Breast cancer screening and treatment, especially in younger women

[Editor's note: I was on Twitter, as usual, a couple of days ago, and started seeing tweets with the hashtag #SSCAbc. They contained information that I, an avid consumer of science and medical information, don't normally see addressed in breast cancer stories, including for young women with breast cancer and how to talk to children about having breast cancer. I've aggregated some of those tweets below, but you can read more at the hashtag here, which represents the Seattle Cancer Care Alliance, whose representatives were conducting the Twitter session.]

[View the story "Seattle Cancer Care Alliance: Talking about breast cancer" on Storify]

Seattle Cancer Care Alliance: Talking about breast cancer

http://www.sccablog.org/2012/10/tweeting-for-breast-cancer-awareness-month/ Twitter handles @SeattleCCA, @UWMedicineNews, and @HutchinsonCtr; also @jrgralow and @SeattleMamaDoc

Storified by Emily Willingham · Mon, Oct 15 2012 13:00:07

“@stales: MT @SeattleMamaDoc: Exercise lowers hormone levels, consequently lowers risk of breast cancer.#SCCAbc #SCCAbc”MESFER AL SHAHRANI
#SCCAbc Topic 3: If your mother or sister had breast cancer, especially < age 40, you may be at increased risk.Julie Gralow
RT @jrgralow: Breast cancer in multiple family members, especially at young age, increases risk. Great info: http://ow.ly/euFq8 #SCCAbcWendySueSwanson MD
THIS IS A TRIPLE WHAMMY: Breast feeding is good for mom, great for baby, & lowers breast cancer risk (less estrogen while nursing) #SCCAbcWendySueSwanson MD
RT @SeattleCCA: Recap T2: earlier age at first #pregnancy, more pregnancies & #breastfeeding can decrease #breastcancer risk #SCCAbcAlicia C. Staley
Tough for many of us—and not necessary–but earlier pregnancies (esp under age 20) dec risk of breast cancer #SCCAbcWendySueSwanson MD
RT @SeattleMamaDoc: Tell your teens. Scream it from the rooftop RT @jrgralow: #SCCAbc Oral contraceptives do NOT increase breast cancer riskDominique B.
TOPIC 4 Q1: What is the recommended age for a #mammogram, and why? #SCCAbcSeattle Cancer Care
RT @jrgralow: We recommend starting age 40 for most women. If you have higher or lower risk than average this will vary. #SCCAbcUW Medicine News
Mammograms can decrease rate of death from breast cancer, especially true in those women over age 50 #SCCAbc http://1.usa.gov/puQ0NcWendySueSwanson MD
RT @seattlecca: T4 Q2: What else can a woman do other than a #mammogram to screen for #breastcancer? #SCCAbcUW Medicine News
RT @jrgralow: #SCCAbc Topic 4: Younger women have denser breasts, making mammos less reliable. Here’s some info: http://ow.ly/euH6tUW Medicine News
RT @jrgralow:Topic 4: Ultrasound is great in young, dense breast when abnormality is noted. So far, not a good screening tool yet. #SCCAbcUW Medicine News
#SCCAbc Topic 4: Breast MRI more sensitive than mammo in young women. For women with strong family history we recommend breast MRI .Julie Gralow
BRCA1 & BRCA2 are genes that can be passed in families & inc your risk of breast cancer. There’s blood tests 4 BRCA1&2 gene changes. #SCCAbcWendySueSwanson MD
#SCCAbc Topic 3: We can test for BRCA1/2, also sometimes PTEN or p53 or other tests may be applicable.Julie Gralow
RT @SeattleMamaDoc If concerned abt costs of genetic test, call ur insurance prior to tests. I also rec genetic counseling visits. #SCCAbcAlicia C. Staley
RT @SeattleMamaDoc Mammos, like most things, arent perfect. Esp in the young. If high risk 2 fam history/genes, ask abt breast MRI #SCCAbcAlicia C. Staley
RT @uwmedicinenews: Topic 5 Q1: how would you recommend speaking with young children about a loved one’s breast cancer? #SCCAbcHutchinson Center
More than anything, take ur time in explaining breast ca diagnosis with children. There isn’t urgent rush for all details at once #SCCAbcWendySueSwanson MD
@jrgralow Children learn fear of cancer from us. Be open/provide info, take them to chemo if they want, helps normalize #gr8 advice #SCCAbcUW Medicine News
RT @jrgralow: SCCAbc Topic 5: I love this book (by one of my patients) on talking about chemo with kids. http://ow.ly/euInm #SCCAbcSeattle Cancer Care
RT @jrgralow: Young Survival Coalition offers great support for young women w breast cancer http://www.youngsurvival.org/ #SCCAbcWendySueSwanson MD
RT @SeattleMamaDoc: Tip: Let people help you on YOUR terms when navigating cancer diagnosis &raising children. #SCCAbcUW Medicine News
#SCCAbc Topic 5: 2 great sets of info on coping and relationships and cancer. http://ow.ly/euITz http://ow.ly/euIUHJulie Gralow
Consider freezing eggs before chemo RT @jrgralow #SCCAbc T2: Chemo can put young women into early menopause, decrease future ferility.Ruth Ann Crystal, MD
RT @jrgralow: #SCCAbc Topic 1: Presidents Cancer Panel report on healthly lifestyles and cancer: http://ow.ly/er0pE #SCCAbcAlicia C. Staley
T4Q1: Thanks to @Safeway for supporting SCCA’s #MammoVan, will be in Safeway parking lots throughout Oct: http://ow.ly/euGjx #SCCAbcSeattle Cancer Care
RT @SeattleMamaDoc: PS– Breast feeding after breast cancer is okay: http://ti.me/coREKR #SCCAbc cc @brochmanSara

Modern Astronomers

This edition of the Notable Women in Science series presents modern astronomers. Many of these women are currently working in fields of research or have recently retired. As before, pages could be written about each of these women, but I have limited information to a summary of their education, work, and selected achievements. Many of these blurbs have multiple links, which I encourage you to visit to read extended biographies and learn about their current research interests.

From L to R: Anne Kinney, NASA Goddard Space Flight Center, Greenbelt, Md.; Vera Rubin, Dept. of Terrestrial Magnetism, Carnegie Institute of Washington; Nancy Grace Roman Retired NASA Goddard; Kerri Cahoy, NASA Ames Research Center, Moffett Field, Calif.; Randi Ludwig. University of Texas, Austin, Texas.
Vera Cooper Rubin was making advancements decades ahead of popularity of her research topic.  She received her B.A. from Vassar College, M.A. from Cornell University, and her Ph.D. from Georgetown University in the 1940s and 50s. She continued at Georgetown University as a research astronomer then assistant professor, and then moved to the Carnegie Institution. Among her honors is her election to the National Academy of Sciences and receiving the National Medal of Science, Gold Medal of the Royal Astronomical Society. She was only the second female recipient of this medal, the first being Caroline Herschel. She has had an asteroid and the Rubin-Ford effect named after her. She is currently enjoying her retirement.

Dr. Nancy Roman
Nancy Grace Roman has a lifetime love for astronomy. She received her B.A. from Swarthmore College and Ph.D. from the University of Chicago in the 1940s. She started her career as a research associate and instructor at Yerkes Observatory, but moved on due to a low likelihood of tenure because of her gender. She eventually moved through chief and scientist positions to Head of the Astronomical Data Center at NASA. She was the first female to hold an executive position at NASA. She has received honorary D.Sc. from several colleges and has received several awards, including the American Astronautical Society’s William Randolf Lovelace II Award and the Women in Aerospace’s LIfetime Achievement Award. She is currently continuing to inspire young girls to dream big by consulting and lecturing by invitation at venues across the U.S.

Catharine (Katy) D. Garmany researches the hottest stars. Dr. Garmany earned her B.S. from Indiana University and her M.A. and Ph.D. from the University of Virginia in the 1960s and 70s. She continued with research and teaching at several academic institutions. She has served as past president of the Astronomical Society of the Pacific and received the Annie Jump Cannon Award. She is currently associated with the National Optical Astronomy Observatory with several projects.

Dr. Elizabeth Roemer
Elizabeth Roemer is a premier recoverer of “lost” comets. She received her B.A.  and Ph.D. from University of California – Berkeley in the 1950s. She spent some time as a researcher at U.S. Observatories before going to the University of Arizona and moving through the professorial ranks. She has received several awards, including Mademoiselle Merit Award, one of only four recipients of the Benjamin Apthorp Gould Prize from the National Academy of Sciences, and a NASA Special Award. She is currently Professor Emerita at the University of Arizona with research interests in comets and minor planets (“asteroids”), including positions (astrometry), motions, and physical characteristics, especially of those objects that approach the Earth’s orbit.

Margaret Joan Geller is a widely respected cosmologist. She received her A.B. from the University of California-Berkeley, and M.A. and Ph.D. from Princeton University in the 1970s. She moved through the professorial ranks at Harvard University and is currently an astrophysicist at the Smithsonian Astrophysical Observatory. Some of her awards include the MacArthur “Genius” Award and the James Craig Watson Award from the National Academy of Sciences. She continues to provide public education in science through written, audio, and video media.

In 1995, the majestic spiral galaxy NGC 4414 was imaged by the Hubble Space Telescope as part of the HST Key Project on the Extragalactic Distance Scale. An international team of astronomers, led by Dr. Wendy Freedman of the Observatories of the Carnegie Institution of Washington, observed this galaxy on 13 different occasions over the course of two months.


Wendy Laurel Freedman is concerned with the fundamental question”How old is the universe?”  She received her B.S., M.S., and Ph.D. from the University of Toronto in the 1970s and 80s. After earning her Ph.D. she joined Observatories of the Carnegie Institution in Pasadena, California as a postdoctoral fellow and became faculty a few years later, as the first woman to join the Observatory’s permanent scientific staff. She has received several awards and honors, among them the Gruber Cosmology Prize. Her current work is focusing on the Giant Magellan Telescope and the questions it will answer. 

Sandra Moore Faber researches the origin of the universe. Dr. Faber earned her B.A. from Swarthmore College and her Ph.D. from Harvard University in the 1960s and 70s. She joined the Lick Observatory at the University of California – Santa Cruz and moved through the Astronomer and Professorial rankings. Her achievements include being elected to the National Academy of Sciences, the Heineman Prize, a NASA Group Achievement Award, Harvard Centennial Medal, and the Bower Award. She continues to research the formation and evolution of galaxies and the evolution ofstructure in the universe.


Dr. Heidi Hammel

Heidi Hammel is known as an excellent science communicator, researcher, andleader. She earned her B.S. from Massachusetts Institute of Technology and Ph.D. from the University of Hawaii in the 1980s. At NASA she led the imaging team of the Voyager 2’s encounter with Neptune and became known for her science communication for it.  She returned to MIT as a scientist for nearly a decade. Among her honors, she has received Vladimir Karpetoff Award , Klumpke-Roberts Award, and the Carl Sagan Medal.  She is currently at the Space Science Institute with a research focused on ground- and space-based studies of Uranus and Neptune.


Judith Sharn Young was inspired by black holes. She earned her B.A. from Harvard University and her M.S. and Ph.D. from the University of Minnesota in the 1970s. She began her academic career at the University of Massachusetts – Amherst, proceeding through the professorial ranks. She has earned several honors, including the Annie Jump Cannon Prize, the Maria Goeppert-Mayer Award, and a Sloan Research Fellowship. She is currently teaching and researching galaxies and imaging at the University of Massachusetts. 


Jocelyn Bell Burnell is the discoverer of pulsars. She earned her B.Sc. from the University of Glasgow and her Ph.D. from Cambridge University in the 1960s. After her graduation, she worked at the University of Southampton in research and teaching, and continued to work in research positions at several institutions. She is well known for her discovery of pulsars, which earned her research advisor a Nobel Prize. Among her awards are the Albert A. Michelson Prize, Beatrice Tinsley Prize, Herschel Medal, Magellanic Premium, and Grote Reber Metal. She has received honorary doctorates from Williams College, Harvard University, and the University of Durham. She is currently Professor of Physics and Department Chair at the Open University, England. 



