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Features
Fossil Human Ancestor ‘Lucy’ Remains
Pivotal 50 Years after Discovery
Half a century after its discovery, this iconic fossil remains central to our understanding of
human origins

New Nasal Vaccines Offer Stronger Protection

from COVID, Flu, and More—No Needle
Needed
Gentle nasal spray vaccines against COVID, the flu and RSV are coming. They may work
better than shots in the arm

Could ‘Early Dark Energy’ Resolve the

Mystery of Cosmic Expansion?
Estimates of how fast the universe is expanding disagree. Could a new form of dark energy
resolve the problem?

Leap Seconds May Be Abandoned by the

World’s Timekeepers
We have been adding “leap seconds” to time kept by our atomic clocks, but soon we may have
to subtract one. Are the tiny adjustments worth the bother?

How to Make Progress in Health Equity

This collection shows what works to advance health equity around the world

New Medical Diagnoses and Tools Are

Removing Historical Biases
New formulas, devices and tools are removing historical bias from medical diagnoses

Rural Health Innovations Are Improving

Health Care
Some of the most inventive changes to health care have started in rural communities around
the world
See How Many Lives Vaccines Have Saved
around the World
Vaccines are the first step toward health equity in many parts of the world

Health Experts Share What Gives Them Hope

for Improving Equity
Health experts share what gives them hope for improving health for all

Cultural Competency in Health Care Can Save

Lives
Medical professionals who connect with their patients’ language and culture provide better
care

Asian American, Native Hawaiian and Pacific

Islander People Need Better Health Data
Separating medical data from culturally distinct Asian American, Native Hawaiian and Pacific
Islander (AANHPI) groups can improve health outcomes

The Mpox Response Has Learned from

HIV/AIDS History
Tools and networks that have helped control HIV/AIDS are now working against mpox

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How the Famous Lucy Fossil Revolutionized the

Study of Human Origins

Half a century after its discovery, this iconic fossil remains central
to our understanding of human origins
By Donald C. Johanson & Yohannes Haile-Selassie

John Gurche

Every once in a great while paleontological fieldwork turns up a

fossil so extraordinary that it revolutionizes our understanding of
the origin and evolution of an entire branch of the tree of life. Fifty
years ago one of us (Johanson) made just such a discovery on an
expedition to the Afar region of Ethiopia. On November 24, 1974,
Johanson was out prospecting for fossils of human ancestors with
his graduate student Tom Gray, eyes trained on the ground, when
he spotted a piece of elbow with humanlike anatomy. Glancing
upslope, he saw additional fragments of bone glinting in the
noonday sun. In the weeks, months and years that followed, as the
expedition team worked to recover and analyze all the ancient
bones eroding out of that hillside, it became clear that Johanson
had found a remarkable partial skeleton of a human ancestor who
had lived some 3.2 million years ago. She was assigned to a new
species, Australopithecus afarensis, and given the reference
number A.L.288-1, which stands for “Afar locality 288,” the spot
where she, the first hominin fossil, was found. But to most people,
she is known simply by her nickname, Lucy. With the discovery of
Lucy, scientists were forced to reconsider key details of the human
story, from when and where humanity got its start to how the
various extinct members of the human family were related to one
another—and to us. Her combination of apelike and humanlike
traits suggested her species occupied a key place in the family tree:
ancestral to all later human species, including members of our
genus, Homo.

It can be precarious to hang such a pivotal argument on a single

fossil individual. But in the half a century since Lucy’s unveiling,
many more specimens of Au. afarensis have been found. Together
they provide an exceptionally detailed record of this ancient
species, revealing where it roamed, how it lived, how its members
differed from one another and how long it endured before going
extinct.

In 1972 researchers traveled to the Afar region of northeastern Ethiopia to look for hominin fossils
dating to more than three million years ago. A site called Hadar looked especially promising, its
rugged landscape chock-full of mammal fossils that erode out of the hillsides over time.
David L. Brill
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We have also learned a lot about Lucy’s own predecessors—and

her contemporaries. One of the most exciting developments in the
field of human origins research since the discovery of Lucy has
been the revelation that for most of our prehistory multiple human
species, or hominins, roamed the planet. One of us (Haile-Selassie)
has found hominins that overlapped in time and space with Lucy’s
kind. These members of the human family are fascinating in their
own right. They also provide vital context for understanding the
evolution of the species that may very well have given rise to us
all.

To understand why Lucy had such a massive impact on

paleoanthropology, we have to look at the state of the science at the
time of her discovery. Back in the early 1970s, the oldest hominin
fossils on record were thought to be around 2.5 million years old
and belonged to a species called Australopithecus africanus from
South Africa. Younger fossils fell into one of two groups: the so-
called robust australopiths, with their giant molars and powerful
jaws, and the more delicately built, or “gracile,” forms, which
included Homo. Although Au. africanus was classified as gracile, it
didn’t particularly resemble either of these later groups. Yet it was
the only sufficiently well-documented hominin we had that was old
enough to be ancestral to them. There were a few scraps of fossil
material from eastern Africa that were older, but there wasn’t
enough material preserved to get a good sense of the kinds of
creatures they came from. And so scientists drew their evolutionary
trees with Au. africanus as the all-important ancestor of Homo and
the robust forms. But what they really needed to test that
hypothesis about Au. africanus were more complete fossils in
excess of three million years old.

In the spring of 1972 Johanson journeyed to Ethiopia with French

geologist Maurice Taieb in search of hominin fossils from beyond
the three-million-year mark. Taieb was keen to take him to the Afar
region of northeastern Ethiopia, where he had previously seen pig
and elephant fossils that looked to be from the time period
Johanson was targeting. Perhaps hominin fossils were there, too,
waiting to be discovered. Surveying a bunch of fossil-bearing
locations in the region, the team zeroed in on a site called Hadar.
Brimming with fossils of rodents, elephants, rhinos, hippos,
monkeys, horses, antelopes and carnivores, Hadar must have been
a bountiful environment millions of years ago to support so many
animals. It seemed like a promising area to search for ancient
human ancestors. Johanson knew that if hominin fossils were found
there, they could upend our understanding of how humans came to
be.

On November 24, 1974, Donald C. Johanson discovered the nearly 3.2-million-year-old Lucy
skeleton on one of the hillsides. A stake marks the spot where the fossil was found.
David L. Brill

When the expedition team returned to Hadar the following year,

Johanson made a tantalizing discovery: a knee joint estimated to be
3.4 million years old. Anatomical details of the knee indicated that
it had come from a hominin that walked upright, like us,
confirming the fossil hunters’ hunch that Hadar had hominins.
Johanson suspected the knee belonged to an Australopithecus
individual, but without more anatomical information to go on, he
could not determine whether it came from Au. africanus or a new
species. What the team needed most was to find remains of skulls
and teeth, the body parts that contain the most diagnostic features
for distinguishing species in fossil mammals. The researchers could
only hope that the next field season would turn up cranial and
dental specimens.

Their dream came spectacularly true on that momentous day in

1974. The Lucy fossil preserved skull fragments and a lower jaw
with teeth, as well as parts of the arm, leg, pelvis, spine and ribs—
47 bones in all representing a whopping 40 percent of the skeleton
of a single individual. Her remains promised untold insights into
the human past.

Named after the Beatles song “Lucy in the Sky with Diamonds,”
which played on the tape deck at camp as the team celebrated,
Lucy became an instant sensation. Nothing like her had ever been
found before. She was diminutive—her 12-inch-long thigh bone
indicated that she stood only three and a half feet tall and weighed
60 to 65 pounds. Like many other animals, early hominins exhibit a
condition called sexual dimorphism, wherein males are much larger
than females, among other morphological differences. Lucy was
too small to be a male. And her erupted wisdom teeth and lack of
unfused growth plates in her limb bones confirmed she was an
adult.
The expedition camped along the banks of the Awash River and began a targeted search of the area’s
fossil-bearing sediments.
David L. Brill

Other features attested to how she carried herself. After closely

inspecting her knee, hip and ankle, as well as conducting extensive
biomechanical studies, Johanson and his colleagues concluded that
she walked upright—a trait that Charles Darwin argued was a
hallmark of humans—with a gait very much like our own. Other
scholars interpreted the bones differently, arguing that she walked
with her knees and hips bent like chimpanzees do when they
occasionally travel on two legs. Final resolution of this debate
came in 1978, after researchers discovered a stunning trail of
hominin footprints impressed in 3.7-million-year-old volcanic ash
at the site of Laetoli in Tanzania. Some of the prints are so detailed
that all the characteristics of a modern human footprint left on a
beach are visible. They showed that the Laetoli track makers
walked like us, not like chimpanzees. And because hominin teeth
and jaws similar to those from Hadar had been found at Laetoli, it
stood to reason that Lucy’s kind left the prints.

Traits such as a receding chin, strongly projecting snout, low and

sloping forehead, and very small brain size placed Lucy in the
genus Australopithecus. But certain aspects of her anatomy hinted
that she might be more primitive than other known species in that
group. Her first lower premolar was oval in shape and had a single
cusp, like an ape’s. Likewise, her lower limbs were relatively short,
possibly an evolutionary feature left over from her ancestors who
lived a more arboreal life. Although only bits of her braincase were
recovered, the fragments suggested a brain volume of 388 cubic
centimeters. That’s very small compared with the modern human
brain, which averages 1,400 cubic centimeters, and comparable to
the average modern chimp brain. Lucy confirmed earlier suspicions
that upright walking evolved before large brains.

With so many parts of her skeleton preserved, Lucy was a trove of

information. But she was still just one individual. For a deeper
understanding of her species, we needed more specimens. To that
end, continued fieldwork at Hadar and other sites in the region has
yielded a wealth of additional Au. afarensis fossils that together
provide a detailed portrait of this ancestor.

In 1975, just one year after Lucy was found at Afar Locality 288,
the Hadar team discovered more than 200 fossil hominin specimens
eroding from a single layer of rock at nearby Afar Locality 333.
Dated to a little more than 3.2 million years ago, the sample
consisted of male and female adults as well as portions of infants
and juveniles estimated to represent at least 17 individuals, all
presumably related. The group became known as the “First
Family.”

When Lucy was discovered 50 years ago, she was the oldest, most complete early member of the
human family that had ever been found, with 47 bones representing 40 percent of the skeleton.
Features of her hip, knee and ankle indicate that she walked upright on two legs like we do. Yet in
other respects she was primitive, with a brain less than a third of the size of our own.
David L. Brill

Combining the expanded Hadar collection with Lucy’s Tanzanian

counterparts allowed the team to reconstruct the skull of the
hominin species found at Hadar and to evaluate the fossils’
taxonomic status and position on the human family tree. In 1978,
following a thorough comparative study of all the australopith
species then known, Johanson and his colleagues concluded that
although some of the dental and cranial features evident in these
remains are found in other members of Australopithecus, the total
morphological package seen in the Hadar and Laetoli fossils was
unique and constituted a species new to science: Australopithecus
afarensis. Furthermore, they proposed, Au. afarensis occupied a
prominent position on the family tree, replacing Au. africanus as
the last common ancestor of later hominins, including Homo and
the robust australopiths.

Not everyone in the paleoanthropological community embraced the

naming of this new species. Detractors argued that the hominin
record between two million and three million years ago was too
sparse to support the claim that Au. afarensis was the ancestor of
later hominins. The discovery of more fossils from this time period
would be crucial for testing this hypothesis.
 In 1975 Johanson, shown here with graduate student Tom Gray, discovered fossils from a group of
hominins—dubbed the First Family—who had died together at another locality in Hadar and
belonged to the same species as Lucy.
David L. Brill

That additional evidence has since come in. In 1985 researchers

working in northern Kenya discovered a 2.5-million-year-old
cranium of the robust australopith Paranthropus aethiopicus.
Dubbed the “Black Skull” for its manganese-tinged color, it
possessed a powerful masticatory system, including large crushing
and grinding teeth, similar to those of a robust australopith
individual sometimes referred to as “Nutcracker Man,” who lived
1.8 million years ago and belonged to the species Paranthropus
boisei. The Black Skull also shared several traits with Au.
afarensis, including an extremely projecting lower face. When the
three species are considered together, Au. afarensis is a compelling
ancestor for P. aethiopicus, which in turn appears ancestral to P.
boisei.

Further support for the hypothesis that Au. afarensis gave rise to
later australopiths in eastern Africa came in 1990, when a cranium
the same age as the Black Skull surfaced in Ethiopia’s Middle
Awash Valley. The discovery team deemed it a new species,
Australopithecus garhi, and claimed that it occurred at the right
time and place to be ancestral to Homo. Like the robust
australopiths, this specimen had an impressive masticatory system,
with big jaws and a crest atop its head that would have anchored
strong chewing muscles. It also had a facial structure similar to that
of Au. afarensis. Other scientists have surmised that Au. garhi
descended from Au. afarensis and evolved its formidable chewing
anatomy in parallel with the robust australopiths but did not itself
give rise to later hominin species.

Cranial and dental remains from this find allowed researchers to reconstruct the skull of that species,
Australopithecus afarensis.
David L. Brill
Other fossil finds bolstered the proposed link between Au. afarensis
and Homo. For a long time the oldest known fossils in the genus
Homo dated only as far back as around two million years ago,
leaving a worrying gap of more than a million years between the
youngest Au. afarensis and the oldest Homo. In 1994 researchers at
Hadar found a 2.33-million-year-old palate—the bone that makes
up the roof of the mouth—that shared morphological traits with
Homo habilis, “Handy Man,” the earliest known member of our
genus, narrowing that temporal gap by a few hundred thousand
years. And in 2013 a team working at a site northeast of Hadar
called Ledi-Geraru recovered the left half of a 2.8-million-year-old
mandible bearing a combination of primitive Au. afarensis features
and characteristics of early Homo. The Ledi-Geraru jaw provided
another stepping stone between Au. afarensis and Homo and
strengthened the morphological connection between them as well,
helping to validate the hypothesis that Au. afarensis is the best
candidate we have for the ancestor of our own genus.

Human fossils are generally rare, which means that our

understanding of the past can change dramatically when new
specimens surface. When Au. afarensis was named as a new
species in 1978, it was the earliest human ancestor ever
documented, with an age range of 3.8 million to 3.0 million years
ago. Fossils recovered in the mid-1990s extended the early hominin
record back even farther. In 1994 researchers working in the
Middle Awash region of Ethiopia’s Afar Rift found hominin fossils
dated to 4.4 million years ago. They assigned the remains to a new
species, Ardipithecus ramidus. The following year another new
species was named based on fossil discoveries from Kanapoi and
Allia Bay in Kenya’s Turkana Basin: Australopithecus anamensis,
which lived from 4.3 million to 3.8 million years ago. With the
naming of these two species, Au. afarensis lost the distinction of
being the oldest hominin, but it gained an origin story of its own:
Au. anamensis is believed to be the direct ancestor of Au. afarensis.
More recently, discoveries in Chad, Kenya and Ethiopia have
pushed the origin of humankind back as far as seven million years.

Other fossil finds have shown that Au. afarensis was not the only
hominin species around during its long reign, raising the question
of whether Au. afarensis or one of these other hominins is the
ancestor of Homo and Paranthropus. Far from diminishing the
significance of Lucy’s species, these findings enrich its story: we
now have many more puzzle pieces from which to reconstruct the
evolution of the line that led to us and the factors that shaped it
along the way. The picture that is emerging from this work is far
more complex—and fascinating—than the one
paleoanthropologists traditionally envisioned.

Jen Christiansen

Prior to 1960, human origins researchers thought that only a single

hominin species lived at any given time in the past. This notion
stemmed from the idea that competition prohibits the coexistence
of related species with similar adaptations, a principle known as
competitive exclusion. The fossil record of hominins seemed to
support this concept until fossils of two different hominin species
were recovered from the same geological layer at sites in Kenya
and Tanzania. Still, there was no evidence that another species
lived alongside Au. afarensis, and because of that, it was
considered to be the ancestor of all later hominins.

Eventually, however, challengers turned up from various sites in

eastern and central Africa. In 1995 a team lead by paleontologist
Michel Brunet discovered a 3.5-million-year-old partial hominin
jaw from a site in northern Chad known as Koro-Toro and assigned
it to a new species, Australopithecus bahrelghazali. This fossil was
significant not only because it was found outside the East African
Rift System, where almost all early hominins have been recovered,
but also because it overlapped in time with Au. afarensis. Not
everyone agreed that the jaw was distinctive enough to represent a
new species. Nevertheless, it was the first hint that Au. afarensis
may not have been the only hominin species around 3.5 million
years ago.

A second hint came in 2001, when paleontologist Meave Leakey

and her team announced their discovery of a 3.5-million-year-old
cranium from Lomekwi, a site in northwest Kenya, and assigned it
to a new genus and species called Kenyanthropus platyops, partly
on the basis of what they saw as a distinctive flatness of its face.
Critics also challenged the validity of this species, arguing that the
badly crushed skull was too distorted for its true shape to be
discernible. Regardless, it was another indication that Au. afarensis
might not have been alone—even in eastern Africa.
 For the past two decades Yohannes Haile-Selassie has been working at a fossil site some 40
kilometers north of Hadar called Woranso-Mille. There he has recovered fossils belonging to
contemporaries of Au. afarensis, including jawbones belonging to a species called Australopithecus
deyiremeda and afoot belonging to a yet unidentified species that had a diver gent big toe like an
ape’s.
Cleveland Museum of Natural History

More recently, Haile-Selassie has found the strongest evidence yet

that Au. afarensis had company. Two decades ago he set out to look
for new paleontological sites in the Afar Rift containing hominin
fossils between three million and four million years old. His efforts
resulted in the discovery of a spectacular new site called Woranso-
Mille just 40 kilometers north of Hadar. With fossils spanning the
time from 3.8 million to 3.0 million years ago, it has become one of
the most important sites in all of Africa for hominins from the
Pliocene epoch.

Perhaps the most remarkable aspect of Woranso-Mille is the

diversity of hominins found there. The site has yielded remains of
both Au. anamensis (including a nearly complete skull that has
given us our first look at the face of this ancestor) and its
descendant, Au. afarensis. It has also produced other hominins. In
2012 Haile-Selassie and his colleagues announced their discovery
of an enigmatic hominin foot with a divergent big toe more like an
ape’s. At 3.4 million years old, it was contemporaneous with Au.
afarensis. Yet it clearly did not come from that species, whose big
toe lined up with the other digits, like ours does. Without any
associated skull or tooth remains to guide them, the researchers did
not want to assign the foot to a species. But it showed beyond any
doubt that Lucy’s species shared the landscape with a
fundamentally different kind of hominin.

Further evidence that Au. afarensis overlapped with other hominins

came in 2015, when Haile-Selassie and his colleagues announced
their discovery of fossilized upper and lower jaws from a species
new to science, Australopithecus deyiremeda. Dated to 3.3 million
to 3.5 million years ago, this species was contemporaneous with
both Au. afarensis and the owner of the mysterious foot that was
recovered from the same site. Whether the foot belongs to Au.
deyiremeda, given the proximity of the finds, remains to be seen.

A foot belonging to a yet unidentified species that had a divergent big toe like an ape’s.
Cleveland Museum of Natural History
The discoveries at Woranso-Mille show that Au. afarensis didn’t
just share the same continent or even the same side of the continent
with other hominin species but lived virtually side by side with
them. They may have been able to do this by exploiting different
ecological niches within the same area. The species with the
divergent big toe probably could have climbed trees more
efficiently than Au. afarensis, for example, and so might have
focused on arboreal resources while Au. afarensis favored
terrestrial ones.

Comparison of the paleoenvironments at the sites where these

fossils are found may provide further clues. Hadar and Woranso-
Mille are similar in having hosted both Au. afarensis and other
nonhominin mammals simultaneously. But only Woranso-Mille had
more than one hominin species. Why were there multiple
contemporaneous hominin species at Woranso-Mille and not at
nearby Hadar? One hypothesis we are testing is that Woranso-Mille
encompassed a greater diversity of habitats, which could have
supported multiple hominins without substantial direct competition.
 Jawbones belonging to a species called Australopithecus deyiremeda.
Cleveland Museum of Natural History

The realization that Au. afarensis might have had as many as three
other hominin contemporaries has raised questions about the claim
that it was the ancestor of all later hominins, including members of
Homo. We have to consider whether any of these other species may
be a better candidate ancestor than Au. afarensis. In practice, it’s
hard to connect the dots with certainty. One big problem is that the
sample sizes of these other species are too small to allow for
meaningful comparisons. For example, researchers have argued
that K. platyops had a flat face like early Homo and could thus be
considered the ancestor of that genus. But we have only one skull
of K. platyops to go on, and it’s badly crushed. Did this creature
actually have a flat face, or did its poor preservation distort its true
features? We would need well-preserved skulls of this species to
know. What is more, K. platyops is separated from its proposed
descendant, Homo rudolfensis, by about a million years, making it
difficult to link the two. If we had more fossils of K. platyops from
different time periods to establish how long this species persisted,
we might be able to bridge that gap, but we don’t.

We simply don’t have enough information about K. platyops or the

other Au. afarensis contemporaries to know what kinds of creatures
they were and how they are related to the rest of the human family.
That leaves Au. afarensis—represented by hundreds of fossils from
numerous individuals, juvenile and adult, spanning some 800,000
years—as the best candidate ancestor of Homo and Paranthropus.
As additional fossils of these more recently identified hominins
come to light, perhaps one of them might emerge as the front-
runner. Until then, Au. afarensis remains the most likely ancestor
and one of the most important species in human evolutionary
history.
Donald C. Johanson is founding director of the Institute of Human Origins at Arizona State
University and discoverer of the 3.18-million-year-old human ancestor known as Lucy.

Yohannes Haile-Selassie is director of the Institute of Human Origins and lead investigator for the
Woranso-Mille field site, which has yielded fossil contemporaries of Lucy’s species.

This article was downloaded by calibre from

https://www.scientificamerican.com/article/fossil-human-
ancestor-lucy-remains-pivotal-50-years-after-discovery

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New Nasal Vaccines Offer Better Protection from

COVID and Flu—No Needle Needed

Gentle nasal spray vaccines against COVID, the flu and RSV are
coming. They may work better than shots in the arm
By Stephani Sutherland

Sam Falconer

Alyson Velasquez hates needles. She never liked getting shots as a

kid, and her anxiety only grew as she got older. “It really ballooned
in my teens and early 20s,” she says. “It became a full-blown
phobia.” She would panic at the sight of a needle being brought
into an exam room; more than once she passed out. Velasquez says
that she took an antianxiety medication before one appointment yet
still ran around the room screaming inconsolably “like I was a
small child; I was 22.” After that episode Velasquez, now a 34-
year-old financial planner in southern California, quit needles
completely. “No vaccinations, no bloodwork. For all of my 20s it
was a no-go for me,” she says.
Then COVID showed up. “It finally hit a point where it wasn’t just
about me,” Velasquez says. “It felt so selfish not to do this for the
greater public health and the safety of our global community.” So
she got vaccinated against the SARS-CoV-2 virus in 2021,
although she had to sit on her husband’s lap while he held her arms.
“It was a spectacle. The poor guy at CVS ... he did ask me, ‘Are
you sure you want to do this?’” She very much did. “I’m very pro-
vaccine. I am a rational human. I understand the necessity of
[getting] them,” she insists. But today she still struggles with each
injection.

Those struggles would end, however, if all her future vaccinations

could be delivered by a nasal spray. “Oh, my God, amazing!”
Velasquez says.

On supporting science journalism

If you're enjoying this article, consider supporting our award-

winning journalism by subscribing. By purchasing a subscription
you are helping to ensure the future of impactful stories about the
discoveries and ideas shaping our world today.

The amazing appears to be well on its way. Vaccines delivered

through the nose are now being tested for several diseases. In the
U.S., early clinical trials are showing success. Two of these
vaccines have generated multiple immune system responses against
the COVID-causing virus in people who received them through a
puff up the nose; earlier this year their makers received nearly $20
million from Project NextGen, the Biden-Harris administration’s
COVID medical initiative. Researchers are optimistic that a nasal
spray delivering a COVID vaccine could be ready for the U.S. as
soon as 2027. Although recent efforts have focused on inoculations
against SARS-CoV-2, nasal vaccines could also protect us against
the flu, respiratory syncytial virus (RSV), and more.

A few nasal vaccines have been introduced in the past, but they’ve
been beset by problems. The flu inoculation FluMist has not gained
popularity because of debates about its effectiveness, and a
different vaccine was pulled from the market decades ago because
some people had serious side effects. In China and India, nasal
vaccines for COVID have been approved because those countries
prioritized their development during the pandemic, whereas the
U.S. and other wealthy nations opted to stick with arm injections.
But this new crop of vaccines takes advantage of technology that
produces stronger immune responses and is safer than preparations
used in the past.

In fact, immunologists say these spritzes up the nose—or inhaled

puffs through the mouth—can provide faster, stronger protection
against respiratory viruses than a shot in the arm. That is because
the new vaccines activate a branch of the immune system that has
evolved for robust, rapid responses against airborne germs. “It may
be more likely to really prevent infection from getting established,”
says Fiona Smaill, an infectious disease researcher at McMaster
University in Ontario. Such inoculations may also help reduce the
enormous inequities in vaccine access revealed by the pandemic.
These formulations should be cheaper and easier to transport to
poor regions than current shots.

But nasal vaccines still face technical hurdles, such as how best to
deliver them into the body. And unlike injected vaccines, which
scientists can measure immune responses to with blood tests alone,
testing for immunity that starts in nose cells is more challenging.
But researchers working in this field agree that despite the hurdles,
nasal formulations are the next step in vaccine evolution.
Traditional vaccines injected through the skin and into an arm
muscle provide excellent protection against viruses. They coax
immune cells into making widely circulated antibodies—special
proteins that recognize specific structural features on viruses or
other invading pathogens, glom on to them and mark them for
destruction. Other immune cells retain a “memory” of that
pathogen for future encounters.

Intramuscular injection vaccines are good at preventing a disease

from spreading, but they do not stop the initial infection. A nasal
spray does a much better job. That’s because sprays are aimed
directly at the spot where many viruses first enter the body: the
nose and the tissue that lines it, called the mucosa.

Mucosa makes up much of our bodies’ internal surfaces, stretching

from the nose, mouth and throat down the respiratory tract to the
lungs, through the gastrointestinal tract to the anus, and into the
urogenital tract. Mucosa is where our bodies encounter the vast
majority of pathogenic threats, Smaill says, be it flu, COVID, or
bacterial infections that attack the gut. This tough, triple-layered
tissue is specialized to fight off invaders with its thick coating of
secretory goo—mucus—and with a cadre of resident immune cells
waiting to attack. “Mucosa is really the first line of defense against
any infection we’re exposed to,” Smaill says.

“We’re expecting to see fewer breakthrough infections in

people who got the vaccine up the nose.”

—Michael Egan Castlevax

Mucosal immunity not only prepares the immune system for the
fight where it occurs but also offers three different types of
protection—at least one more than a shot does. Nasal vaccines and
shots both mobilize immune messenger cells, which gather the
interlopers’ proteins and display them on their surfaces. These cells
head to the lymph nodes, where they show off their captured prize
to B and T cells, which are members of another part of the immune
system called the adaptive arm. B cells, in turn, produce antibodies,
molecules that home in on the foreign proteins and flag their
owners—the invading microbes—for destruction. Killer T cells
directly attack infected cells, eliminating them and the microbes
inside. This provides broad protection, but it takes time, during
which the virus continues to replicate and spread.

That’s why a second type of protection, offered only by the

mucosal tissue, is so important. The mucosa holds cells of the
innate immune system, which are the body’s “first responders.”
Some of these cells, called macrophages, recognize invasive
microbes as foreign and swallow them up. They also trigger
inflammation—an alarm sounded to recruit more immune cells.

Another part of this localized response is called tissue-resident

immunity. These cells don’t have to detect telltale signs of a
pathogen and make a long journey to the infected tissue. They are
more like a Special Forces unit dropped behind enemy lines where
a skirmish is occurring rather than waiting for the proverbial
cavalry to arrive. This localized reaction can be quite potent. Its
activation is notoriously difficult to demonstrate, however, so
historically it’s been hard for vaccine makers to show they’ve hit
the mark. But it turns out that one type of antibody, called IgA, is a
good indicator of mucosal immunity because IgAs tend to
predominate in the mucosa rather than other parts of the body. In an
early trial of CoviLiv, a nasal COVID vaccine produced by
Codagenix, about half of participants had detectable IgA responses
within several weeks after receiving two doses. That trial also
showed the vaccine was safe and led to NextGen funding for a
larger trial of the vaccine’s efficacy.

It’s possible an inhaled vaccine may provide yet one more layer of
protection, called trained innate immunity. This reaction is a bit of
a mystery: although immunologists know it exists and appears also
to be produced by intramuscular injections, they can’t quite explain
how it works. Immune cells associated with trained innate
immunity seem to have memorylike responses, reacting quickly
against subsequent infections. They also have been found to
respond against pathogens entirely unrelated to the intended
vaccine target. Smaill and her colleagues found that when they
immunized mice with an inhaled tuberculosis vaccine and then
challenged them with pneumococcal bacteria, the mice were
protected. In children, there is some evidence that a tuberculosis
vaccine, in the arm, generates this type of broad response against
other diseases.

Akiko Iwasaki, an immunologist at Yale University who is working

to develop a nasal vaccination for COVID, sees two major potential
benefits to nasal immunity in addition to better, faster, more
localized protection. First, attacking the virus in the nose could
prevent the disease from being transmitted to others by reducing
the amount of virus that people breathe out. And second, Iwasaki
says, the spray may limit how deeply the infection moves into the
body, so “we believe that it will also prevent long COVID.” That
debilitating postinfection condition, sometimes marked by signs of
entrenched viral particles, disables people with extreme fatigue,
chronic pain, a variety of cognitive difficulties, and other
symptoms.

Making a new vaccine is hard, regardless of how you administer it.

It needs to raise an immune response that’s strong enough to
protect against future invasions but not so strong that the
components of that response—such as inflammation and fever—
harm the host.

The lining of the nose puts up its own barriers—literal, physical

ones. Because the nasal mucosa is exposed to so many irritants
from the air, ranging from pet hair to pollen, the nose has multiple
lines of defense against invading pathogens. Nostril hair, mucus,
and features called cilia that sweep the nasal surface all aim to trap
small foreign objects before they can get deeper into the body—
and that includes tiny droplets of vaccine.

And lots of small foreign particles—often harmless—still make it

through those defenses. So the nose has developed a way to
become less reactive to harmless objects. This dampened reactivity
is called immunological tolerance, and it may be the biggest hurdle
to successful development of a nasal vaccine. When foreign
particles show up in the bloodstream, a space that is ostensibly
sterile, immune cells immediately recognize them as invaders. But
mucosal surfaces are constantly bombarded by both pathogens and
harmless materials. The immune system uses tolerance—a complex
series of decisions carried out by specialized cells—to determine
whether a substance is harmful. “This is very important because we
can’t have our lungs or gastrointestinal tract always responding to
nonharmful foreign entities that they encounter,” says Yale
infectious disease researcher Benjamin Goldman-Israelow. For
example, inflammation in the lungs would make it hard to breathe;
in the gut, it would prevent the absorption of water and nutrients.
Jen Christiansen; Source: Florian Krammer, Icahn School of Medicine at Mount Sinai and Medical
University of Vienna, Austria (consultant)

These barriers may hamper the effectiveness of a nasal flu vaccine

that’s been around for a while, called FluMist in the U.S. and
Fluenz in Europe. The inoculation is safe, says infectious disease
scientist Michael Diamond of Washington University in St. Louis,
but it faces a similar problem as do injected flu vaccines: it isn’t
very effective at warding off new seasonal flu strains. This might
be because flu strains are so common, and people are frequently
infected by the time they are adults. Their immune systems are
already primed to recognize and destroy familiar flu particles.
FluMist is built from a live flu virus, so immune cells probably
treat the vaccine as an invader and demolish it as soon as it shows
up in the nose, before it has a chance to do any good. This
preexisting immunity isn’t such an issue in children, who are less
likely to have had multiple flu infections. Nasal flu vaccines are
routinely used to inoculate kids in Europe.

In other vaccines, researchers often use adjuvants, special agents

that attract the attention of immune cells, to boost a response. Some
nasal vaccines use adjuvants to overcome tolerance, but in the
nose, adjuvants can pose unique dangers. In at least one case, a
nasal adjuvant led to disastrous consequences. An intranasal
vaccine for influenza, licensed in Switzerland for the 2000–2001
season, used a toxin isolated from Escherichia coli bacteria as an
adjuvant to provoke a reaction to the inactivated virus. No serious
side effects were reported during the trial period, but once the
vaccine was released, Swiss officials saw a concerning uptick in
cases of Bell’s palsy, a disease that causes weakness or paralysis of
the facial muscles, often leading to a drooping or disfigured face.
Researchers at the University of Zurich estimated that the
adjuvanted flu vaccine had increased the risk of contracting Bell’s
palsy by about 20 times, and the vaccine was discontinued. “We
need to be cautious about using adjuvants like that from known
pathogens,” says pharmaceutical formulations scientist Vicky Kett
of Queen’s University Belfast in Northern Ireland.

To get around the challenges posed by the nose, some researchers

are exploring vaccines inhaled through the mouth. Smaill is
working on one of them. She and her McMaster colleagues
aerosolized their vaccine for COVID into a fine mist delivered by a
nebulizer, from which it rapidly reaches the lungs. Experiments in
mice have shown promising results, with mucosal immunity
established after administration of the vaccine.

Another vaccine strategy is to use a harmless virus to carry viral

genes or proteins. Researchers at the Icahn School of Medicine at
Mount Sinai in New York City selected a bird pathogen, Newcastle
disease virus (NDV). “It’s naturally a respiratory pathogen,” so it
infects nasal cells, says Michael Egan, CEO and chief scientific
officer of CastleVax, a company that formed to develop the NDV
vaccine for COVID. A small early clinical trial showed the
CastleVax vaccine was safe and caused robust immune responses in
people. “Those results were very promising,” Egan says. People
who received the vaccine also produced antibodies that indicated
multitiered mucosal immunity, not simply the adaptive immunity
from a shot in the arm.

Following that trial, the CastleVax project received NextGen

funding, and results from a trial of 10,000 people are expected in
2026. Half of those people will receive a messenger RNA (mRNA)
injection, and half will get the new NDV nasal spray. The data
should show whether the new nasal vaccine can do a better job of
preventing infection than the mRNA injections. Egan has high
hopes. “We’re expecting to see a lot fewer breakthrough infections
in people who got the vaccine up the nose by virtue of having those
mucosal immune responses,” he says.

Florian Krammer, one of the Mount Sinai researchers behind the

vaccine, engineered NDV particles to display a stabilized version
of the spike protein that’s so prominent in SARS-CoV-2. “You end
up with a particle that’s covered with spike,” he says. Spike protein
in the bloodstream can raise an immune response. But the NDV
vaccine works in another way, too. The virus particle can also get
into cells, where it can replicate enough times to cause virus
particles to emerge from the cells, provoking another immune
reaction. Before moving into human trials, however, researchers
had to complete clinical trials to establish that the Newcastle virus
is truly harmless because the nose is close to the central nervous
system—it has neurons that connect to the olfactory bulb, which is
part of the brain. Those trials confirmed that it is safe for this use.

