Is this drug combo a true fountain of youth?

Is rejuvenation of the thymus a key to restoring youth? Maybe it is.

A very surprising result appeared last week in a journal called Aging Cell. A team of scientists published the first results of a study that showed, in a small group of older men, that some signs of aging could be reversed with a 3-drug combination.

Not just slowed down. Reversed.

If this holds up, it could literally be life-changing for millions of people. I was initially very skeptical, having read countless claims of anti-aging treatments over the years, virtually all of which turned out to be wrong. Anti-aging treatments are a huge commercial market, full of misleading promises and vague claims. Youth-restoring skin treatments (which don't work) are a particular favorite of cosmetics companies.

But this new study is different. The scientists decided to explore whether recombinant human growth hormone (rhGH) could help to restore the thymus gland. Your thymus is in the middle of your chest, and it is part of your immune system, helping to produce the T cells that fight off infections. As we age, the thymus shrinks and starts to get "clogged with fat," as a news story in Nature put it. Hints that rhGH could help restore the thymus goes back decades, but it had never before been tested in humans.

The scientists leading the study added two more drugs, DHEA and metformin, because rhGH does carry some increased risk of diabetes. Both of these drugs help to prevent diabetes, and both might also have anti-aging benefits, although neither of them is known to affect the thymus.

Amazingly, in 7 out of 9 men in the study (it was a very small study), the thymus showed clear signs of aging reversal, with new thymus tissue replacing fat. The side effects of rhGH are very mild, and none of the men in this study had any significant problems from it or from the other two drugs.

Equally remarkable was another, unanticipated, sign of anti-aging. The study measured "epigenetic age" in all the subjects by four different methods. "Epigenetic age" refers to markers at the cellular level that change as we age, and as the study explains:
"Although epigenetic age does not measure all features of aging and is not synonymous with aging itself, it is the most accurate measure of biological age and age‐related disease risk available today."
After 9 months of treatment, the epigenetic age of the men in this study was 2.5 years younger. The treatment didn't just slow aging–it reversed it. The effects persisted in a followup 6 months later: one and a half years after the study began, the men's epigenetic age was 1.5 years younger than at the beginning. This is truly remarkable.

Any study has limitations, so I should mention a couple here. First, the study was very small, just 9 men, but the effects were strong and significant. Second, the lead scientist of the study, Gregory Fahy, is the co-founder of a company called Intervene Immune that plans to market anti-aging treatments. The authors also include scientists from Stanford, UCLA, and the University of British Columbia.

A few years ago I wrote about another drug combination, dasatinib and quercetin, which showed great promise in reversing aging, but only in mice. We're still waiting to hear more about that treatment, although a test in humans showed some promise earlier this year.

The new 3-drug combination is the most promising I've seen yet. The possible benefits are enormous: as the study points out, they include lower risks for at least 8 types of cancer, heart disease, and stroke. Unlike many other anti-aging treatments, this one has genuine plausibility, and the effects on the thymus can be measured almost immediately. Let's hope this one works out; we'll all be better off if it does.

College football season is starting up. Why do universities support a sport that harms their student athletes?

For those of us in academia, September means a new school year, and all of the excitement and energy that students bring as they return to campus. Strolling around, you can feel the energy in the air.

September is also the beginning of the college football season (in the U.S.). For many students, alumni, and other fans, watching the game each week is one more fall activity they look forward to.

But now, thanks to a rapidly growing body of new research, we know that football can severely harm and even kill its players. Not right away, but years later, through a brain disease called CTE, or chronic traumatic encephalopathy. This is a frightening disorder that gradually destroys brain cells, causing memory loss, confusion, impaired judgment, and progressive dementia. Many former players die very young, in their 40s or 50s, after first suffering for years.

CTE is caused by repeated blows to the head, events that are common to football. It has grown worse in recent decades as the players have gotten bigger and stronger. Improvements in helmet technology haven't helped, and they might even have made CTE even worse, because the helmets allowed players (by their own admission) to use their heads as battering rams.

Two years ago now, a large medical study of football players' brains showed that an appallingly high percentage of those players had CTE. In that study, Boston University scientists led by Jesse Mez and Ann McKee found CTE in the brains of 110 out of 111 former NFL players (99%), and 48 out of 53 college players (91%).

As the BU scientists themselves pointed out, the former players and their families may have suspected something was wrong, and that may have motivated them to participate in the study. Thus the extremely high proportion of deceased players showing CTE in this study is certainly an overestimate. But as I wrote at the time:
"is it okay to ask young men to play football if the risk of permanent brain damage is only 50%? What if it's just 10 or 20%? Is that okay? Is football that important?"
Clearly, the answer should be no. University presidents are constantly, even obsessively, worrying about the safety of their students. Campuses have many programs in place to protect students from crime, from sexual harrassment, from emotional distress, and more. And yet every fall, they willingly–no, enthusiastically–subject the 100 or so students on their football teams to a serious risk of lifelong, life-threatening brain damage. This simply should end.

For an especially poignant story, watch this short video about Greg Ploetz, who played on the 1969 national championship football team at the University of Texas, and who died in 2015 after years of worsening dementia:
As his daughter says in the video,
"If [today's football players] knew what he went through, and what we went through as a family, there's no way that people would decide to keep playing." 
Perhaps universities could take a cue from former Baltimore Ravens player John Urschel, widely considered the smartest player in the NFL, who was pursuing a Ph.D. in mathematics at MIT while simultaneously playing pro football. Two years ago, Urschel quit, because he was worried that brain damage would destroy his ability to think clearly. And just one week ago, Indianapolis Colts' star quarterback Andrew Luck retired early because football had "wrecked his body and stolen his joy."

Brain damage may be happening to much younger players too. A study from the University of Washington last year found that 5% of youth football players aged 5-14 had experienced concussions each season. Three years ago, a mother sued the Pop Warner youth football organization after her son committed suicide at age 25. An autopsy showed that he had CTE, and the mother argued that his brain damaged was caused by his years playing youth football. The Pop Warner organization settled the suit for close to $2 million, but other lawsuits have been filed since.

As I and others have written, football and its promise of big-money television contracts has corrupted our universities. While universities build ever-bigger football stadiums and pay coaches exhorbitant salaries, they force the players to play for free. Now we know that players face a much more direct threat: long-term brain damage.

Let me ask university presidents this question as bluntly as I can: how much brain damage is acceptable for your football players? If your answer is "none," then it's time to get football out of our universities.

$545 million wasn't enough for chiropractors. Now they're lobbying Congress for much more.

Medicare currently wastes more than $545 million a year on chiropractors, as I revealed in an article last year. Wasteful as this is, it's not enough for chiropractors, who have successfully lobbied to have two Congressmen propose a new bill, HR3654, that will require Medicare to pay chiropractors for the full range of services that real doctors offer.

