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Mind: When All You Have Left Is Your Pride
By BENEDICT CAREY, The New York Times, April 7, 2009
Look around you. On the train platform, at the bus stop, in the car pool lane: these days someone there is probably faking it, maintaining a job routine without having a job to go to.
The Wall Street type in suspenders, with his bulging briefcase; the woman in pearls, thumbing her BlackBerry; the builder in his work boots and tool belt — they could all be headed for the same coffee shop, or bar, for the day.
“I have a new client, a laid-off lawyer, who’s commuting in every day — to his Starbucks,” said Robert C. Chope, a professor of counseling at San Francisco State University and president of the employment division of the American Counseling Association. “He gets dressed up, meets with colleagues, networks; he calls it his Western White House. I have encouraged him to keep his routine.”
The fine art of keeping up appearances may seem shallow and deceitful, the very embodiment of denial. But many psychologists beg to differ.
To the extent that it sustains good habits and reflects personal pride, they say, this kind of play-acting can be an extremely effective social strategy, especially in uncertain times.
“If showing pride in these kinds of situations was always maladaptive, then why would people do it so often?” said David DeSteno, a psychologist at Northeastern University in Boston. “But people do, of course, and we are finding that pride is centrally important not just for surviving physical danger but for thriving in difficult social circumstances, in ways that are not at all obvious.”
For most of its existence, the field of psychology ignored pride as a fundamental social emotion. It was thought to be too marginal, too individually variable, compared with basic visceral expressions of fear, disgust, sadness or joy. Moreover, it can mean different things in different cultures.
But recent research by Jessica L. Tracy of the University of British Columbia and Richard W. Robins of the University of California, Davis, has shown that the expressions associated with pride in Western society — most commonly a slight smile and head tilt, with hands on the hips or raised high — are nearly identical across cultures. Children first experience pride about age 2 ½, studies suggest, and recognize it by age 4.
It’s not a simple matter of imitation, either. In a 2008 study, Dr. Tracy and David Matsumoto, a psychologist at San Francisco State, analyzed spontaneous responses to winning or losing a judo match during the 2004 Olympic and Paralympic games. They found that expressions of pride after a victory were similar for athletes from 37 nations, including for 53 blind competitors, many of them blind from birth.
“It’s a self-conscious emotion, reflecting how you feel about yourself, and it has this important social component,” Dr. Tracy said. “It’s the strongest status signal we know of among the emotions; stronger than a happy expression, contentment, anything.”
In one continuing experiment, Dr. Tracy, along with Azim Shariff, a doctoral student at British Columbia, have found that people tend to associate an expression of pride with high status — even when they know that the person wearing it is low on the ladder. In their study, participants impulsively assigned higher status to a prideful water boy than to a team captain who looked ashamed.
The implications of this are hard to exaggerate. Researchers tend to split pride into at least two broad categories. So-called authentic pride flows from real accomplishments, like raising a difficult child, starting a company or rebuilding an engine. Hubristic pride, as Dr. Tracy calls it, is closer to arrogance or narcissism, pride without substantial foundation. The act of putting on a good face may draw on elements of both.
But no one can tell the difference from the outside. Expressions of pride, whatever their source, look the same. “So as long as you’re a decent actor, and people don’t know too much about your situation, all systems are go,” said Lisa A. Williams, a doctoral candidate in psychology at Northeastern University.
The various flavors of pride may even feel similar on the inside, when the stakes are high enough. “She was always scrupulous about keeping up appearances to herself,” wrote Edith Wharton of her tragic heroine Lily Bart in “The House of Mirth.” “Her personal fastidiousness had a moral equivalent, and when she made a tour of inspection in her own mind there were certain closed doors she did not open.” If you believe it, so will they.
A feeling of pride, when it’s convincing, acts something like an emotional magnet. In a recent study, Ms. Williams and Dr. DeSteno of Northeastern had a group of 62 undergraduates take tests supposedly measuring their spatial I.Q. The patterns flashed by too fast for anyone to truly know how well they did.
The researchers manipulated the amount of pride each participant felt in his or her score. They either said nothing about the score; remarked, in a matter-of-fact tone, that it was one of the best scores they had seen; or gushed that the person’s performance was wonderful, about as good as they had ever seen.
The participants then sat down in a group to solve similar puzzles. Sure enough, the students who had been warmly encouraged reported feeling more pride than the others. But they also struck their partners in the group exercise as being both more dominant and more likable than those who did not have the inner glow of self-approval. The participants, whether they had been buttered up or not, were completely unaware of this effect on the group dynamics.
“We wondered at the beginning whether these people were going to come across as arrogant jerks,” Dr. DeSteno said. “Well, no, just the opposite; they were seen as dominant but also likable. That’s not a combination we expected.”
Therapists say that in time, people usually do better when they come clean. “In some ways it’s easier to do this now, with so many people out of work,” said Michael C. Lazarchick, an employment counselor in southern New Jersey. “You may very well find out that others are going through the same thing, or something like it — ‘Oh yeah, I just took a big cut in pay.’ ”
But in the short term, projecting pride may do more than help manage others’ impressions. Psychologists have found that wearing a sad or happy face can have a top-down effect on how a person feels: Smile and you may feel fleetingly happier. The same most likely is true for an expression of pride. In a 2008 study, the Northeastern researchers found that inducing a feeling of pride in people solving spatial puzzles motivated them to try harder when they tackled the next round.
Pride, in short, begets perseverance. All of which may explain why, when the repo man is at the door, people so often remind themselves that they still have theirs, and that it’s worth something. Because they do, and because it is.
However much pride may go before a fall, it may be far more useful after one.
Answering Baseball’s What-Ifs
By ALAN SCHWARZ, The New York Times, April 7, 2009
You can learn a lot during a major league baseball game. Like Ukrainian, if it is a particularly slow nine innings.
As for the science of baseball strategy, one game teaches precious little. A well-timed sacrifice bunt can backfire and lose the game; a foolish steal can appear brilliant. The vagaries of randomness — the way Sandy Koufax got battered occasionally and a pipsqueak named Bucky Dent hit one of the most famous home runs ever — camouflage the game’s inner forces, which for 150 years have operated somewhere between fact and fable.
One game has little meaning. A thousand seasons can take a while. Thank goodness for quad-core processors.
“Computer simulations work pretty well in baseball for two reasons,” said Carl Morris, a professor of statistics at Harvard University who has written several papers that commingled baseball and formal statistical theory. “In general, they allow you to study fairly complicated processes that you can’t really get at with pure mathematics. But also, sports are great for simulations — you can play 10,000 seasons overnight.”
No one can afford to wait less than major league teams, which crave every extra run or victory they can wring from their $100 million rosters. John Abbamondi, the assistant general manager for the St. Louis Cardinals, says his team and about 10 others use simulations to evaluate potential trades and how they might affect the pennant race.
“It’s all part of the statistical analysis that complements the more traditional scouting we do,” he said.
Using computer simulations to explore in-game and other baseball strategies is by no means new. As early as 1958, a professor at the Massachusetts Institute of Technology programmed a behemoth I.B.M. 704 mainframe to investigate whether the sacrifice bunt was a smart play. (More on that later.) Simulators have since grown so complex that the most sophisticated one available to the public, called Diamond Mind, not only runs lickety-split on laptops but even considers minutiae like the effects of wind in individual ballparks.
Under what conditions is bunting advantageous? When does trying to steal make sense, and when does it decrease the chances of scoring? Questions like these turn out to be ideally suited to computer programs through which millions of iterations can smooth out the peaks and valleys of randomness, and converge toward a reliable approximation.
Known among formal statisticians as the Monte Carlo method, this approach takes spectacularly complex phenomena like weather patterns and stock performance and allows their behavior to be approximated, if not determined.
