What's the limit of the human lifespan? And what do World War I veterans have to do with it?

Graph showing lower rate of mortality (blue) in people aged
90-95 versus the rate in people aged 50-55 (orange). Figure
from S.J. Newman (2018) Errors as a primarycause of late-life
mortality deceleration and plateaus. PLoS Biol 16(12):
e2006776. https://doi.org/10.1371/journal.pbio.2006776

An intriguing phenomenon has emerged in recent years: among very old people, the rate at which people die appears to decline when they get past a certain age. In other words, as these authors claimed in their 2011 book, aging slows down and maybe even stops. Or at least the mortality rate levels off past the age of 100, according to another study published earlier this year. This has led some scientists to speculate that the upper limit on human lifespan may be much older than anyone alive today.

Not so fast, says a new study by Saul Newman in PLoS Biology. Newman looked at the data and found something quite different: it's all just a mistake. Well, perhaps not a mistake exactly, but a consequence of many small errors. Let me explain.

In almost all species, mortality rates increase with age. In other words, as you get older, your likelihood of dying in a given year slowly but inexorably increases. Intuitively, we all know this: if young people die, it's tragic because we don't expect it. When people in their eighties and nineties die, it's sad, but no one is really surprised.

The evidence for decreasing mortality among very old humans has emerged from a number of studies that provide seemingly solid evidence that people over 100 die at the same or even lower rates then people between 80 and 90, or between 90 and 100.

Not surprisingly, many people would like to believe that human lifespan is unlimited. Indeed, it's one of the hottest topics in Silicon Valley these days. And perhaps someone will invent some true life-extension technology someday. But Newman's analysis pours cold water on the notion that our natural longevity is unlimited.

One difficulty with studying very old people is that there simply aren't that many of them, so the studies tend to be small. Another problem–and this is what Newman zeroes in on–is that we don't have very good birth records for people over 100 years old. They were born a long time ago, when record keeping wasn't always so good. What if there are a few errors?

It might seem that this shouldn't matter, as long as the errors are random–in other words, as long as people's ages are both under- and over-estimated at the same rates. The problem is that even if the errors are random, they don't play out that way. Here's why.

For the sake of argument, let's imagine a set of people whose true ages are off by 5 years in either direction. (I know that's a lot, but bear with me.) By the age of 100, as Newman points out, virtually no one is alive from the cohort that underestimated their age; these are people who have a true age of 105. But many more will be alive from those who overestimated their age; these are the 95-year-olds who think they're 100.

Newman's paper points out that if only a few people are overestimating their age, this can cause mortality rates to flatten or decelerate–or at least they appear to decelerate, because these people aren't really as old as we (or they) think they are. He then shows, in considerable detail, that only a very small error rate is more than enough to explain all of the apparent decline in mortality rates from recent studies. In other words, the decline in mortality is simply an illusion.

What does World War I have to do with any of this? Newman explains:

"approximately 250,000 youths inflated their ages to enter the 1894–1902 birth cohorts and fight for the United Kingdom in World War I."

The same thing happened in the U.S. and other countries: 16- and 17-year-old boys said they were 18 so they could sign up. Coincidentally, these men would have been around 100 years old when many of the recent studies of centenarians were conducted, and it's very likely that some of these men were included in those studies. It wouldn't take many to distort the apparent mortality rates.

Who could have imagined that these brave young men who signed up to fight for their country (my grandfather was one of them), so many years ago, would have this completely unexpected effect on the science of aging, almost exactly 100 years after the war ended? It seems somehow appropriate that today, as the last veterans of the Great War leave us forever, they can still remind us of their sacrifice.

Russian homeopathy, hiding in plain sight

It turns out that Russia has its very own brand of bogus medicine:"release-active drugs," or RADs. Dozens of scientific articles have been published claiming that these substances can be used to treat or cure a remarkably broad range of illnesses, including:

"... influenza, hemorrhagic fever, meningococcal meningitis, herpes, HIV, diabetes, erectile dysfunction, sleep disorders, obesity, chronic inflammatory joint diseases, attention deficit hyperactivity disorder, ..., alcoholism, allergies, and many other health problems." 

If this sounds too good to be true, that's because it is.

Thanks to a new report published in the journal BMJ Evidence-Based Medicine (provocatively titled "Drug discovery today: no molecules required") we now know that RADs aren't drugs at all, because they don't actually contain anything. As the new study reveals,

"The problem [with RADs] is that typical dilutions of the active ingredient are so high (from 1:10²⁴ to 1:10¹⁹⁹¹) that no molecules of the initial antibodies should be present in the ‘drug’ itself."

In other words, RADs are simply homeopathy by another name. As I've written many times before, homeopathy is one of the most patently absurd forms of pseudoscience, and although it's been debunked countless times, it remains popular due in part to commercial interests that profit handsomely from selling ineffective but expensive sugar pills.

RADs are produced by a single Russian company, with the odd name "OOO NPF Materia Medica Holding." The papers promoting the benefits of RADs are authored by a variety of Russian authors, but they are nearly all co-authored by or associated with one person, Oleg Epstein, who is also the company's founder.

Epstein and his Russian compatriots have been very clever about disguising the fact that their "release-active drugs" aren't drugs at all. Their papers are full of scientific jargon, which has no doubt helped them get their work past reviewers who (as every scientist who has published papers knows) can sometimes be a bit lazy.

They've also taken advantage of–one might say abused–the U.S. clinical trials system, ClinicalTrials.gov, by registering 22 studies of RADs there, such as this one.

The authors of the BMJ report (Alexander Panchin, Nikita Khromov-Borisov, and Evgenia Dueva, all Russian, though Dueva is based in Canada) are unsparingly blunt in revealing how Epstein has manipulated the scientific system in Russia to gain approval (and lucrative sales) of his so-called drugs. For example, Epstein has published 90 papers on RADs in a single journal, including 48 in a special issue that he edited himself.

Panchin and colleagues also took a closer look at 6 papers about RADs that were published in English-language journals, all co-authored by Epstein. They report that

"the articles contained misleading descriptions of active substance concentrations, severe flaws in study design and methodology, as well as concealed conflict of interests.... the authors did not mention that MMH manufactures and sells RADs and holds the corresponding patents. Epstein was not mentioned as the founder and CEO of MMH."

They contacted all of these journals, and only one journal, PLoS ONE, went so far as to retract the bogus science on RADs. Kudos to PLoS ONE for doing so. The other journals, some of them published by reputable scientific publishers including Elsevier, Wiley, and Springer, either didn't respond or refused to take action.

Fortunately for consumers, RADs haven't yet spread into U.S. and European markets, although their manufacturers are trying. In a recent letter published in a the Journal of Medical Virology, Epstein and his co-authors write that

"Currently we are in the process of approving evaluation requirements for our products, taking into account their peculiarities and allowing their potential authorization in the USA and Europe."

Buyer beware. The Russian quacks are coming.

Don't smack your kids!

Spanking doesn't work. What's more, it may cause long-term harm to children.

With the holidays approaching, families will be spending more time together, and much of that time will be rich and rewarding. But kids being kids, many of them will misbehave. Parents, in their turn, may grow exasperated and frustrated.

