Still in the Stone Age down under

Debate is heating up in Australia about the use of mifepristone (RU-486) for medical (as opposed to surgical) abortions. Tony Abbott, who is clearly highly qualified to have an opinion about (a) medicine (he has an Economics/Law double degree) and (b) women (he quite obviously isn’t one), has decided that he should be more cautious than the Australian Medical Association, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the World Health Organization and keep mifepristone off the shelves in Australia. Well, that’s his story, anyway. Unfortunately for Mr Abbott, people aren’t stupid and are quite able to see that his views on mifepristone are just thinly veiled anti-abortion views (which go hand in hand with his anti-stem cell research views).

All research and medical opinion points to mifepristone’s safety and efficacy in inducing termination, when combined with a prostaglandin analogue such as misoprostol (which is already available in Australia for other uses). From the reading I’ve done, I can’t see how medical abortion is any less safe than a spontaneous abortion. Both can lead to complications, such as incomplete abortion, which can be taken care of with medical help.

It’s insulting to doctors for Abbott to suggest that they would not be able to deal with the complications that can arise. If they can deal with a miscarriage, they can deal with a medical abortion too. And it’s insulting to suggest that they would prescribe mifepristone unwisely. Any doctor prescribing it would, of course, be there to deal with any adverse effects, same as they would be for any medication they prescribed. Rural doctors, in particular, should be offended at the implication that they can’t handle complications of pregnancy, when they can probably deal with them better than some over-specialised urban doctors. Should they be recommending that all female regional inhabitants relocate to cities for pregnancy care?

Abortion isn’t nice or pleasant but it’s a reality that some women find themselves facing for a variety of reasons. Whether the underlying cause is their own stupidity or the cruelty of rape, no woman should find herself facing the alternative of an unsafe abortion, or an unwanted pregnancy that will produce an unwanted child, who might never receive adequate care or love. And medical abortion makes it easier — some might say too easy, but I feel that the option needs to be there for women in remote areas, or from communities where abortion is not acceptable, and going to the doctor for a pill and pretending that you’ve had a miscarriage might be your only option.

It’s just mind-boggling that this decision is in the hands of one man who’s clearly biased, rather than where it belongs: in the hands of each individual woman.

Forward, march

It’s always tempting to do a ‘year in review’ type of article at this time of year. It’s not hard (especially after every other publication has done theirs). For example, science in 2005 can be summed up thus: embarrassing NASA failures; freakish meteorology; bird flu fears and cover-ups; evangelism masquerading as science; the rise, rise and fall of Woo Suk Hwang and his therapeutic cloning; and perhaps the only proud moment: the completion of the chimp genome.

Too easy. So of course I’ll have to put my foot in it and hazard a guess as to what might be the ‘year in review’ for 2006. Some of it’s easy because it’s just more of the same, really. Bird flu is only going to become a bigger problem, as is climate change. It would be nice to see some successes in space exploration. (It would be even nicer to put that kind of money into feeding the starving and AIDS prevention [for example], but you can’t have everything.) Physicists will keep nattering on about string and other things that I don’t pretend to understand (anyone care to calculate the trajectory of physics wooshing over my head?).

Apart from bird flu, obesity will probably be the most important health issue (unless there’s some other awful pandemic). Genomes, which are just so last century really, will continue to be superseded by proteomes and epigenomes. But I think there’s a very big missing link between genotype and phenotype that we’re just not getting, sort of like the dark matter of biology — the setbacks with cloning and the final figure of 96% similarity between the human and chimp genomes point to that. I’ll be surprised if 2006 is the year that solves that mystery, though. And I’m going to be optimistic and hope for a new stem cell hero.

I’m not particularly optimistic about climate. There are so many pitfalls to all the alternatives to oil (the destruction of forests in developing countries for biofuels, for example) that I think headway will only be made when it’s too late. It’s already too late, really.

Technology will probably keep moving along the lines of smaller, faster, and cuter, and as usual not spend too much time on actually being helpful.

Not too cheery overall. But one thing I can predict with confidence: like every year, there will be good bits and bad bits. Is the ratio even up to us? Who knows?

… the harder they fall

Hiding behind evolution’s victory in a Pennsylvania district court room this week is something that has the potential to become an even bigger embarrassment for science.

In August, Woo Suk Hwang was Korea’s “king of cloning” (New Scientist, 3 August 2005. And he wasn’t just the king of animal (or more specifically, Afghan hound) cloning; he was most famous for his success with human embryonic stell cells.