Nasal sprays aim directly at the spot where most viruses first
enter the body: the nose.

This type of caution is one reason a COVID nasal vaccine

approved in India hasn’t been adopted by the U.S. or other
countries. The inoculation, called iNCOVACC, uses a harmless
simian adenovirus to carry the spike protein into the airway. The
research originated in the laboratories of Diamond and some of his
colleagues at Washington University at the start of the pandemic,
when they tested the formulation on rodents and nonhuman
primates. “The preclinical data were outstanding,” Diamond says.
Around the time he and his colleagues published initial animal
results in Cell in 2020, Bharat Biotech in India licensed the idea
from the university. In a 2023 phase 3 clinical trial in India, the
nasal vaccine produced superior systemic immunity compared with
a shot.

Diamond says American drug companies didn’t pursue this

approach, because “they wanted to use known quantities,” such as
the mRNA vaccines, which were already proving themselves in
clinical trials in 2020. As the pandemic took hold, there was little
appetite to develop nasal vaccine technology to stimulate mucosal
immunity while the tried-and-true route of shots in the arm was
available and working. But now, four years later, an inhaled
vaccine using technology similar to iNCOVACC’s is being
developed for approval in the U.S. by biotech company Ocugen.
Both inhaled and nasal forms of the vaccine are set to undergo
clinical trials as part of Project NextGen. These new vaccines are
using classical vaccine methods based on the virus rather than
using new, mRNA-based technology. The mRNA preparations
were developed specifically for intramuscular injections and would
have to be significantly modified.

Codagenix, which is developing CoviLiv, sidestepped the need for

a new viral vector or an adjuvant by disabling a live SARS-CoV-2
virus. To make it safe, scientists engineered a version of the virus
with 283 mutations, alterations to its genetic code that make it hard
for the virus to replicate and harm the body. Without all these
genetic changes, there would be a chance the virus could revert to a
dangerous, pathogenic form. But with hundreds of key mutations,
“statistically, it’s basically impossible that this will revert back to a
live virus in the population,” says Johanna Kaufmann, who helped
to develop the vaccine before leaving Codagenix for another
company earlier this year.

Because most people on the planet have now been exposed to

SARS-CoV-2—in the same way they’re regularly exposed to the
flu—some nasal vaccines are being designed as boosters for a
preexisting immune response that is starting to wane. For example,
Yale researchers Iwasaki and Goldman-Israelow are pursuing a
strategy in animals deemed “prime and spike.”

The idea is to start with a vaccine injection—the “prime” that

stimulates adaptive immunity—then follow it a few weeks later
with a nasal puff that “spikes” the system with more viral protein,
leading to mucosal immunity. In a study published in 2022 in
Science, Iwasaki and her colleagues reported that they primed
rodents with the mRNA vaccine developed by Pfizer and
BioNTech, the same shot so many of us have received. Two weeks
later some of the mice received an intranasal puff of saline
containing a fragment of the SARS-CoV-2 spike protein. Because
the animals had some preexisting immunity from the shot, the
researchers didn’t add any adjuvants to heighten the effects of the
nasal puff. Two weeks later researchers detected stronger signs of
mucosal immunity in mice that had received this treatment
compared with mice that got only the shot.

“Not only can we establish tissue-resident memory T cells” to fight

off the virus in the nose, Iwasaki says, but the prime-and-spike
method also produces those vigorous IgA antibodies in the mucosal
layer. “And that’s much more advantageous because we can
prevent the virus from ever infecting the host,” she notes. The
study suggests that this approach might also lessen the chances of
transmitting the disease to others because of the lower overall viral
load. Experiments in hamsters demonstrated that vaccinated
animals shed less virus, and they were less likely to contract
COVID from infected cage mates that had not been vaccinated
themselves.

Although most of the new vaccine strategies are aimed at COVID,

nasal vaccines for other diseases are already being planned.
Kaufmann, formerly of Codagenix, says the company currently has
clinical trials underway for nasal vaccines against flu and RSV.
CastleVax’s Egan says “we have plans to address other pathogens”
such as RSV and human metapneumovirus, another leading cause
of respiratory disease in kids.

Vaccines that don’t need to be injected could clear many barriers to

vaccine access worldwide. “We saw with COVID there was no
vaccine equity,” Smaill says. Many people in low-income countries
never received a shot; they are still going without one four years
after the vaccines debuted.

In part, this inequity is a consequence of the high cost of delivering

a vaccine that needs to stay frozen on a long journey from
manufacturing facilities in wealthy countries. Some of the nasal
sprays in development don’t need deep-cold storage, so they might
be easier to store and transport. And a nasal spray or an inhaled
puff would be much easier to administer than a shot. No health
professional is required, so people could spray it into their noses or
mouths at home.

For these reasons, needle-free delivery matters to the World Health

Organization. The WHO is using the Codagenix nasal spray in its
Solidarity Trial Vaccines program to improve vaccine equity. The
CoviLiv spray is now in phase 3 clinical trials around the world as
part of this effort. “The fact that the WHO was still interested in a
primary vaccination trial in the geographies it’s passionate about—
that’s indicative that there is still a gap,” Kaufmann says. CoviLiv
was co-developed with the Serum Institute of India, the world’s
largest maker of vaccines by dose. The partnership enabled
production at the high volume required for Solidarity.

The CastleVax vaccine with the NDV vector provides another layer
of equity because the facilities required to make it already exist in
many low- and middle-income countries. “The cool thing is that
NDV is a chicken virus, so it grows very well in embryonated eggs
—that’s exactly the system used for making flu vaccines,”
Krammer says. For example, for a clinical trial in Thailand, “we
just shipped them the seed virus, and then they produced the
vaccine and ran the clinical trials,” he says. Many countries around
the world have similar facilities, so they will not need to depend on
pharma companies based in richer places.

Even high-income countries face barriers to vaccination, although

they may be more personal than systemic. For very many people,
the needle itself is the problem. Extreme phobia such as
Velasquez’s is uncommon, but many people have a general fear of
needles that makes vaccinations stressful or even impossible for
them. For about one in 10 people needle-related fear or pain is a
barrier to vaccinations, says C. Meghan McMurtry, a psychologist
at the University of Guelph in Ontario. Needle fear “is present in
most young kids and in about half of adolescents. And 20 to 30
percent of adults have some level of fear.” A review of studies of
children showed that “concern around pain and needle fear are
barriers to vaccination in about 8 percent of the general population
and about 18 percent in the vaccine-hesitant population,”
McMurtry adds.

Some people are wary of injected vaccines even if they’re not

afraid of needles, Kett says; they see injections as too invasive even
if the needle doesn’t bother them. “We’re hopeful that something
administered by the nasal route would be less likely to come across
some of those issues,” Kett says.

In the U.S., however, sprays and puffs won’t be available until they
are approved by the Food and Drug Administration, which requires
clear evidence of disease protection. As Diamond points out,
standards for such evidence are well established for injections, and
vaccine makers can follow the rule book: regulations point to
particular antibodies and specific ways to measure them with a
simple blood test. But for nasal vaccines, Iwasaki says, “we don’t
have a standard way to collect nasal mucus or measure antibody
titers. All these practical issues have not been worked out.”

Iwasaki is also frustrated with a restriction by the U.S. Centers for

Disease Control and Prevention that stops researchers from using
existing COVID vaccines in basic research to develop new nasal
sprays. The rule is a holdover from 2020, when COVID injections
had just been developed and were in short supply; people had to
wait to get vaccinated until they were eligible based on factors such
as age and preexisting conditions. “That made sense back then, but
those concerns are years old; things are different now,” Iwasaki
says. “Now we have excess vaccine being thrown out, and we
cannot even get access to the waste, the expired vaccine.”
Today scientists want to contrast the effectiveness of nasal
formulations with injections already in use. “Those comparisons
are really important for convincing the FDA that this is a worthy
vaccine to pursue,” Iwasaki says. But the restriction has held up
studies by her company, Xanadu, slowing down work. (The CDC
did not respond to a request for comment.)

Despite the bureaucratic and scientific hurdles, the sheer number of

nasal vaccines now in clinical trials encourages Iwasaki and other
scientists pursuing the needle-free route. They say it seems like
only a matter of time before getting vaccinated will be as simple as
a spritz up the nose.

Velasquez, for one, can’t wait for that day to arrive. The
circumstances that finally forced her to reckon with her fear of
needles (a global pandemic, the prospect of parenthood and the
numerous blood tests that accompanied her pregnancy) were so
much bigger than her. If not for them, she might still be avoiding
shots. “So having vaccines without needles—I would get every
vaccine any doctor wanted me to get, ever. It would be a complete
game changer for me.”
Stephani Sutherland is a neuroscientist and science journalist based in southern California. She
wrote about the causes of long COVID in our March 2023 issue. Follow her on X @SutherlandPhD

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A Weird Form of Dark Energy Might Solve a

Cosmic Conundrum

Estimates of how fast the universe is expanding disagree. Could a

new form of dark energy resolve the problem?
By Marc Kamionkowski & Adam G. Riess

Chris Gash

Fifteen years ago cosmologists were flying high. The simple but
wildly successful “standard model of cosmology” could, with just a
few ingredients, account for a lot of what we see in the universe. It
seemed to explain the distribution of galaxies in space today, the
accelerated expansion of the universe and the fluctuations in the
brightness of the relic glow from the big bang—called the cosmic
microwave background (CMB)—based on a handful of numbers
fed into the model. Sure, it contained some unexplained exotic
features, such as dark matter and dark energy, but otherwise
everything held together. Cosmologists were (relatively) happy.

Over the past decade, though, a pesky inconsistency has arisen, one
that defies easy explanation and may portend significant breaks
from the standard model. The problem lies with the question of
how fast space is growing. When astronomers measure this
expansion rate, known as the Hubble constant, by observing
supernovae in the nearby universe, their result disagrees with the
rate given by the standard model.

This “Hubble tension” was first noted more than 10 years ago, but
it was not clear then whether the discrepancy was real or the result
of measurement error. With time, however, the inconsistency has
become more firmly entrenched, and it now represents a major
thorn in the side of an otherwise capable model. The latest data,
from the James Webb Space Telescope (JWST), have made the
problem worse.

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The two of us have been deeply involved in this saga. One (Riess)
is an observer and co-discoverer of dark energy, one of the last
pieces of the standard cosmological model. He has also
spearheaded efforts to determine the Hubble constant by observing
the local universe. The other (Kamionkowski) is a theorist who
helped to figure out how to calculate the Hubble constant by
measuring the CMB. More recently he helped to develop one of the
most promising ideas to explain the discrepancy—a notion called
early dark energy.

One possibility is that the Hubble tension is telling us the baby

universe was expanding faster than we think. Early dark energy
posits that this extra expansion might have resulted from an
additional repulsive force that was pushing against space at the
time and has since died out.

This suggestion is finally facing real-world tests, as experiments

are just now becoming capable of measuring the kinds of signals
early dark energy might have produced. So far the results are
mixed. But as new data come in over the next few years, we should
learn more about whether the expansion of the cosmos is diverging
from our predictions and possibly why.

The idea that the universe is expanding at all came as a surprise in

1929, when Edwin Hubble used the Mount Wilson Observatory
near Pasadena, Calif., to show that galaxies are all moving apart
from one another. At the time many scientists, including Albert
Einstein, favored the idea of a static universe. But the separating
galaxies showed that space is swelling ever larger.

If you take an expanding universe and mentally rewind it, you

reach the conclusion that at some finite time in the past, all the
matter in space would have been on top of itself—the moment of
the big bang. The faster the rate of expansion, the shorter the time
between that big bang and today. Hubble used this logic to make
the first calculation of the Hubble constant, but his initial estimate
was so high that it implied the universe was younger than the solar
system. This was the very first “Hubble tension,” which was later
resolved when German astronomer Walter Baade discovered that
the distant galaxies Hubble used for his estimate contained
different kinds of stars than the nearby ones he used to calibrate his
numbers.

A second Hubble tension appeared in the 1990s as a result of

sharpening observations from the Hubble Space Telescope. The
observatory’s measured value of the Hubble constant implied that
the universe’s oldest stars were older than stellar-evolution theories
suggested. This tension was resolved in 1998 with the discovery
that the expansion of the cosmos was accelerating. This shocking
revelation led scientists to add dark energy—the energy of empty
space—to the standard model of cosmology. Once researchers
understood that the universe is expanding faster now than it did
when it was young, they realized it had to be several billion years
older than previously thought.

One possible explanation is that the Hubble tension is telling

us the baby universe was expanding faster than we think.

Since then, our understanding of the origin and evolution of the

universe has changed considerably. We can now measure the CMB
—our single greatest piece of evidence about cosmic history—with
a precision unimaginable at the turn of the millennium. We have
mapped the distribution of galaxies over cosmic volumes hundreds
of times larger than we had then. Likewise, the number of
supernovae being used to measure the expansion history has
reached several thousand.

Yet our estimates of how fast space is growing still disagree. For
more than a decade increasingly precise measurements of the
Hubble constant based on the local universe, made without
reference to the standard model and therefore directly testing its
accuracy, have converged around 73 kilometers per second per
megaparsec (km/s/Mpc) of space, plus or minus 1. This figure is
too large, and its estimated uncertainty too small, to be compatible
with the value the standard model predicts based on CMB data:
67.5 ± 0.5 km/s/Mpc.

The local measurements are largely based on observations of

supernovae in a certain class, type Ia, that all explode with a similar
energy output, meaning they all have the same intrinsic brightness,
or luminosity. Their apparent luminosity (how bright they appear in
the sky) is a proxy for their distance from Earth. And comparing
their distance with their speed—which we get by measuring their
redshift (how much their light has been shifted toward the red end
of the electromagnetic spectrum)—tells us how fast space is
expanding.

Astronomers calibrate their type Ia supernova distance

measurements by comparing them with values for nearby galaxies
that host both a supernova of this type and at least one Cepheid
variable star—a pulsating supergiant that flares on a timescale
tightly correlated to its luminosity, a fact discovered a century ago
by Henrietta Swan Leavitt. Scientists in turn calibrate this period-
luminosity relation by observing Cepheids in very nearby galaxies
whose distances we can measure geometrically through a method
called parallax. This step-by-step calibration is called a distance
ladder.

Twenty-five years ago a landmark measurement of this kind came

out of the Hubble Key Project, resulting in a Hubble constant
measurement of H0 = 72 ± 8 km/s/Mpc. About a dozen years ago
this value improved to 74 ± 2.5 km/s/Mpc, thanks to work by two
independent groups (the SH0ES team, led by Riess, and the
Carnegie Hubble Program, led by Wendy L. Freedman of the
University of Chicago). In the past few years these measurements
have been replicated by many studies and further refined with the
aid of the European Space Agency Gaia parallax observatory to 73
± 1. Even if we replace some of the steps in the parallax-Cepheid-
supernova calibration sequence with other estimates of stellar
distances, the Hubble constant changes little and cannot be brought
below about 70 km/s/Mpc without uncomfortable contrivances or
jettisoning most of the Hubble Space Telescope data. Even this
lowest value, though, is far too large compared with the number
inferred from the CMB to be chalked up to bad luck.

Astronomers have worked through a long list of possible problems

with the supernova distances and suggested many follow-up tests,
but none have revealed a flaw in the measurements. Until recently,
one of the remaining concerns involved how we determine Cepheid
brightness in crowded fields of view. With the Hubble Space
Telescope, some of the light from any given Cepheid star
overlapped with light from other stars close to it, so scientists had
to use statistics to estimate how bright the Cepheid was alone.
Recently, however, JWST allowed us to reimage some of these
Cepheids with dramatically improved resolution. With JWST, the
stars are very cleanly separated with no overlap, and the new
measurements are fully consistent with those from Hubble.

The method for inferring the Hubble constant from the CMB is a
bit more involved but is based on similar principles. The intensity
of the CMB light is very nearly the same everywhere in space.
Precise measurements show, however, that the intensity varies from
one point to another by roughly one part in 100,000. To the eye,
this pattern of intensity variations appears fairly random. Yet if we
look at two points that are separated by around one degree (about
two full moons side by side on the sky), we see a correlation: their
intensities (temperatures) are likely to be similar. This pattern is a
consequence of how sound spread in the early universe.

During the first roughly 380,000 years after the big bang, space
was filled with a plasma of free protons, electrons and light. At
around 380,000 years, though, the cosmos cooled enough that
electrons could combine with protons to form neutral hydrogen
atoms for the first time. Before then electrons had zoomed freely
through space, and light couldn’t travel far without hitting one.
Afterward the electrons were bound up in atoms, and light could
flow freely. That initial release of light is what we observe as the
CMB today.
Jen Christiansen (graphic), ESA and the Planck Collaboration; NASA/WMAP Science Team (CMB
images); Source: “A Tale of Many H0,” by Licia Verde et al., arXiv preprint; November 22, 2023
(Hubble constant data)

During those first 380,000 years, small changes in the density of

the electron-proton-light plasma that filled space spread as sound
waves, just as sound propagates through the air in a room. The
precise origin of these sound waves has to do with quantum
fluctuations during the very early universe, but we think of them as
noise left over from the big bang. A cosmological sound wave
travels a distance determined by the speed of sound in a medium
multiplied by the time since the big bang; we call this distance the
sound horizon. If there happened to be a particularly “loud” spot
somewhere in the universe at the big bang, then it will eventually
be “heard” at any point that is a sound horizon away. When the
CMB light was released at 380,000 years, it was imprinted with the
intensity of the soundscape at that point. The one-degree scale
correlation in the CMB intensity thus corresponds to the angular
size of the sound horizon at that time.

That scale is determined by the ratio of the sound horizon to the

distance to the “surface of last scatter”—essentially, how far light
has traveled since it was freed when the CMB was released (the
moment electrons were all bound up in atoms, and light could
travel freely for the first time). If the expansion rate of the universe
is larger, then that distance is smaller, and vice versa.

Astronomers can therefore use the measurement of the sound

horizon to predict the current rate of the universe’s expansion—the
Hubble constant. The standard model of cosmology predicts a
physical length for the sound horizon based on the gravitationally
attracting ingredients of the early universe: dark matter, dark
energy, neutrinos, photons and atoms. By comparing this length
with the measured angular length of the horizon from the CMB
(one degree), scientists can infer a value for the Hubble constant.
The only problem is that this CMB-inferred value is smaller, by
about 9 percent, than the number we obtain by using supernovae.
Had the CMB-inferred value turned out to be larger than the local
value, we would have had a fairly obvious explanation. The
distance to the surface of last scatter also depends on the nature of
dark energy. If the dark energy density is not precisely constant but
decreases slowly with time (as some models, such as one called
quintessence, propose), then the distance to the surface of last
scatter will be decreased, bringing the CMB-based value of the
Hubble constant down to the value observed locally.

Conversely, if the dark energy density were slowly increasing with

time, then we would infer from the CMB a larger Hubble constant,
and there would be no tension with the supernova measurements.
Yet this explanation requires that energy somehow be created out
of nothing—a violation of energy conservation, which is a sacred
principle in physics. Even if we are perverse enough to imagine
models that don’t respect energy conservation, we still can’t seem
to resolve the Hubble tension. The reason has to do with galaxy
surveys. The distribution of galaxies in the universe today evolved
from the distribution of matter in the early cosmos and thus
exhibits the same sound-horizon bump in its correlations. The
angular scale of that correlation also allows us to infer distances to
the same types of galaxies that host supernovae, and these distances
(using the same sound horizon as employed for the CMB) give us a
low value of the Hubble constant, consistent with the CMB.
 Jen Christiansen (graphic), ESA and the Planck Collaboration (CMB image)

We’re left to conclude that “late-time” solutions for the Hubble

tension—those that attempt to alter the relation between the Hubble
constant and the distance to the CMB surface of last scattering—
don’t work or at least are not the whole story. The alternative, then,
is to surmise that there may be something missing in our
understanding of the early universe that leads to a smaller sound
horizon. Early dark energy is one possibility.

Kamionkowski and his then graduate student Tanvi Karwal were

the first to explore this idea in 2016. The expansion rate in the early
universe is determined by the density of all the matter in the
cosmos at the time. In the standard cosmological model, this
includes photons, dark energy, dark matter, neutrinos, protons,
electrons and helium nuclei. But what if there were some new
component of matter—early dark energy—that had a density
roughly 10 percent of the value for everything else at the time and
then later decayed away?

The most obvious form for early dark energy to take is a field,
similar to an electromagnetic field, that fills space. This field would
have added a negative-pressure energy density to space when the
universe was young, with the effect of pushing against gravity and
propelling space toward a faster expansion. There are two types of
fields that could fit the bill. The simplest option is what’s called a
slowly rolling scalar field. This field would start off with its energy
density in the form of potential energy—picture it resting on top of
a hill. Over time the field would roll down the hill, and its potential
energy would be converted to kinetic energy. Kinetic energy
wouldn’t affect the universe’s expansion the way the potential
energy did, so its effects wouldn’t be observable as time went on.

A second option is for the early dark energy field to oscillate

rapidly. This field would quickly move from potential to kinetic
energy and back again, as if the field were rolling down a hill, into
a valley, up another hill and then back down again over and over. If
the starting potential is chosen correctly, then the average leads to
an overall energy density with more potential energy than kinetic
energy—in other words, a situation that produces negative pressure
against the universe (as dark energy does) rather than positive
pressure (as ordinary matter does). This more complicated
oscillating scenario is not required, but it can lead to a variety of
interesting physical consequences. For instance, an oscillating early
dark energy field might give rise to particles that could be new dark
matter candidates or might provide additional seeds for the growth
of a large cosmic structure that could show up in the later universe.

Side-by-side photographs of a Cepheid star in NGC 5468, a galaxy at the far end of the Hubble Space
Telescope’s range, as taken by the James Webb Space Telescope (JWST) and the Hubble, show how
much sharper the new observatory’s imaging is. The JWST data confirmed that distance
measurements from Hubble were accurate, despite the blurring of Cepheids with surrounding stars in
the Hubble data.
NASA, ESA, CSA, STScI, Adam G. Riess/ JHU, STScI

After their initial suggestion of early dark energy in 2016,

Kamionkowski and Karwal, along with Vivian Poulin of the French
National Center for Scientific Research (CNRS) and Tristan L.
Smith of Swarthmore College, developed tools to compare the
model’s predictions with CMB data. It’s hard to depart much from
the standard cosmological model when we have such precise
measurements of the CMB that so far match the model very well.
We figured it was a long shot that early dark energy would actually
work. To our surprise, though, the analysis identified classes of
models that would allow a higher Hubble constant and still fit the
CMB data well.

This promising start led others to create a proliferation of variants

of early dark energy models. In 2018 these models fared about as
well as the standard model in matching CMB measurements. But
by 2021 new, higher-resolution CMB data from the Atacama
Cosmology Telescope (ACT) seemed to favor early dark energy
over the standard model, which drew even more scientists toward
the idea. In the past three years, however, more measurements and
analysis from ACT, as well as from the South Pole Telescope, the
Dark Energy Survey and the Dark Energy Spectroscopic
Instrument, led to more nuanced conclusions. Although some
analyses keep early dark energy in the running, most of the results
seem to be converging toward the standard cosmological model.
Even so, the jury is still out: a broad array of imaginable early dark
energy models remain viable.

Many theorists think it may be time to explore other ideas. The

problem is that there aren’t any particularly compelling new ideas
that seem viable. We need something that can increase the
expansion of the young universe and shrink the sound horizon to
raise the Hubble constant. Perhaps protons and electrons somehow
combined differently to form atoms at that time than they do now,
or maybe we’re missing some effects of early magnetic fields,
funny dark matter properties or subtleties in the initial conditions of
the early universe. Cosmologists will agree that simple
explanations continue to elude us even as the Hubble tension
becomes more firmly embedded in the data.

To progress, we must continue to find ways to scrutinize, check and

test both local and CMB-inferred values of the Hubble constant.
Astronomers are developing strategies for gauging local distances
to augment the supernova-based approaches. Measurements of
distances to quasars based on radio-interferometric techniques, for
instance, are advancing, and there are prospects for using
fluctuations in galaxy-surface brightness. Others are trying to use
type II supernovae and different kinds of red giant stars to measure
distances. There are even proposals to use gravitational-wave
signals from merging black holes and neutron stars. We are also
intrigued by the potential to determine cosmic distances with
gravitational lensing.

Although current results are not yet precise enough to weigh in on

the Hubble tension, we expect to see great progress when the Vera
C. Rubin Observatory and the Nancy Grace Roman Space
Telescope come online. For now we have no good answers, but lots
of great questions and experiments are underway.
Marc Kamionkowski is a theoretical physicist at Johns Hopkins University, where he studies
cosmology and particle physics.

Adam G. Riess is an astrophysicist at Johns Hopkins University and the Space Telescope Science
Institute. His research on distant supernovae revealed that the expansion of the universe is
accelerating, a discovery for which he shared the 2011 Nobel Prize in Physics.

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Should We Abandon the Leap Second?

We have been adding “leap seconds” to time kept by our atomic

clocks, but soon we may have to subtract one. Are the tiny
adjustments worth the bother?
By Mark Fischetti & Matthew Twombly

Matthew Twombly

Long ago we humans defined a day as the time it takes Earth to

make one rotation about its axis, with one sunrise and one sunset.
Our predecessors partitioned that day into 24 hours. But if Earth’s
rotation slows down a little, it takes a bit longer than one day to
complete it. That has been happening for many years. Because the
atomic clocks we use to pace everything from Internet
communications to GPS apps to automated stock trades never slow
down, global timekeepers periodically have added a leap second to
the clocks to keep them in sync with Earth. Since 1972 we have
made this awkward addition 27 times.

For the first time, however, we may have to subtract a leap second
because since around 1990 Earth’s rotation has been speeding up,
counteracting the slowdown and shortening the day. There are two
explanations for why, which I’ll explain ... in a second.

The reversal has many people asking why we should bother with
leap seconds at all. Each time an adjustment is needed, a mind-
boggling number of computers and telecom operations have to be
changed. On a regular day, the National Institute of Standards and
Technology, which keeps atomic time for the U.S. and
synchronizes most of the world’s computers, receives more than
100 billion time-coordination requests from up to a billion
computers. And leap-second adjustments can create problems. An
addition in 2012 was blamed for Reddit suddenly going dark and
for foiling operational systems at Qantas Airways, leading to long
flight delays across Australia.

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What if we just ignored the fact that Earth’s rotation and atomic
clocks are off by a second or even off by one minute, which they
are estimated to be a century from now if we do nothing until then?
In our highly digitized world, does the exact length of the rotational
day even matter?

Earth rotates because our solar system condensed from a rotating

cloud of gas and dust. Outer space provides virtually zero drag, so
the planets, including Earth, just keep spinning. As Earth turns, the
gravitational pull between it and the moon, and to a lesser degree
the sun, creates ocean tides. As tides grind across the seafloor, they
create friction, which gradually slows the planet’s rotation. Back in
the dinosaur era, a day was about 23.5 hours long; since then, tidal
friction has extended it.

Matthew Twombly

Studies of seismic waves show that Earth has a solid inner core and
a liquid outer core, which are wrapped by a solid mantle and crust.
Currents in the outer core cause the mantle to rotate faster or
slower in any given year, but over centuries the changes tend to
cancel out, making tidal slowing the prevailing trend.

Matthew Twombly

Tidal slowing is consistent, but Earth’s rotational speedup has been

counteracting that trend, and the time between added leap seconds
has been getting longer, from about a year in the 1970s to three or
four years in the 2010s.

Jen Christiansen (timeline); Source: Time Service Department, U.S. Naval Observatory (timeline
data)

Calculations indicated that by 2026 the ongoing speedup would

overtake the slowdown, and we would have to subtract a leap
second.

But now global warming is complicating that projection. As the

massive ice sheets across the North and South Poles melted at the
end of the most recent ice age, the weight of that ice decreased, and
the crust that had been compressed underneath it began to rebound,
which it is still doing today. That has made Earth more spherical.
(The planet is not a perfect sphere; it’s slightly wider around the
equator.) The change in shape means Earth’s overall mass is
distributed a little closer to its axis of rotation, speeding its
movement in the same way that ice skaters spin faster when pulling
in their outstretched arms.

Matthew Twombly
As ice sheets warm, however, the meltwater spreads out across the
global ocean, and most of the ocean is at lower latitudes, farther
from the rotation axis than the ice caps are. That slows the spin (the
skaters extending their arms outward). For now this effect is
stronger, delaying how soon the rotational speedup will overtake
the tidal slowdown. According to a recent study, this counterforce
means we won’t have to subtract a leap second until 2029.

Matthew Twombly

Given so many vagaries, it’s reasonable to ask if we should add or

subtract leap seconds at all. And because tidal slowing will always
be the long-term trend, we may never again need to subtract a
second, so why go through the trouble one time? Few computer
programs are written to allow for a negative leap second.

Reverence for the rotational day may be the only reason to keep
atomic time in sync with it. If the two time stamps diverge, “for
most people, there are no real ramifications,” says Duncan Carr
Agnew, a geophysicist at the Scripps Institution of Oceanography,
who wrote the 2024 Nature paper projecting a negative leap second
in 2029. Rather than advocating for frequent and random
adjustments of a second, Agnew favors the idea of waiting a
century, then making one big adjustment because preparations
could be made well ahead of time.

This idea has had support for a while. In 2022 parties to the
international General Conference on Weights and Measures voted
to stop making leap-second adjustments by 2035. After that,
timekeepers might agree to a fix every 20 years or perhaps every
100. Whatever the choice, “we want consistency,” says physicist
Elizabeth Donley, chief of the time and frequency division at NIST.
“Time is the most important unit in the international system of
units; a lot of other standards depend on it.”

Some large Internet providers already follow their own protocols.

Rather than waiting for any leaps, Google “smears” its clocks by
thousandths of a second once every day. Such independent efforts
don’t seem to cause any global discontinuities, but if more and
more large entities start winging it, “that becomes anarchy,”
Donley says.

Waiting decades for a well-planned adjustment means astronomical

(rotational) time, known as UT1, will diverge more widely from the
coordinated universal time (UTC) that is based on atomic clocks.
But Donley doesn’t think problems will arise. “Computer
networks,” she says, “don’t care where the sun is in the sky.”
Mark Fischetti has been a senior editor at Scientific American for 17 years and has covered
sustainability issues, including climate, weather, environment, energy, food, water, biodiversity,
population, and more. He assigns and edits feature articles, commentaries and news by journalists
and scientists and also writes in those formats. He edits History, the magazine's department looking at
science advances throughout time. He was founding managing editor of two spinoff magazines:
Scientific American Mind and Scientific American Earth 3.0. His 2001 freelance article for the
magazine, "Drowning New Orleans," predicted the widespread disaster that a storm like Hurricane
Katrina would impose on the city. His video What Happens to Your Body after You Die?, has more
than 12 million views on YouTube. Fischetti has written freelance articles for the New York Times,
Sports Illustrated, Smithsonian, Technology Review, Fast Company, and many others. He co-authored
the book Weaving the Web with Tim Berners-Lee, inventor of the World Wide Web, which tells the
real story of how the Web was created. He also co-authored The New Killer Diseases with
microbiologist Elinor Levy. Fischetti is a former managing editor of IEEE Spectrum Magazine and of
Family Business Magazine. He has a physics degree and has twice served as the Attaway Fellow in
Civic Culture at Centenary College of Louisiana, which awarded him an honorary doctorate. In 2021
he received the American Geophysical Union's Robert C. Cowen Award for Sustained Achievement
in Science Journalism, which celebrates a career of outstanding reporting on the Earth and space
sciences. He has appeared on NBC's Meet the Press, CNN, the History Channel, NPR News and
many news radio stations. Follow Fischetti on X (formerly Twitter) @markfischetti

Matthew Twombly is a freelance illustrator and infographic designer. His work can be viewed at
www.matthewtwombly.com
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How to Make Progress in Health Equity

This collection shows what works to advance health equity around

the world
By Lauren Gravitz

Luisa Jung

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

The country someone is born into has a lifelong effect on their

health. So does the neighborhood they live in, the color of their
skin, their income and their level of social support. It’s unjust. After
centuries of persistent health disparities, researchers, advocates,
clinicians and public health experts are finding ways to improve
health for everyone.
New advances sometimes exaggerate inequities before helping
reduce them. But there are reasons for optimism, which journalist
Anil Oza shares here. More than almost any other development,
vaccines have advanced health equity around the world. They have
averted 154 million deaths over the past 50 years, a life saved every
10 seconds, as health writer Tara Haelle explains with graphics.
Collaborative campaigns have brought this powerful preventive
health care to children in even the most impoverished regions.
Writer Carrie Arnold shows how rural areas around the world are
benefiting from other inventive and resourceful ways to deliver
needed care—from telemedicine to micro clinics to a traveling
dialysis bus.

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Researchers are working to remove racial bias that has been built
into diagnostics, and by doing so they’re changing not just tools
and algorithms but lives. As journalist Cassandra Willyard writes,
some Black patients once deemed ineligible for new kidneys,
despite having the same laboratory results as white patients, are
now moving up the wait list for transplant; others with respiratory
issues might be able to file for disability after previously being
judged unqualified. Epidemiologists and other public health
scientists are discovering that prior assumptions about race have
lumped together disparate groups with different needs and health
risks, particularly within Asian American communities [see graphic
here]. Now, by teasing apart the data, they are able to better
diagnose, treat and even prevent disease. Health writer Jyoti
Madhusoodanan reveals how this data-driven approach is already
saving lives.

Certain diseases and conditions have been used to justify

discrimination, especially when the disease is more prevalent in a
group that’s already marginalized. The people most at risk for
mpox, for instance, are men who have sex with men—a community
already hit hard by HIV/AIDS. But as global health expert Charles
Ebikeme writes, researchers, clinicians and community members
have learned from past experiences and are building up existing
networks and clinics that cater specifically to this stigmatized
population. Even health-care communication is improving, writer
Rod McCullom shares, as the movement toward culturally sensitive
care helps clinicians better understand and empathize with their
patients.

Improving health equity requires rethinking our global health

infrastructure, and we are still at the beginning. But each solution
adds support and begins to build a path toward justice.
Lauren Gravitz is a science journalist in San Diego, Calif., who has contributed to Nature, NPR, the
Washington Post, MIT Technology Review and the Economist, among other publications. She is a
2021–2022 Knight Science Journalism Project Fellow at the Massachusetts Institute of Technology.

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Removing Bias from Devices and Diagnostics Can

Save Lives

New formulas, devices and tools are removing historical bias from
medical diagnoses
By Cassandra Willyard

Luisa Jung

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

Melanie Hoenig was teaching first-year medical students how to

estimate kidney function when one of them, Cameron Nutt, raised
his hand. Why, he asked, did the diagnostic algorithm include an
adjustment for Black patients? In the U.S., Black people have
higher rates of kidney disease and kidney failure and are less likely
to get a kidney transplant than white people, but the adjustment
makes it seem as though Black people have better kidney function
than people of other races who have the same test results.

Good question, thought Hoenig, a kidney specialist at Beth Israel

Deaconess Medical Center in Boston. She had never wondered
why this might be. “I said, ‘You’re right. That doesn’t make any
sense,’” Hoenig recalls of the 2016 classroom conversation.

