artdiamondblog.com – Page 2 – Art Diamond's web log

L.E.D. Pioneer Akasaki’s “Perseverance — Sheer Doggedness — Paid Off”

(p. B10) Isamu Akasaki, a Japanese physicist who helped develop blue light-emitting diodes, a breakthrough in the development of LEDs that earned him a Nobel Prize and transformed the way the world is illuminated, died on Thursday [April 1, 2021] in a hospital in Nagoya, Japan. He was 92.

. . .

Bob Johnstone, a technology journalist and the author of “L.E.D.: A History of the Future of Lighting” (2017), said in an email, “The prevailing opinion in the late 1980s was that, because of the number of flaws in the crystal structure of gallium nitride, it would never be possible to make light-emitting diodes from it, so why would you even try?”

Dr. Akasaki, he continued, “was willing to stick at what was almost universally recognized to be a lost cause, working away long after researchers at RCA and other U.S. pioneers of gallium nitride LED technology had given up.”

“Eventually,” Mr. Johnstone said, “his perseverance — sheer doggedness — paid off.”

. . .

Dr. Akasaki was awarded hundreds of patents for his research over the years, and the royalties from his groundbreaking work with Dr. Amano eventually funded the building of a new research institute, the Nagoya University Akasaki Institute, completed in 2006.

. . .

When asked in a 2016 interview with the Electrochemical Society to summarize the philosophy guiding his many years of single-minded research, Dr. Akasaki replied, “No pain, no gain.”

“I say this to younger people: Experience is the best teacher,” he continued. “That is, sometimes there is no royal road to learning.”

For the full obituary see:

Scott Veale. “Isamu Akasaki, 92, Nobel Laureate Whose LED Breakthrough Rippled Around the World.” The New York Times (Wednesday, April 7, 2021 [sic]): B10.

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

(Note: the online version of the obituary has the date April 6, 2021 [sic], and has the title “Isamu Akasaki, 92, Dies; Nobel Winner Lit Up the World With LEDs.”)

The book by Bob Johnstone mentioned above is:

Johnstone, Bob. L.E.D.: A History of the Future of Lighting. Scotts Valley, CA: CreateSpace Independent Publishing Platform, 2017.

600,000 Americans Projected to Die of Cancer in 2025

Progress has been made against some specific cancers for some specific people. But overall there’s still a lot of cancer to be cured.

(p. A1) More Americans are surviving cancer, but the disease is striking young and middle-aged adults and women more frequently, the American Cancer Society reported on Thursday [Jan. 16, 2025].

. . .

Cancer is the second leading cause of death in the United States, but the leading cause among Americans under 85. The new report projects that some 2,041,910 new cases will occur this year and that 618,120 Americans will die of the disease.

Six of the 10 most common cancers are on the rise, including cancers of the breast and the uterus. Also increasing are colorectal cancers among people under 65, as well as prostate cancer, melanoma and pancreatic cancer.

For the full story see:

Roni Caryn Rabin. “Cancer Striking Younger Women.” The New York Times (Friday, January 19, 2025): A1 & A18.

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

(Note: the online version of the story was updated Jan. 17, 2025, and has the title “Cancer’s New Face: Younger and Female.”)

The academic article that is the basis for the summary statistics quoted above is:

Siegel, Rebecca L., Tyler B. Kratzer, Angela N. Giaquinto, Hyuna Sung, and Ahmedin Jemal. “Cancer Statistics, 2025.” CA: A Cancer Journal for Clinicians 75, no. 1 (Jan./Feb. 2025): 10-45.

Some of the key statistics from the academic article appear in:

American Cancer Society. “Cancer Facts & Figures 2025.” Atlanta: American Cancer Society, 2025.

Amar Bhidé on Uncertainty

I have not read the latest book by Amar Bhidé, briefly discussed in the passages quoted below, but I have assigned a couple of his earlier books in my Economics of Entrepreneurship and Economics of Technology seminars. Bhidé asks important questions and I like his empirically rich and methodologically pluralist approach to answering them.

