aads

Physics Blogging Round-Up: April [Uncertain Principles]

It’s the first week of May, which means we’re due to see flowers watered by all this damn rain soon, and also a recap of the various posts I wrote for Forbes during April:

Why Are There Too Many Papers In Theoretical Physics?: A look at the origins of “ambulance chasing” in high-energy theory, where dozens of people jump on the slightest hint of a new effect.

A Little Luck Is Essential For Success In Science: Some historical examples of physicists who succeeded thanks to a lucky break of one sort or another.

What Sorts Of Problems Are Quantum Computers Good For? Prompted by news of a “quantum traveling salesman” algorithm, a look at the general shape of problems where quantum computing offers a big speed-up over the best classical approaches.

Why Do We Teach ‘Physics For Poets’ But Not ‘Poetry For Physicists’?: Some thoughts about why it is that we have students take courses in other disciplines, and how reform efforts that work too hard to appeal to non-majors might undermine the whole point of liberal education.

What Does It Mean For ‘Science’ To Rise And Fall?: Some thoughts about cycles in the history of science as applied to particular definitions of “Science.”

A decent mix of stuff this month; some long-running obsessions popping up again, some more topical stuff. Two of these are actually very long and well-disguised subtweets, in that they spun out of thinking about kerfuffles in social media that it wouldn’t be productive to write about directly.

You may have noticed a pattern to these recaps, in that there are always five posts; that’s because my contract with Forbes pays me more if I do at least five posts in a month, so I try to hit that. It also works reasonably well in terms of workflow, because that’s just over one post per week, and that’s a decent rate for me in terms of producing fairly consistent quality without cutting too much into my other activities. I may do a navel-gazing post later about how my blogging practices have evolved over time, though…

Anyway, another month, another chunk of blogging. There was a bit of a dry spell in there in terms of material I could usefully write about, and now in keeping with tradition I find myself with an oversupply of blog-worthy material and an undersupply of time in which to write about it. Such is the glamorous life, etc.



from ScienceBlogs http://ift.tt/2p4ti1Z

It’s the first week of May, which means we’re due to see flowers watered by all this damn rain soon, and also a recap of the various posts I wrote for Forbes during April:

Why Are There Too Many Papers In Theoretical Physics?: A look at the origins of “ambulance chasing” in high-energy theory, where dozens of people jump on the slightest hint of a new effect.

A Little Luck Is Essential For Success In Science: Some historical examples of physicists who succeeded thanks to a lucky break of one sort or another.

What Sorts Of Problems Are Quantum Computers Good For? Prompted by news of a “quantum traveling salesman” algorithm, a look at the general shape of problems where quantum computing offers a big speed-up over the best classical approaches.

Why Do We Teach ‘Physics For Poets’ But Not ‘Poetry For Physicists’?: Some thoughts about why it is that we have students take courses in other disciplines, and how reform efforts that work too hard to appeal to non-majors might undermine the whole point of liberal education.

What Does It Mean For ‘Science’ To Rise And Fall?: Some thoughts about cycles in the history of science as applied to particular definitions of “Science.”

A decent mix of stuff this month; some long-running obsessions popping up again, some more topical stuff. Two of these are actually very long and well-disguised subtweets, in that they spun out of thinking about kerfuffles in social media that it wouldn’t be productive to write about directly.

You may have noticed a pattern to these recaps, in that there are always five posts; that’s because my contract with Forbes pays me more if I do at least five posts in a month, so I try to hit that. It also works reasonably well in terms of workflow, because that’s just over one post per week, and that’s a decent rate for me in terms of producing fairly consistent quality without cutting too much into my other activities. I may do a navel-gazing post later about how my blogging practices have evolved over time, though…

Anyway, another month, another chunk of blogging. There was a bit of a dry spell in there in terms of material I could usefully write about, and now in keeping with tradition I find myself with an oversupply of blog-worthy material and an undersupply of time in which to write about it. Such is the glamorous life, etc.



from ScienceBlogs http://ift.tt/2p4ti1Z

This could be the future of how doctors view cancer

Virtual reality

The room I’m standing in is unlike any I’ve been in before.

With 4 large desks facing me, and a panoramic view of what looks like a distant universe out the window, this feels more Star Wars than cancer lab.

I place a card labelled ‘sample 1’ onto a desk that’s linked to a projector. A cloud of different shaped bubbles appear in front of me.

I’m told that the bubbles are in fact different types of cell. And this cloud is the complete picture of a single breast tumour.

But the room I’m in, and everything in it, doesn’t actually exist.

I’m in a virtual lab, projected through a headset. And I’m experiencing the future of how scientists and doctors might one day view, study and understand tumours.

This world is the brainchild of Professor Greg Hannon, from our Cambridge Institute, who’s leading a team of international scientists looking to change the way we see cancer.

Hannon’s team has recently been awarded £20 million through our Grand Challenge. And while their virtual reality vision is not yet fully operational, the demo is an impressive centrepiece to an ambitious research plan that draws in cell biology, astronomy, maths and genetics.

Precise predictions

“This does sound a bit like science fiction,” says Hannon. “We want to develop an entirely new way to look at cancer.”

Professor Greg Hannon

The goal of our project is to create an interactive 3D atlas of cancers where we know every cell, we know what kind of cell it is, and we know its general features – Professor Greg Hannon

The project builds on the work of the Cambridge Institute’s Professor Carlos Caldas, which 5 years ago redefined breast cancer as 10 distinct subtypes of tumour.

Research has shown that each of these subtypes could help predict how a patient may fare. But the classifications can’t, as yet, offer definitive answers for each patient.

“The importance of this project is to be able to take those broad classifications and make more precise predictions,” says Hannon. “So it’s not just ‘you have a type of tumour where we think there is a 50% chance that this treatment will really help you’, but to know which 50% each person falls in to.”

One of the challenges scientists have faced in refining these predications is that the tissue samples (biopsies) they have access to offer just a single snapshot of a tumour.

Biopsies play a crucial part in a patient’s journey through cancer. They are required to diagnose the disease and make decisions around treatment. And researchers also use this precious tissue to learn more about tumours.

Analysing these samples to search for faulty genes and molecules has been incredibly useful in guiding treatment, particularly for breast cancer. But the techniques that do this only take an average of all the cells, molecules and DNA a sample may hold, meaning some details may be missed. This would be like deciding to give everyone at a dinner party steak, just because the majority of guests are meat-eaters. And, according to Hannon, offers “an imprecise picture of what tumours really look like”.

In recent years, it has become clear that tumours differ greatly between patients. These differences can also appear within each patient’s tumour, raising further challenges for treatment. As this idea has taken hold, the techniques used to characterise tumours in the lab have become focused on each individual cancer cell, rather than information averaged from many.

Hannon says this has been an improvement, because it gives much more detailed information. But he believes this needs to be taken a step further, drawing in the geography of tumours to build a more complete picture and refine predications around treatment.

Tumours aren’t made of just one type of cell, says Hannon. So more needs to be done to find out which cells are inside tumours, where they are, and who their neighbours are. “Tumour cells within a cancer have different properties, different capabilities,” he explains. And the team want to define these differences for every cancer cell in a tumour, and study how this affects the healthy cells that can be corrupted and controlled by tumours, such as immune cells.

Building the atlas

“The goal of our project is to create an interactive 3D atlas of cancers where we know every cell, we know what kind of cell it is, and we know its general features,” says Hannon.

This is an ambitious goal, but not out of reach.

“We think about this almost like saying ‘OK, we’re going to put a man on Mars’.” What they’re trying to do doesn’t violate any particular laws of physics, he adds. This means that the technology exists, but they’ll have to push the boundaries of what can be done with it right now to get there.