There are many ways to discipline kids, but hitting them is a bad idea. The American Academy of Pediatrics just issued a new policy statement, its strongest ever, telling parents that spanking or hitting their kids is not only ineffective, it is harmful. They don't allow for any exceptions, stating that

"corporal punishment is invariably degrading."

This idea has been gaining traction for decades. In 1989, the UN Committee on the Rights of the Child called for all nations to ban corporal punishment of children, and over the years, many countries have heeded that call. Just two months ago, the Global Initiative to End All Corporal Punishment of Children reported that 54 countries around the world have banned spanking in all settings, including the home.

Nonetheless, the average American still thinks spanking is a good idea. A few years ago, FiveThirtyEight reported that 70% of U.S. adults still agreed that "it is sometimes necessary to discipline a child with a good, hard spanking." This was an improvement over 1986, when 84% of adults agreed with that sentiment, but we obviously have a long way to go.

Even worse, corporal punishment in school is still permitted in 19 states, as described in a study by Elizabeth Gershoff and Sarah Font earlier this year. These states are primarily in the southern U.S., with the top offenders being Arkansas, Mississippi, and Alabama, where over 50% of the schools still use corporal punishment. In these schools, as Gershoff and Font write,

“a teacher or administrator typically administers corporal punishment by using a large wooden board or 'paddle' to strike the buttocks of a child.”

Perhaps it's no coincidence that the schools in those states rank among the 10 worst in the nation: Arkansas is 42nd, Alabama is 43rd, and Mississippi is 48th.

The American Academy of Pediatrics (AAP) report warns of multiple harms that come from corporal punishment, including:

• "spanking ... is associated with outcomes similar to those in children who experience physical abuse;
• experiencing corporal punishment makes it more, not less, likely that children will be defiant and aggressive in the future;
• corporal punishment is associated with an increased risk of mental health disorders and cognition problems."

The AAP report also includes warns that verbal abuse, including any language "that causes shame or humiliation," can be as harmful to children as physical punishment.

Why would violence against a child ever be a good idea? The answer is simple: it never is. Children, especially younger children, cannot understand that a thrashing is intended to send a message about their behavior. Instead, they often think that their parent is angry at them (and sometimes they're right), which in turn makes them fear their own parents.

Parents do need to discipline their children at times, as anyone who's had kids will know. Parents who want guidance can visit the AAP's parent-focused website, healthychildren.org, where they offer alternatives to spanking, for both younger and older children.

Many parents think that spanking works, because they were spanked and turned out okay. That might be true for some, but it's not true for everyone. The AAP report cites nearly 100 studies showing that spanking doesn't work.

So don't hit your kids–and if you're in one of the 16 states that allow schools to hit them, contact your local school district and ask them to change this outdated and abusive practice.

The problem with our democracy isn't gerrymandering. It's integers

(This week, in the wake of the recent U.S. elections, I take a detour from my usual topics to apply a little math to our election system.)

As everyone knows, the U.S. Congress has grown increasingly un-representative. We have states where the population is evenly split among Democrats and Republications, but where–thanks to partisan gerrymandering–the number of House members is grossly skewed in favor of one party. Even without gerrymandering, voters for the losing side in many House districts feel, justifiably, that they have no representation in Congress.

The solution is surprisingly simple. We can save it with a little math. It's not even that complicated. The problem, as I explain below, is integers.

The New York Times just published an argument that the House of Representatives is too small. They point out that the House grew every decade until 1911, when its size was frozen at 435. The Times says that after 100 years of population growth, "America needs a bigger House."

Fair enough, but how do we fix it? The Times argues, oddly enough, that the right number is 593 representatives. Why? Because 593 is the cube root of the total U.S. population. Curiously, many other democracies follow a cube root rule, first described in this 1972 paper by Rein Taagepera. The legislature of Denmark, for instance, has 179 representatives for a population of 5.77 million, and 179 cubed is 5,375,339. Canada has 37 million people and 333 members of their House of Commons, a near-perfect example of this rule, if you ignore their 105 senators.

The first thing to point out is that the NY Times got the math a little bit wrong. The current U.S. population is 329 million, for which the cube root is 690. So if we keep the Senate at 100 members, then we need 590 Representatives in the House, not 593. But the Canadian model doesn't count their senate, so perhaps we need 690 Representatives. But that's a small quibble.

The real problem, though, is that expanding the House by 35% won't address the fundamental problems of our democracy. The Times observed, correctly, that a single representative can't stay in touch with 750,000 people. Increasing the size of the House to 593 will reduce that number to 550,000, which will hardly help. The framers of the Constitution wanted one representative for every 30,000 people, by the way, but that would yield a ridiculously large House today.

The real solution is to get rid of our reliance on integers. Let me explain.

The root of our problem is that each Congressional district elects just one person, in a winner-take-all election where you only need to win by one vote. This means that the losers end up with a Representative who simply doesn't represent them. This means that, in a close election, 49.9% of the voters can be effectively disenfranchised. Even in lopsided victories, where 70% of the voters support the winner, the remaining 30% are stuck with someone who doesn't represent them.

The solution: elect TWO representatives from each Congressional district, and award them each a fractional vote in Congress. Each of the top two vote-getters would have a Congressional vote that is proportional to the number of voters who supported them. Thus if a district elects a Democrat (D) with 55% of the vote, and the losing Republican (R) gets 45%, both of them go to Congress, and D gets 0.55 votes while R gets 0.45 votes.

This will double the size of the House, to 830 members. It will also completely fix partisan gerrymandering. Here's why: imagine a state that is 50-50 Democrat and Republican, but that has packed one district so that 80% of its voters are Republican, allowing it to create three majority-Democratic districts that are 60-40 in favor of D's. Under the current system, that state has 3 Democrats and 1 Republican in Congress. (We have many states that look just like this under our current system.)

Under my new system, our hypothetical state would send 4 D's and 4 R's to Congress. The R from the "packed" district would get 0.8 votes, and the R's from the other three districts would get 0.4 votes each. The entire state delegation would therefore have 0.8 + 0.4 + 0.4 + 0.4 = 2 Republican votes, and 0.2 + 0.6 + 0.6 + 0.6 = 2 Democratic votes, accurately reflecting the overall population of the state.

Gerrymandering is nearly impossible in this system. Packing voters into one district would simply increase the voting power of the majority member for that district, while reducing the voting power of other members of the same party by a corresponding amount.

My system is perfectly legal, and Congress could create it with a simple bill, just as they increased the size of the House in the past. No Constitutional amendment is necessary.

What if more than two people are running for a House seat, as is often the case? We could divide the single House vote proportionally among the top two vote-getters, ignoring the third parties. (States could also use ranked-choice voting to re-apportion the votes of the losing candidates.) A nice side effect is that "protest" votes for third parties wouldn't have such a devastating effect on either of the top candidates. What if only one person ran for a seat? Easy: he or she would get a full vote in Congress rather than a fractional vote. What if the top two vote-getters were from the same party? No problem there, they would both go to Congress, and their party would get a full vote from that district.

Of course, this would make counting votes in the House a bit more complicated. The majority and minority whips wouldn't be able to simply count integers; instead, they'd have to add up the fractional votes of their 435 members. But why should we limit ourselves to a voting system that only uses first grade math? In the U.S., fractions and decimals are covered by the fourth grade. I think Congress can handle that.

