Despite robust efforts to fight it, malaria remains one of the most significant infectious diseases affecting humans. According to UNICEF – ” In 2021, there were 247 million malaria cases globally that led to 619,000 deaths in total. Of these deaths, 77 per cent were children under 5 years of age.” Efforts to minimize malaria cost about $7 billion per year, through vaccination, drug therapy, and spraying pesticides to kill the mosquitos that carry the disease. Mosquito populations are developing resistance to the pesticides, however, which could raise the costs of control, while available funds can fluctuate.

One potential solution is using genetic engineering to fight malaria, and there are several approaches being developed that are close to being ready for deployment. They all use an approach known as a gene drive, which causes a desired trait to spread more quickly through a population than regular Mendelian genetics would allow. This idea is actually 60 years old, but newer techniques, such as CRISPR, are making it much easier and more powerful.

With sexual reproduction, each offspring has two sets of chromosomes, one from each parent. So organisms have two copies of each gene (each copy is called an allele). They then pass one of their two copies onto each offspring. Mendelian genetics assumes that there is a 50% chance for each allele to be inherited, and this is mostly true. The gene drive phenomenon refers to situations in which one allele has an advantage over the other, so it is more likely to be inherited. There are naturally occurring gene drives, but we’re going to focus on the latest synthetic gene drive, which involves CRISPR.

Continue Reading »

This is one of those technologies that most people probably never think about, but could potentially have a significant impact on our lives – timed drug release. The concept is nothing new, but there is a lot of room for improvement on current technologies. We already have time-release capsules, patches, and some drugs that can have long term effects with one dose, like Depo Provera. But for most drugs, you have to dose them every day at least.

Only about  50% of people take their medication correctly, without missing doses. This has huge consequences, resulting in, “100,000 deaths, as much as 25% of hospitalizations, and a healthcare cost exceeding $100 billion” in the US alone. Right now we primarily deal with this problem through patient education and using drugs, when possible, that have longer dosing times. Sometimes we also monitor patient compliance with blood tests. There is also occasionally talk of developing a medicine bottle that monitors compliance (going back to at least 1989), but such technologies are not in widespread use.

There is therefore a lot of benefit that could potentially result from developing a drug delivery platform that can deliver a consistent dose of medication over weeks or even months. Imagine getting a shot every three months (perhaps even self-administered at home) rather than taking a pill every day. Researchers have recently published one potential such technology, they are calling PULSED – Particles Uniformly Liquified and Sealed to Encapsulate Drugs. Continue Reading »

As many experts predicted, the COVID-19 pandemic is slowly sliding into an endemic infection. A pandemic is essentially when an epidemic goes worldwide. Endemic means that an infection is here to stay. It is no longer considered an “outbreak” but is constantly spreading around a population without having to be introduced. The flu, for example, is endemic, although it is also seasonal. Measles was endemic in the US, but then was eliminated through vaccination and was reduced to isolated outbreaks. However, it is transitioning to being endemic again because of vaccine hesitancy.

While we are all anxious for the COVID-19 pandemic to be over, I don’t remember any expert claiming that the virus would go away, or be eliminated to any significant degree. Rather, it would simply become like the flu, an endemic simmering infection that becomes part of the background. The only question has been – what is the best path to transition from pandemic to endemic? Some argued that perhaps the best path was to simply let the pandemic run its course, and create immunity through natural infection. This has always been an unscientific and dangerous suggestion, because that path leads through a maximum of disease and death.

The evidence clearly shows that the best path to minimizing COVID while ending its pandemic status was through a combination of vaccination and infection. We have no choice about the infection part because there is no plausible way to reduce it to zero (as China discovered). But we do want to reduce the spread of COVID, especially to vulnerable populations, while reducing the risk of serious illness, hospitalization and death through vaccination. Pandemics always eventually burn themselves out, even in the pre-vaccination era, but we don’t want that to happen from a plague-level decimation.

