As the science of genetics advances, the task of informing patients has grown both more complicated and more essential. Good communication must reflect the science of the genetic situation and the attitudes and beliefs of patients and their families, says Roxanne Parrott, professor of communication arts and sciences, and health policy, at Penn State.

Photo: futurowoman

This child may one day choose to know the genetic risks passed down from her parents.

In starting a new study, Parrott used a survey to elicit attitudes and beliefs from family members and patients with three genetic conditions: Down syndrome, Marfan syndrome and neurofibromatosis. The results, she says, confirm the idea that communication must reflect the audience: “There is not a one-size-fits-all notion of how to communicate about genetic conditions, but there are enough patterns that we don’t have to adapt to each individual or family member.”

Although some genetic mutations always cause disease, more raise the risk without spelling doom — and that’s often a hard concept to get across, she adds. “There is so much media attention to genetic determinism,” so those who would communicate with patients must realize that many people assume that having a gene means getting a disease, when in fact more disease genes raise the odds of getting that disease, but are also affected by environmental and behavioral factors.

Talking genes blues

Communications researchers “have focused on the threat, and on trying to motivate people to take action,” says Parrott, “and this is correct, as long as we package the message in ways that can help them change their behavior and reduce the threat.”

A fearsome genetic test

Huntington’s disease, a hereditary neurological disorder, was one of the first diseases linked to a single gene. Huntington’s progressively attacks motor, mental and emotional abilities.

Photo: Library of Congress Prints and Photographs Division, Digital ID: cph 3c30859

American folk singer Woody Guthrie died from Huntington’s disease in 1967. His son Arlo Guthrie chose to be tested for HD and found that he does not carry the mutation.

HD is caused by a dominant mutation in the Huntington gene, so any child of a parent with HD has a 50 percent risk of inheriting the disease. Huntington’s is the archetype of genetic determinism: if you have the mutation, HD is inevitable.

Once the genetic test became available, a child of a parent with HD could be tested for the mutated gene. This is a difficult decision: Would you rather live in uncertainty, or get tested and possibly learn you will develop a fatal, incurable disease?

Messages about the genetic contribution to heart disease, cancer and diabetes should reflect the needs of patients with disparate beliefs, says Parrott. She and co-author Kathryn Peters, a genetic counselor, found that each group was about equally common among family members and diagnosed patients. “When we think about communication, these four frameworks represent quite different things to listen for, ideas to probe for, and a different approach to communication.”

In an online survey of 541 patients and family members, Parrott and Peters found that some beliefs were misconceptions while others were accurate, and that despite the media emphasis on single mutations as causing disease, not everybody thought “that genes alone determine health.”

Genes are relative

One interesting result came from the “integrated relativists,” who talked about how behavior, religious faith and social support “could come together to predict health,” Parrott says. That is a rather sophisticated attitude concerning genomic information, she adds.

Unfortunately, “The integrated folks were the most uncertain about their future, and how things would work out with their diagnoses,” says Parrott. “That’s probably a good indication of having almost too much information, conflicting information. Their integrated perspective puts them in a situation where they … believe that a lot of things contribute to their health, and they don’t know what to do about it.”

Learning what’s inside your genes can have a psychological impact, Parrott adds. “How do you know who to tell? How could this affect your personal relationships? When do you start having these conversations? Does your identity become a package of genes?”

In hot, dry places, water recycling has joined water conservation as a weapon against water shortages. After being treated at a sewage plant, wastewater is increasingly used for irrigation, industrial purposes, restoring groundwater, and after further purification, for drinking.

Photo: gingerpig2000

He thinks it’s pure water, but could this thirsty hiker be guzzling recycled filtered, treated, oxidized, and disinfected, sewage water?  Could that be safe?

About 0.1 percent of the municipal wastewater treated in the United States is reused for potable (drinking) water, according to a new National Research Council report. That may sound trivial, but “reclaimed water can account for the majority of the drinking water supply in some areas,” the report said.

In general, those areas have taken every reasonable measure to clamp down on water waste before embarking on the more dicey path of reuse. Drinking water is a small part of the growing movement toward reuse; far more common is the recycling of water for irrigating farms and landscapes, recharging groundwater, and for cooling generators and other industrial equipment.

But recycling for potable water is a growing trend in the Middle East, Australia, California and Florida. Miami-Dade County, Florida is about 80 percent through a project at a sewage plant that will use microfiltration, reverse osmosis, advanced oxidation and ultraviolet disinfection to disinfect partially treated wastewater. Each day, 21 million gallons of water “whose quality will be near that of distilled water” will be piped from a moat at the Miami Metrozoo. From there, the water will percolate into the ground to recharge groundwater.

The interest in reuse coincides with a need to update potable water-treatment plants, to the tune of $200 to $300-billion over the next 20 to 25 years.

In 2002, Florida was recycling the most wastewater, followed by California, Texas and Arizona.

The 2004 Guidelines for Water Reuse from the Environmental Protection Agency (EPA) estimated total U.S. water reuse at 1.7 billion gallons per day, with a growth rate of 15 percent per year.

But that’s just an estimate; the comprehensive Research Council report could not find solid numbers on current water recycling in the United States. “In 30 years we have not made a concerted effort in the United States to even figure out how much water we are reusing,” says Anders Andren, a professor of environmental chemistry and technology at the University of Wisconsin-Madison, and director of its Sea Grant Institute.

Globally, the estimate on total (not just potable) water reuse was 5.5 billion gallons per day.

Drink in the irony

If you’re gagging at the idea of guzzling highly treated wastewater, you may already be doing so, courtesy of “de-facto reuse.” The treated effluent discharged by wastewater plants often winds up in rivers, streams and lakes, and can easily enter intakes at downstream water utilities.

“Nobody has tried to figure out where we are in the United States by doing a quantitative survey of de facto reuse,” says Andren, meaning an unknown number of water utilities are delivering drinking water containing an unknown amount of treated wastewater.

If drinking water meets federal water-purity standards, it’s safe, but the issue of de facto reuse does merit further study. “This is the kind of thing every water system ought to be looking at, where the source water is coming from, and what is its quality,” says Henry Anderson, adjunct professor of population health science at the University of Wisconsin-Madison. In most cases, he says, the quality of the intake water is already a factor in deciding how to treat potable water.

On a per-capita basis, Israel, Singapore and Australia are leaders in water reuse. In every case, the local culture, economy, environment and demand for water affect how water is treated and used.

Here, we’ll concentrate on drinking water — the most demanding aspect of water reuse. Because it’s not legal to connect a drinking-water system directly to a sewage plant outfall in the United States, the treated effluent must reside in groundwater, surface water or a container for a while before it is piped to the water-treatment plant.

This delay provides a second layer of protection called “environmental attenuation,” says Anderson, who helped write the recent Research Council report. “The concern of the committee is that no system works with 100 percent efficiency all the time. If you are using a membrane to treat wastewater and it tears … we want multiple layers of protection.”

During attenuation, the treated wastewater can be mixed with surface water or groundwater, and then the water will go through the complete process for treating potable water, Anderson says.

How clean is safe?

Science and technology play dual roles in the adoption of water recycling. Improving water purification technology is offering an increasing number of choices. But technology costs money, and drinking water that comes from ground- or surface water is almost always cheaper than reclaimed drinking water.

But science is also able to detect an increasing number of contaminants in drinking water, and at ever-lower doses. In recent years, this analytical equipment has raised worries about hormones and pharmaceuticals in wastewater that have added to traditional worries about pathogens.

However, these highly accurate chemical-detection methods can raise spurious warnings, says Andren, an expert in water purification techniques. “Analytical capacities are such now that you can find literally everything, but they may pose no health hazard at those concentrations. It’s getting to the point that we can detect a thousand molecules in a liter of water, but this does not necessarily mean there’s anything wrong with the water.”

How it’s done

Water treatment plants come in two varieties. Some treat sewage, and others treat drinking water. In essence, water recycling creates a loose connection between these two plants, although federal law requires that treated wastewater be mixed and stored before it enters a plant treating potable water.

Both types of water plant already use multiple steps for treating water, but recycling has entailed an increase in the amount and intensity of treatment.

The specific treatment methods depend on the nature of the incoming water stream, which could come from sewage treatment plants, street runoff or industry. “The incoming streams can vary so much, in composition, type, quality and quantity,” he says.

Technologies must be chosen to deal with the situation, says Andren. “In certain instances, the main problem is getting rid of salt, in others it’s getting rid of bacteria, or pharmaceuticals, or organic chemicals or metals. It depends on the source water.”

Many challenges

Even though per-capita use in the United States is declining, recycling makes a lot of sense in water-short regions, says Andren. In the United States, “about 12 billion gallons a day [of 32 billion gallons treated per day] is shot into estuaries and oceans. In areas with generally high populations we are shooting away this water and will never have our hands on it again. If just a part of that could be reused, that would be good.”

But due to cost, recycling will only interest places with significant water shortages, Andren says. “We can do a great job at a cost, we can do anything at a cost.”

Ramping up reuse depends on introducing new technology, but that is a natural outgrowth of the steady introduction of sophisticated ways to clean wastewater and drinking water.

Andren, who reviewed the recent National Research Council report, says, “One of the major recommendations is that we basically have the treatment technology, and the approach to assess the hazards through risk assessment. Now we have to formalize that and work together on federal guidelines on how to start using more reclaimed water in daily life.”

Although a water shortage is not healthy, recycling, even if it increases supply, must still overcome the obvious “ecch” factor. “A lot of people ask, ‘If you have effluent from a sewage plant, and it goes through treatment, would you drink that?’” Anders says. “Absolutely, the technology is there, it’s being done all over the world. Our treatment technology and our ability to determine the quality of the water are such that it can be absolutely safe; it can be better than what you presently get out of the tap.”

