Is the Alzheimer’s protein contagious?


Controversial new research suggests that the Alzheimer’s disease protein amyloid-beta (above) may be transmissible via surgical instruments or other medical procedures

 

Controversial new research suggests that the Alzheimer’s disease protein amyloid-beta (above) may be transmissible via surgical instruments or other medical procedures

 

Beginning in 1958, roughly 30,000 people worldwide—mostly children—received injections of human growth hormone extracted from the pituitary glands of human cadavers to treat their short stature. The procedure was halted in 1985, when researchers found that a small percentage of recipients had received contaminated injections and were developing Creutzfeldt-Jakob disease (CJD), a fatal neurodegenerative condition caused by misfolded proteins called prions.

Now, a new study of the brains of eight deceased people who contracted CJD from such injections suggests that the injections may also have spread amyloid-β, the neuron-clogging protein that is a hallmark of Alzheimer’s disease. The study is the first evidence in humans that amyloid-β might be transmissible through medical procedures such as brain surgery—according to the researchers. Skeptics, however, note that the CJD prion itself often triggers unusual amyloid deposits; epidemiological studies, they say, find no connection between the injections and increased risk of developing Alzheimer’s disease.

Aside from CJD and the related mad cow disease, kuru is perhaps the most famous prion disease. Endemic to Papua New Guinea and now essentially eradicated, kuru is transmitted through the ritual consumption of human brain tissue at funerals. Increasingly, however, scientists are recognizing that a number of other neurodegenerative diseases, including Alzheimer’s, Huntington disease, and Parkinson’s disease, also involve aberrant proteins that act like “seeds” in the brain. They convert otherwise normal proteins into fibers that “break, form more seeds, break, and form more seeds,” says John Collinge, a neuropathologist at University College London and lead author of the new study.

Still unknown in Alzheimer’s is what role misfolded proteins such as amyloid-β and tau play in the disease, and whether they are transmissible through direct contact with or consumption of contaminated brain tissue. Although scientists have successfully induced amyloid-β transmission in rodents, these experiments relied on “massive” overexpression of the protein, says Samuel Gandy, a neuropathologist at the Icahn School of Medicine at Mount Sinai in New York City. “Exhaustive” attempts to reproduce such transmission in primates have failed, he says, leading many to doubt whether such propagation is possible.

In the current study, Collinge and colleagues examined the brain tissue of eight people, aged 36 to 51, who died of CJD roughly 30 to 40 years after they received the growth hormone injections. Four had a pattern of amyloid-β that pathologists consider moderate-to-severe in people with Alzheimer’s, though they lacked a second type of protein, tau, that is considered an important hallmark of the disease as well, the team reports online today in Nature. Two had milder, more patchy deposits; one was amyloid-free. “It’s a highly unusual finding,” Collinge says. “In that age group, you really don’t see this kind of pathology unless you have a genetic predisposition to Alzheimer’s,” which none of them did, he says.

Still, scientists have known since the 1990s that the prion protein that causes CJD can “cross-seed” amyloid-β, causing abnormal deposits to form, and vice versa, Gandy says. In such a small, observational study, it is impossible to determine whether CJD itself caused the amyloid-β seen in the deceased subjects’ brain tissue, or seeds of the protein were transmitted via injection, he argues. None of the subjects showed signs of tau, the other protein associated with Alzheimer’s disease, he and others point out.

To explore the possibility that CJD, and not amyloid-β seeds, was the culprit, Collinge and colleagues also examined the brains of 116 people with a range of prion diseases unrelated to the hormone injections. They found little to no β amyloid pathology in that group, suggesting that CJD alone was not responsible for the pathology, they say. That’s a “strong argument” in the group’s favor, says Claudio Soto, a neuroscientist at the University of Texas Health Science Center at Houston. Given that prions come in many different forms, however, it’s still possible that the β-amyloid deposits found in the brains of the injection recipients were indeed caused by CJD, whereas the controls remained plaque-free, he notes.

Next, Collinge’s team plans to test vials of archived growth hormone from the original treatments to see whether they can detect amyloid-β protein “seeds.” One obstacle, however, is that scientists don’t know precisely what constitutes such seeds on a molecular level, Collinge says.

Although provocative, the new study cannot answer the question of whether pathogenic amyloid-β “seeds” can be transmitted from person to person through contaminated surgical instruments or blood, Collinge and Soto agree. There is no epidemiological evidence to support that possibility, and any alarm over Alzheimer’s infectiousness is premature, they emphasize. Still, “that’s something that needs to be investigated,” Soto says.

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Everything You Know About Obesity Is Wrong


For decades, the medical community has ignored mountains of evidence to wage a cruel and futile war on fat people, poisoning public perception and ruining millions of lives.

It’s time for a new paradigm.

 

From the 16th century to the 19th, scurvy killed around 2 million sailors, more than warfare, shipwrecks and syphilis combined. It was an ugly, smelly death, too, beginning with rattling teeth and ending with a body so rotted out from the inside that its victims could literally be startled to death by a loud noise. Just as horrifying as the disease itself, though, is that for most of those 300 years, medical experts knew how to prevent it and simply failed to.

In the 1600s, some sea captains distributed lemons, limes and oranges to sailors, driven by the belief that a daily dose of citrus fruit would stave off scurvy’s progress. The British Navy, wary of the cost of expanding the treatment, turned to malt wort, a mashed and cooked byproduct of barley which had the advantage of being cheaper but the disadvantage of doing nothing whatsoever to cure scurvy. In 1747, a British doctor named James Lind conducted an experiment where he gave one group of sailors citrus slices and the others vinegar or seawater or cider. The results couldn’t have been clearer. The crewmen who ate fruit improved so quickly that they were able to help care for the others as they languished. Lind published his findings, but died before anyone got around to implementing them nearly 50 years later.

This kind of myopia repeats throughout history. Seat belts were invented long before the automobile but weren’t mandatory in cars until the 1960s. The first confirmed death from asbestos exposure was recorded in 1906, but the U.S. didn’t start banning the substance until 1973. Every discovery in public health, no matter how significant, must compete with the traditions, assumptions and financial incentives of the society implementing it.

Which brings us to one of the largest gaps between science and practice in our own time. Years from now, we will look back in horror at the counterproductive ways we addressed the obesity epidemic and the barbaric ways we treated fat people—long after we knew there was a better path.

I have never written a story where so many of my sources cried during interviews, where they shook with anger describing their interactions with doctors and strangers and their own families.

About 40 years ago, Americans started getting much larger. According to the Centers for Disease Control and Prevention, nearly 80 percent of adults and about one-third of children now meet the clinical definition of overweight or obese. More Americans live with “extreme obesity“ than with breast cancer, Parkinson’s, Alzheimer’s and HIV put together.

And the medical community’s primary response to this shift has been to blame fat people for being fat. Obesity, we are told, is a personal failing that strains our health care system, shrinks our GDP and saps our military strength. It is also an excuse to bully fat people in one sentence and then inform them in the next that you are doing it for their own good. That’s why the fear of becoming fat, or staying that way, drives Americans to spend more on dieting every year than we spend on video games or movies. Forty-five percent of adults say they’re preoccupied with their weight some or all of the time—an 11-point rise since 1990. Nearly half of 3- to 6- year old girls say they worry about being fat.

The emotional costs are incalculable. I have never written a story where so many of my sources cried during interviews, where they double- and triple-checked that I would not reveal their names, where they shook with anger describing their interactions with doctors and strangers and their own families. One remembered kids singing “Baby Beluga” as she boarded the school bus, another said she has tried diets so extreme she has passed out and yet another described the elaborate measures he takes to keep his spouse from seeing him naked in the light. A medical technician I’ll call Sam (he asked me to change his name so his wife wouldn’t find out he spoke to me) said that one glimpse of himself in a mirror can destroy his mood for days. “I have this sense I’m fat and I shouldn’t be,” he says. “It feels like the worst kind of weakness.”

My interest in this issue is slightly more than journalistic. Growing up, my mother’s weight was the uncredited co-star of every family drama, the obvious, unspoken reason why she never got out of the car when she picked me up from school, why she disappeared from the family photo album for years at a time, why she spent hours making meatloaf then sat beside us eating a bowl of carrots. Last year, for the first time, we talked about her weight in detail. When I asked if she was ever bullied, she recalled some guy calling her a “fat slob” as she biked past him years ago. “But that was rare,” she says. “The bigger way my weight affected my life was that I waited to do things because I thought fat people couldn’t do them.” She got her master’s degree at 38, her Ph.D. at 55. “I avoided so many activities where I thought my weight would discredit me.”