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This value for kidney function, called the estimated glomerular

filtration rate (eGFR), helps doctors figure out when to send
patients to a specialist, when to start dialysis, when they are eligible
to join the wait list for a kidney transplant, and where their name
lands on that list. Adjusting the algorithm for Black patients
decreased their chances for treatment and transplant.

The equations and instruments doctors rely on are infused with

historical bias. Medicine has long treated race as though it provides
important information about the underlying biology and genetics of
disease, a strategy that has had an enormous impact on diagnosis
and treatments. People have been passed over for kidney
transplants, denied therapies and diagnosed with diseases later than
necessary simply because of the color of their skin.

Race is a social construct that reveals little about ancestry. There is

more genetic variation within racial groups than between them.
“The racial differences found in large datasets most likely often
reflect effects of racism—that is, the experience of being Black in
America rather than being Black itself,” researchers wrote in a
2020 New England Journal of Medicine article outlining the
dangers of race-adjusted algorithms.

To undo this bias, researchers are changing the algorithms and

instruments and finding new models to reduce disparities.

Kidneys filter waste and excess water from the blood through tiny
structures called glomeruli. Directly measuring how well these
glomeruli are functioning is possible but cumbersome, so instead
doctors rely on blood levels of a protein called creatinine, a waste
product produced by muscles and a by-product of protein
metabolism, to estimate the glomerular filtration rate (GFR). When
kidneys are working well, they filter out creatinine; if the kidneys
start to fail, creatinine levels rise. The protein is easy and
inexpensive for laboratories to measure.

The first equation to assess kidney function, developed in the

1970s, relied on age, sex, weight and creatinine levels in the blood.
But the formula wasn’t precise. So, in the late 1990s, a team of
researchers set out to develop a more accurate one. They used
existing data from a study of creatinine and GFR in more than
1,600 people, then correlated the two measurements. The team
looked at 16 different factors that might influence the relationship.
(We tend to lose muscle mass as we age, for example, so older
people have lower creatinine levels than younger people.) The
authors noted that for any given GFR, creatinine was higher in
Black people than in white people. Why that might be wasn’t clear.
Maybe it was because Black people had higher muscle mass, they
speculated. The study population was only 12 percent Black, yet
the difference felt too substantial to ignore.

To account for this difference, the researchers added an adjustment

for Black patients: a multiplication factor of up to 1.21, which
essentially inflated their estimated kidney function by as much as
21 percent. In 2009 the researchers published an updated equation,
but the Black correction factor remained, albeit lower, up to 1.16.
“We always recognized that race was not the biological process by
which African Americans differed from non–African Americans in
the relationship between GFR and creatinine,” Andrew Levey, who
worked to develop both equations, later explained. But “it stood in
for something that was important.”

“The way the lab report was written was, if your creatinine is a 4.0,
your kidney function is 19 percent. Oh, unless you’re African
American; then it’s 22 percent,” says Martha Pavlakis, a
nephrologist at Beth Israel Deaconess. “It makes no sense.” In
people with healthy kidneys, small differences don’t matter. But
when kidney function declines, eGFR, which decreases as blood
creatinine levels rise, becomes crucial. That number helps to
determine whether a patient is referred to a nephrologist, diagnosed
with kidney disease or deemed eligible to join the wait list for a
kidney transplant.

“Half the Black patients on the transplant list got extra priority
added to their standing because of this project.”

—Martha Pavlakis Beth Israel Deaconess Medical Center

Hoenig began working with a small group of students from

Harvard Medical School’s Racial Justice Coalition to lobby to
eliminate the correction factor, and in 2017 Beth Israel Deaconess
became the first medical center to do so. Efforts elsewhere largely
stalled until the deaths of George Floyd, Ahmaud Arbery and
Breonna Taylor, three Black Americans whose deaths made
national news. In the wake of their killings, conversations about
race rippled throughout the medical community, Pavlakis says.

As protests erupted across the country, medical students and faculty

at many major universities began to circulate petitions calling for
an end to the use of the racial correction in eGFR. Some major
academic health systems began removing race from the equation,
but their approaches were inconsistent. Neil Powe, chief of
medicine at Zuckerberg San Francisco General Hospital and
Trauma Center, and other experts watched the changes unfold with
concern. There was no unified way of diagnosing kidney disease.
“You could be at one hospital and have a diagnosis of kidney
disease. You go down the street [to another hospital], and you
wouldn’t have kidney disease,” Powe says. “That was just chaos.”

In the summer of 2020 the National Kidney Foundation and the

American Society of Nephrology formed a task force to assess how
best to move forward. “They thought we’d solve it overnight, but it
took us about 10 to 11 months to churn through this,” says Powe,
who co-led the task force. Ultimately they chose an equation that
used the same 2009 data but eliminated race as a variable, then refit
the curve to the whole dataset.

A conversation about race was also happening at the Organ

Procurement and Transplantation Network (OPTN), which
manages transplants from deceased donors. The wait list for a
kidney is long. Patients aren’t eligible to join until they meet
certain criteria; these can vary at different transplant centers, but all
candidates must have an eGFR of 20 percent or less. And because
of the eGFR correction factor, Black patients needed higher
creatinine levels than people of other races to pass that threshold.
“Nobody who came up with the formula was like, let’s keep Black
people off the list. But that, in fact, was the result,” Pavlakis says.

In July 2022 the race variable was explicitly forbidden in organ

allocation. Pavlakis saw that as just the first step. She wanted to
help Black patients already on the list and those who had
previously been denied entry because of their kidney function
numbers.
In January 2023 the OPTN decided that transplant centers should
look back at the lab reports of Black patients on the list and
recalculate their eGFR using the race-neutral equation to see
whether they should have been referred for transplant. “Basically,
half the Black patients on the transplant list got extra priority added
to their standing because of this project,” Pavlakis says.

Pavlakis acknowledges that this change doesn’t fix every disparity

in kidney allocation. But she also sees it as restorative justice. “It’s
not perfect,” she says, but “I think it’s probably the largest example
of fixing a race disparity that is out there.”

Pulmonologists have been grappling with a similar problem. To

assess lung function, doctors ask patients to blow into a device
called a spirometer, which measures the maximum amount of air a
person can exhale and how much they can force out of their lungs
in a single second. The spirometer compares those numbers with
reference values for “normal” lung function. The results help
doctors diagnose diseases such as emphysema and chronic
obstructive pulmonary disease, assess severity of those conditions
and monitor declines in lung function.

What constitutes “normal” varies by age, sex, height and, until

recently, race. Why race? Data collected in the late 1800s and early
1900s suggested different races have different lung capacities, a
phenomenon researchers ascribed to innate biology rather than
social, economic or environmental factors. By the early 20th
century the idea that lung capacity varied among racial groups was
“an ostensible fact,” wrote Brown University researcher Lundy
Braun in a 2015 article on the historical use of race in spirometry.
What experts missed was that race was probably a proxy for other
factors, such as air quality, nutrition, and other exposures, that
affect lung health and development.
When the European Respiratory Society’s Global Lung Function
Initiative developed reference values for spirometry in 2012, it
used more than 160,000 spirometry results from 33 countries.
Researchers observed “proportional differences in pulmonary
function between ethnic groups” and decided to develop separate
values for four groups: Caucasian, African American, North Asian
and Southeast Asian. They also used an “other” category for people
who didn’t fit elsewhere. The model assumes that, compared with
white adults, Black adults have about 10 to 15 percent smaller lung
capacity and that adults of Asian ancestry have 4 to 6 percent
smaller lung capacity. So the same spirometry results in Black,
Asian and white people led to different interpretations of health. As
a result, lung diseases in certain populations have gone
undiagnosed and untreated.

The division of reference values by race is problematic for many

reasons. “We’re a big melting pot,” says Alexander Niven, a
pulmonologist at the Mayo Clinic in Minnesota. So even if there
were “a specific cluster of genes that predispose people to greater
or less lung function, that’s highly unlikely to remain a pure cluster
in this global world.”

What’s more, lungs are in constant contact with the outside world
and continue developing throughout childhood and into early
adulthood, Niven says. “It’s impossible to separate race from all of
these other factors that unfortunately are inexplicably linked to
different populations within our society, many of which are likely
coloring the changes in lung function that we see in different social
groups.”

In practice, the race-based model doesn’t seem to improve

predictions when it comes to outcomes that matter. “You can’t tell
any better who’s going to go to the hospital. You can’t tell any
better who’s going to die. You can’t tell any better who has severe
symptoms and who doesn’t. And in some of those cases, you
actually worsen your ability to predict by adding race,” says Aaron
Baugh, a pulmonary and critical care physician at the University of
California, San Francisco.

In 2023 the Global Lung Function Initiative replaced race-based

equations with a race-neutral equation. That same year the
American Thoracic Society and the European Respiratory Society
recommended all health-care providers switch to the new formula.

That shift is happening now, and researchers are just beginning to

uncover the broad impact of this change. “Long story short, it’s
profound,” says Arjun Manrai, a bioinformatics researcher at
Harvard Medical School. Lung function helps to determine
disability payments, candidacy for some professions, priority for
lung transplants, and more. Manrai and his colleagues found that
some 10 million people in the U.S. would have their diagnosis or
the severity of their disease reclassified. Disability payments could
increase by more than $1 billion. Such changes are not always
beneficial. A new diagnosis can make someone ineligible for
certain jobs, such as firefighting. And a Black person with lung
cancer might not be identified as a good candidate for surgery
because their lung function may be too poor to allow for removal
of part of their lung. “There are trade-offs essentially attached to
these reclassifications,” Manrai says.

The new equation comes from the same 2012 data as the original
formula, and it isn’t perfect. “We kind of settled on the race-neutral
equations we have now as the best current option, knowing that in
the future, something better might arise,” Baugh says.

Manrai thinks a lot about how traditional algorithms operationalize

race, adjusting what constitutes “normal” for any particular patient,
and how lessons from those algorithms can be incorporated into
producing more sophisticated machine-learning algorithms. “They
can be biased, and they can propagate the very same sort of race-
based medicine,” he says. “But they’re a tool, and the tool can also
be used in the reverse direction: to mitigate existing disparities and
to potentially reduce existing biases in the health-care system.”

One example of how AI might help improve health equity is

evident in research on disparities in knee pain. Previous studies
have shown that Black people routinely report more intense knee
pain from arthritis than people of other races. But often that pain
can’t be explained by the structural damage visible in x-rays. As a
result, it is often dismissed or attributed to external factors such as
psychological stress.

Emma Pierson, who studies machine learning and health-care

inequities at Cornell University, and her colleagues wanted to
understand whether there might be physical signs in the knee itself
that could explain this pain disparity. They used knee radiographs
and patient pain scores from more than 4,000 people who had
osteoarthritis or were at risk of developing it to train a machine-
learning model.

Surprisingly, the model predicted pain better than the traditional

arthritis scoring system. Specifically, Pierson says, “it seems to be
picking up on factors that disproportionately affect underserved
patients.” What those factors might be isn’t clear, and Pierson
emphasizes a need for caution. “In general, the capabilities of these
models tend to outstrip our ability to understand how they’re
achieving those capabilities,” she says.

Sometimes diagnostic instruments introduce bias. The fingertip

clamps doctors use to measure oxygen levels in the blood, for
example, work by measuring the absorption of different
wavelengths of light to estimate the blood oxygen level. But the
device, called a pulse oximeter, tends to overestimate oxygen
saturation in people with darker skin tones.
Researchers have known about this problem for decades, but
manufacturers didn’t feel much pressure to fix the problem. The
effect was relatively minor, and it was most prominent at low
oxygen saturations. “That difference was probably correctly
assumed to not be physiologically relevant,” says Michael Lipnick,
an anesthesiologist at the University of California, San Francisco,
who leads a research project to assess pulse oximeter performance.
“If somebody’s oxygen saturation is really 1 percent or even 2
percent higher or lower than the real value, there’s no harm.”

When the COVID pandemic sickened millions of people, however,

small biases had an outsize effect. “Clinical decisions were being
made based on that number,” Lipnick says. In 2023 a team of
researchers looked at health records from more than 24,000 people
hospitalized with COVID during the first 19 months of the
pandemic. They zeroed in on those who had both a pulse oximeter
reading and an arterial blood gas test, the gold standard for
measuring oxygen saturation in the blood. Pulse oximeter readings
consistently overestimated oxygen levels in Black and Hispanic
patients. Black patients were also more likely than white patients to
have their need for COVID therapy underestimated because of
inaccurate pulse oximeter readings. Such oversight has clinical
consequences: being passed over for COVID treatment resulted in
an hour’s delay in care on average and a higher risk of readmission.

Lipnick is part of the Open Oximetry Project, which has been

testing different pulse oximeters in diverse groups to get a sense of
their real-world performance. He and his colleagues have seen a
range of variability. Most devices tended to perform worse when
used on people with darker skin pigment, but some performed
better.

Researchers are working to develop more accurate tools, and

regulators are considering larger test populations with a variety of
skin tones. Lipnick wants better pulse oximeters but worries that
some of the fixes may increase costs. “It’s a big concern, especially
in low- and middle-income countries, where the majority of the
world’s people with darker skin pigment live,” he says.

In the short term, Lipnick says, clinicians should rethink how they
use data from pulse oximeters. “It gives a number, and we assume
that that number is truth.” In reality, the number might be off by as
much as 5 percent. If doctors recognize the error rate, they can
make decisions that aim to minimize health-care disparities. “I
think a lot of the solution will lie in how we use the technology,” he
says.

Pavlakis also sees a need for more critical thinking on the part of
clinicians. She is dismayed at the number of years that she relied on
the eGFR equation without stopping to carefully consider the
rationale for its race correction. “When we were taught this
formula, we were like, ‘This is data-driven. This is from a research
study. This must be accurate,’” she says. Evidence-based, however,
doesn’t always mean equitable, and that’s the real goal. Hoenig’s
students and other people who recognized bias are making health
care better for all.
Cassandra Willyard is a science journalist based in Madison, Wis. She covers public health,
medicine, and more.

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Innovations from Rural Communities Are

Improving Health Care

Some of the most inventive changes to health care have started in

rural communities around the world
By Carrie Arnold

For Eliza Scott, who lives on a farm 2.5 hours away from the Bemidji clinic in rural Minnesota,
virtual prenatal care with a clinic-provided home-monitoring kit has meant the difference between
getting care or no care at all.
Nīa MacKnight

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

On a frigid winter evening about five years ago, a desperately ill

young woman walked through the doors of the Sanford Bemidji
Medical Center in rural Minnesota. Several weeks before, she had
labored alone for hours in her tiny mobile home to bring a new
baby into the world. The woman had received no prenatal care and
no medical attention at delivery—the kind of situation that has
made maternal mortality rates for Native American women in rural
areas twice as high as those of white women. The only reason she
was showing up now was that the baby wasn’t eating. She had no
running water to make formula. The hospital was her only option.
Johnna Nynas, the obstetrician on call, quickly diagnosed her
patient with postpartum preeclampsia, a rare condition that affects
people after pregnancy and can be deadly if untreated.

For Nynas’s pregnant patients, the hospital in Bemidji is the only

option between Duluth, Minn. (three hours away), and Fargo, N.D.
(2.5 hours away). The surrounding area is one of the poorest in
Minnesota. Some residents of the nearby Leech Lake, Red Lake
and White Earth Indian Reservations don’t have reliable access to
running water. With so many pressing unmet needs, people find it
difficult to get prenatal care. Transportation (especially in winter)
and child care for medical visits that require a several-hour car ride
and possibly an overnight hotel stay are often unaffordable, even if
Medicaid covers the cost of the health care. Nynas, who was born
and raised in rural Minnesota, says that by the time an expectant
parent arrives in her office, they may have a list of health concerns
that have gone untreated for years. She links this lack of care
directly to the elevated risk of pregnancy-related deaths and
complications in the region.

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“When we first meet patients, it’s probably the first contact they’ve
had with the health-care system in quite some time,” Nynas says.
Haunted by her patient’s preeclampsia emergency, she set out to
remove barriers to needed care. Loaned blood pressure cuffs and
bathroom scales let many of her low-risk patients receive checkups
over the phone. This communication made it easier to schedule in-
person visits for ultrasounds and blood tests.

David Driscoll, director of the Healthy Appalachia Institute at the

University of Virginia, isn’t surprised that the impetus for change
began in a rural area. The regions that face staggering health
inequalities are developing innovative solutions to enhance well-
being for everyone. Rural communities’ perpetual need to do more
with less and to overcome obstacles not found elsewhere has led to
modernized care delivery. Although many of the innovations are
tech-centric, not all require Internet access to work. These shifts are
helping doctors bring world-class medical care to even the most
far-flung patients.

One challenge for rural health experts is to ensure solutions don’t

exacerbate existing disparities. Doctor visits via a video call won’t
help someone without an adequate Internet connection, for
example. But advocates say thoughtful action paired with
infrastructure investment will broaden access to services.

Simple equipment sent home with low-risk pregnant patients

helped Nynas’s northern Minnesota families deliver healthy
infants. Nynas’s success with home devices such as bathroom
scales, blood pressure cuffs and fetal heart-rate monitors convinced
her to expand her reach. Collaborating with several local
community groups, Nynas applied for a grant from the federal
government’s Rural Maternity and Obstetric Management
Strategies program. With this funding, Nynas was able to not only
expand patients’ virtual care but also provide additional local
resources, such as an in-hospital food pantry, transportation
services and a visiting-nurses program. She is setting up a satellite
clinic at an Indian Health Service facility, which typically has
limited prenatal services. This approach will let patients without
home Internet or phones upload their data and connect with nearby
providers in consultation with remote experts for complex
pregnancies.

Health-care micro sites such as these act as a bridge between major

medical centers and small communities and are showing huge
promise in rural health, says Michael Carney, interim provost at the
University of Wisconsin–Eau Claire, because they combine the best
of telemedicine and in-person care. Patients without broadband
Internet can go to a local clinic and talk to a specialist online.
Nurses and other providers at the local clinic can do bloodwork,
measure vital signs and nurture the doctor-patient relationship.
These micro sites are the flagship of the University of Wisconsin’s
ongoing rural health partnership with the Mayo Clinic, Carney
says, and are intended to bolster the health of his hometown.
Carney says practitioners worldwide are asking, “How do we
deliver health care in a cost-effective way to people who can’t
come to a traditional clinic?”

In southwestern Virginia, where Driscoll grew up, the distances

between two points aren’t that far as the crow flies. But the
residents of the area’s tiny towns and hollers aren’t crows. The
narrow, winding roads mean even seemingly short drives can take
hours. Without public transportation, many of the area’s older
adults can’t travel to medical appointments. Driscoll’s first job, in
the 1990s, was with a community organization that drove local
patients to clinics and hospitals.

Driscoll chatted with his passengers, listening to their problems.

Many said the doctor’s visit they were headed to was their first in
years because they had been physically unable to get to
appointments. Multiple, untreated chronic diseases such as asthma,
diabetes and hypertension were the rule, not the exception. With
poverty rates high and grocery stores few and far between, most of
his passengers experienced food insecurity, and their diets lacked
fresh fruits and vegetables. The few people who had home Internet
relied on dial-up because broadband wasn’t available yet.

Rural communities in Virginia and around the world face many of

the same challenges—lack of clean drinking water, unreliable
transportation, lagging investments in infrastructure and
technology, and hospital and clinic closures. Driscoll’s
conversations revealed precisely how those challenges contribute to
health disparities. It sparked his lifelong interest in rural health and
ultimately brought him back home to the rugged hills where
Virginia disappears into Tennessee and Kentucky.

Today, with a $5.1-million federal grant, Driscoll is addressing

problems that have been amplified by the COVID pandemic.
According to one study, so-called diseases of despair, including
opiate misuse and overdose, suicide and alcohol-related liver
disease, spiked by 40 percent in central Appalachia during the
beginning of the pandemic. As a result, the number of premature
deaths in Appalachia is 25 percent higher than in the rest of the
U.S.

Like many rural health programs, the efforts at the University of

Virginia rely extensively on telehealth. That’s largely because in
the mid-1980s, awareness of these kinds of health disparities (and
their origins) dovetailed with emerging technological
breakthroughs. As a policy analyst at the Virginia Department of
Health, Kathy Wibberly was tasked with helping to address deficits
in health-care access in rural parts of the state. One of the solutions
that emerged was the potential for telemedicine. Many of the
region’s small, rural hospitals didn’t have the patient volume to
warrant hiring, say, a neurologist or a neonatologist. Very sick
newborns or people experiencing a potential stroke would have to
be sent by ambulance or helicopter to a large medical center, often
hours away. Such delays in care can prove deadly. “With stroke,
time is precious. You’re saving the brain,” Wibberly says.

Instead of moving patients, Wibberly began working to connect

small hospitals with their large, urban counterparts via
videoconferencing and other technologies. Rural physicians could
consult with on-call specialists in distant parts of the state to
stabilize or manage fragile patients. This approach, she says,
“saved lives and saved brains and saved disability further down the
road.” In 2019 more than one quarter of U.S. hospitals had the
capacity for telehealth-based stroke care.

After some initial success, Wibberly began trying to expand

telehealth access. Her biggest problem, however, wasn’t related to
technology. It was convincing patients, insurers and especially
physicians that the approach could work. Few doctors have
received telemedicine training during their residencies and
internships, then or now, Wibberly says. They learn to see patients
in person—that’s the model they’re trained with and used to.

“Yet at the same time, the landscape has changed,” Wibberly says.
Medicine is no longer strictly an in-office practice. COVID
accelerated the adoption and acceptance of telemedicine, and it has
become a mainstay of rural health care, she says, especially in
behavioral health care and psychiatry.

Telehealth alone can’t fix all the health problems facing rural areas.
Limited broadband access means not everyone can set up a video
chat with their doctor. And a lot of medical care requires in-person
visits and readily available providers—things that aren’t guaranteed
as rural hospitals continue to shrink or close. To tackle these issues,
providers have gotten creative.

A diagnosis of kidney failure is life-altering. For residents of the

remote Australian outback, it can be doubly so. The Pintubi people
returned to Kintore, around 500 kilometers west of Alice Springs in
the Northern Territory, in the 1980s after forced displacement by
the Australian government starting in the 1940s. Those who needed
dialysis had to leave again to receive care at the nearest clinics in
Alice Springs or Darwin. Indigenous peoples such as the Pintubi
make up almost 4 percent of Australia’s population and more than
14 percent of people on dialysis in the country. In 2016 research
showed that Aboriginal people’s kidneys reached end-stage failure
decades sooner than the kidneys of non-Indigenous Australians and
New Zealanders, and an earlier study had found they were 1.5
times more likely to die on dialysis. For those who survived,
quality of life was low.

Aboriginal Australians wanted to be “on country”—to live in their

ancestral homelands with loved ones—while on dialysis. When the
Australian government rebuffed their requests, Indigenous artists
auctioned their work to raise more than $1 million (AUD) to build
a nonprofit dialysis clinic, Purple House, in Kintore.

But bringing dialysis to an area where sheep overwhelmingly

outnumbered people wasn’t an easy proposal. What’s more,
dialysis is a thirsty procedure, using hundreds of liters of water for
a single week’s treatment. Such a water-intensive therapy is ill-
suited to the outback, which contains some of the driest biomes in
the world. Purple House CEO Sarah Brown, who was tapped to
lead the organization after a long career as a bush nurse, needed a
therapy she could bring to her patients that merely sipped from the
region’s scarce water supply.

To make matters worse, what limited water does exist in the area’s
deep wells has too much fluoride and other contaminants to be
drinkable, let alone used in dialysis. To address the problem, a team
of engineers developed a way to filter the water so it could be used
for dialysis. Then, rather than discarding it, the clinic devised a
setup that let it reuse the water to provide pressure for the system.
Brown knew they also needed to work with community leaders to
integrate traditional Aboriginal beliefs and healing into dialysis
treatments.

Over the next 20 years the Purple House transformed dialysis in

Australia. In recognition of its efforts, the government created a
special billing code to allow more nurses to deliver dialysis in
remote communities. “We have gone from the worst survival rates
in the country to the best,” Brown says.

Brown’s group also built a traveling dialysis bus known as the

Purple Truck. The bus visits communities not served by the clinics
and allows residents of Alice Springs and Darwin to visit family.
Both survival and quality of life have improved. Now densely
populated regions such as Sydney and Melbourne have built their
own dialysis buses. The approach not only brings access to the life-
saving therapy but allows Australians to travel without missing
crucial dialysis sessions.

Brown remade dialysis from the ground up. “We’re disruptors,” she
says. “You don’t have to assume that something is going to stay the
same. You can work together, and you can change the system.”

A maternal mental health program has had a similar impact in parts

of rural Pakistan. To address growing global mental health needs,
Atif Rahman, a researcher at the University of Liverpool in
England, has developed short-term interventions that can be
delivered by peers and other nonspecialists. The idea, he says, is to
bolster access to behavioral health care, especially where treatment
is virtually nonexistent.

Many of Rahman’s efforts have focused on perinatal health in

Pakistan, where he is originally from. His team trained rural
community members there to deliver coaching sessions to decrease
the mental health struggles of new moms. “It’s a powerful
combination,” Rahman says. “We are freeing the peer to be more of
a human support.”

With a worldwide shortage of mental health workers, especially in

the Global South, being able to rely on nonprofessionals opens
doors to those most in need. Rahman says the community members
in his program “are doing as good a job as trained therapists who
spend years and years training.” He is now expanding the perinatal
mental health program to parts of other low- and middle-income
countries.

Not all these experiments in rural health will prove successful or be

transferable to other communities, says Lauren Eberly of the
University of Pennsylvania, a cardiologist who developed a phone-
based treatment program for people with heart failure who live in
the Navajo Nation. Different rural communities have different
needs and barriers, she says, and scientists must gain local input
and insight to determine what help people need and what they will
accept. Researchers have to start by asking questions and listening
to feedback rather than assuming they know how to solve long-
standing, deep-seated problems, Eberly says.

“The traditional health-care system really benefits those who are

fluent and those who are white. It’s really marginalized a lot of
other groups,” Eberly says. “We really need to rethink how we can
deliver health care in a way that makes sense for our communities
and our patients.” The point, she says, is to use successful
interventions as creative inspiration for solving other issues in
health care and health equity.

Transportation issues aren’t limited to rural settings; they can affect

urban areas, too. So can lack of broadband access, food insecurity,
and other disparities. Because many innovations developed in rural
areas target these broad problems, urban and suburban areas can
also benefit from them. Telehealth is a prime example, Wibberly
says. The advantages of telemedicine first appeared most obvious
for rural areas, but the approach has gone mainstream. She is
confident that other rural health programs will become standard
medical practice.

To Wibberly, the reason so much innovation occurs in rural health

is simple. “It’s a smaller community. People know one another.
They know who the trusted entities are,” she says. “Let them figure
out what will work for them because it’s a whole lot easier to fix
access to care issues for a city of 20,000 than it is for one of 20
million.”
Carrie Arnold is an independent public health journalist in Virginia.

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The Staggering Success of Vaccines

Vaccines are the first step toward health equity in many parts of the
world
By Tara Haelle

Luisa Jung

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

Once a week, early in the morning, community health worker

Kiden Josephine Francis Laja mounts her bicycle and pedals as far
as 10 miles away from her small village in South Sudan. Some
weeks Laja is doing outreach, spending her day educating a
community about which vaccines she can provide and what
diseases they prevent. “It’s my responsibility to tell the mothers to
bring the children for vaccination,” she says. She answers their
questions and lets them know she’ll be back, usually the following
week, to vaccinate their children. Late in the evening she mounts
her bike and heads home.
When Laja returns with the vaccines, kept in a cooler with ice
packs, she will spend the day immunizing anywhere from a few to
200 children against a range of diseases: polio, tetanus, diphtheria,
pertussis, hepatitis B, influenza, bacterial meningitis, tuberculosis
and, more recently, COVID. Most people in high-income countries
haven’t seen these diseases in decades, but the people of South
Sudan know them well. Many have seen family and friends die
from them.

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During the rest of the week Laja works at the community health
center in her village of Pure, monitoring the solar-powered
refrigerator and the vials inside. She vaccinates anyone who comes
to the facility and metes out drugs for a few maladies such as
ulcers, malaria and typhoid. But the village doesn’t have antibiotics
—or electricity. Villagers grow their own food, raise goats and
chickens, and get their water from wells in the ground.

It’s not easy work for just $102 a month, especially when it
sometimes takes three months for the 25-year-old mother of two to
get her pay. When it rains on travel days, she and her outreach
pamphlets get soaked. She must regularly check the temperature of
the vials in the cooler and replace the ice packs at just the right
time to ensure the vaccines don’t go bad.

People in South Sudan don’t have much, but they have this
program. “Vaccines are very important to me and my community
and even to my country,” Laja says. During a large outbreak of
measles that began in 2022 in the country, thousands of children
suffered from the disease, and many died, leading to a nationwide
vaccination campaign in 2023. “Now in our community you cannot
find cases of measles,” she says.

Around the globe the measles vaccine has saved nearly 94 million
lives over the past 50 years. This and other vaccinations have
revolutionized global health. “Immunization is the most universal
innovation that we have across humankind,” says Orin Levine, a
fellow at the Center for Global Development in Washington, D.C.
He notes that there are people around the world without access to
telephones or even toilets, but they find ways to get their children
immunized. “It’s the innovation that demonstrates what is possible
in terms of delivery of service to everyone everywhere.”

A May study in the Lancet estimated that vaccines against 14

common pathogens have saved 154 million lives over the past five
decades—at a rate of six lives every minute. They have cut infant
mortality by 40 percent globally and by more than 50 percent in
Africa. Throughout history vaccines have saved more lives than
almost any other intervention. And vaccines’ promotion of health
equity goes far beyond preventing death. The Lancet study found
that each life saved through immunization resulted in an average 66
years of full health, without the long-term problems that many
diseases cause. Vaccines play a role in nearly every measurement
of health equity, from improving access to care, to reducing
disability and long-term morbidity, to preventing loss of labor and
the death of caretakers.

“Vaccines level the playing field....But frankly, it was a really

long road to get to that kind of equity.”

—Nicole Lurie Coalition for Epidemic Preparedness

Innovations
“We say vaccines are one of humanity’s great achievements in
terms of having furthered the lifespan and life quality for humanity
in the past 50 years,” says Aurélia Nguyen, chief program officer at
Gavi, the Vaccine Alliance, a public-private partnership that works
to ensure low- and middle-income countries have access to
vaccines against more than 20 infectious diseases. Of all the
different health interventions that exist, she says, “vaccines have
the widest reach across the world.” The clearest evidence of
vaccines’ impact on equity is that they are often the first
intervention introduced into a community with no other health-care
resources.

“When you don’t have a health worker or health system, there’s

nothing. If you have no money, then you want the best bang for the
buck, and it’s going to be immunization,” says Seth Berkley,
former CEO of Gavi. “For every dollar you invest in immunization,
you get $54 of benefit. From a cost-effectiveness point of view, it’s
the best investment, so it tends to be the intervention that gets out
to those communities first. And once you do that, you have a health
worker who’s visiting those communities on a regular basis, and
then that begins to start the conversation toward more primary
health care, and that leads to getting a basic clinic set up.
Immunization is the vanguard of the health system.”

Every country in the world has an immunization program thanks to

the World Health Organization’s Expanded Program on
Immunization, which was established in 1974. “Every single
country and territory” has access to at least some vaccines, says
Kate O’Brien, director of the WHO’s immunization, vaccines and
biologicals department. Poverty, malnutrition, underlying health
conditions, overcrowding, human conflict, displacement, and lack
of access to medical care, hygiene or sanitation—all of these are
risk factors for infectious disease, O’Brien says. Vaccines’ ability to
reduce disease in the settings most plagued by these problems gives
them disproportionate power to improve equity.
There may be no greater demonstration of vaccines’ power to
deliver health equity than their success with smallpox. “The
magnitude of the accomplishment of having eradicated smallpox,
where absolutely nobody on this earth gets the disease,” O’Brien
says, “that’s the ultimate in the issue of equity.”

A version of a smallpox vaccine was developed in 1796, and in

1959 global health experts decided to pursue full eradication. In the
decade that followed, it became clear that such an ambitious goal
would require more than political will. Although smallpox had
been eliminated from North America and Europe, frequent
outbreaks continued in South America, Africa and Asia.

In 1967 the WHO started its Intensified Eradication Program,

which prompted a series of innovations. The bifurcated needle,
which was developed around that time, allowed for smaller doses
and required less user expertise for vaccine delivery than the
previously favored jet injector. Researchers created a surveillance
system to better track disease and vaccinate close contacts of
infected people, making mass vaccination campaigns more
effective. The last documented case of smallpox occurred in
Somalia in 1977, and the WHO declared smallpox officially
eradicated three years later.

That success inspired a similarly lofty goal in 1988 that has proved
far more challenging: eradicating polio. Since the establishment of
the Global Polio Eradication Initiative, cases have fallen 99 percent
worldwide, but that last 1 percent is taking decades longer than
planned. Public health experts now recognize that very few
diseases can be completely eradicated through immunizations.
Even so, they aim to decrease vaccine-preventable diseases to such
low levels that severe morbidity and mortality are negligible. The
WHO’s renamed Essential Program on Immunization initially
focused on six childhood diseases: polio; measles; disseminated
tuberculosis, the form of the disease most common in children; and
diphtheria, tetanus and pertussis, for which children receive the
combined DTP vaccine. It has now expanded to include vaccines
against 13 diseases.

Jen Christiansen (styling); Source: “Contribution of Vaccination to Improved Survival and Health:
Modelling 50 Years of the Expanded Programme on Immunization,” by Andrew J. Shattock et al., in
 Lancet, Vol. 403; May 25, 2024

Jen Christiansen (styling); Source: “Contribution of Vaccination to Improved Survival and Health:
Modelling 50 Years of the Expanded Programme on Immunization,” by Andrew J. Shattock et al., in
Lancet, Vol. 403; May 25, 2024

“We have to look backward, in some ways, to realize how far

we’ve really gone,” says Lois Privor-Dumm of Johns Hopkins
University, who recently retired from her role as a senior research
associate. “There has been tremendous progress over the past 50
years, and what is really left is making sure the equity agenda is
really a focus.”

Now the question is how best to do it. A raft of technological and

policy innovations aim to help. Before the WHO’s current
vaccination program began, fewer than 5 percent of the world’s
babies had access to routine immunizations. Today 84 percent of
infants have received three doses of the DTP vaccine, the metric
used to assess global immunization coverage.

“[Vaccines] level the playing field in terms of who gets these

diseases and who doesn’t,” says Nicole Lurie, U.S. director of the
Coalition for Epidemic Preparedness Innovations (CEPI), a
foundation formed specifically to develop and improve access to
vaccines for diseases that lack strong market demand. “But frankly,
it was a really long road to get to that kind of equity.”

Setbacks through the 1990s led global health leaders to rethink

their approach, and in 2000 Gavi was founded collaboratively by
the WHO, UNICEF, the World Bank and the Gates Foundation.
Thanks to Gavi, says Violaine Mitchell, director of immunization at
the Gates Foundation, “now countries not only assume but demand
that when a vaccine is introduced in the developed world, it’s also
made available in the developing world.”

