SEPTEMBER 2023

The Science
of Narcissism

Deep-Sea Mining

How AI Learns What

No One Taught It
SCIENTIFICAMERICAN.COM

Dinosaur Giants How the biggest animals ever to walk Earth got so huge
 September 202 3

VO LU M E 3 2 9, N U M B E R 2

PA L E O N TO LO G Y COMPUTING
34
26 Evolution of 58 An AI Mystery
the Earth Shakers Researchers are struggling to
Sauropod dinosaurs are by far understand how artificial-intelli-
the biggest creatures ever to have gence models know things no one
walked on Earth. New research told them. B
 y George Musser
hints at how they got to be so COGNITIVE SCIENCE
­gargantuan. By Michael D. D’Emic 62 The Dementia Defense
ENVIRONMENT When criminal behavior overlaps
34 Deep-Sea Dilemma with degenerative cognitive
Mining the seafloor could boost disease, the justice system often
production of clean energy tech- falters. By Jessica Wapner
nology. It might destroy irreplace- MEDICINE
able ocean ecosystems in the 70 The Long Shot
process. By Olive Heffernan After decades of frustration,
A S T R O N O MY scientists finally have successful
44 Celestial Wonders vaccines and treatments for the
A class of rare, doomed stars respiratory disease RSV. ON THE C OVER
enshroud themselves in mystery. By Tara Haelle Argentinosaurus is the biggest definitive
By Peter Tuthill sauropod dinosaur on record. It weighed an
N AT U R E O U T LO O K estimated 75 metric tons. Sauropods attained
P S YC H O LO G Y SC1 Smoking the largest sizes of all terrestrial animals, and
52 What Is Narcissism? This special report documents they evolved these supersized proportions
again and again over the course of their
The latest science on a widely how smoking continues to kill.
150-million-year history. New research hints
misunderstood psychological The global decline in this deadly and how—and why—they became giants.
condition. By Diana Kwon habit must be accelerated. Illustration by Chase Stone.

Photograph by Vincent Fournier September 2023, ScientificAmerican.com 1

 Kenn Brown/Mondolithic Studios

David Wall/Getty Images

Bob Staake

7 8 78

3 From the Editor 20 Meter 78 The Universe

The poetry of water striders Can extraterrestrials hear
4 Letters and gardens. our radio noise? By Phil Plait
6 Science Agenda By Lynn Levin
80 Reviews
Artificial intelligence has permeat- Parenthood and Antarctica’s “dooms­­­-
22 The Science of Health
ed all parts of society, meaning that day glacier.” Spirits and landscapes.
Hearing aids may reduce
every federal agency has a stake Global smog. Turtles’ tender lives.
the risk of dementia. 
in ensuring its safety and efficacy. Road ecology. B y Amy Brady
By the Editors By Lydia Denworth

24 Q&A 82 Observatory
7 Forum Child labor laws are under attack—
The earlier students start learning An antiquated obscenity law
again. By Naomi Oreskes
about quantum computing, the is still being enforced in the U.S.
better for science and the ­economy. By Tanya Lewis 84 50, 100 & 150 Years Ago
By Olivia Lanes By Mark Fischetti
76 Mind Matters
8 Advances Frontotemporal dementia can 86 Graphic Science
Black hole evaporation. Secret release the creative potential How stress affects inflammatory
messages via meme. How to win of the brain’s visual areas. bowel disease. B
 y Josh Fischman
the “bottle flip” challenge. By Robert Martone and Now Medical Studios

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2 Scientific American, September 2023

 FROM
Laura Helmuth is editor in chief of Scientific American.  THE EDITOR
Follow her on Twitter @laurahelmuth

Living Large CCZ’s potato-size nodules containing valuable metals. The prob-
lem is that the CCZ is pristine, barely explored and full of unknown
species that could be valuable in their own right. Scientists are
Do you know someone who is a narcissist? You probably do—an rushing to understand the ecosystem and the potential im­­­pacts of
estimated 6 percent of the population has at some point fit the mining, as journalist Olive Heffernan shares on page 34, and the
criteria for narcissistic personality disorder. It’s a difficult condi- International Seabed Authority has to decide soon whether to
tion to diagnose, in part because many people who have it think allow massive dredging of this unique environment.
they’re just fine (or exceptional) the way they are, and they don’t Artificial-intelligence systems also learn, in a way—and it’s a
seek help. The researchers who study the condition and the ther- way we don’t entirely understand. As S  cientific American c on-
apists who treat it tend to disagree about some of the fundamen- tributing editor George Musser describes on page 58, AIs seem
tal characteristics of narcissism. They agree that there seem to to build a model of the world. This representation allows them
be two main expressions of narcissism: grandiosity and vulner- to make connections and express knowledge that goes well
ability. They disagree about whether these two primary charac- beyond what they were trained to do. Stay tuned.
teristics always overlap or whether grandiosity can exist on its Dementia can increase the risk of criminal behavior, and the
own. As writer Diana Kwon explains on page 52, new research, justice system is poorly equipped to handle such cases. On page 62,
including brain imaging, is starting to resolve some of the big writer Jessica Wapner narrates the story of one defendant who did
questions about narcissism. the crime (health-care fraud)—but to what extent was he responsi-
Sauropods, like narcissists, are difficult to study. You’d think ble? Some experts are calling for a special court system for people
the largest land animals in the history of Earth would be promi- with cognitive decline, modeled on the juvenile justice system.
nent in the fossil record, but their bones tended to scatter, and it’s Some of the most spectacular stars in the universe are called
tough to get a lot of data when each femur requires a forklift to Wolf-Rayets. They’re enormous, hot, rare and dramatic—the final
move. (In case you’re wondering, blue whales are almost as long stage in an enormous star’s fast-burning life before it goes super-
as the longest sauropods, but they weigh much more because the nova. Astronomer Peter Tuthill (page 44) has found some fasci-
effect of gravity is different in water.) Paleontologist Michael D. nating Wolf-Rayets, and he and his colleagues are now using
D’Emic recently analyzed sauropod size around the world and James Webb Space Telescope images to understand their fine
found that different lineages evolved into giants three dozen times. structure and fate.
In our cover story starting on page 26, he theorizes about how and Here’s some great news as we head into the fall: vaccines for
why they grew so big. Enjoy the many dino illustrations included. respiratory syncytial virus, or RSV, are now available for older
One thing I think all of us at Scientific American love about adults, and new treatments are available for infants. On page 70,
our jobs is that we learn something new every day. I hadn’t known journalist Tara Haelle spells out the history of research that led
about the Clarion-Clipperton Zone (CCZ) of the Pacific before this to these advances. RSV is a nasty virus that kills more than
issue, for example, but we could all be hearing much more about 14,000 people in the U.S. every year, and we hope this work will
it in the next year. Deep-sea mining operations want to harvest the save many lives.

BOARD OF ADVISERS
Robin E. Bell Jennifer A. Francis John Maeda
Research Professor, Lamont-Doherty Earth Observatory, Senior Scientist and Acting Deputy Director, Chief Technology Officer, Everbridge
Columbia University Woodwell Climate Research Center Satyajit Mayor
Emery N. Brown Carlos Gershenson Senior Professor, National Center for Biological Sciences,
Edward Hood Taplin Professor of Medical Engineering Research Professor, National Autonomous University of Mexico, Tata Institute of Fundamental Research
and of Computational Neuro­science, M.I.T., and Visiting Scholar, Santa Fe Institute John P. Moore
and Warren M. Zapol Prof­essor of Anesthesia, Harvard Medical School Alison Gopnik Professor of Microbiology and Immunology,
Weill Medical College of Cornell University
Vinton G. Cerf Professor of Psychology and Affiliate Professor
Chief Internet Evangelist, Google of Philosophy, University of California, Berkeley Priyamvada Natarajan
Professor of Astronomy and Physics, Yale University
Emmanuelle Charpentier Lene Vestergaard Hau
Scientific Director, Max Planck Institute for Infection Biology, Mallinckrodt Professor of Physics and of Applied Physics,
Donna J. Nelson
Professor of Chemistry, University of Oklahoma
and Founding and Acting Director, Max Planck Unit for the Harvard University
Science of Pathogens Lisa Randall
Hopi E. Hoekstra
Professor of Physics, Harvard University
Rita Colwell Alexander Agassiz Professor of Zoology and Curator of Mammals,
Martin Rees
Distinguished University Professor, University of Maryland College Park Museum of Comparative Zoology, Harvard University
Astronomer Royal and Emeritus Professor of Cosmology and
and Johns Hopkins Bloomberg School of Public Health Ayana Elizabeth Johnson Astrophysics, Institute of Astronomy, University of Cambridge
Kate Crawford Co-founder, Urban Ocean Lab, and Co-founder, Daniela Rus
Research Professor, University of Southern California Annenberg, The All We Can Save Project Andrew (1956) and Erna Viterbi Professor of Electrical Engineering
and Co-founder, AI Now Institute, New York University Christof Koch and Computer Science and Director, CSAIL, M.I.T.
Nita A. Farahany Chief Scientist, MindScope Program, Allen Institute for Brain Science Meg Urry
Professor of Law and Philosophy, Director, Meg Lowman Israel Munson Professor of Physics and Astronomy and Director,
Duke Initiative for Science & Society, Duke University Director and Founder, TREE Foundation, Rachel Carson Fellow, Yale Center for Astronomy and Astrophysics, Yale University
Jonathan Foley Ludwig Maximilian University Munich, and Research Professor, Amie Wilkinson
Executive Director, Project Drawdown University of Science Malaysia Professor of Mathematics, University of Chicago

Illustration by Nick Higgins September 2023, ScientificAmerican.com 3

LETTERS
[email protected]

“Physicist Chien- small acts of kindness can have a large im-

pact on recipients’ moods. When I read the
Shiung Wu’s article, I was reminded of special moments
contribution to in my life: Last winter in a tiny Mexican
fishing village, I gave a bilingual edition of
science despite the Curious George to a seven- or eight-year-old
challenges she faced boy. Later he was seen clutching his trea-
sured book to his chest. When I gave a
is so inspirational.” Spanish version of “The Little Mermaid” to
jacqui gilmour v ia e-mail a young girl, she wouldn’t stop hugging me.
What joy for both of us! Next winter I will
spread even more joy with classic picture
Berkeley. My editor, Jen Schwartz, and I books for the children.
decided not to include that change of plans Merilyn Grosshans L  as Vegas, Nev.
in this article simply for space reasons and
to keep the narrative moving. There is a OPEN CONTEMPT
layered story about why Wu changed her “Why People Hate Open Offices,” by
mind, though. It involves allegations of George Musser, makes a number of inter-
April 2023 gender discrimination at the University of esting points about the health and pro-
Michigan’s student union and an informal ductivity problems created by such de-
campus tour of U.C. Berkeley’s world-class signs. It fails, however, to mention the
PHYSICS PIONEER physics department. That tour was led by worst plan of all: a hybrid in which open-
“A Hidden Variable behind Entanglement,” Luke Chia-Liu Yuan, the man whom Wu ness at the center of the floor is encircled
Michelle Frank’s article on physicist would later marry. Whether Yuan himself by traditional window offices for manage-
Chien-Shiung Wu’s early work on entan- or the prospect of access to a cyclotron had ment, with senior management in the
glement, was such an amazing story and a greater influence on Wu’s transfer deci- highly desirable corner offices. The mes-
so beautifully written. Wu’s contribution sion remains open to debate! sage couldn’t be clearer: there’s a strict hi-
to science despite the challenges she faced erarchy here, and you peons in the middle
for recognition and career progression is FALSE TALK are at the absolute bottom.
so inspirational. The photograph of her I am deeply disturbed by “Chatbots Talk- John Sechrist P  ittsburgh, Pa.
sitting in the front row at a particle phys- ing,” Giacomo Miceli’s article on how he
ics conference really got me. Powerful stuff. created an artificial-intelligence-generated RULES OF RESPECT
Jacqui Gilmour v  ia e-mail conversation between two real people who In “Beyond the Golden Rule” [The Science
did not actually have that discussion. “I of Health, February], Claudia Wallis argues
Thank you for Frank’s revealing article on built this conversation as a warning,” he that in life-or-death cases, physicians
our society’s gender bias against Wu. The writes, and so it is. The easy, quick, inex- should not follow the Golden Rule and de-
article states that she boarded a ship for pensive and very available method of cide on patient care according to what they
California in 1936 and that “at the Univer- voice cloning using AI will have enormous would want if they had the patient’s condi-
sity of California, Berkeley, Wu became a impact on all societies around the world. tion. Instead they should follow the “plati-
star student.” But an accompanying pho- Because synthetic voices and the conver- num rule”: the patient’s autonomy (self-
tograph of her immigration file shows that sations they engage in can be so convinc- rule) should be respected, and the physi-
her visa stated she would “pursue a course ingly real and natural, this technology’s cian should make decisions in line with the
in Physics at the University of Michigan.” opportunity for abuse is unimaginable. patient’s own wishes.
Is this early evidence of entanglement at a The thing that bothers me most is that I agree that the patient’s own wishes
distance? As the proud parent of a Michi- voice and video manipulation will bring must be respected. But the author is mis-
gan grad, I would also ask if it is a demon- about a crisis in trust, as the author men- led in her application of the Golden Rule
stration of parity breaking. tions. How will we trust that the “recording” when she suggests that it does not apply in
John D. Foote via e-mail of a politician, a judge, a law-enforcement cases of quality-of-life decisions. An alter-
officer, a witness in a trial, a doctor or any- native interpretation would apply the
 RANK REPLIES: Thank you so much for
F one in a position of power is genuine? We are Golden Rule as follows: “Respect the pa-
the kind words! Before leaving China, Wu totally unprepared to meet this challenge. tient’s autonomy as you would want your
had been accepted to the University of Robert Walty S  tephens City, Va. own autonomy to be respected in the same
Michigan, and this is why her immigra- circumstances.”
tion paperwork included the details Foote YOU’VE GOT TO BE KIND Don E. Scheid
noticed. When Wu arrived in California, In “Kindness Goes Farther Than You Think” Emeritus professor of philosophy,
however, she decided to transfer to U.C. [Mind Matters], Amit Kumar describes how Winona State University, Minnesota

4 Scientific American, September 2023

 ESTABLISHED 1845

EDITOR IN CHIEF
Laura Helmuth
MANAGING EDITOR Jeanna Bryner COPY DIRECTOR Maria-Christina Keller CREATIVE DIRECTOR Michael Mrak
Thank you for publishing Wallis’s article
EDITORIAL
about the Golden Rule and the platinum CHIEF FEATURES EDITOR Seth Fletcher CHIEF NEWS EDITOR Dean Visser CHIEF OPINION EDITOR Megha Satyanarayana
rule. The latter should have a place in ev- FEATURES
SENIOR EDITOR, SUSTAINABILITY Mark Fischetti SENIOR EDITOR, SCIENCE AND SOCIETY Madhusree Mukerjee
ery doctor’s education. SENIOR EDITOR, MEDICINE / SCIENCE POLICY Josh Fischman SENIOR EDITOR, TECHNOLOGY / MIND Jen Schwartz
SENIOR EDITOR, SPACE / PHYSICS Clara Moskowitz SENIOR EDITOR, EVOLUTION / ECOLOGY Kate Wong
My husband, not knowing the platinum
NEWS AND OPINION
rule even existed, insisted on his doctors SENIOR EDITOR, SPACE / PHYSICS Lee Billings ASSOCIATE EDITOR, TECHNOLOGY Sophie Bushwick
SENIOR EDITOR, HEALTH AND MEDICINE Tanya Lewis ASSOCIATE EDITOR, SUSTAINABILITY Andrea Thompson
listening to him. We had a marvelous pal- SENIOR EDITOR, MIND / BRAIN Gary Stix ASSOCIATE EDITOR, HEALTH AND MEDICINE Lauren J. Young
liative care doctor who did listen and gave SENIOR OPINION EDITOR Dan Vergano ASSISTANT NEWS EDITOR Sarah Lewin Frasier
NEWS REPORTER Meghan Bartels
him the satisfaction of a peaceful end. Too MULTIMEDIA
often doctors apply their rules. They need CHIEF MULTIMEDIA EDITOR Jeffery DelViscio CHIEF NEWSLETTER EDITOR Andrea Gawrylewski
SENIOR MULTIMEDIA EDITOR Tulika Bose CHIEF AUDIENCE ENGAGEMENT EDITOR Sunya Bhutta
to learn how to step back and let the pa- MULTIMEDIA EDITOR Kelso Harper ASSOCIATE ENGAGEMENT EDITOR Arminda Downey-Mavromatis

tient and patient’s family tell them what is ART

SENIOR GRAPHICS EDITOR Jen Christiansen PHOTOGRAPHY EDITOR Monica Bradley ART DIRECTOR, ONLINE Ryan Reid
wanted without bias. ASSOCIATE GRAPHICS EDITOR Amanda Montañez ASSOCIATE PHOTO EDITOR Liz Tormes
Nan Sopin v  ia e-mail COPY & PRODUCTION
SENIOR COPY EDITORS Angelique Rondeau, Aaron Shattuck ASSOCIATE COPY EDITOR Emily Makowski
MANAGING PRODUCTION EDITOR Richard Hunt PREPRESS AND QUALITY MANAGER Silvia De Santis
SEMANTICS OF FUEL CONTRIBUTOR S
As someone who works in thought leader- Mariette DiChristina, John Rennie
EDITORS EMERITI
EDITORIAL Rebecca Boyle, Amy Brady, Katherine Harmon Courage, Lydia Denworth, Ferris Jabr,
ship across the public sector, I often point Anna Kuchment, Michael D. Lemonick, Robin Lloyd, Steve Mirsky, Melinda Wenner Moyer,
out how language around “climate disrup- George Musser, Ricki L. Rusting, Dava Sobel, Claudia Wallis, Daisy Yuhas
ART Edward Bell, Violet Isabelle Frances, Lawrence R. Gendron, Nick Higgins, Kim Hubbard, Katie Peek, Beatrix Mahd Soltani
tion” conveys the wrong meaning, eliciting EXECUTIVE ASSISTANT SUPERVISOR Maya Harty SENIOR EDITORIAL COORDINATOR Brianne Kane
ineffective ways of addressing the problem.
Semantics are very important, as Susan Joy SCIENTIFIC A MERIC AN CUS TOM MEDIA
Hassol tells us in “Changing the Language EDITORIAL DIRECTOR Cliff Ransom CREATIVE DIRECTOR Wojtek Urbanek
CHIEF MULTIMEDIA EDITOR Kris Fatsy SENIOR MULTIMEDIA EDITOR Ben Gershman SENIOR EDITOR Dan Ferber
of Climate Change” [February]. SENIOR ENGAGEMENT EDITOR Dharmesh Patel SENIOR PUBLISHING MANAGER Samantha Lubey
I would only add “fossil fuels” to Hassol’s
list of terms that could be replaced with a PRESIDENT
Kimberly Lau
better description. We can use “dirty fuels”
PUBLISHER AND VICE PRESIDENT Jeremy A. Abbate VICE PRESIDENT, COMMERCIAL Andrew Douglas
instead. Both my five- and seven-year-olds VICE PRESIDENT, PRODUCT AND TECHNOLOGY Dan Benjamin VICE PRESIDENT, CONTENT SERVICES Stephen Pincock

have a fascination for fossils. “Fossil” evokes CLIENT MEDIA SOLUTIONS

HEAD, PUBLISHING STRATEGY Suzanne Fromm MARKETING PROGRAM MANAGER Leeor Cohen
something cool, discovery, science—large- DIRECTORS, INTEGRATED MEDIA Matt Bondlow, Stan Schmidt PROGRAMMATIC PRODUCT MANAGER Zoya Lysak
ly a positive meaning. I’m afraid that by re- DIRECTOR, CONTENT PARTNERSHIPS Marlene Stewart DIGITAL ADVERTISING OPERATIONS MANAGER Lizzie Ng

PRODUC T & TECHNOLOGY

peating the term “fossil fuels,” we are unin-
DIRECTORS Jason Goldstein, Mike Howsden ENGINEERS Kenneth Abad, Hector Coronado, Ruben Del Rio,
tentionally passing the positive meaning to PRODUCT MANAGERS Ian Kelly, Miguel Olivares Haronil Estevez, Michael Gale, Akwa Grembowski,
DIGITAL PRODUCER Isabella Bruni Grace Millard, Negin Rahbar, Stephen Tang
the whole dirty fuel industry. DATA ANALYST Jackie Clark
Luis Sena Esteves CONSUMER MARKETING

Melbourne, Australia HEAD, MARKETING Christopher Monello

SENIOR COMMERCIAL OPERATIONS COORDINATOR Christine Kaelin
MARKETING COORDINATOR Justin Camera

MOURNING RITUAL ANCILL ARY PRODUC TS

ASSOCIATE VICE PRESIDENT, BUSINESS DEVELOPMENT Diane McGarvey
I wish to express my appreciation for Piers CUSTOM PUBLISHING EDITOR Lisa Pallatroni
Vitebsky’s report on the Sora spiritual tra- C O R P O R AT E

dition of “Dialogues with the Dead” [Janu- SENIOR COMMUNICATIONS MANAGER Sarah Hausman
PRINT PRODUC TION
ary]. Vitebsky has managed to express in a
PRODUCTION CONTROLLER Madelyn Keyes-Milch ADVERTISING PRODUCTION MANAGER Michael Broomes
beautiful way the human drama of losing ADVERTISING PRODUCTION CONTROLLER Michael Revis-Williams
these spiritually valuable customs. He has
LE T TER S TO THE EDITOR
also put this into the perspective of the
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problems of present society. Letters may be edited for length and clarity. We regret that we cannot answer each one.
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September 2023, ScientificAmerican.com 5

SCIENCE AGENDA
O PINI O N A N D A N A LYS I S FR OM
S C IENTIFIC A MERIC AN ’ S B OA R D O F E D ITO R S

Safeguarding AI don’t quite know how their products use training data to make
decisions. When you get a wrong diagnosis, you can ask your

Is Up to Everyone
doctor why, but you can’t ask AI. This is a safety issue.
If you are turned down for a home loan or not considered for
a job that goes through automated screening, you can’t appeal
The use of artificial intelligence is so varied to an AI. This is a fairness issue.
and industry-specific, no one federal agency Before releasing their products to companies or the public,
AI creators test them under controlled circumstances to see
can manage it alone whether they give the right diagnosis or make the best custom-
By the Editors er service decision. But much of this testing doesn’t take into
account real-world complexities. This is an efficacy issue.
Artificial intelligence is everywhere, and it poses a monumen- And once artificial intelligence is out in the real world, who
tal problem for those who should monitor and regulate it. At is responsible? ChatGPT makes up random answers to things.
what point in development and deployment should government It hallucinates, so to speak. DALL-E allows us to make images
agencies step in? Can the abundant industries that use AI con- using prompts, but what if the image is fake and libelous? Is Ope-
trol themselves? Will these companies allow us to peer under nAI, the company that made both these products, responsible,
the hood of their applications? Can we develop artificial intelli- or is the person who used it to make the fake? There are also sig-
gence sustainably, test it ethically and deploy it responsibly? nificant concerns about privacy. Once someone enters data into
Such questions cannot fall to a single agency or type of over- a program, who does it belong to? Can it be traced back to the
sight. AI is used one way to create a chatbot, it is used another user? Who owns the information you give to a chatbot to solve
way to mine the human body for possible drug targets, and it is the problem at hand? These are among the ethical issues.
used yet another way to control a self-driving car. And each has The CEO of OpenAI, Sam Altman, has told Congress that AI
as much potential to harm as it does to help. We recommend needs to be regulated because it could be inherently dangerous. A
that all U.S. agencies come together quickly to finalize cross- bunch of technologists have called for a moratorium on develop-
agency rules to ensure the safety of these applications; at the ment of new products more powerful than ChatGPT while all these
same time, they must carve out specific recommendations that issues get sorted out (such moratoria are not new—biologists did
apply to the industries that fall under their purview. this in the 1970s to put a hold on moving pieces of DNA from one
Without sufficient oversight, artificial intelligence will con- organism to another, which became the bedrock of molecular biol-
tinue to be biased, give wrong information, miss medical diag- ogy and understanding disease). Geoffrey Hinton, widely credit-
noses, and cause traffic accidents and fatalities. ed as developing the groundwork for modern machine-learning
There are many remarkable and beneficial uses of AI, includ- techniques, is also scared about how AI has grown.
ing in curbing climate change, understanding pandemic-potential China is trying to regulate AI, focusing on the black box and
viruses, solving the protein-folding problem and helping identify safety issues, but some see the nation’s effort as a way to main-
illicit drugs. But the outcome of an AI product is only as good as tain governmental authority. The European Union is approach-
its inputs, and this is where much of the regulatory problem lies. ing AI regulation as it often does matters of governmental inter-
Fundamentally, AI is a computing process that looks for pat- vention: through risk assessment and a framework of safety first.
terns or similarities in enormous amounts of data fed to it. When The White House has offered a blueprint of how companies and
asked a question or told to solve a problem, the program uses researchers should approach AI development—but will anyone
those patterns or similarities to answer. So when you ask a pro- adhere to its guidelines?
gram like ChatGPT to write a poem in the style of Edgar Allan Recently Lina Khan, Federal Trade Commission head, said
Poe, it doesn’t have to ponder weak and weary. It can infer the based on prior work in safeguarding the Internet, the FTC could
style from all the available Poe work, as well as Poe criticism, adu- oversee the consumer safety and efficacy of AI. The agency is now
lation and parody, that it has ever been presented. And although investigating ChatGPT’s inaccuracies. But it is not enough. For
the system does not have a telltale heart, it seemingly learns. years AI has been woven into the fabric of our lives through cus-
Right now we have little way of knowing what information tomer service and Alexa and Siri. AI is finding its way into med-
feeds into an AI application, where it came from, how good it is ical products. It’s already being used in political ads to influence
and if it is representative. Under current U.S. regulations, com- democracy. As we grapple in the judicial system with the regu-
panies do not have to tell anyone the code or training material latory authority of federal agencies, AI is quickly becoming the
they use to build their applications. Artists, writers and software next and perhaps greatest test case. We hope that federal over-
engineers are suing some of the companies behind popular gen- sight allows this new technology to thrive safely and fairly.
erative AI programs for turning original work into training data
without compensating or even acknowledging the human cre- J O I N T H E C O N V E R S AT I O N O N L I N E
ators of those images, words and code. This is a copyright issue. Visit Scientific American on Facebook and Twitter
Then there is the black box problem—even the developers or send a letter to the editor: [email protected]

6 Scientific American, September 2023

 Olivia Lanes is North American lead of IBM Quantum
FORUM
C OMM E N TA RY O N S C IE N C E IN
Community. She also sits on the National Q–12 Education T H E N E W S FR OM T H E E X PE R T S
Council, which focuses on workforce development
at a national level. Lanes holds a Ph.D. in quantum physics.

Quantum Physics start with concepts such as strings on pulleys and inclined planes.
Quantum concepts end up in the realm of higher-level studies.

for K–12
Technology demonstrations from IBM (my employer), Google
and other industry players prove that useful quantum computing
is on the horizon, and demand for quantum-savvy scientists is
To create a tech-literate workforce, schools already skyrocketing. Yet a recent McKinsey report predicted that
need to teach quan­tum computing sooner major talent shortages will persist for years, with as much as 50
percent of quantum job openings potentially going unfilled.
By Olivia Lanes Mc­Kinsey also estimated that the U.S. will fall behind China and
Europe in building a quantum talent pool. China has announced
The harnessed power of the subatomic world could soon upend the most public funding for quantum computing of any country
the modern computing industry. Quantum computers are all over to date, more than double the investments by European Union
the news, and fundamental work on the theory that gave rise to governments and eight times more than the U.S. government.
them won last year’s Nobel Prize in Physics. Thankfully, things are changing. Universities are exposing stu-
One place you might not hear about them is inside a high dents sooner to once feared quantum mechanics courses. Students
school physics classroom. But if we want to have any hope of are learning through less traditional means, such as YouTube
developing a tech-savvy workforce for this emerging field, that channels and online courses, and seeking out open-source com-
needs to change. munities to begin their quantum journeys.
Unlike the computer at your desk, which encodes words or num- In recent years the University of Wisconsin–Madison and the
bers as collections of ones and zeros called “bits,” quantum com- University of California, Los Angeles, have welcomed inaugural
puters rely on quantum bits, or “qubits.” Qubits can take on zero classes of quantum information master’s degree students into year-
and one simultaneously during a calculation and interact via the long programs. The University of Pittsburgh has launched an under-
probabilistic mathematical rules of quantum physics rather than grad major that combines physics and computer science, an­­swering
classical logic. Re­­search­ers hope this novel computing architecture the need for four-year programs that prepare students for either
will significantly speed up certain hard problems such as factoring quantum employment or more education. Ohio has become the
gargantuan numbers, which could take a regular computer billions first state to add quantum training to its K–12 science curricula.
of years to perform but a quantum computer just a few days. And universities around the world are beginning to teach
This way of computing could open new frontiers in drug dis- courses using Qiskit, Cirq and other open-source quantum pro-
covery or artificial intelligence, for example. But rather than expos- gramming frameworks that let their students experiment on real
ing students to quantum phenomena, most physics curricula today quantum computers through the cloud.
What can really be gained by trying to teach quantum physics
to students so young? Quantum is more than just a technology;
it’s a field of study that undergirds chemistry, biology and engi-
neering. Quantum computing education i s S  TEM education,
as Charles Tahan, director of the National Quantum Coordi-
nation Office, once told me. Quantum computing students
might work in a related field, such as fiber optics or cyberse-
curity, that would benefit from their knowledge of quantum
programming or in a business where they can make better deci-
sions based on their understanding of the technology.
Quantum overturns our perception of reality. It draws peo-
ple in and keeps them there, as the popularity of nasa and
the moon landing did for astrophysics.
For schools adapting to the emerging quantum era, don’t
underestimate your students. Universities should introduce
quantum information sooner; K–12 schools should not shy
away from teaching some basic quantum concepts to younger
kids. We should lean into what captures students’ attention
and shape our programs to meet these desires—and prepare
new generations for the quantum future.

J O I N T H E C O N V E R S AT I O N O N L I N E
Visit Scientific American on Facebook and Twitter
or send a letter to the editor: [email protected]

Illustration by Bob Staake September 2023, ScientificAmerican.com 7

ADVANCES

8 Scientific American, September 2023

D I S PATC H E S FR OM T H E FR O N TIE R S O F S C IE N C E , T E C H N O LO GY A N D M E D I C IN E IN S ID E

• Unfurling electrode minimizes invasive

brain surgeries
• An AI model predicts hit songs
• Meet the snailfish living at nearly
impossible depths
• A rat kidney is successfully transplanted
after a 100-day deep freeze

A STROPHYSIC S

Disappearing
Act
Black holes eventually
evaporate—and everything else
might, too
Stars, planets, people and petunias:
everything emits a special kind of radiation
and will, if it sticks around long enough,
evaporate into nothing.
That’s the claim in a new study of phys-
ics effects that were previously thought
to occur only near a black hole. In that
extreme environment, some of the largest
and smallest things in the universe rub up
against one another. To describe events
on such different scales, scientists must use
both Einstein’s theory of relativity (rules
governing the big stuff) and quantum
mechanics (rules for itty-bitty things), lead-
ing to some outlandish effects. But if the
new calculations are correct, such evapo-
ration may be commonplace—even when
black holes aren’t around.
In the 1970s the late British physicist Ste-
phen Hawking began thinking about what
happened to particles that experienced
the unparalleled gravitational forces at the
edge of a black hole, a place known as the
event horizon. Anything slightly inside the
event horizon will un­­avoid­ab­ly fall into the
black hole, whereas anything just outside it
still has a chance to escape.