(p. R2) “Uncertainty and Enterprise: Venturing Beyond the Known” is a must-read for anyone seeking a roadmap to the bewildering array of new technologies exploding today. Written with considerable charm by the distinguished economist and scholar Amar Bhidé— . . . —the book makes a compelling case that hard facts alone cannot prove or predict whether a new political movement, business idea, technology or TV series will succeed. The author offers a fascinating array of stories, examples and ideas of great thinkers— . . . —rather than relying solely on math or statistics. This book provides a new way of looking not only at risk but, more importantly, at uncertainty in an unpredictable world.

For the full review, see:

Elaine Chao. “12 Months of Reading: Elaine Chao.” The Wall Street Journal (Saturday, December 7, 2024): R2.

(Note: ellipses added.)

(Note: the online version of the review was updated Dec. 6, 2024, and has the title “Who Read What in 2024: Political Voices: Elaine Chao.”)

The book praised by Chao is:

Bhidé, Amar. Uncertainty and Enterprise: Venturing Beyond the Known. New York: Oxford University Press, 2024.

Keep Raging at “the Dying of the Light”

I still remember as an undergraduate at Wabash College reading in our intro psychology textbook of an experiment in which a dog was put in a box. Every time the dog tried to leap out of the box, he received an electric shock. Eventually the electric current was turned off. But the dog never again tried to leap. Are we like the dog, too discouraged by past constraints, so that we are resigned to accept the Biblical limit of “three score and 10” (Psalm 90:10)?

But there is a paradox. Kloc cites an article claiming a very high market value for expanded lifespans. But then where are the voters urgently demanding that medical entrepreneurs be unbound? Where are the citizens demanding that regulators stop mandating Phase 3 clinical trials? Citizens with a sense of urgency can make a difference–see the Act-Up movement in the early years of AIDs. When will they?

(p. 1) The longevity industry is coming off perhaps its best run on record. The expected span of an American life has increased by about three decades since 1900 — to around 78 as of 2023. But for many people, even 78 years just won’t do.

The Methuselah Foundation, a biomedical charity, for example, wants to “make 90 the new 50,” and scientists at one biotechnology firm have argued that, unencumbered by disease, the body could potentially make it all the way to age 150. Even more optimistic estimates put the number closer to 1,000.

Whatever the maximum human life span may be, people appear increasingly determined to find it — in particular men, who are more inclined to favor radically extending life, maybe even indefinitely. Last year, nearly 6,000 studies of longevity made their way onto PubMed, a database of biomedical and life sciences papers; that’s almost five times as many as two decades ago.

Along with the creation of dozens of popular podcasts and a sizable supplement industry, that zeal has led to efforts to preserve organs, search out life-extending diets and even try to reverse aging itself.

. . .

(p. 24) Researchers at Harvard and Oxford recently tried to gauge that interest in the marketplace today. They estimated that the total value of any scientific breakthrough that added another decade to global life expectancy would be worth $367 trillion.

For the full story see:

Joe Kloc. “Gilgamesh, Ponce and the Quest to Live Forever.” The New York Times, First Section (Sunday, January 19, 2025): 1 & 24.

(Note: ellipsis added.)

(Note: the online version of the story has the date Jan. 18, 2025, and has the title “The Centuries-Old, Incredibly Male Quest to Live Forever.”)

When Kloc mentions estimates of possible human lifespan “closer to 1,000” he links to a Scientific American interview with João Pedro de Magalhães, professor of biogerontology at England’s University of Birmingham. João Pedro de Magalhães believes that in principle humans could live to 1,000:

Gifford, Bill. “How Old Can Humans Get?” Scientific American (July 31, 2023). Available from https://www.scientificamerican.com/article/how-old-can-humans-get/.

When Kloc says that some “even try to reverse aging itself” he links to:

Poganik, Jesse R., Bohan Zhang, Gurpreet S. Baht, Alexander Tyshkovskiy, Amy Deik, Csaba Kerepesi, Sun Hee Yim, Ake T. Lu, Amin Haghani, Tong Gong, Anna M. Hedman, Ellika Andolf, Göran Pershagen, Catarina Almqvist, Clary B. Clish, Steve Horvath, James P. White, and Vadim N. Gladyshev. “Biological Age Is Increased by Stress and Restored Upon Recovery.” Cell Metabolism 35, no. 5 (2023): 807-20.

