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.



How not to respond to the EPA's science denialism

You would think that the editors of the top science journals in the world would know how to write clearly. But if you read their joint statement in the journal Science last week, you might be forgiven for wondering what the heck they are talking about. It's not that complicated, really. Let me explain.

EPA Administrator Scott Pruitt, when he's not busy taking expensive trips, renting rooms at a deep discount from coal lobbyists, or building $48,000 soundproof booths for his office, is doing his best to make the U.S. a friendly place for fossil fuel industries. As part of his pollution-friendly mission, Pruitt denies the scientific consensus that climate change is real and is caused in part by human activities, especially by carbon dioxide emissions.

Pruitt has devised a clever new strategy to make science denialism part of official EPA policy, while pretending otherwise: he's issued a new proposed rule that requires the EPA to use only "transparent" science. (The official Federal Register entry is here.) In his press release, Pruitt stated
"The era of secret science at EPA is coming to an end. The ability to test, authenticate, and reproduce scientific findings is vital for the integrity of rulemaking process."
The press release, which is titled "EPA Administrator Pruitt Proposes Rule To Strengthen Science Used In EPA Regulations", seems to be all about science and openness. One thing I've got to give them credit for: the PR people at the EPA know how to obfuscate.

It turns out this is just a ruse. As Pruitt certainly knows, many of the EPA's rules are based on studies of human subjects, which are governed by strict privacy rules–which are necessary not only to get people to participate in the studies, but also because violating people's privacy can be highly unethical. This means that many studies showing the harms of pollution–for example, this massive study, which found that fine-scale particulate matter from coal plants increases the risk of lung and heart disease–are not "transparent" enough for the EPA, because the identities of the participants as well as all their health records are confidential.

In other words, the new EPA policy isn't about scientific transparency. It's a transparent (!) attempt to ignore the negative health effects of pollution, so that Pruitt can put in place new rules allowing polluters to dump more pollutants into our air and water. See how that works?

In response, the Editors-in-Chief of Science, Nature, the Public Library of Science, and the Proceedings of the National Academy of Sciences issued a joint statement. Alas, their statement is anything but clear. They spend about three-fourths of it explaining about how they support data sharing, and finally, in their last sentence, they write this:
"Excluding relevant studies simply because they do not meet rigid transparency standards will adversely affect decision-making processes."
That's it. Even the most sophisticated reader could be forgiven for not understanding what the issue is, not from this statement alone.

Here's what they should have said: the EPA wants to ignore the health consequences of pollution when creating policy. The EPA administrator, Scott Pruitt, has announced a new policy that pretends to be about scientific transparency, but is nothing of the sort. Instead, this policy is designed to undermine the EPA's mission, which is (and you can read this right on the EPA's website "to protect human health and the environment."

Since the EPA's creation in 1970, the U.S. has made tremendous strides in cleaning up our air and water. Let's not start backsliding just to enhance the profits of a few polluters.

[Note: I have written the EPA and asked for comment. I will update this article if they respond.]

Sniffle. It's allergy season again. Do those shots work?

Ah, spring is in the air. The flowers are blooming and the trees are bursting into leaf.

For many of us, this time of year means one thing: allergies. The price of going outside for any length of time is sneezing and itchy eyes that last for many hours, even after we return indoors. Rather than going out and enjoying the warm air and colorful vegetation, we close the doors and windows and stock up on antihistamines and eye drops. Studies show that 20–40% of people in the U.S. have allergies.

Your local pharmacy has shelf after shelf of allergy treatments, ranging from mildly effective (Zyrtec and its equivalents) to laughably ineffective (anything homeopathic). But even the best pills have side effects, and they only serve to suppress the symptoms. As one study put it:
"Patients struggle to alleviate their misery, frequently self-adjusting their treatment regimen of over-the-counter and prescription medications because of lack of efficacy, deterioration of efficacy, lack of 24-hour relief, and bothersome side effects."
Isn't there a way to tell your body to just stop it already? After all, pollen is not a pathogen. Our misery is caused by our own immune system's over-reaction: it ramps up in response to the foreign particles (pollen) in our eyes and airways and creates a histamine reaction, which is simply not necessary.

None of the over-the-counter pills prevent this reaction, but they can dampen it–hence the term "antihistamine." However, what if there were a way to tell your body to simply chill out and ignore the pollen?