Twelve years on, and another billion people are sharing the planet.

Starting half a century ago, the Green Revolution doubled or tripled production of the major grains, using modern seeds, heavy use of fertilizer and irrigation. The revolution helped India and China to feed themselves and averted widespread starvation.

Today, an estimated billion people go to bed hungry. Hundreds of millions are stunted by poor nutrition. And by 2025 another billion people will want to know what’s for dinner…

What to do?

After World War II, agronomist Norman Borlaug played a role in founding international farm research stations that invented and distributed seeds and technologies to Latin America and Asia, with a focus on the big three crops: rice, wheat and corn (maize).

The green revolution that resulted gave a dramatic boost to farm production. But population continues to rise, and funding for food projects tapered off after the initial gains were realized.

The green revolution averted massive starvation “in some situations, but in others, especially Africa, it failed terribly,” says James Lassoie, a professor of natural resources at Cornell University, and leader of Agriculture Bridge, which attempts to harmonize agriculture with conservation.

Small could be beautiful

As the green-revolution research organizations continue working on high-yield crops, a newer approach to raising food production is emerging that concentrates on methods and technologies that can be built and maintained locally.

For reasons related to economics, environment, and efficient technology transfer, the new projects have steered away from large-scale provision of food, equipment, seeds and fertilizer, and toward social and environmental goals. Many projects work in Africa, where food and population problems are most acute, and with women, who do most of the farming.

Although few would discount the role of high-yield seeds in feeding seven billion, “Economic development needs to support both environmental protection and livelihoods,” Lassoie says. “Technologies are not going to help if they don’t also deal with the social and political dynamics.”

Our look at a few of these projects only offer an educated scanning of the horizon. We neither visited these projects nor possess a crystal ball, and so can neither vouch for their results nor predict the end game. But farmers are smart people who gravitate to things that work — if they fit the local culture, economy and environment.

Enough introductory blather. Let’s take a look!

Progress on one acre in Kenya and Rwanda

Africa’s agriculture is dominated by “small-holders,” people who work an acre or two, mainly with family labor, and are an increasing focus of attention in the effort to feed ourselves.

Services are loans, not gifts, and as is common with micro-lenders, borrowers join small groups that guarantee each loan. One Acre says 99 percent of its loans are repaid.

The fund’s advisors offer farming advice during weekly visits that emphasize profitability as much as productivity. For example, because prices are usually lowest during the harvest, the advisors suggest that farmers hold on to their crops for a few months.

One Acre says its growing and marketing strategies double the average farmer’s income, allowing small-holders to pay school fees and buy land to improve family income and food security. One Acre is reaching 55,000 families in Kenya and Rwanda, and aims to enroll 150,000 families by 2013.

Fish, water and wetland in Uganda

The realization that healthy ecosystems improve water quality and store carbon from the atmosphere has spawned a system called “payment for ecosystem services.” After all, if people downstream are getting clean water or hydroelectric power from a well-forested watershed, that should be worth paying for…

It’s a simple concept that conceals any number of complexities, but these payments do bring in outside money that can support environmental improvements.

In densely populated southwestern Uganda, the organization Nature Harness Initiatives is combining payment for ecosystem services with collaborative management to protect the environment of a wetland in the Kanyabaha-Rushebeya region.

The wetland provides fish for food, bees for honey, and fiber for thatch, mats and baskets, but farming and deforestation by people trying to make a living are causing serious soil erosion, harming the wetland and its many human and non-human residents.

Although baseline data on water quality is short, Nature Harness is convinced that it’s program works, and can be expanded to regions with similar problems.

Growing new farmers in Uganda

In Uganda – and elsewhere — farming is often seen as an occupation best suited to school dropouts and people who cannot afford college. Could interesting the younger generation of Ugandans in growing vegetables reverse this trend?

Through the Project for Developing Innovations in School Cultivation, more than 1,100 children in at least 31 schools have transformed schoolyards into gardens as they learn to grow local crops with traditional and environmentally-minded methods.

Project DISC was inaugurated in 2006 to combat rising food shortages and preserve Uganda’s culinary traditions. By allowing children to experience growing, tasting and cooking fruits and vegetables, it is cultivating a generation that values agriculture and quality, local food.

(The whole setup reminds us of the U.S. urban farming movement.)

The farming lessons includes methods for sustainably growing crops in Uganda’s increasingly hostile climate, as the children learn about raised gardens, drip irrigation and drought-tolerant crops.

Project DISC does face obstacles, such as Uganda’s staggering population growth and declining soil fertility. All the more reason to encourage young Ugandans to see agriculture as a respectable livelihood, rather than a last-resort job.

Community grazing rights in Mongolia

In land-locked Mongolia, 2.7 million people coexist with about 10 times as many horses, cattle, sheep, goats and camels. The people of Mongolia have followed their animals for centuries, living a nomadic life in portable shelters called gers.

This windy, dry and cold land exists at the mercy of the weather; the harsh winter of 2010 killed 20 percent of the country’s livestock. Meanwhile, overgrazing is promoting erosion and making the pastures less productive, while the Gobi Desert encroaches from the South.

It’s a classic case of the “Tragedy of the commons,” the idea that resources owned by all are protected by none.

To avert tragedy, Mongolia is experimenting with “co-management,” a system for making joint decisions about the grasslands to maximize benefits and prevent long-term degradation. In co-management, groups of herders contract with the government to assume the regulation and protection of tracts of land. Contracts are adapted as needed during annual renegotiations.

The result has been a reduction in herd size and an attempt to breed better animals to maximize profits from a resources that is now managed with an eye to community prosperity. Evaluations say the process is raising family incomes by 5 to 10 percent annually, and the idea is catching on elsewhere in Mongolia and Central Asia.

Banking on the harvest in Niger

In many lands with poor people and marginal agriculture, the months before harvest are called the “hunger season.” In Niger, in the dry Sahel region just south of the Sahara Desert, the hunger season has been exacerbated by droughts and locusts.

Niger is second to last in the United Nations Human Development Index.

Micro-lending is catching on as a way to fight poverty, but there’s a twist in Niger: Instead of lending money, the Project for the Promotion of Local Initiative for Development in Aguie lends grain through “soudure” (pre-harvest) banks.

The cooperative buys grain from local farmers, and lends it when needed at 25 percent interest, a fraction of what moneylenders charge.

By the middle of 2010, about 168 soudure banks, managed by over 50,000 women, were storing enough millet – a local staple grain — to feed 350,000 people for at least a month. That storehouse helped villagers survive the hunger season (see #38) during the spike in global food prices in 2008.

Beating hillside erosion in Yunnan, China

After a devastating flood in 1998 in Southwest China (blamed largely on deforestation of steep slopes), a new reforestation project focused on planting trees that generate income. (Reforestation projects can drive farmers and herders from their land by planting trees that may offer long-term environmental advantages but do not provide income to local people.)

The World Agroforestry Center has sponsored a different approach to reforestation on a 42-square-kilometer watershed in Yunnan Province. The project began with a collaborative design process that focused on using trees for food, forage or other purposes.

Walnut trees provide edible nuts. Beneath the trees, medicinal herbs are planted as a cash crop. Women may spend four hours a day collecting firewood, but new fermentation devices transform pig dung into biogas for cooking.

Although the project is said to be working on the small scale, and is producing enough income so parents can send kinds to school, these techniques will only provide a meaningful benefit once they are applied more broadly.

WFARM-TV in Benin

Rice, a staple crop and food through much of southern Asia and tropical Africa, is usually grown on small farms. To stimulate and propagate farmer creativity, Africa Rice develops short videos with significant input from local farmers, and distributes them across the rice-growing region.

Farmers are inherently interested in the ideas of other farmers, and seeing their innovations legitimizes farmer experiments and leads to further improvements.

The 10- to 20-minute videos cover such topics as preparing land, transplanting seedlings, managing weeds and harvesting the rice. AfricaRice distributes the videos through farmer associations; the farmers line up the video equipment and stage the screenings, which are often held outdoors.

By 2009, 11 videos were available to communities in Africa; some have been translated into more than 30 African languages and/or been transcribed for radio broadcast.

– David J. Tenenbaum

Poke deep inside an insect cell, and you may be in for a shock. At least we were startled to learn that bacteria live inside many insects, including the fruit fly, one of the workhorses of biology.

Photo: Biodiversity Institute of Ontario

The star of the study, Drosophila mauritiana.

Today, we hear how bacteria of the genus Wolbachia boost egg production in certain fruit flies. The mechanism, says Horacio Frydman, an assistant professor of biology at Boston University, involves a two-step: first the fly makes more egg cells, and then it blocks a process that would normally prune away extra eggs.

Insects, like other animals, are frequently “married” to bacteria in a relationship that benefits one or both parties. This is common: Bacteria in the cow’s rumen break down cellulose eaten by the cow. Bacteria in the human gut form vitamin K, necessary for blood clotting.

And bacteria in aphids synthesize essential amino acids that the aphids cannot make by themselves.
Wolbachia are not essential to the fruit flies, but their presence can quadruple egg production.

Speeding breeding

Producing four times as many offspring “is a powerful driver of infection,” Frydman says. “Wolbachia manipulate their host reproduction to favor their own spread in nature,” noting that in less than 20 years after Wolbachia was detected in fruit flies in southern California, the infection had spread as far as Canada. “It’s considered one of the largest pandemics in the recent evolution of life. Because Wolbachia influence their host reproduction, they also impact the evolutionary history of innumerable hosts.”

Wolbachia have been linked with a wide variety of effects in the insect realm. Wolbachia “lives in at least 20 percent of the world’s arthropods, including insects, spiders, mites, and crustaceans,” according to the Wolbachia project, making them an active area of investigation.

