Women are often stereotyped as having a dislike of dirt, a fear of snakes, an abhorrence of bugs. I happen to like snakes, think dirt is a good thing, and embrace the enormous diversity that is the world of “bugs,” or, more specifically, arthropods. The number of species of bugs may well account for the vast majority of all known animals species and easily exceeds 1 million. With 1 million+ species from which to choose, how can anyone “hate bugs”? So, it is with great delight that we highlight a blog today that’s about a woman and her love of bugs. The appropriately named Bug Girl’s Blog is a wealth of expert information about bugs, palatably presented. (Warning: some entries, especially the limerick contest entries, not suitable for children. This legitimate form of poetry often carries NSFC labels). Naughty proboscis-related poetry aside, at Bug Girl’s Blog, you’ll find all the detail and fascinating information about bugs that only a woman with a PhD in entomology can provide. While Bug Girl is happy to write about bugs and collate bug-related naughty poetry, she will not, she notes, be able to identify your bug for you. Remember that 1 million+ thing? No one can identify each and every one. She will, however, post and discuss videos of the sounds of summer (i.e., cicadas) complete with the related poetry of the ancient Greeks. You’ll learn about those bumps on the undersides of leaves–galls–and what their bug-related purpose is. Bug Girl applies critical thinking and skepticism to claims about bugs–and about what kills them–and tells us which bugs we can eat. Mmm. Ants are spicy. In case you’re interested, Bug Girl has also posted bed bugcoverage. Ewww. Women interested in science careers, in particular bug-related science careers, will also find a wealth of career-related posts. Oh, and National Moth Week? That’s coming up next July, so be sure to be ready for that. The point of it is citizen science, in which citizens engage in the process of science. In case you didn’t know it, moths are pretty cool, often quite beautiful, and rather necessary as pollinators and food. You can follow Bug Girl on Twitter @bug_girl.
According to Leslie Brunetta, she now has much more hair than she had last July.
We became aware of Leslie Brunetta because of her book, Spider Silk: Evolution and 400 Million Years of Spinning, Waiting, Snagging, and Mating, co-authored with Catherine L. Craig. Thanks to a piece Leslie wrote for the Concord Monitor (and excerpted here), we also learned that she is a breast cancer survivor. Leslie agreed to an interview about her experience, and in her emailed responses, she candidly talks about her diagnosis, treatment, and follow-up for her cancers, plural: She was diagnosed simultaneously with two types of breast cancer.
DXS: In your Concord Monitor piece, you describe the link between an understanding of the way evolution happens and some of the advances in modern medicine. What led you to grasp the link between the two?
LB: I think, because I’m not a scientist (I’m an English major), a lot of things that scientists think are obvious strike me as revelations. I somehow had never realized that the search for what would turn out to be DNA began with trying to explain how, in line with the theory of evolution by natural selection, variation arises and traits are passed from generation to generation. As I was figuring out what each chapter in Spider Silk would be about, I tried to think about the questions non-biologists like me would still have about evolution when they got to that point in the book. By the time we got past dragline silk, I realized that we had so far fleshed out the ways that silk proteins could and have evolved at the genetic level. But that explanation probably wouldn’t answer readers’ questions about how, for example, abdominal spinnerets—which are unique to spiders—might have evolved: the evolution of silk is easier to untangle than the evolution of body parts, which is why we focused on it in the first place.
I decided I wanted to write a chapter on “evo-devo,” evolutionary developmental biology, partly because there was a cool genetic study on the development of spinnerets that showed they’ve evolved from limbs. Fortunately, my co-author, Cay Craig, and editor at Yale, Jean Thomson Black, okayed the idea, because that chapter wasn’t in the original proposal. Writing that chapter, I learned why it took so long—nearly a century—to get from Darwin and Mendel to Watson and Crick and then so long again to get to where we are today. If we non-scientists understand something scientific, it’s often how it works, not how a whole string of people over the course of decades building on each other’s work discovered how it works. I knew evolution was the accumulation of gene changes, but, until I wrote that chapter, it hadn’t occurred to me that people began to look for genes because they wanted to understand evolution.
So that was all in the spider part of my life. Then, a few months into the cancer part of my life, I was offered a test called Oncotype DX, which would look at genetic markers in my tumor cells to develop a risk profile that could help me decide whether I should have chemotherapy plus tamoxifen or just tamoxifen. The results turned out to be moot in my case because I had a number of positive lymph nodes, although it was reassuring to find out that the cancer was considered low risk for recurrence. But still—the idea that a genetic test could let some women avoid chemo without taking on extra risk, that’s huge. No one would want to go through chemo if it wasn’t necessary. So by then I was thinking, “Thank you, Darwin!”
And then, coincidentally, the presidential primary season was heating up, and there were a number of serious candidates (well, serious in the sense that they had enough backing to get into the debates) who proudly declared that they had no time for the theory of evolution. And year after year these stupid anti-evolution bills are introduced in various state legislatures. While I was lying on the couch hanging out in the days after chemo sessions, I started thinking, “So, given that you don’t give any credence to Darwin and his ideas, would you refuse on principle to take the Oncotype test or gene-based therapies like Gleevec or Herceptin if you had cancer or if someone in your family had cancer? Somehow I don’t think so.” That argument is not going to convince hard-core denialists (nothing will), but maybe the cognitive dissonance in connection with something as concrete as cancer will make some people who waver want to find out more.
DXS: You mention having been diagnosed with two different forms of cancer, one in each breast. Can you say what each kind was and, if possible, how they differed?
LB: Yes, I unfortunately turned out to be an “interesting” case. This is one arena where, if you possibly can, you want to avoid being interesting. At first it seemed that I had a tiny lesion that was an invasive ductal carcinoma (IDC) and that I would “just” need a lumpectomy and radiation. Luckily for me, the doctor reading my mammogram is known as an eagle eye, and she saw a few things that—given the positive finding from the biopsy—concerned her. She recommended an MRI. In fact, even though I switched to another hospital for my surgery, she sent emails there saying I should have an MRI. That turned up “concerning” spots in both breasts, which led to more biopsies, which revealed multiple tiny cancerous lesions. The only reasonable option was then a double mastectomy.
The lesions in the right breast were IDCs. About 70% of breast cancers are diagnosed as IDCs. Those cancers start with the cells lining the milk ducts. The ones in the left breast were invasive lobular carcinomas (ILCs), which start in the lobules at the end of the milk ducts. Only about 10% of breast cancers are ILCs.
