{"data":{"id":"init","type":"knowables","attributes":{"index":"home-page","name":"Knowable Magazine | Annual Reviews"},"relationships":{"collections":{"data":[{"id":"comics","type":"collections"},{"id":"disease-update","type":"collections"},{"id":"explained","type":"collections"},{"id":"review","type":"collections"},{"id":"qa","type":"collections"},{"id":"story-behind-picture","type":"collections"}]},"footers":{"data":[{"id":"1","type":"footers"}]},"menus":{"data":[{"id":"23a0cfda-6532-4d71-8f2f-cc8b840dc4d3","type":"menus"},{"id":"7f9b9726-d7f9-4ddc-8160-4a55feca2a1e","type":"menus"},{"id":"94d55a37-c493-4da5-8d76-95f3ab937e75","type":"menus"},{"id":"4d4fab3c-3a75-4587-8701-0c4de56352a0","type":"menus"}]},"socials":{"data":[{"id":"2","type":"socials"}]},"topics":{"data":[{"id":"health-disease","type":"topics"},{"id":"living-world","type":"topics"},{"id":"physical-world","type":"topics"},{"id":"society","type":"topics"},{"id":"sustainability","type":"topics"},{"id":"technology","type":"topics"},{"id":"mind","type":"topics"}]},"promo_articles":null}},"included":[{"id":"comics","type":"collections","attributes":{"title":"Comics","bundle":"collections","field_nof":0,"tid":"67","description":"","weight":"0","path":"215","metatags":{"referrer":"origin","title":"Comics | Knowable Magazine | Annual Reviews","description":""},"field_promote":"1"}},{"id":"disease-update","type":"collections","attributes":{"title":"Disease Update","bundle":"collections","field_nof":0,"tid":"38","description":"","weight":"1","path":"86","metatags":{"referrer":"origin","title":"Disease Update | Knowable Magazine | Annual Reviews","description":""},"field_promote":"1"}},{"id":"explained","type":"collections","attributes":{"title":"Explained","bundle":"collections","field_nof":0,"tid":"35","description":"","weight":"2","path":"72","metatags":{"referrer":"origin","title":"Explained | Knowable Magazine | Annual Reviews","description":""},"field_promote":"1"}},{"id":"review","type":"collections","attributes":{"title":"In Review","bundle":"collections","field_nof":0,"tid":"18","description":"","weight":"3","path":"35","metatags":{"referrer":"origin","title":"In Review | Knowable Magazine | Annual Reviews","description":""},"field_promote":"1"}},{"id":"qa","type":"collections","attributes":{"title":"Q&A","bundle":"collections","field_nof":0,"tid":"26","description":"","weight":"4","path":"61","metatags":{"referrer":"origin","title":"Q&A | Knowable Magazine | Annual Reviews","description":""},"field_promote":"1"}},{"id":"story-behind-picture","type":"collections","attributes":{"title":"Story Behind a Picture","bundle":"collections","field_nof":0,"tid":"7","description":"","weight":"5","path":"11","metatags":{"referrer":"origin","title":"Story Behind a Picture | Knowable Magazine | Annual Reviews","description":""},"field_promote":"1"}},{"id":"1","type":"footers","attributes":{"title":"Footer","id":"1","revision_created":"1508257735","created":"1508257735","revision_default":"1","field_copyright":"Annual Reviews, Inc","field_text":"

Knowable Magazine is from Annual Reviews, a nonprofit publisher dedicated to synthesizing and integrating knowledge for the progress of science and the benefit of society.

\n\n"}},{"id":"23a0cfda-6532-4d71-8f2f-cc8b840dc4d3","type":"menus","attributes":{"title":"About","menu_name":"main","mlid":"68","depth":"1","depth_tree":[{"id":"p1","value":"68"},{"id":"p2","value":"0"},{"id":"p3","value":"0"},{"id":"p4","value":"0"}],"link":{"arguments":["page","about-knowable-magazine"],"title":"About","type":"pages"},"weight":"-50"}},{"id":"7f9b9726-d7f9-4ddc-8160-4a55feca2a1e","type":"menus","attributes":{"title":"Staff","menu_name":"main","mlid":"69","depth":"1","depth_tree":[{"id":"p1","value":"69"},{"id":"p2","value":"0"},{"id":"p3","value":"0"},{"id":"p4","value":"0"}],"link":{"arguments":["page","our-staff"],"title":"Staff","type":"pages"},"weight":"-49"}},{"id":"94d55a37-c493-4da5-8d76-95f3ab937e75","type":"menus","attributes":{"title":"Contact","menu_name":"main","mlid":"70","depth":"1","depth_tree":[{"id":"p1","value":"70"},{"id":"p2","value":"0"},{"id":"p3","value":"0"},{"id":"p4","value":"0"}],"link":{"arguments":["page","contact-us"],"title":"Contact","type":"pages"},"weight":"-48"}},{"id":"4d4fab3c-3a75-4587-8701-0c4de56352a0","type":"menus","attributes":{"title":"Newsletter Signup","menu_name":"main","mlid":"71","depth":"1","depth_tree":[{"id":"p1","value":"71"},{"id":"p2","value":"0"},{"id":"p3","value":"0"},{"id":"p4","value":"0"}],"link":{"arguments":["page","newsletter-signup"],"title":"Newsletter Signup","type":"pages"},"weight":"-47"}},{"id":"2","type":"socials","attributes":{"title":"Social Media","id":"2","revision_created":"1508257754","created":"1508257754","revision_default":"1","field_facebook":"https://www.facebook.com/knowablemagazine","field_linkedin":"https://www.linkedin.com/showcase/knowable-magazine/","field_reddit":"https://www.reddit.com/user/KnowableMag","field_rss":"https://www.knowablemagazine.org/rss","field_twitter":"https://twitter.com/knowablemag"}},{"id":"714","type":"images","attributes":{"title":"Sleep1600x600.jpg","filename":"Sleep1600x600.jpg","uri":"public://articles/125/Sleep1600x600.jpg","styles":{"134_y":"https://www.knowablemagazine.org/sites/default/files/styles/134_y/public/articles/125/Sleep1600x600.jpg?itok=216gNlUo","1600_600":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/125/Sleep1600x600.jpg?itok=am5INbJG","285_205":"https://www.knowablemagazine.org/sites/default/files/styles/285_205/public/articles/125/Sleep1600x600.jpg?itok=aAeP8Zeu","305_220":"https://www.knowablemagazine.org/sites/default/files/styles/305_220/public/articles/125/Sleep1600x600.jpg?itok=DWViHXF4","400_y":"https://www.knowablemagazine.org/sites/default/files/styles/400_y/public/articles/125/Sleep1600x600.jpg?itok=kdYI8jYd","500_288":"https://www.knowablemagazine.org/sites/default/files/styles/500_288/public/articles/125/Sleep1600x600.jpg?itok=TnEOex00","645_552":"https://www.knowablemagazine.org/sites/default/files/styles/645_552/public/articles/125/Sleep1600x600.jpg?itok=KJ2Img3Z","750_y":"https://www.knowablemagazine.org/sites/default/files/styles/750_y/public/articles/125/Sleep1600x600.jpg?itok=qAuYzDsT","large":"https://www.knowablemagazine.org/sites/default/files/styles/large/public/articles/125/Sleep1600x600.jpg?itok=9UaBTr2A","linkit_result_thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/linkit_result_thumbnail/public/articles/125/Sleep1600x600.jpg?itok=g7uP3MCm","medium":"https://www.knowablemagazine.org/sites/default/files/styles/medium/public/articles/125/Sleep1600x600.jpg?itok=7W2qjoP5","thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/thumbnail/public/articles/125/Sleep1600x600.jpg?itok=YN9Qzqy3"},"filemime":"image/jpeg","filesize":"432447","status":"1"}},{"id":"health-disease/2018/adults-and-now-teens-poor-sleep-linked-cardiovascular-risk","type":"articles","attributes":{"title":"In adults, and now in teens, poor sleep is linked to cardiovascular risk","nid":"125","created":"1529105718","revision_default":"1","path":"186","body":"

Did you sleep well last night? If not, you’re in good company. About a third of American adults don’t get the recommended seven hours of sleep per night, according to the Centers for Disease Control and Prevention. Many people don’t get enough sleep or sleep poorly because of their jobs or hectic schedules — they work long shifts at night or have to rush to get their kids ready to catch a 6 a.m. school bus. Some 50 million to 70 million Americans have a chronic sleep disorder such as insomnia or sleep apnea, a condition in which breathing repeatedly stops and starts throughout the night.

\n\n

Scientists still fiercely debate sleep’s fundamental biological purpose. In people, however, plentiful evidence suggests that sleep performs a range of vital functions, including restoring damaged tissues, boosting learning and memory, and flushing toxins from the brain. Sleeping too little can have serious long-term health consequences, increasing the risk of obesity, diabetes and cardiovascular disease.

\n\n

A new study in Pediatrics highlights the importance of sleep for teenagers, who often struggle to get the recommended eight to nine hours per night of shut-eye. Out of the more than 800 adolescents in the study, only 2.2 percent got enough sleep, and less than half achieved desirable rates of “sleep efficiency” — the percentage of total time in bed actually spent asleep.

\n\n

Teens short on sleep were more likely to be obese — a trend found in previous studies — and scored higher on several other risk factors for cardiovascular disease, such as high blood pressure and poor glucose metabolism. Those who slept longer and better tended to have less fat around their waists, lower systolic blood pressure and higher levels of “good” cholesterol — all signs of cardiovascular health.

\n\n

Knowable Magazine called one of the study authors, physician Susan Redline of Brigham and Women’s Hospital, to discuss sleep’s powerful influence on our hearts and other body systems, a subject Redline also wrote about in the 2015 Annual Review of Public Health. To reduce our society’s high rates of chronic disease, she says, we need to ensure children get better sleep, as well as other sleep-deprived groups such as minorities and shift workers.

\n\n

This discussion has been edited for clarity and length.

\n\n\n\n

How did you become interested in studying the health impacts of sleep?

\n\n

I was trained in pulmonary medicine in the mid-’80s, shortly after a new therapy for sleep apnea — the Continuous Positive Airway Pressure (CPAP) device — had been developed. Prior to CPAP, patients had to undergo surgery and have tracheostomies and lose the function of their voices. It was very exciting to see a therapy that, literally overnight, could change a person from being very sleepy and having poorly controlled hypertension and even heart failure to someone who was functional.

\n\n

I sought out training in epidemiology and observed how little we understood about the population prevalence and risk factors for sleep apnea. That's when I started developing epidemiologic studies to address those questions. I also became interested in other aspects of sleep, such as the genetics of sleep apnea, insomnia, sleep and children, and the impact of sleep on heart disease.

\n\n

How does poor sleep affect the heart and other aspects of health?

\n\n

Having an adequate quantity of sleep as well as quality of sleep is important for maintaining numerous body systems. Compared with people who get seven or eight hours of sleep per night, for example, short sleepers have a 10 percent to 30 percent increased risk of cardiovascular disease.

\n\n

\"Ten — \n
\n
In 2014, US adults who reported regularly sleeping for less than seven hours in a 24-hour period were also more likely to report having these 10 health problems compared with those who said they usually get the recommended amount of sleep.
\n
\n

\n\n

Getting insufficient sleep — in general less than six hours a night for adults — may trigger the release of various proteins that cause inflammation in the blood and in the body, and cause dysregulation of the immune system. C-reactive protein, interleukin 6, and tumor necrosis factor are three commonly measured inflammatory markers that are increased in association with sleep problems. These inflammatory mediators may also make you less sensitive to insulin, which then will raise your blood sugar and can lead to diabetes.

\n\n

A second problem is getting insufficient amounts of deep sleep, or restorative sleep. In one of the deepest stages, called slow-wave sleep, there is a drop in the level of catecholamine hormones that raise blood pressure, such as adrenaline. People with sleep disorders have what we call arousals — very brief periods of awakening. When you have fragmented sleep, high levels of these hormones can prevent blood pressure from going down. Over time, this can cause stiffening of the heart muscle.

\n\n

Your recent study in Pediatrics showed that lack of sleep increases risk factors for heart disease in adolescents. Do children and teenagers need to sleep the same amount as adults?

\n\n

Infants typically need more than 12 hours of sleep, then by the time you’re an adolescent those needs are closer to eight or nine hours. An average adult needs between seven and eight.

\n\n

What was really interesting about this recent study was that we were able to show that both insufficient sleep and misaligned sleep — sleep that isn’t in sync with a person’s circadian rhythm — are associated with metabolic parameters associated with increased risk of diabetes and heart disease, such as higher central body fat.

\n\n

This study adds to evidence that improving both children’s sleep duration and making their sleep patterns more regular may, over time, protect children from developing metabolic problems.

\n\n

What are the most common sleep disorders? How can you tell if someone has a sleep disorder or is just staying up too late?

\n\n

The two most common sleep disorders are sleep apnea and insomnia. Sleep apnea is when your throat closes during sleep for brief but repetitive periods of time, interfering with your ability to get oxygen into your body and to rid your body of waste products like carbon dioxide. Insomnia is a disorder where individuals have chronic problems falling asleep or maintaining their sleep. Another relatively common sleep disorder is called periodic limb movement disorder, where the individual has disrupted sleep because of involuntary kicking of their legs or arms that wakes them up.

\n\n

Although there is a continuum of symptoms, usually a sign of a disorder is a persistent feeling of tiredness, sleepiness or unrefreshing sleep that isn't explained by another factor like being out all night at a party or working. It's the persistence of daytime symptoms without a clear explanation.

\n\n

Are some racial or ethnic groups more at risk of chronic disease as a result of poor or inadequate sleep?

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In the US, the prevalence of short sleep and poor sleep quality is much higher in ethnic minorities than in the white population. Blacks are as much as five times as likely to report short durations of sleep than whites, for example. That doesn't seem to be completely explained by known sleep disorders, so it suggests there may be multiple social and environmental factors that influence poor sleep quality, such as living in disadvantaged neighborhoods.

\n\n

\"Percent — \n
\n
In 2014, a survey found that short sleep duration, defined as less than the ideal of seven hours per night, was more common in some racial and ethnic groups compared with others in the United States. The results, from the Behavioral Risk Factor Surveillance System, also found shorter nights were more common in people over age 65 than in younger people.
\n
\n

\n\n

One of my interests is in sleep apnea in children. African-American children have much higher rates of sleep apnea than white children, and they actually appear to respond less well to the usual surgery that's done, tonsillectomy, than white children. I've postulated that having sleep apnea at an early age, and going years with untreated sleep apnea, may be one reason that we see much higher rates of hypertension and early-onset hypertension in African-American communities, which is a huge risk factor for stroke and heart disease.

\n\n

So far, we have shown in two different studies that children who live in disadvantaged neighborhoods have higher rates of sleep apnea than other children. Right now we're doing a study in Boston where we are going into the homes of children from diverse neighborhoods in the city and looking to see if there are actually excessive exposures to various allergens, irritants or poor air quality that may be triggering chronic inflammation of the nasal passages and the tonsils that might be contributing to sleep apnea.

\n\n

What are some things that can be done to improve sleep health?

\n\n

Institutionally, we could work harder to ensure that we don't require students or workers to follow unhealthy sleep habits. We could delay school start times so that students don’t have to get up to catch a school bus at 6 a.m., for example. I also work with a group of patient advocates who have suggested that everybody who gets a driver’s license be educated on sleep disorders and the impact of drowsy driving — and to consider including screening for sleep disorders as a part of applying for a license.

\n\n

What are the most compelling unanswered questions about sleep?

\n\n

One question I’m interested in is the variation in susceptibility to sleep disorders — what factors may be inherited or otherwise. I think the question of why African-American children have much more severe sleep apnea than other children is really important, both as a mechanistic and a public health question.

\n\n","field_all_authors":"

By Emily Underwood 06.15.2018

\n\n","field_author_bios":"

Emily Underwood is a freelance science writer and contributing correspondent for Science magazine. She is based in Coloma, California. Email: emily.l.underwood@gmail.com. Twitter: @em_underwood.

\n\n","field_banner_alt":"Time-lapse shows a couple's restless sleep over six hours.","field_banner_title":"Restless night","field_caption":"

Fragmented sleep — or simply not enough of it — has been linked to a higher risk of chronic health issues. Here a couple tosses and turns, as captured by Paul Maria Schneggenburger who uses time-lapse photography to examine sleep as part of his ongoing art project \"The sleep of the beloved.\"

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Q&A — Sleep researcher Susan Redline

\n\n

In adults, and now in teens, poor sleep is linked to cardiovascular risk

\n\n

A slumber researcher explains why getting enough z’s is crucial to your health

\n\n

By Emily Underwood

\n\n

06.15.2018

\n\n

This discussion has been edited for clarity and length.

\n\n

How did you become interested in studying the health impacts of sleep?

\n\n

How does poor sleep affect the heart and other aspects of health?

\n\n

Your recent study in Pediatrics showed that lack of sleep increases risk factors for heart disease in adolescents. Do children and teenagers need to sleep the same amount as adults?

\n\n

Infants typically need more than 12 hours of sleep, then by the time you’re an adolescent those needs are closer to eight or nine hours. An average adult needs between seven and eight.

\n\n

This study adds to evidence that improving both children’s sleep duration and making their sleep patterns more regular may, over time, protect children from developing metabolic problems.

\n\n

What are the most common sleep disorders? How can you tell if someone has a sleep disorder or is just staying up too late?

\n\n

Are some racial or ethnic groups more at risk of chronic disease as a result of poor or inadequate sleep?

\n\n

What are some things that can be done to improve sleep health?

\n\n

What are the most compelling unanswered questions about sleep?

\n\n

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It seemed like a good idea — a Decade of Pain Control and Research, called by the US Congress in 2000 to address inadequate pain management. But what followed was disastrous. Opioid prescriptions increased 300 percent between 2000 and 2010, accompanied by rises in opioid addiction and deaths among patients and others who got hold of the medicines. Demand for opioids also fueled illicit sales of heroin and the powerful opioid fentanyl; heroin and fentanyl-related drugs now account for more deaths than do typically prescribed opioids.

\n\n\n\n

Chronic pain is both difficult to control and incredibly common, afflicting more than 30 percent of American adults and about 50 percent of the elderly. Because high doses and long-term use of opioids raise the risk of addiction, doctors worry more about opioid prescriptions for chronic-pain patients than those who need the medicines for just a few days. Indeed, an estimated 8 to 12 percent of people who take opioids for chronic pain develop an opioid-use disorder — recurrent use despite negative consequences. Addiction is the most severe form.

\n\n

Knowable Magazine spoke with Nora Volkow, director of the National Institute on Drug Abuse, who recently coauthored an article on the use and misuse of opioids in chronic pain situations for the Annual Review of Medicine. She shared her thoughts on how best to treat enduring pain in the face of the opioid crisis. The conversation has been edited for length and clarity.

\n\n

Is it true that until recently doctors thought that patients in pain would not become addicted?

\n\n

That’s the way many of us were trained: If you had a patient who had pain, you shouldn’t be concerned about them getting addicted to their opioid medication. This belief was utterly unfounded.

\n\n

Does pain actually increase the risk for addiction?

\n\n

There is relatively limited research. Addiction is triggered by “conditioning,” the association between consumption of a drug and a pleasurable response. But a drug also can be incredibly rewarding if you have horrible pain and then you take something and it’s gone. It depends on the context, but certainly in some of the animal experiments, high doses of opioids are more rewarding if you have pain than if you don’t.

\n\n

Guidelines from the Centers for Disease Control and Prevention for treating chronic pain favor nonopioid therapies over opioids. Are nonopioid drugs as effective as opioids?

\n\n

There are other medications for some chronic-pain conditions: some anti-epileptics, antidepressants, nonsteroidal anti-inflammatories. There is no evidence that opioids work better than other drugs to improve function in people with chronic pain. Having said that, we have to recognize that for some patients who don't respond to anything else and are in severe, severe pain, the intermittent use of opioids can help.

\n\n

It should not be a first line of treatment, as the CDC very explicitly states; it should be part of a comprehensive plan for management of chronic pain. Unfortunately, these more comprehensive plans are not always reimbursed and, even if they were, there is not the expertise to actually provide them.

\n\n

\n\n

By “comprehensive,” do you mean behavioral therapy and things like that?

\n\n

Behavioral therapy. Physical therapy. Complementary therapeutics, like meditation. There are also interventions to improve sleep behavior patterns that have been shown to decrease pain.

\n\n

Do you also need to change patients’ expectations for pain control?

\n\n

These interventions are going to be much more time-consuming than just giving an opioid pill, and also are not going to lead to the immediate relief that you get with an opioid. And so you also have to change expectations. There is increasing recognition that we should make patients expect that the intervention will help them lead a more normal life and resume their everyday activities, even though they may have to learn to live with some level of discomfort — as opposed to having them expect that any sensation of pain is going to go away.

\n\n

Let’s go back to the expertise issue. Isn’t that a big problem?

\n\n

We need change in the structure of the medical system. The NIH is interested in the development of new models of how to take care of patients with chronic pain conditions, such that physicians may oversee a team of experts that deploy, for example, behavioral, meditation and complementary-medicine interventions. Nurses and physician assistants would be engaged in the process.

\n\n

Is the idea, partly, that patients would be trained to manage pain on their own?

\n\n

That’s the process — to empower patients to modulate their own perception of pain, to gain more control over their emotional reaction to pain. So while you may be perceiving pain, you do not need to get as distressed by that sensation, and that can make it much more manageable.

\n\n

Are there any good data on the effectiveness of these nondrug therapies?

\n\n

Randomized clinical trials that have shown that hypnosis — I’m just giving you an example — can significantly improve the outcomes of patients suffering from pain. Acupuncture and meditation, also. The issue is, how large have these clinical trials been and for what pain conditions? It is clear that chronic pain comes in multiple flavors and that we need to develop targeted interventions for specific pain conditions, as opposed to what we've done in the past — just lump everything together into “chronic pain.”

\n\n

Your review explicitly focuses on chronic pain that is not caused by cancer. Why?

\n\n

The issue relates more to having a terminal condition versus one that is not. When someone has terminal cancer pain, or is in a terminal condition of another type, there is not so much concern that you are going to be living for many years and thus struggling with addiction.

\n\n

Looking back at the review, we should have made clear that when there is a chronic issue with pain for cancer in a non-terminal situation, then one should use the same considerations that apply to any other chronic condition with pain.

\n\n

Patients who have been on opioids for years for pain are being abandoned by doctors spooked by the opioid crisis. Is that a reasonable response?

\n\n

I have seen it, too. It is very stressful for patients, and it is putting some at very high risk for either overdosing or suicide. You can have a patient who is addicted to their opioid medication, and the physician just cuts them off without proper referral for treatment for their opioid-use disorder. As a result, they have the distress of the addiction — the intense craving, plus the severe, severe physical withdrawal, which is also very uncomfortable — and that puts them at risk of going into the black market to get heroin and/or synthetic opioids. Now that a very high percentage of those drugs are laced with fentanyl, this puts the patients at high risk of overdose.

\n\n

Then there are patients who have very severe chronic pain that doesn't respond to anything else, who have some relief from their opioids, getting horrifically distressed at the fear of having the pain return full-blown. You have patients who will kill themselves rather than see no hope for the management of their chronic pain.

\n\n

We want to protect people from getting exposed to opioids when they don't need them, so we come up with measures that then, unfortunately, are affecting those that need them.

\n\n

\n\n

Similarly, Medicare has considered refusing to pay for long-term, high-dose prescriptions for its beneficiaries, and states and private insurers have set hard limits.

\n\n

These rules reflect the urgency of the situation. If we are going to limit in such a draconian fashion the delivery of opioid medications to patients with chronic pain, we need to ensure that they have the support system to manage their pain and, if they have an opioid-use disorder, proper referrals for treatment of it. Otherwise, we are going to do a lot of harm.

\n\n

Are some doctors mistakenly interpreting physical dependence as addiction?

\n\n

We wrote a paper for the New England Journal of Medicine to try to clarify this for physicians. If you end up in an accident and in the hospital and they give you opioids for three days continuously, you will be physically dependent on the opioids; this is very different from addiction, and emerges very rapidly.

\n\n

I speak from experience. I was in a car accident and hospitalized and released with opioids. I didn’t want to take them, so I went cold turkey and had physical withdrawal. The withdrawal was very disagreeable and forced me to take one of the pills even though I didn’t want to.

\n\n

Addiction, on the other hand, takes much longer to develop. Not everyone getting the drugs will become addicted. A physician seeing that a patient with pain is starting to have symptoms of withdrawal may then describe that patient as addicted when they are not; they have physical dependence. And that leads to improper management.

\n\n

It sounds like many doctors need to be better educated about the best ways to manage pain care.

\n\n

Probably the lowest-hanging fruit, and what we should be doing right now, is expanding aggressively the proper training of physicians and health-care providers in the recognition and management of addiction. Things as simple as recognizing the difference between physical dependence — withdrawal — versus addiction, and how you determine when you should refer someone to specialized care. Providing that basic learning and understanding is item number one.

\n\n

We are hurting patients when we come up with a measure that leaves them with no alternative. But the other reality is that by overprescribing opioids, we were hurting patients — not just by increasing the likelihood that they could overdose or become addicted but because chronic opioid use actually can exacerbate pain, can produce “hyperalgesia.”

\n\n

Opioids can worsen pain?

\n\n

In some instances, pain medication that initially provided great relief will exacerbate sensitivity to pain, and so make it worse. When you have a patient who is already on very high doses of opioids yet those are insufficient to control the pain, you might want to consider tapering off. In some instances, the pain will actually get better.

\n\n

\"Vintage — \n
\n
Vintage bottle for opium tincture, also known as laudanum, sold in bygone years for treatment of pain and insomnia. It contained both opium and morphine.
\n
\n\n
CREDIT: SCIENCE MUSEUM, LONDON
\n

\n\n

What else would help improve care?

\n\n

We need to emphasize to doctors the responsibility we have to patients with severe, chronic pain. Changing the way that we reimburse physicians would help ensure adequate care. If you have fifteen minutes to take care of a patient with a complex pain condition, there is no way that you are going to be able to properly address their needs. You should be reimbursed for outcomes and be given the opportunity to have much more time so you can understand the unique needs of that individual — which may include intermittent use of opioids as part of a comprehensive approach. But that will require much more time investment and the resources and expertise of a team to help you do it.

\n\n

What is the government doing about education?

\n\n

At the NIH, as part of the Pain Consortium, we have been supporting Centers of Excellence in Pain Education across the United States for the development of educational curricula for medical students, specialty physicians, nurses, pharmacists and dentists, that will be free and available for schools.

\n\n

Is there anything else important to mention?

\n\n

I very much want to emphasize the opportunity we have here: We have medications that can be used for the treatment of opioid-use disorder, and these medications can be very beneficial. It is important for every physician to know how to properly screen and recognize indications that patients may be early in experimenting with drugs, or misusing them, or fully addicted.

\n\n

Also, we need to recognize that our beliefs about demographics — that it is the young person that is more likely to become addicted — does not necessarily fit the bill. You should monitor every single person, in a nonjudgmental way, for substance-use disorder, the way you monitor for diabetes or allergies.

\n\n","field_all_authors":"

By Ricki Rusting 06.06.2018

\n\n","field_author_bios":"

Ricki Rusting is a freelance science writer and editor based in New York.

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Q&A — NIDA Director Nora Volkow

\n\n

Managing pain in a time of opioid abuse

\n\n

Other therapies, more training, a new mindset: Can doctors bring relief to patients without putting them at risk for addiction?

\n\n

By Ricki Rusting

\n\n

06.06.2018

\n\n

\n\n\n\n

\n\n

Is it true that until recently doctors thought that patients in pain would not become addicted?

\n\n

That’s the way many of us were trained: If you had a patient who had pain, you shouldn’t be concerned about them getting addicted to their opioid medication. This belief was utterly unfounded.

\n\n

Does pain actually increase the risk for addiction?

\n\n

Guidelines from the Centers for Disease Control and Prevention for treating chronic pain favor nonopioid therapies over opioids. Are nonopioid drugs as effective as opioids?

\n\n

By “comprehensive,” do you mean behavioral therapy and things like that?

\n\n

Behavioral therapy. Physical therapy. Complementary therapeutics, like meditation. There are also interventions to improve sleep behavior patterns that have been shown to decrease pain.

\n\n

Do you also need to change patients’ expectations for pain control?

\n\n

Let’s go back to the expertise issue. Isn’t that a big problem?

\n\n

Is the idea, partly, that patients would be trained to manage pain on their own?

\n\n

Are there any good data on the effectiveness of these nondrug therapies?

\n\n

Your review explicitly focuses on chronic pain that is not caused by cancer. Why?

\n\n

Patients who have been on opioids for years for pain are being abandoned by doctors spooked by the opioid crisis. Is that a reasonable response?

\n\n

We want to protect people from getting exposed to opioids when they don't need them, so we come up with measures that then, unfortunately, are affecting those that need them.

\n\n

Similarly, Medicare has considered refusing to pay for long-term, high-dose prescriptions for its beneficiaries, and states and private insurers have set hard limits.

\n\n

Are some doctors mistakenly interpreting physical dependence as addiction?

\n\n

It sounds like many doctors need to be better educated about the best ways to manage pain care.

\n\n

Opioids can worsen pain?

\n\n

What else would help improve care?

\n\n

What is the government doing about education?

\n\n

Is there anything else important to mention?

\n\n

10.1146/knowable-060518-025301

\n\n

Ricki Rusting is a freelance science writer and editor based in New York.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n\n

$\"Knowable$

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Chi Van Dang generally declines to discuss the science that made him famous. A leading authority on cancer metabolism, he routinely is asked to speak about how tumors reprogram biochemical pathways to help them slurp up nutrients, and how disrupting these noxious adaptations could be a powerful approach to treating cancer.

\n\n

Instead, Dang uses his soapbox at every research meeting, every invited lecture and every blue-ribbon panel to advocate for something else entirely: a simple yet radical tweak to how oncologists administer cancer drugs.

\n\n

The approach, known as chronotherapy, involves timing the delivery of drugs so as to minimize the side effects of treatment while maximizing the treatment’s effectiveness. The idea is to synchronize therapy with the body’s natural 24-hour rhythms — the so-called circadian clock — striking either when cancer cells are most vulnerable to assault or when healthy cells are least sensitive to toxicity (or, ideally, both).

\n\n

“It’s just always been on the fringe. There weren’t that many card-carrying cancer biologists like me getting into it.”

\nChi Van Dang

\n\n

Dang didn’t set out to become a global ambassador for this field. But as scientific director of the Ludwig Institute for Cancer Research, a nonprofit that funds hundreds of cancer labs worldwide, and chair of the board of scientific advisors at the US National Cancer Institute, he finds himself in a powerful position to reshape the research agenda — and he believes chronotherapy’s time has come.

\n\n

It is not an entirely new concept. The idea of time-stipulated therapy dates back decades, with some randomized trials in the 1980s and 1990s showing dramatic reductions in toxicities and extended survival times among cancer patients treated in a clock-optimized fashion. But for the most part, “it’s just always been on the fringe,” says Dang. “There weren’t that many card-carrying cancer biologists like me getting into it.”

\n\n

Until now.

\n\n

The concept of chronotherapy got a major boost last year when the Nobel Prize in Physiology or Medicine went to three biologists who first uncovered the inner workings of our bodies’ daily rhythms. Scientists who study the interface of circadian biology and cancer say there’s been an uptick in interest in their work since the prize was announced last October.

\n\n\n\n

\n\n

But arguably, Dang’s own efforts to spread the gospel about the cancer-clock connection and its therapeutic implications have been even more important in revitalizing the field. “It’s capturing people’s interest,” he says — with a growing number of cancer researchers now beginning to explore the ways in which circadian rhythms shape tumor development.

\n\n

They are finding not only new ways of administering old drugs but also clever tactics for rewiring aberrant clocks. And they are transforming a therapeutic strategy long dismissed as complementary or alternative medicine into a rigorous science.

\n\n

“Time is an inconvenient truth” — one that oncologists and cancer researchers alike, Dang says, can no longer afford to ignore.

\n\n

Timing is of the essence

\n\n

A slender and bespectacled 63-year-old with the confident and unhurried voice of a seasoned physician, Dang cites his father — Chieu Van Dang, Vietnam’s first neurosurgeon and former dean of the University of Saigon School of Medicine — as a role model for how he approaches positions of leadership in academic medicine. His father’s death from liver cancer in 2004 remains a lasting inspiration to develop better treatments. And family, again, was a driving factor behind a fortuitous career move that prompted Dang’s recent zeal for circadian biology.

\n\n

He had spent nearly 25 years on faculty at Johns Hopkins University, during which he rose through the ranks to become vice dean for research of the medical school; he figured he’d never leave. But in 2011, after his older brother Bob died of metastatic cancer of the soft tissues, Dang thought to himself: “As a medical oncologist and researcher, I need to do more.” So when the University of Pennsylvania approached him with an offer to become director of its cancer center — home to the original discovery that abnormal chromosomes can cause cancer, and where a new generation of lifesaving T-cell therapies were being developed — he jumped at the opportunity.

\n\n

As luck would have it, Penn also is home to one of the largest assemblages of chronobiology researchers in the country, and Dang soon found himself chatting with — and then collaborating with — clock researchers from across the Philadelphia campus. Those interactions, he says, prompted an academic epiphany: If cancer is a disease of runaway cellular growth, and circadian rhythms are what normally keep the cell cycle in check, then disruption of the internal clock must be, as Dang puts it, a “missing link” of tumor development and growth.

\n\n\n\n

\"A — Researcher Chi Van Dang is convinced that cancer treatments will be more effective and less toxic if we factor in the body's circadian rhythms.
\n\n
CREDIT: THE WISTAR INSTITUTE
\n\n

\n\n

The circadian clock is a complex biological circuit that controls the daily rhythms of sleep, eating habits, body temperature and many other important physiological functions. The body has a master clock in the brain and many secondary clocks in other organs, as well as individual clocks in each and every cell, all controlled by an intricate network of oscillating genes and proteins.

\n\n

When the various clocks are in sync, the body operates like a well-oiled machine. But when certain clock genes are mutated or thrown out of alignment by chronic jet lag, these systems can get out of whack, creating prime conditions for tumors to grow and spread.

\n\n

“If I was still in Baltimore, I would probably be working on something else,” says Dang (who last year moved his lab again, this time just half a mile away to the Wistar Institute, an independent research center on the Penn campus, where he is a professor in the molecular and cellular oncogenesis program). And by extension, if Dang hadn’t started extolling the virtues of this research to officials at the National Cancer Institute, it’s unlikely that the agency — the largest funder of cancer research in the world — would ever have lined up behind the idea. It did so last year, putting out a call for grant applications from scientists seeking to better understand how circadian processes affect tumor development and responses of patients to therapy.

\n\n

According to Dan Xi, a program director at the NCI, there’s now talk of creating a “human circadian rhythm atlas” to bring systems-level understanding to the study of clock disruption in cancer, immunity, psychiatry and general well-being. “The major challenge for the field is understanding how the function and regulation of clock genes contribute to health and diseases,” she says.

