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Sunday, December 31, 2006

Brain wired for sound

Music of the Hemispheres

Images courtesy of Vinod Menon (Stanford University)

Images from an experiment to locate the neural regions of the brain involved in listening to music. Daniel Levitin and another scientist scanned the brains of 13 people as they listened to scrambled and unscrambled versions of a tune.

Published: December 31, 2006

Montreal

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Forum: Popular Music

Stuart McCall/Getty Images, for The New York Times

Daniel Levitin is the rare music scientist to have worked in the music business. “Pop musicians compose with timbre,” he said. “Pitch and harmony are becoming less important.”

“Listen to this,” Daniel Levitin said. “What is it?” He hit a button on his computer keyboard and out came a half-second clip of music. It was just two notes blasted on a raspy electric guitar, but I could immediately identify it: the opening lick to the Rolling Stones’ “Brown Sugar.”

Then he played another, even shorter snippet: a single chord struck once on piano. Again I could instantly figure out what it was: the first note in Elton John’s live version of “Benny and the Jets.”

Dr. Levitin beamed. “You hear only one note, and you already know who it is,” he said. “So what I want to know is: How we do this? Why are we so good at recognizing music?”

This is not merely some whoa-dude epiphany that a music fan might have while listening to a radio contest. Dr. Levitin has devoted his career to exploring this question. He is a cognitive psychologist who runs the Laboratory for Music Perception, Cognition and Expertise at McGill University in Montreal, perhaps the world’s leading lab in probing why music has such an intense effect on us.

“By the age of 5 we are all musical experts, so this stuff is clearly wired really deeply into us,” said Dr. Levitin, an eerily youthful-looking 49, surrounded by the pianos, guitars and enormous 16-track mixers that make his lab look more like a recording studio.

This summer he published “This Is Your Brain on Music” (Dutton), a layperson’s guide to the emerging neuroscience of music. Dr. Levitin is an unusually deft interpreter, full of striking scientific trivia. For example we learn that babies begin life with synesthesia, the trippy confusion that makes people experience sounds as smells or tastes as colors. Or that the cerebellum, a part of the brain that helps govern movement, is also wired to the ears and produces some of our emotional responses to music. His experiments have even suggested that watching a musician perform affects brain chemistry differently from listening to a recording.

Dr. Levitin is singular among music scientists for actually having come out of the music industry. Before getting his Ph.D. he spent 15 years as a record producer, working with artists ranging from the Blue Öyster Cult to Chris Isaak. While still in graduate school he helped Stevie Wonder assemble a best-of collection; in 1992 Dr. Levitin’s sensitive ears detected that MCA Records had accidentally used third-generation backup tapes to produce seven Steely Dan CDs, and he embarrassed the label by disclosing it in Billboard magazine. He has earned nine gold and platinum albums, which he tucks in corners of his lab, office and basement at home. “They look a little scary when you put them all in one place, so I spread them around,” he said.

Martin Grant, the dean of science at McGill, compares Dr. Levitin’s split professional personality to that of Brian Greene, the pioneering string-theory scientist who also writes mass-market books. “Some people are good popularizers, and some are good scientists, but not usually both at once,” Dr. Grant said. “Dan’s actually cutting edge in his field.”

Scientifically, Dr. Levitin’s colleagues credit him for focusing attention on how music affects our emotions, turf that wasn’t often covered by previous generations of psychoacousticians, who studied narrower questions about how the brain perceives musical sounds. “The questions he asks are very very musical, very concerned with the fact that music is an art that we interact with, not just a bunch of noises,” said Rita Aiello, an adjunct professor in the department of psychology at New York University.

Ultimately, scientists say, his work offers a new way to unlock the mysteries of the brain: how memory works, how people with autism think, why our ancestors first picked up instruments and began to play, tens of thousands of years ago.

DR. LEVITIN originally became interested in producing in 1981, when his band — a punk outfit called the Mortals — went into the recording studio. None of the other members were interested in the process, so he made all the decisions behind the board. “I actually became a producer because I saw the producers getting all the babes,” he said. “They were stealing them from the guitarists.” He dropped out of college to work with alternative bands.

Producers, he noted, were able to notice impossibly fine gradations of quality in music. Many could identify by ear the type of amplifiers and recording tape used on an album.

“So I started wondering: How was the brain able to do this?” Dr. Levitin said. “What’s going on there, and why are some people better than others? And why is music such an emotional experience?” He began sitting in on neuroscience classes at Stanford University.

“Even back then, Dan was never satisfied with the simple answer,” said Howie Klein, a former president of Reprise and Sire Records. “He was always poking and prodding.”