As with any journey of exploration, the team needs a map. And they’ll start with a specialised microscope to take a picture of every cell in the tumours they’ll initially be studying in mice, and then in samples from patients.

“The kinds of microscopes that do this, you can’t buy you have to build them,” says Hannon. “You can’t just put an order in. So we have found someone who’s a real expert in this and they’ll come to Cambridge and construct this thing.”

This microscope is unique because it’s attached to what is essentially a tiny bacon slicer. As the microscope captures a picture of a minute layer of cells in a tumour sample, that same layer is sliced off and collected for further analysis.

Once this has been carried out for the entire tumour, the image of each single cell has to be put back together as a complete 3D picture, which means processing a lot of data.

“When I say a lot, I talk about 100 terabytes per sample,” says Dr Dario Bressan, who’s part of Hannon’s team leading on the microscopy arm of the project.

That’s more than twice the amount of data collected by the Hubble Space Telescope in its first 20 years of observation, for each sample the team collects. So, with the hope of analysing thousands of samples during the project, it’s no surprise that they’ve turned to the astronomy department at the University of Cambridge to help them process these data.

“When we told the astronomy guys you have to file through 100 terabytes of data they said: ‘oh, only?’ They’re used to this – they’re topic of discussion is the sky – so they’re adapting their algorithms from finding stars to finding cells,” says Bressan.

Once the 3D image has been complied, the team will then have to overlay data from a suite of techniques that measure the genes and molecules inside each individual cell. This is made possible by applying the techniques to the thin slices that were originally taken from the microscope, and then mapping this to the astronomy team’s 3D image.

At the moment, when used in pathology labs, these techniques can measure the levels of a couple of protein molecules and the activity of a couple of genes. “Our edge here is that we’re collaborating with people who have invented ways to extend this to 1000 or more genes and 53 proteins,” says Bressan.

“Ultimately we want to be able to collect 20,000 plus pieces of information on every cell in a tumour,” adds Hannon. Again, that’s a lot of information.

“We will have to invent an entirely new way for people to interact with this information,” says Hannon.

And that’s where the virtual reality comes in.

Hannon_VR_hero

A new, virtual perspective on cancer. Credit: IMAXT Grand Challenge team

A new perspective

The challenge of how to present and communicate these data is one the team has thought about a lot.

“The only way to put more information on a piece of paper is to write smaller,” says Hannon. “And at some point, there’s diminishing returns in this.

“In virtual reality we can present many more dimensions of information than you can on a piece of paper.”

To tackle this the team has drawn its inspiration from the world of video games, which Bressan says are “really good at showing a lot of information in the blink of an eye”.

The team’s idea, he adds, is that with virtual reality “we don’t just use the position of each cell, but we can use the colour of each cell, we can use whether it’s blinking or not, we can use the size. And already by doing this you are looking at 6-8 dimensions of data at the same time.”

Thanks to a new collaboration with virtual reality designer Owen Harris, artist Flaminia Grimaldi, and programmer Robby Becker, that ambition has quickly been developed in to a working demo.

“When Greg approached me, I’d been working with some Dutch scientists making a VR experience for people with anxiety and depression,” says Harris. While he thought that Hannon’s plan for a virtual cancer lab sounded amazing, Harris wasn’t originally sure he could help due to the scale of the project.

But a visit to Cambridge, and a chat with his aunt Claire, changed his mind.

“I was overwhelmed by the vision of the people in the lab,” he says. “It was exhilarating. So I was thinking I needed to do a little bit on this project.”

His aunt then encouraged him to go further.

“Claire is a very important person in my life. In my teenage years she really encouraged me at times when others weren’t.

“She has breast cancer. And she said to me: ‘you have to do this’. So it’s a mixture of her demand and how impressed with the team I was that has drawn me in deeper and deeper.”

While Harris and his team has developed an impressive early version of the virtual lab, he admits that it has been “held together with virtual duct tape”.

So now the team is working on new features, and strengthening the foundations of the new technology. “The design challenge is exciting because this is the only one of these that exists in the world,” he says.

“It’s one of the most satisfying things I’ve ever worked on.”

The future for the VR is more rooms to look at new data in different ways. These developments, says Harris, are focused on building something that works for researchers, doctors, and people looking to learn about cancer.

170206-HANNON-Project-graphic-final

A new type of pathology?

Hannon’s hope is that the information they gather over the next 5 years, and the technology they build, will become part of modern pathology.

This won’t come through the thousands of measurements they have planned for millions of cells. Instead, they will have to steadily focus down on the most important information for doctors looking to make decisions around treatment.

A big part of this, he says, is that the custom, clunky instruments they’re building will need to be turned into something that “fits inside a shoebox”.

Working in virtual reality also opens up the chance to collaborate across the globe, both for the scientists involved in the early development stages and potentially for doctors in the future.

“This is not a single user interface,” says Hannon. “The thing the gaming world is really good at is having these multi-user designs. So what we envision is not only for researchers to be able to meet in these virtual reality spaces, but for physicians and patients to be looking at these models together.”

That ambition, although it remains a distant goal, is one that is shared by the 2 patient representatives that will be supporting Hannon’s team.

At a recent event where all Grand Challenge teams gathered to present their projects, the patients spoke of how they think that seeing the data, particularly in 3D, might help others understand some of the treatment choices they are presented with.

And that’s the true reality behind the sci-fi goggles, a desire to learn everything about a tumour, so that doctors, patients and the public each have the information they need to navigate their journey through cancer.

Nick



from Cancer Research UK – Science blog http://ift.tt/2p48ozI
Virtual reality

The room I’m standing in is unlike any I’ve been in before.

With 4 large desks facing me, and a panoramic view of what looks like a distant universe out the window, this feels more Star Wars than cancer lab.

I place a card labelled ‘sample 1’ onto a desk that’s linked to a projector. A cloud of different shaped bubbles appear in front of me.

I’m told that the bubbles are in fact different types of cell. And this cloud is the complete picture of a single breast tumour.

But the room I’m in, and everything in it, doesn’t actually exist.

I’m in a virtual lab, projected through a headset. And I’m experiencing the future of how scientists and doctors might one day view, study and understand tumours.

This world is the brainchild of Professor Greg Hannon, from our Cambridge Institute, who’s leading a team of international scientists looking to change the way we see cancer.

Hannon’s team has recently been awarded £20 million through our Grand Challenge. And while their virtual reality vision is not yet fully operational, the demo is an impressive centrepiece to an ambitious research plan that draws in cell biology, astronomy, maths and genetics.

Precise predictions

“This does sound a bit like science fiction,” says Hannon. “We want to develop an entirely new way to look at cancer.”

Professor Greg Hannon

The goal of our project is to create an interactive 3D atlas of cancers where we know every cell, we know what kind of cell it is, and we know its general features – Professor Greg Hannon

The project builds on the work of the Cambridge Institute’s Professor Carlos Caldas, which 5 years ago redefined breast cancer as 10 distinct subtypes of tumour.

Research has shown that each of these subtypes could help predict how a patient may fare. But the classifications can’t, as yet, offer definitive answers for each patient.

“The importance of this project is to be able to take those broad classifications and make more precise predictions,” says Hannon. “So it’s not just ‘you have a type of tumour where we think there is a 50% chance that this treatment will really help you’, but to know which 50% each person falls in to.”

One of the challenges scientists have faced in refining these predications is that the tissue samples (biopsies) they have access to offer just a single snapshot of a tumour.

Biopsies play a crucial part in a patient’s journey through cancer. They are required to diagnose the disease and make decisions around treatment. And researchers also use this precious tissue to learn more about tumours.