Illustration by Kenn Brown/Mondolithic Studios J O I N T H E C O N V E R S AT I O N O N L I N E Visit Scientific American on Facebook and Twitter
ADVANCES

Hawking wanted to know what would of probability regarding where they might
happen to pairs of particles—a particle be located in space, says Tyler McMaken,
and its antiparticle partner—that spontane- a Ph.D. student who studies theoretical
ously appeared near a black hole’s event astrophysics at the University of Colorado
horizon. These couplets emerge from the Boulder. In the absence of any external
“empty” vacuum of space, and quantum forces, electromagnetic or gravitational,
mechanics tells us they constantly wink in the clouds of both the particle and the anti-
and out of existence everywhere. As soon particle will overlap, and they will annihilate
as a particle meets up with its antiparticle, each other. But if gravity or some other
they destroy each other in a fraction of a force tugs on one cloud more than the other,
second, and the universe at large doesn’t each will be shifted slightly. They won’t
notice their presence. overlap and therefore won’t be annihilated.
Hawking showed that if one of the part- Instead they will produce radiation, much
ners appeared within the event horizon, like a particle that gets flung from a black
however, it would fall into the black hole hole’s event horizon.
while its associate on the horizon’s other The team’s calculations, published
side would fly outward at tremendous recently in Physical Review Letters, s uggest
speed. To conserve the total energy of the that anything with gravity (meaning basi-
black hole and abide by a tenet of physics, cally every object in the universe) will emit
the infalling particle must carry negative a Hawking-like radiation and eventually
energy (and hence negative mass), and the evaporate. The equations indicate that this
launched one must have positive energy. In process will take trillions on trillions of years,
this way, black holes emit a type of energy so it’s likely that you and your personal be­­
now called Hawking radiation, and over long­ings will be long gone before this effect
time this escaping positive energy depletes comes into play. But the long-lived rem- C O N S E R VAT I O N
them, causing them to evaporate. nants of dead stars such as white dwarfs
About six years ago astrophysicist Heino
Falcke of Radboud University in the Nether-
and neutron stars—which have enormous
mass—might have their lives shortened
Lawn Gone
lands started thinking more deeply about if the phenomenon is real. Tearing up a historic lawn
the physics involved in these processes— The analysis seems promising, says brings in new bugs, bats
and whether the black hole’s event horizon McMaken, who was not involved in the and plants
was a necessary component. In other words, work. “This shows that there is definitively
could this same evaporation occur with some effect where particles can be ripped The well-manicured lawn b  ehind
other objects? “I asked a few experts and apart just solely from gravitational forces King’s College Chapel at the Univer-
got very different answers,” he recalls. in the vacuum,” he adds. McMaken and his sity of Cambridge predated the
Falcke enlisted the help of quantum colleagues have considered doing similar American Revolution. Then, in 2019,
physicist Michael Wondrak and mathemati- calculations, he says, so he’s pleased that an ecologically minded head gar-
cian Walter van Suijlekom, both at Radboud, scientists did a thorough check to see what dener secured permission to tear up
to take another look at the issue. The trio happens in these situations. a portion of the grass and plant a
decided to approach the topic from an atyp- But other researchers disagree. “Person- meadow in its place. Before long it
ical angle. The scientists used equations ally, I’d be kind of skeptical that all previous bloomed with poppies, buttercups
from a related phenomenon known as the calculations are wrong” about what hap- and Queen Anne’s lace.
Schwinger effect, which describes how pens to particles near massive objects, says Lawns, which became popular in
charged particles and antiparticles get torn theoretical physicist Sabine Hossenfelder the 1700s as displays of wealth, come
apart when they emerge from the vacuum of the Munich Center for Mathematical Phi- at an environmental cost. They re-
in the presence of a powerful electromag- losophy. She suspects that a more careful quire far more water than similar-size
netic field. The process could be considered analysis would show that the particle-anti- meadows, especially in arid regions.
analogous to particle pairs experiencing particle pairs don’t actually radiate from Lawn grass is often overloaded with
strong gravitational forces at a black hole’s massive objects other than black holes. fertilizers and pesticides and is regu-
Geoff Moggridge/King’s College, Cambridge

event horizon. Current technology isn’t sensitive enough larly clipped with gas-guzzling mow-
The researchers’ mathematical analysis to detect this evaporative effect and prove ers. Meadows, in contrast, sequester
showed how any object with mass—and the new claim one way or another. Falcke and more carbon than lawns and foster
not just a superheavy one such as a black his team suggest that further experiments far more biodiversity.
hole—affects the pairs of particles and anti- could focus on observing the Schwinger Yet at half the size of a soccer
particles that emerge from the vacuum of effect, which also remains theoretical at this field, how much wildlife would the
space. In more wavelike terms, these parti- point, to potentially bolster their claims. new Cambridge meadow really sup-
cles can be thought of as having a cloud — Adam Mann port? King’s College botanist Cicely

10 Scientific American, September 2023

 The King’s
The King’s College
College wildflower
meadow bolstered
meadow
wildflower
bolstered biodiversity.
biodiversity.
In Reason
We Trust

Christian nationalists have declared

war on our public schools. They’re:
• Banning books and sex education
• Passing “Don’t Say Gay” laws
• Funneling millions of tax dollars to
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A. M.
M. Marshall
Marshall surveyed
surveyed the the site
site be-
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Meadows Support
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abundance
fore and
fore and after
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makeover. She She and
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site. Color
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her colleagues
her colleagues found found that,that, compared
compared variations represent
variations represent richness
richness (number
(number social policy.
with their
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numbers in in the
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of different species).
species).
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meadow. And And without
without Join now or get a FREE trial
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fertilizer, the
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lawn.
Perhaps because
Perhaps because it’s it’s hemmed
hemmed in in
by buildings
by buildings and and aa river,
river, nono mammals
mammals
were observed
were observed at at the
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site, and
and itit is
is
too small
too small forfor grassland
grassland birds. birds. In In addi-
addi- Bats
Bats
tion, roundworms
tion, roundworms equally equally inhabited
inhabited
Call 1-800-335-4021
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the meadow
the meadow and and the the lawn.
lawn. EvenEven so,so,
Marshall says says she
she waswas “quite
“quite encour-
encour-
Marshall
ffrf.us/science
al.,
et al.,
Climate and
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aged” by the
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tions and
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A. M.

and bugs
and bugs
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“Lawns represent
“Lawns represent an an incredible
incredible loss loss
by Cicely
2023
May 2023

of habitat,”
of habitat,” says
says Sam Sam Quinn,
Quinn, aa conser-
conser-
Planting for
Cambridge,” by

Terrestrial invertebrates,
invertebrates, including
including spiders
spiders and
and
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vation biologist
vation biologist at at the
the State
State University
University Terrestrial
Meadow Planting
College, Cambridge,”

bugs, were
bugs, were also
also measured
measured in in terms
terms of
of biomass.
biomass.
Vol. 4;

of New
of New YorkYork College
College of of Environmental
Environmental
Evidence, Vol.

Lawn Meadow
Wildflower Meadow

Science andand Forestry,

Forestry, who who was was not
not in-in- Lawn Meadow
and Evidence,

Science
King’s College,

volved in
volved in the
the new
new studystudy but but expressed
expressed
“Urban Wildflower

Solutions and

admiration for
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experimental setup. setup.
ffrf.org
at King’s
Ecological Solutions

Fortunately, “the
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restoration part part isis su-
su- 0.2 gram
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Source: “Urban

per easy,”
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get established,
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move right in.
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— Greenspan
esse Greenspan
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Deductible for income tax purposes.

Graphic by
Graphic by Amanda
Amanda Montañez
Montañez September 2023, ScientificAmerican.com 11
ADVANCES
E VO L U T I O N
birds against parasites, Jønsson says. Of
Toxic course, for this strategy to work, the birds
must avoid poisoning themselves. And just
Feathers as toxins are common in biology, so is re­
sistance to them, says University of Califor­
Two new poisonous birds nia, Berkeley, ecologist Rebecca Tarvin.
have been discovered Rufous-naped Bellbird Using computer simulations, the re­­
search­ers studied how each species had
Locals in Papua New Guinea c alled the ral History Museum of Denmark and their evolved different variations in the neuron
birds spicy. When University of Copenha­ colleagues identify two new species of tox­ binding site—the same part of the protein
gen evolutionary ecologist Kasun Boda­ ic birds and show that each independently altered in poison dart frogs—to thwart the
watta handled feathers from the Regent evolved resistance to batrachotoxins’ toxin. But Tarvin isn’t convinced yet. She
Whistler and the Rufous-naped Bellbird, effects via mutations that change the pro­ pointed to a 2021 study in frogs in which
his eyes teared up and itched like he was teins where they bind. Like how fish and sodium-channel mutations did not demon­
chopping onions. It was the ecologist’s first whales separately evolved fins, these birds strate protection from batrachotoxins in
experience with toxic birds. have “arrived at the same way of dealing some species, although Jønsson notes that
The island’s toxic birds were first de­ with” the toxins, Jønsson says. the species tested had lower than average
scribed scientifically in 1992, and research­ California Academy of Sciences ornithol­ levels of the toxins among Papua New
ers have since identified a few more species. ogist Jack Dumbacher first pinned batracho­ Guinean birds. Tarvin says the new study
Their feathers and skin all carry the same toxins as the source of birds’ toxicity three highlights the variation among sodium
type of potent neurotoxin found in South decades ago. At the time batrachotoxins channels, but there remains much to learn
American poison dart frogs. If these sub­ had been found only in poison dart frogs, half about toxin resistance in general.

Martin Willis/Minden Pictures

stances, called batrachotoxins, bind to neu­ a world away. Researchers now hypothesize “Understanding biodiversity and the
rons’ sodium-channel proteins, they cause that the birds acquire batrachotoxins by eat­ diversity of adaptations, especially these ex­
the neurons to fire nonstop. High-enough ing poisonous beetles of the genus C  hore- treme phenotypes,” she says, “can give us
doses can cause muscle paralysis and death. sine, like the frogs do—but no one is certain. really great ideas for medicine, for agriculture
In a paper in M
 olecular Ecology, B
 oda­ Whatever the source, storing the toxin and for understanding how animals adapt
watta, ecologist Knud Jønsson of the Natu­ in skin and feathers may help protect the to pollution.”  —Carrie Arnold

M AT H E M AT I C S aim to embed messages in strings of words their algorithm chooses an ideal “coupling

Out of Sight
or images that are statistically identical to distribution” on the spot—a method that
normal communication. Unfortunately, matches secret bits with innocuous content
human-generated content is not predict­ (for example, cat memes) in a way that pre­
A new method for hiding secrets able enough to achieve this perfect secu­ serves the right distributions of both while
is mathematically proven rity. Artificial intelligence generates text making them as interdependent as possi­
to escape detection and images using rules that are better ble. This approach is computationally quite
defined, potentially enabling completely difficult, but the team incorporated recent
In an advance t hat could benefit spies and undetectable secret messages. information theory advances to find a near-
dissidents alike, computer scientists have University of Oxford researcher Chris­ optimal choice quickly. A receiver on the
developed a way to communicate confi­ tian Schroeder de Witt, Carnegie Mellon lookout for the message can invert the
dential information so discreetly that an University researcher Samuel Sokota and same operation to uncover the secret text.
adversary couldn’t even know secrets were their colleagues used an AI program to cre­ The researchers say this technique has
being shared. Researchers say they have ate innocent-looking chat messages with significant potential as humanlike genera­
created the first-ever algorithm that hides secret content. To outside observers, the tive AI becomes more commonplace.
messages in realistic text, images or audio chat is indistinguishable from any other Joanna van der Merwe, privacy and protec­
with perfect security: there is no way for an communication made by the same genera­ tion lead at Leiden University’s Learning
outside observer to discover a message is tive AI: “They might detect that there is AI- and Innovation Center, agrees. “The use
embedded. The scientists announced their generated content,” Schroeder de Witt says, case that comes to mind is the documen­
results at the recent International Confer­ “but they would not be able to tell whether tation of abuses of human rights under
ence on Learning Representations. you’ve encoded secret information into it.” authoritarian regimes and where the infor­
The art of hiding secrets in plain sight is To achieve this camouflage, the re­­ mation environment is highly restricted,
called steganography—distinct from the search­ers developed an algorithm to opti­ secretive and oppressive,” van der Merwe
more commonly used cryptography, which mally match a clandestine message with says. The technology doesn’t overcome
hides the message itself but not the fact a series of memes (or text) to be sent in the all the challenges in such scenarios, but it’s
that it is being shared. To securely conceal chat, choosing that content on the fly to a good tool, she adds: “The more tools in
their information, digital steganographers suit the context. Their big step was the way the toolbox, the better.”  —Dina Genkina

12 Scientific American, September 2023

 PHYSIC S faster the water was swirled, the lower
a bottle’s bounce. The results were pub-
Expertise.
Flipping lished in Physical
Physical Review Letters.
“It’s true. I’ve tried it,” says Tadd Trus-
Insights.
Out cott, a flfluid
uid physicist at the King Abdullah
University of Science and Technology
Illumination.
Thanks to a viral challenge, in Saudi Arabia, who was not involved Choose the subscription
physicists discover a new flfluid
uid in the work—but says he has tried swirling that’s right for you.
dynamic eff ect
effect and tossing bottles by hand. “And it works
quite well.” PRINT
In experiments iinvolving
nvolving bouncy balls, Like car passengers during a tight turn, DIGITAL
plastic bottles and a high-speed camera, swirling water inside a bottle gets pushed 170+ YEAR ARCHIVE
researchers in Chile discovered that it’s to the sides of the container, forcing it
possible to control the height of a contain- upward evenly along the walls. When the
er’s bounce by swirling the water inside. bottle hits the ground, the spun-up water Scan to learn more
If this experiment sounds like something courses down toward a single point at
out of a social media challenge, that’s the center of the bottle’s base. “All of the
because it is. Pablo Gutiérrez, a physicist flfluid
uid tries to pass through [that point] but
fluid dynamics at Chile’s O’Higgins
studying fluid can’t,” Truscott says.
University, became interested in bouncing With nowhere else to go, the water
containers after his son showed him the flflies
ies back upward. Most of the falling bot-
viral “bottle flflip”
ip” challenge: tossing a half- tle’s momentum gets redirected into
full plastic bottle so it flflips
ips end over end this vertical jet rather than into a bounce,
and sticks the landing. “Pablo became very dampening the impact and explaining
good at this challenge,” laughs Gutiérrez’s why swirled bottles tend to stick their
co-author Leonardo Gordillo, a physicist at landings when “fl ipped.” The spinning
“flipped.”
the University of Santiago. “He was throw- water jet then flflares
ares out like a tornado
ing a lot of bottles.” and flflies
ies apart before much of it can
So the physicists and their research smack the top of a bottle and cause
flipping into the labora-
team took bottle flipping a delayed rebound.
tory. They glued halves of rubber balls Truscott says he’d be interested to see
to the bottles’ bottom to enhance their whether the eff ect works for more viscous
effect
bounce. And they made a key observa- flfluids
uids or for larger container sizes. Such
tion: bottles they’d swirled before releas- fifindings
ndings could perhaps be useful for miti-
ing bounced far less, probably thanks to gating collision damage to flfluid-filled
uid-filled con-
fluid dynamics. To test this, the physicists
fluid tainers like fuel tanks. It could also make
built a contraption that could spin and for an afternoon of fun at home; the re re­­-
drop bottles with scientific
scientific precision. search
search­ers
ers encourage readers to give
A high-speed camera captured the drops a bottle a swirl and replicate the results
at 2,000 frames per second. Indeed, the for themselves.  —Elise
— Elise Cutts

No Rotation Fast Rotation

2023
16, 2023
Containers,”
Filled Containers,”
June 16,
130; June
Vol. 130;
Partially Filled
Letters, Vol.
of Partially
Review Letters,
Bounce of
Physical Review
the Bounce
al., inin Physical
Reduces the
Fluid Reduces
Andrade etet al.,
“Swirling Fluid
Klebbert Andrade
Source: “Swirling

Scientific American is a registered trademark

of Springer Nature America, Inc.
by Klebbert
Source:
by

Graphic by Brown Bird Design September 2023, ScientificAmerican.com 13

ScientificAmerican.com
ADVANCES
ARTIFICIAL INTELLIGENCE

Flop or
Bop?
Researchers are using AI
to try to predict hit songs
Can a machine predict t he song
of the summer? Can it weed out for-
gettable flops? If so, such a technol-
ogy could reduce music production
costs, curate public playlists and even
The electrode’s spiral arms render judges on television talent
unfurl inside the brain. shows obsolete—but after decades
of “hit song science” research, pre-
TECH novel deployment mechanism: Initially the
dicting a successful song is still more
electrode array’s “arms” are tucked inside
Head Space a cylindrical loader like the fingers of an
inverted glove. Once the loader is inserted
of an art than a science.
Now researchers at Claremont
A flexible robot electrode deploys Graduate University in California say
in the small hole, fluid pressure drives each they’ve found a way to use artificial
inside the skull arm to extend horizontally in the one-milli- intelligence to analyze listeners’ phys-
meter space between the skull and the brain. iological signals and predict the next
Scientists have made great strides in devel- A strain sensor signals full extension.
oping soft “biocompatible” electrodes. But chart-topping bop. The team tracked
The team used a physical brain-and-skull participants’ heart activity as they lis-
comparatively less attention has gone model to work out the best shapes and tened to music. The scientists used
toward how to actually get these devices— dimensions to maximize coverage while an algorithm to convert the data into
which have wide applications in brain- minimizing tissue compression. The current what they say is a proxy for neural
machine interfaces, such as for controlling prototype fits through a two-centimeter activity. A machine-learning model
prosthetic devices—inside people’s heads. hole and extends six spiral-shaped arms, trained on the data was then able to
Researchers led by Stéphanie Lacour, a neu- enabling even coverage of a four-centime- determine whether a song was a hit
rotechnologist at Switzerland’s Ecole Poly- ter-diameter area. or a flop with 97 percent accuracy.
technique Fédérale de Lausanne (EPFL), pre- The most similar previous effort, built The findings were published in Fron-
sented an ingenious solution to this problem for the spinal cord, would take up too much tiers in Artificial Intelligence.
in Science Robotics. space if used in the brain. “What’s added Other scientists studying the use
Electrode arrays that sit on the brain’s here is that the implant makes only the of AI to predict hit songs aren’t ready
surface are most often used to map seizure- movement you’d like it to,” Asplund says. to declare victory yet. “The study
related brain activity in people with epilepsy. “It should have minimal volume and expand could be groundbreaking but only
This technique requires arrays that cover only in one plane.” if it’s replicated and generalizable.
relatively large areas, necessitating removal The researchers tested the technique There are many biases that can influ-
of at least an equal area of skull in a proce- by implanting a simpler device with one ence a machine-learning experiment,
dure known as a craniotomy. straight arm in a miniature pig. They posi- especially one that attempts to pre-
The implant Lacour and her colleagues tioned it over the somatosensory cortex, dict human preferences,” says Hoda
built is instead inserted through a much which processes touch, and confirmed that Khalil, a data scientist at Carleton
smaller hole in the skull. “It really solves a appropriate signals registered when the ani- University in Ontario, who was not
major, long-standing practical problem . . . mal’s snout was stimulated. They saw no affiliated with the study.
with a solution simple enough it seems real- visible signs of brain damage afterward, Traditionally, music industry ex­­
istic to translate to the clinic,” says Chalmers although microscopic investigation revealed perts looking to predict the next hit
University of Technology bioengineer Maria a very slight immune reaction. “This has to have relied on large databases to ana-
Asplund, who was not involved in the study be pursued further,” Lacour says, “but these lyze the lyrical and acoustic aspects
but wrote an accompanying commentary. are encouraging first steps.” of hit songs, such as tempo, explicit-
The implant is made of a stretchable A spinoff company, Neurosoft Bioelec- ness and danceability. But this method
“elastomer” material that mimics the dura, tronics, is working on clinical applications. has performed only slightly better
Alain Herzog/EPFL 2023

the membrane surrounding the brain. “They’re making good progress toward med- than a random coin toss. For example,
The study’s lead author, Sukho Song, an ical-grade fabrication,” Lacour says. “And Khalil and her colleagues have ana-
engineer also at EPFL, borrowed a technique they’re in discussion with regulatory bodies.” lyzed data from more than 600,000
called eversion from soft robotics to add a — Simon Makin songs and found no significant corre-

14 Scientific American, September 2023

 lations between various acoustic features
and a tune’s commercial popularity. Emboldening
Rather than focusing on a song’s quali­
ties, the Claremont team sought to ex­ ex­ the Mind
plore how humans respond to music.
“The connection seemed almost too sim­ Since 1845
ple. Songs are designed to create an emo­
tional experience for people, and those
emotions come from the brain,” says
Unlimited Discoveries.
Paul Zak, a neuroeconomist at Claremont Bergen in Norway and guest researcher at
Unlimited Knowledge.
Graduate University and senior author the Max Planck Institute for Human Cogni­
of the new study. tive and Brain Sciences in Germany. Koelsch
Previous attempts to use brain scans also notes that although the study cited sev­
to predict hit songs had limited success. eral papers to support the validity of immer­ Scan to learn more
A 2011 study using functional magnetic sion as a measure of brain activity, not all
resonance imaging, which tracks blood were published in peer-reviewed
peer­reviewed journals.
flow in the brain, identified 90 percent Koelsch is also skeptical that machine-
machine­
of commercial flops but only 30 percent learning models can capture the nuances
of hits. Zak’s team took a different ap­
ap­ that make a song a hit. In a 2019 study,
proach. Instead of directly measuring brain he and his colleagues initially found a rela­
responses, the researchers equipped 33 tion between the predictability of a song’s
participants with wearable cardiac sensors chord progression and listeners’ emotional
that monitor changes in blood flow, similar response, but they have since been unable
to the way traditional smartwatches and to replicate those findings. “It’s very diffi­
fitness trackers detect heart rate. cult to find reliable indicators for even
Participants listened to 24 songs ranging the crudest differences between pleasant
from the megahit “Dance Monkey” by Tones and unpleasant music, let alone for the
and I to the commercial flop “Dekario subtle differences that make a nice musical
(Pain)” by NLE Choppa. Their cardiac data piece become a hit,” he says. As of publi­
were then fed through the commercial plat­ cation time, Zak had not responded to
form Immersion Neuroscience, co-founded
co­founded requests for comment on criticisms of his
by Zak, which he says algorithmically con­ recent study.
verts cardiac activity into a combined metric If this new model’s results are repli­
of attention and emotional resonance cated, it might hold immense commercial
known as immersion (the details of this pro­ potential. To Zak, its primary utility lies in
cess are not outlined in the study). An AI efficiently sorting through the vast library
model trained on these immersion signals of existing songs. “As wearable devices
predicted hit songs with high accuracy, the become cheaper and more common, this
researchers reported. In contrast, partici­ technology can passively monitor your
pants’ ranking of how much they enjoyed brain activity and recommend music, mov­
a song did not reflect its public popularity. ies or TV shows based on those data,” Zak
Zak—who currently serves as Immer­ says. “Who wouldn’t want that?”
sion Neuroscience’s chief immersion Zak envisions an opt-in
opt­in service with data
officer—says there is a rationale for using anonymized and shared when users sign a
cardiac data, which can be easily tracked consent form. But Khalil points out that this
through wearable devices, as a proxy opt-in
opt­in approach can still fail to safeguard
for neural response. He explains that a users. “Many users just accept the terms
robust emotional response triggers the and conditions without even reading them,”
brain to synthesize the “feel-good”
“feel­good” neuro­ Khalil says. “That opens the door for data
chemical oxytocin, intensifying activity in to be unintentionally shared and abused.”
the vagus nerve, which connects the brain, One’s favorite songs may seem like
gut and heart. innocuous data, but they offer a window
Not everyone is convinced. “The study into one’s moods and habits. And if these
miniseries/Getty Images

hinges on the neurophysiological measure details are coupled with data on brain activ­
Scientific American is a registered trademark
of immersion, but this measure needs fur­ ity, consumers may be forced to consider of Springer Nature America, Inc.
ther scientific validation,” says Stefan Koel­ how much information they’re willing to
sch, a neuroscientist at the University of relinquish for the perfect ­p —LLucy
laylist.  —
playlist. ucy Tu

September 2023, ScientificAmerican.com 15

ADVANCES

BIODIVERSIT Y

Science
in Images
By Allison Parshall

Deep in eastern Brazil’s A  tlantic Forest, a team

of biologists spotted a fuzzy purple stalk protruding
from the leaf litter on the ground. Following the
spore-covered body down into the soil, they found
a mummified spider swaddled in fungal filaments
called hyphae.
One of the mycologists, João Araújo, immedi-
ately recognized the purple protrusion as a new,
undocumented species of predatory fungus belong-
ing to the genus Purpureocillium. S  pores from these
fungi latch onto and kill their insect or arachnid
prey—and then a fruiting body bursts from the
corpse to spread more spores.
Purpureocillium species share many similarities
with those of their sister genus O  phiocordyceps,
which includes the “zombifying” fungi that hijack the
bodies of their insect prey and are featured in the
apocalyptic television show and video game T  he Last
of Us. A raújo, who works for the New York Botanical
Garden, has dedicated his career to discovering
new species in this intriguing evolutionary group.
“Many of these specimens we collect are new species,”
he says. “We know so little about them.”
The “beautiful, velvety” purple specimen would
be only the seventh species of Purpureocillium d  is-
covered, says Jennifer Luangsa-ard, a mycologist at
Thailand’s National Center for Genetic Engineering
and Biotechnology. These fungi are found across the
world and include one species that causes eye and
skin infections in immunocompromised people. Sci-
entists know surprisingly little about the fungal king-
dom despite its importance for our health, food and
environment; according to conservative estimates,
only 10 percent of species have been identified,
Luangsa-ard says. “We need more people looking
for the missing taxa,” she adds. There’s “still a lot
to be discovered.”
The wild popularity of T  he Last of Us m
 ay lead
people to spot new species, which are often hiding
in plain sight, Araújo says. He adds that a naturalist
recently spotted two potential species of Ophio-
cordyceps infecting ants at a nature preserve in
Pennsylvania, a short drive from Araújo’s laboratory.
This discovery may allow his team to closely study
the still mysterious ways these fungi manipulate and
kill their prey.

To see more, visit ScientificAmerican.com/science-in-images

16 Scientific American, September 2023

 MEDICINE

Stopping Time
Nanoparticles allow long-term freezing
of transplant organs
Thousands of donated organs a re discarded every year. As soon as
one becomes available, doctors race to find a compatible recipient—
but transplantation time lines are measured in hours, and many organs
still can’t be used. Now researchers publishing
in Nature Communications have success-
fully preserved rat kidneys for 100
days before thawing and transplant-
ing them into other rats.
Scientists have cryogenically
preserved organs for decades
via vitrification: cooling them
so quickly that ice cannot form
and rupture cells. But thawing
them quickly enough to avoid dam-
age has proved nearly impossible.
“If the outside heats faster than the mid-
dle, you get thermal stress—like when you
drop an ice cube in water and you hear it crack,” says study author
Erik Finger, a transplant surgeon at the University of Minnesota.
“You could basically put a crack right through the middle of the organ
and make it not function.”
For the new study, just before vitrification the team flooded the rat
kidneys’ vasculature with iron oxide nanoparticles and a newly devel-
oped cryoprotective solution that can preserve the organs at extremely
low temperatures. After 100 days, they thawed the organs with an alter-
nating magnetic field, which caused the nanoparticles to oscillate and
evenly warm the tissue. The researchers then flushed the nanoparticles
and cryoprotective solution out of the organs before replacing the rats’
native kidneys with these transplants. The recipients were able to live
without medical support.
Only one previous study successfully rewarmed and transplanted
a vitrified organ in any animal, and the rabbit kidney in question had been
vitrified for roughly 10 minutes—and it performed poorly after trans-
plantation. Drastically extending the preservation period and developing
a new method for warming was a “crowning achievement” for the
researchers, says Gloria Elliott, president and chief science officer for
the Organ Preservation Alliance. “No one has been able to do a good job
of reproducing that,” Elliott adds. “So it’s been a long time coming.”
Human organs are bigger than rat organs, but Finger is optimistic
this technology will translate because of how the nanoparticles uni-
formly heat an organ from within. New York University surgery resident
David Andrijevic, who revived dead pigs’ organs while working as a
research scientist at Yale University, says this study completely changes
the field of transplantation. He adds that “100 days is absurdly long.”
Finger’s group hopes to start human organ trials within the next six
months. Scaling up will be a challenge, Finger says, but long-term organ
banking would be invaluable for the 100,000 people on the organ trans-
plant waiting list. “For each organ recipient who does not know when
the transplant might come,” he says, “you can say, ‘What’s in the
João Araújo

freezer?’ and pick out what’s best for this particular patient today.”
— Timmy Broderick

Illustration by Thomas Fuchs September 2023, ScientificAmerican.com 17

ADVANCES
B I O LO G Y
tion seems impossible,” he says. “I can N E W S A R O U N D T H E WO R L D

In the Depths barely swim to the bottom of a swimming

pool without my ears popping.” Quick Hits
The world’s deepest-dwelling fish Jamieson’s team discovered the snailfish By Timmy Broderick
thrives five miles down in August 2022 at the bottom of the Izu-
Ogasawara Trench, near the main islands
ICELAND
Scientists exploring a marine trench near of Japan. The farthest depths of the Japa-
Iceland’s government temporarily halted
Japan were astonished to see a fish in one nese trench reach about 1.7 degrees Celsius
fin whale hunting after the country’s
of the deepest parts of the ocean, at 8,336 (35 degrees Fahrenheit), Jamieson says,
veterinary authority released a gruesome
meters (about five miles) below the surface. which is slightly warmer than the neighbor-
whale hunt video. Public opposition has
The tadpole-shaped, translucent snailfish is ing Mariana. This divergence is key: osmo-
increased in recent years, and experts
probably living at the greatest depth possible. lytes are less effective at low temperatures,
say the ban could become permanent.
“They can’t really go any deeper,” says and these snailfish live near the edge
INDONESIA
marine scientist Alan Jamieson of the Uni- of what’s possible. “The difference is a frac-
Scientists recorded wild orangutans
versity of Western Australia, who led the tion of a degree, so we wouldn’t care,”
producing both voiced and voiceless
team that made the discovery. The previous Jamieson says. “But it makes a difference
vocal patterns—a feat previously attrib-
record holder, a snailfish seen in the Mariana to marine animals.”
uted mostly to songbirds and human
Trench—the world’s deepest location— To photograph the fish, researchers
beatboxers. Orangutans use two sounds
was filmed 8,178 meters under the surface onboard the DSSV P  ressure Drop s ent down
at the same time before combat and as
in 2017. an autonomous underwater “lander”
a warning to others of potential threats.
Fish can tolerate high pressures at equipped with cameras, lights and batteries,
extreme depths because of cellular com- along with a weight to lower the contraption ISRAEL
pounds called osmolytes. Osmolyte concen- to the seafloor. The lander carried dead fish Archaeologists examined sediment in
trations increase at greater depths to ensure as bait to lure deep-sea crustaceans, and the 2,700-year-old toilets in Jerusalem and
that fish cells can withstand such bone- snailfish came to eat the crustaceans— found the oldest known traces of G  iardia
crushing pressures, but these compounds including the record-breaking juvenile snail- duodenalis, a pathogen that can cause
reach their maximum concentration at fish at 8,336 meters. Although the team the intestinal malady dysentery. Ancient
around 8,400 meters. So that’s the theoreti- couldn’t identify its exact species, two oth- texts hint at its existence, but these
cal limit of fish physiology. “If anyone does ers from the species Pseudoliparis belyaevi feces predate most other evidence by
find fish deeper than this, it will not be by were caught in baited traps nearby, at a hundreds of years.
much,” Jamieson says. depth of 8,022 meters. PERU
Ichthyologist Prosanta Chakrabarty, Each of the more than 400 known snail- People have been preparing for El Niño’s
curator of fishes at Louisiana State Universi- fish species adapts to where it lives, from floods for centuries. New research found
ty’s Museum of Natural Science, is im­­ shallow waters to extreme depths, Jamieson millennia-old flood sediments in north-
pressed that the fish could survive at 800 says. “Each trench has its own snailfish in it,” ern Peru that suggest ancient communi-
times the surface’s water pressure. “At that he says. “Once they’ve evolved to cope in a ties were aware of the intermittent
depth everything from gas exchange for trench, they cannot decompress to get from weather pattern’s dangers and built walls
breathing to nearly every physiological func- one trench to another.”  —Tom Metcalfe to protect farmland.
TONGA
Hunga Tonga-Hunga Ha’apai’s volcanic
blast last year was the most powerful
such event ever recorded in the modern
era. Now scientists have released data
showing that the subsequent ash plume
also broke another record: the most
extreme lightning storm known, with
192,000 flashes over 11 hours.
U.K.
In urban landscapes, pollinating moths
may be as important as bees. Researchers
found that these insects carry more
University of Western Australia

diverse pollen than bees do and visit just

as many plants during parts of the sum-
mer—but scientists worry they may be
even more vulnerable to urbanization.
For more details, visit www.ScientificAmerican.
This snailfish lives at nearly impossible depths. com/sep2023/advances

18 Scientific American, September 2023

METER
Edited by Dava Sobel

Water Striders
Little single scullers striding
on the surface tension of the pond
glide by the turtle-paved bank,
can’t sink to the muddy bottom.
Their narrow bodies and thready legs
look like racers’ shells and oars.
They criss and cross their skim of water.
I doubt they ponder what’s above or under.
The regatta of the striders’ lives
looks merry though death will come
by frog or cold or generation’s close.
Best not to dive too deep
into that question but stay amazed
at the forces that let them float
and row with greater ease
than the human sculler in a boat.

