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Breast Cancer Controversies

Question: When is chemotherapy the wrong choice?

Clifford Hudis: 
Well, that’s a hard question to answer because that gets to a real nitty-gritty issue:  Why do we use chemotherapy?  How does it work?  And so there are very specific clinical situations I can describe that would answer your question but they wouldn’t be applicable to most people. They wouldn’t even relate to what most people are going through. An easy example is chemotherapy is not the right choice when somebody does not have an invasive breast cancer. There are some breast cancers that while present have no ability to spread to other parts of the body. The second thing which is-- becomes a little more of a slippery slope is there are some patients with very
low-risk breast cancer where chemotherapy is not the right choice and there are patients who have metastatic breast cancer-- that’s the kind of breast cancer that’s not curable-- where chemotherapy may be the right choice later but maybe not initially. So it’s hard to be more specific than that.


Question: Is breast cancer linked to environmental destruction?

Clifford Hudis:  Well, that’s a very complex issue because specifically there are certainly links. Ozone depletion with increased UV light exposure causes melanoma and less scary skin cancers like basal cells and squamous cells. Toxins in high concentration certainly cause some specific cancers like bladder cancer, lung cancer and so forth. The more general question people are asking is whether their overall environment that they transit through over the course of decades does that cause cancers that are common like breast or colon?  And that’s a pretty tough thing to answer. Very carefully done studies for example of the low-level pesticide exposures that you might get living in a rural community have not-- and I want to emphasize that-- have not shown the expected association with breast cancers yet that’s a popular assumption out there. The other thing that I just will interject and at the risk of being a little bit controversial I want to point this out--  Not talking about industrial accidents or egregious abuse of the environment, but some of the low-level toxins in the environment are there for reasons that in the net sum may be worth it. For example, a very healthy food supply protected by pesticides may raise some risks but this week it’s a topical issue because there’s concerns about the quantity of food produced on earth, and the truth is that we need some kind of management of those crops to feed 6, 7, 9 billion people expected over the next decades. And so we’re balancing kinds of risks and yes, we could have for example a purely organic food supply but what would we trade off to get that?  Would we trade off starvation in poor countries?  Would we trade off occasional poisonings of healthy people because there were bacterial over- there was bacterial overgrowth in those foods and so forth?  And I know venturing a little beyond my narrow area of expertise but I think you have to think somewhat globally about all of this. So an ideal world you’d have perfectly safe pesticides that never caused a problem and that’s what we should work towards but the attribution of causality from the environment to breast cancer in particular remains a very, very difficult issue.

Question: Does mercury in fish cause cancer?

Clifford Hudis: Mercury in fish has been associated with other very specific neurotoxic effects but not specifically breast cancer. I’ll give you a very concrete story. Now again I’m venturing outside my area of expertise but there’s a kind of controversy regarding cell phone use and brain cancer that’s been highlighted by recent events in the news. What’s interesting about it is that the issue was raised, it was refuted by every study that’s looked at it so far, and there’s kind of a second wave of skepticism saying, “Well, how do we know that over the decades to come we won’t discover that it does?”  So then we do basic science and the truth is that at the basic science level right now it’s been very hard to even demonstrate a mechanism by which cell phones would cause brain tumors, and yet the concern lives on and it’s addressed in a very expensive fashion in some cases. So we have to admit that we bring biases to it. In the example I just gave, there is a bias that cell phones must cause some kind of bad outcome, cancers, and we’re willing to explore it ad infinitum as it were, and maybe it does but we don’t have evidence that it does.


Question: Are pharmaceutical companies doing enough?

Clifford Hudis:  Very, very complex question. Pharmaceutical companies are doing what they can do primarily to raise shareholder value. That is of course always embedded in an idea that they’re trying to make the world better but they try to make the world better in part because it improves their profitability. Right? 

In an ideal world more of this work would be done by unbiased investigators funded publicly so that there would be no need to let’s say increase shareholder value, but that’s not the world we live in. In the world we have right now, a modest amount of work is done on the public side and a lot is done on the private side. I would like more to be done but it’s expensive and people make choices based on economics as opposed to health.

Question:Is the government doing enough?