What are the chances of winning a game of solitaire? Rather than writing an equation that tries to take into account the trillions of trillions of possible hands and moves, a statistician can run a computer program that simply plays the game a few million times in minutes to see how often it wins. Dr. Morris says he has seen the Monte Carlo method used to improve computer graphics and explore gene sequences.
Like such competitors as Strat-O-Matic — which made its debut in 1961 with at-bats determined by cards and dice, and remains popular on the personal computer — Diamond Mind is designed to allow fans to play fictional games and seasons, exploring what-if scenarios that real life would be too slow and controversial to allow.
Take the age-old question of how much difference a team’s lineup order makes. This issue so vexed the former manager Billy Martin that he once literally picked his Detroit Tigers batting order out of a hat.
Luke Kraemer of Imagine Sports, which owns Diamond Mind, programmed the simulator to force the 2008 Yankees to bat their best hitter and cleanup man, Alex Rodriguez, ninth — to see how scoring was affected. Mr. Kraemer got the run total not for just one season, which can fluctuate as much as 80 runs in each direction from simple randomness, but for 100 seasons — more than 16,000 Yankees games in all.
The result? The Yankees scored 747 runs per season, 40 fewer than their real-life 787. (Diamond Mind was so accurate that 100 seasons with A-Rod batting fourth averaged 789, almost dead-on.) Most research suggests that those 40 runs would mean only about four fewer victories, for a strategy no manager would ever consider; so the difference with Rodriguez batting third or fifth would be insignificant, and nowhere near worth the forests of trees that would give their lives to the ensuing sports-page debate.
Diamond Mind took its cuts at several other baseball knucklers, running 100 full seasons of games for each:
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The intentional walk. This frequently used defensive strategy avoids dangerous hitters and can set up a double play, but it also awards a free base, and even the best hitters usually make an out. So is it smart in the long run? Diamond Mind found that it was not, though the difference was only about five runs per team per season.
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The stolen base. Advancing from first to second puts the runner in scoring position, but he — and the rest of your hitters — will have a hard time scoring if he gets thrown out. Mr. Kraemer looked at a recent team that ran wild (the 2008 Tampa Bay Rays) and one that barely stole at all (the 2005 Oakland A’s) and switched their mind-sets to see what happened. The A’s scored 20 runs fewer, which probably says more about their players’ inability to run in the first place. But when the speedy Rays stole sparingly, they increased their scoring by 47 runs per season — suggesting that perhaps the Rays were running too often in real life.
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The sacrifice bunt. Is it worth making an out intentionally to move a runner from first to second? Forcing a team that hated that maneuver (the 2005 Boston Red Sox) to do it a lot cost them 19 runs per season. But making a bunting team (the 2008 New York Mets) avoid it also cost them — by 15 runs on average — suggesting that the Mets’ managers, Willie Randolph and Jerry Manuel, used it quite intelligently. (The 1958 M.I.T. statisticians found that the sacrifice was rarely a good move; major league managers paid little attention.)
One problem with computer simulations is that no matter how realistically they might be programmed, they can say more about the programmer than baseball itself. A computer, after all, cannot feel human emotions like pressure or the will to hit in the clutch.
“We can run the experiment in the simulation environment and think we’re measuring the effect of a great defense on a pitching staff, but it might tell us more about how we modeled defense,” said Tom Tippett, who wrote the original Diamond Mind code in the early 1980s. “The simulation is real close to real-life baseball, but in the end it isn’t real-life baseball.”
After developing Diamond Mind into the industry standard, Mr. Tippett was hired a few years ago by the Boston Red Sox — a sign of how much some teams have come to value simulation research. While none will discuss exactly what they model and how, Mr. Abbamondi, of the Cardinals, said they could provide objective insight into how an offense might be affected by trading for a hitter in midseason; how many games that might improve the team; and how that hitter might improve or deteriorate as he ages. Many of these measurements come in the form of scenarios of increasing uncertainty, not unlike the projection of hurricane paths.
As Mr. Tippett suggested, however, simulations have inherent limits, and probably will not ever model baseball’s vicissitudes of fate — how scrubs morph into all-stars and some teams just collapse. (Indeed, fans of the recent New York Mets would be relieved that some things defy re-creation.) Tony La Russa, the Cardinals’ manager, who is a sure bet for the Hall of Fame, said the value of computer simulations in baseball tended to stop at the dugout entrance.
“There’s way too much importance given to what you can produce from a machine,” he said. “These are human beings, and I don’t think any computer is going to model that close to what we deal with at this level.”
That can be as true now as it was 25 years ago, when a Tank McNamara cartoon captured it best. A downtrodden manager peered over his computer. He asked plaintively, “But will it take the blame?”
Empire State Building Plans Environmental Retrofit
By MIREYA NAVARRO, The New York Times, April 7, 2009
Once the world’s tallest building, the Empire State Building is striving for another milestone: It is going green.
Owners of the New York City landmark announced on Monday that they will be beginning a renovation this summer expected to reduce the skyscraper’s energy use by 38 percent a year by 2013, at an annual savings of $4.4 million. The retrofit project will add $20 million to the $500 million building makeover already under way that aims to attract larger corporate occupants at higher rents.
Although the retrofit was specifically designed for the Art Deco office building at 34th Street and Fifth Avenue and its enormous features — 102 stories, 2.6 million square feet, 6,500 windows and 73 elevators — the energy-efficiency improvements are meant to serve as a model for other office buildings around the world, said Anthony E. Malkin, president of Wien & Malkin, which supervises the building on behalf of the owners, the Malkin family and the Helmsley estate.
He said upfront costs are often a deterrent for retrofitting older buildings, but the energy savings for the building , built in 1931, are expected to pay back those costs in only about three years.
“People associate greening with expense and compromise,” Mr. Malkin said. “We’re trying to prove: no compromise and payback.”
Mr. Malkin announced the details of the project at a news conference attended by Mayor Michael R. Bloomberg, who has made sustainability a theme of his administration, and former President Bill Clinton, whose Clinton Climate Initiative program, which works with cities to develop large scale energy efficiency programs, helped facilitate the project.
People involved with the retrofit said the Empire State Building can offer an example of how older buildings can retrofit to the highest energy standards and effectively cut down their greenhouse gas emissions, a contributor to global warming. The largest share of New York City’s greenhouse gas emissions, 78 percent, comes from the city’s buildings, with commercial buildings contributing 25 percent, mostly from the use of electricity and natural gas.
By reducing energy use, the retrofit plan envisions cutting down the pollution the Empire State Building produces by 105,000 metric tons of carbon dioxide emissions a year, although the number of emissions currently emitted was not immediately available.
“They’re showing the rest of the city that existing buildings, no matter how tall they are, no matter how old they are, can take steps to significantly reduce their energy consumption,” Mr. Bloomberg said.
The largest energy guzzlers at the Empire State Building are lighting, cooling and heating, said Paul Rode, a project executive with Johnson Controls, the retrofit designer. The building has 302 office tenants but is occupied by about 13,000 people a day, including visitors to the observatories on the 86th and 102nd floors that are open to the public 18 hours a day, seven days a week.
The designers said that about half the reduction in energy use will be achieved in the first two years of the project as they retrofit the double hung operable windows, insulate behind radiators and rebuild chillers in the cooling plant in the basement.
To avoid transportation-related pollution, the windows will be redone on site, by adding a layer of coated film between two glass panes to increase insulation. at a rate of 50 windows a day.
In all, the retrofit consists of eight projects, including upgrades to the electrical and ventilation systems and installation of sophisticated electronic instrumentation.
The biggest challenge in planning the project, Mr. Rode said, was to figure out what was behind the walls and the ceilings of the 78-year-old skyscraper — in the absence of original drawings and specifications.
“It took a lot of investigative work,” Mr. Rode said.