Awards Mentioned:
The National Academy of Sciences is composed of select scientists who are leaders in their fields.
The National Medal of Science is a presidential award given to physical, biological, mathematical, or engineering scientists who have contributed outstanding knowledge to their field. 
The Gold Medal of the Royal Astronomical Society is the society’s highest honor given in astronomy
American Astronautical Society’s William Randolf Lovelace II Award recognizes outstanding contributions to space science.
The Women in Aerospace’s Lifetime Achievement Award is given for contributions to aerospace science over a career spanning 25 years. 
The Annie Jump Cannon Award is given for outstanding research a doctoral student in astronomy with promise of future excellence. 
The Mademoiselle Merit Award was presented annually to young women showing the promise of great achievement.
The Benjamin Apthorp Gould Prize is given in recognition of scientific accomplishments by an American citizen. 
The NASA Special Award is given for exceptional work.
The MacArthur “Genius” Award is given to those who show exception merit and promise in creative work. 
The James Craig Watson Award is given for contributions in astronomy. 
The Gruber Cosmology Prize is given for fundamental advances in our understanding by a scientists. 
The Heineman Prize is given for outstanding work in the field of astrophysics. 
The NASA Group Achievement Award is given for accomplishment that advances NASA mission. 
The Harvard Centennial Medal is given to graduates of Harvard who have contributed to society upon graduation. 
The Bower Award is given for achievement in science. 
The Vladimir Karapetoff Award is given for outstanding technical achievement. 
The Klumpke-Roberts Award is given for enhancing public understanding and appreciation of astronomy. 
The Carl Sagan Medal is awarded for outstanding communication to the public about planetary science. 
The Maria Goeppert-Mayer Award is given to a female physicist for outstanding achievement in her early career. 
The Albert A. Michelson Prize is given for technical and professional achievement. 
The Beatrice Tinsley Prize is given for outstanding research contribution to astronomy or astrophysics. 
The Herschel Medal is given for investigations of outstanding merit in astrophysics.
The Magellanic Premium Medal is awarded for a discovery or invention advancing navigation or astronomy.


Much of the information for this post came from the book Notable Women in the Physical Sciences: A Biographical Dictionary edited by Benjamin F. Shearer and Barbara S. Shearer.

Adrienne M Roehrich, Double X Science Chemistry Editor

Childbirth and C-sections in pre-modern times

[Today's post first appeared at Dr. Kristina Killgrove's blog, Powered by Osteons. Kristina is a bioarchaeologist who studies the skeletons of ancient Romans to learn more about how they lived. Her biography at her blog begins, "When your life's passion is to study dead Romans, you often get asked for your 'origin story,' something that explains a long, abiding and, frankly, slightly creepy love for skeletons." Now that you undoubtedly want to know more, read the rest of her bio here, and then read below to learn why childbirth is so difficult and what the archaeological record has to tell us about outcomes for mother and child in the ancient world. For more about Kristina and her work, you can see her academic Website at Killgrove.org  and find out about her latest research project at RomanDNAProject.org. You can also find her at her G+ page and on Twitter as @BoneGirlPhD.]

Basically since we started walking upright, childbirth has been difficult for women.  Evolution selected for larger and larger brains in our hominin ancestors such that today our newborns have heads roughly 102% the size of the mother’s pelvic inlet width (Rosenberg 1992).

Yes, you read that right. Our babies’ heads are actually two percent larger than our skeletal anatomy


Fetal head and mother’s pelvic inlet width
Photo credit: Evolution-of-man.info

Obviously, we’ve also evolved ways to get those babies out.  Biologically, towards the end of pregnancy, a hormone is released that weakens the cartilage of the pelvic joints, allowing the bones to spread; and the fetus itself goes through a complicated movement to make its way down the pelvic canal, with its skull bones eventually sliding around and overlapping to get through the pelvis.  Culturally, we have another way to deliver these large babies: the so-calledcaesarean section.

Up until the 20th century, childbirth was dangerous.  Even today, in some less developed countries, roughly 1 maternal death occurs for every 100 live births, most of those related to obstructed labor or hemorrhage (WHO Fact Sheet 2010).  If we project these figures back into the past, millions of women must have died during or just after childbirth over the last several millennia.  You would think, then, that the discovery of childbirth-related burial – that is, of a woman with a fetal skeleton within her pelvis – would be common in the archaeological record.  It’s not.

Archaeological Evidence of Death in Childbirth

Two recent articles in the International Journal of Osteoarchaeology start the exact same way, by explaining that “despite this general acceptance of the vulnerability of young females in the past, there are very few cases of pregnant woman (sic) reported from archaeological contexts” (Willis & Oxenham, In Press) and ”archaeological evidence for such causes of death is scarce and therefore unlikely to reflect the high incidence of mortality during and after labour” (Cruz & Codinha 2010:491).

The examples of burials of pregnant women that tend to get cited include two from Britain (both published in the 1970s), four from Scandinavia (published in the 1970s and 1980s), three from North America (published in the 1980s), one from Australia (1980s), one from Israel (1990s), six from Spain (1990s and 2000s), one from Portugal (2010), and one from Vietnam (2011) (most of these are cited in Willis & Oxenham).  Additionally, I found some unpublished reports: a skeleton from Egypt, a body from the Yorkshire Wolds in England, and a skeleton from England.

The images of these burials are impressive: even more than child skeletons, these tableaux are pathos-triggering, they’re snapshots of two lives cut short because of an evolutionary trade-off.


The wide range of dates and geographical areas illustrated in the slideshow demonstrates quite clearly that death of the mother-fetus dyad is a biological consequence of being human.  But what we have from archaeological excavations is still fewer than two dozen examples of possible childbirth-related deaths from all of human history.

Where are all the mother-fetus burials?


As with any bioarchaeological question, there are a number of reasons that we may or may not find evidence of practices we know to have existed in the past.  Some key issues at play in recovering evidence of death in childbirth include:
  • Archaeological Theory and Methodology.  From the dates of discovery of maternal-fetal death cited above, it’s obvious that these examples weren’t discovered until the 1970s.  Why the 70s?  It could be that the rise of feminist archaeology focused new attention on the graves of females, with archaeologists realizing the possibility that they would find maternal-fetal burials.  Or it could be that the methods employed got better around this time: archaeologists began to sift dirt with smaller mesh screens and float it for small particles like seeds and fetal bones.
  • Death at Different Times.  Although some women surely perished in the middle of childbirth, along with a fetus that was obstructed, in many cases delivery likely occurred, after which the mother, fetus, or both died.  In modern medical literature, there are direct maternal deaths (complications of pregnancy, delivery, or recovery) and indirect maternal deaths (pregnancy-related death of a woman with preexisting or newly arisen health problems) recorded up to about 42 days postpartum.  An infection related to delivery or severe postpartum hemorraging could easily have killed a woman in antiquity, leaving a viable newborn.  Similarly, newborns can develop infections and other conditions once outside the womb, and infant mortality was high in preindustrial societies.  With a difference between the time of death of the mother and child, a bioarchaeologist can’t say for sure that these deaths were related to childbirth.  Even finding a female skeleton with a fetal skeleton inside it is not always a clear example, as there are forensic cases of coffin birth or postmortem fetal extrusion, when the non-viable fetus is spontaneously delivered after the death of the mother.
  • Cultural Practices.  Another condition of being human is the ability to modify and mediate our biology through culture.  So the final possibility for the lack of mother-fetus burials is a specific society’s cultural practices in terms of childbirth and burial.  In the case of complicated childbirth (called dystocia in the medical literature), this is done through caesarean section (or C-section), a surgical procedure that dates back at least to the origins of ancient Rome.

Cultural Interventions in Childbirth


It’s often assumed that the term caesarean/cesarean section comes from the manner of birth ofJulius Caesar, but it seems that the Roman author Pliny may have just made this up. The written record of the surgical practice originated as the Lex Regia (royal law) with the second king of Rome, Numa Pompilius (c. 700 BC), and was renamed the Lex Caesarea (imperial law) during the Empire.  The law is passed down through Justinian’s Digest (11.8.2) and reads:

Negat lex regia mulierem, quae praegnas mortua sit, humari, antequam partus ei excidatur: qui contra fecerit, spem animantis cum gravida peremisse videtur.

The royal law forbids burying a woman who died pregnant until her offspring has been excised from her; anyone who does otherwise is seen to have killed the hope of the offspring with the pregnant woman. [Translation mine]
Example of Roman gynaecological equipment: speculum
From the House of the Surgeon, Pompeii (1st c AD)
Photo credit: UVa Health Sciences Library

There’s discussion as to whether this law was instituted for religious reasons or for the more practical reason of increasing the population of tax-paying citizens.  In spite of this law, though, there isn’t much historical evidence of people being born by C-section.  Many articles claim the earliest attested C-section as having produced Gorgias, an orator from Sicily, in 508 BC (e.g., Boley 1991), but Gorgias wasn’t actually born until 485 BC and I couldn’t find a confirmatory source for this claim.  Pliny, however, noted that Scipio Africanus, a celebrated Roman general in the Second Punic War, was born by C-section (Historia Naturalis VII.7); if this fact is correct, the earliest confirmation that the surgery could produce viable offspring dates to 236 BC.


This practice in the Roman world is not the same as our contemporary idea of C-section.  That is, the mother was not expected to survive and, in fact, most of the C-sections in Roman times were likely carried out following the death of the mother.  Until about the 1500s, when the French physician François Rousset broke with tradition and advocated performing C-sections on living women, the procedure was performed only as a last-ditch effort to save the neonate.  Some women definitely survived C-sections from the 16th to 19th centuries, but it was still a risky procedure that could easily lead to complications like endometritis or other infection.  Following advances in antibiotics around 1940, though, C-sections became more common because, most importantly, they were much more survivable.


Caesarean Sections and Roman Burials


Roman relief showing a birthing scene
Tomb of a Midwife (Tomb 100), Isola Sacra
Photo credit: magistrahf on Flickr

In spite of the Romans’ passion for recordkeeping, there’s very little evidence of C-sections.  It’s unclear how religiously the Lex Regia/Caesarea was followed in Roman times, which means it’s unclear how often the practice of C-section occurred.  Would all women have been subject to these laws?  Just the elite or just citizens?  How often did the section result in a viable newborn?  Who performed the surgery?  It probably wasn’t a physician (since men didn’t generally attend births), but a midwife wouldn’t have been trained to do it either (Turfa 1994).


Whereas we can supplement the historical record with bioarchaeological evidence to understand Romans’ knowledge of anatomy, their consumption of lead sugar, or the practice of crucifixion, this isn’t possible with C-sections – the surgery is done in soft tissue only, meaning we’d have to find a mummy to get conclusive evidence of an ancient C-section.

We can make the hypothesis, though, that because of the Lex Regia/Caesarea, we should findno evidence in the Roman world of a woman buried with a fetus still inside her.  This hypothesis, though, is quickly negated by two reported cases – one from Kent in the Romano-British period and one from Jerusalem in the 4th century AD. The burial from Kent hasn’t been published, although there is a photograph in the slide show above.

Interestingly, the Jerusalem find was studied and reported by Joe Zias, who also analyzed theonly known case of crucifixion to date.  Zias and colleagues report on the find in Nature(1993) and in an edited volume (1995), but their primary goal was to disseminate information about the presence of cannabis in the tomb (and its supposed role in facilitating childbirth), so there’s no picture and the information about the skeletons is severely lacking:

We found the skeletal remains of a girl (sic) aged about 14 at death in an undisturbed family burial tomb in Beit Shemesh, near Jerusalem.  Three bronze coins found in the tomb dating to AD 315-392 indicate that the tomb was in use during the fourth century AD.  We found the skeletal remains of a full-term (40-week) fetus in the pelvic area of the girl, who was lying on her back in an extended position, apparently in the last stages of pregnancy or giving birth at the time of her death… It seems likely that the immature pelvic structure through which the full-term fetus was required to pass was the cause of death in this case, due to rupture of the cervix and eventual haemorrhage (Zias et al. 1993:215).

Both Roman-era examples involve young women, and it is quite interesting that they were already fertile.  Age at menarche in the Roman world depended on health, which in turn depended on status, but it’s generally accepted that menarche happened around 14-15 years old and that fertility lagged behind until 16-17, meaning for the majority of the Roman female population, first birth would not occur until at least 17-19 years of age (Hopkins 1965, Amundsen & Diers 1969).  These numbers have led demographers like Tim Parkin (1992:104-5) to note that pregnancy was likely not a major contributor to premature death among Roman women.  But the female pelvis doesn’t reach skeletal maturity until the late teens or early 20s, so complications from the incompatibility in pelvis size versus fetal head size are not uncommon in teen pregnancies, even today (Gilbert et al. 2004).

More interesting than the young age at parturition is the fact that both of these young women were likely buried with their fetuses still inside them, in direct violation of the Lex Caesarea.  So it remains unclear whether this law was ever prosecuted, or if the application of the law varied based on location (these young women were both from the provinces), social status (both young women were likely higher status), or time period.  Why wasn’t medical intervention, namely C-section, attempted on these young women?  It’s possible that further context clues from the cemeteries and associated settlements could give us more information about medical practices in these specific locales, but neither the Zias articles nor the Kent report make this information available.

Childbirth – Biological or Cultural?

Childbirth is both a biological and a cultural process.  While biological variation is consistent across all human populations, the cultural processes that can facilitate childbirth are quite varied.  The evidence that bioarchaeologists use to reconstruct childbirth in the past includes skeletons of mothers and their fetuses; historical records of births, deaths, and interventions; artifacts that facilitate delivery; and context clues from burials.  The brief case study of death in childbirth in the Roman world further shows that history alone is insufficient to understand the process of childbirth, the complications inherent in it, and the form of burial that results.  In order to develop a better understanding of childbirth through time, it’s imperative that archaeologists pay close attention when excavating graves, meticulously document their findings, and publish any evidence of death in childbirth.