Kloc also links to estimates of the economic value of extending lifespans by one year, and by a decade, as given in:

Scott, Andrew J., Martin Ellison, and David A. Sinclair. “The Economic Value of Targeting Aging.” Nature Aging 1, no. 7 (July 2021): 616-23.

“Rage, rage against the dying of the light” is a line from Dylan Thomas’s poem “Do Not Go Gentle Into That Good Night.”

For Quicker Cures, Do Not Cancel Those Who See What We Do Not See

Dogs smell odors that we do not smell. They say Eskimos can distinguish 40 or more kinds of snow. Physical differences in biology and differences in past experiences allow some people to perceive what other people miss. We should encourage, not cancel, those who see differently. They can communicate and act on what they see, giving us more cures more quickly.

In the passages quoted below, a case is made that Pasteur’s artistic experiences allowed him to see a structural difference (chirality) in crystals; a difference that turns out to matter for medical drug molecules.

(p. D5) In a paper published last month in Nature Chemistry, Dr. Gal explains how a young Pasteur fought against the odds to articulate the existence of chirality, or the way that some molecules exist in mirror-image forms capable of producing very different effects. Today we see chirality’s effects in light, in chemistry and in the body — even in the drugs we take.

And we might not know a thing about them if it weren’t for the little-known artistic experience of Louis Pasteur, says Dr. Gal.

. . .

As a teenager, Pasteur made portraits of his friends, family and dignitaries. But after his father urged him to pursue a more serious profession — one that would feed him — he became a scientist. At the age of 24 he discovered chirality.

To understand chirality, consider two objects held up before a mirror: a white cue ball from a pool table and your hand. The reflection of the ball is exactly like the original. If you could reach into that mirror, pull out the reflection and cram it inside the original, they’d match up point for point. But if you tried the same thing with your hand, no matter how much you tried, the mirror image would never fit into the original.

At the molecular level some objects are like cue balls, and they are always superimposable. But other things are like hands, and they can never be combined.

. . .

During winemaking, a chemical called tartaric acid builds up on vat walls. In the 18th and 19th centuries, makers of medicine and dyes used this acid.

In 1819, factory workers boiled wine too long and accidentally produced paratartaric acid, which had unique properties that intrigued scientists like Pasteur.

. . .

When studying the paratartaric acid, Pasteur found that it produced two kinds of crystals — one like those found in tartaric acid and another that was the mirror opposite. The crystals were handed, or what the Greeks call chiral (kheir) for hand.

. . .

“Several famous or much more accomplished scientists, some well along their illustrious careers, studied the same molecules, the same substances,” said Dr. Gal. “Realistically you would think they’d have beaten him to the punch, and yet they missed it.”

So why did this young, inexperienced chemist get it right?

Dr. Gal thinks the answer might lie in the artistic passions of Pasteur’s youth. Even as a scientist, Pasteur remained closely connected to art. He taught classes on how chemistry could be used in fine art and attended salons. He even carried around a notebook, jotting down 1-4 ratings of artwork he visited.

And then Dr. Gal stumbled upon a letter Pasteur had written to his parents about a lithographic portrait he had made of a friend.

Lithography back then involved etching a drawing onto a limestone slab with wax or oil and acid, and pressing a white piece of paper on top of it. The resulting picture was transposed, like a mirror image of the drawing left on the slab.

In his letter, Pasteur wrote:

“I think I have not previously produced anything as well drawn and having as good a resemblance. All who have seen it find it striking. But I greatly fear one thing, that is, that on the paper the portrait will not be as good as on the stone; this is what always happens.”

Eureka. “Isn’t this the explanation of how he saw the handedness on the crystals — because he was sensitized to that as an artist?” Dr. Gal proposed.

. . .

We now know that many drugs contain molecules that exist in two chiral forms, and that the two forms can react differently in the body. The most tragic example occurred in the 1950s and ’60s, when doctors prescribed Thalidomide, a drug for morning sickness and other ailments, to pregnant women. The drug also contained a chiral molecule that caused disastrous side effects in many babies.

