Well: Exercise and the Ever-Smarter Human Brain

Anyone whose resolve to exercise in 2013 is a bit shaky might want to consider an emerging scientific view of human evolution. It suggests that we are clever today in part because a million years ago, we could outrun and outwalk most other mammals over long distances. Our brains were shaped and sharpened by movement, the idea goes, and we continue to require regular physical activity in order for our brains to function optimally.

Phys Ed

Gretchen Reynolds on the science of fitness.

The role of physical endurance in shaping humankind has intrigued anthropologists and gripped the popular imagination for some time. In 2004, the evolutionary biologists Daniel E. Lieberman of Harvard and Dennis M. Bramble of the University of Utah published a seminal article in the journal Nature titled “Endurance Running and the Evolution of Homo,” in which they posited that our bipedal ancestors survived by becoming endurance athletes, able to bring down swifter prey through sheer doggedness, jogging and plodding along behind them until the animals dropped.

Endurance produced meals, which provided energy for mating, which meant that adept early joggers passed along their genes. In this way, natural selection drove early humans to become even more athletic, Dr. Lieberman and other scientists have written, their bodies developing longer legs, shorter toes, less hair and complicated inner-ear mechanisms to maintain balance and stability during upright ambulation. Movement shaped the human body.

But simultaneously, in a development that until recently many scientists viewed as unrelated, humans were becoming smarter. Their brains were increasing rapidly in size.

Today, humans have a brain that is about three times larger than would be expected, anthropologists say, given our species’ body size in comparison with that of other mammals.

To explain those outsized brains, evolutionary scientists have pointed to such occurrences as meat eating and, perhaps most determinatively, our early ancestors’ need for social interaction. Early humans had to plan and execute hunts as a group, which required complicated thinking patterns and, it’s been thought, rewarded the social and brainy with evolutionary success. According to that hypothesis, the evolution of the brain was driven by the need to think.

But now some scientists are suggesting that physical activity also played a critical role in making our brains larger.

To reach that conclusion, anthropologists began by looking at existing data about brain size and endurance capacity in a variety of mammals, including dogs, guinea pigs, foxes, mice, wolves, rats, civet cats, antelope, mongooses, goats, sheep and elands. They found a notable pattern. Species like dogs and rats that had a high innate endurance capacity, which presumably had evolved over millenniums, also had large brain volumes relative to their body size.

The researchers also looked at recent experiments in which mice and rats were systematically bred to be marathon runners. Lab animals that willingly put in the most miles on running wheels were interbred, resulting in the creation of a line of lab animals that excelled at running.

Interestingly, after multiple generations, these animals began to develop innately high levels of substances that promote tissue growth and health, including a protein called brain-derived neurotrophic factor, or BDNF. These substances are important for endurance performance. They also are known to drive brain growth.

What all of this means, says David A. Raichlen, an anthropologist at the University of Arizona and an author of a new article about the evolution of human brains appearing in the January issue of Proceedings of the Royal Society Biology, is that physical activity may have helped to make early humans smarter.

“We think that what happened” in our early hunter-gatherer ancestors, he says, is that the more athletic and active survived and, as with the lab mice, passed along physiological characteristics that improved their endurance, including elevated levels of BDNF. Eventually, these early athletes had enough BDNF coursing through their bodies that some could migrate from the muscles to the brain, where it nudged the growth of brain tissue.

Those particular early humans then applied their growing ability to think and reason toward better tracking prey, becoming the best-fed and most successful from an evolutionary standpoint. Being in motion made them smarter, and being smarter now allowed them to move more efficiently.

And out of all of this came, eventually, an ability to understand higher math and invent iPads. But that was some time later.

The broad point of this new notion is that if physical activity helped to mold the structure of our brains, then it most likely remains essential to brain health today, says John D. Polk, an associate professor of anthropology at the University of Illinois at Urbana-Champaign, and co-author, with Dr. Raichlen, of the new article.

And there is scientific support for that idea. Recent studies have shown, he says, that “regular exercise, even walking,” leads to more robust mental abilities, “beginning in childhood and continuing into old age.”