The American Chiropractic Association is practically rubbing its (metaphorical) hands together with glee. As they proudly point out, this endorsement of quackery is bipartisan: the bill is sponsored by two New York Congressman, Democrat Brian Higgins and Republican Tom Reed.

The idea of having chiropractors function as regular physicians is very troubling. Chiropractors do not receive proper medical training: they get their Doctor of Chiropractic (D.C.) degrees from one of a very small number of special chiropractic schools, which do not provide the full medical training that real medical schools do. Their curriculum also includes a heavy dose of pseudoscience, especially the training around subluxations.

For a detailed discussion of why chiropractors are not competent to be family physicians, I recommend this article by an experienced physician, Dr. Harriett Hall, titled "Chiropractors as family doctors? No way!" Dr. Hall goes into considerable detail explain why many of the medical practices of chiropractors are non-standard, not evidence-based, and possibly harmful. Or see this lengthy takedown of chiropractic subluxations by Sam Homola, a former chiropractor.

Many chiropractors are also anti-vaccine, unfortunately, as documented just two weeks ago in this article by attorney Jann Bellamy. Among other things, Bellamy points out that a major chiropractic conference this fall will feature a keynote talk by anti-vaccine activist Robert Kennedy Jr. (about whom I've written before).

Even more alarming, as I've explained before, is that chiropractic neck manipulation has been shown to carry a small but real risk of stroke, because it can create a tear in your vertebral arteries. For example, this report from 2016 documented a case of cerebral hemorrhage apparently caused by chiropractic manipulation. The patient in that case was a 75-year-old woman, which puts her squarely in the class of patients eligible for Medicare.

And to those chiropractors who've read this far: I'm sorry that you were hoodwinked into spending 3-4 years in a chiropractic school, paying nearly $200,000 in tuition and fees, with the promise that you'd be a legitimate medical professional. You were scammed, and I'm sorry about that. And I understand that most (perhaps all) chiropractors want to help their patients. The problem is, the training offered by chiropractic colleges is far short of a proper medical degree.

If the chiropractors' lobbying association get its way, this $545 million (annually) in wasted Medicare dollars will soon become a far higher amount–to the detriment of patients. The bill will allow chiropractors to bill Medicare for pretty much any service that a bona fide physician offers.

It's also worth noting that in 2018, Medicare's Inspector General issued a report titled "Medicare needs better controls to prevent waste, fraud, and abuse related to chiropractic services," which revealed that almost half of Medicare spending on chiropractic care from 2010-2015, between $257 million and $304 million per year, was likely wasted or fraudulent. One wouldn't think this is a time to expand Medicare's coverage of chiropractic.

Congress, don't be fooled by arguments that this proposed new law will lower medical costs, or give patients what they need: it won't. Instead, it will dramatically increase the amount of funds wasted on ineffective treatments. The U.S. does need a better health care system, but this bill would be a big step in the wrong direction.

Hey, NY Times: Keep your hands off my smoked salmon

For lovers of smoked salmon, the New York Times featured an alarming headline last week: "Do Lox and Other Smoked Fish Increase Cancer Risk?" The article reported that the American Institute for Cancer Research, a respected nonprofit organization, considers smoked fish (including lox) to be in the same category as "processed meat." The Times answers its own question with "it might."

The Times is wrong. If anything, smoked salmon is good for you. Let me explain.

Where does the concern come from? In 2015, a major report from the International Agency for Research on Cancer (IARC) concluded that red meat and processed meat probably cause cancer, especially colon cancer. To be precise, they wrote that
"there is sufficient evidence in human beings for the carcinogenicity of the consumption of processed meat."
And what, you might ask, is processed meat? According to the IARC:
"Processed meat refers to meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavour or improve preservation."
Although the 2015 IARC report didn't mention smoked fish, the NY Times reporter, Sophie Egan, points out that smoked salmon (lox) is also transformed through salting and smoking (or curing, if you consider gravlox). To support this concern, Egan quotes Alice Bender, a dietitian (with a master's degree but not a doctorate) from the American Institute for Cancer Research. According to Bender, who was not involved in the IARC report,
"Even though it’s possible that processed fish and even chicken and turkey could be better alternatives [to processed meats], for now we have to look at all of it as processed meat."
No, we don't.

I read the IARC report, and it doesn't mentioned smoked fish. It states that processed meats usually "contain pork or beef, but might also contain other red meats, poultry, offal (eg, liver), or meat byproducts such as blood." And an earlier report gave these examples of processed meats: ham, bacon, sausages, blood sausages, meat cuts, liver paté, salami, bologna, tinned meat, luncheon meat, and corned beef. Nothing about fish.

However, I wanted to be certain, so I dug down into the original research. The IARC report is based on a whole raft of earlier studies, which they combined and summarized, and it turns out that some of those studies did indeed look at smoked fish.

In particular, this IARC study from 2007–one of the studies that the 2015 IARC report relied upon–looked at both meat and fish and how they affected the risk of colon cancer. The 2007 study found that consumption of fish reduced the risk of cancer. And most important for today's discussion, they stated explicitly that
"Fish included fresh, canned, salted, and smoked fish."
There you have it. Consumption of fish, including smoked fish, reduces the risk of colon cancer. (A minor caveat: smoked salmon does have a high level of salt, which can be a concern for people with high blood pressure.)

So my response to the NY Times: keep your hands off my bagels and lox. Really, you should know better.

The US will try treating opioid addiction with fake medicine

If you can't afford to offer real medical care, why not offer fake medicine? The U.S. Medicare system is about to give this strategy a try, for treating back pain.

Last week, Medicare announced that it wants to start paying for studies of acupuncture as a treatment for low back pain, as reported by the Washington Post and Stat. The government's reason, according to Secretary of Health and Human Services Alex Azar, was that we need this option to help solve opioid addiction:
“Defeating our country’s epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain.”
If you break down HHS Secretary Azar's statement, it's mostly correct. Yes, treating opioid addition should explore all methods for treating chronic pain. And yes, this program will provide "new" options, even though the option in question is nonsense.

But (3) no, studying acupuncture will not expand our scientific understanding of "alternative approaches" to pain. Why not? Because thousands of studies have already been done, and the verdict was in, long ago, that acupuncture is nothing more than an elaborate placebo.

The problem is, acupuncture proponents never give up. Every time a study shows that acupuncture fails (and this has happened, repeatedly), they claim it wasn't done properly or make another excuse. I've even seen proponents argue that studies in which acupuncture failed were in fact successes, because acupuncture and placebo treatments both outperformed the "no treatment" option.