Analysing these samples to search for faulty genes and molecules has been incredibly useful in guiding treatment, particularly for breast cancer. But the techniques that do this only take an average of all the cells, molecules and DNA a sample may hold, meaning some details may be missed. This would be like deciding to give everyone at a dinner party steak, just because the majority of guests are meat-eaters. And, according to Hannon, offers “an imprecise picture of what tumours really look like”.

In recent years, it has become clear that tumours differ greatly between patients. These differences can also appear within each patient’s tumour, raising further challenges for treatment. As this idea has taken hold, the techniques used to characterise tumours in the lab have become focused on each individual cancer cell, rather than information averaged from many.

Hannon says this has been an improvement, because it gives much more detailed information. But he believes this needs to be taken a step further, drawing in the geography of tumours to build a more complete picture and refine predications around treatment.

Tumours aren’t made of just one type of cell, says Hannon. So more needs to be done to find out which cells are inside tumours, where they are, and who their neighbours are. “Tumour cells within a cancer have different properties, different capabilities,” he explains. And the team want to define these differences for every cancer cell in a tumour, and study how this affects the healthy cells that can be corrupted and controlled by tumours, such as immune cells.

Building the atlas

“The goal of our project is to create an interactive 3D atlas of cancers where we know every cell, we know what kind of cell it is, and we know its general features,” says Hannon.

This is an ambitious goal, but not out of reach.

“We think about this almost like saying ‘OK, we’re going to put a man on Mars’.” What they’re trying to do doesn’t violate any particular laws of physics, he adds. This means that the technology exists, but they’ll have to push the boundaries of what can be done with it right now to get there.

As with any journey of exploration, the team needs a map. And they’ll start with a specialised microscope to take a picture of every cell in the tumours they’ll initially be studying in mice, and then in samples from patients.

“The kinds of microscopes that do this, you can’t buy you have to build them,” says Hannon. “You can’t just put an order in. So we have found someone who’s a real expert in this and they’ll come to Cambridge and construct this thing.”

This microscope is unique because it’s attached to what is essentially a tiny bacon slicer. As the microscope captures a picture of a minute layer of cells in a tumour sample, that same layer is sliced off and collected for further analysis.

Once this has been carried out for the entire tumour, the image of each single cell has to be put back together as a complete 3D picture, which means processing a lot of data.

“When I say a lot, I talk about 100 terabytes per sample,” says Dr Dario Bressan, who’s part of Hannon’s team leading on the microscopy arm of the project.

That’s more than twice the amount of data collected by the Hubble Space Telescope in its first 20 years of observation, for each sample the team collects. So, with the hope of analysing thousands of samples during the project, it’s no surprise that they’ve turned to the astronomy department at the University of Cambridge to help them process these data.

“When we told the astronomy guys you have to file through 100 terabytes of data they said: ‘oh, only?’ They’re used to this – they’re topic of discussion is the sky – so they’re adapting their algorithms from finding stars to finding cells,” says Bressan.

Once the 3D image has been complied, the team will then have to overlay data from a suite of techniques that measure the genes and molecules inside each individual cell. This is made possible by applying the techniques to the thin slices that were originally taken from the microscope, and then mapping this to the astronomy team’s 3D image.

At the moment, when used in pathology labs, these techniques can measure the levels of a couple of protein molecules and the activity of a couple of genes. “Our edge here is that we’re collaborating with people who have invented ways to extend this to 1000 or more genes and 53 proteins,” says Bressan.

“Ultimately we want to be able to collect 20,000 plus pieces of information on every cell in a tumour,” adds Hannon. Again, that’s a lot of information.

“We will have to invent an entirely new way for people to interact with this information,” says Hannon.

And that’s where the virtual reality comes in.

Hannon_VR_hero

A new, virtual perspective on cancer. Credit: IMAXT Grand Challenge team

A new perspective

The challenge of how to present and communicate these data is one the team has thought about a lot.

“The only way to put more information on a piece of paper is to write smaller,” says Hannon. “And at some point, there’s diminishing returns in this.

“In virtual reality we can present many more dimensions of information than you can on a piece of paper.”

To tackle this the team has drawn its inspiration from the world of video games, which Bressan says are “really good at showing a lot of information in the blink of an eye”.

The team’s idea, he adds, is that with virtual reality “we don’t just use the position of each cell, but we can use the colour of each cell, we can use whether it’s blinking or not, we can use the size. And already by doing this you are looking at 6-8 dimensions of data at the same time.”

Thanks to a new collaboration with virtual reality designer Owen Harris, artist Flaminia Grimaldi, and programmer Robby Becker, that ambition has quickly been developed in to a working demo.

“When Greg approached me, I’d been working with some Dutch scientists making a VR experience for people with anxiety and depression,” says Harris. While he thought that Hannon’s plan for a virtual cancer lab sounded amazing, Harris wasn’t originally sure he could help due to the scale of the project.

But a visit to Cambridge, and a chat with his aunt Claire, changed his mind.

“I was overwhelmed by the vision of the people in the lab,” he says. “It was exhilarating. So I was thinking I needed to do a little bit on this project.”

His aunt then encouraged him to go further.

“Claire is a very important person in my life. In my teenage years she really encouraged me at times when others weren’t.

“She has breast cancer. And she said to me: ‘you have to do this’. So it’s a mixture of her demand and how impressed with the team I was that has drawn me in deeper and deeper.”

While Harris and his team has developed an impressive early version of the virtual lab, he admits that it has been “held together with virtual duct tape”.

So now the team is working on new features, and strengthening the foundations of the new technology. “The design challenge is exciting because this is the only one of these that exists in the world,” he says.

“It’s one of the most satisfying things I’ve ever worked on.”

The future for the VR is more rooms to look at new data in different ways. These developments, says Harris, are focused on building something that works for researchers, doctors, and people looking to learn about cancer.

170206-HANNON-Project-graphic-final

A new type of pathology?

Hannon’s hope is that the information they gather over the next 5 years, and the technology they build, will become part of modern pathology.

This won’t come through the thousands of measurements they have planned for millions of cells. Instead, they will have to steadily focus down on the most important information for doctors looking to make decisions around treatment.

A big part of this, he says, is that the custom, clunky instruments they’re building will need to be turned into something that “fits inside a shoebox”.

Working in virtual reality also opens up the chance to collaborate across the globe, both for the scientists involved in the early development stages and potentially for doctors in the future.

“This is not a single user interface,” says Hannon. “The thing the gaming world is really good at is having these multi-user designs. So what we envision is not only for researchers to be able to meet in these virtual reality spaces, but for physicians and patients to be looking at these models together.”

That ambition, although it remains a distant goal, is one that is shared by the 2 patient representatives that will be supporting Hannon’s team.

At a recent event where all Grand Challenge teams gathered to present their projects, the patients spoke of how they think that seeing the data, particularly in 3D, might help others understand some of the treatment choices they are presented with.

And that’s the true reality behind the sci-fi goggles, a desire to learn everything about a tumour, so that doctors, patients and the public each have the information they need to navigate their journey through cancer.

Nick



from Cancer Research UK – Science blog http://ift.tt/2p48ozI

Cassini finds ‘big empty’ near Saturn

Artist’s concepts of Cassini spacecraft diving through the gap between Saturn’s outer atmosphere and inner rings. Cassini will do this 22 times in 2017, before ending its mission at Saturn.

There’s much less dust between Saturn and its inner rings than expected, said NASA engineers, after last week’s historic dive through this gap by the Cassini spacecraft. Astronomers have been contemplating this maneuver by a spacecraft for decades, since the two Voyager spacecraft passed Saturn in the early 1980s. The fear was that a spacecraft might encounter debris that would suddenly end its mission! But Cassini – which is running out of fuel after orbiting Saturn since 2004 – not only passed through the gap successfully but also found it surprising debris-free. Cassini Project Manager Earl Maize of NASA’s Jet Propulsion Laboratory in Pasadena, California said:

The region between the rings and Saturn is ‘the big empty,’ apparently. Cassini will stay the course, while the scientists work on the mystery of why the dust level is much lower than expected.

