Scientific American - 11 2024

CONTENTS
NOVEMBER 2024 VOLUME 331, NUMBER 4
FEATURES
EVOLUTION
22 50 YEARS OF LUCY
Half a century after its discovery, the iconic fossil remains central
to our understanding of human origins.
BY DONALD C. JOHANSON AND YOHANNES HAILE-SELASSIE
MEDICINE
34 NO MORE NEEDLES
Gentle nasal sprays are being tested as vaccines against COVID, the flu,
RSV, and more. They may work better than shots in the arm.
BY STEPHANI SUTHERLAND
COSMOLOGY
42 COSMIC CONFUSION
Measurements of the universe don’t agree on how fast it’s expanding.
Could an extra ingredient in the early cosmos explain the gap? ON THE COVER
Fifty years ago an
BY MARC KAMIONKOWSKI AND ADAM G. RIESS extraordinary fossil
TIME skeleton was discov-
ered in Ethiopia.
50 SHOULD WE ABANDON THE LEAP SECOND? Nicknamed Lucy, the
We have been adding “leap seconds” to time kept by our atomic clocks, skeleton came from a
but soon we may have to subtract one. Are the tiny adjustments worth small-brained, upright-
walking human ancestor
the bother? BY MARK FISCHETTI AND MATTHEW TWOMBLY who lived nearly
3.2 million years ago.
SPECIAL REPORT Today Lucy’s species,
Australopithecus
S1 INNOVATIONS IN SOLUTIONS FOR HEALTH EQUITY afarensis, is the best-
known early human
S3 BETTER MEASURES BY CASSANDRA WILLYARD ancestor on record,
S6 RURAL PRESCRIPTIONS BY CARRIE ARNOLD thanks to the wealth of
additional fossils that
S10 THE STAGGERING SUCCESS OF VACCINES BY TARA HAELLE have been recovered.
S16 OF HOPE AND JUSTICE AS TOLD TO ANIL OZA
Illustration by
S18 CULTURAL COMPETENCY BY ROD MCCULLOM John Gurche/
Created for the Institute
S21 DEFOGGING DATA BY JYOTI MADHUSOODANAN
of Human Origins/
S25 HISTORY LESSONS BY CHARLES EBIKEME Arizona State University
Photograph by David L. Brill NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 1

© 2024 Scientific American
CONTENTS
NOVEMBER 2024 VOLUME 331, NUMBER 4
4 FROM THE EDITOR

6 CONTRIBUTORS
8 LETTERS
10 ADVANCES
Earthquakes producing gold nuggets.
Bizarre taste-bud locations. The sounds
of bird dreams. Sudden spikes in aging.
Tomekbudujedomek/Getty Images
56 SCIENCE AGENDA
Presidential candidate Kamala Harris
promises a better future for our nation.
BY THE EDITORS
58 FORUM
A play raises climate hopes while celebrating
10
how science influences politics.
BY BEN SANTER
59 THE SCIENCE OF HEALTH

Kids with ADHD may still have symptoms
as adults. BY LYDIA DENWORTH
62 MATH
How a teenager cracked a 2,100-year-old
math problem. BY JACK MURTAGH
64 THE UNIVERSE
Why UFOs and UAPs really aren’t aliens.
BY PHIL PLAIT
66 Q&A
Research on basic income shows wide benefits.
BY ALLISON PARSHALL
68 MIND MATTERS
To beat procrastination, think about the positives.
BY JAVIER GRANADOS SAMAYOA
AND RUSSELL FAZIO
U.S. Department of Defense

70 OBSERVATORY
Contrary to the popular maxim, the simplest
explanation is often not the best one.
BY NAOMI ORESKES
71 METER
The poetic motion of plate tectonics. 64
BY DANIEL GALEF
72 REVIEWS Scientific American (ISSN 0036-8733), Volume 331, Number 4, November 2024, published monthly, except for a July/August 2024
issue, by Scientific American, a division of Springer Nature America, Inc., 1 New York Plaza, Suite 4600, New York, N.Y. 10004-1562.
Economies that value nature. The timelessness Periodicals postage paid at New York, N.Y., and at additional mailing offices. Canada Post International Publications Mail
of Ursula K. Le Guin. Treasured trees. The costs (Canadian Distribution) Sales Agreement No. 40012504. Canadian BN No. 127387652RT; TVQ1218059275 TQ0001. Publication
Mail Agreement #40012504. Return undeliverable mail to Scientific American, P.O. Box 819, Stn Main, Markham, ON L3P 8A2.
of electric power. A history of citrus. Individual Subscription rates: 1 year $79 (USD), Canada $89 (USD), International $99 (USD). Institutional Subscription
BY AMY BRADY rates: Schools and Public Libraries: 1 year $84 (USD), Canada $89 (USD), International $99 (USD). Businesses and Colleges/
Universities: 1 year $399 (USD), Canada $405 (USD), International $411 (USD). Postmaster: Send address changes and
74 GRAPHIC SCIENCE subscription payments to Scientific American Box 3187, Harlan, Iowa 51537. Requests for single print copies and back issues:
call (800) 333-1199. U.S. and Canada; other (515) 248-76848 or email [email protected].
Universal patterns in folk songs hint at Reprints inquiries: email [email protected]. Printed in U.S.A.
the origins of music. BY ALLISON PARSHALL, Copyright © 2024 by Scientific American, a division of Springer Nature America, Inc. All rights reserved.
DUNCAN GEERE AND MIRIAM QUICK

Scientific American is part of Springer Nature, which owns or has commercial relations with thousands of scientific
publications (many of them can be found at www.springernature.com/us). Scientific American maintains a strict policy
76 HISTORY of editorial independence in reporting developments in science to our readers. Springer Nature remains neutral with regard
BY MARK FISCHETTI to jurisdictional claims in published maps and institutional affiliations.
2 SCI E N T I F IC A M ER IC A N NOV E M BER 2 02 4

FROM THE EDITOR
Understanding became human. On page 22, her discoverer, Donald C. Johanson,

and paleoanthropologist Yohannes Haile-Selassie, who has dis-
covered many other crucial hominin ancestors, share what we’ve
Our Origins learned about the evolution of human brains, gait, habitats and
diets by studying these precious fossils.
Earth’s daily rotation has slowed down over time; when dino-
saurs roamed the planet, a day lasted just 23.5 hours. This con-
sistent slowing is mostly because of friction. The gravitational
S
OMETHING STRANGE is happening with dark energy. pull of the moon causes ocean tides, and the friction of the oceans
What little we know about it is strange enough: “Dark sliding across the seafloor slows the entire system. Inside the
energy” is the name for an unknown force that is caus- planet, currents in the liquid outer core are now slightly increas-
ing the universe to expand faster all the time. Nobody ing our rotational speed. And global warming is changing
has been able to detect dark energy directly; we can the dynamics of Earth’s rotation as well, as water from melting
only measure its effects. And one of those measurements is a ice moves from the poles toward the equator. It’s a mess. We have
little ... off. The Hubble constant describes how quickly the uni- added “leap seconds” over the years to synchronize atomic
verse is expanding. Physicists estimate its value in the nearby clocks with Earth’s changing rotation. Senior editor Mark Fisch-
universe by measuring distances to supernovae. etti, working with infographic designer Matthew Twombly, asks
The problem is that these estimates for the Hubble constant on page 50 if it’s time to just let clock time and planetary time
don’t match what the standard model of cosmology predicts based drift apart.
on patterns in the cosmic microwave background, the glow left Vaccines delivered through a puff up the nose or into the
over from the early universe. The discrepancy has gotten more pro- mouth could be even more effective than shots at protecting peo-
nounced (and less likely to be a measurement error) in the past few ple from respiratory diseases (plus, no needles). Science journal-
years with more precise observations from the James Webb Space ist Stephani Sutherland on page 34 covers the progress that is
Telescope, building on those from the Hubble Space Telescope. being made on nasal vaccines and the reasons scientists are so
So has dark energy changed over the course of the universe? hopeful about them.
Did an additional “early dark energy” force give the universe We’re publishing our third annual special package on health
some extra oomph immediately after the big bang? Theoretical equity in this issue, starting on page S1, with a focus on solutions.
physicist Marc Kamionkowski and astrophysicist Adam G. Riess Here are some highlights: Vaccines are among the most lifesaving
have been working on this “Hubble tension” problem from the interventions in the history of humanity. People working in rural
beginning. On page 42, they explain the problem and possible areas have come up with innovations that have improved medical
solutions as clearly and entertainingly as I’ve ever seen (as always, care for all. Disaggregating data improperly lumped together can
great graphics help). save lives. Medical devices and algorithms are being corrected for
The Australopithecus afarensis fossil fondly known historical biases. And we talked to several experts in
as Lucy is one of the most important discoveries in the global health about what gives them hope for the
Laura Helmuth
study of human origins. She was found 50 years ago is editor in chief future. We hope the collection is inspiring—it has
and quickly changed our understanding of how we of Scientific American. been for us at Scientific American.
BOARD OF ADVISERS
Robin E. Bell Rita Colwell Jennifer A. Francis Hopi E. Hoekstra John Maeda Martin Rees
Research Professor, Lamont- Distinguished University Senior Scientist and Acting Alexander Agassiz Professor Vice President, Astronomer Royal and Emeritus
Doherty Earth Observatory, Professor, University of Deputy Director, Woodwell of Zoology and Curator of Artificial Intelligence and Professor of Cosmology
Columbia University Maryland College Park and Climate Research Center Mammals, Museum of Design, Microsoft and Astrophysics,
Emery N. Brown Johns Hopkins Bloomberg Carlos Gershenson Comparative Zoology, Satyajit Mayor Institute of Astronomy,
Edward Hood Taplin Professor School of Public Health Research Professor, National Harvard University Senior Professor, University of Cambridge
of Medical Engineering and of Kate Crawford Autonomous University of Ayana Elizabeth Johnson National Center for Biological Daniela Rus
Computational Neuroscience, Research Professor, University Mexico and Visiting Scholar, Co-founder, Urban Ocean Lab, Sciences, Tata Institute Andrew (1956) and Erna Viterbi
M.I.T., and Warren M. Zapol of Southern California Santa Fe Institute and Co-founder, The All We Can of Fundamental Research Professor of Electrical
Professor of Anesthesia, Annenberg, and Co-founder, Alison Gopnik Save Project John P. Moore Engineering and Computer
Harvard Medical School AI Now Institute, Professor of Psychology and Christof Koch Professor of Microbiology and Science and Director,
Vinton G. Cerf New York University Affiliate Professor of Chief Scientist, MindScope Immunology, Weill Medical CSAIL, M.I.T.
Chief Internet Evangelist, Nita A. Farahany Philosophy, University Program, Allen Institute for College of Cornell University Meg Urry
Google Professor of Law and of California, Berkeley Brain Science Priyamvada Natarajan Israel Munson Professor of
Emmanuelle Charpentier Philosophy, Director, Duke Lene Vestergaard Hau Meg Lowman Professor of Astronomy and Physics and Astronomy and
Scientific Director, Max Planck Initiative for Science & Society, Mallinckrodt Professor of Director and Founder, TREE Physics, Yale University Director, Yale Center for
Institute for Infection Biology, Duke University Physics and of Applied Physics, Foundation, Rachel Carson Donna J. Nelson Astronomy and Astrophysics
and Founding and Acting Jonathan Foley Harvard University Fellow, Ludwig Maximilian Professor of Chemistry, Amie Wilkinson
Director, Max Planck Unit for Executive Director, University Munich, and University of Oklahoma Professor of Mathematics,
the Science of Pathogens Project Drawdown Research Professor, University Lisa Randall University of Chicago
of Science Malaysia Professor of Physics,
Harvard University
4 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4
CONTRIBUTORS
STEPHANI SUTHERLAND
NO MORE NEEDLES,
PAGE 34
Health journalist Stephani
Sutherland has long been fas-
cinated by pain; it was the sub-
ject of her Ph.D. research. “You
can’t survive very well without
it, but if you have chronic pain,
it can become really debilitat-
ing,” she says. So when COVID
began causing painful, long-
term illness and neurological
symptoms, she paid close
attention. This condition,
called long COVID, is an exam-
ple of something scientists
began to fully understand
only in the past few decades.
“The nervous system and the
immune system are not sepa-
rate like we were once taught,”
DUNCAN GEERE AND MIRIAM QUICK GRAPHIC SCIENCE, PAGE 74 Sutherland says.
On their podcast, Loud Numbers, Miriam Quick and Duncan Geere (above) turn data into music. The connection between
There’s a techno track charting climate change, a fugue about European bureaucracy, an experi- chronic pain and the immune
mental epic about beer tasting, and more. “You get to ride the waves of the data, moment to system has since sparked
moment, in a much more emotionally resonant way” than looking at a graph, Geere says. her interest in immunology.
As data journalists and storytellers, they use both sonification and visualization to make complex Sutherland’s feature in this
information understandable to our ears and eyes. For this issue’s column on music evolution, with text issue explores a type of
by associate news editor Allison Parshall, Quick and Geere were challenged to represent a song as a needleless vaccine that goes
visual graph. Quick studied music-performance styles for her Ph.D. in musicology, so she has experience in the nose, not the arm, and
using data to “understand the music in a different way,” as she puts it. Geere, who came to data journal- could one day provide better
ism from an earth sciences background, is also passionate about music; he DJs and plays in bands. immunity to infectious dis-
Their graphic uncovers and maps key similarities among pieces of traditional music from all over eases. Nasal vaccines aren’t
the planet. “It suggests that music, or song specifically, occupies a stable position across cultures,” a reality for everyone yet—
Quick says—that is, we humans sing for a common reason. “we’re in early days,” Suther-
land says. But they could be
LUISA JUNG SOLUTIONS FOR HEALTH EQUITY, PAGE S1 safer to administer in places
Early in her career as an architect, Luisa Jung realized something was missing. “The world of ideas, with poorer access to medical
of images,” was what she loved the most, she says—but not so much turning those ideas into build- equipment and even at home.
ings. Jung had moved from Argentina to Germany and was captivated by the illustrations in her new And because they provide
country’s newspapers. So she began building a portfolio of her work. “At first I was kind of afraid to immunology inside the nose
draw, so my style was collage,” she says, but soon she was dabbling in watercolor and then wood- itself, “you can nip the virus in
block printing. the bud right where your body
Now an illustrator, Jung lives happily in the world of ideas and metaphor. In this issue’s special encounters it,” she says. “That
report on innovations in health equity, her illustrations give form to concepts that can be hard to seems really powerful to me.”
visualize, such as cultural competency and data disaggregation, but that nonetheless have real con-
sequences for people’s health. These kinds of visual metaphors—representations such as an hour-
glass of mpox and data as a curtain that can obscure reality—come to her naturally. “It’s the way my
brain works,” she says. Jung aims to “represent complex topics in a way that is also kind of poetic.”
JYOTI MADHUSOODANAN DEFOGGING DATA, PAGE S21

Nineteen years ago Jyoti Madhusoodanan moved from Ahmedabad, India, to Buffalo, N.Y., to complete a Ph.D. in microbiology. That
was when she started having to check a box on forms to indicate her race—and found that the entirety of Asia and the Pacific Islands
was lumped into a single category. She recalls thinking, “Asia is massive! How is this helpful to anyone?” The issue remained on her
mind for years as she moved from New York to the West Coast and began her career as a science journalist covering health.
As Madhusoodanan lays out in her article for our special report on innovations in health equity, this giant category is used all the
time in medicine and health research—and not only is it unhelpful, as she initially suspected, but it does harm. This pooling of data
hides important signals that could be used to save lives. In recent years this practice has finally begun to change, a mark of progress
Tom Allan
that “has been painfully won by people of these communities that have been invisible,” Madhusoodanan says. Everyone she spoke with
for the story “had a deep, deep personal connection to fixing this.”
LETTERS
[email protected]
BEAR IN MIND by physical chemist Christina Tonauer and

“A Grizzly Question,” by Benjamin her colleagues that involved ice XIV, a type
Cassidy, reports on plans to reintroduce of “ordered ice” with ordered hydrogen
grizzly bears to the North Cascades and atoms that can be created within days. I’m
on concerns people have raised about curious: Did the researchers skip ice IX?
their communities’ safety. The situations I guess avoiding the name would be like
presented in the article are common to skipping floor 13 in a hotel, given the
many reintroduction activities. One part destructive power of the fictional sub-
of this is fear of change. Another might be stance “ice-nine” in Kurt Vonnegut’s 1963
shortsighted self-concern. The reaction Cat’s Cradle. I have no desire for all the
is understandable but questionable. liquid in my body to become solid, as
I’ve watched many people going into the happened to characters who got ice-nine
Yellowstone backcountry, and the common in their mouth in the novel, so I hope these
theme has been trepidation. The environ- scientists are up on their literature.
ment creates an uncomfortable awareness COLIN MILDE MAHWAH, N.J.
June 2024
that one, as a person, is not top dog. To
have close encounters with formidable TONAUER REPLIES: There is a real
creatures is a serious education in one’s article, Seaborg and his co-author started ordered ice called ice IX that we didn’t
position in the wilderness—a lesson that with the synthesis of four elements that include in our study. We didn’t skip it for
most people cannot abide. This was a had been “missing” from the periodic table the fear of the effects of the fictitious
factor in the near extinction of grizzlies in and then continued with accounts of ice-nine envisioned by Vonnegut. In fact,
the lower 48 states and is a factor in human how five elements beyond uranium were there was a scientific reason. The formation
resistance to their presence. produced in the laboratory. The series process of most ordered ices has a signifi-
DIRK WINDOLF VIA E-MAIL updated every few years as the number cant kinetic barrier: even though the
of synthesized elements grew. Seaborg ordered ice structure should be favored,
RNA WORLD paid particular attention to the difficulty according to thermodynamics, the process
“The New Code of Life,” by Philip Ball, in obtaining large enough samples to assess is very slow compared with laboratory
describes some of the types and functions their chemical properties. He shared the timescales. Our study reported new
of noncoding RNAs (ncRNAs) found in 1951 Nobel Prize in Chemistry for his work synthesis strategies for overcoming that
human cells and notes that “ncRNAS on synthetic elements, and element 106 barrier and ordering ices faster. Real ice
seem to point to a fuzzier, more collective, was named seaborgium in his honor IX, on the other hand, is an outlier of that
logic to life.” One possible connection was during his lifetime. rule because it starts ordering at the
not mentioned, however: the “RNA I wasn’t around when the original relatively high temperature of 208 kelvins.
world” hypothesis. articles were published in the 1950s, In Olympic terms, it wins a gold medal in
Under this concept, an early proto- but my high school physics teacher had the “ordering race” of ice polymorphs, so
life-form used RNA both for its enzy- a file of old SciAm material that he shared we did not consider it in our study.
matic activities and as its genetic mate- with me. It included articles by Erwin
rial. Even after evolution replaced this Schrödinger, Albert Einstein, George HELPING TEENS COPE
diverse use of RNAs with the specialist Gamow, Fred Hoyle and other notables. “Treating the Anxious Teen,” by BJ Casey
molecules of DNA and proteins, RNAs My teacher said I could take whatever and Heidi Meyer, shines a light on
might still retain many functions as I wanted, so I took the whole file and still advances in the basic clinical science
a remnant of their earlier roles. So the have it in my library. work on addressing fear conditioning.
many ncRNAs that carry out diverse BRUCE A. BOYD ST. LOUIS, MO. Although this work is important, as
functions could reflect some aspect of respectively current and retired profes-
an earlier RNA world. COOL ALLUSION sors of psychology, we would like to note
SCOTT T. MEISSNER VIA E-MAIL “Alien Ice,” by Elise Cutts [Advances; that such optimism is not uniform in the
April], reports on experiments performed field. In a 2023 review in the journal
HISTORICAL ELEMENTS
“Superheavies,” Stephanie Pappas’s article
about superheavy elements, reminded me
of a series of articles on “The Synthetic
“The environment creates an
Elements,” by Glenn T. Seaborg and his uncomfortable awareness that one,
associates, that were published in Scientific
American in April 1950, December 1956, as a person, is not top dog.”
April 1963 and April 1969. In the first —DIRK WINDOLF VIA E-MAIL

®
ESTABLISHED 1845
Behavior Research and Therapy, psycholo- EDITOR IN CHIEF Laura Helmuth
gist Ronald M. Rapee and his colleagues MANAGING EDITOR Jeanna Bryner COPY DIRECTOR Maria-Christina Keller CREATIVE DIRECTOR Michael Mrak
state that when it comes to the effective- EDITORIAL

CHIEF FEATURES EDITOR Seth Fletcher CHIEF NEWS EDITOR Dean Visser CHIEF OPINION EDITOR Megha Satyanarayana
ness of cognitive-behavioral therapy in
children and adolescents, “there remains FEATURES
SENIOR EDITOR, SUSTAINABILITY Mark Fischetti SENIOR EDITOR, SCIENCE AND SOCIETY Madhusree Mukerjee
substantial room for improvement.” SENIOR EDITOR, MEDICINE / SCIENCE POLICY Josh Fischman SENIOR EDITOR, TECHNOLOGY / MIND Jen Schwartz
SENIOR EDITOR, SPACE / PHYSICS Clara Moskowitz SENIOR EDITOR, EVOLUTION / ECOLOGY Kate Wong
One of the issues is that children’s
NEWS
needs are different from those of adults. SENIOR EDITOR, SPACE / PHYSICS Lee Billings ASSOCIATE EDITOR, TECHNOLOGY Ben Guarino
When children and adolescents are SENIOR EDITOR, HEALTH AND MEDICINE Tanya Lewis
SENIOR EDITOR, MIND / BRAIN Gary Stix
ASSOCIATE EDITOR, SUSTAINABILITY Andrea Thompson
ASSOCIATE EDITOR, HEALTH AND MEDICINE Lauren J. Young
being treated, their developmental SENIOR OPINION EDITOR Dan Vergano ASSISTANT NEWS EDITOR Sarah Lewin Frasier
SENIOR NEWS REPORTER Meghan Bartels ASSOCIATE NEWS EDITOR Allison Parshall
status regarding emotional self-regula-
MULTIMEDIA
tion and cognition must be taken into CHIEF MULTIMEDIA EDITOR Jeffery DelViscio CHIEF NEWSLETTER EDITOR Andrea Gawrylewski
account. Therapeutic practices devel- MULTIMEDIA EDITORS Kelso Harper, Fonda Mwangi CHIEF AUDIENCE ENGAGEMENT EDITOR Sunya Bhutta
ASSOCIATE ENGAGEMENT EDITOR Arminda Downey-Mavromatis
oped with adults can have contradictory
ART
effects with children. For example, adults SENIOR GRAPHICS EDITOR Jen Christiansen PHOTOGRAPHY EDITOR Monica Bradley DIGITAL ART DIRECTOR Ryan Reid
ASSOCIATE GRAPHICS EDITOR Amanda Montañez ASSOCIATE PHOTO EDITOR Liz Tormes
find that fear interferes with their ability
to follow through with functional COPY AND PRODUCTION
SENIOR COPY EDITORS Angelique Rondeau, Aaron Shattuck ASSOCIATE COPY EDITOR Emily Makowski
routines. Remove the fear, and adults can MANAGING PRODUCTION EDITOR Richard Hunt PREPRESS AND QUALITY MANAGER Silvia De Santis
resume functionality. Children and teens CONTRIBUTORS

EDITORS EMERITI Mariette DiChristina, John Rennie
are still learning what functional routines EDITORIAL Rebecca Boyle, Amy Brady, Katherine Harmon Courage, Lydia Denworth, Lauren Gravitz, Ferris Jabr,
Lauren Leffer, Michael D. Lemonick, Robin Lloyd, Maryn McKenna, Steve Mirsky, Melinda Wenner Moyer,
are, so they need opportunities to practice George Musser, Sarah Scoles, Dava Sobel, Claudia Wallis, Daisy Yuhas
healthy, functional behavior patterns ART Edward Bell, Violet Isabelle Frances, Lawrence R. Gendron,
Nick Higgins, Kim Hubbard, Katie Peek, Beatrix Mahd Soltani
tailored to the kinds of experiences they
EXECUTIVE ASSISTANT SUPERVISOR Maya Harty EDITORIAL WORKFLOW AND RIGHTS MANAGER Brianne Kane
have outside of the therapy office. Novel
interventions that are quite different from SCIENTIFIC AMERICAN CUSTOM MEDIA
standard cognitive-behavioral therapy EDITORIAL DIRECTOR Cliff Ransom
CHIEF MULTIMEDIA EDITOR Kris Fatsy
CREATIVE DIRECTOR Wojtek Urbanek
SENIOR MULTIMEDIA EDITOR Ben Gershman SENIOR EDITOR Dan Ferber
have shown promise. SENIOR ENGAGEMENT EDITOR Dharmesh Patel SENIOR PUBLISHING MANAGER Samantha Lubey
ERICA KLEINKNECHT O’SHEA

PRESIDENT Kimberly Lau
FOREST GROVE, ORE. PUBLISHER AND VICE PRESIDENT Jeremy A. Abbate VICE PRESIDENT, COMMERCIAL Andrew Douglas
RONALD KLEINKNECHT VICE PRESIDENT, PRODUCT AND TECHNOLOGY Dan Benjamin VICE PRESIDENT, CONTENT SERVICES Stephen Pincock
BELLINGHAM, WASH. CLIENT MEDIA SOLUTIONS

HEAD, PUBLISHING STRATEGY AND COMMERCIAL OPERATIONS Suzanne Fromm MARKETING PROGRAM MANAGER Leeor Cohen
DIRECTORS, INTEGRATED MEDIA Matt Bondlow, Stan Schmidt PROGRAMMATIC PRODUCT MANAGER Zoya Lysak
DIRECTOR, CONTENT PARTNERSHIPS Marlene Stewart DIGITAL ADVERTISING OPERATIONS MANAGER Lizzie Ng
ERRATA
PRODUCT & TECHNOLOGY
“Homeschooling Needs More Uniform DIRECTORS Jason Goldstein, Nico Halpern ENGINEERS Kenneth Abad, Hector Coronado, Ruben Del Rio,
Oversight,” by the Editors [Science PRODUCT MANAGERS Ian Kelly, Miguel Olivares
DIGITAL PRODUCER Isabella Bruni
Michael Gale, Akwa Grembowski, Grace Millard,
Negin Rahbar, Katherine Shelley, Stephen Tang, Tan Tran
Agenda], incorrectly described the DATA ANALYSTS Jackie Clark, Britney Ngaw
11-year-old boy who was found dead in CONSUMER MARKETING

DIRECTOR, MARKETING Christopher Monello-Johnson
2020 as located in Michigan. His family MARKETING MANAGER Charlotte Hartwell
MARKETING COORDINATOR Justin Camera
had moved from that state to California MARKETING AND CUSTOMER SERVICE ASSISTANT Cynthia Atkinson
a few months prior. ANCILLARY PRODUCTS
“The End of the Lab Rat?,” by Rachel ASSOCIATE VICE PRESIDENT, BUSINESS DEVELOPMENT Diane McGarvey
CUSTOM PUBLISHING EDITOR Lisa Pallatroni
Nuwer [September], should have
CORPORATE
said that outside researchers have used COMMUNICATIONS MANAGER Kevin Hurler HEAD OF COMMUNICATIONS, U.S. Eseohe Arhebamen-Yamasaki
Emulate’s chips to create more than PRINT PRODUCTION
PRODUCTION CONTROLLER Madelyn Keyes-Milch ADVERTISING PRODUCTION MANAGER Michael Broomes
30 additional models with cells from ADVERTISING PRODUCTION CONTROLLER Michael Revis-Williams
their labs, not about 70 such models.
LETTERS TO THE EDITOR
In “What If We Never Find Dark Scientific American, 1 New York Plaza, Suite 4600, New York, NY 10004-1562 or [email protected]
Letters may be edited for length and clarity. We regret that we cannot answer each one.
Matter?,” by Tracy R. Slatyer and Tim
M. P. Tait [September], the opening Subscriptions
HOW TO CONTACT US
Reprints Permissions
illustration should have been credited For new subscriptions, renewals, gifts,
payments, and changes of address:
To order bulk reprints of articles
(minimum of 1,000 copies):
For permission to copy or reuse material: Permissions
Department, Scientific American,
to Olena Shmahalo. U.S. and Canada, 800-333-1199;
outside North America, 515-248-7684
[email protected].
Reprint Department, Scientific American,
1 New York Plaza, Suite 4600, New York, NY 10004-
1562; [email protected];
or [email protected]. 1 New York Plaza, Suite 4600, ScientificAmerican.com/contact-us.
“Nobel Connections,” by Sarah Lewin New York, NY 10004-1562. Please allow six to eight weeks for processing.
Submissions For single copies of back issues:
Frasier and Jen Christiansen [Graphic To submit article proposals, 800-333-1199. Advertising
follow the guidelines at ScientificAmerican.com. www.ScientificAmerican.com has electronic
Science; October], should have referred Click on “Contact Us.” contact information for sales representatives
We cannot return and are not responsible of Scientific American in all regions of the U.S.
to Nobel laureate Giorgio Parisi. for materials delivered to our office. and in other countries.
NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 9

CHEMISTRY
Productive
Pressure
Earthquakes may forge
large gold nuggets
SOLID GOLD BARS stacked in bank vaults,
plating on the summer’s Olympic medals,
or even your own pieces of gold jewelry
could owe their existence to earthquakes.
The stress and strain produced by moving
tectonic plates during such an event may
trigger a chemical reaction that causes mi-
nuscule particles of gold to coalesce into
larger nuggets, a new study proposes.
“The biggest finding is showing a new
gold-forming process and providing an
explanation for how really large gold
nuggets might form,” says Christopher
Voisey, a co-author of the study and a ge-
ologist at Monash University in Austra-
lia. “This was always a bit of a conun-
drum, especially when there isn’t field
evidence supporting the alternative gold-
forming processes.”
An estimated 75 percent of all mined
gold comes from deposits nestled in cracks
inside hunks of quartz, one of the most
abundant minerals in Earth’s crust. Geo-
chemists have known that dissolved gold
existed in fluids in the middle to lower lev-
els of the planet’s crust and that the fluids
could seep into quartz cracks. But the
amount of fluid involved seemed to limit
how much gold could dissolve and thus
the size of the gold chunks that formed.
Larger nuggets were hard to explain: ex-
perts had theorized that gold nanoparti-
cles within the fluid might aggregate into Geoscience, suggests that the geological the ability of a material to generate an
Tomekbudujedomek/Getty Images
those bigger chunks within the quartz, yet stress caused by earthquakes might ac- electric charge when placed under me-
it was unclear how. Unlike dissolved gold, tivate a peculiar geochemical property chanical stress. Many everyday items in-
nanoparticles typically wouldn’t have called piezoelectricity—and that such ac- cluding microphones, musical greeting
enough chemical energy to start the neces- tivation makes the formation of larger cards and inkjet printers take advantage
sary reaction to build up on the cracks’ gold nuggets possible. of piezoelectricity, and it occurs naturally
surface and form a nugget. The piezoelectric effect, which has in substances from cane sugar to bone.
The new study, published in Nature been known since the 1880s, is essentially Quartz can produce this effect because
MICROBES BREAK UP SOME KOMODO DRAGONS BOAST MORALITY MAY SHIFT
“FOREVER CHEMICALS” P. 12 IRONCLAD TEETH P. 18 WITH THE SEASONS P. 20
DISPATCHES FROM THE FRONTIERS OF SCIENCE, TECHNOLOGY AND MEDICINE
Gold forms nuggets as it aggregates

within quartz underground.
of its structure: it is built from a repeating electric field and changing the material’s ously unviable chemical reaction to occur
pattern of positively charged silicon and electric state. and allowing the nanoparticles to stick
negatively charged oxygen atoms. When Voisey and his colleagues at Monash— and accumulate.
it’s stretched or compressed, the arrange- located in the historically gold-rich area of To test their idea, the researchers virtu-
ment of these atoms changes, and the Melbourne—thought that this changed ally modeled the electric field that quartz
charges are dispersed asymmetrically. state could lower the energy needed for could produce when subjected to earth-
Negative and positive charges build up in gold nanoparticles in the fluid to interact quakelike forces. They then placed quartz
different areas of the quartz, creating an with the quartz surface, causing a previ- Continued on page 12

ADVANCES
Continued from page 11 ing form these important orogenic gold Studying piezoelectricity at a very large
mineral crystals in a fluid containing dis- nugget deposits,” says James Saunders, a scale may be difficult, says Colgate Univer-
solved gold nanoparticles and other gold consultant geologist who was not involved sity geologist Aubreya Adams, who was
compounds and found that, when under in the study. He says he would like to see also not involved in the study. “Geoscien-
seismic wavelike forces, the quartz was future research look more into the specif- tists are currently working very hard to
able to produce enough voltage to jump- ics of this process. This could include in- quantify how stress (or pressure) varies in
start a buildup of nanoparticles. vestigating how long piezoelectricity- 3D with time and location,” she says,
The study findings point to an intrigu- causing earthquake forces have to last to “something that is easily measured in a lab
ing mechanism that could be responsible produce such deposits and why large gold but much harder to quantify in the crust.”
for forming at least some of the larger gold nugget deposits might develop in only Voisey and his team plan to extend ex-
nuggets in Earth’s crust—especially “oro- some cracks in quartz in a given area, de- perimental parameters by testing differ-
genic” deposits where colliding tectonic spite an earthquake theoretically inducing ent pressures or temperatures, for exam-
plates have folded onto one another to cre- similar stress and strain on all the cracks. ple, to explore their theory further. “This
ate a mountain range. “I think it is a great idea/hypothesis,” is very much the pilot study for this tech-
“It appears to be a certainty that epi- Saunders says. “I’ll be interested if it stands nique,” he says, “so I’m excited to see
sodic earthquakes are important in help- up on further evaluation.” where it can go.” —Kate Graham-Shaw
Chemical Chow Down adjacent to the carbon-fluorine ones. These

“unsaturated” perfluoroalkyl compounds
A microbe family breaks down serve as building blocks for most larger
PFASs; they are produced by chemical man-
certain “forever chemicals” ufacturers and also emerge when PFASs are
destroyed via incineration.
A group of bacteria has tel, a chemist at Northwestern University Scientists had previously demonstrated
MICROBIOLOGY
proved adept at destroying who studies energy-efficient ways to chem- that a microbe called Acidimicrobium sp.
the ultratough carbon-fluorine bonds that ically degrade PFASs. strain A6 could break down carbon-fluorine
give “forever chemicals” their name. This To identify a promising set of bacteria, bonds and completely degrade two of
finding boosts hopes that microbes might the study’s authors screened several the most ubiquitous perfluoroalkyls. This
someday help remove these notoriously per- microbe communities living in microbe grows slowly, however,
vasive pollutants from the environment. wastewater. Four strains from and requires finicky environ-
Nearly 15,000 chemicals commonly the Acetobacterium genus mental conditions to func-
found in everyday consumer products such stood out, the team re- tion. And researchers do
as pizza boxes, rain jackets and sunscreens ported in Science Ad- not yet fully understand
are recognized as perfluoroalkyl and poly- vances. Each strain pro- how this bacterial strain
fluoroalkyl substances, or PFASs. These duced an enzyme that does the job.
chemicals can enter the body via drinking can digest caffeate— The Acetobacteri-
water or sludge-fertilized crops, and they a naturally occurring um lines target a sepa-
have already infiltrated the blood of almost plant compound that rate group of PFASs,
every person in the U.S. Scientists have roughly resembles some and the team hopes to
linked even low levels of chronic PFAS ex- PFASs. This enzyme re- engineer the microbes to
posure to myriad health effects such as placed certain fluorine at- either improve their effi-
kidney cancer, thyroid disease and ulcer- oms in the PFASs with hydro- ciency or expand their reach—
ative colitis. gen atoms; then a “transporter potentially to more perfluoroal-
Current methods to destroy PFASs re- protein” ferried the fluoride ion by-prod- kyls. Lead study author Yujie Men of the
quire extreme heat or pressure, and they ucts out of the single-celled microbes, pro- University of California, Riverside, imag-
work safely only on filtered-out waste. Re- tecting them from damage. Over three ines the microbes would perform best in
searchers have long wondered whether weeks most of the strains split the targeted combination with other approaches to de-
bacteria could break down the chemicals in PFAS molecules into smaller fragments that grade PFASs. The range of chemical struc-
natural environments, providing a cheaper could be degraded more easily via tradition- tures in these compounds means “a single
and more scalable approach. But carbon- al chemical means. lab cannot solve this problem.”
fluorine bonds occur mainly in humanmade By directly targeting carbon-fluorine Any future commercial use of the mi-
materials, and PFASs have not existed long bonds, the Acetobacterium bacteria partial- crobes would face numerous hurdles, in-
enough for bacteria to have specifically ly digested perfluoroalkyls, a type of PFAS cluding breakdown speed and replicability
evolved the ability to digest them. The new that very few microbes can break down. outside of the lab, but Men looks forward to
study—though not the first to identify a mi- Even so, these Acetobacterium strains seeing how far her team can push the tech-
crobe that destroys carbon-fluorine bonds— could work only on perfluoroalkyl molecules nique. “We’re paving the road as we go,”
provides a step forward, says William Dich- that contain carbon-carbon double bonds she says with a laugh. — Saima S. Iqbal
1 2 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Thomas Fuchs

Great Kiskadee
In
WOMEN
We Trust
ANIMAL COGNITION muscle activity that reminds Mindlin “of

learning a musical instrument.”
Dreaming Such “rehearsing” appears far less likely
in the nonlearning Great Kiskadees, says Vote like your rights
in Song study co-author Ana Amador, a neurosci-
entist also at the University of Buenos Aires.
For the new research, the scientists ran this
depend on it
because they do!
Scientists eavesdrop species’ sensor output through a mathemat-
on sleeping birds ical model Mindlin recently developed to
translate muscle movements into audible We support women’s
SCIENTISTS TELL US that the family dog sounds. The kiskadees’ synthesized sleep- right to take charge of
shuffling its legs while asleep on the floor ing tune comprised quick, identical note their health decisions.
really is dreaming. And when a bird silent- syllables that sounded startlingly loud and
ly nods off on its perch, it may also dream aggressive—“more like a nightmare than a
as its singing muscles twitch. Could it be dream,” Amador says. Slumbering kiska-
rehearsing in its sleep? dees frequently combined these movements Join Us!
A substantial proportion of bird spe- with a threatening flash of head feathers,
cies are songbirds with specific brain re- which often occurs during their territorial Sign up for a
gions dedicated to learning songs, accord- disputes while they are awake. FREE trial membership
ing to University of Buenos Aires physicist Listening in on a sleeping songbird to and receive bonus issues
Gabriel B. Mindlin. His research examines better understand its waking behavior— of Freethought Today,
connections between birds’ dreams and and to look for a possible link to dreams—is FFRF’s newspaper.
song production—particularly in Zebra a lot like “cracking a code in a detective
Finches, which often learn new sounds novel,” Amador chuckles.
and songs, and in Great Kiskadees, which University of Chicago neuroscientist
possess a limited, instinctive song- Daniel Margoliash, whose pioneering
learning capacity. 1990s work characterized birds’ song- Call 1-800-335-4021
Scientists had previously observed learning brain regions, says the new results ffrf.us/science
sleeping birds making movements that re- agree with his own observations of sleeping
sembled lip-syncing. In earlier work, birds’ neurons. But he advises caution in
Mindlin and his colleagues implanted elec- describing this sleep activity as “dream- Help ensure state and church stay
trodes in two Zebra Finches; for a recent ing.” Future work should more closely ex- separate and keep your liberties intact.
study in Chaos, they did the same for two amine the sleep states the birds experience
Great Kiskadees. This let them record and during this process, he says—including
compare neuron and muscle activity in the rapid eye movement (REM) sleep, a sleep
sleeping birds. stage that is closely associated with dream-
David Plummer/Alamy Stock Photo
When awake, Zebra Finches sing a ing in other animals.

well-regulated line of staccato notes. But “Is there a distinction between replay
their sleeping song movements are frag- patterns formed during non-REM and
mented, disjointed and sporadic—“rather
like a dream,” Mindlin says. A dozing finch
REM sleep?” Margoliash asks. Such a con-
trast, he adds, “is one we need to keep in
ffrf.org
seems to silently practice a few “notes” and mind when examining what happens FFRF is a 501(c)(3) educational charity.
then add another, producing a pattern of when birds sleep.” —David Godkin
Deductible for income tax purposes.