Further Reading:
ResearchBlogging.orgReferences:

This post was chosen as an Editor's Selection for ResearchBlogging.orgD.W. Amundsen, & C.J. Diers (1969). The age of menarche in Classical Greece and Rome. Human Biology, 41 (1), 125-132. PMID: 4891546.


J.P. Boley (1991). The history of caesarean section. Canadian Medical Association Journal, 145 (4), 319-322. [PDF]


S. Crawford (2007). Companions, co-incidences or chattels? Children in the early Anglo-Saxon multiple burial ritual.  In Children, Childhood & Society, S. Crawford and G. Shepherd, eds.  BAR International Series 1696, Chapter 8. [PDF]

C. Cruz, & S. Codinha (2010). Death of mother and child due to dystocia in 19th century Portugal. International Journal of Osteoarchaeology, 20, 491-496. DOI: 10.1002/oa.1069.

W. Gilbert, D. Jandial, N. Field, P. Bigelow, & B. Danielsen (2004). Birth outcomes in teenage pregnancies. Journal of Maternal-Fetal and Neonatal Medicine, 16 (5), 265-270. DOI:10.1080/14767050400018064.

K. Hopkins (1965). The age of Roman girls at marriage. Population Studies, 18 (3), 309-327. DOI: 10.2307/2173291.


E. Lasso, M. Santos, A. Rico, J.V. Pachar, & J. Lucena (2009). Postmortem fetal extrusion. Cuadernos de Medicina Forense, 15 (55), 77-81. [HTML - Warning: Graphic images!]

T. Parkin (1992).  Demography and Roman society.  Baltimore: Johns Hopkins University Press.

K. Rosenberg (1992). The evolution of modern human childbirth. American Journal of Physical Anthropology, 35 (S15), 89-124. DOI: 10.1002/ajpa.1330350605
J.M. Turfa (1994). Anatomical votives and Italian medical traditions. In: Murlo and the Etruscans, edited by R.D. DePuma and J.P. Small. University of Wisconsin Press.


C. Wells (1975). Ancient obstetric hazards and female mortality. Bulletin of the New York Academy of Medicine, 51 (11), 1235-49. PMID: 1101997.

A. Willis, & M. Oxenham (In press). A Case of Maternal and Perinatal Death in Neolithic Southern Vietnam, c. 2100-1050 BCE. International Journal of Osteoarchaeology, 1-9. DOI:10.1002/oa.1296.


J. Zias, H. Stark, J. Seligman, R. Levy, E. Werker, A. Breuer & R. Mechoulam (1993). Early medical use of cannabis. Nature, 363 (6426), 215-215. DOI: 10.1038/363215a0.

J. Zias (1995). Cannabis sativa (hashish) as an effective medication in antiquity: the anthropological evidence. In: S. Campbell & A. Green, eds., The Archaeology of Death in the Ancient Near East, pp. 232-234.

Note: Thanks to Marta Sobur for helping me gain access to the Zias 1995 article, and thanks toSarah Bond for helping me track down the Justinian reference.

Captivating and matriarchical: the meerkat.

Dominants, alphas, and queens: Happy Mother’s Day!

Mothers who rule in the animal kingdom.

by Jacquelyn Gill     

On the second Sunday in May in the United States, mothers reign supreme, receiving tributes of breakfast in bed, hand-made cards, flowers, and obligatory long-distance phone calls. Meanwhile, for the rest of the animal kingdom, it’s just another day: eat, hunt, mate, birth, nest, migrate, defend, and rest.

Some go it alone, but others—like spotted hyenas and bison—live in groups with complex social structures, and moms are at the top, year-round. In a matriarchy, females hold central roles of leadership and power. This might sound like a nice change of pace for some of us, but most anthropologists now agree that there have likely been no true matriarchal human societies (in spite of popular books like The Chalice and the Blade). Instead, matriarchies are more likely to be found in the rest of the animal kingdom, from meerkats to mammoths. Here are a few examples:

The Queen, surrounded by her supportive workers.

The Queen, surrounded by her supportive workers.

Honey bees: Bee colonies are giant matriarchal societies ruled by a single queen—quite literally the “queen mum.” Her offspring (as many as 25,000 at a time) make up the entire clan of female workers and male drones. The queen spends her life tended to by her worker daughters. These workers have underdeveloped reproductive systems, so the queen is the only female in the hive who gets to mate. The females do the work of the hive and tend to the queen while the male drones laze about until it’s time to mate with the queen. This setup might sound appealing at first, but it comes with a couple of important caveats. The Queen only mates once in her lifetime with a select handful of drones who were bred for that sole purpose (assuming they weren’t pushed out or killed by their worker sisters during tough times, when freeloading is less tolerated). During a series of nuptial flights, the queen gets all the sperm she’ll ever need for an entire lifetime—as many as five million individuals. She uses this sperm for to around 2500 eggs a day, which are tended to by her sterile daughters while she dines on royal jelly. The males get no reward for their service, but instead perish shortly after depositing their sperm, the unfortunate victims of an acute case of exploded abdomen.

Positives: Waited on hand-and-foot, low risk, low stress.  Negatives: Once-in-a-lifetime mating, copious egg-laying.

Captivating and matriarchical: the meerkat.

Captivating and matriarchical: the meerkat.

Meerkats: Meerkat societies are highly structured, with a complex ranking system based on dominance. If you want to get ahead in the meerkat world, perfect the art of chin swiping and hip checking, practiced on those lower down the totem pole while someone more powerful than you is looking the other way. Being on top has its rewards; alpha female meerkats are the only ones who get to mate in meerkat town. A matriarch chooses her partner, who becomes the dominant (and only mating) male. Males initiate copulation by ritually grooming the female until she submits. If the matriarch tires of her partner, he’s quickly deposed by beta males who are more than eager to earn a chance at mating. Alpha females make all the decisions in the group: where to sleep, where to burrow, when to go outside, when to forage. Like bees, meerkat females are typically mother to all the pups in the group (females typically kill pups born of unsanctioned unions). In addition to being free to engage in mating, being a matriarchal meerkat comes with free baby-sitting and nursemaid service from the subordinate females (who also will lactate to feed her pups). The downside is that all the other females want your job; as they get older, the young females start hip-checking, stealing food, and even picking fights. Often, the alpha kicks young competitors out of the group before they get old enough to pose a threat.

Positives: Your clan, your rules; mate selection; ritual grooming; cooperative breeding. Negatives: High risk.

Cooperative and matriarchical.

Cooperative and matriarchical.

Killer whales (orcas): Killer whales have some of the most complex social structures known in nature and are found in large resident groups (mostly fish eaters), smaller transient groups (seal hunters), or offshore groups (of which relatively little is known). Killer whale societies are entirely structured around the maternal line, in a hierarchy of groups. The smallest of these is the matriline, which contains the oldest female and her direct descendents—as many as four generations in one (great grand-whale, grand-whales, mama whales, and baby whales). Several matrilines together make a pod, and groups of pods with the same dialect and shared maternal lineage form a clan. For killer whales in resident groups, the young live with their mothers for the their entire lives, while in the smaller, transient groups, females tend to depart once they become mothers of their own. Meanwhile, male killer whales are mama’s boys, maintaining a strong relationship with their mothers for life. Even siblings remain close after their mother dies. Unlike bees or meerkats, all females can mate as they wish, although almost always only with males from other pods. These close-knit groups are important for successful hunting, as well as for rearing young that require a lot of parental investment (like humans do!). A killer whale’s female relatives assist her during labor, and even help guide her 400 lb calf to the surface to take its first breath. This cooperative behavior is a key part of teaching calves important life skills like the complex group hunting strategies similar to those that wolf packs use.

Positives: Strong family structure, cooperative breeding, matrilineal. Negatives: The kids never leave home.

Don't let the tusks fool you: It's a she, and she's the boss.

Don’t let the tusks fool you: It’s a she, and she’s the boss.

Elephants: Female elephants live together in small family groups, typically consisting of a matriarch and her young or closest relatives. The oldest female elephant in each family group gets the job, and the position is passed down to her oldest daughter when she dies. Matriarchs have a lot of social power but are also the source of important lore in the herd, like where the water is, how to avoid predators, and even how to use various tools like makeshift fly-swatters. Meanwhile, males live bachelor lifestyles, fending for themselves alone or in small groups after getting kicked out at puberty. Male and female elephants occasionally come together to socialize or mate, but otherwise live separately. Unlike bees, meerkats, and killer whales, female elephants have a lot less control in the mating process. Fertile females are followed around by aggressive bulls who rumble, produce a musky scent that they disperse by flapping their ears, and fight off other interested parties. For young female elephants, this mating behavior can be a bit intimidating, and so her female relatives will often stay by her side to provide moral support. After a two-year pregnancy, a female will give birth to a calf, which quickly becomes the center of herd life, as female relatives caress and welcome the newborn. The perks of elephant motherhood include free babysitting and protection from predators; females will circle the young when they sense danger. In some Asian elephant populations, multiple families have even been observed coming together to form specialized groups for nursing or juvenile care, like a cooperative preschool.

Positives: Strong family ties, cooperative parenting. Negatives: Lack of mate control, two-year pregnancy (!).

Many different kinds of matriarchy exist in the animal kingdom, as do many kinds of moms. Whether you’re a queen or a worker, an alpha or a beta, a subdominant or a matriarch, Happy Mother’s Day to moms everywhere.

References 

The Living Elephants: Evolutionary Ecology, Behavior, and Conservation, Raman Sukumar. Oxford University Press, Oxford, UK. Kalahari Meerkat Project, Cambridge University

Killer Whales: The Natural History and Genealogy of Orcinus Orca in British Columbia and Washington, Kenneth C. Ford, Graeme M. Ellis, & Kenneth C. Balcomb. University of British Comumbia Press, Vancouver.

WebBeePop, Carl Hayden Bee Research Center, USDA Agricultural Research Service

[Photo credits: all photos are from Wikipedia with Creative Commons with Attribution liceneses except for #3, which is Public Domain: (1) A queen bee surrounded by her worker daughters. Photo by Waugsberg. (2)  A meerkat in the Kalahari. Photo by Muriel Gottrop. (3) A mother-calf killer whale pair. Photo by Robert Pitman. (4) A matriarchal elephant and her family. Photo by Amoghavarsha.] Continue reading

Anorexia nervosa, neurobiology, and family-based treatment

Via Wikimedia Commons
Photo credit: Sandra Mann
By Harriet Brown, DXS contributor

Back in 1978, psychoanalyst Hilde Bruch published the first popular book on anorexia nervosa. In The Golden Cage, she described anorexia as a psychological illness caused by environmental factors: sexual abuse, over-controlling parents, fears about growing up, and/or other psychodynamic factors. Bruch believed young patients needed to be separated from their families (a concept that became known as a “parentectomy”) so therapists could help them work through the root issues underlying the illness. Then, and only then, patients would choose to resume eating. If they were still alive.

Bruch’s observations dictated eating-disorders treatments for decades, treatments that led to spectacularly ineffective results. Only about 35% of people with anorexia recovered; another 20% died, of starvation or suicide; and the rest lived with some level of chronic illness for the rest of their lives.

Not a great track record, overall, and especially devastating for women, who suffer from anorexia at a rate of 10 times that of men. Luckily, we know a lot more about anorexia and other eating disorders now than we did in 1978.

“It’s Not About the Food”

In Bruch’s day, anorexia wasn’t the only illness attributed to faulty parenting and/or trauma. Therapists saw depression, anxiety, schizophrenia, eating disorders, and homosexuality (long considered a psychiatric “illness”) as ailments of the mind alone. Thanks to the rising field of behavioral neuroscience, we’ve begun to untangle the ways brain circuitry, neural architecture, and other biological processes contribute to these disorders. Most experts now agree that depression and anxiety can be caused by, say, neurotransmitter imbalances as much as unresolved emotional conflicts, and treat them accordingly. But the field of eating-disorders treatment has been slow to jump on the neurobiology bandwagon. When my daughter was diagnosed with anorexia in 2005, for instance, we were told to find her a therapist and try to get our daughter to eat “without being the food police,” because, as one therapist informed us, “It’s not about the food.”

Actually, it is about the food. Especially when you’re starving.

Ancel Keys’ 1950 Semi-Starvation Study tracked the effects of starvation and subsequent re-feeding on 36 healthy young men, all conscientious objectors who volunteered for the experiment. Keys was drawn to the subject during World War II, when millions in war-torn Europe – especially those in concentration camps – starved for years. One of Keys’ most interesting findings was that starvation itself, followed by re-feeding after a period of prolonged starvation, produced both physical and psychological symptoms, including depression, preoccupation with weight and body image, anxiety, and obsessions with food, eating, and cooking—all symptoms we now associate with anorexia. Re-feeding the volunteers eventuallyreversed most of the symptoms. However, this approach proved to be difficult on a psychological level, and in some ways more difficult than the starvation period. These results were a clear illustration of just how profound the effects of months of starvation were on the body and mind.