Of course, the hypothesis that jogging after prey helped to drive human brain evolution is just a hypothesis, Dr. Raichlen says, and almost unprovable.

But it is compelling, says Harvard’s Dr. Lieberman, who has worked with the authors of the new article. “I fundamentally agree that there is a deep evolutionary basis for the relationship between a healthy body and a healthy mind,” he says, a relationship that makes the term “jogging your memory” more literal than most of us might have expected and provides a powerful incentive to be active in 2013.

Read More..

Bits Blog: Facebook Poke and the Tedium of Success Theater

There’s a big problem in social media right now.

It’s boring.

A crucial and indispensable source of news and information, absolutely. But more often than not, it’s also tedious and predictable.

Don’t get me wrong: My use of Instagram, Tumblr, Twitter and Facebook has never been greater. But I’m growing tired of seeing everyone’s perfectly framed, glittering nightscapes of the Manhattan skyline, their impeccably prepared meals, those beautifully blurred views of the world from an airplane window seat. I’m getting tired of carefully crafting and sharing them myself.

As these media have matured and more of our colleagues, former flings, in-laws and friends have migrated to them, our use of them has changed. We’ve become better at choreographing ourselves and showing our best sides to the screen, capturing the most flattering angle of our faces, our homes, our evenings out, our loved ones and our trips.

It’s success theater, and we’ve mastered it. We’ve gotten better at it because it matters more. You never know who is looking or how it might affect your relationships and career down the road, and as a result, we have become more cautious about the version of ourselves that we present to each other and the world. Even Twitter, a service steeped in real-time and right-nowness, has added filters to its photo uploads, letting its users add a washed-out effect to their posts. It makes me miss the raw and unfiltered glimpses those services used to provide of the lives of my friends and the people I follow.

But the ubiquity of success theater is why I’ve become so fascinated with Snapchat and, more recently, Facebook Poke, services that let you send photos, messages and videos with a built-in shelf life, that self-destruct after a time interval that you choose. The beauty of these applications, perhaps their main redemptive quality, is that you can only send photos, messages and videos that you have created within the application. You cannot access your phone’s photo library for a more attractive self-portrait or an exotic locale to mask that you’re really sitting on the couch on Friday night in pajamas, wearing a face mask.

These applications are the opposite of groomed; they practically require imperfection, a sloppiness and a grittiness that conveys a sense of realness, something I’ve been craving in my communication. They transform the screen of your phone into a window into the life of your friend, wherever they are at that exact moment.

All of this is not to say that Snapchat or Facebook Poke have any permanent home in our daily routines. The applications, in their current iterations, have yet to gain significant traction in any of my social circles. Part of the fun is the novelty, as with any new service. And both have specific uses that are not as mainstream as services like Facebook, Instagram, Twitter or even Tumblr. After all, it’s much harder to find your comfort level within them. It’s startling, at first, to see the poorly lit, grainy pictures of your friends’ unfiltered faces, to adjust to the intimacy of realizing that the video of your friend that just landed in your in-box is meant for your eyes only, and that you are expected to send something of equal or greater intimacy in return. It is also possible that over time, Snapchat, VidBurn and Facebook Poke will become warped by their own versions of success theater, or lose steam if they gain seedier reputations.

But they capture a behavior my closest friends and I had already begun to adopt: The practice of showing each other where we are at any given moment in time, either through a short video or photo of our workstations, our faces as we lie half-asleep in bed on rainy Sunday afternoons, a look into our lives that is reserved for only those closest to each other. It is an acknowledgement that the version of ourselves we share through other social media is not the truest one, and has not been for a long time.

This is a variation of the same impulse that made Chatroulette a viral hit, and something that Apple has tried to capture with FaceTime, Google with its Hangouts, even Color’s ill-fated last and final iteration. It’s enough to make me think that the real real-time social Web is coming, in one form or another.

Read More..

Cold Afghan Camps Receive Some Aid, but Shortages Loom





KABUL, Afghanistan — The United Nations High Commissioner for Refugees on Sunday distributed emergency cold weather supplies to families in a refugee camp where two days earlier a 3-year-old child died of exposure to the cold.