ADVANCES
HEALTH dergo a dramatic wave of age-related mo- ods—and they signal to experts that our
lecular changes not only in our 60s but 40s and 50s may be a significant time to
Leap in Time also in our mid-40s.
For a study in Nature Aging, research-
closely monitor health.
The study supports many people’s an-
Aging may happen ers tracked the levels of more than ecdotal reports of noticing changes in
135,000 molecules and microbes, all re- their 40s that range from more muscle
dramatically in flective of activity in cells and tissues, in injuries to worse hangovers, and the data
our 40s and 60s 108 healthy volunteers aged 25 to 75. Each give clues as to why, says senior study
volunteer contributed biological speci- author Michael P. Snyder, a genetics re-
AS A PERSON ENTERS their 60s, the mens, including blood and stool samples, searcher at Stanford Medicine.
health effects of aging often start to be- every three to six months for a median of Compared with younger participants,
come strikingly clear. Many people begin 1.7 years. Results showed that changes in people in their 40s and 60s displayed bio-
to use glasses or hearing aids, or their doc- many molecule and microbe levels clus- logical differences that appeared to be
tors warn them about a sharply increased tered around two distinct time points: linked to muscle weakness and loss, de-
risk of diabetes or heart disease. But re- ages 44 and 60. The findings suggest that cline in heart health, and inefficient caf-
search suggests that our bodies may un- aging might accelerate around those peri- feine metabolism. Those in their 40s also
How Molecules and Microbes ALL MOLECULES AND MICROBES METABOLISM

10,000 700
Number of Significant
Molecules and/or Microbes
First peak at age 44

in the Body Change as We Age 47
Researchers measured how key molecules and microbes differ Second peak at age 60
in abundance across a range of ages, based on data from 108
study participants aged 25 to 75. Blood samples provided data
on molecules; skin, mouth, nose and stool samples provided 57
data on microbes. The charts below show the analysis of total
values (all molecules and microbes) as well as subsets of data
that pertain to specific biological systems or areas of the body.
The study did not follow the same individuals for decades at a time,
so the data reflect variation across groups of different ages.
6,000 500
40 45 50 55 60 65 40 45 50 55 60 65
Age
CYTOKINES LIPIDS PROTEINS RNA MOLECULES

Number of Significant Molecules
70 800 45 275 8,000

Age 51
44
43
Age 61 61
57
Source: “Nonlinear Dynamics of Multi-omics Profiles during Human Aging,”

by Xiaotao Shen et al., in Nature Aging. Published online August 14, 2024
10 400 150 4,000
40 45 50 55 60 65 40 45 50 55 60 65 40 45 50 55 60 65 40 45 50 55 60 65
Age
NASAL MICROBIOME ORAL MICROBIOME GUT MICROBIOME SKIN MICROBIOME
200 100 150 200
Number of Significant Microbes
41 43 43
46
58
58
61
100 40 90 100
40 45 50 55 60 65 40 45 50 55 60 65 40 45 50 55 60 65 40 45 50 55 60 65
Age
14 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Graphic by Amanda Montañez

&ƵŶĚĂŵĞŶƚĂůƐ
&ŝƌƐƚ&ƵŶĚ
Ŷ d&
had reduced activity in cellular pathways ^ǇŵďŽů <EKt
responsible for breaking down alcohol
The data give clues zŽƵƌ ŵŽŶĞǇ
and fats—possibly a sign that people start to why people often ĂƌĞĨƵůůǇŵĂŶĂŐĞĚ
to digest these compounds more slowly report experiencing ÜãØã
around this age. People in their 60s, d(çÂÁÂã¼Ü (¯ØÜã (çÂʍÂd(ʍ ¯Ü ÕØã
meanwhile, had lower levels of various more muscle injuries ÈôÂØ È¨ ÕÕØÈõ¯Áã¼ö ɷɶɶ Õç¼¯¼ö ãØ
ôÈØãö ÈÁÕÂ¯Üʍ Â ¯ã ÈôÂÜ Õç¼¯¼ö
immune system molecules, such as in-
flammatory cytokines, which corre-
and worse hangovers ãØãʒdÜôÈØ¼ô¯ÈÁÕÂ¯Ü Ø
ó¯ã¼ʍ¯ÁÕÈØãÂãʍ çÜ¨ç¼ʍ ÈØ ¸çÜãÕ¼¯Â Â¯ ãÈ
sponded to a weakened immune response. in their 40s, the study ó ØÈçÂʍÂÁÈÜã óÂ ÕçØÜç¯Â©
ã¯Ø çÜ¯ÂÜÜ ÈçØÜ ¨ÈØ Üʒ w
They also showed significant differences authors say. ¯Â¯ó¯ç¼¼ö Ü¼ã ãÜ ÈÁÕÂ¯Ü ô¯ã
in levels of certain molecules associated Ø Â ¯Â ÁÂÂØ ÜãÈ ÜÕØÈçØ Ø¯Ü¹
with carbohydrate digestion and heart ÜÈãã ÂÈ Ü¯Â©¼ÈÁÕÂöóÂã Â çÜ
and kidney function, suggesting that the biological aging—varies widely between ÁÈØ ãÂ Øç¯Üʒ BÜÈÂ Õ¯ã¼ Ü
older participants were more susceptible people of different races and socioeco- ÁÂ© ÁÈÂö ã¯Ü ôö ¨ÈØ ÁÈØ ãÂ
ãØ Üʒ 0¨ öÈç Ø ÁÈØ ÜÕ¯¨¯¼¼ö
to type 2 diabetes, cardiovascular disease nomic classes, and it even differs between ¯ÂãØÜã¯ÂôÈô ØʍÈôôÈ¯ãʍ Â
and kidney issues. individual organs in a person’s body.) ÈôöÈçÁ¯©ã ÕØã¯¯ÕãʍØÈÂʒ
The new study’s time points are similar The reasons ages 44 and 60 might be ôôôʒ(çÂÁÂã¼Ü(¯ØÜã(çÂʒÈÁ
to those identified in a separate 2020 turning points in health are not yet appar- ϮͬϮϭͬϮϰ /WK DĂƌŬĞƚ KƉĞŶ͗ ΨϭϬ͘ϬϬ
study, in which researchers found that ent, but the study authors hope to probe ϴͬϯϬͬϮϰDĂƌŬĞƚůŽƐĞ͗ ΨϭϬ͘ϴϯ
participants’ immune systems grew mark- several hypotheses in future work. Snyder ŝǀŝĚĞŶĚƐ WĂŝĚ͗ Ψ Ϭ͘Ϭϳ
edly less adept at fighting off pathogens in suspects that for people in their 60s, de- ,QYHVWRUV VKRXOG FRQVLGHU WKHLQYHVWPHQW REMHFWLYHV ULVNV
FKDUJHV DQG H[SHQVHV FDUHIXOO\EHIRUH LQYHVWLQJ)RU D
their late 30s to early 40s and again around clines in immune system function might SURVSHFWXV RU VXPPDU\ SURVSHFWXV ZLWKWKLVDQG RWKHU
LQIRUPDWLRQ DERXW WKH)XQG SOHDVHFDOO RU YLVLW
age 65. But the latest study’s findings are precipitate a more widespread organ RXU ZHEVLWH DW ZZZIXQGDPHQWDOVILUVWIXQGFRP
not ironclad; it included a relatively small breakdown. A midlife decline in physical ,QYHVWPHQWV LQYROYHULVN 3ULQFLSDO ORVV LVSRVVLEOH
4XDVDU 'LVWULEXWRUV //&
number of people, all living in California’s activity, meanwhile, could explain the dif-
Palo Alto area. The resulting lack of geo- ferences seen among people in their
graphic diversity makes the data less rep- 40s—but so might hormonal changes,
resentative of the broader public, notes including menopause. Menopause alone,
Aditi Gurkar, who conducts aging-related however, could not explain the trends in
research at the University of Pittsburgh the study, Snyder says: male and female
and was not involved in the recent study. participants appeared to show the same
Those sampled likely had some lifestyle degree of age-related differences at both
factors in common, such as diet, exercise time points.
and environmental exposures, which Snyder suggests the new data can pro-
could have swayed the results, she says. vide actionable health information. Peo-
The study also did not follow any indi- ple in their 40s might benefit from get-
viduals for periods longer than about ting blood tests that track lipid levels, for
seven years, so scientists cannot be certain instance, or from exercising regularly to
that the differences between people in dif- maintain heart health. Snyder also un-
ferent age groups reflect universal changes. derscores the importance of early and
For example, the 40- and 60-year-olds in regular screenings for heart disease for
the study may have aged faster relative to people in this age range who have existing
others of the same age in the broader pop- health conditions.
ulation, Gurkar cautions. She and others Limitations aside, Gurkar says, the ǁĂůůĞƚĚĞƐŝŐŶĞĚƚŽĨŝƚǇŽƵƌĨƌŽŶƚ
say the best way to confirm the results— study is a powerful reminder that lifestyle ƉŽĐŬĞƚʹŶŽǁƚŚĞƌĞ͛ƐĂƐŵĂƌƚŝĚĞĂ͘
and to precisely trace age-related biologi- choices such as diet and exercise can accel- dŚĞZŽŐƵĞtĂůůĞƚ ŝƐŵŽƌĞ
cal shifts—would be through a larger erate aging—or slow it down. Few studies ĐŽŵĨŽƌƚĂďůĞ͕ŵŽƌĞƐĞĐƵƌĞ͕ĂŶĚŚŽůĚƐ
study that tracks the same participants on aging focus on middle-aged partici- ĞǀĞƌǇƚŚŝŶŐǇŽƵ ŶĞĞĚ͘ DĂŶǇ ŵĂĚĞͲŝŶ
over the course of a lifespan. Collecting pants or involve biological sampling as DĂŝŶĞ ĂŶĚZ&/ͲďůŽĐŬŝŶŐƐƚǇůĞƐ
data on factors such as disease status, comprehensive as that of this paper, she ĂǀĂŝůĂďůĞ͘^ƚĂƌƚŝŶŐ ĂƚΨϱϱ͘ϬϬ͖
physical function or disability could also adds. In addition to identifying potential ƐĂƚŝƐĨĂĐƚŝŽŶŐƵĂƌĂŶƚĞĞĚ͘
help researchers better assess the extent to waves of age-related changes, the work 5RJXH,QGXVWULHV
which age-related shifts affect a person’s provides a crucial first step toward large-
overall health. (The amount of stress that scale disease-prediction models based on ZZZ5RJXH,QGXVWULHVFRP
cells and tissues undergo—referred to as biological data. —Saima S. Iqbal

ADVANCES
BIOLOGY Taste buds outside their mouths might be it turns out that even environmental allergies
helping the fish detect bat droppings in may be a matter of taste: dust mites and sev-
A Matter the utterly dark, “food-starved” caves,
Gross says.
eral mold species can also set off a tuft cell’s
taste receptors, Bankova says.
of Taste Wandering taste buds aren’t unheard of

elsewhere, especially in other fish. Some
damselfish cultivate taste buds on their fins,
“Evolutionarily, taste receptors [have
moved around] the body to protect us
from the air we inhale and all the attacks
Flavors are detected and channel catfish have them across their we’re getting through the orifices,” Ban-
outside the mouth, too midsections. And as alien as it may seem, kova says. “They’re in the inner ear, the
many cells throughout the human body can urethra, everywhere something can get
IN EASTERN MEXICO’S UNDERGROUND taste, too. They’re just not sharing the fla- into your body.”
caverns and streams, a blind fish under- vors with your brain like taste buds do. Such “extra” taste receptors aren’t just
goes a peculiar adolescence: as it ap- Lora Bankova is a Harvard Medical bouncers at the door—they taste test for
proaches maturity, taste buds begin to School respiratory biologist who studies tuft our internal systems, too. Receptors for
sprout under its chin and on top of its cells, a cell type sprinkled within human mu- sweet tastes help to tune insulin produc-
head, creeping toward its back. cous tissues like those lining your nostrils, tion in the pancreas and make sure neu-
“It’s a pretty wild amplification of the throat and gut. These “rapid responder” rons in the brain have access to enough
sensory system of taste,” says Josh Gross, cells trigger the immune system if they de- glucose. Sweet, bitter and umami recep-
an evolutionary geneticist at the Univer- tect an outside threat, and many of them rely tors in the gut modulate digestion.
sity of Cincinnati and a co-author of a re- on built-in taste receptors (the same kinds Gross says it’s still a mystery what taste
cent study on the cave fish in Nature Com- found on taste-bud cells) to do so. Bankova receptors the bat guano activates in the
munications Biology. Gross and his team notes that many potentially harmful bacteria blind cave fish. “There may be some sugar
discovered that the new buds blossom communicate via signaling chemicals called content if it’s a fruit bat, maybe some pro-
around the time when the fish transition lactones—which also happen to activate tein content if it’s a carnivorous bat,” he
from eating larval crustaceans to gobbling taste receptors attuned to bitter flavors, says. So far only the cave fish has signed up
up their adulthood staple: bat guano. prompting tuft cells’ immune response. And to sample it. —Elizabeth Anne Brown
Hanjo Hellmann/Alamy Stock Photo
Blind cave tetras develop taste buds on their heads.
Science in
Your Inbox
Sign up for our free
daily newsletter
NEUROSCIENCE tween four and 12 months old while the ba-

bies watched a stream of six images per sec-
Smellavision ond. Each sixth image was a human face,
and the others were animals or objects. The
Odors boost babies’ researchers expected that if the babies were
devoting special attention to faces, there
visual learning would be a once-per-second activity spike
corresponding to their appearance—a so-
BABIES EXPERIENCE a torrent of sensory called face-selective response—from elec-
information from the moment they are trodes placed over brain regions involved in
born. Knowing nothing about the world, visual processing. They also gave the babies
they must learn to sort this deluge into cat- T-shirts that were clean and ones infused
egories of things—especially faces. “Faces with their mother’s body odor.
are one of the most relevant visual signals Overall, face-selective responses in-
babies start to learn during the first creased in strength and complexity with
month,” says Arnaud Leleu, a cognitive age. But the team also found that the moth-
neuroscientist at the University of Bur- er’s scent enhanced responses to faces in
gundy in France. the youngest infants and observed that the
Researchers are still working out how effect progressively decreased in older ba-
infants use various senses for this recogni- bies. “This could mean young babies rely
tion: Newborns categorize faces better if more on their mother’s scent because their
the visual image is accompanied by a voice, ability to identify faces using vision alone
for example. And evidence suggests babies is still developing,” Dekker says. Visual
may also use smell. “We knew babies can ability is known to be poor at birth, whereas
combine their senses,” says Tessa Dekker, smell develops relatively early.
who studies visual development at Univer- The findings highlight the importance
sity College London. “But it wasn’t clear if of multisensory stimulation early in life.
this applied to smells, which aren’t as “To help infants learn, we should use all
linked to specific events because they op- the senses,” Leleu says. “The way we start
erate quite slowly.” to recognize things with our senses is the
In a recent study in Child Development, building block to developing concepts,
Leleu and his colleagues confirmed that language, memories.” He is continuing to
infants’ face perception is aided by their investigate the extent of smell’s effect on
mother’s body odor—and they found that perception, including in other age groups.
the influence of smell declines as babies He says he’s finding that if a recognition
StefaNikolic/Getty Images
grow. The findings expand scientists’ un- task is made difficult enough, even adults
derstanding of the role that multisensory recruit their noses to help. “It works for Scientific American is a registered trademark
of Springer Nature America, Inc.
perception plays in early learning. faces and other objects,” Leleu adds. “We
The team used electroencephalography found an effect using pictures of cars and
to record the brain activity of 50 infants be- gasoline odor.” —Simon Makin

ADVANCES
SCIENCE IN IMAGES amine such teeth divorced from their fero-

cious owners, and he noticed a strange or-
Iron Chompers ange color on the teeth’s tips and serrations.
imageBROKER.com GmbH & Co.KG/

The results of closer inspection, published
Komodo dragons’ intimidating grins have a metallic secret in Nature Ecology & Evolution, revealed that
the orange came from iron reinforcements
Alamy Stock Photo

GETTING UP CLOSE with Komodo dragon remains of previous meals and dozens of rather than from something the creatures
teeth rarely ends well. The massive lizard’s feasting bacteria species. ate—marking the first confirmed finding of
mouth holds 60 serrated teeth at a time, Fortunately, paleontologist Aaron Le- iron chompers in reptiles. (Some fish and
each up to an inch long, peppered with the Blanc of King’s College London got to ex- salamanders as well as a handful of mam-
Origin of Tardigrades,” by M. Mapalo et al., in Nature Communications
From “Cretaceous Amber Inclusions Illuminate the Evolutionary
mals, most notably beavers, are also known
to have iron in their teeth.)
Reptilian teeth have long been consid-
ered simple and “cheap” because they
grow quickly and get replaced several
times throughout their owner’s life. But
Biology; August 6, 2024

research by LeBlanc and his colleagues is
helping to change that perception, says
University of Manitoba paleontologist
The new study’s view of Beorn leggi
Kirstin Brink, who also studies teeth:
“Now that we’re starting to actually take a
closer look at different reptiles, we’re find- PALEONTOLOGY varied little for millions of years, so the
ing all these really cool adaptations.” small visible differences in claw shape of-
Komodo dragons, which live on a few
islands in Indonesia and can grow up to 10
Hardy fered crucial information about where in
the tardigrade family tree these am-
feet long, are “basically tooth factories,”
LeBlanc says. The tip of each frequently
replaced, pointed tooth curves back into
Remnant ber-trapped fossils belonged, says Univer-
sity of Chicago organismal biologist Jas-
mine Nirody (whose own work has also
the animal’s mouth, helping it to tear off Tiny tardigrade fossils examined tardigrade claws).
and swallow large chunks of meat. The suggest when the The authors determined the smaller tar-
iron reinforcement precisely marks a sin- organisms became digrade was a new genus and species: Aero-
gle serration line running down the front bius dactylus. They also revised B. leggi’s de-
ridiculously tough scription and classification based on its claw
joints. Both species were placed in the same
Komodo dragons MICROSCOPIC TARDIGRADES—plump, tardigrade superfamily Hypsibioidea, and
are “basically eight-legged arthropod relatives—are B. leggi was moved into the family Hypsibi-
tooth factories.” nearly indestructible, and their durability
superpower may have helped them weath-
idae. Reclassifying B. leggi based on previ-
ously unseen details clarified its relation-
—Aaron LeBlanc er the deadliest mass extinction in Earth’s ship to living tardigrades.
King’s College London history, according to a new fossil analysis. The resulting family tree recalibration
Tardigrades, also called water bears, allowed the researchers to calculate when
and back of each tooth—more pronounced can withstand extreme heat, cold, pres- the two tardigrade lines that perform
on the back—as well as its tip: puncture, sure and radiation. Two major tardigrade cryptobiosis could have diverged—put-
pull, swallow, repeat. lines survive hostile environments ting a latest date on the likely acquisition of
LeBlanc was drawn to Komodo teeth through a process called cryptobiosis, in that skill. Their work suggests cryptobio-
because their pointed, curved profile which they lose most of their body’s water sis appeared in tardigrades during the
would look at home in dinosaurs’ fearsome and enter a suspended metabolic state. Carboniferous period (359 million to 299
smiles. Such comparisons are valuable for There are only four known tardigrade million years ago), predating a deadly
paleontologists, Brink notes. “When we’re fossils. All are preserved in amber, includ- event known as the Permian extinction, or
studying fossils, especially when we’re trying two inside a pebble that was found in the “Great Dying,” which occurred about
ing to interpret behaviors that we can no Canada in 1940 and dates from 84 million 252 million years ago. The authors suggest
longer observe because the animals are to 72 million years ago. One of the pebble’s that cryptobiosis may have helped tardi-
dead, we have to look to modern ana- tardigrades, representing a species named grades survive the event, which wiped out
logues,” she says. Beorn leggi, was described in 1964. The 96 percent of marine life and 70 percent of
LeBlanc’s team went on to find signs of other was too small to be identified at the life on land.
iron reinforcement in some other monitor time, says Marc Mapalo, a graduate stu- Cryptobiosis’s evolution is challenging
lizard species and crocodilians, as well as dent at Harvard University’s Museum of to study, partly because tardigrade fossils
in dinosaur teeth—but metallic traces in Comparative Zoology. are so scarce, Mapalo says. Additional fos-
the latter most likely came from the fossil- For a new study in Nature Communica- sil discoveries will help scientists pin down
ization process, he says. Still, he and Brink tions Biology, Mapalo and his colleagues details about the appearance of this unique
agree, the research suggests scientists used high-contrast microscopy to uncover survival strategy. By sharing this result, he
should take a closer look at teeth in living previously unseen details in both speci- says, “we hope we will entice other people
reptiles and dinosaurs alike. “We shouldn’t mens’ claws, “which are very important to be aware that fossil tardigrades exist
take for granted how complex reptile teeth taxonomic characteristics in tardigrades,” and there are still more to be found.”
can be,” LeBlanc says. —Meghan Bartels Mapalo says. Tardigrade body plans have —Mindy Weisberger

ADVANCES
PSYCHOLOGY spect for leaders and rules), and purity

(cleanliness and piety) to be “binding”
Seasonal values that promote group cohesion and
conformity. These principles, often asso-
Morality ciated with political conservatism, consis-

tently received weaker endorsements in
summer and winter. And in summer, the
Values may shift
Jasmin Merdan/Getty Images

more extreme the seasonal weather differ-
with the time of year ences, the more pronounced the effect.
(An additional surveyed group in the U.K.
AS LEAVES FALL, snow sweeps in or flow- showed only the changes in summer.)
ers blossom, humans change in measur- Care (preventing harm to others) and
able ways, too. Research suggests a range fairness (equal treatment) are considered
of psychological phenomena—such as our “individualizing” values pertaining to in-
emotional state, diet and exercise habits, dividual rights. These principles showed Howard University psychologist
sexual activity and even color preferenc- no consistent seasonal pattern. Ivory A. Toldson, whose work involves
es—fluctuate throughout the year. And One explanation for seasonal swings practical applications of statistics, notes
now a study in the Proceedings of the Na- could be anxiety. Using a 90,000-respond- that the study relies on data from “West-
tional Academy of Sciences USA demon- ent survey dataset, as well as data on Inter- ern, educated, industrialized, rich and
strates how moral values can also shift. net search frequencies, the researchers democratic (WEIRD)” populations and
For the study, researchers analyzed found that anxiety levels also peak in spring cautions that generalizing from such re-
more than 230,000 online survey respons- and fall. “There is a close relationship be- sults runs the risk of “overlooking the
es—a decade’s worth—from people in the tween anxiety and threat,” says University unique moral experiences of marginalized
U.S., along with smaller groups in Canada of Nottingham psychologist and study co- groups.” Hohm agrees that such a pattern
and Australia. The questions were based on author Brian O’Shea. Other studies have wouldn’t affect everyone the same way but
a standardized framework social scientists shown that people who feel more vulnera- emphasizes that the study highlights the
use to assess people’s judgments of right ble to seasonal illnesses tend to be more dis- seasons’ effect on human psychology.
and wrong. This framework, called moral trustful, more xenophobic and more likely “One thing that this article is showing
foundations theory, sets up a taxonomy of to conform to majority opinion. “When is that we are very seasonal creatures,” says
“five pretty fundamental values that shape you’re threatened,” O’Shea explains, “you Georgetown University School of Med-
human social behavior,” says lead author then want to get protection from your in- icine psychiatrist Norman Rosenthal,
Ian Hohm, a psychology graduate student group.” These findings suggest seasonal a leading expert on seasonal affective
at the University of British Columbia. timing could affect jury decisions, vaccina- disorder who coined the term in the
The framework considers loyalty (de- tion campaigns—and even election out- 1980s. “The internal state definitely affects
votion to one’s own group), authority (re- comes, the study authors say. your behavior.” —Anvita Patwardhan
MATH PUZZLE 40
Playing Architect 26
By Hans-Karl Eder
Source: Hans-Karl Eder/Spektrum der Wissenschaft ( reference)
15
JOVAN BUILT THESE five houses of cards using a total of exactly
90 playing cards. Now he wants to build one large house consisting
of exactly 100 cards. Can such a house of cards exist? 7
For the solution, visit www.ScientificAmerican.com/

2
games/math-puzzles
90
20 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Graphic by Amanda Montañez

EVOLUTION
Half a century after its discovery,

the iconic fossil remains central to
our understanding of human origins
BY DONALD C. JOHANSON
AND YOHANNES HAILE-SELASSIE
ILLUSTRATION BY JOHN GURCHE
PHOTOGRAPHS BY DAVID L. BRILL

50
YEARS
OF

E VERY ONCE in a great while pale-
ontological fieldwork turns up a
fossil so extraordinary that it
revolutionizes our understand-
ing of the origin and evolution of
an entire branch of the tree of life. Fifty years ago
one of us (Johanson) made just such a discovery on
an expedition to the Afar region of Ethiopia. On
November 24, 1974, Johanson was out prospecting
for fossils of human ancestors with his graduate stu-
dent Tom Gray, eyes trained on the ground, when he
spotted a piece of elbow with humanlike anatomy.
Glancing upslope, he saw additional fragments of
bone glinting in the noonday sun. In the weeks,
months and years that followed, as the expedition
team worked to recover and analyze all the ancient
bones eroding out of that hillside, it became clear that
Johanson had found a remarkable partial skeleton
of a human ancestor who had lived some 3.2 million
years ago. She was assigned to a new species, Australo-
pithecus afarensis, and given the reference number
A.L.288-1, which stands for “Afar locality 288,” the
spot where she, the first hominin fossil, was found. But
Donald C. Johanson to most people, she is known simply by her nickname,
is founding director of Lucy. With the discovery of Lucy, scientists were forced
the Institute of Human to reconsider key details of the human story, from when
Origins at Arizona State and where humanity got its start to how the various ex-
University and discover-
er of the 3.18-million- tinct members of the human family were related to one
year-old human ances- another—and to us. Her combination of apelike and
tor known as Lucy. humanlike traits suggested her species occupied a key
place in the family tree: ancestral to all later human spe-
Yohannes Haile- Selassie
is director of the
cies, including members of our genus, Homo.
Institute of Human It can be precarious to hang such a pivotal argument
Origins and lead on a single fossil individual. But in the half a century since
investigator for the Lucy’s unveiling, many more specimens of Au. afarensis
Woranso-Mille field site,
which has yielded fossil
have been found. Together they provide an exceptionally
contemporaries detailed record of this ancient species, revealing where it
of Lucy’s species. roamed, how it lived, how its members differed from one
In 1972 researchers traveled to the Afar region of northeastern Ethiopia to look for hominin fossils dating
to more than three million years ago. A site called Hadar looked especially promising, its rugged landscape
chock-full of mammal fossils that erode out of the hillsides over time (top left). The expedition camped along
the banks of the Awash River and began a targeted search of the area’s fossil-bearing sediments (right).
On November 24, 1974, Donald C. Johanson discovered the nearly 3.2-million-year-old Lucy skeleton on one
of the hillsides. A stake marks the spot where the fossil was found (bottom left).

another and how long it endured before going extinct. pithecus individual, but without more anatomical in-
We have also learned a lot about Lucy’s own prede- formation to go on, he could not determine whether it
cessors—and her contemporaries. One of the most ex- came from Au. africanus or a new species. What the
citing developments in the field of human origins re- team needed most was to find remains of skulls and
search since the discovery of Lucy has been the revelation teeth, the body parts that contain the most diagnostic
that for most of our prehistory multiple human species, features for distinguishing species in fossil mammals.
or hominins, roamed the planet. One of us (Haile-Selas- The researchers could only hope that the next field
sie) has found hominins that overlapped in time and season would turn up cranial and dental specimens.
space with Lucy’s kind. These members of the human Their dream came spectacularly true on that mo-
family are fascinating in their own right. They also pro- mentous day in 1974. The Lucy fossil preserved skull
vide vital context for understanding the evolution of the fragments and a lower jaw with teeth, as well as parts
species that may very well have given rise to us all. of the arm, leg, pelvis, spine and ribs—47 bones in all
representing a whopping 40 percent of the skeleton of
O UNDERSTAND WHY LUCY had such a massive a single individual. Her remains promised untold in-
T impact on paleoanthropology, we have to look at

the state of the science at the time of her discov-
ery. Back in the early 1970s, the oldest hominin fossils
sights into the human past.
Named after the Beatles song “Lucy in the Sky with
Diamonds,” which played on the tape deck at camp as
on record were thought to be around 2.5 million years the team celebrated, Lucy became an instant sensation.
old and belonged to a species called Australopithecus Nothing like her had ever been found before. She was
africanus from South Africa. Younger fossils fell into one diminutive—her 12-inch-long thigh bone indicated
of two groups: the so-called robust australopiths, with that she stood only three and a half feet tall and
their giant molars and powerful jaws, and the more del- weighed 60 to 65 pounds. Like many other animals,
icately built, or “gracile,” forms, which included Homo. early hominins exhibit a condition called sexual di-
Although Au. africanus was classified as gracile, it didn’t morphism, wherein males are much larger than fe-
particularly resemble either of these later groups. Yet it males, among other morphological differences. Lucy
was the only sufficiently well-documented hominin we was too small to be a male. And her erupted wisdom
had that was old enough to be ancestral to them. There teeth and lack of unfused growth plates in her limb
were a few scraps of fossil material from eastern Africa bones confirmed she was an adult.
that were older, but there wasn’t enough material pre- Other features attested to how she carried herself.
served to get a good sense of the kinds of creatures they After closely inspecting her knee, hip and ankle, as well
came from. And so scientists drew their evolutionary as conducting extensive biomechanical studies, Johan-
trees with Au. africanus as the all-important ancestor of son and his colleagues concluded that she walked up-
Homo and the robust forms. But what they really needed right—a trait that Charles Darwin argued was a hall-
to test that hypothesis about Au. africanus were more mark of humans—with a gait very much like our own.
complete fossils in excess of three million years old. Other scholars interpreted the bones differently, argu-
In the spring of 1972 Johanson journeyed to Ethiopia ing that she walked with her knees and hips bent like
with French geologist Maurice Taieb in search of homi- chimpanzees do when they occasionally travel on two
nin fossils from beyond the three-million-year mark. legs. Final resolution of this debate came in 1978, after
Taieb was keen to take him to the Afar region of north- researchers discovered a stunning trail of hominin
eastern Ethiopia, where he had previously seen pig and footprints impressed in 3.7-million-year-old volcanic
elephant fossils that looked to be from the time period ash at the site of Laetoli in Tanzania. Some of the prints
Johanson was targeting. Perhaps hominin fossils were are so detailed that all the characteristics of a modern
there, too, waiting to be discovered. Surveying a bunch human footprint left on a beach are visible. They
of fossil-bearing locations in the region, the team ze- showed that the Laetoli track makers walked like us,
roed in on a site called Hadar. Brimming with fossils of not like chimpanzees. And because hominin teeth and
rodents, elephants, rhinos, hippos, monkeys, horses, jaws similar to those from Hadar had been found at La-
antelopes and carnivores, Hadar must have been a etoli, it stood to reason that Lucy’s kind left the prints.
bountiful environment millions of years ago to support Traits such as a receding chin, strongly projecting
so many animals. It seemed like a promising area to snout, low and sloping forehead, and very small brain
search for ancient human ancestors. Johanson knew size placed Lucy in the genus Australopithecus. But cer-
that if hominin fossils were found there, they could up- tain aspects of her anatomy hinted that she might be
end our understanding of how humans came to be. more primitive than other known species in that group.
When the expedition team returned to Hadar the Her first lower premolar was oval in shape and had a
following year, Johanson made a tantalizing discovery: single cusp, like an ape’s. Likewise, her lower limbs were
a knee joint estimated to be 3.4 million years old. An- relatively short, possibly an evolutionary feature left
atomical details of the knee indicated that it had come over from her ancestors who lived a more arboreal life.
from a hominin that walked upright, like us, confirm- Although only bits of her braincase were recovered, the
ing the fossil hunters’ hunch that Hadar had hominins. fragments suggested a brain volume of 388 cubic centi-
Johanson suspected the knee belonged to an Australo- meters. That’s very small compared with the modern

When Lucy was
discovered 50 years
ago, she was the oldest,
most complete early
member of the human
family that had ever
been found, with
47 bones representing
40 percent of the
skeleton. Features of
her hip, knee and ankle
indicate that she
walked upright on two
legs like we do. Yet in
other respects she was
primitive, with a brain
less than a third of the
size of our own.

human brain, which averages 1,400 cubic centimeters,
and comparable to the average modern chimp brain.
Lucy confirmed earlier suspicions that upright walk-
ing evolved before large brains.
ITH SO MANY PARTS of her skeleton pre-
W served, Lucy was a trove of information. But

she was still just one individual. For a deeper
understanding of her species, we needed more speci-
mens. To that end, continued fieldwork at Hadar and
other sites in the region has yielded a wealth of addi-
tional Au. afarensis fossils that together provide a de-
tailed portrait of this ancestor.
In 1975, just one year after Lucy was found at Afar
Locality 288, the Hadar team discovered more than
200 fossil hominin specimens eroding from a single
layer of rock at nearby Afar Locality 333. Dated to a
little more than 3.2 million years ago, the sample con-
sisted of male and female adults as well as portions of
infants and juveniles estimated to represent at least 17
individuals, all presumably related. The group became
known as the “First Family.”
Combining the expanded Hadar collection with
Lucy’s Tanzanian counterparts allowed the team to re-
construct the skull of the hominin species found at Ha-
dar and to evaluate the fossils’ taxonomic status and
position on the human family tree. In 1978, following a
thorough comparative study of all the australopith spe-
cies then known, Johanson and his colleagues concluded
that although some of the dental and cranial features
evident in these remains are found in other members of
Australopithecus, the total morphological package seen
in the Hadar and Laetoli fossils was unique and consti-
tuted a species new to science: Australopithecus afarensis.
Furthermore, they proposed, Au. afarensis occupied
a prominent position on the family tree, replacing
Au. africanus as the last common ancestor of later hom-
inins, including Homo and the robust australopiths.
Not everyone in the paleoanthropological commu-
nity embraced the naming of this new species. Detrac- Further support for the hypothesis that Au. afarensis
tors argued that the hominin record between two mil- gave rise to later australopiths in eastern Africa came in
lion and three million years ago was too sparse to sup- 1990, when a cranium the same age as the Black Skull
port the claim that Au. afarensis was the ancestor of later surfaced in Ethiopia’s Middle Awash Valley. The discov-
hominins. The discovery of more fossils from this time ery team deemed it a new species, Australopithecus
period would be crucial for testing this hypothesis. garhi, and claimed that it occurred at the right time and
That additional evidence has since come in. In 1985 place to be ancestral to Homo. Like the robust australo-
researchers working in northern Kenya discovered a piths, this specimen had an impressive masticatory
2.5-million-year-old cranium of the robust australopith system, with big jaws and a crest atop its head that
Paranthropus aethiopicus. Dubbed the “Black Skull” for would have anchored strong chewing muscles. It also
its manganese-tinged color, it possessed a powerful mas- had a facial structure similar to that of Au. afarensis.
ticatory system, including large crushing and grinding Other scientists have surmised that Au. garhi descended
teeth, similar to those of a robust australopith individual from Au. afarensis and evolved its formidable chewing
sometimes referred to as “Nutcracker Man,” who lived anatomy in parallel with the robust australopiths but
1.8 million years ago and belonged to the species Paran- did not itself give rise to later hominin species.
thropus boisei. The Black Skull also shared several traits Other fossil finds bolstered the proposed link be-
with Au. afarensis, including an extremely projecting tween Au. afarensis and Homo. For a long time the
lower face. When the three species are considered to- oldest known fossils in the genus Homo dated only as
gether, Au. afarensis is a compelling ancestor for P. aethi- far back as around two million years ago, leaving a
opicus, which in turn appears ancestral to P. boisei. worrying gap of more than a million years between the
youngest Au. afarensis and the oldest Homo. In 1994 named as a new species in 1978, it was the earliest hu- In 1975 Johanson, shown
researchers at Hadar found a 2.33-million-year-old man ancestor ever documented, with an age range of here with graduate
student Tom Gray,
palate—the bone that makes up the roof of the 3.8 million to 3.0 million years ago. Fossils recovered in
discovered fossils from
mouth—that shared morphological traits with Homo the mid-1990s extended the early hominin record back a group of hominins—
habilis, “Handy Man,” the earliest known member of even farther. In 1994 researchers working in the Middle dubbed the First Family—
our genus, narrowing that temporal gap by a few hun- Awash region of Ethiopia’s Afar Rift found hominin who had died together
at another locality in
dred thousand years. And in 2013 a team working at a fossils dated to 4.4 million years ago. They assigned the
Hadar and belonged to
site northeast of Hadar called Ledi-Geraru recovered remains to a new species, Ardipithecus ramidus. The the same species as
the left half of a 2.8-million-year-old mandible bear- following year another new species was named based Lucy (left). Cranial and
ing a combination of primitive Au. afarensis features on fossil discoveries from Kanapoi and Allia Bay in Ken- dental remains from this
and characteristics of early Homo. The Ledi-Geraru ya’s Turkana Basin: Australopithecus anamensis, which find allowed researchers
to reconstruct the
jaw provided another stepping stone between Au. afa- lived from 4.3 million to 3.8 million years ago. With the skull of that species,
rensis and Homo and strengthened the morphological naming of these two species, Au. afarensis lost the dis- Australopithecus
connection between them as well, helping to validate tinction of being the oldest hominin, but it gained an afarensis (right).
the hypothesis that Au. afarensis is the best candidate origin story of its own: Au. anamensis is believed to be
we have for the ancestor of our own genus. the direct ancestor of Au. afarensis. More recently, dis-
coveries in Chad, Kenya and Ethiopia have pushed the
HUMAN FOSSILS are generally rare, which means that origin of humankind back as far as seven million years.
our understanding of the past can change dramatically Other fossil finds have shown that Au. afarensis
when new specimens surface. When Au. afarensis was was not the only hominin species around during its

TODAY Homo sapiens
Homo erectus
Homo rhodesiensis
MEMBERS OF THE GENUS HOMO

spread across Africa and Eurasia;
one species, H. sapiens, colonized
1 MILLION YEARS AGO the globe. Hominins in this group
had large brains and small teeth
and jaws. They invented ever more
sophisticated tools to procure
and process a wide range of plant
and animal foods.
Homo habilis
2 MILLION YEARS AGO
Tentative lines of descent (dotted lines)
3 MILLION YEARS AGO Australopithecus afarensis