(Aside: we use placebo treatments because we've known for decades that any treatment, even a sugar pill, may show a benefit as compared to no treatment at all. Acupuncture research has created placebos by using fake needles that don't actually pierce the skin, or by placing needles in random places rather than the so-called acupuncture points. Scientifically speaking, if a treatment doesn't outperform a placebo, then the treatment is a failure.)

To make matters worse, the new HHS program will fund "pragmatic" clinical trials rather than the usual, gold-standard randomized trials (RCTs). Without going into details, let's just say that pragmatic trials are much less well-controlled than RCTs, allowing more room for mistakes and misinterpretation. This is a bad idea even when the intervention being studied is legitimate. It's an even worse idea here, where trials have shown, over and over, that acupuncture doesn't work.

Secretary Azar might be confused because the acupuncture industry has managed to get hundreds of studies published, many of them positive–but most of them are poorly designed, and who has time to read all that bad science? (The rare well-designed studies always show that acupuncture doesn't work.) Acupuncturists have even created pseudoscientific journals devoted entirely to acupuncture, as I wrote about in 2017. Some of these journals are published by respected scientific publishers, but they are still little more than fake journals.

Not surprisingly, with entire journals trying to fill each issue with acupuncture articles, last week's Medicare announcement noted that
"the agency [CMS] recognizes that the evidence base for acupuncture has grown in recent years". 
No, it hasn't. What has grown is the number of articles. Adding more garbage to a pile doesn't make it smell better.

For those who aren't familiar with the claims of acupuncture, let's do a very quick summary: acupuncturists stick needles in a person's body at specific points in order to manipulate a mystical life force that they call "qi" (proounced "chee"). This idea is "a pre-scientific superstition" that has no basis in medicine, physiology or biology, and has never had any good scientific evidence to support it.  Acupuncturists don't even agree on where the acupuncture points are, which should make it impossible to do a scientific study. It's not at all surprising that acupuncture doesn't work; indeed, if it did work, modern medicine would have to seriously examine what mechanism could possibly explain it.

But wait, argue proponents, what about all the wise traditional doctors in China who developed acupuncture over thousands of years? Well, it turns out that acupuncture wasn't popular in China until the mid-20th century, when Chairman Mao pulled a fast one on his population because he couldn't supply enough real medical care. Mao didn't use acupuncture himself and apparently didn't believe in it. I highly recommend this expose of Mao's scam, by Alan Levinovitz in Slate.

So rather than spend millions of dollars on yet another study of acupuncture for pain, I have a better suggestion for HHS: invest the funds in basic biomedical research, which has had a flat budget for more than a decade now. As long as it goes through proper peer review, almost any research will be far better than wasting the money on acupuncture.

Now, I'm not naive enough to think that Medicare will take my advice, but I can tell them right now what their new "pragmatic" trials will reveal. Acupuncturists will happily take the money, treat people suffering from back pain, and report that some of them experienced reductions in pain. Some of the patients will invariably agree, because back pain comes and goes, and it's hard to know why it went away.

Then the acupuncturists will say, "look, it works! Now please cover acupuncture for all Medicare patients." Then we'll spend more tax dollars on pseudoscience, and patients will be in just as much pain as ever. If Medicare falls for this (and I fear they will), then Chairman Mao will have fooled the U.S. government, just as he fooled many of his own people half a century ago.

The loneliest word, and the extinction crisis

We're in the midst of an extinction crisis. Just two months ago, an international committee known as IPBES released a report, compiled over 3 years by 145 experts from 50 countries, that said 1,000,000 plant and animal species are threatened with extinction, many within the next few decades.

Martha, the very last passenger
pigeon, shown when she was
still alive.
Before getting to that report, I want to introduce a word that I only just learned: endling. An endling (the word was coined in 1996) is the last surviving member of a species. One example was Martha, the very last passenger pigeon, who died in the Cinncinnati Zoo in 1914. Passenger pigeons numbered in the billions in the 19th century, but humans wiped them out.

In 2012 we lost another endling, Lonesome George–the very last Pinto Island tortoise from the Galapagos Islands–who died at around age 100.

If you want to see a particularly poignant example of an endling, watch this rare and heartbreaking video of Benjamin, the very last Tasmanian tiger (or thylacine), pacing around his cramped enclosure in Hobart, Tasmania. This film from 1933 is the last known motion picture of a living thylacine. Benjamin died in 1936.
Two Tasmanian tigers in the Washington, D.C. zoo, in a photo
taken around 1904. Photo credit: Baker; E.J. Keller. from the
Smithsonian Institution archives

We have records of other endlings too: the last Caspian tiger was killed in the 1950s in Uzbekistan, and the last great auks were killed for specimen collectors in 1844.

Unfortunately, we're likely to see more and more endlings in the years to come. The causes of extinction are varied, and many of them are related to human activities. The IPBES ranked the culprits, in descending order, as:

  1. changes in land and sea use,
  2. direct exploitation of organisms,
  3. climate change,
  4. pollution, and
  5. invasive alien species.

In response to the IPBES report, the House of Representatives held a hearing in May to discuss the findings. Republicans on the committee took the opportunity to display a new form of denialism: extinction denialism. As reported in The Guardian, Representatives Tom McClintock and Rob Bishop used their time to attack the reputations of the report's authors, rather than addressing the very serious consequences of large-scale extinction. They called two climate-change deniers as witnesses, who also used their time to attack the authors.

This is a classic strategy used by deniers: attack the messenger, rather than dealing with the substance of the report. Let's consider just a few of the report's main findings (see much more here):

  • Across the planet, 75% of the land and about 66% of the marine environments have been significantly altered by human actions.
  • Up to $577 billion in annual global crops are at risk from pollinator loss (bees and other insects)
  • In 2015, 33% of marine fish stocks were being harvested at unsustainable levels; 60% were maximally sustainably fished.
  • Plastic pollution has increased tenfold since 1980, 300-400 million tons of heavy metals, solvents, toxic sludge and other wastes from industrial facilities are dumped annually into the world’s waters, and fertilizers entering coastal ecosystems have produced more than 400 ocean ‘dead zones’, covering a combined area greater than that of the United Kingdom.

The report is a call to action. It explains that transformative change is needed to protect and restore nature, and collective action is needed to overcome special interests such as the fossil fuel industry, which donates heavily to politicians. The Congressional hearing was a vivid demonstration of how effective the anti-environmental lobbyists have been.

Endling is the saddest word in any language. If we humans continue to treat nature as we've done in the past, we're going to see many more videos like the one of Benjamin, the last Tasmanian tiger. Let's hope we can do better.

Does the length of your fingers predict sexual orientation?

Imagine my surprise last week when I saw an article in Science that claimed "finger lengths can predict personality and health."* Huh?