\n\n

Some of the first hints that a disrupted clock could lead to cancer came in 2001, when two teams of epidemiologists working with independent datasets came to the same conclusion: that women who regularly worked the night shift had an increased chance of developing breast cancer. Later studies established a link between graveyard shifts and cancers of the colon, prostate and endometrium — which prompted the World Health Organization’s International Agency for Research on Cancer in 2007 to designate night-shift work involving circadian disruption as a probable carcinogen.

\n\n

Researchers now generally think that nocturnal light, by decreasing the body’s natural synthesis of the clock-regulating hormone melatonin, explains such a cancer link — which suggests that taking melatonin pills or modulating ambient lighting could help mitigate the risk among shift workers. But prospectively testing that idea would be difficult given the number of study subjects and years needed to detect a small number of cancers — and as yet, says Steven Hill, a circadian cancer researcher at Tulane University, “there are no published studies or active interventional studies” to that effect.

\n\n

Cancer never sleeps

\n\n

Logistically — and financially — it is far easier to do such trials for cancer treatment than for cancer prevention, and it’s here that many researchers are now focused. Earlier this year, for example, a team led by circadian biologist Satchidananda Panda at the Salk Institute for Biological Studies in La Jolla, California, described two novel drugs that target key clock components and kill several different types of cancer cells in a laboratory dish, as well as slow the growth of brain tumors in mice.

\n\n

The drugs, by reawakening the circadian clock in cancer cells, seemed to block biological functions that tumors rely upon, including a garbage cleanup system that helps clear away toxic byproducts and a molecular pathway needed for fat synthesis. Importantly, the drugs had this therapeutic effect on tumors without causing any overt toxicity in the mice.

\n\n

In fact, there’s even some data to suggest that resetting the clock in tumors could mitigate the side effects of cancer experienced elsewhere in the body. Cancer biologist Thales Papagiannakopoulos of New York University — his postdoc adviser called him “Chronos” given his Greek roots and academic interests — showed that lung tumor cells secrete a factor that travels through the blood to the liver, where it disrupts normal oscillatory patterns. Such effects, Papagiannakopoulos says, “could explain a lot of the symptoms of having cancer.”

\n\n

For example, the liver is critical for draining blood from several organs, including the spleen, and altered liver rhythms could lead to splenic backups and congestion that shorten the lifespan of blood cells. This could account for common side effects of cancer, including anemia and leukopenia, the low counts of blood cells experienced by many cancer patients. And if something similar is happening in muscle tissues, circadian dysfunction could underpin cachexia, a devastating loss of body weight and strength that often afflicts people in the final stages of cancer.

\n\n\n\n

\"Colored — A colored scanning electron micrograph of a lung cancer cell undergoing division. Tumors often have malfunctioning circadian clocks.
\n\n
CREDIT: SPL / SCIENCE SOURCE
\n

\n\n

Dang’s own therapeutics-related research has focused mainly on showing how a notorious cancer gene named MYC is involved in suppressing genes that lie at the very core of the mammalian clock, such as one called BMAL1. This perturbs the normal oscillatory cycles of molecular regulation inside the cell, and instead pushes protein synthesis into an aberrant, perpetual state of activity that drives tumor progression. This revealed a potential drug target — one that researchers at Texas Children’s Cancer Center have run with. Last year, they reported that a drug that indirectly stimulates BMAL1 activity could help blunt the growth of neuroblastoma, a cancer of the nerve tissue, both in cell cultures and in mouse models.

\n\n

Dang, meanwhile, has recently turned his attention to a class of drugs that target NAMPT, an enzyme involved in both cancer metabolism and circadian feedback loops. Around 10 to 20 years ago, a handful of NAMPT inhibitors entered clinical testing. But they all caused such low platelet counts in recipients that they never progressed past early trials.

\n\n

Now, working with mouse models of lymphoma, Dang’s team has found that administering these drugs at either 10 a.m. or 6 p.m. caused the same degree of tumor regression — with a key difference. Only at 6 p.m., when NAMPT expression was at its natural zenith in the liver, did the treatment cause low platelet counts in the mice. Inhibiting NAMPT at 10 a.m. caused no such problems whatsoever.

\n\n

The work, which the group is retesting before submitting it for publication, has led Dang to think that chronotherapy could help salvage this promising class of new cancer drugs. “We may be interfering with liver function simply by giving those drugs at the wrong time,” he says.

\n\n

Peaks and valleys

\n\n

Another drug that doctors may currently be administering suboptimally is streptozocin, a chemotherapeutic agent that’s routinely used to treat a rare form of pancreatic cancer. In a paper published in 2017, Penn sleep medicine doctor Ron Anafi took reams of gene-activity data from both cancerous and healthy liver tissue, and then developed an algorithm that models all the molecular rhythms.

\n\n

His analysis showed that activity levels of a gene called SLC2A2, which encodes a glucose transporter protein that shuttles streptozocin, cycled in a daily fashion in normal liver cells. Together with John Hogenesch, a chronobiologist at Cincinnati Children’s Hospital Medical Center, he then showed that administering streptozocin to mice at the nadir of SLC2A2 expression, when levels of streptozocin’s gatekeeper protein are low, minimized drug toxicity.

\n\n

Anafi and Hogenesch hope to eventually test this time-optimized treatment schedule for streptozocin in patients with pancreatic tumors. At the moment, though, there is only one chronotherapy trial running in the United States (unlike in Europe and Asia, where these kinds of studies are more common). It’s happening at the Washington University School of Medicine in St. Louis, where neuro-oncologist Jian Campian and her colleagues have enrolled 30 people with brain cancer and given them a standard chemotherapy drug called temozolomide either at 8 a.m. or 8 p.m.

\n\n

So far, says Campian, it looks as if the side effects of the drug are far worse when people take their pills in the morning. It’s too early to say anything conclusive, although animal studies from Campian’s collaborators, Erik Herzog and Joshua Rubin, suggest that the drug should work best when activity of the core clock regulator BMAL1 is highest in the tumor cells.

\n\n\n\n

\n\n

That would imply that the 8 p.m. dosing strategy will work better than the 8 a.m. one, at least on average. But, as Herzog points out, “people are different from each other.” We have something called a chronotype that, at its most basic level, determines whether someone is a morning person or an evening person, and that will probably affect individual responses to drugs like temozolomide.

\n\n

Ideally, says Herzog, the timing of treatments would be finely tuned to a patient’s unique chronotype, and thus to the peaks and crests of their internal molecular activity. “This might end up being the ultimate personalized medicine,” he says.

\n\n

But measuring something like BMAL1 activity in a tumor is no small task. It’s invasive (one has to obtain the tumor samples), expensive and unfeasible to do routinely, in real time and for many patients. In search of an easier way, a research team at Northwestern University has a 30-person pilot study looking for genomic indicators of clock status in blood and saliva.

\n\n

Yet most clock researchers have settled on tracking cruder measures like skin temperature and wrist actigraphy to get a rough estimate of whether the body is in its activity or rest phase. Those are imperfect proxies, acknowledges Francis Lévi, a luminary in the field of chronotherapy from the University of Warwick in the United Kingdom. “We still need to identify better biomarkers to personalize chronotherapy.”

\n\n

Even if there were an ideal biomarker, there’s still the problem of the medical system being designed around a standard working day. It’s not built to administer drugs at off hours — and there’s little financial incentive for change. So rather than bend the system to the needs of the patient, it might be easier to bend the circadian clock to the needs of the system. This may be possible simply by time-shifting eating, sleeping, exercise habits or ambient lighting to get a patient’s biological rhythms in sync with the business hours of a chemo ward.

\n\n

Or perhaps the tumor’s clock itself could be reprogrammed. In a study published in 2017, Silke Kiessling, a circadian biologist who conducted the work as a postdoc at McGill University in Canada, showed that injecting tumors in mice with a steroid drug called dexamethasone reset genes like BMAL1 and induced rhythmicity in the cancer cells. Conceivably, that means a patient could take a shot of steroid a few hours before treatment so that, no matter when therapy is scheduled, that patient gets the benefit of chronotherapy without the inconvenience.

\n\n

“This could be applicable for any kind of cancer you can reach with a needle,” says Kiessling, now at the Technical University of Munich in Germany. She is also thinking about making an aerosolized formulation for extending the strategy to lung cancer. “I’m more than confident that this could work, even in humans.”

\n\n

Bedtime routine

\n\n

For now, most of the human data come from anecdotal reports like those of Joe Kuna, who was diagnosed with metastatic colon cancer in 2014 and given two to five years to live. Four years on, the 61-year-old has beaten back a tennis-ball-size tumor in his colon and 15 lesions in his liver. Kuna, who runs a family-owned bowling alley in Johnsburg, Illinois, opted to undergo chronotherapy at the nearby Block Center for Integrative Cancer Treatment.

\n\n

“We still need to identify better biomarkers to personalize chronotherapy.”

\nFrancis Lévi

\n\n

For the better part of two years after his diagnosis, Kuna would arrive at the center every other Tuesday, usually some time between 1 p.m. and 3:30 p.m., for his dose of oxaliplatin. Since different anticancer drugs kill cells in different ways, “each drug has a window of time” when it works best, says oncologist Keith Block, medical director of the clinic in Skokie, Illinois — and oxaliplatin, according to Block, seems to work best in the afternoon.

\n\n

Kuna would sit in the cubicle with the palm tree painted on the wall and eat his tuna fish sandwich while the intravenous medication dripped into his veins through a port implanted over his right nipple.

\n\n

Another one of the drugs in Kuna’s chemotherapeutic cocktail, fluorouracil, is considered more of a nighttime agent — which meant Kuna had to take home a special pump, about the size of a paperback novel, that he could carry around in a fanny pack or leave on the mattress next to him in bed. The pump was programmed to kick in at 10 p.m., initially as a slow trickle. The flow would ramp up until 4 a.m. before dialing back down again and finishing up at 10 in the morning.

\n\n

If you ask Kuna, this unusual drug regimen, plus the diet he followed and supplements he took as directed by the clinic, is the reason he’s alive today. “I truly believe it’s why I’m still here,” he says. And although a scan from January 2018 revealed two new cancerous spots in his liver, Kuna is confident that, with surgery and more chronotherapy, he could be cancer-free once more. Doctors removed the tumors on April 26.

\n\n

But there’s no proof, without controlled trials, that the therapy as Kuna received it made a difference. Notably, of the other patients whom Kuna befriended at the Block Center, none is alive today. Most chronotherapy strategies now in place are based on a limited understanding of clock biology — which frustrates experts like Dang.

\n\n

“We really want to provide the mechanistic basis of why you treat at a certain time of day,” Dang says, “and not just rely on trial and error.”

\n\n

It’s defining why those little tweaks to common drug regimens improve patient outcomes that captures Dang’s imagination as he stares out the window of the Amtrak train on his semiweekly commute from Philadelphia, where he lives and runs his lab, to New York, for his office job at the Ludwig. Just as a small career move reshaped his own research agenda, “it could be,” he says, “that simple adjustments make a big difference for patients.”

\n\n","field_all_authors":"

By Elie Dolgin 05.01.2018

\n\n","field_author_bios":"

Elie Dolgin is a science writer in Somerville, Massachusetts.

\n\n","field_credit":"CREDIT: BRIAN STAUFFER","field_doi":"10.1146/knowable-050118-014201","field_is_hero":"1","metatags":{"referrer":"origin","title":"How to ruin cancer’s day","description":"By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.","google_plus_name":"How to ruin cancer’s day","og_title":"How to ruin cancer’s day","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/health-disease/2018/how-ruin-cancers-day","dcterms_description":"By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.","dcterms_identifier":"10.1146/knowable-050118-014201","dcterms_publisher":"Annual Reviews","dcterms_title":"How to ruin cancer’s day","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/CancerClocks1600x600_0.png?itok=FlHVbHR4","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Tuesday, May 1, 2018 - 08:00","citation_title":"How to ruin cancer’s day","article_modified_time":"Friday, May 18, 2018 - 13:20","article_published_time":"Tuesday, May 1, 2018 - 08:00","og_description":"By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/CancerClocks1600x600_0.png?itok=FlHVbHR4","og_image_height":"600","og_image_type":"image/png","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/CancerClocks1600x600_0.png?itok=FlHVbHR4","og_image_width":"1600","og_updated_time":"Friday, May 18, 2018 - 13:20","og_url":"/article/health-disease/2018/how-ruin-cancers-day","twitter_cards_description":"By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/CancerClocks1600x600_0.png?itok=FlHVbHR4","twitter_cards_image_height":"600","twitter_cards_image_width":"1600","twitter_cards_page_url":"/article/health-disease/2018/how-ruin-cancers-day","twitter_cards_site":"@knowablemag","twitter_cards_title":"How to ruin cancer’s day","dc_identifier":"10.1146/knowable-050118-014201"},"field_primary_author":"By Elie Dolgin","field_published":"2018-05-01","field_republish_html":"

How to ruin cancer’s day

\n\n

By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.

\n\n

By Elie Dolgin

\n\n

05.01.2018

\n\n

“It’s just always been on the fringe. There weren’t that many card-carrying cancer biologists like me getting into it.”

\nChi Van Dang

\n\n

Until now.

\n\n

\n\n

“Time is an inconvenient truth” — one that oncologists and cancer researchers alike, Dang says, can no longer afford to ignore.

\n\n

Timing is of the essence

\n\n

Cancer never sleeps

\n\n

Peaks and valleys

\n\n

\n\n

Bedtime routine

\n\n

“We still need to identify better biomarkers to personalize chronotherapy.”

\nFrancis Lévi

\n\n

“We really want to provide the mechanistic basis of why you treat at a certain time of day,” Dang says, “and not just rely on trial and error.”

\n\n

10.1146/knowable-050118-014201

\n\n

Elie Dolgin is a science writer in Somerville, Massachusetts.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n $\"Knowable$ \n\n","field_tagline":"By taking advantage of differing circadian rhythms in healthy cells and tumors, researchers hope to add a powerful new tool for treating the disease.","field_xml_enabled":"0"},"relationships":{"field_ar_related_articles":{"data":[{"id":"672","type":"paragraphs"}]},"field_banner":{"data":{"id":"638","type":"images"}},"field_footer_articles":{"data":[{"id":"health-disease/2017/notch-many-paths-cancer","type":"articles"},{"id":"health-disease/2017/can-marriage-make-you-sick","type":"articles"}]},"field_topic":{"data":{"id":"health-disease","type":"topics"}},"field_topics":{"data":[{"id":"health-disease","type":"topics"}]}}},{"id":"health-disease","type":"topics","attributes":{"title":"Health & Disease","bundle":"topics","field_nof":3,"tid":"12","description":"","weight":"0","path":"24","metatags":{"referrer":"origin","title":"Health & Disease | Knowable Magazine | Annual Reviews","description":""},"field_pattern":"pattern-health","field_promote":"1"},"relationships":{"field_featured_articles":{"data":[{"id":"health-disease/2018/adults-and-now-teens-poor-sleep-linked-cardiovascular-risk","type":"articles"},{"id":"health-disease/2018/managing-pain-time-opioid-abuse","type":"articles"},{"id":"health-disease/2018/how-ruin-cancers-day","type":"articles"}]}}},{"id":"712","type":"images","attributes":{"title":"Monarch1600x600.gif","filename":"Monarch1600x600.gif","uri":"public://articles/124/Monarch1600x600_1.gif","styles":{"134_y":"https://www.knowablemagazine.org/sites/default/files/styles/134_y/public/articles/124/Monarch1600x600_1.gif?itok=a2t2O-Wa","1600_600":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/124/Monarch1600x600_1.gif?itok=MxPCv6Mw","285_205":"https://www.knowablemagazine.org/sites/default/files/styles/285_205/public/articles/124/Monarch1600x600_1.gif?itok=sLIzfify","305_220":"https://www.knowablemagazine.org/sites/default/files/styles/305_220/public/articles/124/Monarch1600x600_1.gif?itok=IzpBmV49","400_y":"https://www.knowablemagazine.org/sites/default/files/styles/400_y/public/articles/124/Monarch1600x600_1.gif?itok=apeMb4uj","500_288":"https://www.knowablemagazine.org/sites/default/files/styles/500_288/public/articles/124/Monarch1600x600_1.gif?itok=nHngjCDO","645_552":"https://www.knowablemagazine.org/sites/default/files/styles/645_552/public/articles/124/Monarch1600x600_1.gif?itok=-v5OKiUG","750_y":"https://www.knowablemagazine.org/sites/default/files/styles/750_y/public/articles/124/Monarch1600x600_1.gif?itok=b_rFQETk","large":"https://www.knowablemagazine.org/sites/default/files/styles/large/public/articles/124/Monarch1600x600_1.gif?itok=a6ACY7Jw","linkit_result_thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/linkit_result_thumbnail/public/articles/124/Monarch1600x600_1.gif?itok=24pFRsAi","medium":"https://www.knowablemagazine.org/sites/default/files/styles/medium/public/articles/124/Monarch1600x600_1.gif?itok=LTCHqjaJ","thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/thumbnail/public/articles/124/Monarch1600x600_1.gif?itok=wPSaAX00","gif":"https://www.knowablemagazine.org/sites/default/files/articles/124/Monarch1600x600_1.gif"},"filemime":"image/gif","filesize":"925597","status":"1"}},{"id":"living-world/2018/monarchs-stupendous-migration-dissected","type":"articles","attributes":{"title":"The monarch’s stupendous migration, dissected","nid":"124","created":"1529004496","revision_default":"1","path":"185","body":"

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\n\n","field_all_authors":"

Story by Tim Vernimmen Illustrated by Maki Naro 06.14.2018

\n\n","field_author_bios":"

Tim Vernimmen is a freelance journalist based near Antwerp, Belgium. He writes about the science of life.

\n\n

Maki Naro is an award-winning feral cartoonist and science communicator. You can reliably find him online, where he tweets from the handle @sciencecomic.

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Here’s how scientists figured out those tricks — and what they don’t yet understand.","field_xml_enabled":"1"},"relationships":{"field_ar_related_articles":{"data":[{"id":"755","type":"paragraphs"},{"id":"756","type":"paragraphs"},{"id":"757","type":"paragraphs"}]},"field_banner":{"data":{"id":"712","type":"images"}},"field_collections":{"data":[{"id":"comics","type":"collections"}]},"field_footer_articles":{"data":[{"id":"physical-world/2017/particles-get-move-without-motors","type":"articles"},{"id":"sustainability/2017/plant-reap-repeat-and-now-rethink","type":"articles"}]},"field_import_zip":{"data":{"id":"713","type":"images"}},"field_topic":{"data":{"id":"living-world","type":"topics"}},"field_topics":{"data":[{"id":"living-world","type":"topics"}]}}},{"id":"706","type":"images","attributes":{"title":"P_BordersMap.jpg","filename":"P_BordersMap.jpg","uri":"public://articles/122/P_BordersMap_0.jpg","styles":{"134_y":"https://www.knowablemagazine.org/sites/default/files/styles/134_y/public/articles/122/P_BordersMap_0.jpg?itok=6AoY0GcG","1600_600":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/122/P_BordersMap_0.jpg?itok=pNC8xs5K","285_205":"https://www.knowablemagazine.org/sites/default/files/styles/285_205/public/articles/122/P_BordersMap_0.jpg?itok=5AH5T5Do","305_220":"https://www.knowablemagazine.org/sites/default/files/styles/305_220/public/articles/122/P_BordersMap_0.jpg?itok=OReeCVtz","400_y":"https://www.knowablemagazine.org/sites/default/files/styles/400_y/public/articles/122/P_BordersMap_0.jpg?itok=xvpAu5hz","500_288":"https://www.knowablemagazine.org/sites/default/files/styles/500_288/public/articles/122/P_BordersMap_0.jpg?itok=6ESOwMMX","645_552":"https://www.knowablemagazine.org/sites/default/files/styles/645_552/public/articles/122/P_BordersMap_0.jpg?itok=Z0GXFD80","750_y":"https://www.knowablemagazine.org/sites/default/files/styles/750_y/public/articles/122/P_BordersMap_0.jpg?itok=vixPkgBL","large":"https://www.knowablemagazine.org/sites/default/files/styles/large/public/articles/122/P_BordersMap_0.jpg?itok=-D2KkfgJ","linkit_result_thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/linkit_result_thumbnail/public/articles/122/P_BordersMap_0.jpg?itok=_Fnu1Gek","medium":"https://www.knowablemagazine.org/sites/default/files/styles/medium/public/articles/122/P_BordersMap_0.jpg?itok=xY5xyNnH","thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/thumbnail/public/articles/122/P_BordersMap_0.jpg?itok=psDi1Pi8"},"filemime":"image/jpeg","filesize":"172953","status":"1"}},{"id":"sustainability/2018/effects-fence","type":"articles","attributes":{"title":"Effects of a fence","nid":"122","created":"1528491737","revision_default":"1","path":"181","body":"

\"A — \n
\n
A satellite image shows how a decades-old fence erected between Finland and Norway affected Arctic vegetation by altering the movement of reindeer herds.
\n
\n\n
CREDIT: ANNUAL REVIEW OF ENVIRONMENT AND RESOURCES 2017
\n

\n\n

Fences tend to be invisible on satellite images — you won’t see one in the image above, no matter how much you squint. Yet even without the labels, it would be easy to make out where the governments of Norway and Finland built a border fence back in the 1950s. In atlases, countries are different colors, of course. But in real life? How can that be?

\n\n

The explanation is in the vegetation, says Bruce Forbes, a geoscientist at the University of Lapland in Finland and coauthor of a paper in the Annual Review of Environment and Resources on ways that people are altering ecology in the Arctic. “Since this is a satellite image, the colors are false,” Forbes first says of this 2001 picture, plucked from the paper. But, he adds, the hues represent real wavelengths of light, some of them invisible to the human eye. And their patterns reveal large differences in the local vegetation that might spell trouble for the future.

\n\n

Forbes knows what the colors correspond to, since he’s been out in the field many times to check what the satellite data mean and to conduct experiments. The black areas, he explains, are bodies of water. The red patches are covered in mosses and vascular plants such as grasses, sedges and shrubs — most of them in low-lying wetlands. Brightness reveals vegetation quality: Dull red means plants are short, while intense red indicates a certain lushness — usually tall shrubs. “That really bright-red patch next to the lake north of the fence? That’s the lushest vegetation,” Forbes points out. “Those willow shrubs may reach up to my waist.” (In most of the Arctic, willows never make it to full tree size.)

\n\n

South of the fence, the duller red indicates that most willows in northern Finland aren’t even shrub-sized. They’ve been grazed down to the ground by reindeer, which are present in higher densities in northern Finland than they are on the other side of the fence, in Norway. But perhaps we shouldn’t weep for the willow, nor rein in the reindeer. Many scientists and environmentalists have expressed concern that rapid climate warming may cause Arctic shrubs to thrive, resulting in a “shrubification” of the landscape.

\n\n

Such shrubification might give rise to a vicious cycle, Forbes says. Since shrubs are darker than the other Arctic vegetation, they absorb more sunlight. This may cause more snow to melt more rapidly. If that happens, the surface will become even darker, and that could speed up warming even more. Grazing reindeer may help to nip shrubification in the bud, which could slow down local warming trends.

\n\n

But there’s a problem: Reindeer throughout the Arctic are struggling due to climate change.

\n\n

“Warmer temperatures mean that the air is more humid,” says Forbes. “This leads to more snowfall, which makes it harder for the reindeer to dig up the lichens they feed on in winter. It might even rain on the snow, which can then freeze over and turn into ice that the reindeer can’t dig through.” This has caused the deaths of tens of thousands of reindeer across the Arctic in recent decades.

\n\n

\"Grazing — \n
\n
Grazing reindeer in Finnish Lapland.
\n
\n\n
CREDIT: TATU EERO ANTON LAJUNEN / ALAMY STOCK PHOTO
\n

\n\n

And there’s more. In northern Finland, other problems compromise the reindeer’s ability to find food in winter. Again, the satellite image tells the story: Grayish areas on the Finnish side of the fence are mostly bare ground — the lichens gone, trampled by reindeer in the summer when they are dry and brittle and crumble very easily.

\n\n

It looks, then, as if the fence has at least protected the lichens of Arctic Norway, by keeping the lichen-stomping reindeer out. But it’s not so simple, Forbes says. Once upon a time, the reindeer would migrate north and south at will, and would hang around in northern Finland only in the winter. Come summer, they’d head further north to forage in the wetlands on the coast of Norway. The result was that fewer lichens got trampled, both in Finland and Norway.

\n\n

Then came the building of the fence, part of a 1950s government effort to enforce the borders and compel the local Sámi herders — who used to follow the migrating reindeer — to settle. And so the migration route was blocked.

\n\n

The most obvious solution might be to remove the fence and allow the reindeer (and herders) to migrate as they traditionally used to. But Forbes thinks that is unlikely to happen: “I’m afraid the border fences are there to stay,” he says. So what can be done? Forbes believes the Sámi could still help to make reindeer herding more sustainable — if policymakers would consult them more often. And if damage to lichens could be minimized, grazing reindeer might be an eco-friendly way to keep shrubification at bay.

\n\n

Indeed, some spots where shrubification is on the rise used to have more reindeer herding, and today’s lusher vegetation may be due, in part, to the local disappearance of this traditional way of life. But climate change is also important, as there are changes all across the Arctic. “Arctic ecosystems change at a fairly glacial pace,” says Signe Normand, an ecologist at Aarhus University in Denmark and first author of the review article. “They are slow to respond to new conditions and slow to recover when disturbed.” That lag between our actions and their consequences buys some time to intervene, she says. “But it can also make us complacent.”

\n\n","field_all_authors":"

By Tim Vernimmen 06.08.2018

\n\n","field_author_bios":"

Tim Vernimmen is a freelance journalist based near Antwerp, Belgium. He writes about the science of life.

\n\n","field_banner_alt":"A satellite image shows how a decades' old fence erected between Finland and Norway has affected Arctic vegetation by altering the movement of reindeer herds.      ","field_banner_title":"Satellite image of Arctic","field_doi":"10.1146/knowable-060818-095801","field_headline":"Story Behind a Picture","field_headline_url":{"arguments":["collection","story-behind-picture"],"type":"client"},"field_is_hero":"0","metatags":{"referrer":"origin","title":"Effects of a fence","description":"A satellite image reveals how humans and their herds are changing the Arctic from the ground up","google_plus_name":"Effects of a fence","og_title":"Effects of a fence","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/sustainability/2018/effects-fence","dcterms_description":"A satellite image reveals how humans and their herds are changing the Arctic from the ground up","dcterms_identifier":"10.1146/knowable-060818-095801","dcterms_publisher":"Annual Reviews","dcterms_title":"Effects of a fence","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"A satellite image reveals how humans and their herds are changing the Arctic from the ground up","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/122/P_BordersMap_0.jpg?itok=pNC8xs5K","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Friday, June 8, 2018 - 08:00","citation_title":"Effects of a fence","article_modified_time":"Thursday, September 6, 2018 - 12:38","article_published_time":"Friday, June 8, 2018 - 08:00","og_description":"A satellite image reveals how humans and their herds are changing the Arctic from the ground up","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/122/P_BordersMap_0.jpg?itok=pNC8xs5K","og_image_height":"766","og_image_type":"image/jpeg","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/122/P_BordersMap_0.jpg?itok=pNC8xs5K","og_image_width":"1020","og_updated_time":"Thursday, September 6, 2018 - 12:38","og_url":"/article/sustainability/2018/effects-fence","twitter_cards_description":"A satellite image reveals how humans and their herds are changing the Arctic from the ground up","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/122/P_BordersMap_0.jpg?itok=pNC8xs5K","twitter_cards_image_height":"766","twitter_cards_image_width":"1020","twitter_cards_page_url":"/article/sustainability/2018/effects-fence","twitter_cards_site":"@knowablemag","twitter_cards_title":"Effects of a fence","dc_identifier":"10.1146/knowable-060818-095801"},"field_primary_author":"By Tim Vernimmen","field_published":"2018-06-08","field_republish_html":"

Story Behind a Picture

\n\n

Effects of a fence

\n\n

A satellite image reveals how humans and their herds are changing the Arctic from the ground up

\n\n

By Tim Vernimmen

\n\n

06.08.2018

\n\n

But there’s a problem: Reindeer throughout the Arctic are struggling due to climate change.

\n\n

Then came the building of the fence, part of a 1950s government effort to enforce the borders and compel the local S�mi herders — who used to follow the migrating reindeer — to settle. And so the migration route was blocked.

\n\n

The most obvious solution might be to remove the fence and allow the reindeer (and herders) to migrate as they traditionally used to. But Forbes thinks that is unlikely to happen: “I’m afraid the border fences are there to stay,” he says. So what can be done? Forbes believes the S�mi could still help to make reindeer herding more sustainable — if policymakers would consult them more often. And if damage to lichens could be minimized, grazing reindeer might be an eco-friendly way to keep shrubification at bay.

\n\n

10.1146/knowable-060818-095801

\n\n

Tim Vernimmen is a freelance journalist based near Antwerp, Belgium. He writes about the science of life.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n\n

$\"Knowable$

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We’ve known for a long time that viruses aren’t all bad. Many just hitchhike through living organisms without causing any problems. And some are beneficial, even necessary, for life on Earth. We wouldn’t be here without them, says Marylin Roossinck of Pennsylvania State University.

\n\n

Roossinck loves viruses so much she wrote the book “Virus: An Illustrated Guide to 101 Incredible Microbes” (Princeton University Press, 2016). She also coauthored the article “Symbiosis: Viruses as Intimate Partners,” in the 2017 Annual Review of Virology.

\n\n\n\n

And the association is intimate. Viruses can only survive by entering and copying themselves inside a living cell. They use the machinery of the host cell to replicate their genetic material and produce more viral particles.

\n\n

More than 200 kinds of viruses are known to infect people, and scientists estimate that a few hundred thousand infect other mammals. Add in those that infect plants, bacteria and other organisms, and viruses are big players in the biosphere. Overall, scientists propose there are 10³¹ individual viruses on the planet — that’s 10 nonillion of them.

\n\n

Knowable Magazine caught up with Roossinck to ask about how viruses benefit plants and people, and to discuss the plant viruses she’s most excited about right now.

\n\n

Why do you, personally, study viruses?

\n\n

I fell in love with viruses when I was an undergraduate student, taking a microbiology course. A virus of bacteria called lambda was the first virus I met, and it looked so cool, like a little spaceship. I was amazed at the intricacy of their relationships with their hosts and I made a decision, at that moment, that I was going to be a virologist. I still love them. They’re just amazing.

\n\n

What do we know today about viral numbers and diversity on Earth?

\n\n

Viruses are the most abundant and diverse beings on the planet, and they’re found everywhere. We probably still know only a small fraction of the viruses that exist, but we’re learning more every day. We keep accumulating more and more virus-like genetic sequences from what are called metagenomics studies — where scientists are just sampling everything in an environment.

\n\n

What we are really lacking is an understanding of what any of these things we’ve sequenced do, or how they might be related to each other. Often, we don’t even know what their host is.

\n\n

Do we have any idea how many viruses a single person hosts at a given time?

\n\n

That’s a tough question to answer these days. Scientists are finding lots and lots of viruses in metagenomics studies of the human gut, and a lot of these viruses are probably infecting the bacteria in the gut, rather than the person’s cells. I wouldn’t like to put a number on it, but when people ask I usually say, “a bazillion.” We don’t know, there’s a lot.

\n\n

And do we know how many viruses are bad, good or neutral for their host?

\n\n

I like to say 1 percent are pathogens, which harm their host, but I think that’s probably a very high estimate. That’s based on early studies with simian [ape and monkey] viruses, which were studied a lot during early days in molecular virology. There were 80-something of these simian viruses they discovered and they were numbered SV1, SV2, etc. Of those, SV40 is the only one that’s had very much study done, and that’s because it turned out to be a pathogen, causing tumors in mice. None of the rest of them had any effect on the host they were tested in. That’s where I get my “about 1 percent.”

\n\n

You were originally inspired by bacterial viruses, but in your research today, do you have a favorite virus, or one that particularly interests you?

\n\n

I would say, more like a favorite class of viruses. For the last few years I’ve become really fascinated with what are called “persistent plant viruses.” This is largely because when I was doing virus discovery work, we found they were the most common type of viruses in wild plants. They’re also very common in crops, but nobody had studied them very much.

\n\n

These are viruses that have infected their hosts for, probably, thousands of years. They’re passed, through the seed, into the next generation, and then they infect every single cell in the host. They don’t pass between adult plants, so far as we know.

\n\n

They’re usually found in pretty low numbers, and we don’t know very much about what they do. In some cases, we know they benefit the plant. For example, white clover cryptic virus affects nodulation in legumes. Legumes normally form nodules of bacteria, in their roots, to help them take up nitrogen from the atmosphere. But doing so is costly for the plant. In virus-infected legumes, when there’s enough nitrogen in the soil, then they don’t form nodules, and that’s a benefit to the plant.

\n\n

\n\n

We’ve been studying another one called pepper cryptic virus. It’s a very hard thing to prove, but it seems like virus-infected seeds have a lot longer longevity than uninfected ones. After a couple of years, the uninfected seeds don’t germinate, whereas the infected cells last for many years.

\n\n

Because these kinds of viruses are in a lot of crop plants, we think they probably confer some benefit, like perhaps that longevity, that made farmers breed and plant them during early agriculture.

\n\n

What are some other ways viruses benefit their hosts?

\n\n

Many plant viruses confer drought tolerance or cold tolerance to plants. We don’t always know how this works but, for example, elevated sugar is very common in virus-infected plants. More sugar would allow the plant cells to retain more water, protecting them from drought. And you know, things that are really sweet freeze slowly, so extra sugar would make plants cold-resistant.

\n\n

And in animals, actually in mice, herpes viruses confer resistance against bubonic plague. That’s because the herpes virus, dormant in the mouse, turns up the mouse’s immune system and makes it better able to fight the plague.

\n\n

Similarly, in people, hepatitis G virus may offer some protection against AIDS. Hepatitis G, now called pegivirus or GB virus C, is quite common in humans, and isn’t known to cause any disease. But it does affect the immune system in a variety of ways. If people are infected with hepatitis G first, and then HIV, it takes longer for it the HIV to progress to AIDS.

\n\n

Some viruses even become an integral part of their host, with their genes incorporated into the host’s DNA. Can you give some examples of that?

\n\n

We call that symbiogenesis. “Symbiogenesis” has been used to refer to things like the mitochondria or chloroplasts, that were of bacterial origin and then were involved in the evolution of eukaryotic life. But the more genomes we sequence, the more we find viruses. And not just retroviruses, which we know integrate into host genomes during their normal life cycle, but all kinds of RNA viruses, small DNA viruses. There are lots of things that viruses could do in a host genome. For example, they might turn genes on or off.

\n\n

I think the very first example of symbiogenesis that was studied by scientists has to do with the breakdown of starches by our saliva. Most of us did this little experiment in elementary school: You chew bread until it turns sweet. That’s because an enzyme called amylase, in our saliva, breaks the starch down into sugars. A more obvious place for amylase is in the gut, to break down food. The reason it’s made in the salivary glands too is because viral genetic material integrated in front of the amylase gene, and turns it on in salivary glands.