Well, maybe. You can get allergy shots. This is a surprisingly simple procedure: your doctor takes a small, diluted amount of the allergen (pollen, cat dander, etc.) and injects it into your arm. Over the course of many months, your doctor will very gradually increase the amount being injected. You have to go for the shots every week, and continue them for several years.

The question is, do they work? The answer is a qualified yes.

NIH and the Agency for Healthcare Research and Quality (AHRQ) have put together a long explainer of the evidence for and against allergy shots, which you can find at PubMed Health. The NIH study looked at 74 clinical studies of allergy shots. To save you some time, I'll cut to the chase: the evidence is quite good that shots work. Or, as the AHRQ study put it,
"we found high grade evidence that subcutaneous immunotherapy reduces rhinitis/rhinoconjunctivitis symptoms."
This might seem like pseudoscience, but it's not: what's happening is that your immune system is being de-sensitized to the allergen. It doesn't work for everyone, but in many people, this gradual de-sensitization trains their immune system not to react so badly. It's not necessarily permanent, either: after stopping the shots, allergies might re-appear after a few years.

So if you're looking out your window at the beautiful spring weather with a box of tissues by your side, maybe you have a way out. Talk to your doctor or visit the AAAAI site to find an allergy specialist. Don't expect miracles or a quick fix, but allergy shots are the best we've got, for now.


Anti-vaxxers use religious exemptions as false cover for their beliefs

History of measles in the 20th century.
For several years now, anti-vaxxers have been claiming that they have religious objections to vaccines. This is nonsense.

Just last month, the New England Journal of Medicine featured an article describing how the federal Equal Employment Opportunity Commission (EEOC) has been suing hospitals that deny employee requests for religious exemptions to the hospitals' vaccination requirements. The NEJM documented 14 cases where employees sued claiming that they had religious objections to the flu vaccine. Six of the cases were settled, and in the other cases, sometimes the hospital won, sometimes the employees. It's a mess.

The NEJM article focused on the legal perspective, advising hospitals on how they might avoid lawsuits. That's understandable, but it misses the broader point: there's virtually no such thing as a religious objection to vaccines. All of the world's major religions support vaccination, and only a few tiny, extremist sects teach their followers that vaccines are contrary to their faith.

What's really going on is that anti-vaxxers are using religious exemptions as cover for non-religious (and erroneous) objections to vaccines. The anti-vaxxers have convinced people that vaccines are harmful, or scary, or both. They are wrong.

Vaccines are the probably the greatest success story in the history of medicine. They've saved millions of lives. Consider that in the decade before the measles vaccine was introduced in 1963,
"3 to 4 million people in the United States were infected each year [and] an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles." (Source: CDC)
And that's just measles. People no longer suffer and die from smallpox and polio, which have been eradicated worldwide (except for a few countries where polio still has a foothold). Vaccines protect us from multiple other formerly common childhood infections, and they've been so effective that people are no longer afraid of these diseases. That very success is the opening that the anti-vaxxers use to spread disinformation and fear.

It's not just the EEOC that has been enabling anti-vaxxers. Many U.S. states have passed laws that allow religious exemptions to vaccination. (Note that vaccines are required before children can enroll in public school systems, an incredibly important public health requirement. The exemptions refer to this requirement.)

Here, though, there are signs of hope. After suffering from repeated outbreaks of preventable diseases like measles, many states have recently awakened to the risks caused by unvaccinated children in public schools, and they are moving to remove or tighten these exemptions.

New Jersey is the latest state to act. While the bill introduced in the New Jersey legislature last week doesn't quite eliminate religious exemptions, it makes them harder to get, requiring considerably more documentation from parents claiming a religious exemption from vaccines for their children. NJ took action after realizing that these so-called "religious" objections had risen dramatically, from 3,865 in 2009 to 10,407 in 2016. That rise was fueled, apparently, by anti-vaxxers taking advantage of the loophole in the law, not by any genuine religious objection to vaccines.

It's worth noting that all states allow medical exemptions to childhood vaccination, which are legitimate and necessary. For example, a child undergoing leukemia treatment may have a severely weakened immune system, and a vaccine would be ineffective and possibly harmful. These children are precisely the ones who can only be protected by requiring all the other children in their school to be vaccinated.

