THE SKY IS FALLING! Should you worry? (No.) Should FEMA? (A bit, yes.)

            A friend of mine posted a snarky comment on Facebook about how foolish FEMA sounds, announcing it’s preparing for the crash landing of a satellite somewhere this week. Somewhere on the entire planet…nobody can be sure where.  But 7/10’s of the earth’s surface is ocean, and the fires ignited by resistance of the earth’s atmosphere will reduce the 6 ton satellite to about 1,000 lbs of chunks of metal…so isn’t it ridiculous that an emergency management agency, with floods and storms and wild fires and earthquakes and all sorts of ‘real’ risks to prepare for, would get ready for this?

            Well, yes. And no. Yes, the odds that any of this satellite’s remaining pieces will hit anybody, or even any building, are fantastically remote. So on the statistical likelihood that we are at risk, any investment in preparation seems ludicrous. But the odds aren’t zero, and that brings some other perspectives into play, because risk perception is not just about the odds. Trust in FEMA was demolished by the way the agency struggled to respond to Hurricane Katrina, part of which was their fault and part of which was the unprecedented severity and scope of that storm’s damage. The agency has been under new management and repairing it’s image pretty well with the competent way they’ve handled storms and floods and fires and other disasters the past few years. But that image repair is a fragile work in progress, and if a piece of the falling satellite whacked some neighborhood, or power plant, or school, or something that in fact did require an emergency response, FEMA would look pretty bad if they DIDN’T at least pay a little attention to this risk.

            What we think of FEMA is not just an issue for morale at that agency. It actually matters for our own well-being. The more we trust public safety agencies like FEMA (remember, FEMA and the state ‘EMAs’ are only coordinators of local resources like police and fire and other public safety services that do most of the actual responding), the more seriously we take their advisories about preparing for impending storms, the more we follow requests/orders for evacuation,  the more we support them rather than criticize them, which keeps them adequately funded…and all of those things are good for OUR health and safety.

            There is another risk issue raised by the imminent crash of satellite parts from the Upper Atmosphere Research Satellite (it ran out of fuel in 2005 so it can’t be steered to land in a particular spot.) The chances of serious damage are remote, but the consequence should a chunk of defunct satellite hit something critical (a power plant, an oil refinery, a bridge, a high rise urban office tower full of people) is potentially high. We invest huge amounts in preparing for low probability-high consequence risks all the time. Plane crashes. Nuclear power plant accidents. Just think of what we’re spending to respond if (most experts say when) terrorists strike again.  I’m not talking about what we spend to prevent these events. I’m talking about preparations for responding to them if they happen. They are extraordinarily unlikely, but bad when they occur. So we get ready. Just in case.

            And we expect the government agencies responsible for such things to be ready. And we criticize them when they aren’t. And our trust in them goes down. Which is actually not great for our health and safety. So while FEMA’s preparations (which basically just consist of having already on-duty personnel monitoring the situation) may seem ridiculous given the long odds that somebody or someplace gets whacked by falling satellite bits, “risk” involves more than the odds and statistics. It’s a matter of feelings too. It may sound silly that FEMA is preparing for this slim threat, but its also reassuring, and it is a wise bit of trust-building risk communication for them to let us know that they are paying attention, or our behalf…just in case.

            (In case you’re actually worried about the soon-to-crash space debris…don’t worry too much. Here’s a great rundown of similar events. So far, no serious damage done.)

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Yale scientists restore brain function to 32 clinically dead pigs

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Still from John Stephenson's 1999 rendition of Animal Farm.
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  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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