There. I've now fixed our democracy. Time to get back to science.

Football has corrupted our universities. Time for it to leave.

The University of Maryland, College Park began their first
game of the season by honoring their teammate Jordan
McNair, number 79, who died during a May 2018 practice.

The University of Maryland, where I was a professor for six years, is embroiled in a football scandal that started with the tragic death of a young player, Jordan McNair, who died of heat stroke during practice. On an especially hot day in late May, the coaches were driving the players too hard, and when McNair collapsed, they failed to immerse him in cold water, which might have saved his life.

This past week, as the results of a 192-page inquiry were being leaked to the press, the university's Board of Regents has been meeting this weekend to decide what actions to take. According to the Washington Post and the Baltimore Sun, the board is considering whether to fire the coach, DJ Durkin (who has been on administrative leave since early September), the president of U. Maryland, Wallace Loh, and the athletic director, Damon Evans.

The University of Maryland has made one mistake after another with its football program, as I've pointed out again and again. Let's look at a timeline:

2010: in virtually his very first major decision as president, Wallace Loh approved the hiring of a new coach (Randy Edsall) and a $2 million payout to the old coach (Ralph Friedgen), who was pushed out a year early. This was at a time when the entire university system was in the midst of a 3-year hiring and salary freeze, which included unpaid furloughs (basically, pay cuts) for almost all employees. Not for football, though.

2011: UMD doubled down: in order to invest more in football, the university eliminated 8 other varsity sports, all of them sports that are healthy for students and that don't carry any risk of permanent brain damage. 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. Loh's argument at the time: "should we have fewer programs so that they can be better supported and, hence, more likely to be successful at the highest level? Or, should we keep the large number of programs that are undersupported compared to their conference peers?"

It pains me to read these words again. Is this what "successful" means for a major university? That its football team wins a few more games? Meanwhile, hundreds of students who played those other sports, all of which likely enriched their lives and their health, were left without teams.

2012: Maryland left the ACC, to which it had belonged for over 50 years, and joined the Big Ten conference, a move that was supposed to make more money. Never mind that it would require the players to travel much longer distances for games at other schools in the Big Ten. Never mind the $50 million exit fee to leave the ACC.

2015: Deja vu! Maryland football was still losing, so they fired the coach again, giving him a $4.7 million payout from state funds, to hire another new coach, DJ Durkin. The coach they fired, Randy Edsall, was the guy who was supposed to take the Terrapins "from good to great." That worked out well, didn't it?

2017: How is that team doing, anyway? Overall record 4-8, tied for dead last in the Big Ten's eastern division. What was it that president Loh said again about being successful at the highest level?

2018: Under coach DJ Durkin, a team practice on a very hot day causes the tragic death of a young player, Jordan McNair.

This slow-moving disaster illustrates what I've pointed out before:

• Universities have no business trying to run a big-time sports entertainment business–and make no mistake, that's what NCAA Division I football is.
• They're often very bad at it, as Wallace Loh and UMD have illustrated.
• Universities treat players as indentured servants: they refuse to pay the players for their work, and they often spit them out after four years without even providing a proper education. This undermines their core mission, which is educating and nurturing their students. (Read Taylor Branch's compelling exposé in the Atlantic for much more on this topic.)
• Making matters even worse, we now know that there's a serious risk that football players will suffer chronic traumatic encephalopathy later in life, a permanently disabling form of brain damage.

The bottom line: football is corrupting our universities, and it needs to go. This doesn't necessarily mean that fans must lose their favorite college teams. Here's one possible solution.

Football fans, including state legislators and university administrators, like to claim that football makes a profit. Let's suppose that's true: then it will do just fine as an independent business. Get football out of the universities, and make it a privately-run minor league for the NFL (which it already is, in effect). Let each team pay fees for use of the university's name, the stadium, practice fields, and parking on game days. Then the football club can pay its coaches whatever it wants, and it will have to pay the athletes, who are disgracefully paid nothing right now. And the university will still have its team, but without the corrupting influence of money. Even better, universities won't have to pretend that they are providing a first-class education to the players, while padding their coffers at the players' expense.

Let's end the farce of having university presidents try to manage large, commercial sports programs. Let them get back to focusing on research and education, topics on which they actually have some expertise.

I'm not naive: I don't think any major university is going to get rid of football any time soon, despite the growing evidence that football carries a major risk of brain damage to the players. This has only happened once, when the University of Chicago eliminated its football program in 1939, and brought it back in decades later as much-reduced program, now in NCAA Division III. The university itself has remained a powerhouse, routinely ranked in the top universities in the country academically.

Meanwhile, the Maryland Board of Regents is trying to decide what to do. If they read the timeline above, they'll know what I think: get rid of the whole lot, including the football program, and get the university back to its real mission.

A dubious homeopathy study made its way into a scientific journal. Will it be retracted?

Homeopaths did it again–they snuck a dubious study into a respectable journal. Well, sort of. Let's quickly look at the study, and then look at the journal that published it.

The paper has a very science-y sounding title, which likely helped it sneak under the radar: "Ultra-diluted Toxicodendron pubescens attenuates pro-inflammatory cytokines and ROS-mediated neuropathic pain in rats." It seems they were studying pain in rats, but what else is hiding inside this title?

The first warning here is the phrase "ultra-diluted." In the world of homeopathy, substances are diluted until there is literally nothing left, not a single molecule. Some of the dilutions in this paper were indeed extremely dilute, down to 10^-30, which means that they were just water. So they can't possibly have any therapeutic effect, at least no more effect than plain water.

You might also be wondering what Toxicodendron pubescens is. That's poison oak! Here's what homeopaths claim about poison oak: that if you dilute it down sufficiently, it reduces itching and pain. This is one of the basic principals of homeopathy, that "like cures like"–that if you want to treat a symptom, using a substance that causes the same symptom, only dilute it way down. Feeling itchy? Rub some poison oak on that! I'm not kidding–here's a link to a product you can buy that really makes this claim.

Of course this is utter nonsense, as I and many others have written before. Homeopathy doesn't work for anything at all, as a massive Australian study concluded back in 2015.

Now let's look at where this dubious study appeared: in a journal called Scientific Reports. Scientific Reports is a mega-journal that publishes 25,000 papers per year, making it the largest journal in the world. What's also interesting is that it is published by the Nature publishing group, which also publishes the highly prestigious journal Nature and many other related, high-quality journals. (Full disclosure: I've published many papers in those journals.) PLoS ONE was the first mega-journal, and it was so successful (i.e., it made so much money for its publishers) that Nature decided to imitate it. They've managed to steal a lot of the "customers" from PLoS ONE because the Nature brand is, apparently, more appealing to many authors.

It's tempting to argue that everything in Scientific Reports is just low-quality stuff, so one more bad paper doesn't mean anything. But it's not so simple. Scientific Reports is trying to be a decent journal, one that has a very high acceptance rate (59%, according to their website) but that nonetheless publishes only valid science. Last year I was involved in a kerfuffle with them over a plagiarized paper, and after lots of pressure, we did get them to retract the paper. It wasn't easy, but the Editor in Chief corresponded with me at the time, and he really does seem to be trying to enforce some decent standards.