Immediately, however, camp leaders and Afghan government officials criticized the aid delivery as inadequate to protect camp residents from continued cold weather conditions and to prevent further deaths of children from the cold.


Last winter more than 100 children died of the cold in refugee camps around Kabul, with 26 of the deaths in the Charahi Qambar camp in Kabul alone. That is also where the child died Friday, the first confirmed cold death this winter.


The distribution at the camp in western Kabul city, which has about 900 families, had previously been scheduled and was not prompted by news reports about the child’s death, according to Mohammad Nader Farhad, a spokesman for the U.N.H.C.R. in Kabul.


On less than an hour’s notice, the agency convened a news conference with Afghan government officials at the camp to announce the distribution.


Each family was given warm children’s clothing, blankets, tarps, cooking utensils and soap. Separately, other aid groups, financed by the United Nations and other donors, will be distributing charcoal once every month through February.


United Nations officials acknowledged, however, that the fuel distributions in themselves were not enough to heat the mud and tarp huts throughout the cold season, and there are no plans to distribute food to the families. In most cases the men, who are largely war-displaced refugees, are unable to find casual day labor work in the cold weather, so they are usually unable to buy food.


“We are happy to receive this,” said Tawoos Khan, one of the camp representatives. “But we want food and we need more fuel, we have all run out of firewood and charcoal.” He and other camp officials said large sacks of charcoal were distributed to every family more than two weeks ago, but supplies had run out.


“It’s supplementary,” said Douglas DiSalvo, a U.N.H.C.R. protection officer who was at the Charahi Qambar camp. “People have some level of support they can achieve for themselves.”


Mr. Farhad said: “The assistance we are providing, at least it is mitigating the harsh winter these families are experiencing right now.”


The estimated 35,000 people in 50 camps in and around Kabul city are not classified as refugees from an international legal point of view, but as “internally displaced persons.” Since the U.N.H.C.R.’s mandate is primarily to help refugees, defined as those who flee across international borders, in the past it has not provided support to these camps. That changed late last winter when the Afghan government asked it to do so in response to the emergency conditions that were taking so many lives.


This year, the agency is spearheading the effort to supply the camps, along with the Afghan government’s Ministry of Refugees and Repatriation, other United Nations agencies, and several aid groups, in order to prevent a recurrence of last winter’s crisis.


Ministry officials, however, were vocally critical of the effort on Sunday — even though they were joint sponsors of the distribution. “We have never claimed that we provided the internally displaced Afghans with sufficient food items, clothing or means of heat. We admit this, what the internally displaced people have received so far is not adequate at all,” said Islamuddin Jurat, a spokesman for the Ministry of Refugees and Repatriation.


“Before the arrival of harsh winter, we asked the international community and donor countries to help the internally displaced people, and luckily today U.N.H.C.R. provided them with some humanitarian assistance, but again we believe it’s not sufficient at all,” he added.


In the past, both aid officials and Afghan government officials have said they were wary about providing too much aid to the Kabul camps, for fear that it would turn the camps into magnets and encourage more people to leave their homes elsewhere in the country. That fear has also been why the Afghan government has refused to allow permanent buildings to be built in the camps, many of which are five or more years old.


“The illegal nature of these squatter settlements poses an obstacle to more lasting interventions and improvements,” Mr. Farhad said. “Coordination this year has been very strong, and we expect that the multiagency effort will help us to detect and respond to particular problem areas as the winter progresses. “


Little is provided in the way of food aid. The only food program in the Charahi Qambar camp, for instance, is a hot lunch program for 750 students run at a tented school staffed by an Afghan aid group, Aschiana.


The U.N.H.C.R. is providing the cold weather packages to 40,000 families throughout the country, 5,000 of them in the Kabul camps, at a total cost of $6 million. Other Kabul camps will receive distributions in the next two days, Mr. Farhad said.


The packages, which cost about $150 each, include two tarpaulins, three blankets, six bars of soap, a cooking utensils set, and 26 clothing items ranging from jackets and sweaters to socks and hats, mostly for children.