All that began to unravel last month when his American co-author Gerald Schatten announced that some of the eggs Hwang used for his experiments were donated by junior staff in his lab; a serious ethical breach (at least for Westerners; in South Korea the women were hailed as heroes rather than portrayed as victims). Hwang admitted to everything, resigned, and was hospitalised for stress.

As if that wasn’t bad enough, due to media pressure Hwang was forced to admit to Science, who published his last two ground-breaking papers, that some of his data was flawed. At first it seemed that the corrections he was making wouldn’t alter his findings, but last Friday (16 December), Hwang and his co-authors retracted their 2005 paper. Their 2004 article is now being re-examined too.

This whole chain of events erases scientists’ excitement over Hwang’s achievements and for him and his co-authors it is certainly a personal tragedy (albeit self-afflicted to some degree). And it must be a blow for anyone suffering one of the many diseases that may one day be cured by stem cell therapy. Christopher Reeve must be turning over in his grave. But there are deeper concerns for the broader scientific community; deeper than those caused by Luk Van Parijs’s falsifications in physics.

Stem cell research has always been stymied by the far right’s “moral” obligations, and by laypeople’s squeamish imaginations conjuring up pictures of humanoid fetuses being murdered and dissected (the embryos used are really just bundles of cells). But the uphill battle that Western stem cell researchers faced when trying to carry out their work was at least somewhat alleviated by the knowledge that the work was being done, albeit not by them. But Hwang has given his detractors the perfect ammunition: he didn’t follow ethical guidelines when obtaining the eggs crucial to his research, and he falsified his data. The conclusions they’ll draw: Hwang is a bad, bad man, and what’s more, his research didn’t even work. Extrapolate that out to all stem cell researchers and suddenly they’re all unethical and wastefully ineffectual.

Stem cell research, both fact and philosophy, is certainly worse off. If I’m right in assuming that at least some of the anti-stem cell mob are also part of the intelligent design mob, it’s not such a victory in Pennsylvania. It’s a 1-1 draw if we’re lucky.

Is it in our nature?

Although some of the events of the past week or so have made me want to go back to bed and hide under the covers (out of embarrassment and denial), it’s impossible not to write about the race riots at Cronulla.

There’s the cringe factor, wondering what the rest of the world must think of us (and how it will affect our relations with them). There’s the element of fear, that this kind of sentiment is what led to the Armenian Genocide, the Holocaust, and other race/creed-based genocides. The fear that until it’s over, there’s no way of knowing how far it will go.

But beyond that, I have to wonder why this kind of thing happens. Psychology of mob behaviour is complex, and it can cascade quite unbelievably: see Mass hysteria at Melbourne Airport. But I’m not just talking about the actions; I’m talking about what makes a neo-Nazi, a white supremacist, or even what motivates a teenage boy to write “we grew here, you flew here” in permanent marker on his chest.

A letter in last week’s New Scientist, Born to be good, made me think. The letter is about cooperative behaviour in animals and humans (if you want to make a distinction); the author believes that moral behaviour is behaviour that strengthens the group. Critically, he describes the hunter-gatherer mentality as “cooperative, comradely, compassionate and, if necessary, self-sacrificing, as well as hostile to outsiders [my emphasis]”. Xenophobia is so ubiquitous; it has caused so much bloodshed and has hardly helped civilisation as a whole. But what if it’s an evolved trait; something that’s in all of us, and the only variation is the degree to which we use our rationality to disarm it?

It’s not a happy thought. It might just be enough to really make me want to go back to bed.

Fluoride and the thought police

A naturopath I know recently sent me an article entitled Media Reports on Dangers of Fluoride in Your Water. I’ve had fascinating discussions with this woman in the past, which have included gems such as, “pathology tests are really just scientific experiments”.

Even if I usually expected better of her, a quick glance at the homepage would convince me not to take this article seriously. If you sign up for the site’s newsletter, you also get a “FREE must-read bonus report on “The Dangers of Grains and Sugars!” Funny, but I thought that grains and sugars contained something essential for our survival… oh yeah, energy. Clearly, functionality isn’t homoeopathic.

But back to the fluoride. As a much-needed brain exercise, I decided to go through the article and try and pick out the dubious points… without researching. With the internet, it’s too easy to find information, even reliable information. So, curbing my knee-jerk response to look up every health-related concept on NCBI, I tackled quackery at its best.