Chances of a woman classified as obese achieving a “normal” weight:0.8%Source: American Journal of Public Health, 2015 But my mother’s story, like Sam’s, like everyone’s, didn’t have to turn out like this. For 60 years, doctors and researchers have known two things that could have improved, or even saved, millions of lives. The first is that diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets. Since 1959, research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost. The reasons are biological and irreversible. As early as 1969, research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism—a body-wide starvation response that blasts you with hunger hormones and drops your internal temperature until you rise back to your highest weight. Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.

The second big lesson the medical establishment has learned and rejected over and over again is that weight and health are not perfect synonyms. Yes, nearly every population-level study finds that fat people have worse cardiovascular health than thin people. But individuals are not averages: Studies have found that anywhere from one-third to three-quarters of people classified as obese are metabolically healthy. They show no signs of elevated blood pressure, insulin resistance or high cholesterol. Meanwhile, about a quarter of non-overweight people are what epidemiologists call “the lean unhealthy.” A 2016 study that followed participants for an average of 19 years found that unfit skinny people were twice as likely to get diabetes as fit fat people. Habits, no matter your size, are what really matter. Dozens of indicators, from vegetable consumption to regular exercise to grip strength, provide a better snapshot of someone’s health than looking at her from across a room.

The terrible irony is that for 60 years, we’ve approached the obesity epidemic like a fad dieter: If we just try the exact same thing one more time, we’ll get a different result. And so it’s time for a paradigm shift. We’re not going to become a skinnier country. But we still have a chance to become a healthier one.

A NOTE ABOUT OUR PHOTOGRAPHSSo many images you see in articles about obesity strip fat people of their strength and personality. According to a recent study, only 11 percent of large people depicted in news reports were wearing professional clothing. Nearly 60 percent were headless torsos. So, we asked our interview subjects to take full creative control of the photos in this piece. This is how they want to present themselves to the world.
“As a kid, I thought that fat people were just lonely and sad—almost like these pathetic lost causes. So I want to show that we get to experience love, too. I’m not some ‘fat friend’ or some dude’s chubby chasing dream. I’m genuinely happy. I just wish I’d known how possible that was when I was a kiddo.”— CORISSA ENNEKING

This is Corissa Enneking at her lightest: She wakes up, showers and smokes a cigarette to keep her appetite down. She drives to her job at a furniture store, she stands in four-inch heels all day, she eats a cup of yogurt alone in her car on her lunch break. After work, lightheaded, her feet throbbing, she counts out three Ritz crackers, eats them at her kitchen counter and writes down the calories in her food journal.

Or not. Some days she comes home and goes straight to bed, exhausted and dizzy from hunger, shivering in the Kansas heat. She rouses herself around dinnertime and drinks some orange juice or eats half a granola bar. Occasionally she’ll just sleep through the night, waking up the next day to start all over again.

The last time she lived like this, a few years ago, her mother marched her to the hospital. “My daughter is sick,” she told the doctor. “She’s not eating.” He looked Enneking up and down. Despite six months of starvation, she was still wearing plus sizes, still couldn’t shop at J. Crew, still got unsolicited diet advice from colleagues and customers.

Enneking told the doctor that she used to be larger, that she’d lost some weight the same way she had lost it three or four times before—seeing how far she could get through the day without eating, trading solids for liquids, food for sleep. She was hungry all the time, but she was learning to like it. When she did eat, she got panic attacks. Her boss was starting to notice her erratic behavior.

“Well, whatever you’re doing now,” the doctor said, “it’s working.” He urged her to keep it up and assured her that once she got small enough, her body would start to process food differently. She could add a few hundred calories to her diet. Her period would come back. She would stay small, but without as much effort.

“If you looked at anything other than my weight,” Enneking says now, “I had an eating disorder. And my doctor was congratulating me.”

Ask almost any fat person about her interactions with the health care system and you will hear a story, sometimes three, the same as Enneking’s: rolled eyes, skeptical questions, treatments denied or delayed or revoked. Doctors are supposed to be trusted authorities, a patient’s primary gateway to healing. But for fat people, they are a source of unique and persistent trauma. No matter what you go in for or how much you’re hurting, the first thing you will be told is that it would all get better if you could just put down the Cheetos.

Emily went to a gynecological surgeon to have an ovarian cyst removed. The physician pointed out her body fat on the MRI, then said, “Look at that skinny woman in there trying to get out.” This phenomenon is not merely anecdotal. Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

Some of these doctors are simply applying the same presumptions as the society around them. An anesthesiologist on the West Coast tells me that as soon as a larger patient goes under, the surgeons start trading “high school insults” about her body over the operating table. Janice O’Keefe, a former nurse in Boston, tells me a doctor once looked at her, paused, then asked, “How could you do this to yourself?” Emily, a counselor in Eastern Washington, went to a gynecological surgeon to have an ovarian cyst removed. The physician pointed out her body fat on the MRI, then said, “Look at that skinny woman in there trying to get out.”

“I was worried I had cancer,” Emily says, “and she was turning it into a teachable moment about my weight.”

Other physicians sincerely believe that shaming fat people is the best way to motivate them to lose weight. “It’s the last area of medicine where we prescribe tough love,” says Mayo Clinic researcher Sean Phelan.

In a 2013 journal article, bioethicist Daniel Callahan argued for more stigma against fat people. “People don’t realize that they are obese or if they do realize it, it’s not enough to stir them to do anything about it,” he tells me. Shame helped him kick his cigarette habit, he argues, so it should work for obesity too.

This belief is cartoonishly out of step with a generation of research into obesity and human behavior. As one of the (many) stigma researchers who responded to Callahan’s article pointed out, shaming smokers and drug users with D.A.R.E.-style “just say no” messages may have actually increased substance abuse by making addicts less likely to bring up their habit with their doctors and family members.

Plus, rather obviously, smoking is a behavior; being fat is not. Jody Dushay, an endocrinologist and obesity specialist at Beth Israel Deaconess Medical Center in Boston, says most of her patients have tried dozens of diets and have lost and regained hundreds of pounds before they come to her. Telling them to try again, but in harsher terms, only sets them up to fail and then blame themselves.

89%of obese adults have been bullied by their romantic partnersSource: University of Connecticut, 2017 Not all physicians set out to denigrate their fat patients, of course; some of them do damage because of subtler, more unconscious biases. Most doctors, for example, are fit—“If you go to an obesity conference, good luck trying to get a treadmill at 5 a.m.,” Dushay says—and have spent more than a decade of their lives in the high-stakes, high-stress bubble of medical schools. According to several studies, thin doctors are more confident in their recommendations, expect their patients to lose more weight and are more likely to think dieting is easy. Sarah (not her real name), a tech CEO in New England, once told her doctor that she was having trouble eating less throughout the day. “Look at me,” her doctor said. “I had one egg for breakfast and I feel fine.”

Then there are the glaring cultural differences. Kenneth Resnicow, a consultant who trains physicians to build rapport with their patients, says white, wealthy, skinny doctors will often try to bond with their low-income patients by telling them, “I know what it’s like not to have time to cook.” Their patients, who might be single mothers with three kids and two jobs, immediately think “No, you don’t,” and the relationship is irretrievably soured.

When Joy Cox, an academic in New Jersey, was 16, she went to the hospital with stomach pains. The doctor didn’t diagnose her dangerously inflamed bile duct, but he did, out of nowhere, suggest that she’d get better if she stopped eating so much fried chicken. “He managed to denigrate my fatness and my blackness in the same sentence,” she says.

“There is so much agency taken from marginalized groups to mute their voices and mask their existence. Being depicted as a female CEO—one who is also black and fat—means so much to me. It is a representation of the reclamation of power in the boardroom, classroom and living room of my body. I own all of this.”— JOY COX

Many of the financial and administrative structures doctors work within help reinforce this bad behavior. The problem starts in medical school, where, according to a 2015 survey, students receive an average of just 19 hours of nutrition education over four years of instruction—five hours fewer than they got in 2006. Then the trouble compounds once doctors get into daily practice. Primary care physicians only get 15 minutes for each appointment, barely enough time to ask patients what they ate today, much less during all the years leading up to it. And a more empathic approach to treatment simply doesn’t pay: While procedures like blood tests and CT scans command reimbursement rates from hundreds to thousands of dollars, doctors receive as little as $24 to provide a session of diet and nutrition counseling.