The author, science writer Mitch Leslie, gives us the rather startling number that over the past 20 years, more than 1400 papers have been published linking finger lengths to personality, sexual orientation, cardiovascular disease, cancer, and more.

What is this magical finger length ratio? Simple: it's the ratio between the lengths of your index (2nd) and ring (4th) fingers, also called the 2D:4D ratio. Take a look: is your index finger longer than your ring finger?

It turns out that most people have slightly longer ring fingers than index fingers, and in men the difference is a bit larger. If the ringer finger is longer, than the 2D:4D ratio is less than one. One recent study reported that this ratio was 0.947 in men and 0.965 in women. Another study found average values of 0.984 and 0.994 for men and women. Not only is this a tiny difference, but in every study, the 2D:4D ratio among men and women overlapped, meaning the number alone doesn't tell you very much.

Nonetheless, some researchers have taken this tiny physiological difference and run with it. Nearly 20 years ago, Berkeley psychologist Marc Breedlove (now at Michigan State) published a study in Nature where he and his colleagues measured finger-length ratios in 720 adults in San Francisco. Based on this data, they concluded that finger-length ratios show
"evidence that homosexual women are exposed to more prenatal androgen than heterosexual women are; also, men with more than one older brother, who are more likely than first-born males to be homosexual in adulthood, are exposed to more prenatal androgen than eldest sons."
Whoa! They are not only claiming that the 2D:4D ratio is predictive of homosexuality, but also that exposure to prenatal androgen is the root cause of both finger lengths and sexual orientation. (Confusing correlation with causation, perhaps?) Not surprisingly, this claim is not widely accepted.

There are many, many more claims out there. In 2010, the BBC boldly reported that 
“The length of a man's fingers can provide clues to his risk of prostate cancer, according to new research.”
based on this study in the British Journal of Cancer. That study found that men whose index fingers were longer than their ring fingers had a reduced risk of cancer. (I don't believe it for a second, but if it makes you feel better, go ahead.) And a 2016 report found that both men and women with a low 2D:4D ratio (longer ring fingers) had better athletic abilities. 

The Science article goes on to explain, though, that "the results often can't be replicated." Most of these studies are small, the measurement techniques vary widely, and efforts to reproduce them (when others have tried, which isn't that often) usually fail. It didn't take me long to find a few, such as this study from 2012, which swas the 2nd failure to replicate a result claiming a link between sex hormone exposure and the 2D:4D ratio.
The author's left hand

After reading the whole Science article, one comes away with the impression that finger ratio science is almost certainly bogus. The presentation, though, gives far more space to the claims of those who believe in it, and one gets the strong impression that the journalist (Mitch Leslie) is on their side. A hint to that is in his last sentence where, after saying that the two sides are "talking past one another," he writes "more than 20 papers using the digit ratio have already come out last year."

And since the last sentence is often a giveaway for what the writer really thinks, let me conclude by saying that both my ring fingers are longer than my index fingers.

[*The print version of Science contains precisely this claim in the subheading to the article: "Some researchers say a simple ratio of finger lengths can predict personality and health." Interestingly, the online version of the same article does not have this headline. Instead, it reads "Scientists try to debunk idea that finger length can reveal personality and health." It appears as if the online editors were more skeptical than the print editors.]

Google ran a secret experiment to search for cold fusion. Did they find it?

A non-working cold fusion apparatus
at the San Diego Naval Warfare 
Center. Source: Wikipedia
The journal Nature last week revealed the results of a 4-year, $10 million experiment to test cold fusion. The experiments were kept secret in order to avoid the negative publicity that cold fusion attracted when it burst upon the scene 30 years ago.

I've been talking to a few non-scientists about this, and it appears that many people don't know about the cold fusion saga, so here's a quick recap: back in 1989, two chemists at the University of Utah, Stanley Pons and Martin Fleischmann, held a press conference to announce a startling discovery: they had generated fusion energy at room temperature. If true, this would have been a profound, civilization-changing discovery: cold fusion had the potential to provide nearly free energy to the entire world, eliminating our dependence on fossil fuels and promising unheard-of economic and environmental benefits.

[A physics aside for those who might be curious: fusion energy is produced when two atoms are smashed together to form a new, heavier atom. Four hydrogen atoms can be fused to form one helium atom, for example. A tiny bit of mass is converted to energy in the process, and that tiny amount produces enormous amounts of energy, as given by Einstein's famous equation, E=MC2. Fusion is the process that powers the sun and other stars, but humans have never been able to control it. It's also the source of the energy released by a thermonuclear bomb. The only nuclear energy we humans can control is fission, which is what nuclear power plants use. And the only fusion we know about requires crazily high temperatures, which is why room temperature would be "cold."]

Unfortunately for Pons and Fleischmann, whose reputations were forever tarnished, the 1989 experiments were fatally flawed. Many scientists tried to reproduce the results, but they all failed, and the criticism mounted quickly. Pons and Fleischmann never published their findings, and cold fusion later became a meme for flawed or impossible scientific results. Even today, calling something "cold fusion" is form of ridicule.

Despite the dramatic failure 30 years ago, cold fusion isn't fundamentally impossible, unlike homeopathy, acupuncture, reiki, or other forms of pseudoscience. Fusion is a very real phenomenon, and no one really knows if it might be possible to sustain a fusion reaction at low temperatures, or what those temperature limits might be. This is what led Google and the scientific team they funded to give cold fusion another serious look.

The new Google-funded experiments were run by a team of about 30 graduate students, postdoctoral fellows, and professors. The seven leaders of the team, who include scientists from UBC, MIT, the University of Maryland, LBL, and Google, described their findings in a paper just published in Nature. After four years of careful experiments, they conclude:
"So far, we have found no evidence of anomalous effects claimed by proponents of cold fusion."
In other words, they couldn't get cold fusion to work. They tried 3 different experimental setups that have been proposed by others, but despite their best efforts, nothing produced any signs of fusion energy.

The news isn't all negative. The scientists emphasized that in the course of trying to produce cold fusion, they had to design new instrumentation and study new types of materials that have received little attention before now. They wrote:
"... evaluating cold fusion led our programme to study materials and phenomena that we otherwise might not have considered. We set out looking for cold fusion, and instead benefited contemporary research topics in unexpected ways."
They cite go on to say:
"Finding breakthroughs requires risk taking, and we contend that revisiting cold fusion is a risk worth taking."
I have to agree with them here. As the scientists themselves pointed out, even though their experiments didn't produce cold fusion, "this exploration of matter far from equilibrium is likely to have a substantial impact on future energy technologies." In other words, if we keep trying, who knows what we might find?


Does ginkgo biloba enhance memory? I forgot.

I recently saw an ad that claimed ginkgo biloba can treat the signs of dementia. A quick search on Amazon.com yielded hundreds of products, many claiming that gingko is a "brain sharpener" or that it "supports focus, memory, brain function and mental performance," or other similar claims.

