Monday, February 27, 2012
Sunday, February 26, 2012
Could this be the case that breaks the hold that anti-vaccination idiocy has over certain sectors of our country? Janice D'Arcy reports at the Washington Post on the latest measles outbreak traced back to anti-vaccination fanatics, but this time, instead of an outbreak being traced back to a Whole Foods or a nursery school---the usual places where the kids of yuppie anti-vaxxers have a chance to expose and be exposed---the trail for this one leads back to the Super Bowl. Indiana has had 14 cases of measles since the game, and 13 of those have been confirmed as occurring in anti-vaccination families. The outbreak started with two infected people who went to the Super Bowl village, visited a few places, and thereby set off the mini-epidemic. As D'Arcy points out, if not for widespread vaccination, the numbers of exposed would have reached the hundreds of thousands.
In most cases, measles just creates a few days of utter misery for the patient---which is reason enough to vaccinate, unless you have some sadistic streak---but in some cases, it can lead to pneumonia or encephalitis, causing brain damage or death. I genuinely don't think anti-vaccination parents want their kids to get sick, even though some of them act disturbingly blase about that possibility or minimize the suffering these diseases can cause. (I still can recall with great clarity what torture the chicken pox was, and curse any parent who thinks it's better to put a kid through that than simply give them a shot.) The problem is that anti-vaccination parents are making a virtue out of selfishness, imagining that they're doing right by their kid by making them a free rider that uses herd immunity. This is wrong-headed thinking. To be a proper free rider, you have to be accruing benefits without making sacrifices, but outside of a little pain and maybe a slight fever, getting vaccinated is not a sacrifice. Unlike with other competitive yuppie child-rearing practices, such as trying to get your kid into the right preschool, someone else's loss isn't your gain. As painful as it is for anyone in the 21st century to admit, there is such thing as a win/win solution, and vaccination is it. You help others while helping yourself. The victims in this case are, after all, people who opted out of vaccinations. Additionally, anti-vaccination fanatics are aggressive at recruiting. With every successful convert to the cause, the herd immunity they rely on diminishes, as demonstrated by the fact that this particular outbreak spread through a group of people who ran in similar social circles.
The Super Bowl example also demonstrates the limits of herd immunity for protecting the unvaccinated. In our modern era of plane travel, dense cities, and events like the Super Bowl, the average person has plenty of opportunities to inhale the germs of a large and diverse group of people---and take those germs further faster than ever before. Considering that the exposure point was the Super Bowl, we should all be very concerned. These cases are so far limited to Indiana, but think of how many people were exposed and then got on a plane after the game to return home to every corner of the U.S. Luckily, the vast majority of them are vaccinated against the measles, but with the growing ranks of anti-vaccination converts, our luck may not hold out forever.
Saturday, February 25, 2012
The misalignment of politics and reality threatens to scuttle both major parties, but it’s especially gratifying to see the Republicans sail off the edge of their own flat earth on the winds of religious idiocy.
For forty years it has not been enough for them to just be a conservative party. They had to enlist the worst elements of ignorance and reaction, and they found an endless supply of it in the boom regions of the Sunbelt with its brotherhood of TV evangelist con-artists and a population fretful with suburban angst.
Now, in the last hours of the cheap oil economy, the forty year miracle of the Sunbelt boom dwindles and a fear of approaching darkness grips the people there like a rumor of Satan. The long boom that took them from an agricultural backwater of barefoot peasantry to a miracle world of Sonic Drive-ins, perpetual air-conditioning, WalMarts, and creation museums is turning back in the other direction and they fear losing all that comfort, convenience, and spectacle.
Since they don’t understand where it came from, they conclude that it was all a God-given endowment conferred upon them for their exceptional specialness as Americans, and so only the forces of evil could conspire to take it all away.
Hence, the rise of a sanctimonious, hyper-patriotic putz such as Rick Santorum and his take-back-the-night appeal to those who sense the gathering twilight. And the awful ordeal of convictionless pander and former front-runner Mitt Romney drowning in his own bullshit as he struggles to extrude one whopper after another just to keep up with the others in this race to the bottom of the political mud-flow.
There is an obvious dither backstage now among those who cynically thought they could manipulate and control these dark impulses of the frightened masses as the candidates all pile into a train wreck of super-PAC obloquy. Won’t some level-headed adult like the governors of New Jersey and Indiana step up and volunteer?
Is this finally its Whig Moment – the point where the Republican Party has offended history so gravely that it goes up in a vapor of its own absurdity? I hope so. The conservative impulse is hardly all bad. We need it in civilization. But it can’t be vested in the sheer and constant repudiation of reality.
The opposing Democrats have their own problem with reality, which is that they don’t tell the truth about so many things despite knowing better, and, under Obama, they act contrary to their stated intentions often enough, and in matters of extreme importance, that they deserve to go down in flames, too. Just as there is a place for conservatism in civilized life, there is also a place for the progressive impulse, let’s call it – for making bold advance in step with the mandates of reality and an interest in justice for all those along on the journey.
The Democrats under Obama don’t want to go to that place. They want to really go to the same place as the fretful Sunbelt fundamentalists, but by a different route – and that place is yesterday, by means of a campaign to sustain the unsustainable. Mr. Obama is pretending that an economic “recovery” is underway when he knows damn well that the banking system is just blowing smoke up the shredded ass of what’s left of that economy.
He pretends to an interest in the rule of law in money matters but he’s done everything possible to prevent the Department of Justice, the SEC, and a dozen other regulatory authorities from functioning the way they were designed.
He has never suggested resurrecting the Glass-Steagall act, which kept banking close to being honest for forty years. He never issued a peep of objection about the Citizens United case where the Supreme Court tossed the election process into a crocodile pit of corporate turpitude (he could have proposed a constitutional amendment redefining corporate “personhood.”). He declared he’d never permit a super-PAC to be created in his name, and now he’s got one.
Mr. Obama represents a lot of things to a lot of people. He is mainly Progressivism’s bowling trophy, its symbol of its own triumphant wonderfulness in overcoming the age old phantoms of race prejudice. Alas, that’s not enough. Where exactly is the boundary between telling “folks” what they want to hear and just flat-out lying?
Neither party can articulate the current reality, which is that we have to reorganize civilization pretty drastically. I’ve reviewed that agenda many times in this space and it largely amounts to rebuilding local economies at a smaller and finer scale.
That is just not on the table for all current leadership, or even in the room. If neither party can frame an agenda consistent with that reality, then we’ll have to get there without them, probably after a very rough period when the pretending still lingers in the air like a bad odor and no reality-based consensus is able to form, no agreement about what we should do.
That’s the period when a lot of things fall apart and people get hurt. These are the choices we’re making right now.
Tuesday, February 21, 2012
You don't need a bunch of pills and supplements to make sure you get your daily dose of vitamins and minerals. There are plenty of easy ways to add a big nutritional boost to your dishes and make an already healthy meal even better for your mind and your body. We asked a nutritionist to give us some pointers on simple ways to get a big improvement in our diet, and here's what he suggested.
Improve Your Meal by Sprinkling On Some Delicious Nutritional All-Stars
We sat down with Andy Bellatti, a Seattle-based registered dietitian and nutritionist who's helped us before with our first food myths post and its myth-smashing sequel. We asked him how you can boost the nutritional content of your meals. It turns out there are some nutritional all-stars that make for great additions to soups, stews, yogurt, pilafs, salads, and more. Here are a few:
- José Maria Silveira Neto.
- Nutritional Yeast. Nutritional yeast is actually a favorite of mine, and Andy loves it too. I stumbled onto it when entertaining a vegan friend, who suggested I sprinkle some on popcorn. Sure enough, nutritional yeast has a very cheesy, Parmesan-like flavor that's good on vegetables, in dips, and anywhere you want a cheesy, umami flavor boost. "A 2 tablespoon serving," Andy notes, "provides 4 g of fiber, 8 g of protein, loads of B vitamins, and as much potassium as a small banana. Some brands are especially fortified with vitamin B12." You can't go wrong here, especially if you love savory foods.
- Nori (Seaweed). If you haven't tried adding nori strips or snacks to your diet, you're missing out on another delicious savory boost with big nutritional bonuses. Most people know nori from their sushi rolls, but it can also be ripped and flaked over soups, salads, and even laid over noodles. Nori is also rich in vitamins A and C, and EPA (a type of omega-3 that's normally found in fish...because they eat sea vegetables.)
- Wheat Germ. Wheat germ is another staple in my kitchen, and adds a crunchy, nutty, and mildly sweet flavor that's specifically good as a lightly crunchy topper for yogurt, cereal, or oatmeal, and is also a great additive to mix in if you're making your own cereal or granola or even whipping up a batch of energy bars. "A 50 calorie, 2 tablespoon serving," says Andy, "delivers 2.5 grams of fiber and is an excellent source of manganese, zinc, iron, and thiamin."
- Cocoa Powder and Cacao Nibs. Two different products born from the same plant, cocoa powder (as long as you get unsweetened, non-alkalized cocoa) can add fiber, potassium, and magnesium when sprinkled into a smoothie or mixed into a drink. Cacao nibs on the other hand are 100% cocoa, and include the fatty acids available in the pure product. They're sharp, bitter, and crunchy, offering a kind of coffee-like flavor that's great in granola, oatmeal, cereal, and more. Andy points out that they're also great sources of fiber, magnesium, and zinc.
- Hemp Seeds. Ah, hemp. It's good for tons of things, but on your food they add a serious nutritional punch to your salads, stews, cereals, granolas, oatmeal, and just about anything else you can add it to. For all of its nutty flavor, Andy reminds us that you also get 6.5 grams of protein (as much as one egg) per 2 tablespoon serving, along with 2 grams of fiber and a good bit of your recommended daily allowance of zinc, iron, magnesium, manganese, and yes, omega 3 fatty acids. Title image remixed from jurgajurga (Shutterstock).
- Oat Bran. Everyone's had an oat bran muffin, and even if you didn't care for it, oat bran itself has great heart benefits, incredible amounts of fiber (2.5 grams per 2 tablespoon, 30 calorie serving) and sizable dozes of phosphorus, selenium, and manganese. Andy suggests adding them to smoothies if you don't want it in baked goods, and we suggest mixing some in with your granola, hot cereals, or on top of yogurt or cottage cheese.
These are just a few great boosts you can add to just about any type of meal, specifically breakfasts, cereals, salads, soups and stews, a steaming pot of lentils, or even dairy. It's just the tip of the iceberg however, and you can also add a nutritional punch with some more common seeds and superfoods, like ground flax, pomegranate seeds, and sunflower seeds. All of these are great sources of vitamins, minerals, and fiber that can be added to soups, salads, and stews, or stand on their own as a healthy mid-day snack. Plus, everything listed here should be available in your local grocery store or health food store. They may not all be cheap, but your health is worth it.
Note: These Are Healthy Additions to a Healthy Diet
These nutritional boosts are designed to make a healthy diet even healthier. None of them are a magic bullet that make sure you get your recommended dietary allowance of necessary vitamins and minerals—there is no such single fix. Andy notes that the idea here is to add these boosts to healthful, whole meals. You're not going to sprinkle some ground flax onto a pizza and somehow make that pizza good for you. Adding some chia seeds to a bowl of oatmeal, or some hemp seeds to whole grain pancake batter, will boost flavor and texture as well as nutritional content. When you're taking these tips to heart and introducing them to your diet, make sure you're also making the dietary changes necessary to maximize their impact.
Sunday, February 19, 2012
The information at our everyday disposal is growing at a breathtaking rate. From the beginning of civilization to 2003, the world accumulated 1 billion gigabytes of data. Today, we create 1 trillion gigabytes every year. These advances have transformed the way we think about knowledge, communication and countless aspects of our everyday life — and they have the potential to revolutionize the way we think about our own health.
In his new book, “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care,” Eric Topol, a former professor and researcher at the University of Michigan and Case Western University, and chief academic officer for Scripps Health, a nonprofit healthcare system based in San Diego, argues that the digital revolution can democratize our medical system. Topol demonstrates how the digital revolution can be used to change individual care and prevention, and even the economics of American healthcare. From cellphones that automatically collect medical data, to biosensors, advanced imaging, individualized prescriptions and gene-specific drugs, Topol’s book leads readers through science-fiction-sounding scenarios that may soon be a reality.
