Category: Methodology

Following Salt Consumption Guidelines Increases Risk of Death

Official experts often turn out to be wrong, as in the salt consumption guidelines discussed below. The fallibility of expert knowledge provides an added reason, besides respect for freedom, why government should not mandate an individual’s food and drug decisions.

(p. D4) People with high blood pressure are often told to eat a low-sodium diet. But a diet that’s too low in sodium may actually increase the risk for cardiovascular disease, a review of studies has found.

Current guidelines recommend a daily maximum of 2.3 grams of sodium a day — the amount found in a teaspoon of salt — for most people, and less for the elderly or people with hypertension.

Researchers reviewed four observational studies that included 133,118 people who were followed for an average of four years. The scientists took blood pressure readings, and estimated sodium consumption by urinalysis. The review is in The Lancet.

Among 69,559 people without hypertension, consuming more than seven grams of sodium daily did not increase the risk for disease or death, but those who ate less than three grams had a 26 percent increased risk for death or for cardiovascular events like heart disease and stroke, compared with those who consumed four to five grams a day.

In people with high blood pressure, consuming more than seven grams a day increased the risk by 23 percent, but consuming less than three grams increased the risk by 34 percent, compared with those who ate four to five grams a day.

For the full story see:

Nicholas Bakalar. “Low-Salt Diet as a Heart Risk.” The New York Times (Tuesday, Oct. 11, 2016 [sic]): D4.

(Note: ellipses added.)

(Note: the online version of the story has the date May 25, 2016 [sic], and has the title “A Low-Salt Diet May Be Bad for the Heart.”)

The academic paper reporting the results summarized above is:

Mente, Andrew, Martin O’Donnell, Sumathy Rangarajan, Gilles Dagenais, Scott Lear, Matthew McQueen, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Wei Li, Yin Lu, Sun Yi, Lei Rensheng, Romaina Iqbal, Prem Mony, Rita Yusuf, Khalid Yusoff, Andrzej Szuba, Aytekin Oguz, Annika Rosengren, Ahmad Bahonar, Afzalhussein Yusufali, Aletta Elisabeth Schutte, Jephat Chifamba, Johannes F. E. Mann, Sonia S. Anand, Koon Teo, and S. Yusuf. “Associations of Urinary Sodium Excretion with Cardiovascular Events in Individuals with and without Hypertension: A Pooled Analysis of Data from Four Studies.” The Lancet 388, no. 10043 (2016): 465-75.

Techno-Optimist Claims AI Tools “Will Help Scientists Design Therapies Faster and Better”

(p. A13) It is said that triumphant Roman generals, to ensure that the rapture of victory didn’t go to their heads, would require a companion to whisper in their ear: “Remember, you are only a man.” Jamie Metzl worries that we may have learned all too well such lessons in humility. Given remarkable recent advances in technology—and the promise of more to come—we need to lean into our emerging godlike powers, he believes, and embrace the opportunity to shape the world into a better place. In “Superconvergence,” he sets out to show us how, after first helping us overcome our hesitations.

. . .

. . . the big advances will be in medicine—and indeed are already in evidence. Mr. Metzl points to the blisteringly fast development of the Covid-19 mRNA vaccine, from digital file to widespread immunization in less than a year; and to gene-editing technologies like Crispr. He cites the experience of Victoria Gray, a young woman from Mississippi who was suffering from sickle-cell disease until, in 2019, researchers in Nashville, Tenn., reinfused her with her own cells, which had been Crispr-edited; the treatment worked, liberating her from the disease’s tormenting pain and crippling fatigue. For Mr. Metzl, these are just the first intimations of a revolution to come. AI tools like DeepMind’s Alphafold, he says, will help scientists design therapies faster and better.

To get smarter about human health, though, AI will need more information, and here Mr. Metzl’s ebullience edges toward the willful suspension of disbelief. His imagined future of healthcare will require “collecting huge amounts of genetic and systems biology data in massive and searchable databases.” The details will include not only medical records and the results of laboratory tests but data from the sensors he anticipates will be everywhere—“bathrooms, bedrooms, and offices”—as information is hoovered up from “toilets, mirrors, computers, phones and other devices without the people even noticing.” While acknowledging that such a scenario sounds like “an authoritarian’s dream and a free person’s nightmare,” he suggests that the chance to catch disease early may offset the risks. This trade-off promises to be a tough sell.

