30 articles from SATURDAY 5.10.2019

A new scientific statement identifies the risks and benefits of novel interventional devices compared to anticoagulation alone in the treatment of patients with pulmonary embolism. Authors conclude there is little data -- particularly, as it pertains to the treatment of patients with 'intermediate-risk PE' -- that suggests these interventional approaches are more safe and effective than the use of anticoagulation alone.

Scientists Solve a Puzzle: What's Really in a FatbergLONDON -- When a giant fatberg was discovered in the sewer of a small coastal town in southwestern England last year, the company that manages the pipes was so mystified by the greasy mass of solidified fats and waste materials that it enlisted the help of scientists to discover what it was made of.The grisly results of an autopsy were made public Friday, and they were not pretty, but held some surprises. Stuck within the massive, stomach-churning lump were wet wipes, as expected; oils; sanitary products; and even a set of false teeth.Fatbergs are more commonly associated with large cities such as London and New York. Their contents can become a taxonomy of the habits of the inhabitants of nearby towns or cities.When a 140-ton fatberg was found in the East End of London in 2017, a subsequent autopsy revealed that the city's residents had been flushing condoms, syringes and narcotics -- including cocaine and ketamine -- down the toilet, and they were all lodged inside it.But how a 210-foot-long fatberg could have festered for years underneath the picturesque seaside town of Sidmouth, England, more than 160 miles from London, presented a different puzzle to the company that manages the sewers in the area. Sidmouth, which counts only around 13,000 people as permanent residents, was not considered a prime fatberg target.So before all trace of the fatty mass was destroyed, South West Water, the company that manages the sewers in Sidmouth and across 4,300 square miles of England, demanded answers.Four 22-pound lumps were taken from the beastly blockage and dispatched to scientists at the University of Exeter nearby for analysis."We wanted to learn as much as we could about it, how it was created and what it was made of," Andrew Roantree, South West Water's director of wastewater, said in a statement.A team of 10 scientists welcomed the unusual challenge and carried out a dissection that involved melting down some parts of the fatberg, extracting and identifying the waste materials and even performing DNA sequencing.The study was fascinating, John Love, a professor of synthetic biology at the University of Exeter and the project's leader, said in an interview Friday. But his team did not embrace all parts of the autopsy."It was my first time analyzing a fatberg, and when you smell it, you think this is going to be the last time because the smell was honking," Love said. "It was awful to do, it smelled gross."He explained that he and his colleagues wore stab-proof gloves and steel-capped shoes to protect themselves from any potential dangers within the samples. But after weeks analyzing Sidmouth's fatberg, the scientists realized they had nothing to fear.The results found no dangerous bacteria or chemicals in the lumps, which were composed of domestic waste glued together by fats used in home cooking."We were all rather surprised to find that this Sidmouth fatberg was simply a lump of fat aggregated with wet wipes, sanitary towels and other household products that really should be put in the bin and not down the toilet," Love said in the statement.But, the experts discovered, just as the analysis of London's fatberg revealed some of its residents' illicit habits, the contents of Sidmouth's fatberg hinted at the town's population -- or more accurately, the kind of things they threw away or lost.A set of false teeth was found within it. So, too, were a number of incontinence pads."Sidmouth is a small coastal community that is largely populated by retired people, so in a sense that explains it," Love said. "This is not a hotbed of crime and drug-taking or anything like that," he added.London's Whitechapel fatberg was declared the biggest example in British history, and a piece taken from the 820-foot-long mass was put on display at the Museum of London last year.The exhibition captured the imagination of the public, bumping up visitor numbers, and the museum acquired the remaining parts for its permanent collection, even setting up a live-stream video of a piece of a yellowing fatty lump.Sidmouth's example, although it pales in comparison to its London equivalent, was the largest discovered in the service history of South West Water. A routine check in its sewers before Christmas last year revealed the fatberg longer than the Tower of Pisa lurking underneath the town's seafront road known as the Esplanade.Dismantling the lump was a huge operation: It took workers eight weeks to excavate 36 tanker loads -- each 3,000 gallons -- of debris from the site, and it cost the business around 100,000 pounds (about $123,000.)Despite the efforts made to banish the monster fatberg earlier this year, within the last few weeks, South West Water has revisited the sewer and noticed another one starting to form.The size is nowhere near that of the fatberg discovered last year, Roantree said Friday, adding hastily that officials would clear it away to make sure it does not grow any larger.This article originally appeared in The New York Times.(C) 2019 The New York Times Company