\n\n

The most dramatic example of symbiogenesis is in the evolution of the mammalian placenta. A protein called syncytin fuses cells together to make a placenta, and it evolved from a virus protein. So the gene for this protein, normally part of the membrane that surrounds a virus, integrated into the mammalian genome during the evolution of the placenta.

\n\n

What else is in the future for virology?

\n\n

I would say that in the future, we’re going to find a lot of things that we can use viruses for, as beneficial agents. For example, I know there is some work going on right now to use viruses to get rid of bacteria that are infecting crop plants.

\n\n

But the biggest obstacle, I would say, is that people are still a little afraid of viruses. If you say to somebody, “Why don’t you ingest some hepatitis G virus because it would protect you from AIDS?” — you know, probably nobody’s going to do it. Even among some virologists, that bias against viruses is still a hurdle.

\n\n

You have written that viruses are central to life. Can you imagine what would a virus-free world look like?

\n\n

There wouldn’t be a world. I think that viruses are probably remnants of the original life form. It’s high time they got the credit they’re due.

\n\n","field_all_authors":"

By Amber Dance 05.23.2018

\n\n","field_author_bios":"

Amber Dance has a healthy respect for viruses.

\n\n","field_banner_alt":"Bacteriophage","field_banner_title":" Bacteriophage virus attacks a bacterium.","field_caption":"

Viruses are everywhere, even on other microbes. A phage virus infects a bacterial cell in this illustration.

\n\n","field_credit":"CREDIT: THIERRY BERROD, MONA LISA PRODUCTION / SCIENCE SOURCE","field_doi":"10.1146/knowable-052318-085601","field_headline":"Q&A — Viral ecologist Marilyn Roossinck","field_headline_url":{"arguments":["collection","qa"],"type":"client"},"field_is_hero":"1","metatags":{"referrer":"origin","title":"Why viruses deserve a better reputation","description":"Sure they cause disease, but the microbes can be a help as well. Witness long-lasting pepper seeds, drought-resistant crop plants and even our own placentas.","google_plus_name":"Why viruses deserve a better reputation","og_title":"Why viruses deserve a better reputation","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/living-world/2018/why-viruses-deserve-better-reputation","dcterms_description":"Sure they cause disease, but the microbes can be a help as well. Witness long-lasting pepper seeds, drought-resistant crop plants and even our own placentas.","dcterms_identifier":"10.1146/knowable-052318-085601","dcterms_publisher":"Annual Reviews","dcterms_title":"Why viruses deserve a better reputation","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"Sure they cause disease, but the microbes can be a help as well. Witness long-lasting pepper seeds, drought-resistant crop plants and even our own placentas.","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/116/GoodGuyVirus1600x600_3.jpg?itok=EtL0E930","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Wednesday, May 23, 2018 - 08:00","citation_title":"Why viruses deserve a better reputation","article_modified_time":"Thursday, September 6, 2018 - 12:34","article_published_time":"Wednesday, May 23, 2018 - 08:00","og_description":"Sure they cause disease, but the microbes can be a help as well. Witness long-lasting pepper seeds, drought-resistant crop plants and even our own placentas.","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/116/GoodGuyVirus1600x600_3.jpg?itok=EtL0E930","og_image_height":"600","og_image_type":"image/jpeg","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/116/GoodGuyVirus1600x600_3.jpg?itok=EtL0E930","og_image_width":"1600","og_updated_time":"Thursday, September 6, 2018 - 12:34","og_url":"/article/living-world/2018/why-viruses-deserve-better-reputation","twitter_cards_description":"Sure they cause disease, but the microbes can be a help as well. Witness long-lasting pepper seeds, drought-resistant crop plants and even our own placentas.","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/116/GoodGuyVirus1600x600_3.jpg?itok=EtL0E930","twitter_cards_image_height":"600","twitter_cards_image_width":"1600","twitter_cards_page_url":"/article/living-world/2018/why-viruses-deserve-better-reputation","twitter_cards_site":"@knowablemag","twitter_cards_title":"Why viruses deserve a better reputation","dc_identifier":"10.1146/knowable-052318-085601"},"field_primary_author":"By Amber Dance","field_published":"2018-05-23","field_republish_html":"

Q&A — Viral ecologist Marilyn Roossinck

\n\n

Why viruses deserve a better reputation

\n\n

Sure they cause disease, but the microbes can be a help as well. Witness long-lasting pepper seeds, drought-resistant crop plants and even our own placentas.

\n\n

By Amber Dance

\n\n

05.23.2018

\n\n

\n\n\n

\n\n

More than 200 kinds of viruses are known to infect people, and scientist estimate that a few hundred thousand infect other mammals. Add in those that infect plants, bacteria and other organisms, and viruses are big players in the biosphere. Overall, scientists propose there are 10³¹ individual viruses on the planet — that’s 10 nonillion of them.

\n\n

Knowable Magazine caught up with Roossinck to ask about how viruses benefit plants and people, and to discuss the plant viruses she’s most excited about right now.

\n\n

Why do you, personally, study viruses?

\n\n

What do we know today about viral numbers and diversity on Earth?

\n\n

What we are really lacking is an understanding of what any of these things we’ve sequenced do, or how they might be related to each other. Often, we don’t even know what their host is.

\n\n

Do we have any idea how many viruses a single person hosts at a given time?

\n\n

And do we know how many viruses are bad, good or neutral for their host?

\n\n

You were originally inspired by bacterial viruses, but in your research today, do you have a favorite virus, or one that particularly interests you?

\n\n

Because these kinds of viruses are in a lot of crop plants, we think they probably confer some benefit, like perhaps that longevity, that made farmers breed and plant them during early agriculture.

\n\n

What are some other ways viruses benefit their hosts?

\n\n

Some viruses even become an integral part of their host, with their genes incorporated into the host’s DNA. Can you give some examples of that?

\n\n

What else is in the future for virology?

\n\n

You have written that viruses are central to life. Can you imagine what would a virus-free world look like?

\n\n

There wouldn’t be a world. I think that viruses are probably remnants of the original life form. It’s high time they got the credit they’re due.

\n\n

10.1146/knowable-052318-085601

\n\n

Amber Dance has a healthy respect for viruses.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n\n

$\"Knowable$

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Almost anybody who has ever thought deeply about the universe sooner or later wonders if there is more than one of them. Whether a multiplicity of universes — known as a multiverse — actually exists has been a contentious issue since ancient times. Greek philosophers who believed in atoms, such as Democritus, proposed the existence of an infinite number of universes. But Aristotle disagreed, insisting that there could be only one.

\n\n

Today a similar debate rages over whether multiple universes exist. In recent decades, advances in cosmology have implied (but not proved) the existence of a multiverse. In particular, a theory called inflation suggests that in the instant after the Big Bang, space inflated rapidly for a brief time and then expanded more slowly, creating the vast bubble of space in which the Earth, sun, Milky Way galaxy and billions of other galaxies reside today. If this inflationary cosmology theory is correct, similar big bangs occurred many times, creating numerous other bubbles of space like our universe.

\n\n

Properties such as the mass of basic particles and the strength of fundamental forces may differ from bubble to bubble. In that case, the popular goal pursued by many physicists of finding a single theory that prescribes all of nature’s properties may be in vain. Instead, a multiverse may offer various locales, some more hospitable to life than others. Our universe must be a bubble with the right combination of features to create an environment suitable for life, a requirement known as the anthropic principle.

\n\n\n\n

But many scientists object to the idea of the multiverse and the anthropic reasoning it enables. Some even contend that studying the multiverse doesn’t count as science. One physicist who affirms that the multiverse is a proper subject for scientific investigation is John Donoghue of the University of Massachusetts, Amherst.

\n\n

As Donoghue points out in the 2016 Annual Review of Nuclear and Particle Science, the Standard Model of Particle Physics — the theory describing the behavior of all of nature’s basic particles and forces — does not specify all of the universe’s properties. Many important features of nature, such as the masses of the particles and strengths of the forces, cannot be calculated from the theory’s equations. Instead they must be measured. It’s possible that in other bubbles, or even in distant realms within our bubble but beyond the reach of our telescopes, those properties might be different.

\n\n

Maybe some future theory will show why nature is the way it is, Donoghue says, but maybe reality does encompass multiple possibilities. The true theory describing nature might permit many stable “ground states,” corresponding to the different cosmic bubbles or distant realms of space with different physical features. A multiverse of realms with different ground states would support the view that the universe’s habitability can be explained by the anthropic principle — we live in the realm where conditions are suitable — and not by a single theory that specifies the same properties everywhere.

\n\n\n\n

Knowable Magazine quizzed Donoghue about the meaning of the multiverse, the issues surrounding anthropic reasoning and the argument that the idea of a multiverse is not scientific. His answers have been edited for brevity and clarity.

\n\n

Can you explain just what you mean by multiverse?

\n\n

For me, at least, the multiverse is the idea that physically out there, beyond where we can see, there are portions of the universe that have different properties than we see locally. We know the universe is bigger than we can see. We don’t know how much bigger. So the question is, is it the same everywhere as you go out or is it different?

\n\n

If there is a multiverse, is the key point not just the existence of different realms, but that they differ in their properties in important ways?

\n\n

If it’s just the same all the way out, then the multiverse is not relevant. The standard expectation is that aside from random details — like here’s a galaxy, there’s a galaxy, here’s empty space — that it’s more or less uniform everywhere in the greater universe. And that would happen if you have a theory like the Standard Model where there’s basically just one possible way that the model looks. It looks the same everywhere. It couldn’t be different.

\n\n\n\n

\n\n

Isn’t that what most physicists would hope for?

\n\n

Probably literally everyone’s hope is that we would someday find a theory and all of a sudden everything would become clear — there would be one unique possibility, it would be tied up, there would be no choice but this was the theory. Everyone would love that.

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But the Standard Model does not actually specify all the numbers describing the properties of nature, right?

\n\n

The structure of the Standard Model is fixed by a symmetry principle. That’s the beautiful part. But within that structure there’s freedom to choose various quantities like the masses of the particles and the charges, and these are the parameters of the theory. These are numbers that are not predicted by the theory. We’ve gone out and we’ve measured them. We would like eventually that those are predicted by some other theory. But that’s the question, whether they are predicted or whether they are in some sense random choices in a multiverse.

\n\n

The example I use in the paper is the distance from the Earth to the sun. If you were studying the solar system, you’d see various regularities and a symmetry, a spherically symmetrical force. The fact that the force goes like 1 over the radius squared is a consequence of the underlying theory. So you might say, well, I want to predict the radius of the Earth. And Kepler tried to do this and came up with a very nice geometric construction, which almost worked. But now we know that this is not something fundamental — it’s an accident of the history. The same laws that give our solar system with one Earth-to-sun distance will somewhere else give a different solar system with a different distance for the planets. They’re not predictable. So the physics question for us then is, are the parameters like the mass of the electron something that’s fundamentally predictable from some more fundamental theory, or is it the accident of history in our patch of the universe?

\n\n

How does the possibility of a multiverse affect how we interpret the numbers in the Standard Model?

\n\n

We’ve come to understand how the Standard Model produces the world. So then you could actually ask the scientific question: What if the numbers in the Standard Model were slightly different? Like the mass of the electron or the charge on the electron. One of the surprises is, if you make very modest changes in these parameters, then the world changes dramatically. Why does the electron have the mass it does? We don’t know. If you make it three times bigger, then all the atoms disappear, so the world is a very, very different place. The electrons get captured onto protons and the protons turn into neutrons, and so you end up with a very strange universe that’s very different from ours. You would not have any chance of having life in such a universe.

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Are there other changes in the Standard Model numbers that would have such dramatic effects?

\n\n

My own contribution here is about the Higgs field [the field that is responsible for the Higgs boson]. It has a much smaller value than its expected range within the Standard Model. But if you change it by a bit, then atoms don’t form and nuclei don’t form — again, the world changes dramatically. My collaborators and I were the ones that pointed that out.

\n\n

There’s some maybe six or seven of these constraints — parameters of the Standard Model that have to be just so in order to satisfy the need for atoms, the need for stars, planets, et cetera. So about six combinations of the parameters are constrained anthropically.

\n\n

By “anthropically,” you mean that these parameters are constrained to narrow values in order to have a universe where life can exist. That is an old idea known as the anthropic principle, which has historically been unpopular with many physicists.

\n\n

Yes, I think almost anybody would prefer to have a well-developed theory that doesn’t have to invoke any anthropic reasoning. But nevertheless it’s possible that these types of theories occur. To not consider them would also be unscientific. So you’re forced into looking at them because we have examples where it would occur.

\n\n

Historically there’s a lot of resistance to anthropic reasoning, because at least the popular explanations of it seem to get causality backwards. It was sort of saying that we [our existence] determine the parameters of the universe, and that didn’t feel right. The modern version of it, with the multiverse, is more physical in the sense that if you do have these differing domains with different parameters, we would only find ourselves in one that allows atoms and nuclei. So the causality is right. The parameters are such that we can be here. The modern view is more physical.

\n\n

If there is a multiverse, then doesn’t that change some of the goals of physics, such as the search for a unified theory of everything, and require some sort of anthropic reasoning?

\n\n

What we can know may depend on things that may end up being out of our reach to explore. The idea that we should be searching for a unified theory that explains all of nature may in fact be the wrong motivation. It’s certainly true that multiverse theories raise the possibility that we will never be able to answer these questions. And that’s disturbing.

\n\n

Does that mean the multiverse changes some of the questions that physicists should be asking?

\n\n

We certainly still should be trying to answer “how” questions about how does the W boson decay or the Higgs boson, how does it decay, to try to get our best description of nature. And we have to realize we may not be able to get the ultimate theory because we may not be able to probe enough of the universe to answer certain questions. That’s a discouraging feature. I have to admit when I first heard of anthropic reasoning in physics my stomach sank. It kills some of the things that you’d like to do.

\n\n

Don’t some people even argue that though a multiverse would seem to justify anthropic reasoning, that approach should still be regarded as not scientific?

\n\n

It’s one of the things that bothers me about the discussion. Just because you feel bad about the multiverse, and just because some aspects of it are beyond reach for testing, doesn’t mean that it’s wrong. So if it’s worth considering, and looking within the class of multiverse theories to see what it is that we could know, how does it change our motivations? How does it change the questions that we ask? And to say that the multiverse is not science is itself not science. You’re not allowing a particular physical type of theory, a possible physical theory, that you’re throwing out on nonscientific grounds. But it does raise long-term issues about how much we could understand about the ultimate theory when we can just look locally. It’s science, it’s sometimes a frustrating bit of science, but we have to see what ideas become fruitful and what happens.

\n\n

An important part of investigating the multiverse is finding a theory that includes multiple “ground states.” What does that mean?

\n\n

The ground state is the state that you get when you take all the energy out of a system. Normally if you take away all the particles, that’s your ground state — all the background fields, the things that permeate space. The ground state is described by the Standard Model. Its ground state tells you exactly what particles will look like when you put them back in; they will have certain masses and certain charges.

\n\n

You could imagine that there are theories which have more than one ground state, and if you put particles in this state they look one way and if you put particles in another state they look another way — they might have different masses. The multiverse corresponds to the hypothesis that there are very many ground states, lots and lots of them, and in the bigger universe they are realized in different parts of the universe.

\n\n\n\n

\"Kepler's — In the early 1600s, German astronomer Johannes Kepler sought a mathematical theory for explaining the distances of the six known planets from the sun. He found his answer in the ratios of geometrical solids, or polyhedra. By embedding one within another, Kepler showed that their dimensions roughly corresponded to the planetary distances. But he didn’t know about other planets and other solar systems; planetary distances differ from star to star and are determined by local conditions, not a mathematical formula. Some scientists today think that the properties of the universe are similarly not determined by a formula, but they differ in different realms of space composing a multiverse.
\n\n
CREDIT: NORTH WIND PICTURE ARCHIVES / ALAMY STOCK PHOTO
\n\n

\n\n

Even if a theory of particles and forces can accommodate multiple ground states, don’t you need a method of creating those ground states?

\n\n

Two features have to happen. You have to have the possibility of multiple ground states, and then you have to have a mechanism to produce them. In our present theories, producing them is easier, because inflationary cosmology has the ability to do this. Finding theories that have enough ground states is a more difficult requirement. But that’s a science question. Is there one, is there two, is there a lot?

\n\n

Superstring theory encompasses multiple ground states, described as the “string landscape.” Is that an example of the kind of theory that might imply a multiverse?

\n\n

The string landscape is one of the ways we know that this [multiple ground states] is a physical possibility. You can start counting the number of states in string theory, and you get a very enormous number, 10 to the 500. So we have at least one theory that has this property of having a very large number of ground states. And there could be more. People have tried cooking up other theories that have that possibility also. So it is a physical possibility.

\n\n

Don’t critics say that neither string theory nor inflationary cosmology has been definitely established?

\n\n

That’s true of all theories beyond the Standard Model. None of them are established yet. So we can’t really say with any confidence that there is a multiverse. It’s a physical possibility. It may be wrong. But it still may be right.

\n\n","field_all_authors":"

By Tom Siegfried 04.26.2018

\n\n","field_author_bios":"

Tom Siegfried is a science writer and editor in the Washington, DC, area. He writes the Context blog for Science News and is at work on a book about the history of the multiverse.

\n\n","field_banner_alt":"Artist's imagining of a multiverse ","field_banner_title":"Multiverse art","field_caption":"

No one knows if the universe is uniform in its physics throughout its expanse. If not, multiple physical realities may exist in many universes, as imagined in this illustration.

\n\n","field_credit":"CREDIT: IDA VIGGIANI ","field_doi":"10.1146/knowable-042618-070001","field_headline":"Q&A — Theoretical physicist John Donoghue","field_headline_url":{"arguments":["collection","qa"],"type":"client"},"field_is_hero":"1","metatags":{"referrer":"origin","title":"Making sense of many universes","description":"The idea of a multiverse — multiple realms of space differing in basic properties of physics — bugs some scientists. Others find it a real possibility that should not be ignored.","google_plus_name":"Making sense of many universes","og_title":"Making sense of many universes","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/physical-world/2018/making-sense-many-universes","dcterms_description":"The idea of a multiverse — multiple realms of space differing in basic properties of physics — bugs some scientists. Others find it a real possibility that should not be ignored.","dcterms_identifier":"10.1146/knowable-042618-070001","dcterms_publisher":"Annual Reviews","dcterms_title":"Making sense of many universes","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"The idea of a multiverse — multiple realms of space differing in basic properties of physics — bugs some scientists. Others find it a real possibility that should not be ignored.","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/Multiverse1600x600.jpg?itok=AAWsrTuw","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Thursday, April 26, 2018 - 08:00","citation_title":"Making sense of many universes","article_modified_time":"Thursday, September 6, 2018 - 12:34","article_published_time":"Thursday, April 26, 2018 - 08:00","og_description":"The idea of a multiverse — multiple realms of space differing in basic properties of physics — bugs some scientists. Others find it a real possibility that should not be ignored.","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/Multiverse1600x600.jpg?itok=AAWsrTuw","og_image_height":"600","og_image_type":"image/jpeg","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/Multiverse1600x600.jpg?itok=AAWsrTuw","og_image_width":"1600","og_updated_time":"Thursday, September 6, 2018 - 12:34","og_url":"/article/physical-world/2018/making-sense-many-universes","twitter_cards_description":"The idea of a multiverse — multiple realms of space differing in basic properties of physics — bugs some scientists. Others find it a real possibility that should not be ignored.","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/Multiverse1600x600.jpg?itok=AAWsrTuw","twitter_cards_image_height":"600","twitter_cards_image_width":"1600","twitter_cards_page_url":"/article/physical-world/2018/making-sense-many-universes","twitter_cards_site":"@knowablemag","twitter_cards_title":"Making sense of many universes","dc_identifier":"10.1146/knowable-042618-070001"},"field_primary_author":"By Tom Siegfried","field_published":"2018-04-26","field_republish_html":"

Q&A — Theoretical physicist John Donoghue

\n\n

Making sense of many universes

\n\n

The idea of a multiverse — multiple realms of space differing in basic properties of physics — bugs some scientists. Others find it a real possibility that should not be ignored.

\n\n

By Tom Siegfried

\n\n

04.26.2018

\n\n

\n\n\n

\n\n

Can you explain just what you mean by multiverse?

\n\n

If there is a multiverse, is the key point not just the existence of different realms, but that they differ in their properties in important ways?

\n\n

\n\n

Isn’t that what most physicists would hope for?

\n\n

But the Standard Model does not actually specify all the numbers describing the properties of nature, right?

\n\n

How does the possibility of a multiverse affect how we interpret the numbers in the Standard Model?

\n\n

Are there other changes in the Standard Model numbers that would have such dramatic effects?

\n\n

By “anthropically,” you mean that these parameters are constrained to narrow values in order to have a universe where life can exist. That is an old idea known as the anthropic principle, which has historically been unpopular with many physicists.

\n\n

If there is a multiverse, then doesn’t that change some of the goals of physics, such as the search for a unified theory of everything, and require some sort of anthropic reasoning?

\n\n

Does that mean the multiverse changes some of the questions that physicists should be asking?

\n\n

Don’t some people even argue that though a multiverse would seem to justify anthropic reasoning, that approach should still be regarded as not scientific?

\n\n

An important part of investigating the multiverse is finding a theory that includes multiple “ground states.” What does that mean?

\n\n

Even if a theory of particles and forces can accommodate multiple ground states, don’t you need a method of creating those ground states?

\n\n

Superstring theory encompasses multiple ground states, described as the “string landscape.” Is that an example of the kind of theory that might imply a multiverse?

\n\n

Don’t critics say that neither string theory nor inflationary cosmology has been definitely established?

\n\n

10.1146/knowable-042618-070001

\n\n

Tom Siegfried is a science writer and editor in the Washington, DC, area. He writes the Context blog for Science News and is at work on a book about the history of the multiverse.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n\n

$\"Knowable$

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Some 4.5 billion years ago, the solar system was a nursery full of planetary toddlers.

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Around the young sun swirled a disk of gas and dust left over from the solar system’s birth. Studded within the orbiting disk were planetesimals, rocky objects roughly 1 to 100 kilometers across, and bigger protoplanets some 1,000 kilometers wide. It was as if a bunch of children of different sizes were corralled into the same room.

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Like any nursery, it was a rowdy place. Planetesimals whizzed past, and occasionally smashed into, one another. Fragments of dust and rock raced through the disaster zone. It took a few million years for the preschool chaos to settle down and the bulk of today’s planets to emerge.

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Scientists used to think that planets formed as planetesimals collided and merged, like fistfuls of Play-Doh slapped together. But it turns out that that process would have taken too long. So astronomers recently proposed a new way to explain how baby planets grew.

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Computer simulations show that small pebbles within the dusty disk would have glommed onto the growing protoplanets. Those tiny pebbles coalesced so rapidly that the protoplanets grew quickly into full-fledged planets — like a kid suddenly packing on enough pounds to become an adult.

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This theory, known as pebble accretion, is reshaping how scientists think about the early solar system. It also opens new research directions, such as exploring how planets form around stars other than the sun. “You can form these bodies easily and quickly,” says Michiel Lambrechts, an astronomer at Lund University in Sweden and coauthor of the theory. “Pebble accretion provides a solution to so many problems.”

\n\n

Chief among those problems is how planets could form before the dusty disk ran out of the raw ingredients needed to make them. Models suggest that the disk would have cleared itself out in about 1 million to 10 million years as its gas evaporated and its dust spiraled into the gravitational pull of the newborn sun. The biggest planets, such as Jupiter and Saturn, somehow packed together a core of about 10 Earth masses before the disk vanished. Making planets from planetesimals would have simply taken too long, since planetesimals typically whiz past a baby planet without being captured by its gravity.

\n\n\n\n

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Pebbles, on the other hand, are easily captured by a protoplanet’s gravity, and their accumulation could build a planet in just a million years or so. Astronomers know that such pebbles exist, because they have seen them orbiting infant stars. Radio telescopes such as the Very Large Array near Socorro, New Mexico, have measured the size of particles in protoplanetary disks by the way the material glows in radio wavelengths. The disks often contain huge numbers of pebbles — in some cases, the equivalent of hundreds of Earth masses slowly drifting toward the star.

\n\n

The pebbles form when smaller dust particles collide and coalesce. “Most of the dust in the disk becomes pebbles,” says Anders Johansen, an astronomer at Lund University and the other coauthor of the theory. He calls the protoplanetary disks “pebble factories.”

\n\n

Around 2010, Johansen and Lambrechts began to wonder how all these pebbles might relate to planets being born. They began a series of calculations on how pebbles might interact with other large rubbly fragments floating in the protoplanetary disk. To their surprise, Johansen and Lambrechts found that pebbles could quickly glom onto a protoplanet.

\n\n

The key is friction. Imagine a stream of pebbles whizzing by a 100-kilometer-wide protoplanet. As pebbles plow through gas within the disk, friction slows them down enough to be captured by the protoplanet’s gravitational field. The pebbles begin looping around the larger rock and soon smash onto its surface. Each collision adds a tiny bit of mass — and with enough such collisions, the protoplanet grows quickly, to 1,000 kilometers across or more. “In many ways, pebble accretion is the most efficient way of adding mass to a body,” says Lambrechts.

\n\n

If a protoplanetary disk included equal masses of rock, half in planetesimals and half in pebbles, the pebbles would accrete 1,000 times more effectively than the planetesimals, says Lambrechts. He and Johansen reported their initial ideas in a series of papers starting in 2012 and published an overview last year in the Annual Review of Earth and Planetary Sciences.

\n\n

Pebble accretion helps explain a number of features about the solar system. For one, NASA’s Juno spacecraft, now orbiting Jupiter, found that the gas giant has a much larger and more diffuse core than scientists had expected. That could mean pebble accretion was at work, Johansen says — it is the only way to build up a core that large in the time available, before the dusty disk dissipates.

\n\n

Pebble accretion also illuminates the long-standing mystery of how Uranus and Neptune formed. Puzzlingly, these ice-giant planets started off with large cores but did not swaddle themselves in huge amounts of gas the way Jupiter and Saturn did. Baby Jupiter and baby Saturn eventually reached a point called the pebble isolation mass, where they were large enough to generate a pressure bump in the surrounding gas that pushed away any approaching pebbles. Once they stopped gobbling pebbles, Jupiter and Saturn began pulling in gas instead. In contrast, Uranus and Neptune never made it to the pebble isolation mass, which increases with orbital distance. They became ice giants rather than gas giants.

\n\n\n\n

\n\n

Beyond the solar system, pebble accretion explains mysteries such as how big planets can form at large distances from their stars. For instance, the young star HR 8799, about 129 light-years from Earth in the constellation Pegasus, has four planets bigger than Jupiter with orbits ranging out to 68 times the Earth-to-sun distance (for comparison, Jupiter orbits at about five times the Earth-sun distance). Johansen and Lambrechts’s computer simulations suggest that the planets could have started even farther out and swept up pebbles, growing bigger as they spiraled in toward their current orbits. The whole process could have taken place during the lifetime of the protoplanetary disk. That couldn’t happen in the old scenario, because there wouldn’t have been enough planetesimals at those great distances to accrete efficiently.

\n\n

One big question remains unanswered: Where did the protoplanets come from in the first place? One possibility is the place known as the snow line — the distance from a star at which liquid water freezes. There, dust and pebbles experience a shift in their physical properties as they change from being wet to dry. They begin to clump together and, unlike in other parts of the star-encircling disk, can form the large chunks that serve as planetary seeds for other pebbles to accrete on.

\n\n

That makes the snow line a very good place for the first protoplanets to be born, says Joanna Drazkowska, an astrophysicist at the University of Zurich who published the idea recently in Astronomy & Astrophysics. Once those initial protoplanets were established, they could have begun gobbling up pebbles in the disk.

\n\n\n\n

\"TRAPPIST — The seven planets of the TRAPPIST-1 system, shown in this artist’s conception next to the ultracool dwarf star they orbit, are all Earth-sized and some may harbor liquid water. The planets’ formation is best explained by pebble accretion.
\n\n
CREDIT: JPL-CALTECH/NASA
\n\n

\n\n

This scenario could have happened with one of the most famous planetary systems out there: the seven Earth-size planets orbiting the star TRAPPIST-1, 39 light-years from Earth in the constellation Aquarius. Chris Ormel, an astronomer at the University of Amsterdam, and his colleagues recently calculated that protoplanets began to form at the snow line around the star, then grew quickly by accreting pebbles. The fledgling planets halted at about the size of Earth because of the way their gravity influenced the surrounding disk.“This particular system is hard to explain by classical concepts,” Ormel says — but pebble accretion can do the trick.

\n\n

As astronomers discover more and more planets around other stars, pebble accretion can help them understand how the menagerie of planet types found could have evolved, says Lambrechts.“It makes all of planetary formation much more dynamic.\"

\n\n","field_all_authors":"

By Alexandra Witze 04.20.2018

\n\n","field_author_bios":"

Alexandra Witze is a science journalist in Boulder, Colorado. Reach her: witzescience@gmail.com.

\n\n","field_banner_alt":"Early solar system","field_banner_title":"Early solar system","field_caption":"

In the early solar system, planets arose from a disk of rocks, pebbles, dust and gas that surrounded the young sun (illustrated here). A leading theory now posits that pebbles, not the larger rocky bodies, would have been more efficient at bulking up the young protoplanets.

\n\n","field_credit":"Early solar system: RICHARD BIZLEY / SCIENCE SOURCE","field_doi":"10.1146/knowable-042019-123401","field_is_hero":"1","metatags":{"referrer":"origin","title":"Building planets, piece by piece","description":"The theory of “pebble accretion” explains how infant worlds got so big so quickly","google_plus_name":"Building planets, piece by piece","og_title":"Building planets, piece by piece","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/physical-world/2018/building-planets-piece-piece","dcterms_description":"The theory of “pebble accretion” explains how infant worlds got so big so quickly","dcterms_identifier":"10.1146/knowable-042019-123401","dcterms_publisher":"Annual Reviews","dcterms_title":"Building planets, piece by piece","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"The theory of “pebble accretion” explains how infant worlds got so big so quickly","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/PlanetPebble1600x600.jpg?itok=DYBtCF6k","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Friday, April 20, 2018 - 08:00","citation_title":"Building planets, piece by piece","article_modified_time":"Tuesday, May 22, 2018 - 16:22","article_published_time":"Friday, April 20, 2018 - 08:00","og_description":"The theory of “pebble accretion” explains how infant worlds got so big so quickly","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/PlanetPebble1600x600.jpg?itok=DYBtCF6k","og_image_height":"600","og_image_type":"image/jpeg","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/PlanetPebble1600x600.jpg?itok=DYBtCF6k","og_image_width":"1600","og_updated_time":"Tuesday, May 22, 2018 - 16:22","og_url":"/article/physical-world/2018/building-planets-piece-piece","twitter_cards_description":"The theory of “pebble accretion” explains how infant worlds got so big so quickly","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/PlanetPebble1600x600.jpg?itok=DYBtCF6k","twitter_cards_image_height":"600","twitter_cards_image_width":"1600","twitter_cards_page_url":"/article/physical-world/2018/building-planets-piece-piece","twitter_cards_site":"@knowablemag","twitter_cards_title":"Building planets, piece by piece","dc_identifier":"10.1146/knowable-042019-123401"},"field_primary_author":"By Alexandra Witze","field_published":"2018-04-20","field_republish_html":"

Building planets, piece by piece

\n\n

The theory of “pebble accretion” explains how infant worlds got so big so quickly

\n\n

By Alexandra Witze

\n\n

04.20.2018

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Some 4.5 billion years ago, the solar system was a nursery full of planetary toddlers.

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10.1146/knowable-042019-123401

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Alexandra Witze is a science journalist in Boulder, Colorado. Reach her: witzescience@gmail.com.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n $\"Knowable$

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To most humans, icebergs play a simple role in the seas: They sink ships. After all, the most famous berg in history gained notoriety by killing 1,500 people when it sent the Titanic to the bottom of the ocean. But as melting poles set more large chunks of ice afloat, icebergs may be in for a reputation overhaul. To scientists studying these frozen barges, they are anything but simple.

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As they slowly see-saw and spin through polar currents, icebergs fertilize the oceans. Carrying nutrients from land and sometimes reaching the size of small US states, they drive blooms of life that influence the carbon cycle, as shown in the diagram above. Much more than cold, lifeless killers, they are wandering, dynamic islands — promoting marine life, sucking carbon dioxide from the air and changing as they traverse the seas. The massive and mysterious habitats they create are realms scientists have only just begun to understand.

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When ice sets sail

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Icebergs are commonly thought of as creatures of the oceans, but in fact they are born on land. They begin as pieces of glaciers — thousands of years of snowfall compacted into mountainous rivers of ice. In slow motion, these rivers flow, churning up and entrapping masses of rock and soil as they grind across the land. A peppering of airborne particles settle on the ice, becoming trapped by new layers of falling snow. These sediments paint the walls of some glaciers (and icebergs) with dark stripes. By the time a chunk of glacier falls into the sea, it is packed with minerals and nutrients from the land — and this enshrined rubble is one way icebergs transform the oceans. As ocean currents carry the berg through its life, it slowly melts, sprinkling iron and other nutrients into the waters around it. These minerals fertilize the tiny photosynthetic plankton that live off sunlight and form the foundation of the marine food web.

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\"You have this big chunk of iron floating around out there and you get this big intense growth and you can actually see it,\" says Karen Osborn, a research zoologist at the Smithsonian's National Museum of Natural History who studies how marine invertebrates adapt to challenging environments.

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\"Striped — Icebergs come in varied hues and stripes. The patterns record the changing temperatures, rocks, dirt and air particles encountered during their previous lives as glaciers and ice sheets.
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CREDIT: MATTIAS CAPE
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Satellite images show that the boon to primary productivity brought by an iceberg is surprisingly expansive and can extend as much as 10 times an iceberg's length. A team of UK scientists found that this fertilization could trail more than 600 miles behind the iceberg — with chlorophyll levels in the iceberg's wake spiking as much as 10 times typical levels.

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But minerals captured from a life on land explain only part of the burst. The ocean is a stratified system, with horizontal layers forming distinct segments of the ecosystem. Sometimes these layers are as shallow as 60 meters — a bit longer than an Olympic swimming pool. Due to the sheer amount of water they displace as they travel, icebergs can fundamentally disrupt this ocean structure.

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Bergy bits and dropstones: Icy terms from icebergs

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Icebergs come in a vast range of sizes, from areas slightly smaller than a softball infield to nearly the size of Connecticut.
Smaller ice chunks not quite grand enough to be dubbed icebergs are called “bergy bits,” with heights from 3 to 16 feet.
The National Oceanic and Atmospheric Administration calls smaller fragments (roughly the size of a grand piano or maybe a small truck) “growlers.”
When icebergs head out to sea they carry cryoconites, pockets of minerals and microbes from windblown dust and ocean spray. It's not clear what happens to those microbes when the icebergs melt.
Not only do icebergs sprinkle nutrients into ocean waters, they also drop chunks of rock termed glacial dropstones. A recent study in shallow waters found that while dropstones covered less than 1 percent of the ocean floor, they harbored about 20 percent of seafloor life.