Lesley Williams, a family medicine doctor in Phoenix, tells me she gets an alert from her electronic health records software every time she’s about to see a patient who is above the “overweight” threshold. The reason for this is that physicians are often required, in writing, to prove to hospital administrators and insurance providers that they have brought up their patient’s weight and formulated a plan to bring it down—regardless of whether that patient came in with arthritis or a broken arm or a bad sunburn. Failing to do that could result in poor performance reviews, low ratings from insurance companies or being denied reimbursement if they refer patients to specialized care.

Another issue, says Kimberly Gudzune, an obesity specialist at Johns Hopkins, is that many doctors, no matter their specialty, think weight falls under their authority. Gudzune often spends months working with patients to set realistic goals—playing with their grandkids longer, going off a cholesterol medication—only to have other doctors threaten it all. One of her patients was making significant progress until she went to a cardiologist who told her to lose 100 pounds. “All of a sudden she goes back to feeling like a failure and we have to start over,” Gudzune says. “Or maybe she just never comes back at all.”

60%of the calories Americans consume come from “ultra-processed foods”Source: British Medical Journal, 2016 And so, working within a system that neither trains nor encourages them to meaningfully engage with their higher-weight patients, doctors fall back on recommending fad diets and delivering bland motivational platitudes. Ron Kirk, an electrician in Boston, says that for years, his doctor’s first resort was to put him on some diet he couldn’t maintain for more than a few weeks. “They told me lettuce was a ‘free’ food,” he says—and he’d find himself carving up a head of romaine for dinner.

In a study that recorded 461 interactions with doctors, only 13 percent of patients got any specific plan for diet or exercise and only 5 percent got help arranging a follow-up visit. “It can be stressful when [patients] start asking a lot of specific questions” about diet and weight loss, one doctor told researchers in 2012. “I don’t feel like I have the time to sit there and give them private counseling on basics. I say, ‘Here’s some websites, look at this.’” A 2016 survey found that nearly twice as many higher-weight Americans have tried meal-replacement diets—the kind most likely to fail—than have ever received counseling from a dietician.

“It borders on medical malpractice,” says Andrew (not his real name), a consultant and musician who has been large his whole life. A few years ago, on a routine visit, Andrew’s doctor weighed him, announced that he was “dangerously overweight” and told him to diet and exercise, offering no further specifics. Should he go on a low-fat diet? Low-carb? Become a vegetarian? Should he do Crossfit? Yoga? Should he buy a fucking ThighMaster?

“She didn’t even ask me what I was already doing for exercise,” he says. “At the time, I was training for serious winter mountaineering trips, hiking every weekend and going to the gym four times a week. Instead of a conversation, I got a sound bite. It felt like shaming me was the entire purpose.”

All of this makes higher-weight patients more likely to avoid doctors. Three separate studies have found that fat women are more likely to die from breast and cervical cancers than non-fat women, a result partially attributed to their reluctance to see doctors and get screenings. Erin Harrop, a researcher at the University of Washington, studies higher-weight women with anorexia, who, contrary to the size-zero stereotype of most media depictions, are twice as likely to report vomiting, using laxatives and abusing diet pills. Thin women, Harrop discovered, take around three years to get into treatment, while her participants spent an average of 13 and a half years waiting for their disorders to be addressed.

“A lot of my job is helping people heal from the trauma of interacting with the medical system,” says Ginette Lenham, a counselor who specializes in obesity. The rest of it, she says, is helping them heal from the trauma of interacting with everyone else.

“My weight makes me anxious. I’m constantly sucking my stomach in when I stand, and if I’m sitting, I always grab a pillow or couch cushion to hold in front of it. I’m most comfortable in my bathrobe, alone. At the same time, my brain starves for attention. I want to be onstage. I want to be the one holding a microphone. So, I decided to split the difference with this photograph: to perform and to obscure. The worst part is that intellectually I know that I have worth beyond pounds and waist inches and stereotypes. But I still feel like I have to hide.”— SAM (NOT HIS REAL NAME)

If Sonya ever forgets that she is fat, the world will remind her. She has stopped taking the bus, she tells me, because she can sense the aggravation of the passengers squeezing past her. Sarah, the tech CEO, tenses up when anyone brings bagels to a work meeting. If she reaches for one, are her employees thinking, “There goes the fat boss”? If she doesn’t, are they silently congratulating her for showing some restraint?

Emily says it’s the do-gooders who get to her, the women who stop her on the street and tell her how brave she is for wearing a sleeveless dress on a 95-degree day. Sam, the medical technician, avoids the subject of weight altogether. “Men aren’t supposed to think about this stuff—and I think about it constantly,” he admits. “So I never let myself talk about it. Which is weird because it’s the most visible thing about me.”

Again and again I hear stories of how the pressure to be a “good fatty” in public builds up and explodes. Jessica has four kids. Every week is a birthday party or family reunion or swimming pool social, another opportunity to stand around platters of spare ribs and dinner rolls with her fellow moms.

“Your conscious mind is busy the whole day with how many calories is in everything, what you can eat and who’s watching,” she says. After a few intrusive comments over the years—should you be eating that?—she has learned to be careful, to perform the role of the impeccable fat person. She nibbles on cherry tomatoes, drinks tap water, stays on her feet, ignores the dessert end of the buffet.

Then, as the gathering winds down, Jessica and the other parents divvy up the leftovers. She wraps up burgers or pasta salad or birthday cake, drives her children home and waits for the moment when they are finally in bed. Then, when she’s alone, she eats all the leftovers by herself, in the dark.

“It’s always hidden,” she says. “I buy a package of ice cream, then eat it all. Then I have to go to the store to buy it again. For a week my family thinks there’s a thing of ice cream in the fridge—but it’s actually five different ones.”

Ratio of soda and candy ads seen by black children compared to white children:2:1Source: UConn Rudd Center for Food Policy and Obesity, 2015 This is how fat-shaming works: It is visible and invisible, public and private, hidden and everywhere at the same time. Research consistently finds that larger Americans (especially larger women) earn lower salaries and are less likely to be hired and promoted. In a 2017 survey, 500 hiring managers were given a photo of an overweight female applicant. Twenty-one percent of them described her as unprofessional despite having no other information about her. What’s worse, only a few cities and one state (nice work, Michigan) officially prohibit workplace discrimination on the basis of weight.

Paradoxically, as the number of larger Americans has risen, the biases against them have become more severe. More than 40 percent of Americans classified as obese now say they experience stigma on a daily basis, a rate far higher than any other minority group. And this does terrible things to their bodies. According to a 2015 study, fat people who feel discriminated against have shorter life expectancies than fat people who don’t. “These findings suggest the possibility that the stigma associated with being overweight,” the study concluded, “is more harmful than actually being overweight.”

And, in a cruel twist, one effect of weight bias is that it actually makes you eat more. The stress hormone cortisol—the one evolution designed to kick in when you’re being chased by a tiger or, it turns out, rejected for your looks—increases appetite, reduces the will to exercise and even improves the taste of food. Sam, echoing so many of the other people I spoke with, says that he drove straight to Jack in the Box last year after someone yelled, “Eat less!” at him across a parking lot.

“I don’t want to be portrayed; this is not about me. It’s about that guy you always see on the far treadmill at the gym. Or the lady who brings the most beautiful salads to work every day for lunch. It’s about the little girl who got bullied because of her size, and the little boy who was told he wasn’t man enough. It’s not about me, but had it been about me when I was that chubby little girl, maybe I wouldn’t be standing here, head against the door, wondering if I’m enough.”— ERIKA

There’s a grim caveman logic to our nastiness toward fat people. “We’re attuned to bodies that look different,” says Janet Tomiyama, a stigma researcher at UCLA. “In our evolutionary past, that might have meant disease risk and been seen as a threat to your tribe.” These biological breadcrumbs help explain why stigma begins so early. Kids as young as 3 describe their larger classmates with words like “mean,” “stupid” and “lazy.”

And yet, despite weight being the number one reason children are bullied at school, America’s institutions of public health continue to pursue policies perfectly designed to inflame the cruelty. TV and billboard campaigns still use slogans like “Too much screen time, too much kid” and “Being fat takes the fun out of being a kid.” Cat Pausé, a researcher at Massey University in New Zealand, spent months looking for a single public health campaign, worldwide, that attempted to reduce stigma against fat people and came up empty. In an incendiary case of good intentions gone bad, about a dozen states now send children home with “BMI report cards,” an intervention unlikely to have any effect on their weight but almost certain to increase bullying from the people closest to them.

This is not an abstract concern: Surveys of higher-weight adults find that their worst experiences of discrimination come from their own families. Erika, a health educator in Washington, can still recite the word her father used to describe her: “husky.” Her grandfather preferred “stocky.” Her mother never said anything about Erika’s body, but she didn’t have to. She obsessed over her own, calling herself “enormous” despite being two sizes smaller than her daughter. By the time Erika was 11, she was sneaking into the woods behind her house and vomiting into the creek whenever social occasions made starving herself impossible.