For the full story see:

Joanna Klein. “How Pasteur’s Artistic Insight Changed Chemistry.” The New York Times (Tuesday, June 20, 2017 [sic]): D5.

(Note: ellipses added.)

(Note: the online version of the story has the date June 14, 2017 [sic], and has the same title as the print version.)

The academic article in Nature Chemistry authored by Gal and mentioned above is:

Gal, Joseph. “Pasteur and the Art of Chirality.” Nature Chemistry 9, no. 7 (2017): 604-05.

Ozempic 25 Years Sooner Would Have Saved and Improved Many Lives

Apparently Ozempic had been discovered in the late 1980s and could have been on the market roughly 25 years ago. Pfizer decided that the likely potential revenues were not sufficient to justify the huge costs. But what if the costs had not been so huge? For instance what if we adopted the proposal suggested by Milton Friedman, and advocated by me, to stop mandating hyper-expensive Phase 3 clinical trials to prove efficacy? (The mandates to prove safety through Phase 1 and Phase 2 trials would be retained.) With lower costs, Pfizer might have moved forward. Or if Pfizer had not, some other firm probably would have entered the breach sooner. If Ozempic had been available sooner, by now it would be much cheaper. Many lives would have been saved that have been lost. Other lives would have been healthier and happier.

(p. A26) They called 2023 the year of Ozempic, but it now seems GLP-1 drugs might define an entire decade — or an even longer era. The game-changing drugs, which mimic the hormone GLP-1, offer large benefits for not just diabetes management and especially weight loss but also, apparently, heart and kidney and liver disease, Alzheimer’s and dementia, Parkinson’s and addiction of all kinds. And perhaps because of widespread use of the drugs, the obesity epidemic in America may finally and mercifully be reversing.

But of all the things we learned this year about GLP-1s, the most astonishing could be that the revolution might have started decades earlier. Researchers identified the key breakthrough for GLP-1 drugs nearly 40 years ago, it turns out, long before most Americans had even heard the phrase “obesity epidemic.”

This summer, a former dean of Harvard Medical School, Jeffrey Flier, published a long personal reflection that doubled as an alternate history of what may well be the most spectacular and impactful medical breakthrough of the century so far. In 1987, Flier co-founded a biotech start-up that pursued GLP-1 as a potential treatment for diabetes, not long after it had first been identified by researchers who’d also found that the hormone enhanced insulin secretion in the presence of glucose.

The startup obtained worldwide rights to develop GLP-1 as a metabolic therapy from a group of those researchers, based at Massachusetts General Hospital. They even generated clinical results that suggested it might have promise as a weight-loss drug as well — only to have Pfizer, which had agreed to fund the research, withdraw its support, without providing the researchers with an especially satisfying explanation. Instead, Pfizer told Flier and his partners that the company didn’t believe there would be a market for another injectable diabetes treatment after insulin. Well, Flier tells me, “they were wrong.”

. . .

. . . Flier’s memoir is not just a lament for what might have been. In the aftermath of the pandemic emergency, as citizens and officials alike have embraced a more libertarian attitude toward public health, there’s been a similar drift in the public conversation about drug discovery and development. Operation Warp Speed is often held up as a new model — calls for an Operation Warp Speed 2.0 have been followed by those for an Operation Warp Speed for everything — . . .

Many of the same reformers will complain about all the red tape at the F.D.A. and C.D.C., tallying up huge mortality costs imposed by slow-moving government, arguing for human challenge trials in which individuals volunteer to take untested drugs and be deliberately infected and even talking about the invisible graveyard of unnecessary regulation and delay.

This is all fine and good — there are surely lots of things those agencies can speed up. And in recent years, reformers of various stripes have lobbied some worthy additional proposals into the biomedical zeitgeist — for a system based not on patents but on huge and direct cash prizes for medical breakthroughs, for instance, or one helped along by advance market commitments or benevolent patent extensions. Just last week the researchers Willy Chertman and Ruxandra Tesloianu published “The Case for Clinical Trial Abundance,” an invigorating manifesto for drug development reform.