By the ’90s Dr. Levitin was disenchanted with the music industry. “When they’re dropping Van Morrison and Elvis Costello because they don’t sell enough records,” he said, “I knew it was time to move on.” Academic friends persuaded him to pursue a science degree. They bet that he would have good intuitions on how to design music experiments.

They were right. Traditionally music psychologists relied on “simple melodies they’d written themselves,” Dr. Levitin said. What could that tell anyone about the true impact of powerful music?

For his first experiment he came up with an elegant concept: He stopped people on the street and asked them to sing, entirely from memory, one of their favorite hit songs. The results were astonishingly accurate. Most people could hit the tempo of the original song within a four-percent margin of error, and two-thirds sang within a semitone of the original pitch, a level of accuracy that wouldn’t embarrass a pro.

“When you played the recording of them singing alongside the actual recording of the original song, it sounded like they were singing along,” Dr. Levitin said.

It was a remarkable feat. Most memories degrade and distort with time; why would pop music memories be so sharply encoded? Perhaps because music triggers the reward centers in our brains. In a study published last year Dr. Levitin and group of neuroscientists mapped out precisely how.

Observing 13 subjects who listened to classical music while in an M.R.I. machine, the scientists found a cascade of brain-chemical activity. First the music triggered the forebrain, as it analyzed the structure and meaning of the tune. Then the nucleus accumbus and ventral tegmental area activated to release dopamine, a chemical that triggers the brain’s sense of reward.

The cerebellum, an area normally associated with physical movement, reacted too, responding to what Dr. Levitin suspected was the brain’s predictions of where the song was going to go. As the brain internalizes the tempo, rhythm and emotional peaks of a song, the cerebellum begins reacting every time the song produces tension (that is, subtle deviations from its normal melody or tempo).

“When we saw all this activity going on precisely in sync, in this order, we knew we had the smoking gun,” he said. “We’ve always known that music is good for improving your mood. But this showed precisely how it happens.”

The subtlest reason that pop music is so flavorful to our brains is that it relies so strongly on timbre. Timbre is a peculiar blend of tones in any sound; it is why a tuba sounds so different from a flute even when they are playing the same melody in the same key. Popular performers or groups, Dr. Levitin argued, are pleasing not because of any particular virtuosity, but because they create an overall timbre that remains consistent from song to song. That quality explains why, for example, I could identify even a single note of Elton John’s “Benny and the Jets.”

“Nobody else’s piano sounds quite like that,” he said, referring to Mr. John. “Pop musicians compose with timbre. Pitch and harmony are becoming less important.”

Dr. Levitin dragged me over to a lab computer to show me what he was talking about. “Listen to this,” he said, and played an MP3. It was pretty awful: a poorly recorded, nasal-sounding British band performing, for some reason, a Spanish-themed ballad.

Dr. Levitin grinned. “That,” he said, “is the original demo tape of the Beatles. It was rejected by every record company. And you can see why. To you and me it sounds terrible. But George Martin heard this and thought, ‘Oh yeah, I can imagine a multibillion-dollar industry built on this.’

“Now that’s musical genius.”

THE largest audience that Dr. Levitin has performed in front of was 1,000 people, when he played backup saxophone for Mel Tormé. Years of being onstage piqued Dr. Levitin’s interest in another aspect of musical experience: watching bands perform. Does the brain experience a live performance differently from a recorded one?

To find out, he and Bradley Vines, a graduate student, devised an interesting experiment. They took two clarinet performances and played them for three groups of listeners: one that heard audio only; one that saw a video only; and one that had audio and video. As each group listened, participants used a slider to indicate how their level of tension was rising or falling.

One rapid, complex passage caused tension in all groups, but less in the one watching and listening simultaneously. Why? Possibly, Dr. Levitin said, because of the performer’s body language: the clarinetist appeared to be relaxed even during that rapid-fire passage, and the audience picked up on his visual cues. The reverse was also true: when the clarinetist played in a subdued way but appeared animated, the people with only video felt more tension than those with only audio.

In another, similar experiment the clarinetist fell silent for a few bars. This time the viewers watching the video maintained a higher level of excitement because they could see that he was gearing up to launch into a new passage. The audio-only listeners had no such visual cues, and they regarded the silence as much less exciting.

This spring Dr. Levitin began an even more involved experiment to determine how much emotion is conveyed by live performers. In April he took participants in a Boston Symphony Orchestra concert — the conductor Keith Lockhart, five of the musicians and 15 audience members — and wired them with sensors to measure their state of arousal, including heart rate, body movements and muscle tension.

At one point during the performance Mr. Lockhart swung his wrist with such force that a sensor attached to his cuff went flying off. Dr. Levitin’s team tried to reattach it with duct tape, until the conductor objected — “Did you just put duct tape on an Armani?” he asked — and lighter surgical tape was used instead.