And the abuse from loved ones continues well into adulthood. A 2017 survey found that 89 percent of obese adults had been bullied by their romantic partners. Emily, the counselor, says she spent her teens and 20s “sleeping with guys I wasn’t interested in because they wanted to sleep with me.” In her head, a guy being into her was a rare and depletable resource she couldn’t afford to waste: “I was desperate for men to give me attention. Sex was a good way to do that.”

Eventually, she ended up with someone abusive. He told her during sex that her body was beautiful and then, in the daylight, that it was revolting. “Whenever I tried to leave him, he would say, ‘Where are you gonna find someone who will put up with your disgusting body?’” she remembers.

Emily finally managed to get away from him, but she is aware that her love life will always be fraught. The guy she’s dating now is thin—“think Tony Hawk,” she says—and she notices the looks they get when they hold hands in public. “That never used to happen when I dated fat dudes,” she says. “Thin men are not allowed to be attracted to fat women.”

The effects of weight bias get worse when they’re layered on top of other types of discrimination. A 2012 study found that African-American women are more likely to become depressed after internalizing weight stigma than white women. Hispanic and black teenagers also have significantly higher rates of bulimia. And, in a remarkable finding, rich people of color have higher rates of cardiovascular disease than poor people of color—the opposite of what happens with white people. One explanation is that navigating increasingly white spaces, and increasingly higher stakes, exerts stress on racial minorities that, over time, makes them more susceptible to heart problems.

But perhaps the most unique aspect of weight stigma is how it isolates its victims from one another. For most minority groups, discrimination contributes to a sense of belongingness, a community in opposition to a majority. Gay people like other gay people; Mormons root for other Mormons. Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them. In a 2005 study, the words obese participants used to classify other obese people included gluttonous, unclean and sluggish.

Andrea, a retired nurse in Boston, has been on commercial diets since she was 10 years old. She knows how hard it is to slim down, knows what women larger than her are going through, but she still struggles not to pass judgment when she sees them in public. “I think, ‘How did they let it happen?’” she says. “It’s more like fear. Because if I let myself go, I’ll be that big too.”

Her position is all-too understandable. As young as 9 or 10, I knew that coming out of the closet is what gay people do, even if it took me another decade to actually do it. Fat people, though, never get a moment of declaring their identity, of marking themselves as part of a distinct group. They still live in a society that believes weight is temporary, that losing it is urgent and achievable, that being comfortable in their bodies is merely “glorifying obesity.” This limbo, this lie, is why it’s so hard for fat people to discover one another or even themselves. “No one believes our It Gets Better story,” says Tigress Osborn, the director of community outreach for the National Association to Advance Fat Acceptance. “You can’t claim an identity if everyone around you is saying it doesn’t or shouldn’t exist.”

Harrop, the eating disorders researcher, realized several years ago that her university had clubs for trans students, immigrant students, Republican students, but none for fat students. So she started one—and it has been a resounding, unmitigated failure. Only a handful of fat people have ever showed up; most of the time, thin folks sit around brainstorming about how to be better allies.

I ask Harrop why she thinks the group has been such a bust. It’s simple, she says: “Fat people grow up in the same fat-hating culture that non-fat people do.”

‘Transmissible’ Alzheimer’s theory gains traction


Mouse tests confirm that sticky proteins associated with degenerative brain diseases can be transferred — but researchers say risks for humans are likely to be minimal.

 

 

Alzheimer's disease

A normal brain of a 70-year-old (left slice), compared with the brain of a 70-year-old with Alzheimer’s disease.

Neuroscientists have amassed more evidence for the hypothesis that sticky proteins that are a hallmark of neurodegenerative diseases can be transferred between people under particular conditions — and cause new damage in a recipient’s brain.

They stress that their research does not suggest that disorders such as Alzheimer’s disease are contagious, but it does raise concern that certain medical and surgical procedures pose a risk of transmitting such proteins between humans, which might lead to brain disease decades later.

“The risk may turn out to be minor — but it needs to be investigated urgently,” says John Collinge, a neurologist at University College London who led the research, which is published in Nature1 on 13 December.

The work follows up on a provocative study published by Collinge’s team in 20152. The researchers discovered extensive deposits of a protein called amyloid-beta during post-mortem studies of the brains of four people in the United Kingdom. They had been treated for short stature during childhood with growth-hormone preparations derived from the pituitary glands of thousands of donors after death.

The recipients had died in middle-age of a rare but deadly neurodegenerative condition called Creutzfeldt-Jakob disease (CJD), caused by the presence in some of the growth-hormone preparations of an infectious, misfolded protein — or prion — that causes CJD. But pathologists hadn’t expected to see the amyloid build up at such an early age. Collinge and his colleagues suggested that small amounts of amyloid-beta had also been transferred from the growth-hormone samples, and had caused, or ‘seeded’, the characteristic amyloid plaques.

Seeds of trouble

Amyloid plaques in blood vessels in the brain are a hallmark of a disease called cerebral amyloid angiopathy (CAA) and they cause local bleeding. In Alzheimer’s disease, however, amyloid plaques are usually accompanied by another protein called tau — and the researchers worry that this might also be transmitted in the same way. But this was not the case in the brains of the four affected CJD patients, which instead had the hallmarks of CAA.

The team has now more directly tested the hypothesis that these proteins could be transmitted between humans through contaminated biological preparations. Britain stopped the cadaver-derived growth hormone treatment in 1985 and replaced it with a treatment that uses synthetic growth hormone. But Collinge’s team was able to locate old batches of the growth-hormone preparation stored as powder for decades at room temperature in laboratories at Porton Down, a national public-health research complex in southern England.

When the researchers analysed the samples, their suspicions were confirmed: they found that some of the batches contained substantial levels of amyloid-beta and tau proteins.

Mouse tests

To test whether the amyloid-beta in these batches could cause the amyloid pathology, they injected samples directly into the brains of young mice genetically engineered to be susceptible to amyloid pathology. By mid-life, the mice had developed extensive amyloid plaques and CAA. Control mice that received either no treatment or treatment with synthetic growth hormone didn’t have amyloid build up.

The scientists are now checking in separate mouse experiments whether the same is true for the tau protein.

“It’s an important study, though the results are very expected,” says Mathias Jucker at the Hertie Institute for Clinical Brain Research in Tubingen, Germany. Jucker demonstrated in 2006 that amyloid-beta extracted from human brain could initiate CAA and plaques in the brains of mice3. Many other mouse studies have also since confirmed this.

Surgical implications

That the transmissibility of the amyloid-beta could be preserved after so many decades underlines the need for caution, says Jucker. The sticky amyloid clings tightly to materials used in surgical instruments, resisting standard decontamination methods4. But Jucker also notes that, because degenerative diseases take a long time to develop, the danger of any transfer may be most relevant in the case of childhood surgery where instruments have also been used on old people.

So far, epidemiologists have not been able to assess whether a history of surgery increases the risk of developing a neurodegenerative disease in later life — because medical databases tend not to include this type of data.

But epidemiologist Roy Anderson at Imperial College London says researchers are taking the possibility seriously. Major population cohort studies, such as the US Framingham Heart Study, are starting to collect information about participants’ past surgical procedures, along with other medical data.

The 2015 revelation prompted pathologists around the world to reexamine their own cases of people who had been treated with similar growth-hormone preparations — as well as people who had acquired CJD after brain surgery that had involved the use of contaminated donor brain membranes as repair patches. Many of the archived brain specimens, they discovered, were full of aberrant amyloid plaques5,6,7. One study showed that some batches of growth-hormone preparation used in France in the 1970s and 1980s were contaminated with amyloid-beta and tau — and that tau was also present in three of their 24 patients.8

Collinge says he applied unsuccessfully for a grant to develop decontamination techniques for surgical instruments after his 2015 paper came out. “We raised an important public-health question, and it is frustrating that it has not yet been addressed.” But he notes that an actual risk from neurosurgery has not yet been established.

Too Much Oxygen Is Harmful


A meta-analysis shows significantly higher mortality with liberal use of supplemental oxygen in acutely ill patients.

 

Supplemental oxygen can be a life-saving intervention for patients with hypoxemic respiratory failure; however, emerging evidence suggests that too much oxygen is harmful (NEJM JW Gen Med Dec 1 2016 and NEJM 2016; 316:1583). Small trials have shown excess cardiac arrhythmias, lung injuries, and other complications in hospitalized patients without demonstrated hypoxemia who receive oxygen or whose oxygen administration results in supra-normal partial pressures (i.e., hyperoxemia). Should we be doing more to turn down the oxygen when it’s not needed?