How could this symbiosis work to increase the number of offspring?

Using sophisticated microscopy, Frydman, Ph.D. student Eva Fast and colleagues tracked the location of Wolbachia in fruit flies. In D. mauritiana, a species native to the Mauritius Islands in the Indian Ocean, the bacteria congregate in the germline stem cell niche — a structure that supports stem cells that develop into eggs. In D. melanogaster, the bacteria accumulate in the niche that harbors a different type of stem cell, which produces the eggshell.

In the germline stem cell niche, the bacteria actually outnumber mitochondria, organelles involved in making energy for the fly.

Having the bacteria in the germline stem cell niche doubled the rate of division among those stem cells. Further investigation showed that the bacteria later also halved the rate of programmed cell death.
So the bottom line was a four-fold increase in egg production.

The virtue of pruning

“It’s remarkable that there are two mechanisms being manipulated by the bacteria, the rate of egg production and the rate of programmed cell death,” says Frydman.

Hitting both systems makes sense, Frydman adds, although the mechanisms remain unclear. “It is not surprising that Wolbachia would evolve to manipulate those two process, because they are key in controlling the rate of egg production, and therefore it has a profound impact in the reproductive success of the infected host and in spreading of bacteria in nature.”

Anything that increases the number of eggs and offspring is likely to be favored by natural selection, Frydman adds.

Photo: CDC, #373

Parasitic worms cause elephantiasis, which afflicts this man from the Philippines. Could killing Wolbachia prevent this disfiguring disease?

A healthy thing?

Beyond an insight into the fascinating biology of symbiosis, the finding could also have health implications. Parasitic worms that cause diseases like elephantiasis seem to benefit from Wolbachia infection.

And Wolbachia can affect insect immunity: Tests have shown that infected fruit flies are more resistant to some viruses, for example. And a recent paper in Nature found that mosquitoes in Australia could not transmit dengue fever if they carried a Wolbachia strain derived from Drosophila.

Mosquitoes also transmit malaria. Conceivably, better knowledge of the interaction between Wolbachia and insects might convert mosquitoes from a carrier of this ancient scourge into a defense against it.

– David J. Tenenbaum

With little notice until recently, a shortage of medicine is starting to impair treatment at America’s hospitals. Common, cheap and necessary drugs needed to fight bacteria or cancer, to ease pain or to nourish premature infants are running out.

Many of these meds are injectables, which must be made under sterile conditions. All are generics, which sell for pennies compared to the buck-buster drugs that feed the bottom lines at the big-name drug companies.

Most shortages are unnanounced until a wholesaler’s shipment arrives lacking an ordered drug. “It’s unbelievable,” says Sara Shull, manager of the drug policy program at the University of Wisconsin Hospitals and Clinics in Madison. “Today I was trying figure out alternatives to papaverin,” an old drug used to prevent spasm in the many surgeries that involve grafting a blood vessel. “We have identified some alternatives, and I am now I working with the surgeon to figure out how to dose them, how to apply them. Is it bathed on? Sprayed on? He’s busy, we’re all busy, and sorting this all out takes a lot of time. The continual need to find replacements gives me a headache.”

Shortage-induced substitution played a role in Alabama, where nine hospital patients were killed by intravenous nutrients this summer, says Allen Vaida, executive vice president of the Institute for Safe Medication Practices, a non-profit that targets medicine hazards. “Because of a shortage, this compounding pharmacy was making a product from raw material, and it got a bacterial contamination.” (The maker of the nutrient solution, Meds IV pharmacy in Birmingham, Ala., is apparently out of business.)

Medications on this rack will restock a robot that fills individual patient envelopes that will be sent tomorrow to nurses’ stations in the hospital. Actually, the robot restocks itself in its 24/7 delivery of thousands of prescription drugs.

Photo: The Why Files

ENLARGE

Source: U.S. House of Representatives

Shortages are growing, especially for injectable medicines.

Running long on shortages

Pharmacists have always had to find substitute medicines, as patients keep coming through the door, but Vaida cites Food and Drug Administration numbers to argue that shortages are now at “crisis” proportions. “The FDA shows 70 shortages in 2006, 129 in 2007 and last year, there were 211. So far this year, we are already above 200 shortages, and the year isn’t done. Shortages have been around forever, but they have never reached this number.”

Some drugs can be substituted, says Vaida, but “especially with chemotherapy and nutritional products, it’s not like are three alternatives for some medications, as there are with blood-pressure drugs. Some chemotherapies are specific for certain cancers, and if they are not available, you may have no alternative or [you] may have to use a third-line alternative.”

The pharmaceutical situation has never been more complicated, with more than 45,000 prescription drug products on the market, from about 1,400 manufacturers. Although we could not easily find numbers, drug shortages are also rising in the United Kingdom, where the supply situation is complicated by the restriction on exports within the European Union.

Shortages have many possible causes, but because manufacturers tend to be closed-mouthed, it’s not clear which problems are most momentous or easiest to solve:

How short is short?

A drug is considered “short” if a specific dosage and formulation is unavailable, and in some cases, a similar item can be substituted. But Shull says that’s still a problem in a big hospital. If a product that is normally purchased in a pre-loaded syringe is only available in a vial, University of Wisconsin Hospitals and Clinics can no longer send a “unit of dose” to the nurse, and “that’s what the nurses are expecting,” Shull says.

Changing procedures complicate care and raise costs, Shull adds. “All our people are working in a complex system, with lives on the line. These shortages can be a recipe for increased errors.” Her hospital must dedicate one staffer to securing supplies of the common blood-thinner heparin, she says. Searching for alternate sources is less rewarding than studying the efficacy of various medication treatments, she adds. “It’s not what I was taught in pharmacy school, but when your back is up against the wall, you have no other options.”

Beyond impairing patient care, shortages have also become a major burden in medical research. Tests of new medicines, often set up to run at several hospitals nationwide, must give standardized meds to the treatment and control groups, and chaos can result when the drugs become unavailable. “These shortages are now affecting clinical trial options for patients with cancer,” Robert DiPaola, director of the Cancer Institute of New Jersey, told the House Energy and Commerce Subcommittee on Health on Sept. 23. “Due to the uncertainty of being able to obtain many of these drugs, enrollment of patients on clinical trials has been delayed or stopped in several of our trials.”

Howard Koh, assistant secretary of health and human services, reinforced that message to the committee: “Many of the cancer drugs in short supply … are mainstays of the anti-cancer arsenal, and were largely developed through federally funded research begun 20, 30, even 40 years ago. They are still essential to treatment and research,” he said. The National Cancer Institute is currently sponsoring 349 clinical trials that require these drugs, Koh added. “Taken together, these studies represent thousands of patients, as well as a significant federal investment in clinical trials research.”

At the same hearing, Mike Alkire, chief operating officer of Premier healthcare alliance, told Congress how widespread the shortages have become. In a recent Premier survey, 53 percent of hospital pharmacists said they had faced at least six shortages “that had the potential to cause a medication safety issue or an error in patient care.” And 34 percent of respondents said at least six shortages had “resulted in a delay or cancellation of a patient-care intervention.”

Premier estimates that the 2,500-plus non-profit U.S. hospitals in its membership pay an extra $66 million per year due to these shortages — which translates to $415 million at all U.S. hospitals.

Market going gray?

When the usual sources run dry, hospital pharmacists often get emails, faxes and phone calls from the “gray market,” sources outside the usual supply chain. In the summer of 2011, the Institute for Safe Medication Practices surveyed 549 hospitals and found that:

Alkire, of the Premier alliance, told Congress that the gray market is “appalling,” with an average markup of 650 percent. Forty-five percent of the offers were marked up at least 1,000 percent above normal price, and drugs for leukemia and non-Hodgkin’s lymphoma were marked up 4,000 percent. “We saw similar markups for medicines for sedation during surgeries; to dilate veins and prevent brain or heart spasms; and to prevent damage during a heart attack,” Alkire said.

For these reasons, University Hospital at UW-Madison does not buy gray, says Shull, although it does buy from a wholesaler that seems to have supplies of drugs when nobody else does.

The gray market arouses suspicion: How do some firms know about shortages before anybody else? How do they obtain drugs when normal sources are short?

“There is speculation going on,” says Vaida. “Some secondary wholesalers may try to buy up some available drugs and sell them for higher prices. Often times, they are looking for people who need the product, and try to obtain it from whatever sources. Some are playing it almost like Wall Street, anticipating what may go on shortage — if two manufacturers have just consolidated, and there’s a generic product that is only going to be made by one of them.”

Cures for missing meds

Many measures have been proposed to ease the medication shortage:

Photo: Armin Kübelbeck

Generic, injectable drugs comprise the majority of shortages.

The FDA seems to be getting the message. In testimony to the subcommittee on Sept. 23, Koh claimed that the agency had already headed off 99 looming shortages in 2011, compared to 38 for all of 2010. But Koh added that today’s shortages “include standard therapies for the treatment of lung, breast, ovarian, testicular and colorectal cancers, as well as several types of lymphomas and leukemias.”

Sometimes, Koh said, common-sense, proven measures can sidestep shortages. “… the FDA was able to mitigate a shortage by allowing the use of a filter to safely remove foreign particles contained within vials of injectable drugs, averting the obvious risk to patients of having metal shavings or other particulate matter injected into their veins.”

A pessimist, of course, could say the higher number of averted shortages simply reflects the greater number of shortages overall.

At any rate, organizations concerned with shortages say they are in a vise. “From our members’ perspective, it’s become [a] crisis,” says Hill. “We are seeing shortages nationwide. We have been tracking this for about 10 years, but in the last few years, we’ve seen a spike in the numbers.”