The point of the experiment is to determine whether the conductor creates noticeable changes in the emotional tenor of the performance. Dr. Levitin says he suspects there’s a domino effect: the conductor becomes particularly animated, transmits this to the orchestra and then to the audience, in a matter of seconds. Mr. Lockhart is skeptical. “As a conductor,” he said, “I’m a causatory force for music, but I’m not a causatory force for emotion.” But Dr. Levitin is still crunching the data.

“It might not turn out to be like that,” he said, “But wouldn’t it be cool if it did?”

Dr. Levitin’s work has occasionally undermined some cherished beliefs about music. For example recent years have seen an explosion of “Baby Mozart” videos and toys, based on the idea — popular since the ’80s — that musical and mathematical ability are inherently linked.

But Dr. Levitin argued that this could not be true, based on his study of people with Williams syndrome, a genetic disorder that leaves people with low intelligence. Their peak mental capacities are typically those of young child, with no ability to calculate quantities. Dr. Levitin once asked a woman with Williams to hold up her hand for five seconds; she left it in the air for a minute and a half. “No concept of time at all,” he said, “and definitely no math.”

Yet people with Williams possess unusually high levels of musical ability. One Williams boy Dr. Levitin met was so poorly coordinated he could not open the case to his clarinet. But once he was holding the instrument, his coordination problems vanished, and he could play fluidly. Music cannot be indispensably correlated with math, Dr. Levitin noted, if Williams people can play music. He is now working on a study that compares autistics — some of whom have excellent mathematical ability, but little musical ability — to people with Williams; in the long run, he said, he thinks it could help shed light on why autistic brains develop so differently.

Not all of Dr. Levitin’s idea have been easily accepted. He argues, for example, that music is an evolutionary adaptation: something that men developed as a way to demonstrate reproductive fitness. (Before you laugh, consider the sex lives of today’s male rock stars.) Music also helped social groups cohere. “Music has got to be useful for survival, or we would have gotten rid of it years ago,” he said.

But Steven Pinker, a cognitive scientist at Harvard known for his defense of evolutionary psychology, has publicly disparaged this idea. Dr. Pinker has called music “auditory cheesecake,” something pleasant but not evolutionarily nutritious. If it is a sexual signal for reproduction, then why, Dr. Pinker asked, does “a 60-year-old woman enjoy listening to classical music when she’s alone at home?” Dr. Levitin wrote an entire chapter refuting Dr. Pinker’s arguments; when I asked Dr. Pinker about Dr. Levitin’s book he said he hadn’t read it.

Nonetheless Dr. Levitin plugs on, and sometimes still plugs in. He continues to perform music, doing several gigs a year with Diminished Faculties, a ragtag band composed entirely of professors and students at McGill. On a recent December afternoon members assembled in a campus ballroom to do a sound check for their performance that evening at a holiday party. Playing a blue Stratocaster, Dr. Levitin crooned the Chris Isaak song “Wicked Game.” “I’m not a great guitarist, and I’m not a great singer,” he said.

But he is not bad, either, and still has those producer’s ears. When “Wicked Game” ended, the bass player began noodling idly, playing the first few notes of a song that seemed instantly familiar to all the younger students gathered. “That’s Nirvana, right?” Dr. Levitin said, cocking his head and squinting. “ ‘Come As You Are.’ I love that song.”



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Thursday, December 28, 2006

Energy Sustainability

A Series

The Energy Challenge

Articles in this series will periodically examine the ways in which the world is, and is not, moving toward a more energy efficient, environmentally benign future.

No Perfect Solution
It’s Free, Plentiful and Fickle
By MATTHEW L. WALD
Wind, almost everybody’s best hope for big supplies of clean, affordable electricity, is turning out to have complications. (Dec. 28, 2006)

Global Trades
Outsize Profits, and Questions, in Effort to Cut Warming Gases
By KEITH BRADSHER
A fast-growing climate plan that pushes foreign companies to clean up third-world factories has revealed hidden problems. (Dec. 21, 2006)
Graphics: Cleaning Up

Fossil Fuel Economics
The Cost of an Overheated Planet
By STEVE LOHR
It is increasingly clear that there is a considerable cost to carbon dioxide emissions, especially to future generations. (Dec. 12, 2006)
Graphics: Hungry for Power | Carbon’s Possible Future

A Terrible Thing to Waste. Or Try This.
By JEREMY W. PETERS
The nation’s energy excesses may be politically dangerous, but the federal government isn't rushing to produce a public service campaign. Three advertising agencies give it a shot. (Dec. 10, 2006)