Investigators completed a meta-analysis of 25 randomized trials that included 16,000 acutely ill patients who were treated with either a liberal or a conservative oxygenation strategy. Oxygen targets and supplementation thresholds differed across studies. Median oxygen supplementation levels were fraction of inspired oxygen (FiO2) 0.52 vs. 0.21 (liberal vs. conservative).

Relative risk for death at 30 days was significantly higher in patients who received liberal oxygen (RR, 1.14), although no association was evident between mortality and either peripheral saturation or FiO2. Risk for disability, length of stay, and incidence of hospital-acquired infections, including pneumonia, were similar under both strategies.

Comment

All too often, a patient’s oxygen saturation is maintained at 100%. This is not only unnecessary but also probably harmful. It should become part of our practice to turn down the supplemental oxygen until we see oxygen saturations no higher than 95% for most patients and to stop oxygen use as soon as it is not needed. I suspect that we will learn that a target saturation lower than 95% is safe, but for now, avoiding hyperoxemia makes sense.

Whole-Fat or Nonfat Dairy? The Debate Continues


It’s been 40 years since the federal government first recommended that everyone except young children opt for low-fat or nonfat dairy products over high-fat dairy products as part of an overall goal of reducing saturated fat intake and calories.

Image description not available.

A decade later, US sales of low-fat and skim milk combined exceeded those of whole milk for the first time, according to the International Dairy Foods Association. And in 2010, the Healthy, Hunger-Free Kids Act required that schools follow dietary recommendations and replace whole milk with nonfat or low-fat unflavored milk or nonfat flavored milk.

But some recent studies have suggested that high-fat milk, cheese, and yogurt are at least as healthful as their low-fat or nonfat counterparts, and their authors are questioning the wisdom of advising people to avoid whole milk and products made with it.

“I don’t think there’s enough evidence to recommend low-fat dairy,” said cardiologist Dariush Mozaffarian, MD, dean of the Friedman School of Nutrition Science and Policy at Tufts University. However, Mozaffarian added, “I don’t think there’s enough evidence to recommend whole-fat dairy, either.”

Although dairy products account for about 10% of total fats in the average US diet, “we’ve been making recommendations on them based on theories,” he said.

Just as the evidence suggests that not all food sources of saturated fats—ie, animals, plants, and dairy—are the same, neither are all sources of dairy fats, Mozaffarian said. Because cheese is fermented and some yogurts contain probiotics, “they are probably better for you than milk,” he said. And yet, Mozaffarian said, scientists and dietary guidelines tend to lump all dairy products together.

“This is a very complicated area, because dairy is not a homogeneous food,” said Frank Hu, MD, PhD, MPH, chair of the nutrition department at Harvard University’s T. H. Chan School of Public Health. “Also, dietary patterns are very different among people who eat dairy products.”

For example, Hu said, while US consumers chow down on cheeseburgers and pizza, Europeans are more likely to eat cheese for cheese’s sake, not as a topping for foods that without it are already high in fat or sodium or both.

Teasing Out Dairy

Most of the evidence about the health effects of dairy products has come from observational studies. One of the largest to look at the association between dairy intake and cardiovascular disease (CVD) and mortality, the Prospective Urban Rural Epidemiology (PURE) study, involved 136 384 individuals aged 35 to 70 years in 21 countries on 5 continents. Participants recorded their intake of high-fat and low-fat milk, yogurt, and cheese on a food frequency questionnaire at the beginning of the study. During the 9.1-year follow-up, there were 6796 deaths and 5855 major cardiovascular events (death due to cardiovascular causes, nonfatal heart attack, stroke, or heart failure) among study participants.

A higher intake of total dairy, defined as more than 2 servings a day, was associated with a lower risk of death or a major cardiovascular event than no intake. However, the authors found no significant association between dairy intake and heart attack, and only consumption of milk and yogurt, not cheese or butter, was significantly associated with the studied outcomes.

Whole-fat dairy products appeared to be more protective than nonfat or low-fat products, which aren’t available in some PURE countries, including India and South Africa, noted coauthor Mahshid Dehghan, PhD, an investigator with the Population Health Research Institute at McMaster University. “In some countries,” Dehghan added, “daily [dairy] consumption is not part of the diet. In Malaysia, people do not drink milk or consume yogurt.”

Because of these variations in dairy consumption, Dehghan and her coauthors, who included Mozaffarian, conducted a subgroup analysis to determine whether the associations between dairy intake and outcomes were similar in each region. To minimize the possibility of reverse causality, they excluded people with known CVD, who might be more likely to choose lowfat or nonfat dairy.

“The consistency of results across regions with markedly different lifestyles makes it less likely that confounders, which are likely to vary in different regions, explain our observations,” the authors concluded.

However, the PURE study didn’t adjust for many socioeconomic variables that could influence individuals’ risk of CVD and death, Hu said. For example, he said, in poorer, developing countries, “if you have more money, you can afford to buy dairy, meats, eat more protein, less carbohydrates,” which leads to improved nutritional status compared with the poorest people in these countries. In other words, he said, dairy consumption alone might not deserve the credit for the better outcomes.

As John P. A. Ioannidis, MD, DSc, a professor at the Stanford Research Prevention Center, wrote in a recent JAMA Viewpoint, “extensive residual confounding and selective reporting” in nutritional epidemiologic research can lead to “implausible estimates of benefits or risks associated with diet.”

Another problem, Hu said, is that the highest category of dairy consumption in PURE was only 2 servings a day. “That’s not really generalizable to the United States,” he said. After all, the US dietary guidelines recommend 3 servings a day (although less than 20% of the population meets or exceeds that goal, according to the 2015-2020 guidelines report).

Looking at Biomarkers

The PURE study depended on participants’ recall of their average daily dairy consumption for the past year. However, “self-reported consumption may be limited by errors or reporting bias,” according to a recently published observational study that took a different approach. Besides, the authors continued, people might not be aware of how much dairy fat they’re consuming in a range of foods, including baked goods, sauces, fried foods, and coffee drinks.

So instead of depending on study participants to accurately report their dairy intake, the authors looked at the relationship between circulating biomarkers of fatty acids found in dairy products and total mortality, cause-specific mortality, and CVD risk among 2907 US adults aged 65 and older who did not have CVD when the study began. The researchers measured participants’ fatty acid concentrations at baseline and then 6 years and 13 years later.

During 22 years of follow-up, none of the fatty acids was significantly associated with total mortality. But high levels of one type of fatty acid, heptadecanoic acid, were inversely associated with CVD and stroke mortality. However, the authors note that other components of dairy products, such as protein, lactose, and minerals, could have confounded these findings.

Mozaffarian, a coauthor of the fatty acids and CVD risk study, and Hu were among the authors of a recent article examining the relationship of 3 fatty acids (that partly reflect dairy fat consumption) with type 2 diabetes risk. In their pooled analysis of 16 prospective cohort studies, totaling 63 682 adults who did not have diabetes at baseline, higher levels of the fatty acids were associated with a lower risk of type 2 diabetes.

While the biomarkers assessed are correlated with dairy intake, Hu said, he acknowledged that they have limitations. “This is a relatively crude estimate of the exact amount of intake,” he said. Some fatty acids are produced endogenously, Hu said. In addition, an individual who drank 3 glasses of low-fat milk could have higher levels of the dairy fatty acids than someone who drank 1 glass of full-fat milk.

Although biomarkers aren’t a perfect measure of dairy intake, “they’re a step in the right direction,” said Mario Kratz, PhD, a faculty member of the Nutritional Sciences Program at the University of Washington School of Public Health, who was not involved in either biomarker study.

Beyond Observational Studies

A randomized controlled trial would avoid the potential of confounding in observational studies that rely on biomarkers or food frequency questionnaires, Kratz said. But, he added, when he proposed seeking a National Institutes of Health grant to fund a randomized trial to study the health effects of dairy, a senior colleague advised him not to waste his time. That’s because it’s likely that at least 1 reviewer would think that the question had already been answered, according to his colleague.

“Our opinion is this was not fundable with public funds,” Kratz said. Reluctantly, he said, he decided to seek industry funding instead.

Kratz raised $1 million to fund his study from such organizations as the Dairy Research Institute, the Dairy Farmers of Canada, and Dairy Management Inc, all of whom took a risk, he said, because “it’s not guaranteed that dairy will look favorable. We may be just fine without any dairy.”