Gavi has vaccinated more than one billion children with a routine
suite of shots and given a total of 1.8 billion immunizations to
people of all ages through campaigns for illnesses such as measles
in Ethiopia, Afghanistan and Somalia and yellow fever in Congo,
averting more than 17 million deaths through 2022. Since Gavi was
established, there has been a 70 percent reduction in deaths from
vaccine-preventable diseases in children living in the lower-income
countries the alliance supports, and mortality among children
younger than five years in those countries has been halved. The
pneumococcal and rotavirus vaccines have been particularly
significant—pneumonia and diarrhea are among the top global
killers of children under five.

But even those impressive numbers don’t fully capture the dramatic
ways vaccines advance health equity. For example, epidemics of
meningococcal meningitis were common in the “meningitis belt,” a
stretch of 26 countries just south of the Sahara desert that has the
highest rates of meningococcal disease in the world. Up to half of
those infected die without treatment; even with treatment, one in 10
people dies. Since the development and distribution of a vaccine
against meningitis A, this form of the disease has been nearly
eliminated. The vaccine has not only saved lives but prevented
long-term effects that meningitis survivors often suffer, including
hearing loss, seizures, limb amputations or weakness, scarring,
vision problems and cognitive difficulties.

Another example is the human papillomavirus (HPV) vaccine,

which can prevent up to 90 percent of HPV-related cancers,
including nearly all cervical cancer. Because high-income countries
implemented cervical cancer screening programs decades ago, 94
percent of global deaths from cervical cancer in 2022 were in low-
and middle-income countries. Gavi programs have vaccinated more
than 16 million girls worldwide against HPV, and the organization
aims to vaccinate 86 million by 2025. The physical benefits won’t
be seen for years—it takes up to two decades for an HPV infection
to develop into cancer—but the ripple effects of prevention go far
beyond saving a single person’s life. A death from cervical cancer
may mean loss of a family caretaker, loss of income and difficulty
meeting children’s continuing health needs. “The tsunami effect of
losing a mother to children, especially for those who are not
economically stable, is devastating to a family,” O’Brien says.
“Their lives are entirely dependent on the survival of that person.”

Vaccination can be a key entry point to additional health care.

William Foege, a former director of the U.S. Centers for Disease
Control and Prevention, who was instrumental in leading smallpox
eradication and in setting up Gavi, called vaccines “the tugboat” for
preventive care.

When health workers arrive to vaccinate children in a community,

they can assess other children’s growth trajectories and nutritional
issues, provide vitamin A supplements where there are deficiencies,
distribute deworming tablets, monitor mosquito-borne diseases and
check on additional needs. “If you manage to reach a child and give
them a measles vaccine, then you may be able to give their mother
maternal services,” Nguyen says. “It’s a perfect time to say: Are
you sleeping under a bed net? Do you need a bed net? What are
you doing for family planning?” Mitchell says. “All those
conversations can come about because of the contact between the
caregiver and the health worker that wouldn’t [otherwise] happen.”

In 1985 Rotary International launched its PolioPlus program, which

used vaccination campaigns as an opening for other health
interventions. “When Rotary and its partners added other things to
improve the health systems of countries, it was a game changer,”
says Stella Anyangwe, a Rotary International EndPolioNow
coordinator and former WHO official. By strengthening laboratory
systems, the cold-chain network of refrigerated storage necessary
for transporting the vaccine, and overall disease surveillance, she
says, improving systems for polio eradication “strengthened the
health systems in general.” In short, Levine says, “immunization is
an innovation that is pulling other innovations along.”

It can also free up valuable time and resources in health care. As

infectious disease incidence falls, health workers and hospital beds
become available for people with other conditions. This may
already be happening with malaria. In Burkina Faso, about two out
of every five visits to a healthcare provider are for malaria, which
historically accounts for more than 60 percent of the country’s
hospitalizations. Similarly, malaria cases make up about half of
hospitalizations in Cameroon; most of those patients are children
under five who are eligible for the malaria vaccine. Although
current malaria vaccines don’t prevent infection altogether, they
reduce severe disease by 30 percent and all-cause mortality by 13
percent. Gavi began rolling out vaccination campaigns against
malaria last year, providing 18 million doses to a dozen African
countries, and malaria deaths have already begun falling. “You can
imagine how much that’s going to free up capacity for health-care
workers to focus on other [issues],” Nguyen says.

Vaccines help countries with fewer resources protect themselves

from disease. Outbreaks disproportionately affect poorer areas: the
2014–2016 Ebola epidemic in West Africa, for example, devastated
the region’s health-care infrastructure. Since the development of an
Ebola vaccine in the late 2010s, subsequent outbreaks have
remained comparatively small. And the current outbreak of mpox
[see “History Lessons,” by Charles Ebikeme], which led the WHO
to declare a global public health emergency in August, is being
managed with vaccines that became available only in the past few
years.

Gavi now supports stockpiles of outbreak-specific vaccines for

cholera, yellow fever, meningococcal disease and Ebola so the
countries most affected can focus their health-care resources on
chronic disease, snakebites, cancer and HIV, among other
conditions.

In late 2019, when a novel coronavirus detected in Wuhan, China,

kicked off one of the largest, deadliest pandemics in a century,
everyone looked to the same solution: a vaccine. COVID’s
devastation hit poorer countries with less developed health-care
systems particularly hard, and in wealthier countries people from
underserved and low-income communities suffered higher rates of
illness, death and economic hardship. It was clear that a COVID
vaccine would be the most equitable solution.

The U.S. quickly directed $10 billion toward vaccine development,

and dozens of other countries allocated what they could. The effort
broke every record for the fastest vaccine development. The
Chinese CDC released the sequence of SARS-CoV-2 on January
10, 2020, and just 11 months later, on December 8, 2020, the first
COVID vaccine was administered outside of a clinical trial.

Officials at Gavi, UNICEF, WHO and CEPI quickly organized

Covax, an international effort to accelerate COVID vaccine
development and “to guarantee fair and equitable access for every
country in the world,” according to the WHO. Covax delivered
nearly two billion vaccines to more than 140 countries in the two
years after the vaccines’ introduction, “by far the fastest, largest
and most effective public health roll-out in history,” a Gavi
spokesperson says. A 2022 study in the Lancet Infectious Diseases
estimates that COVID vaccination worldwide prevented 19.8
million excess deaths, 7.4 million of those in Covax countries.

The challenges were steep and vaccine distribution contentious.

“At no point did a richer country with access to vaccine doses
choose to slow down its rollout to make doses available for people
at higher risk in lower-income countries,” Levine says. “That’s
vaccine nationalism, and it undermined the success of hardworking
folks at Covax.”

Those problems have prompted a lot of reflection and a lot of new

action. The organizations behind Covax have now set their sights
on improving vaccine equity during future pandemics. Because
Africa lacked vaccine access and had few manufacturing
capabilities of its own, the new efforts are particularly focused on
boosting the continent’s vaccine-manufacturing capabilities. The
Africa CDC has partnered with other organizations to create the
Partnerships for African Vaccine Manufacturing with a goal of
making 60 percent of its needed vaccines by 2040. In June 2024
Gavi launched the African Vaccine Manufacturing Accelerator, a
financing program developed with the Africa CDC and African
Union to put up to $1.2 billion over the next decade toward
building up the continent’s vaccine-manufacturing capacity.

In the almost 25 years since Gavi was launched, it has made

substantial progress in advancing equity in vaccine manufacturing.
In 2000 four of its five vaccine suppliers were in wealthy countries.
Today most of its 20 or so suppliers are in developing countries. “It
opened up a marketplace for large-scale, low-cost manufacturing in
India, in Brazil, in China and in Indonesia,” says Berkley, former
Gavi CEO.

It will still be immensely challenging to get vaccines into the arms

and mouths of people who need them most. Health workers must
find and immunize zero-dose children—children who have yet to
receive vaccines of any kind, like the ones Laja sees in South
Sudan. And low-income countries must acquire the financing and
build the infrastructure to facilitate that process. Then Laja and her
peers must educate people so fear does not become a barrier to
access.

Workers such as Laja are part of the global workforce that the
WHO, Gavi, UNICEF, the Gates Foundation, Rotary, and other
organizations have trained to use vaccines against disease and
health disparities. Earlier this year Laja completed training in
preparation for South Sudan’s malaria-vaccine rollout. In 2022
there were almost 7,000 malaria deaths in South Sudan, and the
disease is the top killer of young children in the country. The
previous year South Sudan’s malaria fatalities accounted for more
than 1.2 percent of the total worldwide.

Laja is eager to see the vaccines’ impact on her community and in

the villages she visits, where parents will walk for miles from
outlying areas to meet her. “There are very few things women and
caretakers will walk hours and hours for, but vaccines are still one
of them,” says Mitchell of the Gates Foundation. “People will
literally drop everything to come and vaccinate their child.”
Tara Haelle is a Dallas-based science journalist whose specialties include infectious disease, medical
research and health disparities. Follow her on X @tarahaelle

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What Gives You Hope for Health Equity?

Health experts share what gives them hope for improving health for
all
By Anil Oza

Top row from left to right: Courtesy of Pai Madhu; University of Sydney; Chris Cooper/University of
Minnesota School of Public Health. Bottom row from left to right: Hugh Siegel/ICAP at Columbia
University; Morehouse School of Medicine; American Medical Association

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

The journey toward health equity can, at times, feel endless. But it
can also be exciting and inspiring. Scientific American asked some
of the researchers, physicians, advocates, and others working on
health equity what they are most hopeful about. Each had
numerous concerns but also reasons for optimism. They pointed to
progress in widening access to health care, making science more
inclusive, and reducing the health burden of systemic racism and
other biases. They are also emboldened by the energy and
enthusiasm of their colleagues working to advance health equity.
“Any level of justice work has to be rooted in a context of hope,
right?” says Aletha Maybank, chief health equity officer at the
American Medical Association. “A hope and faith that we will all
be able to have an experience of optimal health.”

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The following interviews have been edited for length and clarity.

Madhukar Pai

Chair, Epidemiology and Global Health, McGill University

My biggest source of hope is young people. It’s the youngest

people who are shining a clear light on why climate change is
devastating and why leaders are not acting on what has been
obvious for many years. It’s the youngest people who are doing
great work in the U.S. on gun control, even as they’re getting
slaughtered in schools. It’s the young people who are alarmed
about the rollback of reproductive rights in the U.S., in
Afghanistan, you name it.

I feel like their moral clarity is the clearest because, unlike older
people who already bought into something or were worried about
their next paycheck or position or winning awards, young people
are devastatingly clear in terms of what’s wrong. Their problem
statements are spectacularly accurate and on point, and so they give
me a huge amount of hope. That’s partly why I still teach global
health to young people.

Just fanning their energy, their passion, might well be the biggest
source of hope for all of humankind. But we need to go beyond that
because although their diagnosis is perfect, their ability to act is
limited. They’re not in power; they often are not voting. They’re
usually given two minutes to speak at the front end of the meeting
and shown out of the door while the adults are making big
decisions. So how do we potentiate them to go beyond just sound
bites or nice photo ops to action and give them empowered ways of
doing things?
Seye Abimbola

Associate Professor, Health Systems, University of Sydney

One of the things about which I’m hopeful is a growing confidence

and restlessness and disquiet from global health professionals and
academics from and in the Global South about how the field itself
works and needs to change. Historically the field was premised on
this idea that the West—or the Global North, as we refer to it today
—has a right and a duty to impose itself on the rest of the world.

For example, if someone wanted to do a study in Nigeria and the

people who are going to lead it come from London, they would rely
on a lot of the infrastructure in Nigeria but disregard that the local
collaborators know anything. Then they go home and write this
paper and publish it in the BMJ or in the Lancet. Now, for me, what
I think has changed, what I see changing more and more, is the
pushback on that. That’s just the tip of the iceberg. But that
physically measurable, countable phenomenon of partnership
research sits on a whole bed of assumptions and normalized
practices that we took from the colonial experience.

Rachel Hardeman
Director, Center for Antiracism Research for Health Equity,
University of Minnesota School of Public Health

One of the things that gives me hope is the work that I’m doing,
along with many other incredibly brilliant scholars across the
country, around measuring racism. In my work and within our
research center, we have to be able to make the invisible visible.
Racism is so often passed off as this insidious thing that is baked
into the system, and it’s so hard to identify, especially when it’s not
an explicit interaction with someone.

In a lot of my work and in what I’m seeing across the country with
other scholars—incredibly brilliant Black scholars in particular—is
an investment and interest in figuring out how we leverage data to
measure structural and other forms of racism and then how to use
that to inform policy change. We’re coalescing around the need to
understand that health policy and social policy go hand in hand. We
can’t, for example, talk about historical redlining and racial
covenants and birth outcomes in those communities without having
the data, without understanding the history as well as what’s
happening currently. And then using that to inform housing policy
just as much as we might use that evidence to inform health policy.
Wafaa El-Sadr

Director, Global Health Initiative, Columbia University

Mailman School of Public Health

When I think back to what things looked like 25 years ago,

compared with today, it’s night and day. Investments in health
systems, largely driven by the HIV epidemic, have borne fruit in
amazing ways. No services were available, or those that did exist
were fractured. There were no resources; there was no access to
medicines or lab tests. It’s just been an enormous transformation in
only a couple of decades, so that gives me hope for the future.

More than 20 years ago I remember going to a clinic very far away
from the capital city in one of the provinces in South Africa. There
was nothing available for HIV testing or for treatment, and, I
remember this vividly, this nurse very proudly opened a notebook
that she had in a drawer in her very rickety desk and said, “I have a
list of people here who need treatment.” And then she pulled out
another sheet of paper, and she said, “Look at this. I have a
certificate. I’ve been trained. I’m ready. I want to save my people.”
And I remember walking away thinking, “This gives me hope.
There are people who care about their communities. They’re ready,
they’re willing.” And I’ll never forget that, and I’ll never forget the
look on her face of “I can’t wait anymore.”
Barney Graham

Founding Director, David Satcher Global Health Equity

Institute, Morehouse School of Medicine

Hopefulness comes from a faith and belief that things have a way
of evolving toward the good. The moral arc of the universe bends
toward the good. But it may take a long time. Helping to diversify
the public health workforce through creating more opportunities
and knowledge for students is a multigenerational process.

Four African American students did almost all the bench work that
was needed to get the Moderna COVID vaccine into that first phase
1 trial in March 2020. We’re very proud of them for getting that
whole vaccine program launched.

We must change the narrative of what people can do and what they
are able to do and start asking, Who gets to be trained? Who gets to
have the knowledge? Who gets to make the decisions? Who gets to
decide what to make and where it goes? All those decisions happen
at some level of leadership. If you diversify that leadership, you
will have a better, more balanced opinion about how things should
be done. That’s how you start moving toward equity.
Aletha Maybank

Chief Health Equity Officer, American Medical Association

It’s helpful looking at progress. The past four years, since the
public murder of George Floyd, there is now the ability to mention
racism where you couldn’t before. Prior to the public murder of
George Floyd, folks would never have expected the AMA to make
a statement about racism being a public health threat. And then the
AMA’s House of Delegates passed a policy that really reaffirms
ridding medicine of medical essentialism and ridding medicine of
the use of race as a proxy for biology. That has been aligned with a
movement around getting rid of racist algorithms, clinical
algorithms [see “Better Measures,” by Cassandra Willyard here].
That would have never started without this national and collective
movement to name racism and the exposure of inequities during
COVID. That response and that collective response do provide
hope.
Anil Oza is a Boston-based science journalist focused on health inequity and neuroscience.

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Cultural Competency in Health Care Can Save

Lives

Medical professionals who connect with their patients’ language

and culture provide better care
By Rod McCullum

Luisa Jung

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

California’s Inland Empire is a broad swath of land east of Los

Angeles, about five times the size of Connecticut, stretching
through desert and surrounded by mountains. It’s one of the state’s
fastest-growing regions, but it’s underresourced, with incomes and
education levels lower than the state average. It is also medically
underserved, with too few primary care physicians and specialists
to adequately tend to the area’s increasing population. In the
region’s many Spanish-speaking communities, finding a doctor
who speaks the same language is difficult. And whether people can
communicate well with their health-care providers affects patient
outcomes.

Three years ago the Inland Empire Free Clinic opened in Colton,
Calif., to provide free health and medical care and social services.
Its clinic is staffed by physicians and medical students from the
nearby California University of Science and Medicine. Many are
proficient in Spanish, and those who aren’t work through
interpreters. “The moment I talk in Spanish to patients, they change
their attitude and are more open to tell me how they actually feel,”
says Alexandra Lopez Vera, director of C.U.S.M.’s medical
Spanish program, who coordinates interpreters for the clinic. “If I
talk to a Latina who comes to see a doctor because they have a
problem related to the reproductive system, they may feel like, ‘I
feel embarrassed to tell this white guy who doesn’t speak my
language about this situation that I’m having.’ They request for me
to be with them.”

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Research has shown that in the U.S., patients with limited English
proficiency have a higher risk of hospital readmission and greater
difficulty adhering to medication regimens. More than 25 million
people who live in the U.S. have limited English proficiency.
Because the majority of those are Spanish speakers, many medical
schools now offer medical Spanish. C.U.S.M., which was founded
in 2018, has made it mandatory. Finding a common language is just
one way in which medical schools, clinics, hospitals and health-
care networks are working to address health disparities as part of an
increasingly visible movement known as culturally sensitive or
concordant care.

When patients don’t trust the providers caring for them or when
they feel dismissed or misunderstood, they’re less likely to share
relevant information. And when providers don’t understand a
patient’s life experiences and culture or don’t speak their language,
they may be less likely to ask relevant questions. Culturally
sensitive care starts with the premise that people come from diverse
cultural, ethnic, religious and socioeconomic backgrounds and that
understanding these differences is crucial for proper health care.
Hospitals and medical schools are now adding tools to help their
providers improve sensitivity around language, traditions and
cultural expectations. The strategy is already advancing health
equity. A growing body of research shows that by addressing bias
and stigma directly in a rapidly diversifying patient population,
culturally concordant care results in better health outcomes across a
person’s lifespan—from prenatal and maternal health to pediatrics
to end-of-life decisions.

Maternal mortality rates in the U.S. are higher than in any other
high-income nation in the world. In 2022 that rate was about 22
deaths per 100,000 live births, according to the Centers for Disease
Control and Prevention’s National Center for Health Statistics,
down from almost 33 deaths per 100,000 live births in 2021.

The death rates are the worst in Black communities. Data from the
Chicago Department of Public Health revealed that in 2019, Black
women in Chicago were almost six times more likely than white
women to die during pregnancy or within one year of giving birth.
To try to reduce this number, the University of Illinois Hospital and
Health Sciences System (UI Health) introduced a new initiative in
2022: its Melanated Group Midwifery Care program.

“Folks are using the health-care system more. They’re not

running from it. They’re empowered from their maternity
experience.”

—Karie Stewart Melanated Group Midwifery Care

The midwifery group was born out of Karie Stewart’s frustration

with a system that was failing Black and brown families. “The
Black population is experiencing the most deadly outcomes when it
comes to pregnancy,” says Stewart, a certified nurse-midwife at UI
Health and one of the investigators leading the Melanated Group
Midwifery Care program’s research. The patients she serves are
predominantly Black and live on the west and south sides of
Chicago, where a number of hospitals shut down their labor and
delivery units during the worst of the COVID pandemic. “There is
a lack of care for those already disadvantaged,” she says. Stewart
approached Kylea Laina Liese and Stacie Geller of the University
of Illinois Chicago, who study risk factors associated with maternal
health, and together they made a plan, secured a $7.1-million
research grant and got to work.

The research project includes people at all stages of pregnancy,

from the first trimester to 12 months after birth. It matches Black
pregnant people with Black midwives and is expanding prenatal
care in communities with limited maternal health services. The
program provides group education to support people in different
stages of pregnancy, offers breastfeeding resources, helps
participants with family planning after their babies are born, and
ultimately reframes maternal and postpartum care in a way that
respects Black patients’ needs and experiences in a health-care
system still recovering from historical and systemic racism.

Today Stewart and her team are four years into the five-year grant,
and they can point to qualitative changes in the community they
serve. (The team expects to share quantitative data after the
research period ends in 2025.) “We’re seeing folks use the health-
care system more. They’re not running from it,” Stewart says.
“They’re empowered from their maternity experience. They’re
empowered to share what’s going on.” Given that many of these
patients had previously avoided the health-care system, she sees
this as a big win. “We want them to be engaged in their health care
not just when they’re pregnant but after having a child and to seek
care for anything else they have going on.”

In medical schools across the country, clinicians, faculty,

administrators and students are reviewing their curricula to identify
existing biases and teach cultural sensitivity to the next generation
of physicians. When schools integrated information on racial
disparities into their teachings, according to a 2019 study in
Academic Medicine, students were more motivated to work in
diverse communities.

In 2021 Temple University’s Lewis Katz School of Medicine in

Philadelphia formed a task force of students and faculty to identify
potential problems in the school’s course curricula, says Abiona
Berkeley, an anesthesiologist and interim associate dean of the
school’s diversity, equity and inclusion office. There were 346
instances in the curriculum, she says, “where we had an
opportunity for development and growth.” These included dozens
of examples of racial or ethnic stereotypes, as well as symptoms
that had never been studied in groups representing a range of
human skin tones. Berkeley says several members of the faculty
have told her, “It’s changed the way I look at some of my patients
and how I engage with them.”
Hillel Maresky, a cardiothoracic radiologist, arrived at Temple
University in 2019, before the cultural sensitivity task force was
assembled. He soon noticed an odd phenomenon. Many of his
Black female patients had chest x-rays, computed tomography
scans and magnetic resonance imaging (MRI) that seemed to
include shadows or squiggly lines known as artifacts. He
discovered that these artifacts were being caused by the women’s
hair braids, locs and twists and the hair bands that held them in
place. Certain hair oils and conditioners used by Black women also
presented problems: the oils occasionally contain trace amounts of
metals that interfere with MRI machines’ powerful magnets. “As I
was compiling these cases, I learned that there really was a hole in
the medical literature on this topic,” Maresky says.

When images are unclear or contain artifacts, patients must be

scanned again. And additional testing means additional radiation
exposure, as well as logistical challenges such as transportation or
loss of hours at work. The lack of familiarity with these hairstyles
and the lack of data regarding their effect on imaging present
problems not only for radiologists but for clinicians in a wide range
of medical fields.

Maresky began collecting a dataset that now includes more than

100 images of such artifacts that mirrored disease, and Angela
Udongwo, a fourth-year medical student in his laboratory, has now
presented their findings at a couple of conferences and to other
medical schools in the Philadelphia area. They have also completed
a pilot study on physicians’ awareness of and familiarity with Black
hairstyles. “We found the length of your career correlated with how
familiar and comfortable you are with identifying these hairstyles
in imaging,” Udongwo says. But these are skills that can be taught.
“There is no curriculum developed around teaching this.”

Udongwo is Nigerian American and has worn braids for years.

While collecting research for the project, she heard one story after
another about patients who encountered radiologists with little
cultural sensitivity or understanding. It just doesn’t make sense, she
says, that radiologists in 2024 aren’t familiar with these hairstyles.

Medical schools are beginning to catch up. In 1991–1992,

researchers surveyed all 126 medical schools in the U.S. about
whether they had implemented cultural-sensitivity training or had
plans to do so in the future. Their results were published in 1994 in
Academic Medicine. Of the 98 schools that responded, only 13
provided a cultural-sensitivity course, and only one of those was a
requirement. Today medical schools, governments and hospitals
across the U.S. have guidelines for cultural-sensitivity training.
They’re expanding their sensitivity around communication, too: as
of 2019, almost 80 percent of the nation’s medical schools offered
medical Spanish.

Not only does language concordance improve outcomes, but it can

also enhance patients’ experiences. A small study by Lopez Vera
assessed patient satisfaction at the Spanish-friendly Inland Empire
Free Clinic and found that those treated by a doctor who spoke
their language had the highest satisfaction scores. These days,
between technology and artificial intelligence, some people assume
they don’t need to learn a new language, Lopez Vera says. But the
evidence shows that the human-to-human approach is not just more
empathetic but more effective.
Rod McCullum is a science writer whose work has appeared in Undark, Nature, the Atlantic and
M.I.T. Technology Review, among other magazines.

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How to Fix Health Data for People with Asian and

Pacific Islander Heritage

Separating medical data from culturally distinct Asian American,

Native Hawaiian and Pacific Islander (AANHPI) groups can
improve health outcomes
By Jyoti Madhusoodanan

Luisa Jung

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

Many of the patients who come to Eugene Yang’s cardiology clinic

trace their origins back to India, China, Korea, and multiple parts
of Southeast Asia. His clinic is in Seattle, a hub for the tech
industry and home to thousands of immigrant workers. Yang had
seen firsthand how people from each of these groups were at risk of
heart disease and how their typical lifestyles differ.
Yet despite differences in their cultures and backgrounds, these
patients have been lumped together with people from other
communities in a single category: Asian American, Native
Hawaiian and Pacific Islander, or AANHPI. So Yang and his
colleagues created a study looking at how social stress factors
affect heart health in the Asian American communities he treats.
The researchers analyzed stressors such as food insecurity, delays
in medical care and living in a neighborhood that didn’t feel close-
knit or safe. Then they correlated these issues with risk factors for
heart disease among Chinese, Filipino and Asian Indian adults.
Other Asian communities were grouped together into a single
category.

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The recently completed study showed that the same stressors

manifest differently in people of different ethnicities. Across the
board, those who experienced more social stress had poorer sleep,
struggled to exercise and used more nicotine—all factors
associated with higher rates of heart disease. But differences
emerged between groups. In Chinese Americans high stress was
associated with an increased risk of diabetes, whereas in Filipino
adults it was linked to high blood pressure. Asian Indians were
most likely to experience poor sleep and physical inactivity when
bearing the brunt of social stress. “There are significant differences
in how social determinants of health impact the different Asian
subgroups,” Yang says. Recognizing this variation is a first step
toward helping physicians tailor interventions more appropriately.
For decades such nuance had been all but invisible to scientists,
clinicians and policymakers. The single AANHPI category, which
was defined in the 1997 U.S. Census, is still used widely by
hospitals, as well as by state and national health databases.
Researchers and policymakers use these data to assess disease rates
and people’s health needs and to decide how to allocate resources.

But the AANHPI category masks rich diversity. People in this

group have ancestral links to more than 50 countries. They
collectively speak more than 100 different languages, have widely
variable ways of life that differentially affect their health risks and
represent a diversity of genetic backgrounds. They’re also the
fastest-growing racial and ethnic minority in the U.S. By pooling
their data, researchers end up with a potpourri that obscures
population-specific health needs or health risks. “When you lump
everybody together, you don’t see that maybe there are important
differences,” Yang says.

Now efforts led by advocates, researchers and community

organizers—most of them from AANHPI communities—are
paving the way to data equity and better health.

Spurred in part by the realization that aggregated data masked stark

health disparities during the COVID pandemic, researchers began
studying disease risk in specific AANHPI cohorts such as Pacific
Islander, South Asian and Vietnamese populations. They’re finding
that teasing apart data in community-specific ways lets them use
race and ethnicity information without conflating it with biology.
Policymakers are catching up, too, using data specific to individual
communities to better understand how to allocate resources and
communicate more effectively.

These efforts are improving AANHPI health outcomes, says

epidemiologist Stella Yi of New York University Langone Health.
In recent years disaggregating AANHPI data has helped health-care
professionals improve hepatitis B vaccination rates, reduce the
devastation that has been caused by COVID and wildfires among
Hawaiian communities, and identify better diet strategies to help
South Asian communities reduce their risk of heart disease. “It’s
been really exciting to watch,” Yi says.

Tellie (Chantelle) Matagi was a 20-inch, eight-pound, six-ounce

bundle of newborn joy in a Utah hospital nursery when her identity
vanished into the health system. On hospital forms Matagi, who is
of Samoan ancestry, had been labeled Asian, a category that blurred
racial lines so completely it rendered them meaningless. Matagi, a
community health leader who managed the Pacific Islander Task
Force within the Hawaii State Department of Health during the
early days of the COVID pandemic, says the record bothered her
parents. It also troubled Asian staff at the hospital, who recognized
the incongruity of so many people being lumped together. Matagi
ended up quitting her job in 2022 to address her own health. She
had diabetes and high blood pressure, and her doctors suggested
she just lose weight. But because she was familiar with the science
and knew aggregated data were masking her Samoan ancestry, she
realized they couldn’t understand her true health risks. “I knew I
wasn’t being seen,” she says.

Grouping too much data blurs the reality of people’s lives. For
example, in the aggregate, the risk of cancer death among Asian
Americans is about 40 percent lower than that for white people.
But disaggregating data reveals important patterns. Within the
AANHPI group, lung cancer is the leading cancer diagnosis among
Vietnamese, Laotian and Chamorro (those with ancestry in the
Mariana Islands) men, and colorectal cancer is highest among
Laotian, Hmong and Cambodian men.

When data are pooled, these nuances vanish. “One group looks
better than they really are, the other group looks worse than they
really are, and you can’t rely on those estimates anymore,” says
Joseph Kaholokula, a physician at the University of Hawai̒i at
Mānoa. “It’s nonsense. It’s not good science, yet people have been
doing this for decades.”

That’s because for decades federal and state health databases have
offered researchers only a high-altitude view. Early attempts to
break population data down with greater granularity failed because
there simply weren’t enough people in each group. The effort
sparked concerns that, although the people included in these health-
related data samples should remain anonymous, there were so few
they could be easily identified. And funding to look at AANHPI
health has been limited—a 2019 study reported that over the
previous 25 years, only 0.17 percent of all National Institutes of
Health funding for clinical research supported projects focused on
AANHPI communities.

This is in part the result of broader stereotyping of Asian

Americans as a “model minority,” a category in which everyone is
assumed to be well educated, financially secure and generally
healthy. The model-minority trope illustrates how race-based
assumptions can bias scientific research, says Tina Kauh, a
program manager at the Robert Wood Johnson Foundation. “It’s
important for people to recognize that systemic racism is really
what’s driving the fact that we don’t disaggregate data.” With so
little NIH funding to support their work, scientists have struggled
to dispel the model-minority myth. “It’s like this hamster wheel
you get stuck on,” Kauh says.

Kauh first bumped into that cycle in college during an

undergraduate psychology class about how culture and ethnicity
shape someone’s behaviors and perceptions of social norms.
Fascinated, she tried to dig deeper into the experiences of Asian
Americans, yet she couldn’t find the data. Kauh persisted,
revisiting the topic in graduate school but says she found it
“basically impossible” to get funders interested. Since then, she
says, “it’s been this mission of mine to try to push for collecting
data about Asian Americans.”

Kauh’s parents were Korean immigrants who owned a convenience

store in Philadelphia. Even as a teen, Kauh could tell that their
grueling schedules, language issues and social isolation took a
physical and mental toll. Their lives were hardly those of a model
minority. “I could see the challenges they experienced on a daily
basis, but no one ever really talked about that except to frame it as
‘look how hardworking they are,’” she says.

The social stressors Kauh’s parents experienced were financial and

cultural, both of which can affect a person’s health. Language
barriers, racism, changes in diet with the move to a new country
and the circumstances of that move—whether someone migrates to
pursue a graduate degree or to flee from conflict—can add up.
None of these factors are related to the biological basis of disease,
but they determine what resources a person or community might
need to achieve good health.
 Jen Christiansen; Source: “Social Determinants of Cardiovascular Risk Factors among Asian
American Subgroups,” by Alicia L. Zhu et al., in Journal of the American Heart Association, Vol. 13;
April 2024 (data)

When researchers understand the links between social factors and

people’s health, they can begin to design tailored solutions. Food is
one clear example. In the U.S., South Asian communities have
disproportionately high rates of heart disease—an observation often
explained by diet, says Alka Kanaya, a clinician who studies
diabetes at the University of California, San Francisco. Researchers
typically gather details about food habits using a list of standard
questions based on Western diets that don’t represent global
cuisines. Advice about what constitutes a “healthy” food is also
based on studies conducted with Western diets. “You have to be
specific to what people may be eating and how they may be
cooking it. Having nonaccurate ways of measurement just gives
you useless data,” Kanaya says.

For the past decade Kanaya and other researchers have run a study
of heart health among South Asians living in the U.S. called
Mediators of Atherosclerosis in South Asians Living in America
(MASALA). It includes a food-frequency questionnaire that lists
many South Asian foods, such as dhokla (a savory cake), sambar
(lentil stew), steamed fish, lamb curry and popular snacks. Last
year the researchers analyzed the diets of nearly 900 people from
the study and identified foods correlated with a “South Asian
Mediterranean-style diet”—one rich in fresh vegetables, fruit, fish,
beans and legumes. They found that people who ate more of these
foods had a lower risk of heart disease and diabetes than other
people in the cohort.

Data such as these can help clinicians advise patients more

effectively by offering dietary solutions that may be easier for them
to follow rather than forcing a more Western lifestyle on them,
Kanaya explains.
Getting granular with community data proved to be a lifesaving
strategy in Hawaii during the worst of the COVID pandemic. The
state health department’s infectious disease team was heavily
focused on controlling the spread of the virus at the start in 2020.
But the scientists were “thinking of it in terms of a purely
biological system versus understanding what puts people at risk,”
says Joshua Quint, an epidemiologist at the Hawaii State
Department of Health. “Accurate measurement of social factors is
so important.”

To gather those data, Quint teamed up with Matagi and

Kaholokula, the University of Hawai̒i physician, to form a COVID
investigation team. The group quickly discovered there was no way
to figure out which of the Native Hawaiian and 20 or more Pacific
Islander communities needed resources or what those resources
were. The data at hand were simply too sparse to base any
estimates on. So the team began recording COVID deaths with
more specific demographic details. When counts were low enough
that they risked making individuals identifiable, the team noted
these details in a separate section of the database to ensure that
information from smaller communities was not lost in an
aggregate, Matagi says.

When researchers understand the links between social factors

and health, they can begin to design tailored solutions.

The team members didn’t just gather information—they shared it

with the communities through hours of virtual visits and phone
calls. As they talked, the carefully gathered and stored details
helped communities see their own losses amid the sea of numbers.
No one could deny the devastation they’d experienced, nor could
their experiences be minimized by a database that didn’t represent
them and their needs. The strategy was especially effective among
the Samoan, Marshallese and Chuuk (people originally from part of
Micronesia), Matagi says, because they were the three Pacific
Islander communities most affected by the disease.
The researchers worked with each community to identify specific
requirements. Some needed a safe place to keep healthy family
members distanced from those with COVID, others wanted more
resources allocated to food or medical care, and still others sought
a way to maintain social connections or attend religious gatherings
virtually while observing COVID precautions.

The same approach helped the team customize care after the Maui
wildfires by recognizing specific needs such as food, shelter and
medicine. Its methods have since been highlighted by the World
Health Organization as an effective way to reduce health
disparities.

Identifying a community’s needs and meeting them appropriately

can make a range of infectious diseases more manageable. In New
York City in the early 2000s, routine hepatitis B vaccination was
available only to children. Among adults the virus was typically
seen as a sexually transmitted infection (STI), and testing and
treatment were offered primarily at HIV clinics.

But the infection was common among Asian American immigrants

because of high endemic rates in their countries of origin. In
families the virus passed between married partners, from person to
person through household contact such as the sharing of utensils,
and from mother to child during childbirth. These adults were
unlikely to seek care at an STI clinic. At the time, researchers
reported rates of hepatitis B among Asian Americans that were
about 50 times higher than those among non-Hispanic white
people, as well as rates of liver cancer, a common consequence of
infection, that were several times higher. In 2003 researchers at
New York University teamed up with community organizers,
politicians and clinicians in the city to help address the disparity.