Oncologists hate lobular cancer. Unlike ductal cancers, which form as clumps of cells, lobular cancers form as single-file ribbons of cells. The tissue around ductal cancer cells reacts to those cells, which is why someone may feel a lump—she’s (or he’s) not feeling the cancer itself but the inflammation of the tissue around it. And because the cells clump, they show up more readily on mammograms. Not so lobular cancers. They mostly don’t give rise to lumps and they’re hard to spot on mammograms. They snake their way through tissue for quite a while without bothering anything.
In my case, this explains why last spring felt like an unremitting downhill slide. Every time someone looked deeper, they found something worse. It turned out that on my left side, the lobular side, I had multiple positive lymph nodes, which was why I needed not just chemo but also radiation (which usually isn’t given after a mastectomy). That was the side that didn’t even show up much on the mammogram. On the right side, the ductal side, which provoked the initial suspicions, my nodes were clear. I want to write about this soon, because I want to find out more about it. I’ve only recently gotten to the place emotionally where I think I can deal with reading the research papers as opposed to more general information. By the way, the resource that most helped us better understand what my doctors were talking about was Dr. Susan Love’s Breast Book. It was invaluable as we made our way through this process, although it turned out that I had very few decisions to make because there was usually only one good option.
DXS: As part of your treatment, you had a double mastectomy. One of our goals with this interview is to tell women what some of these experiences with treatment are like. If you’re comfortable doing so, could you tell us a little bit about what a double mastectomy entails and what you do after one in practical terms?
LB: A mastectomy is a strange operation. In a way, it’s more of an emotional and psychological experience than a physical experience. My surgeon, who was fantastic, is a man, and when we discussed the need for the mastectomies he said that I would be surprised at how little pain would be involved and how quick the healing would be. Even though I trusted him a lot by then, my reaction was pretty much, “Like you would know, right?” But he did know. When you think about it, it’s fairly non-invasive surgery. Unless the cancer has spread to the surrounding area, which doesn’t happen very often now due to early detection, no muscle or bone is removed. (Until relatively recently, surgeons removed the major muscle in the chest wall, and sometimes even bone, because they believed it would cut the risk of recurrence. That meant that many women lost function in their arm and also experienced back problems.) None of your organs are touched. They don’t go into your abdominal cavity. Also, until recently, they removed a whole clump of underarm lymph nodes when they did lumpectomies or mastectomies. Now they usually remove just a “sentinel node,” because they know that it will give them a fairly reliable indicator of whether the cancer has spread to the other nodes. That also makes the surgery less traumatic than it used to be.
I opted not to have reconstruction. Reconstruction is a good choice for many women, but I didn’t see many benefits for me and I didn’t like the idea of a more complicated surgery. My surgery was only about two hours. I don’t remember any pain at all afterwards, and my husband says I never complained of any. I was in the hospital for just one night. By the next day, I was on ibuprofen only. The bandages came off two days after the surgery.
That’s shocking, to see your breasts gone and replaced by thin red lines, no matter how well you’ve prepared yourself. It made the cancer seem much more real in some way than it had seemed before. In comparison, the physical recovery from the surgery was fairly minor because I had no infections or complications. There were drains in place for about 10 days to collect serum, which would otherwise collect under the skin, and my husband dealt with emptying them twice a day and measuring the amount. I had to sleep on my back, propped up, because of where the drains were placed, high up on my sides, and I never really got used to that. It was a real relief to have the drains removed.
My surgeon told me to start doing stretching exercises with my arms right away, and that’s really important. I got my full range of motion back within a couple of months. But even though I had my surgery last March, I’ve noticed lately that if I don’t stretch fully, like in yoga, things tighten up. That may be because of the radiation, though, because it’s only on my left side. Things are never quite the same as they were before the surgery, though. Because I did have to have the axillary nodes out on my left side, my lymph system is disrupted. I haven’t had any real problems with lymphedema yet, and I may never, but in the early months I noticed that my hands would swell if I’d been walking around a lot, and I’d have to elevate them to get them to drain back. That rarely happens now. But I’ve been told I need to wear a compression sleeve if I fly because the change in air pressure can cause lymph to collect. Also, I’m supposed to protect my hands and arms from cuts as much as possible. It seems to me that small nicks on my fingers take longer to heal than they used to. So even though most of the time it seems like it’s all over, I guess in those purely mechanical ways it’s never over. It’s not just that you no longer have breasts, it’s also that nerves and lymph channels and bits of tissue are also missing or moved around.
The bigger question is how one deals with now lacking breasts. I’ve decided not to wear prostheses. I can get away with it because I was small breasted, I dress in relatively loose clothes anyway, and I’ve gained confidence over time that no one notices or cares and I care less now if they do notice. But getting that self-confidence took quite a while. Obviously, it has an effect on my sex life, but we have a strong bond and it’s just become a piece of that bond. The biggest thing is that it’s always a bit of a shock when I catch sight of myself naked in a mirror because it’s a reminder that I’ve had cancer and there’s no getting around the fact that that sucks.
DXS: My mother-in-law completed radiation and chemo for breast cancer last year, and if I remember correctly, she had to go frequently for a period of weeks for radiation. Was that you experience? Can you describe for our readers what the time investment was like and what the process was like?
LB: I went for radiation 5 days a week for about 7 weeks. Three days a week, I’d usually be in and out of the hospital within 45 minutes. One day a week, I met with the radiology oncologist and a nurse to debrief, which was also a form of emotional therapy for me. And one day a week, they laid on a chair massage, and the nurse/massage therapist who gave the massage was great to talk to, so that was more therapy. Radiation was easy compared to chemo. Some people experience skin burning and fatigue, but I was lucky that I didn’t experience either. Because I’m a freelancer, the time investment wasn’t a burden for me. I’m also lucky living where I live, because I could walk to the hospital. It was a pleasant 3-mile round-trip walk, and I think the walking helped me a lot physically and mentally.
DXS: And now to the chemo. My interest in interviewing you about your experience began with a reference you made on Twitter to “chemo brain,” and of course, after reading your evolution-medical advances piece. Can you tell us a little about what the process of receiving chemotherapy is like? How long does it take? How frequently (I know this varies, but your experience)?
LB: Because of my age (I was considered young, which was always nice to hear) and state of general good health, my oncologist put me on a dose-dense AC-T schedule. This meant going for treatment every two weeks over the course of 16 weeks—8 treatment sessions. At the first 4 sessions, I was given Adriamycin and Cytoxan(AC), and the last 4 sessions I was given Taxol (T). The idea behind giving multiple drugs and giving them frequently is that they all attack cancer cells in different ways and—it goes back to evolution—by attacking them frequently and hard on different fronts, you’re trying to avoid selecting for a population that’s resistant to one or more of the drugs. They can give the drugs every two weeks to a lot of patients now because they’ve got drugs to boost the production of white blood cells, which the cancer drugs suppress. After most chemo sessions, I went back the next day for a shot of one of these drugs, Neulasta.