Most famous specimen: Lucy
Australopithecus bahrelgazali
Burtele foot
Australopithecus anamensis
4 MILLION YEARS AGO
Ardipithecus ramidus
THE EARLIEST HOMININS lived

in woodland settings in Africa. They
could walk upright on two legs but
5 MILLION YEARS AGO also spent a significant amount
of time in the trees. Aspects of their
Ardipithecus kadabba
teeth indicate that they ate a
broader range of foods than their
forest-dwelling ape ancestors,
Sahelanthropus tchadensis who ate mostly fruit.
Orrorin tugenensis
6 MILLION YEARS AGO
Stacked thin horizontal

lines indicate uncertainty
about the age of the fossils
7 MILLION YEARS AGO
long reign, raising the question of whether Au. afaren- similar adaptations, a principle known as competitive
sis or one of these other hominins is the ancestor of exclusion. The fossil record of hominins seemed to sup-
Homo and Paranthropus. Far from diminishing the port this concept until fossils of two different hominin
significance of Lucy’s species, these findings enrich its species were recovered from the same geological layer
story: we now have many more puzzle pieces from at sites in Kenya and Tanzania. Still, there was no evi-
which to reconstruct the evolution of the line that led dence that another species lived alongside Au. afarensis,
to us and the factors that shaped it along the way. The and because of that, it was considered to be the ancestor
picture that is emerging from this work is far more of all later hominins.
complex—and fascinating—than the one paleoan- Eventually, however, challengers turned up from
thropologists traditionally envisioned. various sites in eastern and central Africa. In 1995 a
Prior to 1960, human origins researchers thought team lead by paleontologist Michel Brunet discovered
that only a single hominin species lived at any given time a 3.5-million-year-old partial hominin jaw from a site
in the past. This notion stemmed from the idea that com- in northern Chad known as Koro-Toro and assigned it
petition prohibits the coexistence of related species with to a new species, Australopithecus bahrelghazali. This
30 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Graphic by Jen Christiansen

Homo neanderthalensis Homo floresiensis
Paranthropus boisei
Paranthropus robustus
Astralopithecus sediba
Homo rudolfensis
Australopithecus africanus
Australopithecus garhi
Paranthropus aethiopecus
Kenyanthropus platyops Australopithecus deyiremeda
THE AUSTRALOPITHS lived in

a variety of habitats—from wood-
lands to grasslands—across the
African continent. They were fully
bipedal and had lost key morpholog-
ical features that make primates
Ancestor of Consequence
good at climbing trees. Their jaws Back when the Lucy skeleton was discovered in 1974, there
and teeth were adapted to eating were only a few fossil human species on record. A species from
difficult-to-process foods. South Africa known as Australopithecus africanus was the old-
est one known, and scientists figured it was ancestral to all
later hominins, including our genus, Homo. When researchers
analyzed Lucy along with similar fossils from other localities in
Ethiopia and Kenya in 1978, they concluded that the fossils
belonged to a species new to science, Australopithecus afaren-
sis, that was older than Au. africanus and whose features made
it a more compelling ancestor of later hominins. Fossils discov-
ered since then have shown that other hominin species lived at
the same time as Au. afarensis, raising the question of whether
one of these contemporaries might be the all-important ances-
tor instead. But Au. afarensis remains the most compelling can-
didate for the ancestor of Homo and Paranthropus.
fossil was significant not only because it was found face. Critics also challenged the validity of this species,
outside the East African Rift System, where almost all arguing that the badly crushed skull was too distorted
early hominins have been recovered, but also because for its true shape to be discernible. Regardless, it was
it overlapped in time with Au. afarensis. Not everyone another indication that Au. afarensis might not have
agreed that the jaw was distinctive enough to represent been alone—even in eastern Africa.
a new species. Nevertheless, it was the first hint that More recently, Haile-Selassie has found the stron-
Au. afarensis may not have been the only hominin spe- gest evidence yet that Au. afarensis had company. Two
cies around 3.5 million years ago. decades ago he set out to look for new paleontological
A second hint came in 2001, when paleontologist sites in the Afar Rift containing hominin fossils between
Meave Leakey and her team announced their discovery three million and four million years old. His efforts re-
of a 3.5-million-year-old cranium from Lomekwi, a sulted in the discovery of a spectacular new site called
site in northwest Kenya, and assigned it to a new genus Woranso-Mille just 40 kilometers north of Hadar. With
and species called Kenyanthropus platyops, partly on fossils spanning the time from 3.8 million to 3.0 million
the basis of what they saw as a distinctive flatness of its years ago, it has become one of the most important sites

For the past two decades in all of Africa for hominins from the Pliocene epoch. Australopithecus deyiremeda. Dated to 3.3 million to
Yohannes Haile-Selassie Perhaps the most remarkable aspect of Woranso- 3.5 million years ago, this species was contemporane-
(right) has been working
at a fossil site some Mille is the diversity of hominins found there. The site ous with both Au. afarensis and the owner of the mys-
40 kilometers north of has yielded remains of both Au. anamensis (including a terious foot that was recovered from the same site.
Hadar called Woranso- nearly complete skull that has given us our first look at Whether the foot belongs to Au. deyiremeda, given the
Mille. There he has the face of this ancestor) and its descendant, Au. afar- proximity of the finds, remains to be seen.
recovered fossils belong-
ing to contemporaries ensis. It has also produced other hominins. In 2012 The discoveries at Woranso-Mille show that Cleveland Museum of Natural History (this page and opposite page)
of Au. afarensis, includ- Haile-Selassie and his colleagues announced their dis- Au. afarensis didn’t just share the same continent or
ing jawbones belonging covery of an enigmatic hominin foot with a divergent big even the same side of the continent with other homi-
to a species called toe more like an ape’s. At 3.4 million years old, it was nin species but lived virtually side by side with them.
Australopithecus
deyiremeda (fossil cast,
contemporaneous with Au. afarensis. Yet it clearly did They may have been able to do this by exploiting dif-
center) and a foot be- not come from that species, whose big toe lined up with ferent ecological niches within the same area. The
longing to a yet unidenti- the other digits, like ours does. Without any associated species with the divergent big toe probably could have
fied species that had skull or tooth remains to guide them, the researchers did climbed trees more efficiently than Au. afarensis, for
a divergent big toe like
not want to assign the foot to a species. But it showed be- example, and so might have focused on arboreal re-
an ape’s (left).
yond any doubt that Lucy’s species shared the landscape sources while Au. afarensis favored terrestrial ones.
with a fundamentally different kind of hominin. Comparison of the paleoenvironments at the sites
Further evidence that Au. afarensis overlapped with where these fossils are found may provide further clues.
other hominins came in 2015, when Haile-Selassie and Hadar and Woranso-Mille are similar in having hosted
his colleagues announced their discovery of fossilized both Au. afarensis and other nonhominin mammals
upper and lower jaws from a species new to science, simultaneously. But only Woranso-Mille had more
than one hominin species. Why were there multiple have a flat face, or did its poor preservation distort its
contemporaneous hominin species at Woranso-Mille true features? We would need well-preserved skulls of
and not at nearby Hadar? One hypothesis we are testing this species to know. What is more, K. platyops is sepa-
is that Woranso-Mille encompassed a greater diversity rated from its proposed descendant, Homo rudolfensis,
of habitats, which could have supported multiple by about a million years, making it difficult to link the
hominins without substantial direct competition. two. If we had more fossils of K. platyops from different
time periods to establish how long this species persisted,
HE REALIZATION that Au. afarensis might have we might be able to bridge that gap, but we don’t.
T had as many as three other hominin contempo-

raries has raised questions about the claim that
it was the ancestor of all later hominins, including
We simply don’t have enough information about
K. platyops or the other Au. afarensis contemporaries
to know what kinds of creatures they were and how
members of Homo. We have to consider whether any they are related to the rest of the human family. That
of these other species may be a better candidate ances- leaves Au. afarensis—represented by hundreds of fos-
tor than Au. afarensis. In practice, it’s hard to connect sils from numerous individuals, juvenile and adult,
the dots with certainty. One big problem is that the spanning some 800,000 years—as the best candidate
sample sizes of these other species are too small to al- ancestor of Homo and Paranthropus. As additional FROM OUR
low for meaningful comparisons. For example, re- fossils of these more recently identified hominins ARCHIVES
searchers have argued that K. platyops had a flat face like come to light, perhaps one of them might emerge as Lucy’s Baby.
Kate Wong;
early Homo and could thus be considered the ancestor of the front-runner. Until then, Au. afarensis remains the December 2006.
that genus. But we have only one skull of K. platyops to most likely ancestor and one of the most important ScientificAmerican.
go on, and it’s badly crushed. Did this creature actually species in human evolutionary history. com/archive

MEDICINE
No
More
Needles
Gentle nasal sprays
are being tested as vaccines
against COVID, the flu, RSV,
and more. They may work better
than shots in the arm
BY STEPHANI SUTHERLAND
ILLUSTRATION BY SAM FALCONER
A She never
LYSON VELASQUEZ HATES NEEDLES.
liked getting shots as a kid, and her anxiety only
grew as she got older. “It really ballooned in my
teens and early 20s,” she says. “It became a full-
blown phobia.” She would panic at the sight of a
needle being brought into an exam room; more than once she passed out.
Velasquez says that she took an antianxiety medication before one appoint-
ment yet still ran around the room screaming inconsolably “like I was a
small child; I was 22.” After that episode Velasquez, now a 34-year-old
financial planner in southern California, quit needles completely. “No vac-
cinations, no bloodwork. For all of my 20s it was a no-go for me,” she says.
Then COVID showed up. “It finally hit a point where ated multiple immune system responses against the
it wasn’t just about me,” Velasquez says. “It felt so self- COVID-causing virus in people who received them
ish not to do this for the greater public health and the through a puff up the nose; earlier this year their mak-
safety of our global community.” So she got vaccinated ers received nearly $20 million from Project NextGen,
against the SARS-CoV-2 virus in 2021, although she the Biden-Harris administration’s COVID medical
had to sit on her husband’s lap while he held her arms. initiative. Researchers are optimistic that a nasal spray
“It was a spectacle. The poor guy at CVS ... he did ask delivering a COVID vaccine could be ready for the U.S.
me, ‘Are you sure you want to do this?’” She very much as soon as 2027. Although recent efforts have focused
did. “I’m very pro-vaccine. I am a rational human. I un- on inoculations against SARS-CoV-2, nasal vaccines
derstand the necessity of [getting] them,” she insists. could also protect us against the flu, respiratory syn-
But today she still struggles with each injection. cytial virus (RSV), and more.
Stephani Sutherland
is a neuroscientist and
Those struggles would end, however, if all her fu- A few nasal vaccines have been introduced in the
science journalist based ture vaccinations could be delivered by a nasal spray. past, but they’ve been beset by problems. The flu in-
in southern California. “Oh, my God, amazing!” Velasquez says. oculation FluMist has not gained popularity because
She wrote about the The amazing appears to be well on its way. Vaccines of debates about its effectiveness, and a different
causes of long COVID
in our March 2023 issue.
delivered through the nose are now being tested for vaccine was pulled from the market decades ago be-
Follow her on X several diseases. In the U.S., early clinical trials are cause some people had serious side effects. In China
@SutherlandPhD showing success. Two of these vaccines have gener- and India, nasal vaccines for COVID have been ap-
proved because those countries prioritized their
development during the pandemic, whereas the U.S.
Nasal sprays aim directly at
and other wealthy nations opted to stick with arm the spot where most viruses
injections. But this new crop of vaccines takes ad-
vantage of technology that produces stronger im- first enter the body: the nose.
mune responses and is safer than preparations used
in the past. mune messenger cells, which gather the interlopers’
In fact, immunologists say these spritzes up the proteins and display them on their surfaces. These cells
nose—or inhaled puffs through the mouth—can pro- head to the lymph nodes, where they show off their
vide faster, stronger protection against respiratory vi- captured prize to B and T cells, which are members of
ruses than a shot in the arm. That is because the new another part of the immune system called the adaptive
vaccines activate a branch of the immune system that arm. B cells, in turn, produce antibodies, molecules
has evolved for robust, rapid responses against airborne that home in on the foreign proteins and flag their own-
germs. “It may be more likely to really prevent infection ers—the invading microbes—for destruction. Killer
from getting established,” says Fiona Smaill, an infec- T cells directly attack infected cells, eliminating them
tious disease researcher at McMaster University in On- and the microbes inside. This provides broad protec-
tario. Such inoculations may also help reduce the enor- tion, but it takes time, during which the virus continues
mous inequities in vaccine access revealed by the pan- to replicate and spread.
demic. These formulations should be cheaper and That’s why a second type of protection, offered
easier to transport to poor regions than current shots. only by the mucosal tissue, is so important. The mu-
But nasal vaccines still face technical hurdles, such cosa holds cells of the innate immune system, which
as how best to deliver them into the body. And unlike are the body’s “first responders.” Some of these cells,
injected vaccines, which scientists can measure im- called macrophages, recognize invasive microbes as
mune responses to with blood tests alone, testing for foreign and swallow them up. They also trigger in-
immunity that starts in nose cells is more challenging. flammation—an alarm sounded to recruit more im-
But researchers working in this field agree that despite mune cells.
the hurdles, nasal formulations are the next step in Another part of this localized response is called tis-
vaccine evolution. sue-resident immunity. These cells don’t have to detect
telltale signs of a pathogen and make a long journey to
TRADDTDONAL VACCDNES injected through the skin the infected tissue. They are more like a Special Forces
and into an arm muscle provide excellent protection unit dropped behind enemy lines where a skirmish is
against viruses. They coax immune cells into making occurring rather than waiting for the proverbial cav-
widely circulated antibodies—special proteins that alry to arrive. This localized reaction can be quite po-
recognize specific structural features on viruses or tent. Its activation is notoriously difficult to demon-
other invading pathogens, glom on to them and mark strate, however, so historically it’s been hard for vac-
them for destruction. Other immune cells retain a cine makers to show they’ve hit the mark. But it turns
“memory” of that pathogen for future encounters. out that one type of antibody, called IgA, is a good in-
Intramuscular injection vaccines are good at pre- dicator of mucosal immunity because IgAs tend to
venting a disease from spreading, but they do not stop predominate in the mucosa rather than other parts of
the initial infection. A nasal spray does a much better the body. In an early trial of CoviLiv, a nasal COVID
job. That’s because sprays are aimed directly at the vaccine produced by Codagenix, about half of partic-
spot where many viruses first enter the body: the nose ipants had detectable IgA responses within several
and the tissue that lines it, called the mucosa. weeks after receiving two doses. That trial also showed
Mucosa makes up much of our bodies’ internal sur- the vaccine was safe and led to NextGen funding for a
faces, stretching from the nose, mouth and throat down larger trial of the vaccine’s efficacy.
the respiratory tract to the lungs, through the gastroin- It’s possible an inhaled vaccine may provide yet one
testinal tract to the anus, and into the urogenital tract. more layer of protection, called trained innate immu-
Mucosa is where our bodies encounter the vast majority nity. This reaction is a bit of a mystery: although immu-
of pathogenic threats, Smaill says, be it flu, COVID, or nologists know it exists and appears also to be produced
bacterial infections that attack the gut. This tough, tri- by intramuscular injections, they can’t quite explain
ple-layered tissue is specialized to fight off invaders how it works. Immune cells associated with trained in-
with its thick coating of secretory goo—mucus—and nate immunity seem to have memorylike responses,
with a cadre of resident immune cells waiting to attack. reacting quickly against subsequent infections. They
“Mucosa is really the first line of defense against any also have been found to respond against pathogens en-
infection we’re exposed to,” Smaill says. tirely unrelated to the intended vaccine target. Smaill
Mucosal immunity not only prepares the immune and her colleagues found that when they immunized
system for the fight where it occurs but also offers three mice with an inhaled tuberculosis vaccine and then
different types of protection—at least one more than a challenged them with pneumococcal bacteria, the mice
shot does. Nasal vaccines and shots both mobilize im- were protected. In children, there is some evidence that

a tuberculosis vaccine, in the arm, generates this type mon, and people are frequently infected by the time
of broad response against other diseases. they are adults. Their immune systems are already
Akiko Iwasaki, an immunologist at Yale University primed to recognize and destroy familiar flu particles.
who is working to develop a nasal vaccination for FluMist is built from a live flu virus, so immune cells
COVID, sees two major potential benefits to nasal im- probably treat the vaccine as an invader and demolish
munity in addition to better, faster, more localized it as soon as it shows up in the nose, before it has a
protection. First, attacking the virus in the nose could chance to do any good. This preexisting immunity
prevent the disease from being transmitted to others isn’t such an issue in children, who are less likely to
by reducing the amount of virus that people breathe have had multiple flu infections. Nasal flu vaccines are
out. And second, Iwasaki says, the spray may limit how routinely used to inoculate kids in Europe.
deeply the infection moves into the body, so “we be- In other vaccines, researchers often use adjuvants,
lieve that it will also prevent long COVID.” That debil- special agents that attract the attention of immune
itating postinfection condition, sometimes marked by cells, to boost a response. Some nasal vaccines use ad-
signs of entrenched viral particles, disables people with juvants to overcome tolerance, but in the nose, adju-
extreme fatigue, chronic pain, a variety of cognitive vants can pose unique dangers. In at least one case, a
difficulties, and other symptoms. nasal adjuvant led to disastrous consequences. An
intranasal vaccine for influenza, licensed in Switzer-
AKING A NEW VACCINE is hard, regardless of land for the 2000–2001 season, used a toxin isolated
M how you administer it. It needs to raise an im-

mune response that’s strong enough to protect
against future invasions but not so strong that the com-
from Escherichia coli bacteria as an adjuvant to pro-
voke a reaction to the inactivated virus. No serious side
effects were reported during the trial period, but once
ponents of that response—such as inflammation and the vaccine was released, Swiss officials saw a concern-
fever—harm the host. ing uptick in cases of Bell’s palsy, a disease that causes
The lining of the nose puts up its own barriers—lit- weakness or paralysis of the facial muscles, often lead-
eral, physical ones. Because the nasal mucosa is exposed ing to a drooping or disfigured face. Researchers at the
to so many irritants from the air, ranging from pet hair University of Zurich estimated that the adjuvanted flu
to pollen, the nose has multiple lines of defense against vaccine had increased the risk of contracting Bell’s
invading pathogens. Nostril hair, mucus, and features palsy by about 20 times, and the vaccine was discon-
called cilia that sweep the nasal surface all aim to trap tinued. “We need to be cautious about using adjuvants
small foreign objects before they can get deeper into the like that from known pathogens,” says pharmaceutical
body—and that includes tiny droplets of vaccine. formulations scientist Vicky Kett of Queen’s Univer-
And lots of small foreign particles—often harm- sity Belfast in Northern Ireland.
less—still make it through those defenses. So the nose To get around the challenges posed by the nose,
has developed a way to become less reactive to harm- some researchers are exploring vaccines inhaled
less objects. This dampened reactivity is called immu- through the mouth. Smaill is working on one of them.
nological tolerance, and it may be the biggest hurdle She and her McMaster colleagues aerosolized their
to successful development of a nasal vaccine. When vaccine for COVID into a fine mist delivered by a neb-
foreign particles show up in the bloodstream, a space ulizer, from which it rapidly reaches the lungs. Exper-
that is ostensibly sterile, immune cells immediately iments in mice have shown promising results, with
recognize them as invaders. But mucosal surfaces are mucosal immunity established after administration
constantly bombarded by both pathogens and harm- of the vaccine.
less materials. The immune system uses tolerance—a Another vaccine strategy is to use a harmless virus
complex series of decisions carried out by specialized to carry viral genes or proteins. Researchers at the Icahn
cells—to determine whether a substance is harmful. School of Medicine at Mount Sinai in New York City
“This is very important because we can’t have our selected a bird pathogen, Newcastle disease virus
lungs or gastrointestinal tract always responding to (NDV). “It’s naturally a respiratory pathogen,” so it
nonharmful foreign entities that they encounter,” says infects nasal cells, says Michael Egan, CEO and chief
Yale infectious disease researcher Benjamin Gold- scientific officer of CastleVax, a company that formed
man-Israelow. For example, inflammation in the lungs to develop the NDV vaccine for COVID. A small early
would make it hard to breathe; in the gut, it would clinical trial showed the CastleVax vaccine was safe and
prevent the absorption of water and nutrients. caused robust immune responses in people. “Those
These barriers may hamper the effectiveness of a results were very promising,” Egan says. People who
nasal flu vaccine that’s been around for a while, called received the vaccine also produced antibodies that in-
FluMist in the U.S. and Fluenz in Europe. The inocu- dicated multitiered mucosal immunity, not simply the
lation is safe, says infectious disease scientist Michael adaptive immunity from a shot in the arm.
Diamond of Washington University in St. Louis, but Following that trial, the CastleVax project received
it faces a similar problem as do injected flu vaccines: it NextGen funding, and results from a trial of 10,000
isn’t very effective at warding off new seasonal flu people are expected in 2026. Half of those people will
strains. This might be because flu strains are so com- receive a messenger RNA (mRNA) injection, and half
The Vaccine Advantages of a Puff Up the Nose
As kids and adults, we become very familiar with the vaccine needle. Jabs for measles, mumps, COVID, flu, polio, and more protect peo-
ple against all kinds of diseases. The injection starts in the arm but triggers an immune response that travels the body. It kicks in, how-
ever, after an infection starts. A new type of vaccine is emerging, though, for viruses and bacteria that we breathe. It meets the threat
at the earliest moment: in the nose and mouth. These nasal or inhaled vaccines could stop pathogens almost before they get started.
A SHOT IN THE ARM A SPRAY UP THE NOSE

Traditional vaccines go into an arm Nasal vaccines stimulate a particular
muscle. The vaccines carry molecules tissue: the mucosa. It lines the
that are part of a germ or sometimes insides of our noses and mouths,
a badly weakened or killed version stretching down to the lungs and
of the germ itself. The goal is to through our gastrointestinal
introduce these targets to what’s tracts. In addition to adaptive
called the adaptive immune immune cells, the mucosa holds
system. This system essentially “first responder” cells that
trains cells and proteins to immediately attack germs. They
recognize the invader. The adaptive are part of what’s called the
system retains a memory of the innate immune system. And nasal
germ and travels through the body vaccine sprays contain parts of those
looking to attack it. This response takes germs, to trigger innate and adaptive
time, however. immune responses.
A A B
SYSTEMIC/ADAPTIVE IMMUNITY RESIDENT MUCOSAL IMMUNITY
1 A vaccine is introduced Vaccine particle Vaccine particle 1 Vaccine is introduced

to the body. Mucosal to the body—directly
epithelial cell into a mucosal area.
2 Resident antigen-
2 Specialized immune presenting immune
cells take up the cells take up the vaccine
vaccine material. material, then display
3 The aptly named antigen-
fragments on their
presenting cells travel Antigen
surface to resident
to a lymph node via the Antigen-presenting cell helper T cells in the
circulatory system. sIgA
Lymph node mucosa-associated
Source: Florian Krammer, Icahn School of Medicine at Mount Sinai and Medical University of Vienna, Austria (consultant)
lymphoid tissue.
Killer T cell
Antigen- 3 Helper T cells engage
4 In the lymph node, presenting cell additional immune
Helper T cell
antigens are cells already on site,
presented to helper causing them to
Activated B cell T cells. Helper secrete a mucosal-
T cells engage specific antibody
Helper T cell
B cell additional immune called sIgA, as well as
cells, priming them priming the cells for
Memory cells for later action. later action.
SUBSEQUENT EXPOSURE TO A VIRUS SUBSEQUENT EXPOSURE TO A VIRUS
5 When the target sIgA Infected 4 When the target virus

Virus
Virus-disabling virus enters the host cell enters the body via the
antibodies from B cells body—often same mucus-lined
through the nose— route, the primed
primed immune immune cells and sIgA
cells and antibodies are already in position,
released from acti- ready to disable the
Virus Killer T cell virus and destroy
vated B cells travel
from lymph nodes Activated B cell infected cells.
to the site via the
circulatory system.
Antibodies disable TRAINED INNATE IMMUNITY
Infected host cell the virus, and killer Some research indicates that nasal vaccines also prime
T cells destroy host cells of the innate branch of the immune system—
cells, preventing including macrophages—to be more efficient at destroying
Killer T cell further replication. subsequent viruses unrelated to the target pathogen.
Graphic by Jen Christiansen NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 39

“We’re expecting to see fewer based on the virus rather than using new, mRNA-
based technology. The mRNA preparations were de-
breakthrough infections in people veloped specifically for intramuscular injections and
who got the vaccine up the nose.” would have to be significantly modified.
Codagenix, which is developing CoviLiv, side-
—MICHAEL EGAN CASTLEVAX stepped the need for a new viral vector or an adjuvant
by disabling a live SARS-CoV-2 virus. To make it safe,
will get the new NDV nasal spray. The data should scientists engineered a version of the virus with 283
show whether the new nasal vaccine can do a better job mutations, alterations to its genetic code that make it
of preventing infection than the mRNA injections. hard for the virus to replicate and harm the body. With-
Egan has high hopes. “We’re expecting to see a lot out all these genetic changes, there would be a chance
fewer breakthrough infections in people who got the the virus could revert to a dangerous, pathogenic form.
vaccine up the nose by virtue of having those mucosal But with hundreds of key mutations, “statistically, it’s
immune responses,” he says. basically impossible that this will revert back to a live
Florian Krammer, one of the Mount Sinai research- virus in the population,” says Johanna Kaufmann, who
ers behind the vaccine, engineered NDV particles to helped to develop the vaccine before leaving Codagenix
display a stabilized version of the spike protein that’s for another company earlier this year.
so prominent in SARS-CoV-2. “You end up with a par-
ticle that’s covered with spike,” he says. Spike protein ECAUSE MOST PEOPLE on the planet have now
in the bloodstream can raise an immune response. But
the NDV vaccine works in another way, too. The virus
particle can also get into cells, where it can replicate
B been exposed to SARS-CoV-2—in the same way
they’re regularly exposed to the flu—some nasal
vaccines are being designed as boosters for a preexist-
enough times to cause virus particles to emerge from ing immune response that is starting to wane. For ex-
the cells, provoking another immune reaction. Before ample, Yale researchers Iwasaki and Goldman-
moving into human trials, however, researchers had Israelow are pursuing a strategy in animals deemed
to complete clinical trials to establish that the Newcas- “prime and spike.”
tle virus is truly harmless because the nose is close to The idea is to start with a vaccine injection—the
the central nervous system—it has neurons that con- “prime” that stimulates adaptive immunity—then
nect to the olfactory bulb, which is part of the brain. follow it a few weeks later with a nasal puff that
Those trials confirmed that it is safe for this use. “spikes” the system with more viral protein, leading
This type of caution is one reason a COVID nasal to mucosal immunity. In a study published in 2022 in
vaccine approved in India hasn’t been adopted by the Science, Iwasaki and her colleagues reported that they
U.S. or other countries. The inoculation, called iNCO- primed rodents with the mRNA vaccine developed by
VACC, uses a harmless simian adenovirus to carry the Pfizer and BioNTech, the same shot so many of us have
spike protein into the airway. The research originated received. Two weeks later some of the mice received
in the laboratories of Diamond and some of his col- an intranasal puff of saline containing a fragment of
leagues at Washington University at the start of the the SARS-CoV-2 spike protein. Because the animals
pandemic, when they tested the formulation on ro- had some preexisting immunity from the shot, the
dents and nonhuman primates. “The preclinical data researchers didn’t add any adjuvants to heighten the
were outstanding,” Diamond says. Around the time effects of the nasal puff. Two weeks later researchers
he and his colleagues published initial animal results detected stronger signs of mucosal immunity in mice
in Cell in 2020, Bharat Biotech in India licensed the that had received this treatment compared with mice
idea from the university. In a 2023 phase 3 clinical trial that got only the shot.
in India, the nasal vaccine produced superior systemic “Not only can we establish tissue-resident memory
immunity compared with a shot. T cells” to fight off the virus in the nose, Iwasaki says,
Diamond says American drug companies didn’t but the prime-and-spike method also produces those
pursue this approach, because “they wanted to use vigorous IgA antibodies in the mucosal layer. “And
known quantities,” such as the mRNA vaccines, which that’s much more advantageous because we can pre-
were already proving themselves in clinical trials in vent the virus from ever infecting the host,” she notes.
2020. As the pandemic took hold, there was little ap- The study suggests that this approach might also
petite to develop nasal vaccine technology to stimulate lessen the chances of transmitting the disease to others
mucosal immunity while the tried-and-true route of because of the lower overall viral load. Experiments
FROM OUR ARCHIVES
Nose Spray Vaccines shots in the arm was available and working. But now, in hamsters demonstrated that vaccinated animals
Could Quash COVID four years later, an inhaled vaccine using technology shed less virus, and they were less likely to contract
Virus Variants. similar to iNCOVACC’s is being developed for ap- COVID from infected cage mates that had not been
Marla Broadfoot; proval in the U.S. by biotech company Ocugen. Both vaccinated themselves.
ScientificAmerican.
com, May 3, 2022.
inhaled and nasal forms of the vaccine are set to un-
ScientificAmerican. dergo clinical trials as part of Project NextGen. These ALTHOUGH MOST OF THE NEW vaccine strategies are
com/archive new vaccines are using classical vaccine methods aimed at COVID, nasal vaccines for other diseases
are already being planned. Kaufmann, formerly of 30 percent of adults have some level of fear.” A review
Codagenix, says the company currently has clinical of studies of children showed that “concern around
trials underway for nasal vaccines against flu and pain and needle fear are barriers to vaccination in
RSV. CastleVax’s Egan says “we have plans to ad- about 8 percent of the general population and about
dress other pathogens” such as RSV and human 18 percent in the vaccine-hesitant population,” Mc-
metapneumovirus, another leading cause of respi- Murtry adds.
ratory disease in kids. Some people are wary of injected vaccines even if
Vaccines that don’t need to be injected could clear they’re not afraid of needles, Kett says; they see injec-
many barriers to vaccine access worldwide. “We saw tions as too invasive even if the needle doesn’t bother
with COVID there was no vaccine equity,” Smaill says. them. “We’re hopeful that something administered by
Many people in low-income countries never received the nasal route would be less likely to come across
a shot; they are still going without one four years after some of those issues,” Kett says.
the vaccines debuted. In the U.S., however, sprays and puffs won’t be
In part, this inequity is a consequence of the high available until they are approved by the Food and
cost of delivering a vaccine that needs to stay frozen Drug Administration, which requires clear evidence
on a long journey from manufacturing facilities in of disease protection. As Diamond points out, stan-
wealthy countries. Some of the nasal sprays in devel- dards for such evidence are well established for injec-
opment don’t need deep-cold storage, so they might tions, and vaccine makers can follow the rule book:
be easier to store and transport. And a nasal spray or regulations point to particular antibodies and spe-
an inhaled puff would be much easier to administer cific ways to measure them with a simple blood test.
than a shot. No health professional is required, so But for nasal vaccines, Iwasaki says, “we don’t have
people could spray it into their noses or mouths a standard way to collect nasal mucus or measure an-
at home. tibody titers. All these practical issues have not been
For these reasons, needle-free delivery matters to worked out.”
the World Health Organization. The WHO is using Iwasaki is also frustrated with a restriction by the
the Codagenix nasal spray in its Solidarity Trial Vac- U.S. Centers for Disease Control and Prevention that
cines program to improve vaccine equity. The CoviLiv stops researchers from using existing COVID vaccines
spray is now in phase 3 clinical trials around the world in basic research to develop new nasal sprays. The rule
as part of this effort. “The fact that the WHO was still is a holdover from 2020, when COVID injections
interested in a primary vaccination trial in the geog- had just been developed and were in short supply;
raphies it’s passionate about—that’s indicative that people had to wait to get vaccinated until they were
there is still a gap,” Kaufmann says. CoviLiv was eligible based on factors such as age and preexisting
co-developed with the Serum Institute of India, the conditions. “That made sense back then, but those
world’s largest maker of vaccines by dose. The part- concerns are years old; things are different now,” Iwa-
nership enabled production at the high volume re- saki says. “Now we have excess vaccine being thrown
quired for Solidarity. out, and we cannot even get access to the waste, the
The CastleVax vaccine with the NDV vector pro- expired vaccine.”
vides another layer of equity because the facilities re- Today scientists want to contrast the effectiveness
quired to make it already exist in many low- and mid- of nasal formulations with injections already in use.
dle-income countries. “The cool thing is that NDV is “Those comparisons are really important for convinc-
a chicken virus, so it grows very well in embryonated ing the FDA that this is a worthy vaccine to pursue,”
eggs—that’s exactly the system used for making flu Iwasaki says. But the restriction has held up studies by
vaccines,” Krammer says. For example, for a clinical her company, Xanadu, slowing down work. (The CDC
trial in Thailand, “we just shipped them the seed virus, did not respond to a request for comment.)
and then they produced the vaccine and ran the clini- Despite the bureaucratic and scientific hurdles, the
cal trials,” he says. Many countries around the world sheer number of nasal vaccines now in clinical trials
have similar facilities, so they will not need to depend encourages Iwasaki and other scientists pursuing the
on pharma companies based in richer places. needle-free route. They say it seems like only a matter
Even high-income countries face barriers to vacci- of time before getting vaccinated will be as simple as
nation, although they may be more personal than sys- a spritz up the nose.
temic. For very many people, the needle itself is the Velasquez, for one, can’t wait for that day to arrive.
problem. Extreme phobia such as Velasquez’s is un- The circumstances that finally forced her to reckon
common, but many people have a general fear of nee- with her fear of needles (a global pandemic, the pros-
dles that makes vaccinations stressful or even impos- pect of parenthood and the numerous blood tests that
sible for them. For about one in 10 people needle-re- accompanied her pregnancy) were so much bigger
lated fear or pain is a barrier to vaccinations, says C. than her. If not for them, she might still be avoiding
Meghan McMurtry, a psychologist at the University of shots. “So having vaccines without needles—I would
Guelph in Ontario. Needle fear “is present in most get every vaccine any doctor wanted me to get, ever. It
young kids and in about half of adolescents. And 20 to would be a complete game changer for me.”

COSMOLOGY
Cosmic
Confusion
Measurements of the universe don’t agree
on how fast it’s expanding. Could an extra
ingredient in the early cosmos explain the gap?
BY MARC KAMIONKOWSKI AND ADAM G. RIESS
ILLUSTRATION BY CHRIS GASH

Marc Kamionkowski
F
is a theoretical physicist
IFTEEN YEARS AGO COSMOLOGISTS WERE FLYING HIGH.
The simple but wildly successful “standard model of cos-
mology” could, with just a few ingredients, account for
a lot of what we see in the universe. It seemed to explain
the distribution of galaxies in space today, the acceler-
ated expansion of the universe and the fluctuations in the brightness of
the relic glow from the big bang—called the cosmic microwave background
(CMB)—based on a handful of numbers fed into the model. Sure, it
contained some unexplained exotic features, such as dark matter and
dark energy, but otherwise everything held together. Cosmologists were
(relatively) happy.
Over the past decade, though, a pesky inconsisten- The two of us have been deeply involved in this
at Johns Hopkins
University, where cy has arisen, one that defies easy explanation and may saga. One (Riess) is an observer and co-discoverer of
he studies cosmology portend significant breaks from the standard model. dark energy, one of the last pieces of the standard cos-
and particle physics. The problem lies with the question of how fast space mological model. He has also spearheaded efforts to
is growing. When astronomers measure this expan- determine the Hubble constant by observing the local
Adam G. Riess
is an astrophysicist sion rate, known as the Hubble constant, by observing universe. The other (Kamionkowski) is a theorist who
at Johns Hopkins supernovae in the nearby universe, their result dis- helped to figure out how to calculate the Hubble con-
University and the agrees with the rate given by the standard model. stant by measuring the CMB. More recently he helped
Space Telescope This “Hubble tension” was first noted more than 10 to develop one of the most promising ideas to explain
Science Institute.
His research on distant years ago, but it was not clear then whether the dis- the discrepancy—a notion called early dark energy.
supernovae revealed crepancy was real or the result of measurement error. One possibility is that the Hubble tension is telling
that the expansion With time, however, the inconsistency has become us the baby universe was expanding faster than we
of the universe is accel- more firmly entrenched, and it now represents a major think. Early dark energy posits that this extra expan-
erating, a discovery
for which he shared
thorn in the side of an otherwise capable model. The sion might have resulted from an additional repulsive
the 2011 Nobel Prize latest data, from the James Webb Space Telescope force that was pushing against space at the time and has
in Physics. ( JWST), have made the problem worse. since died out.
This suggestion is finally facing real-world tests, as
experiments are just now becoming capable of mea-
One possible explanation is that
suring the kinds of signals early dark energy might
have produced. So far the results are mixed. But as new
the Hubble tension is telling us
data come in over the next few years, we should learn the baby universe was expanding
more about whether the expansion of the cosmos is
diverging from our predictions and possibly why. faster than we think.
THE DDEA THAT THE UNDVERSE is expanding at all came to be compatible with the value the standard model
as a surprise in 1929, when Edwin Hubble used the predicts based on CMB data: 67.5 ± 0.5 km/s/Mpc.
Mount Wilson Observatory near Pasadena, Calif., to
show that galaxies are all moving apart from one another. THE LOCAL MEASUREMENTS are largely based on ob-
At the time many scientists, including Albert Einstein, servations of supernovae in a certain class, type Ia, that
favored the idea of a static universe. But the separating all explode with a similar energy output, meaning they
galaxies showed that space is swelling ever larger. all have the same intrinsic brightness, or luminosity.
If you take an expanding universe and mentally Their apparent luminosity (how bright they appear in
rewind it, you reach the conclusion that at some finite the sky) is a proxy for their distance from Earth. And
time in the past, all the matter in space would have comparing their distance with their speed—which we
been on top of itself—the moment of the big bang. The get by measuring their redshift (how much their light
faster the rate of expansion, the shorter the time be- has been shifted toward the red end of the electromag-
tween that big bang and today. Hubble used this logic netic spectrum)—tells us how fast space is expanding.
to make the first calculation of the Hubble constant, Astronomers calibrate their type Ia supernova dis-
but his initial estimate was so high that it implied the tance measurements by comparing them with values
universe was younger than the solar system. This was for nearby galaxies that host both a supernova of this
the very first “Hubble tension,” which was later re- type and at least one Cepheid variable star—a pulsating
solved when German astronomer Walter Baade dis- supergiant that flares on a timescale tightly correlated
covered that the distant galaxies Hubble used for his to its luminosity, a fact discovered a century ago by
estimate contained different kinds of stars than the Henrietta Swan Leavitt. Scientists in turn calibrate this
nearby ones he used to calibrate his numbers. period-luminosity relation by observing Cepheids in
A second Hubble tension appeared in the 1990s as very nearby galaxies whose distances we can measure
a result of sharpening observations from the Hubble geometrically through a method called parallax. This
Space Telescope. The observatory’s measured value of step-by-step calibration is called a distance ladder.
the Hubble constant implied that the universe’s oldest Twenty-five years ago a landmark measurement of
stars were older than stellar-evolution theories sug- this kind came out of the Hubble Key Project, resulting
gested. This tension was resolved in 1998 with the in a Hubble constant measurement of H 0 = 72 ±
discovery that the expansion of the cosmos was accel- 8 km/s/Mpc. About a dozen years ago this value im-
erating. This shocking revelation led scientists to add proved to 74 ± 2.5 km/s/Mpc, thanks to work by two
dark energy—the energy of empty space—to the stan- independent groups (the SH0ES team, led by Riess,
dard model of cosmology. Once researchers under- and the Carnegie Hubble Program, led by Wendy L.
stood that the universe is expanding faster now than Freedman of the University of Chicago). In the past few
it did when it was young, they realized it had to be years these measurements have been replicated by
several billion years older than previously thought. many studies and further refined with the aid of the
Since then, our understanding of the origin and European Space Agency Gaia parallax observatory to
evolution of the universe has changed considerably. We 73 ± 1. Even if we replace some of the steps in the par-
can now measure the CMB—our single greatest piece allax-Cepheid-supernova calibration sequence with
of evidence about cosmic history—with a precision other estimates of stellar distances, the Hubble con-
unimaginable at the turn of the millennium. We have stant changes little and cannot be brought below about
mapped the distribution of galaxies over cosmic vol- 70 km/s/Mpc without uncomfortable contrivances or
umes hundreds of times larger than we had then. Like- jettisoning most of the Hubble Space Telescope data.
wise, the number of supernovae being used to measure Even this lowest value, though, is far too large com-
the expansion history has reached several thousand. pared with the number inferred from the CMB to be
Yet our estimates of how fast space is growing still chalked up to bad luck.
disagree. For more than a decade increasingly precise Astronomers have worked through a long list of pos-
measurements of the Hubble constant based on the sible problems with the supernova distances and sug-
local universe, made without reference to the standard gested many follow-up tests, but none have revealed a
model and therefore directly testing its accuracy, have flaw in the measurements. Until recently, one of the re-
converged around 73 kilometers per second per mega- maining concerns involved how we determine Cepheid
parsec (km/s/Mpc) of space, plus or minus 1. This fig- brightness in crowded fields of view. With the Hubble
ure is too large, and its estimated uncertainty too small, Space Telescope, some of the light from any given Cephe-