\"Think about it like a layer cake,\" says Osborn. \"It's much more common to find a certain species of jellyfish in Japan and in California at the same depth versus the same species of jelly at 400 and 2,000 meters in California.\"

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Icebergs, whose enormous underwater bases famously belie their exposed tips, can stretch hundreds of meters deep. During one expedition, Osborn and her colleagues used an unmanned vehicle to follow an iceberg wall deeper than a submerged Seattle Space Needle would reach before the submarine came to the end of its tether. When bergs come crashing through, those nice ocean cake layers are toast. The mixing of the strata, boosted by the iceberg's low-density water melting and rising to the surface, brings massive benefits for microbial life.

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An iceberg's wake is invisible, but you can detect it in measures of salinity, oxygen and temperature, says Alison Murray, a marine microbial ecologist at the Desert Research Institute of Nevada, who visits Antarctica every few years for her research. \"Most of the time, the bacteria down in the Southern Ocean — I think that they're starving,\" she says. \"When an iceberg goes by it basically stirs up the ocean, and biology likes that, because a lot of the good things lie down below.\"

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A traveling boomtown

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Observed by a remotely operated submarine moving down the side of an iceberg, that biology becomes pretty obvious. Algae live in fist-sized grooves that dimple the ice like the face of a golf ball. The algae nestle into the lower ledges of these divots, pointing themselves toward the sun. Other life visits too. Sometimes krill swarm the submarine in hordes so thick \"that it blocks the light of a submersible camera,\" says Osborn. \"Other times you'll go minutes without seeing anything.\"

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But the waiting is always well worth it, she says. Witness: sea angels, shell-less relatives of the snail, at their largest roughly the width of a bottle cap, that flap through the water as if they had wings. And strange tomopterid worms, which dance by the ice face, showing off their translucent, fern-shaped bodies.

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\"Bristle — Bristle worms (genus: Tomopteris), which live at mid-water depths in the ocean, act as both predators and prey in iceberg ecosystems. When attacked, they can emit flashes to confuse approaching predators.
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CREDIT: DAVID WROBEL/VISUALS UNLIMITED
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Larger life comes around as well. Fish explore caves in the iceberg walls, squawking flocks of petrels and other flying seabirds circle looking for food, and seals and penguins use the floating islands as both shelter and hunting grounds. Occasionally, rare whales have been spotted alongside icebergs, leading scientists to wonder if they too are attracted by the frigid boomtown.

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Sending carbon to the depths

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All this life generates waste, which is key to the second super power of icebergs: They create a carbon sink. Plankton that harvest energy from sunlight do so with carbon dioxide pulled from the air. The process results in an organic form of carbon, stored in the bodies of the plankton and the animals that eat them. As these life forms die — and when they expel waste —that carbon clumps together and sinks to the ocean floor, where, under certain conditions, it may be stored for thousands of years. And it's not a small amount that gets pulled down.

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\"Plant life in the ocean is just horrendous,\" says Ken Smith, an open-ocean ecologist at the Monterey Bay Aquarium Research Institute, referring to the amount of carbon dioxide consumed by the plankton. \"One-fourth of the anthropogenic increase in carbon dioxide is absorbed by the ocean, with 30 percent going into plants.\"

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Icebergs may play a role in keeping this number high. University of Sheffield researcher Grant Bigg and his team estimated that as much as 20 percent of the carbon-sink activity in the Southern Ocean is driven by fertilization from giant icebergs. Icebergs, therefore, are a small but important factor in estimating the speed at which our planet is warming, he says.

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\"Sea — Clione lamacina, or the sea angel (also called a sea butterfly), is a relative of the snail that grows only to about 30 millimeters (just over an inch) in length. They have been spotted along the hulls of icebergs and likely attract hungry fish and birds.
\n\n
CREDIT: KEVIN RASKOFF/HIDDEN OCEAN 2005 EXPEDITION: NOAA OFFICE OF OCEAN EXPLORATION
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But getting a handle on the exact extent of icebergs' influence on the carbon cycle is no small feat. The equation is complicated by the specifics of each chunk: where it's from, how quickly it escapes to open waters, its size, and how rapidly it melts. In the Arctic, for example, \"iron is all over because of the input from rivers, which you don't have in the Antarctic,\" says Smith. Less is known about the effects of icebergs in the north where iron is more abundant.

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And icebergs have a dark side. They gouge sea beds in shallow water, scraping whole stretches of marine life off the ocean floor, including substantial numbers of carbon fixers, which can make it that much harder to figure out icebergs' overall effects on the planet's ocean carbon sinks.

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Icebergs up close

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More careful, up-close studies of icebergs could build more understanding of their role in the global carbon budget and in ocean life. But that comes with many financial and logistical challenges. Icebergs can get locked in sea ice, making them difficult to reach year-round. Once freed, they move and can be difficult to track. Icebergs can be so large that they have their own waterfalls and airplane-hangar-like caves, and simply approaching them in a vessel can pose dangers. Being too close when a sizable iceberg collapses could have serious consequences.

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Mattias Cape, a biological oceanographer at the University of Washington, recalls one Antarctic expedition during which his group was forced to retreat through a narrow stretch between an iceberg and the edge of the continent. Shifting winds had closed their original path and the crew had decided not to wait around to see if the massive iceberg would creep back toward the continent, closing off the remaining escape route.

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\"You look up and you can't see the top of this iceberg that's tens of meters high. And then you just imagine: If it's 30 meters high, then what's below me?\" Cape recalls.

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\"Penguins — Icebergs serve as shelters and hunting grounds for marine animals such as these Antarctic Adélie penguins.
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CREDIT: MATTIAS CAPE
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But just as icebergs can be intimidating, they can also be beautiful, Cape says. Far out in the Antarctic, away from friends and family and in a landscape made almost entirely of shades of grays, blues and whites, spotting icebergs provides a pastime. Penguins or seals might leap from their surfaces as a ship approaches. And the icebergs themselves can have \"strange combinations that are pretty mesmerizing\": a dark blue-black iceberg so transparent that \"you could see every one of the little air bubbles within it.\" Or one with translucent blue streaks alternating across its length like \"bands on a zebra.\" The icebergs are not silent, he says. They creak and crack in the waters, and sometimes they'll suddenly flip, exposing their pocked underbellies.

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Even without seeing all the life swirling around below, watching them \"is a full sensory experience,\" he says.

\n\n","field_all_authors":"

By Lindzi Wessel 03.15.2018

\n\n","field_author_bios":"

Lindzi Wessel is a staff reporter at Knowable Magazine who loves learning about all things science — marine research being just the tip of the iceberg. Reach her at lwessel@annualreviews.org.

\n\n","field_banner_alt":"Large iceberg","field_banner_title":"Large iceberg","field_caption":"

Icebergs, which can be large enough to sport caves and waterfalls, serve as massive mobile habitats for polar life — both above water and underneath the ocean's surface. The iceberg pictured is an estimated 65 feet tall. But that's just the part that sticks out of the water.

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curious case of acrylamide: California’s Prop. 65 explained","nid":"117","created":"1527193224","revision_default":"1","path":"175","body":"

Most of us think of coffee as a morning essential, not a cancer-causing hazard. So the nation got a jolt after a California judge made a final ruling in May that Starbucks and other coffee sellers must inform customers about carcinogenic chemicals in their brews.

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The ruling stemmed from a court case invoking Proposition 65, a state law that requires warnings if products or places contain certain types of hazardous chemicals. But the implications reach far beyond the Golden State. California has the sixth-largest economy in the world, so manufacturers of consumer goods worldwide try to abide by Prop. 65 regulations.

\n\n

Here’s a primer on how hazardous chemicals get listed and regulated, the ongoing coffee case — yes, it’s still not over — and what might be labeled or litigated next.

\n\n

Why will there be signs next to Starbucks registers warning that coffee contains chemicals that cause cancer and birth defects?

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In late March, a Los Angeles Superior Court judge ruled that cups of coffee sold to consumers would fall under the Safe Drinking Water and Toxic Enforcement Act — Prop. 65 — which was passed by a ballot vote of California residents in 1986. The judge made a final ruling May 7.

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\"A — \n
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A Proposition 65 sign in a San Francisco Starbucks warns of acrylamide in coffee and baked goods. It is located by the sugar and creamer; Starbucks was sued to place the warning at the point of sale.
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CREDIT: ROBERT ALEXANDER / GETTY IMAGES
\n

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The law applies because roasted coffee beans — and beverages brewed from them — contain acrylamide, which is on Prop. 65’s state-regulated list of chemicals “known” to cause cancer, birth defects or reproductive harm. If a product contains any of the list’s approximately 900 chemicals, it must be labeled to warn consumers, or the chemical must be removed or reduced to levels that Prop. 65 regulators consider safe.

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In April 2010, an organization called the Council for Education and Research on Toxics (CERT), which is located at the same address as the Long Beach law firm that represented it and that specializes in litigating such cases, sued about 160 companies, including Starbucks Corp. and the convenience store 7-Eleven, to force them to label their coffee with Prop. 65 warnings. The Los Angeles judge ruled that companies failed to demonstrate that the health benefits of coffee outweighed the risks posed by acrylamide, which include cancer and developmental and reproductive harm. 7-Eleven and some other companies have already settled out of court, agreeing to pay fines and place warning signs at the point of sale.

\n\n

What does a Prop. 65 warning say and mean?

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Up till now, generally words along the lines of: “WARNING: This product/area contains chemicals known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov.”

\n\n

\"A — \n
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Proposition 65 warnings, like this one at Disneyland, have generally been very vague. New laws will require that the warnings name specific chemicals and their sources.
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CREDIT: PATRICK PELLETIER / WIKIMEDIA COMMONS
\n

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Such signs on a product, or in a restaurant, workplace, living space or parking garage, mean that the product or environment contains a chemical on the Prop. 65 list. A business must give “clear and reasonable warning” if knowingly exposing anyone, unless it can show the exposure falls under “safe harbor” levels: amounts determined by the state to pose no significant risk. (California set acrylamide’s safe harbor levels for cancer risk at 0.2 micrograms per day — its estimation of a dose that would risk cancer developing in 1 in 100,000 people, based on laboratory rat data. It set the level for reproductive risk at 140 micrograms per day.)

\n\n

How does acrylamide end up in foods?

\n\n

The chemical naturally forms in items such as baked goods, cereals, potato products and coffee during the Maillard, or browning, reaction, when the amino acid asparagine and a sugar combine in the presence of heat higher than 120 degrees Celsius (248°F).

\n\n

“Any time you heat-process a food — toast a piece of bread, fry potatoes, bake a crust — sugars react with amino acids to form a whole catalog of chemicals. Acrylamide happens to be one of those chemicals,” says James Coughlin, a chemist in Aliso Viejo, California, and an independent consultant for the food industry. (Coughlin has consulted for the National Coffee Association and Starbucks in the past but is not currently working for any companies in the California court case.)

\n\n

\"Six — \n
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Acrylamide forms when bread is toasted and the amino acid asparagine reacts with sugars at high heat.
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CREDIT: MILOS LUZANIN / SHUTTERSTOCK
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When green coffee beans are roasted (typically at 180° to 240°C for about 15 minutes), more than 1,000 chemical compounds result as different sugars and amino acids combine and break down. “Coffee is the best example of the browning reaction gone wild,” Coughlin says. That swirl of chemicals gives coffee its complex tastes and aromas.

\n\n

What is the evidence that acrylamide causes cancer or reproductive harm?

\n\n

Acrylamide is used in industry and research to make polymers and is a neurotoxin at very high doses. It was found to be present in starchy, browned foods in 2002.

\n\n

For cancer studies in 1986 and 1995, researchers fed rats high doses of acrylamide in their drinking water throughout their two-year lifetime. The highest doses increased rates of thyroid, testicular and breast tumors. In 2012, the US government’s National Toxicology Program (NTP), which tests environmental chemicals for potentially hazardous health effects, found similar increases in rats and mice. In male rats, the rate of thyroid tumors rose from 6 percent in rats fed no acrylamide to 25 percent in those fed the highest dose, for example. In females, the rate of a breast tumor rose from 33 percent without acrylamide to 65 percent for the highest dose.

\n\n

(The NTP also assessed for reproductive harm in 2005 and found that while acrylamide causes slight increases in the incidence of low birth weight and less effective sperm in mice and rats fed high doses, there was no evidence that acrylamide exposure in people results in adverse reproductive effects.)

\n\n

But experts say that the carcinogenicity of acrylamide in people is still up for debate. For one thing, says Coughlin, doses fed to rodents in these studies were extremely high — the equivalent of a 150-pound person drinking 11,000 to 136,500 eight-ounce cups of coffee per day. For another, population studies of workplace exposure to acrylamide have not found dose-related increases in any specific cancer or in overall cancer mortality.

\n\n

An analysis of 25 epidemiology studies, encompassing 39,476 people, found no increased risk for 15 types of cancer when comparing people with average dietary intakes of acrylamide to those with daily intakes 10 micrograms higher (the amount in five eight-ounce cups of coffee). The authors concluded that dietary levels of acrylamide do not pose an increased risk of most types of cancer.

\n\n

How do chemicals get on the Prop. 65 list?

\n\n

In four ways. A chemical is automatically added if listed as a carcinogen or a developmental or reproductive toxicant by any of five authoritative bodies — the National Toxicology Program and three other US agencies, or the World Health Organization’s International Agency for Research on Cancer (IARC). It only takes one agency to spark a listing; in the case of acrylamide, all five agencies list it as a probable human carcinogen.

\n\n

A chemical may also be added if the California Labor Code deems it a cancer or reproductive risk, or if another agency requires a label. And it can be added if California-appointed State Qualified Experts — committees of researchers who specialize in cancer or developmental and reproductive biology — review the science and declare a chemical harmful by a majority vote.

\n\n

\"An — \n
\n
Processed meats such as sausages were listed in 2015 by the International Agency for Research on Cancer as “carcinogenic to humans,” based on population studies that reported slightly increased rates of colorectal cancer in people who consumed the meats. Some speculate that processed meats will soon be added to Proposition 65's list of chemicals.
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CREDIT: PIXABAY
\n

\n\n

That can be a tough call because the data are often imperfect, says toxicologist David Eastmond of the University of California, Riverside, a member of the Carcinogen Identification Committee. It bothers him that even if committees have reviewed a chemical and deemed it safe, another agency can override that work. “It’s not real often that you have differences,” he says. “But it makes you wonder, are you doing something consistent?”

\n\n

Acrylamide was added to the Prop. 65 list in 1990 because both the IARC and the US Environmental Protection Agency (another of the triggering bodies) listed it as a carcinogen based on animal studies.

\n\n

Are chemicals ever taken off the list?

\n\n

Yes. Several have been delisted after studies showed them not to be carcinogens or reproductive toxins. (A reassessment can be triggered by State Qualified Experts, a state agency or petition by a member of the public.) One notable case is the artificial sweetener saccharin, which was listed as a carcinogen in 1989 because it caused bladder cancer in rodent studies, and was delisted in 2001. Decades of research showed that the way saccharin caused bladder cancer in male rats was not possible in humans.

\n\n

Why are items listed when they might not be harmful to people?

\n\n

The statute is designed to be precautionary and protective, says Claudia Polsky, director of the Environmental Law Clinic at UC Berkeley Law. “If it’s possible to decrease the levels of acrylamide in coffee, then people will have a lower exposure over their lifetime of a probable carcinogen,” she says. And the regulation, she adds, forces industry to innovate to find ways to remove or reduce harmful chemicals.

\n\n

“Drinking coffee is still fine, and possibly even good for you,” she says. “But thanks to Prop. 65, coffee manufacturers might be able to make it even better.”

\n\n

So is it safe to drink coffee or not?

\n\n

The Food and Drug Administration, the European Food Safety Authority and Health Canada have all ruled coffee safe to drink, except for pregnant women, who should limit their intake.

\n\n

A review of more than 100 epidemiology studies encompassing more than 21 million people found that coffee consumption has an overall health benefit, decreasing risks for a variety of diseases including cardiovascular disease, type II diabetes, Parkinson’s disease and several cancers.

\n\n

Coughlin says that roasted coffee beans or their grounds contain about 450 micrograms of acrylamide per kilogram, but brewed coffee contains only about 10 to 30 — a tiny dose compared to eating french fries or potato chips, which can contain acrylamide in the thousands of micrograms. The amount in an eight-ounce cup of coffee, 2 micrograms, is ten times the state’s safe harbor level of 0.2 micrograms a day. Acrylamide reacts with other proteins in the body as soon as it is absorbed, Coughlin adds, and is also detoxified by an enzyme called glutathione transferase.

\n\n

\"Photograph — \n
\n
Saccharin, found in products such as Sweet'N Low, was removed from Proposition 65’s list of risky chemicals in 2001. Decades of research showed it did not pose a cancer risk in people.
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CREDIT: SIMON QIAO / FLICKR
\n

\n\n

“The bottom line for coffee is that while it does contain a small dose of acrylamide along with several other animal carcinogens, the overall beverage is loaded with antioxidants and has been shown to reduce the risk of several cancers,” he says.

\n\n

Could it be made safer?

\n\n

Maybe. After potato chip and french fry makers were sued by the California attorney general in 2005, they found ways to reduce acrylamide levels. Potatoes can be blanched to reduce sugar content, treated with an enzyme to remove much of the asparagine, or cooked for less time or at lower temperatures.

\n\n

But coffee is trickier. Coffee company scientists say they have tried to reduce acrylamide levels by altering roasting times or steaming, but achieved only modest reductions and distorted the brew’s flavor and aroma.

\n\n

Does Prop. 65 do a good job of protecting people from harmful chemicals?

\n\n

Polsky and others who support the law point to Prop. 65’s successes: Coke and Pepsi removed 4-methylimidazole, a carcinogen in caramel coloring, from their sodas; companies have removed lead, a potent developmental toxin, from children’s jewelry, wine bottle caps and candy imported to the United States from Mexico. Target and CVS pharmacies have pledged to remove phthalates and formaldehyde from cosmetics and personal-care products due in part to pressure from the law.

\n\n

But some worry that the sheer number of Prop. 65 warning signs seen in parking garages, auto mechanic shops, dentist’s and doctor’s offices and coffee shops erodes their clout. “Are you unduly frightening the public or are you posting warnings so often that people ignore them?” asks Eastmond. “Coffee and acrylamide might be one of those cases where we are warning someone about something that’s not really a serious health concern.”

\n\n

Megan Schwarzman, an environmental health scientist and physician at the UC Berkeley School of Public Health, agrees that the media spotlight on what looks like an absurd coffee warning could undermine the law’s effectiveness and overshadow cases where it has compelled large companies to remove or reduce truly dangerous chemicals.

\n\n

And Schwarzman, Coughlin and Eastmond all point to one major failing of the law: It does not take into account the doses that were used in toxicology studies when deciding to list a chemical. People drinking coffee — even large amounts daily — do not come remotely close to the concentrations that caused harm in animal tests.

\n\n

There hasn’t been a scientific evaluation of the law’s effectiveness to date. But Schwarzman, Polsky and a team of researchers are taking the first systematic look at whether Proposition 65 has been effective in one particular arena: reducing exposure of Californians to chemicals associated with breast cancer, such as endocrine disruptors, phthalate plasticizers and diesel exhaust.

\n\n

Could Prop. 65 be improved?

\n\n

Experts agree that there’s room for improvement in the way the statute is written and enforced.

\n\n

One major criticism is that Prop. 65 warnings are too generic to be useful. Until now, signs usually have not noted which chemicals are present or whether people are at risk from, say, just walking to and from a parked car in a garage. Nor do they distinguish between high, medium and low risks. Warnings, Schwarzman says, should “only exist for significant public health risks.”

\n\n

New rules taking effect in August will require inclusion of names of specific chemicals and their source.

\n\n

Another criticism is that the law has become a cash cow for law firms seeking to force companies into settlements. In 2015, $26 million was paid in Prop. 65 settlements, of which nearly $18 million, or 68 percent, went toward plaintiff attorney fees. In 2016, the California attorney general’s office, which enforces Prop. 65, changed how settlements could be made in Prop. 65 lawsuits brought by private plaintiffs. The aim was to limit the portion of settlements that could go to plaintiffs and ensure that the state got its fair share of civil penalties. There still is no limit on how much of a settlement can go toward paying plaintiff attorney fees.

\n\n

In another ongoing Prop. 65 court case, a judge ruled that the herbicide chemical glyphosate did not have to be labeled. Why not?

\n\n

Glyphosate is a chemical found in the widely popular herbicide Roundup, produced by the company Monsanto.

\n\n

\"Spray — \n
\n
Glyphosate, found in Roundup herbicide, was added to the Prop. 65 list in 2017. The International Agency for Research on Cancer has classified it as a “probable human carcinogen” but four other agencies have concluded it is safe. Roundup’s maker, Monsanto, has sued to avoid Prop. 65 warning requirements.
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CREDIT: LEON WERDINGER / ALAMY STOCK PHOTO
\n

\n\n

Of the five triggering agencies, only the World Health Organization’s IARC has classified the chemical as a “probable human carcinogen.” The other four say it has low toxicity and does not pose a risk. Glyphosate went on the Prop. 65 list in July 2017.

\n\n

The IARC is the most precautionary of the five triggering agencies, and works only with published data. In situations where much of the research is proprietary, that can be an issue, Eastmond says. He says he has seen the extensive unpublished data on glyphosate toxicology in rats, and epidemiology in exposed farm workers, and believes that the IARC very likely would not have reached the conclusion it did if it had reviewed those data too.

\n\n

Monsanto does not want glyphosate regulated under Prop. 65 and sued the state of California in federal court in November 2017 to prevent a labeling requirement. A judge ruled in February that since only one agency had found glyphosate a possible carcinogen, the company could not be compelled to label its product as “known to cause cancer”; that would be compelled speech and could mislead a reasonable consumer. Glyphosate remains on the Prop. 65 list, but the judge temporarily barred the state from enforcing the warning requirement.

\n\n

Neither the coffee nor the glyphosate case is settled. Some of the coffee companies may appeal after the final judgment of the penalty phase of that case is decided this summer or later, and the glyphosate ruling is just a “preliminary injunction” as that case proceeds.

\n\n

What lawsuits might come next?

\n\n

Prop. 65 lawsuits are scattershot and hard to predict, but there are clues. In the first week of May alone, private citizens filed 29 notices of violation with the California attorney general’s office seeking to sue companies for Prop. 65 violations. The complaints target items like phthalates in cosmetics, acrylamide in almonds and lead in dietary supplements. The notified companies include CVS pharmacies, Trader Joe’s and Nordstrom.

\n\n

What might be listed next?

\n\n

Processed meats — such as bacon and hot dogs — were listed in 2015 by the IARC as “carcinogenic to humans.” The agency listed red meat as “probably carcinogenic to humans” (the same category as acrylamide) because the evidence was more limited. Both listings, finalized in March, were based on epidemiological studies of colorectal cancer, which showed slightly increased risks associated with processed meat and red-meat consumption.

\n\n

Coughlin suspects that this will trigger California to add processed meats to the Prop. 65 list. Interestingly, after facing public uproar in 2015, the WHO released a statement that processed meats were still part of a healthy diet.

\n\n","field_all_authors":"

By Kendall Powell 05.24.2018

\n\n","field_author_bios":"

Kendall Powell is a freelance science writer. If she tilts her head just right, she can see the Rocky Mountains from her home office near Denver, Colorado. Reach her at kendall2@nasw.org or @KendallSciWrite.

\n\n","field_banner_alt":"Conceptual warning sign with image of a cup of coffee on it","field_banner_title":"Coffee warning sign","field_caption":"

Conceptual coffee warning sign

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Since May 2015, in a portion of its WorldPort distribution center in Louisville, Kentucky, United Parcel Service has been operating a spare parts warehouse with no spare parts. Instead, the facility is stocked with ultrafast 3-D printers that can build up almost any plastic part that’s required, layer by layer by layer — and have it ready for UPS to deliver anywhere in the United States by morning.

\n\n

“It was a no-brainer,” says Alan Amling, UPS’s vice president for corporate strategy. Storing spare parts for quick delivery was already a big moneymaker for the company, he says. UPS operates more than a thousand field stocking locations worldwide — all full of items that somebody might need someday, maybe. The industrial customers who pay for that service have to keep the parts available because of warranty contracts, says Amling. But they hate it. “Inventory storage costs are massive,” he says. “So we started to see 3-D printing as a solution.”

\n\n

Although 3-D printing isn’t cost-effective for every part, says Amling, the Louisville microfactory has already been successful enough for UPS to replicate it at several sites around the United States, with plans to eventually take it worldwide. And that’s before the centers add the capacity to print metal parts later in 2018. But what Amling particularly savors is the way 3-D printing has blurred the boundaries. When a delivery firm suddenly starts doubling as a manufacturer, he says, you’ve arrived at someplace new — “a white space.”

\n\n\n\n

\"Metal — As part of an effort to supply parts \"on-demand,\" United Parcel Service has partnered with Fast Radius, which can tap an array of additive and traditional methods to custom build metal and plastic parts (shown).
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CREDIT: UPS
\n\n

\n\n

It’s the kind of genre-scrambling that 3-D printing is starting to get very good at. The various technologies that fall under that heading have always encompassed much more than the low-cost hobbyist machines most of us know. But in just the past few years, 3-D printers have begun to emerge as a serious alternative to standard fabrication techniques like casting, milling and injection molding. Often called “additive manufacturing” for the way they add material to make a part rather than grinding it away, this suite of 3-D technologies is increasingly being seen as a force that could transform the very idea of a factory, in much the same way that personal computers have transformed the rest of the world.

\n\n

“I think of additive as the democratization of manufacturing,” says Mike Molnar, a manufacturing engineer turned policy director at the National Institute of Standards and Technology in Gaithersburg, Maryland. Molnar directs Manufacturing USA (initially called the National Network for Manufacturing Innovation), a series of federally funded laboratories that do research on additive technologies, artificial intelligence, robotics and other advanced industrial techniques.

\n\n

“Additive has lots of hype. But take 90 percent of that hype and throw it away, and the rest is still revolutionary.”

\nMike Molnar

\n\n

As he explains it, 3-D printing promises a new era of on-demand, distributed manufacturing that’s as close as possible to the consumer — when it’s not literally in the hands of the consumer. UPS’s Louisville microfactory is an example. So is the 3-D printer that NASA installed on the International Space Station in March 2016, so that astronauts can print hard-plastic ratchet wrenches and other parts without having to wait months for the next resupply launch. In neither case does anyone need elaborate assembly lines and machine tools, just digital files.

\n\n\n\n

\"Astronaut — A part of 3-D printing's appeal is its ability to create tools and parts as needed, in remote locations. Aboard the International Space Station in 2014, NASA astronaut Barry Wilmore displays a ratchet wrench created from a 3-D printer a long way from Earth.
\n\n
CREDIT: NASA
\n\n

\n\n

But just as important, says Molnar, 3-D printing unleashes the creativity of inventors and designers. They can optimize their parts for shape, strength, weight or whatever else they can imagine, without ever having to worry about whether it’s physically possible to machine, cast or assemble the things. One example is the SuperDraco thruster developed by the private rocket company SpaceX. The intricately shaped nickel-alloy device isn’t put together in the usual way from dozens of smaller parts. It is 3-D-printed as a whole from metal powder fused by a laser. Another example is Adidas’s Futurecraft 4D running shoe line, which features midsoles with a 3-D-printed foam structure that is designed for ideal support and minimal weight — and that can be tailored to each customer’s foot and running style.

\n\n\n\n

\"A — SpaceX launched its first metal rocket hardware created by 3-D printing in 2014. The SuperDraco Thruster, shown here, is made of a high-performance metal alloy and was created using additive manufacturing techniques in less time than traditional machining. The thruster was designed to fire as part of the launch escape system for SpaceX's piloted Dragon spacecraft.
\n\n
CREDIT: SpaceX
\n\n

\n\n

Granted, says Molnar, “additive has lots of hype.” In the real world, for example, most additive technologies are much slower than standard fabrication methods like casting or machining, and can work with only a comparative handful of polymers, ceramics and metal alloys. “But take 90 percent of that hype and throw it away,” says Molnar, “and the rest is still revolutionary.”

\n\n

That prospect is why the Obama Administration made additive technology a top priority when it launched Molnar’s manufacturing research program in 2011. It’s why established companies and start-ups alike have entered the game, determined to achieve dramatic increases in printing speed. In 2016, for example, HP Inc. (formerly known as Hewlett Packard) introduced a system that can churn out plastic parts ten times faster than previous 3-D printers at half the cost. The machines can even help “print the printer” by making some of the parts required to clone themselves.

\n\n

And it’s why companies like the German firm EOS, which has been making 3-D printers for nearly three decades (including the ones used by SpaceX), is experiencing a boom in demand. “It took us twenty years to sell our first 1,000 printers,” says Glynn Fletcher, president of EOS’s North American division. “Today we’re gearing up for 1,000 per year.”

\n\n

“Additive manufacturing today is a $5- to $6-billion industry,” continues Fletcher. And while that’s a lot, he says, “it’s only a tiny fraction of 1 percent of the total manufacturing industry.” So with even a little bit of additional market penetration, “additive has the potential to go from $5 billion to $50 billion in the not too distant future.”

\n\n

“We have the potential to be very disruptive,” says Fletcher. “We just have to figure out how.”

\n\n\n\n

\n\n

Homebrews

\n\n

The idea of 3-D printing was definitely in the air by the early 1980s, says Timothy Gornet, who manages the Rapid Prototyping Center at the University of Louisville in Kentucky. “Laser and inkjet 2-D printing was advancing rapidly,” he says, “so I believe for engineers it was natural to think, ‘If I can drive a 2-D printer from a digital file, why not do that to create a 3-D part?’”

\n\n

In fact, he says, that idea was so compelling that inventors independently found more than half a dozen ways to implement it.

\n\n

One evening in March 1983, for example, engineer Charles Hull phoned home from the little lab his company let him use nights and weekends. Come on down here, he told his wife — you’ve got to see this!

\n\n

“It had better be good,” replied his wife, who was already in her pajamas.

\n\n

It was. Hull’s day job was to make plastic coatings for tabletops: Just brush on a liquid acrylic resin, hit it with ultraviolet light, and the resin would instantly harden into a protective surface. But on his own time, Hull had been trying to add a dimension. His idea was to take a pot of that same resin, illuminate its surface with ultraviolet light in a pattern that would make a portion of the liquid harden into the cross-section of some part, then raise the level of the liquid a tiny bit to form a new layer and repeat. Eventually, he would be able to drain the unhardened liquid to reveal the finished item.

\n\n

Hull called the process “stereolithography” — a mashup of Greek terms that roughly translates as “3-D writing in stone.” What he proudly showed his wife on that March evening was his first successful print job: a small plastic eye cup that he still has. The company Hull cofounded in 1986 to commercialize the technology, 3D Systems of Rock Hill, South Carolina (originally based in Valencia, California), continues to be a major player in the field.

\n\n\n\n

\"A — Plastic T. rex toys printed by Carbon using a variant of stereolithography.
\n\n
CREDIT: Courtesy of Carbon
\n\n

\n\n

Three years later, in Eden Prairie, Minnesota, mechanical engineer Scott Crump carried out an experiment in the family kitchen. He’d been inspired by the way standard plotters move pens around on 2-D sheets of paper to make blueprints and architectural drawings. He wanted to do something similar in 3-D, using “pens” that built up solid objects by extruding material one layer at a time. And he’d finally figured out a way to demonstrate the idea. Using a handheld hot-glue gun that he’d filled with a mix of polyethylene and candle wax, he systematically built up a toy plastic frog for his 2-year-old daughter.

\n\n

She loved it. And that positive customer response encouraged Crump to keep experimenting with the technique, which is now called fused deposition modeling (FDM). His wife, Lisa, finally exiled him from the kitchen to the garage after everything the family ate started tasting like plastic. But Stratasys, the company that Scott and Lisa Crump founded later in 1989, has gone on to become another major maker of 3-D printers.

\n\n

At the University of Texas in Austin, meanwhile, a mechanical engineering graduate student named Carl Deckard had spent the mid-1980s working out the kinks in a scheme that had obsessed him since his senior year in college. The idea was to lay down a thin layer of powdered plastic — Deckard initially used a large salt shaker — then trace the cross-section of a part with a laser guided by a computer (a heavily modified Commodore 64.) The plastic would melt wherever the laser touched it, fusing with the cross-section below. Then the process would repeat after he added a new layer of powder. At the end, the leftover powder could be vacuumed up for reuse, leaving just the finished part.

\n\n

Deckard eventually got this laser sintering technique to work well enough to earn his master’s degree in 1986 and his PhD in 1988. The company he cofounded to commercialize it, DTM, was later purchased by 3D Systems — and laser sintering is now one of the go-to techniques for industrial-strength additive manufacturing.

\n\n\n\n

\n\n

In the early years, these 3-D printing techniques and the others that soon followed were collectively known as “rapid prototyping” — largely because that was almost the only profitable application. 3-D printing turned out to be a very good way to make new device prototypes, which engineers still liked to use for checking fit and function, or for holding in their hands as a communication tool. (“If a picture is worth a thousand words,” says Gornet, “a part is worth a thousand pictures.”)

\n\n

The pioneers in the field had plenty of other applications in mind, adds Gornet. “As soon as engineers were able to get prototypes quickly,” he says, “they immediately started to think how 3-D printing could be used” to advance manufacturing customization, on-demand spare parts and all the rest. But reality too often intervened. Early 3-D polymer parts were often quite brittle, for example. They also tended to be expensive, mainly because the printing was so painfully slow that it took days to make even simple parts. And the range of available materials was quite limited, with metal and ceramic parts not yet out of the laboratory, and polymer parts pretty much restricted to nylon.

\n\n

Still, by the end of the 1990s researchers had made steady progress on these problems, and 3-D printing was beginning to find other profitable niches in applications where the advantages outweighed the time and cost penalties. Orthodonture was an early example: In 1999, the Netherlands-based firm Align Technology introduced Invisalign, first of the removable, clear-plastic inserts that serve as an alternative to conventional wire braces. Because each of the devices had to be custom-fitted to an individual patient’s teeth, Align started 3-D-printing them with stereolithography, as did the competitors that followed. This meant that the inserts were roughly twice as expensive as wire braces — the cost of a full set today averages $5,000 — but the convenience factor made them a hit anyway. They require fewer orthodontist visits, and can easily be removed for eating and tooth-brushing. The industry is currently printing millions of the inserts per year, each of them customized by a simple change in the printer’s programming.

\n\n\n\n

\"Custom-fitted, — One of the most commercially successful applications of 3-D printing so far has been customized, see-through braces (sold as Invisalign and under other names) made by stereolithography.
\n\n
CREDIT: DAVIS DENTAL / WIKIMEDIA COMMONS
\n\n

\n\n

Hearing aids followed a similar path, starting in 2000 when the Swiss company Phonak began using stereolithography to make hearing aids that were customized to fit each patient’s ear canals. Today, the vast majority of in-ear hearing aids are made this way.