Taj Mohammad, the father of the child who died, Janan, said Sunday that he believed his son might have survived if the cold weather kit had arrived earlier. But like many of the refugees, he was critical of its contents, which he said were hard to sell in exchange for food.


“I didn’t know a package costs $150,” he said. “It’s a lot of money. It would have been much better if they had given us the money, and we would have spent it on what we need the most.”


Read More..

China Toughens Restrictions on Internet Use





HONG KONG — The Chinese government issued new rules on Friday requiring Internet users to provide their real names to service providers, while assigning Internet companies greater responsibility for deleting forbidden postings and reporting them to the authorities.




The decision came as government censors have sharply stepped up restrictions on China’s international Internet traffic in recent weeks. The restrictions are making it harder for businesses to protect commercial secrets and for individuals to view overseas Web sites that the Chinese Communist Party deems politically sensitive.


The new regulations, issued by the Standing Committee of the National People’s Congress, allow Internet users to continue to adopt pseudonyms for their online postings, but only if they first provide their real names to service providers, a measure that could chill some of the vibrant discourse on the country’s Twitter-like microblogs. The authorities periodically detain and even jail Internet users for politically sensitive comments, such as calls for a multiparty democracy or accusations of impropriety by local officials.


Any entity providing Internet access, including over fixed-line or mobile phones, “should when signing agreements with users or confirming provision of services, demand that users provide true information about their identities,” the committee ordered.


In recent weeks, Internet users in China have exposed a series of sexual and financial scandals that have led to the resignations or dismissals of at least 10 local officials. International news media have also published a series of reports in recent months on the accumulation of wealth by the family members of China’s leaders, and some Web sites carrying such reports, including Bloomberg’s and the English- and Chinese-language sites of The New York Times, have been assiduously blocked, while Internet comments about them have been swiftly deleted.


The regulations issued Friday build on a series of similar administrative guidelines and municipal rules issued over the past year. China’s mostly private Internet service providers have been slow to comply with them, fearing the reactions of their customers. The committee’s decision has much greater legal force, and puts far more pressure on Chinese Internet providers to comply more quickly and more comprehensively, Internet specialists said.


In what appeared to be an effort to make the decision more palatable to the Chinese public, the committee also included a mandate for businesses in China to be more cautious in gathering and protecting electronic data.


“Nowadays on the Internet there are very serious problems with citizens’ personal electronic information being recklessly collected, used without approval, illegally disclosed, and even traded and sold,” Li Fei, a deputy director of the committee’s legislative affairs panel, said on Friday at a news conference in Beijing. “There are also a large number of cases of invasive attacks on information systems to steal personal electronic information, as well as lawbreaking on the Internet through swindles and through defaming and slandering others.”


Mr. Li denied that the government was seeking to prevent the exposure of corruption.


“When citizens exercise these rights according to the law, no organization or individual can use any reason or excuse to interfere, and cannot suppress them or exact revenge,” he said. “At the same time, when citizens exercise their rights, including through use of the Internet, they should stay within the bounds of the Constitution and the laws, and must not harm the legitimate rights and interests of the state, society, the collective or of other citizens.”


A spokesman for the National People’s Congress said that 145 members of the committee voted in favor of the new rules, with 5 abstaining and 1 voting against them.


The requirement for real names appeared to be aimed particularly at cellphone companies and other providers of mobile Internet access. At the news conference, an official from the Ministry of Industry and Information Technology, Zhao Zhiguo, said that nearly all fixed-line services now had real-name registration, but that only about 70 percent of mobile phones were registered under real names.


Read More..

Surgery Returns to NYU Langone Medical Center


Chang W. Lee/The New York Times


Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.







NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.




While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.


The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.


“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.


Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.


“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.


The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.


The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.


In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.


Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.


The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.


The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.


Read More..

Russian Acquittal Escalates Human Rights Feud With U.S.





MOSCOW — A judge issued an acquittal on Friday of the only official to have gone to trial in Russia in the case of Sergei L. Magnitsky, a lawyer whose death in prison three years ago inspired the United States Congress to pass a law addressing human rights abuses in Russia.