Salon spoke with Topol over the phone about the empowered consumer, rebooting the life science industry, and the doctors of the future.
“Digitizing the human” is a provocative phrase you use throughout the book; what does this mean, and how can it lead to what you call the “democratization of medicine”?
We’re so used to digitizing everything — books and movies and periodicals — everything except for our bodies. My idea is to digitize the essence of what makes us tick — our genome and our physiology —thanks to different biosensors which are largely wearable, put right on a band-aid or a wrist or on the sole of a shoe. This would be combined with imaging, the ability to image any part of the body with a high-resolution pocket ultrasound device. When you take all these things together, along with personalized electronic health records and health information systems, this gives us a really panoramic, deep view of each individual.
How do cellphones fit into this?
Well, the cellphone has been the basis of a lot of democratization. You look at the Arab Spring and the Occupy movement and it’s the mobile phones that are bringing people together, through Facebook and Twitter and sharing pictures and videos and emotions. Now the digital infrastructure supports the whole medical side of this; you could have your own data for blood pressure or glucose or mood or anything quantified, right on your phone. And then that information can be shared with your social network, or your doctor, or whoever.
So the ability to have this mini computer in your pocket, that you’re essentially surgically attached to, is such a powerful force for the use of that data.
What role will the consumers play in this revolutionary shift?
I envision the consumer being the primary driver. That’s why I actually wrote the book. I’ve written a lot of medical textbooks, and I’ve lived in the medical microcosm until recent years, but then I started realizing that this digital world is really changing everything. The medical community itself is so resistant to change. The government and the life science industry are not going to be active in promoting a radical change. But consumers can do it and they’re more truly empowered, more resourceful and bound together and powerful than ever before.
And there’s one other lesson that’s really valuable: Back in 1997, the United States approved Direct to Consumer Advertising on TV for drugs, which I think was a dreadful mistake, by the way. But what’s interesting about it was it basically fueled this “Ask your Doctor” movement: a patient-centered, consumer-centered model. It was very powerful because of course these drugs [being advertised] became extraordinarily widely used. I don’t want to promote that, but on the other hand, if consumers are partnering with doctors, like, “Here’s my genome, Doctor, what do you think of it? Here’s my blood pressure and vital signs for the last three months,” it’s not just “ask your doctor” anymore it’s tell your doctor, share with your doctor.
Why is the medical field so resistant to digitization/digital records? Other industries have done this almost a decade ago.
Well, this is the history of medicine. If you go back to 1816 when the stethoscope was invented, it took 20 years before doctors would use them. The average time it takes for a medical innovation to come into daily practice is 17 years, which is just horrible. And they had all kinds of excuses, similar to the excuses that they have today. Basically, one of the main reasons doctors wouldn’t use a stethoscope was because they said it would interfere with their interactions with patients. And they didn’t want to learn all these new heart sounds and breath sounds and that sort of thing.
There’s an unwillingness to change. For example, a lot of physicians I work with are bothered by the fact that they have to be typing at a computer, looking at a screen, rather than interacting with a patient. And I understand that; both the physician and the patient take a hit in terms of optimal communication. How do we deal with that? A lot of physicians now have scribes that do the computing of data while they never lose eye contact with the patient. The patient obviously knows very well whether they’re not being listened to or looked at. So part of it is resistance to change and part of it is losing touch with a visit with a patient.
You mention this in your book, but isn’t it dangerous to have our medical files out there, in terms of security issues?
Like everything else that’s digitized, when you digitize a human being you have the potential for hacking, privacy and security issues. And already there have been breaches of electronic medical records in major medical centers around the country. So this has to be attended to with the maximal assurance that we’ll do everything we can to preserve that security. It’s a tradeoff: Do the benefits of having the essence of each individual captured digitally override the hopefully small, negligible risk of a breach of that data?
How do American doctors compare to doctors in other countries in terms of their attitudes toward technology?
Medicine on a planetary basis, on a global basis, is very conservative and resistant to change. But there are some specific examples where there’s a real gradient or heterogeneity, a real marked difference in cultures. In the U.S. the adoption of technology can be stymied because of reimbursement issues. In other countries where there’s no fee-for-service private practice, there’s been remarkable adoption of certain technologies. A great example of that is the portable ultrasound; I haven’t used a stethoscope now in two years. I use this pocket ultrasound device so I can see everything in the heart rather than listen to the heart’s sound. In the U.S., hardly any doctors are using that because they can’t get reimbursed; they much prefer to send the patient to get a cardiogram, which is an ultrasound of the heart, or an ultrasound of the abdomen or whatever the ultrasound is. Whereas in India, Brazil, China, this is one of the hottest new technologies because it saves costs dramatically and there are no issues with respect to reimbursement.
In what ways can recent breakthroughs in our understanding of the genome – from the Human Genome Project of 2000 to today –contribute to the shift to individual-based medicine?
There are three biggies right now. The longest chapter in the whole book is on genomics. The first is pharmacogenomics. Now, in the U.S. alone, we spend $350 billion a year for prescription medicines, and so many of these drugs have known serious side effects, that can be predicted by knowing a particular genotype. And in addition, some medicines don’t work for a lot of people, and we could predict that with a very simple genotype — like Plavix, which a third of people don’t respond to but they keep taking every day, or Metformin for diabetes, which 25 percent of patients don’t respond to. Tegretol has a horrendous side-effect profile. We don’t screen for it in the U.S., but you can’t get a Tegretol prescription in Taiwan without having a genotype. So in that sense we’re way behind. I could go on, a lot more examples are in the book, but that’s No. 1 – the use of genomics today. We’re not leveraging that great new knowledge.
Second is in the field of cancer therapeutics. If you have a new diagnosis of a significant cancer today, the best way to potentially get the right therapy is to get a whole genome sequence of the tumor, and also of your native so-called germline DNA, and compare the two. By comparing the mutation in the tumor to what you’re born with in your DNA, you can see what went off the tracks (because cancer is by definition a genomic disease) and then you can fashion a therapy specifically for that individual.
The third area is the elimination of the idiopathic, which is a very fancy medical term used for “we don’t know.” There’s a lot of people walking around with debilitating serious disease, and trying to get a diagnosis for what is wrong with them and they haven’t been able to do it. The issue is, until now we didn’t have a way to sort this thing out but with whole genome sequencing, we can in many of these individuals determine the root cause, the biologic basis for their illness.
Competing manufacturers of these new technologies will be required to agree upon uniform standards; is this a feasible hope?
This is a really interesting trend to watch. Now in the networking electronic world we live in, you see some unprecedented collaboration among even competing life science industry companies. So, for example, in the case of Alzheimer’s disease, where they haven’t come up with anything to prevent or change the course of Alzheimer’s, it’s been very frustrating. Many companies have invested billions of dollars in this whole objective. But now, they are working together. So most of the large pharma companies are pooling their data to basically do an autopsy of the failed drugs to find out what went wrong. And you never would have seen that in the past – I mean that’s actually remarkable.
If everyone working on cancer that did a genome sequence of an affected individual put that data in a common place and all the companies were also involved, we could really get so far ahead in this cancer problem, which is quickly emerging as the No. 1 cause of death, overriding heart disease. But we don’t have that type of collaboration yet. We need it to cross national boundaries, and to get the academic and life science industries to converge. That would be creative destruction in high gear!
What technological innovations in medicine are you most excited about?
I think the one I’m most excited about is the embedded nano-sensor. You have to put it in the bloodstream and get it to localize, either in the finger or the wrist, someplace that’s hyper handy that will communicate with your cellphone. And that embedded nano-sensor can be used to pick up, for example, the first cancer cell that shows up in the bloodstream, which would promote the earliest possible detection of cancer.
It also could help with the autoimmune form of diabetes, called Type 1, which usually affects kids. If we have that embedded nano-sensor constantly monitoring, and a medicine used to block the immune system when needed, this, hopefully, could lead to the end of autoimmune diabetes, which is really exciting.
And the other really far out thing is the area of heart attack prevention, again through an embedded nano-sensor. It can be used to pick up cells in an artery that’s starting to crack a week or two before a heart attack. We have some really good data to suggest that this will ultimately be possible.
How does Obamacare fit into this? How much will this cost? Where will the money come from?
Obamacare is in a different orbit. There’s nothing in the 2,000-plus page bill that gets into this kind of hyper innovative individual medicine, biosensor leveraging, genome and all these sorts of things – it doesn’t really show up. But it is a great opportunity to make medicine and healthcare more affordable. For example, it’s estimated that about a third of the $350 billion spent a year on prescriptions is a total waste. So there’s a great opportunity there, with gene-specific drugs. If we do the 20 million echocardiograms, and almost as many abdominal and fetal ultrasounds, for free with ultrasound pocket devices, there are billions of dollar we could save there. With sensors, if we could get tens of millions of people in this country to manage or prevent their diabetes that could have enormous financial implications. And it’s the same for high blood pressure: 50 percent of people with high blood pressure do not have it adequately managed, so they’re vulnerable for strokes and heart attacks. If we can manage it with a simple cellphone sensor, that would be an enormous potential to lower costs for stroke disabilities, heart attack, heart failure, all those sorts of things.
In what ways can social networking be useful for physicians?
Patients share on online health communities and each of these social networks have amassed an enormous following. Let’s say you have a particular condition like multiple sclerosis, or a form of cancer or diabetes. You go on these social networks and find peers whom you’ve never met with, but they become your guidance and connections. And they are now more trusted than doctors by a substantial proportion of participants in these online health communities. Now, on the doctor side, almost 90 percent don’t even know these online communities exist, which is in itself surprising. But, if we work together, this is another opportunity to get information out there.
On the other hand, you don’t exactly want to have your patient as your Facebook friend. But one thing that’s striking me is, just a couple weeks ago in the Wall Street Journal there was this big debate: Should doctors email with their patients? And I thought, “How could that even be a question?” It seemed like a crazy throwback to a different era. Then there was an article in the Journal of American Medical Association asking, should patients be able to access their laboratory data? You’ve gotta be kidding. How could this be a question in 2012? This is the paternalistic, Doctor Knows Best mind-set that is still carrying over to today. We’re too far away from democratization, and I’m hoping we can change that.
What does all this mean for the individual consumer? How will our actual experience of going to the doctor of the future change?
The doctor of the future, who has plasticity and has moved into the digital era, will be up on all these things. There may not be in-office visits, there may be virtual visits on Skype or Facetime, and patients could send all their data real time through their phone. I think each physician has to say [to patients], We want you to have all your data. We want you to be participatory. We need you to be fully engaged. And if you’re fully engaged, you’re the one with the most vested interest in your condition. We want you to have all the data, whether it’s your lab test, your notes, your metrics on your phone, your genomic data, your scans, whatever it is, we want you to have it because we want you to help drive this process.
Thursday, February 16, 2012
Pole has a master’s degree in statistics and another in economics, and has been obsessed with the intersection of data and human behavior most of his life. His parents were teachers in North Dakota, and while other kids were going to 4-H, Pole was doing algebra and writing computer programs. “The stereotype of a math nerd is true,” he told me when I spoke with him last year. “I kind of like going out and evangelizing analytics.”
As the marketers explained to Pole — and as Pole later explained to me, back when we were still speaking and before Target told him to stop — new parents are a retailer’s holy grail. Most shoppers don’t buy everything they need at one store. Instead, they buy groceries at the grocery store and toys at the toy store, and they visit Target only when they need certain items they associate with Target —cleaning supplies, say, or new socks or a six-month supply of toilet paper. But Target sells everything from milk to stuffed animals to lawn furniture to electronics, so one of the company’s primary goals is convincing customers that the only store they need is Target. But it’s a tough message to get across, even with the most ingenious ad campaigns, because once consumers’ shopping habits are ingrained, it’s incredibly difficult to change them.
There are, however, some brief periods in a person’s life when old routines fall apart and buying habits are suddenly in flux. One of those moments — the moment, really — is right around the birth of a child, when parents are exhausted and overwhelmed and their shopping patterns and brand loyalties are up for grabs. But as Target’s marketers explained to Pole, timing is everything. Because birth records are usually public, the moment a couple have a new baby, they are almost instantaneously barraged with offers and incentives and advertisements from all sorts of companies. Which means that the key is to reach them earlier, before any other retailers know a baby is on the way. Specifically, the marketers said they wanted to send specially designed ads to women in their second trimester, which is when most expectant mothers begin buying all sorts of new things, like prenatal vitamins and maternity clothing. “Can you give us a list?” the marketers asked.