Given the problem’s multiple and sometimes obscure, roots, Hill sees “no single solution, and that’s the troublesome part. Unfortunately we will be dealing with this for a while. But there are some things we can do. We’d like to establish a mandatory early-warning system, so a manufacturer that has a problem has to notify the FDA. The FDA says it has avoided 99 shortages in the past year when it had that information. When there are multiple sources, the FDA can reach out to other manufacturers and urge them to ramp up production.”

David J. Tenenbaum

We guess you could call that a failure, but Diana Nyad’s 29-hour quest to swim from Cuba to Florida was called on account of shoulder pain, waves and asthma. But no matter how disappointed Nyad may have been, we’re impressed.

Jolted by the thought that a 61-year old would jump into the ocean to embark on a 103-mile swim, we looked around and saw a mushrooming number of insanely hard runs, swims, triathlons and bike rides — and spotted a trend.

In running, ultra-endurance events are defined as longer than the 26-mile marathon. In cycling, longer than the 100-mile century. There’s no set definition in swimming, so far as we can tell, but Australia’s 19.7 kilometer, open-ocean Rottnest Channel Swim, has to qualify. The race had 173 solo entrants in 2011, up from 100 in 2001.

While the rest of us may wonder what it takes to run 26 miles or ride 100, ultra-athletes don’t stop with such paltry challenges. The Ironman triathlon, which features a 2.4 mile swim, 112 mile bike ride, and 26 mile run, once seemed intense, the far end of endurance.

No longer. The ultra-bikathons include Wisconsin’s Dairyland Dare, which maxes out at 180 miles of hills.

And from there, things get worse. Much worse. The Tour de France bike race is one of three “grand tours” that normally exceed 2,000 miles in length. There’s the Furnace Creek 508, which bikes non-stop across 508 miles of Death Valley and the Mojave Desert.

And there’s the Race Across America, an annual, coast-to-coast sufferfest where sleep is optional and minimized, and where the bikers sometimes use duct tape or bungee cords to hold their heads up.

France has a triple-Ironman, and Africa has the Marathon des Sables, a gritty, six-day, 155-mile jog ‘n slog through the Sahara Desert.

Once a year, you can swim around Manhattan. It’s only 28 miles, and we hear raw sewage has stopped spewing into the Hudson River…

So we got to wondering. How (and why?) do these athletes attempt the near-impossible? Are the barriers physical — or mental? What are the rewards – and what are the risks of attempting such outlandish performance?

Why – the motivation question

Let’s start with the hardest question. Why in the world would anyone attempt these distances without being paid for it? “There are extremists in all activities,” says Ronnie Carda, a marathoner who heads the physical education activity program at the University of Wisconsin-Madison. “These are very committed individuals. Everyone looks at it as challenge, but most have a real love for it. I had a good friend who used to do ultra-endurance runs, absolutely loved it. But I assume there are people who get obsessed, and I have talked to some who have tried double Ironmans [swim 4.8. miles, bike 224 and run 52] and said one was enough.”

“Certain people, personalities, have to keep proving things to themselves,” says Bob Mazzeo, an associate professor of kinesiology and applied physiology at the University of Colorado, who studies high-altitude athletes.

“People ask, why am I doing this, and I say why do people climb Mt. Everest or do any other tough athletic endeavor?” says Charles Olson, who rode the Furnace Creek 508 last year under the nickname Brooklyn Beast. “It’s to see if you can. I was doing the Ironman, but it wasn’t enough. I’ve always been interested to see how far I could push things, including myself. As a child, I had slot cars and model trains, would see how fast they would go until they fell off the tracks or the engines would burn out.”

Finally, there’s the age factor. Ultra sports are made for older folks, says David Tanner, 61, who has completed Ironmans, the Race Across America (RAAM) and other ultra rides, swims and runs. “I have been around ultras in a lot of different sports, and most competitors weren’t superfast when they were 20. This is an opportunity for people who have perseverance and a good mental attitude to do well in a sport where they weren’t maybe fast enough when they were younger. In an ultra-marathon, sometimes the older you are, the wiser you are, and wisdom is more important than a high VO₂ max or muscle mass.”

VO₂ max measures the amount of oxygen a person can take in; higher levels allow greater athletic performance.

Tanner, a research associate at the Indiana University Human Performance Lab, added one more reason to push the limits. “Everything in your life can be going down the tubes, but you can enter an ultra, forget your problems for a day or two, finish dead last, and still feel good about yourself. It all comes down to self-satisfaction and personal achievement.”

Evolution ‘r us

This outburst of ultra-athleticism may amount to a return to our evolutionary roots, says Joel Stager, in the department of kinesiology at Indiana University. “There is a lot of evidence that humans may be some of the best endurance athletes on the planet, that we evolved to out-endure most animals.”

This excellence shows up in the most basic measurement of metabolic capacity, the volume of oxygen that can be delivered to the muscles per unit time. “Humans have a high value for VO₂ max per kilogram of body weight,” Stager says. “We have the ability to out-metabolize, and the ability to run long distances at a relatively modest pace, so if you put those together, we can out-endure most other species.”

What must training accomplish?

Training for an endurance sport has both emotional and physical goals, and while each event has its particular needs, the focus is on high-endurance, slow-contracting muscles.

Physically, training for an ultra-endurance event should:

Tanner says one of the biggest improvements in endurance athletics concerns nutrition. “Most of us used to make do with homemade brews, whatever you could get in real food. Today, so many companies engineer food that is specifically designed for endurance. You do need protein during a long event, people did not think that before. We have products that are more easily digestible, so you can get close to matching your caloric intake to your output.”

Not just a body game

Sources differed on whether ultra-endurance sports are tougher on the mind or the body, but there is no question that a multi-day race can tax the willpower. Having swum 10 miles or run 50 – do you have what it takes to swim another 10 or run another 50 to reach the finish line?

Training eases the inevitable confrontation with the pain and suffering of a long event, says Olson. “There are tough times in training. Last summer, I would be training 18 hours a day, would leave at 4:45 a.m., and on such a long day, it’s a struggle to find places to eat and drink.”

Olson, who trains in all weather, says “Through the training, you are learning how to deal with adversity.”

Mind control also helps during a race, Olson adds. “When you start getting negative, you have to be cognizant of that, typically you are getting hungry or thirsty, or your mind is playing tricks on you to get you to stop. I eat, change my cadence, or take a five-minute break; do what I need to do to get my mind back in synch. I tell myself I don’t want to let my children down, try to set an example, show that you can do anything you put your mind to.”

How to train

If the goals of training are clear, there’s no clear agreement on what it takes to reach them. Just as carbo loading in preparation for a long race faded 30 years ago, training hours are also on the wane, says Tanner. “Some people thrive on a massive amount of training, but most ultras are not doing the mileage we were 20 years ago. For [the 1989] RAAM, I was training 600 miles a week. I think most people now do not do that much, they substitute quality, hills, intervals, time trials, indoor efforts. There is whole lot more science to training.”

The nature of the training depends on the goal. “There is a huge difference between the people who are competing for the trophy versus the people who are out there for the challenge of going the distance,” says Carda of Wisconsin. “I can’t tell you the number of people that do an Ironman and don’t have a whole lot of intention of running much in the marathon.” Instead, many people many walk a large section of the marathon, which concludes the event. “It’s more about going the distance.”

And those differences affect the training, Carda adds. “If I’m going to compete, there has to be an intensity element. If your goal is strictly a finish, to meet the challenge of the distance, [you will use a different training routine]. It really depends on what your goals are.”

But even a moderate training schedule for, say, an Ironman or a 100-mile foot race will be intense – and time-consuming. Many ultras “are very good time managers,” says Carda. “One gentleman I know who does the Ironman annually found a way to train on an hour a night during the week, and went for long ride on the weekend.” Another would start a 100-mile bike ride at 5 a.m. Saturday, then met his wife and kids at a park. “They would have lunch and he’d be finished for the day. He found a way to put his family into it.”

Running risks

Even in sports that require an extraordinary physical effort, it’s possible to overdo it, says Mazzeo, who focuses on high-altitude athletic performance. “At Pikes Peak, in August, they have a half-marathon, starting at 8,000 feet, up to the summit at 14,000 feet. The next day, there’s a full marathon, up and down, and there are people who run both of them. That is crazy.”

The result of too much exertion, day after day, is called staleness or over-training syndrome, and the symptoms include lowered performance, sleep disturbances, unusual muscle soreness and a feeling of heaviness, even depression. These symptoms are “pretty common here in Colorado, with many triathletes training twice a day for six or seven days a week,” says Mazzeo. “Full-blown over-training syndrome can take a year for recovery, it’s quite significant.”

Ultra-endurance sports can hurt. Bikers can suffer neck seizures and genital numbness, or crash. Runners injure feet, joints and soft tissue.

And there is some evidence linking regular, long-term exertion with atrial fibrillation, a sometimes permanent heart-rhythm abnormality. “Endurance sport practice increases between 2 and 10 times the probability of suffering atrial fibrillation, after adjusting for other risk factors,” according to a 2008 study.¹ This surprising rate of atrial fibrillation may be due to genetics, changes in heart structure or inflammation.

And benefits

And what are the pay-offs of such exertion? We’ve all seen research showing manifold benefits of regular physical activity, and we have to suspect that many apply to ultra-athletes. “When we look at people who have maintained a highly active lifestyle for decades, we don’t find a lot of downsides,” says Indiana’s Stager. “They have lower blood pressure, lower heart rate, less body fat, and muscle mass, better cardiopulmonary performance, more heart capacity, and more elasticity of the arteries.”

High-level exercise helps the brain’s ability to think and make decisions. According to a 2010 ³ review of exercise in older adults, “A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices.”