Alas, Keys’ findings were pretty much ignored by the field of eating-disorders treatment for 40-some years, until new technologies like functional magnetic resonance imaging (fMRI) and research gave new context to his work. We now know there is no single root cause for eating disorders. They’re what researchers call multi-factorial, triggered by a perfect storm of factors that probably differs for each person who develops an eating disorder. “Personality characteristics, the environment you live in, your genetic makeup—it’s like a cake recipe,” says Daniel le Grange, Ph.D., director of the Eating Disorders Program at the University of Chicago. “All the ingredients have to be there for that person to develop anorexia.”

One of those ingredients is genetics. Twenty years ago, the Price Foundation sponsored a project that collected DNA samples from thousands of people with eating disorders, their families, and control participants. That data, along with information from the 2006 Swedish Twin Study, suggests that anorexia is highly heritable. “Genes play a substantial role in liability to this illness,” says Cindy Bulik, Ph.D., a professor of psychiatry and director of the University of North Carolina’s Eating Disorders Program. And while no one has yet found a specific anorexia gene, researchers are focusing on an area of chromosome 1 that shows important gene linkages.

Certain personality traits associated with anorexia are probably heritable as well. “Anxiety, inhibition, obsessionality, and perfectionism seem to be present in families of people with an eating disorder,” explains Walter Kaye, M.D., who directs the Eating Disorders Treatment and Research Program at the University of California-San Diego. Another ingredient is neurobiology—literally, the way your brain is structured and how it works. Dr. Kaye’s team at UCSD uses fMRI technology to map blood flow in people’s brains as they think of or perform a task. In one study, Kaye and his colleagues looked at the brains of people with anorexia, people recovered from anorexia, and people who’d never had an eating disorder as they played a gambling game. Participants were asked to guess a number and were rewarded for correct guesses with money or “punished” for incorrect or no guesses by losing money.

Participants in the control group responded to wins and losses by “living in the moment,” wrote researchers: “That is, they made a guess and then moved on to the next task.” But people with anorexia, as well as people who’d recovered from anorexia, showed greater blood flow to the dorsal caudate, an area of the brain that helps link actions and their outcomes, as well as differences in their brains’ dopamine pathways. “People with anorexia nervosa do not live in the moment,” concluded Kaye. “They tend to have exaggerated and obsessive worry about the consequences of their behaviors, looking for rules when there are none, and they are overly concerned about making mistakes.” This study was the first to show altered pathways in the brain even in those recovered from anorexia, suggesting that inherent differences in the brain’s architecture and signaling systems help trigger the illness in the first place.

Food Is Medicine

Some of the best news to come out of research on anorexia is a new therapy aimed at kids and teens. Family-based treatment (FBT), also known as the Maudsley approach, was developed at the Maudsley Hospital in London by Ivan Eisler and Christopher Dare, family therapists who watched nurses on the inpatient eating-disorders unit get patients to eat by sitting with them, talking to them, rubbing their backs, and supporting them. Eisler and Dare wondered how that kind of effective encouragement could be used outside the hospital.

Their observations led them to develop family-based treatment, or FBT, a three-phase treatment for teens and young adults that sidesteps the debate on etiology and focuses instead on recovery. “FBT is agnostic on cause,” says Dr. Le Grange. During phase one, families (usually parents) take charge of a child’s eating, with a goal of fully restoring weight (rather than get to the “90 percent of ideal body weight” many programs use as a benchmark). In phase two, families gradually transfer responsibility for eating back to the teen. Phase three addresses other problems or issues related to normal adolescent development, if there are any.

FBT is a pragmatic approach that recognizes that while people with anorexia are in the throes of acute malnourishment, they can’t choose to eat. And that represents one of the biggest shifts in thinking about eating disorders. The DSM-IV, the most recent “bible” of psychiatric treatment, lists as the first symptom of anorexia “a refusal to maintain body weight at or above a minimally normal weight for age and height.” That notion of refusal is key to how anorexia has been seen, and treated, in the past: as a refusal to eat or gain weight. An acting out. A choice. Which makes sense within the psychodynamic model of cause.

But it doesn’t jibe with the research, which suggests that anorexia is more of an inability to eat than a refusal. Forty-five years ago, Aryeh Routtenberg, then (and still) a professor of psychology at Northwestern University, discovered that when he gave rats only brief daily access to food but let them run as much as they wanted on wheels, they would gradually eat less and less, and run more and more. In fact, they would run without eating until they died, a paradigm Routtenberg called activity-based anorexia (ABA). Rats with ABA seemed to be in the grip of a profound physiological imbalance, one that overrode the normal biological imperatives of hunger and self-preservation. ABA in rats suggests that however it starts, once the cycle of restricting and/or compulsive exercising passes a certain threshold, it takes on a life of its own. Self-starvation is no longer (if it ever was) a choice, but a compulsion to the death.

That’s part of the thinking in FBT. Food is the best medicine for people with anorexia, but they can’t choose to eat. They need someone else to make that choice for them. Therapists don’t sit at the table with patients, but parents do. And parents love and know their children. Like the nurses at the Maudsley Hospital, they find ways to get kids to eat. In a sense, what parents do is outshout the anorexia “voice” many sufferers report hearing, a voice in their heads that tells them not to eat and berates them when they do. Parents take the responsibility for making the choice to eat away from the sufferer, who may insist she’s choosing not to eat but who, underneath the illness, is terrified and hungry.

The best aspect of FBT is that it works. Not for everyone, but for the majority of kids and teens. Several randomized controlled studies of FBT and “treatment as usual” (talk therapy without pressure to eat) show recovery rates of 80 to 90 percent with FBT—a huge improvement over previous recovery rates. A study at the University of Chicago is looking at adapting the treatment for young adults; early results are promising.

The most challenging aspect of FBT is that it’s hard to find. Relatively few therapists in the U.S. are trained in the approach. When our daughter got sick, my husband and I couldn’t find a local FBT therapist. So we cobbled together a team that included our pediatrician, a therapist, and lots of friends who supported our family through the grueling work of re-feeding our daughter. Today she’s a healthy college student with friends, a boyfriend, career goals, and a good relationship with us.

A few years ago, Dr. Le Grange and his research partner, Dr. James Lock of Stanford, created a training institute that certifies a handful of FBT therapists each year. (For a list of FBT providers, visit the Maudsley Parents website.) It’s a start. But therapists are notoriously slow to adopt new treatments, and FBT is no exception. Some therapists find FBT controversial because it upends the conventional view of eating disorders and treatments. Some cling to the psychodynamic view of eating disorders despite the lack of evidence. Still, many in the field have at least heard of FBT and Kaye’s neurobiological findings, even if they don’t believe in them yet.

Change comes slowly. But it comes.

* * *

Harriet Brown teaches magazine journalism at the S.I. Newhouse School of Public Communications in Syracuse, New York. Her latest book is Brave Girl Eating: A Family’s Struggle with Anorexia (William Morrow, 2010).

be there for that person to develop anorexia.”

One of those ingredients is genetics. Twenty years ago, the Price Foundation sponsored a project that collected DNA samples from thousands of people with eating disorders, their families, and control participants. That data, along with information from the 2006 Swedish Twin Study, suggests that anorexia is highly heritable. “Genes play a substantial role in liability to this illness,” says Cindy Bulik, Ph.D., a professor of psychiatry and director of the University of North Carolina’s Eating Disorders Program. And while no one has yet found a specific anorexia gene, researchers are focusing on an area of chromosome 1 that shows important gene linkages.
Certain personality traits associated with anorexia are probably heritable as well. “Anxiety, inhibition, obsessionality, and perfectionism seem to be present in families of people with an eating disorder,” explains Walter Kaye, M.D., who directs the Eating Disorders Treatment and Research Program at the University of California-San Diego. Another ingredient is neurobiology—literally, the way your brain is structured and how it works. Dr. Kaye’s team at UCSD uses fMRI technology to map blood flow in people’s brains as they think of or perform a task. In one study, Kaye and his colleagues looked at the brains of people with anorexia, people recovered from anorexia, and people who’d never had an eating disorder as they played a gambling game. Participants were asked to guess a number and were rewarded for correct guesses with money or “punished” for incorrect or no guesses by losing money.
Participants in the control group responded to wins and losses by “living in the moment,” wrote researchers: “That is, they made a guess and then moved on to the next task.” But people with anorexia, as well as people who’d recovered from anorexia, showed greater blood flow to the dorsal caudate, an area of the brain that helps link actions and their outcomes, as well as differences in their brains’ dopamine pathways. “People with anorexia nervosa do not live in the moment,” concluded Kaye. “They tend to have exaggerated and obsessive worry about the consequences of their behaviors, looking for rules when there are none, and they are overly concerned about making mistakes.” This study was the first to show altered pathways in the brain even in those recovered from anorexia, suggesting that inherent differences in the brain’s architecture and signaling systems help trigger the illness in the first place.
Food Is Medicine
Some of the best news to come out of research on anorexia is a new therapy aimed at kids and teens. Family-based treatment (FBT), also known as the Maudsley approach, was developed at the Maudsley Hospital in London by Ivan Eisler and Christopher Dare, family therapists who watched nurses on the inpatient eating-disorders unit get patients to eat by sitting with them, talking to them, rubbing their backs, and supporting them. Eisler and Dare wondered how that kind of effective encouragement could be used outside the hospital.
Their observations led them to develop family-based treatment, or FBT, a three-phase treatment for teens and young adults that sidesteps the debate on etiology and focuses instead on recovery. “FBT is agnostic on cause,” says Dr. Le Grange. During phase one, families (usually parents) take charge of a child’s eating, with a goal of fully restoring weight (rather than get to the “90 percent of ideal body weight” many programs use as a benchmark). In phase two, families gradually transfer responsibility for eating back to the teen. Phase three addresses other problems or issues related to normal adolescent development, if there are any.
FBT is a pragmatic approach that recognizes that while people with anorexia are in the throes of acute malnourishment, they can’t choose to eat. And that represents one of the biggest shifts in thinking about eating disorders. The DSM-IV, the most recent “bible” of psychiatric treatment, lists as the first symptom of anorexia “a refusal to maintain body weight at or above a minimally normal weight for age and height.” That notion of refusal is key to how anorexia has been seen, and treated, in the past: as a refusal to eat or gain weight. An acting out. A choice. Which makes sense within the psychodynamic model of cause.
But it doesn’t jibe with the research, which suggests that anorexia is more of an inability to eat than a refusal. Forty-five years ago, Aryeh Routtenberg, then (and still) a professor of psychology at Northwestern University, discovered that when he gave rats only brief daily access to food but let them run as much as they wanted on wheels, they would gradually eat less and less, and run more and more. In fact, they would run without eating until they died, a paradigm Routtenberg called activity-based anorexia (ABA). Rats with ABA seemed to be in the grip of a profound physiological imbalance, one that overrode the normal biological imperatives of hunger and self-preservation. ABA in rats suggests that however it starts, once the cycle of restricting and/or compulsive exercising passes a certain threshold, it takes on a life of its own. Self-starvation is no longer (if it ever was) a choice, but a compulsion to the death.
That’s part of the thinking in FBT. Food is the best medicine for people with anorexia, but they can’t choose to eat. They need someone else to make that choice for them. Therapists don’t sit at the table with patients, but parents do. And parents love and know their children. Like the nurses at the Maudsley Hospital, they find ways to get kids to eat. In a sense, what parents do is outshout the anorexia “voice” many sufferers report hearing, a voice in their heads that tells them not to eat and berates them when they do. Parents take the responsibility for making the choice to eat away from the sufferer, who may insist she’s choosing not to eat but who, underneath the illness, is terrified and hungry.
The best aspect of FBT is that it works. Not for everyone, but for the majority of kids and teens. Several randomized controlled studies of FBT and “treatment as usual” (talk therapy without pressure to eat) show recovery rates of 80 to 90 percent with FBT—a huge improvement over previous recovery rates. A study at the University of Chicago is looking at adapting the treatment for young adults; early results are promising.
The most challenging aspect of FBT is that it’s hard to find. Relatively few therapists in the U.S. are trained in the approach. When our daughter got sick, my husband and I couldn’t find a local FBT therapist. So we cobbled together a team that included our pediatrician, a therapist, and lots of friends who supported our family through the grueling work of re-feeding our daughter. Today she’s a healthy college student with friends, a boyfriend, career goals, and a good relationship with us.
A few years ago, Dr. Le Grange and his research partner, Dr. James Lock of Stanford, created a training institute that certifies a handful of FBT therapists each year. (For a list of FBT providers, visit the Maudsley Parents website.) It’s a start. But therapists are notoriously slow to adopt new treatments, and FBT is no exception. Some therapists find FBT controversial because it upends the conventional view of eating disorders and treatments. Some cling to the psychodynamic view of eating disorders despite the lack of evidence. Still, many in the field have at least heard of FBT and Kaye’s neurobiological findings, even if they don’t believe in them yet.
Change comes slowly. But it comes.
* * *
Harriet Brown teaches magazine journalism at the S.I. Newhouse School of Public Communications in Syracuse, New York. Her latest book is Brave Girl Eating: A Family’s Struggle with Anorexia (William Morrow, 2010).