The official, Dr. Dmitry Kratov, the former head of the medical service at Butyrka Prison, where Mr. Magnitsky had been held, was accused of negligence for refusing repeated requests for treatment for a life-threatening illness.


Charges against another doctor had been dismissed earlier, elevating the significance of Dr. Kratov’s trial, coming just weeks after Congress passed the Magnitsky Act, which was critical of the Russian courts for failing to prosecute any suspects in the lawyer’s death.


But far from pursuing the case, prosecutors announced at a hearing on Monday that they would no longer press for a conviction and instead asked the judge, Tatiana Neverova, to acquit Dr. Kratov.


That reversal came four days after President Vladimir V. Putin said at a news conference that Mr. Magnitsky had died of natural causes, a statement that a lawyer for the family said had sent a message to prosecutors to drop the case.


In granting the prosecutor’s request for an acquittal, Judge Neverova also indicated that Dr. Kratov could sue the government for damages under a Russian law related to illegal prosecution, Interfax reported. Dr. Kratov told journalists at the Tverskoi Court that he had not decided whether to sue.


The judge said she had seen no evidence in the course of the proceedings incriminating Dr. Kratov or convincing her that any connection existed between his actions and Mr. Magnitsky’s death, Interfax reported.


Dr. Kratov was the only person on a list of 60 Russian officials implicated in the Magnitsky case by the United States Helsinki Commission to have stood trial in Russia. Fewer than 1 percent of suspects are acquitted in Russian criminal trials.


Nikolai Gorokhov, a lawyer representing the Magnitsky family, said that Dr. Kratov had signed documents refusing Mr. Magnitsky’s request to be moved to an infirmary and that he had been aware of a diagnosis of pancreatitis and gallstones five days before Mr. Magnitsky death.


In the United States, the Magnitsky Act bans suspects like Dr. Kratov from entering the country and freezes assets in the American banking system.


In retaliation, Mr. Putin signed the Dmitri Yakovlev Act on Friday, named for a Russian child adopted in the United States who died after being forgotten in a hot car. The law bans Americans from adopting Russian orphans because of cases of abuse like Dmitri’s.


Mr. Magnitsky’s employer, the hedge fund Hermitage Capital, issued a statement Friday calling the ruling “a total miscarriage of justice.”


“There is no doubt that people responsible for Magnitsky’s death are being protected by the president of Russia,” the statement said. “Now that President Putin is personally involved in the obstruction of justice in a major case of extrajudicial killing, he will have to face the consequences of his actions.”


Read More..

Reid Says a Deal Is Unlikely Before the Fiscal Deadline





WASHINGTON — Senator Harry Reid of Nevada, the majority leader, warned Thursday morning that there was scant time to put together a Congressional deal to avert the impending fiscal crisis and that no resolution was in sight.




“I have to be very honest,” Mr. Reid said as the Senate convened Thursday in an unusual session between Christmas and New Year’s Day. “I don’t know time-wise how it can happen now.”


Mr. Reid offered his pessimistic assessment shortly before President Obama, cutting his vacation short, arrived back in Washington on Air Force One. White House officials said that before leaving Hawaii, Mr. Obama had spoken separately by phone with each of the four Congressional leaders about the status of negotiations, but they gave no details of the discussion.


On the Senate floor, Mr. Reid excoriated House Republicans for failing to consider a Senate-passed measure that would extend lower tax rates on household income up to $250,000. He urged House members, who remained away from Washington, to return to the Capitol to put together at least a modest deal to avoid the more than half-a-trillion dollars in automatic tax increases and spending cuts set to begin in January.


“The American people are waiting for the ball to drop,” Mr. Reid said, “but it’s not going to be a good drop.”


House Republicans planned a midafternoon conference call among members to discuss, among other things, their possible return this weekend; members were told they would be given 48 hours’ notice before any impending return. Republican senators were also planning to convene at the Capitol — normally somnolent during Christmas week — to strategize.


A spokesman for Senator Mitch McConnell, Republican of Kentucky and the minority leader, confirmed that he had spoken with the president, and said that Mr. McConnell was “happy to review what the president has in mind.” But the spokesman, Don Stewart, said Senate Democrats had not come ahead with a plan.