The Research Shortage
Budgets Falling in Race to Fight Global Warming
By ANDREW C. REVKIN
In the U.S., annual federal spending for all energy research and development is less than half what it was a quarter-century ago. (Oct. 30, 2006)
Graphics: What Matters Most | Declining Investment in Energy R&D
Related: British Government Report Calls for Broad Effort on Climate Issues
Q&A With Andrew C. Revkin

Clearing the Air
California, Taking Big Gamble, Tries to Curb Greenhouse Gases
By FELICITY BARRINGER
California’s decision to impose stringent demands on suppliers even outside its borders is but one example of the state’s effort to remake its energy future. (Sept. 15, 2006)
Graphics: Green and Getting Greener | An Energy-Thrifty State
Video: A California Solar Subdivision

Driving the Ethanol Corridor
Fill Up on Corn if You Can
By ALEXEI BARRIONUEVO
Even in the Midwest where ethanol is most popular, its success as an alternative fuel is far from assured. (August 31, 2006)
Graphic: Driving on E-85
Graphic: Where to Find E-85
Audio Feature: Ethanol Flows at a Trickle

The Nuclear Choice
Slow Start for Revival of Nuclear Reactors
By MATTHEW L. WALD
Utility executives are sharply divided over whether nuclear power offers an attractive choice as they seek to satisfy a growing demand for electricity. (August 22, 2006)
Graphic: New Plants on the Way?

Liquid Coal
Search for New Oil Sources Leads to Processed Coal
By MATTHEW L. WALD
Illinois alone has more energy than Saudi Arabia, but turning coal into fuel for consumers has a big catch. (July 5, 2006)
Graphic: Changing Black Rock to Black Gold

Exotic Visions
How to Cool a Planet, Maybe
By WILLIAM J. BROAD
The fight against global warming has largely focused on reducing greenhouse gases. But what if ... ? (June 27, 2006)
Graphic: Science Fiction? Maybe Not.

A Modern Day Gold Rush
Boom in Ethanol Reshapes Economy of Heartland
By ALEXEI BARRIONUEVO (Reported by Alexei Barrionuevo, Simon Romero and Michael Janofsky)
Small towns are becoming flashpoints in the ethanol bonanza that is reshaping rural America's economic base. (June 25, 2006)
Interactive Graphic: Fuel On-the-cob
A Range of Estimates on Ethanol's Benefits

The Not So Good Earth
By DAVID BARBOZA
Thousands of acres of land in northern China are sinking because of the ravages of underground coal mining. (June 23, 2006)
Audio & Photos: Victims of a Coal Boom

Sooty Future
Europe's Image Clashes With Reliance on Coal
By MARK LANDLER
Europe likes to think of itself as beyond its sooty past, yet it still depends on a cheap, plentiful fuel. (June 20, 2006)
Graphic: Generating Electricity and Emissions

The Cost of Coal
Pollution From Chinese Coal Casts a Global Shadow
By KEITH BRADSHER and DAVID BARBOZA
Coal is China's double-edged sword — the new economy's black gold and the fragile environment's dark cloud. (June 11, 2006)
Video: China's Dark Clouds
Graphic: Future Shock

Extra Credit
The Greener Guys
By JAD MOUAWAD
Americans are increasingly identifying global warming as a serious problem, and a few companies are taking special steps to curb carbon emissions. (May 30, 2006)

Green, at a Cost
2 Industry Leaders Bet on Coal but Split on Cleaner Approach
By SIMON ROMERO
Coal is poised to once again become the nation's favorite fuel, but its role in global warming causes concern. (May 28, 2006)
Interactive Graphic: A Closer Look at Coal
Audio Slide Show: The Return of King Coal

Turf Battles
A Greener Way to Cut the Grass Runs Afoul of a Powerful Lobby
By FELICITY BARRINGER
Lawn mowers lack catalytic converters, but the dominant engine manufacturer vigorously opposes adding them. (April 24, 2006)

Turning to the Sun
Forget Computers. Here Comes the Sun
By JOHN MARKOFF
The fledgling solar-cell industry uses just about as many silicon wafers as the chip industry does, but the resemblance ends there. (April 14, 2006)

Horsepower Wars
Automakers Use New Technology to Beef Up Muscle, Not Mileage
By MATTHEW L. WALD
For two decades, automakers have been concentrating on making vehicles bigger and faster instead of improving efficiency. (March 30, 2006)

Tips

To find reference information about the words used in this article, hold down the ALT key and click on any word, phrase or name. A new window will open with a dictionary definition or encyclopedia entry.


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Wednesday, December 27, 2006

Immigration Irony

Op-Ed Contributor

Our Founding Illegals


Published: December 27, 2006

EVERY nation is a nation of immigrants. Go back far enough and you’ll find us all, millions of potential lives, tucked in the DNA of our African mother, Lucy. But the immigrant experience in the United States is justly celebrated, and perhaps no aspect of that experience is more quintessentially American than our long heritage of illegal immigration.