20 Scientific American, September 2023

 Lynn Levin t eaches writing and literature at Drexel University.
Her 2023 debut collection of short stories, House Parties (Spuyten
Duyvil), follows her numerous books of poetry, among them
The Minor Virtues (2020) and Miss Plastique (2013), both published
by Ragged Sky Press.

Fallowing
I cosseted my weary garden with clover,
practiced patience, saw the vanity of overwork.
The plants fixed nitrogen in the dark
and new riches formed under the green cover.

The land’s sabbatical is not unlike human sleep

when the dark dome drops over the aviary of the mind
and the brain consolidates its record of time
through mysterious processes in slow-wave sleep

inscribing in cells what one has skimmed

from the hours: joy and sorrow, anxiety, relief.
That year of fallowing felt brief
but not as brief as the days that spin

or the busy nights that fix in the mind

precious faces, conversations, names,
the memories one wishes to keep safe
though some be rooted in places hard to find.

Phil Degginger/Alamy Stock Photo

September 2023, ScientificAmerican.com 21

THE SCIENCE Lydia Denworth is an award-winning science journalist and
OF HEALTH contributing editor for Scientific American. S he is author
of Friendship: The Evolution, Biology, and Extraordinary Power
of Life’s Fundamental Bond ( W. W. Norton, 2020) and several
other books of popular science.

Hearing Aids loss. In 2020 a Lancet Commission on dementia identified hear-

ing loss as the leading modifiable midlife risk factor for later de-

May Lower Risk

velopment of the disease.
In July, at the annual meeting of the Alzheimer’s Association,
Frank Lin, an otolaryngologist and director of the Cochlear Cen-

of Dementia ter for Hearing and Public Health at Johns Hopkins University,
presented results from a first-of-its-kind randomized clinical tri-
al of 977 adults between 70 and 84 with untreated hearing loss.
Age-related hearing loss is linked One group received best-practice hearing care, including aids, and
to mental and physical problems another group took part in a program about successful aging.
Three years later hearing aids did not make much difference to
By Lydia Denworth the healthiest participants. But those who were at the higher risk
for dementia because of age and underlying health conditions saw
A friend recently noticed that she couldn’t always hear her phone a 48 percent reduction in cognitive change if they got hearing aids.
ringing or family members calling from another room. A hearing When hearing loss is untreated, the brain’s organization chang-
test revealed mild loss in high frequencies, which was possibly es, says auditory neuroscientist Anu Sharma of the University of
age-related—she is in her early 60s, and some difficulty with these Colorado Boulder. In adults with mild hearing loss, studies show
frequencies often comes with advancing years. She didn’t need a decrease in gray matter. Sharma found early signs that vision and
hearing aids yet, but she says she’ll monitor the situation and get touch areas of the brain encroach on and repurpose underused
them if the time comes. She was glad she asked for the test. hearing areas. Adults with hearing loss also show more activity
Not many people do, nor do most doctors offer. It’s not rou- in working memory areas; they need to make extra efforts just
tine to screen adults for hearing loss even though about 14 per- to listen, Sharma says, which may deplete cognitive reserves.
cent of Americans older than 12 have trouble hearing. The prev- Hearing loss is also associated with more falls, higher health-
alence increases dramatically with age, to half or more of those care costs, and increased loneliness and social isolation. “Hear-
over 70. Hearing loss often comes on so gradually that many don’t ing is fundamental to healthy aging,” says Nicholas Reed, an au-
notice; others ignore it. Only an estimated 15 to 25 percent of diologist and epidemiologist at Johns Hopkins, who worked with
adults who would benefit from hearing aids use them, and use is Lin on the cognitive-decline study.
lowest among people who have less access to health care. These consequences of hearing loss contributed to the Food
Yet recent research has revealed that even mild or moderate and Drug Administration’s decision last year to create a category
hearing loss in older adults is associated with accelerated cogni- of over-the-counter hearing aids. Traditional aids, dispensed by
tive decline. People with hearing loss are more likely to develop audiologists, average $4,700 a pair and are not covered by Medi-
dementia, and the likelihood increases with the severity of the care or most private insurance. Most of the new OTC devices cost
between $500 and $1,900. But quality varies a lot in this
range. The high end includes customizable devices. Less
expensive aids are preset with limited options—a one-
size-fits-all approach that doesn’t really fit all.
Most users of OTC devices still benefit from help get-
ting set up and then troubleshooting devices. But set-
up help doesn’t have to come from audiologists. In Bal-
timore, the Johns Hopkins Cochlear Center created a
successful program of peer mentoring for older low-in-
come adults with hearing loss.
It’s too soon to assess whether the new devices will
close the yawning gap between the large need for hear-
ing aids and the smaller demand for them. In one sur-
vey, only about half of nonusers said they would use
hearing aids even if they were free. It may help that pop-
ular consumer-oriented brands such as Hewlett-Pack-
ard and Jabra have jumped into the field. The key to
getting around stigma will be “the ubiquity of wanting
to hear well” and the sense that “everyone is doing it,”
Lin says. If “wireless earbuds also become hearing aids,
that changes the whole perspective of what it means to
use hearing technology.”

22 Scientific American, September 2023 Illustration by Jay Bendt

Q&A

Puritanical Law ing, but the case is most likely headed back to the Supreme Court.
Kacsmaryk’s ruling and the initial Fifth Circuit decision cit-

Strikes Again
ed a 19th-century law known as the Comstock Act of 1873, which
made it illegal to send “obscene, lewd or lascivious” materials by
mail—including information related to abortion or contracep-
tion. Although the Supreme Court greatly weakened the law in
The Comstock Act against “obscene” the 1960s, it quietly remained on the books until the mifepris-
material has legal influence today tone lawsuit revived it.
By Tanya Lewis Science journalist and author Annalee Newitz spent years in-
terviewing people about the Comstock Act and researching Com-
A high-stakes case i nvolving access to the abortion pill mifepris- stock himself for their 2019 novel The Future of Another Time-
tone has been wending its way through the courts this year. At line, i n which characters time travel to try to block the original
issue is the U.S. Food and Drug Administration’s approval of the antiobscenity crusade. Scientific American spoke with Newitz
drug, one of two medications that have been prescribed togeth- about how this 150-year-old law is still being used to restrict re-
er for more than two decades to end pregnancies. productive rights.
In early April, Texas district judge Matthew Kacsmaryk
ruled in favor of antiabortion organizations and doctors de- [A
 n edited transcript of the interview follows.]
manding the fda’s approval of mifepristone be revoked. The
Fifth Circuit Court of Appeals issued a partial stay of the ruling, Tell me about Anthony Comstock, for whom this law is named.
maintaining mifepristone’s approval but restricting its distri- He was a very famous moral crusader based in New York [City]
bution. The U.S. Supreme Court temporarily preserved access in the mid-19th century. Comstock was interested in stamping
to the drug while the case is being heard by the Fifth Circuit out obscenity—and by “obscenity,” he meant any imagery or lit-
Court. As of this writing, the appeals court had not issued a rul- erature that contained nudity, among other things. He was ex-

24 Scientific American, September 2023 Illustration by Shideh Ghandeharizadeh

 Tanya Lewis is a senior editor
covering health and medicine
for Scientific American.

treme for his time, but at a certain point kind of rejiggering of the First Amend- ous—and what we need is a law that says
he managed to connect with the New York ment—because, remember, obscenity is abortion is legal and birth control is legal.
City YMCA, which was also against what an exemption to the First Amendment. But what we keep doing because of our
it was referring to as obscenity. By con- In the early 20th century this idea of Comstockery as a nation is saying, “Oh, we
necting with that organization, he got ac- Comstockery became very popular. The wouldn’t want to give people rights to have
cess to a lot of powerful New Yorkers who laws were viewed as old-fashioned, and an abortion. Why don’t we just say that
were able to fund his campaign. He got they weren’t really taken off the books, they have a right to do whatever they want
himself a position as a special inspector at but they were mostly ignored. And at the in private, and then we’ll just avoid talking
the postal service. Much of the Comstock same time, courts were using them to con- about the issue?” And what that means is
Act’s power comes from the ability to reg- tinue limiting, especially, abortifacients, that we continue to allow women to be
ulate communications across state lines. abortion information and reproductive [treated like] second-class citizens.
The law forbids the sending of obscene health information.
materials through the mail. Comstock was In the 1930s there were some rulings How did Comstock use the courts and
enforcing the law by ordering tons of items around the Comstock Act that broadened other means to enforce his agenda?
through the mail, from contraceptives and its application to different kinds of birth In the 19th century Comstock was like,
sex toys to erotic images and abortifacients control but at the same time limited how “I’m going to use surveillance, and I’ll use
[substances that end a pregnancy]. Then, the law could be used if people were send- this brand-new position in the postal ser-
after receiving the items, he would prose- ing abortifacients for unlawful uses. So in vice to police what I call obscenity.” He
cute the people sending them. He was tar- the 1930s there’s this limit where it counts also ran this organization called the New
geting people who were known to be sell- under the Comstock Act only if you delib- York Society for the Suppression of Vice,
ing the raw material but also, more impor- erately are sending somebody something which just sounds like something out of a
tant, people who were selling any kind of to illegally abort a pregnancy. Then, in the Marvel comic. And they would do these ar-
information that was [sex] education-re- 1950s, there was an expansion of the Com- rests all the time. So it feels very much like,
lated—literally things like “here’s how to stock Act to include any substance that yes, it comes out of using the courts. But
make a baby” and information about birth could lead to an abortion. it also comes out of abusing police power
control and abortion. The Comstock Act Then you get this shift in the early because these were people who were, like,
was actually a First Amendment exemp- 1970s around privacy law, and reproduc- pseudo police officers, and they would fig-
tion law. It was a law about what could be tive health is placed under privacy. Pretty ure out who was an abortion provider.
said and what could be passed through the much every lawyer I’ve ever talked to It’s all tied up with a lot of the same is-
mail. Any information or material related about this who’s superknowledgeable sues that we’re grappling with nowadays:
to reproductive health or abortion or sex about reproductive rights is like, Why did What kinds of books should we allow chil-
education was classified as obscene. we do that? That was such a precarious dren to read? What should police powers
In the early 20th century playwright ruling—so easy to roll back, as we’ve seen be? What is the role of courts? But now that
George Bernard Shaw wrote an op-ed in with last year’s Supreme Court decision they’re picking on mifepristone, I think
the N ew York Times m  aking fun of Com- overturning R  oe v. Wade. B ut it seemed we’re going to get a really funny backlash
stock—because by the late 19th century, like a good idea at the time. In the process, from an unexpected source perhaps—which
even though the laws were in effect, many of course, that meant these Comstock laws is the pharmaceutical industry. I think the
modern young people thought he was an remained on the books in many places. pharmaceutical industry is saying, “This
idiot. Shaw said America was suffering is going to go after our bottom line.”
from “Comstockery.” He was using this In T he Future of Another Timeline,
term to refer to the censorship and puri- characters travel back in time to try to What happened to Comstock himself?
tanical nature of American art, and it be- prevent the Comstock laws. When you He was basically laughed out of his posi-
came a meme. People started using “Com- wrote the book, did you expect these tions of power. By the time he died, he was
stockery” to make fun of any kind of art or laws to be used in a ruling like that in considered to be just a joke. Right after
storytelling or writing or politics that was the recent mifepristone case? he died is when Margaret Sanger started
old-fashioned and puritanical. Definitely not. I’m probably the only per- founding her clinics, which eventually be-
son who has written a time-travel story came Planned Parenthood. So even that
How have the Comstock Act and about trying to defeat Comstock, although aspect of his work was kind of crushed
related laws evolved over time? I’d love to be wrong about that. But there under the wheels of this new era of fami-
The Comstock laws were being actively are a lot of law experts and obscenity ex- ly planning.
used basically through the 1960s, which perts whose work I’ve read over the years
is shocking. And in the 1970s we saw on who have said the laws that protect peo- J O I N T H E C O N V E R S AT I O N O N L I N E
the Supreme Court a revolution in our un- ple’s rights to have an abortion and to have Visit Scientific American on Facebook and Twitter
derstanding of what obscenity is and a access to birth control are superprecari- or send a letter to the editor: [email protected]

September 2023, ScientificAmerican.com 25

PA L E O N T O L O G Y

Evolution of the

Earth
Shakers
Sauropod dinosaurs
are by far the biggest
creatures ever to have
walked on Earth.
New research hints
at how they got to be
so gargantuan
By Michael D. D’Emic
Illustration by Chase Stone

26 Scientific American, September 2023

 SAUROPOD DINOSAURS such as
 rgentinosaurus evolved larger body sizes
A
than any other group of terrestrial animals.

September 2023, ScientificAmerican.com 27

 Michael D. D’Emic is a paleontologist at Adelphi University.
He studies the evolution of growth and body size in dinosaurs.

O
f all the animals ever to have roamed the planet, the iconic
long-necked, long-tailed dinosaurs known as sauropods
stand unrivaled. No other terrestrial creatures have come
close to attaining their colossal sizes. They overshadowed
all other dinosaurs, from the duck-billed hadrosaurs and
the horned ceratopsians to the armored ankylosaurs and
predatory tyrannosaurs. Even the mightiest land mam-
mals—mammoths and rhinoceroslike beasts that were up
to twice as heavy as the largest elephants alive today—were
featherweights compared with the biggest sauropods.
From an evolutionary perspective, this singularity Thanks to a wealth of sauropod discoveries over
makes sauropods an intriguing anomaly. Evolution is the past few decades, paleontologists are beginning
rampant with examples of convergence, in which the to piece together the answer to this question. Analy-
same feature evolves more than once independently ses of this burgeoning fossil record reveal where and
in different groups of organisms. A classic example of when these dinosaurs became giants, and the factors
convergence is powered flight—flapping wings evolved that allowed them to evolve extreme sizes again and
in birds, bats, pterosaurs and insects, but the partic- again over the course of their nearly 150-million-year-
ular bones or other structures making up the wings long reign. They also suggest that, as mind-bogglingly
differ among the groups, attesting to their indepen- huge as the largest-known sauropods were, even big-
dent evolutionary origins. Convergence in evolution ger ones remain to be discovered.
is very common even when it comes to complicated
features: warm-bloodedness, eyes that can move and A GROWING FOSSIL RECORD
focus, bipedal locomotion, the loss of limbs, the use Figuring out how sauropods evolved their uniquely
of tools, and live birth all evolved multiple times in enormous sizes has proved challenging because his-
different animal groups. Convergence is widespread torically they had a relatively terrible fossil record—
in the plant kingdom as well: carnivorous plants much worse than that of many other land animals and
evolved at least a dozen times, roots evolved more than orders of magnitude worse than that of most animals
once, and even arborescence—plants taking the form that live in the sea. The first step in becoming a fossil
of trees—evolved more than once. With convergence is burial, and for immense sauropods that would have
so common in nature, sauropods’ uniqueness in size required an event that could deposit a lot of sediment
is special in itself. No other land animal has ap­­ on the body at once. Think landslides and flash floods,
proach­ed even a third of the largest sauropods’ which might take place only a few times a decade or
weight. What makes sauropods stand out from the century in a given region, as opposed to the seasonal
crowd, both literally and figuratively? flooding of smaller streams and rivers that can bury

28 Scientific American, September 2023

 Brachytrachelopan mesai Giraffatitan brancai Camarasaurus supremus Omeisaurus tianfuensis Diplodocus carnegii

smaller animals multiple times a year. Compounding species known from around the globe, and research-
this problem, landslides and flash floods are violent ers continue to make important discoveries in areas
affairs that scatter the fragile parts of an animal’s skel- that are relatively unexplored, such as Antarctica,
eton. Sauropods had particularly uneven skeletons, and in areas that have been surveyed for decades, in­­
combining dense limb bones as thick as tree trunks, clud­ing Australia and North America.
vertebrae so riddled with air sacs that they resemble From these new discoveries we know that sauro-
honeycomb, and small skulls composed of sometimes pods’ overall body proportions varied quite a bit.
paper-thin bones. Some were slender like giraffes, and others were
There’s a human element holding back the sauro- stocky like elephants. Some had necks that elegantly
pod fossil record as well. A paleontologist can spend mirrored their tails, whereas others appeared unset-
a field expedition digging up just a handful of sauro- tlingly off-kilter. Some had longer front legs than
pod bones or, in the same amount of time, scout and rear, giving them a stately appearance; others had
collect several skeletons of smaller creatures. Like- low-slung shoulders, keeping their necks and heads
wise, scientists can spend their finite research time near the ground. From their footprints we know that
in a museum waiting to get a single bone down from some sauropods walked with their legs near the mid-
a shelf with a forklift or get straight to the business line like most quadrupeds; others held their legs far-
of studying the anatomy of a more sensibly sized ani- ther out, like 50-foot-long French bulldogs. This
mal. With limited time and grant funding, sometimes diversity of body forms meant that multiple sauro-
sauropods are skipped over. pods could coexist in the same ecosystems, with each
Despite these hindrances, both the sauropod fos- species adapted to exploiting different resources
sil record and our understanding of it have im­­proved within a given setting. We often find more than one
greatly over the past few decades. Throughout most sauropod species from a given time and place.
of the 20th century, few new sauropods came to light. Their diversity of body forms also makes compar-
In the 1990s the situation began to change, as inter- ing the evolution of body size in terms of length or
est in dinosaurs ratcheted up and paleontologists height tricky, so biologists turn to body mass (or
undertook more excavations. Around the turn of the weight) to make more equitable comparisons. Body
millennium, sauropod discoveries increased quickly. mass is not just useful for making apples-to-apples
For the past decade researchers have commonly comparisons. It also correlates with biologically im­­
announced around 10 new species each year. With port­ant features such as metabolic rate, growth rate,
this better sauropod record available, we can finally nest clutch size, longevity and home range size. In
start to study the evolution of their tremendous sizes. this way, calculating body mass can give us an idea
of these features of an extinct animal, so long as we
14 are mindful of how fuzzy or sharp the correlation is.
Annual Number of
Newly Named Sauropod Species

12 Several methods exist for estimating body mass

in extinct animals. The most popular is based on limb
10
bone dimensions. Think of sauropod limb bones as
8 columns supporting a building. Because the amount
6 of weight supported by a column increases with
thickness, we can estimate the mass of a sauropod
Michael D. D’Emic, restyled by Jen Christiansen (c hart)

4
based on the cross-sectional area of its limb bones.
2 About 200 of the 250 sauropod species on record are
0 known from fossils that include limb bones complete
1985 1990 1995 2000 2005 2010 2015 2020 enough to measure this way.
I recently obtained these measurements and used
them to chart sauropod body mass evolution. It turns
TIPPING THE SCALE out that over their long history, sauropods evolved a
To figure out why sauropods are so exceptional, we wide range of sizes. The largest include the truly gar-
must first understand when, where and how they got gantuan, such as the more than 50-metric-ton titano-
that way. Currently there are about 250 sauropod saur Patagotitan. The smallest, such as the 20-foot-

Illustrations by Scott Hartman September 2023, ScientificAmerican.com 29

 long M
 agyarosaurus, w  eighed only as much as a bull.  iplodocus, an especially long-tailed sauropod that
D
I plotted these species on an evolutionary tree and inhabited western North America around 155 million
stretched the tree over time to see when and how to 145 million years ago. The D  iplodocus specimen
many times sauropods increased or decreased their known as “Dippy,” replicas of which are exhibited in
body mass. When they first appeared more than 200 museums around the world, weighed a paltry 14 tons
million years ago, they were relatively small—about in life, smaller than the largest mammoths or rhinoc-
the size of a rhinoceros. By around 165 million years eroslike mammals of the past. Dippy’s weight is close
ago the first giants, non-neosauropods, including the to the average sauropod body mass. Like Dippy, three
ultralong-necked mamenchisaurids, evolved. fourths of all sauropods weighed less than the larg-
Most sauropods were not exceptional in size com- est land mammal.
pared with the largest terrestrial mammals. Consider From this relatively modest stock, I found, sauro-

Becoming Giant Again and Again

Sauropods evolved a wide range of sizes o  ver the course of their 25,000 kilograms—36 times. Each new family gave rise to one
nearly 150-million-year reign. The earliest ones were relatively or more lineages that became huge. These largest sauropods
small, around the size of a rhinoceros. The first giants emerged differed from one another in the shape of their teeth and heads
by 165 million years ago. In the span of 100 million years, sauro- and in their body proportions, indicating that they ate dif­-
pods evolved enormous sizes—with masses of more than ferent things—and thus occupied different ecological niches.

Non-neosauropods Diplodocoids Turiasaurians Brachiosaurids Early macronarians Titanosaurs

The maximum known body mass for land mammals is around 25,000 kilograms. The first sauropods to
cross this threshold for gigantism were the non-neosauropods (lime green), followed by the diplodocoids
Body Mass (kilograms) (blue). In total, 36 sauropod lineages representing at least six families evolved giant proportions.
70,000
60,000
50,000
40,000 First known massive
sauropod species
30,000

20,000
Ancestor of first
massive sauropod

10,000

5,000

Most sauropod species were

not especially huge compared Each endpoint is a species
Michael D. D’Emic, restyled by Jen Christiansen (c hart)

with the largest known land Each vertex is a reconstructed ancestor

mam­mals—certain extinct Lines connect reconstructed
elephant relatives and a ancestors with known species
rhino­ceros­like creature called
Paraceratherium. B ut the 1,000 Europasaurus
largest sauropods towered Magyarosaurus
over these mammalian giants,
as well as duck-billed dinosaurs Triassic Jurassic Cretaceous
such as S hantungo­saurus
and predatory dinosaurs 220 200 180 160 140 120 100 80
such as T . rex. Millions of Years Ago

30 Scientific American, September 2023 Illustrations by Scott Hartman

 pods evolved their record sizes a remarkable three
dozen times on six landmasses over the course of 100
million years. Sauropods evolved their hallmark sizes
early on, and with each new family to evolve, one or
more lineages independently reached superlative sta-
tus. This filling and refilling of the “ex­­tremely large
body” niche mirrors the pattern seen in land mam-
mals, which evolved very large body sizes quickly in
the wake of the dinosaur extinction, before plateau-
ing in the gigantic-mammoth range.
The largest-of-the-large sauropods had differently
shaped teeth and heads and distinctively propor-
tioned bodies, indicating that these herbivorous
dinosaurs ate different plants and lived in subtly dif-
ferent habitats. In other words, like sauropods in gen-
eral, the heftiest sauropods occupied somewhat dif-
ferent ecological niches from one another.

THE LIMITS OF EVOLUTION

The sheer size of the biggest-known sauropods raises
fascinating questions about the limits of evolution:
Just how big can animals get on land? And why can’t
they get bigger than that? Biomechanical studies
provide some hints. Mobility decreases as limb bones
increase in thickness to support a larger animal’s
weight, so there is an upper limit to how thick limb
bones can be while still supporting a functional ani-
mal. From a physics perspective, research by Jyrki
Hokkanen of the University of Helsinki suggests that
the theoretical limit for terrestrial body mass based
on biomechanics is well over 100 metric tons. Over
the years, murky reports of a few now-lost fossils
have hinted at the existence of sauropods with
masses greater than that. But the largest definitive
sauropod, the exceptional 75-metric-ton A  rgentino-
saurus, doesn’t approach that limit. In addition to
biomechanics, factors such as resource and habitat
availability and heat dissipation also limit maximum
body mass in complex and interacting ways that are
difficult to predict. For now all we can say is that ter-
restrial animals could get at least as big as A  rgenti-
nosaurus a nd most likely bigger. It is probably only
a matter of time before sauropods larger than Argen-
tinosaurus are discovered.
To reach their record sizes, sauropods underwent
record growth. They had the most growing to do of
any animal (in an absolute sense), passing through
four orders of magnitude in body mass. They had to just a foot or two long. In contrast, placental mam- PATAGOTITAN,
grow so much not only because their adult body sizes mals, which give birth to live offspring, have young discovered in
were huge but also because they started out so small. that start out relatively large. For example, blue Argentina in 2010,
is one of the largest
© chrisstockphotography/Alamy Stock Photo

Like other dinosaurs, including modern birds, sauro- whale calves are around 20 to 25 feet long when they
pods hatched from eggs. The larger an egg is, the are born, so they must approximately quadruple in sauropods on
sturdier the shell needs to be. But evolution can length to reach their adult size—a modest task com- record. It weighed
thicken and strengthen eggshell only so much be­­ pared to the perhaps 100-fold increase in length set an estimated
cause the shell must allow for gas exchange and the before a hatchling sauropod. 50 metric tons
eventual exit of the hatchling. These demands greatly Studies of the bones of several sauropod species or more.
restrict egg size. Sauropod eggs were cantaloupe- to have revealed how they accomplished this growth.
basketball-sized, smaller than those of the biggest Just as trees contain rings that can be counted to
birds. Even a 100-foot-long sauropod started out life de­termine their ages and growth histories, bones

September 2023, ScientificAmerican.com 31

DIPLODOCUS, contain rings that record a vertebrate animal’s age Sauropods probably needed to grow fast because
the most common and its rate and duration of growth. Modern-day ver- although adults may have been safe from predators,
sauropod exhibited tebrates exhibit a variety of growth strategies. Rep- hatchlings were easy prey that had to compete with
in museums, tiles, including alligators, lizards and turtles, grow other groups of dinosaurs and animals for resources.
inspires awe for relatively slowly, whereas large mammals such as the Unlike large mammals such as whales, which spend
its size. At around blue whale grow rapidly. If sauropods grew at the rel- years raising each calf, sauropods pursued a quan-
14 metric tons atively sluggish rates that reptiles do today, it would tity-over-quality approach to reproduction, produc-
Dan Kitwood/Getty Images

it weighed only have taken a century or more for them to reach their ing lots of eggs and then leaving their young to fend
a sixth as much immense sizes. Instead, as the growth rings reveal, for themselves. Fossils show that at least some groups
as the largest they grew impressively quickly—on par with the of sauropods nested in colonies and built their nests
sauropod, however. growth rates seen in many large mammals to­­day— quite close together—too close for an adult to pass
attaining adult size in 20 to 50 years. between—which would have prevented parental care.

32 Scientific American, September 2023

 food was available year-round could have facilitated
this sustained growth. A research team I was part of re­­
cent­ly showed that some sauropods likely migrated
great distances, for example from the Great Lakes
region to the Rocky Mountains. The ability to continue
growing throughout the year may have been a key inno-
vation, sustained by great migrations, that facilitated
the emergence of gigantism in early sauropods.

WHY SUPERSIZED?
We are only just b  eginning to understand why sau-
ropods got so big. The answer seems to be complex,
with no single way to explain the existence of all of
the largest-of-the-large species. Like all dinosaurs,
sauropods exhibited a mix of characteristics found in
today’s reptiles, birds and mammals. A large team led
by a group of researchers from the University of Bonn
in Germany has shown that some of the sauropods’
more “reptilian” traits are probably what allowed
them to become the largest animals ever to walk on
land. Sauropods had simple teeth incapable of chew-
ing, which meant they could ingest food quickly and
ferment it in their gut, as evidenced by their volumi-
nous rib cages. Not chewing also meant they didn’t
need bulky jaw muscles, so their heads could stay
small. That arrangement, in turn, allowed for the evo-
lution of a longer neck, which let them reach wide
swaths of food without moving much—a very energy-
efficient way of life. Reproducing by laying eggs and
not caring for their young allowed sauropods to focus
their energy and resources on growth.
Sauropods also independently evolved a birdlike
lung with air sacs throughout their bodies, making
their breathing more efficient and their bodies lighter
for their size. Many large sauropods were upward of
10 percent air inside, overall.
Their long necks and small heads, lack of paren-
tal care, and air-filled bodies explain why sauropods
are bigger than other land animals in general. But
these traits don’t explain why 36 lineages within the
sauropod group surpassed the other lineages to
attain truly epic proportions. Each case seems to have
been distinct—predation pressure may have led to
the evolution of increased growth rates in one in­­
stance, resource abundance could have allowed for
extended growth seasons in another—and will re­­
quire a lot more study to solve.
The faster hatchlings could grow, the better their So much about sauropods is awe-inspiring: they
odds of surviving predators. pushed the bounds of biological possibility not once
That said, sauropod growth rates varied quite a bit but dozens of times. With an ever improving fossil
from species to species. As sauropods initially evolved record, we hope to soon understand some of the evo-
larger sizes, they did so by growing faster during annual lutionary pressures that led sauropods to become,
growth pulses while pausing growth during unfavor- over and over, the largest land animals of all time.
able seasons, like most animals do. Later sauropods
seem to have further adapted by eliminating or mini-
mizing seasonal pauses and growing quickly through- FROM OUR ARCHIVES
out the year, according to re­­search carried out by Ceci- Triumph of the Titans. Kristina A. Curry Rogers and Michael D. D’Emic; May 2012.
lia Alpadetti of the National University of San Juan in
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a
Argentina and her colleagues. Migrating to areas where

September 2023, ScientificAmerican.com 33

POLYMETALLIC NODULES
from the deep ocean floor are
rich in valuable minerals such
as cobalt and nickel.

34 Scientific American, September 2023

 ENVIRONMENT

DEEP-SEA
DILEMMA
Mining the seafloor could boost
production of clean energy technology.
It might destroy irreplaceable
ocean ecosystems in the process
By Olive Heffernan

Photographs by Vincent Fournier

September 2023, ScientificAmerican.com 35

 Olive Heffernan is a science journalist based in Dublin,
Ireland, and author of a book about the high seas,
forthcoming in the spring of 2024.

B
izarre creatures from the black ocean abyss, preserved in glass jars, line stacks of
shelves in deep-sea biologist Adrian Glover’s laboratory at London’s Natural History
Museum. Among them is a ghostly white animal, oddly elegant and shaped like an
ornamental flower with a glass stalk, retrieved from the bottom of the Pacific Ocean,
five kilometers down. Ninety percent of the species Glover has assembled had never
before been seen by humans.
Glover is part of an international effort to discover little about,” Glover says. “Whether they would provide
what lives on a remote part of the Pacific Ocean seafloor food on a plate or stop climate change or become the
called the Clarion-Clipperton Zone. The CCZ is a vast next cure for cancer, we can’t say yet. Though we could
abyssal plain slightly larger than the European Union, do the research to find out.”
situated between Mexico and Hawaii, dotted with rocky Not everyone wants to wait for more discovery. A
outcrops and seamounts. It is one of the most pristine Vancouver-based start-up called The Metals Company
and least explored parts of our planet—and it may soon (TMC) is pushing to start mining the CCZ in 2024, in
endure the world’s first deep-sea mining operation. partnership with the Pacific Island nation Nauru. Big
Trillions of black, potato-size rocks known as poly­ machines would scrape the seafloor, scooping up nod-
metallic nodules are strewn across the CCZ seafloor. ules while kicking up clouds of sediment, potentially
The nodules contain valuable metals, including cobalt, damaging the deep sea on a vast scale by removing hab-
copper and nickel needed for electric vehicles; rare itat and species and altering ecosystems.
earth elements crucial for clean energy technologies; Whether TMC goes ahead with its plans is up to the
and smaller amounts of lithium, in high demand for International Seabed Authority (ISA), a United
batteries. Surveyors expect the overall tonnage across Nations–affiliated agency responsible for promoting
the CCZ to be substantial, in some cases higher than deep-sea mining in international waters while also
the sources now mined on land. protecting the deep sea from harm. ISA has not final-
Glover hands me a nodule, which looks and feels like ized its mining code, so deep-sea miners such as TMC
a small lump of coal, cold and lifeless. On closer inspec- have no guidelines about how they should operate.
tion I can see faint traces of foraminifera, single-cell There are significant unknowns about po­­tent­ial envi-
organisms fundamental to the marine food web, which ronmental damage, as well as about what lives in this
once covered its surface. Each nodule starts as a little remote part of the Pacific and how the region may con-
fragment, perhaps a shark’s tooth or a piece of seashell. tribute to ocean health. Given ISA’s conflicting man-
Over a long time, metals slowly gather and form an date, many experts are concerned that it will prema-
expanding crust around this node, growing just one to turely green-light commercial extraction because of
10 centimeters every million years. The specimen in my industry pressure.
hand would have taken about 10 million years to form. It’s not just environmentalists who are concerned;
Out on the soft CCZ seafloor, nodules offer a hard governments and even corporations that want the
surface for tiny creatures, from microbes to sponges, minerals in the nodules have taken a stand against
to cling to—a life-giving substrate in a severe habitat. mining in international waters, at least until the
Water temperatures can reach zero degrees Celsius, potential impacts of deep-sea mining can be fully
there is virtually no light, and pressures can exceed assessed. The growing chorus of voices includes
1,000 bars, equivalent to having a couple of elephants France, Germany and Chile; BMW and Google; and
standing on your big toe. The minuscule life attracts more than 700 experts. Scientists such as Glover are
other animals; octopuses, for example, lay eggs in the scrambling to collect data, in many instances funded
sponges. Over time, unique communities form across by contractors, in­­clud­ing TMC, which need it to
seafloors strewn with nodules. obtain mining approval. “The rush to understand this
Life in the CCZ doesn’t exist in great abundance, but place has been related to the fact that we may lose it,”
it does exist in great diversity. The nodules “are home says Diva Amon, a deep-sea biologist at the Universi-
to hundreds, maybe thousands, of species that we know ty of California, Santa Barbara.