. . . in focusing on government bureaucracy as the major biomedical bottleneck, we are seeing just one piece of the picture and overlooking what is perhaps the central challenge of research and development — that it is, at present, so complicated that difficulties or bad decisions at any stage can stifle the whole decades-long process, distorting the actual medical and public-health functions of drug development in countless ways.

For the full commentary see:

David Wallace-Wells. “We Could Have Had Ozempic Years Ago.” The New York Times, SundayOpinion Section (Sunday, Jan. 5, 2025): 11.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Dec. 25, 2024, and has the title “Pfizer Stopped Us From Getting Ozempic Decades Ago.”)

Dr. Flier’s published “memoir” mentioned above is:

Flier, Jeffrey S. “Drug Development Failure: How GLP-1 Development Was Abandoned in 1990.” Perspectives in Biology and Medicine 67, no. 3 (Summer 2024): 325-36.

“The Clinical Trial Manifesto” mentioned above is the introductory essay in the compilation referenced below. Another essay that looks promising in the compilation is “Unblocking Human Challenge Trials for Faster Progress.”

Chertman, Willy, and Ruxandra Tesloianu, eds. The Case for Clinical Trial Abundance: A Series of Short Papers Outlining Reform Possibilities for Our Nation’s Clinical Trials. Washington, DC: The Institute for Progress (IFP), 2024.

Reductio ad Absurdum: When a Functional MRI Showed Activity in a Dead Salmon’s Brain

I have long thought that most college students would benefit from a course in practical reasoning. One topic in such a course would be to define and illustrate the Reductio ad Absurdum argument. The argument starts with a proposition, and then infers an absurdity from the proposition, thereby refuting the original proposition. The review quoted below mentions such an argument that implicitly starts with the proposition that fMRI scans are reliable guides to human thought. The absurdity is that fMRI scans sometimes light up in the presence of a dead Atlantic salmon, which would seem to suggest that the salmon is thinking. The conclusion: be careful what you infer from fMRI scans.

My favorite reductio ad absurdum argument starts with the proposition that all actionable knowledge must derive from randomized double-blind clinical trials (RCTs). The argument then shows that no RCTs have been performed to show the efficacy of parachutes. The absurdity is that before anyone uses a parachute when exiting a flying airplane, he must first find an RCT to prove the efficacy of parachutes. The conclusion: when you volunteer for the first such RCT, hope that you are not assigned to the control group!

(p. A15) In 2009 a group of researchers placed a dead salmon in a functional magnetic resonance imaging (fMRI) scanner and showed the fish some photos of people in social situations. Their results, presented under the title “Neural Correlates of Interspecies Perspective Taking in the Post-Mortem Atlantic Salmon,” were surprising. The scans revealed a red spot of activity centered in the salmon’s brain.

The authors of the study weren’t trying to pull a fast one on the scientific community. Nor did they believe in zombie fish. They were showing that statistics, used incorrectly, can demonstrate almost anything. Specifically, a certain type of data analysis, often used on fMRI scans, can find signal where there should be only noise.

Russell Poldrack, a psychologist at Stanford University, mentions the stunt in “The New Mind Readers: What Neuroimaging Can and Cannot Reveal About Our Thoughts.” His book, ostensibly about fMRI and its use in studying how the brain functions (hence “functional”), serves as a lesson in how the science works—or should work. Through blunders and baloney, innovation and self-correction, the young field of cognitive neuroscience is quickly evolving.

For the full review see:

Matthew Hutson. “Bookshelf; Scanning For Thoughts.” The Wall Street Journal (Wednesday, November 28, 2018 [sic]): A15.

(Note: the online version of the review has the date November 27, 2018 [sic], and has the title “Bookshelf; ‘The New Mind Readers’ Review: Scanning for Thoughts.”)

The book under review is:

Poldrack, Russell. The New Mind Readers: What Neuroimaging Can and Cannot Reveal About Our Thoughts. Princeton, NJ: Princeton University Press, 2018.

The parachute reductio argument is in:

Smith, Gordon C. S., and Jill P. Pell. “Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systematic Review of Randomised Controlled Trials.” BMJ 327, no. 7429 (Dec. 18, 2003): 1459-61.