When you publish 25,000 papers a year, though, some garbage is going to slip through. To their credit, Scientific Reports has now issued a note of concern on this homeopathy paper, as reported by the alert team at Retraction Watch. Here's the note in its entirety:

"Editors’ Note: Readers are alerted that the conclusions of this paper are subject to criticisms that are being considered by the editors. Appropriate editorial action will be taken once this matter is resolved."

The right thing to do would be to retract this paper, because its results are simply not valid. We'll see if that happens.

Meanwhile, when reading the paper, I noticed that no less than eight of its references are to a journal called Homeopathy, published by Elsevier, one of the biggest and most profitable academic publishers in the world. Unlike Scientific Reports, Homeopathy is not even trying to publish valid science; its entire existence is premised on a nonsensical set of beliefs.

The good folks over at Retraction Watch wrote about this journal two years ago, in an article called "Does a journal of homeopathy belong in science?" Spoiler alert: it doesn't. As Ivan Oransky and Adam Marcus wrote then:

"the issue is that science publishers, even legitimate global corporations like Elsevier, will accept something patently unscientific if it might make them money."

So while Nature does deserve criticism for letting bad science slip into its mega-journal, Elsevier has a lot more explaining to do. At least Nature is trying.

World Health Organization endorses TCM. Expect deaths to rise.

Mother and young rhinoceros killed for their horns.

Image credit: Wikipedia

A few days ago, a news story in the journal Nature reported that the World Health Organization, which is supposed to be devoted to improving the health and medical care of people around the globe, will for the first time endorse a belief system called "traditional Chinese medicine." I'm labeling TCM a belief system because that's what it is–but the WHO will be endorsing it as a set of medical practices.

The Nature writer, David Cyranoski, presents this news in a classic two-sides-of-the-story format, describing the "endless hours" that TCM proponents spent on such important topics as the "correct location of acupuncture points and less commonly known concepts such as ‘triple energizer meridian’ syndrome." Later in the article (but much later), he points out that scientists have argued that qi and meridians simply don't exist.

Cyranoski also falls into the trap of using the phrase "Western medicine" as if it were just an alternative point of view. An apt response is this comment from a biology Ph.D. student, who goes by @astrelaps on Twitter:

"What a weak, equivocal article from the world's preeminent scientific journal. "For those steeped in Western medicine..." is like writing "For those steeped in climate science" or "For those steeped in evolutionary biology" when reporting on climate change denial or creationism."

Well put. On the other hand, Cyranoski does point out that the major motivation for TCM is money:

"[China] has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market."

Were you thinking this was about health care? Afraid not. Cyranoski goes on to point out some serious problems with TCM, for example:

"Critics view TCM practices as unscientific, unsupported by clinical trials, and sometimes dangerous: China’s drug regulator gets more than 230,000 reports of adverse effects from TCM each year."

Actually, it's much worse than this.  Here's what TCM really looks like: the horrific slaughter of the last remaining rhinoceroses in Africa in order to hack off their horns, which are sold to become part of elixirs that some people mistakenly think confer strength or virility. Last year, National Geographic ran a heart-wrenching photo essay showing some of the awful results of rhinoceros poaching in Africa; take a look at these photos here.

TCM also looks like this: black bears kept in grotesquely cruel "farms" with a permanent tube inserted into their abdomens so that their bile can be harvested. Despite a growing movement to end this inhumane practice (see this NY Times story), it persists today, with thousands of bears kept in cages so small they can barely move. No one can view photos such as these and say that TCM is a good thing.

And TCM is behind the slaughter of the last remaining wild tigers, which are virtually extinct now in Asia, so that men can foolishly eat their bones, claws, and genitals in the mistaken belief that tiger parts will make them virile. Here too, National Geographic has details and photographs that are almost too painful to look at.

And don't get me started on pangolins, the beautiful, peaceful mammal that's now perilously endangered because TCM practitioners think its scales have some sort of medicinal value. (They don't.) For more on these gentle creatures, see the article I wrote last year.

I can almost hear the counter argument: but what about artemisinin? That's a plant extract derived from Artimisia annua, an herb that was traditionally used in China to treat malaria. Turns out that it really works, and artemisinin is now the basis of a number of modern malaria treatments.

Well, great. If an herb has the potential to treat disease, we should (and can, and do) study it, figure out what the active ingredient is, develop a controlled process for delivering effective doses, and use it. That's what happened with artemisia, and it also happened with taxol, an effective cancer chemotherapy derived from the Pacific yew tree, and common aspirin, derived from the willow tree.

But one success doesn't excuse hundreds of bogus claims that are based on little more than magical thinking.

There's no legitimate reason to use terms such as "Chinese" medicine, or American, Italian, Spanish, Indian, or [insert your favorite nationality] medicine. There's just medicine–if a treatment works, then it's medicine. If something doesn't work, then it's not medicine and we shouldn't sell it to people with false claims. The same is true for alternative, holistic, integrative, and functional medicine: these are all just marketing terms, with no scientific meaning. They merely serve to disguise sloppy, unscientific thinking at best, and in a less charitable interpretation, outright fraud.

As the Nature article points out, TCM has been a scam for decades: it was revived and heavily promoted in China by former dictator Mao Zedong, who didn't believe in it himself, but pushed it as a cheap alternative to real medicine. I won't go over that again here, but see these stories from Alan Levinovitz in Slate and David Gorski at Science-based Medicine.

Finally, why would the World Health Organization start pushing a set of unscientific practices that are likely to harm people's health? Support for TCM grew during the tenure of former WHO director Margaret Chan, who ran the WHO until 2017 and who had close ties to China. When Nature tried to contact Dr. Chan, the WHO responded that Chan "is not answering questions on matters related to the WHO."

By endorsing TCM, the WHO is taking a big step backwards. Let's hope that the current leaders of the WHO will realize that this step undermines their core mission. The WHO should not advocate treatments that not only have no evidence to support them and that can cause real harm to patients, but also are the primary reason that humans are hunting rhinoceroses, tigers, pangolins, and other animals to extinction.

Play Tennis For A Longer Life. Science Proves It.

Chris Evert and former President George H.W. Bush playing
tennis at Camp David during Bush's presidency.

Tennis might just be the best thing you can do to extend your life.

A new study from Denmark, published just last week by Peter Schnohr and colleagues, shows that playing tennis may extend your life by nearly 10 years. That's a remarkably big benefit, one that even the study authors were surprised at.

It's been well-established for a while now that exercise helps you live longer. For example, the Cardiovascular Health Study found that people over the age of 75 can expect to gain 1 to 1.5 years of healthy living by being active rather than sedentary. Others studies have looked at the effects of running or walking and found similar positive benefits.

The authors of the new study wanted to look at other sports activities, not just running. Using a large cohort of 20,000 healthy people in the Copenhagen City Heart Study, they identified 8,577 who were in the study from the early 1990s until 2017 and who met a variety of other criteria for inclusion. This gave them 25 years of followup, long enough to ask the question: how does participation in sports affect life expectancy?

In particular, they looked at tennis, badminton, soccer, jogging, cycling, calisthenics, swimming, and health club activities (which included treadmills, ellipticals, and weights).