More than many techno-optimists, Mr. Metzl seems to grasp the intricacy of biological systems; he notes that they are beyond our full understanding right now. Even so, a time will come when “the sophistication of our tools and understanding meets and then exceeds the complexity of biology.”

For the full review, see:

David A. Shaywitz. “Getting Better, Faster.” The Wall Street Journal (Thursday, July 11, 2024): A13.

(Note: the online version of the review has the date July 10, 2024, and has the title “‘Superconvergence’ Review: Getting Better, Faster.”)

The book under review is:

Metzl, Jamie. Superconvergence: How the Genetics, Biotech, and AI Revolutions Will Transform Our Lives, Work, and World. New York: Timber Press, 2024.

Kahneman’s “Adversarial Collaboration” Might Bring Us More Joy and Better Science

(p. A19) Professor Kahneman, who died . . . at the age of 90, is best known for his pathbreaking explorations of human judgment and decision making and of how people deviate from perfect rationality. He should also be remembered for a living and working philosophy that has never been more relevant: his enthusiasm for collaborating with his intellectual adversaries. This enthusiasm was deeply personal. He experienced real joy working with others to discover the truth, even if he learned that he was wrong (something that often delighted him).

. . .

Professor Kahneman saw . . . “angry science,” which he described as a “nasty world of critiques, replies and rejoinders” and “as a contest, where the aim is to embarrass.” As Professor Kahneman put it, those who live in that nasty world offer “a summary caricature of the target position, refute the weakest argument in that caricature and declare the total destruction of the adversary’s position.” In his account, angry science is “a demeaning experience.”

. . .

Professor Kahneman meant both to encourage better science and to strengthen the better angels of our nature.

For the full commentary see:

Cass R. Sunstein. “The Value of Collaborating With Adversaries.” The New York Times (Wednesday, April 3, 2024): A19.

(Note: ellipses added.)

(Note: the online version of the commentary has the date April 1, 2024, and has the title “The Nobel Winner Who Liked to Collaborate With His Adversaries.”)

Since Wood Tools Are Rarely Preserved, “Preservation Bias Distorts Our View of Antiquity”

(p. D3) In 1836, Christian Jürgensen Thomsen, a Danish antiquarian, brought the first semblance of order to prehistory, suggesting that the early hominids of Europe had gone through three stages of technological development that were reflected in the production of tools. The basic chronology — Stone Age to Bronze Age to Iron Age — now underpins the archaeology of most of the Old World (and cartoons like “The Flintstones” and “The Croods”).

Thomsen could well have substituted Wood Age for Stone Age, according to Thomas Terberger, an archaeologist and head of research at the Department of Cultural Heritage of Lower Saxony, in Germany.

“We can probably assume that wooden tools have been around just as long as stone ones, that is, two and a half or three million years,“ he said. “But since wood deteriorates and rarely survives, preservation bias distorts our view of antiquity.” Primitive stone implements have traditionally characterized the Lower Paleolithic period, which lasted from about 2.7 million years ago to 200,000 years ago. Of the thousands of archaeological sites that can be traced to the era, wood has been recovered from fewer than 10.

Dr. Terberger was team leader of a study published last month in the Proceedings of the National Academy of Sciences that provided the first comprehensive report on the wooden objects excavated from 1994 to 2008 in the peat of an open-pit coal mine near Schöningen, in northern Germany. The rich haul included two dozen complete or fragmented spears (each about as tall as an N.B.A. center) and double-pointed throwing sticks (half the length of a pool cue) but no hominid bones. The objects date from the end of a warm interglacial period 300,000 years ago, about when early Neanderthals were supplanting Homo heidelbergensis, their immediate predecessors in Europe. The projectiles unearthed at the Schöningen site, known as Spear Horizon, are considered the oldest preserved hunting weapons.

For the full story see:

Franz Lidz. “In the Stone Age, Wood Was Pivotal, a Study Says.” The New York Times (Tuesday, May 7, 2024): D3.

(Note: the online version of the story was updated May 6, 2024, and has the title “Was the Stone Age Actually the Wood Age?”)

Terberger’s co-authored academic paper mentioned above is:

Leder, Dirk, Jens Lehmann, Annemieke Milks, Tim Koddenberg, Michael Sietz, Matthias Vogel, Utz Böhner, and Thomas Terberger. “The Wooden Artifacts from Schöningen’s Spear Horizon and Their Place in Human Evolution.” Proceedings of the National Academy of Sciences 121, no. 15 (2024): e2320484121.