Stager says that in an ongoing study, the cerebellum, a part of the brain that is involved in voluntary motion, “appears to have a greater mass, more cells and more connectivity. As we age, we start having balance and gait problems that lead to falls and injury. What if we found that one hour of exercise a day would offset as many as 20 years of aging, which is what we appear to be finding?”

“There are some pretty surprising” results, Stager says. “The message for years was that the brain wasn’t involved in exercise, but that does not seem to be the case.”

Stager recognizes that these benefits are not affecting the majority of the population, which is growing more sedentary and obese. “What’s happening is that in term of fitness is that the haves have more, the have-nots have less.”

And while these benefits are not exclusive to ultra-endurance athletes, the rise of these long-distance events does seem to represent the extreme of a significant shift toward higher intensity. Marathon runs, to take one gauge of popularity, are surging: In 2011, more than 100,000 people applied for the New York marathon, and almost 27,000 ran the Boston marathon. And the 160-mile Race Across Indiana had about a dozen participants when it started 25 years ago; 1,250 finished the 2011.

Is it about togetherness?

Another factor that explains the explosion of ultra-endurance sports is marketing, Carda says. Ultras, Carda adds, are “just the next phase. In the ’60s, people started running, there was a fitness craze. There were marathons — not everybody got involved – but suddenly every city had a marathon.” In a beneficial spiral, cities have realized that ultra events – from the marathon up, can attract dollars. “There have always been bikers and runners, and the triathlon has been around for a long time, but the marketing end of things has caught up. “The Ironman is one of those events that has cachet, it’s the in thing to do.”

One more thought. Most people cannot relate to the idea of completing a marathon, let alone an ultra event, but the utterly ridiculous nature of these challenges brings the participants closer. “There is an ultra family, it doesn’t seem to matter what sport,” says Tanner. “There is competition between individuals, but the real competition is you against the distance, against the course. If you finish, then you win, in your own mind. You enjoy the people you are with, make a lot of friends, and when you go back to work on Monday, you have the satisfaction that you were able to push your limit, do something you thought maybe you could not do.”

That’s pretty much what we heard from Olson, who’s heading back to the Furnace Creek this fall. “Anybody who is going an ultra distance, even the real racers, will look to help you along in your journey. They will offer advice because they want you to finish.”

– David J. Tenenbaum

Uganda is looking for answers as about 20 students and a teacher were killed June 28 by lightning that struck their school in this highland nation in Eastern Africa. With dozens of children also injured by electricity, Ugandans wonder if the serious string of lightning strikes is related to climate changes, or are just the consequence of an unusually heavy stream of moist air coming from the Atlantic.

We can’t answer, but the tragedy did get us Why Filers to thinking about lightning. Although lightning bolts killed “only” an average of 39 Americans over a recent 10-year stretch, the injuries, which concentrate on the vulnerable nervous system, can be severe and lifelong.

Satellites tell us that 1.2 billion lightning flashes occur in the atmosphere each year — although not all reach Earth.

What is lightning? How does it injure and kill? And what has been learned in the past few years from the millions spent studying nature’s electricity?

2003, NASA Johnson Space Center

A string of lightning flashes are seen from space.

Boom-boom room

Thunder — the cracking or rumbling you often hear — is caused by thermal expansion and contraction. Lightning bolts can get far hotter than the sun’s surface — up to 20,000° Celsius. That heats the air, causing it to expand, and starting a shock wave that moves as sound waves — thunder.

If you’re close to the lightning bolt, you’ll hear a cracking; further away, you’ll hear rumbling because that sound has come from several parts of the bolt, and been reflected from buildings and hills.

And yes, if you start counting “one Mississippi,” when you see the flash, you can estimate the distance to the bolt: Light essentially reaches you instantly, but sound takes about five seconds to travel one mile. Divide the number of seconds by five to find miles, or by three for kilometers.

Silence is — mysterious

One of the many lightning mysteries is this: Sometimes you hear the thunder, and sometimes you don’t. For example, “heat lightning” is an eerie, silent flash that often lights clouds in thunderstorms.

The sound has been gobbled by an audio version of the visual mirages that cause trekkers to see water in stone-dry desert. These visual mirages are caused by heat that bends light waves. You look straight ahead, but you actually see the sky, shimmering like a tempting lake.

Similarly, in a thunderstorm, the sharp boundaries between warm and cool air can channel sound waves away from the observer, as you can see from the nifty applet, below.

Much the same phenomenon was noticed during the Civil War, when artillery was visible in the distance but audible only in some parts of the battlefield.

Go play with lightning.

Nature’s lighting foundry

We think of clouds as billowy places, couches for angels in Renaissance paintings. In thunderclouds, however, air and water – liquid, frozen and in between — may be whizzing up and down at a furious clip — up to 100 miles an hour.

That’s a place where angels fear to tread.

The motion in these cumulonimbus clouds is powered by convection, a force that separates fluids based on density. The dense, cold air falls while the warmer air rises. Smaller water droplets hitchhike up on the updrafts, which can’t support the larger droplets.

Because smaller particles tend to carry positive charges, the movement caused by temperature, humidity and density (which can include snow, ice, and water vapor) segregates electrical charges: The top of a cloud becomes positive and the bottom negative.

Regions of different charge can only exist if surrounded by an insulator — namely air. Insulators, however, eventually fail when they are overwhelmed by electric “pressure.” In a thunderstorm, that “failure” results in lightning.

Hangin’-motor blues

Having trouble envisioning this? Imagine a chain holding a greasy V-8 motor above a ’63 Ford Fairlane in a shade-tree auto mechanic’s backyard. If the engine is too heavy, or the chain too weak, the chain will snap as it is overwhelmed by the gravitational attraction between Earth and engine.

Thunk!

Substitute air’s insulation for the chain, and electrical attraction between positive and negative charges for gravity, and you have a greasy-fingered picture of how air can separate electrical charges during a thunderstorm.

To go further, we need one hunk of physical-science jargon: electrical potential is how fast charge changes with distance, and it’s measured in volts per meter. Electrical potential is the “pressure” that’s “trying” to start an electric current between areas of opposite charge.

(Opposite electrical charges are like young lovers: They will do anything to get together.)

Just as an overweight V-8 can snap a skimpy chain, excess electrical potential can “break” air’s insulation. When that happens, an electrical current — in the form of a lightning bolt — neutralizes the opposing charges.

Flash!

Diagram: Encyclopædia Britannica, Inc.

Lightning leaps between separate negative and positive regions during a storm. Most cloud-to-ground flashes originate in the cloud’s negative regions.

In a cloud-to-ground flash, the huge electrical potential — measured in millions of volts — eventually overcomes air’s electrical resistance, and a “streamer” or “leader” begins reaching, about 50 meters at a time, toward ground. The streamer makes an ionized (conducting) pathway of plasma, allowing current to flow.

Where am I safe?

As the current approaches the ground, its electrical potential can cause a surge of oppositely-charged particles to “reach” up toward it. Because this upward current often springs from tall objects, trees and other tall objects make lousy shelter during a storm.

For a 2001 Why File on lightning, David Rust, who was then director of forecast research and development at the National Severe Storms Laboratory, told us that the safety of a building is determined by the degree of grounding. A steel building that’s securely grounded, he said, will be safer than a wooden one that’s not, even if the steel building is taller. Steel and other conductive metals provide an easy pathway to ground for the lightning, and that translates into safety.

Once the ionized pathway is established, electric currents flow back and forth between ground and cloud so quickly that they appear as flickers rather than separate bolts. (More on lightning safety.)

We’ve heard that a big cloud-to-ground bolt carries one trillion watts of electricity. If that estimate is right, during its fraction-of-a-millisecond life, the flash carries about the same current as the total U.S. generating capability. (Watts measure the flow of electric current at any instant. The more familiar watt-hours measures an hour of flow of a given current; 1 kilowatt hour equals 1,000 watt hours.)

But nobody has figured out how to put this energy to work. Though we have heard one proposal, the currents are insanely high and the strikes are too brief and too unpredictable.

Keeping a close watch on lightning

Our understanding of lightning grows with improvements in technology, and a new instrument on trusty weather balloons has pointed to a surprising source for the electric charge. The process involves a small, spongy relative of hail called graupel, says Don MacGorman a physicist at NOAA’s National Severe Storms Laboratory.

“As graupel accumulates tiny, pristine ice particles, and then falls through liquid water, there can be some charge exchange in collisions where the tiny ice particles rebound,” MacGorman says. In the lab, this interaction seems powerful enough to be main source of electricity – and therefore lightning — in large areas of the storm.

Within a few years, a better understanding of lightning formation could improve predictions, MacGorman says. “We will not be able to say lightning will a hit particular location. Lightning is too random for that, but we are getting to the place where it may be possible to say that a storm will produce a little or lot of lightning, and that would be helpful for storm safety.”

Cloudy picture

The graupel explanation, however, raises a question: If the interaction of water and ice creates the electric charge, why is lightning found in dry sectors of the storm, including the large “anvil” structure that exhausts cold, dry air above the storm? “We have seen lightning initiated almost 100 kilometers from the heavy precipitation area, so something else must be going on in the anvil,” says MacGorman. “This does not accord with how we’d viewed anvils.”

Scientists are also probing cloud flashes, caused by the flow of current between regions of clouds with opposite charges and does not hit the ground. Formerly dissed because they don’t kill people, cloud flashes are getting some respect.

For one thing, they are the most common type of lightning, accounting for perhaps one-quarter of all lightning flashes. Adding cloud-to-ground and cloud-to-cloud lightning gives a better indicator of total storm intensity than ground flashes alone, “which have very little relationship to storm severity,” says MacGorman. “You can have huge ground flashes in a relatively innocuous storm, but total lightning is well related to things that affect severity and strength: the size of the updraft, the amount of ice in the clouds, and so it gives us clues as to how intense the storm is.”