You wouldn’t know it from the immigration debate going on all year (the bipartisan immigration bill-in-progress, announced this week, is unlikely to mention it), but America’s pioneer values developed in a distinctly illegal context. In 1763, George III drew a line on a map stretching from modern-day Maine to modern-day Georgia, along the crest of the Appalachians. He declared it illegal to claim or settle land west of the line, all of which he reserved for Native Americans.

George Washington, a young colonel in the Virginia militia, instructed his land-buying agents in the many ways of getting around the law. Although Washington was not alone in acquiring forbidden tracts, few were as energetic in the illegal acquisition of western land. And Washington was a model of decorum compared to Ethan Allen, a rowdy from Connecticut who settled with his brothers in a part of the Green Mountains known as the Hampshire Grants (later known as “Vermont”). The province of New York held title to the land, but Allen asserted his own kind of claim: He threw New Yorkers out, Tony Soprano style, then offered to sell their lots to what he hoped would be a flood of fellow illegals from Connecticut.

Meanwhile, illegal pioneers began moving across the Alleghenies and into the upper Ohio Valley, violating the king’s 1763 proclamation and a few more besides. (George would today be accused of softness on immigration; he kept shifting the line westward.) Immigrants from such déclassé spots as Germany and Ireland violated the laws and settled where they pleased. The upper Ohio was rife with illegal immigrants, ancestors of people who, in country clubs today, are implying a Mayflower ancestry.

Parallels to today’s illegal immigration are striking. Then as now, it was potentially deadly to bring a family across the line. But once across, illegals had a good chance of avoiding arrest and settling in. Border patrols, in the forms of the British Army and provincial militias, were stretched thin. The 18th-century forest primeval, like a modern city, offered ample opportunities for getting lost. Complex economies thrived in the virgin backwoods, unfettered by legitimate property titles.

When conflicts developed between the first and second waves of illegals, some salient social ironies arose, too. By the early 1770’s, George Washington had amassed vast tracts to which his titles were flatly invalid. The Revolution rectified that. With British law void, Washington emerged from the war with his titles legal by default. But he acquired another problem: low-class illegals were squatting on his newly authenticated, highly valuable property.

Washington harbored no fond feeling for breakers of laws that he too had recently flouted. “It is hard upon me,” he lamented without irony, “to have property which has been fairly obtained disputed and withheld.” He went to court to have the squatters evicted, complaining that they had “not taken those necessary steps pointed out by the law.” He was appealing to righteousness from atop a high but wobbly horse.

Descendants of the great immigration experiences of the 19th and 20th centuries visit the Ellis Island Immigration Museum to learn of the tribulations of ancestors who risked much to become Americans. Those of us whose ancestors risked everything as illegal immigrants, and in the process helped found a nation, owe our forebears a debt of gratitude, too. Without their daring disregard of immigration laws, we might not be here today.

William Hogeland is the author of “The Whiskey Rebellion: George Washington, Alexander Hamilton and the Frontier Rebels Who Challenged America’s Newfound Sovereignty.”



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Tuesday, December 26, 2006

Alcohol & Head Injury

In Study, Alcohol Seems to Help in Head Trauma

Published: December 26, 2006

For as long as people have been drinking, people have been getting hurt, with alcohol playing a role in injuries from the most inconsequential to the most extreme. Few if any doctors would argue that excessive drinking is not an important public health threat.

But a new report suggests that sometimes things are more complicated than that. When it comes to serious head injuries, researchers said, people who have drunk moderate amounts of alcohol seem to be at less risk of dying than people who are sober. The report appears in The Archives of Surgery, and its authors were at pains to say they were not endorsing heavy drinking, especially during the holiday season. In the study, the heaviest drinkers were the most likely to die.

“Certainly, if you take all things equally, if you drink and drive you’re still much more likely to die from an accident,” the lead author, Dr. Homer C. N. Tien of the University of Toronto, said in an interview.

The researchers nevertheless found clear evidence that in some cases, a certain amount of alcohol helps the brain recover from blunt trauma injury. Before laying out the possible benefits of alcohol, the authors presented a fairly damning indictment of it, at least when it is abused.

As many as half of all patients hospitalized with trauma, they said, are intoxicated when they are hurt. Alcohol is believed to play a role in about a third of all deaths from injury. And by impairing motor skills, reaction time and judgment, alcohol increases the risk of injury in almost every imaginable way, leading to car crashes, falls, assaults and self-inflicted wounds.

The study then took a look at what happened to more than 1,100 patients who arrived at a Toronto trauma center over a 16-year period.

The researchers divided the patients into three groups: those with no alcohol in their blood upon arrival at the hospital, those who had a small to moderate amount, and those who had a large amount.