“When they do, members on both sides of the aisle will review the legislation and make decisions on how best to proceed,” Mr. Stewart said.


Mr. Reid said that absent a move from Republicans, the Senate would move forward this week on the national security measure concerning espionage, as well as a bill to help states that have suffered hurricane damage, with multiple votes possible.


“We are here in Washington working,” Mr. Reid said, “while the members of the House of Representatives are out watching movies and watching their kids play soccer and basketball and doing all kinds of things. They should be here.”


Senators, frustrated, pessimistic and in some cases downright miserable, returned to Washington with no clear fiscal agenda. Senator Ben Nelson, a retiring Democrat of Nebraska, arrived shortly after midnight on Thursday on a flight that was delayed more than four hours. As he walked through the airport, he lamented the deteriorating political comity that he has observed during two terms in the Senate and two terms as a Democratic governor of a conservative state.


“There are folks who are elected who have come here with an agenda to do nothing and want to stop everything,” Mr. Nelson said in an interview. “It may be the new norm – blocking everything.”


For Mr. Nelson, who decided against seeking a third term, the looming fiscal crisis would be the final legislative act of a political career built around a bipartisan voting record. He said he was not confident that a real deal could be reached that would be acceptable to both sides, considering that Congress is filled with many people “who didn’t accept the 2008 presidential election and haven’t accepted the 2012 election either.”


Jeff Zeleny contributed reporting.



Read More..

Books: From Bang to Whimper: A Heart Drug’s Story





On June 23, 2005, American medicine managed to take a small step forward and a giant step backward at precisely the same time, with government approval of the first medication to be earmarked for a specific racial group. It was BiDil, a drug designed to treat heart failure in blacks.




Enthusiasts hailed BiDil’s approval by the Food and Drug Administration as a landmark event in the nascent field of pharmacogenomics, which aims to create drugs tailored to fit an individual’s genetic makeup as precisely as a bespoke suit drapes its owner’s shoulders. Critics just winced and clocked one more misstep in medicine’s long history of race-related disasters.


You would think that the elucidation of the human genome would have cleared up most of the hoary untruths surrounding race and health. But as Jonathan Kahn makes clear in his worthy if convoluted review of the events surrounding the birth of BiDil, the genome has in many respects only made things worse.


It has been clear for decades that race has minimal relevance to the body’s inner workings. Research has repeatedly shown that the biologic variations among individuals of the same race are reliably great enough for race to retain little utility as a biologic predictor. You might as well sort people by height. Or, in the words of an editorial writer for Nature Biotechnology in 2005, “Pooling people in race silos is akin to zoologists grouping raccoons, tigers and okapis on the basis that they are all stripy.”


But old misconceptions die hard, particularly for entrepreneurs eagerly awaiting cash bonanzas from the genomic revolution.


Race may be irrelevant; it may be, as Dr. Francis Collins, the director of the National Institutes of Health, put it, “a weak and imperfect proxy” for genetic differences. But it is also a familiar concept — and asking people what race they are is substantially cheaper than genotyping them.


So in a peculiar paradox, race has come to serve in some circles as a crude surrogate for genetic analysis until actual genomic medicine comes along — a temporary bridge from now to later, known to be flawed but still a quasi-legitimate stand-in for the real thing.


Against this background unfolds the story of BiDil, a drama of greed and good intentions.


Several observations prompted the drug’s development. Among them was the common assertion from the last century that blacks with heart failure were more likely to die than whites. (Mr. Kahn does an impressive job of researching and debunking this statistic.) Then there was the belief that blacks often reacted badly to some of the newer drugs used for treating heart failure, and the results of a study dating from the 1980s suggesting that many black patients did well with two old standby drugs.


Those two drugs were (and are) on sale as generics, costing pennies a pill. But just suppose they were combined into a single pill that could be then specifically marketed to patients who just happened to be thought in particular need of effective medication? Now there was a pharmacologic and marketing plan that would extend a lucrative new patent for decades.