Meanwhile, the EEOC should stop suing hospitals. Hospitals are filled with very sick and vulnerable people, and employees have an obligation not to expose patients to possibly deadly infections. If a hospital employee doesn't take that obligation seriously, then s/he should find another job.

Here's $142M we'll be wasting on pseudoscience in the new US Budget

After much unnecessary drama and 6 months late, Congress finally passed a budget last week funding the government for the fiscal year that started in October 2017. While much of the news is good, or at least not too bad, the 2,232 page budget contains lots of goodies for special interests.

I downloaded the whole thing so you don't have to.

One of the worst pieces of wasteful spending is tucked away on page 934: $142,184,000 for the National Center for Complementary and Integrative Health. Incredibly, this is a 9% increase over the NCCIH's 2017 budget of $130.5 million. Is this because they've discovered new and effective treatments? Alas, no.

NIH has been spending money on so-called alternative medicine since 1992. Over the years, the budget has increased from just $2 million to the very hefty $142 million this year. NIH has now spent a total of $2.366 billion dollars on its alternative medicine center.

The NCCIH started as an "office," funded by a $2 million earmark by former Senator Tom Harkin, who later elevated it to a National Center called NCCAM. On Harkin's retirement in 2015, his buddies renamed it as NCCIH, adopting the buzzword "integrative" as a jazzier word than "alternative." It's a classic (and sad) example of how once something gets started by Congress, it grows relentlessly, creating its own constituency of people and industries who consume the funding and clamor incessantly for more.

What have we learned for our $2.4 billion? Have new cures been developed, new medicines been discovered? Has NIH provided good scientific evidence that any of the "alternative" methods–which include acupuncture, homeopathy, naturopathy, Ayurveda, therapeutic touch, reiki, aromatherapy, and others–actually work? The answer to all these questions is no.

On the other hand, the real work of biomedical research, funded by the rest of NIH, has yielded tremendous progress on a wide range of diseases. These include cures that we could only have dreamed about 10 or 20 years ago, such as this amazing stem cell cure of a 7-year-old boy with a devastating skin disorder, or this leukemia treatment reported in 2013.

After 26 years and $2.3 billion spent trying–and failing–to prove that alternative medicine works, it's long past time to end this nonsense and shut down NCCIH, as I and many other scientists have been saying for years. That $142 million could be used far more effectively studying real treatments for real diseases, rather than imaginary treatments that have failed, time and again, to prove their merits.

$142 million. To those who argue that it's only a small percentage of the NIH budget, I would point out that a typical NIH research grant is under $500K. This means we could fund at least 300 additional biomedical research projects every year if we got rid of this giant special-interest earmark that has utterly failed to produce anything useful.

Instead, someone in Congress managed to sneak in the largest budget increase that NCCIH has seen in 15 years. What a waste.

Starving science: a petty, shortsighted national "strategy"

This image taken approximately 438 miles above the earth's
surface provides a spectacular view of the Lena Delta in
Russia. Image courtesy of the U.S. Geological Survey, whose
 images are all in the public domain.
150 years ago, passenger pigeons were so numerous that they could black out the sky when their flocks passed overhead. The last passenger pigeon, a female named Martha, died in the Cinncinnati Zoo in 1914. All we have left of this species are specimens held in museum collections.

One of the most extensive collections of animal specimens in the world is managed by a tiny unit of the U.S. Geological Survey, called the Biological Survey Unit. A small group of curators maintains a collection of more than one million animals collected over the past 130 years by scientists and ordinary citizens across the U.S.

Now, for reasons that are at best mysterious, the USGS is planning to eliminate the Biological Survey Unit. The BSU has a very small budget, a mere $1.6 million out of the USGS's budget of $1.1 billion, and an even tinier fraction of the country's $4.4 trillion budget.

What the heck are they thinking? Shutting down the Biological Survey Unit won't save enough money in the vast government budget to even be noticed, but the loss of its precious collections will reverberate through the decades. Does someone in the USGS or the Department of the Interior have a grudge against the BSU? Or are they just petty?

The BSU's collection resides in the Smithsonian Museum of Natural History, one of the great museums of its type in the world. The collection contains some 370,000 birds, 300,000 mammals, and 390,000 amphibians and reptiles, many of them dating back to the late 19th century. These specimens represent a unique view back in time, illustrating the natural history of our continent and the animals that have lived on it over the years.