The Hubble METHOD 1: DISTANCE LADDERS
Constant To find out how quickly the universe is expanding, scientists need to know two things: how fast galaxies are moving
away from us and how far away they are. The first quantity is fairly easy to measure with “redshift”—the amount the
galaxy’s light has been shifted toward the red end of the electromagnetic spectrum by the Doppler effect. But figuring
Problem out distance is trickier.
Ever since Edwin Hubble dis-
covered in 1929 that the uni- INVERSE-SQUARE LAW
verse was expanding, scien- This rule tells us that when the distance
tists have wanted to know from a light-emitting object is doubled, its
brightness decreases by a factor of four. Star
how fast. But the latest mea-
Thus by knowing how luminous something
surements present a puzzle.
is inherently and comparing that with how
One way of calculating the bright it appears, we can measure its
cosmic expansion rate, known distance. Special cosmic objects known as
as the Hubble constant, is by standard candles all have the same
looking at the relatively nearby intrinsic brightness as others in their class.
objects in the universe using These include periodically brightening
what’s called a distance lad- stars called Cepheids and so-called type 4 3 2 1 Distance
der. The other method involves Ia supernova explosions. Scientists
studying the faraway light left calibrate their distance measurements
using ladders with three rungs. 6.25% 11.1% 25% 100% Light intensity
over from the big bang, called
the cosmic microwave back-
ground (CMB), and using the FIRST RUNG SECOND RUNG THIRD RUNG
standard model of cosmology The first starts with Astronomers then look at farther Researchers can then compare the brightness
to extrapolate the current Cepheids that are close Cepheids in other galaxies and of even more distant type Ia supernovae to
expansion rate. Over the years enough that scientists compare their apparent brightness determine their positions. When astronomers
the two methods have become can triangulate their with that of the known nearby ones combine these with redshifts, they get
increasingly precise, yet they position by observing to measure their distances. They distance and speed measurements for
deliver irreconcilable rates. them at different points can apply these distances to type Ia increasingly faraway galaxies, allowing them
along Earth’s orbit. supernova in the same galaxies. to calculate the Hubble constant.
Cepheid in nearby galaxy Type Ia supernova

in distant galaxy
Sun
Cepheid in Milky Way Type Ia supernova in same

Earth nearby galaxy as Cepheid
id star overlapped with light from other stars close to it, be similar. This pattern is a consequence of how sound
so scientists had to use statistics to estimate how bright spread in the early universe.
the Cepheid was alone. Recently, however, JWST allowed During the first roughly 380,000 years after the big
ESA and the Planck Collaboration; NASA/WMAP Science Team ( CMB images)
us to reimage some of these Cepheids with dramatically bang, space was filled with a plasma of free protons,
improved resolution. With JWST, the stars are very electrons and light. At around 380,000 years, though,
cleanly separated with no overlap, and the new measure- the cosmos cooled enough that electrons could com-
ments are fully consistent with those from Hubble. bine with protons to form neutral hydrogen atoms for
the first time. Before then electrons had zoomed freely
THE METHOD FOR INFERRING the Hubble constant through space, and light couldn’t travel far without
from the CMB is a bit more involved but is based on hitting one. Afterward the electrons were bound up in
similar principles. The intensity of the CMB light is atoms, and light could flow freely. That initial release
very nearly the same everywhere in space. Precise of light is what we observe as the CMB today.
measurements show, however, that the intensity var- During those first 380,000 years, small changes in the
ies from one point to another by roughly one part in density of the electron-proton-light plasma that filled
100,000. To the eye, this pattern of intensity varia- space spread as sound waves, just as sound propagates
tions appears fairly random. Yet if we look at two through the air in a room. The precise origin of these
points that are separated by around one degree (about sound waves has to do with quantum fluctuations during
two full moons side by side on the sky), we see a cor- the very early universe, but we think of them as noise left
relation: their intensities (temperatures) are likely to over from the big bang. A cosmological sound wave trav-
METHOD 2: COSMIC MICROWAVE BACKGROUND MEASUREMENTS A Sampling of Hubble Constant Estimates,
The CMB light is mostly uniform but contains small variations in temperature from Organized by Measuring Method
point to point. A pattern in these variations reflects how far sound waves could Kilometers per second per 3.26 million light-years
spread when the CMB was created, which in turn can be used to figure out how
far the CMB has traveled to reach us. This information, combined with the 65 70 75 80
standard model of cosmology, predicts the Hubble constant. Increasingly sharp
observations of the CMB, from the WMAP satellite in 2012 to the Planck DISTANCE VS. REDSHIFT RELATIONS
spacecraft in 2018, have provided increasingly precise estimates of the constant. Methods centered on Cepheids
and type Ia supernovae
Method centered on stars in the Error bars

tip of the red-giant branch
Variations (including single-rung

ladders with Miras, Masers
and type II supernovae)
Beyond (including surface

brightness fluctuations,
HIl galaxies and galaxy mass)
COSMIC MICROWAVE BACKGROUND MEASUREMENTS

WMAP
South Pole Telescope (SPT)
WMAP Census Planck Census
Atacama Cosmology Telescope (ACT)
WMAP + SPT
WMAP + ACT
Planck
Distance ladder and

CMB estimate bands
RESULTS
Over the years the distance ladder measurements of the Hubble constant
have converged at a value of 73 ± 1 kilometers per second per megaparsec
(km/s/Mpc). The CMB method, on the other hand, gives an estimate of
67.5 ± 0.5 km/s/Mpc. The two values are too far apart to explain. Perhaps
there is some overlooked error in the methods, or maybe they are telling us
our cosmological model is incomplete.
els a distance determined by the speed of sound in a me- universe’s expansion—the Hubble constant. The stan-
dium multiplied by the time since the big bang; we call dard model of cosmology predicts a physical length for
this distance the sound horizon. If there happened to be the sound horizon based on the gravitationally attract-
a particularly “loud” spot somewhere in the universe at ing ingredients of the early universe: dark matter, dark
the big bang, then it will eventually be “heard” at any energy, neutrinos, photons and atoms. By comparing
point that is a sound horizon away. When the CMB light this length with the measured angular length of the hori-
was released at 380,000 years, it was imprinted with the zon from the CMB (one degree), scientists can infer a
arXiv preprint; November 22, 2023 (Hubble constant data)
intensity of the soundscape at that point. The one-degree value for the Hubble constant. The only problem is that
scale correlation in the CMB intensity thus corresponds this CMB-inferred value is smaller, by about 9 percent,
Source: “A Tale of Many H 0 ,” by Licia Verde et al.,
to the angular size of the sound horizon at that time. than the number we obtain by using supernovae.
That scale is determined by the ratio of the sound
horizon to the distance to the “surface of last scatter”— AD THE CMB-DNFERRED VALUE turned out to be
essentially, how far light has traveled since it was freed
when the CMB was released (the moment electrons
were all bound up in atoms, and light could travel freely
H larger than the local value, we would have had a
fairly obvious explanation. The distance to the
surface of last scatter also depends on the nature of
for the first time). If the expansion rate of the universe dark energy. If the dark energy density is not precisely
is larger, then that distance is smaller, and vice versa. constant but decreases slowly with time (as some mod-
Astronomers can therefore use the measurement els, such as one called quintessence, propose), then the
of the sound horizon to predict the current rate of the distance to the surface of last scatter will be decreased,
Graphics by Jen Christiansen NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 47

bringing the CMB-based value of the Hubble constant
Early Dark Energy down to the value observed locally.
One way to reconcile the differing measurements of the Hubble constant Conversely, if the dark energy density were slowly
is to add an extra component to the universe. One example is “early dark increasing with time, then we would infer from the CMB
energy,” a hypothetical field spread throughout space. When the universe was a larger Hubble constant, and there would be no tension
young, this field would have had a large energy density and a strong effect with the supernova measurements. Yet this explanation
on space, causing it to expand faster than it otherwise would have. Today, requires that energy somehow be created out of noth-
though, its energy density would be much smaller and its effects negligible. ing—a violation of energy conservation, which is a sa-
cred principle in physics. Even if we are perverse enough
to imagine models that don’t respect energy conserva-
tion, we still can’t seem to resolve the Hubble tension.
The reason has to do with galaxy surveys. The distribu-
Inflation
tion of galaxies in the universe today evolved from the
distribution of matter in the early cosmos and thus ex-
hibits the same sound-horizon bump in its correlations.
Big Bang The angular scale of that correlation also allows us to
infer distances to the same types of galaxies that host
supernovae, and these distances (using the same sound
horizon as employed for the CMB) give us a low value of
Cosmic Microwave Background
Today
the Hubble constant, consistent with the CMB.
380,000 years after the big bang
13.8 billion years We’re left to conclude that “late-time” solutions for
after the the Hubble tension—those that attempt to alter the re-
big bang lation between the Hubble constant and the distance to
the CMB surface of last scattering—don’t work or at
Redshift Value
least are not the whole story. The alternative, then, is to
10,000,000 100,000 1,000 100 10 1
surmise that there may be something missing in our
understanding of the early universe that leads to a small-
Energy Density
Very high
er sound horizon. Early dark energy is one possibility.
KAMIONKOWSKI AND HIS THEN GRADUATE student

Tanvi Karwal were the first to explore this idea in 2016.
The expansion rate in the early universe is determined
Radiation
by the density of all the matter in the cosmos at the time.
In the standard cosmological model, this includes pho-
Very low
tons, dark energy, dark matter, neutrinos, protons,

electrons and helium nuclei. But what if there were
some new component of matter—early dark energy—
that had a density roughly 10 percent of the value for
Energy Density
Very high
everything else at the time and then later decayed away?

The most obvious form for early dark energy to take
is a field, similar to an electromagnetic field, that fills
space. This field would have added a negative-pres-
sure energy density to space when the universe was
Matter young, with the effect of pushing against gravity and
propelling space toward a faster expansion. There are
Very low
two types of fields that could fit the bill. The simplest

option is what’s called a slowly rolling scalar field. This
field would start off with its energy density in the form
of potential energy—picture it resting on top of a hill.
Energy Density
Very high
ESA and the Planck Collaboration (CMB image)
Over time the field would roll down the hill, and its
potential energy would be converted to kinetic energy.
Kinetic energy wouldn’t affect the universe’s expan-
sion the way the potential energy did, so its effects
wouldn’t be observable as time went on.
Early Dark Energy A second option is for the early dark energy field to
Very low
oscillate rapidly. This field would quickly move from

potential to kinetic energy and back again, as if the field
were rolling down a hill, into a valley, up another hill
and then back down again over and over. If the starting
Side-by-side photo-
graphs of a Cepheid star
in NGC 5468, a galaxy at
Webb Near-IR Hubble Near-IR the far end of the Hub-
ble Space Telescope’s
range, as taken by the
James Webb Space
Telescope (JWST) and
the Hubble, show how
much sharper the new
observatory’s imaging
is. The JWST data con-
firmed that distance
measurements from
Hubble were accurate,
despite the blurring
of Cepheids with sur-
rounding stars in the
Hubble data.
potential is chosen correctly, then the average leads to most of the results seem to be converging toward the
an overall energy density with more potential energy standard cosmological model. Even so, the jury is still
than kinetic energy—in other words, a situation that out: a broad array of imaginable early dark energy
produces negative pressure against the universe (as models remain viable.
dark energy does) rather than positive pressure (as or- Many theorists think it may be time to explore other
dinary matter does). This more complicated oscillating ideas. The problem is that there aren’t any particularly
scenario is not required, but it can lead to a variety of compelling new ideas that seem viable. We need some-
interesting physical consequences. For instance, an os- thing that can increase the expansion of the young
cillating early dark energy field might give rise to parti- universe and shrink the sound horizon to raise the
cles that could be new dark matter candidates or might Hubble constant. Perhaps protons and electrons some-
provide additional seeds for the growth of a large cos- how combined differently to form atoms at that time
mic structure that could show up in the later universe. than they do now, or maybe we’re missing some effects
After their initial suggestion of early dark energy in of early magnetic fields, funny dark matter properties
2016, Kamionkowski and Karwal, along with Vivian or subtleties in the initial conditions of the early uni-
Poulin of the French National Center for Scientific Re- verse. Cosmologists will agree that simple explana-
search (CNRS) and Tristan L. Smith of Swarthmore tions continue to elude us even as the Hubble tension
College, developed tools to compare the model’s predic- becomes more firmly embedded in the data.
tions with CMB data. It’s hard to depart much from the To progress, we must continue to find ways to scru-
standard cosmological model when we have such precise tinize, check and test both local and CMB-inferred
measurements of the CMB that so far match the model values of the Hubble constant. Astronomers are devel-
very well. We figured it was a long shot that early dark oping strategies for gauging local distances to augment
energy would actually work. To our surprise, though, the the supernova-based approaches. Measurements of
analysis identified classes of models that would allow a distances to quasars based on radio-interferometric
higher Hubble constant and still fit the CMB data well. techniques, for instance, are advancing, and there are
This promising start led others to create a prolifer- prospects for using fluctuations in galaxy-surface
ation of variants of early dark energy models. In 2018 brightness. Others are trying to use type II supernovae
NASA, ESA, CSA, STScI, Adam G. Riess/JHU, STScI
these models fared about as well as the standard model and different kinds of red giant stars to measure dis-
in matching CMB measurements. But by 2021 new, tances. There are even proposals to use gravitation-
higher-resolution CMB data from the Atacama Cos- al-wave signals from merging black holes and neutron
mology Telescope (ACT) seemed to favor early dark stars. We are also intrigued by the potential to deter-
energy over the standard model, which drew even mine cosmic distances with gravitational lensing.
more scientists toward the idea. In the past three years, Although current results are not yet precise enough
however, more measurements and analysis from ACT, to weigh in on the Hubble tension, we expect to see FROM OUR ARCHIVES
as well as from the South Pole Telescope, the Dark En- great progress when the Vera C. Rubin Observatory The Puzzle of Dark
Energy. Adam G. Riess
ergy Survey and the Dark Energy Spectroscopic Instru- and the Nancy Grace Roman Space Telescope come and Mario Livio;
ment, led to more nuanced conclusions. Although online. For now we have no good answers, but lots of March 2016. Scientific
some analyses keep early dark energy in the running, great questions and experiments are underway. American.com/archive


TIME
Should
We
Abandon
the
Leap
Second?
We have been adding “leap seconds” to time
kept by our atomic clocks, but soon we may have
Mark Fischetti
is a senior editor
for sustainability at
Scientific American.
to subtract one. Are the tiny adjustments
worth the bother? Matthew Twombly
is a freelance illustrator
TEXT BY MARK FISCHETTI and infographic designer
(www.matthew
ILLUSTRATION AND GRAPHICS BY MATTHEW TWOMBLY twombly.com).

clocks are off by a second or even off by one minute, which they are
estimated to be a century from now if we do nothing until then? In
our highly digitized world, does the exact length of the rotational
day even matter?
Earth rotates because our solar system condensed from a ro-
tating cloud of gas and dust. Outer space provides virtually zero
drag, so the planets, including Earth, just keep spinning. As Earth
turns, the gravitational pull between it and the moon, and to a
lesser degree the sun, creates ocean tides. As tides grind across the
seafloor, they create friction, which gradually slows the planet’s
rotation. Back in the dinosaur era, a day was about 23.5 hours long;
since then, tidal friction has extended it.
The gravitational pull of the

moon and sun generates
Earth’s tides, which create
friction that gradually slows Tidal bulge
DECREASES
the planet’s rotation. CITY
ELO
ONG AGO WE HUMANS defined a day V
L
AL
N
IO
as the time it takes Earth to make
AT
ROT
Moon’s path
one rotation about its axis, with one
sunrise and one sunset. Our prede-
cessors partitioned that day into
24 hours. But if Earth’s rotation slows
down a little, it takes a bit longer than one
day to complete it. That has been happening
for many years. Because the atomic clocks
we use to pace everything from Internet Studies of seismic waves show that Earth has a solid inner core
and a liquid outer core, which are wrapped by a solid mantle and
communications to GPS apps to automated crust. Currents in the outer core cause the mantle to rotate faster
stock trades never slow down, global time- or slower in any given year, but over centuries the changes tend to
cancel out, making tidal slowing the prevailing trend.
keepers periodically have added a leap
second to the clocks to keep them in sync
Currents in Earth’s
with Earth. Since 1972 we have made this molten outer core
cause the mantle
awkward addition 27 times. to rotate faster or
slower over time.
For the first time, however, we may have to subtract a leap sec-
ond because since around 1990 Earth’s rotation has been speeding
up, counteracting the slowdown and shortening the day. There
are two explanations for why, which I’ll explain ... in a second.
The reversal has many people asking why we should bother
with leap seconds at all. Each time an adjustment is needed, a
Solid inner core
mind-boggling number of computers and telecom operations
have to be changed. On a regular day, the National Institute of Liquid outer core
Standards and Technology, which keeps atomic time for the U.S. Solid mantle
and crust
and synchronizes most of the world’s computers, receives more
than 100 billion time-coordination requests from up to a billion
computers. And leap-second adjustments can create problems.
An addition in 2012 was blamed for Reddit suddenly going dark
and for foiling operational systems at Qantas Airways, leading to
long flight delays across Australia.
What if we just ignored the fact that Earth’s rotation and atomic
Tidal slowing is consistent, but Earth’s rotational speedup has speedup will overtake the tidal slowdown. According to a recent
been counteracting that trend, and the time between added leap study, this counterforce means we won’t have to subtract a leap
seconds has been getting longer, from about a year in the 1970s to second until 2029.
three or four years in the 2010s.
Meltwater from the

poles spreads out over Polar ice
Leap Seconds Added Since 1972
Each black bar represents a second added the oceans, moving
mass a little farther
from Earth’s axis
of rotation.
Meltwater
1975 1980 1985 1990 1995 2000 2005 2010 2015 2020
ROTATIO S
NAL VELOCITY DECREASE
Calculations indicated that by 2026 the ongoing speedup
would overtake the slowdown, and we would have to subtract a
leap second.
But now global warming is complicating that projection. As
the massive ice sheets across the North and South Poles melted at
the end of the most recent ice age, the weight of that ice decreased,
and the crust that had been compressed underneath it began to
rebound, which it is still doing today. That has made Earth more Given so many vagaries, it’s reasonable to ask if we should add
spherical. (The planet is not a perfect sphere; it’s slightly wider or subtract leap seconds at all. And because tidal slowing will al-
around the equator.) The change in shape means Earth’s overall ways be the long-term trend, we may never again need to subtract
mass is distributed a little closer to its axis of rotation, speeding a second, so why go through the trouble one time? Few computer
its movement in the same way that ice skaters spin faster when programs are written to allow for a negative leap second.
pulling in their outstretched arms. Reverence for the rotational day may be the only reason to keep
atomic time in sync with it. If the two time stamps diverge, “for
most people, there are no real ramifications,” says Duncan Carr
Melting ice sheets have Crust Agnew, a geophysicist at the Scripps Institution of Oceanography,
lessened weight on the crust, rebounds
which has been rebounding, who wrote the 2024 Nature paper projecting a negative leap sec-
moving Earth’s mass a little ond in 2029. Rather than advocating for frequent and random
closer to its axis of rotation. adjustments of a second, Agnew favors the idea of waiting a cen-
Glacial tury, then making one big adjustment because preparations could
depression
Ice caps melt be made well ahead of time.
This idea has had support for a while. In 2022 parties to the
Jen Christiansen (timeline); Source: Time Service Department, U.S. Naval Observatory (timeline data)
international General Conference on Weights and Measures voted

to stop making leap-second adjustments by 2035. After that, time-
keepers might agree to a fix every 20 years or perhaps every 100.
Whatever the choice, “we want consistency,” says physicist Eliz-
abeth Donley, chief of the time and frequency division at NIST.
Mass redistributed “Time is the most important unit in the international system of
units; a lot of other standards depend on it.”
Some large Internet providers already follow their own proto-
ROTATION cols. Rather than waiting for any leaps, Google “smears” its clocks
AL VELOCITY INCREASES
by thousandths of a second once every day. Such independent efforts
don’t seem to cause any global discontinuities, but if more and more
large entities start winging it, “that becomes anarchy,” Donley says.
Waiting decades for a well-planned adjustment means astro-
nomical (rotational) time, known as UT1, will diverge more widely
from the coordinated universal time (UTC) that is based on atomic
clocks. But Donley doesn’t think problems will arise. “Computer
As ice sheets warm, however, the meltwater spreads out networks,” she says, “don’t care where the sun is in the sky.”
across the global ocean, and most of the ocean is at lower lati-
tudes, farther from the rotation axis than the ice caps are. That FROM OUR ARCHIVES
slows the spin (the skaters extending their arms outward). For How Measuring Time Shaped History. Clara Moskowitz; ScientificAmerican.com,
now this effect is stronger, delaying how soon the rotational January 28, 2022. ScientificAmerican.com/archive

A SPECIAL REPORT FROM SCIENTIFIC AMERICAN
INNOVATIONS IN
SOLUTIONS FOR
HEALTH EQUITY
7.1
7.
7.1 inches
.1 iin
nc
nch
ch
hes
es w
wide
iid
d
de
e by
by 8
8.3
.3
3 iinches
nch
nche
es hi
h
high
ig
gh
h
PRODUCED WITH SUPPORT FROM TAKEDA PHARMACEUTICALS
Illustrations by Luisa Jung NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S1

INNOVATIONS IN SOLUTIONS FOR HEALTH EQUITY
SPECIAL REPORT
S3 BETTER MEASURES
Health Equity Progress
New devices, formulas and tools THE COUNTRY SOMEONE IS BORN INTO has a lifelong effect on their health.
are removing historical bias from So does the neighborhood they live in, the color of their skin, their income
medical diagnoses. and their level of social support. It’s unjust. After centuries of persistent
BY CASSANDRA WILLYARD health disparities, researchers, advocates, clinicians and public health
experts are finding ways to improve health for everyone.
S6 RURAL PRESCRIPTIONS New advances sometimes exaggerate inequities before helping reduce them.
Some of the most innovative solutions But there are reasons for optimism, which journalist Anil Oza shares on page S16.
for health care come from rural regions More than almost any other development, vaccines have advanced health equity
around the world. around the world. They have averted 154 million deaths over the past 50 years,
BY CARRIE ARNOLD a life saved every 10 seconds, as health writer Tara Haelle explains on page S10,
S10 THE STAGGERING with graphics on pages S12–S13. Collaborative campaigns have brought this
SUCCESS OF VACCINES powerful preventive health care to children in even the most impoverished
Vaccines have been aiding health equity regions. Writer Carrie Arnold on page S6 shows how rural areas around the
for 200 years, and today they are poised to world are benefiting from other inventive and resourceful ways to deliver
save even more lives from more diseases. needed care—from telemedicine to micro clinics to a traveling dialysis bus.
BY TARA HAELLE Researchers are working to remove racial bias that has been built into diag-
nostics, and by doing so they’re changing not just tools and algorithms but lives.
S16 OF HOPE AND JUSTICE As journalist Cassandra Willyard writes on page S3, some Black patients once
AS TOLD TO ANIL OZA deemed ineligible for new kidneys, despite having the same laboratory results as
S18 CULTURAL COMPETENCY white patients, are now moving up the wait list for transplant; others with respi-
A movement, which aims to help ratory issues might be able to file for disability after previously being judged
providers better understand their unqualified. Epidemiologists and other public health scientists are discovering
patients’ culture and language, that prior assumptions about race have lumped together disparate groups with
is gaining traction and hopes to different needs and health risks, particularly within Asian American communi-
improve care and save lives. ties [see graphic on page S23]. Now, by teasing apart the data, they are able to bet-
BY ROD MCCULLOM ter diagnose, treat and even prevent disease. Health writer Jyoti Madhusoodanan
on page S21 reveals how this data-driven approach is already saving lives.
S21 DEFOGGING DATA Certain diseases and conditions have been used to justify discrimination,
As researchers separate out health data especially when the disease is more prevalent in a group that’s already mar-
from culturally distinct groups, they’re ginalized. The people most at risk for mpox, for instance, are men who have
finding ways to reduce health disparities. sex with men—a community already hit hard by HIV/AIDS. But as global
BY JYOTI MADHUSOODANAN health expert Charles Ebikeme writes on page S25, researchers, clinicians
S25 HISTORY LESSONS and community members have learned from past experiences and are build-
Clinics and public health researchers are ing up existing networks and clinics that cater specifically to this stigmatized
taking direct aim at the mpox outbreak population. Even health-care communication is improving, writer Rod
by starting in local clinics and using tools McCullom shares on page S18, as the movement toward culturally sensitive
that were developed to tackle HIV/AIDS. care helps clinicians better understand and empathize with their patients.
BY CHARLES EBIKEME Improving health equity requires rethinking our global health infrastruc-
ture, and we are still at the beginning. But each solution adds support and
This report, published in Scientific American, is supported
by Takeda Pharmaceuticals. It was produced independently begins to build a path toward justice.
by the editors of Scientific American, who take sole —LAUREN GRAVITZ,
responsibility for the editorial content. CONTRIBUTING EDITOR
EDITORIAL
EDITOR IN CHIEF CREATIVE DIRECTOR COPY DIRECTOR MANAGING PRODUCTION EDITOR

Laura Helmuth Michael Mrak Maria-Christina Keller Richard Hunt
MANAGING EDITOR PHOTOGRAPHY EDITOR SENIOR COPY EDITOR PREPRESS AND QUALITY MANAGER
Jeanna Bryner Monica Bradley Angelique Rondeau Silvia De Santis
CHIEF FEATURES EDITOR SENIOR GRAPHICS EDITOR SENIOR COPY EDITOR PUBLISHER AND VP
Seth Fletcher Jen Christiansen Aaron Shattuck Jeremy A. Abbate
SENIOR EDITOR ASSOCIATE GRAPHICS EDITOR ASSOCIATE COPY EDITOR DIRECTOR, CONTENT PARTNERSHIPS
Josh Fischman Amanda Montañez Emily Makowski Marlene Stewart
CONTRIBUTING EDITOR
Lauren Gravitz
S2 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4
INNOVATIONS
IN
N NO
N OVA
VATI
TO ON
N S IN SOLU
SOLUTIONS
S
SOO LU
U TION
N S FOR HEALTH
HEAL
A TH
AL H EQUITY
E QU
U IT
TY
Better Measures wondered why this might be. “I said,

‘You’re right. That doesn’t make any
New devices, formulas and tools are removing historical sense,’” Hoenig recalls of the 2016 class-
room conversation.
bias from medical diagnoses BY CASSANDRA WILLYARD This value for kidney function, called
the estimated glomerular filtration rate
MELANIE HOENIG WAS TEACHING first- a kidney transplant than white people, but (eGFR), helps doctors figure out when to
year medical students how to estimate kid- the adjustment makes it seem as though send patients to a specialist, when to start
ney function when one of them, Cameron Black people have better kidney function dialysis, when they are eligible to join the
Nutt, raised his hand. Why, he asked, did than people of other races who have the wait list for a kidney transplant, and where
the diagnostic algorithm include an adjust- same test results. their name lands on that list. Adjusting the
ment for Black patients? In the U.S., Black Good question, thought Hoenig, a kid- algorithm for Black patients decreased their
people have higher rates of kidney disease ney specialist at Beth Israel Deaconess chances for treatment and transplant.
and kidney failure and are less likely to get Medical Center in Boston. She had never The equations and instruments doctors
NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S3

rely on are infused with historical bias. speculated. The study population was only unified way of diagnosing kidney disease.
Medicine has long treated race as though it 12 percent Black, yet the difference felt too “You could be at one hospital and have a di-
provides important information about the substantial to ignore. agnosis of kidney disease. You go down the
underlying biology and genetics of disease, To account for this difference, the re- street [to another hospital], and you
a strategy that has had an enormous impact searchers added an adjustment for Black wouldn’t have kidney disease,” Powe says.
on diagnosis and treatments. People have patients: a multiplication factor of up to 1.21, “That was just chaos.”
been passed over for kidney transplants, which essentially inflated their estimated In the summer of 2020 the National Kid-
denied therapies and diagnosed with dis- kidney function by as much as 21 percent. In ney Foundation and the American Society
eases later than necessary simply because 2009 the researchers published an updated of Nephrology formed a task force to assess
of the color of their skin. equation, but the Black correction factor re- how best to move forward. “They thought
Race is a social construct that reveals lit- mained, albeit lower, up to 1.16. “We always we’d solve it overnight, but it took us about
tle about ancestry. There is more genetic recognized that race was not the biological 10 to 11 months to churn through this,” says
variation within racial groups than between process by which African Americans dif- Powe, who co-led the task force. Ultimately
them. “The racial differences found in large fered from non–African Americans in the they chose an equation that used the same
datasets most likely often reflect effects of relationship between GFR and creatinine,” 2009 data but eliminated race as a variable,
racism—that is, the experience of being Andrew Levey, who worked to develop both then refit the curve to the whole dataset.
Black in America rather than being Black equations, later explained. But “it stood in A conversation about race was also hap-
itself,” researchers wrote in a 2020 New En- for something that was important.” pening at the Organ Procurement and
gland Journal of Medicine article outlining “The way the lab report was written Transplantation Network (OPTN), which
the dangers of race-adjusted algorithms. was, if your creatinine is a 4.0, your kidney manages transplants from deceased donors.
To undo this bias, researchers are chang- function is 19 percent. Oh, unless you’re The wait list for a kidney is long. Patients
ing the algorithms and instruments and African American; then it’s 22 percent,” aren’t eligible to join until they meet certain
finding new models to reduce disparities. says Martha Pavlakis, a nephrologist at criteria; these can vary at different trans-
Beth Israel Deaconess. “It makes no sense.” plant centers, but all candidates must have
IDNEYS FILTER WASTE and excess wa- In people with healthy kidneys, small dif- an eGFR of 20 percent or less. And because
K ter from the blood through tiny struc-

tures called glomeruli. Directly mea-
suring how well these glomeruli are func-
ferences don’t matter. But when kidney
function declines, eGFR, which decreases
as blood creatinine levels rise, becomes
of the eGFR correction factor, Black patients
needed higher creatinine levels than people
of other races to pass that threshold. “No-
tioning is possible but cumbersome, so crucial. That number helps to determine body who came up with the formula was
instead doctors rely on blood levels of a pro- whether a patient is referred to a nephrol- like, let’s keep Black people off the list. But
tein called creatinine, a waste product pro- ogist, diagnosed with kidney disease or that, in fact, was the result,” Pavlakis says.
duced by muscles and a by-product of pro- deemed eligible to join the wait list for a In July 2022 the race variable was explic-
tein metabolism, to estimate the glomerular kidney transplant. itly forbidden in organ allocation. Pavlakis
filtration rate (GFR). When kidneys are Hoenig began working with a small saw that as just the first step. She wanted to
working well, they filter out creatinine; if the group of students from Harvard Medical help Black patients already on the list and
kidneys start to fail, creatinine levels rise. School’s Racial Justice Coalition to lobby to those who had previously been denied entry
The protein is easy and inexpensive for lab- eliminate the correction factor, and in 2017 because of their kidney function numbers.
oratories to measure. Beth Israel Deaconess became the first med- In January 2023 the OPTN decided that
The first equation to assess kidney func- ical center to do so. Efforts elsewhere largely transplant centers should look back at the
tion, developed in the 1970s, relied on age, stalled until the deaths of George Floyd, Ah- lab reports of Black patients on the list and
sex, weight and creatinine levels in the maud Arbery and Breonna Taylor, three recalculate their eGFR using the race-neu-
blood. But the formula wasn’t precise. So, in Black Americans whose deaths made na- tral equation to see whether they should
the late 1990s, a team of researchers set out tional news. In the wake of their killings, have been referred for transplant. “Basical-
to develop a more accurate one. They used conversations about race rippled through- ly, half the Black patients on the transplant
existing data from a study of creatinine and out the medical community, Pavlakis says. list got extra priority added to their standing
GFR in more than 1,600 people, then cor- As protests erupted across the country, because of this project,” Pavlakis says.
related the two measurements. The team medical students and faculty at many major Pavlakis acknowledges that this change
looked at 16 different factors that might in- universities began to circulate petitions call- doesn’t fix every disparity in kidney alloca-
fluence the relationship. (We tend to lose ing for an end to the use of the racial correction. But she also sees it as restorative justice.
muscle mass as we age, for example, so older tion in eGFR. Some major academic health “It’s not perfect,” she says, but “I think it’s
people have lower creatinine levels than systems began removing race from the equa- probably the largest example of fixing a race
younger people.) The authors noted that for tion, but their approaches were inconsistent. disparity that is out there.”
any given GFR, creatinine was higher in Neil Powe, chief of medicine at Zuckerberg
Black people than in white people. Why that San Francisco General Hospital and Trauma PULMONOLOGISTS have been grappling
might be wasn’t clear. Maybe it was because Center, and other experts watched the with a similar problem. To assess lung func-
Black people had higher muscle mass, they changes unfold with concern. There was no tion, doctors ask patients to blow into a de-
vice called a spirometer, which measures the

maximum amount of air a person can exhale
“Half the Black patients on the transplant
and how much they can force out of their
lungs in a single second. The spirometer
list got extra priority added to their
compares those numbers with reference val- standing because of this project.”
ues for “normal” lung function. The results —Martha Pavlakis Beth Israel Deaconess Medical Center
help doctors diagnose diseases such as em-
physema and chronic obstructive pulmonary
disease, assess severity of those conditions tact with the outside world and continue The new equation comes from the same
and monitor declines in lung function. developing throughout childhood and into 2012 data as the original formula, and it isn’t
What constitutes “normal” varies by age, early adulthood, Niven says. “It’s impossible perfect. “We kind of settled on the race-neu-
sex, height and, until recently, race. Why to separate race from all of these other fac- tral equations we have now as the best cur-
race? Data collected in the late 1800s and tors that unfortunately are inexplicably rent option, knowing that in the future,
early 1900s suggested different races have linked to different populations within our something better might arise,” Baugh says.
different lung capacities, a phenomenon re- society, many of which are likely coloring
searchers ascribed to innate biology rather the changes in lung function that we see in MANRAI THINKS A LOT about how tradi-
than social, economic or environmental fac- different social groups.” tional algorithms operationalize race, ad-
tors. By the early 20th century the idea that In practice, the race-based model doesn’t justing what constitutes “normal” for any
lung capacity varied among racial groups seem to improve predictions when it comes particular patient, and how lessons from
was “an ostensible fact,” wrote Brown Uni- to outcomes that matter. “You can’t tell any those algorithms can be incorporated into
versity researcher Lundy Braun in a 2015 better who’s going to go to the hospital. You producing more sophisticated ma-
article on the historical use of race in spi- can’t tell any better who’s going to die. You chine-learning algorithms. “They can be
rometry. What experts missed was that race can’t tell any better who has severe symp- biased, and they can propagate the very
was probably a proxy for other factors, such toms and who doesn’t. And in some of those same sort of race-based medicine,” he says.
as air quality, nutrition, and other exposures, cases, you actually worsen your ability to “But they’re a tool, and the tool can also be
that affect lung health and development. predict by adding race,” says Aaron Baugh, used in the reverse direction: to mitigate ex-
When the European Respiratory Soci- a pulmonary and critical care physician at isting disparities and to potentially reduce
ety’s Global Lung Function Initiative devel- the University of California, San Francisco. existing biases in the health-care system.”
oped reference values for spirometry in In 2023 the Global Lung Function Initia- One example of how AI might help im-
2012, it used more than 160,000 spirometry tive replaced race-based equations with a prove health equity is evident in research on
results from 33 countries. Researchers ob- race-neutral equation. That same year the disparities in knee pain. Previous studies
served “proportional differences in pulmo- American Thoracic Society and the European have shown that Black people routinely re-
nary function between ethnic groups” and Respiratory Society recommended all health- port more intense knee pain from arthritis
decided to develop separate values for four care providers switch to the new formula. than people of other races. But often that
groups: Caucasian, African American, That shift is happening now, and re- pain can’t be explained by the structural
North Asian and Southeast Asian. They also searchers are just beginning to uncover the damage visible in x-rays. As a result, it is of-
used an “other” category for people who broad impact of this change. “Long story ten dismissed or attributed to external fac-
didn’t fit elsewhere. The model assumes short, it’s profound,” says Arjun Manrai, a tors such as psychological stress.
that, compared with white adults, Black bioinformatics researcher at Harvard Med- Emma Pierson, who studies machine
adults have about 10 to 15 percent smaller ical School. Lung function helps to deter- learning and health-care inequities at Cor-
lung capacity and that adults of Asian ances- mine disability payments, candidacy for nell University, and her colleagues wanted
try have 4 to 6 percent smaller lung capacity. some professions, priority for lung trans- to understand whether there might be
So the same spirometry results in Black, plants, and more. Manrai and his colleagues physical signs in the knee itself that could
Asian and white people led to different in- found that some 10 million people in the U.S. explain this pain disparity. They used knee
terpretations of health. As a result, lung dis- would have their diagnosis or the severity of radiographs and patient pain scores from
eases in certain populations have gone undi- their disease reclassified. Disability pay- more than 4,000 people who had osteoar-
agnosed and untreated. ments could increase by more than $1 bil- thritis or were at risk of developing it to
The division of reference values by race lion. Such changes are not always beneficial. train a machine-learning model.
is problematic for many reasons. “We’re a A new diagnosis can make someone ineligi- Surprisingly, the model predicted pain
big melting pot,” says Alexander Niven, a ble for certain jobs, such as firefighting. And better than the traditional arthritis scoring
pulmonologist at the Mayo Clinic in Minne- a Black person with lung cancer might not system. Specifically, Pierson says, “it seems
sota. So even if there were “a specific cluster be identified as a good candidate for surgery to be picking up on factors that dispropor-
of genes that predispose people to greater or because their lung function may be too poor tionately affect underserved patients.” What
less lung function, that’s highly unlikely to to allow for removal of part of their lung. those factors might be isn’t clear, and Pierson
remain a pure cluster in this global world.” “There are trade-offs essentially attached to emphasizes a need for caution. “In general,
What’s more, lungs are in constant con- these reclassifications,” Manrai says. the capabilities of these models tend to out-

strip our ability to understand how they’re Researchers are working to develop in how we use the technology,” he says.
achieving those capabilities,” she says. more accurate tools, and regulators are con- Pavlakis also sees a need for more critical
sidering larger test populations with a vari- thinking on the part of clinicians. She is dis-
SOMETDMES DDAGNOSTDC DNSTRUMENTS ety of skin tones. Lipnick wants better pulse mayed at the number of years that she relied
introduce bias. The fingertip clamps doctors oximeters but worries that some of the fixes on the eGFR equation without stopping to
use to measure oxygen levels in the blood, may increase costs. “It’s a big concern, espe- carefully consider the rationale for its race
for example, work by measuring the absorp- cially in low- and middle-income countries, correction. “When we were taught this for-
tion of different wavelengths of light to es- where the majority of the world’s people mula, we were like, ‘This is data-driven.
timate the blood oxygen level. But the de- with darker skin pigment live,” he says. This is from a research study. This must be
vice, called a pulse oximeter, tends to over- In the short term, Lipnick says, clini- accurate,’” she says. Evidence-based, how-
estimate oxygen saturation in people with cians should rethink how they use data ever, doesn’t always mean equitable, and
darker skin tones. from pulse oximeters. “It gives a number, that’s the real goal. Hoenig’s students and
Researchers have known about this and we assume that that number is truth.” other people who recognized bias are mak-
problem for decades, but manufacturers In reality, the number might be off by ing health care better for all.
didn’t feel much pressure to fix the problem. as much as 5 percent. If doctors recognize
The effect was relatively minor, and it was the error rate, they can make decisions
Cassandra Willyard is a science journalist based
most prominent at low oxygen saturations. that aim to minimize health-care dispari- in Madison, Wis. She covers public health, medicine,
“That difference was probably correctly as- ties. “I think a lot of the solution will lie and more.
sumed to not be physiologically relevant,”
says Michael Lipnick, an anesthesiologist at
the University of California, San Francisco,
who leads a research project to assess pulse
oximeter performance. “If somebody’s ox-
Rural Prescriptions
ygen saturation is really 1 percent or even
Some of the most innovative solutions for health care come
2 percent higher or lower than the real value, from rural regions around the world BY CARRIE ARNOLD
there’s no harm.”
When the COVID pandemic sickened
millions of people, however, small biases ON A FRIGID WINTER EVENING about five met needs, people find it difficult to get
had an outsize effect. “Clinical decisions years ago, a desperately ill young woman prenatal care. Transportation (especially in
were being made based on that number,” walked through the doors of the Sanford winter) and child care for medical visits
Lipnick says. In 2023 a team of researchers Bemidji Medical Center in rural Minnesota. that require a several-hour car ride and
looked at health records from more than Several weeks before, she had labored alone possibly an overnight hotel stay are often
24,000 people hospitalized with COVID for hours in her tiny mobile home to bring a unaffordable, even if Medicaid covers the
during the first 19 months of the pandemic. new baby into the world. The woman had cost of the health care. Nynas, who was
They zeroed in on those who had both a received no prenatal care and no medical born and raised in rural Minnesota, says
pulse oximeter reading and an arterial blood attention at delivery—the kind of situation that by the time an expectant parent arrives
gas test, the gold standard for measuring that has made maternal mortality rates for in her office, they may have a list of health
oxygen saturation in the blood. Pulse oxim- Native American women in rural areas concerns that have gone untreated for
eter readings consistently overestimated twice as high as those of white women. The years. She links this lack of care directly to
oxygen levels in Black and Hispanic pa- only reason she was showing up now was the elevated risk of pregnancy-related
tients. Black patients were also more likely that the baby wasn’t eating. She had no run- deaths and complications in the region.
than white patients to have their need for ning water to make formula. The hospital “When we first meet patients, it’s prob-
COVID therapy underestimated because of was her only option. Johnna Nynas, the ob- ably the first contact they’ve had with the
inaccurate pulse oximeter readings. Such stetrician on call, quickly diagnosed her health-care system in quite some time,”
oversight has clinical consequences: being patient with postpartum preeclampsia, a Nynas says. Haunted by her patient’s pre-
passed over for COVID treatment resulted rare condition that affects people after preg- eclampsia emergency, she set out to remove
in an hour’s delay in care on average and a nancy and can be deadly if untreated. barriers to needed care. Loaned blood pres-
higher risk of readmission. For Nynas’s pregnant patients, the hos- sure cuffs and bathroom scales let many of
Lipnick is part of the Open Oximetry pital in Bemidji is the only option between her low-risk patients receive checkups over
Project, which has been testing different Duluth, Minn. (three hours away), and the phone. This communication made it
pulse oximeters in diverse groups to get a Fargo, N.D. (2.5 hours away). The sur- easier to schedule in-person visits for ultra-
sense of their real-world performance. He rounding area is one of the poorest in Min- sounds and blood tests.
and his colleagues have seen a range of vari- nesota. Some residents of the nearby Leech David Driscoll, director of the Healthy
ability. Most devices tended to perform Lake, Red Lake and White Earth Indian Appalachia Institute at the University of
worse when used on people with darker skin Reservations don’t have reliable access to Virginia, isn’t surprised that the impetus for
pigment, but some performed better. running water. With so many pressing un- change began in a rural area. The regions
that face staggering health inequalities are of the University of Wisconsin’s ongoing ture deaths in Appalachia is 25 percent
developing innovative solutions to enhance rural health partnership with the Mayo higher than in the rest of the U.S.
well-being for everyone. Rural communi- Clinic, Carney says, and are intended to bol- Like many rural health programs, the ef-
ties’ perpetual need to do more with less ster the health of his hometown. Carney forts at the University of Virginia rely exten-
and to overcome obstacles not found else- says practitioners worldwide are asking, sively on telehealth. That’s largely because in
where has led to modernized care delivery. “How do we deliver health care in a cost-ef- the mid-1980s, awareness of these kinds of
Although many of the innovations are fective way to people who can’t come to a health disparities (and their origins) dove-
tech-centric, not all require Internet access traditional clinic?” tailed with emerging technological break-
to work. These shifts are helping doctors throughs. As a policy analyst at the Virginia
bring world-class medical care to even the N SOUTHWESTERN VIRGINIA, where Department of Health, Kathy Wibberly was
most far-flung patients.
ONE CHALLENGE for rural health experts is