Evidence has been building that the best immunity from COVID is through hybrid immunity – a combination of vaccination and breakthrough infection. I managed to go two years without getting COVID, for example, but eventually succumbed once mask-wearing no longer became commonplace. However, by that time I had been fully vaccinated and boosted, so when I did get COVID it was indistinguishable from a fairly mild cold. If there weren’t a pandemic (and I didn’t test positive) I would have just thought I had a summer cold. Hybrid immunity works either way, whether you were infected then vaccinated, or vaccinated and then contracted COVID (the preferred order).  Continue Reading »

Happy New Year to all my readers.

Early in each new year I like to see what the preliminary reports are for the climate over the past year. Final number crunching won’t be available for months, and it may take more than a year for the final tweaks to be reported and reviewed. But we do have a preliminary estimate of the temperature over the last year. The World Meteorological Organization reports:

The global average temperature in 2022 is estimated to be about 1.15 [1.02 to 1.28] °C above the 1850-1900 average. 2015 to 2022 are likely to be the eight warmest years on record. La Niña conditions have dominated since late 2020 and are expected to continue until the end of 2022. Continuing La Niña has kept global temperatures relatively «low» for the past two years – albeit higher than the last significant La Niña in 2011.

It looks like 2022 will be the fourth hottest year on record globally. Some specific locations had their warmest year, such as the UK and Spain (and perhaps most of Europe). As the WMO points out, we are in the middle of a La Niña cycle, which brings cooler temperatures globally. That is a short term fluctuation on the longer term trend. This also means that as we shift into an El Niño cycle we are likely to break new records.

I feel compelled to point all this out (as I am sure many scientists and science communicator will) because it is a critically important piece of information. But I also want to put it into a broader long term context. I have been engaged in skeptical activism now for 27 years, and followed many skeptical topics for longer than that. There is one extremely important pattern that emerges when you cover a topic for a long time – scientifically valid concepts tend to not only accumulate evidence but the evidence gets better and builds on itself. Meanwhile, pseudosciences do not display this pattern. They tend to go around in circles with low quality evidence. You can see this pattern across multiple disciplines.

Continue Reading »

What are the known factors that increase the risk of getting cancer? Most people know about smoking, but can probably only guess at other factors, and are likely to endorse things that do not contribute to cancer risk. The known contributors to cancer risk include: smoking, consuming alcohol, low levels of physical activity, getting sunburnt as a child, family history of cancer, HPV infection, and being overweight. But there are also a number of “mythic” causes that do not contribute to cancer risk but are widely believed to: artificial sweeteners or additives and genetically modified food; using microwave ovens, aerosol containers, mobile phones, and cleaning products; living near power lines and feeling stressed.

These are all lifestyle factors that people can influence by changing their behavior. Therefore there is a direct utility to informing the public about the true causes of cancer and identifying the factors that they should not worry about. I see the effects of misinformation and poor communication on a regular basis. Often my patients will express to me that they are highly motivated to get healthier by changing their lifestyle, and then they rattle off a list of things they are doing, most of which are useless or counterproductive. Forget all that – just stop smoking and let’s talk about a healthy and practical exercise routine for you.

A recent study seeks to shed light on why there is so much misinformation about the modifiable causes of cancer. This is a complex question, and any one study is only going to look at a tiny slice of potential contributing factors. Also, this is the type of question that is hard to look at in a controlled experiment, so we will have to make due with observational data that can have a lot of confounding factors. The authors did a survey of several English and Spanish language forums, assessing knowledge of true and mythic causes of cancer, and correlating them with belief in conspiracies, preference for alternative medicine, and lack of COVID-19 vaccination. The results are pretty much what you would expect, but let’s dive into some details.

Continue Reading »

A panel of 386 experts from various disciplines and 122 countries have put together a consensus statement on how the world can best deal with the continued challenge of COVID-19. The statement contains 57 specific recommendations that had >95% consensus from the panel, with most having >99% consensus. This is like an M&M rounds for the world’s COVID response. In medicine we have morbidity and mortality rounds where we review both statistics and individual cases with bad outcomes. The point is to explore those cases and determine what went wrong, if anything, and how individually and systemically we can prevent or minimize future similar negative outcomes. This panel did the same thing for our COVID response.