The chemo clinic was, bizarrely, a very relaxing place. The nurses who work there were fantastic, and the nurse assigned to me, Kathy, was always interesting to talk with. She had a great sense of humor, and she was also interested in the science behind everything we were doing, so if I ever had questions she didn’t have ready answers for, she’d find out for me. A lot of patients were there at the same time, but we each had a private space. You’d sit in a big reclining chair. They had TVs and DVDs, but I usually used it as an opportunity to read. My husband sat through the first session with me, and a close friend who had chemo for breast cancer 15 years ago sat through a few other sessions, but once I got used to it, I was comfortable being there alone. Because of the nurses, it never felt lonely.
I’d arrive and settle in. Kathy would take blood for testing red and white blood counts and, I think, liver function and some other things, and she’d insert a needle and start a saline drip while we waited for the results. I’ve always had large veins, so I opted to have the drugs administered through my arm rather than having a port implanted in my chest. Over the course of three to four hours, she’d change the IV bags. Some of the bags were drugs to protect against nausea, so I’d start to feel kind of fuzzy—I don’t think I retained a whole lot of what I read there! The Adriamycin was bright orange; they call it the Red Devil, because it can chew up your veins—sometimes it felt like it was burning but Kathy could stop that by slowing the drip. Otherwise, it was fairly uneventful. I’d have snacks and usually ate lunch while still hooked up.
I was lucky I never had any reactions to any of the drugs, so actually getting the chemo was a surprisingly pleasant experience just because of the atmosphere. On the one hand, you’re aware of all these people around you struggling with cancer and you know things aren’t going well for some of them, so it’s heartbreaking, and also makes you consider, sometimes fearfully, your own future no matter how well you’re trying to brace yourself up. But at the same time, the people working there are so positive, but not in a Pollyannaish-false way, that they helped me as I tried to stay positive. The social worker stopped in with each patient every session, and she was fantastic—I could talk out any problems or fears I had with her, and that helped a huge amount.
DXS: Would you be able to run us through a timeline of the physical effects of chemotherapy after an infusion? How long does it take before it hits hardest? My mother-in-law told me that her biggest craving, when she could eat, was for carb-heavy foods like mashed potatoes and for soups, like vegetable soup. What was your experience with that?
LB: My biggest fear when I first learned I would need chemo was nausea. My oncologist told us that they had nausea so well controlled that over the past few years, she had only had one or two patients who had experienced it. As with the surgeon’s prediction about mastectomy pain, this turned out to be true: I never had even a single moment of nausea.
But there were all sorts of other effects. For the first few days after a session, the most salient effects were actually from the mix of drugs I took to stave off nausea. I generally felt pretty fuzzy, but not necessarily sleepy—part of the mix was steroids, so you’re a little hyped. There’s no way I’d feel safe driving on those days, for example. I’d sleep well the first three nights because I took Ativan, which has an anti-nausea effect. But except for those days, my sleep was really disrupted. Partly that’s because, I’m guessing, the chemo hits certain cells in your brain and partly it’s because you get thrown into chemical menopause, so there were a lot of night hot flashes. Even though I’d already started into menopause, this chemo menopause was a lot more intense and included all the symptoms regularly associated with menopause.
By the end of the first session, I was feeling pretty joyful because it was much less bad than I had thought it would be. By the second week in the two-week cycle, I felt relatively normal. But even though it never got awful, the effects started to accumulate. My hair started to fall out the morning I was going to an award ceremony for Spider Silk. It was ok at the ceremony, but we shaved it off that night. I decided not to wear a wig. First, it was the summer, and it would have been hot. Second, I usually have close to a buzz cut, and I can’t imagine anyone would make a wig that would look anything like my hair. My kids’ attitude was that everyone would know something was wrong anyway, so I should just be bald, and that helped a lot. But it’s hard to see in people’s eyes multiple times a day their realization that you’re in a pretty bad place. Also, it’s not just your head hair that goes. So do your eyebrows, your eyelashes, your pubic hair, and most of the tiny hairs all over your skin. And as your skin cells are affected by the chemo (the chemo hits all fast-reproducing cells), your skin itself gets more sensitive and then is not protected by those tiny hairs. I remember a lot of itching. And strange things like my head sticking to my yoga mat and my reading glasses sticking to the side of my head instead of sliding over my ears.
I never lost my appetite, but I did have food cravings during the AC cycles. I wanted sushi and seaweed salad, of all things. And steak. My sense of taste went dull, so I also wanted things that tasted strong and had crunch. I stopped drinking coffee and alcohol, partly because of the sleep issues but partly because it didn’t taste very good anyway. I drank loads of water on the advice of the oncologist, the nurses, and my acupuncturist, and I think that helped a lot.
During the second cycle, I developed a fever. That was scary. I was warned that if I ever developed a fever, I should call the oncologist immediately, no matter the time of day or day of week. The problem is that your immune response is knocked down by the chemo, so what would normally be a small bacterial infection has the potential to rage out of control. I was lucky. We figured out that the source of infection was a hemorrhoid—the Adriamycin was beginning to chew into my digestive tract, a well-known side effect. (Having to pay constant attention to yet another usually private part of the body just seemed totally unfair by this point.) Oral antibiotics took care of it, which was great because I avoided having to go into the hospital and all the risks entailed with getting heavy-duty IV antibiotic treatment. And we were also able to keep on schedule with the chemo regimen, which is what you hope for.
After that, I became even more careful about avoiding infection, so I avoided public places even more than I had been. I’m very close to a couple of toddlers, and I couldn’t see them for weeks because they were in one of those toddler constant-viral stages, and I really missed them.
The Taxol seems to be much less harsh than the AC regimen, so a lot of these side effects started to ease off a bit by the second 8 weeks, which was certainly a relief.
I was lucky that I didn’t really have mouth sores or some of the other side effects. Some of this is, I think, just because besides the cancer I don’t have any other health issues. Some of it is because my husband took over everything and I don’t have a regular job, so I had the luxury of concentrating on doing what my body needed. I tried to walk every day, and I slept when I needed to, ate when and what I needed to, and went to yoga class when my immune system was ok. I also went to acupuncture every week. I know the science is iffy on that, but I think it helped me with the side effects, even if it was the placebo effect at work (I’m a big fan of the placebo effect). We also both had extraordinary emotional support from many friends and knew we could call lots of people if we needed anything. That’s huge when you’re in this kind of situation.