I Driscoll grew up, the distances between
two points aren’t that far as the crow flies.
But the residents of the area’s tiny towns
tasked with helping to address deficits in
health-care access in rural parts of the state.
One of the solutions that emerged was the
to ensure solutions don’t exacerbate exist- and hollers aren’t crows. The narrow, potential for telemedicine. Many of the re-
ing disparities. Doctor visits via a video call winding roads mean even seemingly short gion’s small, rural hospitals didn’t have the
won’t help someone without an adequate drives can take hours. Without public patient volume to warrant hiring, say, a neu-
Internet connection, for example. But advo- transportation, many of the area’s older rologist or a neonatologist. Very sick new-
cates say thoughtful action paired with in- adults can’t travel to medical appoint- borns or people experiencing a potential
frastructure investment will broaden access ments. Driscoll’s first job, in the 1990s, was stroke would have to be sent by ambulance
to services. with a community organization that drove or helicopter to a large medical center, often
Simple equipment sent home with low- local patients to clinics and hospitals. hours away. Such delays in care can prove
risk pregnant patients helped Nynas’s Driscoll chatted with his passengers, lis- deadly. “With stroke, time is precious.
northern Minnesota families deliver tening to their problems. Many said the You’re saving the brain,” Wibberly says.
healthy infants. Nynas’s success with home doctor’s visit they were headed to was their Instead of moving patients, Wibberly
devices such as bathroom scales, blood first in years because they had been physi- began working to connect small hospitals
pressure cuffs and fetal heart-rate monitors cally unable to get to appointments. Multi- with their large, urban counterparts via vid-
convinced her to expand her reach. Collab- ple, untreated chronic diseases such as asth- eoconferencing and other technologies.
orating with several local community ma, diabetes and hypertension were the Rural physicians could consult with on-call
groups, Nynas applied for a grant from the rule, not the exception. With poverty rates specialists in distant parts of the state to sta-
federal government’s Rural Maternity and high and grocery stores few and far be- bilize or manage fragile patients. This ap-
Obstetric Management Strategies program. tween, most of his passengers experienced proach, she says, “saved lives and saved
With this funding, Nynas was able to not food insecurity, and their diets lacked fresh brains and saved disability further down
only expand patients’ virtual care but also fruits and vegetables. The few people who the road.” In 2019 more than one quarter of
provide additional local resources, such as had home Internet relied on dial-up be- U.S. hospitals had the capacity for tele-
an in-hospital food pantry, transportation cause broadband wasn’t available yet. health-based stroke care.
services and a visiting-nurses program. She Rural communities in Virginia and After some initial success, Wibberly be-
is setting up a satellite clinic at an Indian around the world face many of the same gan trying to expand telehealth access. Her
Health Service facility, which typically has challenges—lack of clean drinking water, biggest problem, however, wasn’t related to
limited prenatal services. This approach unreliable transportation, lagging invest- technology. It was convincing patients, in-
will let patients without home Internet or ments in infrastructure and technology, and surers and especially physicians that the
phones upload their data and connect with hospital and clinic closures. Driscoll’s con- approach could work. Few doctors have re-
nearby providers in consultation with re- versations revealed precisely how those ceived telemedicine training during their
mote experts for complex pregnancies. challenges contribute to health disparities. residencies and internships, then or now,
Health-care micro sites such as these act It sparked his lifelong interest in rural Wibberly says. They learn to see patients in
as a bridge between major medical centers health and ultimately brought him back person—that’s the model they’re trained
and small communities and are showing home to the rugged hills where Virginia dis- with and used to.
huge promise in rural health, says Michael appears into Tennessee and Kentucky. “Yet at the same time, the landscape has
Carney, interim provost at the University of Today, with a $5.1-million federal grant, changed,” Wibberly says. Medicine is no
Wisconsin–Eau Claire, because they com- Driscoll is addressing problems that have longer strictly an in-office practice. COVID
bine the best of telemedicine and in-person been amplified by the COVID pandemic. accelerated the adoption and acceptance of
care. Patients without broadband Internet According to one study, so-called diseases telemedicine, and it has become a mainstay
can go to a local clinic and talk to a specialist of despair, including opiate misuse and of rural health care, she says, especially in
online. Nurses and other providers at the overdose, suicide and alcohol-related liver behavioral health care and psychiatry.
local clinic can do bloodwork, measure vital disease, spiked by 40 percent in central Ap- Telehealth alone can’t fix all the health
signs and nurture the doctor-patient rela- palachia during the beginning of the pan- problems facing rural areas. Limited
tionship. These micro sites are the flagship demic. As a result, the number of prema- broadband access means not everyone can

set up a video chat with their doctor. And developed a way to filter the water so it man says the community members in his
a lot of medical care requires in-person could be used for dialysis. Then, rather than program “are doing as good a job as trained
visits and readily available providers— discarding it, the clinic devised a setup that therapists who spend years and years train-
things that aren’t guaranteed as rural hos- let it reuse the water to provide pressure for ing.” He is now expanding the perinatal
pitals continue to shrink or close. To tackle the system. Brown knew they also needed mental health program to parts of other
these issues, providers have gotten creative. to work with community leaders to inte- low- and middle-income countries.
grate traditional Aboriginal beliefs and Not all these experiments in rural
DIAGNOSIS OF KIDNEY FAILURE is healing into dialysis treatments. health will prove successful or be transfer-
A life-altering. For residents of the re-

mote Australian outback, it can be
doubly so. The Pintubi people returned to
Over the next 20 years the Purple House
transformed dialysis in Australia. In recog-
nition of its efforts, the government created
able to other communities, says Lauren
Eberly of the University of Pennsylvania,
a cardiologist who developed a phone-
Kintore, around 500 kilometers west of Al- a special billing code to allow more nurses to based treatment program for people with
ice Springs in the Northern Territory, in the deliver dialysis in remote communities. heart failure who live in the Navajo Nation.
1980s after forced displacement by the Aus- “We have gone from the worst survival rates Different rural communities have differ-
tralian government starting in the 1940s. in the country to the best,” Brown says. ent needs and barriers, she says, and sci-
Those who needed dialysis had to leave Brown’s group also built a traveling di- entists must gain local input and insight to
again to receive care at the nearest clinics in alysis bus known as the Purple Truck. The determine what help people need and
Alice Springs or Darwin. Indigenous peo- bus visits communities not served by the what they will accept. Researchers have to
ples such as the Pintubi make up almost clinics and allows residents of Alice start by asking questions and listening to
4 percent of Australia’s population and Springs and Darwin to visit family. Both feedback rather than assuming they know
more than 14 percent of people on dialysis survival and quality of life have improved. how to solve long-standing, deep-seated
in the country. In 2016 research showed that Now densely populated regions such as problems, Eberly says.
Aboriginal people’s kidneys reached end- Sydney and Melbourne have built their “The traditional health-care system re-
stage failure decades sooner than the kid- own dialysis buses. The approach not only ally benefits those who are fluent and those
neys of non-Indigenous Australians and brings access to the life-saving therapy but who are white. It’s really marginalized a lot
New Zealanders, and an earlier study had allows Australians to travel without miss- of other groups,” Eberly says. “We really
found they were 1.5 times more likely to die ing crucial dialysis sessions. need to rethink how we can deliver health
on dialysis. For those who survived, quality Brown remade dialysis from the ground care in a way that makes sense for our com-
of life was low. up. “We’re disruptors,” she says. “You don’t munities and our patients.” The point, she
Aboriginal Australians wanted to be “on have to assume that something is going to says, is to use successful interventions as
country”—to live in their ancestral home- stay the same. You can work together, and creative inspiration for solving other issues
lands with loved ones—while on dialysis. you can change the system.” in health care and health equity.
When the Australian government rebuffed Transportation issues aren’t limited to
their requests, Indigenous artists auctioned A MATERNAL MENTAL health program has rural settings; they can affect urban areas,
their work to raise more than $1 million had a similar impact in parts of rural Paki- too. So can lack of broadband access, food
(AUD) to build a nonprofit dialysis clinic, stan. To address growing global mental insecurity, and other disparities. Because
Purple House, in Kintore. health needs, Atif Rahman, a researcher at many innovations developed in rural areas
But bringing dialysis to an area where the University of Liverpool in England, has target these broad problems, urban and sub-
sheep overwhelmingly outnumbered developed short-term interventions that urban areas can also benefit from them.
people wasn’t an easy proposal. What’s can be delivered by peers and other nonspe- Telehealth is a prime example, Wibberly
more, dialysis is a thirsty procedure, using cialists. The idea, he says, is to bolster access says. The advantages of telemedicine first
hundreds of liters of water for a single to behavioral health care, especially where appeared most obvious for rural areas, but
week’s treatment. Such a water-intensive treatment is virtually nonexistent. the approach has gone mainstream. She is
therapy is ill-suited to the outback, which Many of Rahman’s efforts have focused confident that other rural health programs
contains some of the driest biomes in the on perinatal health in Pakistan, where will become standard medical practice.
world. Purple House CEO Sarah Brown, he is originally from. His team trained To Wibberly, the reason so much inno-
who was tapped to lead the organization rural community members there to deliv- vation occurs in rural health is simple. “It’s a
after a long career as a bush nurse, needed er coaching sessions to decrease the men- smaller community. People know one an-
a therapy she could bring to her patients tal health struggles of new moms. “It’s a other. They know who the trusted entities
that merely sipped from the region’s scarce powerful combination,” Rahman says. are,” she says. “Let them figure out what
water supply. “We are freeing the peer to be more of a will work for them because it’s a whole lot
To make matters worse, what limited human support.” easier to fix access to care issues for a city of
water does exist in the area’s deep wells has With a worldwide shortage of mental 20,000 than it is for one of 20 million.”
too much fluoride and other contaminants health workers, especially in the Global
to be drinkable, let alone used in dialysis. To South, being able to rely on nonprofession- Carrie Arnold is an independent public health
address the problem, a team of engineers als opens doors to those most in need. Rah- journalist in Virginia.
S8 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Photograph by Nīa MacKnight

For Eliza Scott, who lives on a farm
2.5 hours away from the Bemidji clinic
in rural Minnesota, virtual prenatal care
with a clinic-provided home-monitoring
kit has meant the difference between
getting care or no care at all.

The Staggering Success health equity goes far beyond preventing

death. The Lancet study found that each life
saved through immunization resulted in an
of Vaccines average 66 years of full health, without the
long-term problems that many diseases
Vaccines have been aiding health equity for 200 years, cause. Vaccines play a role in nearly every
measurement of health equity, from im-
and today they are poised to save even more lives from
proving access to care, to reducing disability
more diseases BY TARA HAELLE and long-term morbidity, to preventing loss
of labor and the death of caretakers.
ONCE A WEEK, early in the morning, com- to get her pay. When it rains on travel days, “We say vaccines are one of humanity’s
munity health worker Kiden Josephine she and her outreach pamphlets get great achievements in terms of having fur-
Francis Laja mounts her bicycle and pedals soaked. She must regularly check the tem- thered the lifespan and life quality for hu-
as far as 10 miles away from her small village perature of the vials in the cooler and re- manity in the past 50 years,” says Aurélia
in South Sudan. Some weeks Laja is doing place the ice packs at just the right time to Nguyen, chief program officer at Gavi, the
outreach, spending her day educating a ensure the vaccines don’t go bad. Vaccine Alliance, a public-private partner-
community about which vaccines she can People in South Sudan don’t have much, ship that works to ensure low- and mid-
provide and what diseases they prevent. “It’s but they have this program. “Vaccines are dle-income countries have access to vac-
my responsibility to tell the mothers to bring very important to me and my community cines against more than 20 infectious
the children for vaccination,” she says. She and even to my country,” Laja says. During diseases. Of all the different health inter-
answers their questions and lets them know a large outbreak of measles that began in ventions that exist, she says, “vaccines
she’ll be back, usually the following week, to 2022 in the country, thousands of children have the widest reach across the world.”
vaccinate their children. Late in the evening suffered from the disease, and many died, The clearest evidence of vaccines’ impact
she mounts her bike and heads home. leading to a nationwide vaccination cam- on equity is that they are often the first in-
When Laja returns with the vaccines, paign in 2023. “Now in our community you tervention introduced into a community
kept in a cooler with ice packs, she will spend cannot find cases of measles,” she says. with no other health-care resources.
the day immunizing anywhere from a few to Around the globe the measles vaccine “When you don’t have a health worker
200 children against a range of diseases: po- has saved nearly 94 million lives over the or health system, there’s nothing. If you
lio, tetanus, diphtheria, pertussis, hepati- past 50 years. This and other vaccinations have no money, then you want the best
tis B, influenza, bacterial meningitis, tuber- have revolutionized global health. “Immu- bang for the buck, and it’s going to be im-
culosis and, more recently, COVID. Most nization is the most universal innovation munization,” says Seth Berkley, former
people in high-income countries haven’t that we have across humankind,” says Orin CEO of Gavi. “For every dollar you invest
seen these diseases in decades, but the peo- Levine, a fellow at the Center for Global De- in immunization, you get $54 of benefit.
ple of South Sudan know them well. Many velopment in Washington, D.C. He notes From a cost-effectiveness point of view, it’s
have seen family and friends die from them. that there are people around the world the best investment, so it tends to be the
During the rest of the week Laja works without access to telephones or even toilets, intervention that gets out to those commu-
at the community health center in her vil- but they find ways to get their children im- nities first. And once you do that, you have
lage of Pure, monitoring the solar-pow- munized. “It’s the innovation that demon- a health worker who’s visiting those com-
ered refrigerator and the vials inside. She strates what is possible in terms of delivery munities on a regular basis, and then that
vaccinates anyone who comes to the facil- of service to everyone everywhere.” begins to start the conversation toward
ity and metes out drugs for a few maladies A May study in the Lancet estimated that more primary health care, and that leads to
such as ulcers, malaria and typhoid. But vaccines against 14 common pathogens have getting a basic clinic set up. Immunization
the village doesn’t have antibiotics—or saved 154 million lives over the past five de- is the vanguard of the health system.”
electricity. Villagers grow their own food, cades—at a rate of six lives every minute. Every country in the world has an im-
raise goats and chickens, and get their wa- They have cut infant mortality by 40 per- munization program thanks to the World
ter from wells in the ground. cent globally and by more than 50 percent in Health Organization’s Expanded Program
It’s not easy work for just $102 a month, Africa. Throughout history vaccines have on Immunization, which was established
especially when it sometimes takes three saved more lives than almost any other in- in 1974. “Every single country and territo-
months for the 25-year-old mother of two tervention. And vaccines’ promotion of ry” has access to at least some vaccines,

INNOVATIONS
IN
N N OVATIONS IN
N SO
SOLUTIONS
O LU
L TI
T I ON
ONS F
ONS FOR
O R HEALTH
H EQUITY
EQ
QUU IT
IT Y
says Kate O’Brien, director of the WHO’s nitude of the accomplishment of having era- series of innovations. The bifurcated nee-
immunization, vaccines and biologicals dedicated smallpox, where absolutely nobody dle, which was developed around that time,
partment. Poverty, malnutrition, underly- on this earth gets the disease,” O’Brien says, allowed for smaller doses and required less
ing health conditions, overcrowding, hu- “that’s the ultimate in the issue of equity.” user expertise for vaccine delivery than the
man conflict, displacement, and lack of A version of a smallpox vaccine was de- previously favored jet injector. Researchers
access to medical care, hygiene or sanita- veloped in 1796, and in 1959 global health created a surveillance system to better track
tion—all of these are risk factors for infec- experts decided to pursue full eradication. disease and vaccinate close contacts of in-
tious disease, O’Brien says. Vaccines’ abil- In the decade that followed, it became clear fected people, making mass vaccination
ity to reduce disease in the settings most that such an ambitious goal would require campaigns more effective. The last docu-
plagued by these problems gives them dis- more than political will. Although smallpox mented case of smallpox occurred in Soma-
proportionate power to improve equity. had been eliminated from North America lia in 1977, and the WHO declared smallpox
and Europe, frequent outbreaks continued officially eradicated three years later.
THERE MAY BE NO GREATER demonstration in South America, Africa and Asia. That success inspired a similarly lofty
of vaccines’ power to deliver health equity In 1967 the WHO started its Intensified goal in 1988 that has proved far more chal-
than their success with smallpox. “The mag- Eradication Program, which prompted a lenging: eradicating polio. Since the estab-
NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S1 1

Total Number of Deaths
Averted Globally because of
Vaccines between 1974 and
2024, for Selected Diseases
Millions and Millions Saved
The Essential Program on Immunization (EPI) was developed in 1974
with a goal of vaccinating children in every country against six dis-
Deaths Averted by Selected Vaccines (cumulative 1974–2024, in millions)
Global
150 eases: diphtheria, pertussis, tetanus, polio, measles and a form of
tuberculosis. In the 50 years since, it has grown to include immuni-
zation against seven additional infections: Haemophilus influenzae Measles
140 type B (Hib) bacteria, hepatitis B, rubella, pneumococcal disease, 93,712,000
rotavirus, human papillomavirus (HPV) and, for adults, COVID.
Additionally, organizations such as Gavi, the Vaccine Alliance,
130
have run vaccination campaigns against other diseases, including Tetanus
malaria, Ebola and cholera. 27,955,000
120 The cumulative efforts to vaccinate the world over the past
half a century have saved more lives than nearly any other
health intervention to date. A study published in the Lancet
110 calculated the global impact of worldwide vaccination
by modeling the averted deaths that could have been Pertussis
caused by 14 major pathogens in 194 World Health 13,155,000
100
Organization member states from 1974 to 2024,
including most of those in the current EPI program.
90 The magnitude of the results is striking, yet they Tuberculosis
still underestimate the true impact because 10,902,000
the study did not include vaccines for COVID,
80 influenza, HPV, malaria, Ebola, or several
others known to reduce mortality. Even so, Haemophilus
the authors found that the immunizations influenzae
70 type B (Hib)
they did include have prevented 154
2,858,000
million deaths—95 percent of which
60 would have been of children under Poliomyelitis
five years old. In some regions, 1,570,000
vaccination cut infant mortality
50
in half, and the measles Other
vaccine had the greatest pathogens
40 effect overall on keeping included in
children alive. Shaded areas the study
represent deaths (diphtheria,
30 averted for hepatitis B,
individuals Japanese
5 years and older. encephalitis,
20 Most avoided Neisseria
deaths were for meningitidis,
children younger rotavirus,
10 than 5 years. rubella,
pneumococcal
disease and
0
yellow fever)
1974 1984 1994 2004 2014 2024 3,706,000
BCG—tuberculosis
100% Vaccination Rates over Time Measles first dose
Global Vaccine Coverage
DTP third dose—

diphtheria, tetanus and pertussis
80%
Poliomyelitis third dose
Hepatitis B
60% Haemophilus influenzae type B (Hib)
Measles second dose
40% Pneumococcal conjugate vaccine
(PCV)—pneumococcal disease
Rotavirus
20%
Yellow fever
Hepatitis B birth dose
0
1974 1984 1994 2004 2014 2024
S1 2 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Graphics styled by Jen Christiansen

Measles Measles
Measles
28,660,000 20,517,000
12,887,000
Deaths Averted (cumulative 1974–2024, in millions)
African Region Tetanus Eastern Southeast

Tetanus Tetanus
50 9,545,000 Mediterranean Asia Region
8,501,000 9,237,000
Region
Pertussis Pertussis
40 Pertussis
4,191,000 1,871,000 4,428,000
30 Tuberculosis Tuberculosis Tuberculosis

6,568,000 822,000 2,416,000
Hib Hib Hib
20 1,536,000 433,000 601,000
Poliomyelitis Poliomyelitis Poliomyelitis
10 151,000 119,000 347,000
Other Other Other
2,190,000 442,000 485,000
0
1974 2024 1974 2024 1974 2024
Measles
M Measles
Region of Western European Region

1
14,894,000 10,192,000 6,562,000
50 the Americas Pacific Region
Tetanus Tetanus Tetanus
65,000 586,000 21,000
40
Pertussis Pertussis Pertussis
368,000 2,066,000 231,000
30 Tuberculosis Tuberculosis Tuberculosis
231,000 757,000 108,000
Hib Hib Hib
20 181,000 71,000 36,000
Poliomyelitis Poliomyelitis Poliomyelitis
10 218,000 491,000 244,000
Other Other Other
163,000 349,000 77,000
0
1974 2024 1974 2024 1974 2024
WHERE IT MATTERS MOST

Low-Income Lower- to Middle- to High-Income

Vaccines’ relative impact on
Countries Middle-Income Upper-Income Countries
mortality varies by country 70
Countries Countries
depending on how affected
that country already is by a
particular disease and the other 60
major causes of disease there.
Vaccine-preventable diseases
cause far fewer deaths in 50
high-income countries, where
sanitation, hygiene, nutrition,
medical infrastructure and 40
health-care access have already
substantially improved survival.
30
Meanwhile, vaccines have an
outsized impact on preventing
deaths in low- and middle- 20
income countries where
infectious disease remains
a top killer. In short, as the 10
Lancet study authors write,
“Vaccines promote equity
by saving more lives in places 0
where more deaths occur.” 1974 2024 1974 2024 1974 2024 1974 2024
Source: “Contribution of Vaccination to Improved Survival and Health: Modelling 50 Years of the
Expanded Programme on Immunization,” by Andrew J. Shattock et al., in Lancet, Vol. 403; May 25, 2024 NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S1 3
high-income countries implemented cervi-

“Vaccines level the playing field.... cal cancer screening programs decades ago,
But frankly, it was a really long road 94 percent of global deaths from cervical
cancer in 2022 were in low- and middle-
to get to that kind of equity.” income countries. Gavi programs have vac-
cinated more than 16 million girls world-
—Nicole Lurie Coalition for Epidemic Preparedness Innovations
wide against HPV, and the organization
aims to vaccinate 86 million by 2025. The
lishment of the Global Polio Eradication Bank and the Gates Foundation. Thanks to physical benefits won’t be seen for years—it
Initiative, cases have fallen 99 percent Gavi, says Violaine Mitchell, director of takes up to two decades for an HPV infec-
worldwide, but that last 1 percent is taking immunization at the Gates Foundation, tion to develop into cancer—but the ripple
decades longer than planned. Public health “now countries not only assume but de- effects of prevention go far beyond saving
experts now recognize that very few diseas- mand that when a vaccine is introduced in a single person’s life. A death from cervical
es can be completely eradicated through the developed world, it’s also made avail- cancer may mean loss of a family caretaker,
immunizations. Even so, they aim to de- able in the developing world.” loss of income and difficulty meeting chil-
crease vaccine-preventable diseases to such Gavi has vaccinated more than one bil- dren’s continuing health needs. “The tsu-
low levels that severe morbidity and mor- lion children with a routine suite of shots nami effect of losing a mother to children,
tality are negligible. The WHO’s renamed and given a total of 1.8 billion immuniza- especially for those who are not economi-
Essential Program on Immunization initial- tions to people of all ages through cam- cally stable, is devastating to a family,”
ly focused on six childhood diseases: polio; paigns for illnesses such as measles in Ethi- O’Brien says. “Their lives are entirely de-
measles; disseminated tuberculosis, the opia, Afghanistan and Somalia and yellow pendent on the survival of that person.”
form of the disease most common in chil- fever in Congo, averting more than 17 mil-
dren; and diphtheria, tetanus and pertussis, lion deaths through 2022. Since Gavi was ACCINATION CAN BE A KEY entry point
for which children receive the combined
DTP vaccine. It has now expanded to in-
clude vaccines against 13 diseases.
established, there has been a 70 percent
reduction in deaths from vaccine-prevent-
able diseases in children living in the low-
V to additional health care. William
Foege, a former director of the U.S. Cen-
ters for Disease Control and Prevention,
“We have to look backward, in some ways, er-income countries the alliance supports, who was instrumental in leading smallpox
to realize how far we’ve really gone,” says and mortality among children younger eradication and in setting up Gavi, called
Lois Privor-Dumm of Johns Hopkins Uni- than five years in those countries has been vaccines “the tugboat” for preventive care.
versity, who recently retired from her role halved. The pneumococcal and rotavirus When health workers arrive to vacci-
as a senior research associate. “There has vaccines have been particularly signifi- nate children in a community, they can as-
been tremendous progress over the past cant—pneumonia and diarrhea are among sess other children’s growth trajectories
50 years, and what is really left is making the top global killers of children under five. and nutritional issues, provide vitamin A
sure the equity agenda is really a focus.” But even those impressive numbers supplements where there are deficiencies,
Now the question is how best to do it. A don’t fully capture the dramatic ways vac- distribute deworming tablets, monitor
raft of technological and policy innova- cines advance health equity. For example, mosquito-borne diseases and check on ad-
tions aim to help. Before the WHO’s cur- epidemics of meningococcal meningitis ditional needs. “If you manage to reach a
rent vaccination program began, fewer were common in the “meningitis belt,” a child and give them a measles vaccine, then
than 5 percent of the world’s babies had stretch of 26 countries just south of the Sa- you may be able to give their mother mater-
access to routine immunizations. Today hara desert that has the highest rates of nal services,” Nguyen says. “It’s a perfect
84 percent of infants have received three meningococcal disease in the world. Up to time to say: Are you sleeping under a bed
doses of the DTP vaccine, the metric used half of those infected die without treat- net? Do you need a bed net? What are you
to assess global immunization coverage. ment; even with treatment, one in 10 peo- doing for family planning?” Mitchell says.
“[Vaccines] level the playing field in ple dies. Since the development and distri- “All those conversations can come about
terms of who gets these diseases and who bution of a vaccine against meningitis A, because of the contact between the caregiv-
doesn’t,” says Nicole Lurie, U.S. director of this form of the disease has been nearly er and the health worker that wouldn’t
the Coalition for Epidemic Preparedness eliminated. The vaccine has not only saved [otherwise] happen.”
Innovations (CEPI), a foundation formed lives but prevented long-term effects that In 1985 Rotary International launched
specifically to develop and improve access meningitis survivors often suffer, including its PolioPlus program, which used vacci-
to vaccines for diseases that lack strong hearing loss, seizures, limb amputations or nation campaigns as an opening for other
market demand. “But frankly, it was a real- weakness, scarring, vision problems and health interventions. “When Rotary and
ly long road to get to that kind of equity.” cognitive difficulties. its partners added other things to improve
Setbacks through the 1990s led global Another example is the human papillo- the health systems of countries, it was a
health leaders to rethink their approach, mavirus (HPV) vaccine, which can prevent game changer,” says Stella Anyangwe, a
and in 2000 Gavi was founded collabora- up to 90 percent of HPV-related cancers, Rotary International EndPolioNow coor-
tively by the WHO, UNICEF, the World including nearly all cervical cancer. Because dinator and former WHO official. By

strengthening laboratory systems, the IN LATE 2019, when a novel coronavirus ing with a goal of making 60 percent of its
cold-chain network of refrigerated storage detected in Wuhan, China, kicked off one needed vaccines by 2040. In June 2024
necessary for transporting the vaccine, of the largest, deadliest pandemics in a cen- Gavi launched the African Vaccine Manu-
and overall disease surveillance, she says, tury, everyone looked to the same solution: facturing Accelerator, a financing program
improving systems for polio eradication a vaccine. COVID’s devastation hit poorer developed with the Africa CDC and Afri-
“strengthened the health systems in gen- countries with less developed health-care can Union to put up to $1.2 billion over the
eral.” In short, Levine says, “immuniza- systems particularly hard, and in wealthier next decade toward building up the conti-
tion is an innovation that is pulling other countries people from underserved and nent’s vaccine-manufacturing capacity.
innovations along.” low-income communities suffered higher In the almost 25 years since Gavi was
It can also free up valuable time and re- rates of illness, death and economic hard- launched, it has made substantial progress
sources in health care. As infectious disease ship. It was clear that a COVID vaccine in advancing equity in vaccine manufac-
incidence falls, health workers and hospital would be the most equitable solution. turing. In 2000 four of its five vaccine sup-
beds become available for people with other The U.S. quickly directed $10 billion to- pliers were in wealthy countries. Today
conditions. This may already be happening ward vaccine development, and dozens of most of its 20 or so suppliers are in devel-
with malaria. In Burkina Faso, about two other countries allocated what they could. oping countries. “It opened up a market-
out of every five visits to a health-care pro- The effort broke every record for the fastest place for large-scale, low-cost manufactur-
vider are for malaria, which historically ac- vaccine development. The Chinese CDC re- ing in India, in Brazil, in China and in In-
counts for more than 60 percent of the leased the sequence of SARS-CoV-2 on Jan- donesia,” says Berkley, former Gavi CEO.
country’s hospitalizations. Similarly, ma- uary 10, 2020, and just 11 months later, on It will still be immensely challenging
laria cases make up about half of hospital- December 8, 2020, the first COVID vaccine to get vaccines into the arms and mouths
izations in Cameroon; most of those pa- was administered outside of a clinical trial. of people who need them most. Health
tients are children under five who are eli Officials at Gavi, UNICEF, WHO and workers must find and immunize ze-
gible for the malaria vaccine. Although cur- CEPI quickly organized Covax, an interna- ro-dose children—children who have yet
rent malaria vaccines don’t prevent infec- tional effort to accelerate COVID vaccine to receive vaccines of any kind, like the
tion altogether, they reduce severe disease development and “to guarantee fair and eq- ones Laja sees in South Sudan. And low-in-
by 30 percent and all-cause mortality by uitable access for every country in the come countries must acquire the financing
13 percent. Gavi began rolling out vaccina- world,” according to the WHO. Covax de- and build the infrastructure to facilitate
tion campaigns against malaria last year, livered nearly two billion vaccines to more that process. Then Laja and her peers must
providing 18 million doses to a dozen Afri- than 140 countries in the two years after the educate people so fear does not become a
can countries, and malaria deaths have al- vaccines’ introduction, “by far the fastest, barrier to access.
ready begun falling. “You can imagine how largest and most effective public health roll- Workers such as Laja are part of the glob-
much that’s going to free up capacity for out in history,” a Gavi spokesperson says. al workforce that the WHO, Gavi, UNICEF,
health-care workers to focus on other [is- A 2022 study in the Lancet Infectious Diseas- the Gates Foundation, Rotary, and other
sues],” Nguyen says. es estimates that COVID vaccination world- organizations have trained to use vaccines
Vaccines help countries with fewer re- wide prevented 19.8 million excess deaths, against disease and health disparities. Ear-
sources protect themselves from disease. 7.4 million of those in Covax countries. lier this year Laja completed training in
Outbreaks disproportionately affect poor- The challenges were steep and vaccine preparation for South Sudan’s malaria-vac-
er areas: the 2014–2016 Ebola epidemic in distribution contentious. “At no point did cine rollout. In 2022 there were almost
West Africa, for example, devastated the a richer country with access to vaccine doses 7,000 malaria deaths in South Sudan, and
region’s health-care infrastructure. Since choose to slow down its rollout to make dos- the disease is the top killer of young children
the development of an Ebola vaccine in the es available for people at higher risk in low- in the country. The previous year South Su-
late 2010s, subsequent outbreaks have re- er-income countries,” Levine says. “That’s dan’s malaria fatalities accounted for more
mained comparatively small. And the cur- vaccine nationalism, and it undermined the than 1.2 percent of the total worldwide.
rent outbreak of mpox [see “History Les- success of hardworking folks at Covax.” Laja is eager to see the vaccines’ impact
sons,” by Charles Ebikeme, on page S25], Those problems have prompted a lot of on her community and in the villages she
which led the WHO to declare a global reflection and a lot of new action. The or- visits, where parents will walk for miles
public health emergency in August, is be- ganizations behind Covax have now set from outlying areas to meet her. “There are
ing managed with vaccines that became their sights on improving vaccine equity very few things women and caretakers will
available only in the past few years. during future pandemics. Because Africa walk hours and hours for, but vaccines are
Gavi now supports stockpiles of out- lacked vaccine access and had few manu- still one of them,” says Mitchell of the Gates
break-specific vaccines for cholera, yel- facturing capabilities of its own, the new Foundation. “People will literally drop ev-
low fever, meningococcal disease and efforts are particularly focused on boosting erything to come and vaccinate their child.”
Ebola so the countries most affected can the continent’s vaccine-manufacturing ca-
focus their health-care resources on pabilities. The Africa CDC has partnered Tara Haelle is a Dallas-based science journalist
chronic disease, snakebites, cancer and with other organizations to create the Part- whose specialties include infectious disease, medical
HIV, among other conditions. nerships for African Vaccine Manufactur- research and health disparities.
NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S1 5

MADHUKAR PAI
CHAIR, EPIDEMIOLOGY
AND GLOBAL HEALTH,
MCGILL UNIVERSITY
My biggest source of hope is
young people. It’s the youngest
people who are shining a clear
light on why climate change
is devastating and why leaders
are not acting on what has
been obvious for many years.
SEYE ABIMBOLA
It’s the youngest people who
are doing great work in the U.S. ASSOCIATE PROFESSOR,
on gun control, even as they’re HEALTH SYSTEMS,
getting slaughtered in schools. UNIVERSITY OF SYDNEY
It’s the young people who are One of the things about which
alarmed about the rollback of I’m hopeful is a growing confi-
reproductive rights in the U.S., dence and restlessness and
in Afghanistan, you name it. disquiet from global health
I feel like their moral clarity professionals and academics
is the clearest because, unlike from and in the Global South
older people who already bought about how the field itself works
into something or were worried and needs to change. Histori-
about their next paycheck or cally the field was premised on
position or winning awards, this idea that the West—or the
Of Hope young people are devastatingly
clear in terms of what’s wrong.
Global North, as we refer to it
today—has a right and a duty
and Justice Their problem statements are

spectacularly accurate and
on point, and so they give me
to impose itself on the rest
of the world.
For example, if someone
AS TOLD TO ANIL OZA a huge amount of hope. That’s wanted to do a study in Nigeria
partly why I still teach global and the people who are going
The journey toward health equity can, at times, feel end- health to young people. to lead it come from London,
less. But it can also be exciting and inspiring. SCIENTIFIC Just fanning their energy, they would rely on a lot of the
AMERICAN asked some of the researchers, physicians, their passion, might well be the infrastructure in Nigeria but
advocates, and others working on health equity what biggest source of hope for all of disregard that the local collab-
they are most hopeful about. Each had numerous humankind. But we need to go orators know anything. Then
concerns but also reasons for optimism. They pointed beyond that because although they go home and write this
to progress in widening access to health care, making their diagnosis is perfect, their paper and publish it in the
science more inclusive, and reducing the health burden ability to act is limited. They’re BMJ or in the Lancet. Now,
of systemic racism and other biases. They are also not in power; they often are for me, what I think has
emboldened by the energy and enthusiasm of their not voting. They’re usually given changed, what I see changing
colleagues working to advance health equity. two minutes to speak at the more and more, is the push-
“Any level of justice work has to be rooted in a front end of the meeting and back on that. That’s just the tip
context of hope, right?” says Aletha Maybank, chief shown out of the door while of the iceberg. But that physi-
health equity officer at the American Medical Associ- the adults are making big deci- cally measurable, countable
ation. “A hope and faith that we will all be able to have sions. So how do we potentiate phenomenon of partnership
an experience of optimal health.” them to go beyond just sound research sits on a whole bed
bites or nice photo ops to action of assumptions and normalized
The following interviews have been edited for length and give them empowered ways practices that we took from
and clarity. of doing things? the colonial experience.
S16 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 From left to right: Courtesy of Pai Madhu; University of Sydney

