Mariette DiChristina

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 Editor Jeanne 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.


Also on Double X Science

More about Mariette DiChristina

Mariette DiChristina oversees Scientific American Continue reading

Double Xpression: Meghan Groome

Meghan Groome, PhD, Director of K12 Education and Science & the City, New York Academy of Sciences
[Ed. note: Double X Science has started a 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 Meghan Groome, PhD, New York Academy of SciencesDirector of K12 Education and Science & The City, who answered our questions via email with DXS Biology Editor Jeanne Garbarino.

DXS: First, can you give me a quick overview of what your scientific background is and your current connection to science?

MG: I was a bio major since age two. Growing up (and still today) I had a deep love of all things gross, icky, creepy, and crawly and a deep dislike of anything math related. My parents didn’t really know what to do with me, so a theme to my scientific background is that although I was a straight-A student in my bio classes, no one had any idea that I should be doing enrichment programs or making an effort to learn math. I figured that by being a great bio major, I would become a great scientist. So I was an excellent consumer of scientific knowledge but only realized late in life that I needed to be a producer to actually become a scientist.

Being a straight-A student doesn’t actually get you a job when you graduate from a small liberal arts college with a degree in biology and theater, and out of desperation, I took a job teaching. While I wasn’t a good scientist, I turned out to be an excellent teacher and loved the creativity, energy, and never-ending questions that go along with being a science teacher. If you teach from the perspective that science is an endless quest for knowledge, you’ll never get bored taking kids on that journey.

While my background is in biology, my graduate degree is in science education, and I study gender dynamics and student questioning the middle-school classrooms. I currently work for the New York Academy of Sciences as the Director of K12 Education and public programs and spend most of my day convincing scientists that education outreach is not only part of their jobs but a lot of fun.

DXS: What ways do you express yourself creatively that may not have a single thing to do with science?

MG: I’m also a photographer and spend a lot of time wandering around neighborhoods in Brooklyn with a special love of decaying buildings and empty lots. I love how nature conquers things that we humans consider to be permanent – like how we have to constantly beat back the invading hordes of plants and animals even in one of the most man-made environments in the world.

I was also a theater major, so (I) have a strong background in costume design and stage directing. I hate acting but love dance. If I had any talent I would have become a musical theater star but unfortunately enthusiasm and determination can only get you so far.

DXS: Do you find that your scientific background informs your creativity, even though what you do may not specifically be scientific?

MG: I find great joy in seeing how nature conquers human engineering. When I learned about Lynn Margulis’ Gaia hypothesis, I began seeing it everywhere and I think I love photography because I’m documenting the Earth fighting back.

Most of my creative energy comes from working with kids and listening to the wonderful way in which they think about the natural world. Adults can be so rigid in their thinking and are often afraid to say ideas that are out of the mainstream thinking. The older a kid gets, the more we expect them to conform to the adult way of thinking. Middle-school kids are old enough to express their wacky ideas, and young enough to not recognize that their ideas are considered “wrong.”

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?

MG: People tell me all the time “You’re not what we expected” and I’m not really sure how to respond.

In the science education world, my research is informed by my experiences teaching in a very poor district and from a social justice perspective. It’s a rather controversial theoretical framework because it says, “I have an agenda to use my research to bring about equity in an unequal world.” From a research perspective, it means you need to be explicit in your point of view and your biases and have much greater validity and reliability to show that your research is solid. My work is very passion driven so I’ve had to learn when it’s appropriate to pull out my soap box and go full-out social justice to them.

This is changing, but for a long time I kept my personality under wraps in a professional setting. It’s only now — with 10 years professional experience, great organizations on my resume, and a PhD — that I can be clever, confront those I disagree with, and even smile. Anyone who’s ever had a beer with me knows that I’m a goofball and will do just about anything to make someone laugh. I’m a science person, a theater person, a teacher, researcher, policy maker, consultant, and have seen a lot of exquisitely bad and good stuff in my life and so I am frequently the voice of an outsider even though I look and sound like a total insider. That can really freak people out especially if they’ve only read my bio or seen me in my most professional mode.
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?

MG: I approach teaching science from a fairly theatrical perspective. In my class we dance, sing, laugh, talk about the real world. I’ve never used the textbook, and I’m very insistent that everything be in the first person when writing or speaking about science. I much prefer teaching regular classes — not honors or AP — and can’t stand kids who remind me of myself in high school.