36 Scientific American, September 2023

 AN ANIMAL c alled
a crinoid, or sea lily,
inhabits the seafloor
4,800 meters deep,
in the central Pacific
Ocean’s Clarion-
Clipperton Zone,
targeted for mining.

September 2023, ScientificAmerican.com 37

 Where the Nodules Are
Polymetallic nodules—small rocks containing valuable minerals— of the likely concentration of nodules and the likely density of
can be found in abundance on various regions of the deep sea- metals in them, extrapolated from samples and seafloor charac-
floor. The U.S. Geological Survey has identified four zones where teristics. The International Seabed Authority has granted 17 of
prospects are high. Each zone represents a unique combination its 30 exploration licenses in the Clarion-Clipperton Zone.

Nodule Zones Atlantic Ocean Peru Basin

Clarion-Clipperton Zone - Central Indian Ocean Basin West Pacific Ocean - Penrhyn Basin

Clarion-Clipperton
Zone (CCZ)

SUNKEN TREASURE TMC has contracts to explore three CCZ plots for
Gerard Barron, CEO of TMC, d  escribes a polymetallic nod- nodules, in partnership with sponsoring states Nauru,
ule as a “battery in a rock.” The self-assured prospector Tonga and Kiribati. In June 2021 TMC and Nauru,
says deep-sea mining is a rare opportunity to transition through a venture called Nauru Ocean Resources, Inc.
the world off fossil fuels. His company has secured the (NORI), invoked an arcane ISA statute known as the

Based on Regional Variations and Genetic Types of Nodules,” by Kira Mizell, James R. Hein, Manda Au and Amy Gartman,
Source: “Estimates of Metals Contained in Abyssal Manganese Nodules and Ferromanganese Crusts in the Global Ocean
rights to explore for minerals across several large tracts two-year rule, which obligates ISA to allow mining to
of the CCZ—enough metals, he claims, to power 280 proceed within two years, regardless of whether a min-
million electric vehicles, equivalent to the entire U.S. car ing code is in place. In theory, TMC could have begun
fleet. Prospectors note that deep-sea mining could be commercial extraction in July.
the start of ethical mineral extraction: doing away with In November 2022 the company completed its first
child labor linked to terrestrial mines in some countries, trial; onboard the 228-meter-long mining vessel H  id-

in Perspectives on Deep-Sea Mining, e dited by Rahul Sharma. Springer, 2022 (reference)

providing revenue to developing nations through deep- den Gem, Barron’s team hauled up more than 3,000
sea profit sharing and leaving a better environmental metric tons of nodules from 4.3 kilometers underneath
legacy than mining has on land. the ocean’s surface, proving that it is ready, and
No one has yet scoured the deep sea commercially, equipped, to start commercial work.
but exploration is happening in national and interna- TMC is the likely frontrunner in the race to mine
tional waters. Norway, for example, has recently pro- the deep sea because it is the only contractor to have
posed opening its continental shelf to mining. ISA, invoked the two-year rule. Barron plans to start in 2024.
which presides over the international seabed, has grant- The company rose from the ashes of Nautilus Miner-
ed 30 exploration contracts covering 1.4 million square als, a Canadian start-up headed by a geologist and
kilometers of the seafloor to prospective miners. Of friend of Barron’s named David Heydon, who subse-
those, 17 are for sites in the CCZ; each plot measures quently founded DeepGreen, later rebranded as TMC.
around 75,000 square kilometers, roughly the size of Barron was one of the early Nautilus investors. Nauti-
Ireland. The other contracts cover nodules in the West- lus intended to excavate minerals from hydrothermal
ern Pacific Ocean and Indian Ocean, as well as massive vents, often teeming with exotic life, in Papua New
sulfide deposits at hydrothermal vents in the Atlantic Guinea’s territorial waters. The start-up developed and
and Indian Oceans, and cobalt crusts that line the tested three big mining machines, each the size of a
flanks and summits of seamounts at various Pacific sites. combine harvester and weighing about six metric tons,

38 Scientific American, September 2023 Map by Jo Hannah Asetre

which quickly came to symbolize the damage industry the standard duration, could strip 10,000 square kilo-
could impose on the ocean floor. Faced with issues meters (3,900 square miles) of seabed.
related to securing a vessel, as well as lack of invest- Some upset is certain. Given the incredibly long time
ment, in 2019 the company liquidated. it takes nodules to grow and their role as a substrate for
Barron, who got out before Nautilus went bust, has marine life, “it’s very clear that if you take the nodules
cast himself as a green miner. The 56-year-old Austra- away, the ecosystem would move to a different state for
lian exhibits the casual ease of a Silicon Valley tech millions of years,” says Sabine Gollner, a research scien-
mogul: tight beard, shaggy hair, jeans and white tist at the Royal Netherlands Institute for Sea Research.
T-shirt. He also wears a combat-style jacket, inside As the big machines crawl along, they will suspend
which he carries a softball-size polymetallic nodule— large amounts of fine sediment in the water, which
a portable prop for his pitches. When he talks about could settle as much as tens of kilometers away. Scien-
his company’s plans, Barron exudes confidence and tists have little evidence for what the effects might be,
calm optimism. “I think it’s important to remember but it is plausible the plume could smother sedentary
that we’re doing this because the world agrees that we creatures such as sea anemones and sponges. Barron
should move away from fossil fuels,” he told me when cites a 2022 study led by the Massachusetts Institute
we met recently at a café in west London. “That tran- of Technology that found that the sediment plume
sition is going to be very, very metal-intensive.” kicked up by mining vehicles didn’t disperse as wide-
Prospectors contend that without deep-sea mining ly as people thought it would. But that was from an
the world will run out of valuable metals for green experimental trial with a prototype collector about
technologies. According to the World Bank, we’ll need one-third the size of an actual machine.
more than three billion (nonmetric) tons of minerals Sediment stuck to the nodules is sucked up along
and metals to deploy the wind, solar and geothermal with them to the surface vessel. Onboard, the nodules
power required to avoid two degrees C of global warm- would be cleaned before being transported to a shore-
ing. Some estimates predict that the reserves of cobalt, based facility for processing, and the waste sediment
used widely in rechargeable batteries, and of nickel, would be pumped back into the ocean through anoth-
used in electric vehicle batteries and renewable ener- er long pipe. To save on expenses, most contractors plan
gy storage, in the CCZ are significantly larger than the to release this “dewatering plume” at around 1,000
remaining reserves on land, although it’s hard to gauge meters above the ocean floor. This rain of sediment is
the real extent of resources in the abyss, especially likely to cause problems for midwater swimmers, such
those that are easily recoverable. as jellyfish, by interfering with their visual communi-
Not everyone is convinced of an impending short- cation cues or their ability to filter food from the water.
age—or that, in the event of one, deep-sea mining is the It could also clog the gills of commercial species that
only solution. The Institute of Sustainable Futures says forage there, such as fish and shrimp, which are eaten
a global transition toward 100 percent renewable ener- by larger species like tuna and billfish.
gy could be met with land-based reserves. “Urban min- Barron’s response to environmental concerns is that
ing”—recovering metals from our discarded comput- land mining creates extensive ecological damage and
ers, mobile phones, tablets and other electronics— in some places involves human labor abuses. He points
could also be greatly scaled up. The world recycles less to the growth in nickel mining in the world’s equatori-
than 20 percent of its electronic waste, and safe dispos- al rain forests, notably Indonesia and the Philippines,
al is a rapidly growing problem. Also, future demand which studies have shown seriously harms ecosystems
for certain metals, such as cobalt and lithium, may not there. “You can’t look at one [environmental] situation
be as high as once anticipated; Tesla now uses cobalt- without having an eye on the other,” he contends.
free batteries in half of its new cars. Manufacturers are
exploring alternatives to lithium-based batteries, too. WEAK SCIENCE
Under ISA rules, c ontractors have up to 15 years to
SMOTHERED BY SEDIMENT explore their claim areas. They must conduct a “base-
If the 17 CCZ exploration contracts all progress to line survey” of the nodules and the environment—
exploitation, it’s possible that within a decade, multi- including details of the habitat and what lives there—
ple operators will be dredging the seafloor for nodules. and submit it to the ISA’s Legal and Technical Com-
Most operators, including TMC, would use harvesters mission as part of their exploitation application. The
to mine the dark seafloor. A typical harvester is fitted type and amount of data included in the survey, how-
with twin caterpillar tracks like those on an army tank ever, are left up to the contractors, based on ISA guide-
so it can crawl across the seabed sediment. The har- lines, and the commission is still discussing what data
vester sucks up nodules, whipping up a cloud of fine might be acceptable.
silt as it travels along, and sends them to a surface ves- Some mistrust stems from the fact that ISA has
sel through a pipe called a vertical riser. An average never refused an application for exploration, even
harvester would gather about 400 metric tons of nod- in regions recommended as marine-protected areas
ules per hour from the CCZ floor; that’s 67,000 metric by international conservation organizations. One espe-
tons per week. One machine, over a 30-year contract, cially contentious case is a 2018 contract awarded

September 2023, ScientificAmerican.com 39

 Elements of Interest Elements likely to be found in
polymetallic nodules
Seafloor nodules can contain numerous metals and other
elements (light blue), although some of the concentrations Top 10 elements in nodules,
by estimated tonnage
may be small. Many of the top 10 most abundant materials
(by weight) are commercially important (dark blue). Many Elements designated as
of them are in the U.S. Geological Survey’s most recent list “critical minerals” by the U.S.
Geological Survey in 2022
H of critical minerals—those considered essential to the economy He
and at risk of reliable supply—and minerals important to
Lithium Beryll- clean energy, such as cobalt, lithium and nickel, may abound. B C N O F Ne
ium These characterizations are based on limited nodule samples
and could vary widely across ocean floors. Alum- Phos-
Sodium Magnes- inum Silicon phorus S Cl Ar
ium

Potas- Calcium Scand- Titanium Vana- Chrom- Manga- Iron Cobalt Nickel Copper Zinc Ga Ge Arsenic Se Br Kr
sium ium dium ium nese

Rubid- Stront- Yttrium Zircon- Niobium Molyb- Tc Ru Rh Pd Ag Cad- In Sn Anti- Te I Xe

ium ium ium denum mium mony

Cesium Barium Hf Ta Tungsten Re Os Ir Pt Au Hg Thallium Lead Bismuth Po At Rn

Fr Ra Rf Db Sg Bh Hs Mt Ds Rg Cn Nh Fl Mc Lv Ts Og

Lanth- Cerium Praseo- Neo- Pm Samar- Europ- Gadolin- Terbium Dyspro- Holmium Erbium Thulium Ytterb- Lutetium
anum dymium dymium ium ium ium sium ium

Ac Thorium Pa Uranium Np Pu Am Cm Bk Cf Es Fm Md No Lr

to Poland to explore a vast site in the mid-Atlantic, all contractors are doing a lot of science. And not all

Sources: “Estimates of Metals Contained in Abyssal Manganese Nodules and Ferromanganese Crusts in the Global Ocean Based on Regional
Variations and Genetic Types of Nodules,” by Kira Mizell, James R. Hein, Manda Au and Amy Gartman, in Perspectives on Deep-Sea Mining,
next to and partly in the site of the Lost City hydro- contractors are making their science accessible.” Mal-
thermal field—one of the most extreme environments colm Clark, a biologist who has served as an adviser

e dited by Rahul Sharma. Springer, 2022 (n odule data) ; “2022 Final List of Critical Minerals,” by U.S. Geological Survey (reference)
ever discovered on Earth, which scientists hope will on the ISA’s Legal and Technical Commission for the
be considered for World Heritage status. past seven years, agrees.
Diva Amon, a biologist from Trinidad, is one of ISA’s TMC has conducted several baseline surveys of one
most vocal critics. She says the agency’s re­­quire­ments of its three CCZ sites, called NORI-D, collecting data
for contractors are far too weak. Amon’s first postdoc- on the density and location of the nodules, and the
toral research position, at the University of Hawaii, area’s habitat and biology. In March 2023 it submit-
took her to the CCZ, where—like Glover—she was col- ted the first tranche of these data to ISA, saying it
lecting biological data from a site targeted for mining, intended to submit the remaining data before August
in her case by UK Seabed Resources, then a subsidiary 2023. Amon claims the information is insufficient. “A
of the arms giant Lockheed Martin. In 2017 Amon big part of understanding a place—especially a place
founded SpeSeas—a nonprofit dedicated to raising that you’ve never been to—is understanding the vari-
ocean awareness—and in 2020 she was named a ation over a [long] period of time,” she says.
National Geographic Emerging Explorer. She starred Renee Grogan shares some of Amon’s frustrations
alongside Will Smith in the actor’s documentary series with the ISA. She is co-founder and chief sus­tainability
Welcome to Earth. Now at U.C. Santa Barbara, Amon officer of Impossible Metals, a start-up that is promot-
focuses on understanding the deep sea, including the ing what it calls a less intrusive extraction method—
CCZ; she is no longer collecting data for contractors. using a fleet of autonomous robots to pick up nodules
Amon says “there’s a fundamental difference be­­ individually from the seafloor rather than sucking up
tween science to understand and science to exploit”— everything in a machine’s path. ISA should force
something she has learned from working in both sit- transparency from contractors, says Grogan, who pre-
uations. She says science to exploit often be­­comes “a viously worked on sustainability for Nautilus Miner-
tick box exercise”—doing only what’s needed to satis- als. “Regulators with backbones” are needed for that
fy a checklist. The problem with that, Amon says, is to happen, she says.
“not all contractors are doing high-quality science. Not Another concern about ISA’s conflicting mandate

40 Scientific American, September 2023 Graphic by Jen Christiansen

 to regulate and promote mining is that ISA recom-
mends, but does not require, that contractors conduct
small-scale tests of their operation’s potentially harm- How Deep-Sea
ful impacts. Clark says few contractors could afford
the financial risk without any surety they would be Mining Works
licensed. “Going into test mining is a huge increase in
Heavy harvester machines, the size of a farm combine rolling on cater­
the complexity and the expense of what a contractor
pillar treads, crawl along the seafloor scouring the surface and life on it,
might need to do,” he says. He acknowledges that very
vacuuming up nodules and kicking up a cloud of sediment. Nodules are
little is known about the impacts mining could create.
pumped up to a surface vessel, where they are cleaned before transport
“That’s obviously a very big question, as you start to
to shore. Waste sediment is discharged down a pipe into the water
move from a few hundreds of [metric] tons of resource
column. The sediment plumes could make it hard for animals and plants
extraction into thousands and millions of tons over
to breathe or filter food. Other designs are being considered.
much larger areas.”
Barron claims that nodule mining could have a
regenerative effect on marine life. “What we’re finding
Sea surface
now is that actually, when you do disturb an area, it
creates much more attraction . . . for organisms to Ship and
come back,” he says. “Once we start to collect nodules, mining
the area starts to rehabilitate pretty well straight away.” platform
Without mining having been done, it is hard to sub-
stantiate such a claim. A 2022 project Barron referred
to, which involved a few mining study sites, looked
only at foraminifera and found no statistical difference Potential for
sediment leaks
between sites, whether mined or untouched. When
queried, TMC responded in writing that “further study
of the impacts of actual collection system tests, such
as those NORI is undertaking, [is] essential.”

MISSING DATA
In March 2022 Amon led a review, with 30 other scien- Inflow pipe
Outflow pipe
tists, to identify categories of information needed to
manage a mining operation, including how animals
that live there vary over time and space and their re-
lationships to one another, as well as noise and light Sediment
discharge after
pollution, sediment plumes and the re­­­lease of toxic
ship processing
metals. One issue was whether a contractor or the reg-
ulator has an effective management plan in place: If Hydraulic
pump system
there is an adverse impact, whose job is it to mitigate
the consequences? The study concluded that, for the
Clipperton Fracture Zone,” b y Benjamin Gillard. Ph.D. thesis, Jacob’s University; November 2019 (reference)
Source: “ Towards Deep Sea Mining—Impact of Mining Activities on Benthic Pelagic Coupling in the Clarion

CCZ, sufficient data to sustainably manage a mining

operation exist for only 15 percent of the categories. Crawler Sediment plume
Filling in the knowledge gaps would be a “monumen- from collector
tal task” that could take a decade or more, the experts Scoured
wrote. Ten of the 30 authors support a moratorium. seafloor
One unanswered question is how mining will
impact life in the water column. Jeff Drazen, a biolo-
gist at the University of Hawaii whom TMC has con-
tracted to collect biological data in the CCZ, worries
that this issue is being ignored. “Despite a lot of scien- Seafloor
tists wanting to monitor [midwater] biology, we were
not asked to do that. So that has still not happened,” he
says, noting that contractors have not required it. Dra- Incoming
zen says that when TMC tested its mining equipment water
in ­NORI-D there was no capability on the ship to look Collector head
at impacts on midwater life.
Another open question is whether mining will
impact the survival of isolated populations. For exam-
ple, one strategy to maintain deep-sea diversity might Not drawn to scale
Outgoing water
be to rake long strips of seafloor that are separated by and sediment
Nodule
Graphic by Violet Isabelle Frances for Bryan Christie Design
 intact strips. But would the newly isolated populations
be able to survive?
Barron says Amon’s review is flawed, claiming it
includes only the views and data of select experts and
excludes contractor data, which he says show that min-
ing impacts are likely far less than once feared. In reply,
Amon says contractor data were mostly missing from
DeepData, the platform ISA uses to house information.
“It may be true that there are more data out there. But
they are not accessible to any stakeholders in a mean-
ingful way,” says Beth Orcutt, a marine biologist at the
Bigelow Laboratory for Ocean Sciences in Maine.
According to ISA more than 100 CCZ surveys have
been done. Data from just 24 of them reside on Deep-
Data. A recent study led by Muriel Rabone, a data cura-
tor at London’s Natural History Museum, unearthed
problems with the biological information stored on
the platform, including duplication of records and mis-
identification of species. Rabone has communicated
her concerns to ISA and says the regulator is working
hard to fix the problems. Rabone says that until cor-
rections are made, experts analyzing the data could
reach false conclusions.

TRUST
Barron remains o  utwardly optimistic that mining will
start soon, even though the past few months have been
tough for TMC. In March the International Union for
the Conservation of Nature, with 160 member coun-
tries, urged ISA members to back a moratorium on
deep-sea mining. In May the shipping company Maersk,
an investor in TMC since Barron became CEO in 2017,
announced that it was divesting, without detailing rea-
sons why. TMC’s share price has been volatile in recent
months. Still, now that the two-year rule’s embargo
date has passed, TMC could just begin mining, with-
out ISA having finalized its regulations, as long as there
is no veto from ISA member nations indicating a need
to wait for those guidelines.
Scientists hope the effort being made to understand
the ocean’s abyss will lead to an informed decision.
“There has to be a level of trust that [contractors] are
doing it correctly and reporting it correctly,” Orcutt
says. “So much of deep-sea mining is going to rely on
trust because no one can go out there and watch what
they’re doing.” A crucial consideration for ISA will be
deciding how much evidence about harm is enough.
“This is essentially a decision as to what level of risk
people are prepared to accept,” Glover says. “We’re nev-
er going to answer every question.”
Mining’s larger future will rest largely on how ISA
finalizes its rule book amid the rush to scour the sea-
floor. ISA has a rare chance to regulate an industry
before the industry has begun.

FROM OUR ARCHIVES

It’s Time for Ocean Zoning. Tundi Agardy; Special Editions, June 2009.
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a

42 Scientific American, September 2023

CREATURES f rom the Clarion-Clipperton seabed
include (left to right) a sea cucumber (purple),
a different sea cucumber (white), a glass sponge,
a sea star and a sea anemone.

September 2023, ScientificAmerican.com 43

A S TRONOMY

Celestial
Wonders

A
A class of rare, doomed stars enshroud themselves in mystery
By Peter Tuthill

stronomers tend to exhaust superlatives when they talk about the

ferociously hot and luminous stars known as Wolf-Rayets, which are
among the largest, hottest and rarest stars in the universe. Wolf-Rayets
are believed to be the final, fleeting stage in the lives of the most mas-
sive stars—those starting life with anywhere from 20 to more than 200
times the mass of the sun. These heavyweights are blue and incredibly
luminous, burning rapidly through vast reserves of hydrogen fuel with
live-fast, die-young abandon. As they burn up, they eject huge amounts of mass in dense,
fast winds that flow at astonishing speeds. When they run out of this fuel, these stars col-
lapse under their own gravity in the cataclysmic events we observe as supernovae.

44 Scientific American, September 2023

 A SPIRAL DUST PLUME s treams
off the WR 104 binary-star system,
as seen
September in infrared.
2023, ScientificAmerican.com 45
AN INFRARED
image from the
James Webb
Space Telescope
(left) shows the
peculiar ripples
of dust surround-
ing the WR 140
star system.
The photograph
closely matches
a numerical
simulation (right)
depicting 15
successive dust
shells puffed out
at intervals coin-
ciding with the
system’s eight-
year binary orbit.

Their extreme nature marks them as celestial out- A N ENIGMA IS BORN

casts that cluster at the borders of astronomy’s foun- In 1876, w
 hen French astronomers Charles Wolf and
dational chart, the Hertzsprung-Russell diagram, Georges Rayet first puzzled over three stars in the
which maps stars by their brightness and tempera- constellation of Cygnus, the science of spectroscopy—
ture. Wolf-Rayets rise above and beyond the diagram’s studying astronomical objects by spreading their
“main sequence,” where ordinary stars congregate. light into its constituent colors—was in its infancy.
They are bloated monsters with surface temperatures Still, Wolf and Rayet had seen enough normal stars to
that can exceed 200,000 kelvins—30 times hotter know that something deeply bizarre was going on.
than the sun—and radiation fields that can outshine Ordinary stars like the sun have spectra consisting of
the sun by factors of more than a million. light from across the range of visible colors, imprinted
The defining trait of a Wolf-Rayet star—a low abun- with a scattering of narrow, fine dark lines that repre-
dance of hydrogen—turns out to be a harbinger of sent wavelengths being absorbed by the chemical ele-

W. M. Keck Observatory/Peter Tuthill (preceding page); NASA/ESA/CSA/STScI/Lau et al., 2022 (top left);
doom. After a star exhausts its hydrogen, it will start ments in the stars. The new stars in Cygnus appeared
burning other fuels, such as helium, but this gains the to be something else entirely: they showed vibrant

Shashank Dholakia/Peter Tuthill (top left image processing); Yinuo Han/Peter Tuthill (top right)
star only a modest stay of execution. Wolf-Rayet lives bands of bright color “more reminiscent of nebulae,”
are measured in millions of years and sometimes the astronomers wrote, causing them to speculate
much less. This is a blink of the eye compared to our that these stars might “mainly owe their brilliance to
sun’s 10-billion-year life span. And be­­cause massive incandescent vapors.”
stars are already exceptions among star types, Wolf-
Rayets are doubly rare: they are literally one star in a Spectrum of Sun
billion. Although their brightness makes them easy for
telescopes to find, we know of only a few hundred of
them in our entire galaxy.
Despite their rarity, these enigmatic stars have a Spectrum of WR 137 (one of Wolf and Rayet’s prototypes in Cygnus)
history of entanglement with the most pressing astro-
Peter Tuthill nomical questions of the day. As more observations of
is an astronomer them arrive from powerful facilities such as the
at the University James Webb Space Telescope, this trend is repeating Over the following decades, astronomers began to
of Sydney in
itself. Recently Wolf-Rayets have presented us with better understand the spectra of most stellar types, but
Australia, where
he researches new questions about the physics that drives them, Wolf-Rayets still languished as an incomprehensible
astronomy which may help solve big mysteries about the nature oddity. They did occasionally ensnare scientists such
and optics. and fate of stars. as Ralph Copeland. In 1884 he made an expedition to

46 Scientific American, September 2023

 the shores of high-altitude Lake Titicaca in Peru, with
astronomical equipment packed in by mule train.
There he stumbled across the star g Argus (“gamma
Argus,” now known as g Velorum), whose “intensely
Hertzsprung-Russell
bright line in the blue and the gorgeous group of three Diagram
bright lines in the yellow and orange render its spec-
This essential astronomical plot, called the Hertzsprung-Russell
trum incomparably the most brilliant and striking in
diagram, charts stars by temperature and brightness for comparison.
the whole heavens.” Copeland was hooked: “The ex­­­
Most stars, including our sun, spend the bulk of their lives somewhere
traordinary beauty of this spectrum ... led me to de­­vote
on the “main sequence.” Eventually stars swell into giants or supergiants
a considerable part of my time to more or less system-
as a prelude to their demise, which depends critically on their mass.
atic sweeps of the neighborhood of the Milky Way.” He
The heavyweights explode as supernovae, leaving a black hole or
eventually netted another five similar stars. Al­­though
neutron star remnant, whereas ordinary stars dwindle, leaving white
none were as spectacular as g Velorum, this effort more
dwarfs. Wolf-Rayets embody the extreme: hot, bright and with masses
than doubled the catalog of known Wolf-Rayets.
that doom them to a fiery end in a supernova.
For half a century the Wolf-Rayet phenomenon
remained “a door yet unopened and with a key so curi-

Luminosity (relative to sun)

ous that we are not even sure how to insert it into the

More luminous than sun

106 Supergiants
lock,” as American astronomer Donald H. Menzel
wrote in 1929. But during the 1930s various studies 105
resulted in a gradual understanding of the physics
behind the stars. Wolf and Rayet’s comment about 104
“incandescent vapors” was on the right track all along, Wolf-Rayet
but astronomers had been reluctant to dial up the phys- 103
ical conditions to the mind-boggling levels required. Ma Giants
102 in
The searing temperatures in Wolf-Rayets fuel a se
qu
radiation field at the stars’ surface so powerful that the 10 en
ce
light itself becomes a force to be reckoned with. There
is a fundamental upper bound to the luminosity of any 1
celestial object beyond which “the radiation observed
10–1
to be emitted . . . would blow up the star,” Arthur Sun
Eddington wrote in an influential 1926 paper. Wolf-
Less luminous than sun

10–2 White dwarfs

Rayets, it turns out, are so luminous that they flirt with
this “Eddington limit,” causing their surface layers to 10–3
be continually driven off by the stars’ incandescent
glare. The key that opened Menzel’s door turned out to 10–4
be this strong stellar wind, streaming at several thou-
10–5
sand kilometers per second—around 1 percent the 30,000 10,000 6,000 3,000
speed of light. The phrase “solar hurricane” is some-
times used, but this comparison to our sun’s solar wind
does not remotely do it justice. Imagine the lightest Hotter than sun Cooler than sun
discernible breath of air on a calm day compared to the Surface Temperature (kelvins)
force of a powerful water cannon. The divergence
between our sun’s solar wind and that of a Wolf-Rayet
exceeds that ratio by a factor of more than 10,000. dust creation is somewhere bathed in the hot, harsh
Even a tiny handful of these overachievers can ultraviolet radiation surrounding a Wolf-Rayet.
profoundly impact the ecosystem of an entire galaxy. The conundrum of how to form snowflakes in hell
Streaming winds carry energy, momentum and newly was resolved only with the discovery of the miracu-
forged elements out into the voids between the stars, lous system named WR 140. In the 1980s a team led
blowing bubbles, compressing clouds and heating by Peredur Williams of the Royal Observatory Edin-
gas. The most important contribution to the galactic burgh found that dust produced by this star came in
balance from Wolf-Rayet stars is the least expected: pulses spaced eight years apart. The discovery imme-
stardust. Dust—tiny flakes of star stuff—plays all diately linked the creation of dust to the eight-year
kinds of crucial roles in the grand cycle of matter in period of a binary companion co-orbiting with the
the galaxy, perhaps most of all by shielding and cool- Wolf-Rayet. This companion was another luminous
ing the gas throughout, allowing it to condense to blue star on an elliptical orbit. In this binary system,
form new generations of stars. Yet astronomers have astronomers realized, dust forms when the pair
struggled to account for all the dust they see. In makes its closest approach. As the wind from the
astronomy, dust is a little like snow: plentiful in calm Wolf-Rayet collides with and entangles the wind of
conditions and cool climates. The last place to expect the massive companion, the two fight each other to a

Graphics by Sayo Studio September 2023, ScientificAmerican.com 47

 standstill. Here the cool, calm conditions are just student John D. Monnier. The giant Keck Telescopes
right for dust to condense out of the gas. This collid- in Hawaii had just opened for business. To under-
ing-wind dust mechanism requires that both stars stand Wolf-Rayet dust formation, however, we
launch powerful winds—a condition that can be met needed sharp images revealing a level of detail that
because massive stars often form along with similarly was beyond the capability of even Keck’s huge
massive companions. 10-meter mirrors. Today we could just switch on an
Unlike WR 140, many other Wolf-Rayets continu- adaptive optics system—now standard equipment
ously pump out dust, apparently with no regard for that counteracts the shimmering of Earth’s atmo-
the timing of their orbit. Figuring out why, and sphere. But in the 1990s technology able to image our
whether the continuous dust makers work differently Wolf-Rayet stars was tens of years and many millions
from the clockwork dust-created-each-orbit variety, of dollars in the future.
became a key question for my own research. Necessity being the mother of invention, we had
no option but to think laterally. We secured a large
T HE PINWHEELS metal mask, about the size of a trash can lid with
In the mid-1990s I was working in the group of Nobel carefully arranged perforated holes, to one of the
Laureate Charles H. Townes in California with then Keck telescopes. By blocking much of the starlight,

The Enigma of Dust Formation

Astronomers were puzzled w  hen they first saw an elegant
spiral around a Wolf-Rayet star. The spiral was made of
glowing stardust, but scientists struggled to understand Binary-star orbit
(looking down
how the dust formed. They eventually realized that it
on orbital plane)
arose because of the colliding stellar winds of two stars:
the Wolf-Rayet and its binary companion star.
When the two winds clash, the gas gets com-
pressed along a shock front but stays cool
because of its distance from both stars, Stellar winds
creating the ideal conditions for dust to
condense out of gas. As the dust is
Binary
carried outward by the expanding
companion star Wolf-Rayet star

W. M. Keck Observatory/Peter Tuthill (m odel series)

wind, the spiral is engraved on the
dust plume by the binary orbit.
Shock front
(exists at collision
of stellar winds
Dust spiral Binary-star orbit where dust is formed)
Outflow of dust
(primarily in
plane of orbit)

Dust spiral
Orbital plane Rotation axis

48 Scientific American, September 2023

we transformed the primary mirror into an array of never hope to witness. It’s as if nature writes its
small collectors, allowing Keck to work much like secrets in a script too tiny to see, but then the ex­­
modern radio telescopes that link many smaller pand­ing wind inflates the text into a giant banner.
antennas together. The gains in image fidelity Here were the properties of the winds, the stars that
exceeded our wildest dreams. The entire performance launched them and the parameters of their orbital
required climbing onto the telescope to swap out dance, laid out for us to read. WR 104 became the
masks in the night while perched 15 meters above the prototype for a new class of nebulae that we chris-
observatory floor, which is something I am eternally tened “pinwheels.” We soon found more systems,
surprised they ever let us get away with. given names like WR 112 and WR 98a, that shared a
Forming images using this technique required sig- common architecture, yet each was unique and dis-
nificant computer processing, plus a lot of custom tinctly beautiful.
code. When we first beheld our most important Wolf-
Rayet target, a star designated WR 104, on a compu­ A NEW MYSTERY
ter monitor, it was a shimmering spiral that resem- In the years since, the pinwheels have continued to
bled a weirdly distorted Christmas bauble. I looked at fascinate, beguile and confound us.
John and groaned, “Never heard of any star shaped One ongoing puzzle began back in 1963, when the
like a spiral. How did we get a bug in the code to pro- Partial Test Ban Treaty between the U.S. and the
duce that kind of error?” We went back and improved U.S.S.R. came into force, prompting America to
the code, but the spiral stayed put. It was not until a launch the Vela satellites to monitor compliance by
few months later, when data from a second visit to sensing gamma rays given off by nuclear tests. The
the Keck telescope produced another spiral, that we sensors onboard these satellites began reporting
accepted reality. The new image was almost the same events coming from above, not just below. These so-
spiral shape as before but rotated by about 90 degrees. called gamma-ray bursts have since become one of
The spiral was real, and furthermore, we had a mov- the hottest topics in astronomy. A subtype of longer-
ing target on our hands. duration bursts, which last more than two seconds,
Hindsight being what it is, I understand now that are thought to arise from the supernovae marking the
a spiral is exactly what we should have been looking deaths of Wolf-Rayet stars.
for all along. What confused us was that dust needs Not only are gamma-ray bursts intriguing, but
dense, cool gas to form. A Wolf-Rayet can meet only over cosmic time they may even pose a safety risk.
one of these conditions at any given spot: close to the Typical supernovae can really affect only their imme-
star the gas is dense but hot, whereas far away it is diate stellar neighborhood. This may not be true of
cool but too tenuous. This is where the binary pair gamma-ray-burst supernovae. Here the energy out-
comes in. When the winds from the two stars collide, put is confined to a narrow and powerful beam, so A SERIES o f
the gas compresses far enough away from the stars with the right alignment they are visible at vast cos- images shows
for it to stay cool—conditions leading to a “dust nurs- mic distances. Such an alignment for a nearby event the motion
ery.” Dust grains condense out of the gas along a bowl- may herald danger. of the dust
shaped “shell” where the winds clash. As the stars Speculative studies have suggested that events in spiral in the
orbit and their expanding winds sweep outward, the Earth’s fossil record, such as the Late Ordovician WR 104 system,
dust spirals out like the jet from a lawn sprinkler. mass extinction, could have been caused by a gamma- which spins on
The result of all this physics manifests as a majes- ray-burst strike. The risk of such a cataclysm exists the sky over the
tic spiral plume. To the eye of an astrophysicist, how- only when Earth is situated exactly along the line of duration of one
ever, the beauty is deeper. These structures open a the burst. For the first time our data allowed us to eight-month
rare window into phenomena we could otherwise analyze the likely axis of a possible future burst from orbital cycle.