The bottom line: compared to a sedentary lifestyle, playing tennis extends one's life expectancy by 9.7 years. The other sports all provided benefits too, though tennis was the clear winner. Here's a summary:

• Tennis: 9.7 years gain in life expectancy
• Badminton: 6.2 years
• Soccer: 4.7 years
• Cycling: 3.7 years
• Swimming: 3.4 years
• Jogging: 3.2 years
• Calisthenics: 3.1 years
• Health club activities: 1.5 years

The authors didn't expect tennis to do so well, as you can see in this quote:

"Surprisingly, we found that tennis players had the longest expected lifetime among the 8 different sports."

For those who don't read scientific papers regularly, I should point out that the word "surprisingly" rarely gets past the editors unless the result truly is surprising. One part of the surprise is that spending more time exercising did not correlate with the greatest benefits. In fact, the cohort of people who spent the longest time on their exercise was the health club group, who showed the smallest increase in longevity.

One possible reason for tennis, badminton, and soccer doing so well is that out of the 8 sports studied, these are the ones that require 2 or more people and involve social interaction. As the authors explain,

"Belonging to a group that meets regularly promotes a sense of support, trust, and commonality, which has been shown to contribute to a sense of well-being and improved long-term health."

Or it might be that the type of exercise you get in tennis – short bursts of activity rather than slow, steady plodding exercise – might be better for you. The authors noted that

"short repeated intervals of higher intensity exercise appear to be superior to continuous moderate intensity physical activity for improving health outcomes."

If you're still skeptical, the only other study similar to this one, a very large study from Britain published last year, came to the same conclusion: racquet sports had the greatest benefit on all-cause mortality, followed by swimming and aerobics.

So if you're not doing it already, take up tennis! It's easy to find clinics and teams at almost any level (in the U.S., that is), thanks to the thousands of local clubs and to the huge network of USTA leagues, with play ranging from beginners on up, and age groups up to 85 and even 90.

That's right, there are tennis leagues for the 90-and-over set. Maybe tennis players really do live longer.

(Caveats: this was an observational study, based on surveys of people's behavior over a 25-year time span. The scientists tried to take into account all the other variables that might affect life expectancy, but humans are complicated and surveys are never entirely reliable. We don't know that tennis, badminton, and the other sports were the cause of longer life–it might be that people who play sports are generally healthier, and that both leads to longer life and allows them to play more sports.)

Can fasting help you burn off those vacation pounds?

Vacation's over, and with it comes the end of the french fries, ice cream, and other delicious but fattening foods that are hard to resist. "I'm on vacation," we tell ourselves, "I can diet later."

Well, it's later now. How about fasting? Is that an effective way to take off the weight?

Fasting has been growing in popularity in recent years. One of the latest fads is intermittent fasting, in which you fast at regular intervals and then eat all you want in between. There's the 5-2 fast, where you eat for 5 days and fast for 2, every week. Or there's alternate-day fasting, where you eat one day and fast the next, for as long as you can. Or you can fast every day for 16 hours and get all your eating done in the other 8.

Here's the thing: eating is easy, and fasting is hard. If you're going to fast to lose weight, you probably will lose a bit, but the evidence is that most people gain the weight back fairly soon once the fasting diet is over. So fasting might provide a quick reward in terms of weight loss, but the loss will be fleeting.

Suprisingly, though, fasting may be a good idea. A recent review by Stephen Anton and colleagues, in the journal Obesity, found that intermittent fasting may come with a variety of health benefits, including reducing inflammation, improving the ratio of lean tissue to fat, improving cognitive function, preventing type 2 diabetes, and possibly even prolonging life span.

How does fasting produce these benefits? Professor Valter Longo of USC, one of the leading researchers on fasting and longevity, hypothesizes that fasting forces your body to recycle many of its immune cells, particularly white blood cells. Then your body works hard to replenish its white blood cells, essentially re-setting parts of your immune system. Longo is also the inventor of the fast-mimicking diet, where you eat a special diet for 5 days every month, one that makes your body think you're fasting even though you're getting adequate calories and nutrients. (See Alice Walton's story in Forbes for more about that.)

Another effect of fasting is a change in metabolism. As Anton's article explained:

"the key mechanism responsible for many of these beneficial effects appears to be flipping the metabolic switch." 

This happens when the body runs out of its normal fuel, glucose, and begins to burn fat, which means it's converting fat to fatty acids, which in turn produce ketones. The body then uses ketones instead of glucose.

So how much fasting do you need to flip the switch from glucose to ketones? Anton et al. write that

"The metabolic switch usually occurs between 12 and 36 hours after cessation of food consumption, depending on the liver glycogen content and on the amount of exercise during the fast."

This doesn't tell the whole story, because once the switch occurs, you need to burn ketones for some time to gain any benefits. Back in 2014, I wrote about new evidence (from Valter Longo's research) that a longer fast, such as 3 days or more provide significant long-term health benefits. Three days is a long time to fast, but Longo has said that you don't need to do it more than a few times per year.

If you do decide to try a fast, don't expect it to be easy: you're going to get really hungry, and fasting can also interfere with social obligations in an inconvenient way.

I should emphasize that the evidence isn't yet clear for any of these strategies, and there are multiple studies going on now that may provide a clearer picture. Nonetheless, despite the current fad of fasting strategies and diets, fasting really does seem to have some potential health benefits.

(A final caveat: 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.)

Conspiracy theories and snake oil, the perfect pair

Why on earth would people rely on a conspiracy theorist, someone with only a high school education, for medical or health advice? And yet, some people do.

Alex Jones, the far-right conspiracy theorist who runs the Infowars radio program and website, was temporarily suspended by Twitter this week, following bans by Apple, YouTube, and Facebook. These social media companies banned him for repeatedly violating their rules about hate speech and inciting violence. Among other notorious claims, Jones has falsely claimed that children murdered in the mass shooting in Sandy Hook were just actors and that their parents faked their deaths.

What many people don't know, though, is that Jones also runs a dietary supplement business from his Infowars site. Despite reports that Jones' supplements are little more than "overpriced, mundane vitamins," his supplement sales seem to be quite profitable–so much so, in fact, that Buzzfeed reported that the supplement business "largely funds Jones' highly controversial Infowars media empire."

I was curious to see what Jones was selling, so I looked at his Infowars web store. It features an array of products with names like:

• Brain Force Plus
• Super Male Vitality
• The Real Red Pill, DNA Force, and more

Each of these products is marketed with breathless claims for what it can do, including testimonials from Jones himself. For example, Brain Force Plus claims to "supercharge your state of mind," and Jones plugs it with this quote:

"This is what I take before a hard-hitting show. I absolutely love it, and the crew does too. This stuff is over the top powerful!"

Well then. Never mind that Brain Force is really just a collection of herbal extracts and vitamin B-12, none of them proven to "supercharge" your mind or any other body part.

In a similar vein, Jones hypes Super Male Vitality with this claim:

"This product works so well for me that I actually had to stop taking it before I go on air or else I would want to do hours and hours of overdrive with complete focus on the topics at hand."

From the name, you might guess that Super Male Vitality has something to do with testosterone, and the website does state that it "may help support normal testosterone levels in men." What's in it? A collection of plant extracts, none of them proven to maintain or increase testosterone or to have any actual medical benefit.