“We knew that if we could identify them in their second trimester, there’s a good chance we could capture them for years,” Pole told me. “As soon as we get them buying diapers from us, they’re going to start buying everything else too. If you’re rushing through the store, looking for bottles, and you pass orange juice, you’ll grab a carton. Oh, and there’s that new DVD I want. Soon, you’ll be buying cereal and paper towels from us, and keep coming back.”
The desire to collect information on customers is not new for Target or any other large retailer, of course. For decades, Target has collected vast amounts of data on every person who regularly walks into one of its stores. Whenever possible, Target assigns each shopper a unique code — known internally as the Guest ID number — that keeps tabs on everything they buy. “If you use a credit card or a coupon, or ﬁll out a survey, or mail in a refund, or call the customer help line, or open an e-mail we’ve sent you or visit our Web site, we’ll record it and link it to your Guest ID,” Pole said. “We want to know everything we can.”
Also linked to your Guest ID is demographic information like your age, whether you are married and have kids, which part of town you live in, how long it takes you to drive to the store, your estimated salary, whether you’ve moved recently, what credit cards you carry in your wallet and what Web sites you visit. Target can buy data about your ethnicity, job history, the magazines you read, if you’ve ever declared bankruptcy or got divorced, the year you bought (or lost) your house, where you went to college, what kinds of topics you talk about online, whether you prefer certain brands of coffee, paper towels, cereal or applesauce, your political leanings, reading habits, charitable giving and the number of cars you own. (In a statement, Target declined to identify what demographic information it collects or purchases.) All that information is meaningless, however, without someone to analyze and make sense of it. That’s where Andrew Pole and the dozens of other members of Target’s Guest Marketing Analytics department come in.
Almost every major retailer, from grocery chains to investment banks to the U.S. Postal Service, has a “predictive analytics” department devoted to understanding not just consumers’ shopping habits but also their personal habits, so as to more efficiently market to them. “But Target has always been one of the smartest at this,” says Eric Siegel, a consultant and the chairman of a conference called Predictive Analytics World. “We’re living through a golden age of behavioral research. It’s amazing how much we can figure out about how people think now.”
The reason Target can snoop on our shopping habits is that, over the past two decades, the science of habit formation has become a major field of research in neurology and psychology departments at hundreds of major medical centers and universities, as well as inside extremely well financed corporate labs. “It’s like an arms race to hire statisticians nowadays,” said Andreas Weigend, the former chief scientist at Amazon.com. “Mathematicians are suddenly sexy.” As the ability to analyze data has grown more and more fine-grained, the push to understand how daily habits influence our decisions has become one of the most exciting topics in clinical research, even though most of us are hardly aware those patterns exist. One study from Duke University estimated that habits, rather than conscious decision-making, shape 45 percent of the choices we make every day, and recent discoveries have begun to change everything from the way we think about dieting to how doctors conceive treatments for anxiety, depression and addictions.
This research is also transforming our understanding of how habits function across organizations and societies. A football coach named Tony Dungy propelled one of the worst teams in the N.F.L. to the Super Bowl by focusing on how his players habitually reacted to on-field cues. Before he became Treasury secretary, Paul O’Neill overhauled a stumbling conglomerate, Alcoa, and turned it into a top performer in the Dow Jones by relentlessly attacking one habit — a specific approach to worker safety — which in turn caused a companywide transformation. The Obama campaign has hired a habit specialist as its “chief scientist” to figure out how to trigger new voting patterns among different
Researchers have figured out how to stop people from habitually overeating and biting their nails. They can explain why some of us automatically go for a jog every morning and are more productive at work, while others oversleep and procrastinate. There is a calculus, it turns out, for mastering our subconscious urges. For companies like Target, the exhaustive rendering of our conscious and unconscious patterns into data sets and algorithms has revolutionized what they know about us and, therefore, how precisely they can sell.
Inside the brain-and-cognitive-sciences department of the Massachusetts Institute of Technology are what, to the casual observer, look like dollhouse versions of surgical theaters. There are rooms with tiny scalpels, small drills and miniature saws. Even the operating tables are petite, as if prepared for 7-year-old surgeons. Inside those shrunken O.R.’s, neurologists cut into the skulls of anesthetized rats, implanting tiny sensors that record the smallest changes in the activity of their brains.
An M.I.T. neuroscientist named Ann Graybiel told me that she and her colleagues began exploring habits more than a decade ago by putting their wired rats into a T-shaped maze with chocolate at one end. The maze was structured so that each animal was positioned behind a barrier that opened after a loud click. The first time a rat was placed in the maze, it would usually wander slowly up and down the center aisle after the barrier slid away, snifﬁng in corners and scratching at walls. It appeared to smell the chocolate but couldn’t ﬁgure out how to ﬁnd it. There was no discernible pattern in the rat’s meanderings and no indication it was working hard to find the treat.
The probes in the rats’ heads, however, told a different story. While each animal wandered through the maze, its brain was working furiously. Every time a rat sniffed the air or scratched a wall, the neurosensors inside the animal’s head exploded with activity. As the scientists repeated the experiment, again and again, the rats eventually stopped snifﬁng corners and making wrong turns and began to zip through the maze with more and more speed. And within their brains, something unexpected occurred: as each rat learned how to complete the maze more quickly, its mental activity decreased. As the path became more and more automatic — as it became a habit — the rats started thinking less and less.
This process, in which the brain converts a sequence of actions into an automatic routine, is called “chunking.” There are dozens, if not hundreds, of behavioral chunks we rely on every day. Some are simple: you automatically put toothpaste on your toothbrush before sticking it in your mouth. Some, like making the kids’ lunch, are a little more complex. Still others are so complicated that it’s remarkable to realize that a habit could have emerged at all.
Take backing your car out of the driveway. When you ﬁrst learned to drive, that act required a major dose of concentration, and for good reason: it involves peering into the rearview and side mirrors and checking for obstacles, putting your foot on the brake, moving the gearshift into reverse, removing your foot from the brake, estimating the distance between the garage and the street while keeping the wheels aligned, calculating how images in the mirrors translate into actual distances, all while applying differing amounts of pressure to the gas pedal and brake.
Now, you perform that series of actions every time you pull into the street without thinking very much. Your brain has chunked large parts of it. Left to its own devices, the brain will try to make almost any repeated behavior into a habit, because habits allow our minds to conserve effort. But conserving mental energy is tricky, because if our brains power down at the wrong moment, we might fail to notice something important, like a child riding her bike down the sidewalk or a speeding car coming down the street. So we’ve devised a clever system to determine when to let a habit take over. It’s something that happens whenever a chunk of behavior starts or ends — and it helps to explain why habits are so difficult to change once they’re formed, despite our best intentions.
To understand this a little more clearly, consider again the chocolate-seeking rats. What Graybiel and her colleagues found was that, as the ability to navigate the maze became habitual, there were two spikes in the rats’ brain activity — once at the beginning of the maze, when the rat heard the click right before the barrier slid away, and once at the end, when the rat found the chocolate. Those spikes show when the rats’ brains were fully engaged, and the dip in neural activity between the spikes showed when the habit took over. From behind the partition, the rat wasn’t sure what waited on the other side, until it heard the click, which it had come to associate with the maze. Once it heard that sound, it knew to use the “maze habit,” and its brain activity decreased. Then at the end of the routine, when the reward appeared, the brain shook itself awake again and the chocolate signaled to the rat that this particular habit was worth remembering, and the neurological pathway was carved that much deeper.
The process within our brains that creates habits is a three-step loop. First, there is a cue, a trigger that tells your brain to go into automatic mode and which habit to use. Then there is the routine, which can be physical or mental or emotional. Finally, there is a reward, which helps your brain ﬁgure out if this particular loop is worth remembering for the future. Over time, this loop — cue, routine, reward; cue, routine, reward — becomes more and more automatic. The cue and reward become neurologically intertwined until a sense of craving emerges. What’s unique about cues and rewards, however, is how subtle they can be. Neurological studies like the ones in Graybiel’s lab have revealed that some cues span just milliseconds. And rewards can range from the obvious (like the sugar rush that a morning doughnut habit provides) to the infinitesimal (like the barely noticeable —but measurable — sense of relief the brain experiences after successfully navigating the driveway). Most cues and rewards, in fact, happen so quickly and are so slight that we are hardly aware of them at all. But our neural systems notice and use them to build automatic behaviors.
Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately ﬁght a habit — unless you ﬁnd new cues and rewards — the old pattern will unfold
“We’ve done experiments where we trained rats to run down a maze until it was a habit, and then we extinguished the habit by changing the placement of the reward,” Graybiel told me. “Then one day, we’ll put the reward in the old place and put in the rat and, by golly, the old habit will re-emerge right away. Habits never really disappear.”
Luckily, simply understanding how habits work makes them easier to control. Take, for instance, a series of studies conducted a few years ago at Columbia University and the University of Alberta. Researchers wanted to understand how exercise habits emerge. In one project, 256 members of a health-insurance plan were invited to classes stressing the importance of exercise. Half the participants received an extra lesson on the theories of habit formation (the structure of the habit loop) and were asked to identify cues and rewards that might help them develop exercise routines.
The results were dramatic. Over the next four months, those participants who deliberately identified cues and rewards spent twice as much time exercising as their peers. Other studies have yielded similar results. According to another recent paper, if you want to start running in the morning, it’s essential that you choose a simple cue (like always putting on your sneakers before breakfast or leaving your running clothes next to your bed) and a clear reward (like a midday treat or even the sense of accomplishment that comes from ritually recording your miles in a log book). After a while, your brain will start anticipating that reward — craving the treat or the feeling of accomplishment —and there will be a measurable neurological impulse to lace up your jogging shoes each morning.
Our relationship to e-mail operates on the same principle. When a computer chimes or a smartphone vibrates with a new message, the brain starts anticipating the neurological “pleasure” (even if we don’t recognize it as such) that clicking on the e-mail and reading it provides. That expectation, if unsatisfied, can build until you find yourself moved to distraction by the thought of an e-mail sitting there unread — even if you know, rationally, it’s most likely not important. On the other hand, once you remove the cue by disabling the buzzing of your phone or the chiming of your computer, the craving is never triggered, and you’ll find, over time, that you’re able to work productively for long stretches without checking your in-box.
Some of the most ambitious habit experiments have been conducted by corporate America. To understand why executives are so entranced by this science, consider how one of the world’s largest companies, Procter & Gamble, used habit insights to turn a failing product into one of its biggest sellers. P.& G. is the corporate behemoth behind a whole range of products, from Downy fabric softener to Bounty paper towels to Duracell batteries and dozens of other household brands. In the mid-1990s, P.& G.’s executives began a secret project to create a new product that could eradicate bad smells. P.& G. spent millions developing a colorless, cheap-to-manufacture liquid that could be sprayed on a smoky blouse, stinky couch, old jacket or stained car interior and make it odorless. In order to market the product — Febreze — the company formed a team that included a former Wall Street mathematician named Drake Stimson and habit specialists, whose job was to make sure the television commercials, which they tested in Phoenix, Salt Lake City and Boise, Idaho, accentuated the product’s cues and rewards just right.
The first ad showed a woman complaining about the smoking section of a restaurant. Whenever she eats there, she says, her jacket smells like smoke. A friend tells her that if she uses Febreze, it will eliminate the odor. The cue in the ad is clear: the harsh smell of cigarette smoke. The reward: odor eliminated from clothes. The second ad featured a woman worrying about her dog, Sophie, who always sits on the couch. “Sophie will always smell like Sophie,” she says, but with Febreze, “now my furniture doesn’t have to.” The ads were put in heavy rotation. Then the marketers sat back, anticipating how they would spend their bonuses. A week passed. Then two. A month. Two months. Sales started small and got smaller. Febreze was a dud.
The panicked marketing team canvassed consumers and conducted in-depth interviews to figure out what was going wrong, Stimson recalled. Their first inkling came when they visited a woman’s home outside Phoenix. The house was clean and organized. She was something of a neat freak, the woman explained. But when P.& G.’s scientists walked into her living room, where her nine cats spent most of their time, the scent was so overpowering that one of them gagged.