The plan also calls for tenants’ involvement in monitoring their own energy use in their offices through a Web-based dashboard accessible from their computers, which keeps track of how much energy is being used and where.
Some tenants are already ahead of their landlord. Skanska, a Swedish construction company that took over the 32nd floor in November with 80 employees, renovated its 24,400 square feet of office space to green standards like daylight sensors to conserve energy and dual-flush toilets to avoid wasting water.
The company, which says it has cut its electric bill by one-third with the improvements, is seeking platinum certification, the highest level awarded by the United States Green Building Council, which certifies buildings and commercial interiors for energy, water efficiency and other green features.
The federal Environmental Protection Agency rates buildings for energy efficiency under its Energy Star program, and 6,200 commercial and institutional buildings have earned the label by achieving 30 to 40 percent greater efficiency than their peers. The Empire State Building is expected to fall in the top 10 percent of Energy Star office buildings when its renovation is completed, the project designers said.
While the energy-saving improvements will be substantial, no one visiting the building is very likely to notice them — most involve slight changes or will be hidden in the building’s innards. The night lighting that makes the building a distinctive part of the city’s skyline represents a small draw of energy during off-peak hours and will continue without changes, Mr. Malkin said.
He said the green features will be highlighted for visitors as an educational tool, and tenants may also see a mark-up on rents because of the desirability of green features.
Jacques Catafago, president of the Empire State Building Tenants Association, called making the building more energy-efficient “a laudable effort” but said that rent increases were a concern. Mr. Catafago, a lawyer whose firm has been in the building since 1990, said that “34th Street is not 57th Street — the rents are very reasonable here.”
But Mr. Malkin said he was looking at the larger goal.
“If we don’t change our unsustainable practices and the amount of energy we consume, if we don’t make our city more efficient, we’re toast,” he said. “We won’t be able to avoid the sort of changes that would spell a reduced quality of life.”
DNA Test Outperforms Pap Smear
By DONALD G. McNEIL Jr., The New York Times, April 7, 2009
A new DNA test for the virus that causes cervical cancer does so much better than current methods that some gynecologists hope it will eventually replace the Pap smear in wealthy countries and cruder tests in poor ones.
Not only could the new test for human papillomavirus, or HPV, save lives; scientists say that women over 30 could drop annual Pap smears and instead have the DNA test just once every 3, 5 or even 10 years, depending on which expert is asked.
Their optimism is based on an eight-year study of 130,000 women in India financed by the Bill and Melinda Gates Foundation and published last week in The New England Journal of Medicine. It is the first to show that a single screening with the DNA test beats all other methods at preventing advanced cancer and death.
The study is “another nail in the coffin” for Pap smears, which will “soon be of mainly historical interest,” said Dr. Paul D. Blumenthal, a professor of gynecology at Stanford medical school who has tested screening techniques in Africa and Asia and was not involved in the study.
But whether the new test is adopted will depend on many factors, including hesitation by gynecologists to abandon Pap smears, which have been remarkably effective. Cervical cancer was a leading cause of death for American women in the 1950s; it now kills fewer than 4,000 a year.
In poor and middle-income countries, where the cancer kills more than 250,000 women a year, cost is a factor, but the test’s maker, Qiagen, with financing from the Gates Foundation, has developed a $5 version and the price could go lower with enough orders, the company said.
“The implications of the findings of this trial are immediate and global,” Dr. Mark Schiffman of the National Cancer Institute wrote in an editorial accompanying the study. “International experts in cervical cancer prevention should now adopt HPV testing.”
At the moment, there are huge gaps in how rich and poor countries screen.
In the West, women get smears named for their inventor, Dr. Georgios Papanikolaou. Cells are scraped from the cervix and sent to a laboratory, where they are stained and inspected under a microscope by a pathologist looking for abnormalities. Results may take several days.
The DNA screen also needs a cervical scraping, but it is mixed with re-agents and read by a machine.
In poor countries, most women get no routine screening. Pain sends them to a hospital, by which time it is often too late.
But in some countries, women get “visualization,” pioneered in the last decade, also with Gates Foundation support: a health worker looks at the cervix with a flashlight and swabs it with vinegar. Spots that turn white may be precancerous lesions, and are immediately frozen off. Diagnosis and treatment take only one visit.
Pap smears fail in the third world because there are too few trained pathologists and because women told to return often cannot.
The Indian study, begun in 1999, divided 131,746 healthy women ages 30 to 59 from 497 villages into four groups. One group, the control, got typical rural clinic care: advice to go to a hospital if they wanted screening. The second got Pap smears, the third got flashlight-vinegar visualization, and the fourth got a DNA test, then made by Digene, which is now owned by Qiagen. The company did not pay for or donate to the study, its authors said.
After eight years, the visualization group had about the same rates of advanced cancer and death as the control group. The Pap-smear group had about three-fourths the rates, and the DNA test had about half.
Significantly, none of the women who were negative on their DNA test died of cervical cancer. “So if you have a negative test, you’re good to go for several years,” Dr. Blumenthal said.
The study’s chief author, Dr. Rengaswamy Sankaranarayanan of the International Agency for Research on Cancer in Lyon, France, said, “With this test, you could start screening women at 30 and do it once every 10 years.”
Asked whether that advice would apply in the United States, Debbie Salsow, director of gynecologic cancer for the American Cancer Society, replied, “Absolutely no.”
“A negative test would mean a woman’s chances of developing cancer are small, but not zero,” she added. “But if he’d said five years, I wouldn’t have a strong reaction.”
Since 1987, she said, the cancer society and the American College of Obstetricians and Gynecologists have recommended Pap smears only every three years after initial negative ones. In 2002, they recommended the HPV test too, and evidence is mounting that the Pap smear can be dropped.
“But we haven’t been able to get doctors to go along,” Dr. Salsow said. “The average gynecologist, especially the older ones, says, ‘Women come in for their Pap smear, and that’s how we get them in here to get other care.’ We’re totally overscreening, but when you’ve been telling everyone for 40 years to get an annual Pap smear, it’s hard to change.”
Dr. Sankaranarayanan said most European countries screen every three to five years, and many do not start before age 30.
Cervical cancer is caused by a few of the 150 strains of the human papillomavirus. Women pick strains up as soon as they start having intercourse, but more than 90 percent of cases clear up spontaneously within two years. Early DNA tests would find these, but lead to useless overtreatment. So in women ages 20 to 30, doctors often order repeat Pap tests, which is expensive but may catch the tiny minority of cancers that develop in less than 15 years.
“The U.S. has high resources and low risk-tolerance,” Dr. Schiffman explained, while countries like India have little money and are forced to tolerate risk.
Dr. Jan Agosti, the Gates Foundation officer overseeing its third world screening, said Qiagen’s new $5 test — which proved itself in a two-year study in China — runs on batteries without water or refrigeration, and takes less than three hours. In countries where women are “shyer about pelvic exams,” she added, it even works “acceptably well” on vaginal swabs they can take themselves.
Scratching Relieves Itch by Quieting Nerve Cells
By BENEDICT CAREY, The New York Times, April 7, 2009
As common as it is, scratching to relieve an itch has long been considered a biological mystery: Are cells at the surface of the skin somehow fatigued, in need of outside stimulation? Or is the impulse, and its relief, centered in the brain?
Perhaps neither one, a new study suggests. Neuroscientists at the University of Minnesota report that specialized cells in the spinal cord appear to be critically involved in producing the sensation of itch and the feeling of relief after the application of fingernails, at least in healthy individuals. The study appears in the current issue of the journal Nature Neuroscience.
“It’s as if there’s a little brain in there that creates this state in which scratching — which normally excites pain cells — instead inhibits them,” said Glenn J. Giesler, a co-author of the study. The same cells that register the itch also are sensitive to pain.