The Absence of a Randomized Double-Blind Clinical Trial Is Used as an Excuse to Ignore an Emergency Procedure That Saves Lives

In an urgent emergency the son and wife of a man with a stopped heart, improvised the use of a toilet plunger to get his heart to start pumping again. In his wonderful account of the sources of insight, Gary Klein told a different example of urgent emergency improvisation: “Wag” Dodge saved himself from a massive wildfire racing toward him by lighting a match to the grass at his feet to pre-burn a patch he could lie down in. When the wildfire reached him, it passed on both sides, avoiding the patch that now had no fuel. Neither the son-and-mother, nor Wag Dodge, got their insight from collaboration or a randomized double-blind controlled trial.

(p. D5) In 1988, a 65-year-old man’s heart stopped at home. His wife and son didn’t know CPR, so in desperation they grabbed a toilet plunger to get his heart going until an ambulance showed up.

Later, after the man recovered at San Francisco General Hospital, his son gave the doctors there some advice: Put toilet plungers next to all of the beds in the coronary unit.

The hospital didn’t do that, but the idea got the doctors thinking about better ways to do CPR, or cardiopulmonary resuscitation, the conventional method for chest compressions after cardiac arrest. More than three decades later, at a meeting of emergency medical services directors this week in Hollywood, Fla., researchers presented data showing that using a plunger-like setup leads to remarkably better outcomes for reviving patients.

. . .

The new procedure, known as neuroprotective CPR, has three components. First, a silicone plunger forces the chest up and down, not only pushing blood out to the body, but drawing it back in to refill the heart. A plastic valve fits over a face mask or breathing tube to control pressure in the lungs.

The third piece is a body-positioning device sold by AdvancedCPR Solutions, a firm in Edina, Minn., that was founded by Dr. Lurie. A hinged support slowly elevates a supine patient into a partial sitting position. This allows oxygen-starved blood in the brain to drain more effectively and to be replenished more quickly with oxygenated blood.

. . .

. . ., a study carried out in four states found . . . [p]atients who received neuroprotective CPR within 11 minutes of a 911 call were about three times as likely to survive with good brain function as those who received conventional CPR.

. . .

Dr. Karen Hirsch, a neurologist at Stanford University and a member of the CPR standards committee for the American Heart Association, said that the new approach was interesting and made physiological sense, but that the committee needed to see more research on patients before it could formally recommend it as a treatment option.

“We’re limited to the available data,” she said, adding that the committee would like to see a clinical trial in which people undergoing cardiac arrests are randomly assigned to conventional CPR or neuroprotective CPR. No such trials are happening in the United States.

Dr. Joe Holley, the medical director for the emergency medical service that serves Memphis and several surrounding communities, isn’t waiting for a larger trial. Two of his teams, he said, were getting neurologically intact survival rates of about 7 percent with conventional CPR. With neuroprotective CPR, the rates rose to around 23 percent.

His crews are coming back from emergency calls much happier these days, too, and patients are even showing up at fire stations to thank them for their help.

“That was a rare occurrence,” Dr. Holley said. “Now it’s almost a regular thing.”

For the full story see:

Joanne Silberner. “How a Plunger Improved CPR.” The New York Times (Tuesday, June 27, 2023 [sic]): D5.

(Note: ellipses added.)

(Note: the online version of the story has the date June 15, 2023 [sic], and has the title “How a Toilet Plunger Improved CPR.”)

The Gary Klein book that I praised above is:

Klein, Gary. Seeing What Others Don’t: The Remarkable Ways We Gain Insights. Philadelphia, PA: PublicAffairs, 2013.

The “study carried out in four states,” and mentioned above, is:

Moore, Johanna C., Paul E. Pepe, Kenneth A. Scheppke, Charles Lick, Sue Duval, Joseph Holley, Bayert Salverda, Michael Jacobs, Paul Nystrom, Ryan Quinn, Paul J. Adams, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter M. Antevy, Charles Coyle, Eric Grizzard, Sebastian Garay, Remle P. Crowe, Keith G. Lurie, Guillaume P. Debaty, and José Labarère. “Head and Thorax Elevation During Cardiopulmonary Resuscitation Using Circulatory Adjuncts Is Associated with Improved Survival.” Resuscitation 179 (2022): 9-17.