Don’t worry so much about being the right type of science role model

Role models: How do they look? (Source)
[Today we have a wonderful guest post from Marie-Claire Shanahan, continuing the conversation about what makes someone a good role model in science. This post first appeared at Shanahan's science education blog, Boundary Vision, and she has graciously agreed to let us share it here, too. Shanahan is an Associate Professor of Science Education and Science Communication at the University of Alberta where she researches social aspects of science such as how and why students decide to pursue science degrees. She teaches courses in science teaching methods, scientific language and sociology of science. Marie-Claire is also a former middle and high school science and math teacher and was thrilled last week when one of her past sixth grade students emailed to ask for advice on becoming a science teacher. She blogs regularly about science education at Boundary Vision and about her love of science and music at The Finch & Pea.]

What does it mean to be a good role model? Am I a good role model? Playing around with kids at home or in the middle of a science classroom, adults often ask themselves these questions, especially when it come to girls and science. But despite having asked them many times myself, I don’t think they’re the right questions.


Studying how role models influence students shows a process that is much more complicated than it first seems. In some studies, when female students interact with more female professors and peers in science, their own self-concepts in science can be improved [1]. Others studies show that the number of female science teachers  at their school seems to have no effect [2].


Finding just the right type of role model is even more challenging. Do role models have to be female? Do they have to be of the same race as the students? There is often an assumption that even images and stories can change students’ minds about who can do science. If so, does it help to show very feminine women with interests in science like the science cheerleaders? The answer in most of these studies is, almost predictably, yes and no.


Diana Betz and Denise Sekaquaptewa’s recent study “My Fair Physicist: Feminine Math and Science role models demotivate young girls” seems to muddy the waters even further, suggesting that overly feminine role models might actually have a negative effect on students. [3] The study caught my eye when PhD student Sara Callori wrote about it and shared that it made her worry about her own efforts to be a good role model.


Betz and Sekaquaptewa worked with two groups of middle school girls. With the first group (144 girls, mostly 11 and 12 years old) they first asked the girls for their three favourite school subjects and categorized any who said science or math as STEM-identified (STEM: Science, Technology, Engineering and Math). All of the girls then read articles about three role models. Some were science/math role models and some were general role models (i.e., described as generally successful students). 


The researchers mixed things even further so that some of the role models were purposefully feminine (e.g., shown wearing pink and saying they were interested in fashion magazines) and others were supposedly neutral (e.g., shown wearing dark colours and glasses and enjoying reading).* There were feminine and neutral examples for both STEM and non-STEM role models. After the girls read the three articles, the researchers asked them about their future plans to study math and their current perceptions of their abilities and interest in math.**


For the  most part, the results were as expected. The STEM-identified girls showed more interest in studying math in the future (not really a surprise since they’d already said math and science were their favourite subjects) and the role models didn’t seem to have any effect. Their minds were, for the most part, already made up.


What about the non-STEM identified girls, did the role models help them? It’s hard to tell exactly because the researchers didn’t measure the girls’ desire to study math before reading about the role models.  It seems though that reading about feminine science role models took away from their desire to study math both in the present and the future. Those who were non-STEM identified and read about feminine STEM role models rated their interest significantly lower than other non-STEM identified girls who read about neutral STEM role models and about non-STEM role models. A little bit surprising was the additional finding that the feminine role models also seemed to lower STEM-identified girls current interest in math (though not their future interest).


The authors argue that the issue is unattainability. Other studies have shown that role models can sometimes be intimidating. They can actually turn students off if they seem too successful, such that their career or life paths seem out of reach, or if students can write them off as being much more talented or lucky than themselves. Betz and Sekaquaptewa suggest that the femininity of the role models made them seem doubly successful and therefore even more out of the students’ reach.

The second part of the study was designed to answer this question but is much weaker in design so it’s difficult to say what it adds to the discussion. They used a similar design but with only the STEM role models, feminine and non-feminine (and only 42 students, 20% of whom didn’t receive part of the questionnaire due to an error). The only difference was instead of asking about students interest in studying math they tried to look at the combination of femininity and math success by asking two questions:

  1. “How likely do you think it is that you could be both as successful in math/science AND as feminine or girly as these students by the end of high school?” (p. 5)
  2. “Do being good at math and being girly go together?” (p. 5)

Honestly, it’s at this point that the study loses me. The first question has serious validity issues (and nowhere in the study is the validity of the outcome measures established). First, there are different ways to interpret the question and for students to decide on a rating. A low rating could mean a student doesn’t think they’ll succeed in science even if they really want to. A low rating could also mean that a student has no interest in femininity and rejects the very idea of being successful at both. These are very different things and make the results almost impossible to interpret. 

Second these “successes” are likely different in kind. Succeeding in academics is time dependent and it makes sense to ask young students if they aspire to be successful in science. Feminine identity is less future oriented and more likely to be seen as a trait rather a skill that is developed. It probably doesn’t make sense to ask students if they aspire to be more feminine, especially when femininity has been defined as liking fashion magazines and wearing pink.

Question: Dear student, do you aspire to grow up to wear more pink? 

Answer (regardless of femininity): Um, that’s a weird question.

With these questions, they found that non-STEM identified girls rated themselves as unlikely to match the dual success of the feminine STEM role models. Because of the problems with the items though, it’s difficult to say what that means. The authors do raise an interesting question about unattainability, though, and I hope they’ll continue to look for ways to explore it further.

So, should graduate students like Sara Callori be worried? Like lots of researchers who care deeply about science, Sara expressed a commendable and strong desire to make a contribution to inspiring young women in physics (a field that continues to have a serious gender imbalance). She writes about her desire to encourage young students and be a good role model:

When I made the decision to go into graduate school for physics, however, my outlook changed. I wanted to be someone who bucked the stereotype: a fashionable, fun, young woman who also is a successful physicist. I thought that if I didn’t look like the stereotypical physicist, I could be someone that was a role model to younger students by demonstrating an alternative to the stereotype of who can be a scientist. …This study also unsettled me on a personal level. I’ve long desired to be a role model to younger students. I enjoy sharing the excitement of physics, especially with those who might be turned away from the subject because of stereotypes or negative perceptions. I always thought that by being outgoing, fun, and yes, feminine would enable me to reach students who see physics as the domain of old white men. These results have me questioning myself, which can only hurt my outreach efforts by making me more self conscious about them. They make me wonder if I have to be disingenuous about who I am in order to avoid being seen as “too feminine” for physics.

To everyone who has felt this way, my strong answer is: NO, please don’t let this dissuade you from outreach efforts. Despite results like this, when studies look at the impact of role models in comparison to other influences, relationships always win over symbols. The role models that make a difference are not the people that kids read about in magazines or that visit their classes for a short period of time. The role models, really mentors, that matter are people in students’ lives: teachers, parents, peers, neighbours, camp leaders, and class volunteers. And for the most part it doesn’t depend on their gender or even their educational success. What matters is how they interact with and support the students. 
Good role models are there for students, they believe in their abilities and help them explore their own interests.

My advice? Don’t worry about how feminine or masculine you are or if you have the right characteristics to be a role model, just get out there and get to know the kids you want to encourage. Think about what you can do to build their self-confidence in science or to help them find a topic they are passionate about. When it comes to making the most of the interactions you have with science students, there are a few tips for success (and none of them hinge on wearing or not wearing pink):

§   Be supportive and encouraging of students’ interest in science. Take their ideas and aspirations seriously and let them know that you believe in them. This turns out to be by far one of the most powerful influences in people pursuing science. If you do one thing in your interactions with students, make it this.

§  Share with students why you love doing science. What are the benefits of being a scientist such as contributing to improving people’s lives or in solving difficult problems? Students often desire careers that meet these characteristics of personal satisfaction but don’t always realize that being a scientist can be like that.

§  Don’t hide the fact that there are gender differences in participation in some areas of science (especially physics and engineering). Talk honestly with students about it, being sure to emphasize that differences in ability are NOT the reason for the discrepancies. Talk, for example, about evidence that girls are not given as many opportunities to explore and play with mechanical objects and ask them for their ideas about why some people choose these sciences and others don’t.
There are so many ways to encourage and support students in science, don’t waste time worrying about being the perfect role model. If you’re genuinely interested in taking time to connect with students, you are already the right type.
__________________________________________________________

* There are of course immediate questions about how well supported these are as feminine characteristics but I’m willing to allow the researchers that they could probably only choose a few characteristics and had to try to find things that would seem immediately feminine to 11-12 year olds. I still think it’s a shallow treatment of femininity, one that disregards differences in cultural and class definitions of femininity. (And I may or may not still be trying to sort out my feelings about being their gender neutral stereotype, says she wearing grey with large frame glasses and a stack of books beside her).

**The researchers unfortunately did not distinguish between science and math, using them interchangeably despite large differences in gender representation and connections to femininity between biological sciences, physical sciences, math and various branches of engineering.

[1] Stout, J. G., Dasgupta, N., Hunsinger, M., & McManus, M. A. (2011). STEMing the tide: Using ingroup experts to inoculate women’s self-concept in science, technology, engineering, and mathematics (STEM).Journal of Personality and Social Psychology, 100, 255-270.

[2] Gilmartin, S., Denson, N., Li, E., Bryant, A., & Aschbacher, P. (2007). Gender ratios in high school science departments: The effect of percent female faculty on multiple dimensions of students’ science identities.Journal of Research in Science Teaching, 44, 980–1009.

[3] Betz, D., & Sekaquaptewa, D. (2012). My Fair Physicist? Feminine Math and Science Role Models Demotivate Young Girls Social Psychological and Personality Science DOI: 10.1177/1948550612440735


Further Reading

Buck, G. A., Leslie-Pelecky, D., & Kirby, S. K. (2002). Bringing female scientists into the elementary classroom: Confronting the strength of elementary students’ stereotypical images of scientists. Journal of Elementary Science Education, 14(2), 1-9.

Buck, G. A., Plano Clark, V. L., Leslie-Pelecky, D., Lu, Y., & Cerda-Lizarraga, P. (2008). Examining the cognitive processes used by adolescent girls and women scientists in identifying science role models: A feminist approach. Science Education, 92, 2–20.

Cleaves, A. (2005). The formation of science choices in secondary school.International Journal of Science Education, 27, 471–486.

Ratelle, C.F., Larose, S., Guay, F., & Senecal, C. (2005). Perceptions of parental involvement and support as predictors of college students’ persistence in a science curriculum. Journal of Family Psychology, 19, 286–293.

Simpkins, S. D., Davis-Kean, P. E., & Eccles, J. S. (2006). Math and science motivation: A longitudinal examination of the links between choices and beliefs. Developmental Psychology, 42, 70–83.

Stout, J. G., Dasgupta, N., Hunsinger, M., & McManus, M. (2011). STEMing the tide: Using ingroup experts to inoculate women’s self-concept and professional goals in science, technology, engineering, and mathematics (STEM). Journal of Personality and Social Psychology, 100,255–270.


Biology Explainer: The big 4 building blocks of life–carbohydrates, fats, proteins, and nucleic acids

The short version
  • The four basic categories of molecules for building life are carbohydrates, lipids, proteins, and nucleic acids.
  • Carbohydrates serve many purposes, from energy to structure to chemical communication, as monomers or polymers.
  • Lipids, which are hydrophobic, also have different purposes, including energy storage, structure, and signaling.
  • Proteins, made of amino acids in up to four structural levels, are involved in just about every process of life.                                                                                                      
  • The nucleic acids DNA and RNA consist of four nucleotide building blocks, and each has different purposes.
The longer version
Life is so diverse and unwieldy, it may surprise you to learn that we can break it down into four basic categories of molecules. Possibly even more implausible is the fact that two of these categories of large molecules themselves break down into a surprisingly small number of building blocks. The proteins that make up all of the living things on this planet and ensure their appropriate structure and smooth function consist of only 20 different kinds of building blocks. Nucleic acids, specifically DNA, are even more basic: only four different kinds of molecules provide the materials to build the countless different genetic codes that translate into all the different walking, swimming, crawling, oozing, and/or photosynthesizing organisms that populate the third rock from the Sun.

                                                  

Big Molecules with Small Building Blocks

The functional groups, assembled into building blocks on backbones of carbon atoms, can be bonded together to yield large molecules that we classify into four basic categories. These molecules, in many different permutations, are the basis for the diversity that we see among living things. They can consist of thousands of atoms, but only a handful of different kinds of atoms form them. It’s like building apartment buildings using a small selection of different materials: bricks, mortar, iron, glass, and wood. Arranged in different ways, these few materials can yield a huge variety of structures.

We encountered functional groups and the SPHONC in Chapter 3. These components form the four categories of molecules of life. These Big Four biological molecules are carbohydrates, lipids, proteins, and nucleic acids. They can have many roles, from giving an organism structure to being involved in one of the millions of processes of living. Let’s meet each category individually and discover the basic roles of each in the structure and function of life.
Carbohydrates

You have met carbohydrates before, whether you know it or not. We refer to them casually as “sugars,” molecules made of carbon, hydrogen, and oxygen. A sugar molecule has a carbon backbone, usually five or six carbons in the ones we’ll discuss here, but it can be as few as three. Sugar molecules can link together in pairs or in chains or branching “trees,” either for structure or energy storage.