FDA Approves New HIV-Prevention Drug, but Not for WomenThe Food and Drug Administration on Thursday approved a new drug, Descovy, for prevention of infection with HIV, only the second drug approved for this purpose.The first, Truvada, has become a mainstay of government efforts to turn back the HIV epidemic. But the FDA approved Descovy for use only in men and transgender women, because its maker, Gilead Sciences, tested it only in those groups.The approval explicitly excludes women and does not outline a plan for making the drug available to them. Some activists and scientists said the approval sets a dangerous precedent by allowing companies to dodge expensive trials needed to test medicines in women.Such an exclusion of women "should be unacceptable in these days and times," said Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital.It's important to test the drug specifically in women, she added, because Descovy may work differently in the vagina than in rectal tissues.The FDA, in fact, will require Gilead to study Descovy in women, company officials said. Gilead is considering a trial in Africa.Gilead also makes Truvada. Both medicines are to be taken daily, an HIV-prevention strategy called preexposure prophylaxis, or PrEP.The company has come under heavy criticism for selling Truvada at a high cost, currently about $20,000 a year. Critics have said the expense keeps the drug out of reach of Americans who would benefit from it. Few patients actually pay the full price, Gilead has said.Less expensive generic versions of Truvada are expected next year, as the drug's patent protections expire. But Descovy's approval ensures Gilead's continued dominance of the market for PrEP, said Jeremiah Johnson, a project director at Treatment Action Group, an advocacy organization.Descovy is not more effective than Truvada, Johnson noted. But in various presentation materials, Gilead on occasion has hinted that it is, and Johnson and others fear patients may reject affordable and accessible generic versions of Truvada in favor of the more expensive Descovy.Any suggestion that Descovy is more effective than Truvada was unintentional, said Diana Brainard, who oversees Gilead's HIV division. The company's message, she added, is that both Descovy and Truvada are highly effective at preventing HIV infection when taken daily."It's always good to have choice," she said.Descovy's patent is supposed to expire in 2026, but a nonprofit group called Prep4All Collaboration hopes to find a way to end it in 2022.The group had been running a campaign called "Break the Patent" to limit Truvada's patent protection, which was supposed to expire in 2021. But in May, Gilead announced that a generic version would be available next year."As of today, we're adding an 's' -- it's 'Break the Patents,' " said Peter Staley, a founder of the collaboration.Descovy contains a newer version of tenofovir, the active ingredient in Truvada. Gilead tested Descovy in a multinational trial that included 5,313 men and 74 transgender women who have sex with men. There were no cisgender women, and 84% of the participants were white."They did a terrible job of inclusion for a company that dominates the market," Johnson said.There are some data suggesting that Descovy has fewer side effects on bones and kidneys than Truvada, but those problems have only been seen in a small number of people taking Truvada, Walensky said.She also noted that although Gilead scientists have presented some of their data at conferences, they have yet to publish their results in a peer-reviewed journal.At a hearing in August, some activists urged the FDA to deny approval for use of Descovy in women or to require Gilead to test the drug in a large number of women promptly after approval.Unless forced to do so by the FDA, critics said, the company has no motivation to test the drug in women."We had at least hoped that they would say something the day they approved it without an indication for women, that they would have a plan or forceful language laid out on how this disgraceful situation is going to be rectified," Staley said.Although the FDA's announcement does not mention it, the agency is requiring such a study.Brainard said Gilead plans to start the study in at least 1,500 high-risk women in southern Africa -- where the incidence of HIV in women is higher than in the United States -- by the end of 2020. The FDA's approval letter requires the company to complete the trial by December 2024.Walensky said she is disappointed by the numbers and timeline of that trial."I want to see a large-scale, rapid effort to get data in women as soon as possible," she said. "That, in my mind, is the only way to rectify this."This article originally appeared in The New York Times.(C) 2019 The New York Times Company


Give up wanting to be liked, live with imposter syndrome and love what you do. Suzanne Moore advises aspring women writers

How does a woman write? This woman is writing on her laptop in bed wearing her lipstick. She looks quite ridiculous. She is wishing the teenagers downstairs would make less noise and will go down periodically to shout at them and to get some biscuits, maybe some cheese, a small snack that she needs to sustain herself every other paragraph or so.

This woman wishes she was like the young people she sees writing in cafés or on the bus, who seem to be able to write anywhere. She wishes she wasn’t so precious about peace and quiet and remembers she didn’t used to be. In fact, she used to sit next to a man in a newspaper office who was covered in nicotine patches, chewing nicotine gum and drinking double espressos until he vibrated. Still, she always met the deadline. He didn’t, so was in a constant state of torture.