It's only through collections like this that scientists can understand how human activities have affected our natural world. For example, historical collections of eggs from wild birds allowed scientists to document the thinning of eggshells caused by the pesticide DDT, which was made famous by Rachel Carson's book Silent Spring.

Just a few weeks ago, the presidents of three of the leading animal science societies in the U.S. wrote a letter to Science magazine pleading for the USGS to continue funding its Biological Survey Unit. So far, the USGS has not responded to them.

Museum collections may not be as flashy as some areas science (perhaps we need a new Indiana Jones movie to raise their profile), but that doesn't mean they are not critically important to our understanding of the natural world. Once the BSU disappears, it's not coming back: the curators will retire or find other jobs, and the collection will become inaccessible, even if it still exists somewhere in the bowels of the Smithsonian.

The plan to shutdown the Biological Survey Unit seems indicative of a larger trend of neglecting investment in our future. It may reflect a particular form of neglect by the USGS, as pointed out by Cynthia Ramotnik in a 2015 article. It also reflects the severe cut to the USGS budget proposed by Donald Trump last month: he requested a total budget of $860 million, which represents a 20% cut from the current year's budget of $1.08 billion. But in the case of the BSU, the budget impact is so small that it seems worse than neglectful to cut it: it is shortsighted and petty.

When asked by the Washington Post, former House speaker (and current Trump enthusiast) Newt Gingrich admitted that the cutting the BSU's $1.6 million budget wouldn't matter to the larger budget, but he then went on to comment, “if this collection is that valuable, there are probably 20 billionaires that could endow it.”

Great: let's hand over our national resources to billionaires, and if they're not interested, well, it must be that the resources weren't that valuable in the first place. Not.

This is ridiculous. We're still a rich country, and we shouldn't be eliminating projects like the Biological Survey Unit just to give a massive tax cut to rich people, or just to make a point about budget cutting, or whatever the reason that the USGS and the Department of the Interior might offer. (The USGS hasn't responded to my inquiries.) Maintaining our museum collections not only shows respect for the thousands of people who built them over the years, but it benefits the countless scientists, educators, school children, and others who will learn from these collections in the future.

Coffee causes cancer. Coffee prevents cancer. Who to believe?

California might soon start requiring Starbucks to warn its customers that coffee causes cancer. Has  California gone nuts, or is there something to this?

A lawsuit filed in 2010 by a group called the Council for Education and Research on Toxics is in its final stages, and the judge might rule soon unless the plaintiffs settle the case. Several of the plaintiffs, including 7-Eleven, have already settled and agreed to post warnings in their stores.

The basis for the lawsuit is that brewing hot coffee produces acrylamide, which is on a list of substances that California claims cause cancer or reproductive toxicity. (It's a very long list.) Even though acrylamide has been on the list since 1990, it wasn't until 2002 that Swedish scientists discovered that acrylamide is present in many foods.

As the American Cancer Society explains,
"Acrylamide is found mainly in plant foods, such as potato products, grain products, or coffee. Foods such as French fries and potato chips seem to have the highest levels of acrylamide."
Uh oh. Coffee, french fries, and potato chips. Where's the joy in life without these?

But wait a second: how come people aren't keeling over with cancer left and right, especially in our coffee-loving, french-fry-loving society? (And what about the French?)

It turns out the evidence against acrylamide is pretty sketchy. If you give it to mice in the lab, at doses 1000 times greater than the amounts found in food, it does seem to increase their risk of cancer. But mice are not people, and 1000 times is a whole lot of acrylamide. The ACS concludes that
"it’s not yet clear if acrylamide affects cancer risk in people."
It's just as easy to find claims that coffee prevents cancer. A 2017 review found that one cup of coffee a day is associated with a slight reduction in the risk of liver cancer and endometrial cancer. A 2010 review of over 500 studies found the same reductions, but a slight increase in the risk of bladder cancer among heavy coffee drinkers. Another large review in 2017, by Robin Poole and colleagues in the UK, found not only a reduced risk of cancer, but a reduction in heart disease and overall mortality.

The Poole study concluded:
"Coffee consumption seems generally safe within usual levels of intake, with [the] largest risk reduction for various health outcomes at three to four cups a day, and more likely to benefit health than harm."
Coffee lovers, rejoice! But let's not kid ourselves: no one is drinking coffee for its health benefits, are they? The stuff just tastes good.

