How much medicine is too much medicine?
Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: With the global population exploding, how much health care is too much?
Neil Schluger: Well, the natural life span is probably between 100 and 120 years. That seems to be about what people can handle. It’s true that in the United States and other established market economy countries, wealthy countries, we spend a tremendous amount of money at the end of life. Now I’m one of these people who thinks that everybody’s life is of equal value. The life of an 85-year-old is just as precious as a 12-year-old and they’re entitled to as many efforts to save their life as a younger person, and I don’t think one can say that well, a 12-year-old or a 20-year-old because they have so much more potential years ahead of them is more valuable as a human being than someone who is 85. On the other hand, I think we have to be cognizant that when we spend money for health care it should be for health care. Sometimes we spend money just prolonging the dying process and that’s clearly I think the wrong thing to do not just from a financial point of view but from a human point of view. If all we’re doing is increasing someone’s suffering and not really doing anything that can meaningfully prolong their life in a way that has value to them, then I think we shouldn’t do that, but it sort of raises I think a larger issue, your question, about how we can make the population generally healthier. As everyone knows and it’s been widely reported, we spend more money on health care in the United States than any other country but we don’t seem to be the healthiest people on earth. We don’t live longer than other people. In fact, we live less long than people in many countries. Infant mortality in the United States is higher than it is in many countries who spend less money on health care than we do so I think we could be getting more out of the money we spend on health care, and one of the ways to do that is to think about public health approaches to improving the health of the population. And I always like to point out that frankly the person who’s done more for the health of New Yorkers in the last several years than anyone is the mayor and that’s because he’s really made it so difficult to smoke cigarettes in New York. It’s very expensive and you can’t do it in public and smoking rates have dropped quite a bit in New York. That’s a good example of a public health approach to a problem. All sorts of things affect health, not just medicine, legal things, economic things, cultural things, social things. All these things address health, impact health, and I think if we realized that we’d get a lot more out of the money we spend on health care.
Recorded on: 04/25/2008
With the global population exploding, is there a limit to how much effort we should put into keeping everyone alive as long as possible?
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The images and our best computer models don't agree.
A trio of intriguing galaxy clusters<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQzNDA0OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTkzNzUyOH0.0IRzkzvKsmPEHV-v1dqM1JIPhgE2W-UHx0COuB0qQnA/img.jpg?width=980" id="d69be" class="rm-shortcode" data-rm-shortcode-id="2d2664d9174369e0a06540cb3a3a9079" data-rm-shortcode-name="rebelmouse-image" />
The three galaxy clusters imaged for the study
Mapping dark matter<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="d904b585c806752f261e1215014691a6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/fO0jO_a9uLA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The assumption has been that the greater the lensing effect, the higher the concentration of dark matter.</p><p>As scientists analyzed the clusters' large-scale lensing — the massive arc and elongation visual effects produced by dark matter — they noticed areas of smaller-scale lensing within that larger distortion. The scientists interpret these as concentrations of dark matter within individual galaxies inside the clusters.</p><p>The researchers used spectrographic data from the VLT to determine the mass of these smaller lenses. <a href="https://www.oas.inaf.it/en/user/pietro.bergamini/" target="_blank" rel="noopener noreferrer">Pietro Bergamini</a> of the INAF-Observatory of Astrophysics and Space Science in Bologna, Italy explains, "The speed of the stars gave us an estimate of each individual galaxy's mass, including the amount of dark matter." The leader of the spectrographic aspect of the study was <a href="http://docente.unife.it/docenti-en/piero.rosati1/curriculum?set_language=en" target="_blank">Piero Rosati</a> of the Università degli Studi di Ferrara, Italy who recalls, "the data from Hubble and the VLT provided excellent synergy. We were able to associate the galaxies with each cluster and estimate their distances." </p><p>This work allowed the team to develop a thoroughly calibrated, high-resolution map of dark matter concentrations throughout the three clusters.</p>
But the models say...<p>However, when the researchers compared their map to the concentrations of dark matter computer models predicted for galaxies bearing the same general characteristics, something was <em>way</em> off. Some small-scale areas of the map had 10 times the amount of lensing — and presumably 10 times the amount of dark matter — than the model predicted.</p><p>"The results of these analyses further demonstrate how observations and numerical simulations go hand in hand," notes one team member, <a href="https://nena12276.wixsite.com/elenarasia" target="_blank">Elena Rasia</a> of the INAF-Astronomical Observatory of Trieste, Italy. Another, <a href="http://adlibitum.oats.inaf.it/borgani/" target="_blank" rel="noopener noreferrer">Stefano Borgani</a> of the Università degli Studi di Trieste, Italy, adds that "with advanced cosmological simulations, we can match the quality of observations analyzed in our paper, permitting detailed comparisons like never before."</p><p>"We have done a lot of testing of the data in this study," Meneghetti says, "and we are sure that this mismatch indicates that some physical ingredient is missing either from the simulations or from our understanding of the nature of dark matter." <a href="https://physics.yale.edu/people/priyamvada-natarajan" target="_blank">Priyamvada Natarajan</a> of Yale University in Connecticut agrees: "There's a feature of the real Universe that we are simply not capturing in our current theoretical models."</p><p>Given that any theory in science lasts only until a better one comes along, Natarajan views the discrepancy as an opportunity, saying, "this could signal a gap in our current understanding of the nature of dark matter and its properties, as these exquisite data have permitted us to probe the detailed distribution of dark matter on the smallest scales."</p><p>At this point, it's unclear exactly what the conflict signifies. Do these smaller areas have unexpectedly high concentrations of dark matter? Or can dark matter, under certain currently unknown conditions, produce a tenfold increase in lensing beyond what we've been expecting, breaking the assumption that more lensing means more dark matter?</p><p>Obviously, the scientific community has barely begun to understand this mystery.</p>
Astronomers spot an object heading into Earth orbit.