* Loaded language: before the end of the introduction, there are three loaded phrases used: “dangers of fluoride”; “terrible effects”; and “harm”.

* “Water fluoridation then spread across the United States despite concerns by respected doctors and scientists that adding it to public water supplies could cause serious health problems that would only become evident years later.” How prophetic of them. I wonder, also, if these doctors have names…

* “According to a 2001 study released by the Centers for Disease Control and Prevention (CDC), it was found that by age 12, kids who live in fluoridated communities averaged only 1.4 fewer cavities that those in non-fluoridated communities.” If this is true, it’s probably because the anti-fluoride lobby has succeeded in getting people to filter their water.

* Under the heading “Dental Fluorosis Running Rampant”, Mesquita makes use of the dodgiest statistics I’ve ever seen: he decides that of the 32% of US children that have some form of fluorosis, all of these must come from cities where the water is artificially fluoridated. He uses this assumption to increase the percentage from 32% to 53%, conveniently forgetting all other factors that could cause fluorosis in other cities (too much toothpaste? Fluoride happy dentists? Naturally occurring fluoride?).

* “A 1991 study by the U.S. Public Health Service found a strong link between fluoride exposure and bone cancer in boys. They found there was a 79 percent increase in osteosarcoma in fluoridated communities and a 4 percent decrease in non-fluoridated communities.” I wonder what made the non-fluoridated communities have a decrease in bone cancer? There must be some other factors here, even if these statistics were true (see below).

* Apparently 50% of ingested fluoride is deposited in your bones. I’d like to know how they determine this kind of thing. I don’t think I’d like to be part of the study… sounds painful. Also, fluoride not only causes bone cells to grow, it also causes them to mutate. Multi-talented little ion really.

* Apparently the FDA requires warning labels on toothpaste stating that if more than used for brushing is accidentally swallowed, one should seek medical advice. Of course, nowhere in the article do they mention how much fluoride is found in toothpaste and whether this is more or less (I’m suspecting A LOT more) than is found in water.

* At the end of the article there’s an advertisement (well, that’s what it looks like to me) from the owner of the website, for a water testing company — he helped them develop their product. Can anyone spell conflict of interest?

* This article has no references, and even the studies and “facts” referred to within the text would be difficult to find without an extensive search, because no author’s name is given. There’s no accountability, which is obviously the way this kind of writer likes it. You’re not meant to think about it, you’re just meant to be scared and above all, buy their product. So if the facts are faked and the statistics are dubious, hopefully you won’t notice until it’s too late (if at all).

Well, that’s as much as I could think of off the top of my head. Now for some research.

According to Quackwatch, fluoride use was much better investigated and researched than Mesquita would have you believe. It was first studied by comparing the dental hygiene in different cities; eventually naturally occurring fluoride was found to improve dental hygiene (Peterson J. J Hist Dent. 1997 45:57-61). The ideal amount of fluoride in water was found to be one part per million (ppm).

Addition of fluoride to water supplies was tested much more broadly than the Mesquita article mentions; 21 cities in four US states, not just two states, were studied before the concept was rolled out to other states and countries (Dean HT. Nutrition. 1990 6:435-445).

The article claims that in 2001, the Centers for Disease Control and Prevention (CDC) found that fluoridation of water only marginally decreased the amount of cavities in 12-year-old children; but in the same year the CDC continued to recommend use of fluoride toothpaste and water fluoridation (MMWR Recomm Rep. 2001 50(RR-14):1-42). Mesquitea also claims that fluoridation of water increases fluorosis (MeSH definition); but a 2002 study showed that children in areas where fluoride occurs naturally in water were more likely to suffer fluorosis, due to the higher amounts that can occur in the water (Beltran-Aguilar ED et al. J Am Dent Assoc. 2002 133:157-165). According to Mequita, 84% of the population in places with over 3.7 ppm fluoride have fluorosis; he doesn’t mention that no city would ever add that much, since 1 ppm was found to be optimal; higher amounts are due to naturally occurring fluoride.

I couldn’t find a study from 1991 that showed a link between fluoride and bone cancer; however I found a couple from 1991 that said there was no link (McGuire SM et al. J Am Dent Assoc. 1991 122:38-45; Mahoney MC et al. Am J Public Health. 1991 81:475-479). A more recent review concurred (Cook-Mozaffari P. Community Dent Health. 1996 13 Suppl 2:56-62.)

My conclusions: I’ll keep drinking fluoridated water, and be glad I’ve got it (and a brain to suss out what’s what).