The coalition’s work helped to establish that the problem would not
be stemmed by STI clinic screenings, because that “was not
somewhere that we knew Asian American immigrant adults would
feel comfortable going,” says epidemiologist Simona Kwon of
N.Y.U. Langone Health, who joined the effort a few years after it
began. “The communities are very different,” Kwon says, “and the
health priorities are different.” Western social norms and biased
perceptions had been unintentionally driving health outcomes for
hepatitis B.

The N.Y.U. team helped city officials implement community-based

programs and offer adult vaccinations at primary care clinics and
through community-based organizations. Recognizing that not just
viral infection rates but social conventions guide people’s choices
about care was the key to driving down hepatitis B transmission.

Quint warns that in efforts to apply race and ethnicity data,

researchers and policymakers should be careful not to conflate a
person’s health with these factors alone. Aggregated or not, race
and ethnicity are always simple representations of broader social
and cultural factors that affect health. But disaggregation, he says,
can “help us get beyond race and talk about ethnicity in ways that
are more meaningful and helpful.”

Efforts to create community-specific solutions are what “actually

move the disparities dial,” Matagi says. Now, after the success of
state- and community-level studies, policymakers are launching
larger studies and investing more money in the hopes of better
understanding the health of different groups under the AANHPI
umbrella.

Last year the White House announced a national effort to prioritize

equity for AANHPI communities, and earlier this year the National
Heart, Lung, and Blood Institute launched a large epidemiological
study to understand health trends in these populations. This seven-
year project, named the Multi-ethnic Observational Study in
American Asian and Pacific Islander Communities (MOSAAIC),
aims to track the health of 10,000 people who identify with various
AANHPI subgroups. One challenge, Kanaya says, will be to find
out how granular they can get—keeping the data anonymized but
with sufficient detail to identify meaningful trends, yet without
adding so many checkboxes that a long list leaves participants
exhausted.

Establishing new categories of race and ethnicity may seem to

contradict efforts to make medicine and health care equitable and
free of racial bias. But done right, these endeavors can be
complementary. “There’s a push to avoid talking about race, and I
think there are big risks associated with that if it’s coming from a
place of wanting to ignore problems,” Quint says. “We need
statistics that cut across all ranges of demographic factors so we
can find out if we’re building a more just and fair society.”
Jyoti Madhusoodanan is a science journalist based in Portland, Ore. She covers health, medicine
and the life sciences.

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How the Mpox Response Has Learned from

History

Tools and networks that have helped control HIV/AIDS are now
working against mpox
By Charles Ebikeme

Luisa Jung

This article is part of “Innovations In: Solutions for Health

Equity,” an editorially independent special report that was
produced with financial support from Takeda Pharmaceuticals.

The abandoned buildings behind the New Somerset hospital in

Cape Town, South Africa, are prime real estate along the
waterfront, so guards patrol the area day and night to protect
against squatters. But squatters aren’t the only visitors. Tucked in
among the empty facades is the Ivan Toms Center for Health, one
of the first clinics in South Africa for men who have sex with men.
It was launched in 2009 to provide comprehensive, free and
sensitive health care. These days a new concern is on the minds of
its visitors: mpox.
The first human case of mpox, formerly known as monkeypox, was
described in the 1970s. The disease is thought to be caused by a
virus that jumped from animals to humans and causes symptoms
similar to smallpox. This past August the World Health
Organization designated mpox a public health emergency of
international concern for the second time in two years. Although
the risk of mpox is not limited to men who have sex with men, the
transmission dynamics of the 2022 outbreak led researchers and
public health officials to identify them as a high-risk group. During
2022 more than 90 percent of known cases were among gay,
bisexual, and other men who have sex with men. As the outbreak
builds, Ivan Toms and similar clinics have seen an increase in
patients wanting information.

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Epidemics begin and end in communities. Today people around the

world understand and respond to outbreaks differently than they
did before the COVID pandemic. They appreciate concepts of
transmission, protection and vaccine availability at a deeply
personal level and are hungry for information. They want to know
if a case has appeared locally and, if so, how to protect themselves.
And the community most affected by mpox is one that has suffered
multiple other outbreaks—most notably, the HIV/AIDS crisis.
Critically, that means it’s a community that clinicians and public
health researchers know, understand and collaborate with.
Dimie Ogoina, a Nigerian infectious disease physician-scientist,
and his team were the first to describe sexual transmission of mpox
in Nigeria in 2017. He believes that what makes the disease so
challenging is the comorbidities that exist in Africa, especially co-
infection with HIV. His team noticed that those with the most
severe cases of mpox also had HIV infections. “Most of them had
advanced HIV ... and [were] not on treatment,” Ogoina says.

People with HIV accounted for around 40 percent of those

diagnosed with mpox in the 2022 outbreak, and recent studies
suggest that people who have more advanced HIV have worse
clinical outcomes and higher mortality from mpox. How the two
diseases interact is still a mystery, however. Researchers have yet
to tease apart whether HIV infection raises the risk of acquiring
mpox or increases its severity or whether people living with HIV
simply might be more likely to be diagnosed because they’re
already receiving better care. Better understanding this connection
could be critically important. As the outbreak spreads to more
nonendemic countries, effective treatment of HIV could hold one
key to bringing the outbreak to an end.

Mpox’s present echoes HIV’s past—it’s a disease that has the

potential to affect everyone and is more dangerous within a specific
community. The comparison is etched in the brick and mortar of
the clinic on the waterfront: Ivan Toms, the man, was both an anti-
Apartheid and a gay rights activist.

The challenge with both diseases is how to get information to an

already stigmatized group of people in a timely enough manner to
halt the ongoing outbreak without making that stigma even worse.
The 2022 outbreak showed that our first attempts failed: an article
in PLOS Global Health was simply entitled “Monkeypox Is Not a
Gay Disease,” recognizing that stigma had quickly emerged around
the virus, echoing the early days of the HIV pandemic.
The advantage today is that those dealing with mpox have lessons
from HIV/AIDS to follow. One small but meaningful way this has
already been addressed is its name: monkeypox was renamed in
2022 to mitigate against racist and stigmatizing language. And as a
result of the 2022 global emergency and lessons learned from the
HIV/AIDS pandemic, public health officials are better equipped to
build coordinated messaging and meet patients where they are.

“[Our] clients overall are now familiar with mpox, as we had the
2022 outbreak and did extensive education,” says Johan Hugo, an
HIV clinician at the Ivan Toms Center. The center has integrated
mpox services into its HIV care as recommended by the WHO and
is part of a network of clinics and government agencies, including
the South African Department of Health, that are using common
messaging and strategies for mpox. “We work closely with
organizations that support key populations to ensure we remain in
line with one another,” he says. Such coordination in messaging
helps to combat stigma around a disease that is not yet fully
understood.

Despite significant improvements in access to HIV/AIDS

treatment, gaps persist because patients are worried about their
diagnosis creating stigma related to sexual and reproductive health.
It is no different with mpox. The stigma associated with mpox can
adversely affect prevention and treatment, with people less likely to
disclose symptoms or seek care—they may even hide their
condition for fear of being diagnosed. There is no specific
treatment for mpox, and its symptoms are similar to those of other
viruses such as chicken pox. But rapid, accurate diagnosis is the
only way to prevent transmission and end outbreaks.

To achieve this, public health officials are taking everything

they’ve learned from HIV and using it to attack mpox outbreaks.
For instance, Ivan Toms and other clinics have developed
approaches for delivering health services that allow for discretion
and privacy. In addition to onsite testing and health checks, the
center also packages and dispenses medications for its clients,
eliminating the need to visit a general pharmacy. The approach has
been so successful that after becoming the first clinic to run
demonstration projects for HIV Pre-Exposure Prophylaxis (PrEP)
in Africa in 2015, Ivan Toms is now one of the largest providers of
PrEP in South Africa and a key training institution for service
providers across 11 African countries.

PrEP reduces HIV risk by preventing HIV from entering the body
and replicating. But protection requires that users maintain high
levels of the medication in their bodies. Because adherence is
crucial, practitioners aim for frictionless care that removes any
social barriers. To that end, the clinic runs a WhatsApp service,
smart lockers that safely store patients’ medicines, and mobile units
that go directly into communities. Across the entire Cape Metro
area, mobile units provide comprehensive HIV testing, treatment
and prevention services, including self-screening, PrEP,
antiretroviral drug initiation and follow-up, viral load testing, and
screening for sexually transmitted infections. “Our mobile units are
an extension of our facility and seek to provide the same level of
care,” Hugo says. “Each of our teams provides comprehensive HIV
testing, treatment and prevention.”

Because so many men who have acquired mpox are using PrEP,
researchers think HIV may simply be another marker of higher-risk
behaviors facilitating infection. The goal will be for mpox services
to follow the same community outreach. “Our strategy for mpox
currently is to provide broader information online and then to
ensure that every client who comes through our services is
provided direct information about the current situation,” Hugo
says. Most days, that’s as many as 120 to 150 people.

There are two variants of mpox virus: clade I is endemic to central

Africa and has killed up to 10 percent of the people it has infected
during previous outbreaks, making it far deadlier than clade II, the
type responsible for the 2022 outbreak. Both are circulating today
in different countries in Africa. And unlike the 2022 outbreak, this
one—which is tearing through the Democratic Republic of Congo
(DRC)—has largely spread through men seeing women who are
sex workers. “We are not dealing with one outbreak of one clade—
we are dealing with several outbreaks of different clades in
different countries with different modes of transmission and
different levels of risk,” said Tedros Adhanom Ghebreyesus,
WHO’s director general, during his opening remarks at the
emergency committee meeting where the global health emergency
was declared. “Stopping these outbreaks will require a tailored and
comprehensive response, with communities at the center.”

In July 2024 South Africa notified the WHO of 20 confirmed mpox

cases between May 8 and July 2, including three deaths—the first
reported in the country since 2022. Cases occurred in three of
South Africa’s nine provinces, including the Western Cape, where
the Ivan Toms Center for Health resides. How the outbreak evolves
from here will depend heavily on case identification and treatment
management.

There is one internationally approved vaccine for mpox (another is

approved in Japan with emergency approval in the DRC), which
can act as both preexposure and postexposure prophylaxis for
people at high risk. But although the vaccine is available in
numerous high-income nations, current access in South Africa is
limited to nonexistent. “The vaccine was originally made for
smallpox, with U.S. funding,” says Mohga Kamal-Yanni, a senior
policy adviser to the People’s Medicines Alliance, a global
coalition with the goal of creating equitable access to vaccines and
other medical technology. The companies that make these vaccines
hold their patents, she says, “and when the mpox outbreak started,
there was no discussion on technology transfer to another potential
manufacturer.”

During the COVID pandemic, African countries surpassed all

expectations despite challenges in vaccine access. Tanzania
emerged as one of the best-performing African countries for
COVID vaccination rates: Between January 2022 and April 2023
the country managed to bump its total population vaccination rate
from 2.8 to 51 percent. This happened in part because COVID-
specific vaccinations were integrated with other routine health
services, allowing for effective delivery.

The COVID pandemic forever changed Africa’s policy, regulatory

and vaccine landscapes. Low-income countries have learned to
push through regulatory red tape, advocate for their people and
work with high-income nations to get vaccines distributed more
equitably. After putting a vaccination plan in place, Nigeria
received the first donation of 10,000 vaccines from the U.S. just a
few days after the global mpox emergency was declared. Other
donations are aimed at countries across the African continent:
Spain promised 500,000 doses from its stockpile, the U.S.
committed to sending another 50,000 doses to the DRC, and Japan
pledged millions of doses. Some of those vaccines have already
arrived in Africa.

Citing lessons learned from COVID, global health institutions are

also mobilizing resources. Gavi, the Vaccine Alliance, has
mobilized resources for mpox, the rollout of which will be an early
test of Gavi’s First Response Fund. The fund aims to make
resources immediately available for a vaccine response to a public
health emergency and includes a $500-million fund aimed at
ensuring early access to vaccines within days of an emergency
declaration. This, according to Gavi director of development
finance David Kinder, was one of the big lessons learned from
COVID.

The 2022 mpox outbreak was deemed to be over about nine months
after the WHO declared an emergency. The 2024 outbreak could be
larger and longer. If it is going to be extinguished as quickly,
lessons learned from previous pandemics hold the key.
Charles Ebikeme is a freelance science writer and journalist specializing in the intersection of health
and society.

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Aging
Drastic Molecular Shifts in People’s 40s and
60s Might Explain Age-Related Health
Changes
A new study suggests that waves of aging-related changes occur at two distinct points in our
life

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Why Aging Comes in Dramatic Waves in Our 40s

and 60s

A new study suggests that waves of aging-related changes occur at

two distinct points in our life
By Saima S. Iqbal

Bob_Bosewell/Getty Images

As a person enters their 60s, the health effects of aging often start
to become strikingly clear. Many people begin to use glasses or
hearing aids, or their doctors warn them about a sharply increased
risk of diabetes or heart disease. But research suggests that our
bodies may undergo a dramatic wave of age-related molecular
changes not only in our 60s but also in our mid-40s.

For a study in Nature Aging, researchers tracked the levels of more

than 135,000 molecules and microbes, all reflective of activity in
cells and tissues, in 108 healthy volunteers aged 25 to 75. Each
volunteer contributed biological specimens, including blood and
stool samples, every three to six months for a median of 1.7 years.
Results showed that changes in many molecule and microbe levels
clustered around two distinct time points: ages 44 and 60. The
findings suggest that aging might accelerate around those periods
—and they signal to experts that our 40s and 50s may be a
significant time to closely monitor health.

The study supports many people’s anecdotal reports of noticing

changes in their 40s that range from more muscle injuries to worse
hangovers, and the data give clues as to why, says senior study
author Michael P. Snyder, a genetics researcher at Stanford
Medicine.

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Amanda Montañez; Source: “Nonlinear Dynamics of Multi-omics Profiles during Human Aging,” by
Xiaotao Shen et al., in Nature Aging. Published online August 14, 2024

Compared with younger participants, people in their 40s and 60s

displayed biological differences that appeared to be linked to
muscle weakness and loss, decline in heart health, and inefficient
caffeine metabolism. Those in their 40s also had reduced activity in
cellular pathways responsible for breaking down alcohol and fats—
possibly a sign that people start to digest these compounds more
slowly around this age. People in their 60s, meanwhile, had lower
levels of various immune system molecules, such as inflammatory
cytokines, which corresponded to a weakened immune response.
They also showed significant differences in levels of certain
molecules associated with carbohydrate digestion and heart and
kidney function, suggesting that the older participants were more
susceptible to type 2 diabetes, cardiovascular disease and kidney
issues.

The new study’s time points are similar to those identified in a

separate 2020 study, in which researchers found that participants’
immune systems grew markedly less adept at fighting off
pathogens in their late 30s to early 40s and again around age 65.
But the latest study’s findings are not ironclad; it included a
relatively small number of people, all living in California’s Palo
Alto area. The resulting lack of geographic diversity makes the data
less representative of the broader public, notes Aditi Gurkar, who
conducts aging-related research at the University of Pittsburgh and
was not involved in the recent study. Those sampled likely had
some lifestyle factors in common, such as diet, exercise and
environmental exposures, which could have swayed the results, she
says.

The study also did not follow any individuals for periods longer
than about seven years, so scientists cannot be certain that the
differences between people in different age groups reflect universal
changes. For example, the 40- and 60-year-olds in the study may
have aged faster relative to others of the same age in the broader
population, Gurkar cautions. She and others say the best way to
confirm the results—and to precisely trace age-related biological
shifts—would be through a larger study that tracks the same
participants over the course of a lifespan. Collecting data on factors
such as disease status, physical function or disability could also
help researchers better assess the extent to which age-related shifts
affect a person’s overall health. (The amount of stress that cells and
tissues undergo—referred to as biological aging—varies widely
between people of different races and socioeconomic classes, and it
even differs between individual organs in a person’s body.)

The reasons ages 44 and 60 might be turning points in health are

not yet apparent, but the study authors hope to probe several
hypotheses in future work. Snyder suspects that for people in their
60s, declines in immune system function might precipitate a more
widespread organ breakdown. A midlife decline in physical
activity, meanwhile, could explain the differences seen among
people in their 40s—but so might hormonal changes, including
menopause. Menopause alone, however, could not explain the
trends in the study, Snyder says: male and female participants
appeared to show the same degree of age-related differences at both
time points.

Snyder suggests the new data can provide actionable health

information. People in their 40s might benefit from getting blood
tests that track lipid levels, for instance, or from exercising
regularly to maintain heart health. Snyder also underscores the
importance of early and regular screenings for heart disease for
people in this age range who have existing health conditions.

Limitations aside, Gurkar says, the study is a powerful reminder

that lifestyle choices such as diet and exercise can accelerate aging
—or slow it down. Few studies on aging focus on middle-aged
participants or involve biological sampling as comprehensive as
that of this paper, she adds. In addition to identifying potential
waves of age-related changes, the work provides a crucial first step
toward large-scale disease-prediction models based on biological
data.
Saima S. Iqbal is Scientific American’s current news intern. She specializes in health and medicine
and is based in New York City.

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Animals
Birds Practice Singing in Their Sleep
New work listens in on bird dreams

Cave Fish Adolescence Means Sprouting Taste

Buds in Weird Places
Cave fish develop taste buds on their head and below their chin—and even in humans, taste
cells grow in truly unexpected locations

Komodo Dragons’ Nightmare Iron-Tipped

Teeth Are a Reptilian First
Reptile teeth have long been considered simple and cheap because the animals replace them
regularly. That isn’t so, Komodo dragons show

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Birds Practice Singing in Their Sleep

New work listens in on bird dreams

By David Godkin

Great Kiskadee.
David Plummer/Alamy Stock Photo

Scientists tell us that the family dog shuffling its legs while asleep
on the floor really is dreaming. And when a bird silently nods off
on its perch, it may also dream as its singing muscles twitch. Could
it be rehearsing in its sleep?

A substantial proportion of bird species are songbirds with specific

brain regions dedicated to learning songs, according to University
of Buenos Aires physicist Gabriel B. Mindlin. His research
examines connections between birds’ dreams and song production
—particularly in Zebra Finches, which often learn new sounds and
songs, and in Great Kiskadees, which possess a limited, instinctive
song-learning capacity.

Scientists had previously observed sleeping birds making

movements that resembled lip-syncing. In earlier work, Mindlin
and his colleagues implanted electrodes in two Zebra Finches; for a
recent study in Chaos, they did the same for two Great Kiskadees.
This let them record and compare neuron and muscle activity in the
sleeping birds.

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When awake, Zebra Finches sing a well-regulated line of staccato

notes. But their sleeping song movements are fragmented,
disjointed and sporadic—“rather like a dream,” Mindlin says. A
dozing finch seems to silently practice a few “notes” and then add
another, producing a pattern of muscle activity that reminds
Mindlin “of learning a musical instrument.”

Such “rehearsing” appears far less likely in the nonlearning Great

Kiskadees, says study co-author Ana Amador, a neuroscientist also
at the University of Buenos Aires. For the new research, the
scientists ran this species’ sensor output through a mathematical
model Mindlin recently developed to translate muscle movements
into audible sounds. The kiskadees’ synthesized sleeping tune
comprised quick, identical note syllables that sounded startlingly
loud and aggressive—“more like a nightmare than a dream,”
Amador says. Slumbering kiskadees frequently combined these
movements with a threatening flash of head feathers, which often
occurs during their territorial disputes while they are awake.

Listening in on a sleeping songbird to better understand its waking

behavior—and to look for a possible link to dreams—is a lot like
“cracking a code in a detective novel,” Amador chuckles.

University of Chicago neuroscientist Daniel Margoliash, whose

pioneering 1990s work characterized birds’ song-learning brain
regions, says the new results agree with his own observations of
sleeping birds’ neurons. But he advises caution in describing this
sleep activity as “dreaming.” Future work should more closely
examine the sleep states the birds experience during this process,
he says—including rapid eye movement (REM) sleep, a sleep stage
that is closely associated with dreaming in other animals.

“Is there a distinction between replay patterns formed during non-

REM and REM sleep?” Margoliash asks. Such a contrast, he adds,
“is one we need to keep in mind when examining what happens
when birds sleep.”
David Godkin is an award-winning science writer and frequent contributor to Scientific American
and science-based biomedical engineering publications. He lives and works in Toronto.

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Cave Fish Adolescence Means Sprouting Taste

Buds in Weird Places

Cave fish develop taste buds on their head and below their chin—
and even in humans, taste cells grow in truly unexpected locations
By Elizabeth Anne Brown

Blind cave tetras develop taste buds on their head.

Hanjo Hellmann/Alamy Stock Photo

In eastern Mexico’s underground caverns and streams, a blind fish

undergoes a peculiar adolescence: as it approaches maturity, taste
buds begin to sprout under its chin and on top of its head, creeping
toward its back.

“It’s a pretty wild amplification of the sensory system of taste,”

says Josh Gross, an evolutionary geneticist at the University of
Cincinnati and a co-author of a recent study on the cave fish in
Nature Communications Biology. Gross and his team discovered
that the new buds blossom around the time when the fish transition
from eating larval crustaceans to gobbling up their adulthood
staple: bat guano. Taste buds outside their mouths might be helping
the fish detect bat droppings in the utterly dark, “food-starved”
caves, Gross says.

Wandering taste buds aren’t unheard of elsewhere, especially in

other fish. Some damselfish cultivate taste buds on their fins, and
channel catfish have them across their midsections. And as alien as
it may seem, many cells throughout the human body can taste, too.
They’re just not sharing the flavors with your brain like taste buds
do.

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Lora Bankova is a Harvard Medical School respiratory biologist

who studies tuft cells, a cell type sprinkled within human mucous
tissues like those lining your nostrils, throat and gut. These “rapid
responder” cells trigger the immune system if they detect an
outside threat, and many of them rely on built-in taste receptors
(the same kinds found on taste-bud cells) to do so. Bankova notes
that many potentially harmful bacteria communicate via signaling
chemicals called lactones—which also happen to activate taste
receptors attuned to bitter flavors, prompting tuft cells’ immune
response. And it turns out that even environmental allergies may be
a matter of taste: dust mites and several mold species can also set
off a tuft cell’s taste receptors, Bankova says.

“Evolutionarily, taste receptors [have moved around] the body to

protect us from the air we inhale and all the attacks we’re getting
through the orifices,” Bankova says. “They’re in the inner ear, the
urethra, everywhere something can get into your body.”

Such “extra” taste receptors aren’t just bouncers at the door—they

taste test for our internal systems, too. Receptors for sweet tastes
help to tune insulin production in the pancreas and make sure
neurons in the brain have access to enough glucose. Sweet, bitter
and umami receptors in the gut modulate digestion.

Gross says it’s still a mystery what taste receptors the bat guano
activates in the blind cave fish. “There may be some sugar content
if it’s a fruit bat, maybe some protein content if it’s a carnivorous
bat,” he says. So far only the cave fish has signed up to sample it.
Elizabeth Anne Brown is a freelance science journalist based in Copenhagen, Denmark. Her work
has appeared in National Geographic, the New York Times, the Washington Post, and many other
outlets. Read more at elizabeth-anne-brown.com, and follow her on X (formerly Twitter)
@eabrown18

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Komodo Dragons’ Nightmare Iron-Tipped Teeth

Are a Reptilian First

Reptile teeth have long been considered simple and cheap because
the animals replace them regularly. That isn’t so, Komodo dragons
show
By Meghan Bartels

An adult Komodo dragon seen at a zoo.

Jürgen & Christine Sohns/imageBROKER.com GmbH & Co. KG/Alamy Stock Photo

There aren’t many scenarios in which getting a good look at a

bunch of Komodo dragon teeth ends well. The massive lizard’s
mouth holds 60 serrated teeth, each up to an inch long, that get
replenished throughout the creature’s life. And dangling from the
serrations are the remains of previous meals, plus dozens of
bacteria that feast on them.

To be fair, Aaron LeBlanc, a paleontologist at King’s College

London, got his close look at Komodo dragon teeth minus the
grizzly decor and detached from their ferocious owners. His
examinations paid off. “Every now and then, I would see this sort
of orange discoloration to the outer layer of the teeth,” LeBlanc
says. “I honestly probably saw it three, four times and just
dismissed it as staining from feeding.”

But closer inspection proved that the orange hue LeBlanc saw on
the serrations and tips of Komodo dragon teeth was iron that was
present before they ever took a bite. The result, described in
research published on July 24 in the journal Nature Ecology &
Evolution, is the first confirmed finding of iron chompers in
reptiles. (Some fish and salamanders, as well as a handful of
mammals—most notably beavers—are also known to include iron
in their teeth.)

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Reptilian teeth have long been considered simple and cheap

because they grow quickly and get replaced several times
throughout their owner’s life. Research like that in the new paper is
changing that perception, however. “We’re basically just starting to
scratch the surface into how complex reptile teeth can actually be,”
says Kirstin Brink, a paleontologist at the University of Manitoba,
who studies teeth but was not involved in the new study. “Now that
we’re starting to actually take a closer look at different reptiles,
we’re finding all of these really cool adaptations.”
 Close-up images showing orange serrations running down the front and back of a Komodo dragon
tooth.
From “Iron-coated Komodo Dragon Teeth and the Complex Dental Enamel of Carnivorous Reptiles,”
by A.R.H. LeBlanc et al., in Nature Ecology & Evolution. Published online July 24, 2024

Komodo dragons, which can grow up to 10 feet long and live on a

few islands in Indonesia, are typical reptiles in terms of teeth
replacement, LeBlanc says. “They’re basically tooth factories,” he
adds. The tip of each pointed tooth curves back into the animal’s
mouth, which allows it to tear off and swallow large chunks of
meat. And the iron reinforcement is strategic as well, LeBlanc says.
The orange detailing precisely marks a single line of serration
running down the front and back of each tooth—with the serrations
more pronounced on the back—and marks the tooth’s tip: puncture,
pull, swallow, repeat.

LeBlanc was drawn to the giant lizards’ teeth because of their

pointed, curved profile, which would look at home in the smiles of
even more fearsome animals: dinosaurs. Such comparisons are a
valuable approach for paleontologists, Brink notes. “When we’re
studying fossils, especially when we’re trying to interpret behaviors
which we can no longer observe because the animals are dead, we
have to look to modern analogues,” she says.

Inspired by the Komodo dragon finding, LeBlanc and his

colleagues looked for signs of similar iron reinforcement in the
teeth of other living reptiles and dinosaurs. They discovered that a
few different species of monitor lizards had the adaptation, though
to a lesser extent, and that some crocodilians showed signs of iron
in their teeth as well. For the dinosaur teeth, the team found iron
throughout, but think it was likely deposited from the fossilization
process, given the abundance of iron on Earth’s surface. “Iron is
probably the worst thing to look at in fossil reptile teeth,” LeBlanc
says. “If you bury a dinosaur tooth in the ground for tens of
millions of years, iron will eventually seep into every nook and
cranny.”

Still, he and Brinks agree, the research suggests that scientists

should take a closer look at teeth in living reptiles and dinosaurs
alike, with eyes peeled for unexpected dental adaptations like those
of the Komodo dragon. “We shouldn’t take for granted how
complex reptile teeth can be,” LeBlanc says.

A version of this article entitled “Iron Chompers” was adapted for

inclusion in the November 2024 issue of Scientific American.
Meghan Bartels is a science journalist based in New York City. She joined Scientific American in
2023 and is now a senior news reporter there. Previously, she spent more than four years as a writer
and editor at Space.com, as well as nearly a year as a science reporter at Newsweek, where she
focused on space and Earth science. Her writing has also appeared in Audubon, Nautilus, Astronomy
and Smithsonian, among other publications. She attended Georgetown University and earned a
master’s degree in journalism at New York University’s Science, Health and Environmental
Reporting Program.

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Arts
Poem: ‘Alfred Wegener to the World’
Science in meter and verse

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Poem: ‘Alfred Wegener to the World’

Science in meter and verse

By Daniel Galef

Masha Foya

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Edited by Dava Sobel

And yet it moves! Shh—hear the mountains murmur?

Peripatetic prairies slowly creep
across the globe. There is no terra firma.
Is that so terra-ble? We’ll have to keep
producing new and updated editions
of every atlas. But it’s no one’s fault
that continents collide, or split in fissions.
On groaning sleds of granite and basalt,
coastlines advance on trans-oceanic missions
like runners in the world’s most boring race
(though slow, they never fail to cover ground)
and somehow, still, their clip exceeds the pace
a stubborn academic comes around
to evidence, and changes his positions.

Author’s note: Wegener was an early proponent of continental

drift—a theory initially met with resistance.
Daniel Galef writes poetry, plays, short stories, and humor. His book Imaginary Sonnets contains 70
monologues spoken by historical figures—scientists, artists, saints, murderers, and one fish.

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Book Reviews
Book Review: How the Author of Braiding
Sweetgrass Imagines a New Economy
Robin Wall Kimmerer changed our ideas of sustainability. Can she do the same for
economics?

Book Review: How Our Love for Citrus

Shaped the Modern World
A history of citrus fruits, from the Han Dynasty to the modern orange juice industry

Book Review: The Big Costs of Mining the

Planet for Electric Power
Vince Beiser’s tour of the “Electro-Digital Age” puts resource extraction at the center

Book Review: Fifty years later, Ursula K. Le

Guin’s Novel about Utopian Anarchists Is as
Relevant as Ever
In The Dispossessed, a physicist is caught between societies

Book Review: Inside the Global Movement to

Protect Forests from Climate Change
Lessons from the people making forest ecosystems more resilient

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| Next | Section menu | Main menu |
Book Review: How the Author of Braiding
Sweetgrass Imagines a New Economy

Robin Wall Kimmerer changed our ideas of sustainability. Can she

do the same for economics?
By Meera Subramanian

Elva Etienne/Getty Images

NONFICTION

The Serviceberry: Abundance and Reciprocity in the Natural

World
by Robin Wall Kimmerer.
Scribner, 2024 ($20)

Nature provides many gifts, but it is easy to take them for granted.
It’s not just the strawberries you buy at the grocery store but also
the plastic container that holds them, made of ancient life-forms
transformed into fossils and then feedstock for plastics. How can
we better recognize the value of the natural world and build
communities—and economies—that acknowledge such
abundance?
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This is the central question of The Serviceberry: Abundance and

Reciprocity in the Natural World. It’s the third book by Robin Wall
Kimmerer, an ecologist, professor at the State University of New
York College of Environmental Science and Forestry, and member
of the Citizen Potawatomi Nation. For seven sleepy years, her last
book, Braiding Sweetgrass: Indigenous Wisdom, Scientific
Knowledge, and the Teachings of Plants, published in 2013, quietly
grew in popularity, until it leaped onto the New York Times
bestseller list in 2020, where it has remained. It was as though
Kimmerer’s concepts about animating nature and respecting
nonhuman species as if they were people, told through the personal
lens of an Indigenous scientist, struck a chord that was aching to be
played. These ideas continue to reverberate: she is routinely invited
to be a keynote speaker, her words are emblazoned on museum
walls, and in 2022 she received the prestigious MacArthur
Foundation “genius” grant.

The Serviceberry, which grew out of a 2022 essay in Emergence

Magazine, is a much slimmer volume than Braiding Sweetgrass but
is written with the same lyrical, personable voice that invites
readers into worlds of possibility. In short chapters punctuated by
line drawings from illustrator John Burgoyne, this sweet offering
builds on her ideas about the gift economy and how Indigenous
wisdom might inform it. She explores ancient guidelines known as
the Honorable Harvest, her interpretation a bulleted manifesto for
gratitude and how circular economies are a way to put these
concepts into practice.

Kimmerer also continues her inquiry into language and what it

reveals about worldviews. In the opening chapter, we learn
Bozakmin is the Potawatomi word for “serviceberry,” a native
shrub integral in Indigenous foodways that produces a
blueberrylike fruit. Bozakmin is, literally, the “best of the berries,”
and the Potawatomi root word for “berry” also means “gift.”
Languages around the world offer examples that demonstrate the
deeper connections we once had to the earth that very literally
sustains us. The Greek word oikos, Kimmerer writes, is the root for
both “ecology” and “economy.”

Oh, but how we’ve forgotten the link! As Kimmerer fills a pail with
an abundance of serviceberries in the opening scene, a flock of
cedar waxwings joining her in the harvest, she sees the fruit as “a
pure gift from the land. I have not earned, paid for, nor labored for
them.” She urges readers to take note of the small bequests that
abound, which remind us we live in a world of reciprocity where
giving can be liberated from an artificial market that manufactures
scarcity and individual desire: Little Free Libraries on front lawns
and free boxes of clothes and the invitation from a neighbor to
come pick berries for free.

Kimmerer admits this way of generous living—intimate with both

the land and one’s neighbors—works best in small, close-knit
communities. Yet more than half the world’s population now lives
in urban environments, and the flow from country to city continues.
Given this context, how do we, as she writes, “reclaim ourselves as
neighbors”? If serviceberries were a marketable commodity, I can’t
help but wonder, would her neighbors have opened their farm to
her for a free day of harvesting? I wanted her to wrestle more with
the capitalist juggernaut in which nearly all of us are enmeshed,
one dominated by the schemes of people untroubled by destroying
what others love in the name of profit.
“Recognizing ‘enoughness’ is a radical act,” she writes, “in an
economy that is always urging us to consume more.” Recognition
is one step. Transforming economies is something else altogether.
Kimmerer, who donated her book advance to land conservation and
social justice work, writes that she knows little of economics or
finance. Although she seeks understanding through books and
conversations, she seems to struggle the way many of us do with
how such ideas would scale.

The answer, Kimmerer writes in the last and strongest chapter, is to

look to ecological succession in the natural world, where
disturbances cause seemingly intransient systems to transform.
Capitalism may not crumble, but we could pursue conditions for
economic succession to a space where reciprocity is recognized.
Not just by imagining another way to be in the world but by
creating it. Many plants and animals go dormant, waiting for the
right moment to resurface and come fully alive again. Can ideas
and ways of being, like rhizomes reaching through soil, do the
same?

Meera Subramanian is an award-winning independent journalist, author of A River Runs Again

(PublicAffairs, 2015) and a contributing editor at Orion magazine.
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Book Review: How Our Love for Citrus Shaped
the Modern World

A history of citrus fruits, from the Han Dynasty to the modern

orange juice industry
By Lucy Tu

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Citrus: A World History

by David J. Mabberley.
Thames and Hudson, 2024 ($50)
The relationship between people and citrus is a millennia-long
balance of push and pull, adaptation and adjustment. Botanist
David J. Mabberley skillfully traces this captivating saga, exploring
trade deals that have been forged through these fruits’ flavor,
extensive art inspired by their beauty, and medical and genetic
innovations inspired by their biological properties. Mabberley’s
vibrant account of citrus, which begins with the Han Dynasty and
ends with the modern orange juice industry, will fascinate history
enthusiasts as much as it will delight design aficionados in search
of the ideal coffee-table book.
Lucy Tu is a freelance writer and a Rhodes Scholar studying reproductive medicine and law. She was
a 2023 AAAS Mass Media Fellow at Scientific American.