His trial has enrolled 75 men and women with metabolic syndrome; as of mid-October, 72 participants had completed a 4-week wash-in period—in which they were given the option of consuming 3 servings of skim milk per week but no more—and the first clinic visit. After the wash-in period, participants have been randomized to 1 of 3 groups for 12 weeks: up to 3 servings of skim milk per week, 3.3 daily servings of nonfat or low-fat dairy, or 3.3 daily servings of full-fat dairy. The dairy products were weighed, packaged, and distributed to study participants via the Fred Hutchinson Cancer Research Center’s Human Nutrition Laboratory (Fred Hutchinson provided approximately $500 000 to fund the study).

Besides their dairy assignment, participants have been told to eat what they normally eat except for no dairy besides what is provided. Because food diaries are unreliable, Kratz said, study participants received surprise phone calls from dietitians asking what they had eaten in the previous 24 hours.

Kratz and his collaborators want to see how different amounts and types of dairy products affect blood glucose regulation and cardiometabolic health. “All of us are excited about the study, because we really have no idea what the results [will be],” he said.

Weighty Matters

One reason people opt for low-fat or nonfat dairy products is because they think consuming whole-fat milk, yogurt, and cheese will make them gain weight and will elevate their blood lipids.

However, “these are really rich sources of important nutrients,” said Marcia de Oliveira Otto, PhD, assistant professor in the Department of Epidemiology, Human Genetics and Environmental Science at the UTHealth School of Public Health in Houston and a coauthor of the study that assessed dairy fat biomarkers and CVD risk.

In fact, Kratz said, “the data never overwhelmingly showed that full-fat dairy made you gain weight, contributed to heart disease, contributed to metabolic disease.” Actually, he added, “people who eat the most full-fat dairy products in observational studies are usually among the ones who gain the least amount of weight.”

That seems counterintuitive, but, Kratz said, “it’s very likely that there’s a type of compensation going on.” Low-fat or nonfat dairy isn’t as filling as whole-fat dairy, so people might end up craving unhealthy snacks if they opt for the former, he said. However, he added, “I would never recommend people consume large amounts of butter and cream.”

Time to Change Dietary Guidelines?

The US Department of Agriculture and the US Department of Health and Human Services publish Dietary Guidelines for Americans every 5 years. Development of the 2020-2025 guidelines is already under way, and de Oliveira Otto said that it might be time to revise the decades-old recommendation about choosing low-fat or nonfat dairy products over full-fat versions.

But Hu, who served on the panel that drew up the most recent US Dietary Guidelines, issued in 2015, continues to stand by that advice.

Members of the panel charged with writing the 2020-2025 Dietary Guidelines have not yet been selected, but, Hu said, he doesn’t expect them to change the recommendation that favors low-fat and nonfat dairy products over high-fat dairy products. “As far as I can tell, the evidence base hasn’t really changed substantially,” he said.

Hu recently coauthored a review of evidence about dairy products, dairy fatty acids, and the prevention of cardiometabolic disease. Although the more recent studies suggesting benefits of full-fat dairy were not included in his review, they would not have changed his conclusion that “more research is needed to examine health effects of different types of dairy products in diverse populations.”

Meanwhile, Hu advises, “don’t get overstressed about just one thing. Overall dietary pattern is very important, and dairy is only 1 of many food items on our plate.”

Reality is an illusion: The scientific proof everything is energy and reality isn’t real


Quantum physicists are discovering facts about the world that we would never have thought to be possible.

The scientific breakthroughs that have taken place in the last few years are as significant to our understanding of reality as Copernicus’s outline of the solar system.

The problem? Many of us simply do not understand quantum physics. And this all began roughly a hundred years ago, when physicists began challenging the assumption that the physical space and universe that we see around us is actually “real”.

Scientists decided that to prove that reality was not, in fact, simply an illusion, they had to discover the “point particle”, and this would be accomplished with innovations like the Large Hadron Collider.

This machine was initially built to smash particles into one another, and this is where they made the greatest discovery: the physical world is not as physical as we believe. Reality is an illusion as we see it.  Instead, everything around us is just energy.

How Reality Is Just Energy

We think of the atom as an organized group of electrons and protons zooming around a neutron, but this figure is completely wrong.

The particles that make up the atoms have no structure or size, no weight or physical presence.

They have no height, length, width, or weight, and are nothing more than events in time. They have zero dimensions.

Electrons also do not have a singular presence—they are both a particle and a wave simultaneously, depending on how they are observed.

They are never in a single location at a single moment, and instead exist in several moments at the same time.

Scientists also discovered what is known as the “superposition”, in which several particles aside from electrons can be proven to exist in multiple places at a single moment.



What does all this mean?

It means that the more we discover about the subatomic world, the more we discover that we know nothing about the true nature of reality at all.

The Copenhagen Interpretation

Many scientists have come to the Copenhagen Interpretation as their conclusion for understanding reality.

The Copenhagen Interpretation comes from the school of quantum mechanics, and it believes that reality does not exist without an observer to observe it.

As reality is nothing more than energy (what gives us physicality if the smallest parts of us have no physical characteristics?), then the energy is conscious when consciousness is observing it.

This may be difficult to understand.

Think of it this way: since particles exist in several areas at the same time, then it must respond to an observation by choosing to exist in a singular location, allowing the observer to have an image to observe.

A growing number of researchers in this field believe that reality exists only because human consciousness wills it to exist, by interacting with the energy that makes up the universe.



Understanding the Universe as Information

Another mind-blowing discovery in quantum physics is entanglement.

Entanglement is when a pair of particles have interacted and have affected the spin of the other particle.

What’s strange is that once these two particles have become tangled with one another, they can never become untangled.

No matter how far apart they may stretch from the other, the spin of one particle will always affect the spin of the other.

Researchers have observed this in living cells, communicating over far distances. In one famous experiment, researchers grew algae cells in a petri dish. They then separated these cells into two halves, taking one half to another laboratory.

What they found was that no matter how much they separated the two dishes, a low-voltage current applied on one dish would always affect the cells in the other dish in the exact same way at the exact same moment.

How Is this possible?

Understanding this requires shifting the way we think of the universe. We can no longer think of the universe as a physical realm in which the things we observe and sense are all that exists.

Instead, as famous physicist Sir Roger Penrose theorized, we must envision the universe as nothing but information.

We must believe that the physical universe is just a product of an abstract universe, in which we are all connected in an unobservable way.

Information is simply embedded into the physical constructs of the physical universe, but is transmitted to our physical states from the abstract realm, first theorized by Greek philosopher, Plato.

As Erwin Schrodinger famously stated, “What we observe as material bodies and forces are nothing but shapes and variations in the structure of space. Particles are just appearances.”

Simply put, everything is nothing but energy.

Coping With A Different Reality

There are certain questions and realizations you must come to terms with after learning this true state of reality. You could obsess over the implications indefinitely, but here are a few to start you off:

  • You have never touched anything, and you never will. The electrons that make up your atoms repulse against the electrons of other physical entities, making it impossible for you to interact with other material at the subatomic level.
  • If we are not touching anything, then what is it that we feel when we “touch”?
  • How is the world physical when the building blocks that make it have no dimensions?
  • How is anything real, and what does real mean?
  • Is reality determined by physicality?

Reality show idea: Make Flat-Earthers search for the world’s edge


The contestants would try to reach the end of the world, as they understand it.

Paul Ratner 25 September, 2018

  • According to Flat-Earthers, our planet is flat and space travel doesn’t happen.
  • People are calling for a reality show about Flat-Earthers.
  • Flat-Earthers say a 150-foot ice wall surrounds the world.

Amidst all the fake news, misinformation sponsored by governments, and the explosion of conspiracy theories that bombard us daily, it’s no surprise that there seems to be a growing number of Flat-Earthers. After all, once you start doubting reality and the solidity of the institutions around you, being unsure whether the Earth is flat or round seems almost warranted. This said, there is a strong demand (at least online) for a reality show about Flat-Earthers searching for the edge of the world.

Ah. And what else could better signify our times?

Your basic flat earth belief kit often stems from biblical references, such as one, apparently, that mentions a giant tree that’s supposedly visible from all corners of the Earth — at its “farthest bounds.” If the planet was spherical this would not be possible while a flat Earth allows for such a scenario. Other beliefs that go along with this include claiming that gravity isn’t real and that a Game of Thrones-like wall of ice surrounds the rim of the disc-like Earth. This wall is Antarctica while the Arctic Circle is the disc’s center. If you went over the wall, you would fall into outer space or end up on an infinite plane. But, as the Flat Earth Society site admits, “To our knowledge, no one has been very far past the ice wall and returned to tell of their journey.”