\n\n

Tipping point

\n\n

A few years into this century, the industry reached a tipping point, as sales of all kinds of 3-D fabricators and raw materials began to accelerate substantially. One impetus was simply the passage of time: Because US patents generally last for only 20 years, the ones granted during that first flurry of 3-D printing innovation in the 1980s were beginning to expire. This had a particularly strong impact on the low-end hobbyist market, which was (and is) almost entirely based on fused deposition modeling — Crump’s glue-gun extrusion technique. The raw materials were inexpensive and nontoxic, and the fabricators were safe to use in the home or office. So after Crump’s basic patent expired in 2009, copycats were quick to jump in, the price of the machines fell from more than $10,000 to under $1,000, and they became common sights in “makerspaces” and even schools. “I once counted about 50 companies marketing low-end 3-D printers,” says University of Texas materials engineer David Bourell.

\n\n

Another key factor was that laser sintering of metal parts had finally emerged from the laboratory, after years of efforts by Bourell and others to eliminate voids and weaknesses in the fused powder grains. EOS announced the first commercial metal fabricator in 2004, and continues to dominate this sector. “The metals machines offered a way to manufacture complex parts and achieve mechanical properties very similar to those from traditional methods,” says Gornet. And this, he says, “really triggered the thought that additive manufacturing may be able to grow dramatically” — that 3-D printing could move out of its niche markets and begin to challenge traditional technologies on their own turf.

\n\n\n\n

\n\n

For that to happen, however, researchers would have to overcome 3-D printing’s biggest shortcomings, starting with its painful slowness. Using standard laser sintering, says Amling, “it would take two days to make a coffee cup.”

\n\n

That slowness automatically puts additive manufacturing at a severe economic disadvantage, says John Dulchinos, vice president for global automation at Jabil, an international “contract manufacturing” company that does much of the actual production for brand-name firms such as HP. For most products, says Dulchinos, manufacturers typically do production runs numbering in the hundreds of thousands. But today, he says, “3-D is competitive only at tens of thousands.” And even that is only when the parts are intricately shaped and small. When you’re building things up point by point, notes Bourell, “if a part is twice as big, it takes eight times longer.” All of which is why researchers in industry and academia alike have been making speed a top priority.

\n\n

One notable effort is HP’s first foray into 3-D printing, which has drawn a lot of attention because the company is already a major player, not just another start-up. The company’s “Multi Jet Fusion” fabricator first lays down a thin layer of powdered polymer in much the same way as a laser sintering system. But instead of tracing the cross-section of the part with a laser, it prints the cross-section with microscopic drops of infrared-sensitive ink. (“The print heads are the same as those we use in our industrial inkjet printers,” says Paul Benning, HP’s chief technologist for 3-D printing.) Then it follows up with a flash of heat that is absorbed by the ink, which fuses the powder underneath. Finally, the cycle repeats with a new layer.

\n\n

This all happens very quickly, making HP’s machine about 10 times faster and substantially cheaper than an equivalent laser sintering system. “HP is pretty good at inkjets,” notes Bourell. That said, the first model is limited to plastic parts; the company has announced that metal fabricators are coming, but not until later in 2018.

\n\n

And by that point, HP may well have company: Desktop Metal, a startup based in Burlington, Massachusetts, has announced that it will soon be coming out with a high-speed metal fabricator that will work in somewhat the same way as HP’s. (Instead of ink, it sprays each layer with a binder that holds the powder together until the whole part can be fused in a separate heater.) “Our study concluded that you can do well over 500 parts in a day, while with lasers you could do 12 in a day,” says Desktop Metal’s chief technology officer, Jonah Meyerberg. The company’s machines can also use a wider (and cheaper) range of metal powders, he says, since the material doesn’t have to be optimized for laser melting.

\n\n

In Redwood City, California, meanwhile, Carbon, Inc. has achieved dramatic speed-ups in stereolithography. Carbon founder and president Joseph DeSimone credits several key innovations. The first, developed in his lab at the University of North Carolina, Chapel Hill, is a technique that exposes the working liquid to ultraviolet light and oxygen simultaneously. The resulting chemical interplay, dubbed Continuous Liquid Interface Production (CLIP), “allows us to go really fast” in printing an object, says DeSimone — up to 100 times faster than conventional stereolithography. That’s one reason Adidas is using the company’s fabricators to make its Futurecraft 4D midsoles.

\n\n

The second innovation is that the working liquid isn’t just a single photosensitive resin, but a mix of several compounds. “Only about 10 to 15 percent of the volume is light sensitive,” says DeSimone, and is there simply to set the shape of the part. The other components are chemicals that will react to form a strong polymer once the fully shaped part is sent to a baking oven. “It’s like epoxy glue, where you get the bond when you react two liquids,” he says. This mixing approach also allows the company to produce a much wider range of materials than was possible with earlier stereolithography systems.

\n\n

Expanding the range of available materials is, in fact, another key challenge for everyone in the field. EOS, for example, is taking a comparatively incremental approach to increased speed — mainly by improving the fabricators’ powder-handling, and having two, four or even eight lasers working in parallel. But the company has a whole subsidiary, Advanced Laser Materials (ALM), working to improve the stuff that goes under the laser.

\n\n\n\n

\n\n

This is especially difficult when it comes to polymers, says ALM President Donnie Vanelli. Within the laser sintering sector, he says, “80 to 90 percent of what’s moved to date has been built on nylon.” That’s because nylon is one of the few polymers that can not only be ground into a powder that rolls out nicely in the machine, but also melts well under the laser. ALM has been able to make nylon harder, stiffer, lighter and stronger with fillers such as carbon fiber, tiny glass spheres and even aluminum granules. “But nylon is not what people typically build parts out of,” says Vanelli. “So, if we really want to expand the future in additive, we have to be able to tell engineers, ‘We can do the materials you’re familiar with.’” There’s been some progress. In November 2017, for example, EOS and sportswear maker Under Armour announced a partnership to develop running shoes with soles made by laser-sintering a flexible polyurethane that’s very common in footwear.

\n\n

The fundamental challenge

\n\n

For everyone in additive manufacturing, however, easily the biggest challenge is what EOS’s Fletcher calls “the habits of the present.”

\n\n

His office is in Michigan, explains Fletcher, surrounded by factories supplying parts to the automotive industry. “They’re making things in the traditional way,” he says. “They are comfortable with that. And they are not going to overnight throw all that equipment in the dumpster and go to additive manufacturing.”

\n\n

On the other hand, he says, when you talk to engineers about the advantages of additive — the nonexistent retooling costs, say, or the freedom to design parts for function instead of for manufacturability — “everybody gets that.” So he thinks it’s a matter of when people make the jump, not if.

\n\n

Certainly it’s the case that EOS, like HP and most other players in the additive manufacturing field, finds itself hosting a growing stream of potential customers who are intrigued by the possibilities — and daunted by the learning curve. “This is a technology that’s very disruptive to process engineering and design,” says EOS marketing director Patrick Boyd. “Potential customers come to us and ask, ‘How do we even start?’” By 2016, he says, EOS was hearing that question so frequently that it launched Additive Minds: a dedicated training division with 100 instructors in five centers worldwide. “It’s Additive Minds’ job to tell people about how to select applications, who needs to be trained, where are the early adopters succeeding,” says Boyd.

\n\n

It seems to be working. In one quarter of 2017, he says, the company sold more than it did in all of 2016. Indeed, the potential looks strong for additive manufacturing across the board.

\n\n

“We’re at the middle of the beginning,” says Boyd, “and it’s going to ramp up very quickly.”

\n\n

Editor's note: This article was updated on May 15 to reflect the current name of HP Inc., which the article originally referred to as Hewlett Packard.

\n\n","field_all_authors":"

By M. Mitchell Waldrop 05.02.2018

\n\n","field_author_bios":"

M. Mitchell Waldrop is a freelance writer and editor based in Washington, DC.

\n\n","field_banner_alt":"Intricately latticed polymer midsole for running shoe emerging from unstructured resin via 3-D printing.","field_banner_title":"Shoe midsole","field_caption":"

An Adidas running shoe Futurecraft 4D midsole is printed on an industrial 3-D printer made by Carbon. The printer uses light and oxygen to create intricate designs, such as the varied lattices seen here, from a liquid resin, in a variant of stereolithography.

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3-D printing finds a custom foothold in manufacturing

\n\n

From rocket thrusters to shoe soles, additive technologies expand their sights

\n\n

By M. Mitchell Waldrop

\n\n

05.02.2018

\n\n

“Additive has lots of hype. But take 90 percent of that hype and throw it away, and the rest is still revolutionary.”

\nMike Molnar

\n\n

\"A — \n
SpaceX launched its first metal rocket hardware created by 3-D printing in 2014. The SuperDraco Thruster, shown here, is made of a high-performance metal alloy and was created using additive manufacturing techniques in less time than traditional machining. The thruster was designed to fire as part of the launch escape system for SpaceX's piloted Dragon spacecraft.
\n\n
CREDIT: SpaceX
\n

\n\n

“We have the potential to be very disruptive,” says Fletcher. “We just have to figure out how.”

\n\n

Homebrews

\n\n

In fact, he says, that idea was so compelling that inventors independently found more than half a dozen ways to implement it.

\n\n

“It had better be good,” replied his wife, who was already in her pajamas.

\n\n

\"A — \n
Plastic T. rex toys printed by Carbon using a variant of stereolithography.
\n\n
CREDIT: Courtesy of Carbon
\n

\n\n

Tipping point

\n\n

The fundamental challenge

\n\n

For everyone in additive manufacturing, however, easily the biggest challenge is what EOS’s Fletcher calls “the habits of the present.”

\n\n

It seems to be working. In one quarter of 2017, he says, the company sold more than it did in all of 2016. Indeed, the potential looks strong for additive manufacturing across the board.

\n\n

“We’re at the middle of the beginning,” says Boyd, “and it’s going to ramp up very quickly.”

\n\n

Editor’s note: This article was updated on May 15 to reflect the current name of HP Inc., which the article originally referred to as Hewlett Packard.

\n\n

10.1146/knowable-050218-053401

\n\n

M. Mitchell Waldrop is a freelance writer and editor based in Washington, DC.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n $\"Knowable$

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It takes a deft touch to draw a decent heart in latte foam, but that’s not the hardest part about working as a barista. The real backbreaker: cheerfully greeting a hundred people in a row, even that one guy who hasn’t left a tip in three years but always complains that his coffee isn’t hot enough except for the times that it’s too hot.

\n\n

For baristas, salespeople, flight attendants and many other service workers, fake smiles and forced pleasantries often come with the job description. But psychologists warn that emotions can’t just be flipped on like an espresso machine, and smiles aren’t as easy to put on as name tags. Feigning feelings at work — what psychologists call “emotional labor” — can be as mentally and physically taxing as any other type of workplace stress, but few workers or employers recognize the threat, says Neal Ashkanasy, a professor of business management at Queensland University in Brisbane, Australia. “People just put expressions on their faces without any idea what kind of stress it’s causing,” he says.

\n\n

Americans expect bottomless reserves of cheerfulness from service workers.

\n\n

Alicia Grandey, a psychologist at Pennsylvania State University and a leader in emotional labor research, had to put on a happy face as a barista at Starbucks before she started grad school in the 1990s. “I’m a reasonably social person, but it was exhausting,” she says. “I would come home from a day of barista-ing and my face would hurt. I thought I was just being whiny.” Now she knows what was really happening: The sheer effort of expressing emotions she wasn’t always feeling was wearing her down, one smile at a time.

\n\n

Emotional labor taxes some of the deepest parts of the psyche. As Ashkanasy explains, genuine smiles, laughs, frowns and other outward signs of true emotions mostly flow from the amygdala, a part of the brain that shapes our most fundamental impulses, from fear to lust. Putting on a fake emotion means going against the wishes of the amygdala, a piece of anatomy that’s used to getting its way. “Your brain has to do a lot of work to keep that under control, and it uses physical resources to do it,” Ashkanasy says.

\n\n

“I would come home from a day of barista-ing and my face would hurt. I thought I was just being whiny.”

\nAlicia Grandey\n

\n\n

That kind of effort is more than just tiring. Over time, it could become unhealthy. “If your feelings are different from what you’re showing, you can start to get back strain, neck strain and stomachaches,” Grandey says. The toll of emotional labor at work can follow people after hours, too. A 2013 study of bus drivers found that those who reported faking emotions during the day were more likely to suffer from insomnia, anxiety and emotional exhaustion at home. A 2014 study of hotel managers by Grandey and colleagues found that people who had to feign their feelings on the job tended to be less helpful at home, presumably because they were too tired to pick up a broom or dishrag. And in yet-to-be-published research, Grandey and colleagues also found that people who fake positive emotions at less-than-positive jobs tend to drink more alcohol at home, perhaps because they feel inclined to cut loose after keeping things buttoned up. Other studies have suggested a similar lack of control with food. “You feel like you don’t have any willpower,” Grandey says.

\n\n

Like any other task, emotional labor is easier for some people than others, Ashkanasy says. People who are naturally cheerful will have less trouble embracing the joy of scanning groceries or refilling baskets with bread sticks. They won’t have to expend as much effort putting on a brave face, which makes it easier to thrive at their work, at least for a while.

\n\n

Like a method actor trying to get into a role, a flight attendant could convince himself that he enjoys performing safety demonstrations that nobody watches.

\n\n

Those who aren’t actually happy with their work have another option: actively creating emotions needed for a job. Like a method actor trying to get into a role, a flight attendant could convince himself that he enjoys performing safety demonstrations that nobody watches. “You can try to recall moments that connect to the emotional state that you want to be in,” Ashkanasy says. You aren’t standing there holding an oxygen mask for the 1,488th time, no. “You’re hanging out at a great party.”

\n\n

Once it’s perfected, the acting approach can lessen much of the sting of emotional labor. After all, it doesn’t take much effort to smile if you’re actually happy. But if your name isn’t Daniel Day-Lewis, method acting takes effort and training, something that few employers are able or willing to provide. “When I worked at Starbucks, we had two-week training that included role-playing situations with customers,” Grandey says. “They don’t do that anymore.” (Starbucks did not respond to a request for comment before publication.)

\n\n

It’s not just corporate culture that makes life difficult for service employees; the national culture matters, too. While Americans expect bottomless reserves of cheerfulness from service workers, customers in some other countries can be more forgiving. A 2005 study by Grandey and colleagues found that employees in France don’t suffer as many consequences from emotional labor, partly because being rude and gruff on the job is a bit of a French tradition. “If they’re smiling, it’s because they want to,” Grandey says. “They don’t have the same requirements about ‘service with a smile’ as the US.”

\n\n

Fake smiles take less effort when you’re not getting yelled at behind the scenes.

\n\n

Expectations in US restaurants and coffee shops aren’t likely to change soon, but employers can still take steps to lessen the strain of emotional labor. Ideally, Grandey says, all service employees would have a break room outside of the public eye where they could truly be themselves, at least for a little while. Also, she says, bosses and supervisors who expect smiles from their employees should try to promote a supportive work atmosphere — fake smiles take less effort when you’re not getting yelled at behind the scenes.

\n\n

Employers can also help their workers by encouraging them to think about the pleasant customers they meet throughout the day, not the few bad actors, says Allison Gabriel, a business psychologist at the University of Arizona. And if the public learned more about emotional labor, perhaps they would show a little more sympathy, making jerkish encounters fewer and farther between. “When I see a service employee who is not smiling or who is not super enthusiastic, I’ll stop and say, ‘How is your day going?’” Gabriel says. “I remind myself that their job may look simple, but so much of their job is managing their emotions to make my experience better. We don’t give them enough credit.”

\n\n","field_all_authors":"

By Chris Woolston 03.30.2018

\n\n","field_author_bios":"

Chris Woolston is a freelance science writer living in Billings, Montana. He can be reached at cdwoolston@gmail.com.

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This barista appears genuinely delighted as he hands a hot beverage to a customer. But many employees have to fake the expected “service with a smile,” and it comes at psychological cost, studies find.

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Farm animals hold an unusual place in society: They are both creatures and commodities, animals that live and die to support the global economy and a burgeoning human population hungry for protein. Their fates may be inevitable, but the quality of their lives can vary dramatically, from cows grazing green pastures to hogs that never see daylight.

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The health and happiness of farm animals has become an important cause for animal-rights activists and an increasing number of consumers, but experts say that improving the lives of pigs, chickens and cows isn't just a moral issue. Faced with public pressure, new government regulations and an evolving agricultural system moving further and further away from the small family farm, farmers will have to rededicate themselves to animal welfare to protect their own bottom line.

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“It's a cool and exciting time to be involved in agriculture,” says Daniel Weary of the University of British Columbia in Vancouver. “There's a growing interest in farming and where our food comes from. We're taking a step back and questioning some of the things we've done for a long time.”

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And though opinions differ, some experts think that improving the lives of farm animals could be an important step not just for farmers and animals but toward feeding and protecting the planet.

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\"Cows — Cows in a field at an organic dairy farm in Oregon.
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CREDIT: PHOTO BY LYNN KETCHUM / OREGON STATE UNIVERSITY
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The cost of caring

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Most farmers and ranchers already take animal welfare seriously, Weary adds. But caring for animals isn't cheap, and any large-scale attempts to improve welfare would likely come with a large price tag. In a 2017 report in the Annual Review of Resource Economics, Harald Grethe, an agricultural economist at Humboldt University in Berlin, estimated that livestock producers in the US and Europe can easily sink 30 percent to 40 percent of their total production costs into the welfare of their animals. A German agency estimated that it would take an investment of €3 billion to €5 billion ($3.7 billion to $6.1 billion) to ensure that all animals had amenities like room to move and the chance to perform natural feeding and grooming behaviors. And that's in a country where standards are already relatively high. In other parts of the world, the costs — and the need — could be significantly higher.

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A growing awareness about farm animal welfare has already improved the lives of some animals, but it has also heightened the conviction that the status quo isn't acceptable. As Grethe writes, “It is widely accepted in many countries that the farm animal welfare level needs to be substantially improved.” He adds: “Humans have certain duties to animals.”

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Under pressure to change

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Spurred on by public demands, federal and state governments have stepped in to improve the health and well-being of farm animals. Some new laws target obviously dubious practices: Starting in 2019, German farmers will no longer be able to castrate pigs without anesthesia. A California law enacted in 2015 requires that all chicken cages, veal crates and sow gestation crates give animals enough space to “turn around freely, lie down, stand up and fully extend their limbs.”

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Not all farmers will be eager to make such investments of their own accord, but to face the future, they'll need to make animal welfare a priority, says Daniel Berckmans, a bioscience engineer at the University of Leuven in Belgium. Berckmans explains that stress and disease slow the growth of animals, and most livestock fall about 30 percent short of their genetic potential as a result. Healthier, happier animals could put on more weight with the same amount of feed, a huge advantage in an industry where profit margins per animal are often razor-thin.

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But there could be more at stake than profits. Roughly 65 billion cows, pigs and chickens are slaughtered every year to provide protein to humans, a harvest that already puts a significant environmental strain on the planet. The Food and Agriculture Organization of the United Nations estimates that the demand for meat could jump 70 percent by 2050, which would send even more animals to the slaughterhouse, a situation that may be unsustainable. “That would be a disaster, just from the manure and the emissions,” Berckmans says. “It's hard to accept killing 100 billion animals a year.”

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Instead of jamming more animals into already crowded facilities, Berckmans says that livestock producers could take a big step toward meeting global demand by simply treating their animals better. “Animal welfare is the key to making the process more efficient,” he says. “It took me many years to understand this.”

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Weary, for his part, has dedicated his career to improving farm animal welfare to help not so much the world as the animals and the farmers. He says that developed countries already consume far more protein than they really need, so bulkier pigs and cows may not be crucial to the future. “I'm skeptical of the narrative that we have to do X and Y to feed the planet,” he says.

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Large-scale precision

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Advances in technology could help farmers improve lives of animals, and with it, their own. Since the early 1990s, Berckmans and colleagues have been working on precision livestock farming (PLF) systems that monitor large numbers of farm animals and provide real-time warnings about infections, injuries and other breakdowns, giving farmers a chance to act quickly to prevent a crisis. For example, a camera system called eYeNamic can constantly track the movement patterns of 30,000 or so chickens in a single barn, potentially saving the farmer a lot of time and visits with the birds.

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In tests conducted on European farms in 2016, Berckmans and his team found that the eYeNamic system detected 95 percent of all problems, including diseases, blocked feeder lines and other disruptions to the normal flow of activity in the barn. “We convinced ourselves that the technology works,” he says. The system isn't yet cost effective, but he believes that prices will go down as technology matures. “Five years from now, PLF will have proven its value,” he says.

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\"Man — Technological advances could allow farmers to monitor animals remotely and rapidly detect problems such as blocked feeder lines, infections or injuries. In this image, a user monitors poultry with a system known as eYeNamic that can track thousands of chickens at a time.
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CREDIT: FANCOM B.V.
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Berckmans is working on other potential solutions as the chief technology officer of BioRICS, a Belgian company that makes wearable stress monitors for athletes, including the members of the AC Milan soccer team. He envisions a time when such individual monitors will be common accessories for cows and other farm animals. “This will be crucial for making the system more efficient and more acceptable to the general public,” he says.

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The coming megafarm

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PLF or other innovations could become increasingly important as small family farms continue to give way to larger industrial operations, Berckmans says. With the number of farmers on the decline and the demand for food on the increase, he foresees the rise of animal metropolises with perhaps 25,000 milking cows, 200,000 pigs or a few million chickens in a single facility. Despite widespread concerns about the horrors of “factory farms,” animals at large facilities aren't necessarily worse off than those on smaller farms (see sidebar). Still, such large facilities will produce challenges for animal welfare. A single infection, for instance, could quickly spread through an entire flock or herd, increasing the need for careful monitoring and rapid response.

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Do megafarms really breed cruelty?

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The mention of a huge “factory farms” can conjure up images of large-scale horrors that would make anyone rethink their appetite for hamburgers. But though farms with thousands or tens of thousands of animals do tend have a more industrial approach than the family farm, it's wrong to assume that large operations are necessarily more cruel or dangerous for animals, says Daniel Weary, a professor in the animal welfare program at the University of British Columbia in Vancouver. “Just like large schools or large hospitals, large farms do some things extremely well,” he says.

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Animals in large operations may not get much individual attention, Weary says, but the farmer is likely to have advanced technology and scientific approaches to raising animals with a minimum of loss to injury or disease. In a 2016 review in the Journal of Animal Science, Weary and coauthors found no consistent relationship between the size of a farm and the welfare of dairy cows or other livestock. As is often the case, every situation had trade-offs. Cows on small dairy farms were likely to have at least some access to outside pastures, but they were also more likely than cows on large farms to spend large parts of their day tied up in a narrow stall.

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Harald Grethe at Humboldt University in Berlin, reached a similar conclusion in a 2017 review of the economics of farm animal welfare: “High levels of animal welfare can be reached on large farms as well as on small farms,” he wrote. —Chris Woolston

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Evolving attitudes about animal welfare could also change the way things are done on the farm, Weary says. “People are going back to the issue with fresh eyes. You don't want to have your customers or your neighbors walk up to you and say that what you're doing is against their values.” He says that the dairy farmers he works with generally agree that their cows would be healthier and happier if they had regular opportunities to graze in pastures, and widespread demand for milk from pasture-fed cows could make it worth farmers' while. “It's an opportunity for them to do something that perhaps they want to do anyway,” Weary says.

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The grocery store would seem like an obvious place for consumers to support animal welfare, but making such a statement isn't simple, says Jayson Lusk, an agricultural economist at Purdue University in West Lafayette, Indiana. Some people may decide to reduce suffering on the farm by going vegan. That might reduce the number of animals headed for slaughter, he says, but it doesn't do much to improve the lives of the animals that still go from farm to table. Consumers can shop for foods with reassuring labels such as “cage-free” eggs, but that term doesn't necessarily mean hens are living in a chicken utopia. In many cases, hens that avoid cages end up in huge flocks. That might give them more room and more opportunities to act like chickens, but they also tend to be more likely to break bones or die prematurely.

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And then there's the cost: In a 2017 report in the Journal of Agricultural Economics, Lusk and a colleague estimated that the California law that gave chickens more room will cost consumers roughly $25 million a year in higher egg prices.

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In the end, Lusk says, every animal's ability to grow and produce will be inexorably tied to its living conditions. “You have to make sure the animals are healthy enough to be able to put on weight and lay eggs and give milk,” he says. But as long as farmers can improve their profits by crowding more chickens or pigs into a barn, he says, the lengths they'll be willing to go to nurture and protect each animal will remain an open question. “There's always a trade-off.”

\n\n","field_all_authors":"

By Chris Woolston 4.24.2018

\n\n","field_author_bios":"

Chris Woolston is a freelance science writer living in Billings, Montana. He can be reached at cdwoolston@gmail.com.

\n\n","field_banner_alt":"Thousands of poultry packed into a barn.","field_banner_title":"Poultry in barn","field_caption":"

Poultry reared for slaughter are often packed close in large barns, as seen on this farm in Brazil.

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Happy hens, happy world

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Farmers are recommitting themselves to animal welfare, and that might help the planet, too

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By Chris Woolston

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4.24.2018

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And though opinions differ, some experts think that improving the lives of farm animals could be an important step not just for farmers and animals but toward feeding and protecting the planet.

\n\n

The cost of caring

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Under pressure to change

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Large-scale precision

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The coming megafarm

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Do megafarms really breed cruelty?

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10.1146/knowable-042418-040901

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Chris Woolston is a freelance science writer living in Billings, Montana. He can be reached at cdwoolston@gmail.com.

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This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n $\"Knowable$ \n\n","field_tagline":"Farmers are recommitting themselves to animal welfare, and that might help the planet, too ","field_xml_enabled":"0"},"relationships":{"field_ar_related_articles":{"data":[{"id":"661","type":"paragraphs"}]},"field_banner":{"data":{"id":"625","type":"images"}},"field_footer_articles":{"data":[{"id":"technology/2018/science-better-beer","type":"articles"},{"id":"physical-world/2018/invisibility-aside-metamaterials-are-making-waves","type":"articles"}]},"field_topic":{"data":{"id":"sustainability","type":"topics"}},"field_topics":{"data":[{"id":"society","type":"topics"},{"id":"sustainability","type":"topics"}]}}},{"id":"603","type":"images","attributes":{"title":"OceanOxygenLoss1600x600.png","filename":"OceanOxygenLoss1600x600.png","uri":"public://articles/banner/2018-04/OceanOxygenLoss1600x600.png","styles":{"134_y":"https://www.knowablemagazine.org/sites/default/files/styles/134_y/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=XW8asa7_","1600_600":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=unvXHwWy","285_205":"https://www.knowablemagazine.org/sites/default/files/styles/285_205/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=06ykHgAl","305_220":"https://www.knowablemagazine.org/sites/default/files/styles/305_220/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=jYdqnmB-","400_y":"https://www.knowablemagazine.org/sites/default/files/styles/400_y/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=wXF2VMlk","500_288":"https://www.knowablemagazine.org/sites/default/files/styles/500_288/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=ChCqjj9N","645_552":"https://www.knowablemagazine.org/sites/default/files/styles/645_552/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=kL4mYDXz","750_y":"https://www.knowablemagazine.org/sites/default/files/styles/750_y/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=KuAFeSmt","large":"https://www.knowablemagazine.org/sites/default/files/styles/large/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=pVXOtTE1","linkit_result_thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/linkit_result_thumbnail/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=u8m89i_t","medium":"https://www.knowablemagazine.org/sites/default/files/styles/medium/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=9e02Z0sM","thumbnail":"https://www.knowablemagazine.org/sites/default/files/styles/thumbnail/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=yT1qs-le"},"filemime":"image/png","filesize":"504562","status":"1"}},{"id":"sustainability/2018/marine-wildlife-starting-suffocate","type":"articles","attributes":{"title":"Marine wildlife is starting to suffocate","nid":"101","created":"1523465987","revision_default":"1","path":"160","body":"

A multitude of marine species, from bottom-dwellers to fish and octopuses, are gasping for air. In swaths of ocean the world over, creatures are being increasingly deprived of oxygen. It’s a hidden consequence of climate change, less obvious than rising seas and mass coral-bleaching events — yet no less dangerous to marine life.

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Oxygen levels vary in oceans around the world, but signs of global warming–driven declines have begun to emerge beyond those natural fluctuations, and conditions in coastal areas exposed to agricultural runoff, such as the Gulf of Mexico and the East Coast’s Chesapeake Bay, are worsening. The declines are wreaking ecological change that won’t be reversed for centuries, if at all, climate scientists warn.

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The very existence of some species is at stake, according to research led by Lisa Levin, a biological oceanographer at the Scripps Institution of Oceanography in La Jolla, California, who is known for her studies of deep-sea ecosystems and oxygen-deficient ocean waters. “Climate change and warming are making naturally occurring, low-oxygen areas bigger than they were,” Levin says. “They’re exacerbating coastal nutrient-driven ‘dead zones,’ making them occur in more places, start earlier in the summer, and last longer.”

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Over the past half-century, the open ocean has lost about 2 percent of its oxygen on average, but some areas — such as the north and east Pacific Ocean, tropical waters and the Southern Ocean — have experienced more precipitous declines. Most other oceans face similar drops within the next 15 to 25 years, according to climate projections that were modeled assuming that carbon emissions would continue to be business as usual.

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Ocean-dwelling phytoplankton (also known as microalgae) and other plants add oxygen into the water during photosynthesis. But as temperatures rise, especially in the upper ocean, less oxygen can dissolve in the seawater. Warming also slows down the ventilation of the waters by winds and currents, which would normally stir in oxygen. Less mixing leads the water to become more stratified, causing an isolated, oxygen-deficient zone to develop at depths of 100 meters to 1 kilometer.

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Warming also increases the respiration rates of microbes and animals, so they use up more oxygen than they would at lower temperatures just to meet their bodies’ metabolic demands. Phytoplankton, which both produce and respire oxygen, grow more vigorously in warmer waters, then die off, decay and sink to the bottom, where bacteria feed on them and suck up yet more oxygen in the process.

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\"Marine — Marine phytoplankton, such as these tiny coccolithophores (shown here in false color under a scanning electron microscope) add oxygen to the upper levels of the ocean. But an increase in their numbers can reduce the already-limited oxygen supply in deeper water. As they die and sink to the ocean floor, they fuel the activity of oxygen-consuming decomposers.
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Credit: Steve Gschmeissner/Science Source
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Ecological effects

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To make matters worse, runoffs from rivers and estuaries along major coastal areas carry nutrients from agricultural waste and inadequately treated human sewage. Nitrates from fertilizers, for example, leach into groundwater, make it out to sea and spur dense growths of algae, known as algal blooms. These blooms gobble up much more oxygen than normal, giving rise to dead zones.

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“Things aren’t really dead there — there are little animals that can tolerate it,” Levin says. She and her colleagues found that many microbes, tiny worms and even some fish and sea urchins can survive in these harsh, nearly oxygen-free conditions. But most other wildlife has to move or die.

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Animals living on the ocean bottom are especially susceptible, says Denise Breitburg, a marine scientist at the Smithsonian Environmental Research Center in Edgewater, Maryland, who studies marine ecosystems and the effects of oxygen loss. And even though fish tend to relocate to spots outside the most severely depleted areas, they still can suffer. “Some end up being exposed to chronic low oxygen, reducing their populations, too,” Breitburg says.

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Harm can be more subtle than outright death. For some marine animals, sparse oxygen can damage vision, for example, by increasing the likelihood of diseases associated with the eye, according to new research by Levin and her team. The scientists now want to know whether this inhibits finding mates for reproduction or makes creatures more vulnerable to starvation or predation. If octopuses or squid, for example, now need more light, they might move to new spots with less food, or more predators.

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These oxygen-starved regions are expanding, and they’re pushing the intolerant species up into shallower water, Levin says. But there’s a limit to how shallow they can go — oceans have a surface, after all. This creates a phenomenon known as “habitat compression.”

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Consider the rockfish. Many species live off the coast of Southern California as well as in the northern Pacific, at depths as low as 1,500 meters. But they’re not tolerant of the low oxygen increasingly found there. As they lose habitat areas, they end up aggregating in shallower, better-lit waters, where they’re more easily targeted by commercial fishers, Levin and her colleagues have found. Rockfish are now overfished.

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Omens from the past

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Rockfish are just one of many interconnected species in many oceans around the world that stand to be affected as oxygen-deficient zones persist and grow. Entire ecosystems could be transformed, becoming less habitable than the driest deserts. “Levin’s really tying this to the biological record and what this might mean for the future, such as whether we are heading to a sixth mass extinction,” says Jeremy Owens, a marine geologist at Florida State University in Tallahassee.

\n\n

Owens’s own work examines fossils in the geological record, and waves of past extinctions, some of which may parallel what’s happening in the ocean today and offer clues to where ocean life may be heading. In a minor extinction event some 94 million years ago, for example, widespread volcanic activity increased carbon dioxide levels in the atmosphere, raised surface temperatures and sea levels, and trapped extra nutrients in ocean waters. Evidence also points to a rapid oxygen loss in that ancient climatic event that likely played a role in the extinctions (including the demise of the ichthyosaurs and more than a quarter of marine invertebrates).

\n\n

Similarly, some scientists think that the even more dramatic Permian-Triassic extinction event of about 252 million years ago — in which more than 90 percent of marine species perished — followed a similar pattern, with ocean oxygen depletion partly to blame. Today’s situation is not as extreme: Carbon dioxide emissions would have to continue at the current level for more than a century before ocean oxygen loss reached a similar level, says Matthew Long, a climate scientist at the National Center for Atmospheric Research in Boulder, Colorado.

\n\n

Still, Long is already concerned. “It’s amazing to me how life evolved on Earth in this co-dependent way: Microorganisms invented photosynthesis that resulted in the production of oxygen, and suddenly that created this intricate network of life,” he says. “Then I imagine what we’re doing through human-driven warming — changing oxygen, an important control on the metabolism of animals. Seventy percent of the planet is being changed in invisible ways that will have profound impacts on marine ecosystems.”

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What can be done

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Just as humans have the power to wreak havoc with marine life, they also have the power to alleviate these problems. The world’s oceans have seen warming, acidification, sea-level rise and depleted oxygen — but reducing greenhouse gas emissions would address them all in one fell swoop, Levin says. For nutrient-driven oxygen loss closer to shore, Breitburg argues that people could develop agricultural practices that minimize nutrient runoff; treat sewage and wastewater before it reaches the ocean; and better regulate power-plant emissions, which include airborne nitrogen that contributes to the formation of dead zones.

\n\n\n\n

\"The — Jellyfish and jellyfish-like comb jellies, such as this *Mnemiopsis leidyi,* are some of the few kinds of marine wildlife that can tolerate low oxygen levels. Their growing populations can further diminish oxygen in deeper waters.
\n\n
Credit: WaterFrame / Alamy Stock Photo
\n\n

\n\n

But since oxygen-limited oceans will persist for decades or more even if all the right things are done, Levin calls for more work on adaptation — incorporating the effects of climate change into environmental management. People could manage fish in a way that considers particularly vulnerable species, such as rockfish. This might, she says, mean setting aside protected marine areas or adding species that are intolerant of low oxygen to no-fishing lists.