“It’s a very important study; itching is a major problem for millions of patients,” said Dr. Gil Yosipovitch, a dermatologist at the Wake Forest University School of Medicine and founder of the International Forum for the Study of Itch.
Dr. Yosipovitch cautioned that the findings may not apply to the sort of chronic itch that plagues people with atopic eczema, H.I.V. or chronic kidney problems. “But this is the kind of work that should help open this area up to more research.”
In the study, led a postdoctoral student, Steve Davidson, researchers isolated in monkeys cellular connections that run from the surface of the foot to the spinal cord and then to the thalamus, a clearinghouse for sensations in the brain, down through the spinal cord to the surface of the foot. They induced the sensation by injecting histamines under the skin.
The scientists took single-cell recordings in an area at the base of the spinal cord, in the lower back, in so-called spinothalamic neurons. These cells are sprinkled throughout the spinal cord. Most are sensitive to pain, and some to both pain and itch. The cells apparently detected the injection and began firing immediately afterward. And when the researchers scratched the itchy skin on the monkeys’ feet, it quieted the cells’ activity.
“It’s the first time I’ve ever seen a noxious stimulus — the scratching — stop the firing of cells,” Dr. Giesler said. His co-authors, along with Mr. Davidson, were Xijing Zhang, Sergey G. Khasabov and Donald A. Simone.
Scientists argue that itching is most likely related to grooming, and evolved to protect animals against some toxic plants, as well as insects, along with the diseases they can transmit, like malaria, yellow fever and river blindness. But the biology of itch has been a mystery, and neglected for years by researchers, who have been far more focused on pain.
Some 50 diseases leave people in a misery of itching which usually cannot be treated. Studies among kidney disease patients and psychiatric inpatients have found that itch is among the top complaints. And when it is severe it keeps people up at night, often worsening their condition.
The new study suggests that itch, like pain, may be a “gated” system in which signals from other nerve cells can interfere with or moderate the sensation. Scratching the skin near, but not directly on, the spot that itches often provides relief, just as rubbing an aching limb can reduce pain. Perceptions in the brain, too, probably moderate the urge to scratch: some chronic, compulsive cases of itching suggest that the brain is not properly reading the effect of outside signals at all but is instead acting on a mistaken internal representation of what is happening to the skin.
As with some kinds of pain, subtle reminders of an itching sensation can get people scratching, often without being entirely aware of it.
“I give lectures about itching,” Dr. Giesler said, “and I’ll stand up there in front of a whole roomful of people, show a few slides and pretty soon I’ll look out and 90 percent of the audience is scratching.”
Like yawning, itching also seems to be contagious, which suggests a significant top-down influence from the brain.
Dr. Yosipovitch said there was a long way to go before doctors could expect treatments. For one thing, the miserable, chronic itch common in many medical problems most likely involves other mechanisms in addition to those identified in the study. And the brain may be critically involved in escalating itch, in ways that are not yet understood. “But as a clinician, I feel excited about the finding,” he said. “It’s a sign that this field is really evolving.”
House Dust Yields Clue to Asthma: Roaches
By ELISSA ELY, M.D, The New York Times, April 7, 2009
Asthma is the most common chronic disease of childhood, one that strikes the poor disproportionately. Up to one-third of children living in inner-city public housing have allergic asthma, in which a specific allergen sets off a cascade of events that cause characteristic inflammation, airway constriction and wheezing.
Now, using an experimental model that required leaving the pristine conditions of the lab for the messier ones of life, a team of scientists from the Boston University School of Medicine have discovered what that allergen is.
“For inner-city children,” said the lead researcher, Dr. Daniel G. Remick, a professor of pathology, “the major cause of asthma is not dust mites, not dog dander, not outdoor air pollen. It’s allergies to cockroaches.”
Dr. Remick and his colleagues (then at the University of Michigan) published their first paper in 2002, after developing their model over several years. Their laboratory was in Detroit, where, as in many other cities, public housing suffered from pest infestation.
The team made home visits with an old-time data-collection instrument: the vacuum cleaner.
“We collected house dust — big dust bunnies — added water, let them mix overnight, and spun the junk out of them, until we had extract,” said Dr. Remick, now 56.
The extract was filled with proteins from Blattella germanica — the common cockroach — whose exoskeletons and droppings become airborne after death. Back in the laboratory, mice were exposed to the dust bunny particles. After being injected, they were immunologically primed: their cellular response systems went on alert.
When exposed to the same particles a second time by inhaling them, the systems on alert went to attack. Mice that had been breathing easily had difficulty exhaling, and their respiration slowed — a rodent corollary to wheezing. They were having asthma attacks.
Analysis of their lungs showed that their airways were clogged with white blood cells, mostly of a type called eosinophils, that caused mucus secretion, tissue damage and changes in muscle contractibility. Mice in a control group, exposed to dust mites instead of cockroach protein, had none of the same respiratory or pathologic changes.
The team reproduced their results in several sites; different dust bunnies, same allergic reaction.
“We’re pretty excited,” Dr. Remick said in an interview, “because this is the first time someone has actually taken stuff from houses where kids have asthma.”
Researchers not directly involved with the studies said they were excited, too. “It’s a clever thing,” said Dr. Lester Kobzik, a pathology professor at Harvard Medical School. “He’s collected the nasty material people actually get allergic to.
“You can’t call up your chemical supplier of scientific reagents and say, ‘I would like five pounds of exactly the same house dust,’ ” Dr. Kobzik continued. “Remick had a bucketload, so he could do several years’ worth of experimentation and study it carefully.”
Dr. Peter A. Ward, a professor of pathology at the University of Michigan Health Services, who recruited Dr. Remick into residency almost 25 years ago, called the work “probably the closest thing in animal models to simulating what one sees in human asthma.”
Most laboratory asthma research still uses genetically created proteins to induce symptoms in mice; often, the proteins are taken from egg whites. This is scientifically pleasing, but less relevant to real life. Egg whites (which humans rarely grow allergic to) have little in common with the city dust children are more likely to cavort through and inhale.
Using the same mouse model, Dr. Remick is now studying the effects of various asthma treatments, including the anti-inflammatory drugs called tumor necrosis factor inhibitors, like Remicade and Enbrel. The drugs, already used for treating rheumatoid arthritis and inflammatory bowel disease, appear to derail a crucial immunologic compound that attracts eosinophils.
“Blocking tumor necrosis factor in a mouse model improves asthma,” Dr. Remick said. “It’s pretty slick.”
And a more exotic strategy is also under investigation. A few years ago, when Dr. Remick’s colleague Jiyoun Kim presented results of the mouse model at a professional conference in Korea, an audience member asked whether he had heard about standard Chinese herbal treatment.
He took herb samples back to the United States, and in mice they proved to block eotaxin, the compound that sets off asthmatic reactions.
Chinese herbs carry the whiff and romance of an easy solution without the rigors of federal drug trials. But Dr. Remick warns that caution is in order.
“The power and trouble with Chinese herbal medicines,” he said, “is that they have more than one active ingredient — they have dozens. We know they block eotaxin, but we don’t know everything they block, or what actually makes things better.”
Complicating the treatment is the disease; asthma has many mechanisms. “There may be 50 different inflammatory processes going on,” Dr. Remick went on. “We’re still in the process of precisely defining which part of the herbs block which part of the inflammatory response.”
Still, hopeful parents, attracted by herbal treatments, have caused the researchers some anxious moments. “Yesterday,” Dr. Remick said, “I was contacted by someone whose co-worker wanted to know whether she should use Chinese herbs to treat her daughter’s asthma. I immediately replied that she shouldn’t. It’s not a question of Eastern versus Western medicine. Other drugs that treat asthma are better defined at this point. Herbs shouldn’t be front-line.”
“If my child had asthma,” he added, “I’d take her to the pediatrician.”