Notably, according to the Flat-Earthers, the 150-foot-tall wall is guarded by NASA. The agency’s real mission is to keep the truth away from regular citizens while being an embezzlement front and faking space travel.

Although these beliefs are certainly not supported by the ample evidence to the contrary, provided by people who have experienced the planet’s curvature from above — or those who have been to Antarctica — the number of Flat-Earthers is likely to grow. According to a 2018 survey, about a third of millennials are willing to entertain doubts about the Earth being round. Not all of these believe in the planet being flat, but it’s easy to envision their ranks expanding, as such memes tend to acquire new converts by their sheer scope and intellectual frivolity. One clear catalyst for the resurgence of this idea has certainly been the Internet.

An animation of the day/night cycle according to Flat Earth Theory over the course of 24 hours.

Credit: Flat Earth Society.

The net, in its infinite wisdom, keeps a strong meme alive. So it is in this case, as the desire to watch a reality show about Flat-Earthers searching for the edge of the world keeps popping up on popular Reddit threads time and time again, causing tends of thousands of upvotes and comments. Of course, the impetus behind this show stems, for many, from the hope Flat-Earthers will fail spectacularly.

One such thread proposes that it would be “funny” to “give them access to a helicopter, boats, transportation, and flights to try and find the end of the world.” And then, suggests user “Pilotavery,” the contestants or “Flerfers” should be made to tell the organizers where they plan to go. The poster thinks this would dampen their enthusiasm, adding “I wonder how long it will take before they give up?” On the other hand, the poster thinks it would be “funny to see how frustrated they get.”

We should fund a reality TV show, funding/following flat earthers in the search for the end of the earth. from r/flatearth

Another idea is to have a voting component to the show, with “the most trustworthy” Flat-Earthers being sent to the International Space Station to see the truth for themselves.

While it’s certainly amusing, there is clearly a danger of such a show being set up to make the contestants look ridiculous, especially if you believe that they will not find the edge of the world. The upside for Flat-Earthers could be an opportunity to share their beliefs to millions via television, all the while trying to prove their theory right. Maybe they can make everyone else looks silly by actually finding a wall of ice at the end of the world. Wouldn’t you want to watch that to find out?

In any case, no such show exists at the moment. But, Hollywood, if you’re reading this, the internet wants what the internet wants. Make it happen.

Facebook Isn’t Sorry


On Monday morning Facebook revealed a new gadget — a voice-activated video chat tablet with an always-listening microphone and camera for your living room or kitchen that can detect when you are in your own house. This in-home panopticon is called Facebook Portal, and its debut comes at what might seem like an inopportune time for the company — days after a Gizmodo report revealed it was harvesting two-factor authentication numbers; less than 10 days after it revealed that an attack on its computer network had exposed the personal information of nearly 50 million users (and left 40 million more vulnerable); and barely six months after CEO Mark Zuckerberg appeared before Congress to explain how it let Cambridge Analytica acquire the private information of up to 87 million users without consent to be used for psychographic profiling.

To call Facebook’s newest home surveillance device ill-timed is generous. It’s like Trump announcing a new resort and casino in Moscow or BP announcing a fleet of Deepwater Horizon oil tankers. It’s a flagrant flex of Facebook’s market share muscle and a yet another reminder that the company’s data collection ambitions supersede all else.

It’s also further confirmation that Facebook isn’t particularly sorry for its privacy failures — despite a recent apology tour that included an expensive “don’t worry, we got this” mini-documentary, full-page apology ads in major papers, and COO Sheryl Sandberg saying things like, “We have a responsibility to protect your information. If we can’t, we don’t deserve it.” Worse, it belies the idea that Facebook has any real desire to reckon with the structural issues that obviously undergird its continued privacy missteps.

But more troubling still is what a product like Portal says about us, Facebook’s users: We don’t care enough about our privacy to quit it.

Tone-deaf business decisions like Portal are nothing new for Facebook. Eleven years ago, before Facebook was even a full behemoth, it was rolling out invasive features only to issue awkward apologies. The company didn’t appear to have the foresight then, and it doesn’t appear to now.

Weeks after the Cambridge Analytica privacy scandal broke, Facebook announced at its annual conference that it would soon use its trove of user data to roll out a dating app to help pair users together in “long-term” romantic relationships. Later in the year, while Zuckerberg told Congress “I promise to do better for you” and pledged increased transparency in its handling of users’ data, the company admitted to secretly using a private tool to delete the old messages of its founder. This summer, just days after Zuckerberg assured “we have a responsibility to protect people,” reports surfaced that Facebook asked US banks for granular customer financial data (including card transactions and checking account balances) to use for a banking feature. Even the company’s good faith attempts to secure its platform feel ham-handed and oblivious, like last November when Facebook asked users in Australia to upload their nude photos to Facebook for employee review to combat revenge porn.

To observers, these might seem like easily avoidable errors, but to Facebook, whose very identity and foundational mandate is the instinctual drive to amass personal data, they make perfect sense.

Facebook’s unquenchable thirst for personal information is often interpreted as sinister or malicious in nature — a frame that feels a bit too convenient. Facebook is quite obviously interested in profit and power, but its problems seem to stem less from some inherent evil than a broader, foundational failure to see itself outside of this data-gathering, world-connecting prism.

Facebook is a company founded on the principle of collecting data, and virtually every part of its two core missions (“to bring the world closer together” and to deliver profit to shareholders) require amassing more data and finding creative new ways to parse and connect it. Almost every part of Facebook — from Messenger to News Feed advertisements — improves with every new morsel of personal information collected. For this reason, many of Facebook’s biggest problems are technological problems of scale — of amassing and processing so much data — and yet Facebook argues that amassing more data is the way to improve every experience, which includes fixing its myriad problems. Advertisements intrusive and clumsy? Collect more and more precise information with which to make them more relevant! Too much algorithmically tailored, low-quality content in News Feed? Ask people to rate and rank it! Collect more data! Feed it to the algorithms! Then collect even more data and use the algorithms to police it.

Facebook has seen enormous success with this strategy. Despite all of the bad press and fallout (which includes everything from disrupting the media business to election interference to ethnic cleansing in places like Myanmar), the company is vast, powerful, and profitable. You know what happened after the Cambridge Analytica scandal? After its first president, Sean Parker, expressed regret over its ruthless monetization of attention? After legislators trotted out examples of election interference in front of executives? Facebook reported earnings and monthly average users that exceeded expectations. The stock spiked.

For Facebook employees, there’s often a cognitive dissonance between their work and how they see it described beyond company walls. “If you could see what I see, a lot of this would make more sense,” one current employee told me in October of 2017. Only recently does that answer really begin to make sense: It’s about the data.

A former senior employee described this as part of the “deeply rational engineer’s view” that guides Facebook’s decisions. “They believe that to the extent that something flourishes or goes viral on Facebook — it’s not a reflection of the company’s role, but a reflection of what people want,” they said. Data informs how decisions get made; it also conveniently absolves Facebook of blame.

It is the crystal ball that allows the company to see ahead and do what might feel to us mere mortals (privacy advocates, the media, regular users) as reckless. This is why Facebook might feel confident rolling out an always-listening home camera a few weeks after a report revealing the company harvested two-factor authentication phone numbers to target users for advertising purposes. And it might be one reason — perhaps among many — that the founders of both WhatsApp and Instagram have left the company in recent months.

Facebook is intimidatingly large and deeply woven into our cultural fabric, largely because we have allowed it to become so, and we can’t consider a world without Facebook in it. It’s not that we aren’t worried about politics becoming a Facebook data acquisition and targeting game, or outsourcing the public square to a private technology company. It’s that it’s so mind-numbingly hard to imagine how to actually loosen the company’s grip on our discourse, ad ecosystem, and our personal information that we often focus only on superficial or temporary ways to relieve it.

And that’s a great substrate for apathy. We’ve already given it so much, why stop now? No one else is going to delete Facebook, so why should I? Facebook understands this — the data tells them so. It also tells them that slickly produced videos and contrite congressional testimony are small ways to ameliorate lingering public concern.

But the real truth lies in the company’s innovations and ambitions, products like Portal. Facebook doesn’t really care. And maybe we don’t either.

Think You Don’t Need A Flu Shot? Here Are 5 Reasons To Change Your Mind


Alex Schwartzman, a law student at George Washington University in Washington, D.C., is one of only 8 to 39 percent of college students who get the flu shot in a given year.

 

There are a lot of misconceptions out there about the flu shot.