Of course, if you follow the asterisks on both of these pages and read further down, you'll see that

"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."

This statement is the standard disclaimer that supplement manufacturers make in order to avoid FDA oversight. There's no actual scientific evidence (and Jones's Infowars pages don't attempt to cite any) that these products do what the text on the very same page says they do. You just have to take Jones' word for it.

This is pure snake oil. That shouldn't be surprising, not coming from a man who has accused grieving parents of faking their children's deaths, and who claims the U.S. government was behind the 9/11 attacks. It's hard to understand why anyone believes any of the outrageous claims this guy makes, and especially bewildering that people who trust him to advise them on health and diet. His supplements aren't even a good buy, as Buzzfeed reported a year ago. All I can say is, caveat emptor.

You Think It's Hot Now? Just Wait.

Figure from Steffen et al.: a global map of potential

tipping cascades. The individual tipping elements are

color-coded according to estimated thresholds in global

average surface temperature (tipping points).

It's getting hotter all over the planet.

This week the temperature in Bar Harbor, Maine, reached 91° F (32.8° C). In my 20 years vacationing here, this is easily the hottest weather I've ever experienced.

Up and down the U.S. east coast, cities are sweltering, and temperatures out west are even hotter, with California seeing all-time high temperatures, including the hottest July on record in some areas, which has fed damaging fires across the state. Death Valley is always hot, but this week has been crazy, with temperatures on August 7 reaching 122° F (50° C).

At the same time, Europe is baking under a "heat dome" that has brought unprecedented high temperatures, including 45° C (113° F.) in Portugal. It's so hot that people aren't even going to the beach.

Global warming is here, folks. I know we're supposed to call it "climate change," because it's much more complex than simply warming, but warming is one of the most obvious consequences.

And yes, a single heat wave doesn't prove anything, and weather is not the same as climate. I know. But a just-released study from Oxford University found that climate change made this summer's heat wave in Europe twice as likely.

And now, a new study published last week in the Proceedings of the National Academy of Sciences, says it could get much, much hotter if we don't do something about it. In this paper, an international team of climate scientists led by Will Steffen and Hans Joachim Schellnhuber explain that, thanks to human activities, the planet is well on its way to a "Hothouse Earth" scenario.

In a Hothouse Earth, global average temperatures would rise 4–5° C (7–9° F) and sea levels will rise 10–60 meters (33–200 feet) above today's levels. This would be catastrophic for many aspects of modern civilization. Many agricultural regions would become too hot and arid to sustain crops, making it impossible to feed large swaths of humanity. Low-lying coastal areas would disappear or become uninhabitable without massive engineering efforts, displacing hundreds of millions of people. As Steffen et al. put it:

"The impacts of a Hothouse Earth pathway on human societies would likely be massive, sometimes abrupt, and undoubtedly disruptive."

That's putting it mildly.

One reason this scenario is happening, as the study explains, is that we are very close to "tipping points" beyond which certain changes cannot be stopped. (We may have already passed some of them.) These include losing the Arctic ice cap in the summer, and losing the Greenland ice sheet permanently: because they are basically white, these massive expanses of ice serve as giant reflectors to send much of the sun's heat back into space. Without the ice, the darker planet surface absorbs far more heat, creating a positive feedback effect. Another example is the melting of the permafrost, land that has been frozen for thousands of years and that contains a great deal of carbon in the form of methane. Once that methane is released, it will create further warming.

We are also likely to lose the Amazon rainforest, all of our coral reefs, and huge swaths of boreal forests. (See here for a global map of these tipping points.)

If this seems grim, Steffen and colleagues point out that we still have time to avoid it. They propose that societies must act collectively to create a "Stabilized Earth" at no more than 2° C above pre-industrial levels, which is possible but not easy:

"Stabilized Earth will require deep cuts in greenhouse gas emissions, protection and enhancement of biosphere carbon sinks, efforts to remove CO2 from the atmosphere, possibly solar radiation management, and adaptation to unavoidable impacts of the warming already occurring."

None of this is beyond our abilities. We know what we need to do, but it requires large-scale, coordinated action that many governments must agree on if it's to have an impact. Unfortunately, humans (and our governments) tend to do nothing until faced with an emergency, and the tipping points leading to a Hothouse Earth may not look like emergencies, not at first. For example, Arctic sea ice has been declining steadily for 25 years or more, but because few people are aware of this (and even fewer experience it first hand), it doesn't seem urgent. Yet it is.

So perhaps this summer's heat wave can serve as a wake-up call that we need to pay more attention to our planet's health. Otherwise it's going to get a lot hotter.

European Union gets it wrong on GMOS. Again.

Teosinte on the left, modern
corn on the right, a hybrid in

the center.

A European Union court just issued a new decision about GMOs. Disappointingly, this decision is likely to confuse rather than clarify this complex and contentious issue. The court announced that plants whose genomes have been modified with CRISPR technology, a very precise form of genome editing, are subject to the EU's very strict restrictions on genetically modified crops.

More specifically, the Court of Justice of the European Union (ECJ) decided that:

"Organisms obtained by mutagenesis are GMOs."

If we take this literally, then here’s a list of all the foods that have never been subjected to mutagenesis, and are therefore NOT GMO:

1. Salt
2. Wild boar
3. Wild blueberries

That’s it. (OK, maybe there are a few others.)

We have been modifying the genes of the foods we eat for millenia. Every loaf of organic, non-GMO bread is made from wheat that humans have modified since ancient times. Every glass of milk from your grass-fed, bovine-growth-hormone-free cow comes from a cow that humans have bred for centuries. All cows are genetically modified. Those delicious croissants you bought at the organic bakery? Sorry, those are GMOs, no matter how organic you think they are.

And corn? Have you seen what ancient corn, called teosinte, looks like? I encourage you to Google it (or see the image on this blog, above). Modern corn is the result of many generations of human-driven genetic modifications.

To be fair, the EU court recognized that many of our foods have been genetically modified for a long time, and that it might be impractical to remove all of them from our food supply. So they carved out an exception:

"varieties [of plants] obtained by means of mutagenesis techniques which have conventionally been used in a number of applications and have a long safety record are exempt...."

What's ironic here–though I'm confident that the EU court didn't mean this–is that by this definition, virtually all of the GMO crops in the U.S. are exempt. You see, we've been eating them for decades, and they have a phenomenal safety record.

Two years ago, the US National Academies of Sciences, Engineering, and Medicine issued a massive report that reviewed over 1,000 studies of GMOs. The bottom line: there are no health risks whatsoever from eating genetically modified foods.

Earlier gene editing technology sometimes added foreign genes to an organism, such as adding a bacterial gene to a plant. The EU court's new decision is intended to clarify that even if a foreign gene is not involved, plants bred using the newest form of gene editing (CRISPR technology) are nonetheless GMOs.

Banning GMOs doesn't make sense, and it never did. Genetic technology is just a tool, one that can be used for countless purposes, some of them highly beneficial–such as golden rice, which has the potential to prevent blindness in countries where many people depend on rice as their main staple food. If someone objects to a particular use of GM technology, such as Monsanto's use of it to create herbicide-resistant plants, that's something we can reasonably debate. But banning all GMOs is throwing out the baby with the bathwater.

Now if you'll excuse me, I've got to go out to my grill and see how my wild boar is doing. It might need a bit more salt.

