When we report on clinical trials, we need to ask ourselves the following questions, Krumholz says: Where is the kernel of truth that really matters? When does a study convey more spin than substance? Why is it sometimes so hard to determine exactly what a study says? Krumholz brings the perspective of someone who does such trials and who also studies research methods and health policy—so he is involved in practice, and policy. His NIH-supported research has led to reductions in delays in the treatment of patients with heart attacks. In just the past year, he has reported that busier hospitals get better results (to a point), lipid recommendations might be misguided, and that reductions in hospital stays might be increasing readmission rates. Krumholz will tell us what isn’t obvious in the medical literature, and show us how we can better spot that ourselves.
Some patients with depression are helped by therapy, or drugs, or, more often, a combination of the two. But for others, nothing medicine has been able to offer could soften the blackness and bleakness of the illness. Helen Mayberg is working hard to change that, using a technique called deep-brain stimulation, in which electrodes are inserted deep into the cortex of patients with unremitting depression. And although she’s treated only a small number of patients so far, she’s had some spectacular successes.
She will update us on the latest studies, including work on the identification of markers seen during neuroimaging that can predict which treatment is best for an individual patient and how that patient is likely to respond. Her work is unique in both illuminating the causes of depression and providing immediate clues to treatment.
How do we make decisions and exercise judgment? We might expect that these are uniquely human activities, among the things that distinguish us from our non-human primate relatives. But Laurie Santos is pursuing a different notion—namely, that some aspects of the irrational decision-making that human adults are famous for might be shared with children and monkeys. Santos thinks this can teach us something about the origin of basic human irrationalities, such things as loss aversion, cognitive dissonance, or the anchoring bias—favoring some information over other considerations when making a decision. Why would evolution have allowed such things to appear so early in human development, when they seem to be a source of trouble and bad decisions?
Surely the conditions that lead to insurgency and war depend upon such things as ideology, anger, the desire for revenge and other factors unique to each location, to each insurgent group, to each mortal conflict. Neil Johnson and his colleagues, experts in the modeling and understanding of complex systems, weren’t buying that assumption. They reviewed 11 very different conflicts and concluded that the size and timing of violent events across these conflicts showed “remarkable” similarities.
Oddly, they found that this behavior resembles, in many ways, the behavior of financial markets. “We found that the way in which humans do insurgent wars—that is, the number of casualties and the timing of events—is universal,” Johnson says. He says that the model “can predict changes in likelihood of an attack” and how many people it’s likely to kill. Skeptical? He will do his best to persuade you.
For 50 years, researchers have pursued the idea that cancer cells divide quickly. All the drugs developed so far are aimed at those cells. Such drugs now cure 80 percent of cases of ovarian cancer. But much of that cancer recurs within 2 to 5 years, and when it comes back, it kills many of the patients. The five-year survival rate can be as low as 20 to 30 percent, says Gil Mor. (These figures depend upon when the cancer was first detected and treated.) So what’s going wrong? Mor has identified cells that divide very slowly (“We have movies of them!”), and these cells are not affected by chemotherapy. Indeed, the more chemotherapy a patient receives, the more of these cells she is left with. Some people call these cells cancer stem cells; Mor calls them cancer progenitors. And he has already identified three compounds that promise to block the conversion of these cells into classical cancer cells. (If there’s time, ask Mor about his work on viral infections during pregnancy, which can adversely affect the fetus even if the virus never crosses the placenta.)
In November, 2009, hackers released emails from climate researchers at the University of East Anglia in England, prompting wide-ranging attacks on climate research and climate researchers—Michael Mann among them. The author of the famous “hockey-stick” graph of temperatures over the past millennium, Mann was not amused; indeed, for a time his career as one of the world’s leading climate scientists seemed in jeopardy. In July, a university investigation completely vindicated him of charges of data fabrication.
Mann said he was grateful, and eager to return to his research on such things as projecting regional climate change impacts, hurricanes and climate change, ancient climate reconstructions, and climate modeling. He will give us an update on his latest research, and an insider’s view on what it means to be falsely accused of scientific misconduct.
Matthew State, a psychiatrist who went back to school to study genomics, has become one of a group of elite researchers using the newest and fastest genomics analysis—so-called high-throughput technology—to pursue the genes behind Tourette syndrome, autism, obsessive-compulsive disorder and other neuropsychiatric ailments in children, which have clear genetic components but which have proven elusive and difficult to study. The problem has often been that genes that seem linked to these disorders in one family have no apparent connection to the ailment in other families. In May, State reported in the New England Journal of Medicine that he and his colleagues had discovered a rare mutation in a gene in a family with Tourette syndrome—a finding that immediately suggested a possible treatment. State will give us the latest findings on several similar studies now under way.
Antibodies make excellent drugs for such things as rheumatoid arthritis and cancer, but they can’t be taken as a pill, and they can cause life-threatening allergic or immune responses, only making matters worse. David Spiegel has a work-around. He is developing antibody recruiters that can induce a patient’s own antibodies to attack illnesses such as prostate cancer, Staph aureus infections, and HIV. The idea is to exploit the advantages of antibody treatments while using these recruiters to overcome the disadvantages. Spiegel’s molecules are cheaper than antibodies, could be taken by mouth, and easy to synthesize. The research could, Spiegel hopes, “serve as a starting point toward entirely novel therapeutic approaches to a wide range of diseases.”
Why do people often sharply disagree about things that scientists mostly agree on? As Dan Kahan has written, “The same groups who disagree on 'cultural issues' — abortion, same-sex marriage and school prayer — also disagree on whether climate change is real and on whether underground disposal of nuclear waste is safe.” How could views on such divergent issues go together? Kahan and his colleagues are looking at something they call the “cultural cognition of risk” to explain why individuals form opinions at odds with the facts.
People’s assessment of risk—and even their willingness to admit the existence of a scientific consensus—depends upon their values. In one survey, 80 percent of the respondents said they knew little or nothing about nanotechnology—but 90 percent had strong opinions about the risks! Kahan has shown that “experts” who seem to share the values of their audience are judged to be much more persuasive than experts who seem to have different values. He will tell us how his studies shed light on the origins of America’s scientific culture wars, and, if we press him, he might also talk about his findings on public perception of gay and lesbian parenting, and on the likely course of synthetic-biology risk-taking.
In 2001, Jo Handelsman spoke at New Horizons in Tempe, Arizona, where she told us about her pioneering work in extracting DNA of previously unknown organisms from soil—an area of study known as metagenomics. These were organisms that could not be cultured in the laboratory, and so the DNA revealed bits of countless organisms unkown to science. Because many antibiotics come from the soil, Handelsman has since been investigating sources of antibiotic resistance in the soil—that is, genes and proteins that allow bacteria to survive a hit with an antibiotic.
She’s found genes that make bacteria resistant to the most advanced antibiotics, hinting at a future in which they might begin to fail. She’s now interested in sources of antibiotic resistance that reside in the human gut, in organisms that cannot be cultured. And she’s extracting DNA from workers in apple orchards who spray streptomycin on their crops. Macintosh, anyone?