But following a winter in which more than 80,000 people died from flu-related illnesses in the U.S. — the highest death toll in more than 40 years — infectious disease experts are ramping up efforts to get the word out.

“Flu vaccinations save lives,” Surgeon General Jerome Adams told the crowd at an event to kick off flu vaccine awareness last week at the National Press Club in Washington, D.C. “That’s why it’s so important for everyone 6 months and older to get a flu vaccine every year.”

But many Americans ignore this advice. The U.S. vaccination rate hovers at about 47 percent a year. This is far below the 70 percent target. And college students are among the least vaccinated.


“We have long known that college students are at a particularly high risk of getting and spreading flu viruses,” says Lisa Ipp, an adolescent medicine specialist at Weill Cornell Medicine. “Yet, on U.S. college campuses, flu vaccination rates remain strikingly low,” she writes in a 2017 post published by the National Foundation for Infectious Disease. The group sponsored a survey of college students and found that only between 8 and 39 percent of students get the vaccine.

So why aren’t people getting the vaccine? The college survey data point to a mix of misperception and fear.

For instance, among students who don’t get the vaccine, 36 percent say that they are healthy and don’t need it, and 30 percent say they don’t think the vaccine is effective. Then, there’s the fear: 31 percent say they don’t like needles.

So, let’s do a reality check. If you’re on the fence about a flu shot, here are five arguments to twist your arm.

1. You are vulnerable.

People 65 and older are at higher risk of flu-related complications, but the flu can knock young, healthy people off their feet, too. It does every year.

“The flu can, on occasion, take a young, healthy person and put them in the intensive care unit,” says William Schaffner, medical director at the NFID.

And, even when it’s not that severe, it’s still bad. “If you get the flu, you’re [down] for the count for about a week,” Ipp tells her college-age patients.

Here’s a sobering thought: Healthy children die from flu, too. According to the CDC, 172 American children and teens (under the age of 18) died from the flu last winter. Eighty percent of them had not received a flu vaccine. And about half had no underlying illnesses before getting the flu. In other words, they’d been healthy children.

And there’s this: The flu doesn’t just make you feel lousy. It can increase the risk of having a heart attack, according to a study published this year.

2. Getting a flu shot is your civic duty.

“Nobody wants to be the dreaded spreader,” says Schaffner. But everybody gets the flu from somebody else. According to the Centers for Disease Control and Prevention, people who have caught the flu virus are contagious one day before they start to feel sick and for up to seven days after. (Check out our video on flu contagion if you really need to be convinced!)

So getting the flu shot will help protect your family, friends and co-workers. “It’s the socially correct thing to do,” Schaffner says.

3. You can still get the flu, but you won’t be as sick.

After last winter’s severe season, some people are skeptical. They say: “I got the flu shot, but I still caught the flu.”

In fact, the 2017-18 season was the deadliest in more than 40 years. “We had a very vicious virus, the so-called H3N2 influenza strain,” says Schaffner.

And yes, it’s true that the vaccine does not offer complete protection. The CDC estimates that flu vaccination reduces the risk of the virus by about 40 to 60 percent. Think of it this way: If you catch the flu, the vaccine does still offer some protection. It cushions the blow. “Your illness is likely to be milder” if you’ve had a flu shot, says Schaffner. You’re less likely to get pneumonia, which is a major complication of the flu, and less likely to be hospitalized.

4. Pregnant women who get the flu shot protect their babies from flu.

Women who are pregnant should be vaccinated to protect themselves. The vaccine also offers protection after babies are born. “[Women] can pass the protection on, across the placenta,” Schaffner explains. And this will protect their baby during the first six months of life, until the baby is old enough to be vaccinated.

5. You cannot get flu from the flu vaccine.

It’s still a common misperception: the idea that you can get the flu from the flu shot.

The NFID-sponsored survey of college students found that close to 60 percent of students seem to think that the flu vaccine can cause flu. “That’s, of course, incorrect,” says Schaffner.

The most common side effects are a sore arm, and perhaps a little swelling. “A very small proportion of people, 1 to 2 percent, get a degree of fever,” Schaffner says. That’s not the flu, he explains. “That’s the body reacting to the vaccine.”

Because the flu is unpredictable, it’s too soon to know what to expect this winter. But Schaffner has this advice: Don’t wait. “The time to get vaccinated is right now,” he says.

If that doesn’t move you, maybe a little reward will. The survey data of college students found that incentives are a good idea. Think: free food, free entertainment or a gift card for a free coffee. Ipp found about 60 percent of students said these types of incentives would increase the likelihood of their getting the flu vaccine.

Another way to nudge people? Make it super convenient. On the campus of George Washington University, the medical director of the student health center has organized flu-clinic pop-ups in venues where students hang out, such as the library. “We don’t wait for them to come to us,” Isabel Goldenberg told us.

For workers in offices, flu clinics at the workplace can be an effective way to encourage vaccination, too.

What about the use of social media to motivate people? “I’ve had the flu, which was horrible,” Max Webb, a student at George Washington University, told me. He thinks if people shared their flu stories, it could help nudge people in their social networks to get the flu shot.

And what would you name this campaign, I asked Webb? “Say boo to the flu,” Webb replied. Or simply, #boo2flu.

Kinda catchy.

Brain Activity Has Been Recorded as Much as 10 Minutes After Death


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Doctors in a Canadian intensive care unit stumbled on a very strange case last year – when life support was turned off for four terminal patients, one of them showed persistent brain activity even after they were declared clinically dead.

For more than 10 minutes after doctors confirmed death through a range of observations, including the absence of a pulse and unreactive pupils, the patient appeared to experience the same kind of brain waves (delta wave bursts) we get during deep sleep.

And it’s an entirely different phenomenon to the sudden ‘death wave’ that’s been observed in rats following decapitation.

“In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and arterial blood pressure (ABP),” the team from the University of Western Ontario in Canada reported in March 2017.

They also found that death could be a unique experience for each individual, noting that across the four patients, the frontal electroencephalographic (EEG) recordings of their brain activity displayed few similarities both before and after they were declared dead.

“There was a significant difference in EEG amplitude between the 30-minute period before and the 5-minute period following ABP cessation for the group,” the researchers explained.

Before we get into the actual findings, the researchers are being very cautious about the implications, saying it’s far too early to be talking about what this could mean for our post-death experience, especially considering their sample size is one.

In the absence of any biological explanation for how brain activity could possibly continue several minutes after the heart has stopped beating, the researchers said the scan could be the result of some kind of error at the time of recording.

But they were at a loss to explain what that error could be, as the medical equipment showed no signs of malfunction, meaning the source of the anomaly cannot be confirmed – biologically or otherwise.

“It is difficult to posit a physiological basis for this EEG activity given that it occurs after a prolonged loss of circulation,” the researchers wrote.

“These waveform bursts could, therefore, be artefactual [human error] in nature, although an artefactual source could not be identified.”

You can see the brain scans of the four terminal patients below, showing the moment of clinical death at Time 0, or when the heart had stopped a few minutes after life support had been turned off:

brain-waves-deathsNorton et al. (2017)

The yellow brain activity is what we’re looking for in these scans (view a larger version here), and you can see in three of the four patients, this activity faded away before the heart stopped beating – as much as 10 minutes before clinical death, in the case of patient #2.

But for some reason, patient #4 shows evidence of delta wave bursts for 10 minutes and 38 seconds after their heart had stopped.

The researchers also investigated if a phenomenon known as ‘death waves’ occurred in the patients – in 2011, a separate team observed a burst of brain activity in rat brains about 1 minute after decapitation, suggesting that the brain and the heart have different moments of expiration.

“It seems that the massive wave which can be recorded approximately 1 minute after decapitation reflects the ultimate border between life and death,” researchers from Radboud University in the Netherlands reported at the time.

death-wave

When the Canadian team looked for this phenomenon in their human patients, they came up empty.

“We did not observe a delta wave within 1 minute following cardiac arrest in any of our four patients,” they reported.

If all of this feels frustratingly inconsequential, welcome to the strange and incredibly niche field of necroneuroscience, where no one really knows what’s actually going on.

But what we do know is that very strange things can happen at the moment of death – and afterwards – with a pair of studies from 2016 finding that more than 1,000 genes were still functioning several days after death in human cadavers.

And it wasn’t like they were taking longer than everything else to sputter out – they actually increased their activity following the moment of clinical death.

The big takeaway from studies like these isn’t that we understand more about the post-death experience now than we did before, because the observations remain inconclusive and without biological explanation.

But what they do show is that we’ve got so much to figure out when it comes to the process of death, and how we – and other animals – actually experience it, from our bodies to our brains.