Currently, I’m still dealing with some minor joint pains, mostly in my wrists and feet. I wasn’t expecting this problem, but my oncologist says it’s not uncommon: they think it’s because your immune system has to re-find its proper level of function, and it can go into overdrive and set up inflammation in the joints. That’s gradually easing off, though.
Most people don’t have it as easy as I did in terms of the medical, financial, and emotional resources I had to draw on. I’m very mindful of that and very grateful.
DXS: You say that you had “few terrible side effects” and a “very cushy home situation.” I’m sure any woman would like to at least be able to experience the latter while dealing with a full-body chemical attack. What were some factors that made it “cushy” that women might be able to talk to their families or caregivers about replicating for them?
LB: As I’ve said, some of it is just circumstance. For example, my kids were old enough to be pretty self-sufficient and old enough to understand what was going on, which meant both that they needed very little from me in terms of care and also that they were less scared than they might have been if they were younger. My husband happens to be both very competent (more competent than I am) around the house and very giving. I live in Cambridge, MA, where I could actually make choices about where I wanted to be treated at each phase and know I’d get excellent, humane care and where none of the facilities I went to was more than about 20 minutes away.
Some things that women might have some control over and that their families might help nudge them toward:
Find doctors you trust. Ask a lot of questions and make sure you understand the answers. But don’t get hung up on survival or recurrence statistics. There’s no way to know for sure what your individual outcome will be. Go for the treatment that you and your doctors believe will give you the best chance, and then assume as much as possible that your outcome will be good.
Make sure you talk regularly with a social worker or other therapist who specializes in dealing with breast cancer patients. If you have fears or worries that you don’t want to talk to your partner or family about, here’s where you’ll get lots of help.
Find compatible friends who have also had cancer to talk to. I had friends who showed me their mastectomy scars, who showed me their reconstructions, who told me about their experiences with chemo and radiation, who told me about what life after treatment was like (is still like decades later…). And none of them told me, “You should…” They all just told me what was hard for them and what worked for them and let me figure out what worked for me. Brilliant.
Try to get some exercise even if you don’t feel like it. It was often when I felt least like moving around that a short walk made me feel remarkably better. But I would forget that, so my husband would remind me. Ask someone to walk with you if you’re feeling weak. Getting your circulation going seems to help the body process the chemo drugs and the waste products they create. For the same reason, drink lots of water.
Watch funny movies together. Laughter makes a huge difference.
Pamper yourself as much as possible. Let people take care of you and help as much as they’re willing. But don’t be afraid to say no to anything that you don’t want or that’s too much.
Family members and caregivers should also take care of themselves by making some time for themselves and talking to social workers or therapists if they feel the need. It’s a big, awful string of events for everyone involved, not just the patient.
DXS: In the midst of all of this, you seem to have written a fascinating book about spiders and their webs. Were you able to work while undergoing your treatments? Were there times that were better than others for attending to work? Could work be a sort of occupational therapy, when it was possible for you to do it, to keep you engaged?
LB: The book had been published about 6 months before my diagnosis. The whole cancer thing really interfered not with the writing, but with my efforts to publicize it. I had started to build toward a series of readings and had to abandon that effort. I had also started a proposal for a new book and had to put that aside. I had one radio interview in the middle of chemo, which was kind of daunting but I knew I couldn’t pass up the opportunity, and when I listen to it now, I can hear my voice sounds kind of shaky. It went well, but I was exhausted afterwards. Also invigorated, though—it made me feel like I hadn’t disappeared into the cancer. I had two streams of writing going on, both of which were therapeutic. I sent email updates about the cancer treatment to a group of friends—that was definitely psychological therapy. I also tried to keep the Spider Silk blog up to date by summarizing related research papers and other spider silk news—that was intellectual therapy. I just worked on them when I felt I wanted to. The second week of every cycle my head was usually reasonably clear.
I don’t really know whether I have chemo brain. I notice a lot of names-and-other-proper-nouns drop. But whether that’s from the chemo per se, or from the hormone changes associated with the chemically induced menopause, or just from emotional overload and intellectual distraction, I don’t know. I find that I’m thinking more clearly week by week.
DXS: What is the plan for your continued follow-up? How long will it last, what is the frequency of visits, sorts of tests, etc.?
LB: I’m on tamoxifen and I’ll be on that for probably two years and then either stay on that or go onto an aromatase inhibitor [Ed. note: these drugs block production of estrogen and are used for estrogen-sensitive cancers.] for another three years. I’ll see one of the cancer doctors every three months for at least a year, I think. They’ll ask me questions and do a physical exam and take blood samples to test for tumor markers. At some point the visits go to every six months.
For self-care, I’m exercising more, trying to lose some weight, and eating even better than I was before.
DXS: Last…if you’re comfortable detailing it…what led to your diagnosis in the first place?
LB: My breast cancer was uncovered by my annual mammogram. I’ve worried about cancer, as I suppose most people do. But I never really worried about breast cancer. My mother has 10 sisters and neither she nor any of them ever had breast cancer. I have about 20 older female cousins—I was 50 when I was diagnosed last year–and as far as I know none of them have had breast cancer. I took birth control pills for less than a year decades ago. Never smoked. Light drinker. Not overweight. Light exerciser. I breastfed both kids, although not for a full year. Never took replacement hormones. Never worked in a dangerous environment. Never had suspicious mammograms before. So on paper, I was at very low risk as far as I can figure out. After I finished intensive treatment, I was tested for BRCA1 and BRCA2 (because mutations there are associated with cancer in both breasts) and no mutations were found. Unless or until some new genetic markers are found and one of them applies to me, I think we’ll never know why I got breast cancer, other than the fact that I’ve lived long enough to get cancer. There was no lump. Even between the suspicious mammogram and ultrasound and the biopsy, none of the doctors examining me could feel a lump or anything irregular. It was a year ago this week that I got the news that the first biopsy was positive. In some ways, because I feel really good now, it’s hard to believe that this year ever happened. But in other ways, the shock of it is still with me and with the whole family. Things are good for now, though, and although I feel very unlucky that this happened in the first place, I feel extremely lucky with the medical care I received and the support I got from family and friends and especially my husband.
Leslie Brunetta’s articles and essays have appeared in the New York Times,Technology Review, and the Sewanee Review as well as on NPR and elsewhere. She is co-author, with Catherine L. Craig, of Spider Silk: Evolution and 400 Million Years of Spinning, Waiting, Snagging, and Mating (Yale University Press).