According to Stimson, who led the Febreze team, a researcher asked the woman, “What do you do about the cat smell?”
“It’s usually not a problem,” she said.
“Do you smell it now?”
“No,” she said. “Isn’t it wonderful? They hardly smell at all!”
A similar scene played out in dozens of other smelly homes. The reason Febreze wasn’t selling, the marketers realized, was that people couldn’t detect most of the bad smells in their lives. If you live with nine cats, you become desensitized to their scents. If you smoke cigarettes, eventually you don’t smell smoke anymore. Even the strongest odors fade with constant exposure. That’s why Febreze was a failure. The product’s cue — the bad smells that were supposed to trigger daily use — was hidden from the people who needed it the most. And Febreze’s reward (an odorless home) was meaningless to someone who couldn’t smell offensive scents in the first place.
P.& G. employed a Harvard Business School professor to analyze Febreze’s ad campaigns. They collected hours of footage of people cleaning their homes and watched tape after tape, looking for clues that might help them connect Febreze to people’s daily habits. When that didn’t reveal anything, they went into the field and conducted more interviews. A breakthrough came when they visited a woman in a suburb near Scottsdale, Ariz., who was in her 40s with four children. Her house was clean, though not compulsively tidy, and didn’t appear to have any odor problems; there were no pets or smokers. To the surprise of everyone, she loved Febreze.
“I use it every day,” she said.
“What smells are you trying to get rid of?” a researcher asked.
“I don’t really use it for specific smells,” the woman said. “I use it for normal cleaning — a couple of sprays when I’m done in a room.”
The researchers followed her around as she tidied the house. In the bedroom, she made her bed, tightened the sheet’s corners, then sprayed the comforter with Febreze. In the living room, she vacuumed, picked up the children’s shoes, straightened the coffee table, then sprayed Febreze on the freshly cleaned carpet.
“It’s nice, you know?” she said. “Spraying feels like a little minicelebration when I’m done with a room.” At the rate she was going, the team estimated, she would empty a bottle of Febreze every two
When they got back to P.& G.’s headquarters, the researchers watched their videotapes again. Now they knew what to look for and saw their mistake in scene after scene. Cleaning has its own habit loops that already exist. In one video, when a woman walked into a dirty room (cue), she started sweeping and picking up toys (routine), then she examined the room and smiled when she was done (reward). In another, a woman scowled at her unmade bed (cue), proceeded to straighten the blankets and comforter (routine) and then sighed as she ran her hands over the freshly plumped pillows (reward). P.& G. had been trying to create a whole new habit with Febreze, but what they really needed to do was piggyback on habit loops that were already in place. The marketers needed to position Febreze as something that came at the end of the cleaning ritual, the reward, rather than as a whole new cleaning routine.
The company printed new ads showing open windows and gusts of fresh air. More perfume was added to the Febreze formula, so that instead of merely neutralizing odors, the spray had its own distinct scent. Television commercials were filmed of women, having finished their cleaning routine, using Febreze to spritz freshly made beds and just-laundered clothing. Each ad was designed to appeal to the habit loop: when you see a freshly cleaned room (cue), pull out Febreze (routine) and enjoy a smell that says you’ve done a great job (reward). When you finish making a bed (cue), spritz Febreze (routine) and breathe a sweet, contented sigh (reward). Febreze, the ads implied, was a pleasant treat, not a reminder that your home stinks.
And so Febreze, a product originally conceived as a revolutionary way to destroy odors, became an air freshener used once things are already clean. The Febreze revamp occurred in the summer of 1998. Within two months, sales doubled. A year later, the product brought in $230 million. Since then Febreze has spawned dozens of spinoffs — air fresheners, candles and laundry detergents — that now account for sales of more than $1 billion a year. Eventually, P.& G. began mentioning to customers that, in addition to smelling sweet, Febreze can actually kill bad odors. Today it’s one of the top-selling products in the world.
Andrew Pole was hired by Target to use the same kinds of insights into consumers’ habits to expand Target’s sales. His assignment was to analyze all the cue-routine-reward loops among shoppers and help the company figure out how to exploit them. Much of his department’s work was straightforward: find the customers who have children and send them catalogs that feature toys before Christmas. Look for shoppers who habitually purchase swimsuits in April and send them coupons for sunscreen in July and diet books in December. But Pole’s most important assignment was to identify those unique moments in consumers’ lives when their shopping habits become particularly flexible and the right advertisement or coupon would cause them to begin spending in new ways.
In the 1980s, a team of researchers led by a U.C.L.A. professor named Alan Andreasen undertook a study of peoples’ most mundane purchases, like soap, toothpaste, trash bags and toilet paper. They learned that most shoppers paid almost no attention to how they bought these products, that the purchases occurred habitually, without any complex decision-making. Which meant it was hard for marketers, despite their displays and coupons and product promotions, to persuade shoppers to
But when some customers were going through a major life event, like graduating from college or getting a new job or moving to a new town, their shopping habits became flexible in ways that were both predictable and potential gold mines for retailers. The study found that when someone marries, he or she is more likely to start buying a new type of coffee. When a couple move into a new house, they’re more apt to purchase a different kind of cereal. When they divorce, there’s an increased chance they’ll start buying different brands of beer.
Consumers going through major life events often don’t notice, or care, that their shopping habits have shifted, but retailers notice, and they care quite a bit. At those unique moments, Andreasen wrote, customers are “vulnerable to intervention by marketers.” In other words, a precisely timed advertisement, sent to a recent divorcee or new homebuyer, can change someone’s shopping patterns
And among life events, none are more important than the arrival of a baby. At that moment, new parents’ habits are more flexible than at almost any other time in their adult lives. If companies can identify pregnant shoppers, they can earn millions.
The only problem is that identifying pregnant customers is harder than it sounds. Target has a baby-shower registry, and Pole started there, observing how shopping habits changed as a woman approached her due date, which women on the registry had willingly disclosed. He ran test after test, analyzing the data, and before long some useful patterns emerged. Lotions, for example. Lots of people buy lotion, but one of Pole’s colleagues noticed that women on the baby registry were buying larger quantities of unscented lotion around the beginning of their second trimester. Another analyst noted that sometime in the first 20 weeks, pregnant women loaded up on supplements like calcium, magnesium and zinc. Many shoppers purchase soap and cotton balls, but when someone suddenly starts buying lots of scent-free soap and extra-big bags of cotton balls, in addition to hand sanitizers and washcloths, it signals they could be getting close to their delivery date.
As Pole’s computers crawled through the data, he was able to identify about 25 products that, when analyzed together, allowed him to assign each shopper a “pregnancy prediction” score. More important, he could also estimate her due date to within a small window, so Target could send coupons timed to very specific stages of her pregnancy.
One Target employee I spoke to provided a hypothetical example. Take a fictional Target shopper named Jenny Ward, who is 23, lives in Atlanta and in March bought cocoa-butter lotion, a purse large enough to double as a diaper bag, zinc and magnesium supplements and a bright blue rug. There’s, say, an 87 percent chance that she’s pregnant and that her delivery date is sometime in late August. What’s more, because of the data attached to her Guest ID number, Target knows how to trigger Jenny’s habits. They know that if she receives a coupon via e-mail, it will most likely cue her to buy online. They know that if she receives an ad in the mail on Friday, she frequently uses it on a weekend trip to the store. And they know that if they reward her with a printed receipt that entitles her to a free cup of Starbucks coffee, she’ll use it when she comes back again.
In the past, that knowledge had limited value. After all, Jenny purchased only cleaning supplies at Target, and there were only so many psychological buttons the company could push. But now that she is pregnant, everything is up for grabs. In addition to triggering Jenny’s habits to buy more cleaning products, they can also start including offers for an array of products, some more obvious than others, that a woman at her stage of pregnancy might need.
Pole applied his program to every regular female shopper in Target’s national database and soon had a list of tens of thousands of women who were most likely pregnant. If they could entice those women or their husbands to visit Target and buy baby-related products, the company’s cue-routine-reward calculators could kick in and start pushing them to buy groceries, bathing suits, toys and clothing, as well. When Pole shared his list with the marketers, he said, they were ecstatic. Soon, Pole was getting invited to meetings above his paygrade. Eventually his paygrade went up.
At which point someone asked an important question: How are women going to react when they figure out how much Target knows?
“If we send someone a catalog and say, ‘Congratulations on your first child!’ and they’ve never told us they’re pregnant, that’s going to make some people uncomfortable,” Pole told me. “We are very conservative about compliance with all privacy laws. But even if you’re following the law, you can do things where people get queasy.”
About a year after Pole created his pregnancy-prediction model, a man walked into a Target outside Minneapolis and demanded to see the manager. He was clutching coupons that had been sent to his daughter, and he was angry, according to an employee who participated in the conversation.
“My daughter got this in the mail!” he said. “She’s still in high school, and you’re sending her coupons for baby clothes and cribs? Are you trying to encourage her to get pregnant?”
The manager didn’t have any idea what the man was talking about. He looked at the mailer. Sure enough, it was addressed to the man’s daughter and contained advertisements for maternity clothing, nursery furniture and pictures of smiling infants. The manager apologized and then called a few days later to apologize again.
On the phone, though, the father was somewhat abashed. “I had a talk with my daughter,” he said. “It turns out there’s been some activities in my house I haven’t been completely aware of. She’s due in August. I owe you an apology.”
When I approached Target to discuss Pole’s work, its representatives declined to speak with me. “Our mission is to make Target the preferred shopping destination for our guests by delivering outstanding value, continuous innovation and exceptional guest experience,” the company wrote in a statement. “We’ve developed a number of research tools that allow us to gain insights into trends and preferences within different demographic segments of our guest population.” When I sent Target a complete summary of my reporting, the reply was more terse: “Almost all of your statements contain inaccurate information and publishing them would be misleading to the public. We do not intend to address each statement point by point.” The company declined to identify what was inaccurate. They did add, however, that Target “is in compliance with all federal and state laws, including those related to protected health information.”
When I offered to fly to Target’s headquarters to discuss its concerns, a spokeswoman e-mailed that no one would meet me. When I flew out anyway, I was told I was on a list of prohibited visitors. “I’ve been instructed not to give you access and to ask you to leave,” said a very nice security guard named
Using data to predict a woman’s pregnancy, Target realized soon after Pole perfected his model, could be a public-relations disaster. So the question became: how could they get their advertisements into expectant mothers’ hands without making it appear they were spying on them? How do you take advantage of someone’s habits without letting them know you’re studying their lives?
Before I met Andrew Pole, before I even decided to write a book about the science of habit formation, I had another goal: I wanted to lose weight.
I had got into a bad habit of going to the cafeteria every afternoon and eating a chocolate-chip cookie, which contributed to my gaining a few pounds. Eight, to be precise. I put a Post-it note on my computer reading “NO MORE COOKIES.” But every afternoon, I managed to ignore that note, wander to the cafeteria, buy a cookie and eat it while chatting with colleagues. Tomorrow, I always promised myself, I’ll muster the willpower to resist.
Tomorrow, I ate another cookie.
When I started interviewing experts in habit formation, I concluded each interview by asking what I should do. The first step, they said, was to figure out my habit loop. The routine was simple: every afternoon, I walked to the cafeteria, bought a cookie and ate it while chatting with friends.
Next came some less obvious questions: What was the cue? Hunger? Boredom? Low blood sugar? And what was the reward? The taste of the cookie itself? The temporary distraction from my work? The chance to socialize with colleagues?
Rewards are powerful because they satisfy cravings, but we’re often not conscious of the urges driving our habits in the first place. So one day, when I felt a cookie impulse, I went outside and took a walk instead. The next day, I went to the cafeteria and bought a coffee. The next, I bought an apple and ate it while chatting with friends. You get the idea. I wanted to test different theories regarding what reward I was really craving. Was it hunger? (In which case the apple should have worked.) Was it the desire for a quick burst of energy? (If so, the coffee should suffice.) Or, as turned out to be the answer, was it that after several hours spent focused on work, I wanted to socialize, to make sure I was up to speed on office gossip, and the cookie was just a convenient excuse? When I walked to a colleague’s desk and chatted for a few minutes, it turned out, my cookie urge was gone.