Cassini will make its second dive through the gap today (May 2, 2017) at 12:38 p.m. PDT (3:38 p.m. EDT, 19:38 UTC; translate UTC to your time zone)

With information from the first dive in hand, the Cassini team will now move forward with its preferred plan of science observations. NASA said:

A dustier environment in the gap might have meant the spacecraft’s saucer-shaped main antenna would be needed as a shield during most future dives through the ring plane. This would have forced changes to how and when Cassini’s instruments would be able to make observations. Fortunately, it appears that the “plan B” option is no longer needed. (There are 21 dives remaining. Four of them pass through the innermost fringes of Saturn’s rings, necessitating that the antenna be used as a shield on those orbits.)

Based on images from Cassini, models of the ring particle environment in the approximately 1,200-mile-wide (2,000-kilometer-wide) region between Saturn and its rings suggested the area would not have large particles that would pose a danger to the spacecraft.

But because no spacecraft had ever passed through the region before, Cassini engineers oriented the spacecraft so that its 13-foot-wide (4-meter-wide) antenna pointed in the direction of oncoming ring particles, shielding its delicate instruments as a protective measure during its April 26 dive.

The video below represents data collected by Cassini’s Radio and Plasma Wave Science instrument, as it crossed through the gap between Saturn and its rings on April 26. The instrument is able to record ring particles striking the spacecraft in its data. In the data from this dive, there is virtually no detectable peak in pops and cracks that represent ring particles striking the spacecraft. The lack of discernible pops and cracks indicates the region is largely free of small particles. William Kurth, RPWS team lead at the University of Iowa, Iowa City said:

It was a bit disorienting — we weren’t hearing what we expected to hear. I’ve listened to our data from the first dive several times and I can probably count on my hands the number of dust particle impacts I hear.

The team’s analysis suggests Cassini only encountered a few particles as it crossed the gap — none larger than those in smoke (about 1 micron across).

Today’s ring crossing will occur in a region very close to where Cassini passed on last week’s dive. Prior to today’s crossing, Cassini’s cameras have been looking closely at the rings; in addition, the spacecraft was rotated (or “rolled”) faster than engineers have ever allowed it to before, in order to calibrate the magnetometer.

As with the first finale dive, Cassini will be out of contact during closest approach to Saturn, and is scheduled to transmit data from this dive on May 3.

Bottom line: During its April 26, 2017 dive between Saturn and its rings – its first of 22 dives in its Grand Finale this year – the Cassini spacecraft found a relatively dust-free region. Scientists are calling it The Big Empty.

Via NASA



from EarthSky http://ift.tt/2qzinh0

Artist’s concepts of Cassini spacecraft diving through the gap between Saturn’s outer atmosphere and inner rings. Cassini will do this 22 times in 2017, before ending its mission at Saturn.

There’s much less dust between Saturn and its inner rings than expected, said NASA engineers, after last week’s historic dive through this gap by the Cassini spacecraft. Astronomers have been contemplating this maneuver by a spacecraft for decades, since the two Voyager spacecraft passed Saturn in the early 1980s. The fear was that a spacecraft might encounter debris that would suddenly end its mission! But Cassini – which is running out of fuel after orbiting Saturn since 2004 – not only passed through the gap successfully but also found it surprising debris-free. Cassini Project Manager Earl Maize of NASA’s Jet Propulsion Laboratory in Pasadena, California said:

The region between the rings and Saturn is ‘the big empty,’ apparently. Cassini will stay the course, while the scientists work on the mystery of why the dust level is much lower than expected.

Cassini will make its second dive through the gap today (May 2, 2017) at 12:38 p.m. PDT (3:38 p.m. EDT, 19:38 UTC; translate UTC to your time zone)

With information from the first dive in hand, the Cassini team will now move forward with its preferred plan of science observations. NASA said:

A dustier environment in the gap might have meant the spacecraft’s saucer-shaped main antenna would be needed as a shield during most future dives through the ring plane. This would have forced changes to how and when Cassini’s instruments would be able to make observations. Fortunately, it appears that the “plan B” option is no longer needed. (There are 21 dives remaining. Four of them pass through the innermost fringes of Saturn’s rings, necessitating that the antenna be used as a shield on those orbits.)

Based on images from Cassini, models of the ring particle environment in the approximately 1,200-mile-wide (2,000-kilometer-wide) region between Saturn and its rings suggested the area would not have large particles that would pose a danger to the spacecraft.

But because no spacecraft had ever passed through the region before, Cassini engineers oriented the spacecraft so that its 13-foot-wide (4-meter-wide) antenna pointed in the direction of oncoming ring particles, shielding its delicate instruments as a protective measure during its April 26 dive.

The video below represents data collected by Cassini’s Radio and Plasma Wave Science instrument, as it crossed through the gap between Saturn and its rings on April 26. The instrument is able to record ring particles striking the spacecraft in its data. In the data from this dive, there is virtually no detectable peak in pops and cracks that represent ring particles striking the spacecraft. The lack of discernible pops and cracks indicates the region is largely free of small particles. William Kurth, RPWS team lead at the University of Iowa, Iowa City said:

It was a bit disorienting — we weren’t hearing what we expected to hear. I’ve listened to our data from the first dive several times and I can probably count on my hands the number of dust particle impacts I hear.

The team’s analysis suggests Cassini only encountered a few particles as it crossed the gap — none larger than those in smoke (about 1 micron across).

Today’s ring crossing will occur in a region very close to where Cassini passed on last week’s dive. Prior to today’s crossing, Cassini’s cameras have been looking closely at the rings; in addition, the spacecraft was rotated (or “rolled”) faster than engineers have ever allowed it to before, in order to calibrate the magnetometer.

As with the first finale dive, Cassini will be out of contact during closest approach to Saturn, and is scheduled to transmit data from this dive on May 3.

Bottom line: During its April 26, 2017 dive between Saturn and its rings – its first of 22 dives in its Grand Finale this year – the Cassini spacecraft found a relatively dust-free region. Scientists are calling it The Big Empty.

Via NASA



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First quarter moon on May 2

Our friend Patrick Casaert of the Facebook page La Lune The Moon caught the moon on May 1, 2017, when it was nearly 1st quarter.

Help EarthSky stay an independent voice! Donate here.

A first quarter moon shows half of its lighted hemisphere – half of its day side – to Earth.

The moon reaches its first quarter phase on May 3, 2017 at 02:47 UTC. For North American time zones, that translates to May 2 at 11:47 p.m. ADT, 10:47 p.m. EDT, 9:47 p.m. CDT, 8:47 p.m. MDT, 7:47 p.m. PDT, 6:47 p.m. AKDT and 4:47 p.m. HAST.

We call this moon a quarter and not a half because it is one quarter of the way around in its orbit of Earth, as measured from one new moon to the next. Also, although the moon appears half-lit to us, the illuminated portion of a first quarter moon truly is just a quarter. On the night of first quarter moon, we see half the moon’s day side, or a true quarter of the moon. Another lighted quarter of the moon shines just as brightly in the direction opposite Earth!

Here’s what a first quarter moon looks like. The terminator line – or line between light and dark on the moon – appears straight. Aniruddha Bhat in Maryland caught this photo in January, 2016. Notice that he caught Lunar X and Lunar V.

What is Lunar X?

And what about the term half moon? That’s a beloved term, but not an official one.

A first quarter moon rises at noon and is highest in the sky at sunset. It sets around midnight. First quarter moon comes a week after new moon. Now, as seen from above, the moon in its orbit around Earth is at right angles to a line between the Earth and sun.