To Kill a Dam, Environmentalist “Scientists” Lied About the Existence of the So-Called “Snail Darter”

In the 1970s the building of a dam in Tennessee was delayed because environmentalists claimed that its construction would threaten the extinction of a small fish they called the “snail darter.” Now fish biologists have established that there is no snail darter. The fish previously identified as a “snail darter” has the DNA of a small fish called a “stargazing darter” which was not, and is not, endangered.

A co-author of a new study says that this was no innocent mistake.

Dr. Near, . . . a professor who leads a fish biology lab at Yale, and his colleagues report in the journal Current Biology that the snail darter, Percina tanasi, is neither a distinct species nor a subspecies. Rather, it is an eastern population of Percina uranidea, known also as the stargazing darter, which is not considered endangered.

Dr. Near contends that early researchers “squinted their eyes a bit” when describing the fish, because it represented a way to fight the Tennessee Valley Authority’s plan to build the Tellico Dam on the Little Tennessee River, about 20 miles southwest of Knoxville.

“I feel it was the first and probably the most famous example of what I would call the ‘conservation species concept,’ where people are going to decide a species should be distinct because it will have a downstream conservation implication,” Dr. Near said.

In other words environmentalist “scientists” deliberately lied in order to promote their political agenda of cutting energy production.

The New York Times article quoted above is:

Jason Nark. “How a Mistaken Identity Halted a Dam’s Construction.” The New York Times (Sat., Jan. 4, 2025): A13.

(Note: ellipsis added.)

(Note: the online version of The New York Times article was updated Jan. 4, 2025, and has the title “This Tiny Fish’s Mistaken Identity Halted a Dam’s Construction.”)

The academic paper co-authored by Near, that Nark summarizes in The New York Times article mentioned and cited above is:

Ghezelayagh, Ava, Jeffrey W. Simmons, Julia E. Wood, Tsunemi Yamashita, Matthew R. Thomas, Rebecca E. Blanton, Oliver D. Orr, Daniel J. MacGuigan, Daemin Kim, Edgar Benavides, Benjamin P. Keck, Richard C. Harrington, and Thomas J. Near. “Comparative Species Delimitation of a Biological Conservation Icon.” Current Biology. Published online on Jan. 3, 2025.

In 2023, Costs of Medical Care Rose 40% Faster Than Overall Inflation

If rising healthcare costs were clearly due to improving health outcomes, few would be angry. The anger arises from rising fraud, inefficiency, and inertia. Many healthcare workers are paper pushers and the paper pushed is often inaccurate and opaque. Other healthcare workers enforce protocols that slow innovation. And of course mandated regulations, most notably Phase 3 clinical trials, enormously increase costs.

(p. A3) The killing of a health insurance executive in New York City prompted a furious outpouring of anger over the industry and healthcare prices. So just how much have healthcare costs and spending been going up?

The short answer: a lot. National healthcare spending increased 7.5% year over year in 2023 to $4.867 trillion, or $14,570 per person, according to data released Wednesday by the Centers for Medicare and Medicaid Services.

. . .

The 7.5% rise represented a much faster pace of growth than the 4.6% increase in 2022.

. . .

Over the past couple of decades, the price index for what the Labor Department classifies as medical care—which includes visits to doctors, hospital stays, prescription drugs and medical equipment—has risen roughly 40% faster than the overall pace of inflation. Healthcare tends to rise more quickly than overall inflation because of high labor costs in the sector, as well as advancements leading to new and more expensive drugs and treatments. Demand for healthcare is also increasing as the population ages.

. . .

Hospitals are . . . adding billions of dollars in “facility fees” to medical bills for routine care at outpatient centers, according to reporting by The Wall Street Journal. That means patients are often paying hundreds of additional dollars for standard care like colonoscopies, mammograms and heart screenings.

. . .

Employers are shouldering a lot of those costs. For example, the average worker spent $6,296 in premiums for family coverage in 2024, according to KFF [a healthcare nonprofit]. Employers spent $19,276.

But when a company is paying more for insurance premiums for its workers, that leaves it with less money for giving out raises or reinvesting and expansion.