Finally, in answer to my own question at the top of this article: yes, California has gone a bit nuts. Or, as the nonprofit American Council on Science and Health put it:
"If coffee is deemed carcinogenic, then the State of California will be required to give up all pretense at common sense and sanity."
An afterthought: the lawsuit may be just about money. As Bloomberg News explained last October, in a story about the California coffee case: "Unfortunately, it is very easy for ‘bounty hunters’ to file Prop. 65 lawsuits against even small businesses and the cost of settlement and defense often exceeds other types of abusive litigation." The American Council on Science and Health was even more blunt, calling it an attempt to grab "a giant bag of money."

Let's hope the judge in the California case pays attention to the science. Meanwhile, the rest of us can focus on more important questions, such as: dark roast or light? French press or drip?

The federal government is wasting over half a billion dollars a year on chiropractic and osteopathic manipulation

A book on the abuses of chiropractic,
written by a former chiropractor
Here's a quick way for the U.S. government to save over half a billion dollars. Stop paying for coverage of medical procedures that have little or no evidence to support them.

The Centers for Medicare and Medicaid Services (CMS) now releases annual reports of how much it spends, broken down according to the procedures. Their latest data, for the year 2015, reveals that Medicare spent $564,165,721 on pseudoscientific medical practices.

I'm talking about chiropractic and osteopathic manipulation. These are similar but distinct belief systems, both involving bones, and both with little high-quality evidence to back them up. Most people think that chiropractors' spinal "adjustments" can relieve pain from injured or aching backs. It turns out that it's just an elaborate placebo: a back rub at home is likely to work just as well. And that home treatment is probably safer–I'll get to that below.

Osteopathic manipulative therapy (OMT) was invented out of whole cloth in the mid-19th century by Andrew Still. Still believed that every part of the body was linked by a mysterious "myofascial continuity" and that manipulating it could treat a vast range of aches, pains, and other ailments. Most of this is not true. (There is some evidence that OMT can be beneficial in carefully selected cases of lower back pain, but the evidence is quite thin (see this review), and the CMS codes don't distinguish different uses of OMT.)

Osteopathic manipulation is what Larry Nassar, the now-convicted sexual predator, claimed he was doing to the hundreds of young girls whom he molested over the years when he was a sports doctor at Michigan State University and a doctor for the U.S. Olympic gymnastics team. (Osteopathic physicians, which is what Nassar was, generally practice real medicine, and I don't mean to suggest that any of them endorse Nassar's awful abuses. However, OMT is a relic of their pseudoscientific past, and Medicare should not be covering it.)

Chiropractic is no better than OMT. It was invented by D.D. Palmer in the 1890s, around the same time that Andrew Still was concocting OMT.  Palmer mistakenly believed that misalignments of the spine, which he called subluxations, caused a vast range of health problems, even infectious diseases. As retired chiropractor Samuel Homola has written,
there is "no evidence at all to support chiropractic subluxation theory," 
but thanks to clever marketing, chiropractors have convinced millions of people to see them on a regular basis. (See chirobase.org for much, much more.)

Even more alarming is that chiropractic adjustments carry a small but frightening risk of causing a stroke, as a result of tearing the vertebral artery, as I've written about before. In fact, the American Heart Association issued a warning in 2014 that "neck manipulation may be associated with stroke". Not surprisingly, the chiropractors association strenuously denied this, but the evidence speaks otherwise. Indeed, a 2015 study that I described when it appeared showed that Medicare patients–the same cohort whom we are paying half a billion dollars a year to provide chiropractic treatments–suffered a significantly higher risk of stroke after seeing a chiropractor than those who instead saw a real doctor.

And a 2003 study in the journal Neurology show an equally alarming increased risk of stroke due to tears in the vertebral artery after chiropractic in younger patients. The lead author of that study, Dr. Wade Smith, warned that
"physicians and patients should be aware of spinal manipulation therapy as a rare but potentially causal factor in stroke."
[Update: note that a 2016 study, in the journal Cureus, found that the link between chiropractic neck manipulation and arterial dissection was not causal; i.e., that chiropractic did not appear to cause arterial tears. However, concerns remain, as demonstrated in this 2017 case report of cerebral hemorrhage following chiropractic activator treatment.]