When the first quarter moon sets around midnight, the sun is below your feet. See? Good time to get a 3-D sense of the moon as a world in space, always half-illuminated by the sun. Animation created from images of setting first quarter moon, June 12, 2016, by Peter Lowenstein in Mutare, Zimbabwe.

When the first quarter moon sets around midnight, the sun is always below your feet. Good time to experience the moon and Earth as worlds in space, always half-illuminated by the sun. Setting first quarter moon by Peter Lowenstein in Mutare, Zimbabwe.

As the moon orbits Earth, it changes phase in an orderly way. Follow these links to understand the various phases of the moon.

Four keys to understanding moon phases

Where’s the moon? Waxing crescent
Where’s the moon? First quarter
Where’s the moon? Waxing gibbous
What’s special about a full moon?
Where’s the moon? Waning gibbous
Where’s the moon? Last quarter
Where’s the moon? Waning crescent
Where’s the moon? New phase



from EarthSky http://ift.tt/1GsHF3c

Our friend Patrick Casaert of the Facebook page La Lune The Moon caught the moon on May 1, 2017, when it was nearly 1st quarter.

Help EarthSky stay an independent voice! Donate here.

A first quarter moon shows half of its lighted hemisphere – half of its day side – to Earth.

The moon reaches its first quarter phase on May 3, 2017 at 02:47 UTC. For North American time zones, that translates to May 2 at 11:47 p.m. ADT, 10:47 p.m. EDT, 9:47 p.m. CDT, 8:47 p.m. MDT, 7:47 p.m. PDT, 6:47 p.m. AKDT and 4:47 p.m. HAST.

We call this moon a quarter and not a half because it is one quarter of the way around in its orbit of Earth, as measured from one new moon to the next. Also, although the moon appears half-lit to us, the illuminated portion of a first quarter moon truly is just a quarter. On the night of first quarter moon, we see half the moon’s day side, or a true quarter of the moon. Another lighted quarter of the moon shines just as brightly in the direction opposite Earth!

Here’s what a first quarter moon looks like. The terminator line – or line between light and dark on the moon – appears straight. Aniruddha Bhat in Maryland caught this photo in January, 2016. Notice that he caught Lunar X and Lunar V.

What is Lunar X?

And what about the term half moon? That’s a beloved term, but not an official one.

A first quarter moon rises at noon and is highest in the sky at sunset. It sets around midnight. First quarter moon comes a week after new moon. Now, as seen from above, the moon in its orbit around Earth is at right angles to a line between the Earth and sun.

When the first quarter moon sets around midnight, the sun is below your feet. See? Good time to get a 3-D sense of the moon as a world in space, always half-illuminated by the sun. Animation created from images of setting first quarter moon, June 12, 2016, by Peter Lowenstein in Mutare, Zimbabwe.

When the first quarter moon sets around midnight, the sun is always below your feet. Good time to experience the moon and Earth as worlds in space, always half-illuminated by the sun. Setting first quarter moon by Peter Lowenstein in Mutare, Zimbabwe.

As the moon orbits Earth, it changes phase in an orderly way. Follow these links to understand the various phases of the moon.

Four keys to understanding moon phases

Where’s the moon? Waxing crescent
Where’s the moon? First quarter
Where’s the moon? Waxing gibbous
What’s special about a full moon?
Where’s the moon? Waning gibbous
Where’s the moon? Last quarter
Where’s the moon? Waning crescent
Where’s the moon? New phase



from EarthSky http://ift.tt/1GsHF3c

What’s the birthstone for May?

Image via shutterstock.

Our annual fund-raiser ends May 5. EarthSky needs your help to keep going! Please donate!

Want to donate via PayPal or send a check to EarthSky? Click here.

The emerald belongs to the beryl family of minerals that include aquamarine (one of March’s birthstones), heliodor, and morganite. Beryl, or beryllium aluminum silicate in chemical jargon, is a six-sided symmetrical crystal. Beryl contains beryllium, aluminum, silicon, and oxygen.

Emeralds vary in color from light to deep green. It’s commonly thought that an emerald’s color derives from the presence of chromium and/or vanadium replacing some of the aluminum in the mineral’s structure. The stone can, however, lose its color when heated strongly.

Several famous historical artifacts were made of emeralds. Among them is the Crown of the Andes, said to be made from emeralds worn by Atahualpa, the last Inca (king) of Peru. The crown is set with about 450 emeralds, collectively weighing 10 ounces (1523 carats).

Emeralds are most frequently found inside a form of shale – a fine-grained sedimentary rock. Emerald-bearing shale has undergone recrystallization caused by changes in the physical environment such as pressure and temperature. Colombia produces the largest and highest quality emeralds. They were also discovered, and subsequently mined, in the Ural Mountains of Russia around 1830. In the United States, emeralds can be found in North Carolina. Around the world, they also occur in Zambia, Brazil, Pakistan, Norway, Austria, India, Madagascar, and Australia.

Emerald slices

Emerald slices at a gem show. Image Credit: cobalt123

Synthetic manufacture of emeralds was achieved by German chemists shortly before World War II. But growing synthetic stones of fine quality began in the United States in 1946. There are also excellent imitation emeralds on the market made of colored cut glass.

The emerald’s name is indirectly derived from the Greek word “smaragdos,” a term applied to several kinds of green stones. The history of emeralds can be traced back to antiquity. They were worn by royalty in Babylon and Egypt. Tools dating back to 1300 B.C., during the reign of Rameses II, have been found in emerald mines in Egypt. Queen Cleopatra’s emeralds were believed to originate from mines in Southern Egypt, near the Red Sea.

When the conquistadors first arrived in South America from Spain, they saw indigenous rulers wearing emeralds. They took large quantities of emeralds from the Peruvians during the invasion, but the source of the emeralds was not discovered. Then in 1537, the Spaniards found Chivor in Colombia, now the location of an important emerald mine. They also took over the Muzo mine following the defeat of the Muzo Indians. Mining operations at Muzo have continued almost uninterrupted since the Spanish invasion. It is perhaps the most famous emerald mine in Colombia and is said to produce the world’s best emeralds.

There are many myths associated with the emerald. The stone was once believed to prevent epilepsy, stop bleeding, cure dysentery and fever, and protect the wearer from panic. Its magnificent green color was said to rest and relieve the eye. To the ancient Romans, emeralds were dedicated to the goddess Venus because the green emerald symbolized the reproductive forces of nature. Early Christians saw it as a symbol of the resurrection of Christ. In the Middle Ages, emeralds were believed to hold the power to foretell the future.

Find out about the birthstones for the other months of the year.
January birthstone
February birthstone
March birthstone
April birthstone
May birthstone
June birthstone
July birthstone
August birthstone
September birthstone
October birthstone
November birthstone
December birthstone

Bottom line: The birthstone for May is the emerald.



from EarthSky http://ift.tt/1i0DZGU

Image via shutterstock.

Our annual fund-raiser ends May 5. EarthSky needs your help to keep going! Please donate!

Want to donate via PayPal or send a check to EarthSky? Click here.

The emerald belongs to the beryl family of minerals that include aquamarine (one of March’s birthstones), heliodor, and morganite. Beryl, or beryllium aluminum silicate in chemical jargon, is a six-sided symmetrical crystal. Beryl contains beryllium, aluminum, silicon, and oxygen.

Emeralds vary in color from light to deep green. It’s commonly thought that an emerald’s color derives from the presence of chromium and/or vanadium replacing some of the aluminum in the mineral’s structure. The stone can, however, lose its color when heated strongly.

Several famous historical artifacts were made of emeralds. Among them is the Crown of the Andes, said to be made from emeralds worn by Atahualpa, the last Inca (king) of Peru. The crown is set with about 450 emeralds, collectively weighing 10 ounces (1523 carats).