WAFAA EL-SADR
DIRECTOR, GLOBAL
RACHEL HARDEMAN
HEALTH INITIATIVE,
DIRECTOR, CENTER FOR COLUMBIA UNIVERSITY
ANTIRACISM RESEARCH MAILMAN SCHOOL
FOR HEALTH EQUITY, OF PUBLIC HEALTH
BARNEY GRAHAM
UNIVERSITY OF MINNESOTA When I think back to what
SCHOOL OF PUBLIC HEALTH things looked like 25 years ago, FOUNDING DIRECTOR,
One of the things that gives me compared with today, it’s night DAVID SATCHER GLOBAL
hope is the work that I’m doing, and day. Investments in health HEALTH EQUITY INSTITUTE,
MOREHOUSE SCHOOL ALETHA MAYBANK
along with many other incredi- systems, largely driven by the
bly brilliant scholars across the HIV epidemic, have borne fruit OF MEDICINE CHIEF HEALTH EQUITY
country, around measuring rac- in amazing ways. No services Hopefulness comes from a OFFICER, AMERICAN
ism. In my work and within our were available, or those that faith and belief that things have MEDICAL ASSOCIATION
research center, we have to be did exist were fractured. There a way of evolving toward the It’s helpful looking at progress.
able to make the invisible visi- were no resources; there was good. The moral arc of the uni- The past four years, since the
ble. Racism is so often passed no access to medicines or lab verse bends toward the good. public murder of George Floyd,
off as this insidious thing that tests. It’s just been an enor- But it may take a long time. there is now the ability to men-
is baked into the system, and mous transformation in only Helping to diversify the public tion racism where you couldn’t
it’s so hard to identify, espe- a couple of decades, so that health workforce through before. Prior to the public
cially when it’s not an explicit gives me hope for the future. creating more opportunities murder of George Floyd, folks
interaction with someone. More than 20 years ago and knowledge for students would never have expected
In a lot of my work and in I remember going to a clinic is a multigenerational process. the AMA to make a statement
what I’m seeing across the very far away from the capital Four African American stu- about racism being a public
country with other scholars— city in one of the provinces in dents did almost all the bench health threat. And then the
incredibly brilliant Black schol- South Africa. There was noth- work that was needed to get AMA’s House of Delegates
ars in particular—is an investing available for HIV testing the Moderna COVID vaccine passed a policy that really re-
ment and interest in figuring or for treatment, and, I remem- into that first phase 1 trial in affirms ridding medicine of
out how we leverage data to ber this vividly, this nurse very March 2020. We’re very proud medical essentialism and rid-
measure structural and other proudly opened a notebook of them for getting that whole ding medicine of the use of race
forms of racism and then how that she had in a drawer in her vaccine program launched. as a proxy for biology. That has
to use that to inform policy very rickety desk and said, We must change the narra- been aligned with a movement
change. We’re coalescing “I have a list of people here tive of what people can do around getting rid of racist
around the need to understand who need treatment.” And then and what they are able to do algorithms, clinical algorithms
that health policy and social she pulled out another sheet and start asking, Who gets to [see “Better Measures,” by
policy go hand in hand. We of paper, and she said, “Look be trained? Who gets to have Cassandra Willyard, on
can’t, for example, talk about at this. I have a certificate. I’ve the knowledge? Who gets to page S3]. That would have never
historical redlining and racial been trained. I’m ready. I want make the decisions? Who gets started without this national
covenants and birth outcomes to save my people.” And I to decide what to make and and collective movement to
in those communities without remember walking away think- where it goes? All those deci- name racism and the exposure
having the data, without under- ing, “This gives me hope. There sions happen at some level of inequities during COVID.
standing the history as well as are people who care about of leadership. If you diversify That response and that collec-
what’s happening currently. their communities. They’re that leadership, you will have tive response do provide hope.
And then using that to inform ready, they’re willing.” And I’ll a better, more balanced opin-
housing policy just as much as never forget that, and I’ll never ion about how things should Anil Oza is a Boston-based science
we might use that evidence to forget the look on her face of be done. That’s how you start journalist focused on health inequity
inform health policy. “I can’t wait anymore.” moving toward equity. and neuroscience.
From left to right: Chris Cooper/University of Minnesota School of Public Health; Hugh Siegel/ICAP
at Columbia University; Morehouse School of Medicine; American Medical Association NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S17
Cultural Competency
A movement, which aims to help providers better understand
their patients’ culture and language, is gaining traction
and hopes to improve care and save lives BY ROD MCCULLOM
CALIFORNIA’S INLAND EMPIRE is a broad a Latina who comes to see a doctor because ly to ask relevant questions. Culturally
swath of land east of Los Angeles, about they have a problem related to the repro- sensitive care starts with the premise that
five times the size of Connecticut, stretch- ductive system, they may feel like, ‘I feel people come from diverse cultural, ethnic,
ing through desert and surrounded by embarrassed to tell this white guy who religious and socioeconomic backgrounds
mountains. It’s one of the state’s fast- doesn’t speak my language about this situ- and that understanding these differences
est-growing regions, but it’s underre- ation that I’m having.’ They request for me is crucial for proper health care. Hospitals
sourced, with incomes and education lev- to be with them.” and medical schools are now adding tools
els lower than the state average. It is also Research has shown that in the U.S., to help their providers improve sensitivity
medically underserved, with too few pri- patients with limited English proficiency around language, traditions and cultural
mary care physicians and specialists to have a higher risk of hospital readmission expectations. The strategy is already ad-
adequately tend to the area’s increasing and greater difficulty adhering to medica- vancing health equity. A growing body of
population. In the region’s many Spanish- tion regimens. More than 25 million peo- research shows that by addressing bias and
speaking communities, finding a doctor ple who live in the U.S. have limited En- stigma directly in a rapidly diversifying
who speaks the same language is difficult. glish proficiency. Because the majority of patient population, culturally concordant
And whether people can communicate those are Spanish speakers, many medical care results in better health outcomes
well with their health-care providers schools now offer medical Spanish. across a person’s lifespan—from prenatal
affects patient outcomes. C.U.S.M., which was founded in 2018, has and maternal health to pediatrics to end-
Three years ago the Inland Empire Free made it mandatory. Finding a common of-life decisions.
Clinic opened in Colton, Calif., to provide language is just one way in which medical
free health and medical care and social ser- schools, clinics, hospitals and health-care MATERNAL MORTALITY RATES in the U.S.
vices. Its clinic is staffed by physicians and networks are working to address health are higher than in any other high-income
medical students from the nearby Califor- disparities as part of an increasingly visible nation in the world. In 2022 that rate was
nia University of Science and Medicine. movement known as culturally sensitive or about 22 deaths per 100,000 live births,
Many are proficient in Spanish, and those concordant care. according to the Centers for Disease Con-
who aren’t work through interpreters. “The When patients don’t trust the providers trol and Prevention’s National Center for
moment I talk in Spanish to patients, they caring for them or when they feel dis- Health Statistics, down from almost 33
change their attitude and are more open to missed or misunderstood, they’re less like- deaths per 100,000 live births in 2021.
tell me how they actually feel,” says Alex- ly to share relevant information. And The death rates are the worst in Black
andra Lopez Vera, director of C.U.S.M.’s when providers don’t understand a pa- communities. Data from the Chicago De-
medical Spanish program, who coordi- tient’s life experiences and culture or don’t partment of Public Health revealed that in
nates interpreters for the clinic. “If I talk to speak their language, they may be less like- 2019, Black women in Chicago were almost

INNOVATIONS
INNO
IN N OVA
NO VATI
T ON
TI ONS
S IN
N SO
SOLUTIONS
SOLU
LUTI
LU TION
TI O S FO
ON FOR
O R HEALTH
H AL
HE ALTH
T H EQUITY
TH E QU
QUIT
IT
TY
six times more likely than white women to “The Black population is experiencing the during the worst of the COVID pandemic.
die during pregnancy or within one year of most deadly outcomes when it comes to “There is a lack of care for those already
giving birth. To try to reduce this number, pregnancy,” says Stewart, a certified disadvantaged,” she says. Stewart ap-
the University of Illinois Hospital and nurse-midwife at UI Health and one of the proached Kylea Laina Liese and Stacie
Health Sciences System (UI Health) intro- investigators leading the Melanated Group Geller of the University of Illinois Chicago,
duced a new initiative in 2022: its Melanat- Midwifery Care program’s research. The who study risk factors associated with ma-
ed Group Midwifery Care program. patients she serves are predominantly ternal health, and together they made a
The midwifery group was born out of Black and live on the west and south sides plan, secured a $7.1-million research grant
Karie Stewart’s frustration with a system of Chicago, where a number of hospitals and got to work.
that was failing Black and brown families. shut down their labor and delivery units The research project includes people at

student in his laboratory, has now present-

“Folks are using the health-care system ed their findings at a couple of conferences
more. They’re not running from it. They’re and to other medical schools in the Phila-
delphia area. They have also completed a
empowered from their maternity experi- pilot study on physicians’ awareness of and
familiarity with Black hairstyles. “We
ence.” —Karie Stewart Melanated Group Midwifery Care found the length of your career correlated
with how familiar and comfortable you are
all stages of pregnancy, from the first tri- anesthesiologist and interim associate with identifying these hairstyles in imag-
mester to 12 months after birth. It matches dean of the school’s diversity, equity and ing,” Udongwo says. But these are skills
Black pregnant people with Black mid- inclusion office. There were 346 instances that can be taught. “There is no curriculum
wives and is expanding prenatal care in in the curriculum, she says, “where we had developed around teaching this.”
communities with limited maternal health an opportunity for development and Udongwo is Nigerian American and
services. The program provides group ed- growth.” These included dozens of exam- has worn braids for years. While collecting
ucation to support people in different stag- ples of racial or ethnic stereotypes, as well research for the project, she heard one
es of pregnancy, offers breastfeeding re- as symptoms that had never been studied story after another about patients who
sources, helps participants with family in groups representing a range of human encountered radiologists with little cul-
planning after their babies are born, and skin tones. Berkeley says several members tural sensitivity or understanding. It
ultimately reframes maternal and postpar- of the faculty have told her, “It’s changed just doesn’t make sense, she says, that ra-
tum care in a way that respects Black pa- the way I look at some of my patients and diologists in 2024 aren’t familiar with
tients’ needs and experiences in a health- how I engage with them.” these hairstyles.
care system still recovering from historical Hillel Maresky, a cardiothoracic radi-
and systemic racism. ologist, arrived at Temple University in EDDCAL SCHOOLS ARE BEGDNNDNG
Today Stewart and her team are four
years into the five-year grant, and they can
point to qualitative changes in the commu-
2019, before the cultural sensitivity task
force was assembled. He soon noticed an
odd phenomenon. Many of his Black fe-
M to catch up. In 1991–1992, research-
ers surveyed all 126 medical schools
in the U.S. about whether they had imple-
nity they serve. (The team expects to share male patients had chest x-rays, computed mented cultural-sensitivity training or
quantitative data after the research period tomography scans and magnetic resonance had plans to do so in the future. Their re-
ends in 2025.) “We’re seeing folks use the imaging (MRI) that seemed to include sults were published in 1994 in Academic
health-care system more. They’re not run- shadows or squiggly lines known as arti- Medicine. Of the 98 schools that respond-
ning from it,” Stewart says. “They’re em- facts. He discovered that these artifacts ed, only 13 provided a cultural-sensitivity
powered from their maternity experience. were being caused by the women’s hair course, and only one of those was a require-
They’re empowered to share what’s going braids, locs and twists and the hair bands ment. Today medical schools, govern-
on.” Given that many of these patients had that held them in place. Certain hair oils ments and hospitals across the U.S. have
previously avoided the health-care system, and conditioners used by Black women guidelines for cultural-sensitivity training.
she sees this as a big win. “We want them also presented problems: the oils occa- They’re expanding their sensitivity around
to be engaged in their health care not just sionally contain trace amounts of metals communication, too: as of 2019, almost
when they’re pregnant but after having a that interfere with MRI machines’ power- 80 percent of the nation’s medical schools
child and to seek care for anything else they ful magnets. “As I was compiling these offered medical Spanish.
have going on.” cases, I learned that there really was a hole Not only does language concordance
in the medical literature on this topic,” improve outcomes, but it can also enhance
DN MEDDCAL SCHOOLS ACROSS the coun- Maresky says. patients’ experiences. A small study by
try, clinicians, faculty, administrators and When images are unclear or contain Lopez Vera assessed patient satisfaction at
students are reviewing their curricula to artifacts, patients must be scanned again. the Spanish-friendly Inland Empire Free
identify existing biases and teach cultural And additional testing means additional Clinic and found that those treated by a
sensitivity to the next generation of physi- radiation exposure, as well as logistical doctor who spoke their language had the
cians. When schools integrated informa- challenges such as transportation or loss of highest satisfaction scores. These days,
tion on racial disparities into their teach- hours at work. The lack of familiarity with between technology and artificial intelli-
ings, according to a 2019 study in Academic these hairstyles and the lack of data re- gence, some people assume they don’t need
Medicine, students were more motivated garding their effect on imaging present to learn a new language, Lopez Vera says.
to work in diverse communities. problems not only for radiologists but for But the evidence shows that the human-to-
In 2021 Temple University’s Lewis Katz clinicians in a wide range of medical fields. human approach is not just more empa-
School of Medicine in Philadelphia formed Maresky began collecting a dataset that thetic but more effective.
a task force of students and faculty to iden- now includes more than 100 images of Rod McCullom is a science writer whose work
tify potential problems in the school’s such artifacts that mirrored disease, and has appeared in Undark, Nature, the Atlantic and
course curricula, says Abiona Berkeley, an Angela Udongwo, a fourth-year medical M.I.T. Technology Review, among other magazines.

Defogging Data ple’s health needs and to decide how to al-

locate resources.
But the AANHPI category masks rich
As researchers separate out health data from culturally diversity. People in this group have ances-
distinct groups, they’re finding ways to reduce tral links to more than 50 countries. They
health disparities BY JYOTI MADHUSOODANAN collectively speak more than 100 different
languages, have widely variable ways of
life that differentially affect their health
MANY OF THE PATIENTS who come to lor interventions more appropriately. risks and represent a diversity of genetic
Eugene Yang’s cardiology clinic trace their For decades such nuance had been all backgrounds. They’re also the fastest-
origins back to India, China, Korea, and but invisible to scientists, clinicians and growing racial and ethnic minority in the
multiple parts of Southeast Asia. His clinic policymakers. The single AANHPI cate- U.S. By pooling their data, researchers
is in Seattle, a hub for the tech industry gory, which was defined in the 1997 U.S. end up with a potpourri that obscures
and home to thousands of immigrant Census, is still used widely by hospitals, as population-specific health needs or
workers. Yang had seen firsthand how well as by state and national health data- health risks. “When you lump everybody
people from each of these groups were at bases. Researchers and policymakers use together, you don’t see that maybe there
risk of heart disease and how their typical these data to assess disease rates and peo- are important differences,” Yang says.
lifestyles differ.
Yet despite differences in their cul-
tures and backgrounds, these patients
have been lumped together with people
from other communities in a single cate-
gory: Asian American, Native Hawaiian
and Pacific Islander, or AANHPI. So Yang
and his colleagues created a study looking
at how social stress factors affect heart
health in the Asian American communi-
ties he treats. The researchers analyzed
stressors such as food insecurity, delays in
medical care and living in a neighborhood
that didn’t feel close-knit or safe. Then
they correlated these issues with risk fac-
tors for heart disease among Chinese,
Filipino and Asian Indian adults. Other
Asian communities were grouped to-
gether into a single category.
The recently completed study showed
that the same stressors manifest differ-
ently in people of different ethnicities.
Across the board, those who experienced
more social stress had poorer sleep, strug-
gled to exercise and used more nicotine—
all factors associated with higher rates of
heart disease. But differences emerged
between groups. In Chinese Americans
high stress was associated with an in-
creased risk of diabetes, whereas in Fili-
pino adults it was linked to high blood
pressure. Asian Indians were most likely
to experience poor sleep and physical in-
activity when bearing the brunt of social
stress. “There are significant differences
in how social determinants of health im-
pact the different Asian subgroups,”
Yang says. Recognizing this variation is a
first step toward helping physicians tai-

Now efforts led by advocates, research- couldn’t understand her true health risks. nority myth. “It’s like this hamster wheel
ers and community organizers—most “I knew I wasn’t being seen,” she says. you get stuck on,” Kauh says.
of them from AANHPI communities— Grouping too much data blurs the re-
are paving the way to data equity and bet- ality of people’s lives. For example, in the KAUH FDRST BUMPED into that cycle in
ter health. aggregate, the risk of cancer death among college during an undergraduate psychol-
Spurred in part by the realization that Asian Americans is about 40 percent ogy class about how culture and ethnicity
aggregated data masked stark health dis- lower than that for white people. But dis- shape someone’s behaviors and percep-
parities during the COVID pandemic, re- aggregating data reveals important pat- tions of social norms. Fascinated, she
searchers began studying disease risk in terns. Within the AANHPI group, lung tried to dig deeper into the experiences of
specific AANHPI cohorts such as Pacific cancer is the leading cancer diagnosis Asian Americans, yet she couldn’t find the
Islander, South Asian and Vietnamese among Vietnamese, Laotian and Cha- data. Kauh persisted, revisiting the topic
populations. They’re finding that teasing morro (those with ancestry in the Mari- in graduate school but says she found it
apart data in community-specific ways lets ana Islands) men, and colorectal cancer is “basically impossible” to get funders in-
them use race and ethnicity information highest among Laotian, Hmong and Cam- terested. Since then, she says, “it’s been
without conflating it with biology. Policy- bodian men. this mission of mine to try to push for col-
makers are catching up, too, using data When data are pooled, these nuances lecting data about Asian Americans.”
specific to individual communities to bet- vanish. “One group looks better than they Kauh’s parents were Korean immi-
ter understand how to allocate resources really are, the other group looks worse grants who owned a convenience store in
and communicate more effectively. than they really are, and you can’t rely on Philadelphia. Even as a teen, Kauh could
These efforts are improving AANHPI those estimates anymore,” says Joseph tell that their grueling schedules, lan-
health outcomes, says epidemiologist Kaholokula, a physician at the University guage issues and social isolation took a
Stella Yi of New York University Langone of Hawai % i at Mānoa. “It’s nonsense. It’s physical and mental toll. Their lives were
Health. In recent years disaggregating not good science, yet people have been do- hardly those of a model minority. “I could
AANHPI data has helped health-care ing this for decades.” see the challenges they experienced on a
professionals improve hepatitis B vacci- That’s because for decades federal and daily basis, but no one ever really talked
nation rates, reduce the devastation that state health databases have offered re- about that except to frame it as ‘look how
has been caused by COVID and wildfires searchers only a high-altitude view. Early hardworking they are,’” she says.
among Hawaiian communities, and iden- attempts to break population data down The social stressors Kauh’s parents ex-
tify better diet strategies to help South with greater granularity failed because perienced were financial and cultural,
Asian communities reduce their risk of there simply weren’t enough people in each both of which can affect a person’s health.
heart disease. “It’s been really exciting to group. The effort sparked concerns that, Language barriers, racism, changes in
watch,” Yi says. although the people included in these diet with the move to a new country and
health-related data samples should remain the circumstances of that move—whether
ELLDE (CHANTELLE) MATAGD was a anonymous, there were so few they could someone migrates to pursue a graduate
T 20-inch, eight-pound, six-ounce

bundle of newborn joy in a Utah hos-
pital nursery when her identity vanished
be easily identified. And funding to look at
AANHPI health has been limited—a 2019
study reported that over the previous
degree or to flee from conflict—can add
up. None of these factors are related to the
biological basis of disease, but they deter-
into the health system. On hospital forms 25 years, only 0.17 percent of all National mine what resources a person or commu-
Matagi, who is of Samoan ancestry, had Institutes of Health funding for clinical re- nity might need to achieve good health.
been labeled Asian, a category that blurred search supported projects focused on When researchers understand the
racial lines so completely it rendered them AANHPI communities. links between social factors and people’s
meaningless. Matagi, a community health This is in part the result of broader health, they can begin to design tailored
leader who managed the Pacific Islander stereotyping of Asian Americans as a solutions. Food is one clear example. In
Task Force within the Hawaii State Depart- “model minority,” a category in which ev- the U.S., South Asian communities have
ment of Health during the early days of the eryone is assumed to be well educated, fi- disproportionately high rates of heart
COVID pandemic, says the record both- nancially secure and generally healthy. disease—an observation often explained
ered her parents. It also troubled Asian The model-minority trope illustrates by diet, says Alka Kanaya, a clinician who
staff at the hospital, who recognized the in- how race-based assumptions can bias sci- studies diabetes at the University of Cali-
congruity of so many people being lumped entific research, says Tina Kauh, a pro- fornia, San Francisco. Researchers typi-
together. Matagi ended up quitting her job gram manager at the Robert Wood John- cally gather details about food habits us-
in 2022 to address her own health. She had son Foundation. “It’s important for peo- ing a list of standard questions based on
diabetes and high blood pressure, and her ple to recognize that systemic racism is Western diets that don’t represent global
doctors suggested she just lose weight. But really what’s driving the fact that we don’t cuisines. Advice about what constitutes a
because she was familiar with the science disaggregate data.” With so little NDH “healthy” food is also based on studies
and knew aggregated data were masking funding to support their work, scientists conducted with Western diets. “You have
her Samoan ancestry, she realized they have struggled to dispel the model-mi- to be specific to what people may be eating

Heart Health across Asian All Asian Americans except Prevalence values for all
American Communities for Asian Indian, Chinese,

and Filipino. (This subgroup
Asian American adults in the study
(total of 6,395 people)
Food insecurity, living in an unsafe neighborhood, exposure couldn’t be disaggregated
to nicotine, and other social factors can increase risk of heart further because of partici-
pant confidentiality
disease. But not everyone is affected the same way. Grouping
and small sample sizes.) Asian Indian
data from diverse groups together hides the differences. A 2024
analysis by Eugene Yang and his colleagues found that Filipino, (1,383)
Chinese and Asian Indian adults experience different health
outcomes in response to social and environmental stress.
Filipino Chinese
(1,412) (1,341)
Prevalence of Cardiovascular Risk Factors, by Asian American Subgroup (age standardized, self-reported)
Obesity High Blood Pressure Nicotine Exposure
Outer circle: 50%

of study participants
within the group
27%
21%
7%
19% 24% 27% 26% 4%
10%
12% 9%
20% 5%
30% 34%
Insufficient Physical Activity Suboptimal Sleep Diabetes High Cholesterol
47%
35% 28%
10%
49% 43% 40% 28% 29% 28%
11% 12%
11%
Source: “Social Determinants of Cardiovascular Risk Factors among Asian American Subgroups,”
30% 6% 33% 23%

47% 41%
49%
by Alicia L. Zhu et al., in Journal of the American Heart Association, Vol. 13; April 2024 (data)
and how they may be cooking it. Having foods correlated with a “South Asian Hawaii during the worst of the COVID
nonaccurate ways of measurement just Mediterranean-style diet”—one rich in pandemic. The state health department’s
gives you useless data,” Kanaya says. fresh vegetables, fruit, fish, beans and le- infectious disease team was heavily fo-
For the past decade Kanaya and other gumes. They found that people who ate cused on controlling the spread of the virus
researchers have run a study of heart more of these foods had a lower risk of at the start in 2020. But the scientists were
health among South Asians living in the heart disease and diabetes than other “thinking of it in terms of a purely biologi-
U.S. called Mediators of Atherosclerosis people in the cohort. cal system versus understanding what puts
in South Asians Living in America (MAS- Data such as these can help clinicians people at risk,” says Joshua Quint, an epi-
ALA). It includes a food-frequency ques- advise patients more effectively by offer- demiologist at the Hawaii State Depart-
tionnaire that lists many South Asian ing dietary solutions that may be easier for ment of Health. “Accurate measurement
foods, such as dhokla (a savory cake), them to follow rather than forcing a more of social factors is so important.”
sambar (lentil stew), steamed fish, lamb Western lifestyle on them, Kanaya explains. To gather those data, Quint teamed up
curry and popular snacks. Last year the with Matagi and Kaholokula, the Univer-
researchers analyzed the diets of nearly GETTING GRANULAR with community sity of Hawai % i physician, to form a COVID
900 people from the study and identified data proved to be a lifesaving strategy in investigation team. The group quickly
Graphic by Jen Christiansen NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM S23

Quint warns that in efforts to apply

When researchers understand the links race and ethnicity data, researchers and
between social factors and health, they policymakers should be careful not to
conflate a person’s health with these fac-
can begin to design tailored solutions. tors alone. Aggregated or not, race and
ethnicity are always simple representa-
discovered there was no way to figure out ageable. In New York City in the early tions of broader social and cultural factors
which of the Native Hawaiian and 20 or 2000s, routine hepatitis B vaccination that affect health. But disaggregation, he
more Pacific Islander communities needed was available only to children. Among says, can “help us get beyond race and talk
resources or what those resources were. adults the virus was typically seen as a about ethnicity in ways that are more
The data at hand were simply too sparse sexually transmitted infection (STI), and meaningful and helpful.”
to base any estimates on. So the team be- testing and treatment were offered pri-
gan recording COVID deaths with more marily at HIV clinics. FFORTS TO CREATE community-
specific demographic details. When
counts were low enough that they risked
making individuals identifiable, the team
But the infection was common among
Asian American immigrants because of
high endemic rates in their countries
E specific solutions are what “actually
move the disparities dial,” Matagi
says. Now, after the success of state- and
noted these details in a separate section of of origin. In families the virus passed community-level studies, policymakers
the database to ensure that information between married partners, from person are launching larger studies and investing
from smaller communities was not lost in to person through household contact such more money in the hopes of better under-
an aggregate, Matagi says. as the sharing of utensils, and from standing the health of different groups un-
The team members didn’t just gather mother to child during childbirth. These der the AANHPI umbrella.
information—they shared it with the adults were unlikely to seek care at an STI Last year the White House announced
communities through hours of virtual vis- clinic. At the time, researchers reported a national effort to prioritize equity for
its and phone calls. As they talked, the rates of hepatitis B among Asian Ameri- AANHPI communities, and earlier this
carefully gathered and stored details cans that were about 50 times higher year the National Heart, Lung, and Blood
helped communities see their own losses than those among non-Hispanic white Institute launched a large epidemiologi-
amid the sea of numbers. No one could people, as well as rates of liver cancer, a cal study to understand health trends in
deny the devastation they’d experienced, common consequence of infection, that these populations. This seven-year proj-
nor could their experiences be minimized were several times higher. In 2003 re- ect, named the Multi-ethnic Observa-
by a database that didn’t represent them searchers at New York University teamed tional Study in American Asian and Pa-
and their needs. The strategy was espe- up with community organizers, politi- cific Islander Communities (MOSAAIC),
cially effective among the Samoan, Mar- cians and clinicians in the city to help ad- aims to track the health of 10,000 people
shallese and Chuuk (people originally dress the disparity. who identify with various AANHPI sub-
from part of Micronesia), Matagi says, be- The coalition’s work helped to estab- groups. One challenge, Kanaya says, will
cause they were the three Pacific Islander lish that the problem would not be stem- be to find out how granular they can
communities most affected by the disease. med by STI clinic screenings, because that get—keeping the data anonymized but
The researchers worked with each “was not somewhere that we knew Asian with sufficient detail to identify meaning-
community to identify specific require- American immigrant adults would feel ful trends, yet without adding so many
ments. Some needed a safe place to keep comfortable going,” says epidemiologist checkboxes that a long list leaves partici-
healthy family members distanced from Simona Kwon of N.Y.U. Langone Health, pants exhausted.
those with COVID, others wanted more who joined the effort a few years after it Establishing new categories of race
resources allocated to food or medical began. “The communities are very differ- and ethnicity may seem to contradict ef-
care, and still others sought a way to main- ent,” Kwon says, “and the health priori- forts to make medicine and health care
tain social connections or attend religious ties are different.” Western social norms equitable and free of racial bias. But done
gatherings virtually while observing and biased perceptions had been uninten- right, these endeavors can be complemen-
COVID precautions. tionally driving health outcomes for tary. “There’s a push to avoid talking about
The same approach helped the team hepatitis B. race, and I think there are big risks associ-
customize care after the Maui wildfires by The N.Y.U. team helped city officials ated with that if it’s coming from a place of
recognizing specific needs such as food, implement community-based programs wanting to ignore problems,” Quint says.
shelter and medicine. Its methods have and offer adult vaccinations at primary “We need statistics that cut across all
since been highlighted by the World care clinics and through community- ranges of demographic factors so we can
Health Organization as an effective way to based organizations. Recognizing that find out if we’re building a more just and
reduce health disparities. not just viral infection rates but social fair society.”
Identifying a community’s needs and conventions guide people’s choices about Jyoti Madhusoodanan is a science journalist based
meeting them appropriately can make a care was the key to driving down hepati- in Portland, Ore. She covers health, medicine and the
range of infectious diseases more man- tis B transmission. life sciences.

History Lessons
Clinics and public health researchers are taking direct aim at the mpox outbreak
by starting in local clinics and using tools that were developed to tackle HIV/AIDS
BY CHARLES EBIKEME
THE ABANDONED BUILDINGS behind the Dimie Ogoina, a Nigerian infectious dis- The advantage today is that those deal-
New Somerset hospital in Cape Town, ease physician-scientist, and his team were ing with mpox have lessons from HIV/AIDS
South Africa, are prime real estate along the first to describe sexual transmission of to follow. One small but meaningful way
the waterfront, so guards patrol the area day mpox in Nigeria in 2017. He believes that this has already been addressed is its name:
and night to protect against squatters. But what makes the disease so challenging is the monkeypox was renamed in 2022 to miti-
squatters aren’t the only visitors. Tucked in comorbidities that exist in Africa, especially gate against racist and stigmatizing lan-
among the empty facades is the Ivan Toms co-infection with HIV. His team noticed guage. And as a result of the 2022 global
Center for Health, one of the first clinics in that those with the most severe cases of emergency and lessons learned from the
South Africa for men who have sex with mpox also had HIV infections. “Most of HIV/AIDS pandemic, public health officials
men. It was launched in 2009 to provide them had advanced HIV ... and [were] not are better equipped to build coordinated
comprehensive, free and sensitive health on treatment,” Ogoina says. messaging and meet patients where they are.
care. These days a new concern is on the People with HIV accounted for around “[Our] clients overall are now familiar
minds of its visitors: mpox. 40 percent of those diagnosed with mpox in with mpox, as we had the 2022 outbreak and
The first human case of mpox, formerly the 2022 outbreak, and recent studies sug- did extensive education,” says Johan Hugo,
known as monkeypox, was described in the gest that people who have more advanced an HIV clinician at the Ivan Toms Center.
1970s. The disease is thought to be caused HIV have worse clinical outcomes and high- The center has integrated mpox services
by a virus that jumped from animals to hu- er mortality from mpox. How the two dis- into its HIV care as recommended by the
mans and causes symptoms similar to eases interact is still a mystery, however. WHO and is part of a network of clinics and
smallpox. This past August the World Researchers have yet to tease apart whether government agencies, including the South
Health Organization designated mpox a HIV infection raises the risk of acquiring African Department of Health, that are us-
public health emergency of international mpox or increases its severity or whether ing common messaging and strategies for
concern for the second time in two years. people living with HIV simply might be mpox. “We work closely with organizations
Although the risk of mpox is not limited to more likely to be diagnosed because they’re that support key populations to ensure we
men who have sex with men, the transmis- already receiving better care. Better under- remain in line with one another,” he says.
sion dynamics of the 2022 outbreak led re- standing this connection could be critically Such coordination in messaging helps to
searchers and public health officials to iden- important. As the outbreak spreads to more combat stigma around a disease that is not
tify them as a high-risk group. During 2022 nonendemic countries, effective treatment yet fully understood.
more than 90 percent of known cases were of HIV could hold one key to bringing the Despite significant improvements in ac-
among gay, bisexual, and other men who outbreak to an end. cess to HIV/AIDS treatment, gaps persist
have sex with men. As the outbreak builds, because patients are worried about their
Ivan Toms and similar clinics have seen an MPOX’S PRESENT ECHOES HIV’s past—it’s diagnosis creating stigma related to sexual
increase in patients wanting information. a disease that has the potential to affect ev- and reproductive health. It is no different
Epidemics begin and end in communi- eryone and is more dangerous within a spe- with mpox. The stigma associated with
ties. Today people around the world under- cific community. The comparison is etched mpox can adversely affect prevention and
stand and respond to outbreaks differently in the brick and mortar of the clinic on the treatment, with people less likely to disclose
than they did before the COVID pandemic. waterfront: Ivan Toms, the man, was both symptoms or seek care—they may even
They appreciate concepts of transmission, an anti-Apartheid and a gay rights activist. hide their condition for fear of being diag-
protection and vaccine availability at a The challenge with both diseases is how nosed. There is no specific treatment for
deeply personal level and are hungry for to get information to an already stigmatized mpox, and its symptoms are similar to those
information. They want to know if a case group of people in a timely enough manner of other viruses such as chicken pox. But
has appeared locally and, if so, how to pro- to halt the ongoing outbreak without mak- rapid, accurate diagnosis is the only way to
tect themselves. And the community most ing that stigma even worse. The 2022 out- prevent transmission and end outbreaks.
affected by mpox is one that has suffered break showed that our first attempts failed: To achieve this, public health officials are
multiple other outbreaks—most notably, an article in PLOS Global Health was simply taking everything they’ve learned from
the HIV/AIDS crisis. Critically, that means entitled “Monkeypox Is Not a Gay Disease,” HIV and using it to attack mpox outbreaks.
it’s a community that clinicians and public rec og niz ing that stigma had quickly For instance, Ivan Toms and other clinics
health researchers know, understand and emerged around the virus, echoing the early have developed approaches for delivering
collaborate with. days of the HIV pandemic. health services that allow for discretion and

privacy. In addition to onsite testing and ing institution for service providers across store patients’ medicines, and mobile units
health checks, the center also packages and 11 African countries. that go directly into communities. Across
dispenses medications for its clients, elimi- PrEP reduces HIV risk by preventing the entire Cape Metro area, mobile units
nating the need to visit a general pharmacy. HIV from entering the body and replicating. provide comprehensive HIV testing, treat-
The approach has been so successful that But protection requires that users maintain ment and prevention services, including
after becoming the first clinic to run high levels of the medication in their bodies. self-screening, PrEP, antiretroviral drug
demonstration projects for HIV Pre-Expo- Because adherence is crucial, practitioners initiation and follow-up, viral load testing,
sure Prophylaxis (PrEP) in Africa in 2015, aim for frictionless care that removes any and screening for sexually transmitted in-
Ivan Toms is now one of the largest provid- social barriers. To that end, the clinic runs a fections. “Our mobile units are an extension
ers of PrEP in South Africa and a key train- WhatsApp service, smart lockers that safely of our facility and seek to provide the same

formation online and then to ensure that no discussion on technology transfer to an-
every client who comes through our services other potential manufacturer.”
is provided direct information about the During the COVID pandemic, African
current situation,” Hugo says. Most days, countries surpassed all expectations de-
that’s as many as 120 to 150 people. spite challenges in vaccine access. Tanzania
emerged as one of the best-performing
HERE ARE TWO VARIANTS of mpox vi- African countries for COVID vaccination
T rus: clade I is endemic to central Africa

and has killed up to 10 percent of the
people it has infected during previous out-
rates: Between January 2022 and April 2023
the country managed to bump its total pop-
ulation vaccination rate from 2.8 to 51 per-
breaks, making it far deadlier than clade II, cent. This happened in part because
the type responsible for the 2022 outbreak. COVID-specific vaccinations were integrat-
Both are circulating today in different coun- ed with other routine health services, allow-
tries in Africa. And unlike the 2022 out- ing for effective delivery.
break, this one—which is tearing through The COVID pandemic forever changed
the Democratic Republic of Congo (DRC)— Africa’s policy, regulatory and vaccine
has largely spread through men seeing wom- landscapes. Low-income countries have
en who are sex workers. “We are not dealing learned to push through regulatory red
with one outbreak of one clade—we are deal- tape, advocate for their people and work
ing with several outbreaks of different clades with high-income nations to get vaccines
in different countries with different modes distributed more equitably. After putting
of transmission and different levels of risk,” a vaccination plan in place, Nigeria re-
said Tedros Adhanom Ghebreyesus, WHO’s ceived the first donation of 10,000 vac-
director general, during his opening remarks cines from the U.S. just a few days after the
at the emergency committee meeting where global mpox emergency was declared.
the global health emergency was declared. Other donations are aimed at countries
“Stopping these outbreaks will require a tai- across the African continent: Spain prom-
lored and comprehensive response, with ised 500,000 doses from its stockpile, the
communities at the center.” U.S. committed to sending another 50,000
In July 2024 South Africa notified the doses to the DRC, and Japan pledged mil-
WHO of 20 confirmed mpox cases between lions of doses. Some of those vaccines have
May 8 and July 2, including three deaths— already arrived in Africa.
the first reported in the country since 2022. Citing lessons learned from COVID,
Cases occurred in three of South Africa’s global health institutions are also mobiliz-
nine provinces, including the Western Cape, ing resources. Gavi, the Vaccine Alliance,
where the Ivan Toms Center for Health re- has mobilized resources for mpox, the roll-
sides. How the outbreak evolves from here out of which will be an early test of Gavi’s
will depend heavily on case identification First Response Fund. The fund aims to
and treatment management. make resources immediately available for a
There is one internationally approved vaccine response to a public health emer-
vaccine for mpox (another is approved in gency and includes a $500-million fund
Japan with emergency approval in the aimed at ensuring early access to vaccines
DRC), which can act as both preexposure within days of an emergency declaration.
and postexposure prophylaxis for people at This, according to Gavi director of develop-
high risk. But although the vaccine is avail- ment finance David Kinder, was one of the
able in numerous high-income nations, cur- big lessons learned from COVID.
level of care,” Hugo says. “Each of our teams rent access in South Africa is limited to non- The 2022 mpox outbreak was deemed
provides comprehensive HIV testing, treat- existent. “The vaccine was originally made to be over about nine months after the
ment and prevention.” for smallpox, with U.S. funding,” says WHO declared an emergency. The 2024
Because so many men who have acquired Mohga Kamal-Yanni, a senior policy advis- outbreak could be larger and longer. If it is
mpox are using PrEP, researchers think HIV er to the People’s Medicines Alliance, a glob- going to be extinguished as quickly, les-
may simply be another marker of high- al coalition with the goal of creating equita- sons learned from previous pandemics
er-risk behaviors facilitating infection. The ble access to vaccines and other medical hold the key.
goal will be for mpox services to follow the technology. The companies that make these Charles Ebikeme is a freelance science writer and
same community outreach. “Our strategy vaccines hold their patents, she says, “and journalist specializing in the intersection of health
for mpox currently is to provide broader in- when the mpox outbreak started, there was and society.