September 2023, ScientificAmerican.com 49

THE APEP our pinwheel Wolf-Rayets. Unfortunately, WR 104 end-of-the-world Mayan calendar conspiracy theories.
triple-star might be pointing our way. More recently, we’ve recovered spectacular new
system, seen Yet the statistical threat posed by a future gamma- data on the pinwheels from observatories such as the
in infrared ray strike from WR 104 is truly minuscule: several James Webb Space Telescope, the likes of which Wolf
(left), ejects very unlikely things would have to happen all in se­­ and Rayet could hardly have imagined 150 years ago.
a sculpted quence, including the low-probability event WR 104 Among the very first JWST images was a revelatory
plume of hot can host a gamma-ray burst (rather than a typical su­­ vision of an old friend, WR 140 (of the eight-year dust
dust around it. pernova) in the first place. When writing up our re­­ cycle mentioned earlier).
A computer search, my colleagues and I weighed the vanishingly With the staggering leap in sensitivity from this
simulation of small but nonzero odds—and the fact humanity faces new observatory, we can see shell after shell of dust—
the dust (right) more serious threats from things such as climate nearly 20 of them marching out into space, each an
ESO/Callingham et al., 1999

can reproduce change—and decided to include only a few short, exquisitely sculpted replica nested within the older,
much of the carefully worded sentences on this possibility in our more inflated one preceding it. My student Yinuo
complex paper. Of course, these lines immediately went viral Han and I compared this observation with a previous
structure in on the Internet. Soon I was in my department head’s computer model we’d built to describe only WR 140’s
Apep’s shell. office, ex­­plaining how I’d become famous for 2012 single innermost dust shell. When we extrapolated

50 Scientific American, September 2023

 out to see what 150 years of repeat shells might look known to stellar physics. It’s like finding a feather
like, our result almost perfectly mimicked the onion- adrift in a hurricane, somehow floating along at its
layer image from JWST, showing the uncanny power own gentle pace. How does dust around Apep perform
of mathematics to echo the real world. this magic trick? Nobody knows for sure.
Perhaps the most exciting of the new discoveries Once again, Wolf-Rayets are humbling astrono-
has been the first confirmed twin Wolf-Rayet binary, a mers who think they understand how things work.
system called Apep, which my colleagues and I named And by the time we have the answer to this question,
after the mortal enemy of Egyptian sun god Ra. Images I’m sure these enigmatic stars will have given us still
of the system evoke the mythology, suggesting a star deeper mysteries. They have a history of mixing
embattled within a serpent’s coils. Apep also offers a things up every time they make an appearance.
surprise. Our calculations clock the speed of the Wolf-
Rayet’s expanding gas wind, as well as the expansion
Yinuo Han/Peter Tuthill

rate of the dust. These two numbers should agree, and FROM OUR ARCHIVES
for all the other pinwheels, they do. In Apep, however, Explosions at the Edge. Anna Y. Q. Ho; December 2020.
the dust streams out only one third as fast as the gas
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a
yet is caught in the teeth of the strongest howling gale

September 2023, ScientificAmerican.com 51

P S YC H O LO G Y

The latest science

on a widely misunderstood
psychological condition
By Diana Kwon

Illustration by Deena So’Oteh

What Is
Narcissis
52 Scientific American, September 2023
m? September 2023, ScientificAmerican.com 53
 Diana Kwon is a freelance journalist who covers health
and the life sciences. She is based in Berlin.

C an you think of a narcissist? Some people might picture Donald Trump, p­ erhaps,
or Elon Musk, both of whom are often labeled as such on social media. Or maybe
India’s prime minister, Narendra Modi, who once wore a pinstripe suit with
his own name woven in minute gold letters on each stripe over and over again.
But chances are you’ve encountered a narcissist, and they
looked nothing like Trump, Musk or Modi. Up to 6 percent of the
U.S. population, mostly men, is estimated to have had narcissis-
tic personality disorder during some period of their lives. And
the condition manifests in confoundingly different ways. People
with narcissism “may be grandiose or self-loathing, extraverted
or socially isolated, captains of industry or unable to maintain
FANTASY OR REALITY?
Tessa, a 25-year-old who now lives in California, has sometimes
felt on top of the world. “I would wake up every day and go to col-
lege believing I was going to be a famous singer and that my life
was going to be fantastic,” she recalls. “I thought I could just keep
perfecting myself and that someday I would end up as this amaz-
ing person surrounded by this amazing life.”
steady employment, model citizens or prone to antisocial activ- But she also hit severe emotional lows. One came when she
ities,” according to a review paper on diagnosing the disorder. realized that the fabulous life she imagined might never come to
Clinicians note several dimensions on which narcissists vary. be. “It was one of the longest periods of depression I’ve ever gone
They may function extremely well, with successful careers and through,” Tessa tells me. “I became so bitter, and I’m still work-
vibrant social lives, or very poorly. They may (or may not) have ing through it right now.”
other disorders, ranging from depression to sociopathy. And That dissonance between fantasy and reality has spilled into
although most people are familiar with the “grandiose” version her relationships. When speaking to other people, she often finds
of narcissism—as displayed by an arrogant and pompous person herself bored—and in romantic partnerships, especially, she feels
who craves attention—the disorder also comes in a “vulnerable” disconnected from both her own and her partner’s emotions. An
or “covert” form, where individuals suffer from internal distress ex-boyfriend, after breaking up, told her she’d been oblivious to
and fluctuations in self-esteem. What these seeming opposites the hurt she caused him by exploding in rage when he failed to
have in common is an extreme preoccupation with themselves. meet her expectations. “I told him, ‘Your suffering felt like a cry
Most psychologists who treat patients say that grandiosity in the wind—I didn’t know you were feeling that way’ … all I could
and vulnerability coexist in the same individual, showing up in think about was how betrayed I felt,” she says. It upset her to see
different situations. Among academic psychologists, however, him connect with other people; she reacted by degrading his
many contend that these two traits do not always overlap. This friends and trying to stop him from meeting them. And she hated
debate has raged for decades without resolution, most likely him admiring other people because it made her question whether
because of a conundrum: vulnerability is almost always present he’d continue to see her as admirable.
in a therapist’s office, but individuals high in grandiosity are Not being able to live the idealized versions of herself—which
unlikely to show up for treatment. Psychologist Mary Trump include visions of being surrounded by friends and fans who love
deduces, from family history and close observation, that her and idolize her for her beauty and talent—leaves Tessa profoundly
uncle, Donald Trump, meets the criteria for narcissistic as well distressed. “Sometimes I simultaneously feel above everything,
as, probably, antisocial personality disorder, at the extreme end above life itself, and also like a piece of trash on the side of the
of which is sociopathy. But “coming up with an accurate and com- road,” she says. “I feel like I’m constantly trying to hide and cover
prehensive diagnosis would require a full battery of psycholog- things up. I’m constantly stressed and exhausted. I’m also con-
ical and neuropsychological tests that he’ll never sit for,” she stantly trying to build an inner self so I don’t have to feel that way
notes in her book on the former president. anymore.” After her parents suggested therapy, Henderson was
Now brain science is contributing to a better understanding diagnosed with narcissistic personality disorder (NPD) in 2023.
of narcissism. It’s unlikely to resolve the debate, but preliminary What makes narcissism particularly complex is that it may
studies are coming down on the side of the clinicians: vulnera- not always be dysfunctional. “Being socially dominant, being
bility indeed seems to be the hidden underside of grandiosity. achievement-striving and focused on improving one’s own lot in

54 Scientific American, September 2023

life by themselves are not all that problematic and tend to be val- covered enormous variability in how mental health practitioners
ued by Western cultures,” notes Aidan Wright, a psychologist at were conceptualizing NPD, with dozens of labels for the ways in
the University of Michigan. which narcissism expressed itself. But there was also a common
Elsa Ronningstam, a clinical psychologist at McLean Hospi- thread: descriptions of both grandiose and vulnerable ways in
tal in Massachusetts, says the relatively functional variety of nar- which the disorder showed up.
cissism includes having, when things are going well, a positive Since then, researchers have found that both dimensions of
view of oneself and a drive to preserve one’s own well-being, while narcissism are linked to what psychologists call “antagonism,”
still being able to maintain close relationships with others and which includes selfishness, deceitfulness and callousness. But
tolerate divergences from an idealized version of oneself. Then grandiosity is associated with being assertive and attention seek-
there is “pathological” narcissism, characterized by an inability ing, whereas vulnerability tends to involve neuroticism and suf-
to maintain a steady sense of self-esteem. Those with this condi- fering from anxiety, depression and self-consciousness. Vulnera-
tion protect an inflated view of themselves at the expense of oth- ble narcissism also more often goes along with self-harm (which
ers and—when that view is threatened—experience anger, shame, can include hairpulling, cutting, burning and related behaviors
envy and other negative emotions. They can go about living rel- that are also found in people with BPD) and risk of suicide than
atively normal lives and act out only in certain situations. Nar- the grandiose form.
cissistic personality disorder is a subtype of pathological narcis- The two manifestations of narcissism are also linked to dif-
sism in which someone has persistent, long-term issues. It often ferent kinds of problems in relationships. In grandiose states,
occurs along with other conditions, such as depression, bipolar people with NPD may be more vindictive and domineering
disorder, borderline personality or antisocial personality disorder. toward others, whereas in vulnerable phases they may be more
withdrawn and exploitable.
T HE 21ST-CENTURY NARCISSUS
In the ancient Greek tale o  f Narcissus, a young hunter, admired S ELF-ESTEEM JUICE
for his unmatched beauty, spurns many who love and pursue Jacob Skidmore, a 23-year-old with NPD who runs accounts as
him. Among them is Echo, an unfortunate nymph—who, after The Nameless Narcissist on several social media platforms, says
pulling a trick on one of the gods, has lost her ability to speak he often flips from feeling grandiose to vulnerable, sometimes
except for words already spoken by another. Though initially multiple times a day. If he’s getting positive attention from oth-
entranced by a voice that mirrored his own, Narcissus ultimately ers or achieves his goals, he experiences grandiose “highs” when
rejects Echo’s embrace. he feels confident and secure. “It’s almost a euphoric feeling,” he
The god Nemesis then curses Narcissus, causing him to fall in says. But when these sources of ego boosts—something he refers
love with his own reflection in a pool of water. Narcissus becomes to as “self-esteem juice”—dry up, he finds himself slipping into
hopelessly infatuated with his own image, which he believes to be lows when an overwhelming feeling of shame might stop him
another beautiful being, and becomes distraught when he finds it from even leaving his home. “I’m afraid to go outside because I
cannot reciprocate his affection. In some versions of the story, he feel like the world is going to judge me or something, and it’s pain-
wastes away before his own likeness, dying of thirst and starvation. ful,” Skidmore says. “It feels like I’m being stabbed in the chest.”
In the 1960s and 1970s psychoanalysts Heinz Kohut and Otto The desire to fill up on self-esteem has driven many of Skid-
Kernberg sketched what’s now known as the “mask model” of more’s more grandiose behaviors—whether it was making him-
narcissism. It postulated that grandiose traits such as arrogance self the de facto leader of multiple social groups where he referred
and assertiveness conceal feelings of insecurity and low self- to himself as “the Emperor” and punished those who angered
esteem. The 1980 edition of the Diagnostic and Statistical Man- him or forging relationships purely for the sake of boosting his
ual of Mental Disorders ( DSM), the main reference used by clini- self-esteem. Skidmore hasn’t always presented himself in gran-
cians in the U.S., reflected this insight by including vulnerable diose ways: when he was younger, he was much more outwardly
features in its definition of NPD, although it emphasized the gran- sensitive and insecure. “I remember looking in the mirror and
diose ones. But some psychiatrists contended that the vulnera- thinking about how disgusting I was and how much I hated
bility criteria overlapped too much with those of other personal- myself,” he tells me.
ity disorders. Borderline personality disorder (BPD), in particu- Clinicians’ evaluations, as well as studies in the wider popula-
lar, shares with NPD characteristics of vulnerability such as tion, support the idea that narcissists oscillate between these two
difficulty managing emotions, sensitivity to criticism, and unsta- states. In recent surveys, Wright and his graduate student Eliza-
ble relationships. Subsequent versions of the DSM therefore beth Edershile asked hundreds of undergraduate students and
placed even more weight on grandiose features—such as an exag- community members to complete assessments that measured
gerated sense of self-importance, a preoccupation with fantasies their levels of grandiosity and vulnerability multiple times a day
of unlimited success and power, an excessive need for admira- over several days. They found that whereas vulnerability and gran-
tion and a lack of empathy. diosity do not generally coexist in the same moment, people who
In the early 2000s Aaron Pincus, a clinical psychologist at are overall more grandiose also undergo periods of vulnerability—
Pennsylvania State University, noticed that this focus on grandi- whereas those who are generally more vulnerable don’t experi-
osity did not accurately represent what he was seeing in narcis- ence much grandiosity. Some studies suggest that the overlap may
sistic patients. “It was completely ignoring what typically drives depend on the severity of the narcissism: clinical psychologist
patients to come to therapy, which is vulnerability and distress,” Emanuel Jauk of the Medical University of Graz in Austria and
Pincus says. “That got me on a mission to get us more calibrated his colleagues found in surveys that vulnerability may be more
in the science.” In a 2008 review, Pincus and his colleagues dis- likely to appear in highly grandiose individuals.

September 2023, ScientificAmerican.com 55

 The Two Faces of Narcissism
People with narcissistic personality disorder vary with time and circumstances. An grandiosity and vulnerability differ on
vary widely in their levels of grandiosity online survey of hundreds of people (below) “approach-oriented” traits, characterized
(being arrogant and pompous) and by psychologists Zlatan Krizan and by boldness and arrogance, and “avoid-
vulnerability (being shy, insecure and Anne D. Herlache, then at Iowa State Uni- ance-oriented” traits, marked by vigilance
hyper­sensitive). Further, these levels may versity, revealed how narcissistic and avoidance of threats to self-esteem.

Approach-oriented (bold) traits Avoidance-oriented (reactive) traits

Dot placements Strongest possible Strongest possible Strongest possible Strongest possible
show how strongly negative correlation No correlation positive correlation negative correlation No correlation positive correlation
narcissistic grandiosity
and vulnerability
are positively or Motivated by opportunities and rewards Motivated by threats
negatively associated
with each trait.
Sensitive to positive stimuli, such as rewards Sensitive to negative stimuli, such as punishment
Grandiosity
Vulnerability
Extraverted Neurotic

Likely to engage in appearance enhancement (like skin tanning) Prone to angry rumination

Focused on growth, realizing ambitions Focused on safety, security, avoiding negative outcomes

Power-seeking Paranoid

To Diana Diamond, a clinical psychologist at the City Univer- aspect. It’s “a little bit like trying to learn about a lion’s behavior
sity of New York, such findings suggest that the mask model is in a zoo,” he says.
too simple. “The picture is much more complex—vulnerability The unwillingness to seek therapy is especially true of “malig-
and grandiosity exist in dynamic relation to each other, and they nant narcissists,” who, in addition to the usual characteristics,
fluctuate according to what the individual is encountering in life, exhibit antisocial and psychopathic features such as lying chron-
the stage of their own development.” ically or enjoying inflicting pain or suffering on others.
But Josh Miller, a psychologist at the University of Georgia, Marianne (whose name has been changed for privacy) recalls
and others entirely reject the idea that grandiose individuals are her father, a brilliant scientist whom her own therapist deemed
concealing a vulnerable side. Although grandiose people may a malignant narcissist after reading the voluminous letters he’d

Source: “The Narcissism Spectrum Model: A Synthetic View of Narcissistic Personality,” by Zlatan Krizan
sometimes feel vulnerable, that vulnerability isn’t necessarily sent over the years. (He never sought therapy.) It was “all about
linked to insecurities, Miller argues. “I think they feel really angry constant punishment,” Marianne says. He implemented stringent
because what they cherish more than anything is a sense of supe- rules, such as putting a strict time limit on how long their family

and Anne D. Herlache, in Personality and Social Psychology Review, Vol. 22; February 2018
riority and status—and when that’s called into question, they’re of five children could use the bathroom during long road trips. If,
going to lash back,” he adds. Psychologist Donald Lynam of Pur- by the time he’d filled the tank, everyone hadn’t returned to the
due University agrees: “I think people can be jerks for lots of rea- car, he’d leave. On one occasion, Marianne was abandoned at a gas
sons—they could simply think they’re better than others or be station when she couldn’t make it back on time. “There was
asserting status or dominance—it’s an entirely different motiva- [hardly] a day without that kind of drama—one person being iso-
tion, and I think that motivation has been neglected.” lated, punished, humiliated, being called out,” she remembers. “If
These differences in perspective may arise because different you cried, he’d say you’re being histrionic. He didn’t associate that
types of psychologists are studying different populations. In a 2017 crying with his actions; he thought it was performative.”
study, researchers surveyed 23 clinical psychologists and 22 social Her father also pitted her siblings and their mother against one
and/or personality psychologists (who do not work with patients) another to prevent them from forging close connections—and he
and found that although both groups viewed grandiosity as an constantly looked for flaws in those around him. Marianne recalls
essential aspect of narcissism, clinical psychologists were slightly dinner parties at home where her father spent hours trying to pin-
more likely to view vulnerability as being at its core. point weaknesses among the other husbands and to hurt couples’
Most narcissists who seek help are generally more vulnerable, opinions of each other. When Marianne brought home boyfriends,
Miller notes: “These are wounded people who come in to seek her father challenged them and tried to prove that he was supe-
treatment for their wounds.” To him, that means clinics might not rior. And despite being a dazzling academic who easily charmed
be the best place to study narcissism—at least not its grandiose people when they first met, he got fired time and time again

56 Scientific American, September 2023 Graphic by Amanda Montañez

because of conflicts at the universities where he worked. “It was with distress in the face of social exclusion. Interestingly, the
all about one-upmanship,” she says. “His impulse to destroy any- researchers did not find differences in the boys’ self-reports of
thing that was shiny, that was popular, that was loved—it over- distress. In another revealing fMRI study, Jauk and his Graz col-
whelmed everything else.” leagues found that men (but not women) with higher levels of
Malignant narcissists often pose the greatest challenge for grandiose narcissism showed more activity in parts of the ante-
therapists—and they may be particularly dangerous in leader- rior cingulate cortex associated with negative emotions and social
ship positions, Diamond notes. They can have deficient moral pain when viewing images of themselves compared with images
functioning while exerting an enormous amount of influence on of close friends or strangers.
followers. “I think this is something that’s going on right now, The bodies of narcissists bear evidence of elevated stress. Stud-
with the rise of authoritarianism worldwide,” she adds. ies indicate that men with more narcissism have higher levels of
the stress hormone cortisol than those with less narcissism. In a
A N ADVERSE CHILDHOOD? 2020 study, Royce Lee, a psychiatrist at the University of Chicago,
Research with identical a nd nonidentical twins suggests that nar- and his colleagues reported that people with NPD—as well as
cissism may be at least partially genetically heritable, but other those with BPD—have greater concentrations of molecules asso-
studies indicate that dysfunctional parenting might also play a sig- ciated with oxidative stress (a stress response seen at the cellu-
nificant role. Grandiosity may derive from caregivers holding lar level) in their blood.
inflated views about their child’s superiority, whereas vulnerabil- Such findings suggest that “vulnerability is always there but
ity may originate in having a caregiver who was cold, neglectful, maybe not always expressed,” Jauk says. “And under particular
abusive or invalidating. Complicating matters, some studies find circumstances, such as in the lab, you can observe signs of vul-
overvaluation also plays a role in vulnerable narcissism, whereas nerability at a physiological level, even if people say, ‘I don’t have
others fail to find a link between parenting and grandiosity. “Chil- vulnerability.’ ” He adds, however, that these studies are far from
dren who develop NPD may have felt seen and appreciated when the last word on the matter: many of them have a small number
they achieved or behaved in a certain way that satisfied a caregiv- of subjects, and some have reported contradicting findings. Fol-
er’s expectations but ignored, dismissed or scolded when they failed low-up studies, ideally with a larger number of individuals, are
to do so,” Ronningstam summarizes in her guide to the disorder. needed to validate their results. The neuroscience of narcissism
Skidmore attributes his own NPD to both genes and painful “is incredibly interesting, but at the same time, I’m very hesitant
childhood experiences. “I’ve never met a narcissist who has not to interpret any of these results,” says Mitja Back, a psychologist
had trauma,” he says. “People just use love as this carrot on a stick at the University of Münster in Germany.
[that] they hang above your head, and they tell you to behave or
they’ll take it away. And so I have this mindset of, ‘Well then, T OWARD TREATMENTS
screw it! I don’t need love. I can take admiration, achievements, To date, there have been no randomized clinical trials for treat-
my intelligence—you can’t take those things away from me.’ ” ments specific for narcissistic personality disorder. Clinicians have,
Many researchers nonetheless say a lot more work is needed however, begun to adapt psychotherapies that have proved to be
to determine what role, if any, parenting plays. Miller points out effective in other related conditions, such as borderline personal-
that most research to date of grandiosity, in particular, has found ity disorder. Treatments currently used include “mentalization,”
small effects. Further, the work was done retrospectively—ask- which aims to help individuals make sense of both their own and
ing people to recall their past experiences—rather than prospec- others’ mental states, and “transference,” which focuses on
tively to see how early life experiences affect outcomes. enhancing a person’s ability to self-reflect, take the perspective of
There is another way to study what is going on with a narcis- others and regulate their emotions. But there is still a dire need
sist, however: look inside. In a study published in 2015, research- for effective treatments.
ers at the University of Michigan recruited 43 boys aged 16 or 17 “People with pathological narcissism and narcissistic person-
and asked them to fill out the Narcissism Personality Inventory, ality disorder have a reputation of not changing or dropping off
a questionnaire that primarily measures grandiose traits. The from treatment,” Ronningstam says. “Instead of blaming that on
teenagers then played Cyberball, a virtual ball-tossing game, them, the clinicians and researchers need to really further
while their brain activity was measured using functional mag- develop strategies that can be adjusted to the individual differ-
netic resonance imaging (fMRI), a noninvasive neuroimaging ence—and at the same time to focus on and promote change.”
method that en­­ables re­­search­ers to observe the brain at work. Since discovering she has NPD, Tessa has started a YouTube
Cyberball tests how well people deal with social exclusion. channel called SpiritNarc where she posts videos about her expe-
Participants are told that they’re playing with two other people, riences and perspectives on narcissism. “I really want the world
although they are actually playing with a computer. In some to understand [narcissism],” she says. “I’m so sick of the narrative
rounds, the virtual players include the human participant; in that’s going around—people see the outside behavior and say, ‘This
others, the virtual players begin by tossing the ball to everyone means these people are awful.’ ” What these people don’t see, she
but later pass it just between themselves—cutting the partici- adds, is the suffering that lies below the surface.
pant out of the game.
The teenagers with higher levels of grandiose narcissism
turned out to have greater activity in the so-called social pain net- FROM OUR ARCHIVES
work than those with lower scores. This network is a collection The Long Shadow of Trauma. Diana Kwon; January 2022.
of brain regions—including parts of the insula and the anterior
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a
cingulate cortex—that prior studies had found were associated

September 2023, ScientificAmerican.com 57

An AI
COMPUTING

Mystery
Researchers are struggling
to understand how artificial-
intelligence models know
things no one told them
By George Musser

Illustration by Chris Gash

58 Scientific American, September 2023

N
o one yet knows how ChatGPT and its artificial-intelligence
cousins will transform the world, and one reason is that no
one really knows what goes on inside them. Some of these sys-
tems’ abilities go far beyond what they were trained to do—
and even their inventors are baffled as to why. A growing num-
ber of tests suggest these AI systems develop internal models
of the real world, much as our own brain does, although the
machines’ technique is different.
“Everything we want to do with them in order to neural network. Such networks have a structure mod-
make them better or safer or anything like that seems eled loosely after the connected neurons of the human
to me like a ridiculous thing to ask ourselves to do if brain. The code for these programs is relatively simple
we don’t understand how they work,” says Ellie Pavlick and fills just a few screens. It sets up an autocorrection
of Brown University, one of the researchers working to algorithm, which chooses the most likely word to com-
fill that explanatory void. plete a passage based on laborious statistical analysis of
At one level, she and her colleagues understand GPT hundreds of gigabytes of Internet text. Additional train-
(short for “generative pre-trained transformer”) and ing ensures the system will present its results in the
other large language models, or LLMs, perfectly well. form of dialogue. In this sense, all it does is regurgitate
The models rely on a machine-learning system called a what it learned—it is a “stochastic parrot,” in the words

September 2023, ScientificAmerican.com 59

 of Emily Bender, a linguist at the University of Washing- David Bau of Northeastern University; and Fernanda
ton. (Not to dishonor the late Alex, an African Grey Par- Viégas, Hanspeter Pfister and Martin Wattenberg, all at
rot who understood concepts such as color, shape and Harvard—spun up their own smaller copy of the GPT
“bread” and used corresponding words intentionally.) neural network so they could study its inner workings.
But LLMs have also managed to ace the bar exam, write They trained it on millions of matches of the board
a sonnet about the Higgs boson and make an attempt game Othello by feeding in long sequences of moves in
to break up their users’ marriage. Few had expected a text form. Their model became a nearly perfect player.
fairly straightforward autocorrection algorithm to To study how the neural network encoded informa-
acquire such broad abilities. tion, they adopted a technique that Bengio and Guil-
That GPT and other AI systems perform tasks they laume Alain, also at the University of Montreal, devised
were not trained to do, giving them “emergent abili- in 2016. They created a miniature “probe” network to
ties,” has surprised even researchers who have been analyze the main network layer by layer. Li compares
generally skeptical about the hype over LLMs. “I don’t this approach to neuroscience methods. “This is similar
know how they’re doing it or if they could do it more to when we put an electrical probe into the human
generally the way humans do—but they’ve challenged brain,” he says. In the case of the AI, the probe showed
my views,” says Melanie Mitchell, an AI researcher at that its “neural activity” matched the representation of
the Santa Fe Institute. an Othello game board, albeit in a convoluted form. To
“It is certainly much more than a stochastic parrot, confirm this, the researchers ran the probe in reverse to
and it certainly builds some representation of the implant information into the network—for instance, flip-
world—although I do not think that it is quite like how ping one of the game’s black marker pieces to a white one.
humans build an internal world model,” says Yoshua “Basically we hack into the brain of these language mod-
Bengio, an AI researcher at the University of Montreal. els,” Li says. The network adjusted its moves accordingly.
At a conference at New York University in March, The researchers concluded that it was playing Othello
philosopher Raphaël Millière of Columbia University roughly like a human: by keeping a game board in its
offered yet another jaw-dropping example of what “mind’s eye” and using this model to evaluate moves. Li
LLMs can do. The models had already demonstrated says he thinks the system learns this skill because it is the
the ability to write computer code, which is impressive most parsimonious description of its training data. “If
but not too surprising because there is so much code you are given a whole lot of game scripts, trying to figure
out there on the Internet to mimic. Millière went a step out the rule behind it is the best way to compress,” he adds.
further and showed that GPT can execute code, too, This ability to infer the structure of the outside
however. The philosopher typed in a program to calcu- world is not limited to simple game-playing moves; it
late the 83rd number in the Fibonacci sequence. “It’s also shows up in dialogue. Belinda Li (no relation to
multistep reasoning of a very high degree,” he says. And Kenneth Li), Maxwell Nye and Jacob Andreas, all at
the bot nailed it. When Millière asked directly for the M.I.T., studied networks that played a text-based adven-
83rd Fibonacci number, however, GPT got it wrong, ture game. They fed in sentences such as “The key is in
which suggests the system wasn’t just parroting the the treasure chest,” followed by “You take the key.”
Internet. Rather it was performing its own calculations Using a probe, they found that the networks encoded
to reach the correct answer. within themselves variables corresponding to “chest”
Although an LLM runs on a computer, it is not itself and “you,” each with the property of possessing a key or
a computer. It lacks essential computational elements, not, and updated these variables sentence by sentence.
such as working memory. In a tacit acknowledgment The system had no independent way of knowing what
that GPT on its own should not be able to run code, its a box or key is, yet it picked up the concepts it needed
inventor, tech company OpenAI, has since introduced a for this task. “There is some representation of the state
specialized plug-in—a tool ChatGPT can use when hidden inside of the model,” Belinda Li says.
answering a query—that allows it to do so. But that plug- Researchers marvel at how much LLMs are able to
in was not used in Millière’s demonstration. Instead he learn from text. For example, Pavlick and her then Ph.D.
hypothesizes that the machine improvised a memory by student Roma Patel found that these networks absorb
harnessing its mechanisms for interpreting words color descriptions from Internet text and construct
George Musser is according to their context—a situation similar to how internal representations of color. When they see the
a contributing editor nature repurposes existing capacities for new functions. word “red,” they process it not just as an abstract sym-
at S cientific American
This impromptu ability demonstrates that LLMs bol but as a concept that has certain relations to
and author of P utting
Ourselves Back in develop an internal complexity that goes well beyond a maroon, crimson, fuchsia, rust, and so on. Demonstrat-
the Equation (Farrar, shallow statistical analysis. Researchers are finding that ing this was somewhat tricky. Instead of inserting a
Straus and Giroux, these systems seem to achieve genuine understanding probe into a network, the researchers studied its
2023). Follow him of what they have learned. In one study presented in response to a series of text prompts. To check whether
on Mastodon @
May at the International Conference on Learning Rep- it was merely echoing color relations from online refer-
gmusser@mastodon.
social or on Threads resentations, doctoral student Kenneth Li of Harvard ences, they tried misdirecting the system by telling it
@georgemusserjr@ University and his AI researcher colleagues—Aspen K. that red is in fact green—like the old philosophical
threads.net Hopkins of the Massachusetts Institute of Technology; thought experiment in which one person’s red is