Emeralds are most frequently found inside a form of shale – a fine-grained sedimentary rock. Emerald-bearing shale has undergone recrystallization caused by changes in the physical environment such as pressure and temperature. Colombia produces the largest and highest quality emeralds. They were also discovered, and subsequently mined, in the Ural Mountains of Russia around 1830. In the United States, emeralds can be found in North Carolina. Around the world, they also occur in Zambia, Brazil, Pakistan, Norway, Austria, India, Madagascar, and Australia.

Emerald slices

Emerald slices at a gem show. Image Credit: cobalt123

Synthetic manufacture of emeralds was achieved by German chemists shortly before World War II. But growing synthetic stones of fine quality began in the United States in 1946. There are also excellent imitation emeralds on the market made of colored cut glass.

The emerald’s name is indirectly derived from the Greek word “smaragdos,” a term applied to several kinds of green stones. The history of emeralds can be traced back to antiquity. They were worn by royalty in Babylon and Egypt. Tools dating back to 1300 B.C., during the reign of Rameses II, have been found in emerald mines in Egypt. Queen Cleopatra’s emeralds were believed to originate from mines in Southern Egypt, near the Red Sea.

When the conquistadors first arrived in South America from Spain, they saw indigenous rulers wearing emeralds. They took large quantities of emeralds from the Peruvians during the invasion, but the source of the emeralds was not discovered. Then in 1537, the Spaniards found Chivor in Colombia, now the location of an important emerald mine. They also took over the Muzo mine following the defeat of the Muzo Indians. Mining operations at Muzo have continued almost uninterrupted since the Spanish invasion. It is perhaps the most famous emerald mine in Colombia and is said to produce the world’s best emeralds.

There are many myths associated with the emerald. The stone was once believed to prevent epilepsy, stop bleeding, cure dysentery and fever, and protect the wearer from panic. Its magnificent green color was said to rest and relieve the eye. To the ancient Romans, emeralds were dedicated to the goddess Venus because the green emerald symbolized the reproductive forces of nature. Early Christians saw it as a symbol of the resurrection of Christ. In the Middle Ages, emeralds were believed to hold the power to foretell the future.

Find out about the birthstones for the other months of the year.
January birthstone
February birthstone
March birthstone
April birthstone
May birthstone
June birthstone
July birthstone
August birthstone
September birthstone
October birthstone
November birthstone
December birthstone

Bottom line: The birthstone for May is the emerald.



from EarthSky http://ift.tt/1i0DZGU

Tulip field in Holland

Photo by Kerry Greenfield.

Kerry Greenfield captured this image on April 28, 2017 in Keukenhof, Holland. She wrote:

I am from the UK and visited Keukenhof Garden and surrounding tulip fields in Holland last week. This image was taken at one of the tulip fields. The garden and tulip fields are really, really stunning. I loved this particular field because it was so big and the colours so vibrant. One of the features I really liked about the fields was the striking lines between the columns of tulips. In this particular line some of the more unruly tulips have fallen into it!

Thank you, Kerry!



from EarthSky http://ift.tt/2qz6nvQ

Photo by Kerry Greenfield.

Kerry Greenfield captured this image on April 28, 2017 in Keukenhof, Holland. She wrote:

I am from the UK and visited Keukenhof Garden and surrounding tulip fields in Holland last week. This image was taken at one of the tulip fields. The garden and tulip fields are really, really stunning. I loved this particular field because it was so big and the colours so vibrant. One of the features I really liked about the fields was the striking lines between the columns of tulips. In this particular line some of the more unruly tulips have fallen into it!

Thank you, Kerry!



from EarthSky http://ift.tt/2qz6nvQ

Old wine poured into a newer skin: The Society for Integrative Oncology updates its clinical guidelines for breast cancer [Respectful Insolence]

“Integrative medicine” is a term for a form of medicine in which pseudoscience and quackery are “integrated” with real medicine. Unfortunately, as Mark Crislip puts it, when you mix cow pie with apple pie, it doesn’t make the cow pie better; it makes the apple pie worse. Unfortunately these days, there’s a lot of cow pie being mixed with apple pie. Worse, it’s gotten to the point where integrative medicine is subspecializing. For instance, there is now a specialty known as “integrative oncology,” which particularly burns me. Indeed, supportive care oncology has been very susceptible to the woo embraced by integrative oncology, to the point where naturopaths are involved, and when naturopaths are involved quackery such as homeopathy is involved.

Two years ago, the Society for Integrative Oncology, the main society promoting the integration of pseudoscience into science-based oncology, published a monograph in the Journal of the National Cancer Institute (JNCI) with guidelines for what it referred to as the evidence-based supportive care of breast cancer patients. I referred to it at the time as “old wine in a new skin.” Well, leave it to the SIO not to be able to leave bad enough alone, as it’s come up with what I like to refer to as SIO Clinical Guidelines 2: Electric Boogaloo. It comes in the form of an article by Heather Greenlee et al published in CA: A Cancer Journal for Clinicians and entitled Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

Its author list includes MDs, some of them respected, like Debu Tripathy, but it also contains quacks like an acupuncturist named Misha Cohen. It also contains three naturopaths, starting with the first author, Heather Greenlee. Dugald Seely is on the author list again, as well. We’ve met Seely before on multiple occasions. Indeed, he’s quite the flush little naturopathic quack, complete with millions of dollars donated by an anonymous donor to fund “integrative oncology” research at the Ottawa Integrative Cancer Center (OICC). Then there’s Suzanna Zick, who’s even worse than a naturopath. She’s a naturopath at my alma mater, the University of Michigan Medical School. It always depresses me to contemplate that U. of M. actually has a naturopath working for it, but, then, it also has an anthroposophic medicine program. So I guess it’s not a stretch any more for there to be naturopaths there.

Let’s get back to the clinical guidelines and systematic review, such as they are. To show just how debased medicine has become in accepting woo as “evidence-based,” you can even answer questions about the article and earn CME for learning. One thing I can’t figure out is why this group felt the need to update the guidelines a mere two years later, and this explanation doesn’t help:

In November 2014, the Society for Integrative Oncology (SIO) published clinical practice guidelines to inform both clinicians and patients on the use of integrative therapies during breast cancer treatment and to treat breast cancer treatment-related symptoms.[9] The SIO adapted methods established by the US Preventive Services Task Force[10] to develop graded recommendations on the use of specific integrative therapies for defined clinical indications based on the strength of available evidence concerning associated benefits and harms. The 2014 clinical practice guidelines were derived from a systematic review of randomized clinical trials published between 1990 and 2013 and organized by specific clinical conditions (eg, anxiety/stress, fatigue). This review provides an updated set of clinical practice guidelines based on a current, systematic literature review of randomized controlled trials (RCTs) published through December 2015 along with detailed definitions of integrative therapies and clinical outcomes of interest, a detailed summary of the literature upon which the clinical practice guidelines are based, and suggestions for how appropriate therapies may be integrated into clinical practice.

So my first reaction was: Really? You needed to publish again just to add two years’ worth of new trials to the guidelines? Do the new trials add much to the recommendations from the previous iteration of these guidelines? Do they change the recommendations in any substantive way? What do Greenlee et al mean by “recommendations,” anyway. It’s not what you would normally think:

Of note, it is important to define the use of the term recommendation in these clinical practice guidelines. In many settings, a clinical guideline recommendation suggests that it should be used as the standard of care and is favorable or equal compared with all other options based on best clinical evidence for benefit/risk ratio. Here, in the setting of integrative oncology, we use the term recommendation to conclude that the therapy should be considered as a viable but not singular option for the management of a specific symptom or side effect. Few studies have conducted a head-to-head comparison of a given integrative therapy against a conventional treatment, and most integrative therapies are used in conjunction with standard therapy and have been studied in this manner. Moreover, combination-based approaches and the interactions of the numerous permutations of integrative and conventional treatments have not been formally investigated, such that recommendations must account for this limitation of our knowledge. Despite these limitations to evaluating the use of integrative therapies in the oncology setting, there is a body of well conducted trials of specific therapies for specific conditions that provides sufficient evidence to warrant recommendations on the therapies as viable options for treating specific conditions.