Mind: When All You Have Left Is Your Pride
By BENEDICT CAREY, The New York Times, April 7, 2009
Look around you. On the train platform, at the bus stop, in the car pool lane: these days someone there is probably faking it, maintaining a job routine without having a job to go to.
The Wall Street type in suspenders, with his bulging briefcase; the woman in pearls, thumbing her BlackBerry; the builder in his work boots and tool belt — they could all be headed for the same coffee shop, or bar, for the day.
“I have a new client, a laid-off lawyer, who’s commuting in every day — to his Starbucks,” said Robert C. Chope, a professor of counseling at San Francisco State University and president of the employment division of the American Counseling Association. “He gets dressed up, meets with colleagues, networks; he calls it his Western White House. I have encouraged him to keep his routine.”
The fine art of keeping up appearances may seem shallow and deceitful, the very embodiment of denial. But many psychologists beg to differ.
To the extent that it sustains good habits and reflects personal pride, they say, this kind of play-acting can be an extremely effective social strategy, especially in uncertain times.
“If showing pride in these kinds of situations was always maladaptive, then why would people do it so often?” said David DeSteno, a psychologist at Northeastern University in Boston. “But people do, of course, and we are finding that pride is centrally important not just for surviving physical danger but for thriving in difficult social circumstances, in ways that are not at all obvious.”
For most of its existence, the field of psychology ignored pride as a fundamental social emotion. It was thought to be too marginal, too individually variable, compared with basic visceral expressions of fear, disgust, sadness or joy. Moreover, it can mean different things in different cultures.
But recent research by Jessica L. Tracy of the University of British Columbia and Richard W. Robins of the University of California, Davis, has shown that the expressions associated with pride in Western society — most commonly a slight smile and head tilt, with hands on the hips or raised high — are nearly identical across cultures. Children first experience pride about age 2 ½, studies suggest, and recognize it by age 4.
It’s not a simple matter of imitation, either. In a 2008 study, Dr. Tracy and David Matsumoto, a psychologist at San Francisco State, analyzed spontaneous responses to winning or losing a judo match during the 2004 Olympic and Paralympic games. They found that expressions of pride after a victory were similar for athletes from 37 nations, including for 53 blind competitors, many of them blind from birth.
“It’s a self-conscious emotion, reflecting how you feel about yourself, and it has this important social component,” Dr. Tracy said. “It’s the strongest status signal we know of among the emotions; stronger than a happy expression, contentment, anything.”
In one continuing experiment, Dr. Tracy, along with Azim Shariff, a doctoral student at British Columbia, have found that people tend to associate an expression of pride with high status — even when they know that the person wearing it is low on the ladder. In their study, participants impulsively assigned higher status to a prideful water boy than to a team captain who looked ashamed.
The implications of this are hard to exaggerate. Researchers tend to split pride into at least two broad categories. So-called authentic pride flows from real accomplishments, like raising a difficult child, starting a company or rebuilding an engine. Hubristic pride, as Dr. Tracy calls it, is closer to arrogance or narcissism, pride without substantial foundation. The act of putting on a good face may draw on elements of both.
But no one can tell the difference from the outside. Expressions of pride, whatever their source, look the same. “So as long as you’re a decent actor, and people don’t know too much about your situation, all systems are go,” said Lisa A. Williams, a doctoral candidate in psychology at Northeastern University.
The various flavors of pride may even feel similar on the inside, when the stakes are high enough. “She was always scrupulous about keeping up appearances to herself,” wrote Edith Wharton of her tragic heroine Lily Bart in “The House of Mirth.” “Her personal fastidiousness had a moral equivalent, and when she made a tour of inspection in her own mind there were certain closed doors she did not open.” If you believe it, so will they.
A feeling of pride, when it’s convincing, acts something like an emotional magnet. In a recent study, Ms. Williams and Dr. DeSteno of Northeastern had a group of 62 undergraduates take tests supposedly measuring their spatial I.Q. The patterns flashed by too fast for anyone to truly know how well they did.
The researchers manipulated the amount of pride each participant felt in his or her score. They either said nothing about the score; remarked, in a matter-of-fact tone, that it was one of the best scores they had seen; or gushed that the person’s performance was wonderful, about as good as they had ever seen.
The participants then sat down in a group to solve similar puzzles. Sure enough, the students who had been warmly encouraged reported feeling more pride than the others. But they also struck their partners in the group exercise as being both more dominant and more likable than those who did not have the inner glow of self-approval. The participants, whether they had been buttered up or not, were completely unaware of this effect on the group dynamics.
“We wondered at the beginning whether these people were going to come across as arrogant jerks,” Dr. DeSteno said. “Well, no, just the opposite; they were seen as dominant but also likable. That’s not a combination we expected.”
Therapists say that in time, people usually do better when they come clean. “In some ways it’s easier to do this now, with so many people out of work,” said Michael C. Lazarchick, an employment counselor in southern New Jersey. “You may very well find out that others are going through the same thing, or something like it — ‘Oh yeah, I just took a big cut in pay.’ ”
But in the short term, projecting pride may do more than help manage others’ impressions. Psychologists have found that wearing a sad or happy face can have a top-down effect on how a person feels: Smile and you may feel fleetingly happier. The same most likely is true for an expression of pride. In a 2008 study, the Northeastern researchers found that inducing a feeling of pride in people solving spatial puzzles motivated them to try harder when they tackled the next round.
Pride, in short, begets perseverance. All of which may explain why, when the repo man is at the door, people so often remind themselves that they still have theirs, and that it’s worth something. Because they do, and because it is.
However much pride may go before a fall, it may be far more useful after one.
Answering Baseball’s What-Ifs
By ALAN SCHWARZ, The New York Times, April 7, 2009
You can learn a lot during a major league baseball game. Like Ukrainian, if it is a particularly slow nine innings.
As for the science of baseball strategy, one game teaches precious little. A well-timed sacrifice bunt can backfire and lose the game; a foolish steal can appear brilliant. The vagaries of randomness — the way Sandy Koufax got battered occasionally and a pipsqueak named Bucky Dent hit one of the most famous home runs ever — camouflage the game’s inner forces, which for 150 years have operated somewhere between fact and fable.
One game has little meaning. A thousand seasons can take a while. Thank goodness for quad-core processors.
“Computer simulations work pretty well in baseball for two reasons,” said Carl Morris, a professor of statistics at Harvard University who has written several papers that commingled baseball and formal statistical theory. “In general, they allow you to study fairly complicated processes that you can’t really get at with pure mathematics. But also, sports are great for simulations — you can play 10,000 seasons overnight.”
No one can afford to wait less than major league teams, which crave every extra run or victory they can wring from their $100 million rosters. John Abbamondi, the assistant general manager for the St. Louis Cardinals, says his team and about 10 others use simulations to evaluate potential trades and how they might affect the pennant race.
“It’s all part of the statistical analysis that complements the more traditional scouting we do,” he said.
Using computer simulations to explore in-game and other baseball strategies is by no means new. As early as 1958, a professor at the Massachusetts Institute of Technology programmed a behemoth I.B.M. 704 mainframe to investigate whether the sacrifice bunt was a smart play. (More on that later.) Simulators have since grown so complex that the most sophisticated one available to the public, called Diamond Mind, not only runs lickety-split on laptops but even considers minutiae like the effects of wind in individual ballparks.
Under what conditions is bunting advantageous? When does trying to steal make sense, and when does it decrease the chances of scoring? Questions like these turn out to be ideally suited to computer programs through which millions of iterations can smooth out the peaks and valleys of randomness, and converge toward a reliable approximation.
Known among formal statisticians as the Monte Carlo method, this approach takes spectacularly complex phenomena like weather patterns and stock performance and allows their behavior to be approximated, if not determined.