Such endeavors are not about placing blame. We can leave that up to the politicians looking to score points. The purpose is to map out a future course, to take specific actions that will minimize future death and negative health outcomes from the COVID pandemic, which is (despite what you may want to believe) not over. The SARS-CoV-2 virus continues to spread throughout the population, and continues to mutate with variants and subvariants increasingly able to evade prior immunity (from infection or vaccination). As predicted the pandemic is slowly morphing into an endemic infection, like the flu, that will simply be with us indefinitely. But infections are still at pandemic levels.

The focus of the recommendations is on how governments can enact policy and allocate resources to better tamp down infections and reduce negative outcomes. This is needed, because government responses were mostly a failure. This doesn’t mean that the US and other governments didn’t do anything useful. They did. But from the perspective of what a fully prepared optimal response would have been, the actual response, in my opinion, was basically a failure. It’s not like we didn’t see it coming. Even now, after everything the world has been through, our preparedness and response is less than ideal.

Continue Reading »

Genetic engineering is a rapidly progressing scientific discipline, with tremendous current application and future potential. It’s a bit dizzying for a science communicator who is not directly involved in genetics research to keep up. I do have some graduate level training in genetics so at least I understand the language enough to try to translate the latest research for a general audience.

Many readers have by now heard of CRISPR – a powerful method of altering or silencing genes that brings down the cost and complexity so that almost any genetics lab can use this technique. CRISPR is actually just the latest of several powerful gene-altering techniques, such as TALEN. CRISPR is essentially a way to target a specific sequence of the DNA, and then deliver a package which does something, like splice the DNA. But you also need to target the correct cells. In a petri dish, this is simple. But in living organism, this is a huge challenge. We have developed several viral vectors that can be targeted to specific cell types in order to deliver the CRIPR (or TALEN), which then targets the specific DNA.

Now I would like to present a different technique I have not previously written about here – alternative splicing. A recent study presents what seems like a significant advance in this technology, so it’s a good time to review it. “Alternative splicing” refers to a natural phenomenon of genetics. Genes are composed of introns and exons. I always thought the nomenclature was counterintuitive, but the exons are actually the part of the gene that gets expressed into a protein. The introns are the part that is not expressed, so they are cut out of the gene when it is being converted into mRNA, and the exons are stitched together to form the sequence that is translated into a protein. Alternative splicing refers to the fact that the way in which the introns are removed and the exons stitched together can vary, creating alternative forms of the resulting protein. This dramatically increases the number of different proteins that an organism’s genes can code for, because each gene can potentially code for multiple protein variants through alternative splicing.

Continue Reading »

How people make decisions has been an intense area of study from multiple angles, including various disciplines within psychology and economics. Here is a fascinating article that provides some insight into the state of the science addressing this broad question. It is framed as a meta-question – do we have the right underlying model that properly ties together all the various aspects of human decision-making? It is not a systematic review of this question, and really just addresses one key concept, but I think it helps frame the question.

The title reflects the author’s (Jason Collins) approach – “We don’t have a hundred biases, we have the wrong model.” The article is worth a careful read or two if you are interested in this topic, but here’s my attempt at a summary with some added thoughts. As with many scientific phenomena, we can divide the approach to human decision making into at least two levels, describing what people do and an underlying theory (or model) as to why they behave that way. Collins is coming at this mostly from a behavioral economics point of view, which starts with the “rational actor” model, the notion that people generally make rational decisions in their own self-interest. This model also includes the premise the individual have the computational mental power to arrive at the optimal decision, and the willpower to carry it out. When research shows that people deviate from a pure rational actor model of behavior, those deviations are deemed “biases”. I’ve discussed many such biases in this blog, and hundreds have been identified – risk aversion, sunk cost, omission bias, left-most digit bias, and others. It’s also recognized that people do not have unlimited computational power or willpower.