Those with moderate amounts had a mortality rate of about 28 percent, compared with a rate of about 36 percent for those with no alcohol. The ones with high alcohol were the most likely to die, with a mortality rate of almost 45 percent.

Several things may explain the differences. To begin with, a traumatic brain injury is not a split-second process. “Not all of the injury in the brain happens right away,” Dr. Tien said.

Instead, in the hours after the initial trauma, the brain undergoes a series of changes as it tries to fix the damage. In some cases, the flood of neurotransmitters it puts out can actually do more harm than good.

Alcohol, the researchers believe, may act to slow the release of some of those neurotransmitters. The researchers pointed to other studies that have reported that alcohol and caffeine may make strokes less severe. They also said that whatever benefits alcohol might offer to victims of head injury, the popular myth that alcohol helps intoxicated drivers avoid injury by relaxing them is just that: a myth.

The higher rate of death among patients with a high blood-alcohol level may have occurred because alcohol can prevent the body from recovering from the shock that follows major injury, the researchers said.

Of the patients studied, about 64 percent were found to have had no alcohol, while 27 percent had drunk low to moderate amounts, defined as up to a blood-alcohol level of 0.23 — about three times the usual legal definition for driving while intoxicated. The researchers also looked at a group of patients admitted in the same time period with trauma to the torso. In those cases, alcohol consumption appeared to have no effect on the survival rates.

The researchers said there were “major sociological implications” in suggesting that head trauma patients who have been drinking might do better than sober ones. But they emphasized that the only patients they studied were those who made it to the hospital alive.

As a general rule, half of all people killed by trauma never make it to a hospital. And a disproportionate number of those people, the researchers said, had been drinking.



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Hormones & Breast Cancer

Hormones and Cancer: Assessing the Risks


Published: December 26, 2006

When researchers reported recently that a precipitous drop in breast cancerhormones for menopause, women reacted with shock, anger and, in some cases, profound relief that they had never taken the drugs. rates might be explained by a corresponding decrease in the use of

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Jessica Roberts for The New York Times

Research Leader Dr. V. Craig Jordan studies the effects of estrogen-blocking drugs on breast cancer.

But many also had questions. How certain were scientists that the hormones were responsible? How could stopping hormones have such an immediate and pronounced effect? And how much did scientists really know about the biology of breast cancer and hormones?

The data seemed clear enough. In 2003, after climbing for almost seven decades, the breast cancer rate fell for the first time in the United States, and it fell sharply. Over all, the incidence of newly diagnosed breast cancer dropped 7 percent, and it dropped 15 percent among women with cancers whose growth is fueled by estrogen.

There also was no question that at the same time, women had begun to abandon hormones as a treatment for menopause. In July 2002, a large study, the Women’s Health Initiative, concluded that a popular hormone therapy for menopause, Prempro, made by Wyeth, slightly increased the risk of breast cancer. Within the next six months, prescriptions for Prempro dropped by half.

A connection between hormone use and breast cancer rates did not surprise scientists like Dr. V. Craig Jordan, vice president and scientific director for the medical science division at Fox Chase Cancer Center in Philadelphia. Dr. Jordan is a leader in studying the effects of estrogen-blocking drugs on breast cancer. Among his many awards is this year’s American Cancer Society Award from the American Society for Clinical Oncology for his work on estrogen and the prevention and treatment of breast cancer.

Dr. Jordan’s wife, Dr. Monica Morrow, a breast cancer surgeon, is chairwoman of the surgical oncology department at Fox Chase. Their offices, he says, are across the hall from each other, “so we are together 24 hours a day.”

Q. Prempro, the combination drug that many women took for menopause symptoms, contains both estrogen and progestins. And the findings from the Women’s Health Initiative study suggested that estrogen alone has only a tiny effect, if any, on breast cancer risk. So which is the bad actor, progestins or estrogen? Or is it both hormones combined?

A. We’ve known for 30 years that estrogen can directly cause the growth of breast cells and of endometrial cells. Estrogen is fuel for the fire. But progesterone seems to do different things in different places in a woman’s body. In the uterus, it stops the growth of the endometrium and makes it ready for implanting a fertilized egg. In breast cancer, estrogen causes a doubling of cancer cells every 36 hours. Soon, the growing tumor ball needs to increase its blood supply because cells in the middle are not getting enough food and oxygen. Progesterone seems to cause other cells, stromal cells, to gather around the ball of cancer cells and play a supporting role. Stromal cells are the woman’s own cells that researchers now think may be specifically selected to build an architecture and send out signals for more blood supply, more fuel.

