Discounting the obvious

The main events in the history of science have involved new ideas overthrowing conventional wisdom. The notion that the earth was the center of the universe was upended by Copernicus. Species were thought to be permanent and fixed until Darwin. Physics was thought to be completely understood at the end of the nineteenth century and then came relativity theory and quantum mechanics to mess everything up. Godel overthrew the notion that mathematics was infallible. This story has been repeated so many times that people now seem to instinctively look for the counterintuitive answer to every problem. There are countless books on thinking outside of the box.  However, I think that the supplanting of “linear” thinking with “nonlinear” thinking is not always a good idea and sometimes it can have dire consequences.

A salient example is the current idea that fiscal austerity will lead to greater economic growth. GDP is defined as the sum of  consumption, investment, government spending and exports minus imports. If consumption or investment were to decline in an economic contraction, as in the Great Recession, then the simple linear idea would be that GDP and growth can be bolstered by increased government spending. This was the standard government response immediately after the financial crisis of 2008. However, starting in about 2010 when the recovery wasn’t deemed fast enough instead of considering the simple idea that the stimulus wasn’t big enough, the idea that policy makers, especially in Europe, adopted was that government spending was crowding out private spending so that a decrease in government spending would lead to a net increase in GDP and growth. This is very nonlinear thinking because it requires a decrease in GDP to induce an increase in GDP. Thus far this idea is not working and austerity has led to lower GDP growth in all countries that have tried it.  This idea was reinforced by a famous, now infamous, paper by Reinhart and Rogoff, which claimed that when government debt reaches 90% of GDP, growth is severely curtailed. This result has been taken as undisputed truth by governments and the press even though there were many economists who questioned it.  However, it turns out that the paper has major errors (including an Excel coding error). See here for a summary.  This is case where the nonlinear idea (as well as conflating correlation with causation) is probably wrong and has inflicted immense hardship on a large number of people.


New paper on fat

Sex-Associated Differences in Free Fatty Acid Flux of Obese Adolescents.

Diane C Adler-Wailes, Vipul Periwal, Asem H Ali, Sheila M Brady, Jennifer R McDuffie, Gabriel I Uwaifo, Marian Tanofsky-Kraff, Christine G Salaita, Van S Hubbard, James C Reynolds, Carson C Chow, Anne E Sumner, Jack A Yanovski

Section on Growth and Obesity (D.C.A.-W., A.H.A., S.J.R.M., G.I.U., M.T.-K., J.A.Y.), Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Mathematical Cell Modeling Section (V.P., C.C.C.), Division of Extramural Activities (C.G.S.), Division of Nutrition Research Coordination (V.S.H.), and Laboratory of Endocrinology and Receptor Biology (A.E.S.), National Institute of Diabetes and Digestive and Kidney Diseases; and Nuclear Medicine Department (J.C.R.), Hatfield Clinical Research Center, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892.

The Journal of clinical endocrinology and metabolism (impact factor: 6.5). 02/2013; DOI:10.1210/jc.2012-3817

ABSTRACT Context: In obesity, increases in free fatty acid (FFA) flux can predict development of insulin resistance. Adult women release more FFA relative to resting energy expenditure (REE) and have greater FFA clearance rates than men. In adolescents, it is unknown whether sex differences in FFA flux occur. Objective: Our objective was to determine the associations of sex, REE, and body composition with FFA kinetics in obese adolescents. Participants: Participants were from a convenience sample of 112 non-Hispanic white and black adolescents (31% male; age range, 12-18 years; body mass index SD score range, 1.6-3.1) studied before initiating obesity treatment. Main Outcome Measures: Glucose, insulin, and FFA were measured during insulin-modified frequently sampled iv glucose tolerance tests. Minimal models for glucose and FFA calculated insulin sensitivity index (SI) and FFA kinetics, including maximum (l0 + l2) and insulin-suppressed (l2) lipolysis rates, clearance rate constant (cf), and insulin concentration for 50% lipolysis suppression (ED50). Relationships of FFA measures to sex, REE, fat mass (FM), lean body mass (LBM) and visceral adipose tissue (VAT) were examined. Results: In models accounting for age, race, pubertal status, height, FM, and LBM, we found sex, pubertal status, age, and REE independently contributed to the prediction of l2 and l0 + l2 (P < .05). Sex and REE independently predicted ED50 (P < .05). Sex, FM/VAT, and LBM were independent predictors of cf. Girls had greater l2, l0 + l2 and ED50 (P < .05, adjusted for REE) and greater cf (P < .05, adjusted for FM or VAT) than boys. Conclusion: Independent of the effects of REE and FM, FFA kinetics differ significantly in obese adolescent girls and boys, suggesting greater FFA flux among girls.

Hepatitis C and the folly of prizes

The scientific world was set slightly aflutter when Michael Houghton turned down the prestigious Gairdner Award for the the discovery of Hepatitis C. Harvey Alter and Daniel Bradley were the two other recipients. Houghton, who had previously received the Lasker Award with Alter, felt he could not accept one more award because two colleagues Qui-Lim Choo and George Kuo did not receive either of these awards, even though their contributions were equally important.

Hepatitis, which literally means inflammation of the liver, was characterized by Hippocrates and known to be infectious since the 8th century. The disease had been postulated to be viral at the beginning of the 20th century and by the 1960’s two viruses termed Hepatitis A and Hepatitis B had been established. However, there still seemed to be another unidentified infectious agent which was termed Non-A Non-B Hepatitis NANBH.

Michael Hougton, George Kuo and Qui-Lim Choo were all working at the Chiron corporation in the early 1980’s.   Houghton started a project to discover the cause of NANBH in 1982 with Choo joining a short time later. They made significant process in generating mouse monoclonal antibodies with some specificity to NANBH infected materials from chimpanzee samples received from Daniel Bradley at the CDC. They used the antibodies to screen cDNA libraries from infected materials but they had not isolated an agent. George Kuo had his own lab at Chiron working on other projects but would interact with Houghton and Choo. Kuo suggested that they try blind cDNA immunoscreening on serum derived from actual NANBH patients. This approach was felt to be too risky but Kuo made a quantitative assessment that showed it was viable. After two years of intensive and heroic screening by the three of them, they identified one clone that was clearly derived from the NANBH genome and not from human or chimp DNA. This was definitive proof that NANBH was a virus, which is now called Hepatitis C. Kuo then developed a prototype of a clinical Hepatitis C antibody detection kit and used it to screen a panel of NANBH blood provided by Harvey Alter of the NIH. Kuo’s test was a resounding success and the blood test that came out of that work has probably saved 300 million or more people from Hepititis C infection.

The question then is who deserves the prizes. Is it Bradley and Alter, who did careful and diligent work obtaining samples or is it Houghton, Choo, and Kuo, who did the heroic experiments that isolated the virus? For completely unknown reasons, the Lasker was awarded to just Houghton and Alter, which primed the pump for more prizes to these two. Now that the Lasker and Gairdner prizes have been cleared, that leaves just the Nobel Prize. The scientific community could get it right this time and award it to Kuo, Choo, and Houghton.


Addendum added 2013-5-2:  I should add that many labs from around the world were also trying to isolate the infective agent of NANBH and all failed to identify the correct samples from Alter’s panel.  It is not clear how long it would have been and how many more people would have been infected if Kuo, Choo, and Houghton had not succeeded when they did.