Post-Thanksgiving links: All about food…or sorta food
You made it through Thanksgiving even though you ran out of vanilla extract? Let science help you out the next time you fall short of that one important ingredient. Scientists have compiled a list of suitable substitutes for cooks everywhere.
Did you wake up this morning with fingers twice their normal size? Find out where the salt was in that Thanksgiving meal.
Asking, “Are you improbable or inevitable?”, Robert Krulwich tells us that the math determines that we are improbable. But we’re here, so aren’t we…inevitable?
Have you read about “the gene” for ADHD or the “drinking gene”? Stop reading that bad writing! There’s a difference between a trait that a gene confers and the many, many ways someone can manifest that trait. Read more from David Dobbs over at Neuron Culture in “Enough with the ‘slut gene’ already: Behaviors ain’t traits.”
Speaking of how scientists might spend their days, how about spending them watching 400 YouTube videos of dogs chasing their tails? Via DiscoBlog at Discover Science.
Use this app to follow live cameras trained on the wild places animals live in Sri Lanka, Kenya, the UK, and other places. When you spot an animal, identify it for science. Via GeekDad at Wired, Citizen science from Instant Wild! The featured Webcam as we posted these links had captured a porcupine in action.
Maybe you’ve never been in a lab in your life and wouldn’t know PCR from a VCR. That doesn’t matter when you watch this video of stop-motion animation using thousands and thousands of the tiny tubes scientists use when they conduct PCR (polymerase chain reaction). The video is actually a promotional video from vendors of equipment for this kind of lab test.
Conditions in Antarctica are almost unimaginable inhospitable for humans, yet scientists visit there yearly to conduct valuable research. Valuable, dangerous research, but the scenery? Stunning. Via BoingBoing.
The brain is encased in a skull for protection, with a nice fluid surrounding it for extra cushioning. But the human brain was never meant to endure years of the Newtonian physical pounding that comes with playing football. Now, researchers are beginning a brain study to test the brains of 100 former National Football League players to see what harm has been done and how to identify it early. Watch the video below. Imagine the brains inside those skulls. Recall that for every action, there is an equal and opposite reaction. Yikes.
You’ve done it. We’ve done it. You walk from one room to another on a mission and when you get into the other room…you forget why you’re there. Now, instead of blaming age, you can blame the door.
Look around: Do you a see a lot of stuff you just can’t bring yourself to throw away? Read this.
When it comes to sex–studies of it, studies of how it develops–males get a lot of the attention, and the female sex has even (gasp) been referred to as the “default” sex, as in, if there aren’t signals to become male, then females develop by default. That ain’t true, and as it turns out, females have a pathway dedicated to developing and maintaining them just as males do. So there, scientists.
Is it hard for women to self promote? This one is about academe, but it applies across many work places.
You may have read about this person’s efforts to perform a butt injection on a woman using “Fix a Flat.” It’s probably best to just love your butt for what it is, which isn’t Fix a Flat.
In smarter news, NASA is rolling out Aspire 2 Inspire, targeting girls interested in science. Know a girl who’s interested in science? You can start with the Aspire 2 Inspire video below about women in science:
“Yet more must be done to address the projected shortfall of 280,000 math and science teachers that our nation will face by 2015. We need public and private investments in math and science education and we need a commitment to making a difference on a national scale.”
It seems like every spring there is renewed coverage of a partial skeleton that was found on the island of Lazaretto Nuovo (one of two 15th-16th century leper colonies near Venice) in 2009. I’ve never covered it here, but since I was alerted to an airing of a documentary about the skeleton on Italian TV this week, I thought it may be time to track the progress of the so-called Vampire of Venice (“il vampiro di Venezia” in Italian, and not to be confused with a similarly named Dr. Who episode).
Immediately upon excavating this individual from what appears to have been a plague cemetery dating to 1576, archaeologists realized that something was very, very different about the burial treatment: there was a heavy brick placed in the person’s mouth. [BBC news video clip, March 13, 2009] A photograph from National Geographic [March 10, 2009 news story] prior to complete excavation:
During the 16th century, as plague raged around Europe, many people were buried hastily, in mass graves. Without modern forensic knowledge, people didn’t understand how the body decomposed. For example, as the bacteria present in the gut start consuming the internal organs, fluid can be produced and chest cavities can bulge and sink, making the bodies seem to sigh; as the skin dries out and recedes from the fingernails, they can appear to grow longer; and as the muscles go through stages of rigor mortis, bodies can seem to move. Mass plague graves were often reopened to inter more individuals, so seeing corpses that had changed since burial confused and scared the living.
The National Geographic article suggests that a plague victim who was buried in a shroud may have emitted some bodily fluids, staining and dissolving the shroud, making the undertakers think that the person was undead: a vampire who transmitted plague through this fluid. The way to prevent the vampire from continuing to spread the plague was to insert a brick or stone into the person’s mouth. Archaeologists believe that this individual suffered that fate; however, it’s unclear to me if the brick was placed at the time of burial or at a later time, such as on reopening of the grave to bury more people. [More photos of the excavation at KataWeb (labels in Italian)]
A year after excavation, the Vampire of Venice got her own documentary in the National Geographic series Mysterious Science, in an episode entitled “Vampire Forensics” (really, NatGeo? I expect more from you than this sort of pandering). You can actually watch the entire documentary in segments on YouTube: Part 1, Part 2, Part 3, Part 4, and Part 5. (Warning: Part 5 has some very graphic forensic images, which may be re-creations but which are even more graphic than what I normally show my forensic anthropology students.) Or you can watch this less gruesome preview from National Geographic’s website:
Based on anthropological analysis, the Vampire of Venice was, surprisingly, an older woman in her 60s. Forensic specialists have reconstructed her face using her skull and the knowledge of her sex, age, and European ancestry [National Geographic, February 26, 2010]:
Using carbon and nitrogen isotope analysis of a bit of postcranial skeleton, anthropologists discovered that she ate a lot of vegetables and grains, likely a lower-class diet. I’m assuming from reading between the lines of the NatGeo article that C/N isotope analysis of a rib was done, which would have given them information about the protein component of the diet and thus told them that she didn’t eat a lot of meat or fish. Since it wasn’t remarked on and since DNA analysis said she was European, I’m also guessing the C isotope analysis revealed C3 plant consumption (wheat and barley, e.g.).