Ah, “integrative medicine,” where even “recommendation” doesn’t mean what it does in real medicine. In clinical guidelines in real medicine, “recommendation” means just that: a recommendation to use the treatment in question, graded, of course, according to the strength of the evidence. Yet here in the world of integrative medicine, “recommendation” means something…squishier. One can’t help but make the analogy that integrative medicine’s evidence standard is squishier than that of real medicine. Oh, and the answer to that question of whether the new studies add much of anything to the 2014 clinical guidelines is, as I suspected, no, at least as far as I can tell. As was the case with the previous review, interventions are graded thusly:

Grades were based on strength of evidence, determined by the number of trials, quality of trials, magnitude of effect, statistical significance, sample size, consistency of results across studies, and whether the outcomes were primary or secondary. The highest grades (A and B) indicate that a specific therapy is recommended for a particular clinical indication. Grade A indicates there is high certainty that the net benefit is substantial, while grade B indicates there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Grade C indicates that the evidence is equivocal or that there is at least moderate certainty that the net benefit is small. The lowest grades (D, H, and I) indicate no demonstrated effect, suggest harm, or indicate that the current evidence is inconclusive, respectively.

Interestingly, this review does add something in that it defines each intervention more explicitly than the previous guidelines. Not surprisingly, the definition of acupuncture parrots the same sort of revisionist history that acupuncture advocates frequently repeat when justifying the practice. It is, in essence, an appeal to antiquity that paints acupuncture thusly:

Acupuncture involves the stimulation of specific points, (ie, acupoints) by penetrating the skin with thin, solid, metallic needles.[154, 155] A variation of acupuncture includes electroacupuncture, in which a small electric current is passed along acupuncture needles to provide a stronger stimulus than acupuncture alone, with distinct effects suggested by functional magnetic resonance imaging.[156, 157] Acupuncture has been practiced in Asia for thousands of years as a component of traditional medicine systems (eg, traditional forms of Chinese, Japanese, and Korean medicine) and is thought to stimulate the flow of a form of energy called qi (chee) throughout the body. Traditional Chinese acupuncture, which is commonly used in North America, requires needle manipulation to produce a de qi sensation (a soreness, fullness, heaviness, or local area distension[157, 158]), along with a period of rest with the needles in place.[159] It is posited that this removes energetic blockages, thus reestablishing homeostasis. The mechanisms for acupuncture’s effects are not well understood but are thought to function in part through modulation of specific neuronal/cortical pathways.[160]

It’s always a sad day when a respectable medical publication publishes papers that invoke vitalism in the form of the flow of “life energy” and suggests that this flow can be manipulated. Then there’s the revisionist history. Think about it. The claim is that acupuncture has been practiced “thousands of years,” most commonly for at least a couple of thousands of years. Yet two thousand years ago the technology to produce thin needles of the sort used by acupuncturists didn’t exist. In fact, it’s unclear when acupuncture in something resembling its current form evolved, but it appeared to have evolved from bloodletting. Harriet Hall once related the story of Dugald Christie, a Scottish surgeon who served as a missionary doctor in northeastern China from 1883 to 1913, and his experiences observing traditional Chinese medicine (TCM), including acupuncture. Let’s just say that acupuncture practiced 100 years ago was rather brutal. In fact, acupuncture began as nothing more than a Chinese version of bloodletting, very much like “Western” bloodletting and has been called “astrology with needles.” In reality, acupuncture and TCM achieved their current form under Chairman Mao Zedong, who promoted their use when he couldn’t supply enough doctors for his people and exported to the world, something China is still doing. It’s a history that’s been retconned, and Greenlee et al repeat that retconned revisionist history. No wonder there are so many forms of acupuncture.

Basically, there’s not much new in these guidelines. Relatively uncontroversial modalities like meditation, music therapy, stress management, and yoga are given the highest recommendations. However, acupuncture and its bastard offspring electroacupuncture (which really has no basis in TCM, given that there was no electricity hundreds or thousands of years ago to hook needles up to) consistently get B or C recommendations for several indications, despite acupuncture being nothing more than a theatrical placebo that hasn’t convincingly been shown to work for any clinical indication. That includes acupressure.

As is the case with most systematic reviews of integrative medicine, there are some head scratchers. For instance there’s this level C recommendation, meanding that they can be considered

Acupuncture,[49-51, 91, 92] healing touch,[93, 94] and stress management[36-38, 95, 96] can be considered for improving mood disturbance and depressive symptoms.

And:

Acupuncture,[119-124] healing touch,[93] hypnosis,[125, 126] and music therapy[31, 34] can be considered for the management of pain.

Healing touch is the rankest quackery. It’s energy medicine that postulates that practitioners can manipulate human life energy fields. It’s such a silly form of quackery that even a 12-year-old girl could disprove it.

Basically, these guidelines were even more unnecessary and pointless than the first set of guidelines published in 2014. It’s not as though clinical studies have advanced knowledge enough to justify a new set of guidelines, and these guidelines suffer from the same issue that integrative medicine itself suffers from, mixing cow pie with apple pie as though they were equivalent. I called the previous guidelines old wine in a new skin. Greenlee et al have just poured that old wine out of the new skin into a newer skin, seemingly expecting it to make the vinegary wine better.



from ScienceBlogs http://ift.tt/2p3EkUR

“Integrative medicine” is a term for a form of medicine in which pseudoscience and quackery are “integrated” with real medicine. Unfortunately, as Mark Crislip puts it, when you mix cow pie with apple pie, it doesn’t make the cow pie better; it makes the apple pie worse. Unfortunately these days, there’s a lot of cow pie being mixed with apple pie. Worse, it’s gotten to the point where integrative medicine is subspecializing. For instance, there is now a specialty known as “integrative oncology,” which particularly burns me. Indeed, supportive care oncology has been very susceptible to the woo embraced by integrative oncology, to the point where naturopaths are involved, and when naturopaths are involved quackery such as homeopathy is involved.

Two years ago, the Society for Integrative Oncology, the main society promoting the integration of pseudoscience into science-based oncology, published a monograph in the Journal of the National Cancer Institute (JNCI) with guidelines for what it referred to as the evidence-based supportive care of breast cancer patients. I referred to it at the time as “old wine in a new skin.” Well, leave it to the SIO not to be able to leave bad enough alone, as it’s come up with what I like to refer to as SIO Clinical Guidelines 2: Electric Boogaloo. It comes in the form of an article by Heather Greenlee et al published in CA: A Cancer Journal for Clinicians and entitled Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

Its author list includes MDs, some of them respected, like Debu Tripathy, but it also contains quacks like an acupuncturist named Misha Cohen. It also contains three naturopaths, starting with the first author, Heather Greenlee. Dugald Seely is on the author list again, as well. We’ve met Seely before on multiple occasions. Indeed, he’s quite the flush little naturopathic quack, complete with millions of dollars donated by an anonymous donor to fund “integrative oncology” research at the Ottawa Integrative Cancer Center (OICC). Then there’s Suzanna Zick, who’s even worse than a naturopath. She’s a naturopath at my alma mater, the University of Michigan Medical School. It always depresses me to contemplate that U. of M. actually has a naturopath working for it, but, then, it also has an anthroposophic medicine program. So I guess it’s not a stretch any more for there to be naturopaths there.