When you look on a nutrition label, you’ll see reference to “sugars.” That term includes carbohydrates that provide energy, which we get from breaking the chemical bonds in a sugar called glucose. The “sugars” on a nutrition label also include those that give structure to a plant, which we call fiber. Both are important nutrients for people.

Sugars serve many purposes. They give crunch to the cell walls of a plant or the exoskeleton of a beetle and chemical energy to the marathon runner. When attached to other molecules, like proteins or fats, they aid in communication between cells. But before we get any further into their uses, let’s talk structure.

The sugars we encounter most in basic biology have their five or six carbons linked together in a ring. There’s no need to dive deep into organic chemistry, but there are a couple of essential things to know to interpret the standard representations of these molecules.

Check out the sugars depicted in the figure. The top-left molecule, glucose, has six carbons, which have been numbered. The sugar to its right is the same glucose, with all but one “C” removed. The other five carbons are still there but are inferred using the conventions of organic chemistry: Anywhere there is a corner, there’s a carbon unless otherwise indicated. It might be a good exercise for you to add in a “C” over each corner so that you gain a good understanding of this convention. You should end up adding in five carbon symbols; the sixth is already given because that is conventionally included when it occurs outside of the ring.

On the left is a glucose with all of its carbons indicated. They’re also numbered, which is important to understand now for information that comes later. On the right is the same molecule, glucose, without the carbons indicated (except for the sixth one). Wherever there is a corner, there is a carbon, unless otherwise indicated (as with the oxygen). On the bottom left is ribose, the sugar found in RNA. The sugar on the bottom right is deoxyribose. Note that at carbon 2 (*), the ribose and deoxyribose differ by a single oxygen.

The lower left sugar in the figure is a ribose. In this depiction, the carbons, except the one outside of the ring, have not been drawn in, and they are not numbered. This is the standard way sugars are presented in texts. Can you tell how many carbons there are in this sugar? Count the corners and don’t forget the one that’s already indicated!

If you said “five,” you are right. Ribose is a pentose (pent = five) and happens to be the sugar present in ribonucleic acid, or RNA. Think to yourself what the sugar might be in deoxyribonucleic acid, or DNA. If you thought, deoxyribose, you’d be right.

The fourth sugar given in the figure is a deoxyribose. In organic chemistry, it’s not enough to know that corners indicate carbons. Each carbon also has a specific number, which becomes important in discussions of nucleic acids. Luckily, we get to keep our carbon counting pretty simple in basic biology. To count carbons, you start with the carbon to the right of the non-carbon corner of the molecule. The deoxyribose or ribose always looks to me like a little cupcake with a cherry on top. The “cherry” is an oxygen. To the right of that oxygen, we start counting carbons, so that corner to the right of the “cherry” is the first carbon. Now, keep counting. Here’s a little test: What is hanging down from carbon 2 of the deoxyribose?

If you said a hydrogen (H), you are right! Now, compare the deoxyribose to the ribose. Do you see the difference in what hangs off of the carbon 2 of each sugar? You’ll see that the carbon 2 of ribose has an –OH, rather than an H. The reason the deoxyribose is called that is because the O on the second carbon of the ribose has been removed, leaving a “deoxyed” ribose. This tiny distinction between the sugars used in DNA and RNA is significant enough in biology that we use it to distinguish the two nucleic acids.

In fact, these subtle differences in sugars mean big differences for many biological molecules. Below, you’ll find a couple of ways that apparently small changes in a sugar molecule can mean big changes in what it does. These little changes make the difference between a delicious sugar cookie and the crunchy exoskeleton of a dung beetle.

Sugar and Fuel

A marathon runner keeps fuel on hand in the form of “carbs,” or sugars. These fuels provide the marathoner’s straining body with the energy it needs to keep the muscles pumping. When we take in sugar like this, it often comes in the form of glucose molecules attached together in a polymer called starch. We are especially equipped to start breaking off individual glucose molecules the minute we start chewing on a starch.

Double X Extra: A monomer is a building block (mono = one) and a polymer is a chain of monomers. With a few dozen monomers or building blocks, we get millions of different polymers. That may sound nutty until you think of the infinity of values that can be built using only the numbers 0 through 9 as building blocks or the intricate programming that is done using only a binary code of zeros and ones in different combinations.

Our bodies then can rapidly take the single molecules, or monomers, into cells and crack open the chemical bonds to transform the energy for use. The bonds of a sugar are packed with chemical energy that we capture to build a different kind of energy-containing molecule that our muscles access easily. Most species rely on this process of capturing energy from sugars and transforming it for specific purposes.

Polysaccharides: Fuel and Form

Plants use the Sun’s energy to make their own glucose, and starch is actually a plant’s way of storing up that sugar. Potatoes, for example, are quite good at packing away tons of glucose molecules and are known to dieticians as a “starchy” vegetable. The glucose molecules in starch are packed fairly closely together. A string of sugar molecules bonded together through dehydration synthesis, as they are in starch, is a polymer called a polysaccharide (poly = many; saccharide = sugar). When the monomers of the polysaccharide are released, as when our bodies break them up, the reaction that releases them is called hydrolysis.

Double X Extra: The specific reaction that hooks one monomer to another in a covalent bond is called dehydration synthesis because in making the bond–synthesizing the larger molecule–a molecule of water is removed (dehydration). The reverse is hydrolysis (hydro = water; lysis = breaking), which breaks the covalent bond by the addition of a molecule of water.

Although plants make their own glucose and animals acquire it by eating the plants, animals can also package away the glucose they eat for later use. Animals, including humans, store glucose in a polysaccharide called glycogen, which is more branched than starch. In us, we build this energy reserve primarily in the liver and access it when our glucose levels drop.

Whether starch or glycogen, the glucose molecules that are stored are bonded together so that all of the molecules are oriented the same way. If you view the sixth carbon of the glucose to be a “carbon flag,” you’ll see in the figure that all of the glucose molecules in starch are oriented with their carbon flags on the upper left.

The orientation of monomers of glucose in polysaccharides can make a big difference in the use of the polymer. The glucoses in the molecule on the top are all oriented “up” and form starch. The glucoses in the molecule on the bottom alternate orientation to form cellulose, which is quite different in its function from starch.

Storing up sugars for fuel and using them as fuel isn’t the end of the uses of sugar. In fact, sugars serve as structural molecules in a huge variety of organisms, including fungi, bacteria, plants, and insects.

The primary structural role of a sugar is as a component of the cell wall, giving the organism support against gravity. In plants, the familiar old glucose molecule serves as one building block of the plant cell wall, but with a catch: The molecules are oriented in an alternating up-down fashion. The resulting structural sugar is called cellulose.

That simple difference in orientation means the difference between a polysaccharide as fuel for us and a polysaccharide as structure. Insects take it step further with the polysaccharide that makes up their exoskeleton, or outer shell. Once again, the building block is glucose, arranged as it is in cellulose, in an alternating conformation. But in insects, each glucose has a little extra added on, a chemical group called an N-acetyl group. This addition of a single functional group alters the use of cellulose and turns it into a structural molecule that gives bugs that special crunchy sound when you accidentally…ahem…step on them.

These variations on the simple theme of a basic carbon-ring-as-building-block occur again and again in biological systems. In addition to serving roles in structure and as fuel, sugars also play a role in function. The attachment of subtly different sugar molecules to a protein or a lipid is one way cells communicate chemically with one another in refined, regulated interactions. It’s as though the cells talk with each other using a specialized, sugar-based vocabulary. Typically, cells display these sugary messages to the outside world, making them available to other cells that can recognize the molecular language.

Lipids: The Fatty Trifecta

Starch makes for good, accessible fuel, something that we immediately attack chemically and break up for quick energy. But fats are energy that we are supposed to bank away for a good long time and break out in times of deprivation. Like sugars, fats serve several purposes, including as a dense source of energy and as a universal structural component of cell membranes everywhere.

Fats: the Good, the Bad, the Neutral

Turn again to a nutrition label, and you’ll see a few references to fats, also known as lipids. (Fats are slightly less confusing that sugars in that they have only two names.) The label may break down fats into categories, including trans fats, saturated fats, unsaturated fats, and cholesterol. You may have learned that trans fats are “bad” and that there is good cholesterol and bad cholesterol, but what does it all mean?

Let’s start with what we mean when we say saturated fat. The question is, saturated with what? There is a specific kind of dietary fat call the triglyceride. As its name implies, it has a structural motif in which something is repeated three times. That something is a chain of carbons and hydrogens, hanging off in triplicate from a head made of glycerol, as the figure shows.  Those three carbon-hydrogen chains, or fatty acids, are the “tri” in a triglyceride. Chains like this can be many carbons long.

Double X Extra: We call a fatty acid a fatty acid because it’s got a carboxylic acid attached to a fatty tail. A triglyceride consists of three of these fatty acids attached to a molecule called glycerol. Our dietary fat primarily consists of these triglycerides.

Triglycerides come in several forms. You may recall that carbon can form several different kinds of bonds, including single bonds, as with hydrogen, and double bonds, as with itself. A chain of carbon and hydrogens can have every single available carbon bond taken by a hydrogen in single covalent bond. This scenario of hydrogen saturation yields a saturated fat. The fat is saturated to its fullest with every covalent bond taken by hydrogens single bonded to the carbons.

Saturated fats have predictable characteristics. They lie flat easily and stick to each other, meaning that at room temperature, they form a dense solid. You will realize this if you find a little bit of fat on you to pinch. Does it feel pretty solid? That’s because animal fat is saturated fat. The fat on a steak is also solid at room temperature, and in fact, it takes a pretty high heat to loosen it up enough to become liquid. Animals are not the only organisms that produce saturated fat–avocados and coconuts also are known for their saturated fat content.

The top graphic above depicts a triglyceride with the glycerol, acid, and three hydrocarbon tails. The tails of this saturated fat, with every possible hydrogen space occupied, lie comparatively flat on one another, and this kind of fat is solid at room temperature. The fat on the bottom, however, is unsaturated, with bends or kinks wherever two carbons have double bonded, booting a couple of hydrogens and making this fat unsaturated, or lacking some hydrogens. Because of the space between the bumps, this fat is probably not solid at room temperature, but liquid.

You can probably now guess what an unsaturated fat is–one that has one or more hydrogens missing. Instead of single bonding with hydrogens at every available space, two or more carbons in an unsaturated fat chain will form a double bond with carbon, leaving no space for a hydrogen. Because some carbons in the chain share two pairs of electrons, they physically draw closer to one another than they do in a single bond. This tighter bonding result in a “kink” in the fatty acid chain.

In a fat with these kinks, the three fatty acids don’t lie as densely packed with each other as they do in a saturated fat. The kinks leave spaces between them. Thus, unsaturated fats are less dense than saturated fats and often will be liquid at room temperature. A good example of a liquid unsaturated fat at room temperature is canola oil.

A few decades ago, food scientists discovered that unsaturated fats could be resaturated or hydrogenated to behave more like saturated fats and have a longer shelf life. The process of hydrogenation–adding in hydrogens–yields trans fat. This kind of processed fat is now frowned upon and is being removed from many foods because of its associations with adverse health effects. If you check a food label and it lists among the ingredients “partially hydrogenated” oils, that can mean that the food contains trans fat.

Double X Extra: A triglyceride can have up to three different fatty acids attached to it. Canola oil, for example, consists primarily of oleic acid, linoleic acid, and linolenic acid, all of which are unsaturated fatty acids with 18 carbons in their chains.

Why do we take in fat anyway? Fat is a necessary nutrient for everything from our nervous systems to our circulatory health. It also, under appropriate conditions, is an excellent way to store up densely packaged energy for the times when stores are running low. We really can’t live very well without it.

Phospholipids: An Abundant Fat

You may have heard that oil and water don’t mix, and indeed, it is something you can observe for yourself. Drop a pat of butter–pure saturated fat–into a bowl of water and watch it just sit there. Even if you try mixing it with a spoon, it will just sit there. Now, drop a spoon of salt into the water and stir it a bit. The salt seems to vanish. You’ve just illustrated the difference between a water-fearing (hydrophobic) and a water-loving (hydrophilic) substance.

Generally speaking, compounds that have an unequal sharing of electrons (like ions or anything with a covalent bond between oxygen and hydrogen or nitrogen and hydrogen) will be hydrophilic. The reason is that a charge or an unequal electron sharing gives the molecule polarity that allows it to interact with water through hydrogen bonds. A fat, however, consists largely of hydrogen and carbon in those long chains. Carbon and hydrogen have roughly equivalent electronegativities, and their electron-sharing relationship is relatively nonpolar. Fat, lacking in polarity, doesn’t interact with water. As the butter demonstrated, it just sits there.

There is one exception to that little maxim about fat and water, and that exception is the phospholipid. This lipid has a special structure that makes it just right for the job it does: forming the membranes of cells. A phospholipid consists of a polar phosphate head–P and O don’t share equally–and a couple of nonpolar hydrocarbon tails, as the figure shows. If you look at the figure, you’ll see that one of the two tails has a little kick in it, thanks to a double bond between the two carbons there.