Clifford Hudis:  Well, at the risk of sounding self-serving and recognizing that there’s no government on earth that devotes as much money to cancer research as the U.S., I have to point out that the rate of growth in that funding has been essentially zero for many, many years now. In inflationary terms, the purchasing power of the U.S. federal budget for cancer research has gone down. The estimates I’ve heard are about 20% over the last eight to ten years and so we have to ask ourselves as a society, “Is this reduced investment in cancer research specifically and health care research in general actually the way we want to direct our focus?”  If collectively our society says, “Yes. We don’t want to do public sector research,” then I guess we’re doing the right thing. I personally would hope we would come to a different conclusion. I think the public funding of science overall, health overall, and cancer specifically all is important. About a third of Americans are going to die of cancer. The proportion of money we spend on that relative to other less life-threatening concerns is somewhat disheartening at times.



From mercury in fish to whether government does enough.

The “new normal” paradox: What COVID-19 has revealed about higher education

Higher education faces challenges that are unlike any other industry. What path will ASU, and universities like ASU, take in a post-COVID world?

Photo: Luis Robayo/AFP via Getty Images
Sponsored by Charles Koch Foundation
  • Everywhere you turn, the idea that coronavirus has brought on a "new normal" is present and true. But for higher education, COVID-19 exposes a long list of pernicious old problems more than it presents new problems.
  • It was widely known, yet ignored, that digital instruction must be embraced. When combined with traditional, in-person teaching, it can enhance student learning outcomes at scale.
  • COVID-19 has forced institutions to understand that far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted.
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Giant whale sharks have teeth on their eyeballs

The ocean's largest shark relies on vision more than previously believed.

Photo by Koichi Kamoshida/Getty Images
Surprising Science
  • Japanese researchers discovered that the whale shark has "tiny teeth"—dermal denticles—protecting its eyes from abrasion.
  • They also found the shark is able to retract its eyeball into the eye socket.
  • Their research confirms that this giant fish relies on vision more than previously believed.
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A massive star has mysteriously vanished, confusing astronomers

A gigantic star makes off during an eight-year gap in observations.

Image source: ESO/L. Calçada
Surprising Science
  • The massive star in the Kinsman Dwarf Galaxy seems to have disappeared between 2011 and 2019.
  • It's likely that it erupted, but could it have collapsed into a black hole without a supernova?
  • Maybe it's still there, but much less luminous and/or covered by dust.

A "very massive star" in the Kinman Dwarf galaxy caught the attention of astronomers in the early years of the 2000s: It seemed to be reaching a late-ish chapter in its life story and offered a rare chance to observe the death of a large star in a region low in metallicity. However, by the time scientists had the chance to turn the European Southern Observatory's (ESO) Very Large Telescope (VLT) in Paranal, Chile back around to it in 2019 — it's not a slow-turner, just an in-demand device — it was utterly gone without a trace. But how?

The two leading theories about what happened are that either it's still there, still erupting its way through its death throes, with less luminosity and perhaps obscured by dust, or it just up and collapsed into a black hole without going through a supernova stage. "If true, this would be the first direct detection of such a monster star ending its life in this manner," says Andrew Allan of Trinity College Dublin, Ireland, leader of the observation team whose study is published in Monthly Notices of the Royal Astronomical Society.

So, em...

Between astronomers' last look in 2011 and 2019 is a large enough interval of time for something to happen. Not that 2001 (when it was first observed) or 2019 have much meaning, since we're always watching the past out there and the Kinman Dwarf Galaxy is 75 million light years away. We often think of cosmic events as slow-moving phenomena because so often their follow-on effects are massive and unfold to us over time. But things happen just as fast big as small. The number of things that happened in the first 10 millionth of a trillionth of a trillionth of a trillionth of a second after the Big Bang, for example, is insane.

In any event, the Kinsman Dwarf Galaxy, or PHL 293B, is far way, too far for astronomers to directly observe its stars. Their presence can be inferred from spectroscopic signatures — specifically, PHL 293B between 2001 and 2011 consistently featured strong signatures of hydrogen that indicated the presence of a massive "luminous blue variable" (LBV) star about 2.5 times more brilliant than our Sun. Astronomers suspect that some very large stars may spend their final years as LBVs.