“It’s ultimately all of us who pay for [healthcare] either in the form of lower wages for people who have employer insurance or in the form of higher taxes to cover Medicare and Medicaid,” said Katherine Baicker, professor of health economics at the University of Chicago.

For the full story see:

Harriet Torry. “Nation’s Healthcare Tab Is Surging Amid Rising Wages, Hospital Fees.” The Wall Street Journal (Friday, Dec. 20, 2024): A3.

(Note: ellipses added. The first bracketed words were added by me; the second bracketed word was in the original.)

(Note: the online version of the story was updated December 18, 2024, and has the title “Why Are Americans Paying So Much More for Healthcare Than They Used To?” Where there is a slight difference in wording between the print and online versions, the passages I quote above follow the online version.)

The source for some of the data discussed in The New York Times article appears to have been:

“National Health Expenditures 2023 Highlights.” Centers for Medicare & Medicaid Services (CMS), Last modified on Dec. 18, 2024.

Higher Fluoride in Water Correlated with Lower I.Q. in Children

When I was young, in the 1960s, I remember my family opposing the government fluoridation of the South Bend, Indiana water supply, even though our dentist, Dr. Stan Severyn, who we liked and respected, was in favor of fluoridating South Bend water. We thought that when consumed in water, fluoride was a cumulative poison, and we thought the dental benefits of fluoride could be obtained through applying fluoride directly to the teeth (as Dr. Severyn did to my teeth) or through the careful use of fluoridated toothpaste.

My memory is that the South Bend city council overwhelmingly approved adding fluoride to the city waster. My family was in a small minority and our views were widely dismissed. But small minorities are not always wrong. See The New York Times article quoted below. Or see the history of medicine more broadly, for instance when Ignaz Semmelweis was in a small minority suggesting that physicians returning from dissections in the morgue should wash their hands before delivering babies.

When our daughter Jenny was very young, I read that very young children often accidentally swallow toothpaste when they start brushing their own teeth. Then, as now, almost all toothpaste contained fluoride. So when Jenny reached the age of brushing I searched the shelves of several Omaha stores seeking non-fluoridated toothpaste. I finally found a couple of tubes, imported from Sweden I think, in a now defunct store called The Drug Emporium. Jenny used that toothpaste until she was old enough to reliably spit out the toothpaste after brushing.

[In the passages quoted below, “JAMA” stands for The Journal of the American Medical Association which, along with The New England Journal of Medicine and The Lancet, is widely considered to be one of the handful of top medical journals in the world. JAMA Pediatrics is one of several JAMA-associated field journals.]

(p. 19) Water fluoridation is widely seen as one of the great public health achievements of the 20th century, credited with substantially reducing tooth decay. But there has been growing controversy among scientists about whether fluoride may be linked to lower I.Q. scores in children.

A comprehensive federal analysis of scores of previous studies, published this week in JAMA Pediatrics, has added to those concerns. It found a significant inverse relationship between exposure levels and cognitive function in children.

Higher fluoride exposures were linked to lower I.Q. scores, concluded researchers working for the National Institute of Environmental Health Sciences.

. . .

The subject is so divisive that JAMA Pediatrics commissioned two editorials with opposing viewpoints to publish alongside the report.

In one, Dr. Steven M. Levy, a public health dentist at the University of Iowa, said that many of the studies included in the analysis were of very low quality.

. . .

In a second editorial published alongside the new study, a public health expert, Dr. Bruce P. Lanphear, noted that as far back as 1944, the editor of The Journal of the American Dental Association expressed concern about adding fluoride, which he termed “a highly toxic substance,” to drinking water. He wrote that “the potentialities for harm far outweigh those for good.”

Some studies have suggested that dental health has improved not because fluoride was added to water, but because of fluoridated toothpastes and better dental hygiene practices.

. . .

Some 74 studies from 10 countries, including China, Mexico, Canada, India and Denmark, were examined. Dr. Lanphear noted that the consistent links between fluoride and I.Q. were found in very different populations.