\n\n

“I try to advocate for climate-tolerant fisheries. Take the species you know can handle climate change, and stop fishing and buying the ones that can’t,” Levin says. “Scientists need to figure out which is which.”

\n\n

Editor's note: This article was updated May 30, 2018, to correct an error about types of fish vulnerable to low oxygen levels in seawater. Rockfish are indeed particularly vulnerable; black cod and Dover sole, mentioned erroneously in the original version of this article, are in fact highly tolerant.

\n\n","field_all_authors":"

By Ramin Skibba 04.12.2018

\n\n","field_author_bios":"

Ramin Skibba is an astrophysicist turned science writer and freelance journalist, based in San Diego. Reach him at raminskibba@gmail.com or @raminskibba.

\n\n","field_banner_alt":"Large algal bloom in the Barents Sea","field_banner_title":"Algal bloom","field_caption":"

A massive algal bloom in the Barents Sea during the Arctic summer is a riot of life. But its aftermath may be death for those below, as the bloom leads to a scarcity of oxygen in deeper waters.

\n\n","field_credit":"MODIS RAPID RESPONSE TEAM GSFC/NASA","field_doi":"10.1146/knowable-041318-080501","field_is_hero":"1","metatags":{"referrer":"origin","title":"Marine wildlife is starting to suffocate","description":"Global warming and agricultural runoff have driven the loss of oxygen in oceans around the world, with looming ecological consequences.","google_plus_name":"Marine wildlife is starting to suffocate","og_title":"Marine wildlife is starting to suffocate","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/sustainability/2018/marine-wildlife-starting-suffocate","dcterms_description":"Global warming and agricultural runoff have driven the loss of oxygen in oceans around the world, with looming ecological consequences.","dcterms_identifier":"10.1146/knowable-041318-080501","dcterms_publisher":"Annual Reviews","dcterms_title":"Marine wildlife is starting to suffocate","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"Global warming and agricultural runoff have driven the loss of oxygen in oceans around the world, with looming ecological consequences.","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=unvXHwWy","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Thursday, April 12, 2018 - 08:00","citation_title":"Marine wildlife is starting to suffocate","article_modified_time":"Tuesday, June 12, 2018 - 13:45","article_published_time":"Thursday, April 12, 2018 - 08:00","og_description":"Global warming and agricultural runoff have driven the loss of oxygen in oceans around the world, with looming ecological consequences.","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=unvXHwWy","og_image_height":"600","og_image_type":"image/png","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=unvXHwWy","og_image_width":"1600","og_updated_time":"Tuesday, June 12, 2018 - 13:45","og_url":"/article/sustainability/2018/marine-wildlife-starting-suffocate","twitter_cards_description":"Global warming and agricultural runoff have driven the loss of oxygen in oceans around the world, with looming ecological consequences.","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-04/OceanOxygenLoss1600x600.png?itok=unvXHwWy","twitter_cards_image_height":"600","twitter_cards_image_width":"1600","twitter_cards_page_url":"/article/sustainability/2018/marine-wildlife-starting-suffocate","twitter_cards_site":"@knowablemag","twitter_cards_title":"Marine wildlife is starting to suffocate","dc_identifier":"10.1146/knowable-041318-080501"},"field_primary_author":"By Ramin Skibba","field_published":"2018-04-12","field_republish_html":"

Marine wildlife is starting to suffocate

\n\n

Global warming and agricultural runoff have driven the loss of oxygen in oceans around the world, with looming ecological consequences.

\n\n

By Ramin Skibba

\n\n

04.12.2018

\n\n

Oxygen levels vary in oceans around the world, but signs of global warming-driven declines have begun to emerge beyond those natural fluctuations, and conditions in coastal areas exposed to agricultural runoff, such as the Gulf of Mexico and the East Coast’s Chesapeake Bay, are worsening. The declines are wreaking ecological change that won’t be reversed for centuries, if at all, climate scientists warn.

\n\n

Ecological effects

\n\n

Omens from the past

\n\n

What can be done

\n\n

10.1146/knowable-041318-080501

\n\n

Ramin Skibba is an astrophysicist turned science writer and freelance journalist, based in San Diego. Reach him at raminskibba@gmail.com or @raminskibba.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n\n

$\"Knowable$

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How much plastic debris ends up in the world’s oceans every year? That’s a question that preoccupied University of Georgia’s Jenna Jambeck for years until she worked out the math with colleagues in 2015 and published the findings in Science. Bottom line: The tonnage translates to the equivalent of five grocery bags full of plastic lined up on every foot of coastline around the globe.

\n\n

Jambeck coauthored “Plastic as a Persistent Marine Pollutant,” a 2017 review on what’s known about how marine plastics work their way into the food web, in the Annual Review of Environment and Resources. It argues for a “Global Convention on Plastic Pollution,” similar to other international conventions to tackle persistent organic pollutants such as DDT and PCBs.

\n\n

This interview has been edited for length and clarity.

\n\n\n\n

Let’s start with the basics: How does all this plastic debris end up in the ocean?

\n\n

The commonly quoted statistic is that the majority, about 80 percent, comes from land. It gets washed by runoff or blown by wind into the ocean or into waterways that lead to the ocean. The rest, about 20 percent, comes from catastrophic events or maritime sources, much of it fishing gear. In my work, I focus on municipal solid waste and poor design of trash receptacles, collection vehicles and landfills, especially in rapidly developing economies where waste management is lagging. Deliberately tossing litter or open dumping and burning trash is a part of human nature and how we’ve historically managed waste. But some cultures still do it.

\n\n

That wasn’t a problem for the oceans until plastics came on board. If you throw out metal or glass or burn paper, that’s one thing. But plastics are persistent synthetic polymers that can last for centuries. The steep, steep increase of production of plastics, 620 percent in the last 40 years, has completely changed our waste stream.

\n\n\n\n

\n\n

Is the plastic problem growing or shrinking?

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Right now, it’s still on the growth curve because of population growth and increase of plastic use.

\n\n

If there’s so much in the ocean, why don’t we see more of it? Doesn’t it float?

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Some floats and some sinks. It depends on the density of the polymer. Beverage bottles are denser than seawater and would sink, unless the cap is on. Capped bottles are filled with air and people tend to see them floating. Polyethylene, such as milk jugs, and polypropylene, which is used to make food packaging and wrappers, are the most common types of packaging that floats. Over time, the materials fragment into smaller and smaller pieces. Their density can change as they get colonized by bacteria and algae and then they can drift to the seafloor like marine snow.

\n\n

We know that the ocean can spit plastic back on beaches. And there is plastic flying above our heads in the stomachs of seabirds. But we hypothesize that most of it probably ends up at the bottom of the ocean, potentially ground into smaller and smaller bits.

\n\n

Why should we be concerned about this?

\n\n

We’ve all seen heartbreaking pictures of entangled marine life, struggling to get free. We find plastic bags in the stomachs of sea turtles, plastic straws stuck in their nostrils. Plastics don’t biodegrade in the ocean, but fragment over time into microplastics, about the size of pencil erasers. And now we are finding microbeads, the size of the tip of a pencil, or even smaller. They replaced walnut shells or pumice as abrasives in toothpaste and exfoliating agents in body cleansers. And now, there’s a hot new area of environmental research tracking microfibers from synthetic fabrics, like fleece, often made of polyethylene. When you wash these garments, little pieces of these fibers wash out with the wastewater and can end up in the ocean. We’re just learning how all these fragments might come back to haunt us.

\n\n

Can you offer an example of how plastic bits in the ocean might haunt us?

\n\n

Depending on its size, plastic will get consumed by marine organisms. We have found plastic in the bellies of fish, and many, many other animals. Some research focuses on shellfish, like mussels or oysters, which accumulate microplastics and microfibers as they filter seawater to feed on plankton. When we eat an oyster or a clam, we consume the entire animal and everything it has accumulated.

\n\n

Aside from sounding rather unappetizing, is it a problem eating bits of plastic?

\n\n

It can be for wildlife. Seabirds like albatrosses fill their bellies with plastics, which don’t provide them nutrients — so they can starve to death. But it’s also contaminants the plastics can carry, either when they were produced with phthalates [to make them more flexible] or BPA [used to manufacture strong epoxy resin], or what they pick up in the environment. Even though plastics are hard materials, at the microscopic level they absorb persistent organic compounds. Persistent organic pollutants like DDT, PCBs, flame retardants and fabric treatments have an affinity for plastic. Plastics act like sponges, soaking them up. In fact, when you want to explore sediment contamination, you stick in a flat, rectangular sheet of plastic for a few weeks and then pull it out to analyze the contaminant load.

\n\n

So we could be getting a side of pesticides or flame retardants with our seafood dinner?

\n\n

Marine life and humans can be exposed to those chemicals in other ways, of course, but this is another potential pathway for those chemicals to reach us. Chelsea Rochman [an ecologist at the University of Toronto] has shown that fish have absorbed some persistent organic pollutants from plastics and had lesions on their livers, which are precursors to cancer. But we don’t yet understand the link between plastics, toxic compounds they carry, and what this could mean for humans.

\n\n

What does it take for plastic to disintegrate, to break down into component parts?

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Heat and sunlight can break down plastic. But we don’t think there is a lot of biodegradation for traditional polymers in the ocean. We don’t have a lot of sunlight on the ocean floor, and it’s much cooler in temperature. There’s a lot of abrasion and mixing near the surface to grind them up. And science has isolated a couple of strains of microbes and bacteria that can metabolize carbons in plastic. But our common understanding is that the long-chain polymers don’t really biodegrade.

\n\n

We often hear about schemes to clean up the plastic debris in the ocean. Is this the right solution?

\n\n

I like to use the analogy of the overflowing bathtub. If your bathtub is overflowing, the first you thing you do is turn off the tap. There are some worthwhile ocean cleanup efforts, such as collecting nets and fishing gear. But we need to focus on stopping the input from land.

\n\n

How do we do that?

\n\n

There is a whole continuum of solutions upstream that will affect downstream: reducing plastic production and devising ways to deliver products with less waste. We produce almost four times as much waste on a per capita basis as many middle-income countries. There’s talk about new materials, and designing them in a way to retain their value so they can be recycled. When needed, plastics should be properly treated and contained at a disposal site, but that is the least desirable option.

\n\n

It’s exciting to work in a field where we could make a difference so quickly.

\n\n\n\n

\n\n

You sound quite passionate about the topic. How did this start?

\n\n

When I was getting my PhD at University of Florida, I took a solid-waste class and I fell in love with studying solid waste. I’m fascinated with what people decide to throw away and what people decide to pick out and collect. Everywhere I go around the world, I take pictures of trash cans and talk to trash collectors. When I’m at a hotel, and I hear the beeping of a truck backing up, I think that may be the trash truck and I need to get a picture. I’m in an international speakers program sponsored by the [U.S.] State Department, and go to universities to meet with other professors and students and government officials about how to keep plastic from going in the ocean. Sometimes they take me to landfills, but I also like to go independently. I am fascinated with them as places that reveal our history and current state of affairs. I don't associate dumps with waste but with people who threw away the waste, and those who are there to manage it or recycle it. I love to talk to waste pickers to better understand their social and cultural issues. I get so jazzed with those on-the-ground interactions. I just love it.

\n\n

Sounds like dumps are your happy place?

\n\n

They are. I met my husband at the landfill when I was in grad school. We fell in love at the landfill. This was in Florida and the landfill was a high point. We could see romantic sunsets there. My husband doesn't really have the romanticized view of the landfill that I do. But he definitely understands me, which is great.

\n\n

When did you begin to focus on plastic debris flowing into the ocean?

\n\n

I started looking at the issue in 2001 and I was laughed at. Fewer people cared about the issue back then, and the field wasn’t respected as a scientific discipline. But I felt instantly passionate about it. And things have changed. It’s really grown as a research field with recognition that this is a serious issue. If the goal is zero input into the oceans, one important thing you can do downstream is collect data. That’s why I developed an app.

\n\n

An app?

\n\n

Yes, it’s called Marine Debris Tracker and available for iOS and Android. It’s for citizen-science work. People can take a picture of, or tell us, what they find and send it to our database. We also hope they pick up whatever litter they find. We make all of the data available to the public.

\n\n

In your review, you and your co-authors call for a global convention on plastic pollution. Is this really needed?

\n\n

I think it is, because it’s inherently a global problem. Once plastic ends up in the ocean, it can ride the currents and end up anywhere. There are national efforts, like Kenya recently banned plastic bags. And there are regional agreements that can help. But a global convention could bring everyone together to tackle this problem.

\n\n","field_banner_alt":"A pile of trash on the shore. ","field_banner_title":"A pile of trash on the shore. ","field_caption":"

How do you dispose of trash on a remote atoll? On Tarawa, the capital island of the Central Pacific nation of Kiribati, the government has begun trash collection and piling it in one place on the narrow ribbon of sand for burial. Yet plastics do not easily biodegrade, and are often washed or blown into the ocean mere steps away. It’s a waste-management problem found around the globe. An estimated 80 percent of plastic marine debris comes from the land, blown by winds or washed by rivers and streams into the oceans.

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master teller of fish stories","nid":"112","created":"1525905388","revision_default":"1","path":"170","body":"

It has been called “the world’s most dangerous meal,” a fish whose internal organs are laced with one of the deadliest toxins on Earth. Specialized restaurants in Japan and a few other places serve carefully prepared fugu flesh as an expensive delicacy, in part because of this risky thrill.

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But Byrappa Venkatesh was drawn to the fugu for an entirely different reason: It has the smallest genome of any vertebrate. That quality was gold back in the 1990s, when geneticists were still racing to sequence the human genome or that of any other vertebrate: Fugu offered a shortcut to the finish line. The puffer was still a slog, though. It cost Venkatesh and his colleagues nine years of hard work and about $10 million, and, in the end, the human genome project nosed them out, just barely, as the first vertebrate genome ever completed.

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\"\" — The puffer fish Fugu rubripes has the smallest genome of any vertebrate. It was the first fish species selected for genome sequencing.
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CREDIT: BYRAPPA VENKATESH
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The project kindled a passion for fish genomics that has propelled Venkatesh ever since. With good reason: Fish are the most diverse group of vertebrates on the planet. They live in deep ocean, in acid waters and in Antarctic seas below the freezing point of blood. Their bodies range from eely, jawless lampreys to flattened flounders to huge, lumpish ocean sunfish. Some lay eggs, some bear live young, and in seahorses, it is the males that become pregnant. In short, fish are a geneticist’s dream. “They show so many variations,” says Venkatesh. “If there is any adaptation in any vertebrate, it should be there in fish.”

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In the years since completing the fugu genome in 2002, Venkatesh — known universally as Venki — has sequenced the genomes of more than a dozen fishes, from sharks to the living-fossil coelacanth to his personal favorite, the seahorse. “He’s been a champion, in a very mild-mannered but persistent way, for a long time,” says Richard Durbin, a genomicist at the University of Cambridge. “He’s one of the focal persons for evolutionary fish genomics.”

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Venkatesh has seen an enormous growth in sequencing power and technology since the early days of fugu. Today, generating a high-quality genome sequence from scratch takes just two months’ work and about $30,000. “Nobody predicted it would happen so fast,” he says. “You can sequence any genome now.”

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And you can sequence lots of them. Venkatesh, based at Singapore’s Institute of Molecular and Cell Biology, helps lead a consortium with big ambitions to sequence hundreds of vertebrate genomes by the end of this decade, nearly half of them fish, en route to eventually completing sequences of every living vertebrate, and more.

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A student takes the bait

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Despite his current prominence in genomics, Venkatesh came to the field almost by accident. Born in Bangalore, India, to a scientific family — his father was a veterinarian — he chose to study fisheries in university because it sounded like fun. “I thought I could go diving and have a great time,” he recalls.

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He never did learn to dive. Instead, after a few years as a fisheries biologist in India, he headed off to Singapore for graduate school, where he studied the hormonal regulation of pregnancy in guppies.

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While there, he met Sydney Brenner of the University of Cambridge, one of the founders of molecular biology. Brenner wanted to be first to sequence a complete vertebrate genome and selected fugu for its tiny genome. He was looking for scientists to work with him on the project and saw something special in Venkatesh. “He said I should go join him in Cambridge,” says Venkatesh. “I had very little molecular biology background at that time, but he said it would be good for me.” Off he went to Cambridge, as the only fish expert on Brenner’s team.

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In 1992, after Brenner left Cambridge for California, Venkatesh returned to Singapore to take up a job at the institute, bringing the fugu genome project with him. (Eventually Brenner, too, moved to Singapore, where he established his own lab next door to his protege’s. Now age 91, he still lives in Singapore and the two meet weekly for a drink or dinner.)

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The fugu genome gave geneticists a valuable point of comparison to the human genome. They found that, despite its small size — just one-eighth the size of the human genome — the fugu has roughly the same complement of genes, and the on-off switches that control them, as humans do. To reach its slimline state, fugu seems to have lost many of the long, baffling stretches of DNA of unknown function — often called junk DNA — that litter most genomes. That made the fugu genome a helpful tool for separating the human genomic wheat from the chaff and especially for identifying the crucial regulatory switches, says Venkatesh. He later showed that the fugu’s regulatory switches are so similar to their mammalian counterparts that they can sometimes be swapped without loss of function.

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Dipping into the shark tank

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Fresh from that success, Venkatesh turned his attention to other fish genomes. His first goal was to sequence a shark. Sharks lack bony skeletons, which indicates that they are an early branch in the evolutionary tree of vertebrates. Comparing their genes with those of bony fishes can thus shed new light on the evolution of higher fishes and their descendants, including humans.

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But Venkatesh faced a big problem. Most sharks have huge genomes, far larger than those of humans, so they were difficult to sequence with the technology of the day. After two years of rummaging through the genomes of various shark species, he stumbled on the solution: the elephant shark, whose genome is only about a third the size of our own. “It’s the fugu among the sharks,” he says. That one, he could handle.

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The sequencing, completed in 2007, revealed that the elephant shark is a living genomic fossil — it has changed less from its ancestral state than any other vertebrate known. “It’s like a screen shot of the past, how our ancestors looked,” says Venkatesh. “That makes it a very useful model for examining what changes have occurred.”

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More genomes followed quickly, including those of the deep-sea coelacanth (one of the closest living relatives of terrestrial vertebrates) in 2013, the spotted gar (a primitive bony fish) in 2015, and the gigantic ocean sunfish and the distinctively shaped seahorse in 2016. Other research groups joined the hunt, so that by early 2018, Venkatesh could list 60 bony fish genomes completed by various labs around the world.

\n\n\n\n

\"A — The genome of the spotted gar (*Lepisosteus oculatus),* a primitive bony fish, offers insights into the evolution of vertebrate development, gene control, immunity and tissue mineralization.
\n\n
CREDIT: STOCKTREK IMAGES, INC. / ALAMY STOCK PHOTO
\n\n

\n\n

At the molecular level, fish turn out to be much more diverse than land vertebrates. Some time early in their evolution, bony fishes underwent a duplication of their entire genome. This freed up “spare” copies of genes for evolutionary tinkering without risking loss of the original gene function. This may explain why bony fish genomes have evolved more rapidly than those of their terrestrial cousins.

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The big catch

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Though Venkatesh finds fish fascinating in their own right, there is a larger prize in play as well. Humans and fish share most of the same molecular building blocks — their complement of genes — but deploy them in different ways. “You can take a pile of bricks and make a cathedral, you can make a bridge, you can make a villa, or you can make a road. The question is, what are the controlling mechanisms that take those bricks and make them into what you can see? That’s the big question,” says Edward Wiley, an ichthyologist at the University of Kansas. Because fish vary so much in body form, they make an ideal test bed to work out many of those controls, with big potential payoffs for our understanding of all vertebrates, including humans.

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These and other genome studies are now coalescing into a systematic effort to sequence the greatest possible diversity of vertebrate life. Venkatesh is one of the leaders of this consortium, known as Genome 10K, and is playing a key role in identifying which fish to include. “Venki has been in on fish genomics since the beginning. When G10K was formed, it was natural that they would ask him to be responsible for the fishes,” says Wiley who, with Venkatesh, cochairs the effort’s fish section.

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As its name suggests, G10K began with the goal of sequencing 10,000 vertebrate genomes, mostly in a rudimentary fashion. Since then, though, the group has refocused on quality over quantity: sequencing at least one genome from every major group, or order, of vertebrates — some 260 in all — using the newest, high-precision sequencing technology. The first hundred genomes should roll off the line within the next year, and the full set of 260 should be done by 2020, says Erich Jarvis, a genomic neurobiologist at Rockefeller University in New York City, who chairs the project. After that, the group has an even more ambitious goal: to sequence the genomes of every one of the 60,000-plus vertebrate species.

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The technology is advancing so fast that a few genome biologists are talking of the ultimate goal: sequencing the genome of every species on Earth. The plan is not as far-fetched as it sounds. “There are something on the order of a million-and-a-half named species,” says Durbin. “We’ve probably sequenced on the order of a thousand. So there’s a thousandfold improvement to make. Typically, sequencing technologies are improving twofold a year. On that scale, in the next decade we’re going to be able to find the genomes of everything.”

\n\n

If geneticists get anywhere close to that goal, current methods of sorting, comparing and understanding genomes will not cope with the enormous mass of data, says Gene Myers, a bioinformatician at the Max Planck Institute for Molecular Cell Biology and Genetics in Dresden, Germany. But Myers is optimistic that researchers, in time, will solve that problem, just as they learned to handle the once-daunting data management challenge posed by the human genome. “Meeting these challenges is the fun part,” he says. “I want to be overwhelmed and figure it out.”

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Working away on DNA

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Genome researchers will need help on another front, too, Venkatesh notes. Spelling out the genome of a species and picking out the genes it contains is relatively easy. Working out exactly what each gene actually does — and how variations in DNA sequence within the gene alter that — can be a much bigger challenge that involves a lot of detailed lab work. “You can sequence a genome in two months, but understanding the functional aspect of even one variant takes two years. We need to catch up on the functional study.”

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If geneticists can clear these hurdles — and if the consortium can find the funding to do the work — having a complete set of genomes could open whole new avenues of research. “Once you have the blueprints of all vertebrates on the planet, you’re going to be able to address questions that you could never address,” says Jarvis. Evolutionary biologists could track the genetic changes that underpin speciation — how a single cichlid species evolved into hundreds in Africa’s Lake Malawi, for example. Conservation biologists could more easily identify genetically distinct populations of threatened species or nonintrusively monitor their distribution from traces of DNA left in the environment. Someday, they may be able to understand the genetic reasons why some species are rare, and perhaps even resurrect extinct species from their genome sequences.

\n\n

Human geneticists will get their payoff, too. With a complete set of genomes, they could reconstruct the evolutionary history of our own genome and trace the origin and function of each and every gene and on-off switch. “Once we have the complete sequences, we can start asking the question of how they’re regulated, and how that regulation or misregulation affects human health,” says Venkatesh, who has already begun exploring the genomic basis of some rare human diseases. “This is what I’d like to do in ten years, if I’m still around.”

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Editor’s note: This story was updated on August 1 to substitute an image. The original image labeled as fugu (Takifugu rubripes) was not fugu but a box fish, which is in the same order as fugu (Tetraodontiformes) but in a different family, Ostraciidae. Our apologies to the fishes in question and to our readers, and thanks to Byrappa Venkatesh for supplying an image of the correct fish.

\n\n","field_all_authors":"

By Bob Holmes 05.09.2018

\n\n","field_author_bios":"

Bob Holmes is a science writer based in Edmonton, Canada.

\n\n","field_banner_alt":"A school of blue striped grunt","field_banner_title":"Swimming fish","field_caption":"

A school of blue-striped grunt (Haemulon sciurus). As the name implies, this subtropical species makes a grunting sound that's generated when it grinds its teeth together.

\n\n","field_credit":"CREDIT: IMAGE SOURCE / ALAMY STOCK PHOTO","field_doi":"10.1146/knowable-050918-050001","field_is_hero":"1","metatags":{"referrer":"origin","title":"A master teller of fish stories","description":"First came fugu. Then he took a bite out of sharks. Now a pioneer in genome research helps lead the effort to sequence every lineage of vertebrates.","google_plus_name":"A master teller of fish stories","og_title":"A master teller of fish stories","og_site_name":"Knowable Magazine | Annual Reviews","og_type":"article","twitter_cards_type":"summary_large_image","canonical_url":"/article/living-world/2018/master-teller-fish-stories","dcterms_description":"First came fugu. Then he took a bite out of sharks. Now a pioneer in genome research helps lead the effort to sequence every lineage of vertebrates.","dcterms_identifier":"10.1146/knowable-050918-050001","dcterms_publisher":"Annual Reviews","dcterms_title":"A master teller of fish stories","dcterms_type":"article","fb_admins":"1642929092406128","google_plus_description":"First came fugu. Then he took a bite out of sharks. Now a pioneer in genome research helps lead the effort to sequence every lineage of vertebrates.","google_plus_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/FishGenome_1600x600_0.jpg?itok=auGEWYMi","citation_author":"","citation_journal_title":"Knowable Magazine | Annual Reviews","citation_publication_date":"Wednesday, May 9, 2018 - 08:00","citation_title":"A master teller of fish stories","article_modified_time":"Wednesday, August 1, 2018 - 17:00","article_published_time":"Wednesday, May 9, 2018 - 08:00","og_description":"First came fugu. Then he took a bite out of sharks. Now a pioneer in genome research helps lead the effort to sequence every lineage of vertebrates.","og_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/FishGenome_1600x600_0.jpg?itok=auGEWYMi","og_image_height":"600","og_image_type":"image/jpeg","og_image_url":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/FishGenome_1600x600_0.jpg?itok=auGEWYMi","og_image_width":"1600","og_updated_time":"Wednesday, August 1, 2018 - 17:00","og_url":"/article/living-world/2018/master-teller-fish-stories","twitter_cards_description":"First came fugu. Then he took a bite out of sharks. Now a pioneer in genome research helps lead the effort to sequence every lineage of vertebrates.","twitter_cards_image":"https://www.knowablemagazine.org/sites/default/files/styles/1600_600/public/articles/banner/2018-05/FishGenome_1600x600_0.jpg?itok=auGEWYMi","twitter_cards_image_height":"600","twitter_cards_image_width":"1600","twitter_cards_page_url":"/article/living-world/2018/master-teller-fish-stories","twitter_cards_site":"@knowablemag","twitter_cards_title":"A master teller of fish stories","dc_identifier":"10.1146/knowable-050918-050001"},"field_primary_author":"By Bob Holmes","field_published":"2018-05-09","field_republish_html":"

A master teller of fish stories

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First came fugu. Then he took a bite out of sharks. Now a pioneer in genome research helps lead the effort to sequence every lineage of vertebrates.

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By Bob Holmes

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05.09.2018

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A student takes the bait

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Dipping into the shark tank

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\"A — \n
The genome of the spotted gar (*Lepisosteus oculatus),* a primitive bony fish, offers insights into the evolution of vertebrate development, gene control, immunity and tissue mineralization.
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CREDIT: STOCKTREK IMAGES, INC. / ALAMY STOCK PHOTO
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The big catch

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Working away on DNA

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10.1146/knowable-050918-050001

\n\n

Bob Holmes is a science writer based in Edmonton, Canada.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

\n $\"Knowable$

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Light is an adept acrobat. It bounces off mirrors, bends through lenses to magnify matter and carries messages through fibers. But light can’t sidestep objects in its path — avoiding them would require light to bend backward. Light needs help to do that.

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For decades, researchers have been working to build materials that can manipulate light in just that way. Similar materials can camouflage sound. Such metamaterials could endow light and sound waves with many new talents. Perhaps the most tantalizing work has been contouring the two to create invisibility cloaks, potentially enabling an object to disappear from sight or detection by sound. Such invisibility cloaks ignite the imagination, conjuring up comparisons to magical wizard Harry Potter’s cloak or the Romulan cloaking device in Star Trek.

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But long before such cloaking technology appears under the Christmas tree, research on metamaterials and related technology could profoundly affect sound recording and soundproofing, photography and microscopy, and Internet communications. Researchers are working on materials to stop sound in its tracks, to magnify matter with ever-thinner lenses, and to manipulate the movement of radio waves and microwaves for Wi-Fi. The research even has the potential to rein in the seismic waves of earthquakes.

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“Metamaterials give us a way to control waves in ways we’ve never had before,” says Duke University engineer David Smith.

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Going quiet

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Metamaterials first gained attention for their incredible ability to manipulate light. Typically, they are designed from tiny elements of metal or plastic, which are arranged into repeating patterns smaller than the wavelengths of light or sound that researchers want to manipulate. The precise arrangement determines the material’s refractive index — a quantitative figure describing how much it refracts, or bends, an electromagnetic wave. Researchers can design metamaterials with a negative refractive index, meaning the material bends light backwards. It would be like sticking a spoon in water and seeing the round end stick straight back out. New metamaterials that do something similar with sound waves are now gaining momentum. And they might help make the world a quieter place.

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Total sound absorption is one goal of metamaterial research that holds great promise for commercial applications, Min Yang and Ping Sheng of Hong Kong University of Science and Technology wrote last year in the Annual Review of Materials Research. The possibilities are expansive, Sheng says.

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Noise is everywhere. Machines, planes, trains, cars, cooling fans for computers — just about everything gives off some sort of sound. Some normal materials, such as spongy soundproofing textiles, can absorb and reflect sound, but often without allowing ventilation. That means such materials aren’t ideal for soundproofing computer servers, fans, air-conditioning systems and recording studios, examples where air needs to flow so heat can be transferred and dissipated.

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Engineer Yun Jing and his colleagues at North Carolina State University have come up with one design to deal with the problem. To keep these systems soundproof yet ventilated, the researchers have been working on what they call an acoustic “metacage,” a circular ring of CD-case-shaped square structures with tiny gaps, or open channels, in between. A noisemaker, such as a stereo speaker or a fan, sits at the center of the ring. The metacage manipulates the sound waves from the speaker so they can’t escape through the gaps, but air flowing through the structure can move freely.

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\"Sound — A conventional material serving as a sound barrier (left) does not permit the ventilation needed to cool the noise-producing fan. A metacage consisting of special resonators and gaps to allow airflow can eliminate escaping noise while still providing ventilation. Such cages could be useful in soundproofing computer servers or possibly recording studios.
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CREDIT: C. SHEN *ET AL* / *JOURNAL OF APPLIED PHYSICS* 2018
\n\n

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The technology relies on Helmholtz resonance, a phenomenon most know well without knowing its name. If you’ve ever blown air across the top of an empty bottle so it hums, you’ve created it. The metamaterials forming Jing’s metacage are composed of open channels and Helmholtz resonators sensitive to specific frequencies of sound. When sound waves hit the walls of the metacage, the waves are trapped, Jing and colleagues reported in August 2017 in a paper on arXiv.org.

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Seismic waves emitted during earthquakes behave similarly to sound waves, so the development of devices to dampen sound might one day help shield vulnerable structures from shaking. Metamaterials would block the incoming seismic waves by interfering with them.

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Focusing light

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Aside from the potential to mellow the effects of seismic waves, metamaterials are also now poised to change the way we picture the world. Inside a cell phone, for example, is a camera made of layers of glass — each layer is a refractive lens. When each lens is perfectly aligned with the lens on top of it and all the others, the camera produces crisp images, capturing spectacular colors. Even with the latest, slimmest phones, those lenses still make the devices breakable and bulky, with a little bump sticking out where the phone’s camera is positioned.

\n\n

“Companies are extremely interested in eliminating that bump,” says Federico Capasso, a physicist at Harvard University. With metamaterials, he and colleagues have made a single-layer lens that could cut phone cameras’ size by a third or a half. Similar size reductions are possible for security cameras and for cameras in cars and trucks.

\n\n\n\n

\"Metalens — A flat metalens built from titanium dioxide “nanofins” can focus all the colors of visible light in the same spot with high resolution and could allow the lenses to be used in commercial applications such as cameras.
\n\n
CREDIT: COURTESY OF JARED SISLER / HARVARD SEAS
\n\n

\n\n

Capasso and his colleagues designed the flat lens using arrays of tiny titanium dioxide towers. Each tower stands only 600 nanometers tall. When arranged in specific patterns, the towers together can manipulate the direction the light travels so that its different colors all reach the same focal point at exactly the same time. This is fairly easy to do with a single color, or wavelength, of light, but it’s much more challenging when trying to focus the wavelengths of red and blue light and all the colors in between.

\n\n

Capasso explains that in air, light travels at a constant 300,000 kilometers per second. But when waves of light hit a material, their speed changes, depending on wavelength. Red wavelengths are longer, so when they hit a tower, more of the light remains in the air, compared with blue wavelengths, which are shorter and interact more directly with a tower. Knowing this, the researchers developed paired towers that could manipulate the speed of different wavelengths of light simultaneously, creating time delays so that all of the wavelengths of light reach the focal point of the lens at the same time.

\n\n\n\n

\"Beetle — Two images of a beetle (*Chrysina gloriosa*), illuminated by green LED light, were formed by a chiral metalens in the field of view of a color camera. Such an image shows how the lens could be used to study chiral molecules of different shapes and sizes without additional optical equipment.
\n\n
CREDIT: CAPASSO LAB / HARVARDSEAS
\n\n

\n\n

“It’s a very nifty and nontrivial trick,” Capasso says of his current lens, which is thinner than a human hair. His team described the latest lens in January in Nature Nanotechnology. And in November 2017, the researchers posted a paper on arXiv.org describing a metalens just a bit bigger and maybe more useful — millimeters to centimeters in diameter and less than a micrometer thick. It uses silicon towers to manipulate light and can be fabricated in the same way as microchips, so it can be mass-produced, perhaps much more easily than with the grinding and polishing needed to make traditional glass lenses. Ultimately, Capasso says, the team would like to make these lenses with a diameter of about a centimeter, which would open possibilities for the metalenses to be used in virtual reality and other tech devices.

\n\n

“I have quite critical views about the traditional metamaterial work. What is the technological impact?” Capasso says. So far, most metamaterials research has not made it out of the lab. But he thinks the metalens is attainable in the near future. He and his colleagues are negotiating with cell phone companies and other tech innovators to transition from glass to metamaterial lenses.

\n\n

Broadening connections

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Beyond better sound systems and cameras, metamaterials are on the verge of changing how we communicate. “There is an unending thirst for connectivity on a global scale, and it’s been growing exponentially for the last 20 years, with no end in sight,” says Nathan Kundtz, president of Kymeta, a company producing metamaterial-based antennas.

\n\n

Cellular networks help us manage that thirst for connectivity, providing data when we’re mobile. But those networks have limitations, including spotty coverage and slower data rates compared with fiber-optic cables or wired telephone lines. And the bandwidth at cellular frequencies is filling up fast. That’s why he has proposed tapping into higher frequencies, those in the microwave realm of the electromagnetic spectrum, specifically what’s called the Ka-band at 27 to 40 gigahertz. Cellular frequencies are typically in the megahertz range.

\n\n

“If you go into the frequencies that are used for high-capacity satellites, there’s literally 5,000 times more spectrum available than there is available in the cellular band,” Kundtz says. “What that means is that you have a tremendous amount of capacity that is currently untapped, or largely untapped.”