Positively speaking

The biggest recent discovery on lightning, says MacGorman, concerns storms that produce a large amount of positively charged cloud-to-ground lightning rather than the usual negative currents. During a field research program called STEPS, in a lightning-rich region of the high plains, some storms contained negative charges in places that normally would be positive, and vice versa. In these conditions, instead of dropping the normal negative charge to the ground, the lightning bolts were positive.

The unusual phenomenon could arise in clouds containing a high concentration of liquid water, MacGorman says, and that would also raise the odds of large hail. “Hail typically forms because graupel or another seed particle starts collecting liquid water faster than it can freeze, and the water spreads over the surface, then freezes into a solid layer of ice.”

These dense particles are more likely to happen in an area with a lot of liquid water, and therefore, these positive lightning strikes could be a harbinger of large, destructive, hail.

The view from on high

For the next stage in lightning observations, scientists will go to GOES-R, a series of geostationary satellites scheduled for launch in 2015. These high-orbital spyglasses will carry an optical gadget that should “see” upwards of 90 percent of total lightning activity. “The viewing area will cover pretty much all of the continental United States, and parts of Africa and South America, and eventually, half of the Pacific Ocean,” says MacGorman. “This will allow us to detect thunderstorms over the oceans, which we have not had good way to see in the past.”

That should help airplanes dodge storms, but also aid weather prediction, MacGorman says, since thunderstorms can trigger other thunderstorms. They also add water vapor to the lower atmosphere, which also feeds storms.

Nothing light about lightning

Lightning gathers myths. Whether it’s Zeus throwing thunderbolts from the ancient Greek sky, or the moronic misconception that victims become untouchables because they retain an electric charge, these bolts spark the imagination.

But lightning can change your life, as Steven Marshburn, Sr., of Jacksonville, N.C., told us in 2001. Marshburn was struck in 1969 while working in a bank. Although the sky was blue and no storm was in sight, a bolt entered through a wire from the drive-up window.

Afterwards, Marshburn “suffered from severe headaches, chronic daily pain, grand mal [epileptic] seizures, dizziness, problems with my eyes going blurry. Many health problems persist. I have had 20 lightning-related surgeries…”

In 1989, in response to his brush with death, he formed Lightning Strike & Electric Shock Survivors International to investigate the medical aspects of lightning and to support victims and families. In 2001, he told us that members had talked 13 fellow survivors out of suicide.

A shock to the nervous system

Lightning usually kills by attacking the heart, which runs on electrical impulses. While high-voltage electrical injuries often cause severe burns, they are rare with lightning, likely because the bolts — lasting only 0.1 to 1 millisecond –- are too brief to cause severe burns.

Although burns may result if clothing ignites or sweat boils and steam is trapped under clothing, wet, sweaty clothing may actually conduct a heavy current outside the body and reduce the damage.

Raphael Lee, a professor of surgery and medicine at the University of Chicago, and an expert on the effects of lightning strike, told us that most of the initial current in a lightning strike does not pass through the body. However, two electromagnetic phenomena can produce a strong voltage drop across the body:

Strong electric fields are a problem for nerves and muscles, Lee says, because they “have been structured through evolution to be very sensitive to tiny electric fields.” That, combined with their physical length, which spans a large electrical gradient, “makes them very sensitive to lightning.”

Nerve cells can be a meter long, and by extending into different parts of an electric field, they are exposed to high voltages, Lee says. One focus of concern is the cell membrane which can die if strong voltages poke holes in it. Voltage can also wreak havoc in the pores in the membrane, which regulate the cell’s physiology by controlling how ions enter and leave the cell. Normally, for example, the potassium concentration is 1,000 times higher inside a cell, and damage to the pores can result in malfunction or cell death.

Lightning = thunder in the brain?

Although electricity is the natural focus of lightning damage, Lee suspects that an acoustic pulse, or shock wave, plays a major role, and perhaps a dominant one. A lightning bolt is surrounded by hot, ionized gas that arises in nanoseconds or microseconds and whose temperature may exceed 10,000 ° C. “When you heat something in a small area in such a short period, there are going to be shock waves,” he says.

The power of this acoustic wave is obvious when lightning hits and splits a tree, Lee adds. But inside the brain, the shock can trigger traumatic injuries similar to those caused by a roadside bomb or artillery shell.

Neurological injury: no passing matter

Lightning injury can be severe, long-lasting, and hard to treat, and it “may affect any or all parts of the nervous system,” according to Mary Ann Cooper, an emerita professor of emergency medicine at the University of Illinois-Chicago.

In a 2009 study of survivors of lightning and other electric shocks, 78 percent of the survivors had at least one psychiatric diagnosis; many of the troubles related to learning, memory and executive function.

In 2001, Cooper told The Why Files that confusion, caused by slowed information processing, is a hallmark of lightning injury. Symptoms include “difficulty in short-term memory, coding new information and accessing old information, multitasking, distractibility, irritability and personality change.”

Damage to the frontal lobe, the site of much higher thinking, is common, according to Cooper. “Many suffer personality changes because of frontal lobe damage and become quite irritable and easy to anger. The person who ‘wakes up’ after the injury often does not have the ability to express what is wrong with them…and cannot carry on a conversation, work at their previous job, or do the same activities that they used to handle. As a result, many self-isolate, withdrawing from church, friends, family and other activities.”

Cooper said some cell types continue suffering for weeks after the injury, and that nerve cells seem to “spend a long period trying to heal themselves, until finally the cell body is exhausted” and the cell dies. That process accounts for a delayed disability syndrome among survivors.

Help at hand?

Long-term neurological consequences are a major research area, Lee says, because they also occur in traumatic brain injury. “People are trying to sort out what is the best treatment, and understand why some people are more susceptible to delayed neurological problems. The body is very complicated and … the weight of evidence suggests there are genetic predispositions to complications after a blast causes traumatic injury to the brain, and lightning injury may be no different. Many people recover, but some don’t. What is different about the people who don’t?”

– David J. Tenenbaum

Hunger season approaching?

In some places, the harvest is preceded by “hunger season,” when stored crops are exhausted but the new crop is not ready. For many reasons, we’re wondering if the Earth is entering a long hunger season:

Food prices reached records in February, which may even have helped spark the political unrest that swept the Middle East. As Lester Brown of the Earth Policy Institute notes, a 10 percent rise in the price of wheat barely budges the price of bread in developed countries, but directly boosts the price of chapattis in India.

The population is expected to reach about 9 billion by 2050, and 3 billion people with rising incomes have a growing appetite for grain-intensive animal protein.

The World Food Program estimates that one person in seven goes to bed hungry. One reason is poverty: In this world, only the poor are hungry. But other reasons are related to supply and demand:

The end of civilization?

Depleted soil is a legacy of many failed civilizations, wrote soil scientist David Montgomery1 of the University of Washington. “In recent decades, archaeological studies confirmed pronounced episodes of soil erosion associated with the rise and subsequent decline of civilizations in the Middle East, Greece, Rome, and Mesoamerica, as well as other regions around the globe.”

Indeed, Montgomery writes, “a limiting lifespan of an agricultural civilization can be estimated by the time needed for conventional agriculture to erode through the native stock of topsoil,” which “predicts reasonably well the historical pattern of a 500- to several-thousand-year lifespan for major civilizations around the world.” These calculations, he says, support the argument “that it was not the axe that cleared forests but the plow that followed that undermined many ancient societies.”

Soil health is often gauged by the percentage of organic matter — the decomposing plant material that feeds microbes and soil animals, and enables soil to hold water and nutrients, says Jane Johnson, a soil scientist with the U.S. Department of Agriculture in Minnesota. “Most of the characteristics that we associate with high quality soil are directly or indirectly linked to soil organic matter.”

Therefore, the emphasis on protecting and improving soil so it can feed an ever-growing population often comes down to the level of organic matter. In the United States, much of the cropland has already lost 30 to 50 percent of its organic matter since Europeans started farming a couple of centuries ago, says Rattan Lal, a professor of environment and natural resources at Ohio State University.

Most productive soil in Africa and Asia has lost 70 percent to 80 percent of its organic matter, says Lal, an outspoken defender of the soil, and long ago crossed the line toward ruination. “There is a threshold — about 1.2 percent to 2 percent of carbon [the usual measure of organic matter] — to maintain soil health, water retention and other soil services.”

Many soils in Africa, India and China have only one-tenth that much carbon, Lal says, and that leads to a truckload of trouble. “When you add fertilizer, it washes into the groundwater because the organic matter is not there, and the same goes for pesticides and herbicides. These chemicals wash into rivers or the groundwater, or enter the atmosphere, where they cause human health and environmental problems,” without conferring much benefit to the crop.

Lal says a train in his native Punjab, India is dubbed the “Cancer Express” because it travels through a region where “many people are prone to cancer because of pollution of the drinking water. The soil does not have the capacity to hold water and pollutants. That is what the biological health of soil does; you get microbial decomposition, absorption of organic matter and retention of water. If crop residues are taken away, if dung is taken away for cooking, the soil has nothing left to provide the services. It essentially becomes a sand culture.”

Good soil, great benefits…

About the only bright spot in the grim picture of soil destruction is this: many solutions offer synergistic benefits. Leaving a crop residue on the surface cuts wind and water erosion, and raises the level of organic matter. Conservation tillage cuts erosion, reduces the need for irrigation, and stores carbon in the soil. Smart irrigation reduces water use, and the need to plant on steep, erodible slopes.