Collins likens this situation to the Earth-centric model of the universe. Geocentrism was an underlying model of how the universe worked, but did not match observations of the actual universe. So astronomers introduced more and more tweaks and complexities to explain these deviations. Perhaps, Collins argues, we are still in the “geocentrism” era of behavioral psychology and we need a new underlying model that is more elegant, accurate, and has more predictive power – a heliocentrism for human decision-making. He acknowledges that human behavior it too complex and multifaceted to follow a model as simple and elegant as, say, Kepler’s laws of planetary motion, but perhaps we can do better than the rational actor model tweaked with many biases to explain each deviation.

Continue Reading »

There has been a lot of research exploring the phenomenon of rejection of established science, even to the point of people believing demonstrably absurd things. This is a complex phenomenon, involving conspiracy thinking, scientific illiteracy, group identity, polarization, cognitive styles, and media ecosystems, but the research has made significant progress unpacking these various contributing factors. A recent study adds to the list, focusing on the rejection of scientific consensus.

For most people, unless you are an expert in a relevant field, a good first approximation of what is most likely to be true is to understand and follow the consensus of expert scientific opinion. This is just probability – people who have an understanding of a topic that is orders of magnitude beyond yours are simply more likely to have an accurate opinion on that topic than you do. This does not mean experts are always right, or that there is no role for minority opinions. It mostly means that non-experts need to have an appropriate level of humility, and at least a basic understanding of the depth of knowledge that exists. I always invite people to consider the topic they know the best, and consider the level of knowledge of the average non-expert. Well, you are that non-expert on every other topic.

This is also why humility is the cornerstone of good scientific skepticism and critical thinking. We are all struggling to be just a little less wrong. As a science enthusiast we are trying to understanding a topic at a generally superficial technical level. This can still be a very meaningful and generally accurate understanding – just not technically deep or rigorous. It’s one thing to say – yeah, I get the basic concept of quantum computers, how they work, and why they can be so powerful. It’s another to be able to read and understand the technical literature, let alone contribute to it. Often people get into trouble when they confuse their lay understanding of a topic for a deep expert understanding, usually resulting in them becoming cranks.

Continue Reading »

The latest controversy over Joe Rogan and Spotify is a symptom of a long-standing trend, exacerbated by social media but not caused by it. The problem is with the algorithms used by media outlets to determine what to include on their platform.

The quick summary is that Joe Rogan’s podcast is the most popular podcast in the world with millions of listeners. Rogan follows a long interview format, and he is sometimes criticized for having on guests that promote pseudoscience or misinformation, for not holding them to account, or for promoting misinformation himself. In particular he has come under fire for spreading dangerous COVID misinformation during a health crisis, specifically his interview with Dr. Malone. In an open letter to Rogan’s podcast host, Spotify, health experts wrote:

“With an estimated 11 million listeners per episode, JRE, which is hosted exclusively on Spotify, is the world’s largest podcast and has tremendous influence,” the letter reads. “Spotify has a responsibility to mitigate the spread of misinformation on its platform, though the company presently has no misinformation policy.”

Then Neil Young gave Spotify an ultimatum – either Rogan goes, or he goes. Spotify did not respond, leading to Young pulling his entire catalog of music from the platform. Other artists have also joined the boycott. This entire episode has prompted yet another round of discussion over censorship and the responsibility of media platforms, outlets, and content producers. Rogan himself produced a video to explain his position. The video is definitively not an apology or even an attempt at one. In it Rogan makes two core points. The first is that he himself is not an expert of any kind, therefore he should not be held responsible for the scientific accuracy of what he says or the questions he asks. Second, his goal with the podcast is to simply interview interesting people. Rogan has long used these two points to absolve himself of any journalistic responsibility, so this is nothing new. He did muddy the waters a little when he went on to say that maybe he can research his interviewees more thoroughly to ask better informed questions, but this was presented as more of an afterthought. He stands by his core justifications.

Continue Reading »