Ginkgo biloba is a supplement made from the leaves of the gingko biloba tree, which is native to China. The supplements industry claims that gingko has been used for thousands of years to improve memory and stave off dementia. While that may be true (though I doubt it), the argument that a medical treatment was used by pre-scientific cultures is not exactly compelling. After all, people died very young in ancient times, and medical knowledge was little more than superstition, for the most part. I don't know about you, but when I'm looking for medicine, I want the latest stuff.

"But wait!" say ginkgo biloba's advocates: maybe those ancient folk doctors were onto something. Maybe so–and it didn't take me long to find multiple studies testing what those ancients supposedly believed about gingko biloba:

  1. Here's a review from 2009 that looked at gingko biloba for dementia and milder cognitive impairment. It reported that "the evidence that Ginkgo biloba has clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unreliable." Not exactly a ringing endorsement.
  2. Here's another study, from 2012, looking at the effect of gingko biloba on memory in healthy individuals. Is it a "brain sharpener"? Well, no. This study found that gingko "had no ascertainable positive effects on a range of targeted cognitive functions in healthy individuals." In other words, a total dud.
  3. And here's an even more recent study, from 2015. The result: "no convincing evidence ... that demonstrated Ginkgo biloba in late-life can prevent the development of dementia. Using it for this indication is not suggested."

Given that the science says this doesn't work, you might wonder how it is that hundreds of gingko biloba products are still on the market, all of them with claims about memory. Simple: it's a dietary supplement, not a drug, which means that it is essentially unregulated (in the U.S.). The FDA won't step in unless the marketing claims get so outrageous that they cross the line into medicine–and even then, the FDA rarely does more than send a sternly worded letter.

As I've written before, supplement marketing is like the wild west. You generally can't trust anything you read from the manufacturers, except perhaps the ingredients list. And even the ingredients are sometimes inaccurate and contaminated.

(By the way, I find it especially amusing when a pill that has no effect is advertised as "double strength," as Walgreens does for one of their gingko products, here.)

So be skeptical about the marketing claims for gingko biloba. Even NCCIH, the NIH institute whose mission is to promote "alternative" medicine, is remarkably clear about this, stating that:

  • "There’s no conclusive evidence that ginkgo is helpful for any health condition.
  • Ginkgo doesn’t help prevent or slow dementia or cognitive decline.
  • There’s no strong evidence that ginkgo helps with memory enhancement in healthy people, blood pressure, intermittent claudication, tinnitus, age-related macular degeneration, the risk of having a heart attack or stroke, or with other conditions."

I must say, I'm feeling a bit better about NCCIH these days. They got this one right. The bottom line: don't waste your money on gingko biloba.

Why does anyone believe this works? The dangers of cupping.

Cupping therapy. If this looks painful and possibly damaging
to the skin, that's because it is.
People are easily fooled. Even smart people.

I'm not talking about voters in the U.S. and the UK, although both groups have recently demonstrated how easily they can be conned into voting against their own interests. You can read plenty of articles about that elsewhere.

No, I'm talking about the wide variety of health treatments that call themselves alternative medicine, integrative medicine, traditional Chinese medicine, energy medicine, and other names. These are all just marketing terms, but many people, including some physicians and scientists, seem captivated by them.

This week I'm going to look at "cupping," a rather bizarre treatment that, for reasons that escape me, seems to be growing in popularity.

I just returned from a scientific conference, where I happened to speak with an editor for a major scientific journal who also follows this blog. She remarked that she liked some of my articles, but she disagreed with me about cupping, which I wrote about during the 2016 Olympics, where swimmer Michael Phelps was observed to have the circular welts that are after-effects of cupping. This editor's argument boiled down to "it works for me," which left me somewhat flabbergasted.

And just two weeks ago, when I was at my physical therapist's office getting treatment for a shoulder injury, I heard her discussing cupping with another therapist. I then noticed a large box containing cupping equipment on one of the counters. Thankfully, my therapist didn't suggest cupping for me; I'm not sure how I would have replied.

What is cupping? It's a technique where you take glass cups, heat the air inside them, and then place them on the skin. Because hot air is less dense, it creates suction as it cools, which sucks your skin up into the glass. (Some cupping sets use pumps rather than heat to create this effect.) Imagine someone giving you a massive hickey, and then doing another dozen or so all over your back, or legs, or wherever the cupping therapist thinks you need it. If that sounds kind of gross, it is.

Quacktitioners Practitioners of cupping think that it somehow corrects your "qi," a mysterious life force that simply doesn't exist. When pressed, they often remark that it "improves blood flow," a catch-all explanation that has no scientific basis and that is more or less meaningless. What really happens, as the physician and blogger Orac noted, is this:
"The suction from cupping breaks capillaries, which is why not infrequently there are bruises left in the shape of the cups afterward.... If you repeatedly injure the same area of skin over time ... by placing the cups in exactly the same place over and over again, the skin there can actually die."
So maybe cupping isn't so good for you.

Cupping is ridiculous. There's no scientific or medical evidence that it provides any benefit, and it clearly carries some risk of harm. A recent review in a journal dedicated to alternative medicine–one of the friendliest possible venues for this kind of pseudoscience–concluded that
"No explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary."
Right. That's what proponents of pseudoscience always say when the evidence fails to support their bogus claims. Let us do more studies, they argue, and eventually we'll prove what we already believe. That's a recipe for bad science.

Even NCCIH, the arm of NIH dedicated to studying complementary and integrative nonsense medicine, can't bring itself to endorse cupping. Their summary states:

  • There’s been some research on cupping, but most of it is of low quality.
  • Cupping may help reduce pain, but the evidence for this isn’t very strong.
  • There’s not enough high-quality research to allow conclusions to be reached about whether cupping is helpful for other conditions.

In other words, some bad scientists have conducted a few studies but haven't proven anything. But wait, it gets worse. NCCIH goes on to warn that:

  • Cupping can cause side effects such as persistent skin discoloration, scars, burns, and infections, and may worsen eczema or psoriasis. 
  • Rare cases of severe side effects have been reported, such as bleeding inside the skull (after cupping on the scalp) and anemia from blood loss (after repeated wet cupping). 

And still, otherwise intelligent people say "it works for me." I'm left speechless.

The bottom line: save your money and your skin. Don't let anyone suck it into those cups.

Measles is back. Blame the anti-vaxxers.

In the year 2000, the CDC announced that measles had been eliminated from the U.S. This was a fantastic public health achievement, made possible by the measles vaccine, which is 99% effective and which has virtually no side effects.