Phospholipids form a double layer and are the major structural components of cell membranes. Their bend, or kick, in one of the hydrocarbon tails helps ensure fluidity of the cell membrane. The molecules are bipolar, with hydrophilic heads for interacting with the internal and external watery environments of the cell and hydrophobic tails that help cell membranes behave as general security guards.

The kick and the bipolar (hydrophobic and hydrophilic) nature of the phospholipid make it the perfect molecule for building a cell membrane. A cell needs a watery outside to survive. It also needs a watery inside to survive. Thus, it must face the inside and outside worlds with something that interacts well with water. But it also must protect itself against unwanted intruders, providing a barrier that keeps unwanted things out and keeps necessary molecules in.

Phospholipids achieve it all. They assemble into a double layer around a cell but orient to allow interaction with the watery external and internal environments. On the layer facing the inside of the cell, the phospholipids orient their polar, hydrophilic heads to the watery inner environment and their tails away from it. On the layer to the outside of the cell, they do the same.
As the figure shows, the result is a double layer of phospholipids with each layer facing a polar, hydrophilic head to the watery environments. The tails of each layer face one another. They form a hydrophobic, fatty moat around a cell that serves as a general gatekeeper, much in the way that your skin does for you. Charged particles cannot simply slip across this fatty moat because they can’t interact with it. And to keep the fat fluid, one tail of each phospholipid has that little kick, giving the cell membrane a fluid, liquidy flow and keeping it from being solid and unforgiving at temperatures in which cells thrive.

Steroids: Here to Pump You Up?

Our final molecule in the lipid fatty trifecta is cholesterol. As you may have heard, there are a few different kinds of cholesterol, some of which we consider to be “good” and some of which is “bad.” The good cholesterol, high-density lipoprotein, or HDL, in part helps us out because it removes the bad cholesterol, low-density lipoprotein or LDL, from our blood. The presence of LDL is associated with inflammation of the lining of the blood vessels, which can lead to a variety of health problems.

But cholesterol has some other reasons for existing. One of its roles is in the maintenance of cell membrane fluidity. Cholesterol is inserted throughout the lipid bilayer and serves as a block to the fatty tails that might otherwise stick together and become a bit too solid.

Cholesterol’s other starring role as a lipid is as the starting molecule for a class of hormones we called steroids or steroid hormones. With a few snips here and additions there, cholesterol can be changed into the steroid hormones progesterone, testosterone, or estrogen. These molecules look quite similar, but they play very different roles in organisms. Testosterone, for example, generally masculinizes vertebrates (animals with backbones), while progesterone and estrogen play a role in regulating the ovulatory cycle.

Double X Extra: A hormone is a blood-borne signaling molecule. It can be lipid based, like testosterone, or short protein, like insulin.

Proteins

As you progress through learning biology, one thing will become more and more clear: Most cells function primarily as protein factories. It may surprise you to learn that proteins, which we often talk about in terms of food intake, are the fundamental molecule of many of life’s processes. Enzymes, for example, form a single broad category of proteins, but there are millions of them, each one governing a small step in the molecular pathways that are required for living.

Levels of Structure

Amino acids are the building blocks of proteins. A few amino acids strung together is called a peptide, while many many peptides linked together form a polypeptide. When many amino acids strung together interact with each other to form a properly folded molecule, we call that molecule a protein.

For a string of amino acids to ultimately fold up into an active protein, they must first be assembled in the correct order. The code for their assembly lies in the DNA, but once that code has been read and the amino acid chain built, we call that simple, unfolded chain the primary structure of the protein.

This chain can consist of hundreds of amino acids that interact all along the sequence. Some amino acids are hydrophobic and some are hydrophilic. In this context, like interacts best with like, so the hydrophobic amino acids will interact with one another, and the hydrophilic amino acids will interact together. As these contacts occur along the string of molecules, different conformations will arise in different parts of the chain. We call these different conformations along the amino acid chain the protein’s secondary structure.

Once those interactions have occurred, the protein can fold into its final, or tertiary structure and be ready to serve as an active participant in cellular processes. To achieve the tertiary structure, the amino acid chain’s secondary interactions must usually be ongoing, and the pH, temperature, and salt balance must be just right to facilitate the folding. This tertiary folding takes place through interactions of the secondary structures along the different parts of the amino acid chain.

The final product is a properly folded protein. If we could see it with the naked eye, it might look a lot like a wadded up string of pearls, but that “wadded up” look is misleading. Protein folding is a carefully regulated process that is determined at its core by the amino acids in the chain: their hydrophobicity and hydrophilicity and how they interact together.

In many instances, however, a complete protein consists of more than one amino acid chain, and the complete protein has two or more interacting strings of amino acids. A good example is hemoglobin in red blood cells. Its job is to grab oxygen and deliver it to the body’s tissues. A complete hemoglobin protein consists of four separate amino acid chains all properly folded into their tertiary structures and interacting as a single unit. In cases like this involving two or more interacting amino acid chains, we say that the final protein has a quaternary structure. Some proteins can consist of as many as a dozen interacting chains, behaving as a single protein unit.

A Plethora of Purposes

What does a protein do? Let us count the ways. Really, that’s almost impossible because proteins do just about everything. Some of them tag things. Some of them destroy things. Some of them protect. Some mark cells as “self.” Some serve as structural materials, while others are highways or motors. They aid in communication, they operate as signaling molecules, they transfer molecules and cut them up, they interact with each other in complex, interrelated pathways to build things up and break things down. They regulate genes and package DNA, and they regulate and package each other.

As described above, proteins are the final folded arrangement of a string of amino acids. One way we obtain these building blocks for the millions of proteins our bodies make is through our diet. You may hear about foods that are high in protein or people eating high-protein diets to build muscle. When we take in those proteins, we can break them apart and use the amino acids that make them up to build proteins of our own.

Nucleic Acids

How does a cell know which proteins to make? It has a code for building them, one that is especially guarded in a cellular vault in our cells called the nucleus. This code is deoxyribonucleic acid, or DNA. The cell makes a copy of this code and send it out to specialized structures that read it and build proteins based on what they read. As with any code, a typo–a mutation–can result in a message that doesn’t make as much sense. When the code gets changed, sometimes, the protein that the cell builds using that code will be changed, too.

Biohazard!The names associated with nucleic acids can be confusing because they all start with nucle-. It may seem obvious or easy now, but a brain freeze on a test could mix you up. You need to fix in your mind that the shorter term (10 letters, four syllables), nucleotide, refers to the smaller molecule, the three-part building block. The longer term (12 characters, including the space, and five syllables), nucleic acid, which is inherent in the names DNA and RNA, designates the big, long molecule.

DNA vs. RNA: A Matter of Structure

DNA and its nucleic acid cousin, ribonucleic acid, or RNA, are both made of the same kinds of building blocks. These building blocks are called nucleotides. Each nucleotide consists of three parts: a sugar (ribose for RNA and deoxyribose for DNA), a phosphate, and a nitrogenous base. In DNA, every nucleotide has identical sugars and phosphates, and in RNA, the sugar and phosphate are also the same for every nucleotide.

So what’s different? The nitrogenous bases. DNA has a set of four to use as its coding alphabet. These are the purines, adenine and guanine, and the pyrimidines, thymine and cytosine. The nucleotides are abbreviated by their initial letters as A, G, T, and C. From variations in the arrangement and number of these four molecules, all of the diversity of life arises. Just four different types of the nucleotide building blocks, and we have you, bacteria, wombats, and blue whales.

RNA is also basic at its core, consisting of only four different nucleotides. In fact, it uses three of the same nitrogenous bases as DNA–A, G, and C–but it substitutes a base called uracil (U) where DNA uses thymine. Uracil is a pyrimidine.

DNA vs. RNA: Function Wars

An interesting thing about the nitrogenous bases of the nucleotides is that they pair with each other, using hydrogen bonds, in a predictable way. An adenine will almost always bond with a thymine in DNA or a uracil in RNA, and cytosine and guanine will almost always bond with each other. This pairing capacity allows the cell to use a sequence of DNA and build either a new DNA sequence, using the old one as a template, or build an RNA sequence to make a copy of the DNA.

These two different uses of A-T/U and C-G base pairing serve two different purposes. DNA is copied into DNA usually when a cell is preparing to divide and needs two complete sets of DNA for the new cells. DNA is copied into RNA when the cell needs to send the code out of the vault so proteins can be built. The DNA stays safely where it belongs.

RNA is really a nucleic acid jack-of-all-trades. It not only serves as the copy of the DNA but also is the main component of the two types of cellular workers that read that copy and build proteins from it. At one point in this process, the three types of RNA come together in protein assembly to make sure the job is done right.


 By Emily Willingham, DXS managing editor 
This material originally appeared in similar form in Emily Willingham’s Complete Idiot’s Guide to College Biology

LEGO those gender stereotypes


My daughter, patiently waiting to get her own balloon jetpack.
Photo credit: Phil Blake
Why can’t you understand that my daughter wants a damn jetpack?

Last weekend, I took my daughters to a birthday party that featured a magician/balloon artist.  He was really fantastic with the kids, and kept their attention for close to 1 hour (ONE HOUR!!!).  At the end of his magic show, he began to furiously twist and tie balloons into these amazing shapes, promoting energetic and imaginative play.  Of these shapes was his own, very intricate invention: a jetpack.  

When he completed the first jetpack, I watched as the eyes of my five-year-old daughter, who happens to be a very sporty kid, light up with wonder.  She looked at me and smiled, indicating through her facial expression alone that she wanted the same balloon toy.  But, alas, when it was her turn for a balloon, her requests were met with opposition.  Here was the conversation:

Magician: How about a great butterfly balloon?

Daughter: No thanks, I’d like a jetpack please.

Magician: I think you should get a butterfly.

Daughter: I’d prefer a jetpack.

Magician: But you’re a girl.  Girls get butterflies.

Daughter (giving me a desperate look): But I really want a jetpack!

Realizing that my daughter was becoming unnecessarily upset, especially given the fact that there were 3 boys already engaging in play with their totally awesome jetpacks, myself and the hostess mother intervened.  We kindly reiterated my daughter’s requests for a jetpack.  And, so she was given a jetpack.

Later that evening, my daughter asked me why the magician insisted that she get a butterfly balloon when she explicitly asked for a jetpack.  Not wanting to reveal the realities of gender stereotype at that very point in time, I simply stated that sometimes we (a gender neutral “we”) might have to repeat ourselves so that others understand what we want.  Then she asked, “but why are butterflies only for girls?”

I was able to more or less able smooth it over with her, but it was clear to me that a very archaic reality was still in play, and my daughters were about to inherit it.  While I have nothing against typically female role-playing or dolls or princesses, I do not like when they are assumed to be the preferred activities.  I also do not like the idea that some toys, based on years of “market research,” are designed to basically pigeonhole girls into a June Cleaveresque state of being, especially without alternative play options.

The five LEGO Friends 
For instance, LEGO has recently launched a “for-girls-only” campaign, exemplified by the new “Friends” LEGO kit.  Slathered in pink and purple, this kit is designed around a narrative involving five friends and a pretend city named Heartlake.  Like nearly all cities, Heartlake boasts a bakery, a beauty salon, a cafe, and a veterinarian’s office to take care of sick animals.  However, unlike every city, Heartlake lacks things like a hospital, a fire department, a police station, and a local airport (thought they do have a flying club).  In essence, this toy is facilitating pretend play that centers ONLY on domestication, which absolutely limits both experiences and expectations for girls playing with this toy.  In essence, LEGO is assuming that all girls want the butterfly balloon instead of the jetpack.

Some might think, “jeeze, it’s just a toy!” and dismiss my objection to all that the Friends kit encompasses.  And perhaps when the Friends kit is offered in addition to a variety of toy types – gender neutral, masculine, and feminine – it may not have a significant effect on the mindset of its young, impressionable owner.  But what if that’s not the case?

Traditional LEGO bricks: For boys AND girls, goshdarnit!
LEGO has also gotten it wrong when it comes to the assumption that girls are not into the traditional LEGO blocks.  In fact, just last night, my daughter (the very one who wanted a jetpack) saw a commercial for a LEGO City product – I forgot which one – and asked that we put it on her ever expanding Christmas list.  Furthermore, both of my daughters are huge fans of the LEGO produced show on the Cartoon Network, Ninjago: Masters of Spinjitzu, which is based on the traditional LEGO figures and game.  My oldest daughter is arguably very sporty and may be more inclined to like “boy” things, but my younger daughter is chock-full of sugar and spice and yada yada yada.  She prefers to wear dresses, LOVES shoes, and demands to have her nails painted at all times.  And she still gets down with regular LEGOs and monster trucks and basketball and karate (all her own choices).  So why is LEGO shoving pastel bricks down girls’ throats?    

Gender and play

Play is an important part of cognitive development.  When children engage in play, they learn through discovery, become familiar with their own limitations, gain a better understanding of spatial relationships, become introduced to cause and effect, and, most relevant to this discussion, play exposes children to societal and cultural norms, as well as family values.  Placing limits on play can affect how a child sees him or herself in the world, which can impact both career and lifestyle choices.   