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Book Review: The Big Costs of Mining the Planet
for Electric Power

Vince Beiser’s tour of the “Electro-Digital Age” puts resource

extraction at the center
By Dana Dunham

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Power Metal: The Race for the Resources That Will Shape the
Future
by Vince Beiser.
Riverhead, 2024 ($32)
In his unflinching follow-up to The World in a Grain—a book that
turned sand into a riveting story—journalist Vince Beiser reveals
the costs of extracting the “titanic quantities” of minerals necessary
to meet the growing demand for our “Electro-Digital Age.” Beiser
tracks cobalt and lithium from environmentally destructive
excavation sites in Chile’s Atacama Desert and the deep-sea floor
through a geopolitically fraught supply chain to our electric cars
and solar panels. With gains in green energy failing to rebalance
Mother Nature’s scales (as few as one in 10 solar panels are
recycled), Beiser urges us to rethink our understanding of
sustainability.
Dana Dunham is a writer and editor based in Chicago.

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Book Review: Fifty years later, Ursula K. Le
Guin’s Novel about Utopian Anarchists Is as
Relevant as Ever

In The Dispossessed, a physicist is caught between societies

By Alan Scherstuhl

Ron Miller

FICTION

The Dispossessed: A Novel (50th Anniversary Edition)

by Ursula K. Le Guin.
Harper, 2024 ($35)

A little more than halfway through The Dispossessed, Ursula K. Le

Guin’s inexhaustibly rich and wise science-fiction novel about a
physicist caught between societies, the protagonist, Shevek, born
and raised in an anarchist’s collective, gets drunk (for the first time)
at a fancy soiree in a capitalist society on a planet not his own.
There this brilliant but bewildered scientist gets cornered by a
plutocrat with impertinent questions. What is the point of Shevek’s
efforts to create a General Temporal Theory reconciling “aspects or
processes of time”?

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Shevek explains that time in our perceptions is like an arrow,

moving in one direction only. In the cosmos and the atom,
however, it moves in circles and cycles, the “infinite repetition” an
“atemporal process.”

“But what’s the good of this sort of ‘understanding,’” the plutocrat

asks, “if it doesn’t result in practical, technological applications?”

The tensions Le Guin explores here—between the theoretical and

the applicable, the scientist and society—have not diminished in
the 50 years since The Dispossessed swept the Hugo, Locus and
Nebula awards. The science in this 1974 novel—now reissued with
a celebratory, pained-about-the-present introduction by literary
writer Karen Joy Fowler—is vague, a physics explored through
metaphor. But Le Guin’s depiction of a scientist caught between
opposing, utterly convincing worlds remains thrilling in its
precision, at times even frightening.

On the collectivist planet Anarres, a desert landscape ravaged by

famine, Shevek’s search for a General Temporal Theory is thwarted
by scientist-bureaucrats who are concerned his discoveries might
prove counterrevolutionary. After engineering a diplomatic escape
to lush Urras, funded by capitalist plenty, Shevek learns that his
work is viewed as proprietary—a product. This perspective
changes him. Shevek finds himself behaving like the patriarchal
“propertarians” of Urras. Drunk and lonely, this gentle man whose
language has no possessive pronouns seizes a woman as if she is
his. It’s an act that later disgusts him—and sets him on a
revolutionary course that will affect all the worlds that humanity
has reached.

Le Guin, who died in 2018, leaves it to readers to make what they

will of this shift. The arrow of time has sped forward since 1974,
but the circles and cycles of Le Guin’s masterpiece continue to
suggest, with urgent humanity, both present and future.

Alan Scherstuhl is a reviewer and editor who covers books for a variety of publications and jazz for
the New York Times.

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Book Review: Inside the Global Movement to
Protect Forests from Climate Change

Lessons from the people making forest ecosystems more resilient

By Lyndsie Bourgon

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Treekeepers: The Race for a Forested Future

by Lauren E. Oakes.
Basic Books, 2024 ($30)

At the start of Treekeepers, Lauren E. Oakes recalls the feverish

response to a 2019 study published in Science that claimed Earth
could sustain 1.2 trillion new trees. Oakes—an ecologist and
journalist—had spent more than a decade studying old-growth
forests, and as she watched scientists debate the importance of tree
planting in mitigating climate change, she found herself wanting to
answer that question. Treekeepers is an ambitious memoir of
Oakes’s boots-on-the-ground research under old-growth canopy
and a rigorous exploration of forests and climate change. Most of
all, it’s a hopeful profile of the people working to restore, retain
and nurture strong forests.
Lyndsie Bourgon is an oral historian, a 2018 National Geographic Explorer and author of Tree
Thieves: Crime and Survival in North America’s Woods. She is based in Halifax, Nova Scotia.

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Climate Change
Kyoto Tells Us How Humanity Can Come
Together on Climate Change
A play celebrates the agreement that opened nations worldwide to accepting the science of
climate change

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Kyoto Tells Us How Humanity Can Come

Together on Climate Change

A play celebrates the agreement that opened nations worldwide to

accepting the science of climate change
By Ben Santer

Getting Kyoto ready for its world premiere in London this past summer.
Manuel Harlan/RSC

It’s a very strange experience to watch a play in which you are a

character—and to shake hands with the person who plays you. I did
both this past July while attending a performance of Kyoto at the
Swan Theater in Stratford- upon-Avon in England. The moment
meant more, of course, than just a glimpse of oneself on history’s
stage. The play shows how science won out over climate denial in a
critical face-off between scientists and industry over the future of
the planet.

Kyoto is about the Kyoto Protocol, an agreement made more than

25 years ago that, as summarized by the United Nations, committed
“industrialized countries and economies in transition to limit and
reduce greenhouse gases (GHG) emissions in accordance with
agreed individual targets.” Written by Joe Murphy and Joe
Robertson, the play provides a dramatic retelling of a historic
meeting in December 1997 in Kyoto, Japan, where the protocol
was finalized.

At this meeting, a key Intergovernmental Panel on Climate Change

(IPCC) scientific assessment helped to inform the international
emissions-reduction negotiations—the Working Group I part of the
IPCC Second Assessment Report, which was completed in 1995
and published in early 1996. I was convening lead author of
chapter eight, “Detection of Climate Change and Attribution of
Causes.” The role of the IPCC, back in 1995 and today, was to
advise the governments of the world on the science and negative
impacts of climate change, as well as on strategies for mitigating
and adapting to those impacts.

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In 1990 the first IPCC scientific assessment had concluded that the
jury was still out on whether a human-caused climate change signal
could be identified in real-world climate data. The 1995
assessment’s chapter reached a very different conclusion,
encapsulated in 12 simple words: “The balance of evidence
suggests a discernible human influence on global climate.” This
was a momentous statement from cautious scientists and a rather
conservative organization.
Multiple factors contributed to this dramatic transition. Advances in
the science of climate fingerprinting, for example, made a big
difference in climate research during the five years between the two
reports. Fingerprinting seeks to identify the unique signatures of
different human and natural influences on Earth’s climate. This
uniqueness becomes apparent if we probe beyond a single number
—such as the average temperature of Earth’s surface, including
land and oceans—and look instead at complex patterns of climate
change. Patterns have discriminatory power and allow scientists to
separate the signature of human-caused fossil-fuel burning from the
signatures of purely natural phenomena (such as El Niño and La
Niña climate patterns, changes in the sun’s energy output, and
effects of volcanic eruptions).

Kyoto describes some of the fingerprint evidence that was

presented during a key meeting in Madrid in November 1995,
ahead of the Kyoto face-off dramatized in the performance. The
“discernible human influence on global climate” conclusion was
finalized in Madrid, where the participants included 177 delegates
from 96 countries, representatives from 14 nongovernmental
organizations, and 28 lead authors of the IPCC Second Assessment
Report.
 Ben Santer (left) in conversation with Dale Rapley (right), the actor playing Ben Santer in Kyoto.
David Morley

As a lead author of the evidence chapter, I was there among them

in that Madrid plenary room. So were several of the other
characters in Kyoto, including the play’s central one: Donald
Pearlman, who was a lawyer and lobbyist for the Climate Council,
a consortium of energy interests.

Pearlman and I were on opposite sides of the Madrid chessboard.

My efforts were directed toward synthesizing and assessing
complex science and ensuring that the science was accurately
represented in the IPCC report. His were directed toward delaying
international efforts to reduce emissions of heat-trapping
greenhouse gases. Such reductions were bad for the business
interests he represented and for the revenues of oil-producing
countries such as Saudi Arabia and Kuwait.

Pearlman, who died in 2005, understood the singular importance of

the Madrid “discernible human influence” conclusion. He knew it
was the scientific writing on the wall. The jury was no longer out.
Human-caused fingerprints had been identified in records of
Earth’s surface and atmospheric temperatures. Humans were not
innocent bystanders in the climate system; they were active
participants. Burning fossil fuels had changed the chemistry of
Earth’s atmosphere, thereby warming the planet and sending
Earth’s vital signs into concerning territory. The Madrid conclusion
meant the days of unfettered fossil-fuel use and carbon pollution
were numbered.

It also made Pearlman’s lobbying job more difficult. His response

was to attack the science and the scientists as part of a rearguard
action to delay international agreement on reducing greenhouse gas
emissions. As Pearlman’s character explains in Kyoto, it was a
deliberate “scorched-Earth” strategy: torch the science and the
scientists.

I experienced this strategy firsthand in a memorable personal

meeting with Pearlman in Washington, D.C., on May 21, 1996.
After I spoke at the U.S. Congress’s Rayburn House Office
Building about the scientific evidence for human fingerprints on
global climate, Pearlman confronted me and started screaming at
me—literally screaming. He expressed outrage at what he claimed
were unauthorized changes to the chapter I had been responsible
for. The changes had in fact been authorized by the IPCC, as
Pearlman knew very well. He had been present at the Madrid
meeting where the changes were discussed.

Ultimately he lost. Despite tremendous differences among

countries in terms of their national self-interest, culpability for the
problem of human-caused climate change, and vulnerability to the
effects of climate change, an international agreement was finally
reached. The 1997 Kyoto Protocol commits participating countries
to a common goal: reducing greenhouse gas emissions and
avoiding “dangerous anthropogenic interference” in Earth’s climate
system. Kyoto is the dynamic story of how that agreement was
achieved.

In one memorable line in the play, Pearlman’s wife, Shirley, asks

him, “Are we on the wrong side?” The question is prompted by an
exposé of Pearlman’s lobbying activities in the German news
magazine Der Spiegel. Shirley wants to know whether her
husband’s efforts to cast doubt on the climate-change science—and
on the scientists involved in advancing that science—place them on
the wrong side of history. The Pearlman character in the play
responds, “No, Shirley. We’re not on the wrong side.”

But Pearlman and the industries he represented were on the wrong

side of the science. Nearly 30 years after the Madrid IPCC meeting
and after Pearlman’s concerted efforts to undercut climate science,
human fingerprints on Earth’s climate are now unequivocal and
ubiquitous. The cautious 1995 “discernible human influence”
finding has been confirmed and strengthened by all four subsequent
IPCC assessments. The scientists in Madrid got it right.

Pearlman and his employers were also on the wrong side of history.
Today 191 countries have ratified the Kyoto Protocol. Although the
U.S. Congress never did ratify it, the protocol helped to pave the
way for the 2016 Paris Agreement. The serious consequences of
human-caused global warming are now manifest to all, building
momentum for real action to cut carbon pollution. The days of
climate science denial are numbered.

But they are not quite over yet. Another Donald—former president
Donald Trump—has repeatedly denied the reality and seriousness
of climate change. It’s no surprise that his backers look a lot like
Pearlman’s. There is a very small probability that Trump will ever
watch Kyoto. There’s an even smaller probability that Trump will
consider whether he, too, is on the wrong side of science and
history.

Sadly, he is. Trump’s return to the U.S. presidency would reprise

Pearlman’s heyday, when manufactured doubt obscured mature
scientific understanding. Kyoto tells the story of how that scientific
understanding evolved and how powerful vested interests tried to
destroy it. It is absolutely vital to give that account today, with the
bill for climate change coming due all around us.

I hope Kyoto reaches audiences I could never dream of reaching

through all the scientific papers I’ve ever written. And I hope it
provides us with what mathematicians call an existence principle—
proof that something difficult is possible. The existence principle in
Kyoto is that humanity can come together and solve a seemingly
intractable problem.

This is an opinion and analysis article, and the views expressed by

the author or authors are not necessarily those of Scientific
American.
Ben Santer is a climate scientist and a John D. and Catherine T. MacArthur Fellow. From 1992 until
his retirement in 2021, Santer pursued research in climate fingerprinting at Lawrence Livermore
National Laboratory in California. He served as convening lead author of chapter eight of the
Intergovernmental Panel on Climate Change’s (IPCC’s) Second Assessment Report (“Detection of
Climate Change and Attribution of Causes”) and was a contributor to all six IPCC scientific
assessments.

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Communications
Contrary to Occam’s Razor, the Simplest
Explanation Is Often Not the Best One
Occam’s razor holds that the simplest explanation is closest to the truth. But the real world is
quite complex

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Contrary to Occam’s Razor, the Simplest

Explanation Is Often Not the Best One

Occam’s razor holds that the simplest explanation is closest to the

truth. But the real world is quite complex
By Naomi Oreskes

Scott Brundage

If you’ve ever hung around scientists, you’ve most likely at some

point heard one of them say “the best explanation is the simplest
one.” But is it? From the behavior of ants to the occurrence of
tornadoes, the natural world is often quite complex. Why should we
assume the simplest explanation is closest to the truth?

This idea is known as Occam’s (or Ockham’s) razor. It’s also

referred to as the “principle of parsimony” or the “rule of
economy.” And it bears a family relationship to the “principle of
least astonishment,” which holds that if an explanation is too
surprising, it’s probably not right. But real life is often messy and
complicated, and, as every good detective novelist knows,
sometimes the killer is the one you least expect.

Let’s start with some evidence about the idea itself. The name
comes from William of Ockham, a 14th-century scholastic
philosopher and theologian who formulated the principle in Latin:
pluralitas non est ponenda sine necessitate, rendered in English as
“entities should not be multiplied beyond necessity.” The point was
an ontological argument dating back at least as far as Aristotle’s
time about entities: What exists in the world? How do we know
they exist? The philosophical claim is a form of ontological
minimalism: we should not invoke entities unless we have evidence
that they exist. Even if we are sure things exist—say, comets—we
should not invoke them as causal agents unless we have evidence
that they cause the kinds of effects we are assigning to them. In
other words: don’t make stuff up.

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In 1687 Isaac Newton expanded on this notion with his concept of

a vera causa—a true cause—when he wrote in his best-known
work, the Principia Mathematica, “We are to admit no more causes
of natural things than such as are both true and sufficient to explain
their appearances.” He continued: “To this purpose, the
philosophers say that Nature does nothing in vain, and more is in
vain when less will serve; for Nature is pleased with simplicity, and
affects not the pomp of superfluous causes.”
Newton was one of the greatest scientists of all time, but if we stop
to think about it, this claim is a peculiar one. Who is to say what
“pleases nature”? And doesn’t this guidance assume we know what
we are in fact trying to figure out?

Consider the work of astronomer Vera C. Rubin, who found

compelling evidence for the existence of dark matter. While
studying the motion of spiral galaxies, Rubin discovered that the
speed at which stars rotated around the center of their galaxies
made sense only if these galaxies contained an additional mass
weighing about 10 times more than the visible stars. The claim of a
new form of “dark” matter—unseen and unseeable and present in
far greater quantities than the visible matter of the universe—was
not a simple explanation, but it turned out to be the best
explanation.

Physics is filled with explanations that are surprising, unexpected

and hard to get your head around. Newton explained light as being
made of particles, whereas other scientists of his era explained it as
a wave. Quantum mechanics, however, tells us that light is, in some
respects, both a wave and a particle. Newton’s account was
simpler, but modern physics tells us that the more complex model
is closer to the truth.

When we turn to biology, things get even more complicated.

Imagine two smokers, both of whom went through a pack a day for
30 years. One gets cancer; the other does not. The simplest
explanation? For decades the tobacco industry’s answer was that
smoking doesn’t cause cancer. Simple but false. The correct answer
is that disease is complex, and we don’t yet understand all the
factors involved in carcinogenesis.

And then there’s the vexing question of how we define simplicity.

Consider the ongoing debate over the origin of the COVID
pandemic. On the side of the lab-leak theory—that the SARS-CoV-
2 virus escaped from a facility rather than being transmitted from
wild animals to humans—some commentators have invoked
Occam’s razor. But it’s not obvious that this theory is simpler. One
could argue the reverse: given that most past pandemics had a
zoonotic origin, the simpler explanation is that this pandemic did,
too.

Occam’s razor is not a fact or even a theory. It’s a metaphysical

principle: an idea held independently of empirical evidence. (Think
“God is love” or “beauty is truth.”) But unless we are prepared to
make assumptions about God and nature, there is no good reason
that we should prefer a simpler explanation to a complex one.
Moreover, in human affairs things are more often than not
complex. Human motivations are typically multiple. People can be
good and bad at the same time, selfish and selfless, depending on
circumstances. The shelves of ethicists are filled with books
pondering why good people do bad things, and their answers are
rarely short and sweet.

In 1927 British geneticist J.B.S. Haldane wrote in his essay

“Possible Worlds” that “the universe is not only queerer than we
suppose, but queerer than we can suppose.” There are, in fact, new
things under the sun, and rare events may be rare precisely because
they involve a complex confluence of events. Put this way, we can
see Occam’s razor as simply a failure of imagination.

Our explanations should match the world as best as we can make

them. Science is about letting the chips fall, and sometimes this
means accepting that the truth is not simple, even if it would make
our lives easier if it were.

This is an opinion and analysis article, and the views expressed by

the author or authors are not necessarily those of Scientific
American.
Naomi Oreskes is a professor of the history of science at Harvard University. She is author of Why
Trust Science? (Princeton University Press, 2019) and co-author of The Big Myth (Bloomsbury,
2023).
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Culture
Lucy Turns 50, and Dark Energy Gets More
Mysterious
What works to improve health equity? And it might be time to end the leap second

Contributors to Scientific American’s

November 2024 Issue
Writers, artists, photographers and researchers share the stories behind the stories

Readers Respond to the June 2024 Issue

Letters to the editors for the June 2024 issue of Scientific American

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Lucy Turns 50, and Dark Energy Gets More

Mysterious

What works to improve health equity? And it might be time to end

the leap second
By Laura Helmuth

Scientific American, November 2024

Something strange is happening with dark energy. What little we

know about it is strange enough: “Dark energy” is the name for an
unknown force that is causing the universe to expand faster all the
time. Nobody has been able to detect dark energy directly; we can
only measure its effects. And one of those measurements is a little
... off. The Hubble constant describes how quickly the universe is
expanding. Physicists estimate its value in the nearby universe by
measuring distances to supernovae.

The problem is that these estimates for the Hubble constant don’t
match what the standard model of cosmology predicts based on
patterns in the cosmic microwave background, the glow left over
from the early universe. The discrepancy has gotten more
pronounced (and less likely to be a measurement error) in the past
few years with more precise observations from the James Webb
Space Telescope, building on those from the Hubble Space
Telescope.

So has dark energy changed over the course of the universe? Did an
additional “early dark energy” force give the universe some extra
oomph immediately after the big bang? Theoretical physicist Marc
Kamionkowski and astrophysicist Adam G. Riess have been
working on this “Hubble tension” problem from the beginning.
They explain the problem and possible solutions as clearly and
entertainingly as I’ve ever seen (as always, great graphics help).

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The Australopithecus afarensis fossil fondly known as Lucy is one

of the most important discoveries in the study of human origins.
She was found 50 years ago and quickly changed our
understanding of how we became human. Her discoverer, Donald
C. Johanson, and paleoanthropologist Yohannes Haile-Selassie,
who has discovered many other crucial hominin ancestors, share
what we’ve learned about the evolution of human brains, gait,
habitats and diets by studying these precious fossils.

Earth’s daily rotation has slowed down over time; when dinosaurs
roamed the planet, a day lasted just 23.5 hours. This consistent
slowing is mostly because of friction. The gravitational pull of the
moon causes ocean tides, and the friction of the oceans sliding
across the seafloor slows the entire system. Inside the planet,
currents in the liquid outer core are now slightly increasing our
rotational speed. And global warming is changing the dynamics of
Earth’s rotation as well, as water from melting ice moves from the
poles toward the equator. It’s a mess. We have added “leap
seconds” over the years to synchronize atomic clocks with Earth’s
changing rotation. Senior editor Mark Fischetti, working with
infographic designer Matthew Twombly, asks if it’s time to just let
clock time and planetary time drift apart.

Vaccines delivered through a puff up the nose or into the mouth

could be even more effective than shots at protecting people from
respiratory diseases (plus, no needles). Science journalist Stephani
Sutherland covers the progress that is being made on nasal vaccines
and the reasons scientists are so hopeful about them.

We’re publishing our third annual special package on health equity

in this issue, with a focus on solutions. Here are some highlights:
Vaccines are among the most lifesaving interventions in the history
of humanity. People working in rural areas have come up with
innovations that have improved medical care for all.
Disaggregating data improperly lumped together can save lives.
Medical devices and algorithms are being corrected for historical
biases. And we talked to several experts in global health about what
gives them hope for the future. We hope the collection is inspiring
—it has been for us at Scientific American.
Laura Helmuth is editor in chief of Scientific American. She previously worked as an editor for the
Washington Post, National Geographic, Slate, Smithsonian and Science. She is a former president of
the National Association of Science Writers. She is currently a member of the National Academies of
Sciences, Engineering, and Medicine's standing committee on advancing science communication and
an advisory board member for SciLine and The Transmitter. She has a Ph.D. in cognitive
neuroscience from the University of California, Berkeley. She recently won a Friend of Darwin
Award from the National Center for Science Education. Follow her on Bluesky
@laurahelmuth.bsky.social

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Contributors to Scientific American’s November

2024 Issue

Writers, artists, photographers and researchers share the stories

behind the stories
By Allison Parshall

Miriam Quick and Duncan Geere.

Tom Allan

Duncan Geere and Miriam Quick

Graphic Science

On their podcast, Loud Numbers, Miriam Quick and Duncan Geere

(above) turn data into music. There’s a techno track charting
climate change, a fugue about European bureaucracy, an
experimental epic about beer tasting, and more. “You get to ride the
waves of the data, moment to moment, in a much more emotionally
resonant way” than looking at a graph, Geere says.

As data journalists and storytellers, they use both sonification and

visualization to make complex information understandable to our
ears and eyes. For this issue’s column on music evolution, with text
by associate news editor Allison Parshall, Quick and Geere were
challenged to represent a song as a visual graph. Quick studied
music-performance styles for her Ph.D. in musicology, so she has
experience using data to “understand the music in a different way,”
as she puts it. Geere, who came to data journalism from an earth
sciences background, is also passionate about music; he DJs and
plays in bands.

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discoveries and ideas shaping our world today.

Their graphic uncovers and maps key similarities among pieces of

traditional music from all over the planet. “It suggests that music,
or song specifically, occupies a stable position across cultures,”
Quick says—that is, we humans sing for a common reason.

Luisa Jung
Solutions for Health Equity

Early in her career as an architect, Luisa Jung realized something

was missing. “The world of ideas, of images,” was what she loved
the most, she says—but not so much turning those ideas into
buildings. Jung had moved from Argentina to Germany and was
captivated by the illustrations in her new country’s newspapers. So
she began building a portfolio of her work. “At first I was kind of
afraid to draw, so my style was collage,” she says, but soon she was
dabbling in watercolor and then woodblock printing.

Now an illustrator, Jung lives happily in the world of ideas and

metaphor. In this issue’s special report on innovations in health
equity, her illustrations give form to concepts that can be hard to
visualize, such as cultural competency and data disaggregation, but
that nonetheless have real consequences for people’s health. These
kinds of visual metaphors—representations such as an hourglass of
mpox and data as a curtain that can obscure reality—come to her
naturally. “It’s the way my brain works,” she says. Jung aims to
“represent complex topics in a way that is also kind of poetic.”

Stephani Sutherland
No More Needles

Health journalist Stephani Sutherland has long been fascinated by

pain; it was the subject of her Ph.D. research. “You can’t survive
very well without it, but if you have chronic pain, it can become
really debilitating,” she says. So when COVID began causing
painful, long-term illness and neurological symptoms, she paid
close attention. This condition, called long COVID, is an example
of something scientists began to fully understand only in the past
few decades. “The nervous system and the immune system are not
separate like we were once taught,” Sutherland says.

The connection between chronic pain and the immune system has
since sparked her interest in immunology. Sutherland’s feature in
this issue explores a type of needleless vaccine that goes in the
nose, not the arm, and could one day provide better immunity to
infectious diseases. Nasal vaccines aren’t a reality for everyone yet
—“we’re in early days,” Sutherland says. But they could be safer to
administer in places with poorer access to medical equipment and
even at home. And because they provide immunology inside the
nose itself, “you can nip the virus in the bud right where your body
encounters it,” she says. “That seems really powerful to me.”

Jyoti Madhusoodanan
Defogging Data
Nineteen years ago Jyoti Madhusoodanan moved from
Ahmedabad, India, to Buffalo, N.Y., to complete a Ph.D. in
microbiology. That was when she started having to check a box on
forms to indicate her race—and found that the entirety of Asia and
the Pacific Islands was lumped into a single category. She recalls
thinking, “Asia is massive! How is this helpful to anyone?” The
issue remained on her mind for years as she moved from New York
to the West Coast and began her career as a science journalist
covering health.

As Madhusoodanan lays out in her article for our special report on

innovations in health equity, this giant category is used all the time
in medicine and health research—and not only is it unhelpful, as
she initially suspected, but it does harm. This pooling of data hides
important signals that could be used to save lives. In recent years
this practice has finally begun to change, a mark of progress that
“has been painfully won by people of these communities that have
been invisible,” Madhusoodanan says. Everyone she spoke with for
the story “had a deep, deep personal connection to fixing this.”
Allison Parshall is an associate news editor at Scientific American who often covers biology, health,
technology and physics. She edits the magazine's Contributors column and weekly online Science
Quizzes. As a multimedia journalist, Parshall contributes to Scientific American's podcast Science
Quickly. Her work includes a three-part miniseries on music-making artificial intelligence. Her work
has also appeared in Quanta Magazine and Inverse. Parshall graduated from New York University's
Arthur L. Carter Journalism Institute with a master's degree in science, health and environmental
reporting. She has a bachelor's degree in psychology from Georgetown University. Follow Parshall
on X (formerly Twitter) @parshallison

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Readers Respond to the June 2024 Issue

Letters to the editors for the June 2024 issue of Scientific American
By Aaron Shattuck

Scientific American, June 2024

BEAR IN MIND

“A Grizzly Question,” by Benjamin Cassidy, reports on plans to

reintroduce grizzly bears to the North Cascades and on concerns
people have raised about their communities’ safety. The situations
presented in the article are common to many reintroduction
activities. One part of this is fear of change. Another might be
shortsighted self-concern. The reaction is understandable but
questionable.

I’ve watched many people going into the Yellowstone backcountry,

and the common theme has been trepidation. The environment
creates an uncomfortable awareness that one, as a person, is not top
dog. To have close encounters with formidable creatures is a
serious education in one’s position in the wilderness—a lesson that
most people cannot abide. This was a factor in the near extinction
of grizzlies in the lower 48 states and is a factor in human
resistance to their presence.

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DIRK WINDOLF VIA E-MAIL

RNA WORLD

“The New Code of Life,” by Philip Ball, describes some of the

types and functions of noncoding RNAs (ncRNAs) found in human
cells and notes that “ncRNAS seem to point to a fuzzier, more
collective, logic to life.” One possible connection was not
mentioned, however: the “RNA world” hypothesis.

Under this concept, an early proto-life-form used RNA both for its
enzymatic activities and as its genetic material. Even after
evolution replaced this diverse use of RNAs with the specialist
molecules of DNA and proteins, RNAs might still retain many
functions as a remnant of their earlier roles. So the many ncRNAs
that carry out diverse functions could reflect some aspect of an
earlier RNA world.

SCOTT T. MEISSNER VIA E-MAIL

HISTORICAL ELEMENTS
“Superheavies,” Stephanie Pappas’s article about superheavy
elements, reminded me of a series of articles on “The Synthetic
Elements,” by Glenn T. Seaborg and his associates, that were
published in Scientific American in April 1950, December 1956,
April 1963 and April 1969. In the first article, Seaborg and his co-
author started with the synthesis of four elements that had been
“missing” from the periodic table and then continued with accounts
of how five elements beyond uranium were produced in the
laboratory. The series updated every few years as the number of
synthesized elements grew. Seaborg paid particular attention to the
difficulty in obtaining large enough samples to assess their
chemical properties. He shared the 1951 Nobel Prize in Chemistry
for his work on synthetic elements, and element 106 was named
seaborgium in his honor during his lifetime.

“The environment creates an uncomfortable awareness that

one, as a person, is not top dog.”

—Dirk Windolf Via E-Mail

I wasn’t around when the original articles were published in the

1950s, but my high school physics teacher had a file of old SciAm
material that he shared with me. It included articles by Erwin
Schrödinger, Albert Einstein, George Gamow, Fred Hoyle and
other notables. My teacher said I could take whatever I wanted, so I
took the whole file and still have it in my library.

BRUCE A. BOYD ST. LOUIS, MO.

COOL ALLUSION

“Alien Ice,” by Elise Cutts [Advances; April], reports on

experiments performed by physical chemist Christina Tonauer and
her colleagues that involved ice XIV, a type of “ordered ice” with
ordered hydrogen atoms that can be created within days. I’m
curious: Did the researchers skip ice IX? I guess avoiding the name
would be like skipping floor 13 in a hotel, given the destructive
power of the fictional substance “ice-nine” in Kurt Vonnegut’s
1963 Cat’s Cradle. I have no desire for all the liquid in my body to
become solid, as happened to characters who got ice-nine in their
mouth in the novel, so I hope these scientists are up on their
literature.

COLIN MILDE MAHWAH, N.J.

TONAUER REPLIES: There is a real ordered ice called ice IX that

we didn’t include in our study. We didn’t skip it for the fear of the
effects of the fictitious ice-nine envisioned by Vonnegut. In fact,
there was a scientific reason. The formation process of most
ordered ices has a significant kinetic barrier: even though the
ordered ice structure should be favored, according to
thermodynamics, the process is very slow compared with
laboratory timescales. Our study reported new synthesis strategies
for overcoming that barrier and ordering ices faster. Real ice IX,
on the other hand, is an outlier of that rule because it starts
ordering at the relatively high temperature of 208 kelvins. In
Olympic terms, it wins a gold medal in the “ordering race” of ice
polymorphs, so we did not consider it in our study.

HELPING TEENS COPE

“Treating the Anxious Teen,” by BJ Casey and Heidi Meyer, shines

a light on advances in the basic clinical science work on addressing
fear conditioning. Although this work is important, as respectively
current and retired professors of psychology, we would like to note
that such optimism is not uniform in the field. In a 2023 review in
the journal Behavior Research and Therapy, psychologist Ronald
M. Rapee and his colleagues state that when it comes to the
effectiveness of cognitive-behavioral therapy in children and
adolescents, “there remains substantial room for improvement.”
One of the issues is that children’s needs are different from those of
adults. When children and adolescents are being treated, their
developmental status regarding emotional self-regulation and
cognition must be taken into account. Therapeutic practices
developed with adults can have contradictory effects with children.
For example, adults find that fear interferes with their ability to
follow through with functional routines. Remove the fear, and
adults can resume functionality. Children and teens are still
learning what functional routines are, so they need opportunities to
practice healthy, functional behavior patterns tailored to the kinds
of experiences they have outside of the therapy office. Novel
interventions that are quite different from standard cognitive-
behavioral therapy have shown promise.

ERICA KLEINKNECHT O’SHEA FOREST GROVE, ORE.

RONALD KLEINKNECHT BELLINGHAM, WASH.

ERRATA

“Homeschooling Needs More Uniform Oversight,” by the Editors

[Science Agenda], incorrectly described the 11-year-old boy who
was found dead in 2020 as located in Michigan. His family had
moved from that state to California a few months prior.

“The End of the Lab Rat?,” by Rachel Nuwer [September], should

have said that outside researchers have used Emulate’s chips to
create more than 30 additional models with cells from their labs,
not about 70 such models.

In “What If We Never Find Dark Matter?,” by Tracy R. Slatyer and

Tim M. P. Tait [September], the opening illustration should have
been credited to Olena Shmahalo.

“Nobel Connections,” by Sarah Lewin Frasier and Jen Christiansen

[Graphic Science; October], should have referred to Nobel laureate
Giorgio Parisi.
Aaron Shattuck is a senior copy editor at Scientific American.

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Economics
Basic Income Gives Money without Strings.
Here’s How People Spend It
Pilot programs across the U.S., including new research funded by OpenAI, offer a glimpse of
how a universal basic income could improve lives

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Basic Income Gives Money without Strings.

Here’s How People Spend It

Pilot programs across the U.S., including new research funded by

OpenAI, offer a glimpse of how a universal basic income could
improve lives
By Allison Parshall

Shideh Ghandeharizadeh

In 2020, amid widespread layoffs and economic turmoil brought on

by the COVID pandemic, 1,000 low-income people in Texas and
Illinois won something of a lottery. They were selected to receive
$1,000 per month—with no strings attached—for three years as
part of a study on guaranteed income by OpenResearch, a nonprofit
research organization funded in part by OpenAI and its founder,
Sam Altman.

Silicon Valley philanthropists are just one piece of a growing

movement for using basic income to improve people’s lives. In
recent years the Stanford Basic Income Lab and the Center for
Guaranteed Income Research have been tracking 30-plus pilot
programs that have tested basic income in towns and cities across
the U.S.
“There’s a long history of interest in basic income in the United
States,” says Sara Kimberlin, executive director of the Stanford
Center on Poverty and Inequality. Founding father Thomas Paine
advocated for it in The Rights of Man. Martin Luther King, Jr.,
called it the solution to poverty. Even economist and free-market
capitalist Milton Friedman suggested basic income in the form of a
“negative income tax.”

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When people receive unconditional cash, they tend to use the

money in ways that increase their financial security and housing
stability, Kimberlin says, pointing to a “large body of research.”
Those observations line up with the most recent results from
OpenResearch, which showed that participants increased spending
to meet their basic needs and to help family and friends. A separate
study published online in July in the Journal of the American
Medical Association also found that cash benefits reduced
emergency room visits.

"Cash is flexible. It gives people a lot of dignity and autonomy

in deciding how they are going to use it."

—Sara Kimberlin

Taken as a whole, the evidence suggests that when people’s most

basic needs are met, they start to build a firmer financial foundation
for themselves and their family. Scientific American spoke with
Kimberlin to learn more about these basic-income pilot programs
and how this unconditional, guaranteed aid improves people’s
lives.

An edited transcript of the interview follows.

What is the promise of basic income?

A key problem that basic income or guaranteed income is designed

to address is the significant share of people and families who don’t
have enough resources to be able to meet their essential needs. And
we have a lot of research that shows the challenges that arise from
struggling to meet your basic needs. For example, if you don’t have
access to stable, safe housing, health care or food, that interferes
with your ability to be a productive worker or to take care of your
family. And if you’re a child, that interferes with your ability to
concentrate in school.