Soil – some still call it dirt – is not as popular as Facebook or Dancing with the Stars. But it’s a whole lot more important. “Our ability to feed humankind in the future depends on a stable, improved soil resource,” says Jerry Hatfield, director of the Agricultural Research Service lab in Ames, Iowa.

Or, as University of Minnesota soil scientist William Larson once said, “Soil is that thin layer on the planet that stands between us and starvation.”

Enough with the problems. Let’s look at some serious soil solutions.

Washing away

Because water erosion can rapidly flush nutrients, mineral soil and organic matter from hilly land, the battle against water erosion has been a focus of American farmland conservation since the 1930s. One common prescription is contour planting; rows planted across the slope are more resistant to erosion than those running up the slope.

A standard way to protect soil is to leave crop residues in place after harvest, but bioenergy proposals often suggest that these wastes be fermented into cellulosic ethanol. The best solution depends on the situation, Johnson says. “If the land is highly erodible, we should not take residue. But if the landscape has a low erosion risk, then if we can manage it to protect organic matter by leaving enough residue in place, chances are we will have more than enough cover for erosion control. I believe it is possible to take some residue off, but not everywhere.”

The focus in protecting soil has shifted from the mineral component of soil to its organic matter, which is more sensitive, says Johnson. “In most cases, protecting the organic matter will protect against erosion, but if you only manage for erosion control, that may be not enough to retain the organic matter.”

Gone with the wind

The “Black Blizzards” of the 1930s Dust Bowl proved beyond question that wind can transport large amounts of soil to the wrong place. Could we see a rerun of the Dust Bowl? “People say we will never have a Dust Bowl again, because of the conservation practices that we put in,” says Hatfield, but the Dust Bowl also followed years of severe drought, which further stripped farm fields of cover.

Furthermore, says Hatfield, co-editor of a new book on soil management,2 many of the windbreaks planted to slow wind erosion have been removed to allow the use of large farm machinery. “What would happen if, across the Great Plains, we had three or four years with hardly any rainfall? I dare say we would not see the extent of the Dust Bowl, but would our current conservation practices be sufficient? … How much can you expect when the land is naked?”

Confronting drought

The Dust Bowl shocked Americans, but drought is a common problem that has differing consequences. Recent reports show that California’s farm industry did well during the 2007-2009 drought, mainly because large farmers had access to irrigation water. But wheat production in Southwest Kansas is now expected to fall at least 25 percent due to drought. According to Bloomberg News, the state’s wheat crop “has suffered irreversible damage from the country’s driest spring in half a century…”

In places where irrigation is impossible or inadequate, standard soil-conservation techniques, including retaining organic matter in and on the soil, can improve water retention.

ENLARGE

Cities devour farmland

The 80 million people joining the population every year require 3200 square kilometers land for shopping malls, roads, airports and housing. Cruelly, much of that growth occurs in places with productive soil, says Charles Rice, a professor of agronomy at Kansas State University, because big cities typically start out in a region with productive farms. “Chicago is a prime example; the soils in northern Illinois are some of the best in the world, but unfortunately Chicago is growing. I hate to see that valuable productive land paved, built upon. In Asia and Europe, around the world, megacities are consuming land. We need to figure this out, but nobody has.”

Salty soil is worthless soil

A bright idea: reduce tillage, save topsoil

Perhaps the largest success story in protecting soil is the no-till revolution in agriculture. Rather than turning over soil to bury weeds and crop residues, a no-till machine plants directly in the stubble, then controls weeds with herbicide. The process saves diesel fuel and also retains organic matter, says Hatfield, who observes that carbon compounds oxidize rapidly when the soil is disturbed. “We need to protect the soil from within, with more organic matter, and from the external forces, like wind and water.” Sustaining the soil, he says, “Is really about building that organic matter reservoir.”

In 2010, no- or low-till farming occupied at least 20 million hectares each in the United States, Brazil and Argentina, with significant areas in Canada and Australia.

“If you go to South America and talk to producers,” says Hatfield, “they look at conservation practices as the normal accepted practice — if you used a moldboard plow [which turns over the soil and exposes it to erosion] they would probably shoot you! In the last 20 years, they have realized what a precious resources soil is, and to maintain its viability, they have preserved the organic matter.”

But worldwide, no-till occupies only 6 or 7 percent of the 1,500 million hectares under cultivation. “You could call that a success,” says Lal. “But in the places where it is needed most desperately, Africa, Asia, those desperate farmers cannot implement no-till.”

Summing up

Optimism is not a common response to discussions of the world’s degrading soils. Lal says two to three billion hectares already are degraded, but contends that problems related to energy use, global warming and clean water also have strong ties to land degradation.

To take two examples, surface water is easily polluted when it washes off eroded land, and healthy soil stores vast amounts of carbon, slowing global warming. “All these issues are linked with one another, and soil is the common link,” says Lal. “We have the IPCC [Intergovernmental Panel on Climate Change] to address climate change … but soil is addressed by nobody, even though … we cannot address water security, energy, biofuels, global warming, without soil.”

Not to mention the daily problem of putting bread on the table…

But here’s a reason for optimism: The measures that can solve individual problems often can solve multiple problems. Conservation tillage saves water, organic matter, topsoil, even energy. Drip irrigation reduces salinity and saves water and energy. Cover crops raise fertility and reduce erosion.

And, no coincidence, all of these soil-friendly practices also increase yields.

So if you like to eat, the time to think about soil is … now.

Fish in the Gulf of Mexico: How safe?

The fire and deadly explosion of the Deepwater Horizon drilling rig on April 20, 2010 spewed a gusher of crude oil — about 4.4 million barrels — into the Gulf of Mexico.

The blowout flooded all levels of the Gulf with oil. And that oil, combined with millions of gallons of an oil-degrading chemical, raised questions about the health of Gulf seafood, both shellfish and finfish.

Fishing is major in the Gulf of Mexico, which in 2008 produced 15 percent of total weight of U.S. commercial fishing, and which has more sport fishers than any other American region.

Within two weeks, as a precaution to prevent the sale of contaminated fish, the government began closing parts of the Gulf to commercial fishing.

A report published today in Environmental Health Perspectives reviews the aftermath: How big was the threat? Did the closures harm the fishing industry by giving, in effect, official endorsement to the idea that the fish were contaminated? Were there any gaps in protection?

Not very filthy

The report came to an optimistic conclusion: government-sponsored studies of Gulf fish since the blowout found no significant contamination with heavy, persistent compounds called polycyclic aromatic hydrocarbons. “I don’t know that we have any evidence that the fish were contaminated, ever,” says study first author Julia Gohlke, an assistant professor of environmental health science at the University of Alabama-Birmingham.

PAHs can cause cancer and are often used as a measure of hydrocarbon contamination. According to the new study, “Federal seafood testing results released to date” show PAH levels at roughly 1 percent of the “level of concern” that the Food and Drug Administration established for assessing food safety after the Deepwater blowout.

Other results, she says, have focused on total hydrocarbons derived from oil, rather than PAHs. “My analysis looked at what the government has done,” she says. “There are independent reports of contamination that I tried to include, but they did not measure PAHs, only total petroleum hydrocarbons.”

Large oil spills are so ominous that people can overreact, says Gohlke. “People see an oil spill and fisheries closures and assume everything must be contaminated, and nobody wants to eat anything. There is a misunderstanding of what is considered contamination. There is now a large dataset, at this point, to show there hasn’t been significant hydrocarbon contamination to date.”

Gohlke and colleagues looked at data on the BP blowout, and previous oil spills from around the world, to compare toxicity levels and evaluate the procedures used to close and open fisheries. The project was funded by a grant from the Walton Family Foundation to the Environmental Defense Fund.

Looking at samples taken during and after the blowout, no results suggested that eating fish – whether with shells or fins – would contain elevated levels of PAHs, says Gohlke, who cautions that monitoring should continue for years because buried oil may re-enter the water and contaminate fish.

After the BP spill, fishing was banned in as much as 37 percent of the Exclusive Economic Zone in the Gulf of Mexico, which extends 200 nautical miles from the coast. These bans were precautionary, since they were made in advance of contamination tests, says Gohlke.

Although “safe, not sorry” can be justified, closures can also have unintended consequences, or even backfire, she says. “Part of me thinks the precautionary approach is appropriate, but I don’t know how it has contributed to consumer confidence. Without sufficient risk communication, precautionary closures may create an expectation that the fish is contaminated. The last survey I saw, from February, suggested people were still considering Gulf seafood to be contaminated.”

“I think they make some pretty good recommendations to continue monitoring for PAHs,” says Ron Kendall, director of the Institute of Environmental and Human Health at Texas Tech University. “There is a lot of debate about underwater oil mats that are still floating, and how much oil may still be on the seafloor or in coastal marshes. With hurricane season approaching, we don’t know what kind of remobilizing of suspended oil and the mats will take place.”

To date, Kendall says, the data show that seafood has safe levels of PAHs, but “You’ve got to understand that all this oil is not gone. This story is still unfolding.”

No duh.

Year after year, the greeting card and flower industries goad us to honor our mothers, and we Whyfilers are glad to comply. This year, we celebrate by exploring what we learned about mothers at the February, 2011, meeting of the American Association for the Advancement of Science — the AAAS.

It may sound obvious, but understanding mothering helps us understand our world!

In early life, your mother is likely to be your most important person, emotionally, cognitively and behaviorally.
Photo: Din Jimenez

Mothers make us better people (Duh?)

More than 50 years ago, when University of Wisconsin psychologist Harry Harlow separated infant monkeys from their mothers, they grew up anxious, jittery, emotional wrecks. It’s amazing to think somebody needed to prove the value of mother’s love, but during Harlow’s time, behaviorism — a psychology rooted in the study of rats — was ascendant.