Should we all take aspirin? Not so fast.

I thought we'd put this one to bed. A large-scale study showed that low-dose aspirin (one quarter of a standard 325 mg pill, or about 81 mg) taken once a day can prevent heart attacks and some common types of cancer, including colon cancer.

I wrote about this topic just over a year ago, and I've followed my own advice, taking daily 81mg aspirins since then. The US Preventative Services Task Force recommends this too: regular, low-dose aspirin for people between the ages of 50 and 69 helps to prevent heart attacks, strokes and some types of cancer.

But now, a new study just published in The Lancet upends that advice. It's not that the previous study was wrong–it wasn't. It's just that the effects of aspirin vary significantly based on body weight. Essentially, the new study finds, almost all of the benefits accrue to people who weigh 70 kilograms (154 pounds) or less.

The study, a re-analysis by Peter Rothwell and colleagues of ten large trials that included 117,279 participants, is too long and complex to summarize here, so I'll just highlight a few key points. (Because the paper is open access, anyone can read it for free, just by clicking here.)

The good news, for people who weigh between 50 and 70 kg (110-154 lbs), is that the benefits of daily low-dose aspirin are quite good, possibly even better than we thought. The relative risk of a heart attack, stroke, or other major heart-related event is about 25% lower for people in this group.

The bad news, for the rest of us, is that we seem to get no heart-related benefits from taking a daily low-dose aspirin.

So perhaps those of us who weigh more than 70 kg just need a slightly larger daily aspirin pill. There is some good news here: Rothwell and colleagues found that, indeed, higher doses of aspirin are effective at reducing the risk of heart attacks for people who weigh more than 70 kg. This makes sense: adjusting the dosage based on weight is how most drugs are given. The problem is that aspirin generally comes in only 3 pill sizes: 81, 325, and 500 mg. So the studies have only looked at these 3 doses, and 325 mg is likely too large a dose for most people, because it increases the risk of bleeding events.

What about the cancer risk? As I wrote in 2017, the biggest benefit from daily low-dose aspirin is its reduction in the risk of colon cancer, breast cancer, and prostate cancer. Here, the new study doesn't quite give the whole picture, because it didn't look at breast cancer or prostate cancer. For colon cancer, low-dose aspirin reduces the risk significantly for people who weigh less than 70 kg. For heavier people, low-dose aspirin had little to no effect on colon cancer risk, but regular-sized aspirin (325 mg) worked for people up to 80 kg (176 lbs).

What to do now? The new study concludes that:

"The one-dose-fits-all strategy for daily aspirin use is unlikely to be optimal."

 In other words, you will probably benefit from daily aspirin, but the amount you should take depends on your weight. If you weigh less than 70 kg, the 81-mg tablets that you can find almost anywhere will do nicely. 

But what if you weigh more (as most men and many women do)? The science doesn't yet give us an answer: you could simply take 2 low-dose pills a day, but too much aspirin increases the risk of serious bleeding events. You could instead take a few extra pills per week, depending on your weight, which is what I'm going to do, at least until we get better data and more precise guidelines.

(Final note: as always, before you make any changes in your medication, ask your physician.)

Mosquito wars: what works to keep these little buggers away?

It's summer time, and with it comes outdoor dining, sports, and strolls through the neighborhood. But the loveliest evening can be spoiled by mosquitos, who torment us as they suck our blood and leave itchy welts behind.

How can we keep these pests away? Do citronella candles work? How about Victoria's Secret Bombshell perfume? (No, I'm not kidding. Read on.)

First, about mosquitos: they are more than just a nuisance. They also carry diseases, including West Nile virus, which now affects the entire U.S., and far more deadly diseases in other countries, including malaria, yellow fever, and Zika virus.

(Aside: West Nile virus first appeared in the U.S. in 1999, in New York, after a mosquito apparently hitched a ride on a plane from somewhere in the Middle East. A few years later it started spreading rapidly across the country, and now it's basically everywhere. West Nile fever usually manifests as a flu-like illness, but about 1 in 150 people get severe, life-threatening symptoms.)

One of the most popular ways to keep mosquitos off the backyard patio is easy to spot on a summer night in my neighborhood: burning citronella candles (such as this one from Cutter), which contain a natural oil made from grass whose scent is supposed to repel mosquitos. These are very popular and widely sold, but do they work?

Fortunately, the Journal of Insect Science published a study just last year, by Stacy Rodriguez and colleagues from the University of New Mexico, that gives us an answer. The scientists purchased a dozen different products, all from Amazon or local stores, and ran a very nice experiment to figure out how well each product worked.

Here's the setup: the scientists placed a cage full of mosquitos near a human volunteer, who sat 1-3 meters away, with a gentle breeze blowing from the humans towards the mosquitos. (This made it easier for the mosquitos to smell the humans, and also meant that they had to fly against the breeze if they wanted to bite the subjects.) The scientists applied each mosquito repellent (or device) to the volunteers, opened the cage, and counted how many mosquitos were attracted. They also ran controls where the subject had no protection.

So what worked? First off, with no protection, about 88% of the mosquitos were attracted to the human subjects. The three products that worked best at repelling mosquitos were:

1. OFF!® Clip On™, where just 27% of the mosquitos were attracted
2. Cutter® Lemon Eucalyptus, with 30%, and
3. Ben’s® Tick & Insect Repellent, with 34%. 

Nothing else worked nearly as well as these, although several products reduced the proportion of mosquitos from 88% down to 60-70%.

Notably, some of the products did not work at all, including citronella: Cutter Citro Guard had no effect on the mosquito's attraction to the human volunteers. Other failures were Invisaband™ and Mosquitavert, wrist bracelets containing geraniol oil, and the PIC® Personal Sonic Mosquito Repeller, a clip-on ultrasonic device that emits a sound that mosquitos presumably don't like. Mosquitos basically ignored these devices.

So what's the secret in the products that do work? The OFF! device contains metofluthrin, which appears to be the most effective repellent on the market. Lemon eucalyptus oil is a natural product that is nearly as effective, and Ben's Tick & Insect Repellent contains DEET, which has long been known as an effective defense against mosquitos.

The only one of these products that purports to work on a whole area (like your backyard patio) rather than just one person is the citronella candle, which unfortunately just doesn't work. So if you want your garden party guests to be protected, you may have to keep on hand a basket full of products with metofluthrin, lemon eukalyptus oil, or DEET.

And what about Victoria's Secret Bombshell perfume? Well, the same scientists looked at Bombshell in a 2015 study, where they included the perfume thinking that it would attract (rather than repel) mosquitos. Surprisingly, it had the opposite effect: even though DEET and metofluthrin are more effective, the scientist found that:

"Victoria Secret Bombshell repelled mosquitoes quite effectively 120 min post application."

And what is the active ingredient? According to the same study, that's unknown.

Why is a university hosting a conference on a practice that may be an abuse of human rights?

Sometimes you think you've settled an issue, and you can move on. Demonstrating that a health practice is useless and sometimes harmful should be enough to squash it–but not always.

A few days from now, the University of Northern Iowa will host a conference on "facilitated communcation," a thoroughly debunked practice that harms patients and their families and that has been called unethical by leading medical societies.