\n\n

Tapping that spectrum requires satellites in orbit and antennas that can send the signal a long way. Traditional antennas are like those big hunks of metal installed by satellite TV companies. There’s tremendous capacity there, but it’s not really mobile, even though it’s wireless. “That's one of the reasons we’ve historically seen satellites be underadopted and underdeveloped,” Kundtz says.

\n\n\n\n

\"Car — Arranging naturally occurring materials in a specific pattern generates a metamaterial that forms holographic beams (shown) capable of linking to satellites.
\n\n
CREDIT: KYMETA
\n\n

\n\n

Just after he finished his PhD with David Smith at Duke University, Kundtz moved to the West Coast to see if he could connect what he knew about metamaterials with what was needed to make mobile antennas. His solution: a satellite dish that doesn’t physically adjust to find a signal. Instead the flat panel “positions” itself electronically to tune into a signal, with no major moving parts. The antenna, he says, is covered in a holographic surface made of 30,000 metamaterial elements, which act as tiny resonators that can be turned on and off using liquid crystals. The resonators ring loudly at specific frequencies and scatter energy out of the antenna when they’re turned on but not when they’re off. They form beams that can connect and communicate with satellites even when the entire antenna is in motion — on the back of a car, for example, Kundtz says.

\n\n

In essence, the resonators function exactly like pixels on a TV. Because of the similarities, the antennas can even be manufactured on production lines for LCD television screens. Kundtz and colleagues describe the details of the antennas in a paper posted at arXiv.org in November 2017.

\n\n

While his explanation of the antennas seems breezy now, building them was extremely hard. “Launching rockets has nothing on how difficult it is to make an electronically steered antenna, I’ll tell you that,” Kundtz says. Still, despite the difficulty, the hexagonal dishes have been manufactured and are being installed on yachts and cars and could even be installed on aircraft to provide Internet to passengers. All it takes is a satellite connection and a pizza-size antenna that can see the sky.

\n\n

“What will that touch?” Kundtz asks. “I think just about everything.”

\n\n

Capasso says it’s a fair bet that Kundtz and his colleagues are onto something marketable with the metamaterial antennas. They, along with soundproof cages and superthin lenses, obviously aren’t as flashy as invisibility cloaks. But invisibility is far from being practical, Capasso says. “If you want to hide something, you have got to be able to hide it over a very wide frequency range,” essentially covering all wavelengths of light, he says. “It’s very difficult.”

\n\n","field_all_authors":"

By Ashley Yeager 04.19.2018

\n\n","field_author_bios":"

Ashley Yeager is formerly a freelance writer and now an editor at The Scientist. She lives in Durham, North Carolina.

\n\n","field_banner_alt":"Titaniun dioxide towers making up a metalens.","field_banner_title":"Metalens under microscope ","field_caption":"

A scanning electron microscope image reveals the titaniun dioxide towers making up a metalens. A thin, flat lens made of these tiny towers could replace the layers of curved glass in microscopes, telescopes and cameras, and improve the image resolution of such devices.

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Invisibility aside, metamaterials are making waves

\n\n

Materials that manipulate light and sound in ways not seen in nature may be ready for prime time, improving imaging and communications

\n\n

By Ashley Yeager

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04.19.2018

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“Metamaterials give us a way to control waves in ways we’ve never had before,” says Duke University engineer David Smith.

\n\n

Going quiet

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Focusing light

\n\n

Broadening connections

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“What will that touch?” Kundtz asks. “I think just about everything.”

\n\n

10.1146/knowable-041918-104001

\n\n

Ashley Yeager is formerly a freelance writer and now an editor at The Scientist. She lives in Durham, North Carolina.

\n\n

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

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In “I Sing the Body Electric,” poet Walt Whitman waxed lyrically about the “action and power” of “beautiful, curious, breathing, laughing flesh.” More than 150 years later, MIT materials scientist and engineer Canan Dagdeviren and her colleagues are giving new meaning to Whitman’s poem with a device that can generate electricity from the way it distorts in response to the beating of the heart.

\n\n

Electronics are now so powerful that a smartphone has more computing power than all of NASA did when it put the first men on the moon in 1969. The extraordinary advances technology has made over time have raised hopes that devices worn on, or even implanted within, the body can also become ever more capable.

\n\n\n\n

A key drawback of most wearable and implantable devices still remains their batteries, whose limited capacities restrict their long-term use. The last thing you want to do when, say, a pacemaker runs out of power is to open up a patient just for a battery replacement. The solution to this problem may rest inside the human body — rich as it is in energy, in its chemical, thermal and mechanical forms. This has led scientists to investigate a plethora of ways for devices to harvest energy from the bodies that host them, detailed by Dagdeviren and her colleagues in the 2017 Annual Review of Biomedical Engineering.

\n\n

The bellows-like motions that a person makes while breathing, for example, can generate 0.83 watts of power; the heat from a person’s body, up to 4.8 watts; and the motions of a person’s arms, up to 60 watts. That’s not nothing when you consider that a pacemaker needs just 50 millionths of a watt of power, a hearing aid needs a thousandth of a watt, a smartphone requires merely one watt.

\n\n

Now Dagdeviren and others are designing machines that use the human body itself as their source of energy. Increasingly, researchers are testing such wearable or implantable devices in animal models and people.

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Good vibrations

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One energy-harvesting strategy involves converting energy from vibrations, pressure and other mechanical stresses to electrical energy. This approach, producing what is known as piezoelectricity, is often used in loudspeakers and microphones.

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\n\n

A commonly used piezoelectric material is lead zirconate titanate, whose lead content raises concerns that it might prove too toxic for use with humans. “But for lead to decompose from the structures, they would have to be heated to temperatures higher than 700°C,” Dagdeviren says. “You’ll never reach such temperatures in the body.”

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To take advantage of piezoelectricity, Dagdeviren and her colleagues have developed flat devices that can be stuck onto organs and muscles such as the heart, lungs and diaphragm. These devices are “mechanically invisible” in that their mechanical properties are similar to whatever they are laminated onto, so they don’t hinder those tissues when they move.

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So far, such devices have been tested in cows, sheep and pigs, all animals with hearts roughly the same size as those of people. “When these devices mechanically distort, they create positive and negative charges, voltage and current — and you can collect this energy to recharge batteries,” Dagdeviren explains. “You can use them to run biomedical devices like cardiac pacemakers instead of changing them every six or seven years when their batteries are depleted.”

\n\n

Scientists are also developing wearable piezoelectric energy harvesters that can be worn on joints such as the knee or elbow, or in shoes, trousers or underwear. That way, a person can generate electricity for electronics whenever they walk or bend their arms.

\n\n

When designing piezoelectric gadgets, one might — counterintuitively — not want the materials that are best at generating electricity. Instead of choosing a material that converts 5 percent of all mechanical energy it receives into electricity, for example, you might want a material with only 2 percent or less efficiency. If it converts more, “it might do so by placing more of a load on the body, and you don't want it to make you tired,” Dagdeviren says.

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Body heat

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A different energy-harvesting approach uses thermoelectric materials to convert body heat to electricity. “Your heart beats more than 40 million times a year,” Dagdeviren notes. All that energy is dissipated as heat in the body — it’s a rich potential source to capture for other uses.

\n\n\n\n

\n\n

Thermoelectric generators do face some key challenges. They rely on temperature differences, but people usually keep a fairly constant temperature throughout their bodies, so any temperature differences found within are generally not dramatic enough to generate large amounts of electricity. But this is not a problem if the devices are exposed to relatively cool air in addition to the body’s continuous warmth.

\n\n

Scientists are exploring thermoelectric devices for wearable purposes, such as powering wristwatches. In principle, the heat from a human body can generate enough electricity to power wireless health monitors, cochlear implants and deep-brain stimulators to treat disorders such as Parkinson’s disease.

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Static and dynamic

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Scientists have also sought to use the same effect behind everyday static electricity to power devices. When two different materials repeatedly collide with, or rub against, one another, the surface of one material can steal electrons from the surface of the other, accumulating a charge, a phenomenon known as triboelectricity. A key virtue of triboelectricity is that nearly all materials, both natural and synthetic, are capable of creating it, giving researchers a wide range of possibilities from which they can design gadgets.

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“The more I work with triboelectricity, the more exciting it gets, and the more applications it might have,” says nanotechnologist Zhong Lin Wang at Georgia Tech, the review’s co-author. “I can see myself devoting the next 20 years to it.”

\n\n\n\n

\n\n

The surfaces selected for use in triboelectric devices can make a great difference in how much electricity they produce, so scientists are experimenting with a variety of forms and textures. Researchers have fabricated grids of cubes resembling microscopic city blocks, fields of nanowires resembling bamboo forests, and arrays of pyramids resembling those found in Giza. These materials not only “look beautiful,” Wang says, but covering a surface with pyramids can boost the amount of electricity generated by a factor of five compared to just having a flat sheet.

\n\n

Pacemakers, heart monitors and other implantable devices triboelectrically powered by breathing and heartbeats have been tested in rats, rabbits and pigs. “We’re also seeing if triboelectricity can be used inside the body to stimulate cell growth and enhance healing of wounds,” Wang says. “In addition, we’ve started experiments with triboelectricity on nerve stimulation, to see if we can contribute anything to neuroscience.”

\n\n

Wang and his colleagues have also designed triboelectrically powered wearable devices. For instance, they fabricated triboelectric cloth that can recharge a flexible belt containing lithium-ion batteries. That can power a wearable heartbeat meter that uses Bluetooth technology to wirelessly send its data to a smartphone. “The mechanical energy of daily human motions can get converted into electricity by our cloth,” Wang says.

\n\n

Blood and sweat

\n\n

Another strategy relies on devices known as biofuel cells that generate electricity via chemical reactions between enzymes and fuel molecules that are in the body, such as glucose in the blood, or are released from the body, such as lactate secreted in sweat. For example, the enzyme cellobiose dehydrogenase from the fungus Phanerochaete sordida can break down sugars and generate electrical current when stuck onto carbon tubes only nanometers (billionths of a meter) wide.

\n\n\n\n

\"Carbon — A scanning electron micrograph of carbon nanotubes used in experimental biofuel cells that generate electricity from the body. The tubes are coated with enzymes that process natural fuels, such as lactate in sweat or glucose in the blood. They are electroactive and provide a vast surface area for deposition of enzymes, allowing more electricity to be generated from a given volume.
\n\n
CREDIT: C. DAGDEVIREN *ET AL / AR BIOMEDICAL ENGINEERING* 2017
\n\n

\n\n

The choice of enzyme can prove tricky. For instance, while several groups of scientists have found that glucose oxidase can produce electricity in biofuel cells implanted in lab rats, the enzyme also generates hydrogen peroxide, a common bleach. That can deteriorate the performance of the device and prove harmful to the body in the long term.

\n\n

Scientists in France have created a biofuel cell based on enzyme-coated carbon nanotubes that is roughly only half a teaspoon in volume, and when implanted in rats, it can generate enough electricity from blood sugar to power an LED or a digital thermometer. Experiments have also shown that biofuel cells woven into garments such as headbands and wristbands can readily generate enough electricity from chemical reactions with sweat lactate to power a watch.

\n\n\n\n

\n\n

None of these devices are on the market yet, as far as Dagdeviren knows. But it might be less than 10 years before they start appearing for sale, she predicts. And in the future, energy-harvesting devices may become better tailored for the body. Dagdeviren and her colleagues are even investigating dissolvable versions of their gadgets.

\n\n

“Imagine,” she says, “having a device inserted into your body, and after it works for a while, it dissolves away down to the molecular level in your bodily fluids. And you don't have to open your chest to take it out: We can use biodegradable materials such as silk and zinc oxide that can break down over time.”

\n\n

Editor's note: This article was updated June 26, 2018, to clarify wattage requirements of a few devices. The original story stated the wattage requirements for some devices improperly. Watts quantify the power a device needs to operate at any point in time, not over any particular period of time. How long the device will operate depends on the energy capacity of the power supply, not the wattage. A pacemaker requires 50 millionths of a watt of power at any time, not “to last for seven years.”

\n\n","field_all_authors":"

By Charles Q. Choi 04.06.2018

\n\n","field_author_bios":"

Charles Q. Choi is a science reporter who has written for Scientific American, the New York Times, the Washington Post, Science, Nature, Popular Science and National Geographic News, among others. In his spare time, he has traveled to all seven continents.

\n\n","field_banner_alt":"Self-powered pacemaker","field_banner_title":"Self-powered pacemaker","field_caption":"

Scientists are seeking ways to harvest energy from the body to create electricity to power implantable or wearable devices, such as this depiction of a self-powered cardiac pacemaker that draws its energy from muscle movements.

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On a spring day in 1972, physician Pekka Puska, 26 and fresh with ideas and vigor, blew into the far eastern province of North Karelia, Finland, like a bracing north wind. Backed by government and public health authorities anxious for improvements, the young doctor brought with him newfangled and officially sanctioned but unproven plans about what to do for the people of the region. Many provincial citizens were women widowed by a cardiovascular assassin that had torn away their husbands and left fatherless children who smoked by the time they reached middle school.

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Puska arrived as head of the North Karelia Project, by way of a petition from Esa Timonen, the regional governor. Seeing his constituents weathering early death after early death, the governor lobbied vigorously for something to be done. Puska and his team were the something, and what Puska wanted was to overhaul how residents of North Karelia lived, ate and drank. The guiding framework for the project, given the blessing of the Finnish government and the World Health Organization, was to go after three targets — hypertension, cholesterol and smoking — to prevent cardiovascular disease rather than waiting for it to develop and kill.

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\"A — A North Karelian citizen has his blood pressure checked in 1972, as part of a baseline health assessment of the province’s population.
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CREDIT: NORTH KARELIA PROJECT
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Puska and his band of self-described “radicals” saw many routes to these targets, and they tried every one — media campaigns, community meetings, chats in people’s kitchens, carrots and sticks for farmers and food producers — up to and including village-versus-village competitions over cutting back on smoking or reducing cholesterol counts. The tactics even included one of the earliest reality TV shows, a sort of “Biggest Loser” from the late 1970s called “Keys to Health.” Hugely popular, it featured occasionally wretched-looking Finns willing to have their cholesterol levels and smoking habits tracked on national television.

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A crucial winning weapon for Puska and his team was in the home. Men largely ran the government and the health programs, but women in the 1970s still ran the kitchen, controlling what came in and what made it out to the table. In general, they liked Puska’s message. Sick of losing husbands too soon, weary of widowhood and fatherless children, they took the mantra of lower salt, lower fat and more vegetables to heart, and brought the Puska plan to individual family tables.

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The numbers coming out of the project, now grown into a model endeavor in its 45th year, show, as of 2012, an 82 percent reduction since inception in deaths from coronary disease among middle-aged men locally. The project went national in its fifth year, as planned, and Finland saw an 80 percent drop in such deaths countrywide by 2012. The changes are largely credited to Puska, now a member of the Finnish Parliament, and the government that facilitated his work. The effort has spawned more than 1,100 related scientific publications and 65 dissertations.

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Yet questions, perhaps unanswerable, remain. The project was not — could not easily have been — a completely controlled experiment. Scholars say it’s difficult to tease out which tactics of the North Karelia Project definitively helped to reduce rates of heart disease and related deaths, and to what extent — information necessary for applying the approach elsewhere. Some researchers note that the world did not sit still as the Finnish experiment barreled forward and that changes not explicitly related to the effort could also have helped heal Finland’s hearts.

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Still, there is broad agreement that the North Karelia Project blazed a trail as a populist public health success. It took a medical issue out of the clinic and into the culture and tried to change that culture; other nations and regions, including ones in the United States, have sought to employ a similar approach, with varying payoffs. A key success of the North Karelia Project is that its tactics percolated the idea of risk factors into the public consciousness, especially lifestyle factors that people can control for themselves — a “remarkable” shift, says sociologist Glorian Sorensen of the Harvard T.H. Chan School of Public Health. “It was really one of the first studies of its kind,” she says. “And it was very early in thinking about how social factors may really shape health behaviors that are associated with chronic disease.”

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The spoilage of war

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The specter of the Second World War looms large over Finland even today. Men whose fathers fought in the war — against the Soviets at the Karelian border in the Winter War and the Nazis in the northernmost reaches of Lapland — will not fail to mention the family’s service. The war still seems to shadow the national psyche, and none were hit as hard as the men who fought in it. Returned home to a country that lost on many fronts, these men also returned to a nation and economy in flux.

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The Finnish government rewarded its veterans with plots of land, but men of the borderlands were used to cutting down trees for a living. Turning to familiar ways and easy stock, they deforested the land allotted them and used it to rear cows and pigs. Where fish, game, rye bread and root vegetables once ruled the day, salt pork and dairy cream took over in the 1950s and 1960s. Where some plants had once fed humans, the stock animals got the bulk of the greens instead.

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Days were filled with the haze of cigarette smoke — a habit picked up during service — the briny smell of salted meats from the pigs, the heavy aroma of fatty cream and butter from the cows, and the eye-watering sting of alcohol numbing the psychic scars of war. It was, as one resident put it, a life burdened with the “curses of the borderland.”

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At this crossroads of diet and drinking and depression, men began to die, young and suddenly, of cardiovascular disease. The rates in 1969 — 643 of 100,000 men aged 35 to 64 annually — were so striking, so high compared to the rest of the world that the public health authorities couldn’t help but take note. Finland’s death rates from coronary heart disease were two or even three times those of other European countries and Japan. And nowhere were they as high as where Finland had lost a frontier to the Soviet Union: the eastern province of North Karelia.

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\"Smoking — Prizewinners for a 1986 “Quit and Win” smoking cessation campaign in Finland are selected by a blindfolded volunteer, as Pekka Puska (left) looks on.
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CREDIT: NORTH KARELIA PROJECT
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The Seven Countries Study, a famous long-term project begun in the late 1940s, compared how dietary and other practices in different regions influence health. Finland was included in a special comparison, the East-West Study, pitting cardiovascular data for people in the province of Western Finland against those of North Karelia. Results from the late 1960s pinpointed the eastern province as ground zero for the devastation that poor diet can wreak on cardiovascular health.

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The message machine

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The spokes of the North Karelia Project and its expansion, with Puska’s team as the hub, touched seemingly every aspect of Finnish life. There were leaflets, posters, fireside chats at domestic hearths and community gatherings to rally citizens around reducing the province’s collective and individual cardiovascular risk. Schools, doctors and nurses joined in. Newspapers and radio carried the message throughout the province — more than 1,500 related articles were published in the first five years — with national media jumping on board when the project expanded beyond North Karelia. Regardless of the medium, the relentless messages never changed: Reduce salt to lower blood pressure. Stop smoking. Cut saturated fat to decrease blood cholesterol numbers. Eat more produce, less meat.

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Puska will tell you that the people loved him and his team, and their messages. But, he notes, it wasn’t always love at first sight. Buy-in from food producers was crucial, and the dairy farmers were so opposed to the efforts to change local diet — after all, their livelihoods relied heavily on dairy fat — that ultimately they started a bitter battle over butter known as the “fat wars.” But the wars faded after peaking at the end of 1980s as the farmers, aided by legislative changes designed to promote the health endeavor, found other ways to make money from their resources, including exporting their fat to willing consumers outside of Finland.

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Many who took advantage of the new economic framework flourished. Laws that had overwhelmingly favored dairy fat production (subsidies for milk fat and butter, laws that banned mixing butter-only products with vegetable oil) shifted to support other products (subsidies for protein, an end to the fat-oil mixing law). With the emphasis on lower-fat milk, cow-breeding took a turn toward animals that produced less fat. A specially cultivated version of a nontoxic rapeseed crop gained popularity for its responsiveness to Finland’s climate and proved economically viable for oils and margarine for human consumption and as an animal feed. For years, this crop took over ever-increasing acreage, especially in southern Finland, although its yields began a decline after the turn of the twenty-first century, possibly because of warming temperatures.

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\"North — In the popular “Keys to Health” reality-TV–like show, ordinary Finns with raised risk of chronic disease were counseled to adopt healthier lifestyles and reduce their risk factors. Here, North Karelia Project Director Pekka Puska (left), nutritionist Pirjo Pietinen (center) and physician Kaj Koskela (right) are at work planning the show for the 1984-1985 series, which featured eight middle-aged, smoking North Karelians.
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CREDIT: NORTH KARELIA PROJECT
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The project even included an effort to turn Finns back onto the juiciest natural product of the land: its berries. An update on the “East Finland Berry and Vegetable Project,” which promoted berries and their juice to the people and motivated dairy farmers to switch to berry-growing, hasn’t been published since the 1980s. Nevertheless, the berry market in the country remains robust.

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Stealth recipes

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The men may have been fighting over fat or mulling the benefits of berry farming, but the women were quietly waging a new kind of war. Their role in the North Karelia Project was pivotal. Hearkening to the message of heart health shining in vegetable oil and a death threat lurking in butter, North Karelian housewives turned subversive. They mixed oil and butter, and their families apparently never knew the difference.

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According to Puska and many others, women not only sneaked oil into the butter but also secretly diluted the full-fat milk they served their families. Full-fat milk in Finland is sold in red and white cartons, and North Karelian dinner tables were once laden with the “red milk.” After Puska and his team invaded the province, women began quietly thinning red milk to produce their own version of low-fat dairy.

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Women had an existing network for disseminating their secrets: The Martat, or Marthas. The organization took its name from the biblical Martha, who worked to prepare food and lay a table when Jesus visited Martha and her sister, Mary. Biblically, Martha was busy “with many things” while Jesus spoke with Mary. The Marthas, whose symbol is a shapely, fluttering apron, have been busy since 1899 bringing the teachings of health and hearth to women.

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In the 1970s, most Marthas were farmers’ wives, present in every village and municipality. Their power at the hearth was considerable, whether it was secretly adding oil to butter or slipping root vegetables into stews to make them healthier. As willing conduits of the project’s message, they “influenced eating habits and helped decrease the resistance of men,” says Vesa Korpelainen, who retired recently as head of the North Karelia Project’s successor organization, the North Karelia Center for Public Health.

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After many years of affiliation with the project, Korpelainen is a trove of information, with a stack of local and national statistics at his fingertips. A big stack. By 1992, follow-up surveys for the effort showed that nationally, mortality from heart disease associated with blocked arteries had declined by almost 60 percent since 1972 — beating the decline predicted for successfully targeting all three risk factors. Cholesterol levels in middle-aged men fell by a fifth from 1972 to 2007 in North Karelia, and similarly elsewhere.

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National saturated fat intake dropped by almost half from 1982 to 2007, and smoking prevalence fell from more than 50 percent among men in the 1960s to 17 percent in 2014. From 1971 to 2012, life expectancy for men increased by 11.6 years, from 65.9 to 77.5. And the countrywide 80 percent reduction in death rates from coronary heart disease between 1973 and 2013 rode down the steepest slope of all. Korpelainen notes that improved blood cholesterol probably explains about 40 percent of the decreased cardiovascular mortality in the province. By any measure, this would seem to be a war that Puska’s team had won.

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On the eastern front

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Korpelainen, who’s worked for decades in the former province (which, like all provinces in Finland, was abolished in 2010), readily spends a weekend day guiding a one-person tour of local homes, stores and farms to illustrate the positive consequences of Pekka Puska’s efforts. As his modest and well-used subcompact rattles its way down slushy main roads and frost-covered back lanes, Korpelainen points out the municipal healthcare centers in each town, centers that were established around the same time the North Karelia Project took off. One treasure from his information trove: This province in eastern Finland may be one of the few places on Earth where McDonald’s went to die. He proudly relates that the fast food franchise didn’t do well enough to stay open.

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\"Empty — Shelves of low-fat “blue” milk and full-fat “red” milk in a North Karelia supermarket speak to the altered habits of Finns, who once favored the full-fat variety.
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CREDIT: EMILY WILLINGHAM
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Meanwhile, the supermarkets thrive, and the influences of the North Karelia Project are visually obvious. In the dairy section of one store, and in the filled shopping carts, “red milk” is clearly not the popular choice. The shelves of the low-fat “blue” milk stand almost empty next to full rows of red and white cartons. Finland’s Dairy Nutrition Council says that only 10 percent of milk consumed in the country in 2015 was whole milk.

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But behind that clear visual lie some possibly ineradicable human predilections for fat and salt. A visit to the bakery shows wavering commitment to healthy whole-grain baked goods. Side by side with grain-laden, low-salt offerings are trays and trays of Karelian pie, a popular Finnish pastry packed with fat-saturated rice pudding or egg butter.

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Out on store shelves, low-salt and low-fat offerings enjoy uneven success. Part of Finland’s campaign to improve heart health continues with package labeling. Consumers understand the meaning of a government-approved symbol of a red heart inside an incomplete red circle: Items bearing this logo promise food that is low-salt, reduced-fat, OK for the heart. Cheese packaging sports large-font numbers that reveal salt content. The shelves — some close to empty, some well-stocked — seem to communicate that people in Finland, despite messaging and heart symbols, may still like their cheese and bread a little salty (with the bread at least a little whole-grainy).

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The statistics give a broader view. Finns are definitely eating more cheese, with consumption climbing by more than 60 percent from 2000 to 2016. That said, they are doing pretty well with their salt. The salt-reduction effort targeting both producers and consumers was yet another spoke of the North Karelia Project wheel and yielded a national average consumption decline of 40 percent by 2008.

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Those reductions are another factor in the reduced hypertension rates in Finland: In the decades since this effort began, as salt intake fell, blood pressure dropped, too, by 10 mmHg, on average. Messaging alone wouldn’t have done it, researchers have concluded. The campaign needed what Puska included in the North Karelia Project: buy-in from a huge variety of stakeholders, including messages flogged in the news media.

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And the butter? Now that the practice has long been legal, butter admixed with vegetable oil is a staple, and a popular one. National statistics show that Finland’s margarine or butter–oil mixture consumption outpaces butter intake by about three to one. What began with housewives secretly mixing oil into butter in the privacy of their kitchens is now a national practice.

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\"Members — Members of the housewife’s organization known as the Marthas, seen here in 1977. Unbeknownst to their families, Marthas would mix full-fat and low-fat milk to reduce their loved ones’ intake of saturated fat.
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CREDIT: NORTH KARELIA PROJECT
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One little pill

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One stop on Korpelainen’s tour is the living room of the impeccably clean, light-filled home of the Riikonens in the forested municipality of Tohmajärvi. The Riikonen household was one of many in 1970s North Karelia that took Puska’s plan to their kitchen and table. Although Veikko worked in civil service for decades and Eila was a teacher, they have remained, like many Finns, quite close to the land. They offer koivunmahla, their distillation of sap and water collected from dripping birch trees, locally respected as healthy and curative. Also on hand is honey, harvested from bees that Veikko keeps, and although snow now blankets the land around the house, berries will burst forth with the spring.

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Eila and Veikko were young parents when the project began, and they remember the “fat war” tensions. “The milk producers felt that their work was not valued,” Veikko says through an interpreter. “But it changed quite rapidly and even the farmers accepted the message.” The couple’s son, the current mayor of Tohmajärvi, experienced as a child the initial changes related to the North Karelia Project. He was not a fan, Eila says, of the sudden shift to low-fat milk.

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Still, Eila and Veikko were ready adherents to the suggested dietary changes that they learned about from newspapers and radio, and they “tried to make changes and do as much as possible at home,” she says. They participated in one of the health surveys related to the project. They and their friends would talk among themselves about the program. Just as Puska and his colleagues desired, people were discussing cardiovascular health with friends and family, and in terms of prevention, not just cure.

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And their children absorbed these discussions. When their son the current mayor was 5, his spontaneous greeting for a long-ago mayor, a smoker who was visiting their home, was, “By the way, you are not allowed to smoke here.”

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Both Eila and Veikko seem convinced that these changes benefited them, too. Veikko’s father died at age 74 of a heart attack. Veikko, 75 at the time of the visit, says his own health is great. As proof, he takes out a copy of a recent medical report showing blood results. The numbers are good from a metabolic and cardiovascular perspective, and both Eila and Veikko seem fit, healthy and happy. His only struggle with food is to remember to eat it at regular intervals, a lifelong problem. His wife, it seems, is tired of reminding him, so he’s set alarms on his smartphone for midday reminders to eat lunch, which he proudly demonstrates.

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And what does he eat? “Men want to eat meat,” Eila says. Veikko still does. His reasoning is that with all of his physical activity — beekeeping, chopping wood — he needs the dense caloric energy meat provides. His doctors, Veikko reports, say his health is like that of a 50-year-old.

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But tucked away in his medical record is another note that might help explain Veikko's good cardiovascular health. On the back of his report is a list of pharmaceuticals he takes — just two. One is a statin, and the indication, according to the handwritten note, is “hypercholesterolemia,” or high blood cholesterol.

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The cause-and-effect conundrum

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That brief note in Veikko’s medical record represents one of the big challenges in definitively assessing the effects of the Finnish experiment so that the framework can translate into successes elsewhere: Changes unconnected to the project were also in play. After the war, those municipal health centers opened in the provinces, giving people greater access to care. The passing years also ushered in a new era of cardiovascular health, including the introduction of statins like Veikko’s in the 1990s, blood pressure drugs that had fewer side effects than older versions, and improved medical support to help people quit smoking.

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Other factors outside of the project efforts were the social and technological conditions of the population of North Karelia in the postwar years and their gradual resolution, says Mikko Jauho, a sociologist at the University of Helsinki’s Consumer Society Research Center. The landscape changed in the borderlands after the war. It was a countryside in crisis on all fronts at the time, with an exodus of those who could leave — “The young people leave, the old stay,” Jauho says — and a sense of fatalism among those left behind, still nursing the nation’s battle scars.

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\"Still — You do not need to understand Finnish to savor the flavor of this early reality TV show, “Keys to Health,” that tried to steer regular Finns toward better lifestyle habits. The series may lack the energy of “Amazing Race,” the backbiting of “Real Housewives,” but there is vintage charm to these 1980s-era clips of Pekka Puska, fellow counselors and the volunteers, who jog through snow, sample nutritious meals, practice relaxation techniques and good-naturedly receive (a lot of!) advice.
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CREDIT: YLE
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Jauho has pored over hundreds of letters people wrote to project leaders in response to surveys, publishing his findings in a pair of papers. What led to the cardiac crisis in the eastern province? “People felt strongly that it wasn’t the fat, or it might be the fat, too, but it was structural change and all of the problems after the war,” he says. One correspondent expressed his own idea about what would solve the problem: “Give people work, and blood pressure will sink.”

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North Karelia residents who were children at the time recall other changes to everyday life. Take one small, Finnish-language ethnographic study of 12 men who were boys when the project began. They are now middle-aged, and all but one of their fathers are dead, half from heart disease. A big shift they recall is the introduction of freezers into their homes, says study author and social epidemiologist Anne Kouvonen of the University of Helsinki. Freezers, she says, made it possible to preserve meats without salting them to death, and people could keep vegetables longer as well.

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One strong skeptic of the methods of the North Karelia Project is Shah Ebrahim, an epidemiologist associated with the London School of Hygiene and Tropical Medicine. In a 2001 editorial coauthored with clinical epidemiologist George Davey Smith of the University of Bristol, he essentially asked if the improvements were really attributable to the intervention. The pair noted that even as cardiovascular death rates declined from 643 to 118 per 100,000 men ages 35 to 64 in North Karelia, they also dropped like a stone from 1970 to 1985 in the comparison province, Kuopio, where no intervention was being conducted during the early phase. The decline in Kuopio was even steeper than in North Karelia, and rates also fell nationally. And, Shah says, “Other countries that did not invest in this sort of program experienced falls in cardiovascular deaths.”

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\"Margarine — Spreadable margarine in a North Karelia supermarket bears a heart-healthy logo. Finnish laws and economic incentives used to favor butter — but that has changed, along with citizens’ preferences.
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CREDIT: EMILY WILLINGHAM
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When the North Karelia Project was on the drawing board, some experts had argued for a more rigorous design, says Evelyne de Leeuw, a professor of public health at the University of New South Wales in Australia. Their idea was something closer to a randomized controlled trial in which researchers attempt to winnow down anything that affects an outcome to a handful of variables. It may be that those experts had a point. Later community interventions examining the effectiveness of similar programs, some of them randomized controlled studies, failed to yield the anticipated reductions in cardiovascular diseases, Shah says. Instead, the only groups in these studies that saw a decline were those at highest risk — people who had high blood pressure or a high risk of type 2 diabetes, he says, and he strongly suspects that medications made the difference there.

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Nevertheless, Shah calls the North Karelia Project “a milestone in the history of efforts to prevent cardiovascular disease,” noting that when it began, cholesterol-lowering drugs were unavailable, antihypertensives had deterrent side effects and even doctors smoked. Puska’s multi-pronged approach, says Shah, was “innovative and bold and paved the way for community action for the prevention of other diseases,” such as HIV/AIDS.

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“It absolutely stands up as an international landmark,” says de Leeuw. “The Finns started the North Karelia Project from a socially and politically deeply felt need to deal with a significant burden of cardiovascular disease, but they managed to let it evolve into a much more substantial … natural experiment.”

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Indeed, says Jauho, a key legacy of one of public health’s most famous community-based efforts was the introduction of the concept of “risk factors” into everyday language.

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From public health maverick to parliamentarian

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Puska, now a member of Finland’s Parliament, takes on the question of how much these changes are the result of his project without batting an eye. He discusses the issue while sitting in the cafeteria of Finland’s “little Parliament,” across the street from the more imposing and governmental-looking real Parliament, where MPs like Puska can settle when they’re not in session. He’s heard the criticism many times since the first critical salvo fired in 1973, an editorial in a scholarly medical journal that characterized the plans for North Karelia as a sort of “throw it at the wall, see what sticks” approach.

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But he doesn’t find the question of which factors directly led to beneficial change terribly relevant. Puska notes that an international team worked on the effort’s meticulous planning, which, he says, belies any charge of a “kitchen sink approach.”

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\"Pekka — Pekka Puska, now a parliamentarian in his 70s, hews to a healthy lifestyle. This shot was taken in 2015.
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CREDIT: LEHTIKUVA / MARKKU ULANDER
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Now matured from young maverick physician into a sort of Nordic ideal of an elder statesman, Puska gestures at a pile of studies on the table, stacks of papers he has authored or coauthored, describing successful outcomes from the project. He readily notes that the project was not a randomized controlled trial and never could have been, so whittling away all influences to a single or a few critical factors is almost impossible.

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Sure, he acknowledges, other elements may have played a role in the improvements his project tracked. But he’s convinced his team’s tactics were effective. Statistical analyses, he notes, indicate that two-thirds of those outcomes can be traced to changes in people’s cholesterol, hypertension and smoking habits, the exact three targets of the campaign. Beyond that, he says, “you can forever debate on the causality.”

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The MP tells a favorite story: A bus driver in Helsinki, decades after the project began, stopped his bus when he recognized Puska about to get off. “Come here!” the driver shouted. The parliamentarian continues: “He said, ‘When I saw you I decided I’ll give up this,’ and he crushed a packet of Marlboros in his hand.” Puska’s passion beyond the project is obviously the people, and he seems to hold a special place for North Karelians.

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“North Karelians are on the lively side,” he says, smiling. “We had a lot of fun.”