The 2015 numbers from the Centers for Medicare and Medicaid Services show that the vast majority of the wasted funds, $545 million, went to chiropractic treatments, with another $19 million going to osteopathic manipulation. Neither amount is justified by scientific evidence.

Let's stop wasting our money on procedures that don't help, and may harm, Medicare patients. If we want to help patients, let's insist that Medicare spend our money on real medicine.

The flu is getting worse, just as the government shuts down.

Uh oh, this is not good.

The flu season is looking particularly bad this year. We already had signs of trouble back in November and December, when it emerged that the flu vaccine was not very effective against the dominant strain that is circulating this year, which is called H3N2.

Until this past Friday, it seemed that the peak of the flu season might have occurred just around the new year, as shown in this chart from the CDC:
The chart shows a peak in the very last week of 2017, and then the number of reported cases seemed to decline. But then on Friday the CDC reported this alarming trend:
That red line spiking upward in the middle of the chart shows the number of flu-like cases reported by the CDC's national network this year. Rather than going down, the trend shows a sharp rise over the past two weeks. We don't know exactly what it is (these are not laboratory-confirmed flu cases), but more people are getting sick.

Even more alarming are the reports of young, healthy people dying of the flu. This past week the Washington Post reported on a healthy 10-year-old boy who caught the flu and died within just a few days. Just before Christmas, a healthy 21-year old young man in Pennsylvania came down with the flu, and went rapidly downhill until he was rushed to the emergency room on Dec. 27. The hospital was unable to save him, and he died the next day. These cases are truly alarming, and even though the CDC hasn't seen a statistically significant increase in deaths among young people (not yet, at least), everyone needs to take the flu very seriously this year.

With the government shut down, a difficult situation becomes worse. Most of the CDC staff will be forced to sit on their hands when they could be working–and many of them want to work, but they won't be allowed to. What's especially frustrating (and wasteful) is that the U.S. will almost certainly pay all federal employees for this forced time off, as it did in previous shutdowns.

We also need a better way to make the flu vaccine. The U.S. still relies on vaccines that are produced by growing the virus in chicken eggs, a decades-old method. This sometimes requires us to use a strain that doesn't match the circulating virus, because some strains just won't grow in eggs. So instead we manufacture a mediocre vaccine, rather than investing in new, modern technology that wouldn't need eggs and could produce more effective vaccines at lower cost. (Why are we stuck with old technology? It's a long story, but essentially it boils down to the fact that we rely completely on private companies to make the flu vaccine. The government doesn't make vaccines and has no plans to do so.)

With the right technology, we should be able to produce a universal flu vaccine, one that we can take once and never need again, like most other vaccines. Scientists are getting closer to that, with much help from the (currently shut down) NIH.

Meanwhile, we are looking at a particularly dangerous flu season, with few weapons to guard against it other than the not-very-good vaccine. (Aside: ineffective doesn't mean useless. Even if the vaccine is only 30% effective, as some estimates have it for this year, it's still a good idea. Everyone in my family got it.)

Oh, and one more thing: the flu shot cannot give you the flu. I only mention this because anti-vaxxers continue to promote this particular myth. 80% of people who have come down with the flu this year did not get vaccinated.

The #1 bogus argument that quacks and the government use to promote pseudoscience

This does not reduce pain.
Chairman Mao would be delighted, if he were alive to see it. He now has the U.S. government buying into arguments that he used to hoodwink his own people, decades ago. Never mind that the arguments are all bogus.

This morning, the front page of The Baltimore Sun describes how the U.S. Veterans Administration is using acupuncture to treat chronic pain in veterans. The VA especially likes something called "ear acupuncture," the creation (out of thin air) of a VA doctor who claims that a few needles inserted in your ear will cure pain anywhere in your body. The VA also calls this "battlefield acupuncture," and it is not only fake but also dangerous, so much so that in 2011 I labelled it the worst quackery of the year.

And yet it hasn't gone away, as the Baltimore Sun reports. The VA uses acupuncture "across the country," offering it to veterans who have little choice about their health care provider. A few years ago, the VA argued this could help veterans manage chronic pain from war injuries. Now they're claiming that acupuncture will help solve the opioid epidemic. Whether it works or not seems beside the point: a VA doctor quoted in the story argues that "if patients believe that it’s helping their pain, then it is." Unfortunately for her patients, she seems unaware that science has shown that acupuncture does not work–for anything (as Yale neurologist Steven Novella succinctly put it).