And so it came to pass that a collection of eager investors and some of the nation’s foremost cardiologists smiled on the results of an industry-sponsored trial performed on self-identified black subjects with heart failure: The two cheap drugs combined into the not-so-cheap BiDil reduced mortality by 40 percent compared with placebo. This figure was impressive enough to end the trial early and speed BiDil to market.


How did whites do on BiDil? Nobody bothered to check.


Mr. Kahn deserves credit for teasing out all the daunting complexities behind these events, including the details of genetic analysis, the perils of racial determinations and the minutiae of patent law. Unfortunately, though, he suffocates his powerful subject in a dry, repetitive, ponderous read.


A law professor with a doctorate in history and longstanding interest in race issues, Mr. Kahn trudges a partisan path through the drama in which he himself was a player. (He testified before an F.D.A. advisory committee that BiDil should be approved without racial qualifications.)


He heads bravely into many statistical thickets, but omits relevant clinical data; he repeatedly refers to the trial that led to BiDil’s approval, for instance, but I could find its numerical findings nowhere in the book and had to look them up. In a story that fairly drips with potential human interest, he offers the reader not one sip.


The issues raised on every page are so important and so thought-provoking that it would be irresponsible to warn interested readers away. Still, it would be almost as irresponsible to misrepresent the difficulty of the journey.


As it happens, BiDil itself has had a remarkably inglorious career. Despite its much-trumpeted release, patients did not request the medication, and practicing doctors did not prescribe it.


NitroMed, the company that developed it, sponsored no further studies and failed in 2009.


The drug still lingers on the market; Mr. Kahn writes that BiDil may be resurrected in sustained-release form — that other time-honored technique for wringing a few more years from a drug’s patent.


For a parable of early 21st-century medicine, as it treads water between past and future and never hesitates to reach for a buck, it doesn’t get much better than BiDil.


Read More..

Books: From Bang to Whimper: A Heart Drug’s Story





On June 23, 2005, American medicine managed to take a small step forward and a giant step backward at precisely the same time, with government approval of the first medication to be earmarked for a specific racial group. It was BiDil, a drug designed to treat heart failure in blacks.




Enthusiasts hailed BiDil’s approval by the Food and Drug Administration as a landmark event in the nascent field of pharmacogenomics, which aims to create drugs tailored to fit an individual’s genetic makeup as precisely as a bespoke suit drapes its owner’s shoulders. Critics just winced and clocked one more misstep in medicine’s long history of race-related disasters.


You would think that the elucidation of the human genome would have cleared up most of the hoary untruths surrounding race and health. But as Jonathan Kahn makes clear in his worthy if convoluted review of the events surrounding the birth of BiDil, the genome has in many respects only made things worse.


It has been clear for decades that race has minimal relevance to the body’s inner workings. Research has repeatedly shown that the biologic variations among individuals of the same race are reliably great enough for race to retain little utility as a biologic predictor. You might as well sort people by height. Or, in the words of an editorial writer for Nature Biotechnology in 2005, “Pooling people in race silos is akin to zoologists grouping raccoons, tigers and okapis on the basis that they are all stripy.”


But old misconceptions die hard, particularly for entrepreneurs eagerly awaiting cash bonanzas from the genomic revolution.


Race may be irrelevant; it may be, as Dr. Francis Collins, the director of the National Institutes of Health, put it, “a weak and imperfect proxy” for genetic differences. But it is also a familiar concept — and asking people what race they are is substantially cheaper than genotyping them.


So in a peculiar paradox, race has come to serve in some circles as a crude surrogate for genetic analysis until actual genomic medicine comes along — a temporary bridge from now to later, known to be flawed but still a quasi-legitimate stand-in for the real thing.


Against this background unfolds the story of BiDil, a drama of greed and good intentions.


Several observations prompted the drug’s development. Among them was the common assertion from the last century that blacks with heart failure were more likely to die than whites. (Mr. Kahn does an impressive job of researching and debunking this statistic.) Then there was the belief that blacks often reacted badly to some of the newer drugs used for treating heart failure, and the results of a study dating from the 1980s suggesting that many black patients did well with two old standby drugs.