What are the chances of winning a game of solitaire? Rather than writing an equation that tries to take into account the trillions of trillions of possible hands and moves, a statistician can run a computer program that simply plays the game a few million times in minutes to see how often it wins. Dr. Morris says he has seen the Monte Carlo method used to improve computer graphics and explore gene sequences.
Like such competitors as Strat-O-Matic — which made its debut in 1961 with at-bats determined by cards and dice, and remains popular on the personal computer — Diamond Mind is designed to allow fans to play fictional games and seasons, exploring what-if scenarios that real life would be too slow and controversial to allow.
Take the age-old question of how much difference a team’s lineup order makes. This issue so vexed the former manager Billy Martin that he once literally picked his Detroit Tigers batting order out of a hat.
Luke Kraemer of Imagine Sports, which owns Diamond Mind, programmed the simulator to force the 2008 Yankees to bat their best hitter and cleanup man, Alex Rodriguez, ninth — to see how scoring was affected. Mr. Kraemer got the run total not for just one season, which can fluctuate as much as 80 runs in each direction from simple randomness, but for 100 seasons — more than 16,000 Yankees games in all.
The result? The Yankees scored 747 runs per season, 40 fewer than their real-life 787. (Diamond Mind was so accurate that 100 seasons with A-Rod batting fourth averaged 789, almost dead-on.) Most research suggests that those 40 runs would mean only about four fewer victories, for a strategy no manager would ever consider; so the difference with Rodriguez batting third or fifth would be insignificant, and nowhere near worth the forests of trees that would give their lives to the ensuing sports-page debate.
Diamond Mind took its cuts at several other baseball knucklers, running 100 full seasons of games for each:
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The intentional walk. This frequently used defensive strategy avoids dangerous hitters and can set up a double play, but it also awards a free base, and even the best hitters usually make an out. So is it smart in the long run? Diamond Mind found that it was not, though the difference was only about five runs per team per season.
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The stolen base. Advancing from first to second puts the runner in scoring position, but he — and the rest of your hitters — will have a hard time scoring if he gets thrown out. Mr. Kraemer looked at a recent team that ran wild (the 2008 Tampa Bay Rays) and one that barely stole at all (the 2005 Oakland A’s) and switched their mind-sets to see what happened. The A’s scored 20 runs fewer, which probably says more about their players’ inability to run in the first place. But when the speedy Rays stole sparingly, they increased their scoring by 47 runs per season — suggesting that perhaps the Rays were running too often in real life.
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The sacrifice bunt. Is it worth making an out intentionally to move a runner from first to second? Forcing a team that hated that maneuver (the 2005 Boston Red Sox) to do it a lot cost them 19 runs per season. But making a bunting team (the 2008 New York Mets) avoid it also cost them — by 15 runs on average — suggesting that the Mets’ managers, Willie Randolph and Jerry Manuel, used it quite intelligently. (The 1958 M.I.T. statisticians found that the sacrifice was rarely a good move; major league managers paid little attention.)
One problem with computer simulations is that no matter how realistically they might be programmed, they can say more about the programmer than baseball itself. A computer, after all, cannot feel human emotions like pressure or the will to hit in the clutch.
“We can run the experiment in the simulation environment and think we’re measuring the effect of a great defense on a pitching staff, but it might tell us more about how we modeled defense,” said Tom Tippett, who wrote the original Diamond Mind code in the early 1980s. “The simulation is real close to real-life baseball, but in the end it isn’t real-life baseball.”
After developing Diamond Mind into the industry standard, Mr. Tippett was hired a few years ago by the Boston Red Sox — a sign of how much some teams have come to value simulation research. While none will discuss exactly what they model and how, Mr. Abbamondi, of the Cardinals, said they could provide objective insight into how an offense might be affected by trading for a hitter in midseason; how many games that might improve the team; and how that hitter might improve or deteriorate as he ages. Many of these measurements come in the form of scenarios of increasing uncertainty, not unlike the projection of hurricane paths.
As Mr. Tippett suggested, however, simulations have inherent limits, and probably will not ever model baseball’s vicissitudes of fate — how scrubs morph into all-stars and some teams just collapse. (Indeed, fans of the recent New York Mets would be relieved that some things defy re-creation.) Tony La Russa, the Cardinals’ manager, who is a sure bet for the Hall of Fame, said the value of computer simulations in baseball tended to stop at the dugout entrance.
“There’s way too much importance given to what you can produce from a machine,” he said. “These are human beings, and I don’t think any computer is going to model that close to what we deal with at this level.”
That can be as true now as it was 25 years ago, when a Tank McNamara cartoon captured it best. A downtrodden manager peered over his computer. He asked plaintively, “But will it take the blame?”
Empire State Building Plans Environmental Retrofit
By MIREYA NAVARRO, The New York Times, April 7, 2009
Once the world’s tallest building, the Empire State Building is striving for another milestone: It is going green.
Owners of the New York City landmark announced on Monday that they will be beginning a renovation this summer expected to reduce the skyscraper’s energy use by 38 percent a year by 2013, at an annual savings of $4.4 million. The retrofit project will add $20 million to the $500 million building makeover already under way that aims to attract larger corporate occupants at higher rents.
Although the retrofit was specifically designed for the Art Deco office building at 34th Street and Fifth Avenue and its enormous features — 102 stories, 2.6 million square feet, 6,500 windows and 73 elevators — the energy-efficiency improvements are meant to serve as a model for other office buildings around the world, said Anthony E. Malkin, president of Wien & Malkin, which supervises the building on behalf of the owners, the Malkin family and the Helmsley estate.
He said upfront costs are often a deterrent for retrofitting older buildings, but the energy savings for the building , built in 1931, are expected to pay back those costs in only about three years.
“People associate greening with expense and compromise,” Mr. Malkin said. “We’re trying to prove: no compromise and payback.”
Mr. Malkin announced the details of the project at a news conference attended by Mayor Michael R. Bloomberg, who has made sustainability a theme of his administration, and former President Bill Clinton, whose Clinton Climate Initiative program, which works with cities to develop large scale energy efficiency programs, helped facilitate the project.
People involved with the retrofit said the Empire State Building can offer an example of how older buildings can retrofit to the highest energy standards and effectively cut down their greenhouse gas emissions, a contributor to global warming. The largest share of New York City’s greenhouse gas emissions, 78 percent, comes from the city’s buildings, with commercial buildings contributing 25 percent, mostly from the use of electricity and natural gas.
By reducing energy use, the retrofit plan envisions cutting down the pollution the Empire State Building produces by 105,000 metric tons of carbon dioxide emissions a year, although the number of emissions currently emitted was not immediately available.
“They’re showing the rest of the city that existing buildings, no matter how tall they are, no matter how old they are, can take steps to significantly reduce their energy consumption,” Mr. Bloomberg said.
The largest energy guzzlers at the Empire State Building are lighting, cooling and heating, said Paul Rode, a project executive with Johnson Controls, the retrofit designer. The building has 302 office tenants but is occupied by about 13,000 people a day, including visitors to the observatories on the 86th and 102nd floors that are open to the public 18 hours a day, seven days a week.
The designers said that about half the reduction in energy use will be achieved in the first two years of the project as they retrofit the double hung operable windows, insulate behind radiators and rebuild chillers in the cooling plant in the basement.
To avoid transportation-related pollution, the windows will be redone on site, by adding a layer of coated film between two glass panes to increase insulation. at a rate of 50 windows a day.
In all, the retrofit consists of eight projects, including upgrades to the electrical and ventilation systems and installation of sophisticated electronic instrumentation.
The biggest challenge in planning the project, Mr. Rode said, was to figure out what was behind the walls and the ceilings of the 78-year-old skyscraper — in the absence of original drawings and specifications.
“It took a lot of investigative work,” Mr. Rode said.
The plan also calls for tenants’ involvement in monitoring their own energy use in their offices through a Web-based dashboard accessible from their computers, which keeps track of how much energy is being used and where.