I approach scientists in the same way and try to make them comfortable admitting that their more than a brain on a stick. I’ve found one of the biggest fears of young scientists is that their PI will find out that they’re interested in something more than life in the lab so I always try to work within the existing power structure and make sure the PIs and Deans indicate to them that working with the (New York) Academy (of Sciences) is okay.

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?

MG: This question confounds the heck out of me. I am still such a tomboy and have always chosen to present myself as a somewhat genderless individual. I’ve always considered myself “smart not pretty” because I can control how smart I am but not how pretty. A few years ago, my sisters pulled me aside and told me I needed to stop dressing like such a slob. They started buying me pretty, fashionable clothes and insisting that I wear skirts above the knee and get a real hair cut.

Since I started working at the Academy, I have a very public facing role and have grown to accept that I should look nice. This goes along with slowly feeling comfortable letting my personality out in professional settings but I still consider myself a tomboy and consider my outward appearance to be a costume designed to do a job.

So I guess the answer is, femininity, what femininity?

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?

MG: I think very few people are brains on a stick but that being a scientist often requires us to pretend we have no life outside the lab. I’ve now worked with hundreds of young scientists who spend time working with kids and I’m so pleased to see how quickly they shift from lab geek to real person when talking with a 4th grader. I want scientists to be evangelicals for science, and I want that to include the fact that scientists are real, fallible, wacky, wonderful people too.

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?

MG: I was always encouraged to be an individual and be myself. I credit my parents with allowing me to pursue my passion and not try to box me in to one identity. It’s never been easy to forge my own path, and I dedicate a lot of myself to my work.

My advice to my younger self would be to slow down a bit, know that you don’t have to get 100% on everything, and know that the problems of the world don’t have to be solved right now.

And perhaps to learn how to be a bit more like a girl. It’s incredibly powerful to see yourself as smart and pretty.


———————————————————————
Meghan Groome is the Director of K12 Education and Science & the City at the New York Academy of Sciences, an organization with the mission to advance scientific research and knowledge, support scientific literacy, and promote the resolution of society’s global challenges through science-based solutions. After graduating from Colorado College in Biology and Theatre, she desperately needed a job and took one as a substitute teacher at a middle school in Ridgewood, NJ. She discovered that she had a knack for making science interesting and enjoyable, mostly through bringing in gross things, lighting things on fire (but always in a safe manner), and having a large library of the world’s best science writing and science fiction. After teaching in both Ridgewood and Paterson, NJ, she completed her PhD at Teachers College (TC) Columbia University with a focus on student question-asking in the classroom. While at TC, she was a founding member of an international education consulting firm and worked on projects from Kenya to Jordan with a focus on designing new schools and school systems in the developing world. 

After graduating, Dr. Groome became a Senior Policy Analyst at the National Governors Association on Governor Janet Napolitano’s Innovation America Initiative. Prior to her work at the Academy, Dr. Groome worked at the American Museum of Natural History and authored the policy roadmap for the Empire State STEM Education Network and taught urban biodiversity in the Education Department. At the Academy, she is responsible for the Afterschool STEM Mentoring program, which places graduate students and postdocs in the City’s afterschool programs, and the Science Teacher program, where she designs field trips and content talks to the City’s STEM teachers. Connect with her on Twitter, and read her NYAS blog!

Oocytelarge

Old ovaries, new eggs? Hatching a debate

Can adult women make new oocytes? 

by Sarah C.P. Williams      

For decades, biology textbooks have stated this as fact: “Women are born with all the eggs, or oocytes they will ever have.”1 The assumption — which shapes research on infertility and developmental biology, as well as women’s mindsets about their biological clocks — is that as women age, they use up those reserves they are born with. With each menstrual cycle, egg by egg, the stockpile wears down.

But is it true that women can’t produce any new oocytes in their adult life? Over the past decade, some scientists have begun to question the long-held assumption, publishing evidence that they can isolate egg-producing stem cells from adult human ovaries.

Last week, biologist Allan Spradling of the Howard Hughes Medical Institute and Carnegie Institution for Science, cast a shadow over those findings with a new analysis of the ovaries of adult female mice, which have similar reproductive systems to humans. By his measures of new egg formation, which he has previously studied and characterized during fetal development, there were no signs of activity in the adults.

