An Advancement and Missed Opportunity for Alzheimer's

Last week a paper was published in Nature Medicine that drew significant media buzz. The paper was titled "Plasma phospholipids identify antecedent memory impairment in older adults." You may know it better by the headlines "New blood test for Alzheimer's disease" or "Alzheimer's can be predicted three years in advance."

As a scientist, the discord between the popular mainstream media's presentation of this paper and the actual scientific paper was jarring. Firstly, there is a sharp contrast between the precise language of the Nature title and the more attention-seeking, market-sensitive language of the mainstream-media headlines. Secondly, the mainstream-media headlines are relatively misleading. There is no blood test available on the market today; there are still large scientific gaps that we need to fill before the technique can be used to predict Alzheimer's in a diverse population.

The typical quick reader of these headlines will leave with the impression that science is ahead of where it actually is. There is a confidence exuded by the media that is not echoed within the paper. This kind of approach to scientific news does everyone, from patients to scientists, a huge disservice. It is particularly troubling with a disease as prevalent as Alzheimer's, which is predicted to impact one out of every six women over the age of 65 and one out of every 11 men over the age of 65.

A few caveats are stated within the news articles: USA Today, NPR, and CNN all explained that there is still research to be done. According to CNN:

If any of these tests work out -- and that's still an if -- it would take years to make it to doctors' offices, since the test would need to be validated by other labs and with larger groups of people.
However, there is a wide gap between delivering the facts and explaining how the science works.

In this particular paper, the approach to a disease like Alzheimer's was impressive -- and is important for the public to understand. We really do not completely understand how Alzheimer's is triggered, and we can only diagnose it after it has developed past a point. As a result, the authors chose to assay blood from patients with and without cognitive impairments over a period of time, and see if they could find a predictive change in the lipid composition. If I lost you at "lipid composition," think of it like this: Lipids make up the walls of cells, including neurons (brain cells). If those walls change, it may correlate with neurodegeneration, or neurons dying prematurely. So it's smart to think of testing lipid levels in patients with Alzheimer's, and even smarter to think of running a five-year study in which you could track patients with initial cognitive impairments and patients who developed those over time. Identifying lipids as predictive is useful not only for earlier intervention but for identifying potential therapeutic targets. If the public fully understood the merit of this kind of study, setting up a second trial may be an easier, quicker and more thoughtful process.

The second trial is necessary for several reasons. This is the first study of its kind, and it took five years to run. The last paragraph of the Nature paper itself states:

This biomarker panel requires external validation using similar rigorous clinical classification before further development for clinical use. Such additional validation should be considered in a more diverse demographic group than our initial cohort.

In other words, for certain data analysis, they had as few as 41 patients, and depending on the genetic background of participants, they may not be able to make assumptions of predictability for everyone. This is important and is often overlooked when clinical trials are discussed. Scientists desperately need participants from a variety of genetic backgrounds -- and larger numbers of participants to build a test that is accurate and meaningful.

The public's appreciation of the scientific methodology and merit behind the paper are critical to the furthering of research like this. Within science, authors are careful and precise. We understand that there is a fine line between prediction and causation, between statistical significance and repeatability. Every paper that is peer-reviewed is vetted through critical, careful eyes. The claims are brought down to the facts, and the holes punctured quickly.

That process doesn't exist for science in the media world. It's particularly telling that in Nature's social-media indexing for this particular article, they show less than 100 direct Tweets to the paper. CNN's news article had over 500 comments, and it doesn't appear as though the majority had read or understood the actual paper.

As a scientist and as a patient, this is alarming. I understand the need for science to be scientific -- precise, complex and detail-oriented. As a patient, I want to understand things in a way that is relevant to me -- clear, evidence-based and friendly. No matter how empowered I am as a patient, if I don't have access to accurate, complete information, I am still fumbling in the dark. If scientists don't turn the light on for patients and take the lead with scientific education, they will lose out on a population that is eager and energized and wants to meet the same research goals.

Thanks to Climate Change, West Nile Virus Could Be Your New Neighbor

Invasive species aren’t just species — they can also be pathogens. Such is the case with the West Nile virus. A mosquito-borne virus identified in the West Nile subregion in Uganda in 1937 — hence the name — West Nile wasn’t much of a concern to people elsewhere until it broke out of Africa in 1999. The first U.S. cases were confirmed in New York City in 1999, and it has now spread throughout much of the world. Though 80% of infections are subclinical — meaning they yield no symptoms — those who do get sick can get very sick. The virus can lead to encephalitis — inflammation of the brain and nervous system — and even death, with 286 people dying from West Nile in the U.S. in 2012. There were more than 5,500 cases reported that year, and the scary thing is that as the climate warms, West Nile will continue to spread.

That’s the conclusion of a new study from a team of researchers in the U.S., Britain and Germany, including those at the Center for Tropical Research at UCLA’s Institute of the Environment and Sustainability. In a study published in the journal Global Change Biology, the researchers took climate and species-distribution data, and created models that try to project the spread of the virus as the globe warms. West Nile virus is carried by mosquitoes, and infected insects transmit the virus to human beings with a bite. But birds play a role too — if bitten by an infected mosquito, birds can generate high levels of the virus in their bloodstream, and can then transmit it to uninfected mosquitoes, which in turn can infect people. The biggest indicator of whether West Nile virus will occur is the maximum temperature of the warmest month of the year, which is why the virus has caused the most damage in hot southern states like Texas.

The UCLA model indicates that higher temperatures and lower precipitation will generally lead to more cases of West Nile, as well as the spread of the virus to northern territories that haven’t yet been affected by it. In California alone, for example, more than half of the state will see an increased probability of West Nile in the decades to come, and by 2080 the virus may well be prevalent in parts of southern Canada, and as far north as northern British Columbia, as you can see in this map:

The UCLA model looks only at climate data and doesn’t take into account the kind of control methods that can be used to combat West Nile on the ground, including pesticide spraying and land-use changes that deny mosquitoes the pools of stagnant water they use as breeding sites. That’s important to remember: while climate change can raise the risk of typically tropical diseases like West Nile or malaria, smart control efforts can offset at least some of that danger. (Malaria used to be common throughout much of the South — which is easily warm enough in the summer for the disease — before steps were taken to eliminate it, a process that led to the creation of the Centers for Disease Control and Prevention.) But the UCLA study underscores the fact that climate change operates as a threat multiplier for tropical diseases, one that will allow pathogens to invade new territory — and, ultimately, us.

The Happiest and Healthiest States Are In the Midwest

A new Gallup survey of nationwide well-being ranks North Dakota at the top and West Virginia at the very bottom.

The annual survey interviews more 178,000 American adults from all 50 states. The well-being index scores states on various factors, including life evaluation, emotional health, work environment, physical health, healthy behaviors, and access to basic necessities. Hawaii was formerly the reigning state for the last four years, but it dropped to 8th this year. Based on the 2013 data, the states in the Midwest and West were generally the highest scoring, and the South had some of the lowest scores.

Other states reigned in their own well-being factors. For instance, Nebraska ranked highest for Life Evaluation Index, Alaska had the greatest score for Emotional Health Index, and Vermont held the top spot for Health Behaviors.

These are the top five states in the survey:

1. North Dakota
2. South Dakota
3. Nebraska
4. Minnesota
5. Montana

And these are the lowest-ranking states (starting from the bottom):

1. West Virginia
2. Kentucky
3. Mississippi
4. Alabama
5. Ohio