Unfortunately, measles is back. Just last week, the CDC announced that we've had at least 695 cases this year, the most since 2000, primarily from 3 large outbreaks, one in the state of Washington and two in New York. Because the CDC's surveillance is far from perfect, the true number of measles cases is likely much higher. And we're only four months into the year.

Also this week, UCLA and CalState-LA had to quarantine over 700 students and staff members who were exposed to measles from an outbreak in the Los Angeles area. At UCLA, one student who had measles attended multiple classes while still contagious, exposing hundreds of others to the highly contagious virus, according to a message from the university's chancellor.

No one has died as of yet, but if we don't quash these outbreaks, it's only a matter of time before someone will die. Measles has a fatality rate of 0.2%, or 2 deaths per thousand cases. That may sound small, but it's truly frightening when you consider that the U.S. had an estimated 500,000 cases per year before the vaccine was introduced in 1963.

Given the risks of measles, and given the remarkable effectiveness and safety of the vaccine, why don't people vaccinate their children? The primary reason is simple: it's the highly vocal, supremely confident, and utterly misinformed anti-vaccine movement. Anti-vaxxers spread their message daily on Facebook, Twitter, websites, and other media outlets. (I will not link to any of them here because I don't want to increase their influence.) They have launched systematic efforts throughout the U.S. and in other countries to convince parents not to vaccinate their children, claiming that vaccines cause a variety of harms, none of which are correct. (I won't list those here either, because even mentioning them gives the claims credibility.)

In one of the two outbreaks in New York, anti-vaxxers distributed highly misleading pamphlets in an effort to convince parents in an ultra-religious Jewish community not to vaccinate their kids. The anonymously-published pamphlet was "filled with wild conspiracy theories and inaccurate data," but it seems to have worked, as least among some of the parents.

The anti-vax movement is also behind the state-by-state effort to allow parents to opt out of vaccinations for their children in public schools. We're finally seeing some states roll this back, but it is still far too easy for parents to claim an "ethical" or "religious" exemption, allowing them to put their unvaccinated kids in school and thereby expose countless other children to measles and other preventable diseases. (I put those words in quotes because there is no valid ethical or religious objection to vaccines. All major religions strongly support vaccination.) Anti-vax websites provide how-to instructions telling parents how to get exemptions for their kids, and a small number of anti-vax doctors (I'm looking at you, Bob Sears) readily dispense large numbers of anti-vax exemptions. This needs to end.

The modern anti-vaccine movement started in 1998, with a fraudulent paper about the measles, mumps, and rubella vaccine, published by a former doctor who lost his medical license after the fraud was revealed. The lead author was eventually revealed to have taken large sums of money (unbeknownst to his co-authors) from lawyers who were trying to build a case to sue vaccine makers. That same ex-doctor, who I also won't name here (his initials are AW), is now a hero to the anti-vax movement, and he travels the world spreading his toxic message. He's even made an anti-vax movie.

I sincerely hope we won't see any children die before the anti-vaccine movement finally goes away. For any parents who are thinking that they won't vaccinate their kids, I urge them to read the heartbreaking words of Roald Dahl (author of Charlie and the Chocolate Factory, The BFG, and many other wonderful books), whose oldest daughter Olivia died of measles in 1962, at the age of seven:
"...one morning, when [Olivia] was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything.
'Are you feeling all right?' I asked her.
'I feel all sleepy,' she said.In an hour, she was unconscious. In twelve hours she was dead.The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her." 
The measles vaccine was a miracle of modern medicine, and it's been administered safely to hundreds of millions of people. Measles is a dangerous illness, but we can prevent it. No parent should have to go through what Roald Dahl went through.

Climate change is making us sneeze

Allergy sufferers are having a rough time of it this spring. If you're among them, and if you think it's getting worse, you're right–and climate change is at least partly to blame.

Admittedly, warming climate has far more severe consequences, such as the eventual flooding of entire coastal cities. On a personal level, though, pollen allergies make people pretty miserable. (I write this as a lifelong sufferer myself.) When springtime comes and trees burst into buds, some of us shut all the windows and huddle inside.

I hadn't thought that climate change would affect the pollen season until I read a newly published study in a journal called The Lancet Planetary Health. (Aside: yes, there really is a journal with that name, a specialty journal created two years ago by the venerable publishers of The Lancet.)

The new study, by USDA scientist Lewis Ziska and colleagues from 15 other countries, looked at airborne pollen data from 17 locations, spanning the entire globe, and stretching back an average of 26 years. The news isn't good for allergy sufferers:
"Overall, the long-term data indicate significant increases in both pollen loads and pollen season duration over time."
In other words, it's a double whammy: we getting more pollen than ever before, and the allergy season last longer. Okay, not that much longer, only an average of one day. But if you have hay fever, every day is one too many.

To be fair, not every location experienced a significant increase in pollen. Here are the 12 (of 17) that did:
  • Amiens, France
  • Brussels, Belgium
  • Geneva, Switzerland
  • Kevo, Finland
  • Krakow, Poland
  • Minneapolis, USA
  • Moscow, Russia
  • Papillion, USA
  • Reykjavik, Iceland
  • Thessaloniki, Greece
  • Turku, Finland
  • Winnipeg, Canada
Perhaps not coincidentally, the pollen season this spring is making headlines in the U.S. As the NY Times reported this week, "extreme" pollen has blanketed the middle of North Carolina this week. It's so bad that the air has taken on a yellowish tinge, as shown in this unaltered photo, one of several taken by photographer Jeremy Gilchrist and shared last week on social media.
A yellow haze caused by pollen over Durham, North Carolina
in April 2019. Photo credit: Jeremy Gilchrist via Facebook.

According to Ziska et al.'s study, more pollen-filled springs are the new normal. Their projections indicate that pollen seasons will continue to get longer in the future, and that the amount of pollen in the air will also increase during the spring and again in the fall, when ragweed pollen is at its peak.

What can you do about spring allergies? I wrote about this last year: for some people, over-the-counter antihistamines help, although they only treat the symptoms. Allergy shots can provide long-term relief, if you have the time to go through the months-long regimen. Other than these options, the best you can do is stay inside and wait for pollen season to end. You can always catch up on your reading of The Lancet Planetary Health.

NEJM says open access is unnecessary. Right.

Surprise: the New England Journal of Medicine thinks open access is a bad idea. Open access is the model of scientific publishing in which all results are freely available for anyone, anywhere, to read.

This week NEJM published an editorial by one of their correspondents,  Charlotte Haug, that purports to present an objective look at open access publishing, and finds that the "experiment" has failed, and that free access to scientific publications hasn't delivered on its promises.

What is NEJM worried about? Their expensive, exclusive model of publishing–where everyone has to pay high subscription fees, or else pay exhorbitant fees for each article they read–is threatened by scientists who want all science to be free. Pesky scientists!