“Personally, I think it’s quite clear,” says Spradling. “All the evidence has always said this. When oocyte development is going on, you see cysts everywhere. When you look at adults, you don’t see any.”

An oocyte, or egg cell, surrounded by some supporting cells.

The new paper does little to change the direction of those researchers already pursuing the stem cells, though. Jonathan Tilly of Massachusetts General Hospital was among the first to publish evidence that mice and human females have adult germ-line stem cells that can make new eggs.

“There’s so much evidence now from so many labs that have purified these cells and worked with these cells,” says Tilly. “What I don’t find of value is to say these cells don’t exist.”

For now, the two sides remain fractured — Spradling sees weaknesses in the way Tilly and others have isolated cells from the ovaries and suspects that the properties of the cells could change when they’re outside the body. And Tilly proposes that Spradling’s new data could be interpreted in a different way that in fact supports the presence of stem cells.

For women hoping for a scientific breakthrough to treat infertility — or even those simply curious about how their own body works — a consensus on the answer would be nice. But the continued probing on both sides may be just as much a boon to women’s health. After all, it’s questions like these that drive science forward.

In his new study, Spradling labeled a spattering of cells in the ovaries of female mice with fluorescent markers to make them visible and watched them as the mice aged. If any labeled cells were egg-producing stem cells, he says, they would spread the fluorescence as they made clusters of new eggs.

“But you never see clusters,” Spradling says. “Not once.”

In the process of this study, though, Spradling made new observations about how egg cells develop into their final form in female mice, published in a second paper this month. As the precursor cells to eggs mature, they lump together into cysts, a phenomenon also seen in the flies that Spradling has spent decades studying. In flies, one cyst eventually forms one egg. But in the mice, he discovered, those cysts break apart and form multiple eggs.

“This actually leads us to propose a new mechanism for what determines the number of oocytes,” says Spradling.  And, of course, that means a better understanding of reproductive biology.

On the side of those who are confident about the existence of adult ovarian stem cells, the field of fertility medicine could be revolutionized if the cells that Tilly has isolated from ovaries can form healthy egg cells that can be fertilized in vitro. These stem cells could also be a tool to study more basic questions on oocyte development and formation or a screening platform for fertility drugs. Tilly is confident enough in the research that he has founded a company, OvaScience, to pursue the commercial and clinical potential of isolating the stem cells.

“The value for the lay public is that we have a new tool in our arsenal,” says Tilly.

Spradling doesn’t argue that continued research in this area isn’t a good thing. “Scientific knowledge doesn’t just come from the proposal of ideas, but also from their rigorous tests,” he says. “I think the most powerful tool we have in medical science is basic research,” he adds, referencing research using cell and animal studies. Investigations of the basics of how and when oocytes form, he says, are the best way forward toward developing ways to improve egg cell formation or development and could even lead to infertility treatments.

So if it finds support from further studies, Spradling’s new work — which states bluntly right in its title that “Female mice lack adult germ-line stem cells” — needn’t be seen as bad news for those dreaming of a breakthrough in understanding fertility. Instead, whether or not egg stem cells end up having clinical value, it’s a step forward in advancing understanding about women’s reproductive biology.

As Spradling puts it: “You have a much better chance of actually helping someone with infertility if you know what the real biology is. Right now, we’re a ways from really understanding the full biology, but we’re making progress.”

1 Direct quote from the third edition of “Human Physiology: An Integrated Approach”, one published by Pearson Education in 2004 and used in medical school classes.  Continue reading

Pertussis: Get the vax or at least listen to why you should

by Tara Haelle, DXS contributor

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.


Because of the danger to public health when clusters of kids are not vaccinated, my personal opinion on this issue is that “personal belief” exemptions should not be offered in any state, and religious exemptions should be extremely difficult to get, if they are offered at all (which may be the best overall route). Some cite the Amish, Mennonite and Christian Scientists, though actually the majority of Amish children, at least, are vaccinated, and it doesn’t appear that any Amish objections to vaccines are for religious reasons. Christian Scientists have successfully been convicted of neglect in other incidents where their children died from inadequate medical care, though their religion is the only one I’m aware of that vaccination actually, explicitly violates. 

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.]

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).

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.