be awarded by a politically-appointed Prize Committee at NIH is a staggeringly bad idea. Let’s stop this train before it leaves the station.