Research (and experience) has shown that the toys kids choose are shaped by societal expectations; however, these expectations are often dictated by marketing teams and their assumptions of what they think their customers want to see, perpetuating a toy culture that has changed little since the 1950s.  Furthermore, parents may impose toys that are gender “appropriate,” or even punish play that does not align with traditional gender expectations.  But what toys do kids actually want to play with?

In 2003, researchers at the University of Nebraska conducted a study to, in part, identify the impact that stereotyped toys have on play in young children.  There were 30 children who participated in this study, ranging in age from 18-47 months.  They were observed for 30 minutes in a room full of toys, with each toy defined as being traditionally masculine, feminine, or gender neutral.  Interestingly, when assessing the toy preferences of the children, boys tended to play with toys that were either masculine or gender neutral, whereas girls played with toys that were largely gender neutral.  These findings were consistent with previous studies showing that girls tend to play with toys that are not traditionally gendered (i.e. blocks, crayons, puzzles, bears, etc).  
Cherney, et al, 2003
Why is there a disconnect between the natural tendencies of toy choice among female children and what marketing executives deem as appropriate toys for girls?  While fantasy play based on domestic scenarios does have its place during normal development, restricting children to certain types of gendered toys can promote a stereotypical mindset that extends into adulthood, possibly adding to the gender inequity seen in the workplace.  Furthermore, assigning and marketing toys to a specific gender may also contribute to the gendering of household duties and/or recreational activities (i.e. only boys can play hockey or only girls do laundry).

This is obviously problematic for females, especially given the disproportionately low number of women executives and STEM professionals (just to name a few).  However, a conclusion from this study that I hadn’t even considered is the idea that overly feminized toys are not good for boys. 

How “girls only” is disadvantageous to boys

When looking at “masculine” versus “feminine” play, one would see that there is some non-overlap when it comes to learned skills.  For instance, “masculine” play often translates into being able to build something imaginative (like a spaceship or other cool technology) whereas “feminine” toys tend to encourage fantasy play surrounding taking care of the home (like putting the baby to sleep or ironing clothes). 

Both types of learning experiences are useful in today’s world, especially given that more women enter the work force and there is growing trend to more or less split household duties.  So when a kid is being offered toys that encourage play that has both masculine and feminine qualities, there is enhanced development of a variety of skills that ultimately translate into real, modern world scenarios.

However, the issue lies in the willingness to provide and play with strongly cross-gender-stereotyped toys.  Because of the number of toys having this quality, there is a huge gender divide when it comes to play, and boys are much less likely to cross gender lines, especially when toys are overtly “girly” (see figure above).  This is most often because of parents and caregivers who discourage play with “girl” toys, usually citing things like “they will make fun of you.”  Toys heavily marketed to match the stereotypical likes of girls, such as the Friends LEGO kit, clearly excludes boys from engaging in play that develops domestic skills (in addition to pigeonholing girls into thinking that girls can only do domestic things).   

Just yesterday, I came across an article on CNN discussing this issue, and it contained anecdotes similar to the one I described above.  The author described how a little girl was scoffed for having a Star-Wars thermos as well as how a little boy was told (by another little girl) that he could not have the mermaid doll he wanted.  My arguments thus far have been centered on developing a variety of skills through play, but I’d also like to add that limiting self-expression could be disastrous for the future wellbeing of an individual. 

There is some progress being made with regard to how toys are being presented in stores.  For instance, the same article described the new Toy Kingdom at Harrod’s, which does not conform to the traditionally separated “boy” and “girl” sections.  Instead, it has “worlds,” such as The Big Top(with circus acts and fairies) or Odyssey(with space crafts and gadgets).  This type of organization allows any child, regardless of gender, to engage in play that facilitates imagination and cognition.

Hey Toys’R Us, are you listening?                

 Final thoughts

Please don’t misinterpret this as being anti-pink, anti-princess, or anti-feminine.  I embrace my own femininity with vigor and pride.  I like to wear dresses and makeup and get my hair did.  Give me a pair of Manolo Blahniks and I will wear the shit out of them.  But I will do so while elbow deep in a biochemical analysis of intracellular cholesterol transport.    

My point is that if you are going to make a toy more appealing to girls by painting it pink, don’t forget to include facets that allow girls to be comfortable with their femininity while providing an experience that promotes empowerment and an unlimited imagination.  Furthermore, don’t exclude boys from getting an experience that helps them acquire skills that are applicable (and desirable) in the modern world.  As it stands right now, toys like the Friends LEGO kit does neither of these and I believe that they major fails, both of the Double X and the XY variety.    

For more, check out Feminist Frequency’s takedown of LEGO:



References:
Judith E. Owen Blakemore and Renee E. Centers, Characteristics of Boys’ and Girls’ Toys, Sex Roles, Vol. 53, Nos. 9/10, November 2005 [PDF, paywall]

Gerianne M. Alexander, Ph.D., An Evolutionary Perspective of Sex-Typed Toy Preferences: Pink, Blue, and the Brain, Archives of Sexual Behavior, Vol. 32, No. 1, , pp. 7–14, February 2003 [PDF, paywall]

Isabelle D. Cherney, Lisa Kelly-Vance, Katrina Gill Glover, Amy Ruane, and Brigette Oliver Ryalls, The Effects of Stereotyped Toys and Gender on Play Assessment in Children Aged 18-47 Months, Educational Psychology: An International Journal of Experimental Educational Psychology, 23:1, 95-106, 2003

Carol J. Auster and Claire S. Mansbach, The Gender Marketing of Toys: An Analysis of Color and Type of Toy on the Disney Store Website, Sex Roles, 2012 [abstract link]

Isabelle D. Cherney and  Kamala London, Gender-linked Differences in the Toys, Television Shows, Computer Games, and Outdoor Activities of 5- to 13-year-old Children, Sex Roles, 2006 [PDF]

Isabelle D. Cherney and Bridget Oliver Ryalls, Gender-linked differences in the incidental memory of children and adults, J Exp Child Psychol, 1999 Apr;72(4):305-28 [abstract link]

Is the bar high enough for screening breast ultrasounds for breast cancer?

The stormy landscape of the breast, as seen
on ultrasound. At top center (dark circle) is
a small cyst. Source: Wikimedia Commons.
Credit: Nevit Dilmen.
By Laura Newman, contributor

In a unanimous decision, FDA has approved the first breast ultrasound imaging system for dense breast tissue “for use in combination with a standard mammography in women with dense breast tissue who have a negative mammogram and no symptoms of breast cancer.” Patients should not interpret FDA’s approval of the somo-v Automated Breast Ultrasound System as an endorsement of the device as necessarily beneficial for this indication and this will be a thorny concept for many patients to appreciate.

If the approval did not take place in the setting of intense pressure to both inform women that they have dense breasts and lobbying to roll out all sorts of imaging studies quickly, no matter how well they have been studied, it would not be worth posting.

Dense breasts are worrisome to women, especially young women (in their 40s particularly) because they have proved a risk factor for developing breast cancer. Doing ultrasound on every woman with dense breasts, though, who has no symptoms, and a normal mammogram potentially encompasses as many as 40% of women undergoing screening mammography who also have dense breasts, according to the FDA’s press release. Dense breast tissue is most common in young women, specifically women in their forties, and breast density declines with age.

The limitations of mammography in seeing through dense breast tissue have been well known for decades and the search has been on for better imaging studies. Government appointed panels have reviewed the issue and mammography for women in their forties has been controversial. What’s new is the “Are You Dense?” patient movement and legislation to inform women that they have dense breasts.

Merits and pitfalls of device approval
The approval of breast ultrasound hinges on a study of 200 women with dense breast evaluated retrospectively at 13 sites across the United States with mammography and ultrasound. The study showed a statistically significant increase in breast cancer detection when ultrasound was used with mammography.

Approval of a device of this nature (noninvasive, already approved in general, but not for this indication) does not require the company to demonstrate that use of the device reduces morbidity or mortality, or that health benefits outweigh risks.

Eitan Amir, MD, PhD, medical oncologist at Princess Margaret Hospital, Toronto, Canada, said: “It’s really not a policy decision. All this is, is notice that if you want to buy the technology, you can.”

That’s clearly an important point, but not one that patients in the US understand. Patients hear “FDA approval” and assume that means a technology most certainly is for them and a necessary add-on. This disconnect in the FDA medical device approval process and in what patients think it means warrants an overhaul or at the minimum, a clarification for the public.

Materials for FDA submission are available on the FDA website, including the study filed with FDA and a PowerPoint presentation, but lots of luck, finding them quickly. “In the submission by Sunnyvale CA uSystems to FDA, the company stated that screening reduces lymph node positive breast cancer,” noted Amir. “There are few data to support this comment.”

Is cancer detection a sufficient goal?
In the FDA study, more cancers were identified with ultrasound. However, one has to question whether breast cancer detection alone is meaningful in driving use of a technology. In the past year, prostate cancer detection through PSA screening has been attacked because several studies and epidemiologists have found that screening is a poor predictor of who will die from prostate cancer or be bothered by it during their lifetime. We seem to be picking up findings that don’t lead to much to worry about, according to some researchers. Could new imaging studies for breast cancer suffer the same limitation? It is possible.

Another question is whether or not the detected cancers on ultrasound in the FDA study would have been identified shortly thereafter on a routine mammogram. It’s a question that is unclear from the FDA submission, according to Amir.

One of the problems that arises from excess screening is overdiagnosis, overtreatment, and high-cost, unaffordable care. An outcomes analysis of 9,232 women in the US Breast Cancer Surveillance Consortium led by Gretchen L. Gierach, PhD, MPH, at the National Institutes of Health MD, and published online in the August 21 Journal of the National Cancer Institute, revealed: “High mammographic breast density was not associated with risk of death from breast cancer or death from any cause after accounting for other patient and tumor characteristics.” –Gierach et al., 2012

Proposed breast cancer screening tests
Meanwhile, numerous imaging modalities have been proposed as an adjunct to mammography and as potential replacements for mammography. In 2002, proponents of positron emission tomography (PET) asked Medicare to approve pet scans for imaging dense breast tissue, especially in Asian women. The Medicare Coverage Advisory Commission heard testimony, but in the end, Medicare did not approve it for the dense-breast indication.

PET scans are far less popular today, while magnetic resonance imaging (AKA MR, MRI) and imaging have emerged as as adjuncts to mammography for women with certain risk factors. Like ultrasound, the outcomes data is not in the bag for screening with it.

In an interview with Monica Morrow, MD, Chief of Breast Surgery at Memorial Sloan-Kettering Cancer Center, New York, several months ago concerning the rise in legislation to inform women about dense breasts, which frequently leads to additional imaging studies, she said: “There is no good data that women with dense breasts benefit from additional MR screening.” She is not the only investigator to question potentially deleterious use of MR ahead of data collection and analysis. Many breast researchers have expressed fear that women will opt for double mastectomies, based on MR, that in the end, may have been absolutely unnecessary.

“There is one clear indication for MR screening,” stressed Morrow, explaining that women with BRCA mutations should be screened with MRI. “Outside of that group, there was no evidence that screening women with MR was beneficial.”

At just about every breast cancer meeting in the past two years, the benefits and harms of MR and other proposed screening modalities come up, and there is no consensus in the field.  It  should be noted, though, that plenty of breast physicians are skeptical about broad use of MR– not just generalists outside of the field. In other words, it is not breast and radiology specialists versus the US Preventive Services Task Force – a very important message for patients to understand.

One thing is clear: as these new technologies gain FDA approval, it will be a windfall for industry. If industry is successful and doctors are biased to promoting these tests, many may offer them on the estimated 40% of women with dense breasts who undergo routine mammograms, as well as other women evaluated as having a high lifetime risk.  The tests will be offered in a setting of unclear value and uncertain harms. Even though FDA has not approved breast MRI for screening dense breasts, breast MR is being used off label and it is far more costly than mammography.

When patients raise concerns about the unaffordability of medical care, they should be counseled about the uncertain benefit and potential harms of such a test. That may be a tall bill for most Americans to consider: it’s clear that the more is better philosophy is alive and well. Early detection of something, anything, even something dormant, going nowhere, is preferable to skipping a test, and risking who-knows-what, and that is something, most of us cannot imagine at the outset.

[Today's post is from Patient POVthe blog of Laura Newman, a science writer who has worked in health care for most of her adult life, first as a health policy analyst, and as a medical journalist for the last two decades. She was a proud member of the women’s health movement. She has a longstanding interest in what matters to patients and thinks that patients should play a major role in planning and operational discussions about healthcare. Laura’s news stories have appeared in Scientific American blogs, WebMD Medical News, Medscape, Drug Topics, Applied Neurology, Neurology Today, the Journal of the National Cancer Institute, The Lancet, and BMJ, and numerous other outlets. You can find her on Twitter @lauranewmanny.]

Ed note: The original version of this post contains a posted correction that is incorporated into the version you’ve read here.

The opinions in this article do not necessarily conflict with or reflect those of the DXS editorial team.