60 Scientific American, September 2023

 another person’s green. Rather than parroting back an learning follows the same basic computational proce-
incorrect answer, the system’s color evaluations dure as standard learning, known as gradient descent.
changed appropriately to maintain the correct relations. This procedure was not programmed; the system dis-
Picking up on the idea that to perform its autocor- covered it without help. “It would need to be a learned
rection function the system seeks the underlying logic skill,” says Blaise Agüera y Arcas, a vice president at
of its training data, machine-learning re­­search­er Google Research. In fact, he thinks LLMs may have
Sébastien Bubeck of Microsoft Re­­search suggests that other latent abilities that no one has discovered yet.
the wider the range of the data, the more general the “Every time we test for a new ability that we can quan-
rules the system will discover. “Maybe we’re seeing tify, we find it,” he says.
such a huge jump because we have reached a diversity Although LLMs have enough blind spots not to qual-
of data, which is large enough that the only underly- ify as artificial general intelligence, or AGI—the term
ing principle to all of it is that intelligent beings pro- for a machine that attains the resourcefulness of animal
duced them,” he says. “And so the only way to explain brains—these emergent abilities suggest to some
all of the data is [for the model] to become intelligent.” researchers that tech companies are closer to AGI than
In addition to extracting the underlying meaning even optimists had guessed. “They’re indirect evidence
of language, LLMs can learn on the fly. In the AI field,
the term “learning” is usually reserved for the compu-

ChatGPT was playing Othello

tationally intensive process in which developers
expose the neural network to gigabytes of data and
tweak its internal connections. By the time you type a
query into ChatGPT, the network should be fixed;
roughly like a human: by keep­­ing
unlike humans, it should not continue to learn. So it a game board in its “mind’s
came as a surprise that LLMs do, in fact, learn from
their users’ prompts—an ability known as in-context eye” and using this model to
learning. “It’s a different sort of learning that wasn’t
really understood to exist before,” says Ben Goertzel,
evaluate its moves.
founder of AI company SingularityNET.
One example of how an LLM learns comes from the
way humans interact with chatbots such as ChatGPT. that we are probably not that far off from AGI,” Goertzel
You can give the system examples of how you want it said in March at a conference on deep learning at Flor-
to respond, and it will obey. Its outputs are deter- ida Atlantic University. OpenAI’s plug-ins have given
mined by the last several thousand words it has seen. ChatGPT a modular architecture a little like that of the
What it does, given those words, is prescribed by its human brain. “Combining GPT-4 [the latest version of
fixed internal connections—but the word sequence the LLM that powers ChatGPT] with various plug-ins
nonetheless offers some adaptability. Entire websites might be a route toward a humanlike specialization of
are devoted to “jailbreak” prompts that overcome the function,” says M.I.T. researcher Anna Ivanova.
system’s “guardrails”—restrictions that stop the sys- At the same time, though, researchers worry the
tem from telling users how to make a pipe bomb, for window may be closing on their ability to study these
example—typically by directing the model to pretend systems. OpenAI has not divulged the details of how it
to be a system without guardrails. Some people use designed and trained GPT-4, in part because it is
jailbreaking for sketchy purposes, yet others deploy it locked in competition with Google and other compa-
to elicit more creative answers. “It will answer scien- nies—not to mention other countries. “Probably
tific questions, I would say, better” than if you just ask there’s going to be less open research from industry,
it directly, without the special jailbreak prompt, says and things are going to be more siloed and organized
William Hahn, co-director of the Machine Perception around building products,” says Dan Roberts, a theo-
and Cognitive Robotics Laboratory at Florida Atlantic retical physicist at M.I.T., who applies the techniques
University. “It’s better at scholarship.” of his profession to understanding AI.
Another type of in-context learning happens via And this lack of transparency does not just harm
“chain of thought” prompting, which means asking the researchers, says Mitchell of the Santa Fe Institute. It
network to spell out each step of its reasoning—a tactic also hinders efforts to understand the social impacts
that makes it do better at logic or arithmetic problems of the rush to adopt AI technology. “Transparency
requiring multiple steps. (But one thing that made Mil- about these models is the most important thing to
lière’s example so surprising is that the network found ensure safety.”
the Fibonacci number without any such coaching.)
In 2022 a team at Google Research and the Swiss
Federal Institute of Technology in Zurich—Johannes F R O M O U R A R C H I V E S
von Oswald, Eyvind Niklasson, Ettore Randazzo, João AI Writes about Itself. Almira Osmanovic Thunström; September 2022.
Sacramento, Alexander Mordvintsev, Andrey Zhmogi-
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a
nov and Max Vladymyrov—showed that in-context

September 2023, ScientificAmerican.com 61

 COGNITIVE SCIENCE

The
Dementia
Defense
When criminal behavior overlaps with degenerative
cognitive disease, the justice system often falters
By Jessica Wapner

Illustrations by Mark Smith

62 Scientific American, September 2023

 Jessica Wapner is a science journalist. She is author of Wall
Disease (2020) and The Philadelphia Chromosome (2014), both
published by The Experiment. Wapner lives in upstate New York.

D avid Rothman delivered his last baby in 2003 and shut down his obstetrics
practice at the age of 62. A couple of years later he became the medical direc-
tor of a newly opened clinic, called Medcore, that specialized in HIV care.
The clinic was in a nondescript office building in
Miami, out near the airport. Reyes Cruz, who was
diagnosed with HIV in 1994, first visited in the sum-
mer of 2005. He told Rothman that he had stomach
cramps, bleeding gums and diarrhea. Rothman looked
inside his mouth, took his pulse and pressed on his
stomach. Cruz had his blood drawn. Afterward, a
his arrest, Rothman had been diagnosed with Alz­
heim­er’s disease. The legal process that followed
would last 11 years—a costly demonstration of just
how unprepared the criminal justice system is to han-
dle people with dementia.

Nearly 10 percent of U.S. adults age 65 and over have

phlebotomist asked him to sign a form verifying his some form of dementia, and another 22 percent have
visit, then handed him $600 in cash. Cruz visited mild cognitive impairment. Alz­heim­er’s, the most com-
Medcore regularly for nearly a year, receiving $600 mon type, has symptoms we tend to associate with cog-
each time, sometimes in the clinic’s bathroom, some- nitive decline in the elderly—wandering, disorientation,
times in the parking lot. memory loss, struggling to find the right word. In fron-
Cruz later testified that he had lied about his ail- totemporal dementia, a person may become impulsive
ments. The clinic was a scam. The owners bribed peo- or lose their ability to sympathize. Lewy body dementia
ple with HIV to serve as pretend patients. Rothman can cause tremors and change sleep patterns. A person
signed Medicare claim forms for HIV drugs that were with vascular dementia may hallucinate. Symptoms
never purchased by the clinic nor provided to the often overlap, which can make diagnosis tricky.
patients. Over about two years Medcore billed Medi- Some forms of dementia can trigger behaviors that
care for $4,040,895 in fake expenses. Bank records society classifies as criminal. It’s not that these condi-
indicate that Rothman received at least $600,000 tions create an intention to violate the law—most
from Medcore and other similar schemes that he was dementia-related violations are not what neurologists
allegedly involved in. call “instrumental behaviors,” which are calculated in
fbi agents arrested Rothman and seven other peo- advance and executed according to a plan. Rather the
ple in October 2008. (By this time, he’d relinquished radical changes in a person’s behavior and demeanor
his medical license for a different reason: the state’s can erase their sense of social norms. They steal. They
Department of Health accused him of prescribing grope. They shout abusive language at fellow custom-
Viagra based solely on online questionnaires.) Roth- ers in the grocery store. Stacey Wood, a professor of
man was charged with health-care fraud and health- psychology at Scripps College, recalled a patient who
care fraud conspiracy. He faced up to 20 years in began hugging customers at a convenience store and
prison. Four of the indicted defendants pleaded guilty, didn’t stop until the manager called the police.
and four, including Rothman, chose to go to trial. “Mostly we’re talking about impulse-control prob-
Shortly before the jury was set to assemble, Roth- lems,” says Wood, who has provided expert testimony
man’s attorney filed a motion stating that his client in many cases involving defendants and victims with
was incompetent to stand trial. Five months before dementia. “They just have terrible judgment.”

64 Scientific American, September 2023

 These radical changes in a person’s cognition and activity. She interviewed 15 attorneys between 2020
behavior tend to come from a loss of awareness about and 2021, and their responses (which will be pub-
the world. Some people lose what psychologists call lished soon in the American Journal of Law and Med-
theory of mind—that is, the ability to comprehend icine) indicated to Arias that the criminal justice sys-
that other people have minds and mental states just tem lacks a consistent approach for screening older
like they do. People with dementia can also lose self- offenders for dementia.
conscious emotions or “where you see yourself If the police realize that the suspect they’ve just
through others,” says Mario Mendez, director of the arrested has Alz­heim­er’s, they have nowhere to bring
Behavioral Neurology Program at the David Geffen that person besides the nearest precinct or emer-
School of Medicine at U.C.L.A. When that capacity gency room. The attorneys Arias interviewed recog-
evaporates, a person no longer feels shame or guilt nized that jails and prisons aren’t clinically appropri-
about breaking with acceptable social patterns. The ate, because simply being in unfamiliar places and
loss of these capacities may help explain the most situations can be harmful to people with dementia.
common crimes among Alz­heim­er’s patients—public Offenders without caregivers may be best served by
urination, theft, traffic violations, sexual advances placement at a long-term care facility, but often they
and trespassing.
Not everyone with dementia steals or
runs red lights, of course, but it appears
that people with this diagnosis are more In general, people with Alzheimer’s
susceptible to criminal behavior. It’s diffi-
cult to determine just how often the police
are known to be victims of scams,
are called to intervene in dementia-driven not the perpetrators. They don’t start
fake clinics to defraud Medicare.
behavior, but one way to look at it is
through fbi data. More than 100,000 peo-
ple older than 65 were arrested in 2019, a
number that represents about 0.18 percent
of all people older than 65 in the U.S. For comparison, cannot afford it. And the criminal record they now
8.5 percent of the patients seen at the University of have may make them ineligible anyway. “Our legal
California, San Francisco, Memory and Aging Center system as a whole just really hasn’t wrapped its head
between 1999 and 2012 committed crimes after around this particular issue,” Arias says.
receiving their diagnosis. Defendants with psychiatric illnesses may plead
Most dementia-related transgressions do not land not guilty by reason of insanity, or they may insist
the guilty party in prison or even in front of a jury. they didn’t have conscious control over themselves—
Guilt has two properties: that a person committed they were sleepwalking when they stole a candy bar,
the crime and that they intended to do so. The latter, for example. There are no such protections for elderly
known as mens rea, is usually missing when dementia people with cognitive disease.
patients violate the law. Charges are typically dropped In general, people with Alz­heim­er’s are known to
once the police, the victim or the prosecuting attorney be victims of scams, not the perpetrators. They don’t
realizes that a defendant is not of sound mind. start fake clinics to defraud Medicare. A crime like
Still, a portion of older individuals who commit that “is not something that you can easily attribute to
crimes because a neurodegenerative disorder has brain disease,” Mendez says.
warped their sense of acceptable behavior do end up
incarcerated. Mendez recalled a patient of his who The fbi contacted Rothman about his work with
was arrested for touching a child in a way that would ­Medcore in December of 2005. Later that month,
have been acceptable (“something like patting on the according to his daughter Raquel Rothman, he testi-
head,” he explained) if the patient had known the fied before a grand jury. Raquel found out about the
child. Another patient went to jail for taking some- testimony only because her father showed up at her
thing trivial from a store. In 2021 a 67-year-old man sister’s house afterward wearing a suit, which was
with Alz­heim­er’s spent several months in an Okla- odd for him. When her sister asked their dad why he
homa jail for allegedly stealing a car, even though it was so dressed up, he nonchalantly told her where
was clear to the arresting officer that the man didn’t he’d been. Raquel, an attorney, was alarmed to hear
understand why he was being pulled over and was he’d testified without a lawyer present. (The details of
confused about where he was. grand jury hearings are publicly unavailable.)
Jalayne Arias, who studies health policy and be­­ Raquel immediately contacted her dad’s former
hav­i­or­al sciences at the School of Public Health at fraternity brother, Joel Hirschhorn, A 1995 New
Georgia State University, wanted to know how attor- Yorker story described Hirschhorn as a white-collar
neys handle people who are arrested for offenses stem- defense attorney who had formerly defended drug
ming from their dementia, including how they dis- dealers in 1980s Miami. The two men had run into
cern whether the disease is what led to the criminal each other occasionally since college, but it had been

September 2023, ScientificAmerican.com 65

 focused while court is in session;
communicating meaningfully with
an attorney. When a person’s ability
to participate in their defense is in
question, their attorney can request
a competency evaluation, which is
es­­sentially an investigation of the
defendant’s mind.
The modern rules surrounding a
defendant’s competency stem from
Dusky v. United States, a 1958 case
in which a 33-year-old man named
Milton Dusky was accused of kid-
napping a minor. Dusky had schizo-
phrenia, but the court ruled him fit
to handle the criminal justice pro-
cess. He was found guilty and sen-
tenced to 45 years in prison. After
an initial appeal failed, the Supreme
Court reversed the decision in 1960,
leading to the “Dusky standard” of
competency: that defendants un­­
der­stand the charges against them
and the possible penalties and that
they can assist in the preparation of
their defense. 
Dusky applies to all neurologi-
cal conditions. The law does not
differentiate between mental ill-
nesses that can be ameliorated with
medication, such as schizophrenia,
bi­­polar and clinical depression,
and those that are incurable, such
as dementia.
To determine whether a defen-
dant meets the Dusky standards of
competency, the court appoints an
expert to conduct a forensic evalua-
tion. These investigations use the
same tools that a doctor would use to
check for cognitive impairment. First
many years since the last time. When Hirschhorn met come biological tests to rule out other causes of demen-
with Rothman, he seemed “disheveled and depressed,” tia, such as vitamin deficiencies, HIV and urinary tract
nothing like the sharp student he’d remembered. infections, all of which are curable, which means the
Hirschhorn says he gave Rothman the name of a psy- comprehension issues are resolvable. The evaluator
chiatrist. That doctor referred Rothman to a neuro- may also order an imaging scan to check for signs of
psychologist, who diagnosed Rothman with mild cog- erosion inside the brain.
nitive impairment in March 2007 and sent him to a A battery of cognitive tests for dementia includes
neurologist for further testing. In May 2008, more questions that check memory, recognition, language
than two years after the first doctor’s appointment recall, executive function, and other brain skills.
and two months before the indictment, the neurolo- A patient might be asked to name the city and state
gist diagnosed Rothman with Alz­heim­er’s. they’re in or to draw a clock with the hands showing
The Sixth Amendment of the U.S. Constitution a specific time. The evaluator may test a person’s
entitles every criminal defendant to a fair trial. That sense of right and wrong by asking them to explain
includes ensuring that a defendant is fully capable of the meaning of a proverb. In a clinical setting, the
understanding the proceedings. The cognitive de­­ goal is to make a diagnosis. In a forensic setting, the
mands of a trial are substantial: understanding the goal is to determine whether the defendant can plan a
evidence; weighing the benefits and risks of taking the legal strategy, understand courtroom procedure and
stand; considering a plea deal; re­­maining alert and ­de­­corum, comprehend the charges against them,

66 Scientific American, September 2023

­challenge witnesses and feel invested in the outcome. week after Suarez’s evaluation. All the clinicians who
Competency evaluations are rigorous because they had examined Rothman since 2006 gave the judge
connect to a fundamental tenet of the U.S. justice sys- their test results, imaging reports and conclusions
tem: that people must be held accountable for violat- about whether Rothman was fit to stand trial. Every-
ing the law. People with early-stage Alz­heim­er’s are one said Rothman was incompetent, except for Suarez,
no exception. The ability to consult with one’s lawyer who insisted that Rothman didn’t even have demen-
does not mean remembering every relevant fact; even tia. Rather Rothman’s test scores were so in­­con­sist­ent
defendants with amnesia have been ruled competent. and, at times, so low that they could point to only one
“Having mild cognitive impairment or an early conclusion: Rothman was malingering, Suarez said.
dementia, in most legal settings, would be insufficient He was faking it.
to obviate responsibility for a crime,” says Tom Wis-
niewski, who directs N.Y.U. Langone’s Center for  nited States v. Gigante is probably the most famous
U
Memory Evaluation and Treatment. case involving malingering. Gigante faked a mental
Cognitive tests to determine competency to stand illness for decades to cover up his role as the head of
trial provide only a snapshot of the moment at which the Genovese crime family, mumbling to himself as
they’re given, which doesn’t capture the
fluctuations that dementia can cycle
through over a week or even a single day.
They can miss the loss of feelings or inhibi- Clinically, it’s impossible to know
tions. Also, some people may exaggerate
symptoms to stay out of prison. Forensic when dementia first starts taking
and clinical evaluators therefore also inter-
view family and friends. Only people who
root in a person’s brain or when
know the defendant’s history can provide it begins chipping away at a person’s
insights about behavioral changes over
time. “The cognitive assessment of the
empathy or inhibitions.
patient is critically dependent on having an
informant,” Wisniewski says.
When Hirschhorn requested a competency evalua- he walked the city streets in tattered clothes. He used
tion for Rothman, the judge ap­­point­ed a local neuro- that act to delay his conviction for years after he was
psychologist, Enrique Suarez, to conduct it. Suarez arrested in 1990. A judge finally ruled him competent
gave Rothman four cognitive tests over two days in to stand trial, leading to a guilty verdict in 1997.
February 2009 and noticed some peculiarities that (Gigante only admitted the ruse a couple years before
didn’t match a typical Alz­heim­er’s patient. For exam- he died in prison.)
ple, Rothman’s recall was better than his recognition. Detecting that someone is malingering is not an
Rothman got an average score on a word-list recall test exact science. Evaluators often get it wrong. Gigante-
but scored far below average when he was asked style fakes are rare. “People can be mentally ill and ma­­
whether he recognized something he’d been shown a lingering; they can be demented and exaggerate,” says
few minutes earlier. And in a test in which Rothman Rory Houghtalen, a forensic psychiatrist who consults
had to choose which of two words he’d seen before, he on criminal legal cases in New York State. “You gotta
did much poorer than someone at his stage of Alz­heim­ be real careful about throwing the m-word around.”
er’s typically does. His IQ score was 85 (90 to 109 is Still, the judge found Suarez’s testimony to be the
considered average), which struck Suarez as un­­likely most convincing. She didn’t declare that Rothman
for someone with Rothman’s educational and profes- was pretending, but she questioned why Rothman
sional background. It was also 20 points lower than he had not sought treatment until he discovered he was
had scored on the same test administered by his regu- under investigation in 2005. She concluded that
lar neuropsychologist at around the same time. Suarez Rothman was suffering from “a mental disease or
thought it was strange when Rothman disclosed that defect” but not one that compromised his cognition
he’d been suffering from auditory hallucinations— enough to render him legally incompetent. He had
hearing things—for the past 15 years because Rothman explained his innocence to his doctors; surely he
had never mentioned this to any of his doctors. could do the same before a jury. Rothman, she ruled,
For the family component, Suarez interviewed was competent to proceed to trial.
only Raquel. The court records contain no explana- The judge would not permit expert witnesses to tes-
tion of why he did not interview Rothman’s wife of 17 tify that Rothman’s Alzheimer’s diagnosis contributed
years, Amanda Rothman. It also omits the fact that to his participation in the Medcore scheme. Clinically,
Rothman and Raquel had been all but estranged it’s impossible to know when dementia first starts tak-
since she was a teenager, so she would not necessarily ing root in a person’s brain or when it begins chipping
know how her father had changed. away at a person’s empathy or inhibitions. The legal
The competency hearing before the judge came a system couldn’t retroactively determine his state of

September 2023, ScientificAmerican.com 67

 mind when he was signing fraudulent Medicare forms. August 2009. Rothman did not have Alz­heim­er’s, nor
The proceedings lasted two weeks in March 2009. was he malingering, Duara wrote. He had frontotem-
Hirschhorn did not try to blame Rothman’s criminal poral dementia.
actions on Alz­heim­er’s disease, but he did argue that
issues with executive functioning muddled Roth- Humans have an innate ethical compass. The medial
man’s ability to see Medcore for what it was. In his frontal region and anterior temporal region of the
opening statement, he referred to Rothman as “a dod- brain help us evaluate moral questions. The classic
dering old fool” who had “developed extremely poor trolley problem draws on this feature: A train is
judgment.” Later, he argued to the jury that Rothman headed toward five people tied to the track; Do you
was a devoted physician who was trying to take change its course to kill just one person instead? “It’s
proper care of his HIV patients. He was a good doctor very hard to do something for the greater good, for
who had been taken advantage of by bad people. the greater many, if you feel like you’re hurting some-
The jury found Rothman guilty on all five counts body directly,” Mendez says.
against him, and the prosecution requested that he Frontotemporal lobe dementia (FTD) attacks this
spend 135 months (more than 11 years) in prison. (All moral circuitry. It erodes the parts of us that sympa-
the co-defendants were also found guilty.) Rothman thize, that make us feel self-conscious, that help us dis-
posted the $500,000 bond and remained under house tinguish right from wrong. A person with frontotem-
arrest until the sentencing hearing in June. poral lobe dementia may know that stealing is wrong,
Ten days before the hearing, Hirschhorn filed a but if you ask them whether it was wrong of them to
new motion: he wanted the court to grant an evalua- take a scarf from a store without paying, they may say
tion to determine Rothman’s competency to proceed no. “They don’t feel that their actions are wrong but
to sentencing. Dusky a  pplies at this stage, too, that the action itself is wrong,” Mendez says. FTD
because defendants must fully grasp the situation would not lead a reputable obstetrician to design an
before them. Simultaneously, a judge who was not elaborate scam to defraud Medicare, but it could stop
part of the Medcore case appointed Raquel Rothman him from recognizing his participation in the ruse.
as her father’s emergency temporary guardian on the In the U.C.S.F. study that identified high rates of
grounds that he was incapacitated. criminal behavior among people with dementia,
When a person is ruled unable to meet the Dusky those rates were highest among the subset of patients
standards, the law permits a competency restora- with FTD: 64 of 171 patients, or 37 percent. “Patients
tion—a forced stay at a prison hospital or outpatient with FTD can commit criminal violations while
clinic during which the defendant can be appropri- retaining the ability to know the moral rules and con-
ately medicated for their condition and educated on ventions,” Mendez wrote in a 2011 paper describing
the criminal justice system. They may be trained to the predilection of people with FTD to break the law.
answer questions such as, “What is the role of a jury?” Duara was struck by Rothman’s lack of insight
and “What is a plea?” Eventually they are deemed fit about what was going on at Medcore, as well as his
to return to court, and the case resumes. lack of remorse. “He really didn’t think he had done
But what if they are never deemed fit? Dementia is anything wrong,” Duara says. “He didn’t seem to ever
irreversible; no one makes a recovery. The medica- admit that he had made any errors in judgment by
tions available for Alz­heim­er’s may slow disease pro- being involved with this clinic.” An MRI scan re­­veal­ed
gression, but they don’t stop or reverse it. The June that the anterior part of Rothman’s temporal lobe, the
2021 approval of aducanumab for mild Alz­heim­er’s brain region just behind the ears, had shrunk. “There
was controversial because neither of the clinical trials was no question there was something degenerative
that led to the approval showed any improvement in going on in the brain,” Duara says.
symptoms. Lecanemab, approved in January 2023, Given Duara’s departure from the assessments of
also does not reverse symptoms. “Dementia just gets previous experts, the prosecution called for a longer
worse and worse,” Wood says. evaluation. The judge sent Rothman for a 10-day eval-
That means that a defendant with Alz­heim­er’s will uation at the Federal Medical Center in Rochester,
undergo a restoration process that is doomed to fail. Minn. The psychologists there concluded that Roth-
They typically end up committed to the hospital for man was faking his symptoms, but the judge dis-
longer periods than people who have more treatable agreed with their findings—it turned out that the
psychiatric conditions, explains Yale University psy- evaluators had no experience with dementia. In
chiatrist Tobias Wasser, a former chief medical officer August 2010, 17 months after Rothman was found
at a forensic psychiatric hospital. guilty, the judge ruled that Rothman was incompe-
In response to Hirschhorn’s presentencing evalua- tent to proceed to sentencing.
tion request, the judge appointed Ranjan Duara, a The prosecution wanted assurance that Rothman
neurologist who directs the Wien Center for Alz­hei­- would never become fit for sentencing. Rothman surren-
m­er’s Disease and Memory Disorders at Mount Sinai dered to the Bureau of Prisons medical facility in Butner,
Medical Center in Miami, to conduct the competency N.C., for evaluation. This facility is well known among
examination. Duara filed his report to the court in forensic psychiatrists (Unabomber Ted ­Kaczynski was

68 Scientific American, September 2023

housed there until his death in June 2023). The report people with dementia who a  re criminals. States are
provided by the forensic psychologist handling Roth- hamstrung by political will. Another option would be
man’s evaluation confirmed that Rothman had not to allow a plea of “not guilty by reason of dementia”
gotten any better and never would. On June 10, 2011, or to enact sentencing limits similar to those protect-
he was released to the custody of his family. ing juveniles from lifelong incarcerations.
By this time, Rothman’s wife had filed for divorce. When the Bureau of Justice Statistics collects data
Raquel Rothman relocated her father to an assisted on correctional facilities, it doesn’t ask about demen-
living facility in Miami, which he could leave only tia specifically, so the precise number of inmates suf-
with a member of the staff or his family. She was fering from it isn’t known. One 2012 study estimated,
ordered to call her father’s probation officer every somewhat unhelpfully, that dementia rates among
week to confirm that he was at the facility and com- inmates range from 1 to 44 percent depending on the
plying with the restrictions on his whereabouts. “I type and size of the prison. But given the prevalence of
had two alarms on my phone for 10 years to make dementia in the older population in general, it’s rea-
sure I didn’t miss a single phone call,” Raquel says. sonable to assume that number, whatever it is, is
trending upward: In 2013 people older than 55 made
To the end, dementia is a shape-shifter. Duara remained up 10 percent of the state prison population—a 7 per-
Rothman’s doctor, filing dozens of reports to the U.S. cent increase from 20 years earlier. One report pro-
Department of Justice over eight years. In
2016 he took another look at Rothman’s

If prisons are meant for rehabilitation,

brain with a PET scan and found the image
more consistent with atypical Alz­heim­
er’s—a variant that mimics frontotemporal
dementia and causes problems with judg-
then why keep people locked up
ment, insight and executive function. when they no longer understand
In 2019 the Department of Justice filed
a request that the case against Rothman be why they are even there?
dismissed, and the court agreed. Duara,
who checked on Rothman most recently in
January 2023, says that his patient was “moderately jected that by 2030, people age 55 and older will make
to severely impaired.” According to Raquel Rothman, up a third of the U.S. prison population.
her dad can no longer take care of himself and barely The reasons for this increase are multifold. When
speaks. During a visit at the assisted living facility in the U.S. banned the death penalty from 1972 to 1976,
the summer of 2022, when she was sitting in Roth- life sentences became more common and never
man’s room, watching him “go in and out of con- receded even when the ban was lifted. The large Baby
sciousness,” she says he started moving his hands del- Boomer population has been entering the phase of
icately through the air, thumb and forefinger pressed life when dementia is most common, leading to
together. “He was suturing in his sleep,” she says. increasing diagnoses. The lack of exercise and the
Rothman wasn’t necessarily subject to any injus- psychological turmoil of prison life may exacerbate
tice. He may have avoided prison because the justice cognitive decline among aging inmates, especially if
system was working well or because it was working they have other mental health issues.
poorly. Maybe he had a fair and careful judge—or a Most correctional systems offer no geriatric or
really good lawyer. Other defendants with dementia dementia care services. Prison memory wards, such
facing similar charges have not fared nearly as well. as the one that opened in 2019 at the Federal Medical
Wisniewski, who treats dementia at N.Y.U. Langone Center Devens in Massachusetts, could help keep vul-
Health, re­­called a patient—a physician—who began nerable inmates safe. But such interventions drive
writing unnecessary narcotic prescriptions and home a contradiction: If prisons are meant for reha-
ended up in prison for 15 years. “He was barely cogni- bilitation, Arias explains, then why keep people
zant of his name after five years,” Wisniewski says, locked up when they no longer understand why they
“but he stayed incarcerated. Dementia patients are are even there? Arias is continuing to accrue data
dealt with in an extremely cruel fashion.” from attorney interviews to evaluate the purpose of
Among the solutions suggested by experts like our criminal justice system. “Is there a willingness to
Arias would be an elderly, cognitively impaired equiv- concede that incarcerating someone with dementia,”
alent of juvenile court, which recognizes that juve- she asks, “is, maybe, questionable?”
niles should be held to different legal standards than
adults because their brains are not fully developed. At
the federal level, that change would have to be led by FROM OUR ARCHIVES
the Department of Justice, which is currently more Dementia in Prison Is Turning into an Epidemic. Sara Novak; ScientificAmerican.com, September 27, 2022.
focused on protecting people with dementia from
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a
criminals such as scam artists rather than on helping

September 2023, ScientificAmerican.com 69

 The
MEDICINE

Long
Shot
After decades of frustration,
scientists finally have
successful vaccines and
treatments for the
respiratory disease RSV
By Tara Haelle

Illustration by Cristina Bencina

for many people, an infection with respi-

ratory syncytial virus, or RSV, is little more
than a troublesome cold. But the virus
poses a serious danger to young infants,
older adults and immunocompromised
people. The disease is the leading cause of
hospitalization in infants in the U.S. and
was particularly bad in the 2022–2023 sea-
son. An estimated 58,000 children and
177,000 older adults in the U.S. are hospi-
talized with RSV every year. As many as
300 of these children die, along with
approximately 14,000 older adults.
After a decades-long search, vaccines for RSV are finally
here. Scientists have been working on the shots since soon
after the virus was discovered in 1956. But some disastrous
clinical trials in the 1960s and dozens of other failed attempts
stymied progress for many years. Now not just one but two