Academic psychologists focused on stimulus and response, not on the intricacies of the heart.

Today, Harlow’s findings seem like simple common sense, but they made him a rock star to the public — and eventually to his academic colleagues.

Stephen Suomi, one of Harlow’s last graduate students, has continued this line of research at the National Institute of Child Health and Development, again using rhesus macaque monkeys to model human behavior.

Genes don’t equate with destiny.

Back in Harlow’s day, genes were seen as destiny. Now, scientists like Suomi are finding a more interesting and flexible interaction among genes, environment, behavior, hormones and brain structure.

Suomi says that like people, “Between 5 and 10 percent of macaques are unusually impulsive; they do stupid things that most monkeys would not try. They will confront a dominant monkey. Most monkeys know how to back off, but when these monkeys are in an aggressive encounter, somebody can get hurt.”

Similarly, by age 2, some children “are identified as highly aggressive and likely to stay highly aggressive as they grow up,” Suomi says. “At school, they cause classroom disruptions. By their teens, many can be found in prison or the morgue.” In both monkeys and people, “these features show up very early and are remarkably stable.”

Aggression shows up early in some people, often leading to time behind bars.
Photo: Washington State Legislature

Stay close, my baby

Psychologically and physically, the infant monkey is reliant on its mother. Infant macaques “are almost always in physical contact or within arm’s length of their mother,” says Suomi, “which forms a strong, enduring attachment bond that is the functional equivalent of the one that human infants form with a caregiver.”

After a couple of months, that bond is established and the infant starts to explore, using mother as a “secure base,” Suomi says. “If they lose access to her, any motivation to explore will disappear; they get unhappy.” As these developing monkeys spend hours playing with peers, “every behavior pattern for normal functioning is established.”

Harlow raised infant monkeys with inanimate replacements for the mother and saw a range of deranged behavior. These days, Suomi removes young monkeys from mother and raises them with other youngsters. These “peer-reared” monkeys (are you thinking Lord of the Flies?) — develop what Suomi calls “hyper attachments. They spend excessive amounts of time clinging to each other when they should be exploring their world.”

Under these circumstances, play never reaches the normal “intensity and complexity,” Suomi adds.

Peer-reared monkeys spend more time clinging to one another than being Curious Georges.
Photo: Noneotuho

I’m afraid. Why aren’t you?

To understand why this is of more than theoretical interest, we need to meet serotonin, a key chemical for communication among neurons. Some variants of the serotonin genes are linked to high rates of suicide, depression and incarceration, and serotonin metabolism is affected by Prozac and other drugs.

In behavior, Suomi says, the peer-reared monkeys resemble the 5 to 10 percent of normal monkeys that are naturally fearful, anxious and aggressive. Both groups have a defective use of serotonin, but in the peer-reared monkeys, “this is not a product of genetics, it’s a product of social experience.”

Certain variants of the serotonin gene — and also certain experiences — are associated with increased desire for alcohol, Suomi says. When adolescent monkeys attend “the monkey version of a happy hour, some consume more than others, and the peer-reared ones consume considerably more.”

Early experience, in fact, affects the activity of one-fifth of monkey’s entire genome, Suomi says.

Suomi’s studies also show that drinking behavior is crucially dependent on upbringing: a good “childhood” can cancel out the effects of “negative” genes. “If the monkey has a good mother, it doesn’t make a damn bit of difference. It does not matter which alleles [variants] are present; you have normal serotonin metabolism. A good mother protects those who carry this allele, and it’s the same story in aggression, the same story with alcohol. With a good mother, you drink less.”¹

Why does momma matter?

The role of genetics has been a highly controversial area in development. A century ago, genes were destiny: people were essentially robots acting out immutable genetic instructions.

Then the focus shifted to external factors, and autism, for example, was blamed on a “cold” mother. Within a few decades, the advances in analyzing the structure of genes returned genetic determinism to vogue, and researchers began to search, for example, for an autism gene.

That approach quickly faded, W. Thomas Boyce of the University of British Columbia told the AAAS, in favor of a more sophisticated “behavioral genetics” focused on gene-environment interactions.

Genetics is getting more complicated, less deterministic, and more interesting. In the new genetics, mommas matter, even after birth!
Photo: Jen Watson

Now, in recognition that chemicals that are modified by experience affect the activity of genes, that picture is being enlarged in a discipline called epigenetics. In this new view, genes affect our environment, and environment affects whether and how genes act.

“The old metaphor of the genome being a blueprint for constructing the developing brain is faulty in certain ways,” says Boyce. “It may be more accurate to say that we begin with a blueprint, and partly build the house, then the family moves in and the blueprint gets modified. There is a feedback that alters the expression of the blueprint, based on the experience of the individual living in the house.”

The long shadow of poverty

How does this play out in the real world? Unstable and unmarried families tend to be poor, and social class correlates with higher rates of asthma, disease and injuries, says Boyce. At birth, physicians routinely record measures like weight and gestational age as a rough gauge of health, but Boyce thinks they ought to add social factors to the mix.

In fact, a study² that tracked health and education in 4,667 infants born in Winnipeg, Canada, for 19 years showed that the traditional biological measurements were less predictive than social factors related to health and education.

Growing up economically poor could mean growing up with poorer health, too.
Photo: Bread for the World

Since “half the world’s children grow up in poverty,” Boyce says it would make sense to look more closely at social risk factors, rather than focus on physical measures. Given that “15 to 20 percent of the overall population is responsible for over half of medical, psychiatric morbidity, and physician and health care use,” understanding social risk factors could be a key step to ameliorating poor health, he says.

The fragile family

As the American family has changed — some would say disintegrated — social scientists have shifted their focus from divorce, to the “fragile families” formed by unmarried couples. In some fragile families, the mother is single; in others she and the father are cohabiting.

“About 40 percent of American children are born into an unmarried family now,” says Jeanne Brooks-Gunn of Columbia University, a principal investigator on the Fragile Families and Child Wellbeing study.

The study is looking at the environments in which children are being raised, and which factors are most harmful to their health, welfare and education. “Some situations are stable, while others are not,” says Brooks-Gunn.

The Fragile Families study has followed about 5,000 children for nine years, with a focus on “stability and chaos, how they affect resources and investments in child well-being” Brooks-Gunn says. “Nobody will ever do this again; getting approval at 75 hospitals was a nightmare.”

Study personnel interviewed the mother within 24 hours of birth, and also a rather surprising 75 percent of the unwed fathers, Brooks-Gunn said. “Babies are darling, and everybody comes to the hospital to see them.”

The researchers then observed the children at home at ages 3, 5 and 9, to gather data on physical, social and psychological development, and they found the original optimism fading.

While rates have declined a bit, one quarter of all children, and half of black children, live with a single parent. Researchers continue to find high rates of physical, social and economic difficulties in non-married families.
Graph: The State of our Unions 2010, The National Marriage Project

“At birth, everybody expects things will go well; 75 percent of the [unwed] mothers believe they will marry the father,” Brooks-Gunn says, “but by year five, the relationship with the biological dad has ended for two thirds of these mothers. There is a huge increase in new partners, and in having children with a new partner.”

As a rule, the fathers who spent time with their children were those who had not had a child with another woman, says Brooks-Gunn. “And when the mother has a new partner, the father is out of the picture.”

The Fragile Family study³ found that:

• At age 3, children in stable families (whether married, co-habiting or a single mother), had better vocabulary than children of married or cohabiting parents in an unstable relationship.
• Children’s cognitive scores improved when their unwed parents marry.
• Each additional change in family structure increases the odds of behavioral problems. With more family and residential transitions, the mother becomes more likely to report stress and hitting her children.
• Conflicts in the parental relationship intensify behavior problems in children, regardless of the stability of the family structure.
• Having a single mother raises the odds of obesity, asthma, hospitalization and accidents.

Children of stable married couples scored best on the Peabody Picture Vocabulary Test-Revised, a standard intelligence test, implying better cognitive development. Beware: This does not prove that a stable marriage makes kids smarter; socioeconomic status and other factors still matter.
Data: FFCWS. Graph: J. Waldfogel et al, (2010). Fragile Families and Child Wellbeing. Future of Children, 20(2): 87-112.

This is not to say that simply being unmarried is the direct cause of all problems, given the many other factors in play, as Brooks-Gunn and colleagues noted. “While children born to unwed parents are at higher risk of low birth weight … women who are not married at the time of the birth are also more likely to smoke cigarettes and use illicit drugs during pregnancy, and less likely to receive prenatal care in the first trimester of their pregnancy, all of which are associated with low birth weight.”

Many factors may explain how a parental relationship affects children, Brooks-Gunn indicated:

• Parental resources: How much time, money and education?
• Parenting quality: How do the parents interact with the child?
• Father involvement: How present is he?
• Parental relationship: Are the parents stable and loving? Do they interact well with the child?
• Parental mental health: How well are the parents, psychologically?

Child-rearing outside of marriage is increasing among all women, especially among those with the least education.
Graph: The State of our Unions 2010, The National Marriage Project

The Fragile Family studies “add to a large body of earlier work that suggested that children who live with single or cohabiting parents fare worse as adolescents and young adults in terms of their educational outcomes, risk of teen birth, and attachment to school and the labor market than do children who grow up in married-couple families,” Brooks-Gunn and colleagues concluded.

Overall, the findings are distressing, Brooks-Gunn told the American Association for the Advancement of Science in February. “Our findings are more negative than I would expect. There is a lot of instability, and that affects this incredible disparity in how children are doing. This has incredible consequences for society. Forty percent of all kids are born into a non-married household. We are talking about diverging destinies.”

Ecuadorian mother and child
Photo: paggre

– David J. Tenenbaum