All that was left was identifying the cue.
Deciphering cues is hard, however. Our lives often contain too much information to figure out what is triggering a particular behavior. Do you eat breakfast at a certain time because you’re hungry? Or because the morning news is on? Or because your kids have started eating? Experiments have shown that most cues fit into one of five categories: location, time, emotional state, other people or the immediately preceding action. So to figure out the cue for my cookie habit, I wrote down five things the moment the urge hit:
Where are you? (Sitting at my desk.)
What time is it? (3:36 p.m.)
What’s your emotional state? (Bored.)
Who else is around? (No one.)
What action preceded the urge? (Answered an e-mail.)
The next day I did the same thing. And the next. Pretty soon, the cue was clear: I always felt an urge to snack around 3:30.
Once I figured out all the parts of the loop, it seemed fairly easy to change my habit. But the psychologists and neuroscientists warned me that, for my new behavior to stick, I needed to abide by the same principle that guided Procter & Gamble in selling Febreze: To shift the routine — to socialize, rather than eat a cookie — I needed to piggyback on an existing habit. So now, every day around 3:30, I stand up, look around the newsroom for someone to talk to, spend 10 minutes gossiping, then go back to my desk. The cue and reward have stayed the same. Only the routine has shifted. It doesn’t feel like a decision, any more than the M.I.T. rats made a decision to run through the maze. It’s now a habit. I’ve lost 21 pounds since then (12 of them from changing my cookie ritual).
After Andrew Pole built his pregnancy-prediction model, after he identified thousands of female shoppers who were most likely pregnant, after someone pointed out that some of those women might be a little upset if they received an advertisement making it obvious Target was studying their reproductive status, everyone decided to slow things down.
The marketing department conducted a few tests by choosing a small, random sample of women from Pole’s list and mailing them combinations of advertisements to see how they reacted.
“We have the capacity to send every customer an ad booklet, specifically designed for them, that says, ‘Here’s everything you bought last week and a coupon for it,’ ” one Target executive told me. “We do that for grocery products all the time.” But for pregnant women, Target’s goal was selling them baby items they didn’t even know they needed yet.
“With the pregnancy products, though, we learned that some women react badly,” the executive said. “Then we started mixing in all these ads for things we knew pregnant women would never buy, so the baby ads looked random. We’d put an ad for a lawn mower next to diapers. We’d put a coupon for wineglasses next to infant clothes. That way, it looked like all the products were chosen by chance.
“And we found out that as long as a pregnant woman thinks she hasn’t been spied on, she’ll use the coupons. She just assumes that everyone else on her block got the same mailer for diapers and cribs. As long as we don’t spook her, it works.”
In other words, if Target piggybacked on existing habits — the same cues and rewards they already knew got customers to buy cleaning supplies or socks — then they could insert a new routine: buying baby products, as well. There’s a cue (“Oh, a coupon for something I need!”) a routine (“Buy! Buy! Buy!”) and a reward (“I can take that off my list”). And once the shopper is inside the store, Target will hit her with cues and rewards to entice her to purchase everything she normally buys somewhere else. As long as Target camouflaged how much it knew, as long as the habit felt familiar, the new behavior took hold.
Soon after the new ad campaign began, Target’s Mom and Baby sales exploded. The company doesn’t break out figures for specific divisions, but between 2002 — when Pole was hired — and 2010, Target’s revenues grew from $44 billion to $67 billion. In 2005, the company’s president, Gregg Steinhafel, boasted to a room of investors about the company’s “heightened focus on items and categories that appeal to specific guest segments such as mom and baby.”
Pole was promoted. He has been invited to speak at conferences. “I never expected this would become such a big deal,” he told me the last time we spoke.
A few weeks before this article went to press, I flew to Minneapolis to try and speak to Andrew Pole one last time. I hadn’t talked to him in more than a year. Back when we were still friendly, I mentioned that my wife was seven months pregnant. We shop at Target, I told him, and had given the company our address so we could start receiving coupons in the mail. As my wife’s pregnancy progressed, I noticed a subtle upswing in the number of advertisements for diapers and baby clothes arriving at our house.
Pole didn’t answer my e-mails or phone calls when I visited Minneapolis. I drove to his large home in a nice suburb, but no one answered the door. On my way back to the hotel, I stopped at a Target to pick up some deodorant, then also bought some T-shirts and a fancy hair gel. On a whim, I threw in some pacifiers, to see how the computers would react. Besides, our baby is now 9 months old. You can’t have too many pacifiers.
When I paid, I didn’t receive any sudden deals on diapers or formula, to my slight disappointment. It made sense, though: I was shopping in a city I never previously visited, at 9:45 p.m. on a weeknight, buying a random assortment of items. I was using a corporate credit card, and besides the pacifiers, hadn’t purchased any of the things that a parent needs. It was clear to Target’s computers that I was on a business trip. Pole’s prediction calculator took one look at me, ran the numbers and decided to bide its time. Back home, the offers would eventually come. As Pole told me the last time we spoke: “Just wait. We’ll be sending you coupons for things you want before you even know you want them.”
Charles Duhigg is a staff writer for The Times and author of The Power of Habit: Why We Do What We Do in Life and Business, which will be published on Feb. 28. Follow him on Twitter and on Facebook.
Editor: Joel Lovell
Sunday, February 12, 2012
COMMENTARY | We're polite. We're inclusive, giving leeway for ideas not based in logic. We've held our tongues for fear of being offensive, for fear of piercing that bubble that surrounds it.
Yet here we are in a GOP primary with the candidates' religion seemingly discussed as much as their economic plans. Virginia's senate gave the green light to tax-funded groups prohibiting adoptions based on religious objections, reports the Times Dispatch. Oklahoma is considering a Personhood bill so draconian State Senator Constance Johnson has introduced an amendment to ensure that every sperm is sacred , as explained by Jezebel.
I'll say it and I won't say it nicely.
Get your grubby religious paws off of our Constitution. Get your small-minded pseudo-religious ways out of our legislative bodies, and for once, just for once, remember that the First Amendment has not one religion clause, but two: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.
You cannot use the might of the government to force other people to practice your religion. Why? It inherently infringes on my free exercise of my religion. If I must follow laws that, for example, codify conservatives' hatred for people who happen to love people of the same sex, it leaves no room for my own beliefs. If I cannot get contraception from the insurance plan for which I pay a premium because it conflicts with John Boehner's spewing of religious ideology, it hampers me from following my own ideology, which includes the notion that John Boehner is not the boss of my ovaries.
It is a hostile takeover of our nation, coated in sugary religiosity and fiery terms of right and wrong from people who, according to a Rasmussen poll , nearly half of likely voters think are corrupt. There is a difference between genuine faith and faith used as a sword; a means of coercion; a tool of capitulation.
How can I say such a bold, anti-religious thing? Don't I know that it's rude to use the words I'm about use in this sentence when I say these groups' illogical claims often conflict with their own dogma?
I'm going to tell you something, all of you who bemoan your perceived loss of a so-called Christian nation. We never had one. Ever. You cannot lose what you never had, and what you were specifically never meant to have.
How can I make this claim so boldly? I've actually read the Constitution. Every single word of it, and never once does it declare this country a religious anything. In fact, to make sure that the intent was clear, we have the very first clause of the very First Amendment stating that government cannot make laws endorsing religion. If it were a Christian nation, that would be an endorsement of Christianity.
It's that simple.
Can we have an endorsement of Christianity, or any religion for that matter? No, says the First Amendment. Problem solved.
Saturday, February 11, 2012
When weather disasters happen, is climate change to blame? The stories, video, and interactives in Weather on Steroids explore that question from a number of angles. It turns out that blaming climate change for wild weather's not that simple. Here’s why.
30 January 2012 • Why does a good love go bad? What makes a sweet kid turn into a rotten adult? And why did Texas see the hottest, driest summer in its history in 2011?
Some questions don’t have easy answers, but people search for them anyway. We can’t help you with romance or child rearing, but when up to 10% of the trees in your state are dead or dying (as was the case in Texas by the end of 2011), or when your city gets more than twice as much rain in 24 hours as it’s measured on any other day (which happened in Binghamton, New York, last summer), it’s only natural to ask: Was that natural variability or global warming?
Until the last few years, scientists lacked the tools to respond in a satisfying way. But that’s starting to change. Researchers can now estimate how likely several kinds of extreme events would be, with and without human influence. With that information in hand, they can then calculate the probability that a given extreme was made more, or less, likely by our century-plus of fossil-fuel burning.
Scientists at the heart of this work, known as attribution science, see great promise in the emerging ability to provide hard numbers to represent the impact of climate change on extreme weather—even though they sometimes need to cast their findings in a double layer of probability
statistical methods, and a crystal-clear definition of ‘extreme’ for the event at hand. The hope among attribution specialists is that they can streamline the process and generate solid results within a few weeks or months, while the memory of an event is still fresh (see Is this climate change?).
Accelerating the research can’t avert a weather disaster, but the work has a variety of other uses. City and regional planners could take the risks of a given weather extreme into account for preparation and response planning. The findings might also be used to help direct the billions of dollars pledged by nations to go toward climate change adaptation. And these studies not only illuminate the increased odds of some weather risks—they can also estimate whether other events, such as cold waves or snowmelt-induced floods, are becoming less likely in a greenhouse-warmed atmosphere.
CAUSES AND EFFECTS A shocking summer in Europe kick-started the boom in attribution research. Weeks of intense heat in 2003 killed tens of thousands of people across the continent, including more than 14,000 in France alone. Countless temperature records were smashed: England saw its first 100°F (37.8°C) reading in more than 300 years of observations, and Paris had its warmest night ever recorded, with a low of 77.9°F (25.5°C).
Disturbed yet intrigued by the disaster, Allen joined forces with Peter Stott (U.K. Met Office Hadley Centre) and Dáithí Stone (now at the Lawrence Berkeley National Laboratory) to study its roots. In a landmark 2004 Nature paper led by Stott, the trio estimated with greater than 90% confidence that human influence had at least doubled the odds of a record-hot European summer. (For more on how they came up with the numbers, see Fingerprints and percentages, below.)
The 2004 paper marked a turning point in climate change research. Stott, Allen, and Stone have since collaborated with others on several more event-focused studies. One led by Oxford’s Pardeep Pall and published in Nature last year looked at the risk of the kind of flooding that devastated parts of England and Wales in the autumn of 2000. When compared to a simulated atmosphere without the estimated influence of human-produced greenhouse gases, the simulations with those gases raised the risk by more than 20% in 9 out of 10 simulations and by more than 90% in 2 out of 3 simulation events. They’ve then assessed whether various factors—such as prior regional climate trends; atmospheric, ocean, or sea ice states; or current levels of greenhouse gases—would have provided a basis for early warning of the event.
When dissecting an extreme event, the group’s work examines natural variations in the atmosphere and oceans as well as climate shapers related to human activity. Examples on the group’s Interpreting Climate Conditions website include studies of unusually cool U.S. conditions in 2008, the Russian heat wave in 2010, and the spate of U.S. tornadoes in spring 2011. In some cases, the researchers found that enhanced greenhouse gases contributed only a small amount to the strength of a particular extreme event. But they emphasize that the risk of some such events can still be expected to rise in future decades, as greenhouse gases continue to accumulate.
Despite the different approaches of each research strategy, a shared theme is present: if climate change isn’t the main driver behind a given extreme, it might still play an important role—perhaps as the straw that breaks a camel’s back. Two scientists from Germany’s Postdam Institute for Climate Impact Research, Stefan Rahmstorf and Dim Coumou, estimated in a recent study that local warming has boosted the risk of record-setting heat fivefold in Moscow. In another analysis, Texas State Climatologist John Nielsen-Gammon calculated that global warming added about 0.9°F (0.5°C) to the state’s record-breaking hot summer of 2011, which ran a total of 5.4°F (3.0°C) above average. If so, one might argue it was that extra 0.9°F of human influence—small as it may sound—that helped push the event and its impacts into truly unprecedented territory.
According to NCAR’s Kevin Trenberth, it’s critical to recognize that every large-scale weather extreme now operates in an atmosphere that’s been altered by fossil-fuel use. Trenberth, who was among the first to attribute seasonal U.S. weather shifts to El Nio and La Nia, emphasizes the context of increased greenhouse gases, higher temperatures, and enhanced water vapor in which extreme events now play out. He and colleagues have mapped global flows of energy and moisture and estimated how much climate change may have enhanced the amount of rain falling in storms such as Hurricane Katrina.