September 2023, ScientificAmerican.com 71

RSV vaccines for older adults have been approved by the U.S. Food vaccines using virus that was weakened instead of neutralized, or
and Drug Administration and the Centers for Disease Control and deactivated. These didn’t cause enhanced disease, but they also
Prevention. As of this writing, a vaccine given to pregnant people, didn’t make it far in clinical trials. “The problem with live attenu-
designed to protect infants after birth, was on track to be approved ated vaccines is that you’ve got a relatively small therapeutic win-
by the end of the summer. The breakthrough leading to these de- dow, meaning if they’re not attenuated enough, they will cause dis-
velopments happened once researchers solved a 50-year-old mys- ease. Too attenuated, and they won’t be immunogenic enough to
tery about the virus by examining the shape of its proteins. The dis- cause immunity,” says Barney Graham, a vaccinologist and senior
covery has ushered in a new era of vaccine development using de- adviser for global health equity at the Morehouse School of Medi-
signs based on the structure of proteins—the same approach that cine, who has spent his career studying RSV vaccine development
enabled the rapid development of a COVID vaccine. for children but was not involved in those devastating early trials.
Until recently, the main way to prevent RSV infection was the “When you start putting it into lots of children, who have so much
usual hygiene practices used to prevent common colds, such as variability themselves, it’s hard to get that therapeutic window to
wearing a face mask, washing one’s hands and avoiding sick peo- fit all of the children,” says Graham, who was also instrumental in
ple. There was also one medication: palivizumab, a short-acting developing a COVID vaccine.
monoclonal antibody that provides passive immunity (protection Before RSV vaccine research could lead anywhere fruitful, re-
with antibodies created outside a person’s own body) to infants searchers needed to know what had gone so wrong in the 1960s tri-
for up to one month at a time. But palivizumab, which was ap- als to cause antibody-enhanced disease. The mystery wasn’t solved
proved in 1998, requires multiple doses that cost more than until 2008, when Fernando P. Polack, founder of the Infant Foun-
$1,800 each. The drug is licensed for preterm infants born before dation in Argentina, and his team at Johns Hopkins University pub-
35 weeks who are younger than six months at the beginning of lished a study in N ature Medicine describing experiments with mice
the RSV season, which starts in the fall. The American Academy that demonstrated how the antibodies produced by the vaccinated
of Pediatrics recommends restricting the antibody’s use to the children’s immune systems bound to RSV but did not neutralize it.
most vulnerable of these infants because of the cost. With those antibodies failing to neutralize the virus, it prolif-
erated, resulting in a lot of ineffective antibodies and a lot of viral
A GRIM HISTORY antigens clumping together with those antibodies, Graham says.
Thirty years before that drug debuted, scientists were already work- These clumps built up in the tissue, attracting immune system
ing on an RSV vaccine intended to save lives. To their horror, it took proteins that caused a cascade leading to inflammation. That in-
lives away. In 1966 four clinical trials tested a vaccine made with an flammation damaged lung tissue and created mucus that con-
inactivated form of the virus in children who had never gotten RSV stricted the airways and made the children sicker than they would
before. In one of the studies, 80 percent of the vaccinated children have been with no preexisting antibodies. But a big question re-
were hospitalized when they later contracted the virus itself, and mained: Why didn’t those antibodies adequately neutralize the vi-
two toddlers—a 14-month-old and a 16-month-old—died. Typical rus? Later that same year a serendipitous meeting would answer
hospitalization rates for children with RSV are in the single digits, that question and lead to the final steps necessary to make RSV
says Ruth Karron, a pediatrician and director of the Johns Hopkins vaccines a reality.
Vaccine Initiative. Otherwise healthy children do sometimes die
from RSV, but that is most likely to occur in the first six months of A TALE OF TWO PROTEIN SHAPES
life, so the deaths of toddlers were especially telling. In 2008 Jason McLellan, now a molecular biologist at the Universi-
“As you can imagine, this sort of stopped vaccine development ty of Texas at Austin, had just begun a postdoctoral fellowship at
for a very long time,” Karron says. “You took a pathogen that, even the National Institutes of Health Vaccine Research Center, where
then, didn’t kill that many children, and it killed children.” he met Graham. Graham, who was leading RSV vaccine efforts
The disaster was traced to a phenomenon called antibody-de- there, learned that McLellan, who specialized in mapping the atom-
pendent enhancement, in which the body produces antibodies ic structure of proteins, wanted to work on something “a little off
that don’t adequately protect it and instead exacerbate the radar,” Graham says. “Well, we have no structural in-
the infection. Antibody-dependent enhancement had formation on RSV yet,” he told McLellan. Graham was
occurred with an early version of a measles vaccine in particularly interested in the “F protein,” the antigen that
the 1960s that was later pulled from use, and it has since was the main target for RSV vaccine development.
been reported with the dengue fever vaccine. The idea piqued McLellan’s interest. “It became clear
But the mechanism that causes this problem varies de- that RSV was one of the major childhood pathogens for
pending on the pathogen. With dengue, for example, there which we didn’t have a vaccine, so working on a vaccine
are four types of the virus, and antibodies to one do not that can help save the lives of babies and young children
Tara Haelle is a
protect completely against all the others. So when a per- was very motivating,” he says. The pair’s goal—discover-
Texas-based sci-
son develops antibodies in response to one dengue sero- ence journalist and ing the F protein’s structure—would become the key to
type and then becomes infected with another, the body author of V accina- creating a successful vaccine. But the F protein isn’t sta-
tries to fight the second infection with the antibodies tion Investigation: ble: when it fuses with a cell, allowing the virus to en-
from the first and fails, while the infection worsens. The The History and Sci- ter and hijack the cell to reproduce, it changes shape.
ence of Vaccines
problem with RSV was that scientists didn’t know what Antibodies against the so-called postfusion shape—the
( Twenty-First Cen-
caused its antibody-dependent enhancement. tury Books, 2018). ones produced by the immune systems of the children
For the next two decades RSV vaccine progress stag- Follow her on Twit- in the 1960s trials—don’t fully neutralize the circulat-
nated. Researchers developed multiple live attenuated ter @tarahaelle ing form of the virus b efore it binds to cells, known as

72 Scientific American, September 2023

the prefusion form. But if a vaccine could induce antibodies an RSV vaccine in consultation with their health-care provider but
against this form, they should bind properly with the virus’s ac- stopped short of recommending them for all older adults. Both vac-
tive form. The trick was to figure out what that prefusion protein cines should be available this fall as the next RSV season begins.
looked like and how to lock it into that shape. The more challenging need was a vaccine to protect newborns,
To do that, the two researchers first took a harder look at the especially because immune systems less than four months old are
other form, the postfusion protein. “That’s the one that’s easy to too immature to respond to most vaccines and develop the im-
make; it’s stable, and so it’s relatively easy to work with,” Graham mune memory needed to fight a disease. Researchers used the
says. Knowing the structure of both the prefusion and postfusion same approach that protects newborns from flu and pertussis—
proteins would enable Graham and McLellan to understand how administering a vaccine during pregnancy so the parent’s antibod-
the protein morphs between the two shapes. By 2010 McLellan had ies will cross the placenta to the fetus. An RSV vaccine would pro-
determined the structure of the postfusion protein using x-ray crys- tect infants for the first six months after birth, when babies are
tallography. Next, to decipher the prefusion protein, his team need- most at risk for serious complications from the disease.
ed to find an antibody that neutralized the virus without binding The fda’s Vaccines and Related Biological Products Advisory
to the postfusion protein. Committee voted on May 18 to recommend fda approval for Pfiz-
In collaboration with researchers at Xiamen University in Chi- er’s parental RSV vaccine candidate. Pfizer has said its RSV vac-
na, McLellan and Graham screened over 13,000 mouse antibod- cine for pregnant people is 82 percent effective against severe
ies until they found one that effectively neutralized RSV’s prefu- RSV in newborns for up to three months and 69 percent effective
sion F protein without binding to the postfusion one. The win- through six months. The committee was impressed with the vac-
ning antibody was about 50 times more potent at neutralizing cine’s effectiveness, but some members had reservations about
the virus than palivizumab, the fda-approved antibody against its safety data.
RSV. The finding suggested previous vaccine candidates had failed The fda advisory panel voted unanimously in favor of the Pfiz-
because none produced antibodies potent enough to neutralize er vaccine’s effectiveness and 10 to 4 in favor of the vaccine’s safe-
the virus. ty. The primary reason for the four nay votes for safety was that the
The researchers then used a similar human antibody to deter- premature birth rate was slightly higher in the vaccinated group
mine the F protein’s structure. “After we had that structure, every- but not statistically significantly so. “I think the four votes were re-
thing really fell in place,” Graham says. “All of a sudden, we had a ally just an abundance of caution,” Graham says. “They weren’t
new, very vulnerable target on the virus for making a vaccine.” saying it wasn’t safe. They said they wanted more information be-
Now, finally able to see exactly where the antibodies attached fore they said yes,” although it’s not easy to get that additional in-
to the protein, McLellan and the team substituted two amino ac- formation until studies are conducted in the general population.
ids in the sequence that encodes the F protein to create a covalent GSK stopped its own trial of a vaccine for pregnant people be-
bond that effectively “stapled” the protein together, preventing it cause infants born in the vaccine group were 38 percent more like-
from pulling apart into its postfusion shape. They published their ly to be born premature.
method in late 2013, then spent the next few years growing human Beyond vaccines, AstraZeneca and Sanofi announced in March
cells that would produce the prefusion protein and learning how 2022 that nirsevimab, a prophylactic monoclonal antibody drug
to purify it for use in a vaccine. similar to palivizumab, is 75 percent effective against cases of RSV
The first small clinical trials to evaluate the vaccine’s safety be- that require medical care in infants younger than one year with no
gan in 2017 and produced encouraging results two years later. By history of RSV—and the protection lasts five months, which is about
then, “RSV vaccines had a life of their own,” Graham says, as the the length of a typical RSV season. Europe approved nirsevimab in
pharmaceutical industry took over their development. November 2022, and the fda approved it in July 2023. A similar
McLellan, meanwhile, turned his focus to coronaviruses. The long-acting monoclonal antibody made by Merck, clesrovimab, is
RSV work would ultimately pave the way for determining the spike in late-stage trials.
protein structure of SARS-CoV-2, the virus that causes COVID, and One challenge will be assuring the protection of children in low-
enable Moderna, Pfizer and other companies to develop a COVID income families, who are already more vulnerable to worse out-
vaccine in record time. The era of protein-structure-based vaccine comes from RSV. The U.S. Vaccines for Children program ensures
design—starting with figuring out a pathogen’s protein structure all eligible children can access vaccines recommended by the cdc,
and building a vaccine around it—had begun. even if they lack insurance. But that program doesn’t currently in-
clude vaccines for pregnant adults, and as of this writing, it has yet
VACCINES ARRIVE to be determined whether the program will cover nirsevimab.
The two pharmaceutical companies that took the lead in develop- It’s still not clear how insurance companies might decide
ing vaccines based on this science were GSK and Pfizer. The fda whether and when to cover nirsevimab. Either way, by the end of
approved GSK’s Arexvy, the first RSV vaccine for adults 60 and old- 2023, it’s very likely that infants, like older adults, will have at least
er, on May 3 and then approved Pfizer’s Abrysvo for the same age one highly effective option to reduce their risk of RSV for the first
group on May 31. GSK said its vaccine is 94 percent effective against time in the half a century since scientists began the effort.
severe disease and 83 percent effective against symptomatic dis-
ease in adults 60 and older. Pfizer said its vaccine is 86 percent ef-
FROM OUR ARCHIVES
fective against severe disease with at least three symptoms and
RSV Is Spreading: What We Know about This Common and Surprisingly Dangerous
67 percent effective against symptomatic disease with at least two Virus. T ara Haelle; ScientificAmerican.com, November 4, 2022.
symptoms in adults age 60 and older. A cdc advisory panel voted
s c i e n t if i c a m e r i c a n . c o m /m a g a zi n e /s a
in favor of recommending that people in that age group may get

September 2023, ScientificAmerican.com 73

outlook
Smoking

Produced with support from:

Loosening tobacco’s
global grip
outlook
Smoking
For more on smoking
visit nature.com/
collections/smoking-
outlook

S
Editorial moking kills. Maybe that’s not the most original thought you’ve Contents
Herb Brody, Richard Hodson, read today, but it’s worth repeating. In 2019, around 14% of all
Joanna Beckett S2 DATA
deaths were caused by tobacco smoking — and were therefore
An avoidable health disaster
Art & Design entirely preventable. What a colossal waste.
Mohamed Ashour, Andrea Duffy The world is generally moving in the right direction. In S4 POLICY
countries deemed to have the highest level of economic and social The battle against tobacco
Production
development, there are now about as many former smokers as there in Africa
Nick Bruni, Karl Smart, Ian Pope,
Kay Lewis are current smokers. That is encouraging, as is the decline in the global S7 ADDICTION
prevalence of tobacco smoking from 28% in 1990 to 20% in 2019. But A stimulating solution
Sponsorship
we should not confuse progress with victory. As a result of population to smoking
Stephen Brown, Beth MacNamara
growth, there are actually more smokers now than there were in 1990
S10 NICOTINE
Marketing (see page S2). Nicotine on trial
Simrah Zafar Nicotine in cigarettes is highly addictive, which makes quitting smok-
Project Manager ing a miserable experience for many people. A new approach to help
Rebecca Jones people kick the habit involves magnetically stimulating regions of the
brain that are involved in addiction. The technique has already been
Creative Director
approved for use in the United States, and it could improve considerably
Wojtek Urbanek
as researchers get a better handle on what goes on in a nicotine-addicted
Publisher brain (S7).
Richard Hughes Policies that encourage quitting and discourage new smokers will
VP, Editorial continue to be crucial to ridding the world of smoking. In general,
Stephen Pincock high-income countries are ahead of their lower-income neighbours
in this regard — the US Food and Drug Administration is even consid-
Managing Editor
David Payne
ering limiting nicotine levels in cigarettes, to make quitting easier. In
low-income countries in Africa, however, even common anti-smoking
Magazine Editor measures such as raising taxes on cigarettes have proved difficult to
Richard Webb implement, in part owing to the interference of tobacco companies (S4).
Editor-in-Chief The negative health effects of smoked tobacco are unquestionable,
Magdalena Skipper but the role of nicotine itself in perpetrating these harms is not clear.
The rising popularity of alternative nicotine delivery methods, such as
e-cigarettes or vapes, is giving researchers more impetus — and more
opportunity — to find out (S10).
We are pleased to acknowledge the financial support of Haleon in
producing this Outlook. As always, Nature retains sole responsibility
for all editorial content.

Richard Hodson
Senior supplements editor

About Nature Outlooks available free online at go.nature.

Nature Outlooks are supplements com/outlook
to Nature supported by external
funding. They aim to stimulate How to cite our supplements
interest and debate around a subject Articles should be cited as part of a
of particularly strong current supplement to Nature. For example:
interest to the scientific community, Nature Vol. XXX, No. XXXX Suppl.,
in a form that is also accessible to Sxx–Sxx (2023).
policymakers and the broader public. Contact us
Nature has sole responsibility for [email protected]
all editorial content — sponsoring For information about supporting a
organizations are consulted on the future Nature Outlook supplement,
On the cover topic of the supplement, but have visit go.nature.com/partner
Anti-smoking policies and new no influence on reporting thereafter
treatments will help to prevent (see go.nature.com/33m79fz). All Copyright © 2023 Springer Nature
tobacco use. Credit: Daniel Stolle Nature Outlook supplements are Ltd. All rights reserved.

Nature | Vol 618 | 8 June 2023 | S1

Smoking
outlook

AN 1.14
DEFYING PROGRESS
Efforts to discourage smoking

AVOIDABLE
have steadily reduced its
prevalence from 27.8% of the
global population in 1990 to
19.6% in 2019 (ref. 1). Global number of
However, the total number of smokers in 2019

BILLION PEOPLE
people who smoke has

HEALTH
actually increased over the
same period, owing to
population growth.

DISASTER
30 1.2

Number of smokers (billions)

Smoking prevalence (%)
25 0.8 The number of smokers has
increased, despite a fall in
smoking prevalence2.
20 0.4
Tobacco smoking continues to place an extraordinarily
heavy burden on global health. By Richard Hodson;
0 0
infographic by Mohamed Ashour 1990 1995 2000 2005 2010 2015 1990 1995 2000 2005 2010 2015

PREVENTABLE DEATHS ECONOMIC STRAIN

More than one in ten deaths can be attributed to smoking2. Most smoking-related deaths stem Direct health expenditure on smoking-related diseases, as well as
from one of just four non-communicable diseases (NCDs): ischaemic heart disease, chronic indirect costs of smoking such as lost labour due to disability and
obstructive pulmonary disease, stroke and cancer of the trachea, bronchi and lungs. death, cost the world more than US$1.4 trillion in 2012 (ref. 3).
These costs outweigh the value generated by the sale of cigarettes.
Non-communicable Communicable, maternal, neonatal Injuries 7.6%
diseases 74.4% and nutritional diseases 18%
Indirect cost Direct cost
$1.014 trillion $422 billion
ALL DEATHS
Global
economic
cost of
smoking
in 2012

200
SMOKING-RELATED DEATHS

13.6% MILLION $94 BILLION

Annual value
of healthy of cigarette
life were sales in the
lost to United States4
disability

$437 BILLION
and death Annual economic

YEARS
Smoking of all deaths are smoking-related. in 2019 as loss in the United
causes one in a result of States due to
six NCD deaths smoking2. smoking4

NEVER TOO LATE

If current smoking patterns do not change, by the end of the twenty-first century ten times as many people will have died from smoking as during the whole of the twentieth
century5. The vast majority of people who will die will be those who continue to smoke; quitting at any age reduces the risk of a smoking-related death considerably6.

Former Current 4
smokers smokers
Relative risk of death

13% 87% Current

Twentieth Twenty-first 3
smokers
century century
100 million Deaths 2
One billion*
attributable
to smoking in Never
20192 1
smoked
0
20 30 40 50
*projected Age at time of quitting (women, United Kingdom)

S2 | Nature | Vol 618 | 8 June 2023

BATTLING MEN
AN EPIDEMIC
The fight against tobacco
smoking has reached
different stages in various
parts of the world. In many
high-income countries
(HICs), smoking rates are on
the way down from previous
highs, thanks in part to the
adoption of anti-smoking
policies such as plain
packaging and high taxation.
Low- and middle-income
countries are more likely to be
experiencing an earlier phase
of the epidemic, in which
smoking rates are yet to
decline. In some low-income
countries, smoking might not Brazil is one of In Timor-Leste 65%
yet have taken hold at all, only two of men smoke1 —
especially among women8. countries to the highest rate in
implement the world.
tobacco-control
policies to the
full extent
recommended
Phase 1: by the WHO.
high prevalence
and not declining

Phase 2:
high prevalence
WOMEN
and declining

Phase 3:
low prevalence
and declining

Phase 0: France and

never had high Portugal are
prevalence the only HICs
in which
women’s
‘Not declining’ in phase 1 means smoking rates
that smoking rates have never are yet to fall.
declined by more than 10% for
men and 5% for women.

REFERENCES
1. Global Burden of Disease Collaborative Women are yet to
Network. Global Burden of Disease Study take up smoking in
2019 (IHME, 2021). 2. GBD 2019 Tobacco large numbers in
Collaborators. Lancet 397, 2337–2360 40% of countries,
(2021). 3. Goodchild, M., Nargis, N. & Tursan mostly in Africa8.
d’Espaignet, E. Tob. Control 27, 58–64 (2018).
4. Nargis, N. et al. Lancet Public Health 7,
E834–E843 (2022). 5. Jha, P. Addiction 113,
1392–1393 (2018). 6. Pirie, K. et al. Lancet Nature publications remain neutral with regard to
381, 133–141 (2013). 7. Jha, P. eLife 9, e49979 contested jurisdictional claims in published maps.
(2020). 8. Dai, X., Gakidou, E. & Lopez, A. D.

A TURNING TIDE?
Tob. Control 31, 129–137 (2022).

Policies that promote smoking cessation are common in countries with high economic and social development, and

90%
have led to roughly equal numbers of current and former smokers. In nations with lower development, where an
increase in smoking might have occurred more recently, cessation efforts are yet to have as significant an effect8.
25 Current smokers Former smokers

20
Proportion of male
population (%)

15

10

0
Quitting smoking before the age
of 40 avoids more than 90% of High SDI High-middle SDI Middle SDI Low-middle SDI Low SDI
the excess risk of death7. Socio-demographic index (SDI) category (2020)

Nature | Vol 618 | 8 June 2023 | S3

Smoking
outlook
activists have begun raising red flags. Africa’s
improving economy and young, fast-growing
population could drive a surge in smoking. The
confluence of trends has not gone unnoticed
by the tobacco industry, which focuses intense
attention on the region and on governments
that have been slow to introduce anti-smoking
regulations. All of this, says Goma, could add up
to an epidemic in the coming years.

Growth opportunity
Nowhere else has the number of smokers
increased more since 1990 than in Africa —
104% in North Africa and the Middle East and
almost 75% in sub-Saharan Africa2. There were
about 66 million smokers on the continent in
2015; by 2025, it’s estimated there could be
84 million3. It is one of only two parts of the

TOBACCO FREE ASSOCIATION OF ZAMBIA

world, along with the eastern Mediterranean
region, where tobacco smoking is set to grow
in the coming decade.
“Africa is in its nascent stages of develop-
ment,” says Peter Magati, an independent
economist and tobacco researcher based in
Kenya. He sees the region as “playing catch-up”
to Europe and North America, and likely to
Tobacco products are often displayed alongside sweets in some African countries. encounter problems similar to those that
development brought in those areas. “They

The battle against

have already been through this and we are
following the same cycle, being perceived as
a new market for tobacco companies,” he says.

tobacco in Africa
Africa’s young people are a particular target.
A 2022 analysis led by researchers at the Uni-
versity of Sierra Leone found that an average
of 19% of adolescents aged from 11 to 17 in
22 African countries reported using tobacco
Interference from the tobacco industry and a products4. Zimbabwe ranked the highest at
47%. Rates of young men using tobacco were
lack of resources make it difficult to strengthen higher than those of women, at 24% and 14%
anti-smoking regulations. By Tammy Worth respectively. This is similar to the split seen

F
in Africa’s adult population more generally.
“We are still on an upward trajectory in most
astone Goma, a physician and chair Goma is one of a group of individuals and of the countries in Africa,” Goma says. He pins
of the Zambia Non-Communicable organizations that have been working to the most responsibility on tobacco companies,
Disease Alliance, has been working for combat the messages of the tobacco indus- which he contends “are really targeting teens”.
more than 15 years to pass tobacco ces- try, educating lawmakers on how cigarettes As a result, he predicts, “in a few years’ time we
sation legislation in Zambia. Bills have and related products harm the nation’s health are going to see those increased rates among
gone to several ministers of health, agriculture and economy. He hopes that the Tobacco and African adults”.
and commerce, trade and industry for their Nicotine Products Control Bill, a draft of which
consideration. But they have never made it to was finalized in 2018, will succeed where others Actions not taken
the National Assembly for a vote. have failed. The country’s current minister of The researchers at the University of Sierra
Given the forces that hold sway over the health, Sylvia Masebo, has been supportive Leone found that breathing second-hand
country’s economic policies, that outcome is and has an encouraging record. smoke was strongly associated with adoles-
not terribly surprising. “Zambia is one of the It is easy to see why anti-smoking legislation cent tobacco use. But there were several other
major tobacco producers in the sub-Saharan might not always have been a priority for Afri- factors that increased risk, including exposure
Africa region, so when we talk about tobacco can countries. Currently, the continent has the to tobacco industry promotions and a lack of
control, it has to be balanced with the com- lowest rates of smoking in the world: in 2020, education about tobacco’s health effects.
mercial interests of farmers and growers,” only about 10.3% of the population smoked Some of these factors could be addressed
says Goma. “It ends up in an endless cycle, all according to the World Health Organization by implementing recommendations from
aimed at them not losing money from the sale (WHO)1. Worldwide, smoking prevalence stands the WHO Framework Convention on Tobacco
of tobacco.” at 22.3%. But in the past decade, researchers and Control (FCTC). The FCTC was adopted by

S4 | Nature | Vol 618 | 8 June 2023

 the World Health Assembly in 2003 to stymie Policy & Education in Ghana, which has publicly
tobacco use globally through regulatory strate- opposed tobacco control and even the link
gies. The main components include monitoring between smoking and lung cancer. Further-
tobacco use, banning tobacco use in public more, and against FCTC recommendations,
spaces, providing cessation services to peo- tobacco companies in Africa often participate
ple who want to quit, placing graphic warning in corporate social responsibility programmes,
labels on tobacco products, banning tobacco such as providing scholarships to low-income
companies from advertising and sponsorships students, or donating to COVID-19 relief funds.
and raising taxes on tobacco products. “In the United States and United Kingdom, the
So far, 43 of the 46 countries in sub-Saharan industry has been denormalized,” Gilmore
TOBACCO FREE ASSOCIATION OF ZAMBIA

Africa have signed the FCTC. “Countries in says. “But in Africa, the tobacco industry is still
Africa wanted to step forward,” says Anna seen as acceptable and puts loads of money
Gilmore, a public-health researcher at the into maintaining that image.”
University of Bath, UK. “They can’t afford to Nature reached out to tobacco companies
pay for the health-care costs and damage [of including Philip Morris International, Roland
smoking],” adds Gilmore, who is a member of Imperial Tobacco Company and BAT for
Stopping Tobacco Organizations and Products comment. Only BAT responded to questions
(STOP), a global tobacco industry watchdog. regarding the industry’s influence on FCTC
“They were incredibly positive and helped uptake in Africa through e-mail: “We support
drive through a strong treaty.” Brenda Chitindi is the executive director of many of the objectives of the World Health
But despite their engagement in creating the the Tobacco Free Association of Zambia. Organization’s Framework Convention on
FCTC, African countries have typically lagged Tobacco Control. This includes measures to
behind when it comes to enacting its policies. Tobacco International responded by launching reduce underage smoking, reinforcing the
Pictorial warnings on cigarette packages, a campaign called #HandsOffMyChoices argu- already well-established public awareness
smoking bans in restaurants and bars, and bans ing against numerous aspects of the proposed of the health risks of smoking, encouraging
on displaying products in retail — policies that bill, and conducted a survey that suggested smoking cessation, and eliminating illicit trade
many high-income countries have followed for there was little support for plain packaging in tobacco products. We believe regulation
decades — have been adopted by only around among people in South Africa. And the Tobacco should be based on sound evidence and wide
one-third of countries in sub-Saharan Africa3. Institute of Southern Africa, an industry asso- consultation, respect legal rights, and be
ciation, began a ‘#TakeBackTheTax’ campaign aimed at delivering harm reduction.”
Industry pressure that reflects industry arguments regarding the
The main reason that African countries haven’t value of tobacco taxation and employment. A taxing problem
implemented more FCTC recommendations, One of the most effective tools to reduce
according to researchers and activists, is the “When people decrease tobacco use is raising the price of these
influence of the tobacco industry. products by imposing higher taxes on them.
“I think of it in terms of power imbalances,”
spending on tobacco, they According to the WHO, increasing prices by
Gilmore says. In countries with small gross start spending more on 10% can reduce smoking rates by 5% in low- and
domestic products (GDPs), she says, wealthy health care and education.” middle-income countries7. The FCTC recom-
industries can interfere and influence in ways mended tax rate is 75%; globally, the median
that they might not be able to in richer nations. tax rate is 60%. But in Africa, the median tax
“These companies are more outrageous in There are also accusations that the tobacco rate is just 34% — the lowest in the world8.
what they will do in low- and middle-income industry attempts to influence policies by Tobacco companies consistently fight
countries,” she says. making payments to individuals. In 2021, tax increases. In South Africa, for example,
A 2021 report5 by the African Tobacco Con- Gilmore’s research group published an analysis industry-backed groups lobbied successfully
trol Alliance ranked 14 countries in sub-Saharan of documents provided by two whistle-blowers in 2020 to keep taxes on cigarettes unchanged,
Africa according to how much influence the at the cigarette company British American at 40%. The typical arguments of these groups
industry wielded over them, how transparent Tobacco (BAT), one of the main players in Africa. are that increasing taxes on tobacco products
governments made their dealings with tobacco The report claims that, between 2008 and 2013, will reduce legitimate sales and increase illicit
companies and what measures were in place BAT made payments totalling US$601,502 to trade, with the net effect of decreasing govern-
to rebuff their advances. Zambia was found to individuals in the form of cash, wire transfers, ments’ revenue — and thus putting numerous
have the highest level of interference, followed campaign donations and expensive gifts6. The tobacco-related farming and manufacturing
by Tanzania, South Africa and Mozambique. recipients included politicians and civil serv- jobs at risk.
In 2018, comprehensive tobacco legislation ants in Burundi, Comoros, Rwanda and Uganda, “Their pet arguments are about revenue,”
was announced in South Africa that included at a time when tobacco control legislation was says Jeff Drope, a health-policy researcher at
FCTC provisions such as requiring plain pack- being considered in all four countries. Uganda University of Illinois Chicago’s School of Public
aging on cigarettes, banning the display of finally passed comprehensive tobacco legis- Health. He thinks that concerns that revenue
tobacco products in retail and regulating lation in 2015; regulation in the other three will fall if taxes go up are misplaced. “Consump-
e-cigarettes. The bill has yet to pass and, accord- countries still falls short of FCTC guidelines. tion goes down, but revenue goes up because
ing to research by Gilmore and colleagues, Influence can also be subtler. Tobacco people are paying more taxes,” he says. In the
industry efforts could be partially to blame. companies provide funding for public-policy mid-1990s the South African government
For example, cigarette producer Japan think tanks, such as the IMANI Center for decided to increase cigarette taxes to 50% of

Nature | Vol 618 | 8 June 2023 | S5

 Smoking
outlook
the retail price. By 2004, this tax had increased
by 256% per pack, and smoking prevalence
dropped from 32% to 24%. At the same time,
government revenue increased 140% (ref. 9).
The risk of lost jobs might also be overstated
by the industry. “Tobacco doesn’t employ a lot of
people,” Drope says. In Zambia, more than two-
thirds of the population relies on agriculture for
their income, but only a fraction are growing
tobacco. According to a 2017 report co-authored
by Goma and Drope, cotton, tea, coffee and
maize (corn) are the largest export-oriented
TRYGVE BOLSTAD/ PANOS PICTURES

agricultural commodities in Zambia, account-

ing for US$589 million in 2012, or 2.31% of the
nation’s GDP10. Tobacco, by contrast, accounted
for just 0.4% of Zambia’s GDP. Tobacco was
being grown on 59,000 hectares by around
10,000 farmers; the other 4 crops were grown
on about 1.5 million hectares by more than
1.2 million farmers. Cigarette-manufacturing Some tobacco plantations use children to reduce labour costs.
facilities opened in Zambia in 2018 and 2019,
by BAT and Roland Imperial Tobacco Company doesn’t rest with a few individuals,” he says. it really helps,” he says. “It takes folks getting
respectively, reportedly created fewer than “The tobacco industry isn’t able to influence bombarded with the same message from a lot
200 jobs for local workers. here as it can in other places.” of different messengers.”
Brenda Chitindi, executive director of the In 2014, Senegal also introduced com- In Zambia, laws that prohibit smoking in
Tobacco Free Association of Zambia, says that prehensive legislation and began requiring public places are routinely ignored, Goma
the industry exaggerates the number of people graphic health warnings on cigarette packages says, as is a ban on sales to people aged 16 and
employed in it by including family members in 2017. By 2018, the government had raised younger. In fact, he frequently sees young chil-
of employees as workers in ‘tobacco-farming tobacco taxes to 65%. dren selling individual cigarettes. Advertising
households’. Some African farmers are also However, legislating is only part of the restrictions are also not adhered to. “They put
known to use children to reduce their labour battle. Despite its intentions, Senegal has displays targeting children near the sweets and
costs, she says. struggled to implement its plans for smoke- other children’s foods,” Chitindi says.
Drope also thinks that any job losses that free spaces and warning labels. It is not alone “Because rates of tobacco use are still low,
do occur will be balanced by the creation of in this: in many African countries, even when everyone thinks it’s not a problem,” Goma says.
jobs in other sectors. “When people decrease laws are put in place, local authorities lack the This is misguided, he says. “The future is what
spending on tobacco, they start spending will, personnel and money to enforce them. we must be worried about because we are on an
more on health care and education, which “Governments are struggling with budgets and upward trajectory. If we don’t control smoking
are labour-intensive sectors,” he says. “Often, looking at immediate concerns like poverty rates among the young now, we are bound to
there is a net gain in employment.” and hunger, so enforcement agents have have a big problem on our hands.”
Tobacconomics, a tobacco-control think limited resources to function even when they
tank at the University of Illinois Chicago that are committed,” Magati says. Tammy Worth is a freelance health-care
counts Drope among its researchers, studied There aren’t a lot of data on how much reporter based in Kansas City, Missouri.
the potential results of tax increases in several African countries spend on tobacco control,
low- and middle-income countries, including but one estimate puts it at about $0.006 per 1. WHO. WHO Global Report on Trends in Prevalence of
Tobacco Use 2000–2025 (World Health Organization,
North Macedonia, Pakistan, Mexico, Argentina capita3. Staving off the rapid growth of smok- 2021).
and Indonesia. The group found that these ing that many fear Africa could experience will 2. GBD 2019 Tobacco Collaborators. Lancet 397, 2337–2360
countries would end up with at least a small therefore take more than just a willing, edu- (2021).
3. Egbe, C. O. et al. Tobacco Control 31, 153–159 (2022).
net employment gain if tobacco sales dropped cated government — it will also require advo- 4. James, P. B., Bah, A. J., Kabba, J. A., Kassim, S. A. &
because people would spend more on food, cacy from civil society and external funding. Dalinjong, P. A. Arch. Public Health 80, 121 (2022).
education and health, leading to job growth Sierra Leone passed the Tobacco and 5. ATCA. Africa Regional Tobacco Industry Interference Index
(African Tobacco Control Alliance, 2021).
in these sectors (see go.nature.com/3yv2cuv). Nicotine Control Act of 2022 last August. The 6. Jackson, R. R., Rowell, A. & Gilmore, A. B. “Unlawful
bill came to be in part because of investments Bribes?” (UCSF Center for Tobacco Control Research and
Enforcement challenges by the WHO in developing the law and provid- Education, 2021).
7. WHO. WHO Report on the Global Tobacco Epidemic 2021:
Despite industry pressure, some countries ing data to illustrate the impact it would have Addressing New and Emerging Products (World Health
have passed legislation on the basis of FCTC on the country’s health. Drope, meanwhile, is Organization, 2021).
recommendations. In 2007, for example, Kenya advising 22 countries on tobacco taxation. He 8. WHO. 2021 Global Progress Report on Implementation
of the WHO Framework Convention on Tobacco Control
passed the comprehensive Tobacco Control works with local universities and think tanks (World Health Organization, 2021).
Act — an action that Magati attributes to a con- to provide education on smoking and thinks 9. van Walbeek, C. The Economics of Tobacco Control in
stitution that allows citizens to propose legis- these kinds of collaboration are crucial to South Africa. PhD thesis, Univ. Cape Town (2005).
10. Gome, F. et al. The Economics of Tobacco Farming in
lation. In many other African countries, it must helping the continent kick the habit. “When Zambia Revised version (Univ. Zambia School of Medicine
come from government officials. “Power here we are all singing from the same song sheet, and American Cancer Society, 2017).