Q. That seems to be an unusual arrangement. Why would progesterone act on stromal cells in the breast?

A. When a woman is pregnant, her breasts are much larger and her estrogen and progesterone levels are huge. Progesterone is sending out signals that provide a skeleton to build the breasts.

Q. Was it a surprise to learn that estrogen and progestins can cause breast cancer?

A. We’ve known there is a cause and effect with hormones and breast cancer since 1896. If a woman is premenopausal and she has breast cancer and you take out her ovaries, the tumors decrease in size. Not all the tumors — if you took 100 women who were premenopausal and took their ovaries out, 35 percent would have a response. And you could get a dramatic response. A tumor that was the size of a walnut could shrink in six months to the size of a pinhead. It turned out that the tumors that responded contained estrogen receptors. This became cause and effect — the estrogen receptor was the mechanism that estrogen used to stimulate tumors to grow. If there was no estrogen receptor, taking away estrogen didn’t do anything at all.

Q. Did taking away estrogen ever make a breast cancer go away completely?

A. This is the basic difficulty. We were dealing with advanced breast cancer, and what we saw was that we could get complete remissions in 4 or 5 percent of the women. In the majority of women, the remission would last for one to two years. Taking away estrogen slowed things down, it reversed the process, but it did not cure.

Q. Do you agree with the latest analysis indicating that breast cancer is declining because so many women stopped taking Prempro and other menopausal hormones?

A. Throughout the 1990s, physicians were recommending that menopausal women take hormone replacement therapy. What happens is that you increased the rate of breast cancer in the whole country. And it shifted the epidemiology. We have seen an increase in the percentage of estrogen-receptor-positive tumors in the 1990s and in the beginning of the 2000s, so that now 70 percent of tumors are estrogen-receptor positive.

This was, if you like, consistent. Everything was ticking in. The Women’s Health Initiative and the Million Women Study in Britain really said: “Here’s a controlled series of studies comparing taking nothing with taking hormone replacement therapy. How many cancers were there at the end of the day?”

The Women’s Health Initiative found a 23 percent increase in breast cancer; the Million Women Study found a 100 percent increase. Those studies were highly publicized and women stopped taking hormones. Now the breast cancer rates are going down. Now tumors you would have detected are not being detected. There is no proof the tumors will ever go away, but you can’t detect them. And it is possible that many subclinical cancer cells may never grow inside a woman’s breast if she has no estrogen around to fuel that fire.

Q. If a woman has a tumor that is undetectable because she did not take menopausal hormones, will it eventually grow anyway and turn into a cancer that can be seen on a mammogram?

A. We don’t know. What we have learned from the tamoxifen clinical trial is that tamoxifen, which blocks estrogen, did a fantastic job. The cancer rate in the group taking tamoxifen dropped by 50 percent. Tamoxifen prevented the development of breast cancers that were early stage, and it also stopped cells from progressing to breast cancer.

Q. Some people suggest that the real problem was that the hormones women were taking were artificial or were given in artificial ways. Prempro, for example, gets its estrogen from pregnant mares. Some say other hormone preparations, for example, so-called bioidentical hormones, would be safe. Do you agree?

A. We’ve been talking about women’s ovaries producing estrogen and progesterone. When a woman enters menopause, hormone levels drop dramatically. The longer you bathe a woman’s breasts in these hormones, the more likely she will have cancer. If you start menstruating early, if you have two extra years of estrogen in your body, bathing your breasts in that fuel is a risk factor for breast cancer. If you start menopause late, if your periods go on for an extra four or five years, that is a risk. The longer you have menstrual cycles, the higher your probability of breast cancer. And that is with natural hormones, the ones in your body.

Q. What about birth control pills? Do they increase the risk of breast cancer?

A. We have had testing of birth control pills in huge groups of women since the 1950s, and there really is no evidence of a significant rise in breast cancer risk. What we do know is that oral contraceptives reproduce the messages in the brain to stop a woman from ovulating. You are bathing a woman’s body with artificial hormones, but normally she would be bathing her own body with estrogen and progesterone. You don’t have women getting endometrial cancer, and oral contraceptives reduce the risk of getting ovarian cancer by 50 percent. It is one of the few things we know of that reduces the risk of ovarian cancer.

Q. What about chemicals in the environment, like DDT or chemicals in plastics, that can mimic estrogen. Could they be causing breast cancer?

A. There are a group of compounds like DDT that are byproducts of industry and are in our environment. They can affect cells in the laboratory and can affect the reproduction of animals, but in really huge doses. There is an effect, but does it cause an increase in cancer? I personally don’t believe that is the case. I don’t think there is enough around to do that. A pinch of estrogen in the environment is very small compared to the gallons in a woman’s body.