Those two drugs were (and are) on sale as generics, costing pennies a pill. But just suppose they were combined into a single pill that could be then specifically marketed to patients who just happened to be thought in particular need of effective medication? Now there was a pharmacologic and marketing plan that would extend a lucrative new patent for decades.


And so it came to pass that a collection of eager investors and some of the nation’s foremost cardiologists smiled on the results of an industry-sponsored trial performed on self-identified black subjects with heart failure: The two cheap drugs combined into the not-so-cheap BiDil reduced mortality by 40 percent compared with placebo. This figure was impressive enough to end the trial early and speed BiDil to market.


How did whites do on BiDil? Nobody bothered to check.


Mr. Kahn deserves credit for teasing out all the daunting complexities behind these events, including the details of genetic analysis, the perils of racial determinations and the minutiae of patent law. Unfortunately, though, he suffocates his powerful subject in a dry, repetitive, ponderous read.


A law professor with a doctorate in history and longstanding interest in race issues, Mr. Kahn trudges a partisan path through the drama in which he himself was a player. (He testified before an F.D.A. advisory committee that BiDil should be approved without racial qualifications.)


He heads bravely into many statistical thickets, but omits relevant clinical data; he repeatedly refers to the trial that led to BiDil’s approval, for instance, but I could find its numerical findings nowhere in the book and had to look them up. In a story that fairly drips with potential human interest, he offers the reader not one sip.


The issues raised on every page are so important and so thought-provoking that it would be irresponsible to warn interested readers away. Still, it would be almost as irresponsible to misrepresent the difficulty of the journey.


As it happens, BiDil itself has had a remarkably inglorious career. Despite its much-trumpeted release, patients did not request the medication, and practicing doctors did not prescribe it.


NitroMed, the company that developed it, sponsored no further studies and failed in 2009.


The drug still lingers on the market; Mr. Kahn writes that BiDil may be resurrected in sustained-release form — that other time-honored technique for wringing a few more years from a drug’s patent.


For a parable of early 21st-century medicine, as it treads water between past and future and never hesitates to reach for a buck, it doesn’t get much better than BiDil.


Read More..

IHT Rendezvous: Monitoring Mandela, and With Him the Soul of a Nation

PLETTENBERG BAY, South Africa – After almost three weeks of treatment for a recurrent lung infection, Nelson Mandela, the 94-year-old icon of South Africa’s triumph over apartheid, was discharged from hospital late Wednesday. But a terse statement from his physicians saying he would not return immediately to his remote, rural home at Qunu in the Eastern Cape region raised fresh questions that his family and his associates sought to answer a day later.

Page Two

Posts written by the IHT’s Page Two columnists.

Mr. Mandela’s health – and the very question of his longevity – are a national issue reflecting his role as the custodian of his moral legacy. As I write in my latest Page Two column, his survival offers reassurance to many. But there is little doubt about his frailty.

The footage depicting him these days seems to be exclusively from the archives. The precise state of his health remains unclear.
When a television station re-broadcast an interview with his wife, Graça Machel this month, suggesting that his “spirit” and “sparkle” were fading, the alarms spread far beyond South Africa’s borders until the channel apologized, saying her remarks dated to 2009.

The terms of Mr. Mandela’s discharge from the hospital seemed to reflect those uncertainties.

Mr. Mandela’s grandson, Mandla Mandela, was quoted by the news24 Web site on Thursday as saying he hoped “it won’t be too long before he’s with us back in Qunu, where he belongs.” But, he said, the trip could be strenuous and Mr. Mandela’s physicians would determine “when he will be fit and ready to come back home.”

Mac Maharaj, a spokesman for President Jacob Zuma, said doctors had concluded that Mr. Mandela was better off at his home in Houghton, in Johannesburg’s leafy, upmarket northern suburbs, “so that he’s close to all the facilities where we can give him high care,” News24 reported.

“Madiba was doing well, but as you know, when you’re recovering there are ups and downs, slight ups and downs, and the doctors are looking for a steady progress and that began to be registered over the last few days,” Mr. Maharaj said, using Mr. Mandela’s clan name, Madiba.

Read More..