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Scientist Who Discredited Meat Guidelines Didn't Report Past Food Industry TiesA surprising new study challenged decades of nutrition advice and gave consumers the green light to eat more red and processed meat. But what the study didn't say is that its lead author has past research ties to the meat and food industry.The new report, published this week in the Annals of Internal Medicine, stunned scientists and public health officials because it contradicted long-standing nutrition guidelines about limiting consumption of red and processed meats. The analysis, led by Bradley C. Johnston, an epidemiologist at Dalhousie University in Canada, and more than a dozen researchers concluded that warnings linking meat consumption to heart disease and cancer are not backed by strong scientific evidence.Several prominent nutrition scientists and health organizations criticized the study's methods and findings. But Johnston and his colleagues defended the work, saying it relied on the highest standards of scientific evidence, and noted that the large team of investigators reported no conflicts of interest and conducted the review without outside funding.Johnston also indicated on a disclosure form that he did not have any conflicts of interest to report during the past three years. But as recently as December 2016 he was the senior author on a similar study that tried to discredit international health guidelines advising people to eat less sugar. That study, which also appeared in the Annals of Internal Medicine, was paid for by the International Life Sciences Institute, or ILSI, an industry trade group largely supported by agribusiness, food and pharmaceutical companies and whose members have included McDonald's, Coca-Cola, PepsiCo and Cargill, one of the largest beef processors in North America. The industry group, founded by a top Coca-Cola executive four decades ago, has long been accused by the World Health Organization and others of trying to undermine public health recommendations to advance the interests of its corporate members.In an interview, Johnston said his past relationship with ILSI had no influence on the current research on meat recommendations. He said he did not report his past relationship with ILSI because the disclosure form asked only about potential conflicts within the past three years. Although the ILSI-funded study publication falls within the three-year window, he said the money from ILSI arrived in 2015, and he was not required to report it for the meat study disclosure."That money was from 2015 so it was outside of the three-year period for disclosing competing interests," Johnston said. "I have no relationship with them whatsoever."Critics of the meat study say that while Johnston may have technically complied with the letter of the disclosure rules, he did not comply with the spirit of financial disclosure."Journals require disclosure, and it is always better to disclose fully, if for no other reason than to stay out of trouble when the undisclosed conflicts are exposed," said Marion Nestle, a professor of nutrition, food studies and public health at New York University who studies conflicts of interest in nutrition research. "Behind the scenes, ILSI works diligently on behalf of the food industry; it is a classic front group. Even if ILSI had nothing to do with the meat papers -- and there is no evidence of which I am aware that it did -- the previous paper suggests that Johnston is making a career of tearing down conventional nutrition wisdom."Notably, Johnston and colleagues thought it was important to fully disclose their personal eating habits. The meat paper includes an appendix titled "Summary of Panelists' Potential Conflicts of Interest," that discloses whether each author eats red or processed meat and how often. Johnston reported no financial conflicts of interest but disclosed that he eats one to two servings of red or processed meat per week."We think that's a potential bias that is worth disclosing," Johnston said about the researchers' personal eating habits.Johnston's ties to the 2016 ILSI-funded sugar study show how ILSI has methodically cultivated allies in academia around the world, and how it recruits influential scientists to help shape global nutrition advice and counter what it perceives to be anti-food industry guidelines by health organizations.When Johnston and his colleagues first published the sugar study, they said that ILSI had no direct role in conducting the research other than providing funding, but later amended their disclosure statement in the Annals after The Associated Press obtained emails showing that ILSI had "reviewed" and "approved" the study's protocol.Johnston said that when he published the sugar study in 2016, he put his connection with the food industry group "front and center." He said in hindsight he was "naive" when he agreed to work on the ILSI-funded study about sugar guidelines. It was during a conference call on the sugar study that he realized the extent that industry figures were involved with that organization. He declined to say who was on the conference call."It wasn't until I was on a conference call with them and people were introducing themselves where I realized this is not what I expected," he said. "Then I saw the reaction from the paper we did publish, which I think was a very good paper. People didn't get that message. They got stuck on the funding part. That was a big lesson to separate oneself. It's not worth working with industry at all."Dr. Christine Laine, editor-in-chief of the Annals of Internal Medicine, said the medical journal asks people to disclose their financial interests but relies on the integrity of the researcher and does not attempt to verify the forms. "We are really leaving it to the authors to disclose," Laine said. "We advise authors if they wonder 'Should I disclose this or not,' they should err on the side of disclosure."Laine noted that people on both sides of the meat issue have conflicts of interest. "Many of the people who are criticizing these articles have lots of conflicts of interest they aren't talking about," she said. "They do workshops on plant-based diets, do retreats on wellness and write books on plant-based diets. There are conflicts on both sides."Laine said if Johnston had chosen to disclose a financial relationship with the food industry group, it would not have changed the journal's decision to publish the research. What matters to the journal editors and peer-review team, she said, is the fact that the group had clear protocols for examining the data and was transparent about its methods."I don't think we would have made a different decision about publishing the manuscript if he had that on his conflicts disclosure," Laine said. "We certainly know that in the past he did nutrition research that was funded by industry. It's a judgment call if that should be disclosed. I think at some level that's a little bit of noise around this. The methods of what these researchers did and their conclusions are out there, and people can disagree with that."Dr. Gordon Guyatt, chair of the 14-member panel that reviewed the analysis, said he is confident that the work was not in any way influenced by industry. "Perhaps Brad was a little naive, and both I and perhaps Christine Laine were a little negligent in it not occurring to us that he should probably declare the previous money he got from the previous project," said Guyatt, an internal medicine physician and a distinguished professor at McMaster University. "All of that being said, I feel personally extremely comfortable that it had no effect on what we did."Guyatt noted that for 20 years he has been a pescatarian who eats only fish and no other meat. "Before I was involved in these systematic reviews and looking carefully at evidence, I had three reasons for not eating meat -- animal welfare, the environment and health. Now I only have two reasons for not eating meat."Critics of the meat study say that it has similarities to the industry-funded sugar study and uses the same standard to evaluate evidence. Dr. Frank Hu, the chair of the nutrition department at the Harvard T.H. Chan School of Public Health, said he was stunned when he realized that Johnston was both the leader of the meat study and the same researcher who led the industry-funded review that attacked guidelines advising people to eat less sugar. He said that in both cases Johnston undercut sugar and meat recommendations by using a tool called GRADE that was mainly designed to rate clinical drug trials, not dietary studies."You can't do a double-blinded placebo-controlled trial of red meat and other foods on heart attacks or cancer," Hu said. "For dietary and lifestyle factors, it's impossible to use the same standards for drug trials."Drug trials are primarily designed to look at efficacy and safety, Hu said, while the main goal of diet studies is to identify risk factors that influence obesity and chronic diseases. That is why scientists use data from large observational studies and randomized trials to look at the health effects of different eating patterns and other behaviors that cannot be studied like pharmaceutical therapies.Johnston said the real problem is that people don't want to accept findings that contradict long-held views. "People have very strong opinions," he said. "Scientists should have intellectual curiosity and be open to challenges to their data. Science is about debate, not about digging your heels in."But Hu said Johnston's methods were not very objective or rigorous and the tool he employed in his meat and sugar studies could be misused to discredit all sorts of well-established public health warnings, like the link between secondhand smoke and heart disease, air pollution and health problems, physical inactivity and chronic disease, and trans fats and heart disease."Some people may be wondering what his next target will be," Hu said. "But I'm concerned about the damage that has already been done to public health recommendations."This article originally appeared in The New York Times.(C) 2019 The New York Times Company