Though LBVs are known to experience radical shifts in spectra and brightness, they reliably leave specific traces that help confirm their ongoing presence. In 2019 the hydrogen signatures, and such traces, were gone. Allan says, "It would be highly unusual for such a massive star to disappear without producing a bright supernova explosion."

The Kinsman Dwarf Galaxy, or PHL 293B, is one of the most metal-poor galaxies known. Explosive, massive, Wolf-Rayet stars are seldom seen in such environments — NASA refers to such stars as those that "live fast, die hard." Red supergiants are also rare to low Z environments. The now-missing star was looked to as a rare opportunity to observe a massive star's late stages in such an environment.

Celestial sleuthing

In August 2019, the team pointed the four eight-meter telescopes of ESO's ESPRESSO array simultaneously toward the LBV's former location: nothing. They also gave the VLT's X-shooter instrument a shot a few months later: also nothing.

Still pursuing the missing star, the scientists acquired access to older data for comparison to what they already felt they knew. "The ESO Science Archive Facility enabled us to find and use data of the same object obtained in 2002 and 2009," says Andrea Mehner, an ESO staff member who worked on the study. "The comparison of the 2002 high-resolution UVES spectra with our observations obtained in 2019 with ESO's newest high-resolution spectrograph ESPRESSO was especially revealing, from both an astronomical and an instrumentation point of view."

Examination of this data suggested that the LBV may have indeed been winding up to a grand final sometime after 2011.

Team member Jose Groh, also of Trinity College, says "We may have detected one of the most massive stars of the local Universe going gently into the night. Our discovery would not have been made without using the powerful ESO 8-meter telescopes, their unique instrumentation, and the prompt access to those capabilities following the recent agreement of Ireland to join ESO."

Combining the 2019 data with contemporaneous Hubble Space Telescope (HST) imagery leaves the authors of the reports with the sense that "the LBV was in an eruptive state at least between 2001 and 2011, which then ended, and may have been followed by a collapse into a massive BH without the production of an SN. This scenario is consistent with the available HST and ground-based photometry."

Or...

A star collapsing into a black hole without a supernova would be a rare event, and that argues against the idea. The paper also notes that we may simply have missed the star's supernova during the eight-year observation gap.

LBVs are known to be highly unstable, so the star dropping to a state of less luminosity or producing a dust cover would be much more in the realm of expected behavior.

Says the paper: "A combination of a slightly reduced luminosity and a thick dusty shell could result in the star being obscured. While the lack of variability between the 2009 and 2019 near-infrared continuum from our X-shooter spectra eliminates the possibility of formation of hot dust (⪆1500 K), mid-infrared observations are necessary to rule out a slowly expanding cooler dust shell."

The authors of the report are pretty confident the star experienced a dramatic eruption after 2011. Beyond that, though:

"Based on our observations and models, we suggest that PHL 293B hosted an LBV with an eruption that ended sometime after 2011. This could have been followed by
(1) a surviving star or
(2) a collapse of the LBV to a BH [black hole] without the production of a bright SN, but possibly with a weak transient."

NASA releases first sounds ever captured on Mars

On Friday, NASA's InSight Mars lander captured and transmitted historic audio from the red planet.

NASA
Surprising Science
  • The audio captured by the lander is of Martian winds blowing at an estimated 10 to 15 mph.
  • It was taken by the InSight Mars lander, which is designed to help scientists learn more about the formation of rocky planets, and possibly discover liquid water on Mars.
  • Microphones are essentially an "extra sense" that scientists can use during experiments on other planets.
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Changing the way we grade students could trigger a wave of innovation

How students apply what they've learned is more important than a letter or number grade.

Future of Learning
  • Schools are places where learning happens, but how much of what students learn there matters? "Almost all of our learning happens through experience and very little of it actually happens in these kinds of organized, contrived, constrained environments," argues Will Richardson, co-founder of The Big Questions Institute and one of the world's leading edupreneurs.
  • There is a shift starting, Richardson says, in terms of how we look at grading and assessments and how they have traditionally dictated students' futures. Consortiums like Mastery.com are pushing back on the idea that what students know can be reflected in numbers and letter grades.
  • One of the crucial steps in changing how things are done is first changing the narratives. Students should be assessed on how they can apply what they've learned, not scored based on what they know.
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