Why is the VA offering quack treatments to veterans? One reason is that these treatments are popular. The same argument appears in countless forms, but it boils down to: "the people want this, so we should give it to them."

I get it: popularity is good news if you're an actor, or a writer, or a singer, or an athlete, or especially a politician. But it means nothing when we're trying to decide if a medical practice is effective. Doctors in medieval Europe used to bleed their patients, often killing them, in the belief that sickness was caused by "ill humors" in the blood. Bleeding was popular, but it was a very bad idea.

It's not just the VA. This past fall, two Colorado Congressmen, Jared Polis (D) and Mike Coffman, (R) announced the creation of a bipartisan Integrative Health and Wellness Caucus, explaining that:
"While at least a third of Americans use complementary or alternative medicines, access is often inconsistent."
It's not surprising that Polis and Coffman believe that we should give people whatever treatments they ask for. Neither of them is a scientist, so they live in a world (politics) where popularity counts for a lot. How ironic that, in the hyper-partisan U.S. political scene today, the parties have come together to support something that is flat-out wrong.

Just stop it already. Stop arguing that just because something is popular, it must be true, or at least worth investigating (at taxpayer expense). For centuries, most humans believed the Earth was flat, but that didn't turn out to be true, though it was popular. We figured it out and moved on.

Today's versions of medieval bleeding include acupuncture, homeopathy, naturopathy, chiropractic, reiki, Ayurveda, healing touch, various "detox" treatments, and more. Science has figured out that all of these are nonsense, and moved on. (And by calling them "nonsense," I am being generous. Some of them are dangerous.) But people who make money off these practices have been waging a decades-long campaign to keep them going.

Acupuncture is a scam foisted on the Chinese people by Mao Tse-Tung, whose country was too poor to provide real medicine to its population. Instead, Chairman Mao launched a marketing campaign to convince them that the old, traditional medicine was just as good. Kimball Atwood wrote a 4-part history of these events; in part 3 he reveals this gem, from Mao's personal physician:
"Publicly, the Chairman was the leading advocate of traditional medicine, but he refused to use it himself."
And now the U.S. government has fallen for the same scam.

Universities are prey to this as well. This fall, we saw the University of California at Irvine announce a $200 million gift to create a new medical center dedicated to integrative medicine, a disturbing intrusion of junk science into the academic mission of the university. One of the donors, Susan Samueli, argued that "The public is not only interested [in integrative medicine], but they are clamoring for it.”

There it is again–the argument from popularity. And even though this might be privately funded, it is based at a public, state-funded university.

One might hope that the NIH would help set things straight. Think again. Here's an example from NIH's National Center for Complementary and Integrative Health (NCCIH:
"Many Americans—more than 30 percent of adults and about 12 percent of children—use health care approaches developed outside of mainstream Western, or conventional, medicine."
NCCIH's website is careful not to state explicitly that popularity is equivalent to evidence. But then what are they saying? That NIH thinks that 30% of Americans are wrong? (By the way, that 30% number is highly dubious. It includes a wide array of practices, some reasonable and others wacky.)

Why do we even have an NIH center devoted to integrative medicine? It's not because there's any science behind it. On the contrary, NCCIH is a monument to a deep misunderstanding on the part of former Senator Tom Harkin, who created it back in 1991. For an excellent summary of NCCIH's history, see this short video from Reason TV:

or my own talk from a 2015 conference, here. Harkin earmarked a few million dollars to create a small Office of Alternative Medicine in 1991, and with his help it grew over the years into a large, money-wasting administrative behemoth.

NCCIH's website is replete with misleading statements. After pointing out that "millions of Americans use complementary health approaches" (there's that popularity argument again), they offer this sage advice:
"Choose a complementary health practitioner, such as an acupuncturist, as carefully as you would choose a conventional health care provider."
Face, meet palm. No one shouldn't be choosing a "complementary" health provider in the first place, and NIH shouldn't be telling people to do it carefully, whatever the heck that means.

Yes, this stuff is popular. And its popularity has enriched the numerous practitioners of bad medicine, many (most?) of whom may genuinely believe that their snake oil works. But popularity doesn't make something true. Or maybe it does–I hear that the tooth fairy is very popular.