Trenberth’s work relies on a different set of strategies than the ones used by the other groups described in this report (see Extreme weather forensics). While he anticipates much more work on climate change and extreme events, he points to areas of refinement that will further help assess the connections between the two. For example, models cannot yet depict every atmospheric feature with equal accuracy, so key influences may be missed. Also, Trenberth stresses, being unable to prove human influence is not the same thing as being able to disprove it, so researchers may be underestimating the role of climate change by starting from the assumption that it has no influence (the “null hypothesis”).
THREE WAYS OF SEEING Each of the lines of research discussed above offers a different take on attribution science. However, the scientists involved agree that the human role in climate change is real and that natural variations, such as El Nio, are a critical part of the mix—as important to study now as ever.
Moreover, their findings aren’t as much in conflict as it may sometimes seem, given that a relatively modest boost in human influence on climate can still lead to a big rise in probabilities for extreme events. One upcoming study led by Friederike Otto (University of Oxford) examines the two analyses of Russia's 2010 heat wave noted above, which seem to diverge, only to find that there is no major contradiction between them.
As NOAA's Randall Dole puts it, “Results that may be widely touted as in disagreement with prior results might in fact be entirely consistent—just stated another way.”
Here’s a rough analogy from everyday life to help distinguish among the different approaches: Adding just a little bit of speed to your highway commute each month can substantially raise the odds that you’ll get hurt some day. But if an accident does occur, the primary cause may not be your speed itself: it could be a wet road or a texting driver. In this analogy, the NOAA group is looking at accident-causing mechanisms of all types, including speed, while the approach of Stott and colleagues (and Rahmstorf and Coumou) is to measure how much that extra 5 or 10 mph hikes the odds that you’ll get into a wreck. Meanwhile, Trenberth is the safety expert pointing out that, as a rule, extra speed is dangerous.
“The human influence on weather and climate is a very slow but enduring influence,” says Trenberth. “Anything on a year-to-year basis is dominated by El Nio and other regional effects, but there is a small, significant, and growing anthropogenic component.”
The debate over global warming has created predictable adversaries, pitting environmentalists against industry and coal-state Democrats against coastal liberals.
But it has also created tensions between two groups that might be expected to agree on the issue: climate scientists and meteorologists, especially those who serve as television weather forecasters.
Climatologists, who study weather patterns over time, almost universally endorse the view that the earth is warming and that humans have contributed to climate change. There is less of a consensus among meteorologists, who predict short-term weather patterns.
Joe Bastardi, for example, a senior forecaster and meteorologist with AccuWeather, maintains that it is more likely that the planet is cooling, and he distrusts the data put forward by climate scientists as evidence for rising global temperatures.
“There is a great deal of consternation among a lot of us over the readjustment of data that is going on and some of the portrayals that we are seeing,” Mr. Bastardi said in a video segment posted recently on AccuWeather’s Web site.
Such skepticism appears to be widespread among TV forecasters, about half of whom have a degree in meteorology. A study released on Monday by researchers at George Mason University and the University of Texas at Austin found that only about half of the 571 television weathercasters surveyed believed that global warming was occurring and fewer than a third believed that climate change was “caused mostly by human activities.”
More than a quarter of the weathercasters in the survey agreed with the statement “Global warming is a scam,” the researchers found.
The split between climate scientists and meteorologists is gaining attention in political and academic circles because polls show that public skepticism about global warming is increasing, and weather forecasters —especially those on television — dominate communications channels to the public. A study released this year by researchers at Yale and George Mason found that 56 percent of Americans trusted weathercasters to tell them about global warming far more than they trusted other news media or public figures like former Vice President Al Gore or Sarah Palin, the former vice-presidential candidate.
The George Mason-Texas survey found that about half of the weathercasters said they had discussed global warming on their broadcasts during chats with anchors, and nearly 90 percent said they had talked about climate change at live appearances at Kiwanis Club-type events.
Several well-known forecasters — including John Coleman in San Diego and Anthony Watts, a retired Chico, Calif., weatherman who now has a popular blog — have been vociferous in their critiques of global warming.
The dissent has been heightened by recent challenges to climate science, including the discovery of errors in the 2007 report by the United Nations’ Intergovernmental Panel on Climate Change and the unauthorized release of e-mail messages from a British climate research center last fall that skeptics say show that climate scientists had tried to suppress data.
“In a sense the question is who owns the atmosphere: the people who predict it every day or the people who predict it for the next 50 years?” said Bob Henson, a science writer for the University Corporation for Atmospheric Research, who trained as a meteorologist and has followed the divide between the two groups.
Mr. Henson added, “And the level of tension has really spiked in recent months.”
The reasons behind the divergence in views are complex. The American Meteorological Society, which confers its coveted seal of approval on qualified weather forecasters, has affirmed the conclusion of the United Nations’ climate panel that warming is occurring and that human activities are very likely the cause. In a statement sent to Congress in 2009, the meteorological society warned that the buildup of heat-trapping gases like carbon dioxide in the atmosphere would lead to “major negative consequences.”
Yet, climate scientists use very different scientific methods from the meteorologists. Heidi Cullen, a climatologist who straddled the two worlds when she worked at the Weather Channel, noted that meteorologists used models that were intensely sensitive to small changes in the atmosphere but had little accuracy more than seven days out. Dr. Cullen said meteorologists are often dubious about the work of climate scientists, who use complex models to estimate the effects of climate trends decades in the future.
But the cynicism, said Dr. Cullen, who now works for Climate Central, a nonprofit group that works to bring the science of climate change to the public, is in her opinion unwarranted.
“They are not trying to predict the weather for 2050, just generally say that it will be hotter,” Dr. Cullen said of climatologists. “And just like I can predict August will be warmer than January, I can predict that.”
Three years ago, Dr. Cullen found herself in a dispute with meteorologists after she posted a note on the Weather Channel’s Web site suggesting that meteorologists should perhaps not receive certification from the meteorological society if they “can’t speak to the fundamental science of climate change.”
Resentment may also play a role in the divide. Climatologists are almost always affiliated with universities or research institutions where a doctoral degree is required. Most meteorologists, however, can get jobs as weather forecasters with a college degree.
“There is a little bit of elitist-versus-populist tensions,” Mr. Henson said. “There are meteorologists who feel, ‘Just because I have a bachelor’s degree doesn’t mean I don’t know what’s going on.’ ”
Whatever the reasons, meteorologists are far more likely to question the underlying science of climate change. A study published in the January 2009 newsletter of the American Geophysical Union, the professional association of earth scientists, found that while nearly 90 percent of some 3,000 climatologists who responded agreed that there was evidence of human-driven climate change, 80 percent of all earth scientists and 64 percent of meteorologists agreed with the statement. Only economic geologists who specialized in industrial uses of materials like oil and coal were more skeptical.
Seeing danger in the divide between climate scientists and meteorologists, a variety of groups concerned with educating the public on climate change — including the National Environmental Education Foundation, a federally financed nonprofit, and Yale — are working to close the gap with research and educational forums. In 2008, Yale began holding seminars with weathercasters who are unsure about the climate issue and scientists who are leading experts in the field. The Columbia Journalism Review explored the reasons for the split in an article this year.
Conversely, the Heartland Institute, a free-market research organization skeptical about the causes and severity of climate change, is also making efforts to reach out. At its annual conference to be held in May in Chicago, the institute tried without success to put on a special session for the weather predictors.
“What we’ve recognized is that the everyday person doesn’t come across climatologists, but they do come across meteorologists,” said Melanie Fitzpatrick, a climate scientist for the Union of Concerned Scientists. “Meteorologists do need to understand more about climate because the public confuses this so much. That is why you see efforts in this turning up.”
Copyright 2012 The New York Times Company
Friday, February 10, 2012
JAROSLAV FLEGR IS NO KOOK. AND YET, FOR YEARS, HE SUSPECTED HIS MIND HAD BEEN TAKEN OVER BY PARASITES THAT HAD INVADED HIS BRAIN. SO THE PROLIFIC BIOLOGIST TOOK HIS SCIENCE-FICTION HUNCH INTO THE LAB. WHAT HE’S NOW DISCOVERING WILL STARTLE YOU. COULD TINY ORGANISMS CARRIED BY HOUSE CATS BE CREEPING INTO OUR BRAINS, CAUSING EVERYTHING FROM CAR WRECKS TO SCHIZOPHRENIA? A BIOLOGIST’S
SCIENCE- FICTION HUNCH IS GAINING CREDENCE AND SHAPING THE EMERGING SCIENCE OF MIND- CONTROLLING PARASITES.
NO ONE WOULD accuse Jaroslav Flegr of being a conformist. A self-described “sloppy dresser,” the 63-year-old Czech scientist has the contemplative air of someone habitually lost in thought, and his still-youthful, square-jawed face is framed by frizzy red hair that encircles his head like a ring of fire.
Certainly Flegr’s thinking is jarringly unconventional. Starting in the early 1990s, he began to suspect that a single-celled parasite in the protozoan family was subtly manipulating his personality, causing him to behave in strange, often self-destructive ways. And if it was messing with his mind, he reasoned, it was probably doing the same to others.
The parasite, which is excreted by cats in their feces, is called Toxoplasma gondii (T. gondii or Toxo for short) and is the microbe that causes toxoplasmosis—the reason pregnant women are told to avoid cats’ litter boxes. Since the 1920s, doctors have recognized that a woman who becomes infected during pregnancy can transmit the disease to the fetus, in some cases resulting in severe brain damage or death. T. gondii is also a major threat to people with weakened immunity: in the early days of the AIDS epidemic, before good antiretroviral drugs were developed, it was to blame for the dementia that afflicted many patients at the disease’s end stage. Healthy children and adults, however, usually experience nothing worse than brief flu-like symptoms before quickly fighting off the protozoan, which thereafter lies dormant inside brain cells—or at least that’s the standard medical wisdom.
But if Flegr is right, the “latent” parasite may be quietly tweaking the connections between our neurons, changing our response to frightening situations, our trust in others, how outgoing we are, and even our preference for certain scents. And that’s not all. He also believes that the organism contributes to car crashes, suicides, and mental disorders such as schizophrenia. When you add up all the different ways it can harm us, says Flegr, “Toxoplasma might even kill as many people as malaria, or at least a million people a year.”
An evolutionary biologist at Charles University in Prague, Flegr has pursued this theory for decades in relative obscurity. Because he struggles with English and is not much of a conversationalist even in his native tongue, he rarely travels to scientific conferences. That “may be one of the reasons my theory is not better known,” he says. And, he believes, his views may invite deep-seated opposition. “There is strong psychological resistance to the possibility that human behavior can be influenced by some stupid parasite,” he says. “Nobody likes to feel like a puppet. Reviewers [of my scientific papers] may have been offended.” Another more obvious reason for resistance, of course, is that Flegr’s notions sound an awful lot like fringe science, right up there with UFO sightings and claims of dolphins telepathically communicating with humans.
But after years of being ignored or discounted, Flegr is starting to gain respectability. Psychedelic as his claims may sound, many researchers, including such big names in neuroscience as Stanford’s Robert Sapolsky, think he could well be onto something. Flegr’s “studies are well conducted, and I can see no reason to doubt them,” Sapolsky tells me. Indeed, recent findings from Sapolsky’s lab and British groups suggest that the parasite is capable of extraordinary shenanigans. T. gondii, reports Sapolsky, can turn a rat’s strong innate aversion to cats into an attraction, luring it into the jaws of its No. 1 predator. Even more amazing is how it does this: the organism rewires circuits in parts of the brain that deal with such primal emotions as fear, anxiety, and sexual arousal. “Overall,” says Sapolsky, “this is wild, bizarre neurobiology.” Another academic heavyweight who takes Flegr seriously is the schizophrenia expert E. Fuller Torrey, director of the Stanley Medical Research Institute, in Maryland. “I admire Jaroslav for doing [this research],” he says. “It’s obviously not politically correct, in the sense that not many labs are doing it. He’s done it mostly on his own, with very little support. I think it bears looking at. I find it completely credible.”