For those who haven't heard of it, facilitated communication, or FC, is a method where a person (the "facilitator") sits next to someone and guides their hand over a keyboard. For example, a facilitator will hold the hand of a nonspeaking autistic child and guide her as she types out messages.

The problem is, scientific evidence going back 25 years shows that it doesn't work at all. All of the messages come from the facilitator–who might not even be aware that s/he is doing the actual communicating. Even worse, there are multiple documented instances where FC led to false charges of sexual abuse, invented by the facilitator, that severely damaged families and even led to imprisonment of innocent parents. Nonetheless, FC is still used today, and it is easy to find websites claiming that it can help parents communicate with their autistic children.

The American Speech-Language-Hearing Association has recently written that

"FC is not an effective form of communication and does not provide access to communication... [it] has been associated with significant preventable harms arising through false allegations of sexual abuse and mistreatment. (Boynton, 2012; Chan & Nankervis, 2014; Wombles, 2014)"

Others have been even more blunt, writing that "FC is an abuse of human rights." And yet it has not disappeared.

Why do people still practice facilitated communication? Are they even aware that what they're doing is deeply harmful? A compelling case is made in this lengthy expose, published in 2012 by a former facilitator, Janyce Boynton, who admits that she was responsible for "graphic depictions of rape and sexual assault that had no bearing in reality." Her actions led to a family being split apart and the parents being charged with child abuse. 

Yet Boynton believed at the time that what she was doing was real–as she puts it, she simply "did not want to believe that FC was a hoax." She also makes it clear that many of the people she learned from sincerely believed that FC was real. Boynton herself was crushed when she realized that she–and not the severely autistic child who had been entrusted to her care–was typing all the messages. As Boynton eventually discovered: 

"By the mid-1990s, the scientific community had proved over and over again that it was the facilitator—not the disabled communication partner—who was typing the messages. Every time. Full stop."

Ms. Boynton is now leading the effort to try to convince the University of Northern Iowa to cancel its workshop promoting Facilitated Communication. She helped put together a letter, signed by dozens of doctors, scientists, and speech pathologists, urging the dean of the UNI's School of Education not to host the conference.

I wrote to the UNI dean as well, and she forwarded my questions to Christine Ashby, a faculty member at Syracuse University which is co-sponsoring the conference. Prof. Ashby declined to answer my questions, and instead sent me a document that "provides additional information about the method and the research pertaining to its use," as she wrote. I read the document and looked at the references, but I could find nothing that refuted the earlier double-blind studies (or other, more recent studies such as this one) that have shown that FC is ineffective.

The fight against dangerous pseudoscience never ends. As five professors of speech pathology and psychology wrote just a few weeks ago:

"It's time to stop exposing people to the dangers of Facilitated Communication."

And yet it is nearly certain that the University of Northern Iowa will proceed with its workshop on June 18-19, where attendees will not only get college credit, but they may emerge with the mistaken belief that they can unlock hidden thoughts in children who are unable to communicate. This can only cause harm.

Another anti-vax paper bites the dust

Anti-vaxxers learned a lesson from discredited, de-licensed former doctor Andrew Wakefield, who in 1998 published a badly flawed article in The Lancet pushing a link between vaccines and autism. Wakefield's study was eventually shown to be not only flawed but fraudulent, leading all of the co-authors except Wakefield himself to disavow it, and in 2010 the journal finally retracted it after Wakefield lost his medical license.

But it took The Lancet 12 years to retract the paper, and in that time the anti-vaccine movement flourished. Wakefield became a hero within that movement, and continues to push his anti-vaccine propaganda today, even making films presenting himself as a lone hero fighting for truth.

Other anti-vaxxers are very familiar with this saga, and they have followed Wakefield's recipe by writing scientific papers and attempting to get them published in reputable journals. Usually they fail, but now and then one slips through, which they then point to as "proof" that vaccines are harmful.

The latest example is a paper that appeared in Scientific Reports in November 2016 and that the journal just retracted last week. It has a title that sounds highly technical: "Murine hypothalamic destruction with vascular cell apoptosis subsequent to combined administration of human papilloma virus vaccine and pertussis toxin." (Wakefield's 1998 paper had a similarly obscure title.)

What that lengthy title hides is the paper's anti-vaccine message: that the HPV vaccine might cause neurological damage. The paper was quickly called out as pseudoscience by the scientific community, who reacted within days in the blogosphere and elsewhere, as described by a news article in Science that appeared just after the paper's publication.

(Aside: the HPV vaccine protects people from human papillomavirus, which causes many cases of cervical cancer as well as throat cancer. It's the first vaccine that prevents these cancers, which is an amazing breakthrough. Millions of doses have been administered with essentially zero cases of harm.)

What did the paper do? Basically, it was a setup. The authors–most of them from Tokyo Medical University–gave mice a huge dose of HPV vaccine plus (here's the kicker) a large dose of pertussis toxin. There's no valid reason to administer that toxin except to try to induce brain damage, which the authors could then blame on the HPV vaccine. The study design was clearly awful, and the paper should never have been published.

Just after the paper appeared, two groups of scientists wrote to the Nature publishing group (which publishes Scientific Reports) to protest, as reported in the Science story. One letter, from a group of HPV experts at the University of Antwerp, explained that:

"This experimental setup in no way mimics the immunization with HPV vaccines but is gross over-dosage and manipulation of membrane permeability."

This is putting it mildly. For a blunter assessment, see Orac's aptly titled "Torturing more mice in the name of antivaccine pseudoscience," which appeared in November 2016.

What was not publicly known before now was that I too wrote to the journal editors, asking them to "take action quickly, rather than waiting for over 10 years as The Lancet did." First I wrote to the immunology sub-editor, who forwarded my letter to the Editor-in-Chief, Richard White. Dr. White replied on 29 Nov 2016 that "We are looking into the specific issues raised regarding this paper."

That was the last I heard of it, until the journal announced last week that they have retracted the paper.

So in the end, the scientific record was corrected. But why did it take Scientific Reports 18 months to do it? Haven't they learned from the Wakefield debacle how much damage can be done while antivaccine articles like this one remain in the literature? The journal's editors had a responsibility to act more quickly, and they failed. The scientists who wrote those letters back in 2016 had the same complaint, as reported by Dennis Normile in Science last week. Not surprisingly, Scientific Reports refused to comment (when asked by Science) on any details of their review process.

That's not good enough. Scientific Reports is a "mega-journal," a new type of journal that publishes thousands of papers per year, with a relatively low bar for acceptance. The idea (not a bad one, in theory) is that any valid scientific study, even one that makes only a very small contribution, still merits publication somewhere.

What publishers have learned is that these mega-journals are very profitable, because they charge a publishing fee that more than covers their costs. In return for these profits, Nature Publishing has an obligation to remove harmful papers far faster than they did in this case. Otherwise, it's only a matter of time before anti-vaxxers do this again.

Finally, let me repeat something that can't be said often enough: vaccines are perhaps the single greatest medical advance in human history. They have saved millions of lives, and they continue to save lives today. Scourges such as smallpox and polio, which once swept through populations causing terrible pain, suffering, and death, have been conquered thanks to vaccines. Medical researchers continue to work on new vaccines against the infections that still plague us, and they are the real heroes.