The discovery of a skeleton of an older female in a 16th century Italian plague cemetery with an anomalous burial practice that correlates to superstitions about disease and the occult is extremely cool, whether or not she was “il vampiro di Venezia”. Italian archaeologists and anthropologists are learning both about the biology of plague victims and about their cultural explanations for disease prior to modern germ theory. The analysis of this individual is an excellent example of using historical records and biological remains to understand what life was like centuries ago. I wish that National Geographic hadn’t resorted to the “Vampire Forensics” title and that they hadn’t resorted to blatant pandering and sensationalism in making the documentary, because there is some very good science behind the story. But perhaps it’s the marriage of vampires and forensic science that explains why this story keeps surfacing in my news feed and why friends and colleagues keep sending me links to it.
Footnote (7/2/12) – Since I originally wrote this post, a bit of an argument has been kicked off in the academic literature about this burial. The discovery was published in 2010 in the Journal of Forensic Sciences by Nuzzolese and Borrini, although the article seems to be a conference paper rather than a full-length explication of the find. It’s in this brief communication that Nuzzolese and Borrini lay out their argument that the community may have thought of and treated this woman (at least in death) as a vampire.
A few months ago, another group of Italian bioarchaeologists, led by Simona Minozzi, wrote acommentary about this also in the Journal of Forensic Sciences. In essence, they argue that the brick in the mouth, the misaligned collarbones, and other aspects of Nuzzolese and Borrini’s case are simply taphonomic – that is, normal processes that happen by chance after death and burial. They also take issue with Nuzzolese and Borrini’s interpretation of the historical record as well. Minozzi and colleagues don’t buy the vampire interpretation at all, and go so far in this LiveScience article as saying that Borrini is making it up to bring more attention to the perpetually underfunded state of Italian bioarchaeology.
I don’t know if Minozzi or others have been able to take a look at the skeleton itself, but I’m not sure it would help since most of the vampire interpretation lies in the context of the burial rather than in the biological elements. And as we all know, as soon as you excavate something, you destroy the context forever. We may never solve the mystery of whether or not this woman was considered a vampire, but the arguments about the interpretation indicate that researchers need to be meticulous and seek additional input from knowledgeable colleagues before committing on paper to an interpretation as dramatic as “vampire.”
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 beingCaroline Herschel. She has had an asteroid and the Rubin-Ford effect named after her. She is currently enjoying her retirement.
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.
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 Arizonaand 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.
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.
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 POV, the 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.
The past few weeks have seen big news for vaccines. A bill related to vaccine exemptions was signed into law, a court ruled against a parent’s refusal to vaccinate and a recent study points out the value of vaccinating a household — especially mom — to protect a young infant from pertussis (whooping cough).
The latest news is that Governor Jerry Brown in California signed a bill last Sunday that had been sitting on his desk since September 6 and was the target of a number of rallies by parents who didn’t want to see it pass. Among those fighting the bill was Dr. Bob Sears, who says he walks a middle ground with vaccine policy but in reality tends to flirt with those who fear vaccines and rely on misinformation. Although some parents claimed the bill took away their right to choose whether their children get vaccinated, it actually just ensures they get good medical information before they make that choice.
Photo by Dave Gostisha at sxc.hu.
The bill-now-law, AB 2109, proposed by a pediatrician, requires parents to get a statement signed by a health care practitioner that the parents/guardians have received accurate, evidence-based information about the risks and benefits of vaccines before they can use a personal belief exemption to prevent their children from being vaccinated. This law is a tremendous triumph both for informed consent in medical decisions and for the public health of children in California, which saw a considerable outbreak of pertussis (whooping cough) in 2010. Washington state passed a similar law last year and saw 25 percent drop in exemptions filed. Other states are considering similar laws in a nationwide overall shift toward strengthening exemption requirements.
Why are these laws so important? In short, they kill two birds with one stone: They make it more difficult for parents to casually opt out of vaccines on philosophical grounds (as opposed to religious or medical reasons), and they require parents who want to opt out to at least hear out a pediatrician on accurate information about the actual risks (which do exist) and benefits (there are so many) of immunizations. Parents who are determined not to vaccinate their children can still refuse, but many parents who might have signed those forms out of convenience — it can be easier to sign than to get to the doctor’s office for the shot — will now at least hear the impact a decision not to vaccinate can have on the community. (Hopefully, they go to a health care practitioner other than Dr. Sears, whose stances have gradually been moving further and further toward unscientific and misinformation of those who oppose vaccines.)
It’s also particularly notable that California and Washington are the most recent states to tighten opt-out procedures for parents because they are home to some of the more recent pertussis outbreaks. More on that in a moment.
First, a bit of background on vaccine exemptions: Only 20 states have personal belief exemptions, and until last year, eight of these simply require nothing more than a parent signature. Now that number is down to six. (Other types of requirements for philosophical exemptions include writing out your reasons for exemption, requiring the forms to be notarized, requiring education on the risks/benefits, direct involvement from the state or local health department or renewals.)
All states have medical exemptions for patients who have auto-immune disorders, have proof that their bodies do not respond to immunization, have documented allergic reactions or have other circumstances which make it too risky for them to be immunized. In fact, these are the very people that the rest of the population protects through herd immunity when vaccination rates are up where they should be. All but two states have religious exemptions (Mississippi and West Virginia are the exceptions).
And that brings us to some less covered but still significant news about one state’s ruling on a particular case involving religious exemption. Last week, the U.S. district court in Ohio ruled that one woman’s claim of religious objection was insufficient for her children to be exempted from being vaccinated. Read the whole story here. To be fair, this is a complex case involving far more than vaccines; the mother is clearly neglectful and the overall situation is pretty crappy. However, the fact that the court found “the mere assertion of a religious belief … does not automatically trigger First Amendment protections,” and that “it has long been recognized that local authorities may constitutionally mandate vaccinations” is significant in a state that offers both religious and personal belief exemptions.
The constitutionality of religious exemptions is dubious as well. At the very least, however, anyone seeking any exemption should certainly to see a doctor first to be sure they have accurate information and not simply what they have seen online or heard at the playground. Those who absolutely will not vaccinate in states without exemptions may also opt to home school or send their children to private schools that don’t have requirements. But considering the increasing rates of measles and the increasing epidemics of pertussis, the need for high vaccination coverage in communities is more important than ever.
It is true that the pertussis vaccine is not as effective as the old one used to be, something I wrote about a few weeks ago. It’s also true that pertussis peaks every five years or so, but even taking into account the peaks, the overall rate of cases has been steadily on the move upward. Dr. Offit, the chief of the Division of Infectious Disease at Children’s Hospital of Philadelphia and a very vocal advocate of vaccines, said he believes that parents’ refusals to vaccinate are playing their own small part in the increase.