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In the bright land of berries

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In the middle of the fun were some farmers who needed pacifying. When full-fat dairy became a watchword for bad health and the dairy farmers initially rebelled, one substitute market suggested for them was berry growing. Once a staple on Finnish tables, the berry — lots of different kinds of berries — experienced a newfound popularity, resulting in the 100 or so berry farms that now dot the country’s landscape. And perhaps no one in Finland knows more about berries (or is happier to promote them) than Ismo Ruutiainen. He owns one of those farms, in Kitee, in what was North Karelia, and is a retired adviser to agricultural industry in the province.

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Berries may seem like just another spoke in the rolling wheel of the North Karelia Project, but they’re a matter of national pride in Finland. Australia’s de Leeuw points out that this pride isn’t just an odd Finnish obsession. The refocus on berries “indicates a broad societal commitment to a culture of health,” she says, “that has inspired many others around the world.”

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Sitting in his warm home full of visiting family and friends, Ruutiainen beams with that pride as he uses his laptop to show image after image of a luscious variety of the deeply colored berries that his homeland produces. His graphs and charts suggest a longstanding commitment to berry production in Finland, across a variety of crops, including strawberries, raspberries, blueberries and blackberries. Land area devoted to berry production seems to have peaked in Finland in the mid-1990s and early 2000s, but levels still remain well above where they were in the mid-1980s, when the Berry and Vegetable Project was launched.

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Ruutiainen has just returned from a trip to the United States to visit berry farms up and down the Pacific Coast. The farms were fun, but he’s come back unimpressed with US food offerings in general. “No vegetables,” he says, “and so much meat.”

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While Ruutiainen talks, his son Lassi is busy in the open kitchen, making beelines from stove to counter and back. And then the group is gathered around the dining table, eyeing a bright, autumn-colored array of foods the young man has made. Pumpkin and squash with pureed fruit and fresh herbs. A hearty salad of grain, greens and cherry tomatoes with a light creamy dressing. A mashed spring-pea spread for the homemade, whole-grain flatbreads. And of course, for dessert, berry mascarpone with a rich blackberry pastry. Even a carnivorous housecat, stuck outside in the snow, clamors to come in and partake.

\n\n

Not satisfied with this presentation of Finnish food and hospitality, Eeva Ruutiainen, the young man’s mother, calls for a small bowl of Arctic berries, poster fruit for the nation, for their American visitor to try. The obliging chef brings the golden seedy sour berries to the table, having warmed a frozen sample in the microwave. He’s clearly in charge of this kitchen, knowledgeable and savvy about seasonal flavors and the satisfying presentation of the healthy, meat-free meal he’s prepared for the assembled guests.

\n\n

And his mother, Eeva? Rather than cooking, she sits and enjoys the food with everyone else. After all, she’s been busy all week waging war against cardiovascular disease at the North Karelia Center for Public Health, the successor to the project Pekka Puska began more than four decades ago.

\n\n","field_all_authors":"

By Emily Willingham 03.07.2018

\n\n","field_author_bios":"

Emily Willingham’s work has appeared in Forbes, the San Francisco Chronicle, the Washington Post, and Undark, among others. She is the author of The Informed Parent: A Science-Based Guide to Your Child's First Four Years (2016), co-written with Tara Haelle.

\n\n","field_banner_alt":"A frozen river in Joensuu in North Karelia.","field_banner_title":"A frozen river in Joensuu in North Karelia.","field_caption":"

A frozen river in Joensuu in North Karelia. The push to reduce rates of cardiovascular disease began in this part of Finland.

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Every day, 20 Americans die because they need an organ transplant and no donor organ is available. More than 100,000 people are now on transplant waiting lists in the United States alone. The public overwhelmingly supports organ donation — yet barely half the population has registered as donors. We just never get around to it, somehow.

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That's not the only place where our actions don't match up to our good intentions. We promise ourselves that we'll eat a healthier diet and exercise more, yet more than a third of American adults are obese, with a medical price tag approaching $150 billion annually. We know we should be putting money aside for a more comfortable retirement, yet the median American family has saved just $5,000. So often, it seems, we need a bit of help to do what we know we should.

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That's where nudging comes in. Nudges — tiny changes that have surprisingly large effects on how we act — offer policymakers a way to gently push us toward doing the right thing: Automatically sign up drivers as organ donors, or enroll employees in the company retirement plan, unless they opt out. Put the fruit at eye level and hide the cake and candy somewhere inconspicuous. These nudges work because real-world humans don't make decisions like coldly rational Mr. Spocks, but like flawed, idiosyncratic Captain Kirks. Nudges are essentially ways to harness our less-than-rational behaviors to help ourselves, or those around us.

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The idea first came to public view a decade ago through the best-selling book Nudge, by economist Richard Thaler and legal scholar Cass Sunstein. Nudging's profile rose even higher last fall, when Thaler, of the University of Chicago, was awarded the Nobel Prize in economics for introducing irrationality — and hence, nudging — into that overwhelmingly rational field. Nudges offer gentle, non-coercive — and, best of all, cost-effective — ways to guide people toward better choices. And governments and other nudge specialists around the world have jumped on the nudging bandwagon. “The biggest change is the sheer explosion of initiatives, from private and public sectors alike,” says Sunstein, of Harvard University.

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At last count, more than 60 government departments and international agencies have established “nudge units” tasked with finding and pulling the right behavioral levers to accomplish everything from increasing retirement savings to boosting diversity in military recruits to encouraging people to get vaccinated against flu. The United Kingdom's Behavioural Insights Team, one of the first and largest such units, has expanded from a handful of people in 2010 to about 100 today, with global reach. Clearly, nudging has moved into the mainstream.

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But that growth is not the only thing that has changed in the past decade. As nudgers gain experience, they are getting better at analyzing behavioral obstacles and designing nudges to overcome them. At the same time, they have begun to expand the domain of nudging beyond mere procedural tweaks, toward redesigning entire government programs to take into account behavioral insights. This broader philosophical shift in governance, experts say, may be nudging's most significant contribution.

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Context and details matter

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One of the biggest lessons from a decade of practical experience is that nudging is harder than it looks, says economist Pete Lunn of the Economic and Social Research Institute in Dublin, Ireland's independent nudging think tank. Tiny differences in context can mean that a nudge that works well in one circumstance can fail miserably in another. For example, appealing to social norms, through a letter pointing out that most people pay their taxes on time, cut the number of tax delinquents in the UK nearly in half, from 32 percent to 17 percent, and similar reductions have been seen in several other countries. But not all. “We've done experiments like that in Ireland, and guess what? Social norm manipulations don't work here,” says Lunn. “I genuinely do not know why, but I've seen it in multiple studies, to the point where it cannot be a coincidence.”

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Often, too, seemingly insignificant changes in a nudge can send vastly different messages to nudgees. One reason people often fail to save for retirement, for example, is that they are reluctant to give up spending power today for future rewards. To bypass that obstacle, Thaler and his colleagues proposed offering people the chance to earmark part of their next raise for retirement savings — a “save without cutting back” nudge that, over time, boosted savings from 3.5 percent to 13.6 percent of earnings. That's impressive, but it only works if done right. If companies offer both options at once — now or later? — savings actually go down, not up, one study found. The dual-option scenario “sends a signal that maybe my employer doesn't think that saving for retirement is very urgent,” says Craig Fox, a behavioral decision theorist at the University of California, Los Angeles, who cofounded the Behavioral Science and Policy Association, a professional group for nudgers.

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Even the most trivial details of a nudge can matter. Telling householders how their consumption of electricity compared to their neighbors' was enough to nudge heavy users to cut their power use by about five percent. But the information actually increased power consumption by those who used less power than average — unless, that is, researchers included a smiley face on the electricity notice to praise and encourage continued thriftiness.

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Surprises like these — and every behavioral scientist has their own stories to tell — have led to another key step in the evolution of nudging: the realization that testing is a crucial part of the process. “We're doing more large-scale experiments, which is what we have to do to figure out what works in the wild,” says Katherine Milkman, a behavioral economist at the University of Pennsylvania's Wharton School of business. Governments still sometimes balk at the time and money such experiments demand, but many agencies increasingly accept that testing for effectiveness before rolling out a nationwide program can save embarrassment later.

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Targeting behaviors

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IMAGE CREDIT: TEXTBOOK EXAMPLE

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How humans are predictably irrational

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Classical economics and public policy assume that people will always make rational decisions in their own best interest. But real human behavior is messier, as behavioral scientists have found. Here are some of the ways that our decision-making departs from pure rationality:

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We don't like change. Most people accept the default option when given a choice, which makes setting a beneficial default one of the most powerful nudges available.
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We hate losing more than we like winning. Framing incentives as “you will lose your bonus if you don't meet your goals” motivates us more than “you will get a bonus if you meet your goals.”
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We're unrealistically optimistic. That's why people buy lottery tickets, and why it generally takes longer than you think to finish a project. Most people also expect their marriages and businesses to fare better than average.
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We overvalue evidence that comes readily to mind. That means we overestimate the risks of dramatic events like terrorist attacks and murders, and underestimate the risks of less talked-about and less dramatic events like car accidents.
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We like to behave as others do. Reminding taxpayers that most people pay their taxes on time makes them more likely to do so too — whereas telling them that the government wants to reduce the number of late payers has the opposite effect, by making it seem like late payers have plenty of company.
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We become overloaded when offered too many choices, and often do nothing at all. Simplifying the alternatives — such as by lumping health insurance plans into “gold,” “silver” and “bronze” categories — can nudge people to act.
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We procrastinate, especially when doing the right thing involves inconvenience or hassle. This means we often need to be nudged into doing things that are ultimately in our own best interest, such as saving for retirement.
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Because what works is so context-dependent, experienced practitioners say there can never be a standard recipe for choosing the right nudge to use in any particular situation. Instead, nudgers will need to dig into the details of each case. Nonetheless, researchers are zeroing in on a general approach for building good nudges.

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The key first step in the process sounds obvious, but isn't: Identify exactly what behavior you’re trying to change. “There's been a recognition that whether a nudge succeeds really depends on whether you have developed a good understanding of the problem,” says Pelle Guldborg Hansen, a behavioral scientist at Roskilde University in Denmark, who heads the Danish nudge unit.

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Consider the problem of encouraging more people to donate their organs after death. Typically, people need to give explicit consent on a donor form, usually when they renew their driver's license, but relatively few people do so. A classic nudge addresses this by changing the default so that everyone is presumed to have given consent unless they explicitly opt out — and this does, in fact, dramatically increase the proportion of people listed as organ donors. But the Canadian province of Ontario found that this didn't translate into more organs actually being used for transplants, because it solved the wrong problem. Doctors in Ontario still sought consent from next of kin before harvesting organs — and getting that consent was the real bottleneck in the process, says Dilip Soman, a behavioral scientist at the University of Toronto. So now Soman's team is working on a different set of nudges, such as mailing “conversation cards” to newly registered donors to help them discuss their wishes with family members.

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Once nudge designers have targeted the behavior they really want to change, the next step is to identify the barriers that keep that behavior from changing, says Brigitte Madrian, a behavioral economist at Harvard. If people fail to act on their own wishes (such as to eat healthier meals), is that because they forget to act at the appropriate time, don't know what steps to take, or lack the willpower to follow through? Each will require a different nudging technique — in this example, they could be reminders, information, and committing to a plan of action, respectively. If, on the other hand, changing behavior requires overriding an in-the-moment preference (such as saving for retirement or getting a flu shot, neither of which is desirable in the short term), the likeliest nudges might involve providing more information about the benefits, or adding social pressure to conform.

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Based on their analysis of the particular case, practitioners should ideally choose several potential nudges, then test them all to identify which one works best. The nudge finally chosen for deployment may look simple, even obvious. But, notes Hansen, that superficial simplicity hides an enormous amount of work behind the scenes.

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Ethical issues

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Even when done well, nudging carries a strong whiff of paternalism, especially when governments use it to override people's usual behavior and guide them toward what the government thinks they should be doing instead. The implications of that have not been fully examined. “There are legitimate questions about the ethics of nudging that we're only starting to look at now,” says UCLA's Fox.

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Consider, for example, nudging to encourage higher contributions to retirement savings. Most people benefit from higher savings, but a few — such as those who don’t expect to survive for a lengthy retirement — might be better off with lower contributions. Is it acceptable to nudge in this case, knowing that it will harm some people?

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To address this ethical problem, a few behavioral scientists are beginning to develop ways to personalize nudges for individual circumstances. Workers in the United States, for example, receive a maximum government pension if they begin at age 70 but instead can elect to take smaller monthly payments as early as 62. Most are better off in the long run if they wait, but almost half choose the earlier, smaller payouts, says Eric Johnson, a psychologist at Columbia University. The situation seems ripe for a nudge — for example by pointing out how much money a retiree stands to lose through early claiming. But encouraging everyone to wait will hurt the minority who are unlikely to live long enough to recoup the benefits. “There really is potential harm if you just do a one-size-fits-all nudge,” Johnson says.

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So Johnson and his colleagues are developing a system of tailored nudges that help guide each individual to a better decision. Those who visit Johnson's experimental website and answer just few simple questions about their gender, health and parents' longevity provide enough information about life expectancy to yield informed advice (and appropriate nudges), he finds. In other experiments by Johnson's team, questionnaires can help nudge people toward appropriate choices of health insurance plans and other financial decisions.

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The need for tailored nudges may be widespread. Older people, who are seasoned but less mentally nimble than they once were, may make better choices if not overwhelmed by too many options, Johnson says. In contrast, younger people, who have less life experience to draw on, may do better with — and can handle — more detailed explanations and choices.

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Behavioral scientists are also learning to find better lever points for their nudges. To get more people to use generic drugs, rather than functionally identical but more expensive branded versions, nudgers are finding that rather than trying to influence patients (through informational advertisements, say) it is easier to focus on the prescribing habits of doctors. “The doctors are making a single decision about treatment in a controlled clinical environment, mediated by electronic record-keeping systems, which is a perfect environment for nudging,” says Fox. Sure enough, a study that had doctors' prescriptions default to generic drugs unless they specified otherwise boosted the use of generics to 96 percent from 40 percent.

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Nudging the nudgers

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In recent years, this search for better lever points has led many nudge practitioners to take a broader view of the policy landscape. Nudges, as they were first conceived, used behavioral insights to improve the implementation of existing policies by helping people make better choices. But as nudging matures, researchers are beginning to use the same behavioral principles to guide the development of the policies themselves. “We haven't seen a lot of that yet, but I think that's where the potential for greatest impact is,” Madrian says.

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IMAGE CREDIT: TEXTBOOK EXAMPLE

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A catalog of nudges

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Behavioral scientists have developed an extensive toolbox of nudges — that is, ways to influence people's behavior so they're more likely to act in their own best interest, while still offering them the freedom to choose. Here, according to nudge pioneer Cass Sunstein, are some of the most effective:

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Set defaults, such as automatic enrollment in pension plans or organ-donor programs, but allow people to opt out if they wish.
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Simplify or clarify forms and procedures so that people face less hassle and are less likely to give up.
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Provide reminders that an action is due, so that people do not overlook it.
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Put optimal choices first in a list of options. All else being equal, people are more likely to choose the first item on the list.
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Put optimal choices where they are most visible, such as displaying healthy foods at eye level in a cafeteria.
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Add relevant information, such as calorie counts in fast food restaurants.
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Appeal to people's aversion to losing something they already have (such as, “You will lose $50 if you don't conserve energy”).
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Ask people to commit to specifics of a plan of action, such as when and where they plan to vote.
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Prime people to have a desired mindset, such as by reminding them of the need for honesty before they fill out a form, or prompting them to think about their retirement before committing to a savings plan.
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Suggest an amount for a payment or contribution (“Do you want to give $100 to this charity?”). Such “anchoring” tends to focus people's choices somewhere near the suggested value.
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Tell people what others do (for example, “Most people pay their taxes on time”). This puts social pressure on them to do likewise.
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Behavioral economists know, for example, that if people have too many options to choose among, they are more likely to make poor choices through sheer information overload. Thus, they say, disclosures for mortgages, investments, telecommunications plans and other complex offerings could be standardized into formats proven to be easy for customers to understand and compare, improving the ability to make sound decisions. The country of Colombia, for example, has revamped regulations for communications providers so that mobile phone contracts now take an average of 12 minutes to read instead of 6 hours and 15 minutes. The new contracts also give clearer notice of costs and services.

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Behavioral insights can even modify the political process itself. Residents of the island of Jersey in the English Channel can now give the government their views on important local issues such as taxation and environment through an automated chatbot on Facebook that was designed with behavioral principles in mind. “You can do this on your terms — on the bus, at home, on Saturday,” says Simon Day, cofounder of Apptivism, the startup company that designed the chatbot. Each chat session is short and focused, provides personalized feedback to the user, and can easily be shared online — all features shown to nudge users toward greater engagement. The approach yields three to four times more participation than conventional ways of gathering public opinion, Day says. The company has similar pilots underway with a Scottish regulatory agency, a UK political party and several nonprofit organizations.

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Apart from ethical concerns about manipulating people's decisions, nudging has few detractors. After all, nudges generally have to prove themselves in tests before they are rolled out into the wider society, so any failures — which still turn up in perhaps 10 to 30 percent of attempts — are readily weeded out. The greatest risk, according to several leading behavioral scientists, is that nudging's booming popularity is attracting people who lack the training to do the job properly. The Internet is full of nudge consultants with no background in behavioral science, notes Lunn. “I think that presents a challenge,” he says. “Like anything that becomes popular, you can sell versions of it that don't work.”

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The other criticism often leveled at nudging — one that at least some practitioners, such as Lunn, share — is that its gentle tinkering may not be powerful enough to take on society's big issues, such as poverty, obesity and political polarization. But even gentle tinkering, if persistent enough, can make a big difference, say others. “We have this intuition that a big problem needs a big solution,” says Piyush Tantia, co-executive director of Ideas42, a nonprofit behavioral design lab based in New York. “But the mistake we make is to take a big problem like poverty or racism and think there's one big solution. That's not the case. Poverty breaks down into hundreds of little problems that you have to solve to crack it. Once you break it down like that, many of the problems can be solved with a nudge.”

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Researchers at the Abdul Latif Jameel Poverty Action Lab, headquartered at the Massachusetts Institute of Technology, have conducted nearly a thousand controlled trials of strategies — many of them nudges — that can help lift people from poverty. Poor farmers in Kenya, they find, often lack cash to buy fertilizer at planting time, so barely a quarter of them use it. But if the farmers were offered a chance to pre-purchase fertilizer at harvest time, when they have the cash, fertilizer use rose to 38 percent. An earlier study showed that fertilizer can boost incomes by more than 10 percent. A separate study found that putting water chlorination dispensers at village water wells increased social pressure to chlorinate compared with giving people chlorine supplies to use at home. The result was much higher chlorination rates and, hence, less waterborne disease.

\n\n\n\n

\n\n

In the end, though, nudging's biggest contribution to the world of governance may come not from the nudges themselves, but from catalyzing a change in the whole mindset of government. Where once governments and their economists designed policies based on political ideology — just listen to almost any policy debate in the US Congress — the popularity of nudging is pushing some toward a more empirical approach. “It has helped to embed a culture of experimentation inside policymaking. And that is something that is definitely new,” says Faisal Naru, a public policy adviser for the Organization for Economic Cooperation and Development in Paris, and one of the leaders in the nudging world.

\n\n

Colombia, for example, went on to completely redesign its regulations for the telecommunications industry to be more consumer-friendly. In South Africa, the Western Cape government has embedded its nudge unit — and hence its experimental ethos — at the heart of the government, in the Department of the Premier. And in Finland, Prime Minister Juha Sipilä is leading an effort to promote experimentation in everything from recycling initiatives to guaranteed basic incomes. Citizen suggestions and crowdfunded tests are welcome, and failures are expected — last October, the government even celebrated an International Day of Failure to normalize this possibility. The result, both in Finland and eventually elsewhere, may be more effective and less ideologically bound policies.

\n\n

Nudging, in other words, is nudging governments toward a more evidence-based, scientific style of governing. In these contentious times, that can only be a good thing.

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In early April, several hundred scientists converged in the Netherlands for the first-ever meeting of the Society for Interdisciplinary Placebo Studies. The topic drew psychologists, psychiatrists, physiologists, ethicists and neuroscientists, all enthusiastic about focusing a wider lens on a booming area of study: investigation of how beliefs, expectations and motivations can shape health. The well-documented, if often incidental, effects of placebos — drugs with no active ingredients, or other shams concocted to better measure another therapy’s effect — have triggered that boom.

\n\n

But even before the conference date had been set, something was bothering some prospective attendees, an annoyance that had gnawed at a few of them for years. It was the word placebo itself. And though it seems like a small issue — a word choice, a semantic nuisance — it struck scholars like clinical psychologist John Kelley of Harvard that the name was having an outsize effect on doctors’ ability to harness the power of placebos for good.

\n\n

For starters, the name defies logic. “‘The placebo effect’ in and of itself is an oxymoron,” Kelley says. “The placebo effect is the effect of something that has no effect. That can’t be true.”

\n\n

“‘The placebo effect’ in and of itself is an oxymoron.”

\nJohn Kelley

\n\n

Even if it were true, the name comes with baggage. Studies have found that placebos can dampen pain, relieve anxiety and help headaches. Yet despite its growing resumé, placebo effect still carries a strong whiff of woo. That name implies a fake, a sham, an intention to deceive, says neuroscientist Vitaly Napadow of Massachusetts General Hospital and Harvard Medical School. “The word placebo has a really bad connotation that’s holding it back in a way from actually being something we use.”

\n\n

That bad rap came up again in a musty room tucked away in Leiden during a small gathering the day before the official placebo meeting began. Napadow, Kelley and about two dozen other scholars convened to talk about how placebos might transform clinical practice. But almost immediately, the conversation turned to vocabulary as the scientists debated the advantages and practicalities of a rebranding campaign for the poor, shamefaced placebo.

\n\n

Their objection goes beyond PR. The real problem, they argue, is that the term placebo effect is incorrect. Sugar pills, pretend surgeries and fake acupuncture needles are supposed to be inert, existing only so that something else (the “real medicine”) can shine. For people studying placebos seriously, that narrow, dismissive way of thinking is limiting. Placebos fails to capture the deeper essence of how beliefs actually can and do transform the body.

\n\n

But if the old term no longer makes sense, what then to call it?

\n\n

“Language is a real problem here,” Kelley says. But if the old term no longer makes sense, what then to call it? Alternatives — “meaning response,” “expectancy response,” “non-specific effect,” and “context effect” — come with their own squishiness. Kelley, ticking through the list of proposed substitutions, admits there’s still no lexical savior.

\n\n

The meeting ended with no new name, only an acknowledgment that the name, and the concept, of placebos remains a substantial roadblock to incorporating them into everyday medical practice.

\n\n

Still, research marches on. Today’s growing evidence of placebo power is built on more sophisticated explanations of just how beliefs can change the body, as revealed in a bevy of neuroscientific studies. Scientists are figuring out when thoughts and expectations can change outcomes, and when they can’t. More interestingly, these effects aren’t always due to simple learned associations — take a sugar pill, feel better. Instead, the placebo effect appears to hook into a much more active and broad-based neural process, one in which the brain builds its own expectations from a wide range of clues. And that active construction of reality may simply be how our brains work in all situations, making guesses about what will happen next based on past experience and present cues.

\n\n\n\n

\n\n

Researchers looking at how the brain builds the expectations that fuel the placebo response have recently identified one brain region — the ventromedial prefrontal cortex — as particularly important, serving as a neural hub for transforming beliefs into body responses. This brain network helps place a person in context relative to the outer world, a situational awareness that then leads to predictions about, among other things, whether a treatment, sham or real, might work. Other neural networks are no doubt involved, too, depending on the situation. The search for a better name may signal a field coming of age, helping scientists define the mysterious process by what it is and what it isn’t.

\n\n

This, not that

\n\n

One scenario where the term placebo effect fails is in talking about active drugs. Morphine behaves very differently based on whether people know they’re getting it or not. A powerful opiate falters when people don’t know they’ve taken it. That’s not a placebo effect, because there is no placebo. Still, it feels like it should be one, since it’s based on the user’s expectations, Kelley says. “It seems to me that it is exactly the same thing.” Similarly, people can experience negative side effects from a placebo, if that’s what they are expecting. This phenomenon is called the nocebo effect (more problematic vocabulary).

\n\n

Another example comes from studies in psychologist Alia Crum’s lab at Stanford. She and her colleagues gave two groups of people shakes to drink. One group was told the shakes were healthful; the other was told the shakes were an indulgent treat. The shakes were identical, but the people’s bodies responded very differently. The hunger-stimulating hormone ghrelin, produced in the gut, was three times lower in the people who had the “indulgent” shake, as if they knew they should feel sated, Crum and colleagues reported in 2011. In that study, “there’s no doctor, there’s no patient, there’s no placebo,” Kelley says. “Is this the same phenomenon? Not exactly, but to me, it’s very similar.”

\n\n

“The clinical picture that’s emerging is that in many disorders the placebo response is quite strong.”

\nTor Wager\n

\n\n

What these studies have in common is that they deal with psychological adjustments, tweaks to people’s perspectives, beliefs and expectations. As with some types of psychotherapy, people may reframe their beliefs to make space to believe something will help or not (or even hurt them). And these beliefs can have profound influences on the body.

\n\n

Pain and such disorders such as depression, anxiety and Parkinson’s disease seem especially amenable to psychological manipulations delivered as medicine, research suggests. In a study of people with Parkinson’s, brain surgery to implant a virus that enhances dopamine production produced improvements in symptoms for two years. Those gains should have been exciting, but the trial, reported in 2015 in Annals of Neurology, failed. That’s because the same two-year improvements were experienced by the people who underwent sham surgery — a very potent placebo, it turns out.

\n\n\n\n

\n\n

Medically meaningful placebo effects have turned up elsewhere. “The clinical picture that’s emerging is that in many disorders the placebo response is quite strong,” says cognitive neuroscientist Tor Wager of the University of Colorado Boulder. And that response is shaped by a variety of psychological forces.

\n\n

Pavlov’s placebo

\n\n

One of these psychological ingredients may be simple conditioning, a study from Napadow’s lab makes clear. After regularly coming into the lab to receive a small injection of an allergen in their skin, participants learned that the skin prick made them itch. But after a while, the researchers switched the allergen for salt water. “They were led to believe that this is the same allergen they’d been feeling all along,” Napadow says.

\n\n

And lo, they believed it. Participants rated the sensation as itchy, and their brains showed itch-related activity similar to the traditionally acquired itch, Napadow and colleagues reported in Allergy in 2015. “You imagine the itch and you are in fact itching,” he says. “Your perception becomes your reality.”

\n\n\n\n

\n\n

That type of linking of two events may help explain much of the placebo effects that have been observed in creatures with very little psychological baggage: animals and infants, who, it’s been shown, can learn to expect certain outcomes after taking a drug or undergoing a procedure. While this type of Pavlovian learning is certainly part of the placebo spectrum, such conditioning “doesn’t explain the whole story,” says Katja Wiech, a pain researcher at the University of Oxford. That’s true particularly when it comes to pain.

\n\n

People are very good at remembering something that hurts. After a back injury, a person knows exactly which movements to avoid. But “forgetting pain is so much harder,” Wiech says. At the placebo conference in the Netherlands, she presented data that suggest it takes about three times as much evidence for people to learn that the pain is gone.

\n\n

“It’s not about the experience. It’s about the sense you make out of your experience.”

\nKatja Wiech\n

\n\n

If perception were as simple as receiving input from the senses, that difference in learning and unlearning pain might not exist. People would be keen observers of the sensory cues coming in and adjust their experiences to fit with them. But incoming sensory information — a throbbing toe, for instance — is not the only signal that matters. “Over time, we’ve learned that there’s not a direct proportional relationship between tissue damage and the pain,” Wiech says. People can learn to feel pain when they expect it, whether it’s there or not.

\n\n

The pain signals that zing from the toe to the brain are but one piece of evidence the brain uses to build its narrative. Some information is more powerful than others, and we weigh it accordingly. “It’s not about the experience,” Wiech says. “It’s about the sense you make out of your experience.”

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Mapping placebos through the brain

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No matter what they are called, some placebo effects take hold of a compelling piece of neural real estate, Wager and colleagues argue: the ventromedial prefrontal-cortex, or vmPFC. This cortical patch lies near the very front of the brain, behind the eyes. From its perch, the vmPFC forms neural connections that enable it to both help form beliefs and execute their orders. Drawing on memories, sensory cues and emotional input, the vmPFC evaluates relationships between things and creates an idea of the self, positioning a person in the context of her world.

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Because of its far-flung connections to the spinal cord, skin, heart and immune system, the vmPFC and its vast neural networks may also orchestrate the body’s responses to these beliefs. Scientists are drawing increasingly detailed maps of the roads that lead from beliefs in the brain to changes in the body, progress detailed by Wager and his colleagues in 2017 in the Annual Review of Neuroscience.

\n\n\n\n

\n\n

Take pain, for example. Scientists have traced a pathway that converts neural activity into perception of a throbbing toe, for instance, and the vmPFC seems to be a key node. Neurons in the vmPFC send signals directly to a part of the spinal cord called the periaqueductal gray, a hotbed of pain-detecting and pain-alleviating neurons. Other signals arrive here from the amygdala, a structure involved in emotions; the nucleus accumbens, linked with motivation and addiction; and the hypothalamus, a brain structure with basic bodily jobs of regulating temperature, hunger and sleep. These brain structures are all in deep communication with the vmPFC.

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This admixture of signals, which can dial pain up or down, gets shuffled through several more middlemen before creating the sensation of back pain, for instance. Neuroimaging studies suggest that placebos can tweak signals all up and down this pathway. One of the strongest responders to placebos is the vmPFC, Wager and others have found.

\n\n

Those rose-colored assessments mean that a person might selectively see what she already believes. A self-fulfilled prophecy is built.

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A similar pathway exists for a parallel but distinct part of the nervous system called the autonomic nervous system. This network can soothe the body or turn it into a sweaty, heart-thumping lump of panic. Recent work on Cebus monkeys revealed synaptic fibers that run from a part of the pre-frontal cortex near the vmPFC and other cortical areas to a part of the adrenal gland, which can flood the body with adrenaline. The immune system is within the vmPFC’s reach, too. Activity in the region is thought to spur the body to produce inflammatory cytokines and other immune system signals.

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Placebos’ influences on these pathways remain to be worked out, but Wager and others suspect that the vmPFC may turn out to be a key regulator. What’s more, this brain area and its many collaborators may be involved in triggering a positive experience that lasts, Wager believes. His talk at the placebo meeting was about why some placebo effects seem to linger far beyond the time they’d be expected to fade.

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Wager’s idea, and one that recent work from his lab backs up, is that placebo effects kick off feedback loops of goodness. “Once you have a positive expectation, you’re biased toward looking for and learning from things that match those expectations,” he says. “You value the good stuff and discount the bad stuff.” Those rose-colored assessments mean that a person might selectively see what she already believes. A self-fulfilled prophecy is built.

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Better living through placebos

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But despite the positive results, placebos as treatments haven’t overcome their stigma to reach doctors’ offices yet. “We have some pretty good success” with disorders like depression, anxiety and migraines, Kelley says. “But I don’t think anyone is prescribing them. It just feels wrong.”

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“Yes, kind of weird, but in a somewhat mysterious way, empowering,” a top reviewer writes [of “honest” placebos on Amazon].

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People could seek out a placebo prescription. It turns out that’s not necessary, since commercial, over-the-counter “honest” placebos exist. You can Amazon Prime yourself 45 Zeebo brand pills for $24.90. That may seem like a lot to pay for gelatin capsules clearly labeled as containing “no active ingredient,” but there’s evidence that more expensive placebos work better than cheap ones. “Yes, kind of weird, but in a somewhat mysterious way, empowering,” a top reviewer writes.

\n\n

More palatable to physicians may be ideas such as, with the patient’s agreement, slowly tapering a patient’s dosage of an opioid painkiller or other drug. That way, a patient might get pain relief without the risk of side effects or addiction.

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Still, as the more expansive concepts of mindset and beliefs imply, patients’ outlooks can be tweaked without pills, creams or sham surgery. Doctors can take time to sit down, talk through the rationale of why a certain treatment might work, smile. Some people believe that those actions, called the “common factors” in the therapy world, are responsible for much of the improvements that come with psychotherapy. (The controversial “Dodo Bird Verdict,” proposed in the 1930s by psychologist Saul Rosenzweig, posits that most forms of psychotherapy are equally effective, thanks to these common factors. As the dodo said to Alice and her companions in Wonderland after a circular race with no start and no stop, “Everybody has won, and all must have prizes.”)

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Napadow and colleagues are searching for the neurobiological markers of what scientists call the “therapeutic alliance” by measuring brain activity concurrently in doctors and patients. By creating positive expectations, good rapport might lead to better outcomes, the researchers suspect.

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But even the low-tech approach of smiling and seeming to care has not yet made it into the clinic in a rigorous way. “The science of motivation, expectation and decision-making hasn’t percolated into medical practice,” Wager says. “And that would be such an exciting thing to see happen. The science we’re doing is preparing the way for that.”

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“I feel pretty good that there are some people doing placebo research who just really want to know the answers,” no matter how the results turn out, Wager says. “And we need that. Desperately.”

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Of course, placebos — or more general psychological adjustments — won’t work for everything, or perhaps even most things. You can’t think your way out of a brain tumor, Napadow says. “There are obviously going to be limits to how much our brains can control the diseases that are ravaging our bodies,” he says.

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One telling example of placebos’ shortcomings appeared in the New England Journal of Medicine in 2011. People with asthma came into a lab at Harvard and were treated with an albuterol inhaler, a placebo inhaler or sham acupuncture. Afterward, the patients reported similar levels of improvement for all three treatments, but their airways felt the difference: Only after getting the active drug could people objectively blow more air out of their lungs. People taking placebos felt better, but they still couldn’t breathe.

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That study illustrates some newfound rigor for the field of placebo research, which has been plagued by a pro-placebo bent in some cases, Wager says. “I feel pretty good that there are some people doing placebo research who just really want to know the answers,” no matter how the results turn out, he says. “And we need that. Desperately.”

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For now, the questions still outweigh the answers, a point made by a study Wager and colleagues are conducting now. The researchers combined data from most of the existing brain imaging studies on pain and placebos, about 20 studies in all. Overall, placebos’ effect on the pain network in the brain — the one that supposedly jumps into action when something hurts — seems surprisingly small. “For me, that opens up the door to say, ‘OK, it might be pretty rare for placebo manipulation or treatment to have a deep impact on the things that cause pain,’” Wager says. That said, other brain circuits, such as those that handle motivation and value, might have the power to override this pain signal in the brain to make people feel better, he says.

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Untangling the various ingredients that shape our mindsets may well alter clinical practice one day. “There are principles to how we come to those beliefs and how we change them,” Wager says. And now, those principles are beginning to take shape, emerging from their shady history and asking for proper names.

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EXPECTEBO Scientists studying the myriad effects of placebo agree it has real power to heal in some cases. But some say that questions over what to call it — and how to harness its power —has stalled its widespread acceptance in the clinic.

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