On the flip side, there’s a lot of research showing the positive

things that happen when a policy ensures people’s needs can be
met. It shows that when food stamps are introduced in a particular
area, the outcomes for the families improve. Other research shows
that children whose families received the Earned Income Tax
Credit when they were young had more positive long-term
educational outcomes, which translated to stronger financial
security later in life.

Why provide cash, as opposed to food stamps or rent

assistance?

Cash is flexible. People can use it to meet whatever their most

pressing need may be. It’s an efficient way of addressing people’s
needs, and it also gives people a lot of dignity and autonomy in
deciding how they’re going to use it. It helps to avoid situations
where someone may already have resources designated to pay for
food but needs, for example, emergency child care. If they don’t
get it, then they can’t get to their job, which could cause a lot of
disruption down the line by making them miss a paycheck, then
miss the rent. You can look at unconditional cash as a potentially
very promising way of approaching social support because it
streamlines the administrative costs and makes it easier for people
to access the support they are eligible for.

What stood out for you about the new findings from
OpenResearch?

It’s a very large study, and it’s well designed and well funded. It
studied a fairly broad, more representative population, rather than
being targeted to a specific group such as parents of young
children, which meant there was a lot of variation in the outcomes.

It wasn’t surprising that the study found the most common uses of
the funds were to cover basic needs such as housing, food and
transportation. This is something we see consistently across
guaranteed-income pilots that are tracked on the Guaranteed
Income Pilots Dashboard on the Stanford Basic Income Lab
website.

Something that stood out for me was the significant increase in

people spending money to help their friends and family. That struck
me because it means there are some effects of this program that are
not fully captured in the results. If a participant is saying, “Oh, my
cousin called me because her husband lost his job, and they can’t
make their rent this month, and I gave her some money so her
family wouldn’t get evicted”—outcomes like that wouldn’t be fully
captured in the participant data. There’s a ripple of positive effects
that are going out beyond the direct recipient.

People who received the cash worked an average of one hour

less per week and were 2 percent less likely to be employed
than people in a control group that received $50. What does
that tell you?
People wonder: Does receiving unrestricted cash mean people are
going to just stop working? How would that affect the labor
market? There have been different findings across different studies.
Some have shown somewhat increased employment. You can
imagine how that’s possible. If receiving a basic income allows you
to repair your car so that it’s reliable or pay for child care, that
might make it more possible for you to get a job. There have also
been studies that have shown no significant impact on employment.

And then there have been studies that show some reductions in
employment or in number of hours worked compared with a
control group. That’s what was found in these OpenResearch
results.

One important piece of context here is that this study, along with
many of the studies in this recent crop of guaranteed-income pilots,
took place in the unusual economic setting of the pandemic.
Unemployment was very high across the entire U.S. in both the
treatment and the control group at the beginning of this study. Over
the course of the three years lots of people in both groups went out
and got jobs as more jobs became available again—overall,
employment and hours worked increased in both groups, but they
increased less in the group receiving $1,000.

Many of the drivers that might cause somebody to work less when
they receive a basic income could be seen as positive outcomes in
other ways. For example, single parents or parents of young
children might work fewer hours to spend more time directly
caring for their children.

Is just giving people money really a viable solution to poverty?

Basic income, particularly at this scale that has been studied, is not
a cure-all or magical solution to poverty. Access to health care,
schooling, child care and affordable housing are still needed. I
think it makes sense to think about basic income as a promising
intervention that complements other parts of the social safety net.
Unrestricted cash has a lot of power to be able to fill in places
where the safety net is inadequate.

What are some open questions about the impacts of basic

income that you hope more research will answer?

It’s really important to study how these programs work for different
groups of people. There are different pilots focused on specific
populations, such as people aging out of foster care, people
experiencing domestic violence or people reentering society after
incarceration. Understanding how it works for different groups is
helpful for designing programs and policies.

And a critical question is: What are the long-term effects of these
programs, in particular on people’s health? A three-year study can’t
address health problems that have developed over people’s lifetime.
But if you had a long-term program in place, would you see
different effects on people’s health, such as on chronic health
conditions? And studying the potential effects of these programs on
children’s long-term trajectories is very important. Some of those
outcomes are not measurable yet, but they may be quite
consequential for the people who receive the money and may ripple
out to their families and communities.
Allison Parshall is an associate news editor at Scientific American who often covers biology, health,
technology and physics. She edits the magazine's Contributors column and weekly online Science
Quizzes. As a multimedia journalist, Parshall contributes to Scientific American's podcast Science
Quickly. Her work includes a three-part miniseries on music-making artificial intelligence. Her work
has also appeared in Quanta Magazine and Inverse. Parshall graduated from New York University's
Arthur L. Carter Journalism Institute with a master's degree in science, health and environmental
reporting. She has a bachelor's degree in psychology from Georgetown University. Follow Parshall
on X (formerly Twitter) @parshallison

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Extraterrestrial Life
Nope—It’s Never Aliens
Claims of alien starships visiting Earth always fall short, but people still fall for them

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Nope—It’s Never Aliens

Claims of alien starships visiting Earth always fall short, but

people still fall for them
By Phil Plait

A GOFAST video still shows a U.S. Navy F/A-18 jet crew’s encounter with an unexplained
anomalous phenomena, or UAP. (The appearance of U.S. Department of Defense visual information
does not imply or constitute an endorsement.)
U.S. Department of Defense

I grew up believing in UFOs. I watched every TV show about

aliens, spaceships, and aliens in spaceships. I voraciously read
magazines and books on the topic, credulously soaking up
everything I saw and believing it wholeheartedly because, after all,
if someone published a book saying these things are real, they must
be real, right?
Right?

Over the years, though, I took up science as a career and critical

thinking as a passion. Gradually I looked back at all the
information I had taken in as a kid and realized it was
overwhelmingly baloney. It was just scads and scads of nonsense:
bad photography, sketchy witnesses, wild speculation and
evidence-free claims. That was more than 30 years ago. Sadly,
nothing’s changed.

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In this modern age, we don’t call them UFOs anymore; now they’re
UAPs, for unidentified aerial (or anomalous) phenomena. I can’t
help but think that’s to distance the idea from the old “flying
saucers” stigma. But no matter what you call them, it’s all still just
the same breathless headlines and lack of substance behind them.
There’s no there there. Still, we’ve been so primed by so many
stories of alien visitations over the years that even the thinnest of
testimony gets reported far beyond its merit.

One of the more recent blips on the extraterrestrial radar is a

collection of videos declassified by the U.S. Department of
Defense that contain what are purported to be UAPs—true by
semantics if not by implication. Taken from F/A-18 Super Hornet
fighter jets using visible light and infrared cameras, three videos in
particular—called FLIR, GOFAST and GIMBAL—show small
objects moving at terrific speeds, whirling like the spaceships in
Close Encounters of the Third Kind and apparently following the
planes as if piloted. FLIR was filmed in 2004, and GOFAST and
GIMBAL are from January 2015.

These videos made quite a splash in 2017, especially because U.S.

Navy officials flatly stated that the objects were unidentified.
Certainly the pilots don’t seem to know what they’re seeing; in the
GIMBAL video, one can be heard remarking that the object is
going against the direction of the wind, again implying that the
UAP was under some kind of control.

So are these objects alien spacecraft? I would bet a lot of money—

a lot—on “no.”

Mick West, a retired computer programmer and prominent UFO

skeptic, has examined the videos very carefully and applied
trigonometry and physics to what’s seen to find far more plausible
explanations than interstellar visitors. For example, the object
apparently moving against the wind in the GOFAST video is
probably a balloon. In a video analysis, West convincingly argues
that the object is at low altitude and not moving very quickly; it’s
the jet’s motion that makes the object appear to zip across the sky.
This effect, called parallax, is what makes roadside trees whoosh
by when you’re zooming down a highway while distant buildings
seem to move much more slowly. The other UAP videos have
similar mundane explanations.

Occam’s razor, the well-worn rule of thumb for scientific inquiry,

applies well here: the simplest explanation is usually the best. As
critical thinkers sometimes say, “if you hear hoofbeats, think
horses, not unicorns.”

That it was navy pilots who encountered these objects would

seemingly enhance the credibility of these reports. Pilots
inarguably have more experience looking at things in the sky than
the average person, but that doesn’t mean they’re immune to error.
For example, in 2011 an Air Canada first officer reportedly put a
plane in a nosedive because he saw Venus. I’ve seen countless
reports of UFOs that for real and for sure turned out to be Venus,
Jupiter, the moon, airplanes, satellites, meteors, rocket launches,
floating paper bag lanterns or, in one very famous case, military
flares.

The fact is, everyone can make mistakes—even experts. There’s a

reason the term “argument from authority” is considered a logical
fallacy.

Astronomers are no exception; we’ve sometimes been fooled—or

at least momentarily baffled—by unexpected observations. Not that
long ago some of us got excited by what seemed to be a radio
observatory’s detection of a new type of astrophysical signal;
further investigation showed, however, that the signal was
electromagnetic interference from a nearby microwave oven. A
different time, an astronomer accidentally discovered Mars.
Another discovered the sun.

The important part of all these stories is that the scientists involved
didn’t immediately run to the media claiming they had found little
green men. Skepticism and careful analysis won the day.

That’s not always the case. For example, Avi Loeb is a renowned
astrophysicist at the Center for Astrophysics | Harvard &
Smithsonian. He is also a vocal proponent of the idea that small
spherules of metal he and his collaborators found on the ocean
floor are interstellar in origin and may even be from aliens.

This source is, well, unlikely. The idea is that a meteor from
interstellar space (determined from its estimated incoming
trajectory and high speed) burned up in Earth’s atmosphere,
dropping debris into the ocean. An expedition led by Loeb dredged
some of the seafloor where the researchers expected that debris to
be and found tiny metallic balls that they argue are from another
star.

Many other experts hold extremely dim views of these claims. One
of the most outspoken has been astrophysicist and science writer
Ethan Siegel, who bluntly calls them “embarrassing.” Current
consensus is that the meteor’s interstellar origin is far from proven,
the location where debris might have fallen is quite uncertain, and
Loeb’s spherules could originate from modern-day coal ash or
ancient volcanic eruptions rather than the breakup of some
interstellar object in Earth’s atmosphere.

Despite this pushback—and many other critiques, some published

in reputable peer-reviewed scientific journals—Loeb still maintains
that the meteor was interstellar and the spherules are from that very
event. He has even co-founded a multimillion-dollar project to
investigate his own claims. Of course, Loeb’s prestigious status
adds an air of authority to his hypothesis, but his claiming
something, no matter how strenuously, doesn’t make it so.

Should we bother studying unidentified phenomena, aerial or

otherwise? Of course! Not all have been explained, although we
shouldn’t leap to the conclusion that they’re unexplainable. NASA
itself funded a small project to look into UAPs, if only because
they could conceivably be a potential threat to airspace safety and
national security. But in the case of UAPs at least, time and again
there turn out to be simpler explanations, and at some point we
have to admit that in all likelihood, we’re throwing good money
after bad.

To be clear, none of this means we should abandon our searches for

extraterrestrial life. We now know that planets in the Milky Way
probably number in the hundreds of billions, and no doubt some
may resemble Earth and might even host life. But if our own world
is any guide, we should expect few, if any, of these living worlds to
harbor much more than microbes, let alone anything capable of
building starships or radio telescopes. (Earth has had only single-
cellular life for most of its history.) We need to carefully
distinguish between the possibility of life’s mere existence
elsewhere in the cosmos and its even more rare evolution to
intelligence and being able to trek among the stars.

Until we get much better and more reliable data, assume those
hoofbeats are horses.

This is an opinion and analysis article, and the views expressed by

the author or authors are not necessarily those of Scientific
American.
Phil Plait is a professional astronomer and science communicator in Virginia. He writes the Bad
Astronomy Newsletter. Follow him online.

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Geology
Earthquakes May Forge Large Gold Nuggets
Scientists propose that large chunks of gold could form from earthquakes’ pressure

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Earthquakes May Forge Large Gold Nuggets

Scientists propose that large chunks of gold could form from

earthquakes’ pressure
By Kate Graham-Shaw

Gold forms nuggets as it aggregates within quartz underground.

Tomekbudujedomek/Getty Images

Solid gold bars stacked in bank vaults, plating on the summer’s

Olympic medals, or even your own pieces of gold jewelry could
owe their existence to earthquakes. The stress and strain produced
by moving tectonic plates during such an event may trigger a
chemical reaction that causes minuscule particles of gold to
coalesce into larger nuggets, a new study proposes.

“The biggest finding is showing a new gold-forming process and

providing an explanation for how really large gold nuggets might
form,” says Christopher Voisey, a co-author of the study and a
geologist at Monash University in Australia. “This was always a bit
of a conundrum, especially when there isn’t field evidence
supporting the alternative gold-forming processes.”
An estimated 75 percent of all mined gold comes from deposits
nestled in cracks inside hunks of quartz, one of the most abundant
minerals in Earth’s crust. Geochemists have known that dissolved
gold existed in fluids in the middle to lower levels of the planet’s
crust and that the fluids could seep into quartz cracks. But the
amount of fluid involved seemed to limit how much gold could
dissolve and thus the size of the gold chunks that formed. Larger
nuggets were hard to explain: experts had theorized that gold
nanoparticles within the fluid might aggregate into those bigger
chunks within the quartz, yet it was unclear how. Unlike dissolved
gold, nanoparticles typically wouldn’t have enough chemical
energy to start the necessary reaction to build up on the cracks’
surface and form a nugget.

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The new study, published in Nature Geoscience, suggests that the

geological stress caused by earthquakes might activate a peculiar
geochemical property called piezoelectricity—and that such
activation makes the formation of larger gold nuggets possible.

The piezoelectric effect, which has been known since the 1880s, is
essentially the ability of a material to generate an electric charge
when placed under mechanical stress. Many everyday items
including microphones, musical greeting cards and inkjet printers
take advantage of piezoelectricity, and it occurs naturally in
substances from cane sugar to bone.
Quartz can produce this effect because of its structure: it is built
from a repeating pattern of positively charged silicon and
negatively charged oxygen atoms. When it’s stretched or
compressed, the arrangement of these atoms changes, and the
charges are dispersed asymmetrically. Negative and positive
charges build up in different areas of the quartz, creating an electric
field and changing the material’s electric state.

Voisey and his colleagues at Monash—located in the historically

gold-rich area of Melbourne—thought that this changed state could
lower the energy needed for gold nanoparticles in the fluid to
interact with the quartz surface, causing a previously unviable
chemical reaction to occur and allowing the nanoparticles to stick
and accumulate.

To test their idea, the researchers virtually modeled the electric

field that quartz could produce when subjected to earthquakelike
forces. They then placed quartz mineral crystals in a fluid
containing dissolved gold nanoparticles and other gold compounds
and found that, when under seismic wavelike forces, the quartz was
able to produce enough voltage to jump-start a buildup of
nanoparticles.

The study findings point to an intriguing mechanism that could be

responsible for forming at least some of the larger gold nuggets in
Earth’s crust—especially “orogenic” deposits where colliding
tectonic plates have folded onto one another to create a mountain
range.

“It appears to be a certainty that episodic earthquakes are important

in helping form these important orogenic gold nugget deposits,”
says James Saunders, a consultant geologist who was not involved
in the study. He says he would like to see future research look more
into the specifics of this process. This could include investigating
how long piezoelectricity-causing earthquake forces have to last to
produce such deposits and why large gold nugget deposits might
develop in only some cracks in quartz in a given area, despite an
earthquake theoretically inducing similar stress and strain on all the
cracks. “I think it is a great idea/hypothesis,” Saunders says. “I’ll
be interested if it stands up on further evaluation.”

Studying piezoelectricity at a very large scale may be difficult, says

Colgate University geologist Aubreya Adams, who was also not
involved in the study. “Geoscientists are currently working very
hard to quantify how stress (or pressure) varies in 3D with time and
location,” she says, “something that is easily measured in a lab but
much harder to quantify in the crust.”

Voisey and his team plan to extend experimental parameters by

testing different pressures or temperatures, for example, to explore
their theory further. “This is very much the pilot study for this
technique,” he says, “so I’m excited to see where it can go.”
Kate Graham-Shaw is a journalist based in New York City. She covers international news for
Japanese media and also covers health and science topics as a freelancer.

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History
November 2024: Science History from 50, 100
and 150 Years Ago
Computer chess champ; dental chloroform killer

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November 2024: Science History from 50, 100 and

150 Years Ago

Computer chess champ; dental chloroform killer

By Mark Fischetti

1924, Total Eclipse: “The shaded area marks the ‘shadow path’ in which the total eclipse of the sun,
on January 24, 1925, will be visible. At the western end the sun will rise already half eclipsed. At the
heavy line midway along the path the eclipse will be just at its beginning as the sun rises. East of this
midpoint all the eclipse, from beginning to end, will be visible.”
Scientific American, Vol. 131, No. 5; November 1924

1974

Spatial Relations in Boys and Girls

“A cognitive attribute known as ‘spatial ability’ can be assessed by

specially designed tests. Findings that implied a superior male
performance have endured in psychology literature. Jerome Kagan,
a Harvard University psychologist concerned with child
development, and Ann Karnovsky, then one of Kagan’s graduate
students, wondered when this supposed superiority first becomes
evident. They designed a simple test given to 222 boys and 223
girls in the first, second, third and fourth grades in Lexington,
Mass., and the seventh grade in Newton, Mass. The investigators
found no sex difference, with one exception: in the low-ability and
medium-ability division of the seventh-grade mathematics class,
the boys’ performance was significantly superior. Karnovsky and
Kagan conclude that males and females are potentially of equal
competence. The lower scores of some seventh-grade girls
Karnovsky attributes to the effect of cultural conditioning.”

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Computer Chess Champ

“The first world computer chess championship was won in

Stockholm by a Russian program called Kaissa, with four victories
and no defeats. Three programs each lost one game. The tie was
broken based on the fewest total moves and a play-off game.
Second place was awarded to the four-time U.S. national
champion, Chess 4.0 from Northwestern University. Third place
went to Ribbit, the Canadian champion from the University of
Waterloo, and fourth place to Chaos, written by programmers at
Sperry Univac. There were 13 entries from eight countries.”

1924

Precious Stones Inside Plants

“Now and again, substances which closely resemble opals and

pearls are discovered in giant tropical bamboos. In the young stages
of growth the hollow stems are filled with a jelly-like substance. As
time goes on this dries up and an interesting mineral deposit known
as tabasheer is formed. Some of this plays a part in making the
stems stiff and strong but, at times, an excess settles in more or less
rounded lumps at the stem joints. These are pale blue or white.
There is a close chemical connection to an opal, and the general
color and the manner of light reflection are much the same.”

A Swinging Apology

“One of our readers, G.H. Taber of Pittsburgh, has been good

enough to point out an error which crept into the article on fused
quartz in the July issue. On page 59 we said of clocks they run
‘faster as the weather gets warmer and the bob (of the pendulum)
longer.’ Of course, the clock runs slower as the pendulum gets
longer. We are obliged to Mr. Taber. We are sorry. We will try not
to do it again.”

1874

Chloroform Kills Dental Patients

“The death of another patient in the dental chair, while under the
influence of chloroform, again attracts public attention. This latest
accident occurred in Boston. The jury impaneled at the coroner’s
inquest notes that owing to our present lack of knowledge,
chloroform’s use as an anaesthetic is utterly unjustifiable. They also
recommend legislative enactments to prevent its administration.
That does not appear needed, however, since the growing tendency
of the medical profession is in favor of pure ether as a substitute, or
else a mixture of chloroform, ether and alcohol, which we
understand produces good results without causing the dangerous
depressing effect of the chloroform or the nausea of ether. The
employment of nitrous oxide in dental surgery is also greatly
extending; and since it is both a harmless as well as an agreeable
anaesthetic, it possesses peculiar advantages.”

Barns Burst into Flame

“Many farmers have experienced sudden and destructive

conflagrations in their hay lofts. Barns have been known to burst
into flame, almost without warning. Abbé Moigno, in Les Monde,
gives the following theory: Hay, when piled damp and in too large
masses, ferments and turns dark. In decomposing, sufficient heat is
developed and vapors begin to be emitted. The hay becomes
carbonized little by little, and then the charred portion, like peat,
becomes a kind of pyrophorus. The charcoal becomes concentrated
on the surface to such a degree that the mass reaches a temperature
which results in its bursting into flames.”

Mark Fischetti has been a senior editor at Scientific American for 17 years and has covered
sustainability issues, including climate, weather, environment, energy, food, water, biodiversity,
population, and more. He assigns and edits feature articles, commentaries and news by journalists
and scientists and also writes in those formats. He edits History, the magazine's department looking at
science advances throughout time. He was founding managing editor of two spinoff magazines:
Scientific American Mind and Scientific American Earth 3.0. His 2001 freelance article for the
magazine, "Drowning New Orleans," predicted the widespread disaster that a storm like Hurricane
Katrina would impose on the city. His video What Happens to Your Body after You Die?, has more
than 12 million views on YouTube. Fischetti has written freelance articles for the New York Times,
Sports Illustrated, Smithsonian, Technology Review, Fast Company, and many others. He co-authored
the book Weaving the Web with Tim Berners-Lee, inventor of the World Wide Web, which tells the
real story of how the Web was created. He also co-authored The New Killer Diseases with
microbiologist Elinor Levy. Fischetti is a former managing editor of IEEE Spectrum Magazine and of
Family Business Magazine. He has a physics degree and has twice served as the Attaway Fellow in
Civic Culture at Centenary College of Louisiana, which awarded him an honorary doctorate. In 2021
he received the American Geophysical Union's Robert C. Cowen Award for Sustained Achievement
in Science Journalism, which celebrates a career of outstanding reporting on the Earth and space
sciences. He has appeared on NBC's Meet the Press, CNN, the History Channel, NPR News and
many news radio stations. Follow Fischetti on X (formerly Twitter) @markfischetti

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Language
Science Crossword: Girl With Kaleidoscope
Eyes
Play this crossword inspired by the November 2024 issue of Scientific American

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Science Crossword: Girl With Kaleidoscope Eyes

By Aimee Lucido

This crossword is inspired by the November 2024 issue of Scientific

American. Read it here.

We’d love to hear from you! E-mail us at [email protected] to

share your experience.
Aimee Lucido writes crosswords and trivia puzzles that are published everywhere from the New
Yorker to the New York Times to independent publications such as AVCX. She is also author of the
middle-grade novels Emmy in the Key of Code and Recipe for Disaster, as well as the brand-new
picture book Pasta Pasta Lotsa Pasta. Lucido lives with her husband, daughter and dog in New
York.

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Mathematics
Math Puzzle: Play Architect with These
Houses of Cards
Can this house of cards be built?

Why This Great Mathematician Wanted a

Heptadecagon on His Tombstone
Mathematician Gauss left behind a trophy case of mathematical achievements to highlight on
his tombstone, but above all he wanted a regular heptadecagon etched on it

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Math Puzzle: Play Architect with These Houses of

Cards
By Hans-Karl Eder

Jovan built these five houses of cards using a total of exactly 90

playing cards. Now he wants to build one large house consisting of
exactly 100 cards. Can such a house of cards exist?

Amanda Montañez; Source: Hans-Karl Eder/Spektrum der Wissenschaft (reference)

You can build a house of cards with exactly 100 cards; it will have
eight floors.
 Amanda Montañez; Source: Hans-Karl Eder/Spektrum der Wissenschaft (reference)

The number of cards increases level by level in a constant

sequence. If you want to prove the puzzle’s answer, you have to
show that 100 is a term in this sequence.
 Amanda Montañez; Source: Hans-Karl Eder/Spektrum der Wissenschaft (reference)

Because the difference between terms always changes the same

amount—the “second difference” is constant—you can conclude
that the sequence, with number of cards K and number of rows x,
can be represented by a quadratic equation of the form K = ax2 + bx
+ c.

First, determine the values for a, b and c. This can be achieved

using a system of three equations:
 Amanda Montañez; Source: Hans-Karl Eder/Spektrum der Wissenschaft (reference)

With the values found for a, b and c and the calculated value for K
= 100, you can now solve the quadratic equation.

Amanda Montañez; Source: Hans-Karl Eder/Spektrum der Wissenschaft (reference)

One of the values for x is a natural number that lets you build a
house of cards out of exactly 100 cards.

We’d love to hear from you! E-mail us at [email protected] to

share your experience.

This puzzle originally appeared in Spektrum der Wissenschaft and

was reproduced with permission.
Hans-Karl Eder is a German mathematician, educator and author who also works as a MINT
ambassador to get young people interested in mathematics, computer science, natural sciences and
technology.

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Why This Great Mathematician Wanted a

Heptadecagon on His Tombstone

Mathematician Gauss left behind a trophy case of mathematical

achievements to highlight on his tombstone, but above all he
wanted a regular heptadecagon etched on it
By Jack Murtagh

Brown Bird Design

If you had to choose a few words or symbols to encapsulate your

legacy, what would you pick? Johann Carl Friedrich Gauss (1777–
1855) left behind a trophy case stocked with mathematical
achievements to choose from, but above all, he wanted a “regular
heptadecagon” etched on his headstone. The highly symmetrical
17-sided shape starred in a proof that Gauss considered one of his
greatest contributions to math. At just 18 years old, Gauss used a
heptadecagon to solve a classic problem that had stumped
mathematicians for more than 2,000 years. A tour through that
history reveals deep connections between the ancient conception of
shapes as drawings and a modern perspective of the equations that
govern them.
Ancient Greek Geometry

The ancient Greeks excelled at geometry, placing special emphasis

on constructions created with a compass and straightedge. Think of
these constructions as diagrams with desired geometric properties
created solely with a writing utensil and two tools. Given two
points, a drawing compass (not to be confused with the
navigational device) lets a person create a circle that is centered on
either point and passes through the other point. A straightedge can
be used to draw straight lines between the points. Neither tool has
any markings on it, so people cannot measure distances or angles
with them.

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Among all the shapes we can construct with a compass and

straightedge, regular polygons hold a special cachet.

The Greeks didn’t impose arbitrary rules just to make math more
challenging. The game of constructing shapes with a compass and
straightedge originates in Euclid’s Elements from the third century
B.C.E., one of the most important textbooks ever written. Like
modern mathematicians, Euclid set out to derive all of geometry
from a minimal list of assumptions. Instead of merely asserting the
existence of shapes or other geometric objects, Euclid wanted to
build them explicitly from the simplest ingredients: lines and
circles. To get a feel for these constructions, try one for yourself:
find the midpoint of the line segment from A to B below.
Eyeballing won’t suffice; your method must identify the exact
midpoint.

First use a compass to draw a circle that is centered at A and

passing through B. Then repeat this step to make a circle that is
centered at B and passing through A. These circles will intersect at
two points. Use the straightedge to connect these points. Because
of the symmetry in the construction, this vertical line will intersect
the original line segment exactly at its midpoint.

Amanda Montañez

Amanda Montañez

This exercise does much more than bisect a line segment. It creates
a right angle between the two lines, which is not a trivial feat with
such a restricted tool set. And by connecting a few more points,
you can make an equilateral triangle—one whose sides have equal
lengths and whose angles have equal measurements.

Amanda Montañez

Notice that each edge of the triangle is also a radius of one of the
circles. The circles are the same size, and therefore all the triangle’s
sides have the same length. So equilateral triangles are
constructible with a compass and straightedge, QED.
Congratulations on persisting through the first proposition in the
first book of Euclid’s Elements. Only 13 more books to go.
A Roadblock

Among all the shapes one can construct with a compass and
straightedge, regular polygons hold a special cachet. Polygons are
enclosed shapes composed of straight-line edges, such as triangles
and rectangles (as opposed to curved shapes such as circles or
unenclosed shapes such as the letter E). Regular polygons have the
most symmetry in that their sides all have equal lengths and their
angles all have equal measurements (like squares and equilateral
triangles but unlike rectangles and rhombuses). Constructing any
old irregular triangle with a compass and straightedge is child’s
play—just scatter three points on the page and connect them with
lines. But constructing our perfectly symmetrical equilateral
triangle—a regular polygon—requires some elegant legwork.

Euclid figured out how to construct regular polygons with three,

four or five sides—equilateral triangles, squares or regular
pentagons, respectively. He squeezed a few more generalizations
out of these core constructions; for instance, once you have a
regular polygon on the page, a simple maneuver will produce a
new regular polygon with double the number of sides.

Amanda Montañez

You can repeat this doubling procedure as many times as you wish.
That means three-, four- and five-sided regular polygons can be
transformed into six-, eight- and 10-sided regular polygons, as well
as 12-, 16- and 20-sided ones, and so on. Euclid also showed how
to “multiply” the three- and five-sided regular polygons to produce
a regular 15-gon.
 Amanda Montañez

Progress halted there. Somehow Euclid knew a regular 3,072-gon

was constructible in principle (a triangle doubled 10 times), but he
had no idea how to construct a regular seven-gon (heptagon) or 11-
gon (hendecagon). To be clear, regular polygons of any number of
sides greater than two do exist and can be constructed with more
capable tools. The question Euclid left behind asks which ones are
constructible with a compass and straightedge alone. It remained
unanswered for two millennia until a certain German teenager
picked up a pencil.

18th-Century Math to the Rescue

By 1796 no new regular polygons had joined the pantheon of

constructible shapes, yet mathematicians had acquired a deeper
understanding of compass-and-straightedge constructions. Gauss
knew how to reduce the problem of making a regular polygon to
that of merely creating a line segment with a very specific length.
To create a 17-gon, start with a unit circle (where the radius equals
one) and a point A on the circle, as in the graphic below. Imagine
we could find the red point B above A exactly one 17th of the way
around the circle. If we could construct the red point from the blue
point, we could repeat that action all the way around the circle and
connect the dots with our straightedge: voilà, a regular
heptadecagon.

How do we draw point B given point A, though? Notice that if we

can draw the red line segment labeled x, then we can connect that
to the red point B, and we win. The entire problem of constructing
a regular heptadecagon boils down to creating a line segment with
the precise length x. For the mathematically curious, x = cosine
(2π⁄17).

Amanda Montañez

Can we use a compass and straightedge to construct a line segment

of any length? By Gauss’s time, mathematicians knew the
surprising answer to this question. A length is constructible exactly
when it can be expressed with the operations of addition,
subtraction, multiplication, division or square roots applied to
integers. So some strange numbers, such as the square root of 99⁄5,
are constructible (99 and 5 are integers, and we’re applying
division and square root to them), whereas some more familiar
numbers such as pi (π) and the cube root of 2 cannot be
constructed, because one can never write them in terms of these
five operations alone.

Remarkably, the rudimentary tools the ancient Greeks used to draw

their geometric diagrams perfectly match the natural operations of
modern-day algebra: addition (+), subtraction (−), multiplication
(×), division (/) and taking square roots (√). The reason stems from
the fact that the equations for lines and circles use only these five
operations, a perspective Euclid couldn’t have envisioned in the
prealgebra age.

It might surprise you to learn that Gauss never actually drew a

regular heptadecagon. He didn’t need to. He proved that the shape
is constructible in principle by expressing the special length
x[cosine (2π⁄17)] solely in terms of the five algebraic operations the
compass and straightedge allow. Even if you don’t find his
equation particularly enlightening, its complexity demonstrates
how much work the adolescent must have poured into the problem.

Even more impressive, Gauss fully characterized which regular

polygons are constructible and which aren’t (although it was not
until 1837 that Pierre Wantzel provided a rigorous proof showing
Gauss’s characterization didn’t leave out anything). So not only did
Gauss describe the form that all constructible regular polygons
take, but he and Wantzel vindicated Euclid’s frustrations by
proving that the elusive regular heptagon (seven sides) and
hendecagon (11 sides) are impossible to construct with a compass
and straightedge alone, as are infinitely many other shapes.

According to biographer G. Waldo Dunnington, Gauss felt great

pride in cracking the millennia-old problem and told a friend that
he wanted a regular heptadecagon displayed on his headstone.
Sadly, he didn’t get it, but a monument in Gauss’s birth city of
Brunswick, Germany, has a 17-pointed star engraved on the back.
The stonemason chose a star because he believed people couldn’t
distinguish a heptadecagon from a circle. I wonder whether Euclid
would agree.
Jack Murtagh is a freelance math writer and puzzle creator. He writes a column on mathematical
curiosities for Scientific American and creates daily puzzles for the Morning Brew newsletter. He
holds a Ph.D. in theoretical computer science from Harvard University. Follow Jack on X
@JackPMurtagh

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Mental Health
Kids with ADHD May Still Have Symptoms as
Adults
Fortunately, recognition and treatment of attention deficit hyperactivity disorder in grown-ups
are getting better

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Kids with ADHD May Still Have Symptoms as

Adults

Fortunately, recognition and treatment of attention deficit

hyperactivity disorder in grown-ups are getting better
By Lydia Denworth

Jay Bendt

I know of someone who was diagnosed with attention deficit

hyperactivity disorder (ADHD) as a child in the 1990s. When he
turned 18, his insurance company notified him that his medication
—a kind that gives kids with ADHD a better chance to succeed in
school and can be quite pricey—was no longer covered. ADHD,
the insurer said in effect, was a childhood disorder. What an
unfortunate choice: to either struggle financially to pay for your
medication or head into college or the workforce without the
treatment that helps you.
The idea that ADHD was restricted to kids was deeply ingrained at
the time. People thought “it was a developmental lag that just
needed to catch up,” says psychologist Stephen Faraone of Upstate
Medical University in Syracuse, N.Y.

But ADHD often continues into adulthood, multiple studies have

now shown. The current estimated prevalence in adults is around
2.5 to 3 percent, compared with 5 to 6 percent in children. The
2013 edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) made it easier to diagnose adults, saying
grown-ups can have five symptoms instead of the six required in
children and acknowledging that ADHD might look different as
people grow older. “They don’t climb on furniture and stuff like
that,” Faraone says. (The DSM-5 still requires that some symptoms
be present before the age of 12.) The first guidelines for diagnosing
and treating ADHD in adults are now being developed by the
American Professional Society of ADHD and Related Disorders.

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In adults, the disorder can appear rather different than in

youngsters. Grown-ups dealing with inattention and hyperactivity
may have more difficulty than average completing long reports for
work, sitting through meetings or restaurant meals, paying bills on
time, or sustaining romantic relationships. “We’re shining a light
on what’s probably really going on,” says clinical psychologist
Margaret H. Sibley of the University of Washington School of
Medicine, who worked on several of the new studies. “People in
adult mental health settings just aren’t even being screened for it.”

Because of the lack of screening, many people who could benefit

from treatment aren’t getting it, experts say. Also, it is likely that
the rate in adults is higher than the 3 percent I mentioned earlier. A
2021 analysis showed that when based on symptoms alone rather
than documented childhood onset, the rate in adults ranges from
about 9 percent in young adults to more than 4 percent in those
older than 60.

Some people do outgrow the disorder, though probably far fewer

than previously thought. (It’s unclear whether people’s brains
become more neurotypical over time or they learn to compensate.)
A 2022 study in the Journal of American Psychiatry, led by Sibley,
found that slightly more than 9 percent of people diagnosed as
children had no sign of the condition as adults. Usually such people
had milder symptoms and strong support from parents.