This section
was produced
independently
with support from
SPECIAL REPORT FROM
www.ScientificAmerican.com/InnovationsIn/solutions-for-health-equity

SCIENCE AGENDA OPINION AND ANALYSIS FROM SCIENTIFIC AMERICAN’ S BOARD OF EDITORS
Vote in November for Science

Kamala Harris has plans to improve health, boost the economy and mitigate
climate change. Donald Trump has threats and a dangerous record BY THE EDITORS
N THE NOVEMBER ELECTION, the can afford to see doctors for preventive and lic health measures, spread misinformation
I U.S. faces two futures. In one, the new

president offers the country better
prospects, relying on science, solid ev-
idence and the willingness to learn
from experience. She pushes policies that
boost good jobs nationwide by embracing
technology and clean energy. She supports
acute care. Harris supports expansion of
Medicaid, the U.S. health-care program
for low-income people. States that have ex-
panded this program have seen health
gains in their populations, whereas states
that continue to restrict eligibility have
not. To pay for Medicare, the health insur-
about treatments and suggested injections
of bleach could cure the disease. By the end
of that year about 350,000 people in the U.S.
had died of COVID; the current national
total is well over a million. Trump and his
staff had one great success: Operation Warp
Speed, which developed effective COVID
education, public health and reproductive ance program primarily for older Ameri- vaccines extremely quickly. Yet Trump
rights. She treats the climate crisis as the cans, Harris supports a tax increase on plans billion-dollar budget cuts to the Cen-
emergency it is and seeks to mitigate its people who earn $400,000 or more a year. ters for Disease Control and Prevention
catastrophic storms, fires and droughts. And the Biden-Harris administration suc- and the National Institutes of Health, which
In the other future, the new president ceeded in passing the Inflation Reduction started the COVID-vaccine research pro-
endangers public health and safety and re- Act (IRA), which caps the costs of several gram. These steps are in line with the guid-
jects evidence, preferring instead nonsen- expensive drugs, including insulin, for ance of Project 2025, an extreme conserva-
sical conspiracy fantasies. He ignores the Medicare enrollees. Harris’s vice presiden- tive blueprint for the next presidency drawn
climate crisis in favor of more pollution. He tial pick, Tim Walz, signed into law a pro- up by many former Trump staffers. He’s
requires that federal officials show personal hibition against excessive price hikes on also talked about ending the Office of Pan-
loyalty to him rather than upholding U.S. generic drugs as governor of Minnesota. demic Preparedness and Response Policy.
laws. He fills positions in federal science When in office, Trump proposed cuts to
and other agencies with unqualified ideo- Medicare and Medicaid. He also pushed for REPRODUCTIVE RIGHTS. Harris is a
logues. He goads people into hate and divi- a work requirement as a condition for Med- staunch supporter of reproductive rights.
sion, and he inspires extremists at state and icaid eligibility, making it harder for people During the September debate, she spoke
local levels to pass laws that disrupt educa- to qualify for the program. As a candidate, plainly about her desire to reinstate “the
tion and make it harder to earn a living. both in 2016 and this year, he pledged to protections of Roe v. Wade ” and added,
Only one of these futures will improve repeal the ACA, but it’s not clear what he “I think the American people believe that
the fate of this country and the world. That would replace it with. When prodded dur- certain freedoms, in particular the free-
is why, for only the second time in our mag- ing the September debate, he said, “I have dom to make decisions about one’s own
azine’s 179-year history, the editors of Scien- concepts of a plan” but didn’t elaborate. body, should not be made by the govern-
tific American are endorsing a candidate for Like Harris, however, he has voiced con- ment.” She has vowed to improve access to
president. That person is Kamala Harris. cern about drug prices, and in 2020 he abortion. She has defended the right to order
Before making this endorsement, we signed an executive order designed to the abortion pill mifepristone through the
evaluated Harris’s record as a U.S. senator lower prices of drugs covered by Medicare. mail under authorization by the U.S. Food
and as vice president under Joe Biden, as The COVID pandemic has been the and Drug Administration, even as MAGA
well as policy proposals she’s made as a greatest test of the American health-care Republican state officials have tried—so far
presidential candidate. Her opponent, system in modern history. Harris was vice unsuccessfully—to revoke that right. As a
Donald Trump, who was president from president of an administration that boosted senator, she co-sponsored a package of bills
2017 to 2021, also has a record—a disastrous widespread distribution of COVID vaccines to reduce rising rates of maternal mortality.
one. Let’s compare. and created a program for free mail-order Trump said he would vote against a bal-
COVID tests. Wastewater surveillance for lot measure expanding access to abortions
HEALTH CARE. The Biden-Harris admin- viruses has improved, allowing public health in Florida, where he lives. The current
istration shored up the popular Affordable officials to respond more quickly when lev- Florida law makes most abortions illegal
Care Act (ACA), giving more people access els are high. Bird flu now poses a new threat, after six weeks of pregnancy, before many
to health insurance through subsidies. highlighting the importance of the Biden- people even know they are pregnant.
During Harris’s September 10 debate with Harris administration’s Office of Pandemic Trump appointed the conservative U.S.
Trump, she said one of her goals as presi- Preparedness and Response Policy. Supreme Court justices who overturned
dent would be to expand it. Scores of stud- Trump touted his pandemic efforts Roe v. Wade, removing the constitutional
ies have shown that people with insurance during his first debate with Harris, but in right to a basic health-care procedure. He
stay healthier and live longer because they 2020 he encouraged resistance to basic pub- spreads misinformation about abortion—
TECHNOLOGY. The Biden-Harris admin-
istration’s 2023 Executive Order on Safe,
Secure and Trustworthy Development and
Use of Artificial Intelligence requires that
AI-based products be safe for consumers
and national security. The CHIPS and Sci-
ence Act invigorates the chipmaking in-
dustry and semiconductor research while
growing the workforce. A new Trump ad-
ministration would undo all of this work
and quickly. Under the devious and divi-
sive Project 2025 framework, technology
safeguards on AI would be overturned. AI
influences our criminal justice, labor and
health-care systems. As is the rightful
complaint now, there would be no knowing
how these programs are developed, how
they are tested or whether they even work.
THE 2024 U.S. BALLOTS are also about Con-

gress and local officials—people who make
decisions that affect our communities and
families. Extremist state legislators in
during the September debate, he said some an unhappy “fact of life” and the solution Ohio, for instance, have given politicians
states support abortion into the ninth was stronger school security. the right to revoke any rule from the state
month and beyond, calling it “execution health department designed to limit the
after birth.” No state allows this. He also ENVIRONMENT AND CLIMATE. Harris said spread of contagious disease. Other states
refused to answer the question of whether pointedly during the September debate have passed similar measures. In educa-
he would veto a federal abortion ban, say- that climate change was real. She would tion, many states now forbid lessons about
ing Congress would never approve such a continue the responsible leadership shown racial bias. But research has shown such les-
ban in the first place. He made no mention by Biden, who has undertaken the most sons reduce stereotypes and do not prompt
of an executive order and praised the Su- substantial climate action of any president. schoolchildren to view one another nega-
preme Court, three justices of which he The Biden-Harris administration restored tively, regardless of their race. This is the
placed, for sending abortion back to states U.S. membership in the Paris Agreement kind of science MAGA politicians ignore,
to decide. This ruling led to a patchwork of on coping with climate change. Harris’s and such people do not deserve our votes.
laws and entire sections of the country election would continue IRA tax credits for Harris does deserve our vote. She offers
where abortion is dangerously limited. clean energy, as well as regulations to re- us a way forward lit by rationality and re-
duce power-plant emissions and coal use. spect for all. Economically, the renew-
GUN SAFETY. The Biden-Harris admin- This approach puts the country on course to able-energy projects she supports will cre-
istration closed the gun-show loophole, cut U.S. carbon emissions in half by 2030. ate new jobs in rural America. Her plat-
which had allowed people to buy guns The IRA also includes a commitment to form also increases tax deductions for new
without a license. The evidence is clear broadening electric vehicle technology. small businesses from $5,000 to $50,000,
that easy access to guns in the U.S. has in- Trump has said climate change is a making it easier for them to turn a profit.
creased the risk of suicides, murder and hoax, and he dodged the question “What Trump, a convicted felon who was also
firearm accidents. Harris supports a pro- would you do to fight climate change?” found liable for sexual abuse in a civil trial,
gram that temporarily removes guns from during the September debate. He pulled offers a return to his dark fantasies and
people deemed dangerous by a court. the U.S. out of the Paris Agreement. Under demagoguery, whether it’s denying the re-
Trump promised the National Rifle As- his direction, the Environmental Protec- ality of climate change or the election re-
sociation that he would get rid of all Biden- tion Agency and other federal agencies sults of 2020 that were confirmed by more
Harris gun measures. Even after Trump abandoned more than 100 environmental than 60 court cases, including some over-
was injured and a supporter was killed in policies and rules, many designed to en- seen by judges appointed by Trump.
an attempted assassination, the former sure clean air and water, restrict the dan- One of two futures will materialize ac-
president remained silent on gun safety. gers of toxic chemicals and protect wild- cording to our choices in this election.
His running mate, J. D. Vance, said the in- life. He has also tried to revoke funding for Only one is a vote for reality and integrity.
creased number of school shootings was satellite-based climate-research projects. We urge you to vote for Kamala Harris.
Illustration by Luca D’Urbino NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 57

FORUM COMMENTARY ON SCIENCE IN THE NEWS FROM THE EXPERTS
How Science Upstaged As a lead author of the evidence chap-

ter, I was there among them in that Madrid
plenary room. So were several of the other
Climate Denial characters in Kyoto, including the play’s
central one: Donald Pearlman, who was a
A play celebrates the agreement that opened nations lawyer and lobbyist for the Climate Coun-
worldwide to accepting the science of climate change cil, a consortium of energy interests.
Pearlman and I were on opposite sides
BY BEN SANTER
of the Madrid chessboard. My efforts were
directed toward synthesizing and assess-
ing complex science and ensuring that the
T’S A VERY STRANGE experience to whether a human-caused climate change science was accurately represented in the
I watch a play in which you are a charac- signal could be identified in real-world cli-
ter—and to shake hands with the per- mate data. The 1995 assessment’s chapter
son who plays you. I did both this past reached a very different conclusion, encap-
July while attending a performance of sulated in 12 simple words: “The balance of
Kyoto at the Swan Theater in Stratford- evidence suggests a discernible human in-
upon-Avon in England. The moment fluence on global climate.” This was a mo-
meant more, of course, than just a glimpse mentous statement from cautious scientists
IPCC report. His were directed toward de-
laying international efforts to reduce emis-
sions of heat-trapping greenhouse gases.
Such reductions were bad for the business
interests he represented and for the reve-
nues of oil-producing countries such as
Saudi Arabia and Kuwait.
of oneself on history’s stage. The play shows and a rather conservative organization. Pearlman, who died in 2005, under-
how science won out over climate denial in Multiple factors contributed to this dra- stood the singular importance of the Ma-
a critical face-off between scientists and in- matic transition. Advances in the science of drid “discernible human influence” conclu-
dustry over the future of the planet. climate fingerprinting, for example, made sion. He knew it was the scientific writing
Kyoto is about the Kyoto Protocol, an a big difference in climate research during on the wall. The jury was no longer out. Hu-
agreement made more than 25 years ago the five years between the two reports. Fin- man-caused fingerprints had been identi-
that, as summarized by the United Nations, gerprinting seeks to identify the unique fied in records of Earth’s surface and atmo-
committed “industrialized countries and signatures of different human and natural spheric temperatures. Humans were not
economies in transition to limit and reduce influences on Earth’s climate. This unique- innocent bystanders in the climate system;
greenhouse gases (GHG) emissions in ac- ness becomes apparent if we probe beyond they were active participants. Burning fos-
cordance with agreed individual targets.” a single number—such as the average tem- sil fuels had changed the chemistry of
Written by Joe Murphy and Joe Robertson, perature of Earth’s surface, including land Earth’s atmosphere, thereby warming the
the play provides a dramatic retelling of a and oceans—and look instead at complex planet and sending Earth’s vital signs into
historic meeting in December 1997 in Kyoto, patterns of climate change. Patterns have concerning territory. The Madrid conclu-
Japan, where the protocol was finalized. discriminatory power and allow scientists sion meant the days of unfettered fossil-fuel
At this meeting, a key Intergovernmen- to separate the signature of human-caused use and carbon pollution were numbered.
tal Panel on Climate Change (IPCC) scien- fossil-fuel burning from the signatures of It also made Pearlman’s lobbying job
tific assessment helped to inform the inter- purely natural phenomena (such as El Niño more difficult. His response was to attack the
national emissions-reduction negotia- and La Niña climate patterns, changes in science and the scientists as part of a rear-
tions—the Working Group I part of the the sun’s energy output, and effects of vol- guard action to delay international agree-
IPCC Second Assessment Report, which canic eruptions). ment on reducing greenhouse gas emissions.
was completed in 1995 and published in Kyoto describes some of the fingerprint As Pearlman’s character explains in Kyoto,
early 1996. I was convening lead evidence that was presented it was a deliberate “scorched-Earth” strat-
author of chapter eight, “Detec- Ben Santer during a key meeting in Madrid egy: torch the science and the scientists.
tion of Climate Change and At- is a climate scientist in November 1995, ahead of the I experienced this strategy firsthand in
and a John D. and Cath-
tribution of Causes.” The role of erine T. MacArthur Fel- Kyoto face-off dramatized in a memorable personal meeting with Pearl-
the IPCC, back in 1995 and to- low. From 1992 until his the performance. The “dis- man in Washington, D.C., on May 21, 1996.
day, was to advise the govern- retirement in 2021, cernible human influence on After I spoke at the U.S. Congress’s Ray-
ments of the world on the sci- Santer pursued research global climate” conclusion was burn House Office Building about the sci-
in climate fingerprinting
ence and negative impacts of at Lawrence Livermore finalized in Madrid, where the entific evidence for human fingerprints on
climate change, as well as on National Laboratory participants included 177 dele- global climate, Pearlman confronted me
strategies for mitigating and in California. He was gates from 96 countries, repre- and started screaming at me—literally
adapting to those impacts. a contributor to all six sentatives from 14 nongovern- screaming. He expressed outrage at what
of the Intergovernmental
In 1990 the first IPCC scien- Panel on Climate mental organizations, and 28 he claimed were unauthorized changes to
tific assessment had concluded Change’s completed lead authors of the IPCC Sec- the chapter I had been responsible for. The
that the jury was still out on scientific assessments. ond Assessment Report. changes had in fact been authorized by the
THE SCIENCE OF HEALTH
Many
Adults
Don’t
Outgrow
ADHD
The disorder looks different
Getting Kyoto ready for its world premiere in London this past summer.
in grown-ups, but
IPCC, as Pearlman knew very well. He had Pearlman and his employers were also diagnosis is improving
been present at the Madrid meeting where on the wrong side of history. Today 191 BY LYDIA DENWORTH
the changes were discussed. countries have ratified the Kyoto Protocol.
Ultimately he lost. Despite tremendous Although the U.S. Congress never did rat-
differences among countries in terms of ify it, the protocol helped to pave the way
their national self-interest, culpability for for the 2016 Paris Agreement. The serious KNOW OF SOMEONE who was diag-
the problem of human-caused climate
change, and vulnerability to the effects of
climate change, an international agree-
ment was finally reached. The 1997 Kyoto
Protocol commits participating countries
to a common goal: reducing greenhouse
gas emissions and avoiding “dangerous an-
consequences of human-caused global
warming are now manifest to all, building
momentum for real action to cut carbon
pollution. The days of climate science de-
nial are numbered.
But they are not quite over yet. Another
Donald—former president Donald
I nosed with attention deficit hyperac-
tivity disorder (ADHD) as a child in
the 1990s. When he turned 18, his in-
surance company notified him that
his medication—a kind that gives kids
with ADHD a better chance to succeed in
school and can be quite pricey—was no
thropogenic interference” in Earth’s cli- Trump—has repeatedly denied the reality longer covered. ADHD, the insurer said in
mate system. Kyoto is the dynamic story of and seriousness of climate change. It’s effect, was a childhood disorder. What an
how that agreement was achieved. no surprise that his backers look a lot unfortunate choice: to either struggle fi-
In one memorable line in the play, Pearl- like Pearlman’s. There is a very small prob- nancially to pay for your medication or
man’s wife, Shirley, asks him, “Are we on ability that Trump will ever watch Kyoto. head into college or the workforce without
the wrong side?” The question is prompted There’s an even smaller probability that the treatment that helps you.
by an exposé of Pearlman’s lobbying activi- Trump will consider whether he, too, is on The idea that ADHD was restricted to
ties in the German news magazine Der the wrong side of science and history. kids was deeply ingrained at the time. Peo-
Spiegel. Shirley wants to know whether her Sadly, he is. Trump’s return to the U.S. ple thought “it was a developmental lag
husband’s efforts to cast doubt on the presidency would reprise Pearlman’s hey- that just needed to catch up,” says psychol-
climate-change science—and on the scien- day, when manufactured doubt obscured ogist Stephen Faraone of Upstate Medical
tists involved in advancing that science— mature scientific understanding. Kyoto University in Syracuse, N.Y.
place them on the wrong side of history. tells the story of how that scientific under- But ADHD often continues into adult-
The Pearlman character in the play re- standing evolved and how powerful vested hood, multiple studies have now shown.
sponds, “No, Shirley. We’re not on the interests tried to destroy it. It is absolutely The current estimated prevalence in adults
wrong side.” vital to give that account today, with the is around 2.5 to 3 percent, compared with
But Pearlman and the industries he rep- bill for climate change coming due all 5 to 6 percent in children. The 2013 edition
resented were on the wrong side of the sci- around us. of the Diagnostic and Statistical Manual of
ence. Nearly 30 years after the Madrid I hope Kyoto reaches audiences I could Mental Disorders (DSM-5) made it easier
IPCC meeting and after Pearlman’s con- never dream of reaching through all the sci- to diagnose adults, saying grown-ups can
certed efforts to undercut climate science, entific papers I’ve ever written. And I hope have five symptoms instead of the six re-
human fingerprints on Earth’s climate are it provides us with what mathematicians quired in children and acknowledging that
now unequivocal and ubiquitous. The cau- call an existence principle—proof that ADHD might look different as people grow
Manuel Harlan/RSC
tious 1995 “discernible human influence” something difficult is possible. The exis- older. “They don’t climb on furniture and
finding has been confirmed and strength- tence principle in Kyoto is that humanity stuff like that,” Faraone says. (The DSM-5
ened by all four subsequent IPCC assess- can come together and solve a seemingly still requires that some symptoms be pres-
ments. The scientists in Madrid got it right. intractable problem. ent before the age of 12.) The first guide-

THE SCIENCE OF HEALTH
lines for diagnosing and treating ADHD in

adults are now being developed by the
American Professional Society of ADHD
and Related Disorders.
In adults, the disorder can appear
rather different than in youngsters.
Grown-ups dealing with inattention and
hyperactivity may have more difficulty
than average completing long reports for
work, sitting through meetings or restau-
rant meals, paying bills on time, or sus-
taining romantic relationships. “We’re
shining a light on what’s probably really
going on,” says clinical psychologist Mar-
garet H. Sibley of the University of Wash-
ington School of Medicine, who worked
on several of the new studies. “People in
adult mental health settings just aren’t
even being screened for it.”
Because of the lack of screening, many
people who could benefit from treatment
aren’t getting it, experts say. Also, it is likely
that the rate in adults is higher than the
3 percent I mentioned earlier. A 2021 anal-
ysis showed that when based on symptoms
alone rather than documented childhood to flare up when life gets stressful and ease 50 percent discontinue the pills for at
onset, the rate in adults ranges from about when life is calmer. least 180 days, says psychiatric epidemi-
9 percent in young adults to more than Although a few studies have suggested ologist Isabell Brikell of the Karolinska
4 percent in those older than 60. it is possible for ADHD to appear for the Institute in Sweden. Reasons can include
Some people do outgrow the disorder, first time in adulthood, more recent re- adolescent independence, increased costs
though probably far fewer than previously search indicates that adult onset is highly and, for adults, providers less trained in
thought. (It’s unclear whether people’s unlikely. Nearly all such cases are probably treating ADHD. Thanks to parental over-
brains become more neurotypical over either misdiagnoses of another condition, sight, children are more likely to main-
time or they learn to compensate.) A 2022 such as substance use or anxiety, or in- tain treatment, but a large study across
study in the Journal of American Psychia- stances in which childhood symptoms eight countries showed that discontinua-
try, led by Sibley, found that slightly more were missed, Sibley says. tion rates peak for patients at the age of
than 9 percent of people diagnosed as chil- Many parents—and even grandpar- 18. “The transition from child and ado-
dren had no sign of the condition as adults. ents—first recognize their own symptoms lescent psychiatric care does not work
Usually such people had milder symptoms when their child is diagnosed. This is par- well in many countries,” Brikell says.
and strong support from parents. ticularly true of females with the disorder, The lack of proper treatment can raise
A more common scenario is that the whose behavior as children tends to be other health problems. Brikell says several
severity of symptoms fluctuates. Previous more inattentive than hyperactive like the Swedish-led studies have shown that ADHD
studies tested people once in adulthood stereotypical boy with ADHD. As adults, is associated with diseases that increase
and gave a yes/no diagnosis. Sibley’s study however, females are more likely than with aging, such as a slightly higher risk
retested teens and young adults multiple males to seek mental health treatment. of hypertension and other cardiovascular
times and revealed that 60 percent of “When you’re a child, you get mental diseases. The disorder has been linked to
those who showed remission later expe- health treatment if you cause someone else greater risks of obesity, substance use and
rienced a recurrence. “It appears to be a problem,” Faraone says. “When you’re sleep problems.
a condition that waxes and an adult, you go in because you The good news is that because the med-
wanes,” Sibley says. “There is Lydia Denworth have a problem.” ical community is increasingly aware of
likely a role of environment is an award-winning Most people who have been the nuances of adult ADHD, people expe-
in turning up or down the science journalist and diagnosed with ADHD will riencing difficulties have a better chance of
contributing editor for
volume of somebody’s diffi- Scientific American. She try medication (usually stim- getting a professional diagnosis. For
culties.” In other words, is author of Friendship ulants such as Ritalin), but grown-ups, Faraone says, proper treat-
ADHD symptoms may tend (W. W. Norton, 2020). within the first year 40 to ment can be life-changing.
60 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Jay Bendt

MATH
more challenging. The game of construct-

ing shapes with a compass and straight-
edge originates in Euclid’s Elements from
the third century B.C.E., one of the most
important textbooks ever written. Like
modern mathematicians, Euclid set out to
derive all of geometry from a minimal list
of assumptions. Instead of merely assert-
ing the existence of shapes or other geo-
metric objects, Euclid wanted to build
them explicitly from the simplest ingredi-
ents: lines and circles. To get a feel for these
constructions, try one for yourself: find the
midpoint of the line segment from A to
B below. Eyeballing won’t suffice; your
method must identify the exact midpoint.
First use a compass to draw a circle that
is centered at A and passing through B.
Then repeat this step to make a circle that
is centered at B and passing through A.
These circles will intersect at two points.
Use the straightedge to connect these
When Gauss Cracked points. Because of the symmetry in the

construction, this vertical line will inter-
sect the original line segment exactly at
the Heptadecagon its midpoint.
As a teenager, he solved a 2,100-year-old

A B
math problem BY JACK MURTAGH
A B
F YOU HAD TO CHOOSE a few words or symbols to encapsu-
I late your legacy, what would you pick? Johann Carl Friedrich
Gauss (1777–1855) left behind a trophy case stocked with
mathematical achievements to choose from, but above all, he
wanted a “regular heptadecagon” etched on his headstone.
The highly symmetrical 17-sided shape starred in a proof that
Gauss considered one of his greatest contributions to math. At
just 18 years old, Gauss used a heptadecagon to solve a classic
A B
problem that had stumped mathematicians for more than 2,000

years. A tour through that history reveals deep connections be-
tween the ancient conception of shapes as drawings and a mod- A B
ern perspective of the equations that govern them.
Jack Murtagh
The ancient Greeks excelled at geometry, placing special em-
is a freelance math writer
phasis on constructions created with a compass and straight- and puzzle creator.
edge. Think of these constructions as diagrams with desired geo- He writes a column on
metric properties created solely with a writing utensil and two mathematical curiosities This exercise does much more than bi-
for Scientific American
tools. Given two points, a drawing compass (not to be confused sect a line segment. It creates a right angle
and creates daily
with the navigational device) lets a person create a circle that is puzzles for the Morning between the two lines, which is not a triv-
centered on either point and passes through the other point. A Brew newsletter. ial feat with such a restricted tool set. And
straightedge can be used to draw straight lines between the He holds a Ph.D. in by connecting a few more points, you can
theoretical computer
points. Neither tool has any markings on it, so people cannot make an equilateral triangle—one whose
science from Harvard
measure distances or angles with them. University. Follow him sides have equal lengths and whose angles
The Greeks didn’t impose arbitrary rules just to make math on X @JackPMurtagh have equal measurements.
62 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Brown Bird Design

Among all the shapes we can construct
A B
with a compass and straightedge,
regular polygons hold a special cachet.
Notice that each edge of the triangle is three-, four- and five-sided regular poly- how to reduce the problem of making a
also a radius of one of the circles. The cir- gons can be transformed into six-, eight- regular polygon to that of merely creating
cles are the same size, and therefore all the and 10-sided regular polygons, as well as a line segment with a very specific length.
triangle’s sides have the same length. So 12-, 16- and 20-sided ones, and so on. Eu- To create a 17-gon, start with a unit circle
equilateral triangles are constructible clid also showed how to “multiply” the (where the radius equals one) and a point
with a compass and straightedge, QED. three- and five-sided regular polygons to A on the circle, as in the graphic below.
Congratulations on persisting through the produce a regular 15-gon. Imagine we could find the red point B
first proposition in the first book of Eu- above A exactly one 17th of the way around
clid’s Elements. Only 13 more books to go. Regular 15-gon the circle. If we could construct the red
Among all the shapes one can construct point from the blue point, we could repeat
with a compass and straightedge, regular that action all the way around the circle
polygons hold a special cachet. Polygons and connect the dots with our straight-
are enclosed shapes composed of straightedge: voilà, a regular heptadecagon.
line edges, such as triangles and rectangles How do we draw point B given point A,
(as opposed to curved shapes such as cir- though? Notice that if we can draw the red
cles or unenclosed shapes such as the let- line segment labeled x, then we can connect
ter E). Regular polygons have the most that to the red point B, and we win. The en-
symmetry in that their sides all have equal tire problem of constructing a regular hep-
lengths and their angles all have equal tadecagon boils down to creating a line seg-
measurements (like squares and equilat- ment with the precise length x. For the
eral triangles but unlike rectangles and Progress halted there. Somehow Eu- mathematically curious, x = cosine (2π ⁄17).
rhombuses). Constructing any old irregu- clid knew a regular 3,072-gon was con-
lar triangle with a compass and straight- structible in principle (a triangle doubled
edge is child’s play—just scatter three 10 times), but he had no idea how to con-
points on the page and connect them with struct a regular seven-gon (heptagon) or B
lines. But constructing our perfectly sym- 11-gon (hendecagon). To be clear, regular 1 1
of the circle
17
metrical equilateral triangle—a regular polygons of any number of sides greater One edge of the
x A heptadecagon
polygon—requires some elegant legwork. than two do exist and can be constructed
Euclid figured out how to construct with more capable tools. The question Eu-
regular polygons with three, four or five clid left behind asks which ones are con-
sides—equilateral triangles, squares or reg- structible with a compass and straight-
ular pentagons, respectively. He squeezed a edge alone. It remained unanswered for
few more generalizations out of these core two millennia until a certain German
constructions; for instance, once you have a teenager picked up a pencil. Can we use a compass and straightedge
regular polygon on the page, a simple ma- By 1796 no new regular polygons had to construct a line segment of any length?
neuver will produce a new regular polygon joined the pantheon of constructible By Gauss’s time, mathematicians knew
with double the number of sides. shapes, yet mathematicians had acquired a the surprising answer to this question.
You can repeat this doubling procedure deeper understanding of compass-and- A length is constructible exactly when it
as many times as you wish. That means straightedge constructions. Gauss knew can be expressed with the operations of
addition, subtraction, multiplication, di-
To double the number of sides vision or square roots applied to integers.
on a given regular polygon, bisect So some strange numbers, such as the
each side of the polygon, draw square root of 99⁄5 , are constructible (99
a circle centered at the intersection and 5 are integers, and we’re applying di-
of the bisectors and passing
through the vertices of the polygon, vision and square root to them), whereas
and connect the points where some more familiar numbers such as pi (π)
the bisectors meet the circle. and the cube root of 2 cannot be construct-
ed, because one can never write them
Graphics by Amanda Montañez NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 63

MATH UNIVERSE
in terms of these five operations alone.

Remarkably, the rudimentary tools the
ancient Greeks used to draw their geo-
Nope —It’s Never Aliens
metric diagrams perfectly match the nat-
Claims of alien starships visiting Earth
ural operations of modern-day algebra: always fall short BY PHIL PLAIT
addition (+), subtraction (−), multipli-
cation (×),_ division (/) and taking square
roots (3 ). The reason stems from the fact These videos made quite a splash in
I
GREW UP BELIEVING IN UFOS.
that the equations for lines and circles use I watched every TV show about aliens, 2017, especially because U.S. Navy officials
only these five operations, a perspective spaceships, and aliens in spaceships. flatly stated that the objects were uniden-
Euclid couldn’t have envisioned in the I voraciously read magazines and tified. Certainly the pilots don’t seem to
prealgebra age. books on the topic, credulously soak- know what they’re seeing; in the GIMBAL
It might surprise you to learn that ing up everything I saw and believing it video, one can be heard remarking that
Gauss never actually drew a regular hep- wholeheartedly because, after all, if some- the object is going against the direction of
tadecagon. He didn’t need to. He proved one published a book saying these things the wind, again implying that the UAP
that the shape is constructible in principle are real, they must be real, right? was under some kind of control.
by expressing the special length x[cosine Right? So are these objects alien spacecraft?
(2π ⁄17)] solely in terms of the five algebraic Over the years, though, I took up science I would bet a lot of money—a lot—on “no.”
operations the compass and straightedge as a career and critical thinking as a passion. Mick West, a retired computer pro-
allow. Even if you don’t find his equation Gradually I looked back at all the informa- grammer and prominent UFO skeptic, has
particularly enlightening, its complexity tion I had taken in as a kid and realized it examined the videos very carefully and ap-
demonstrates how much work the adoles- was overwhelmingly baloney. It was just plied trigonometry and physics to what’s
cent must have poured into the problem. scads and scads of nonsense: bad photogra- seen to find far more plausible explana-
phy, sketchy witnesses, wild speculation tions than interstellar visitors. For exam-
and evidence-free claims. That was more ple, the object apparently moving against
cos 2/ = 1 317 + 3 34 – 2 317– 1)
17 16 ( than 30 years ago. Sadly, nothing’s changed. the wind in the GOFAST video is probably
In this modern age, we don’t call them a balloon. In a video analysis, West con-
+
1
8 (3 17 + 3 317 – 334 – 2 317– 2 334 + 2 317 )
UFOs anymore; now they’re UAPs, for un- vincingly argues that the object is at low al-
identified aerial (or anomalous) phenom- titude and not moving very quickly; it’s the
Even more impressive, Gauss fully ena. I can’t help but think that’s to distance jet’s motion that makes the object appear to
characterized which regular polygons are the idea from the old “flying saucers” stig- zip across the sky. This effect, called paral-
constructible and which aren’t (although it ma. But no matter what you call them, it’s lax, is what makes roadside trees whoosh
was not until 1837 that Pierre Wantzel pro- all still just the same breathless headlines by when you’re zooming down a highway
vided a rigorous proof showing Gauss’s and lack of substance behind them. There’s while distant buildings seem to move
characterization didn’t leave out any- no there there. Still, we’ve been so primed much more slowly. The other UAP videos
thing). So not only did Gauss describe the by so many stories of alien visitations over have similar mundane explanations.
form that all constructible regular poly- the years that even the thinnest of testimo- Occam’s razor, the well-worn rule of
gons take, but he and Wantzel vindicated ny gets reported far beyond its merit. thumb for scientific inquiry, applies well
Euclid’s frustrations by proving that the One of the more recent blips on the ex- here: the simplest explanation is usually
elusive regular heptagon (seven sides) and traterrestrial radar is a collection of vid- the best. As critical thinkers sometimes
hendecagon (11 sides) are impossible to eos declassified by the U.S. Department of say, “if you hear hoofbeats, think horses,
construct with a compass and straightedge Defense that contain what are purported not unicorns.”
alone, as are infinitely many other shapes. to be UAPs—true by semantics if not by That it was navy pilots who encoun-
According to biographer G. Waldo Dun- implication. Taken from F/A-18 Super tered these objects would seemingly en-
nington, Gauss felt great pride in cracking Hornet fighter jets using visible light and hance the credibility of these reports. Pi-
the millennia-old problem and told a infrared cameras, three videos in particu- lots inarguably have more experience
friend that he wanted a regular heptadeca- lar—called FLIR, GOFAST and GIM- looking at things in the sky than the aver-
gon displayed on his headstone. Sadly, he BAL—show small objects moving at ter- age person, but that doesn’t mean they’re
didn’t get it, but a monument in Gauss’s rific speeds, whirling like the spaceships immune to error. For example, in 2011 an
birth city of Brunswick, Germany, has a in Close Encounters of the Third Air Canada first officer report-
17-pointed star engraved on the back. The Kind and apparently following Phil Plait is a professional edly put a plane in a nosedive
stonemason chose a star because he be- the planes as if piloted. FLIR astronomer and science because he saw Venus. I’ve
lieved people couldn’t distinguish a hepta- was filmed in 2004, and GO- communicator in Virginia. seen countless reports of UFOs
He writes the Bad
decagon from a circle. I wonder whether FAST and GIMBAL are from Astronomy Newsletter. that for real and for sure turned
Euclid would agree. January 2015. Follow him on Beehiiv. out to be Venus, Jupiter, the
spoken has been astrophysicist and science
writer Ethan Siegel, who bluntly calls them
“embarrassing.” Current consensus is that
the meteor’s interstellar origin is far from
proven, the location where debris might
have fallen is quite uncertain, and Loeb’s
spherules could originate from mod-
ern-day coal ash or ancient volcanic erup-
tions rather than the breakup of some in-
terstellar object in Earth’s atmosphere.
Despite this pushback—and many oth-
er critiques, some published in reputable
peer-reviewed scientific journals—Loeb
still maintains that the meteor was inter-
stellar and the spherules are from that very
event. He has even co-founded a multimil-
lion-dollar project to investigate his own
claims. Of course, Loeb’s prestigious status
adds an air of authority to his hypothesis,
but his claiming something, no matter how
strenuously, doesn’t make it so.
Should we bother studying unidenti-
fied phenomena, aerial or otherwise? Of
course! Not all have been explained, al-
though we shouldn’t leap to the conclusion
that they’re unexplainable. nasa itself
funded a small project to look into UAPs, if
only because they could conceivably be a
potential threat to airspace safety and na-
A GOFAST video still shows a U.S. Navy F/A-18 jet crew’s encounter with an unexplained anomalous tional security. But in the case of UAPs at
phenomenon, or UAP. (The appearance of U.S. Department of Defense visual information does not imply least, time and again there turn out to be
or constitute an endorsement.)
simpler explanations, and at some point
we have to admit that in all likelihood,
moon, airplanes, satellites, meteors, rock- had found little green men. Skepticism we’re throwing good money after bad.
et launches, floating paper bag lanterns or, and careful analysis won the day. To be clear, none of this means we
in one very famous case, military flares. That’s not always the case. For exam- should abandon our searches for extra-
The fact is, everyone can make mis- ple, Avi Loeb is a renowned astrophysicist terrestrial life. We now know that planets
takes—even experts. There’s a reason the at the Center for Astrophysics | Harvard & in the Milky Way probably number in the
term “argument from authority” is con- Smithsonian. He is also a vocal proponent hundreds of billions, and no doubt some
sidered a logical fallacy. of the idea that small spherules of metal may resemble Earth and might even host
Astronomers are no exception; we’ve he and his collaborators found on the life. But if our own world is any guide, we
sometimes been fooled—or at least mo- ocean floor are interstellar in origin and should expect few, if any, of these living
mentarily baffled—by unexpected obser- may even be from aliens. worlds to harbor much more than mi-
vations. Not that long ago some of us got This source is, well, unlikely. The idea is crobes, let alone anything capable of
excited by what seemed to be a radio ob- that a meteor from interstellar space (de- building starships or radio telescopes.
servatory’s detection of a new type of as- termined from its estimated incoming tra- (Earth has had only single-cellular life
trophysical signal; further investigation jectory and high speed) burned up in for most of its history.) We need to care-
showed, however, that the signal was elec- Earth’s atmosphere, dropping debris into fully distinguish between the possibility
tromagnetic interference from a nearby the ocean. An expedition led by Loeb of life’s mere existence elsewhere in the
microwave oven. A different time, an as- dredged some of the seafloor where the re- cosmos and its even more rare evolution
U.S. Department of Defense
tronomer accidentally discovered Mars. searchers expected that debris to be and to intelligence and being able to trek
Another discovered the sun. found tiny metallic balls that they argue among the stars.
The important part of all these stories are from another star. Until we get much better and more
is that the scientists involved didn’t im- Many other experts hold extremely dim reliable data, assume those hoofbeats
mediately run to the media claiming they views of these claims. One of the most out- are horses.