Orangutan Effectively Self-Medicates to Heal Facial Wound

The Food and Drug Administration (FDA) is currently investigating whether Rakus the orangutan conducted a randomized double-blind clinical trial to prove the safety and efficacy of akar kuning before he applied it to his wound.

(p. D3) Scientists observed a wild male orangutan repeatedly rubbing chewed-up leaves of a medicinal plant on a facial wound in a forest reserve in Indonesia.

. . .

“Once I heard about it, I got extremely excited,” said Isabelle Laumer, a primatologist with the Max Planck Institute of Animal Behavior in Germany, in part because records of animals medicating themselves are rare — even more so when it comes to treating injuries. She and colleagues detailed the discovery in a study published Thursday [May 2, 2024] in the journal Scientific Reports.

The plant Rakus used, known as akar kuning or yellow root, is also used by people throughout Southeast Asia to treat malaria, diabetes and other conditions. Research shows it has anti-inflammatory and antibacterial properties.

. . .

Orangutans rarely eat the plant. But in this case, Rakus ingested a small amount and also coated the wound several times. Five days after the wound was noticed, it had closed, and less than a month later “healed without any signs of infection,” Dr. Laumer said.

Michael Huffman, a visiting professor at the Institute of Tropical Medicine at Nagasaki University in Japan, who wasn’t involved in the study, said, “This is to the best of my knowledge the first published study to demonstrate an animal using a plant with known biomedical properties for the treatment of a wound.”

Primates have been observed appearing to treat wounds in the past, but not with plants. A group of more than two dozen chimpanzees in Gabon in Central Africa have been seen chewing up and applying flying insects to their wounds, said Simone Pika, an expert on animal cognition at Osnabrück University in Germany who documented that observation.

For the full story see:

Douglas Main. “Primate Self-Medicates To Heal His Wound.” The New York Times (Tuesday, May 7, 2024): D3.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date May 2, 2024, and has the title “Orangutan, Heal Thyself.”)

Laumer’s co-authored academic paper mentioned above is:

Laumer, Isabelle B., Arif Rahman, Tri Rahmaeti, Ulil Azhari, Hermansyah, Sri Suci Utami Atmoko, and Caroline Schuppli. “Active Self-Treatment of a Facial Wound with a Biologically Active Plant by a Male Sumatran Orangutan.” Scientific Reports 14, no. 1 (2024): article #8932.

Seeds of Plant Mostly Used for Pain Relief in Roman Era, Found Stashed in Buried Bone in “Far-Flung” Province

A couple of thousand years ago some humans had figured out how to use a medicinal plant for effective pain relief. And they did so without having conducted randomized double-blind clinical trials. And no agency of the government blocked them from easing their pain.

(p. D2) . . ., Mr. van Haasteren was cleaning the mud from yet another bone when something unexpected happened: Hundreds of black specks the size of poppy seeds came pouring out from one end.

The specks turned out to be seeds of black henbane, a potently poisonous member of the nightshade family that can be medicinal or hallucinogenic depending on the dosage.  . . .

This “very special” discovery provides the first definitive evidence that Indigenous people living in such a far-flung Roman province had knowledge of black henbane’s powerful properties, said Maaike Groot, an archaeozoologist at the Free University of Berlin and a co-author of a paper published in the journal Antiquity last month describing the finding.

The plant was mostly used during Roman times as an ointment for pain relief, although some sources also reference smoking its seeds or adding its leaves to wine.

For the full story see:

Rachel Nuwer. “Psychedelic Stash: Ancient Seeds Courtesy of a Doctor, or a Doctor Feel Good.” The New York Times (Tuesday, April 9, 2024): D2.

(Note: ellipses added.)

(Note: the online version of the story has the date March 21, 2024, and has the title “Long Before Amsterdam’s Coffee Shops, There Were Hallucinogenic Seeds.”)

The academic paper co-authored by Groot and mentioned above is:

Groot, Maaike, Martijn van Haasteren, and Laura I. Kooistra. “Evidence of the Intentional Use of Black Henbane (Hyoscyamus niger) in the Roman Netherlands.” Antiquity 98, no. 398 (2024): 470-85.

Conservatives Are Better Than Liberals at “the Separation of Facts from Feelings”

(p. A13) I don’t know who’s going to win the presidential election, and neither do you. Neither, for that matter, does Nate Silver, notwithstanding his reputation as a political prognosticator. He is more accurately characterized as a forecaster, which is to say that he deals in probabilities, not outright predictions.