Minimoons<p>Scientists have confirmed just two prior minimoons. One was <a href="https://en.wikipedia.org/wiki/2006_RH120" target="_blank">2006 RH120</a>, which orbited us from September 2006 to June 2007. The other was <a href="https://en.wikipedia.org/wiki/2020_CD3" target="_blank">2020 CD3</a>, which got stuck in the 2015–2016 timeframe, and is believed to gotten away in May 2020.</p><p>2020 SO, the new kid on the block, is expected to arrive in October 2020 and pop out of orbit in May 2021.</p><div id="37962" class="rm-shortcode" data-rm-shortcode-id="f4c0fc8a2cba6536ea4cd960ebed3e6e"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1307729521869611008" data-partner="rebelmouse"><div style="margin:1em 0">Asteroid 2020 SO may get captured by Earth from Oct 2020 - May 2021. Current nominal trajectory shows shows capture… https://t.co/F5utxRvN6Z</div> — Tony Dunn (@Tony Dunn)<a href="https://twitter.com/tony873004/statuses/1307729521869611008">1600621989.0</a></blockquote></div>
Identifying 2020 SO<p>The first clue 2020 SO isn't your ordinary asteroid is its exceptionally low velocity. It's traveling much more slowly that a typical asteroid — their <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank">average rate of travel</a> <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank" rel="noopener noreferrer"></a>is 18 kilometers (58,000 feet) per second. Even <a href="https://en.wikipedia.org/wiki/Moon_rock" target="_blank">moon rocks</a> sent careening into Earth orbit by impacts on the lunar surface outpace pokey 2020 SO.</p><p>For another thing, 2020 SO has an orbital path very similar to Earth's, lasting about one Earth year. It's also just slightly less circular than our own orbit, from which it's barely tilted off-axis.</p><p>So, what is it? <a href="https://cneos.jpl.nasa.gov/ca/" target="_blank">NASA estimates</a> that the object has dimensions very reminiscent of a discarded Centaur rocket stage from the <a href="https://en.wikipedia.org/wiki/Surveyor_2" target="_blank" rel="noopener noreferrer">Surveyor 2 mission</a> that landed an unmanned craft on the moon. Back in the day, rocket stages were jettisoned as craft were aimed toward their desired position. This stuff, if released high enough, remains in space. It appears that this Centaur rocket, launched in September 1966, is now making its way back homeward, at least for a little bit.</p><p>When 2020 SO arrives at its closest point in December, the rocket is expected to be about 50,000 kilometers from Earth. Its next closest approach is much further: 220,000 kilometers, in February 2010.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQzMDk3NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyODg1MTQ1MX0.HGknDwqp0GmeuczKY_AS7vrPG7KMFUc_XO95tNoI2xo/img.jpg?width=980" id="e5cda" class="rm-shortcode" data-rm-shortcode-id="85eb1f790d8c3ee5b261f7ba13eaa5e1" data-rm-shortcode-name="rebelmouse-image" alt="Centaur rocket stage" />
Centaur rocket stage
What we may be able to learn<p>Earthly space programs being as young as they are, scientists would love to know what's happened to our rocket during a half century in space.</p><p>While 2020 SO won't get close enough to drop into our atmosphere, its slow progress has scientists hopeful that they'll still get some kind of a decent look at it.</p><p>Spectroscopy may be able to reveal what the rocket's surface is like now — has any of its paint survived, for example? Of course, being out in space, it's likely to have been hit by lots of dust and micrometeorites, so the current state of its surfaces is also of interest. Experts are curious to know how reflective the rocket is at this point, valuable information that can help planners of future long-term missions anticipate how well a craft out in space for extended periods will remain able to reflect sunlight.</p>
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