Q&A WITH SARA KIMBERLIN
observations line up with the most recent

How Basic results from OpenResearch, which showed
that participants increased spending to meet
Income Works their basic needs and to help family and

friends. A separate study published online in
Recent studies show a universal basic income July in the Journal of the American Medical
Association also found that cash benefits re-
could improve lives BY ALLISON PARSHALL duced emergency room visits.
Taken as a whole, the evidence suggests
that when people’s most basic needs are met,
N 2020, AMID WIDESPREAD LAYOFFS and economic tur- they start to build a firmer financial founda-
I moil brought on by the COVID pandemic, 1,000 low-income

people in Texas and Illinois won something of a lottery. They
were selected to receive $1,000 per month—with no strings
attached—for three years as part of a study on guaranteed in-
come by OpenResearch, a nonprofit research organization funded
in part by OpenAI and its founder, Sam Altman.
Silicon Valley philanthropists are just one piece of a growing
tion for themselves and their family. SCIEN-
TIFIC AMERICAN spoke with Kimberlin to
learn more about these basic-income pilot
programs and how this unconditional,
guaranteed aid improves people’s lives.
An edited transcript of the interview follows.
movement for using basic income to improve people’s lives. In recent What is the promise of basic income?
years the Stanford Basic Income Lab and the Center for Guaranteed A key problem that basic income or guar-
Income Research have been tracking 30-plus pilot programs that anteed income is designed to address is the
have tested basic income in towns and cities across the U.S. significant share of people and families
“There’s a long history of interest in basic income in the United who don’t have enough resources to be able
States,” says Sara Kimberlin, executive director of the Stanford to meet their essential needs. And we have
Center on Poverty and Inequality. Founding father Thomas Paine a lot of research that shows the challenges
advocated for it in The Rights of Man. Martin Luther King, Jr., that arise from struggling to meet your ba-
called it the solution to poverty. Even economist and free-market sic needs. For example, if you don’t have
capitalist Milton Friedman suggested basic income in the form of Allison Parshall access to stable, safe housing, health care or
a “negative income tax.” is an associate news food, that interferes with your ability to be
editor at Scientific
When people receive unconditional cash, they tend to use the American who often
a productive worker or to take care of your
money in ways that increase their financial security and housing sta- covers biology, health, family. And if you’re a child, that interferes
bility, Kimberlin says, pointing to a “large body of research.” Those technology and physics. with your ability to concentrate in school.
66 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Shideh Ghandeharizadeh

On the flip side, there’s a lot of research
showing the positive things that happen “Cash is flexible. It gives people a lot of
when a policy ensures people’s needs can be
met. It shows that when food stamps are in-
dignity and autonomy in deciding how
troduced in a particular area, the outcomes they are going to use it.” —SARA KIMBERLIN
for the families improve. Other research
shows that children whose families received
the Earned Income Tax Credit when they fully captured in the results. If a partici- Many of the drivers that might cause
were young had more positive long-term pant is saying, “Oh, my cousin called somebody to work less when they receive
educational outcomes, which translated to me because her husband lost his job, and a basic income could be seen as positive
stronger financial security later in life. they can’t make their rent this month, outcomes in other ways. For example, sin-
and I gave her some money so her family gle parents or parents of young children
Why provide cash, as opposed to food wouldn’t get evicted”—outcomes like that might work fewer hours to spend more
stamps or rent assistance? wouldn’t be fully captured in the parti- time directly caring for their children.
Cash is flexible. People can use it to meet cipant data. There’s a ripple of positive
whatever their most pressing need may be. effects that are going out beyond the Is just giving people money really
It’s an efficient way of addressing people’s direct recipient. a viable solution to poverty?
needs, and it also gives people a lot of dig- Basic income, particularly at this scale that
nity and autonomy in deciding how they’re People who received the cash worked an has been studied, is not a cure-all or magical
going to use it. It helps to avoid situations average of one hour less per week and solution to poverty. Access to health care,
where someone may already have re- were 2 percent less likely to be employed schooling, child care and affordable housing
sources designated to pay for food but than people in a control group that are still needed. I think it makes sense to
needs, for example, emergency child care. received $50. What does that tell you? think about basic income as a promising in-
If they don’t get it, then they can’t get to People wonder: Does receiving unre- tervention that complements other parts of
their job, which could cause a lot of disrup- stricted cash mean people are going to just the social safety net. Unrestricted cash has
tion down the line by making them miss a stop working? How would that affect the a lot of power to be able to fill in places where
paycheck, then miss the rent. You can look labor market? There have been different the safety net is inadequate.
at unconditional cash as a potentially very findings across different studies. Some
promising way of approaching social sup- have shown somewhat increased employ- What are some open questions about
port because it streamlines the adminis- ment. You can imagine how that’s possi- the impacts of basic income that you
trative costs and makes it easier for people ble. If receiving a basic income allows you hope more research will answer?
to access the support they are eligible for. to repair your car so that it’s reliable or pay It’s really important to study how these pro-
for child care, that might make it more grams work for different groups of people.
What stood out for you about the new possible for you to get a job. There have There are different pilots focused on specific
findings from OpenResearch? also been studies that have shown no sig- populations, such as people aging out of fos-
It’s a very large study, and it’s well de- nificant impact on employment. ter care, people experiencing domestic vio-
signed and well funded. It studied a fairly And then there have been studies that lence or people reentering society after in-
broad, more representative population, show some reductions in employment or carceration. Understanding how it works
rather than being targeted to a specific in number of hours worked compared for different groups is helpful for designing
group such as parents of young children, with a control group. That’s what was programs and policies.
which meant there was a lot of variation in found in these OpenResearch results. And a critical question is: What are the
the outcomes. One important piece of context here is long-term effects of these programs, in par-
It wasn’t surprising that the study found that this study, along with many of the stud- ticular on people’s health? A three-year
the most common uses of the funds were to ies in this recent crop of guaranteed-in- study can’t address health problems that
cover basic needs such as housing, food and come pilots, took place in the unusual eco- have developed over people’s lifetime. But if
transportation. This is something we see nomic setting of the pandemic. Unemploy- you had a long-term program in place,
consistently across guaranteed-income pi- ment was very high across the entire U.S. in would you see different effects on people’s
lots that are tracked on the Guaranteed both the treatment and the control group at health, such as on chronic health condi-
Income Pilots Dashboard on the Stanford the beginning of this study. Over the course tions? And studying the potential effects of
Basic Income Lab website. of the three years lots of people in both these programs on children’s long-term
Something that stood out for me was groups went out and got jobs as more jobs trajectories is very important. Some of
the significant increase in people spending became available again—overall, employ- those outcomes are not measurable yet, but
money to help their friends and family. ment and hours worked increased in both they may be quite consequential for the
That struck me because it means there are groups, but they increased less in the group people who receive the money and may rip-
some effects of this program that are not receiving $1,000. ple out to their families and communities.

MIND MATTERS EDITED BY DAISY YUHAS
a series of studies examining task delay,

the behavioral component of procrastina-
tion in which people put off completing
something despite lacking any objectively
strategic reason to do so. We found that
people with a negativity bias tend to delay
tasks more, especially if they tend to be
poor at self-control.
The central idea guiding our work was
that as people pursue their goals, the
environment nudges them to make spe-
cific assessments that can shape their be-
havior. For example, once a taxpayer has
re ceived all the necessary documenta-
tion—typically well before the filing
deadline—they may ask themselves, “Do
I want to do this now? ” This question
should bring to mind some positive out-
comes (for instance, the satisfaction of
completing a chore and, potentially, re-
ceiving a tax refund sooner) and some
that are negative (such as the tediousness
of the task).
Ultimately the positives must be
weighed against the negatives. Notably
there are individual differences in how
people generally weigh positive and nega-
tive signals—a characteristic that psy-
chologists call valence weighting bias.
Whereas some people tend to give greater
How to Beat weight to the pros, others give greater
weight to the cons. We reasoned that
Procrastination those with a more negative weighting bias

should be more likely to procrastinate.
Our first study used surveys to identify
To stop putting off tasks, think about the positives
people who generally expected to receive
BY JAVIER GRANADOS SAMAYOA AND RUSSELL FAZIO a tax refund but tended to submit their
taxes either early (during the last two
weeks of January or early February) or
late in tax season (the first two weeks of
Y APRIL 12, 2024 —three days Chronic procrastinators tend to report April). Some 232 people who met our eli-
B before the deadline for filing tax

returns in the U.S.—more than a
quarter of American taxpayers
had yet to do so. Procrastina-
tion—delaying something despite an
awareness of associated negative conse-
quences, leading to discomfort—is a com-
more symptoms of illness, more visits to
the doctor, lower overall well-being and
even greater financial struggles.
So if procrastination is so costly, why
do so many people regularly do it? Years
of research have provided a reasonably
comprehensive list of psychological fac-
gibility criteria participated in a follow-up
session, in which we measured their val-
ence weighting bias, using a game affec-
tionately called “BeanFest.”
In this game, people viewed images of
beans that varied in shape and number
of speckles. Some beans, when selected,
mon experience for many. Unfortunately, tors that relate to procrastination. But it’s yielded points, whereas others led to a
procrastination tends to carry significant been unclear what mental processes un- loss. We later assessed how participants
costs. For instance, completing a task derlie the decision to start or postpone a generalized from these newly learned
when rushing to finish can affect the qual- task. When faced with an upcoming dead- associations (such as that oblong beans
ity of one’s work. Moreover, procrastina- line, how do people decide to initiate a with many speckles were “bad” and that
tion is by its very definition stressful, and chore or project? circular beans with few speckles were
naturally such stress can take its toll. To explore this question, we conducted “good”) to new bean images that had
68 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Pete Ryan

both positive and negative aspects (such
as circular beans with many speckles). People who are inclined to see the
The people who leaned more heavily on
the negative features when assessing the
negatives rather than the positives are
novel beans had a negative valence weight- more likely to delay tasks, especially
ing bias, whereas those who leaned more
on the positive features had a more posi- if they tend to be poor at self-control.
tive bias.
The decisions that people make in this surprisingly, those who reported better fewer signs of procrastination—that is,
game reveal something very fundamen- self-control tended to participate earlier greater research par ticipation—than
tal: it turns out that people’s tendencies to in the semester. More to the point, those those in the control group. More import-
generalize either positive or negative with a more negative weighting bias ant, this recalibration procedure, as we
associations on this test can serve as a tended to delay, as indicated by the aver- call it, does something the real world
proxy for their general likelihood of age day of earning research hours, and rarely does: it provides objectively correct
weighing pros or cons when making deci- this pattern was most evident among feedback about the appropriate weighting
sions of any kind. Through this process those reporting poorer self-control. of positive and negative signals, and
we found that those people who had Can we disrupt this link between through repetition it shifts valence
reported filing taxes late in the season weighting bias and task delay? In our last weighting tendencies toward a more bal-
exhibited a more negative valence weight- study, we explored that possibility. We anced equilibrium. Even though BeanFest
ing bias. They apparently felt more preoc- again examined student participation in may seem utterly unrelated to something
cupied by the unpleasant aspects of pre- the research experience program. But like research participation, this training
paring their tax return. instead of recruiting from the general exercise works because the act of weigh-
Having found evidence that this bias pool of students, we specifically sought ing the pros and cons of a situation is the
predicted task delay, we followed up with a out those who had reported struggling same, whether it involves beans or a real-
different approach. We asked 147 students with procrastination more generally. world decision. So when people’s bias is
enrolled in an introductory psychology These participants, we reasoned, proba- changed in BeanFest, that naturally gen-
course for their record of participation in bly had a negative weighting bias. eralizes to situations beyond the lab.
a research experience program in which We then randomly assigned the stu- Putting it all together, our research
completing a predetermined number of dents who agreed to participate to either uncovers the processes that lead to pro-
hours of experiments earned extra credit. a control or an experimental condition. crastination. When faced with a deadline,
Using these data, we focused on the aver- Both groups of participants from the psy- people seem to ask themselves, “Do I
age date of research participation; broadly chology course played BeanFest, but the want to do this now?” That leads them to
speaking, later dates indicated greater latter involved a training procedure. Spe- weigh the pros and cons involved—and
task delay. And much like doing taxes, cifically, on each of numerous trials, par- their biases then come into play. Although
putting off these hours of research partic- ticipants indicated whether a novel bean additional rigorous testing is required,
ipation ultimately led to greater stress be- was helpful or harmful, and then we told the training procedure used in our last
cause it exacerbated an “end- them whether their decision study shows promise as an avenue to
of-semester crunch.” Javier Granados was objectively correct. That assist people who struggle with procras-
Then we added one more Samayoa is a research feedback effectively trained tination. Cognitive training based on this
element to this study. Other associate at the Univer- participants to better weigh approach—for example, through a smart-
sity of Pennsylvania.
research has found that val- He studies why people pros versus cons, bringing phone app—could help individuals who
ence weighting bias shapes succeed or fail as they more balance to their perspec- struggle with delaying tasks.
decision-making even more pursue their goals and tive. In the control condi- But there are more immediate impli-
strongly when people are rela- how behavior can be tion—where we did not at- cations of our work as well. Our research
changed to help people
tively unmotivated to deliber- reach their potential. tempt to shape students’ ten- indicates that valence weighting has the
ate beyond their initial impul- dency toward the positive or biggest influence on people who lack the
sive reactions or do not have Russell Fazio negative—we provided no ad- motivation and cognitive resources to
the cognitive re sources and is Harold E. Burtt Chair ditional information. pause and deliberate beyond their initial
in Psychology at the
time to do so. So we asked stu- Ohio State University. After this targeted Bean- quick appraisals on whether to tackle
dents to rate—on a scale of His research concerns Fest intervention, students a task. In other words, just pushing your-
1 (“not at all like me”) to attitudes, including their went back to the semester as self to think a little bit more before acting
5 (“very much like me”)— formation, their accessi- usual. Impressively, when we may help you generate more positive rea-
bility from memory, and
how strongly they agreed with the effect they have followed up with them two sons to get started and to ensure you don’t
statements such as “I am good on attention, judgment weeks later, those in the ex- put off until tomorrow what you might
at resisting temptation.” Not and behavior. per i ment al group showed best do today.

OBSERVATORY
OBSERVATOR
RY K
KEEPING
KEEE
EPPIIN
NG A
ANN EYE
E YE
Y ON SCIENCE
E
ties: What exists in the world? How do

we know they exist? The philosophical
claim is a form of ontological minimalism:
we should not invoke entities unless we
have evidence that they exist. Even if we
are sure things exist—say, comets—we
should not invoke them as causal agents
unless we have evidence that they cause
the kinds of effects we are assigning to
them. In other words: don’t make stuff up.
In 1687 Isaac Newton expanded on this
notion with his concept of a vera causa—a
true cause—when he wrote in his best-
known work, the Principia Mathematica,
“We are to admit no more causes of natural
things than such as are both true and suffi-
cient to explain their appearances.” He con-
tinued: “To this purpose, the philosophers
say that Nature does nothing in vain, and
more is in vain when less will serve; for
Nature is pleased with simplicity, and
affects not the pomp of superfluous causes.”
Newton was one of the greatest scien-
tists of all time, but if we stop to think
about it, this claim is a peculiar one. Who
is to say what “pleases nature”? And
doesn’t this guidance assume we know
what we are in fact trying to figure out?
The Dull Edge Consider the work of astronomer
Vera C. Rubin, who found compelling evi-
of Occam’s Razor dence for the existence of dark matter.

While studying the motion of spiral gal-
Contrary to the popular maxim, the simplest axies, Rubin discovered that the speed at
which stars rotated around the center of
explanation is often not the best one their galaxies made sense only if these gal-
BY NAOMI ORESKES axies contained an additional mass weigh-
ing about 10 times more than the visible
stars. The claim of a new form of “dark”
F YOU’VE EVER HUNG AROUND explanation is too surprising, it’s probably matter—unseen and unseeable and pres-
I scientists, you’ve most likely at some not right. But real life is often messy and
point heard one of them say “the complicated, and, as every good detective
best explanation is the simplest one.” novelist knows, sometimes the killer is the
But is it? From the behavior of ants one you least expect.
to the occurrence of tornadoes, the natu- Let’s start with some evidence about
ral world is often quite complex. Why the idea itself. The name comes from Wil-
should we assume the simplest explana- liam of Ockham, a 14th-century scholastic
ent in far greater quantities than the visi-
ble matter of the universe—was not a sim-
ple explanation, but it turned out to be the
best explanation.
Physics is filled with explanations that
are surprising, unexpected and hard to get
your head around. Newton explained light
tion is closest to the truth? philosopher and theologian who formu- as being made of particles, whereas other
This idea is known as Oc- lated the principle in Latin: scientists of his era explained it as a wave.
Naomi Oreskes is a
cam’s (or Ockham’s) razor. It’s professor of the history pluralitas non est ponenda sine Quantum mechanics, however, tells us
also referred to as the “princi- of science at Harvard necessitate, rendered in English that light is, in some respects, both a wave
ple of parsimony” or the “rule University. She is author as “entities should not be mul- and a particle. Newton’s account was sim-
of economy.” And it bears a of Why Trust Science? tiplied beyond necessity.” The pler, but modern physics tells us that the
(Princeton University
family relationship to the Press, 2019) and co- point was an ontological argu- more complex model is closer to the truth.
“principle of least astonish- author of The Big Myth ment dating back at least as far When we turn to biology, things get
ment,” which holds that if an (Bloomsbury, 2023). as Aristotle’s time about enti- even more complicated. Imagine two
70 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Scott Brundage

METER
METE
TER EDITED BY DAVA SOBEL
smokers, both of whom went through a

pack a day for 30 years. One gets cancer;
the other does not. The simplest explana-
tion? For decades the tobacco industry’s
answer was that smoking doesn’t cause
cancer. Simple but false. The correct
answer is that disease is complex, and we
don’t yet understand all the factors in-
volved in carcinogenesis.
And then there’s the vexing question of
how we define simplicity. Consider the
ongoing debate over the origin of the
COVID pandemic. On the side of the lab-
leak theory—that the SARS-CoV-2 virus
escaped from a facility rather than being
transmitted from wild animals to hu-
mans—some commentators have invoked
Occam’s razor. But it’s not obvious that
this theory is simpler. One could argue the
reverse: given that most past pandemics
had a zoonotic origin, the simpler expla-
nation is that this pandemic did, too.
Occam’s razor is not a fact or even a the-
ory. It’s a metaphysical principle: an idea
held independently of empirical evidence.
(Think “God is love” or “beauty is truth.”)
But unless we are prepared to make
assumptions about God and nature, there
is no good reason that we should prefer a
simpler explanation to a complex one.
Moreover, in human affairs things are
more often than not complex. Human
motivations are typically multiple. People
can be good and bad at the same time, self-
ish and selfless, depending on circum-
stances. The shelves of ethicists are filled ALFRED WEGENER
with books pondering why good people do TO THE WORLD
bad things, and their answers are rarely
short and sweet. And yet it moves! Shh—hear the mountains murmur?
Peripatetic prairies slowly creep
In 1927 British geneticist J.B.S. Hal-
across the globe. There is no terra firma.
dane wrote in his essay “Possible Worlds” Is that so terra-ble? We’ll have to keep
that “the universe is not only queerer producing new and updated editions
than we suppose, but queerer than we can of every atlas. But it’s no one’s fault
suppose.” There are, in fact, new things that continents collide, or split in fissions.
under the sun, and rare events may be On groaning sleds of granite and basalt,
rare precisely because they involve a com- coastlines advance on trans-oceanic missions
plex confluence of events. Put this way, like runners in the world’s most boring race
(though slow, they never fail to cover ground)
we can see Occam’s razor as simply a fail-
and somehow, still, their clip exceeds the pace
ure of imagination. a stubborn academic comes around
Our explanations should match the to evidence, and changes his positions.
world as best as we can make them. Sci-
Author’s note: Wegener was an early proponent of continental drift—
ence is about letting the chips fall, and a theory initially met with resistance.
sometimes this means accepting that the
truth is not simple, even if it would make Daniel Galef writes poetry, plays, short stories, and humor. His book Imaginary Sonnets contains
our lives easier if it were. 70 monologues spoken by historical figures—scientists, artists, saints, murderers, and one fish.
Illustration by Masha Foya NOV E M BER 2 02 4 SC

S C I E N T I F IC
CAME
ER IIC
CAN
N.COM
.C
COM 71
71
REVIEWS EDITED BY AMY BRADY
Gifts from the Land Emergence Magazine, is a

much slimmer volume than
Braiding Sweetgrass but is writ-
neighbors—works best in small,
close-knit communities. Yet
more than half the world’s pop-
Robin Wall Kimmerer reframed ideas ten with the same lyrical, per- ulation now lives in urban envi-
sonable voice that invites read- ronments, and the flow from
of sustainability. Can she do the same ers into worlds of possibility. In country to city continues. Given
with economics? BY MEERA SUBRAMANIAN short chapters punctuated by this context, how do we, as she
line drawings from illustrator writes, “reclaim ourselves as
John Burgoyne, this sweet of- neighbors”? If serviceberries
fering builds on her ideas about were a marketable commodity,
the gift economy and how In- I can’t help but wonder, would
digenous wisdom might inform her neighbors have opened their
it. She explores ancient guide- farm to her for a free day of har-
lines known as the Honorable vesting? I wanted her to wrestle
Harvest, her interpretation a more with the capitalist jugger-
bulleted manifesto for gratitude naut in which nearly all of us are
and how circular economies are enmeshed, one dominated by
a way to put these concepts the schemes of people untrou-
into practice. bled by destroying what others
Kimmerer also continues her love in the name of profit.
inquiry into language and what “Recognizing ‘enoughness’
it reveals about worldviews. In is a radical act,” she writes, “in
the opening chapter, we learn an economy that is always urg-
Bozakmin is the Potawatomi ing us to consume more.” Rec-
word for “serviceberry,” a native ognition is one step. Transform-
shrub integral in Indigenous ing economies is something else
foodways that produces a blue- altogether. Kimmerer, who do-
berrylike fruit. Bozakmin is, lit- nated her book advance to land
erally, the “best of the berries,” conservation and social justice
and the Potawatomi root word work, writes that she knows lit-
for “berry” also means “gift.” tle of economics or finance. Al-
NONFICTION Nature provides Times bestseller list in 2020, Languages around the world though she seeks understand-
many gifts, but it where it has remained. It was as offer examples that demon- ing through books and conver-
is easy to take them for granted. though Kimmerer’s concepts strate the deeper connections sations, she seems to struggle
It’s not just the strawberries about animating nature and re- we once had to the earth that the way many of us do with how
you buy at the grocery store but specting nonhuman species as very literally sustains us. The such ideas would scale.
also the plastic container that if they were people, told through Greek word oikos, Kimmerer The answer, Kimmerer
holds them, made of ancient the personal lens of an Indige- writes, is the root for both “ecol- writes in the last and strongest
life-forms transformed into fos- nous scientist, struck a chord ogy” and “economy.” chapter, is to look to ecological
sils and then feedstock for that was aching to be played. Oh, but how we’ve forgotten succession in the natural
plastics. How can we better These ideas continue to rever- the link! As Kimmerer fills a pail world, where disturbances
recognize the value of the natu- berate: she is routinely invited with an abundance of service- cause seemingly intransient
ral world and build communi- to be a keynote speaker, her berries in the opening scene, a systems to transform. Capital-
ties—and economies—that ac- words are emblazoned on mu- flock of cedar waxwings joining ism may not crumble, but we
knowledge such abundance? seum walls, and in 2022 she re- her in the harvest, she sees the could pursue conditions for
This is the central question ceived the prestigious MacAr- fruit as “a pure gift from the economic succession to a
of The Serviceberry: Abun- thur Foundation “genius” grant. land. I have not earned, paid for, space where reciprocity is rec-
dance and Reciprocity in the The Serviceberry, which nor labored for them.” She urges ognized. Not just by imagining
Natural World. It’s the third grew out of a 2022 essay in readers to take note of the small another way to be in the world
book by Robin Wall Kimmerer, bequests that abound, which but by creating it. Many plants
an ecologist, professor at the remind us we live in a world of and animals go dormant, wait-
State University of New York reciprocity where giving can be ing for the right moment to re-
College of Environmental Sci- liberated from an artificial mar- surface and come fully alive
ence and Forestry, and member ket that manufactures scarcity again. Can ideas and ways of
of the Citizen Potawatomi Na- and individual desire: Little Free being, like rhizomes reaching
tion. For seven sleepy years, her Libraries on front lawns and free through soil, do the same?
Elva Etienne/Getty Images
last book, Braiding Sweetgrass: boxes of clothes and the invita-

Indigenous Wisdom, Scientific tion from a neighbor to come Meera Subramanian is an
Knowledge, and the Teachings The Serviceberry: Abundance pick berries for free. award-winning independent journalist,
of Plants, published in 2013, and Reciprocity in the Natural Kimmerer admits this way author of A River Runs Again (Public-
quietly grew in popularity, until World by Robin Wall Kimmerer. of generous living—intimate Affairs, 2015) and a contributing editor
it leaped onto the New York Scribner, 2024 ($20) with both the land and one’s at Orion magazine.
Time’s Arrow
Fifty years after its initial publication,
The Dispossessed is as relevant as ever
FICTION A little more than this sort of ‘understanding,’”

halfway through the plutocrat asks, “if it
The Dispossessed, Ursula K. doesn’t result in practical,
Le Guin’s inexhaustibly rich technological applications?”
and wise science-fiction The tensions Le Guin
novel about a physicist explores here—between the
caught between societies, theoretical and the applicable,
the protagonist, Shevek, born the scientist and society—
and raised in an anarchist’s have not diminished in the Fowler—is vague, a physics spective changes him. Shevek
collective, gets drunk (for the 50 years since The Dispos- explored through metaphor. finds himself behaving like the
first time) at a fancy soiree sessed swept the Hugo, But Le Guin’s depiction of patriarchal “propertarians” of
in a capitalist society on a Locus and Nebula awards. a scientist caught between Urras. Drunk and lonely, this
planet not his own. There The science in this 1974 opposing, utterly convincing gentle man whose language
this brilliant but bewildered novel—now reissued with worlds remains thrilling has no possessive pronouns
scientist gets cornered by a celebratory, pained-about- in its precision, at times seizes a woman as if she is
a plutocrat with impertinent the-present introduction even frightening. his. It’s an act that later
questions. What is the point by literary writer Karen Joy On the collectivist planet disgusts him—and sets him
of Shevek’s efforts to create Anarres, a desert landscape on a revolutionary course that
a General Temporal Theory ravaged by famine, Shevek’s will affect all the worlds that
reconciling “aspects or pro- search for a General Temporal humanity has reached.
cesses of time”? Theory is thwarted by Le Guin, who died in 2018,
Shevek explains that time scientist-bureaucrats who leaves it to readers to make
in our perceptions is like are concerned his discoveries what they will of this shift.
an arrow, moving in one might prove counterrevolu- The arrow of time has sped
direction only. In the cosmos tionary. After engineering forward since 1974, but the
and the atom, however, it a diplomatic escape to lush circles and cycles of Le Guin’s
moves in circles and cycles, The Dispossessed: A Novel Urras, funded by capitalist masterpiece continue to
the “infinite repetition” an (50th Anniversary Edition) plenty, Shevek learns that suggest, with urgent humanity,
“atemporal process.” by Ursula K. Le Guin. his work is viewed as propri- both present and future.
“But what’s the good of Harper, 2024 ($35) etary—a product. This per- — Alan Scherstuhl
IN BRIEF
Treekeepers: The Race for a Forested Future Power Metal: The Race for the Resources Citrus: A World History
by Lauren E. Oakes. Basic Books, 2024 ($30) That Will Shape the Future by David J. Mabberley. Thames and Hudson, 2024 ($50)
At the start of Treekeepers, by Vince Beiser. Riverhead, 2024 ($32) The relationship between
Lauren E. Oakes recalls the In his unflinching follow-up to people and citrus is a
feverish response to a 2019 The World in a Grain—a book millennia-long balance
study published in Science that turned sand into a rivet- of push and pull, adapta-
that claimed Earth could sus- ing story—journalist Vince tion and adjustment.
tain 1.2 trillion new trees. Beiser reveals the costs of Botanist David J. Mabber-
Oakes—an ecologist and extracting the “titanic quanti- ley skillfully traces this
journalist—had spent more than a decade ties” of minerals necessary to captivating saga, exploring trade deals
studying old-growth forests, and as she meet the growing demand for our “Electro- that have been forged through these
watched scientists debate the importance Digital Age.” Beiser tracks cobalt and lithi- fruits’ flavor, ex tensive art inspired by
of tree planting in mitigating climate change, um from environmentally destructive exca- their beauty, and medical and genetic
she found herself wanting to answer that vation sites in Chile’s Atacama Desert and innovations inspired by their biological
question. Treekeepers is an ambitious mem- the deep-sea floor through a geopolitically properties. Mabberley’s vibrant account
oir of Oakes’s boots-on-the-ground re- fraught supply chain to our electric cars and of citrus, which begins with the Han
search under old-growth canopy and a rigor- solar panels. With gains in green energy fail- Dynasty and ends with the modern orange
ous exploration of forests and climate ing to rebalance Mother Nature’s scales (as juice industry, will fascinate history
change. Most of all, it’s a hopeful profile of few as one in 10 solar panels are recycled), enthusiasts as much as it will delight
the people working to restore, retain and Beiser urges us to rethink our understand- design aficionados in search of the ideal
nurture strong forests. —Lyndsie Bourgon ing of sustainability. —Dana Dunham coffee-table book. —Lucy Tu
Illustration by Ron Miller NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 73

B
GRAPHIC SCIENCE A
Time G
The Evolution F
E
Time elapsed
O second 5
of Music 300 Hz
Pitch (frequency measured in hertz, log scale)

D
Songs and speech across cultures
hint at why music evolved Middle C Middle C (262 Hz)
TEXT BY ALLISON PARSHALL

B
GRAPHIC BY DUNCAN GEERE AND
MIRIAM QUICK FROM LOUD NUMBERS A oing t
o
g
200 Hz
G
UMANS MUST HAVE LEARNED to sing
H early in our history because “we can find

something we can call music in every soci-
F
roug
c arbo
h
ety,” says musicologist Yuto Ozaki of Keio E
University in Tokyo. But did singing evolve a ir
F
u S ?
D
as a mere by-product of speaking or with its own
yo
unique role in human society? To investigate this
e
Ar
question, Ozaki and a large team of collaborators C3 131 Hz
compared samples of songs and speech from around
the world. These categories can vary wildly across B
cultures: songs can be lilting lullabies or rhythmic
chants or wailing laments, and some spoken lan- A SUNG
guages have more “musical” qualities, such as tonal
languages, which convey meaning through pitch. 100 Hz
G
Despite this variation, the researchers found three
worldwide trends: songs tend to be slower than
speech, with higher and slightly more stable pitches. F
SPOKEN
These consistent differences suggest that singing isn’t
E Are you going to Parsley, sage, rosemary
just a by-product of speech, yet why it evolved is still
Scarborough Fair? and thyme
unknown. Perhaps it developed to unite people, an D
idea called the social-bonding hypothesis, says co-au-
thor Patrick Savage, a musicologist at the University DIFFERENT
of Auckland in New Zealand. “Slower, more regular Pitch height SONGS, SIMILAR
and more predictable melodies may allow us to syn- PATTERNS
Higher pitch
chronize and to harmonize,” he says, “and through The researchers analyzed 300
These high-pitched
t melodies audio recordings by 75 collaborators
that, to bring us together in a way that language can’t.” speaking 55 languages. Each person
are played on w
whistles.
sang a traditional song, recited its lyrics,
Language family Sino-Tibetan Language played an instrumental version of its
Indo-European Afro-Asiatic families melody, then described its meaning.
Atlantic-Congo Austronesian with one The authors showed how pitch height,
Japonic Turkic representative tempo and pitch stability vary as a
person moves from instrumental
music to singing to speech, and
they found commonalities
across cultures.
Lower pitch
“Scarborough Fair”
Spoken lyrics
Instrumental
description
Sung lyrics
Spoken
BREAKING
DOWN A SONG
The chart visualizes two recordings of
the English folk song “Scarborough Fair”—
10 15 one sung, one spoken—by Patrick Savage,
a study author and participant. The song unfolds
at around half the speed of the spoken version,
sag ember
and its pitches are generally higher. They are
Rem also more stable, being centered on fixed
e,
musical notes, but with added expressive

me pitch fluctuations such as scoops and
vibrato. In contrast, the spoken
-ley
rose performance never settles

m on a pitch for long.
ary
to on once w
,
thyme as
ew
a
ho
tru
Pars-
and
live
e lo
s th
ve o
re
e
m
f
Small, semiregular pitch fluctuations in e
(for example, on the word “thyme”) She
indicate the use of vibrato, an expressive
technique used by musical performers.
Remember me to one She once was a true Tell her to make me Parsley, sage, rosemary Without no seams Then she’ll be a
who lives there love of mine a cambric shirt and thyme nor needle work true love of mine
Tempo Pitch stability
Outliers include
u songs featuring Pitches tend to be less
Stable pitch
Faster changes
three instruments—the
m Azerbaijani “Scarborough Fair” stable in spoken language
Tar, Swedishh Offerdalspipa than in music and song.
and Balinesee Suling. These
are played wi
with ornamentation,
so the sounds
d change fast.
Mean
“Scarborough
a Fair”
Slower changes
Unstable pitch
Mean
Spoken lyrics
Spoken lyrics
Instrumental
Instrumental
description
description
Sung lyrics
Sung lyrics
Spoken
Spoken
Source: “Globally, Songs and Instrumental Melodies Are Slower and Higher and Use More Stable Pitches
than Speech: A Registered Report,” by Yuto Ozaki et al., in Science Advances, Vol. 10; May 15, 2024 ( data) NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 75
HISTORY COMPILED BY MARK FISCHETTI
50, 100 & 150 Years into the article on fused quartz
in the July issue. On page 59 we
said of clocks they run ‘faster
does not appear needed, how-
ever, since the growing ten-
dency of the medical profes-
was awarded to the four-time as the weather gets warmer sion is in favor of pure ether as
U.S. national champion, Chess and the bob (of the pendulum) a substitute, or else a mixture
4.0 from Northwestern Univer- longer.’ Of course, the clock of chloroform, ether and alco-
sity. Third place went to Ribbit, runs slower as the pendulum hol, which we understand
the Canadian champion from gets longer. We are obliged to produces good results without
the University of Waterloo, and Mr. Taber. We are sorry. We will causing the dangerous de-
fourth place to Chaos, written try not to do it again.” pressing effect of the chloro-
by programmers at Sperry form or the nausea of ether.
Univac. There were 13 entries The employment of nitrous
from eight countries.” oxide in dental surgery is also
greatly extending; and since it
is both a harmless as well as an
agreeable anaesthetic, it pos-
SPATIAL RELATIONS sesses peculiar advantages.”
IN BOYS AND GIRLS
1974 “A cognitive attribute BARNS BURST INTO FLAME
known as ‘spatial “Many farmers have experi-
ability’ can be assessed by enced sudden and destructive
specially designed tests. Find- conflagrations in their hay lofts.
ings that implied a superior Barns have been known to burst
male performance have en- into flame, almost without warn-
dured in psychology literature. CHLOROFORM KILLS ing. Abbé Moigno, in Les Monde,
Jerome Kagan, a Harvard Uni- DENTAL PATIENTS gives the following theory: Hay,
versity psychologist concerned 1874 “The death of an- when piled damp and in too
with child development, and PRECIOUS STONES other patient in the large masses, ferments and
Ann Karnovsky, then one of INSIDE PLANTS dental chair, while under the turns dark. In decomposing,
Kagan’s graduate students, 1924 “Now and again, influence of chloroform, again sufficient heat is developed
wondered when this supposed substances which attracts public attention. This and vapors begin to be emitted.
superiority first becomes evi- closely resemble opals and latest accident occurred in The hay becomes carbonized
dent. They designed a simple pearls are discovered in giant Boston. The jury impaneled at little by little, and then the
test given to 222 boys and 223 tropical bamboos. In the young the coroner’s inquest notes charred portion, like peat,
girls in the first, second, third stages of growth the hollow that owing to our present lack becomes a kind of pyrophorus.
and fourth grades in Lexington, stems are filled with a jelly-like of knowledge, chloroform’s use The charcoal becomes concen-
Mass., and the seventh grade substance. As time goes on this as an anaesthetic is utterly trated on the surface to such
in Newton, Mass. The investi- dries up and an interesting unjustifiable. They also recom- a degree that the mass reaches
gators found no sex difference, mineral deposit known as mend legislative enactments to a temperature which results in
with one exception: in the low- tabasheer is formed. Some prevent its administration. That its bursting into flames.”
ability and medium-ability of this plays a part in
division of the seventh-grade making the stems stiff
mathematics class, the boys’ and strong but, at
performance was significantly times, an excess
superior. Karnovsky and Kagan settles in more or less
conclude that males and fe- rounded lumps at the
males are potentially of equal stem joints. These are
competence. The lower scores pale blue or white.
of some seventh-grade girls There is a close chem-
Karnovsky attributes to the ical connection to an
Scientific American, Vol. 131, No. 5; November 1924
effect of cultural conditioning.” opal, and the general

color and the manner
COMPUTER CHESS CHAMP of light reflection are
“The first world computer chess much the same.”
championship was won in
Stockholm by a Russian pro- A SWINGING
gram called Kaissa, with four APOLOGY
victories and no defeats. Three “One of our readers,
programs each lost one game. G.H. Taber of Pitts- 1924, Total Eclipse: “The shaded area marks the ‘shadow path’ in which the total eclipse
The tie was broken based on burgh, has been good of the sun, on January 24, 1925, will be visible. At the western end the sun will rise already
the fewest total moves and a enough to point out half eclipsed. At the heavy line midway along the path the eclipse will be just at its beginning
play-off game. Second place an error which crept as the sun rises. East of this midpoint all the eclipse, from beginning to end, will be visible.”

Scientific American - 11 2024

Uploaded by

Copyright:

Available Formats

Scientific American - 11 2024

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Scientific American - 11 2024

Uploaded by

Copyright:

Available Formats

CONTENTS

NOVEMBER 2024 VOLUME 331, NUMBER 4

Photograph by David L. Brill NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 1

4 FROM THE EDITOR

59 THE SCIENCE OF HEALTH

U.S. Department of Defense

DUNCAN GEERE AND MIRIAM QUICK

2 SCI E N T I F IC A M ER IC A N NOV E M BER 2 02 4

Understanding became human. On page 22, her discoverer, Donald C. Johanson,

JYOTI MADHUSOODANAN DEFOGGING DATA, PAGE S21

BEAR IN MIND by physical chemist Christina Tonauer and

© 2024 Scientific American

Behavior Research and Therapy, psycholo- EDITOR IN CHIEF Laura Helmuth

state that when it comes to the eﬀective- EDITORIAL

resume functionality. Children and teens CONTRIBUTORS

ERICA KLEINKNECHT O’SHEA

BELLINGHAM, WASH. CLIENT MEDIA SOLUTIONS

11-year-old boy who was found dead in CONSUMER MARKETING

NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 9

DISPATCHES FROM THE FRONTIERS OF SCIENCE, TECHNOLOGY AND MEDICINE

Gold forms nuggets as it aggregates

NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 11

Chemical Chow Down adjacent to the carbon-ﬂuorine ones. These

1 2 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Illustration by Thomas Fuchs

ANIMAL COGNITION muscle activity that reminds Mindlin “of

When awake, Zebra Finches sing a ing in other animals.

© 2024 Scientific American

How Molecules and Microbes ALL MOLECULES AND MICROBES METABOLISM

First peak at age 44

CYTOKINES LIPIDS PROTEINS RNA MOLECULES

70 800 45 275 8,000

Source: “Nonlinear Dynamics of Multi-omics Profiles during Human Aging,”

14 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Graphic by Amanda Montañez

© 2024 Scientific American

of Taste Wandering taste buds aren’t unheard of

Hanjo Hellmann/Alamy Stock Photo

Blind cave tetras develop taste buds on their heads.

NEUROSCIENCE tween four and 12 months old while the ba-

© 2024 Scientific American

SCIENCE IN IMAGES amine such teeth divorced from their fero-

imageBROKER.com GmbH & Co.KG/

Alamy Stock Photo

Biology; August 6, 2024

NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 19

PSYCHOLOGY spect for leaders and rules), and purity

Morality ciated with political conservatism, consis-

Jasmin Merdan/Getty Images

For the solution, visit www.ScientiﬁcAmerican.com/

20 SC I E N T I F IC A M ER IC A N NOV E M BER 2 02 4 Graphic by Amanda Montañez

Half a century after its discovery,

© 2024 Scientific American

© 2024 Scientific American

NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 25

T impact on paleoanthropology, we have to look at

© 2024 Scientific American

© 2024 Scientific American

ITH SO MANY PARTS of her skeleton pre-

W served, Lucy was a trove of information. But

NOV E M BER 2 02 4 SC I E N T I F IC A M ER IC A N.COM 29

MEMBERS OF THE GENUS HOMO