. . .

. . . since I first encountered his work in 2009, Mr. Silver has always struck me as an honest practitioner. Although he describes himself as a “center-left liberal,” he frequently provokes antagonism from fellow liberals when his data and analysis point in directions they’d rather not go.

. . .

Mr. Silver’s career as a political pundit is something of an accident. After earning a bachelor’s degree in economics at the University of Chicago in 2000, he went to work as a KPMG consultant. Bored with his job, he started playing online poker, at first for fun. He says he “eventually deposited money at a real-money site and ran it up from 25 bucks to 15,000 bucks.” He quit KPMG and got a part-time job writing about baseball statistics, but 80% of his income came from poker winnings.

Then in 2006 Congress passed the Unlawful Internet Gambling Enforcement Act, which effectively banned online poker by making it unlawful for the sites to accept payments. “That killed my livelihood,” Mr. Silver says. “I started following politics. I had more time on my hands. I also wanted to see the people behind the bill ousted from office, which they were.” Its primary sponsor, Rep. Jim Leach (R., Iowa), lost his bid for a 16th term.

Mr. Silver still plays poker semiprofessionally—in person—and has earned $855,800 in tournaments, according to the Hendon Mob database. He has a new book out next week, “On the Edge: The Art of Risking Everything,” in which he interviews professional gamblers, venture capitalists, adventurers and others known for their “mastery of risk” and develops a philosophical framework around their insights.

The book touches only lightly on politics, but some of its concepts have obvious application. One of them is “decoupling,” which means, roughly, thinking with analytical detachment, including the separation of facts from feelings. Journalists used to call it objectivity, an aspiration that has fallen out of fashion in recent decades, especially in the Trump era.

A failure to decouple explains the widespread denial of Mr. Biden’s decline in the months before his withdrawal. Clear evidence became mistakable when distorted through the lenses of partisanship, ideology and antipathy toward Mr. Trump. There is no reason to believe people on the left are intrinsically more prone to this sort of error, but Mr. Silver thinks that “liberal bubbles are bigger than conservative bubbles.” Domination of big cities and influential institutions makes it easier for those on the left simply to ignore opposing views.

For the full interview see:

James Taranto. “The Weekend Interview; President Kamala Harris? What Are the Odds?” The Wall Street Journal (Saturday, Aug 10, 2024): A13.

(Note: ellipses added.)

(Note: the online version of the interview has the date August 9, 2024, and has the same title as the print version.)

The “new book” by Silver mentioned above is:

Silver, Nate. On the Edge: The Art of Risking Everything. New York: The Penguin Press, 2024.

In “An Entrenched Echo Chamber” the Highly Credentialed Slow Progress Toward an Alzheimer’s Cure

Centralized research funding (often centralized by government agencies) reduces the pluralism of ideas and methods that often lead to breakthrough innovations. The story of Alzheimer’s research, quoted below, is a dramatic case-in-point.

A secondary related lesson from the story quoted below is that Dr. Thambisetty, one of the outsiders struggling to make a difference, is trying to evade the enormous costs of mandated phase 3 clinical trials, by only investigating drugs that already have been approved by the FDA for use against other conditions. With his severely limited funding, and the huge costs of mandated phase 3 clinical trials, this may be a shrewd strategy for Thambisetty, but notice that by following it, he will never explore all the as-yet-unapproved chemicals that might include the best magic bullet against Alzheimer’s.)

(p. A25) What if a preposterous failed treatment for Covid-19 — the arthritis drug hydroxychloroquine — could successfully treat another dreaded disease, Alzheimer’s?

Dr. Madhav Thambisetty, a neurologist at the National Institute on Aging, thinks the drug’s suppression of inflammation, commonly associated with neurodegenerative disorders, might provide surprising benefits for dementia.

It’s an intriguing idea. Unfortunately, we won’t know for quite a while, if ever, whether Dr. Thambisetty is right. That’s because unconventional ideas that do not offer fealty to the dominant approach to study and treat Alzheimer’s — what’s known as the amyloid hypothesis — often find themselves starved for funds and scientific mind share.

Such shortsighted rigidity may have slowed progress toward a cure — a tragedy for a disease projected to affect more than 11 million people in the United States by 2040.

. . .