He urged the U.S. Public Health Service to set up a committee, perhaps one that does not include researchers who have studied the subject in the past and can take a fresh look at the topic, to examine two questions seriously: whether fluoride is neurotoxic, and whether it is as beneficial for oral health as it is believed to be.

“If that doesn’t happen urgently, my concern is there will be growing distrust of public health agencies amid the public, and they will have deserved it,” he said.

For the full story, see:

Roni Caryn Rabin. “High Fluoride Exposure Is Linked to Lower I.Q. In Children, Study Finds.” The New York Times, First Section (Sunday, January 12, 2025): 19.

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

(Note: the online version of the story has the date January 8, 2025, and has the title “Study Links High Fluoride Exposure to Lower I.Q. in Children.”)

The JAMA Pediatrics academic article mentioned above is:

Taylor, Kyla W., Sorina E. Eftim, Christopher A. Sibrizzi, Robyn B. Blain, Kristen Magnuson, Pamela A. Hartman, Andrew A. Rooney, and John R. Bucher. “Fluoride Exposure and Children’s IQ Scores: A Systematic Review and Meta-Analysis.” JAMA Pediatrics (published online on Jan. 6, 2025).

During the Covid Pandemic, “Public Health Officials Could Not Be Trusted to Tell the Whole Truth”

From the review quoted below, Rivers’s book is refreshingly open about the downsides of public health actions against epidemics. But in the end, I infer that Rivers still gives pride of place to public health actions in fighting epidemics. She wants public health actions to be reformed but believes that public health officials will be and should be the dominant actors during epidemics. I, to the contrary, believe that innovative medical entrepreneurs will be and should be the dominant actors. I believe that partly because medical entrepreneurship respects human liberty, while public health official commands do not respect human liberty, but also partly because medical entrepreneurship is more effective at ending epidemics.

(p. A15) As recently as 2019, confides Caitlin Rivers, an epidemiologist at Johns Hopkins, “I was confident that we knew how to navigate, if not control, a pandemic.” But within a year “that hubris was laid bare.” Covid-19 “overran us,” leaving in its wake a striking loss of confidence in public health.

“Crisis Averted” is Ms. Rivers’s ambitious and, given its charge, surprisingly successful attempt to reset our relationship with the field of public health. With a judicious blend of candor, hopefulness and pragmatism, she calls out its mistakes, reminds us of its historic accomplishments and emphasizes the need for the discipline to adjust its strategies if its full promise is to be realized.

. . .

. . . for every public-health triumph there are heartbreaking disappointments. In 2010, a lack of clean water and adequate sanitation allowed a cholera epidemic to rampage through Haiti after a catastrophic earthquake; worse, the disease, not endemic in the region, arrived through foreign aid workers. Human error was also responsible for the last recorded smallpox fatality, a medical photographer in the U.K. who died after the virus leaked from a sloppy lab on the floor below.

. . .

Animating much of Ms. Rivers’s narrative and analysis is the Covid-19 pandemic, a crisis that, as she laments, wasn’t averted. . . . She . . . describes early advice from public-health officials claiming that mask use was “not recommended” and “should be avoided” as “odd and brittle assertions that did not hold up to the slightest scrutiny” and left many with the impression that “public health officials could not be trusted to tell the whole truth.”

. . .

After years of relentless insistence that we “follow the science,” it’s refreshing to hear an expert illuminate all that remains unknown—from the vagaries of the common cold to the vexing challenge of coaxing healthy behavior change. Most epidemics of the past century, Ms. Rivers points out, “took forms that were slightly off-center from what epidemiologists expected”—the recent pandemic, for example, was caused not by an influenza virus, as anticipated, but rather by a coronavirus. Her advice: Expect a surprise.

For the full review see:

Shaywitz, David A. “Bookshelf; What the Doctors Ordered.” The Wall Street Journal (Wednesday, Oct. 2, 2024): A15.

(Note: ellipses added.)

(Note: the online version of the review has the date October 1, 2024, and has the title “Bookshelf; ‘Crisis Averted’ Review: What the Doctors Ordered.”)

The book under review is:

Rivers, Caitlin. Crisis Averted: The Hidden Science of Fighting Outbreaks. New York: Viking, 2024.