Some tenants are already ahead of their landlord. Skanska, a Swedish construction company that took over the 32nd floor in November with 80 employees, renovated its 24,400 square feet of office space to green standards like daylight sensors to conserve energy and dual-flush toilets to avoid wasting water.
The company, which says it has cut its electric bill by one-third with the improvements, is seeking platinum certification, the highest level awarded by the United States Green Building Council, which certifies buildings and commercial interiors for energy, water efficiency and other green features.
The federal Environmental Protection Agency rates buildings for energy efficiency under its Energy Star program, and 6,200 commercial and institutional buildings have earned the label by achieving 30 to 40 percent greater efficiency than their peers. The Empire State Building is expected to fall in the top 10 percent of Energy Star office buildings when its renovation is completed, the project designers said.
While the energy-saving improvements will be substantial, no one visiting the building is very likely to notice them — most involve slight changes or will be hidden in the building’s innards. The night lighting that makes the building a distinctive part of the city’s skyline represents a small draw of energy during off-peak hours and will continue without changes, Mr. Malkin said.
He said the green features will be highlighted for visitors as an educational tool, and tenants may also see a mark-up on rents because of the desirability of green features.
Jacques Catafago, president of the Empire State Building Tenants Association, called making the building more energy-efficient “a laudable effort” but said that rent increases were a concern. Mr. Catafago, a lawyer whose firm has been in the building since 1990, said that “34th Street is not 57th Street — the rents are very reasonable here.”
But Mr. Malkin said he was looking at the larger goal.
“If we don’t change our unsustainable practices and the amount of energy we consume, if we don’t make our city more efficient, we’re toast,” he said. “We won’t be able to avoid the sort of changes that would spell a reduced quality of life.”
DNA Test Outperforms Pap Smear
By DONALD G. McNEIL Jr., The New York Times, April 7, 2009
A new DNA test for the virus that causes cervical cancer does so much better than current methods that some gynecologists hope it will eventually replace the Pap smear in wealthy countries and cruder tests in poor ones.
Not only could the new test for human papillomavirus, or HPV, save lives; scientists say that women over 30 could drop annual Pap smears and instead have the DNA test just once every 3, 5 or even 10 years, depending on which expert is asked.
Their optimism is based on an eight-year study of 130,000 women in India financed by the Bill and Melinda Gates Foundation and published last week in The New England Journal of Medicine. It is the first to show that a single screening with the DNA test beats all other methods at preventing advanced cancer and death.
The study is “another nail in the coffin” for Pap smears, which will “soon be of mainly historical interest,” said Dr. Paul D. Blumenthal, a professor of gynecology at Stanford medical school who has tested screening techniques in Africa and Asia and was not involved in the study.
But whether the new test is adopted will depend on many factors, including hesitation by gynecologists to abandon Pap smears, which have been remarkably effective. Cervical cancer was a leading cause of death for American women in the 1950s; it now kills fewer than 4,000 a year.
In poor and middle-income countries, where the cancer kills more than 250,000 women a year, cost is a factor, but the test’s maker, Qiagen, with financing from the Gates Foundation, has developed a $5 version and the price could go lower with enough orders, the company said.
“The implications of the findings of this trial are immediate and global,” Dr. Mark Schiffman of the National Cancer Institute wrote in an editorial accompanying the study. “International experts in cervical cancer prevention should now adopt HPV testing.”
At the moment, there are huge gaps in how rich and poor countries screen.
In the West, women get smears named for their inventor, Dr. Georgios Papanikolaou. Cells are scraped from the cervix and sent to a laboratory, where they are stained and inspected under a microscope by a pathologist looking for abnormalities. Results may take several days.
The DNA screen also needs a cervical scraping, but it is mixed with re-agents and read by a machine.
In poor countries, most women get no routine screening. Pain sends them to a hospital, by which time it is often too late.
But in some countries, women get “visualization,” pioneered in the last decade, also with Gates Foundation support: a health worker looks at the cervix with a flashlight and swabs it with vinegar. Spots that turn white may be precancerous lesions, and are immediately frozen off. Diagnosis and treatment take only one visit.
Pap smears fail in the third world because there are too few trained pathologists and because women told to return often cannot.
The Indian study, begun in 1999, divided 131,746 healthy women ages 30 to 59 from 497 villages into four groups. One group, the control, got typical rural clinic care: advice to go to a hospital if they wanted screening. The second got Pap smears, the third got flashlight-vinegar visualization, and the fourth got a DNA test, then made by Digene, which is now owned by Qiagen. The company did not pay for or donate to the study, its authors said.
After eight years, the visualization group had about the same rates of advanced cancer and death as the control group. The Pap-smear group had about three-fourths the rates, and the DNA test had about half.
Significantly, none of the women who were negative on their DNA test died of cervical cancer. “So if you have a negative test, you’re good to go for several years,” Dr. Blumenthal said.
The study’s chief author, Dr. Rengaswamy Sankaranarayanan of the International Agency for Research on Cancer in Lyon, France, said, “With this test, you could start screening women at 30 and do it once every 10 years.”
Asked whether that advice would apply in the United States, Debbie Salsow, director of gynecologic cancer for the American Cancer Society, replied, “Absolutely no.”
“A negative test would mean a woman’s chances of developing cancer are small, but not zero,” she added. “But if he’d said five years, I wouldn’t have a strong reaction.”
Since 1987, she said, the cancer society and the American College of Obstetricians and Gynecologists have recommended Pap smears only every three years after initial negative ones. In 2002, they recommended the HPV test too, and evidence is mounting that the Pap smear can be dropped.
“But we haven’t been able to get doctors to go along,” Dr. Salsow said. “The average gynecologist, especially the older ones, says, ‘Women come in for their Pap smear, and that’s how we get them in here to get other care.’ We’re totally overscreening, but when you’ve been telling everyone for 40 years to get an annual Pap smear, it’s hard to change.”
Dr. Sankaranarayanan said most European countries screen every three to five years, and many do not start before age 30.
Cervical cancer is caused by a few of the 150 strains of the human papillomavirus. Women pick strains up as soon as they start having intercourse, but more than 90 percent of cases clear up spontaneously within two years. Early DNA tests would find these, but lead to useless overtreatment. So in women ages 20 to 30, doctors often order repeat Pap tests, which is expensive but may catch the tiny minority of cancers that develop in less than 15 years.
“The U.S. has high resources and low risk-tolerance,” Dr. Schiffman explained, while countries like India have little money and are forced to tolerate risk.
Dr. Jan Agosti, the Gates Foundation officer overseeing its third world screening, said Qiagen’s new $5 test — which proved itself in a two-year study in China — runs on batteries without water or refrigeration, and takes less than three hours. In countries where women are “shyer about pelvic exams,” she added, it even works “acceptably well” on vaginal swabs they can take themselves.
Scratching Relieves Itch by Quieting Nerve Cells
By BENEDICT CAREY, The New York Times, April 7, 2009
As common as it is, scratching to relieve an itch has long been considered a biological mystery: Are cells at the surface of the skin somehow fatigued, in need of outside stimulation? Or is the impulse, and its relief, centered in the brain?
Perhaps neither one, a new study suggests. Neuroscientists at the University of Minnesota report that specialized cells in the spinal cord appear to be critically involved in producing the sensation of itch and the feeling of relief after the application of fingernails, at least in healthy individuals. The study appears in the current issue of the journal Nature Neuroscience.
“It’s as if there’s a little brain in there that creates this state in which scratching — which normally excites pain cells — instead inhibits them,” said Glenn J. Giesler, a co-author of the study. The same cells that register the itch also are sensitive to pain.
“It’s a very important study; itching is a major problem for millions of patients,” said Dr. Gil Yosipovitch, a dermatologist at the Wake Forest University School of Medicine and founder of the International Forum for the Study of Itch.