NEJM is especially worried about "Plan S", a proposal in Europe to require that all scientists whose work is funded by the public be required to publish their results in open-access venues. Plan S is due to take effect very soon, in 2020 for 11 research funders in Europe.

The NEJM article is a clever but deeply flawed effort to prove that open access isn't working. It's full of fallacies and straw men, so much so that it's hard to know where to begin. Since they're not playing fair, though, I won't either: I'll cherry-pick three of Haug's arguments and explain why she's wrong about each one.

But first, to set the stage, let's remind everyone of what we're talking about. Scientific papers are written by scientists (like me), who are largely funded to do their work by governments, non-profit organizations, and occasionally by commercial companies. The writing is done by the scientists themselves, who submit papers to journals for peer review. The peer reviewing is also done by scientists (again, like me) who do this work for free. The journals pay nothing for all this work.

In other words, we do all the work for free, using funding provided by the public, and the journals then take that work and sell it for a very tidy profit. (Richard Smith estimates that NEJM itself has an income of $100 million with a 30% profit.) The vast majority of scientific and medical journals are owned by five for-profit corporations, as the NEJM points out:
"The five largest publishing houses (SAGE, Elsevier, Springer Nature, Wiley-Blackwell, and Taylor & Francis) continue to grow, with high profit margins."
For the past two decades, scientists have spoken out more and more over the outrageous practices of for-profit publishers, whose subscription fees and profits have grown while the costs of distribution have plummeted. Virtually everyone gets scientific papers online now. Why sign over copyright when we can distribute our work so cheaply now? The open access movement was founded to provide an alternative: open access journals allow everyone to read all the content for free, and the authors retain their copyrights.

Now let's look at the NEJM article. Haug starts by pretending to agree that open access is a good thing, writing:
"The idea — that the results of research should be available to be read, discuss, and examine... — has few, if any, opponents in either the scientific community or the public."
Reading this, you might think that Haug (and NEJM, by extension) are fans of open access. They are not.

Haug then proceeds (she thinks) to dismantle the arguments in favor of open access. First, she states that publishing costs have not dropped, but have increased. As evidence, she asserts that "Electronic production and maintenance of high-quality content are at least as expensive as print production and maintenance." This claim is, frankly, nonsense, but since Haug doesn't cite any evidence to back it up, there's nothing really to refute. It's obviously much cheaper to post a PDF on a website than to print thousands of hardcopies and physically ship them to libraries around the world. If costs are going up (and again, Haug cites no evidence), that could be simply because publishers are paying themselves higher salaries (NEJM reported compensation of  $703,324 for its chief editor in 2017), or hiring large staffs, or renting luxurious offices–who knows? Haug doesn't explain.

In any case, the costs of publishing at NEJM, a closed-access, subscription-based journal, have little to do with whether or not scientific and medical research should be freely available.

Her next argument against open access is that the most highly-cited journals are subscription-based, like (ahem) NEJM. My response: so what? Everyone within academia knows that it takes a very long time to establish a reputation as a "top" journal, and young scientists will always want to publish in those journals, regardless of how expensive they are. This has given closed-access journals like NEJM (and Nature, Science, JAMA, and Cell, to name a few more) tremendous power, which they have wielded to fight against open access at every opportunity. This editorial represents another example of that fight. The fact that many scientists still want to publish in these journals doesn't mean they should keep the results locked behind a paywall.

Setting aside this tiny number of "prestige" journals, open access papers do get cited more, as was demonstrated by this study from 2016. The evidence shows that open access does lead to higher impact: papers that are freely available are read more and cited more.

Finally, let's turn to Haug's coup de grace, which she wields near the end of her piece, as a sort of "proof" that open access is really unnecessary. Here she argues that NEJM is already open, mostly:
"About 98% of the research published in the Journal since 2000 is free and open to the public. Research of immediate importance to global health is made freely accessible upon publication; other research articles become freely accessible after 6 months."
First, let's acknowledge that merely by pointing this out, Haug is admitting that the main arguments for open access are legitimate; i.e., that it's a huge benefit to society to make research freely available. I'm going to agree with her here.

What Haug doesn't mention here is that there is one reason (and only one, I would argue) that NEJM makes all of its articles freely available after some time has passed: the NIH requires it. This dates back to 2009, when Congress passed a law, after intense pressure from citizens who were demanding access to the research results that they'd paid for, requiring all NIH-funded results to be deposited in a free, public repository (now called PubMed Central) within 12 months of publication.

Scientific publishers fought furiously against this policy. I know, because I was there, and I talked to many people involved in the fight at the time. The open-access advocates (mostly patient groups) wanted articles to be made freely available immediately, and they worked out a compromise where the journals could have 6 months of exclusivity. At the last minute, the NIH Director at the time, Elias Zerhouni, extended this to 12 months, for reasons that remain shrouded in secrecy, but thankfully, the public (and science) won the main battle. For NEJM to turn around now and boast that they are releasing articles after an embargo period, without mentioning this requirement, is hypocritical, to say the least. Believe me, if the NIH requirement disappeared (and publishers are still lobbying to get rid of it!), NEJM would happily go back to keeping all access restricted to subscribers.

The battle is far from over. Open access advocates still want to see research released immediately, not after a 6-month or 12-month embargo, and that's precisely what the European Plan S will do.

With Plan S looming, I've no doubt we'll see more arguments against open access in the coming months, but scientists have at least one ace up our sleeves: we're the ones who do all the work. We do the experiments, we write the papers, and we review the papers. Without us, the journals would cease to exist. The journals will have no choice but to go along with plan S, because without the scientists, they'll have nothing to publish. Let's hope the U.S. will follow suit in the very near future. It's long past time to change the archaic, closed-access policies that have kept medical and scientific results–results that were funded by the public–locked behind the paywalls of for-profit publishers.

Salty and saltier: fast food has more sodium than ever before

High blood pressure is one of the biggest health problems in the U.S. today. The CDC estimates that 75 million American adults, about one-third of the adult population, has high blood pressure. Even more alarming is that high blood pressure "was a primary or contributing cause of death for more than 410,000 Americans in 2014," the last year for which the CDC reports data.

One of the main causes of high blood pressure (a.k.a. hypertension) is too much salt in the diet. As Americans have eaten out more and more, they've grown less aware over how much salt goes into their foods. Salt is tasty but invisible: you can't know exactly how much salt is in your food if you didn't prepare it yourself.

Everyone knows that fast foods can be salty, especially those (like French fries) that have salt sprinkled all over them. What they don't know, though, is that over the past 30 years, the amount of salt in fast foods has increased dramatically, as revealed in a new study just published by Megan McCrory and colleagues at Boston University.