“The major contributor is waning immunity. The minor contributor is the choice not vaccinate,” he said. He noted that there are researchers working on the problem, as this Nature article notes (paywall), including attempts to make a better vaccine with more adjuvants, the additives that enhance the body’s immune response to a vaccine. While vaccinated children and adults have been high among the numbers of those getting whooping cough, getting the vaccine remains among the best ways to reduce your risk of contracting it — or of having less rough of a time with it if you do get it. Dr. Offit also pointed out that pregnant women in particular should be sure they get their booster.
Which brings us to the study published last week that relates to the most important reason to get vaccinated, at least from the perspective of preventing deaths — to protect the babies who are too young for the vaccine but most likely to contract it and die from it.
The study, published in the journal Epidemiology last week, looked at how frequently pertussis was transmitted to others within the same household and how effective “cocooning” is. Cocooning is vaccinating all the household members who can get the vaccine for the purpose of protecting young babies who can’t yet be vaccinated for the disease.
They found that transmission rates within the home are high, especially for mothers passing the illness on to their children. Therefore, making sure all pregnant women are vaccinated before their baby arrives would, according to their calculations, cut the risk in half that a baby would contract pertussis. The evidence for sibling vaccination, though weaker, still points to the value of overall cocooning: “Vaccination of siblings is less effective in preventing transmission within the household, but may be as effective overall because siblings more often introduce an infection in the household.”
Indeed, this year, siblings’ bringing home the disease appears more likely than ever in the states experiencing big outbreaks this year. Just how bad are the numbers? Well, 2010 was the last five-year peak, which totaled 27,550 cases. It’s currently September of 2012, and the numbers last reported to the CDC were at 29,834, and that doesn’t even include over 3,700 cases in Minnesota that haven’t been officially reported to the CDC yet. These numbers, which include 14 deaths (primarily of babies under 3 months), may very well end up doubling the 2011 total of 18,719 if they continue at the current rate through the end of the year. It’s the biggest pertussis outbreak since 1959.
Not surprisingly, the majority of the states leading in pertussis cases are also among those that offer personal belief exemptions. Washington, despite their new law, is sitting at 4,190 cases, quadrupling their 2011 count of 965. This is the state where 7.6 percent of parents opted for exemptions (among all grade levels, not just kindergarten) in 2008-09, more than four times the national rate of about 1.5 percent. Minnesota and Wisconsin have similarly high rates and both have personal belief exemptions. The most recent numbers out of Minnesota are 3,748 — they had just 661 cases last year. Wisconsin is leading the nation with 4,640 cases, up from 1,192 in 2011, at last report in the Sept. 28 Morbidity and Mortality Weekly Report (pdf) at the CDC.
But the increases are being seen across the nation, as this CDC map shows. Texas (1,287 cases to date this year), Pennsylvania (1,428 cases) and Colorado (897 cases, though they averaged 158 over the past four years) are among other states with personal belief exemptions (though the Texas one has significant restrictions and hoops to jump through). But it’s clear the decreased effectiveness of the vaccine is playing the biggest role, especially in places like Iowa (1,168 cases) and New York (2,107), neither of which offer personal belief exemptions.
Again, though, a less effective vaccine does not mean a worthless vaccine. It still offers 85 percent protection when you get the shot or the booster, and even as it loses some effectiveness as the years go by, you’re far less likely to have a severe case if you do get the disease. And you’re protecting those around you, including the babies who have only been here a few months and are the most susceptible to catching and dying from the disease.
Bottom line — it’s worth it to get the shot, and to make sure your kids do too.
Opinions expressed in this article do not either necessarily reflect or conflict with those of the DXS editorial team or contributors.
[Tara Haelle (www.tarahaelle.com) is a health and science writer and a photojournalist based in Peoria, IL after years as a Texan, where she earned her undergraduate degrees and MA in journalism at UT-Austin. She’s the mental health editor for dailyRx.com in addition to reporting on pediatrics, vaccines, sleep, parenting, prenatal care and obesity. Her blog, Red Wine & Apple Sauce, focuses on health and science news for moms, and you can follow her on Twitter at @health_reporter and @tarasue. She’s also swum with 9 different species of sharks, climbed Kilimanjaro and backpacked in over 40 countries, but that was in the years of B.C. (Before Children). She finds that two-year-olds are tougher to tussle with than tiger sharks.]
Mariette DiChristina is editor in chief of Scientific American.
[Ed. note: This interview is the second installment in our new series, Double Xpression: Profiles of Women into Science. The focus of these profiles is how women in science express themselves in ways that aren’t necessarily scientific, how their ways of expression inform their scientific activities and vice-versa, and the reactions they encounter.]
Today’s profile is an interview with Mariette DiChristina, editor in chief, Scientific American, who answered our questions via email with DXS Biology EditorJeanne Garbarino. Read on to find out what a Marx Brothers movie has to do with communicating science.
DXS: First, can you give me a quick overview of what your scientific background is and your current connection to science?
MD: Like most kids, I was born a scientist. What I mean is, I wanted to know how everything worked, and I wanted to learn about it firsthand. At a tag sale, for instance, I remember buying a second-hand biology book called The Body along with my second-hand Barbie for 50 cents. “Are you sure your mom is going to be OK with you buying that?” asked the concerned neighbor, eyeing the biology book.
I memorized the names and orbital periods of the planets and of dinosaurs like some kids spout baseball stats (which I could also do as a kid, by the way). We didn’t have a lot of money, so I caught my own pet fish from a nearby pond by using my little finger as a pretend worm. I scooped up my fish with an old plastic container and put it on my nightstand. If it died, I buried it and dug it up later so I could look at the bones. My proudest birthday gifts were when I got a chemistry set and a microscope with 750x. A girlfriend and I got the idea to pick up a gerbil that had a bad habit of biting fingers, just so we could get blood to squeeze on a glass slide. (She was braver than I was about being the one to get bitten.)
In middle school, I was a proud member of the Alchemists—an after-school science club—so I could do extra labs and clean the beakers and put away Bunsen burners for fun. I knew I would be a scientist when I grew up.
But somewhere during my high school courses, I came to believe that being a scientist meant I’d have to pick one narrow discipline and stick to it. I felt that I liked everything too much to do that, however. As an undergraduate, I eventually figured out that what I really wanted was to be a student of many different things for life, and then share those things I learned with others. That led me to a journalism degree. It also means that, as far as knowledge about science goes, I fit the cliché of being “an inch deep and a mile wide.”
DXS: What ways do you express yourself creatively that may not have a single thing to do with science?