Q. What should women do now? Should they ever take menopausal hormones?

A. The value of hormone therapy for women with extremely severe menopausal symptoms is well established, and women, in consultation with their doctors, should consider using it for only a few months to alleviate severe symptoms. The main concern is using the drugs for many years to prevent osteoporosis. They can reduce the risk of hip fractures, but there are now many different alternatives for women to maintain bone density, such as bisphosphonates or raloxifene. Hormone replacement therapy should only be considered after all other options have failed.



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Monday, December 25, 2006

St Francis - Peacemaker

Op-Ed Contributor

The Peaceful Crusader

Published: December 25, 2006

AMID all the useless bloodshed of the Crusades, there is one story that suggests an extended clash of civilizations between Islam and the West was not preordained. It concerns the early 13th-century friar Francis of Assisi, who joined the Fifth Crusade not as a warrior but as a peacemaker.

Francis was no good at organization or strategy and he knew it. He accepted the men and women who presented themselves as followers, befriended them and shared the Gospel with them. But he gave them little else. He expected them to live like him: rejecting distinctions of class, forgoing honors of church or king or commune, taking the words of Jesus literally, owning nothing, suffering for God’s sake, befriending every outcast — leper, heretic, highwayman — thrust in their path.

Francis was not impressed by the Crusaders, whose sacrilegious brutality horrified him. They were entirely too fond of taunting and abusing their prisoners of war, who were often returned to their families minus nose, lips, ears or eyes.

In Francis’ view, judgment was the exclusive province of the all-merciful God; it was none of a Christian’s concern. True Christians were to befriend all yet condemn no one. Give to others, and it shall be given to you, forgive and you shall be forgiven, was Francis’ constant preaching. “May the Lord give you peace” was the best greeting one could give to all one met. It compromised no one’s dignity and embraced every good; it was a blessing to be bestowed indiscriminately. Francis bestowed it on people named George and Jacques and on people named Osama and Saddam. Such an approach, in an age when the most visible signs of the Christian religion were the wars and atrocities of the red-crossed crusaders, was shockingly otherworldly and slyly effective.

Symbolic gesture, Francis’ natural language, was a profound source he called on throughout his life. In one of its most poignant expressions, Francis sailed across the Mediterranean to the Egyptian court of al-Malik al-Kamil, nephew of the great Saladin who had defeated the forces of the hapless Third Crusade. Francis was admitted to the august presence of the sultan himself and spoke to him of Christ, who was, after all, Francis’ only subject.

Trying to proselytize a Muslim was cause for on-the-spot decapitation, but Kamil was a wise and moderate man, who was deeply impressed by Francis’ courage and sincerity and invited him to stay for a week of serious conversation. Francis, in turn, was deeply impressed by the religious devotion of the Muslims, especially by their five daily calls to prayer; it is quite possible that the thrice-daily recitation of the Angelus that became current in Europe after this visit was precipitated by the impression made on Francis by the call of the muezzin (just as the quintessential Catholic devotion of the rosary derives from Muslim prayer beads).

It is a tragedy of history that Kamil and Francis were unable to talk longer, to coordinate their strengths and form an alliance. Had they been able to do so, the phrase “clash of civilizations” might be unknown to our world.

Francis went back to the Crusader camp on the Egyptian shore and desperately tried to convince Cardinal Pelagius Galvani, whom Pope Honorius III had put in charge of the Crusade, that he should make peace with the sultan, who, despite far greater force on his side, was all too ready to do so. But the cardinal had dreams of military glory and would not listen. His eventual failure, amid terrible loss of life, brought the age of the crusades to its inglorious end.

Donald Spoto, one of Francis of Assisi’s most recent biographers, rightly calls Francis “the first person from the West to travel to another continent with the revolutionary idea of peacemaking.” As a result of his inability to convince Cardinal Pelagius, however, Francis saw himself as a failure. Like his model, Jesus of Nazareth, Francis was an extremist. But his failure is still capable of bearing new fruit.

Islamic society and Christian society have been generally bad neighbors now for nearly 14 centuries, eager to misunderstand each other, often borrowing culturally and intellectually from each other without ever bestowing proper credit. But as Sir Jonathan Sacks, chief rabbi of the British Commonwealth, has written, almost as if he was thinking of Kamil and Francis, “Those who are confident of their faith are not threatened but enlarged by the different faiths of others. ... There are, surely, many ways of arriving at this generosity of spirit and each faith may need to find its own.” We stand in desperate need of contemporary figures like Kamil and Francis of Assisi to create an innovative dialogue. To build a future better than our past, we need, as Rabbi Sacks has put it, “the confidence to recognize the irreducible, glorious dignity of difference.”

May the Lord give you peace.

Thomas Cahill is the author of “Mysteries of the Middle Ages: The Rise of Feminism, Science and Art From the Cults of Catholic Europe.”



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