What’s more, many experts think T. gondii may be far from the only microscopic puppeteer capable of pulling our strings. “My guess is that there are scads more examples of this going on in mammals, with parasites we’ve never even heard of,” says Sapolsky.
Familiar to most of us, of course, is the rabies virus. On the verge of killing a dog, bat, or other warm-blooded host, it stirs the animal into a rage while simultaneously migrating from the nervous system to the creature’s saliva, ensuring that when the host bites, the virus will live on in a new carrier. But aside from rabies, stories of parasites commandeering the behavior of large-brained mammals are rare. The far more common victims of parasitic mind control—at least the ones we know about—are fish, crustaceans, and legions of insects, according to Janice Moore, a behavioral biologist at Colorado State University. “Flies, ants, caterpillars, wasps, you name it—there are truckloads of them behaving weirdly as a result of parasites,” she says.
Consider Polysphincta gutfreundi, a parasitic wasp that grabs hold of an orb spider and attaches a tiny egg to its belly. A wormlike larva emerges from the egg, and then releases chemicals that prompt the spider to abandon weaving its familiar spiral web and instead spin its silk thread into a special pattern that will hold the cocoon in which the larva matures. The “possessed” spider even crochets a specific geometric design in the net, camouflaging the cocoon from the wasp’s predators.
Flegr himself traces his life’s work to another master of mind control. Almost 30 years ago, as he was reading a book by the British evolutionary biologist Richard Dawkins, Flegr was captivated by a passage describing how a flatworm turns an ant into its slave by invading the ant’s nervous system. A drop in temperature normally causes ants to head underground, but the infected insect instead climbs to the top of a blade of grass and clamps down on it, becoming easy prey for a grazing sheep. “Its mandibles actually become locked in that position, so there’s nothing the ant can do except hang there in the air,” says Flegr. The sheep grazes on the grass and eats the ant; the worm gains entrance into the ungulate’s gut, which is exactly where it needs to be in order to complete—as the Lion King song goes—the circle of life. “It was the first I learned about this kind of manipulation, so it made a big impression on me,” Flegr says.
After he read the book, Flegr began to make a connection that, he readily admits, others might find crazy: his behavior, he noticed, shared similarities with that of the reckless ant. For example, he says, he thought nothing of crossing the street in the middle of dense traffic, “and if cars honked at me, I didn’t jump out of the way.” He also made no effort to hide his scorn for the Communists who ruled Czechoslovakia for most of his early adulthood. “It was very risky to openly speak your mind at that time,” he says. “I was lucky I wasn’t imprisoned.” And during a research stint in eastern Turkey, when the strife-torn region frequently erupted in gunfire, he recalls being “very calm.” In contrast, he says, “my colleagues were terrified. I wondered what was wrong with myself.”
His bewilderment continued until 1990, when he joined the biology faculty of Charles University. As it happened, the 650-year-old institution had long been a world leader in documenting the health effects of T. gondii, as well as developing methods for detecting the parasite. In fact, just as Flegr was arriving, his colleagues were searching for infected individuals on whom to test their improved diagnostic kits, which is how he came to be asked one day to roll up his sleeve and donate blood. He discovered that he had the parasite—and just possibly, he thought, the key to his baffling self-destructive streak.
He delved into T. gondii’s life cycle. After an infected cat defecates, Flegr learned, the parasite is typically picked up from the soil by scavenging or grazing animals—notably rodents, pigs, and cattle—all of which then harbor it in their brain and other body tissues. Humans, on the other hand, are exposed not only by coming into contact with litter boxes, but also, he found, by drinking water contaminated with cat feces, eating unwashed vegetables, or, especially in Europe, by consuming raw or undercooked meat. Hence the French, according to Flegr, with their love of steak prepared saignant—literally, “bleeding”—can have infection rates as high as 55 percent. (Americans will be happy to hear that the parasite resides in far fewer of them, though a still substantial portion: 10 to 20 percent.) Once inside an animal or human host, the parasite then needs to get back into the cat, the only place where it can sexually reproduce—and this is when, Flegr believed, behavioral manipulation might come into play.
Researchers had already observed a few peculiarities about rodents with T. gondii that bolstered Flegr’s theory. The infected rodents were much more active in running wheels than uninfected rodents were, suggesting that they would be more-attractive targets for cats, which are drawn to fast-moving objects. They also were less wary of predators in exposed spaces. Little, however, was known about how the latent infection might influence humans, because we and other large mammals were widely presumed to be accidental hosts, or, as scientists are fond of putting it, a “dead end” for the parasite. But even if we were never part of the parasite’s life cycle, Flegr reasoned, mammals from mouse to man share the vast majority of their genes, so we might, in a case of mistaken identity, still be vulnerable to manipulations by the parasite.
In the Soviet-stunted economy, animal studies were way beyond Flegr’s research budget. But fortunately for him, 30 to 40 percent of Czechs had the latent form of the disease, so plenty of students were available “to serve as very cheap experimental animals.” He began by giving them and their parasite-free peers standardized personality tests—an inexpensive, if somewhat crude, method of measuring differences between the groups. In addition, he used a computer-based test to assess the reaction times of participants, who were instructed to press a button as soon as a white square popped up anywhere against the dark background of the monitor.
The subjects who tested positive for the parasite had significantly delayed reaction times. Flegr was especially surprised to learn, though, that the protozoan appeared to cause many sex-specific changes in personality. Compared with uninfected men, males who had the parasite were more introverted, suspicious, oblivious to other people’s opinions of them, and inclined to disregard rules. Infected women, on the other hand, presented in exactly the opposite way: they were more outgoing, trusting, image-conscious, and rule-abiding than uninfected women.
The findings were so bizarre that Flegr initially assumed his data must be flawed. So he tested other groups—civilian and military populations. Again, the same results. Then, in search of more corroborating evidence, he brought subjects in for further observation and a battery of tests, in which they were rated by someone ignorant of their infection status. To assess whether participants valued the opinions of others, the rater judged how well dressed they appeared to be. As a measure of gregariousness, participants were asked about the number of friends they’d interacted with over the past two weeks. To test whether they were prone to being suspicious, they were asked, among other things, to drink an unidentified liquid.
The results meshed well with the questionnaire findings. Compared with uninfected people of the same sex, infected men were more likely to wear rumpled old clothes; infected women tended to be more meticulously attired, many showing up for the study in expensive, designer-brand clothing. Infected men tended to have fewer friends, while infected women tended to have more. And when it came to downing the mystery fluid, reports Flegr, “the infected males were much more hesitant than uninfected men. They wanted to know why they had to do it. Would it harm them?” In contrast, the infected women were the most trusting of all subjects. “They just did what they were told,” he says.
Why men and women reacted so differently to the parasite still mystified him. After consulting the psychological literature, he started to suspect that heightened anxiety might be the common denominator underlying their responses. When under emotional strain, he read, women seek solace through social bonding and nurturing. In the lingo of psychologists, they’re inclined to “tend and befriend.” Anxious men, on the other hand, typically respond by withdrawing and becoming hostile or antisocial. Perhaps he was looking at flip sides of the same coin.
Closer inspection of Flegr’s reaction-time results revealed that infected subjects became less attentive and slowed down a minute or so into the test. This suggested to him that Toxoplasma might have an adverse impact on driving, where constant vigilance and fast reflexes are critical. He launched two major epidemiological studies in the Czech Republic, one of men and women in the general population and another of mostly male drivers in the military. Those who tested positive for the parasite, both studies showed, were about two and a half times as likely to be in a traffic accident as their uninfected peers.
WHEN I MET Flegr for the first time, last September, at his office on the third floor of Charles University’s Biological Sciences building, I was expecting something of a wild man. But once you get past the riotous red hair, his style is understated. Thin and slight of build, he’s soft-spoken, precise with his facts, and—true to his Toxo status—clad in old sneakers, faded bell-bottom jeans, and a loose-fitting button-up shirt. As our conversation proceeds, I discover that his latest findings have become—to quote Alice in Wonderland—“curiouser and curiouser,” which may explain why his forehead has the deep ruts of a chronic worrier, or someone perpetually perplexed.
He’s published some data, he tells me, that suggest infected males might have elevated testosterone levels. Possibly for that reason, women shown photos of these men rate them as more masculine than pictures of uninfected men. “I want to investigate this more closely to see if it’s true,” he says. “Also, it could be women find infected men more attractive. That’s something else we hope to test.”
Meanwhile, two Turkish studies have replicated his studies linking Toxoplasma to traffic accidents. With up to one-third of the world infected with the parasite, Flegr now calculates that T. gondii is a likely factor in several hundred thousand road deaths each year. In addition, reanalysis of his personality-questionnaire data revealed that, just like him, many other people who have the latent infection feel intrepid in dangerous situations. “Maybe,” he says, “that’s another reason they get into traffic accidents. They don’t have a normal fear response.”
It’s almost impossible to hear about Flegr’s research without wondering whether you’re infected—especially if, like me, you’re a cat owner, favor very rare meat, and identify even a little bit with your Toxo sex stereotype. So before coming to Prague, I’d gotten tested for the parasite, but I didn’t yet know the results. It seemed a good time to see what his intuition would tell me. “Can you guess from observing someone whether they have the parasite—myself, for example?,” I ask.
“No,” he says, “the parasite’s effects on personality are very subtle.” If, as a woman, you were introverted before being infected, he says, the parasite won’t turn you into a raving extrovert. It might just make you a little less introverted. “I’m very typical of Toxoplasma males,” he continues. “But I don’t know whether my personality traits have anything to do with the infection. It’s impossible to say for any one individual. You usually need about 50 people who are infected and 50 who are not, in order to see a statistically significant difference. The vast majority of people will have no idea they’re infected.”
Still, he concedes, the parasite could be very bad news for a small percentage of people—and not just those who might be at greater risk for car accidents. Many schizophrenia patients show shrinkage in parts of their cerebral cortex, and Flegr thinks the protozoan may be to blame for that. He hands me a recently published paper on the topic that he co-authored with colleagues at Charles University, including a psychiatrist named Jiri Horacek. Twelve of 44 schizophrenia patients who underwent MRI scans, the team found, had reduced gray matter in the brain—and the decrease occurred almost exclusively in those who tested positive for T. gondii. After reading the abstract, I must look stunned, because Flegr smiles and says, “Jiri had the same response. I don’t think he believed it could be true.” When I later speak with Horacek, he admits to having been skeptical about Flegr’s theory at the outset. When they merged the MRI results with the infection data, however, he went from being a doubter to being a believer. “I was amazed at how pronounced the effect was,” he says. “To me that suggests the parasite may trigger schizophrenia in genetically susceptible people.”
One might be tempted to dismiss the bulk of Flegr’s work as hokum—the fanciful imaginings of a lone, eccentric scholar—were it not for the pioneering research of Joanne Webster, a parasitologist at Imperial College London. Just as Flegr was embarking on his human trials, Webster, then a freshly minted Ph.D., was launching studies of Toxo-infected rodents, reasoning, just as Flegr did, that as hosts of the parasite, they would be likely targets for behavioral manipulation.
She quickly confirmed, as previous researchers had shown, that infected rats were more active and less cautious in areas where predators lurk. But then, in a simple, elegant experiment, she and her colleagues demonstrated that the parasite did something much more remarkable. They treated one corner of each rat’s enclosure with the animal’s own odor, a second with water, a third with cat urine, and the last corner with the urine of a rabbit, a creature that does not prey on rodents. “We thought the parasite might reduce the rats’ aversion to cat odor,” she told me. “Not only did it do that, but it actually increased their attraction. They spent more time in the cat-treated areas.” She and other scientists repeated the experiment with the urine of dogs and minks, which also prey on rodents. The effect was so specific to cat urine, she says, that “we call it ‘fatal feline attraction.’”
She began tagging the parasite with fluorescent markers and tracking its progress in the rats’ bodies. Given the surgically precise way the microbe alters behavior, Webster anticipated that it would end up in localized regions of the brain. But the results defied expectations. “We were quite surprised to find the cysts—the parasite’s dormant form—all over the brain in what otherwise appeared to be a happy, healthy rat,” she says. Nonetheless, the cysts were most abundant in a part of the brain that deals with pleasure (in human terms, we’re talking sex, drugs, and rock and roll) and in another area that’s involved in fear and anxiety (post-traumatic stress disorder affects this region of the brain). Perhaps, she thought, T. gondii uses a scattershot approach, disseminating cysts far and wide, enabling a few of them to zero in on the right targets.