MD: This one is a tough one for me to answer because I am always trying to convince people that pretty much everything they care about in the headlines actually has to do with science! In my case, I’ve also always been interested in drawing and in visuals in general. I was a pretty serious art student in high school as well, although I later decided that I didn’t have enough passion for it to make that my career choice. My interest in art partly led me to work at magazines like Scientific American and Popular Science, where the ability to storyboard an informational graphic and otherwise think visually is very helpful.
When I’m home, I really enjoy making things with my two daughters, such as helping them with crafts or scrapbooks, although I definitely spend a lot more time on planning dinners and cooking for (and with) the family than anything else. I like the puzzle solving of setting up the meals for the week during the weekend, so it’s easier for my husband to get things ready weeknights. We’re big on eating dinner together as a family every night. I like gardening and mapping out planting beds. I’m better at planting than at keeping up with tending, however, because of my intense work schedule and travel. In short, if I have free time at all, I’m enjoying it with my family. And if we’re doing some creative expression while we’re at it, great!
DXS: Do you find that your connection to science informs your creativity, even though what you do may not specifically be scientific?
MD: My connection to science informs most things that I do in one way or another. When I’m making dinner, I sometimes find myself talking about the chemistry of cooking with the girls. Especially when our daughters were smaller, if one of them had a question, I’d try to come up with ways to make finding the answer together into a kind of science adventure or project.
I suppose that since I spend most of my waking hours thinking about how best to present science to the public, it’s just a mental routine, or a lens through which I tend to view the world.
DXS: Have you encountered situations in which your expression of yourself outside the bounds of science has led to people viewing you differently–either more positively or more negatively?
MD: It’s more the other way around. I get amusing reactions from people once they find out what I do. How could I seem so normal and yet work in a field that relates to…shudder…science? An attorney friend has sometimes kidded me, saying there’s no way he can understand what’s in Scientific American, so I must be incredibly smart. I don’t feel that way at all! Anybody who has a high school degree and an interest in the topic can understand a feature article in Scientific American. Science is for everyone. And science isn’t only for people who work in labs. It’s just a rational way of looking at life. I also believe science is the engine of human prosperity. And if I sound a little evangelistic about that, well, I am.
DXS: Have you found that your non-science expression of creativity/activity/etc. has in any way informed your understanding of science or how you may talk about it or present it to others?
MD: I think it’s helpful to look to non-science areas for ideas about ways to help make science appealing, especially for people who might be intimidated by the subject. My main job is to try to make a connection for people to the science we cover in Scientific American. I once had a boss at Popular Sciencewho made all us editors take an intensive, three-day screenwriting course that culminated in the showing and exposition, scene by scene, of the structure and writing techniques of Casablanca. When I came back, he gave me a big grin and said, “So, what did you think?” I got his point about bringing narrative techniques into feature articles. Like most people, I enjoy movies and plays; now I also look at them for storytelling tips. And there are lots of creative ways to tell science stories beyond words: pictures, slide shows, videos, songs. Digital media are so flexible.
DXS: How comfortable are you expressing your femininity and in what ways? How does this expression influence people’s perception of you in, say, a scientifically oriented context?
MD: I was the oldest of three daughters raised by a single dad (my mom died when I was 12) and I was always a tomboy, playing softball through college and so on. So I can’t say I’ve ever been terribly feminine, at least in the stereotypical ways. At the same time, I’m obviously a wife and a mother who, like most parents, tries not to talk about my kids so often that it’s irritating to friends and coworkers. I once was scolded in a letter from an irritated reader after I had mentioned my kids in a “From the Editor” column about education. He wrote that if I was so interested in science education and kids, I should go back home and “bake cookies.” I laughed pretty hard at that.
DXS: Do you think that the combination of your non-science creativity and scientific-related activity shifts people’s perspectives or ideas about what a scientist or science communicator is? If you’re aware of such an influence, in what way, if any, do you use it to (for example) reach a different corner of your audience or present science in a different sort of way?
MD: I’m sure that’s true. I think personality and approach also might shift perspectives. A girlfriend of mine once called me “the friendly face of science.” I guess I smile a lot, and I like to meet people and try to get to know them. That ability—being able to make a personal connection to different people—is important for every good editor. My job, essentially, is to understand your interests well enough to make sure Scientific American is something that you’ll enjoy each day, week, month.
Increasingly, also, the audiences are different in different media, so we need to understand how to flex the approach a bit to appeal to those different audiences. In print, for instance, according to the most recent data we have from MRI, the median age of Scientific American readers is 47, with 70 percent men and 30 percent women. The picture is quite different online, where, according to Nielsen, our median age is 40 and the male/female ratio is closer to half and half, with 56.5 percent men to 43.5 percent women. You need to bring a lot of creative thinking to the task of how to make one brand serve rather different sets of people.
Fortunately, I have terrific, creative staff! And another part of the way you do that, I think, is to invite your readers in to collaborate; we’ve done a bit of that in the past year on http://www.scientificamerican.com/, and I’m looking forward to experimenting further in the coming months. Ultimately, I’d like to turn Scientific American from a magazine with an amazing 166-year tradition of being a conduit of authoritative information about science and technology into a platform where curious minds can gather and share.
DXS: If you had something you could say to the younger you about the role of expression and creativity in your chosen career path, what would you say?
MD: I was pretty determined to do something—whatever it was—that would let me satisfy my curiosity and passion about science. I would tell younger me, who, by the way, never intended to go into magazine management: It’s just as fun, rewarding and creative to be a science writer as you suspect it might be. I’d also tell the younger me something that didn’t occur to me early enough to pull it off—that a double major in journalism and science might be a good idea. And, I would add, it’s also a good idea to take some business classes, so you’ll be better armed for dealing with the working world.
[Editor's note: We are pleased to be able to run this post by Dr. Kate Clancy that first appeared at Clancy's Scientific American blog, the wonderful Context and Variation. Clancy is an Assistant Professor of Anthropology at the University of Illinois. She studies the evolutionary medicine of women’s reproductive physiology, and blogs about her field, the evolution of human behavior and issues for women in science. You can follow her on Twitter--which we strongly recommend, particularly if you're interested in human behavior, evolutionary medicine, and ladybusiness--@KateClancy.]
Over the course of my training to become a biological anthropologist with a specialty in women’s reproductive ecology and life history theory, or ladybusiness expert, I have learned a lot about miscarriage. Only it wasn’t miscarriage, it was spontaneous abortion. Except that some didn’t like the term spontaneous abortion and used intrauterine mortality (Wood, 1994). Or fetal loss. Fetal loss is probably the most common.
There is also pregnancy loss (Holman and Wood, 2001). You can use that term, too. Oh, or aContinue reading →