Let’s get back to the clinical guidelines and systematic review, such as they are. To show just how debased medicine has become in accepting woo as “evidence-based,” you can even answer questions about the article and earn CME for learning. One thing I can’t figure out is why this group felt the need to update the guidelines a mere two years later, and this explanation doesn’t help:

In November 2014, the Society for Integrative Oncology (SIO) published clinical practice guidelines to inform both clinicians and patients on the use of integrative therapies during breast cancer treatment and to treat breast cancer treatment-related symptoms.[9] The SIO adapted methods established by the US Preventive Services Task Force[10] to develop graded recommendations on the use of specific integrative therapies for defined clinical indications based on the strength of available evidence concerning associated benefits and harms. The 2014 clinical practice guidelines were derived from a systematic review of randomized clinical trials published between 1990 and 2013 and organized by specific clinical conditions (eg, anxiety/stress, fatigue). This review provides an updated set of clinical practice guidelines based on a current, systematic literature review of randomized controlled trials (RCTs) published through December 2015 along with detailed definitions of integrative therapies and clinical outcomes of interest, a detailed summary of the literature upon which the clinical practice guidelines are based, and suggestions for how appropriate therapies may be integrated into clinical practice.

So my first reaction was: Really? You needed to publish again just to add two years’ worth of new trials to the guidelines? Do the new trials add much to the recommendations from the previous iteration of these guidelines? Do they change the recommendations in any substantive way? What do Greenlee et al mean by “recommendations,” anyway. It’s not what you would normally think:

Of note, it is important to define the use of the term recommendation in these clinical practice guidelines. In many settings, a clinical guideline recommendation suggests that it should be used as the standard of care and is favorable or equal compared with all other options based on best clinical evidence for benefit/risk ratio. Here, in the setting of integrative oncology, we use the term recommendation to conclude that the therapy should be considered as a viable but not singular option for the management of a specific symptom or side effect. Few studies have conducted a head-to-head comparison of a given integrative therapy against a conventional treatment, and most integrative therapies are used in conjunction with standard therapy and have been studied in this manner. Moreover, combination-based approaches and the interactions of the numerous permutations of integrative and conventional treatments have not been formally investigated, such that recommendations must account for this limitation of our knowledge. Despite these limitations to evaluating the use of integrative therapies in the oncology setting, there is a body of well conducted trials of specific therapies for specific conditions that provides sufficient evidence to warrant recommendations on the therapies as viable options for treating specific conditions.

Ah, “integrative medicine,” where even “recommendation” doesn’t mean what it does in real medicine. In clinical guidelines in real medicine, “recommendation” means just that: a recommendation to use the treatment in question, graded, of course, according to the strength of the evidence. Yet here in the world of integrative medicine, “recommendation” means something…squishier. One can’t help but make the analogy that integrative medicine’s evidence standard is squishier than that of real medicine. Oh, and the answer to that question of whether the new studies add much of anything to the 2014 clinical guidelines is, as I suspected, no, at least as far as I can tell. As was the case with the previous review, interventions are graded thusly:

Grades were based on strength of evidence, determined by the number of trials, quality of trials, magnitude of effect, statistical significance, sample size, consistency of results across studies, and whether the outcomes were primary or secondary. The highest grades (A and B) indicate that a specific therapy is recommended for a particular clinical indication. Grade A indicates there is high certainty that the net benefit is substantial, while grade B indicates there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Grade C indicates that the evidence is equivocal or that there is at least moderate certainty that the net benefit is small. The lowest grades (D, H, and I) indicate no demonstrated effect, suggest harm, or indicate that the current evidence is inconclusive, respectively.

Interestingly, this review does add something in that it defines each intervention more explicitly than the previous guidelines. Not surprisingly, the definition of acupuncture parrots the same sort of revisionist history that acupuncture advocates frequently repeat when justifying the practice. It is, in essence, an appeal to antiquity that paints acupuncture thusly:

Acupuncture involves the stimulation of specific points, (ie, acupoints) by penetrating the skin with thin, solid, metallic needles.[154, 155] A variation of acupuncture includes electroacupuncture, in which a small electric current is passed along acupuncture needles to provide a stronger stimulus than acupuncture alone, with distinct effects suggested by functional magnetic resonance imaging.[156, 157] Acupuncture has been practiced in Asia for thousands of years as a component of traditional medicine systems (eg, traditional forms of Chinese, Japanese, and Korean medicine) and is thought to stimulate the flow of a form of energy called qi (chee) throughout the body. Traditional Chinese acupuncture, which is commonly used in North America, requires needle manipulation to produce a de qi sensation (a soreness, fullness, heaviness, or local area distension[157, 158]), along with a period of rest with the needles in place.[159] It is posited that this removes energetic blockages, thus reestablishing homeostasis. The mechanisms for acupuncture’s effects are not well understood but are thought to function in part through modulation of specific neuronal/cortical pathways.[160]

It’s always a sad day when a respectable medical publication publishes papers that invoke vitalism in the form of the flow of “life energy” and suggests that this flow can be manipulated. Then there’s the revisionist history. Think about it. The claim is that acupuncture has been practiced “thousands of years,” most commonly for at least a couple of thousands of years. Yet two thousand years ago the technology to produce thin needles of the sort used by acupuncturists didn’t exist. In fact, it’s unclear when acupuncture in something resembling its current form evolved, but it appeared to have evolved from bloodletting. Harriet Hall once related the story of Dugald Christie, a Scottish surgeon who served as a missionary doctor in northeastern China from 1883 to 1913, and his experiences observing traditional Chinese medicine (TCM), including acupuncture. Let’s just say that acupuncture practiced 100 years ago was rather brutal. In fact, acupuncture began as nothing more than a Chinese version of bloodletting, very much like “Western” bloodletting and has been called “astrology with needles.” In reality, acupuncture and TCM achieved their current form under Chairman Mao Zedong, who promoted their use when he couldn’t supply enough doctors for his people and exported to the world, something China is still doing. It’s a history that’s been retconned, and Greenlee et al repeat that retconned revisionist history. No wonder there are so many forms of acupuncture.

Basically, there’s not much new in these guidelines. Relatively uncontroversial modalities like meditation, music therapy, stress management, and yoga are given the highest recommendations. However, acupuncture and its bastard offspring electroacupuncture (which really has no basis in TCM, given that there was no electricity hundreds or thousands of years ago to hook needles up to) consistently get B or C recommendations for several indications, despite acupuncture being nothing more than a theatrical placebo that hasn’t convincingly been shown to work for any clinical indication. That includes acupressure.

As is the case with most systematic reviews of integrative medicine, there are some head scratchers. For instance there’s this level C recommendation, meanding that they can be considered

Acupuncture,[49-51, 91, 92] healing touch,[93, 94] and stress management[36-38, 95, 96] can be considered for improving mood disturbance and depressive symptoms.

And:

Acupuncture,[119-124] healing touch,[93] hypnosis,[125, 126] and music therapy[31, 34] can be considered for the management of pain.

Healing touch is the rankest quackery. It’s energy medicine that postulates that practitioners can manipulate human life energy fields. It’s such a silly form of quackery that even a 12-year-old girl could disprove it.

Basically, these guidelines were even more unnecessary and pointless than the first set of guidelines published in 2014. It’s not as though clinical studies have advanced knowledge enough to justify a new set of guidelines, and these guidelines suffer from the same issue that integrative medicine itself suffers from, mixing cow pie with apple pie as though they were equivalent. I called the previous guidelines old wine in a new skin. Greenlee et al have just poured that old wine out of the new skin into a newer skin, seemingly expecting it to make the vinegary wine better.



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