To gain more clarity on the matter, she sought the aid of the parasitologist Glenn McConkey, whose team at the University of Leeds was probing the protozoan’s genome for signs of what it might be doing. The approach brought to light a striking talent of the parasite: it has two genes that allow it to crank up production of the neurotransmitter dopamine in the host brain. “We never cease to be amazed by the sophistication of these parasites,” Webster says.
Their findings, reported last summer, created immediate buzz. Dopamine is a critical signaling molecule involved in fear, pleasure, and attention. Furthermore, the neurotransmitter is known to be jacked up in people with schizophrenia—another one of those strange observations about the disease, like its tendency to erode gray matter, that have long puzzled medical researchers. Antipsychotic medicine designed to quell schizophrenic delusions apparently blocks the action of dopamine, which had suggested to Webster that what it might really be doing is thwarting the parasite. Scientists had already shown that adding the medicine to a petri dish where T. gondii is happily dividing will stunt the organism’s growth. So Webster decided to feed the antipsychotic drug to newly infected rats to see how they reacted. Lo and behold, they didn’t develop fatal feline attraction. Suddenly, attributing behavioral changes to the microbe seemed much more plausible.
As the scientific community digested the British team’s dopamine discoveries, Robert Sapolsky’s lab at Stanford announced still more attention-grabbing news. The neuroscientist and his colleagues found that T. gondii disconnects fear circuits in the brain, which might help to explain why infected rats lose their aversion to cat odor. Just as startling, reports Sapolsky, the parasite simultaneously is “able to hijack some of the circuitry related to sexual arousal” in the male rat—probably, he theorizes, by boosting dopamine levels in the reward-processing part of the brain. So when the animal catches a whiff of cat scent, the fear center fails to fully light up, as it would in a normal rat, and instead the area governing sexual pleasure begins to glow. “In other words,” he says, “Toxo makes cat odor smell sexy to male rats.”
The neurobiologist Ajai Vyas, after working with Sapolsky on this study as a postdoctoral student, decided to inspect infected rats’ testicles for signs of cysts. Sure enough, he found them there—as well as in the animals’ semen. And when the rat copulates, Vyas discovered, the protozoan moves into the female’s womb, typically infecting 60 percent of her pups, before traveling on up to her own brain—creating still more vehicles for ferrying the parasite back into the belly of a cat.
Could T. gondii be a sexually transmitted disease in humans too? “That’s what we hope to find out,” says Vyas, who now works at Nanyang Technological University, in Singapore. The researchers also discovered that infected male rats suddenly become much more attractive to females. “It’s a very strong effect,” says Vyas. “Seventy-five percent of the females would rather spend time with the infected male.”
After I return from Prague, Flegr informs me that he’s just had a paper accepted for publication that, he claims, “proves fatal feline attraction in humans.” By that he means that infected men like the smell of cat pee—or at least they rank its scent much more favorably than uninfected men do. Displaying the characteristic sex differences that define many Toxo traits, infected women have the reverse response, ranking the scent even more offensive than do women free of the parasite. The sniff test was done blind and also included urine collected from a dog, horse, hyena, and tiger. Infection did not affect how subjects rated these other samples.
“Is it possible cat urine may be an aphrodisiac for infected men?,” I ask. “Yes. It’s possible. Why not?” says Flegr. I think he’s smiling at the other end of the phone line, but I’m not sure, which leaves me wondering whether I’ve stumbled onto a topic ripe for a Saturday Night Live skit, or a matter worthy of medical concern. When I ask Sapolsky about Flegr’s most recent research, he says the effects Flegr is reporting “are incredibly cool. However, I’m not too worried, in that the effects on humans are not gigantic. If you want to reduce serious car accidents, and you had to choose between curing people of Toxo infections versus getting people not to drive drunk or while texting, go for the latter in terms of impact.”
In fact, Sapolsky thinks that Toxo’s inventiveness might even offer us some benefits. If we can figure out how the parasite makes animals less fearful, he says, it might give us insights into how to devise treatments for people plagued by social-anxiety disorder, phobias, PTSD, and the like. “But frankly,” he adds, “this mostly falls into the ‘Get a load of this, can you believe what nature has come up with?’ category.”
Webster is more circumspect, if not downright troubled. “I don’t want to cause any panic,” she tells me. “In the vast majority of people, there will be no ill effects, and those who are affected will mostly demonstrate subtle shifts of behavior. But in a small number of cases, [Toxo infection] may be linked to schizophrenia and other disturbances associated with altered dopamine levels—for example, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, and mood disorders. The rat may live two or three years, while humans can be infected for many decades, which is why we may be seeing these severe side effects in people. We should be cautious of dismissing such a prevalent parasite.”
The psychiatrist E. Fuller Torrey agrees—though he came to this viewpoint from a completely different angle than either Webster or Flegr. His opinion stems from decades of research into the root causes of schizophrenia. “Textbooks today still make silly statements that schizophrenia has always been around, it’s about the same incidence all over the world, and it’s existed since time immemorial,” he says. “The epidemiology literature contradicts that completely.” In fact, he says, schizophrenia did not rise in prevalence until the latter half of the 18th century, when for the first time people in Paris and London started keeping cats as pets. The so-called cat craze began among “poets and left-wing avant-garde Greenwich Village types,” says Torrey, but the trend spread rapidly—and coinciding with that development, the incidence of schizophrenia soared.
Since the 1950s, he notes, about 70 epidemiology studies have explored a link between schizophrenia and T. gondii. When he and his colleague Robert Yolken, a neurovirologist at Johns Hopkins University, surveyed a subset of these papers that met rigorous scientific standards, their conclusion complemented the Prague group’s discovery that schizophrenic patients with Toxo are missing gray matter in their brains. Torrey and Yolken found that the mental illness is two to three times as common in people who have the parasite as in controls from the same region.
Human-genome studies, both scientists believe, are also in keeping with that finding—and might explain why schizophrenia runs in families. The most replicated result from that line of investigation, they say, suggests that the genes most commonly associated with schizophrenia relate to the immune system and how it reacts to infectious agents. So in many cases where the disease appears to be hereditary, they theorize, what may in fact be passed down is an aberrant or deficient immune response to invaders like T. gondii.
Epstein-Barr virus, mumps, rubella, and other infectious agents, they point out, have also been linked to schizophrenia—and there are probably more as yet unidentified triggers, including many that have nothing to do with pathogens. But for now, they say, Toxo remains the strongest environmental factor implicated in the disorder. “If I had to guess,” says Torrey, “I’d say 75 percent of cases of schizophrenia are associated with infectious agents, and Toxo would be involved in a significant subset of those.”
Just as worrisome, says Torrey, the parasite may also increase the risk of suicide. In a 2011 study of 20 European countries, the national suicide rate among women increased in direct proportion to the prevalence of the latent Toxo infection in each nation’s female population. According to Teodor Postolache, a psychiatrist and the director of the Mood and Anxiety Program at the University of Maryland School of Medicine, a flurry of other studies, several conducted by his own team, offers further support of T. gondii’s link to higher rates of suicidal behavior. These include investigations of general populations as well as groups made up of patients with bipolar disorder, severe depression, and schizophrenia, and in places as diverse as Turkey, Germany, and the Baltimore/Washington area. Exactly how the parasite may push vulnerable people over the edge is yet to be determined. Postolache theorizes that what disrupts mood and the ability to control violent impulses may not be the organism per se, but rather neurochemical changes associated with the body’s immune response to it. “As far-fetched as these ideas may sound,” says Postolache, “the American Foundation for Suicide Prevention was willing to put money behind this research.”
GIVEN ALL THE nasty science swirling around this parasite, is it time for cat lovers to switch their allegiance to other animals?
Even Flegr would advise against that. Indoor cats pose no threat, he says, because they don’t carry the parasite. As for outdoor cats, they shed the parasite for only three weeks of their life, typically when they’re young and have just begun hunting. During that brief period, Flegr simply recommends taking care to keep kitchen counters and tables wiped clean. (He practices what he preaches: he and his wife have two school-age children, and two outdoor cats that have free roam of their home.) Much more important for preventing exposure, he says, is to scrub vegetables thoroughly and avoid drinking water that has not been properly purified, especially in the developing world, where infection rates can reach 95 percent in some places. Also, he advises eating meat on the well-done side—or, if that’s not to your taste, freezing it before cooking, to kill the cysts.
As concerns about the latent infection mount, however, experts have begun thinking about more-aggressive steps to counter the parasite’s spread. Inoculating cats or livestock against T. gondii might be one way to interrupt its life cycle, offers Johns Hopkins’ Robert Yolken. Moving beyond prevention to treatment is a taller order. Once the parasite becomes deeply ensconced in brain cells, routing it out of the body is virtually impossible: the thick-walled cysts are impregnable to antibiotics. Because T. gondii and the malaria protozoan are related, however, Yolken and other researchers are looking among antimalarial agents for more-effective drugs to attack the cysts. But for now, medicine has no therapy to offer people who want to rid themselves of the latent infection; and until solid proof exists that Toxo is as dangerous as some scientists now fear, pharmaceutical companies don’t have much incentive to develop anti-Toxo drugs.
Yolken hopes that will change. “To explain where we are in Toxo research today,” he says, “the analogy I always give is the ulcer bacteria. We first needed to find ways of treating the organism and showing that the disease went away when you did that. We will have to show that when we very effectively treat Toxoplasma, some portion of psychiatric illness goes away.”
But T. gondii is just one of an untold number of infectious agents that prey on us. And if the rest of the animal kingdom is anything to go by, says Colorado State University’s Janice Moore, plenty of them may be capable of tinkering with our minds. For example, she and Chris Reiber, a biomedical anthropologist at Binghamton University, in New York, strongly suspected that the flu virus might boost our desire to socialize. Why? Because it spreads through close physical contact, often before symptoms emerge—meaning that it must find a new host quickly. To explore this hunch, Moore and Reiber tracked 36 subjects who received a flu vaccine, reasoning that it contains many of the same chemical components as the live virus and would thus cause the subjects’ immune systems to react as if they’d encountered the real pathogen.
The difference in the subjects’ behavior before and after vaccination was pronounced: the flu shot had the effect of nearly doubling the number of people with whom the participants came in close contact during the brief window when the live virus was maximally contagious. “People who had very limited or simple social lives were suddenly deciding that they needed to go out to bars or parties, or invite a bunch of people over,” says Reiber. “This happened with lots of our subjects. It wasn’t just one or two outliers.”
Reiber has her eye trained on other human pathogens that she thinks may well be playing similar games, if only science could prove it. For example, she says, many people at the end stages of AIDS and syphilis express an intense craving for sex. So, too, do individuals at the beginning of a herpes outbreak. These may just be anecdotal accounts, she concedes, but based on her own findings, she wouldn’t be surprised if these urges come from the pathogen making known its will to survive.
“We’ve found all kinds of excuses for why we do the things we do,” observes Moore. “‘My genes made me do it.’ ‘My parents are to blame.’ I’m afraid we may have reached the point where parasites may have to be added to the laundry list of excuses.”
She has a point. In fact, I’ve been wondering whether T. gondii might in some small way be contributing to my extreme extroversion—why I can’t resist striking up conversations everywhere I go, even when I’m short of time or with strangers I’ll never see again. Then it occurs to me that cysts in my brain might be behind my seesaw moods or even my splurges on expensive clothes. Maybe, I think with mounting conviction, the real me would have displayed better self-control, had I not been forced to swim upstream against the will of an insidious parasite. With my feline pal Pixie on my lap (for the record, she’s an outdoor cat), I call to get the results of my Toxo test. Negative. I don’t have the latent infection.
I call to tell Flegr the good news. Even though I’m relieved, I know my voice sounds flat. “It’s strange to admit,” I say, “but I think I’m a little disappointed.” He laughs. “People who have cats often feel that way, because they think the parasite explains why they behave this way or that,” he says. “But,” I protest, “you thought the same way.” Then it hits me. I may have dodged T. gondii, but given our knack for fooling ourselves—plus all those parasites out there that may also be playing tricks on our minds—can anyone really know who’s running the show?
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