. . ., in 2006, an animal experiment published in the journal Nature identified a specific type of amyloid protein as the first substance found in brain tissue to directly cause symptoms associated with Alzheimer’s. Top scientists called it a breakthrough that provided a key target for treatments. The paper became one of the most cited in the field, and funds to explore similar proteins skyrocketed.

. . .

In 2022, my investigation in Science showed evidence that the famous 2006 experiment that helped push forward the amyloid hypothesis used falsified data. On June 24 [2024], after most of its authors conceded technical images were doctored, the paper was finally retracted.

. . .

In reporting for my forthcoming book about the disturbing state of play in Alzheimer’s research, I’ve spoken to many scientists pursuing alternatives. Dr. Thambisetty, for example, compares brain tissues from people who died in their 30s or 40s with and without genetic risk factors for Alzheimer’s. He then compares these findings to tissues from deceased Alzheimer’s patients and people who didn’t have the disease. Where changes overlap, drug targets might emerge. Rather than develop new drugs through lab and animal testing, followed by clinical trials that cost vast sums — a process that can take decades — he examines treatments already approved as reasonably safe and effective for other conditions. Patent protections have lapsed for many, making them inexpensive.

Experiments have also begun to test the weight-loss drug semaglutide (sold as Wegovy, among other brands). Researchers hope that results due in 2026 will show that its anti-inflammatory effects — like Dr. Thambisetty’s idea about hydroxychloroquine — slow cognitive decline.

Ruth Itzhaki, a research scientist at the University of Oxford, stirred curiosity in the 1990s when she shared evidence tying Alzheimer’s to herpesvirus — a scourge spread by oral or genital contact and often resulting in painful infections. For years, powerful promoters of the amyloid hypothesis ignored or dismissed the infection hypothesis for Alzheimer’s, effectively rendering it invisible, Dr. Itzhaki said with exasperation. Research suggests that viruses may hide undetected in organs, including the brain, for years, causing symptoms divergent from the original infection.

. . .

Sometimes a disease stems from a single clear-cut origin, such as genetic mutations that cause deadly sickle cell disease. “But very few diseases of aging have just one cause. It’s just not logical,” said Dr. Matthew Schrag, a neurologist at Vanderbilt University Medical Center. Working independently of his university, he discovered the 2006 research image manipulations.

. . .

“There is an entrenched echo chamber that involves a lot of big names,” Dr. Schrag said. “It’s time for the field to move on.”

For the full commentary see:

Charles Piller. “All the Alzheimer’s Research We Didn’t Do.” The New York Times (Friday, July 12, 2024): A25.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the commentary has the date July 7, 2024, and has the same title as the print version. Where there are a couple of small differences in wording, the passages quoted above follow the online version.)

Piller’s paper in Science, mentioned above, is:

Piller, Charles. “Blots on a Field?” Science 377, no. 6604 (July 2022): 358-63.

Piller’s commentary is related to his forthcoming book:

Piller, Charles. Doctored: Fraud, Arrogance, and Tragedy in the Quest to Cure Alzheimer’s. New York: Atria/One Signal Publishers, Forthcoming on February 4, 2025.

Pigeons Can Learn to Accurately Spot Cancerous Breast Cells

(p. C4) . . . researchers at the University of California, Davis, the University of Iowa and Emory University have demonstrated that pigeons are surprisingly good at detecting cancer as well. Using grain as a reward, the scientists managed to train hungry pigeons to reliably spot malignancies in images of human breast cells.

The birds achieved roughly 85% accuracy, which is probably better than beginning medical students, the scientists said, although it doesn’t approach the prowess of seasoned pathologists. On the other hand, the birds’ training only involved 24 slides at four times magnification (and they graduated debt-free). What’s more, when Edward A. Wasserman and his colleagues exploited the “wisdom of flocks” by combining the “votes” of four pigeons on each slide, the birds’ accuracy shot up to an astonishing 99%.

When confronted with mammograms, by contrast, the pigeons were flummoxed. After awhile, they seemed to learn to detect cancer on these images, but when shown new ones, they couldn’t do any better than chance, which implies that they had simply memorized the right calls on the initial images during repeated viewings. By contrast, birds that learned to pick out cancer from tissue samples could carry over their skills to new images.

Why so good with images of actual tissue yet so bad with mammograms? The former consist of breast cells seen under a microscope, while the latter are murkier images of overlapping elements (such as blood vessels) within the breast. Like physicians, pigeons find it easier to make the diagnosis by looking at cells, which is why biopsies are taken.