Young people in the global south have been tackling the climate crisis for years. They should be celebrated too

Ridhima Pandey was just nine years old in 2017 when she filed a lawsuit against the Indian government for failing to take action against climate change. Pandey’s fierce, astounding passion for the environment is not accidental. Her mother is a forestry guard and her father an environmental activist; and the whole family was displaced by the Uttarakhand floods of 2013, which claimed hundreds of lives.

In Kenya Kaluki Paul Mutuku has been actively involved in conservation since college, where he was a member of an environmental awareness club, and has been a member of the African Youth Initiative on Climate Change since 2015. Raised in rural Kenya by a single mother, Mutuku’s vigorous activism, like Pandey’s, was inspired by the direct challenges his family (and wider community) faced from the effects of climate change: “Growing up, I witnessed mothers cover kilometres to fetch water,” he says.

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NASA picks 25 space technologies for testing by Blue Origin and other companiesNASA's Flight Opportunities program has selected 25 promising space technologies for testing aboard aircraft, high-altitude balloons and suborbital rocket ships — including Blue Origin's New Shepard spacecraft. Blue Origin, the space venture created by Amazon CEO Jeff Bezos and headquartered in Kent, Wash., will be involved in testing 11 of the technologies. The company has been providing flights for suborbital space experiments since 2016 at its West Texas spaceport. The latest projects were selected as part of NASA's Tech Flights solicitation. Awardees typically receive a grant or enter into a cost-sharing agreement through which they can select a commercial flight… Read More


NASA sets 1st all-female spacewalk after suit flap in springThe first all-female spacewalk is back on, six months after a suit-sizing flap led to an embarrassing cancellation. NASA announced Friday that the International Space Station's two women will pair up for a spacewalk later this month. Astronauts Christina Koch and the newly arrived Jessica Meir will venture out Oct. 21 to plug in new, upgraded batteries for the solar power system.