A more common scenario is that the severity of symptoms

fluctuates. Previous studies tested people once in adulthood and
gave a yes/no diagnosis. Sibley’s study retested teens and young
adults multiple times and revealed that 60 percent of those who
showed remission later experienced a recurrence. “It appears to be
a condition that waxes and wanes,” Sibley says. “There is likely a
role of environment in turning up or down the volume of
somebody’s difficulties.” In other words, ADHD symptoms may
tend to flare up when life gets stressful and ease when life is
calmer.

Although a few studies have suggested it is possible for ADHD to

appear for the first time in adulthood, more recent research
indicates that adult onset is highly unlikely. Nearly all such cases
are probably either misdiagnoses of another condition, such as
substance use or anxiety, or instances in which childhood
symptoms were missed, Sibley says.
Many parents—and even grandparents—first recognize their own
symptoms when their child is diagnosed. This is particularly true of
females with the disorder, whose behavior as children tends to be
more inattentive than hyperactive like the stereotypical boy with
ADHD. As adults, however, females are more likely than males to
seek mental health treatment. “When you’re a child, you get mental
health treatment if you cause someone else a problem,” Faraone
says. “When you’re an adult, you go in because you have a
problem.”

Most people who have been diagnosed with ADHD will try
medication (usually stimulants such as Ritalin), but within the first
year 40 to 50 percent discontinue the pills for at least 180 days,
says psychiatric epidemiologist Isabell Brikell of the Karolinska
Institute in Sweden. Reasons can include adolescent independence,
increased costs and, for adults, providers less trained in treating
ADHD. Thanks to parental oversight, children are more likely to
maintain treatment, but a large study across eight countries showed
that discontinuation rates peak for patients at the age of 18. “The
transition from child and adolescent psychiatric care does not work
well in many countries,” Brikell says.

The lack of proper treatment can raise other health problems.

Brikell says several Swedish-led studies have shown that ADHD is
associated with diseases that increase with aging, such as a slightly
higher risk of hypertension and other cardiovascular diseases. The
disorder has been linked to greater risks of obesity, substance use
and sleep problems.

The good news is that because the medical community is

increasingly aware of the nuances of adult ADHD, people
experiencing difficulties have a better chance of getting a
professional diagnosis. For grown-ups, Faraone says, proper
treatment can be life-changing.
This is an opinion and analysis article, and the views expressed by
the author or authors are not necessarily those of Scientific
American.
Lydia Denworth is an award-winning science journalist and contributing editor for Scientific
American. She is author of Friendship (W. W. Norton, 2020).

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Microbiology
Enlisting Microbes to Break Down ‘Forever
Chemicals’
Bacteria can degrade particularly tough PFAS varieties

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Enlisting Microbes to Break Down ‘Forever

Chemicals’

Bacteria can degrade particularly tough PFAS varieties

By Saima S. Iqbal

Thomas Fuchs

A group of bacteria has proved adept at destroying the ultratough

carbon-fluorine bonds that give “forever chemicals” their name.
This finding boosts hopes that microbes might someday help
remove these notoriously pervasive pollutants from the
environment.

Nearly 15,000 chemicals commonly found in everyday consumer

products such as pizza boxes, rain jackets and sunscreens are
recognized as perfluoroalkyl and polyfluoroalkyl substances, or
PFASs. These chemicals can enter the body via drinking water or
sludge-fertilized crops, and they have already infiltrated the blood
of almost every person in the U.S. Scientists have linked even low
levels of chronic PFAS exposure to myriad health effects such as
kidney cancer, thyroid disease and ulcerative colitis.
Current methods to destroy PFASs require extreme heat or
pressure, and they work safely only on filtered-out waste.
Researchers have long wondered whether bacteria could break
down the chemicals in natural environments, providing a cheaper
and more scalable approach. But carbon-fluorine bonds occur
mainly in humanmade materials, and PFASs have not existed long
enough for bacteria to have specifically evolved the ability to
digest them. The new study—though not the first to identify a
microbe that destroys carbon-fluorine bonds—provides a step
forward, says William Dichtel, a chemist at Northwestern
University who studies energy-efficient ways to chemically
degrade PFASs.

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To identify a promising set of bacteria, the study’s authors screened

several microbe communities living in wastewater. Four strains
from the Acetobacterium genus stood out, the team reported in
Science Advances. Each strain produced an enzyme that can digest
caffeate—a naturally occurring plant compound that roughly
resembles some PFASs. This enzyme replaced certain fluorine
atoms in the PFASs with hydrogen atoms; then a “transporter
protein” ferried the fluoride ion by-products out of the single-celled
microbes, protecting them from damage. Over three weeks most of
the strains split the targeted PFAS molecules into smaller fragments
that could be degraded more easily via traditional chemical means.
By directly targeting carbon-fluorine bonds, the Acetobacterium
bacteria partially digested perfluoroalkyls, a type of PFAS that very
few microbes can break down. Even so, these Acetobacterium
strains could work only on perfluoroalkyl molecules that contain
carbon-carbon double bonds adjacent to the carbon-fluorine ones.
These “unsaturated” perfluoroalkyl compounds serve as building
blocks for most larger PFASs; they are produced by chemical
manufacturers and also emerge when PFASs are destroyed via
incineration.

Scientists had previously demonstrated that a microbe called

Acidimicrobium sp. strain A6 could break down carbon-fluorine
bonds and completely degrade two of the most ubiquitous
perfluoroalkyls. This microbe grows slowly, however, and requires
finicky environmental conditions to function. And researchers do
not yet fully understand how this bacterial strain does the job.

The Acetobacterium lines target a separate group of PFASs, and the

team hopes to engineer the microbes to either improve their
efficiency or expand their reach—potentially to more
perfluoroalkyls. Lead study author Yujie Men of the University of
California, Riverside, imagines the microbes would perform best in
combination with other approaches to degrade PFASs. The range of
chemical structures in these compounds means “a single lab cannot
solve this problem.”

Any future commercial use of the microbes would face numerous

hurdles, including breakdown speed and replicability outside of the
lab, but Men looks forward to seeing how far her team can push the
technique. “We’re paving the road as we go,” she says with a
laugh.
Saima S. Iqbal is Scientific American’s current news intern. She specializes in health and medicine
and is based in New York City.

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Music
Hidden Patterns in Folk Songs Reveal How
Music Evolved
Songs and speech across cultures suggest music developed similar features around the world

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Hidden Patterns in Folk Songs Reveal How Music

Evolved

Songs and speech across cultures suggest music developed similar

features around the world
By Allison Parshall, Duncan Geere & Miriam Quick

Duncan Geere and Miriam Quick from Loud Numbers

Humans must have learned to sing early in our history because “we
can find something we can call music in every society,” says
musicologist Yuto Ozaki of Keio University in Tokyo. But did
singing evolve as a mere by-product of speaking or with its own
unique role in human society? To investigate this question, Ozaki
and a large team of collaborators compared samples of songs and
speech from around the world. These categories can vary wildly
across cultures: songs can be lilting lullabies or rhythmic chants or
wailing laments, and some spoken languages have more “musical”
qualities, such as tonal languages, which convey meaning through
pitch.
Despite this variation, the researchers found three worldwide
trends: songs tend to be slower than speech, with higher and
slightly more stable pitches. These consistent differences suggest
that singing isn’t just a by-product of speech, yet why it evolved is
still unknown. Perhaps it developed to unite people, an idea called
the social-bonding hypothesis, says co-author Patrick Savage, a
musicologist at the University of Auckland in New Zealand.
“Slower, more regular and more predictable melodies may allow us
to synchronize and to harmonize,” he says, “and through that, to
bring us together in a way that language can’t.”

Breaking Down a Song

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The chart visualizes two recordings of the English folk song

“Scarborough Fair”—one sung, one spoken—by Patrick Savage, a
study author and participant. The song unfolds at around half the
speed of the spoken version, and its pitches are generally higher.
They are also more stable, being centered on fixed musical notes,
but with added expressive pitch fluctuations such as scoops and
vibrato. In contrast, the spoken performance never settles on a pitch
for long.
 Duncan Geere and Miriam Quick from Loud Numbers

Different Songs, Similar Patterns

The researchers analyzed 300 audio recordings by 75 collaborators

speaking 55 languages. Each person sang a traditional song, recited
its lyrics, played an instrumental version of its melody, then
described its meaning. The authors showed how pitch height,
tempo and pitch stability vary as a person moves from instrumental
music to singing to speech, and they found commonalities across
cultures.
 Duncan Geere and Miriam Quick from Loud Numbers; Source: “Globally, Songs and Instrumental
Melodies Are Slower and Higher and Use More Stable Pitches than Speech: A Registered Report,” by
Yuto Ozaki et al., in Science Advances, Vol. 10; May 15, 2024 (data)

Allison Parshall is an associate news editor at Scientific American who often covers biology, health,
technology and physics. She edits the magazine's Contributors column and weekly online Science
Quizzes. As a multimedia journalist, Parshall contributes to Scientific American's podcast Science
Quickly. Her work includes a three-part miniseries on music-making artificial intelligence. Her work
has also appeared in Quanta Magazine and Inverse. Parshall graduated from New York University's
Arthur L. Carter Journalism Institute with a master's degree in science, health and environmental
reporting. She has a bachelor's degree in psychology from Georgetown University. Follow Parshall
on X (formerly Twitter) @parshallison

Duncan Geere is an information designer and data storyteller, specializing in climate and
environmental work.

Miriam Quick is a data journalist and researcher specializing in information visualization.

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Neuroscience
Tiny Babies Who Can Smell Their Mother
Recognize Faces Better
A smell’s effect on facial recognition is key at first—but decreases as a baby’s eyesight
improves

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Tiny Babies Who Can Smell Their Mother

Recognize Faces Better

A smell’s effect on facial recognition is key at first—but decreases

as a baby’s eyesight improves
By Simon Makin

StefaNikolic/Getty Images

Babies experience a torrent of sensory information from the

moment they are born. Knowing nothing about the world, they
must learn to sort this deluge into categories of things—especially
faces. “Faces are one of the most relevant visual signals babies start
to learn during the first month,” says Arnaud Leleu, a cognitive
neuroscientist at the University of Burgundy in France.

Researchers are still working out how infants use various senses for
this recognition: Newborns categorize faces better if the visual
image is accompanied by a voice, for example. And evidence
suggests babies may also use smell. “We knew babies can combine
their senses,” says Tessa Dekker, who studies visual development
at University College London. “But it wasn’t clear if this applied to
smells, which aren’t as linked to specific events because they
operate quite slowly.”

In a recent study in Child Development, Leleu and his colleagues

confirmed that infants’ face perception is aided by their mother’s
body odor—and they found that the influence of smell declines as
babies grow. The findings expand scientists’ understanding of the
role that multisensory perception plays in early learning.

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The team used electroencephalography to record the brain activity

of 50 infants between four and 12 months old while the babies
watched a stream of six images per second. Each sixth image was a
human face, and the others were animals or objects. The
researchers expected that if the babies were devoting special
attention to faces, there would be a once-per-second activity spike
corresponding to their appearance—a so-called face-selective
response—from electrodes placed over brain regions involved in
visual processing. They also gave the babies T-shirts that were
clean and ones infused with their mother’s body odor.

Overall, face-selective responses increased in strength and

complexity with age. But the team also found that the mother’s
scent enhanced responses to faces in the youngest infants and
observed that the effect progressively decreased in older babies.
“This could mean young babies rely more on their mother’s scent
because their ability to identify faces using vision alone is still
developing,” Dekker says. Visual ability is known to be poor at
birth, whereas smell develops relatively early.

The findings highlight the importance of multisensory stimulation

early in life. “To help infants learn, we should use all the senses,”
Leleu says. “The way we start to recognize things with our senses
is the building block to developing concepts, language, memories.”
He is continuing to investigate the extent of smell’s effect on
perception, including in other age groups. He says he’s finding that
if a recognition task is made difficult enough, even adults recruit
their noses to help. “It works for faces and other objects,” Leleu
adds. “We found an effect using pictures of cars and gasoline odor.”
Simon Makin is a freelance science journalist based in the U.K. His work has appeared in New
Scientist, the Economist, Scientific American and Nature, among others. He covers the life sciences
and specializes in neuroscience, psychology and mental health. Follow Makin on X (formerly
Twitter) @SimonMakin

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Paleontology
Tardigrade Fossils Reveal When ‘Water Bears’
Became Indestructible
Around 252 million years ago tardigrades may have escaped extinction using this one weird
trick

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Tardigrade Fossils Reveal When ‘Water Bears’

Became Indestructible

Around 252 million years ago tardigrades may have escaped

extinction using this one weird trick
By Mindy Weisberger

An artistic reconstruction of two tardigrade fossil specimens that were preserved in amber and
analyzed in a recent study.
From “Cretaceous Amber Inclusions Illuminate the Evolutionary Origin of Tardigrades,” by M.A.
Mapalo et al., in Communications Biology, Vol. 7, No. 953. Published online August 6, 2024

Microscopic tardigrades—plump, eight-legged arthropod relatives

—are nearly indestructible, and their durability superpower may
have helped them weather the deadliest mass extinction in Earth’s
history, according to a new fossil analysis.

Tardigrades, also called water bears, can withstand extreme heat,

cold, pressure and radiation. Two major tardigrade lines survive
hostile environments through a process called cryptobiosis, in
which they lose most of their body’s water and enter a suspended
metabolic state.
There are only four known tardigrade fossils. All are preserved in
amber, including two inside a pebble that was found in Canada in
1940 and dates from 84 million to 72 million years ago. One of the
pebble’s tardigrades, representing a species named Beorn leggi,
was described in 1964. The other was too small to be identified at
the time, says Marc Mapalo, a graduate student at Harvard
University’s Museum of Comparative Zoology.

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The tardigrade Beorn leggi, photographed with transmitted light under a compound microscope (A),
photographed with autofluorescence under a confocal microscope (B) and represented as a schematic
drawing (C).
From “Cretaceous Amber Inclusions Illuminate the Evolutionary Origin of Tardigrades,” by Marc A.
Mapalo et al., in Communications Biology, Vol. 7, Article No. 953. Published online August 6, 2024

For a new study in Nature Communications Biology, Mapalo and

his colleagues used high-contrast microscopy to uncover previously
unseen details in both specimens’ claws, “which are very important
taxonomic characteristics in tardigrades,” Mapalo says. Tardigrade
body plans have varied little for millions of years, so the small
visible differences in claw shape offered crucial information about
where in the tardigrade family tree these amber-trapped fossils
belonged, says University of Chicago organismal biologist Jasmine
Nirody (whose own work has also examined tardigrade claws).

The authors determined the smaller tardigrade was a new genus

and species: Aerobius dactylus. They also revised B. leggi’s
description and classification based on its claw joints. Both species
were placed in the same tardigrade superfamily Hypsibioidea, and
B. leggi was moved into the family Hypsibiidae. Reclassifying B.
leggi based on previously unseen details clarified its relationship to
living tardigrades.

The resulting family tree recalibration allowed the researchers to

calculate when the two tardigrade lines that perform cryptobiosis
could have diverged—putting a latest date on the likely acquisition
of that skill. Their work suggests cryptobiosis appeared in
tardigrades during the Carboniferous period (359 million to 299
million years ago), predating a deadly event known as the Permian
extinction, or the “Great Dying,” which occurred about 252 million
years ago. The authors suggest that cryptobiosis may have helped
tardigrades survive the event, which wiped out 96 percent of
marine life and 70 percent of life on land.

Cryptobiosis’s evolution is challenging to study, partly because

tardigrade fossils are so scarce, Mapalo says. Additional fossil
discoveries will help scientists pin down details about the
appearance of this unique survival strategy. By sharing this result,
he says, “we hope we will entice other people to be aware that
fossil tardigrades exist and there are still more to be found.”

Editor’s Note (9/16/24): This article was edited after posting to

correct the descriptions of the how the findings helped researchers
reclassify the tardigrade family tree and when Beorn leggi was first
described.
Mindy Weisberger is a science writer covering biology, paleontology, climate change and space.
She studied film at Columbia University and produced, wrote and directed media for the American
Museum of Natural History for more than a decade, creating videos about dinosaurs, astrophysics,
biodiversity and evolution that have appeared in museums and science centers worldwide. Her book
Rise of the Zombie Bugs: The Surprising Science of Parasitic Mind-Control will be published in the
spring of 2025 by Hopkins Press.

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Politics
Vote for Kamala Harris to Support Science,
Health and the Environment
Kamala Harris has plans to improve health, boost the economy and mitigate climate change.
Donald Trump has threats and a dangerous record

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Vote for Kamala Harris to Support Science,

Health and the Environment

Kamala Harris has plans to improve health, boost the economy and
mitigate climate change. Donald Trump has threats and a
dangerous record
By The Editors

Luca D'Urbino

In the November election, the U.S. faces two futures. In one, the
new president offers the country better prospects, relying on
science, solid evidence and the willingness to learn from
experience. She pushes policies that boost good jobs nationwide by
embracing technology and clean energy. She supports education,
public health and reproductive rights. She treats the climate crisis
as the emergency it is and seeks to mitigate its catastrophic storms,
fires and droughts.

In the other future, the new president endangers public health and
safety and rejects evidence, preferring instead nonsensical
conspiracy fantasies. He ignores the climate crisis in favor of more
pollution. He requires that federal officials show personal loyalty to
him rather than upholding U.S. laws. He fills positions in federal
science and other agencies with unqualified ideologues. He goads
people into hate and division, and he inspires extremists at state
and local levels to pass laws that disrupt education and make it
harder to earn a living.

Only one of these futures will improve the fate of this country and
the world. That is why, for only the second time in our magazine’s
179-year history, the editors of Scientific American are endorsing a
candidate for president. That person is Kamala Harris.

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Before making this endorsement, we evaluated Harris’s record as a

U.S. senator and as vice president under Joe Biden, as well as
policy proposals she’s made as a presidential candidate. Her
opponent, Donald Trump, who was president from 2017 to 2021,
also has a record—a disastrous one. Let’s compare.

Health Care

The Biden-Harris administration shored up the popular Affordable

Care Act (ACA), giving more people access to health insurance
through subsidies. During Harris’s September 10 debate with
Trump, she said one of her goals as president would be to expand
it. Scores of studies have shown that people with insurance stay
healthier and live longer because they can afford to see doctors for
preventive and acute care. Harris supports expansion of Medicaid,
the U.S. health-care program for low-income people. States that
have expanded this program have seen health gains in their
populations, whereas states that continue to restrict eligibility have
not. To pay for Medicare, the health insurance program primarily
for older Americans, Harris supports a tax increase on people who
earn $400,000 or more a year. And the Biden-Harris administration
succeeded in passing the Inflation Reduction Act (IRA), which
caps the costs of several expensive drugs, including insulin, for
Medicare enrollees. Harris’s vice presidential pick, Tim Walz,
signed into law a prohibition against excessive price hikes on
generic drugs as governor of Minnesota.

When in office, Trump proposed cuts to Medicare and Medicaid

(Congress, to its credit, refused to enact them.) He also pushed for
a work requirement as a condition for Medicaid eligibility, making
it harder for people to qualify for the program. As a candidate, both
in 2016 and this year, he pledged to repeal the ACA, but it’s not
clear what he would replace it with. When prodded during the
September debate, he said, “I have concepts of a plan” but didn’t
elaborate. Like Harris, however, he has voiced concern about drug
prices, and in 2020 he signed an executive order designed to lower
prices of drugs covered by Medicare.

The COVID pandemic has been the greatest test of the American
health-care system in modern history. Harris was vice president of
an administration that boosted widespread distribution of COVID
vaccines and created a program for free mail-order COVID tests.
Wastewater surveillance for viruses has improved, allowing public
health officials to respond more quickly when levels are high. Bird
flu now poses a new threat, highlighting the importance of the
Biden-Harris administration’s Office of Pandemic Preparedness
and Response Policy.

Trump touted his pandemic efforts during his first debate with
Harris, but in 2020 he encouraged resistance to basic public health
measures, spread misinformation about treatments and suggested
injections of bleach could cure the disease. By the end of that year
about 350,000 people in the U.S. had died of COVID; the current
national total is well over a million. Trump and his staff had one
great success: Operation Warp Speed, which developed effective
COVID vaccines extremely quickly. Remarkably, however, Trump
plans billion-dollar budget cuts to the Centers for Disease Control
and Prevention and the National Institutes of Health, which started
the COVID-vaccine research program. These steps are in line with
the guidance of Project 2025, an extreme conservative blueprint for
the next presidency drawn up by many former Trump staffers. He’s
also talked about ending the Office of Pandemic Preparedness and
Response Policy, calling it a pork project.

Reproductive Rights

Harris is a staunch supporter of reproductive rights. During the

September debate, she spoke plainly about her desire to reinstate
“the protections of Roe v. Wade” and added, “I think the American
people believe that certain freedoms, in particular the freedom to
make decisions about one’s own body, should not be made by the
government.” She has vowed to improve access to abortion. She
has defended the right to order the abortion pill mifepristone
through the mail under authorization by the U.S. Food and Drug
Administration, even as MAGA Republican state officials have
tried—so far unsuccessfully—to revoke those rights. As a U.S.
senator, she co-sponsored a package of bills to reduce rising rates
of maternal mortality. In August, Trump said he would vote against
a ballot measure expanding access to abortions in Florida, where he
lives. The current Florida “heartbeat” law makes most abortions
illegal after six weeks of pregnancy, before many people even
know they are pregnant.

Trump appointed the conservative U.S. Supreme Court justices

who overturned Roe v. Wade, removing the constitutional right to a
basic health-care procedure. He spreads misinformation about
abortion—during the September debate, he said some states
support abortion into the ninth month and beyond, calling it
“execution after birth.” No state allows this. He also refused to
answer the question of whether he would veto a federal abortion
ban, saying Congress would never approve such a ban in the first
place. He made no mention of an executive order and praised the
Supreme Court, three justices of which he placed, for sending
abortion back to states to decide. This ruling led to a patchwork of
laws and entire sections of the country where abortion is
dangerously limited.

Gun Safety

The Biden-Harris administration closed the gun-show loophole,

which had allowed people to buy guns without a license. The
evidence is clear that easy access to guns in the U.S. has increased
the risk of suicides, murder and firearm accidents. Harris supports a
program that temporarily removes guns from people deemed
dangerous by a court.

Trump promised the National Rifle Association that he would get

rid of all Biden-Harris gun measures. Even after Trump was injured
and a supporter was killed in an attempted assassination, the former
president remained silent on gun safety. His running mate, J. D.
Vance, said the increased number of school shootings was an
unhappy “fact of life” and the solution was stronger school
security.

Environment and Climate

Harris said pointedly during the September debate that climate

change was real. She would continue the responsible leadership
shown by Biden, who has undertaken the most substantial climate
action of any president. The Biden-Harris administration restored
U.S. membership in the Paris Agreement on coping with climate
change. Harris’s election would continue IRA tax credits for clean
energy, as well as regulations to reduce power-plant emissions and
coal use. This approach puts the country on course to spend the
authorized billions of dollars for renewable energy that should cut
U.S. carbon emissions in half by 2030. The IRA also includes a
commitment to broadening electric vehicle technology.

Trump has said climate change is a hoax, and he dodged the

question “What would you do to fight climate change?” during the
September debate. He pulled the U.S. out of the Paris Agreement.
Under his direction the Environmental Protection Agency and other
federal agencies abandoned more than 100 environmental policies
and rules, many designed to ensure clean air and water, restrict the
dangers of toxic chemicals and protect wildlife. He has also tried to
revoke funding for satellite-based climate-research projects.

Technology

The Biden-Harris administration’s 2023 Executive Order on Safe,

Secure and Trustworthy Development and Use of Artificial
Intelligence requires that AI-based products be safe for consumers
and national security. The CHIPS and Science Act invigorates the
chipmaking industry and semiconductor research while growing
the workforce. A new Trump administration would undo all of this
work and quickly. Under the devious and divisive Project 2025
framework, technology safeguards on AI would be overturned. AI
influences our criminal justice, labor and health-care systems. As is
the rightful complaint now, there would be no knowing how these
programs are developed, how they are tested or whether they even
work.

The 2024 U.S. ballots are also about Congress and local officials—
people who make decisions that affect our communities and
families. Extremist state legislators in Ohio, for instance, have
given politicians the right to revoke any rule from the state health
department designed to limit the spread of contagious disease.
Other states have passed similar measures. In education, many
states now forbid lessons about racial bias. But research has shown
such lessons reduce stereotypes and do not prompt schoolchildren
to view one another negatively, regardless of their race. This is the
kind of science MAGA politicians ignore, and such people do not
deserve our votes.

At the top of the ballot, Harris does deserve our vote. She offers us
a way forward lit by rationality and respect for all. Economically,
the renewable-energy projects she supports will create new jobs in
rural America. Her platform also increases tax deductions for new
small businesses from $5,000 to $50,000, making it easier for them
to turn a profit. Trump, a convicted felon who was also found liable
of sexual abuse in a civil trial, offers a return to his dark fantasies
and demagoguery, whether it’s denying the reality of climate
change or the election results of 2020 that were confirmed by more
than 60 court cases, including some that were overseen by judges
whom he appointed.

One of two futures will materialize according to our choices in this

election. Only one is a vote for reality and integrity. We urge you to
vote for Kamala Harris.

A version of this article entitled “Vote in November for Science”

was adapted for inclusion in the November 2024 issue of Scientific
American.

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Psychology
Moral Judgments May Shift with the Seasons
Certain values carry more weight in spring and autumn than in summer and winter

Why People Procrastinate, and How to

Overcome It
To stop putting off tasks, think about the positive

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Moral Judgments May Shift with the Seasons

Certain values carry more weight in spring and autumn than in

summer and winter
By Anvita Patwardhan

Jasmin Merdan/Getty Images

As leaves fall, snow sweeps in or flowers blossom, humans change

in measurable ways, too. Research suggests a range of
psychological phenomena—such as our emotional state, diet and
exercise habits, sexual activity and even color preferences—
fluctuate throughout the year. And now a study in the Proceedings
of the National Academy of Sciences USA demonstrates how moral
values can also shift.

For the study, researchers analyzed more than 230,000 online

survey responses—a decade’s worth—from people in the U.S.,
along with smaller groups in Canada and Australia. The questions
were based on a standardized framework social scientists use to
assess people’s judgments of right and wrong. This framework,
called moral foundations theory, sets up a taxonomy of “five pretty
fundamental values that shape human social behavior,” says lead
author Ian Hohm, a psychology graduate student at the University
of British Columbia.

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The framework considers loyalty (devotion to one’s own group),

authority (respect for leaders and rules), and purity (cleanliness and
piety) to be “binding” values that promote group cohesion and
conformity. These principles, often associated with political
conservatism, consistently received weaker endorsements in
summer and winter. And in summer, the more extreme the seasonal
weather differences, the more pronounced the effect. (An additional
surveyed group in the U.K. showed only the changes in summer.)

Care (preventing harm to others) and fairness (equal treatment) are

considered “individualizing” values pertaining to individual rights.
These principles showed no consistent seasonal pattern.

One explanation for seasonal swings could be anxiety. Using a

90,000-respondent survey dataset, as well as data on Internet search
frequencies, the researchers found that anxiety levels also peak in
spring and fall. “There is a close relationship between anxiety and
threat,” says University of Nottingham psychologist and study co-
author Brian O’Shea. Other studies have shown that people who
feel more vulnerable to seasonal illnesses tend to be more
distrustful, more xenophobic and more likely to conform to
majority opinion. “When you’re threatened,” O’Shea explains,
“you then want to get protection from your in-group.” These
findings suggest seasonal timing could affect jury decisions,
vaccination campaigns—and even election outcomes, the study
authors say.

Howard University psychologist Ivory A. Toldson, whose work

involves practical applications of statistics, notes that the study
relies on data from “Western, educated, industrialized, rich and
democratic (WEIRD)” populations and cautions that generalizing
from such results runs the risk of “overlooking the unique moral
experiences of marginalized groups.” Hohm agrees that such a
pattern wouldn’t affect everyone the same way but emphasizes that
the study highlights the seasons’ effect on human psychology.

“One thing that this article is showing is that we are very seasonal
creatures,” says Georgetown University School of Medicine
psychiatrist Norman Rosenthal, a leading expert on seasonal
affective disorder who coined the term in the 1980s. “The internal
state definitely affects your behavior.”
Anvita Patwardhan is a freelance science and health reporter. She is based in the San Francisco Bay
Area.

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Why People Procrastinate, and How to Overcome

It

To stop putting off tasks, think about the positive

By Javier Granados Samayoa & Russell Fazio

Pete Ryan

By April 12, 2024—three days before the deadline for filing tax
returns in the U.S.—more than a quarter of American taxpayers had
yet to do so. Procrastination—delaying something despite an
awareness of associated negative consequences, leading to
discomfort—is a common experience for many. Unfortunately,
procrastination tends to carry significant costs. For instance,
completing a task when rushing to finish can affect the quality of
one’s work. Moreover, procrastination is by its very definition
stressful, and naturally such stress can take its toll. Chronic
procrastinators tend to report more symptoms of illness, more visits
to the doctor, lower overall well-being and even greater financial
struggles.

So if procrastination is so costly, why do so many people regularly

do it? Years of research have provided a reasonably comprehensive
list of psychological factors that relate to procrastination. But it’s
been unclear what mental processes underlie the decision to start or
postpone a task. When faced with an upcoming deadline, how do
people decide to initiate a chore or project?

To explore this question, we conducted a series of studies

examining task delay, the behavioral component of procrastination
in which people put off completing something despite lacking any
objectively strategic reason to do so. We found that people with a
negativity bias tend to delay tasks more, especially if they tend to
be poor at self-control.

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discoveries and ideas shaping our world today.

The central idea guiding our work was that as people pursue their
goals, the environment nudges them to make specific assessments
that can shape their behavior. For example, once a taxpayer has
received all the necessary documentation—typically well before
the filing deadline—they may ask themselves, “Do I want to do
this now?” This question should bring to mind some positive
outcomes (for instance, the satisfaction of completing a chore and,
potentially, receiving a tax refund sooner) and some that are
negative (such as the tediousness of the task).
 People who are inclined to see the negatives rather than the
positives are more likely to delay tasks, especially if they tend
to be poor at self-control.

Ultimately the positives must be weighed against the negatives.

Notably there are individual differences in how people generally
weigh positive and negative signals—a characteristic that
psychologists call valence weighting bias. Whereas some people
tend to give greater weight to the pros, others give greater weight to
the cons. We reasoned that those with a more negative weighting
bias should be more likely to procrastinate.

Our first study used surveys to identify people who generally

expected to receive a tax refund but tended to submit their taxes
either early (during the last two weeks of January or early
February) or late in tax season (the first two weeks of April). Some
232 people who met our eligibility criteria participated in a follow-
up session, in which we measured their valence weighting bias,
using a game affectionately called “BeanFest.”

In this game, people viewed images of beans that varied in shape

and number of speckles. Some beans, when selected, yielded
points, whereas others led to a loss. We later assessed how
participants generalized from these newly learned associations
(such as that oblong beans with many speckles were “bad” and that
circular beans with few speckles were “good”) to new bean images
that had both positive and negative aspects (such as circular beans
with many speckles).The people who leaned more heavily on the
negative features when assessing the novel beans had a negative
valence weighting bias, whereas those who leaned more on the
positive features had a more positive bias.

The decisions that people make in this game reveal something very
fundamental: it turns out that people’s tendencies to generalize
either positive or negative associations on this test can serve as a
proxy for their general likelihood of weighing pros or cons when
making decisions of any kind. Through this process we found that
those people who had reported filing taxes late in the season
exhibited a more negative valence weighting bias. They apparently
felt more preoccupied by the unpleasant aspects of preparing their
tax return.

Having found evidence that this bias predicted task delay, we

followed up with a different approach. We asked 147 students
enrolled in an introductory psychology course for their record of
participation in a research experience program in which completing
a predetermined number of hours of experiments earned extra
credit. Using these data, we focused on the average date of research
participation; broadly speaking, later dates indicated greater task
delay. And much like doing taxes, putting off these hours of
research participation ultimately led to greater stress because it
exacerbated an “end-of-semester crunch.”

Then we added one more element to this study. Other research has
found that valence weighting bias shapes decision-making even
more strongly when people are relatively unmotivated to deliberate
beyond their initial impulsive reactions or do not have the cognitive
resources and time to do so. So we asked students to rate—on a
scale of 1 (“not at all like me”) to 5 (“very much like me”)—how
strongly they agreed with statements such as “I am good at
resisting temptation.” Not surprisingly, those who reported better
self-control tended to participate earlier in the semester. More to
the point, those with a more negative weighting bias tended to
delay, as indicated by the average day of earning research hours,
and this pattern was most evident among those reporting poorer
self-control.

Can we disrupt this link between weighting bias and task delay? In
our last study, we explored that possibility. We again examined
student participation in the research experience program. But
instead of recruiting from the general pool of students, we
specifically sought out those who had reported struggling with
procrastination more generally. These participants, we reasoned,
probably had a negative weighting bias.

We then randomly assigned the students who agreed to participate

to either a control or an experimental condition. Both groups of
participants from the psychology course played BeanFest, but the
latter involved a training procedure. Specifically, on each of
numerous trials, participants indicated whether a novel bean was
helpful or harmful, and then we told them whether their decision
was objectively correct. That feedback effectively trained
participants to better weigh pros versus cons, bringing more
balance to their perspective. In the control condition—where we
did not attempt to shape students’ tendency toward the positive or
negative—we provided no additional information.

After this targeted BeanFest intervention, students went back to the

semester as usual. Impressively, when we followed up with them
two weeks later, those in the experimental group showed fewer
signs of procrastination—that is, greater research participation—
than those in the control group. More important, this recalibration
procedure, as we call it, does something the real world rarely does:
it provides objectively correct feedback about the appropriate
weighting of positive and negative signals, and through repetition it
shifts valence weighting tendencies toward a more balanced
equilibrium. Even though BeanFest may seem utterly unrelated to
something like research participation, this training exercise works
because the act of weighing the pros and cons of a situation is the
same, whether it involves beans or a real-world decision. So when
people’s bias is changed in BeanFest, that naturally generalizes to
situations beyond the lab.

Putting it all together, our research uncovers the processes that lead
to procrastination. When faced with a deadline, people seem to ask
themselves, “Do I want to do this now?” That leads them to weigh
the pros and cons involved—and their biases then come into play.
Although additional rigorous testing is required, the training
procedure used in our last study shows promise as an avenue to
assist people who struggle with procrastination. Cognitive training
based on this approach—for example, through a smartphone app—
could help individuals who struggle with delaying tasks.

But there are more immediate implications of our work as well.

Our research indicates that valence weighting has the biggest
influence on people who lack the motivation and cognitive
resources to pause and deliberate beyond their initial quick
appraisals on whether to tackle a task. In other words, just pushing
yourself to think a little bit more before acting may help you
generate more positive reasons to get started and to ensure you
don’t put off until tomorrow what you might best do today.

This is an opinion and analysis article, and the views expressed by

the author or authors are not necessarily those of Scientific
American.

*Editor’s Note (8/16/24): This sentence was edited after posting to

correct the description of the time frame in April.
Javier Granados Samayoa is a research associate at the University of Pennsylvania. He studies why
people succeed or fail as they pursue their goals and how behavior can be changed to help people
reach their potential.

Russell Fazio is Harold E. Burtt Chair in Psychology at the Ohio State University. His research
concerns attitudes, including their formation, their accessibility from memory, and the effect they
have on attention, judgment and behavior.

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