For the full commentary see:

Daniel Akst. “R&D; Pigeons That Spot Breast Cancer.” The Wall Street Journal (Saturday, Dec. 12, 2015 [sic]): C4.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Dec. 11, 2015 [sic], and has the title “R&D; The Pigeons That Can Spot Breast Cancer.”)

The research summarized in the passages quoted above, was published in the academic article:

Levenson, Richard M., Elizabeth A. Krupinski, Victor M. Navarro, and Edward A. Wasserman. “Pigeons (Columba Livia) as Trainable Observers of Pathology and Radiology Breast Cancer Images.” PLOS ONE 10, no. 11 (2015): e0141357.

Physicians Are Reluctant to Assign Their Patients to a Clinical Trial of a New Therapy That Might Replace the Therapy They Know and Practice

(p. D1) After learning he had early stage prostate cancer, Paul Kolnik knew he wanted that cancer destroyed immediately and with as little disruption as possible to his busy life as the New York City Ballet’s photographer.

So Mr. Kolnik, 65, chose a type of radiation treatment that is raising some eyebrows in the prostate cancer field. It is more intense than standard radiation and takes much less time — five sessions over two weeks instead of 40 sessions over about two months or 28 sessions over five to six weeks.

. . .

The National Cancer Institute has just agreed to fund a clinical trial that researchers hope will settle which treatment is better. It will randomly assign 538 men to have either a short course of five intense radiation sessions over two weeks or 28 treatments over five and a half weeks, comparing outcomes for quality of life as well as disease-free survival.

But it will be at least eight years before the answers are in. In the meantime, men and their doctors are left with uncertainty.

“Ideally, we want to show five treatments (p. D4) is better,” said Dr. Rodney J. Ellis, a radiation oncologist at Case Comprehensive Cancer Center in Cleveland and the principal investigator for the trial.

One reason for the dearth of data is that prostate cancer usually grows slowly, if at all, so it can take many years to see if a treatment saved lives. It is expensive and difficult to follow patients for such a long time, and the treatments given to the men often change over a decade, making doctors wonder if the results are relevant.

Also, researchers who have tried to conduct studies comparing treatments often failed because specialists were already convinced that the method they used was best and were reluctant to assign men to other treatments. Dr. Ian Thompson of the University of Texas Health Science Center in San Antonio, said he was involved with several clinical trials that withered for that reason.

. . .

The researchers on the new study think recruitment will not be a major problem because they are comparing different courses of radiation, rather than entirely different approaches — for example, surgical removal of the prostate versus implantation of radioactive seeds in the prostate. A study to investigate those two approaches closed because investigators were able to enroll only 20 patients, Dr. Thompson said.

. . .

A few years ago, Dr. Yu and his colleagues looked at Medicare data and reported that men who had more intense radiation therapy were more likely to have urinary problems after two years than those who had the longer-course therapy.

Dr. Yu noted that his study was not a randomized trial, the gold standard, but he said the results were not reassuring. Now, though, he is not so sure the intense therapy is worse.

“In my own experience, these men have done really well,” he said. “That tells us that techniques improved, or the medical claims we evaluated were not indicative of major toxicity, or the way we and others at high-volume centers deliver radiotherapy is different.”

The lack of solid data bothers Dr. Daniel W. Lin, chief of urologic oncology at the University of Washington. When men ask him about the shorter radiation course, he tells them, “It probably can work but it doesn’t have long-term results and it hasn’t been tested against standard radiation.”

At centers like Sloan Kettering, doctors are relying on their own experience.

Dr. Michael J. Zelefsky, a radiation oncologist who treated Mr. Kolnik there, said that several years ago, 90 percent of his patients had the standard course of treatment. Now 90 percent choose the shorter course. On the basis of Sloan Kettering’s experience with several hundred men who had the intense radiation therapy over the past three years, the treatment, he said, “is emerging as a very exciting form of therapy.”

For the full story see:

Gina Kolata. “Unproven Therapy Gains Ground.” The New York Times (Tuesday, March 21, 2017 [sic]): D1 & D4.

(Note: ellipses added.)

(Note: the online version of the story has the date March 20, 2017 [sic], and has the title “Popular Prostate Cancer Therapy Is Short, Intense and Unproven.”)