Dr. Yosipovitch cautioned that the findings may not apply to the sort of chronic itch that plagues people with atopic eczema, H.I.V. or chronic kidney problems. “But this is the kind of work that should help open this area up to more research.”
In the study, led a postdoctoral student, Steve Davidson, researchers isolated in monkeys cellular connections that run from the surface of the foot to the spinal cord and then to the thalamus, a clearinghouse for sensations in the brain, down through the spinal cord to the surface of the foot. They induced the sensation by injecting histamines under the skin.
The scientists took single-cell recordings in an area at the base of the spinal cord, in the lower back, in so-called spinothalamic neurons. These cells are sprinkled throughout the spinal cord. Most are sensitive to pain, and some to both pain and itch. The cells apparently detected the injection and began firing immediately afterward. And when the researchers scratched the itchy skin on the monkeys’ feet, it quieted the cells’ activity.
“It’s the first time I’ve ever seen a noxious stimulus — the scratching — stop the firing of cells,” Dr. Giesler said. His co-authors, along with Mr. Davidson, were Xijing Zhang, Sergey G. Khasabov and Donald A. Simone.
Scientists argue that itching is most likely related to grooming, and evolved to protect animals against some toxic plants, as well as insects, along with the diseases they can transmit, like malaria, yellow fever and river blindness. But the biology of itch has been a mystery, and neglected for years by researchers, who have been far more focused on pain.
Some 50 diseases leave people in a misery of itching which usually cannot be treated. Studies among kidney disease patients and psychiatric inpatients have found that itch is among the top complaints. And when it is severe it keeps people up at night, often worsening their condition.
The new study suggests that itch, like pain, may be a “gated” system in which signals from other nerve cells can interfere with or moderate the sensation. Scratching the skin near, but not directly on, the spot that itches often provides relief, just as rubbing an aching limb can reduce pain. Perceptions in the brain, too, probably moderate the urge to scratch: some chronic, compulsive cases of itching suggest that the brain is not properly reading the effect of outside signals at all but is instead acting on a mistaken internal representation of what is happening to the skin.
As with some kinds of pain, subtle reminders of an itching sensation can get people scratching, often without being entirely aware of it.
“I give lectures about itching,” Dr. Giesler said, “and I’ll stand up there in front of a whole roomful of people, show a few slides and pretty soon I’ll look out and 90 percent of the audience is scratching.”
Like yawning, itching also seems to be contagious, which suggests a significant top-down influence from the brain.
Dr. Yosipovitch said there was a long way to go before doctors could expect treatments. For one thing, the miserable, chronic itch common in many medical problems most likely involves other mechanisms in addition to those identified in the study. And the brain may be critically involved in escalating itch, in ways that are not yet understood. “But as a clinician, I feel excited about the finding,” he said. “It’s a sign that this field is really evolving.”
House Dust Yields Clue to Asthma: Roaches
By ELISSA ELY, M.D, The New York Times, April 7, 2009
Asthma is the most common chronic disease of childhood, one that strikes the poor disproportionately. Up to one-third of children living in inner-city public housing have allergic asthma, in which a specific allergen sets off a cascade of events that cause characteristic inflammation, airway constriction and wheezing.
Now, using an experimental model that required leaving the pristine conditions of the lab for the messier ones of life, a team of scientists from the Boston University School of Medicine have discovered what that allergen is.
“For inner-city children,” said the lead researcher, Dr. Daniel G. Remick, a professor of pathology, “the major cause of asthma is not dust mites, not dog dander, not outdoor air pollen. It’s allergies to cockroaches.”
Dr. Remick and his colleagues (then at the University of Michigan) published their first paper in 2002, after developing their model over several years. Their laboratory was in Detroit, where, as in many other cities, public housing suffered from pest infestation.
The team made home visits with an old-time data-collection instrument: the vacuum cleaner.
“We collected house dust — big dust bunnies — added water, let them mix overnight, and spun the junk out of them, until we had extract,” said Dr. Remick, now 56.
The extract was filled with proteins from Blattella germanica — the common cockroach — whose exoskeletons and droppings become airborne after death. Back in the laboratory, mice were exposed to the dust bunny particles. After being injected, they were immunologically primed: their cellular response systems went on alert.
When exposed to the same particles a second time by inhaling them, the systems on alert went to attack. Mice that had been breathing easily had difficulty exhaling, and their respiration slowed — a rodent corollary to wheezing. They were having asthma attacks.
Analysis of their lungs showed that their airways were clogged with white blood cells, mostly of a type called eosinophils, that caused mucus secretion, tissue damage and changes in muscle contractibility. Mice in a control group, exposed to dust mites instead of cockroach protein, had none of the same respiratory or pathologic changes.
The team reproduced their results in several sites; different dust bunnies, same allergic reaction.
“We’re pretty excited,” Dr. Remick said in an interview, “because this is the first time someone has actually taken stuff from houses where kids have asthma.”
Researchers not directly involved with the studies said they were excited, too. “It’s a clever thing,” said Dr. Lester Kobzik, a pathology professor at Harvard Medical School. “He’s collected the nasty material people actually get allergic to.
“You can’t call up your chemical supplier of scientific reagents and say, ‘I would like five pounds of exactly the same house dust,’ ” Dr. Kobzik continued. “Remick had a bucketload, so he could do several years’ worth of experimentation and study it carefully.”
Dr. Peter A. Ward, a professor of pathology at the University of Michigan Health Services, who recruited Dr. Remick into residency almost 25 years ago, called the work “probably the closest thing in animal models to simulating what one sees in human asthma.”
Most laboratory asthma research still uses genetically created proteins to induce symptoms in mice; often, the proteins are taken from egg whites. This is scientifically pleasing, but less relevant to real life. Egg whites (which humans rarely grow allergic to) have little in common with the city dust children are more likely to cavort through and inhale.
Using the same mouse model, Dr. Remick is now studying the effects of various asthma treatments, including the anti-inflammatory drugs called tumor necrosis factor inhibitors, like Remicade and Enbrel. The drugs, already used for treating rheumatoid arthritis and inflammatory bowel disease, appear to derail a crucial immunologic compound that attracts eosinophils.
“Blocking tumor necrosis factor in a mouse model improves asthma,” Dr. Remick said. “It’s pretty slick.”
And a more exotic strategy is also under investigation. A few years ago, when Dr. Remick’s colleague Jiyoun Kim presented results of the mouse model at a professional conference in Korea, an audience member asked whether he had heard about standard Chinese herbal treatment.
He took herb samples back to the United States, and in mice they proved to block eotaxin, the compound that sets off asthmatic reactions.
Chinese herbs carry the whiff and romance of an easy solution without the rigors of federal drug trials. But Dr. Remick warns that caution is in order.
“The power and trouble with Chinese herbal medicines,” he said, “is that they have more than one active ingredient — they have dozens. We know they block eotaxin, but we don’t know everything they block, or what actually makes things better.”
Complicating the treatment is the disease; asthma has many mechanisms. “There may be 50 different inflammatory processes going on,” Dr. Remick went on. “We’re still in the process of precisely defining which part of the herbs block which part of the inflammatory response.”
Still, hopeful parents, attracted by herbal treatments, have caused the researchers some anxious moments. “Yesterday,” Dr. Remick said, “I was contacted by someone whose co-worker wanted to know whether she should use Chinese herbs to treat her daughter’s asthma. I immediately replied that she shouldn’t. It’s not a question of Eastern versus Western medicine. Other drugs that treat asthma are better defined at this point. Herbs shouldn’t be front-line.”
“If my child had asthma,” he added, “I’d take her to the pediatrician.”
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Date: 2009-04-07 02:50 pm (UTC)http://www.nytimes.com/2009/04/06/health/research/06brain.html