The new study looked at how portion sizes, calories, sodium (salt), calcium, and iron changed in major fast food chains between 1986 and 2016. They analyzed data from these 10 restaurants:
Arby’s, Burger King, Carl’s Jr, Dairy Queen, Hardee’s, Jack in the Box, KFC, Long John Silver’s, McDonald’s, and Wendy’s
They would have looked at more, but others either didn't have data available or didn't have foods in all the categories under study.

Portions and calories all increased over the past 30 years, but I want to focus on the salt.

Back in 1986, sodium content in entrees averaged 36% of the recommended daily allowance–which is pretty high for a single entree (a burger, say). Bad as that is, though, by 2016 this had increased to 47%. Thus a single fast-food entree has nearly half of an entire day's allowance of salt. Sides increased from 14% of the RDA to 26%, which means that if you have an entree and a side (fries!), you're getting 75% of your daily salt allowance. On average, they're adding 50% more salt today than in 1986.

And that's just the average: if you order larger sizes, or one of the saltier choices (though you may not be able to tell what those are), or more than one side dish, you can easily exceed 100% of your recommended salt intake for the day. (And by the way, for the vast majority of people, having less than the "allowance" of salt is just fine.)

I remember having fast food burgers and fries back in the 1980s, and they were quite tasty. I haven't noticed that they taste better today, and it's not clear why the chains increased the amount of salt so much. Presumably they did consumer testing and found that people like more salt, but it could also be simply that adding salt, which is a preservative, allows them to store the food supplies longer and save money.

Now, most people don't think fast food is healthy. It's popular because it tastes good and it's convenient. Nonetheless, for the large numbers of people who have high blood pressure (or pre-hypertension), the fact that salt has increased should be worrisome.

For those who want to do a little homework, you can easily find detailed nutrition facts for all the major chains online now. It took me only a few seconds to find downloadable lists for McDonaldsKFCWendy's, SubwayBurger King, and others, so you can compare all their items before your next visit.

For example, a McDonald's quarter pounder with cheese has 1110 mg of sodium, or 46% of your daily allowance. Their Bacon Smokehouse Artisan Grilled Chicken sandwich has far more, 1940 mg (81%), while their Filet-O-Fish, in contrast, has only 560 mg of sodium (23%). Side dishes can be surprisingly bad (or good) too. KFC's corn on the cob is a gem, with no sodium at all, but their BBQ baked beans weigh in with 820 mg of sodium.

The bottom line, though, is that if you want to eat less salt, the best way is to prepare your own food.  It's more trouble, but it's well worth the effort.

Scientists restart bioweapons research, with NIH's blessing

For more than a decade now, two scientists–one in the U.S. and one in the Netherlands–have been trying to create a deadly human pathogen from avian influenza. That's right: they are trying to turn "bird flu," which does not normally infect people, into a human flu.

Not surprisingly, many scientists are vehemently opposed to this. In mid-2014, a group of them formed the Cambridge Working Group and issued a statement warning of the dangers of this research. The statement was signed by hundreds of scientists at virtually every major U.S. and European university. (Full disclosure: I am one of the signatories.)

In response to these and other concerns, in October 2014 the U.S. government called for a "pause" in this dangerous researchNIH Director Francis Collins said that his agency would study the risks and benefits before proceeding further.

Well, four years later, the risks and benefits haven't changed, but the NIH has (quietly) just allowed the research to start again, as we learned last week in an exclusive report from Science's Jocelyn Kaiser.

I can't allow this to go unchallenged. This research is so potentially harmful, and offers such little benefit to society, that I fear that NIH is endangering the trust that Congress places in it. And don't misinterpret me: I'm a huge supporter of NIH, and I've argued before that it's one of the best investments the American public can make. But they got this one really, really wrong.

For those who might not know, the 1918 influenza pandemic, which killed between 50 and 100 million people worldwide (3% of the entire world population at the time), was caused by a strain of avian influenza that made the jump into humans. The 1918 flu was so deadly that it "killed more American soldiers and sailors during World War I than did enemy weapons."

Not surprisingly, then, when other scientists (including me) learned about the efforts to turn bird flu into a human flu, we asked: why the heck would anyone do that? The answers were and still are unsatisfactory: claims such as "we'll learn more about the pandemic potential of the flu" and "we'll be better prepared for an avian flu pandemic if one occurs." These are hand-waving arguments that may sound reasonable, but they promise only vague benefits while ignoring the dangers of this research. If the research succeeds, and one of the newly-designed, highly virulent flu strains escapes, the damage could be horrific.

One of the deadliest strains of avian flu circulating today is H5N1. This strain has occasionally jumped from birds to humans, with a mortality rate approaching 50%, far more deadly than any human flu. Fortunately, the virus has never gained the ability to be transmitted directly between humans.

That is, it didn't have this ability until two scientists, Ron Fouchier in the Netherlands and Yoshihiro Kawaoka at the University of Wisconsin, engineered it to gain this ability. (Actually, their work showed that the virus could be transmitted between ferrets, not humans, for the obvious reason that you can't ethically test this on humans.)

Well, Fouchier and Kawaoka are back at it again. NIH actually lifted the "pause" in December 2017, and invited scientists to submit proposal for this type of research. Fouchier confidently stated at the time that all he had to do was "find and replace" a few terms in his previous proposal and it would likely sail through peer review. It appears he was correct, although according to the Science article, his study has been approved but not yet actually funded. Kawaoka's project is already under way, as anyone can learn by checking the NIH grants database.

And by the way: why the heck is a U.S. funding agency supporting research in the Netherlands anyway? If Fouchier's work is so great (and it isn't), let the Netherlands fund it.

I've said it before, more than once: engineering the flu to be more virulent is a terrible idea. It appears the review process at NIH simply failed, as multiple scientists stated to Vox last week. This research has the potential to cause millions of deaths.

Fouchier, Kawaoka, and their defenders (usually other flu scientists who also benefit from the same funding) like to claim that their project to engineer a deadlier bird flu will somehow help prevent a future pandemic. This argument is, frankly, nonsense: influenza mutates while circulating among millions of birds, and no one has any idea how to predict or control that process. (I should mention that I know a little bit about the flu, having published multiple papers on it, including this paper in Nature and this paper on H5N1 avian flu.)

Fouchier and Kawaoka have also argued that we can use their work to create stockpiles of vaccines in advance. Yeah, right. We don't even stockpile vaccines for the normal seasonal flu, because it mutates too fast, so we have to produce new vaccines each year. And the notion that anyone can predict a future pandemic strain so precisely that we could design a vaccine based on their prediction is laughable.

I can't quite fathom why NIH seems to be so enraptured with the work of these two labs that, rather than simply deny them funding, it has ignored the warnings of hundreds of scientists and now risks creating a new influenza pandemic. Much as I hate to say this, maybe it's time for Congress to intervene.