S6 | Nature | Vol 618 | 8 June 2023

 Smoking
outlook
DANI MACHLIS/BEN-GURION UNIV. OF THE NEGEV

Neuroscientist Abraham Zangen (right) and two of his students with an early version of their repetitive transcranial magnetic stimulation system.

A stimulating solution to smoking

Magnetic pulses delivered to the brain could help people to overcome addiction
to cigarettes, but there is still a lot to learn. By Simon Makin

G
alit Blecher never wanted to start regions of the brain involved in addiction. The says Abraham Zangen, a neuroscientist at
smoking, but during her service in effect on quit rates in the trial was modest, but Ben-Gurion University of the Negev in Israel,
the Israeli military, she succumbed. comparable to bupropion, which blocks nic- who led the study1. Half of the participants
“Everyone in Israel smoked in the otine receptors in the brain. It was enough to experienced real stimulation of their brains
army,” she says. Having held out for convince the US Food and Drug Administra- through a coil inside a helmet, whereas the
more than one year, an especially tedious tion (FDA) to approve, in August 2020, the use other half received a sham stimulation from
posting broke her resolve. “I was driving three of repetitive TMS to help people quit smoking. a second coil that produced similar sounds and
hours through the desert, several times a However, the scientists working on this sensations on the scalp but did not produce a
week,” she says. “I was falling asleep.” new approach to giving up smoking are not magnetic field that affected the brain.
After returning to civilian life, she gave up finished yet. With so many variables in how The stimulation was aimed at their lateral
smoking twice with the help of an antide- repetitive TMS is delivered, researchers from prefrontal cortex and the deeper-lying
pressant drug called bupropion (also known around the world are now aiming to pool their insula, with the intensity set to 120% of the
as Zyban), which reduces cravings and with- knowledge and standardize methods to help level needed to make each recipient’s thumb
drawal, but she started smoking again each the field move forwards. Understanding of move. “To make brain stimulation effective,
time. Then, six years ago, she joined a clinical the neural circuitry that underlies addiction you need to use meaningful intensities and fre-
trial of a new treatment targeted at people who is improving, which is helping to find ways to quencies,” Zangen says. This is uncomfortable
had tried and failed to quit smoking. She hasn’t make the treatment more effective. And some for patients. “It’s like an electric shock to the
smoked since. “After Zyban, there was always researchers are exploring the use of brain head, you feel your jaw clamping,” says Blecher.
a craving when I saw other smokers,” Blecher imaging to tailor treatment to individuals. “It wasn’t that painful, but it wasn’t pleasant.”
says. “This time it’s a real aversion; I can’t stand Blecher and her fellow participants ini-
smelling cigarettes.” A pivotal trial tially received the treatment every weekday
The treatment that helped Blecher is called Blecher was one of 262 smokers who were for three weeks, and then once per week for
repetitive transcranial magnetic stimulation recruited to test the treatment. “These another three weeks. For people in both the
(TMS), and uses magnetic fields to stimulate were very heavy smokers, for many years,” treatment and sham groups, each half-hour

Nature | Vol 618 | 8 June 2023 | S7

Smoking
outlook
session began with provocation cues designed mainly in the United States, with a few in Europe were people with damage elsewhere in the
to elicit cravings, to activate the neural cir- and India. Psychiatrists and physicians can refer brain. Zangen’s hypothesis was that electri-
cuitry. “When a circuit is active, it’s more liable someone to a TMS centre, and the centres also cally stimulating the insula could have similar
to change,” says Zangen. Afterwards, all par- market the treatment directly to consumers. results, by interfering with cravings. “If we
ticipants received a short motivational talk. reduce excitability of the insular cortex, we’re
Following the treatment period, participants’ Craving success going to reduce cravings,” he says.
smoking behaviour was monitored for four TMS was first approved for treating depres- The standard ‘figure-of-eight’ coils that
weeks, both by self-reporting and by monitor- sion in 2008. Approval for treating obsessive- were used in the first human trials did not
ing urine for cotinine — a product formed when compulsive disorder followed ten years penetrate far enough into the brain to hit the
nicotine is broken down in the body. Anyone later. Its use in addiction is just beginning: insula. So Zangen used a new design that he had
still not smoking at this point was assessed the trial that Blecher participated in was the helped to develop during his time in the United
again 12 weeks later. By this time, 28% of people first multicentre randomized controlled trial States that could reach deeper regions of the
who received the full treatment protocol were of non-invasive brain stimulation as treat- brain5. The patent for this coil is now held by
still not smoking, compared with 12% of those ment for any form of addiction. “Targeting BrainsWay, a medical technology company in
who received the sham stimulation. People brain circuits responsible for symptoms has Burlington, Massachusetts, which developed
in the treatment group also reported greater proven valuable for treating a variety of brain the coil used in the trial and now supplies the
reductions in their cravings for cigarettes. disorders,” says Michael Fox, a neurologist at equipment to treatment centres (Zangen is
“Looking at the percentage of quitters, it’s Harvard Medical School in Boston, Massachu- a scientific consultant for BrainsWay). Other
not that great,” says Zangen. Other treatments, setts. “We’re optimistic it can help patients researchers are now studying how the coils that
such as nicotine replacement therapy, were with addiction.” Zangen and his colleagues developed could
approved by the FDA on the basis of higher Addiction is not one behaviour, but a cycling be used to target several other brain regions.
quitting rates, he says. But these treatments pattern of recurrent relapse. Characteristics
were usually tested on less heavy smokers of this cycle include increasing sensitivity to Unexpected explanations
who had not tried and failed to quit in the past drug-associated cues and the anticipation of Research into TMS has found that high-
as many times as Zangen’s participants had. drug rewards, coupled with decreasing sen- frequency stimulation typically makes an area
Some of those studies also based their results sitivity to those rewards when they come. of the brain more excitable, whereas low fre-
purely on self-reported behaviour and breath People also experience impaired self-control, quencies can reduce activity. Because Zangen
testing for carbon monoxide, which can detect enhanced stress and negative emotions. and his team were aiming to suppress cravings,
whether a person has smoked only within hours Neuroscientists have pinpointed many brain they expected that low frequencies directed
of a cigarette. “You can find traces of cotinine regions involved in these states and behav- at the insula would have the desired effect. To
after a single cigarette smoked a week ago,” iours, including the prefrontal cortex, which their surprise, the opposite was true: high-
says Zangen. “The numbers are small because implements self-control, and the insula, which frequency stimulation proved to be effective6.
our criteria for quitting are very strict, but is thought to integrate autonomic information One possible explanation for this counterin-
they’re absolutely clinically meaningful.” with motivation and emotion, and so give rise tuitive result is that, although the acute effect of
The side effects of magnetic stimulation also to the experience of cravings. high-frequency TMS is to increase excitability,
appear to be minor. During the trial, the most Early in Zangen’s career, he worked on the long-term effect of repeated stimulation
common adverse effects were headaches and reward processing in animal models at the could instead be suppressive. “If we stimulate
discomfort. Nevertheless, the now-approved National Institute on Drug Abuse in Baltimore, the pathological circuitry daily, forseveral days,
treatment can be carried out only under medi- Maryland. He learnt that electrically stimu- we [might] disrupt the processing of informa-
cal supervision because of the risk of seizures. lating a rat’s brain affected certain receptors tion,” Zangen says. “That’s one way to explain it.”
Although none of the participants experienced involved in reward circuitry in the opposite It’s not the only theory, however. “The other
seizures during his pivotal trial, Zangen says way to repeated exposure to cocaine. “I is that we don’t reach all the way to the insula,”
that reports from treating other conditions thought, we must study whether stimula- says Zangen. Support for the idea that the
suggest that around 1 in 5,000 recipients of tion in specific areas can induce behavioural treatment’s effect might come from stimu-
TMS might experience a seizure2. changes in addiction,” he says. In 2007, then at lating a different brain region can be found in
the Weizmann Institute of Science in Rehovot, a study of people with brain damage that was
“If we reduce excitability Israel, Zangen published a paper demonstrat- published last year7. A team led by neurolo-
ing precisely that3. “This was the first ever gist Juho Joutsa at the University of Turku in
of the insular cortex, we’re study showing that brain stimulation, in rats, Finland, mapped the brains of 129 people, all of
going to reduce cravings.” can reduce drug-seeking behaviour,” he says. which had areas of damage. All the participants
“At the same time, I started to develop appli- were smokers at the time they acquired these
cations of these animal studies to humans.” lesions, but 34 of them had quit immediately
Some health insurance providers in the The first studies of repetitive TMS for smok- after injury and not craved cigarettes since.
United States already cover TMS as a treatment ing cessation, which stimulated the prefrontal The brain lesions in those who had stopped
for depression, but not yet for smoking, says cortex, found encouraging but impermanent smoking were not all in the insula. “There were
Zangen. “But they should, because the cost of effects. In search of a longer-lasting impact, many lesions that led to disruption of smoking
hospitalization, and lost working days due to Zangen and his colleagues began to look addiction that didn’t hit the insula, indicat-
chronic obstructive pulmonary disease, and deeper into the brain, towards the insula. ing it’s not the whole story,” says Joutsa. All
cancers and so on, are much higher,” he says. Another 2007 study4 found that people who the lesions that led to smoking cessation did,
The treatment is currently available in more experienced damage to the insula were more however, share a common brain circuit. Joutsa
than 50 centres and psychiatrists’ offices, likely to lose their smoking addiction than calls this the addiction remission network, in

S8 | Nature | Vol 618 | 8 June 2023

 ZAPPING AND MAPPING “We try to harmonize efforts around the world,
A study of people with brain damage , some of whom quit smoking following their injury, associated
7 to make sure people are informed about what
activity in the medial frontopolar cortex with remission from addiction (a). Analysis of the brain regions different labs are doing.”
that are excited by transcranial magnetic stimulation used to aid smoking cessation (b), which is intended Ekhtiari is also pursuing another kind of opti-
to target the insula, shows that it is ideally positioned to stimulate the frontopolar cortex (c). This could
explain the treatment’s effects on addiction. mization: personalization. “The brain is very
different across different people,” he says. This
means that exactly where to optimally stimu-
a b c
late themedial frontopolar cortex, forinstance,
might vary between people. Ekhtiari and his
colleagues are looking for ways to use brain
imaging to characterize these differences and
increase the precision of targeting. A team led by
researchers at Stanford University in California
are already personalizing repetitive TMS
SOURCE: REF. 7

treatment in this way. One clinical trial, using

a protocol called SAINT (Stanford accelerated
intelligent neuromodulation therapy), found a
which many parts of the brain form different addiction. “My idea is that when we target the 53% reduction in symptoms of depression in its
nodes. Some of these areas are positive nodes frontopolar area, we are modulating those sub- active treatment group, compared with 11% in
— that is, activity in these areas is associated cortical areas in a beneficial way,” Ekhtiari says. the group that received the sham stimulation10 —
with increased activity elsewhere in the net- a result that led to FDA approval last September.
work. Other brain regions form negative Finishing touches “That’s the idea we have for nicotine, and other
nodes that are associated with reduced activ- As researchers learn about where and how types of addiction,” says Ekhtiari.
ity elsewhere, probably owing to inhibitory to optimally stimulate the brain, repetitive Many researchers hope repetitive TMS will
connections to the network. TMS treatments could become increasingly be effective not only for smoking cessation but
sophisticated. Devices that could target multi- also for treating a wide range of substance and
“We need a village of ple regions in different ways are already being even behavioural addictions. Already, Joutsa
developed. “That’s where the field is slowly and his colleagues have found that brain
expert people working moving,” says Joutsa. Some regions could lesions that are associated with a lower risk of
together to solve this.” be excited while others are suppressed, for alcohol abuse show similar connectivity pat-
instance. According to Zangen, BrainsWay is terns to the smoking network7. “It doesn’t prove
working on a multichannel stimulator. “I have it’s exactly the same finding in alcoholism, but
This discovery might have huge conse- a prototype in my laboratory,” he says. it suggests the findings could be relevant for
quences for understanding how repetitive TMS The region being targeted is not the only other substances of abuse,” says Joutsa.
helps people to quit smoking. It suggests that variable associated with TMS: the frequency, It is too early to tell whether repetitive TMS
to benefit people with addiction, a device that intensity, duration and pattern of stimula- will have the impact on addiction medicine that
stimulates brain activity should target negative tion could also affect outcomes, as could the its proponents envisage. But even in its current,
nodes. And after scrutinizing Zangen’s work, number of treatment sessions. Much of this nascent form, the technology is already being
Joutsa thinks that might be exactly what their has barely been explored, let alone optimized. used to help some people quit smoking. The
TMS therapy is doing. “They were kind enough “The parameter space is huge,” says Joutsa. “I numbers being helped might be modest so far,
to share the model of the fields generated by hope our findings help narrow down the spa- but for those people for whom it works, the
their coil, and the strongest activation was tial part, so we at least know where to target.” benefits are significant. “I’m really relieved I
actually in the medial frontopolar cortex,” The uncertainty in how best to administer stopped smoking, because of the kids, the
says Joutsa — the largest negative node in their TMS for addiction has led to a wide variety of smell and my husband, who doesn’t like it, and
network. “That aligns perfectly with their excit- trial designs, which is partly why a generally of course the health issues,” says Blecher. “I’m
atory stimulation to that region,” he says (see supportive meta-analysis of the field, pub- never going back.”
‘Zapping and mapping’). lished last year8, carried the caveat that the
Evidence is now pointing to the fronto available evidence enabled the authors to Simon Makin is a freelance writer in Reading,
polar region as being a key treatment target, have only a low level of confidence in their UK.
says Hamed Ekhtiari, a psychiatrist at the Uni- evaluation. To address this problem, many
1. Zangen, A. et al. World Psychiatry 20, 397–404 (2021).
versity of Minnesota in Minneapolis. “When we researchers working in the field have begun 2. Zibman, S., Pell, G. S., Barnea-Ygael, N., Roth, Y. &
expose people to drug-related cues, the fron- to collaborate under the banner of the Interna- Zangen, A. Eur. Neuropsychopharmacol. 45, 73–88 (2021).
3. Levy, D. et al. J. Neurosci. 27, 14179–14189 (2007).
topolar area is activated,” he says. The medial tional Network of tES/TMS Trials for Addiction
4. Naqvi, N. H., Rudrauf, D., Damasio, H. & Bechara, A.
frontopolar cortex connects not just to the Medicine (INTAM). Their aim is to share proto- Science 315, 531–534 (2007).
insula that Zangen was intending to target, cols and propose best practices, identify gaps 5. Zangen, A., Roth, Y., Voller, B. & Hallett, M.
Clin. Neurophysiol. 116, 775–779 (2005).
but also to several parts of the limbic system, in their knowledge and accelerate the creation
6. Dinur-Klein, L. et al. Biol. Psychiatry 76, 742–749 (2014).
such as the amygdala and nucleus accumbens. of effective treatments for addiction based 7. Joutsa, J. et al. Nature Med. 28, 1249–1255 (2022).
“These are important for arousal, for being on non-invasive brain stimulation. “We need 8. Petit, B., Dornier, A., Meille, V., Demina, A. & Trojak, B.
Addiction 117, 2768–2779 (2022).
excited about drugs,” Ekhtiari says. Stimulating a village of expert people working together to
9. Ekhtiari, H. et al. Neurosci. Biobehav. Rev. 104, 118–140
this one area of the brain could therefore affect solve this,” says Ekhtiari, the lead author on a (2019).
numerous other regions that are involved in consensus paper9 the group published in 2019. 10. Cole, E. J. et al. Am. J. Psychiatry 179, 132–141 (2022).

Nature | Vol 618 | 8 June 2023 | S9

Smoking
outlook
Comprehensive Cancer Center in Buffalo, New
York. “It’s not a harmless compound.”
Evidence for direct deleterious effects of
nicotine consumption is limited. “It is hard
to sort out because most nicotine exposure
data comes from cigarette smoking,” says Neal
Benowitz, a physician and nicotine researcher
at the University of California, San Francisco.
With so many toxic compounds in tobacco
smoke, separating nicotine from the rest of
the noxious milieu has been a struggle. “We’ve
done a poor job of dissecting out the various
components of cigarette smoke,” says Gerry
McElvaney, a pulmonary physician at the Royal
College of Surgeons in Ireland, Dublin.
Interest in the effects of nicotine is blos-
soming, partly because of the proliferation
of e-cigarettes, or vapes. Vaping could pro-
vide a nicotine hit without the cancerous
baggage, but it has become fiercely controver-
sial owing to concerns that people who have

LIUDMILA CHERNETSKA/GETTY
never smoked — especially adolescents — will
become hooked. In this new context, deline-
ating the effects of a purer stream of nicotine
is important, and numerous associations are
being made, including purported impacts on
heart health, cancer and brain development.
E-cigarettes contain the highly addictive substance nicotine.
Issues of the heart

Nicotine on trial
When a smoker tugs on a cigarette, their heart
pumps harder, their blood pressure increases
and certain blood vessels dilate or constrict.
These effects are partly due to nicotine, which
triggers the release of various neurotransmit-
As e-cigarettes grow in popularity, the lack of ters and hormones such as epinephrine. This
process happens whether nicotine is inhaled
knowledge about nicotine’s impact on health is from a cigarette or an e-cigarette, or chewed
becoming more worrying. By Anthony King in the case of smokeless tobacco. What these

A
acute impacts mean for long-term cardiovas-
cular health, however, is disputed.
fter a few vigorous puffs of a burning are why nicotine is addictive, and one reason Researchers at the American Heart Associa-
cigarette, a smoker’s lungs will be why smokers crave cigarettes. tion think that the stress nicotine puts on the
filled with a toxic cloud of more than Although the addictive qualities of nico- heart is concerning. “We believe that much
5,000 different substances. Their tine are well known, the damaging health of the cardiovascular effects of smoking are
combined effects on health are well effects of smoking are usually attributed to because of nicotine,” says Bhatnagar. When
known: cancer, heart disease, stroke, chronic more-obvious toxins such as polycyclic aro- nicotine is inhaled, it changes the electrical
obstructive pulmonary disease and many matic hydrocarbons (PAHs), cadmium and the conductivity of the heart that keeps it beating
more conditions. However, the most famous sticky brown tar left inside the lungs. “It has in sync. Nicotine can knock this delicate timing
ingredient of a cigarette — nicotine — has gen- been said since the 1950s that people smoke off and promote abnormal heart rhythms, says
erally not been considered a culprit in these for the nicotine and die from the tar,” says Bhatnagar. Nicotine has also been implicated
health effects. Aruni Bhatnagar, director of the American in stoking inflammation in heart and lung
Nicotine is an alkaloid compound made Heart Association’s Tobacco Regulation tissue, says Laura Crotty Alexander, a pulmo-
by plants to deter herbivores, and it has been and Addiction Center at the University of nary biologist at the University of California,
used as an insecticide. It poisons insects by Louisville, Kentucky. San Diego in La Jolla.
binding to acetylcholine receptors in their But some researchers think that nicotine’s Some researchers think that nicotine has
nervous systems and causing their nerves to influence on health could extend beyond just only a small effect on heart health. “Nicotine is a
fire uncontrollably. In people, nicotine acti- its addictive nature. Receptors that respond minor player with respect to smoking-induced
vates similar receptors throughout the nerv- to nicotine are found not just in the brain, but cardiovascular disease,” says Benowitz. He
ous system, including those in the brain that also in tissues such as muscle. “It changes lots of points to studies of snus — a chewable tobacco
affect the release of the feel-good molecule functions in our bodies,” says Maciej Goniewicz, product that is popular mainly among men
dopamine. The positive feelings this produces a nicotine pharmacologist at Roswell Park in Sweden and is gaining traction elsewhere

S10 | Nature | Vol 618 | 8 June 2023

— which do not generally show a detectable University of North Carolina at Chapel Hill. deliveries compared with pregnancies in which
rise in heart problems among people who Theevidenceisnotunanimous,however,and the mother abstained from all tobacco prod-
use it. However, some studies have suggested there is little known about how this relates to ucts8, Aagaard says. This in turn brings more
that a heart attack or stroke is more likely to people. “Some animal models have found that risks for children, she adds, such as a greater
be fatal for someone who uses snus1, and nicotine does promote cancer,” says Benowitz, risk of developing metabolic disorders.
another found that stopping snus use after a “but the evidence, for me, is not convincing in The UK National Health Service describes
heart attack reduced subsequent short-term tying it to cancer in humans.” A 2009 study of e-cigarettes as safer than smoking for pregnant
mortality2. This suggests that nicotine could long-term nicotine replacement therapy — spe- women, but it notes that there is little research
be more harmful to someone with underlying cifically, a nicotine gum — found no effect on to support the safety of e-cigarettes beyond
cardiovascular disease, Benowitz acknowl- cancer risk5, although nicotine exposure from that. It recommends pregnant women use
edges. And in January, a study suggested gum is lower than would be expected from vap- nicotine patches and gums to stop smoking.
that smokeless tobacco increases the risk of ing or snus. Any connection between nicotine Nicotinic acetylcholine receptors are
peripheral artery disease to a similar extent and human cancers remains unclear. “From involved in forming brain circuits during child-
as does cigarette use3. animal and cell studies, yes, nicotine is doing hood and adolescence. The brain’s prefrontal
The method of nicotine delivery might also something,” says Goniewicz. “How this trans- cortex, responsible for marshalling judge-
affect its impact. Smoking and vaping both lates into a risk for the user, we don’t know.” ment, impulsivity and risk-taking, does not
deliver a concentrated hit; nicotine patches, fully mature in people until their early twen-
which are used by some people to help them A developing problem ties. There is a strong suspicion that nicotine
quit cigarettes, provide a more gradual dose. The strongest evidence against nicotine relates can throw a spanner in the works throughout
This could be an important difference. The to its impact on brain development. Activation this time — a particular concern given the
nicotine hit from smoking and vaping might of acetylcholine receptors helps to regulate growing popularity of vaping among young
produce more noticeable spikes in blood pres- brain development and growth. Nicotine binds people. But the effects of e-cigarettes on teen-
sure. Repeated over time, this could increase to these receptors and can therefore interfere age brain development is yet to be made clear.
the stiffness of arteries and increase pressure with this process. It has been shown that nico- “Nicotine is definitely harmful to the devel-
on the heart. “Nicotine patches and gum are tine is responsible for up to almost 50% of the oping adolescent brain in animals,” Benowitz
not the same as taking a drag on a cigarette,” overall impact that tobacco smoke has on brain says. “In humans, it is harder to establish.”
says Bhatnagar. “You need that hit, and that’s circuitry development in male rats6. Before the advent of e-cigarettes, there was
the hit that causes the cardiovascular issues.” Nicotine subtly changes neurons in addicted less interest in finding an answer to this ques-
adults, but its impact is greatest in the devel- tion — there are already more than enough
Cancer suspicions oping brain, where circuitry is less mature. good reasons to not take up smoking. The
Cigarette smoke is rich in tumour-promoting Exposure in the womb is an independent risk growing popularity of vaping has provided
substances, including arsenic, aromatic factor for developmental disorders, such as fresh impetus, but also represents an oppor-
amines, benzene, ethylene oxide, formalde- attention deficit hyperactivity disorder, says tunity for scientists. Research into the impact
hyde and PAHs. Evidence for nicotine to join Kjersti Aagaard, a maternal-fetal physician at of nicotine on people’s health has long been
that list of direct human carcinogens is limited. Baylor College of Medicine in Houston, Texas. held back by difficulties in isolating the effects
In vivo animal studies of nicotine exposure The brain of a developing fetus or neonate of this one molecule from all the other com-
have returned mixed findings on the com- could be especially vulnerable. “No amount ponents of cigarette smoke. “We never had
pound’s link with cancer. There is evidence of nicotine is known to be safe in pregnancy. a clean nicotine delivery product that would
that nicotine inhibits apoptosis — the pro- None,” Aagaard says. “If you are exposed to be used recreationally for long periods,”
cess by which cells self-destruct, which is an nicotine in the womb, there could be lifelong Goniewicz says. Now, thanks to e-cigarettes,
important guard against tumour formation — consequences.” researchers do.
in cancer cells by binding to cholinergic recep- This continuing population experiment,
tors. Nicotine also ramps up the formation of “If you are exposed to combined with a growing number of cell and
new blood vessels, which can supply nutrients animal studies, could begin to dissipate the fog
to a hungry tumour.
nicotine in the womb, surrounding nicotine’s impact on health. “I’ve
Nicotine’s ability to drive inflammation there could be lifelong been more and more surprised at the changes
might also be of note. Most immune cells consequences.” I’m seeing when I expose cells to nicotine,”
have receptors that nicotine can hack to says Crotty Alexander. “We’ve underplayed
sabotage T cells, inhibit antibody formation the role that nicotine has in the health effects
and interfere with immune messaging. “Some- Nicotine exposure in the womb is associated of tobacco products.”
one chronically exposed to nicotine might with a higher risk of addictive behaviours in
have chronic inflammation,” says Goniewicz. adulthood. Babies could also be exposed to Anthony King is a science writer in Dublin.
“There is speculation that it might contribute nicotine while breastfeeding. A study last year
1. Hansson, J. et al. Eur. J. Epidemiol. 27, 771–779 (2012).
to increased risk of cancer.” A 2021 study that reported that when female mice were exposed 2. Arefalk, G. et al. Circulation 130, 325–332 (2014).
examined the impact of nicotine on mouse to nicotine, they passed the compound to their 3. Van’t Hof, J. R. et al. Am. J. Prev. Med. 64, 728–733 (2023).
4. Tyagi, A. et al. Nature Commun. 12, 474 (2021).
models of metastatic breast cancer concluded pups in their breast milk, and these pups expe-
5. Murray, R. P., Connett, J. E. & Zapawa, L. M.
that chronic exposure to nicotine encouraged rienced long-lasting behavioural changes7. Nicotine Tob. Res. 11, 1076–1082 (2009).
the spread of tumours by ramping up the Beyond just neurological impacts, some epi- 6. Slotkin, T. A. et al. Toxicol. Sci. 147, 178–189 (2015).
7. Pereira Júnior, A. A. et al. Int. J. Dev. Neurosci. 82, 758–770
amount of neutrophils, a type of white blood demiological studies — but not all — have linked
(2022).
cell4. “High levels of neutrophils are damag- the use of e-cigarettes during pregnancy with 8. Kim, S. & Oancea, S. C. BMC Pregnancy Childbirth 20, 557
ing,” says Robert Tarran, a physiologist at the higher rates of preterm and low-birthweight (2020).

Nature | Vol 618 | 8 June 2023 | S11

Smoking
outlook

nature.com/collections/
smoking-outlook

Nature 8 June 2023

MIND MATTERS
Edited by Daisy Yuhas

Dementia Can California, San Francisco, examines the roots of this phenomenon
and provides insight into a possible cause. Neurologist Adit Fried-

Unleash Creativity
berg of U.C.S.F. and her colleagues found that as specific brain ar-
eas diminish in people with FTD, they release their control of oth-
er regions that support artistic expression.
Frontotemporal dementia can release FTD is relatively uncommon—affecting about 60,000 people
in the U.S.—and is distinct from Alzheimer’s, the far more preva-
the creative potential of the brain’s lent form of dementia in which memory deficits predominate. FTD
visual areas is named for the frontal and temporal lobes of the brain, the two
regions that sustain the most damage from this disease. Not every
By Robert Martone person with FTD has the same pattern of neuron loss in these ar-
eas; there are several variants. For example, degeneration in the
In some people, n  eurological conditions can set loose a torrent temporal lobes, which are the seat of language in the brain, leads
of new imaginativeness as if opening some mysterious floodgate. to difficulties in producing and understanding written and spo-
Migraine and epilepsy auras may have influenced a long list of ken communication. Some people have impaired speech produc-
artists, including, some scholars speculate, Pablo Picasso, Vin- tion; others may have trouble understanding word meanings.
cent van Gogh, Giorgio de Chirico, Claude Monet, Georges Seur- People with FTD also experience degeneration in the frontal
at and Lewis Carroll. Traumatic brain injury can result in orig- lobes, which typically engage in a suite of functions related to
inal thinking and newfound artistic drive. Emergent creativity social behavior, empathy, planning and decision-making. Im-
is also an occasional feature of Parkinson’s disease. pairment there can lead to poor judgment and difficulty under-
This burst of inspiration is especially true of frontotemporal standing the perspectives of others. The frontal lobes are in-
dementia (FTD). Although a few rare cases of FTD are linked to volved in the complex interplay of brain areas that supports our
improvements in verbal creativity, such as greater poetic gifts social behavior, helping to balance baser desires and urges with
and increased wordplay and punning, enhanced creativity in the an understanding of social norms and morals. In a healthy brain,
visual arts is an especially notable feature of the condition. This the frontal lobes’ activity can inhibit activity in other regions.
fascinating side effect indicates that the potential to create may This interchange is how the brain counters, for instance, the im-
rest dormant in some of us, only to be unleashed by a disease pulse to use rude language with the recognition that such re-
that also can cause a loss of verbal abilities. sponses can cause offense. Researchers suspect that in those with
Emergence of a vibrant creative spark in the face of devastat- FTD, damage to the frontal lobes impairs the ability to suppress
ing neurological disease speaks to the human brain’s remarkable other brain activity, and their behavior becomes disinhibited
potential and resilience. A study published in JAMA Neurology and socially inappropriate.
by researchers at several institutions, including the University of The J AMA Neurology s tudy suggests that, in a similar way, the
loss of temporal lobe activity somehow disinhibits ar-
tistic creativity in some individuals. The researchers re-
viewed the medical records of 689 people with FTD or
related disorders, looking for evidence of new or signif-
icantly increased or altered artistic expression. In total,
they found this change in 17 people—2.5 percent of their
participants. Most of these individuals painted, al-
though some drew, sculpted, made pottery, crafted jew-
elry or quilted. FTD can sometimes be linked to certain
genes, but no genetic cause of FTD was identified in this
group. Most in this artistic group had forms of FTD in
which language impairment was predominant, suggest-
ing that FTD significantly affected their temporal lobes.
Researchers then selected people to compare with
this artistic group. One set included FTD patients who
were similar to the artists in many ways (including
their diagnosis, age and sex) but did not exhibit an
emergence of visual artistic creativity. An additional
group matched the artists demographically (in age, sex,
education, and other factors) but did not have any form
of dementia or other serious health concern.
The research team used magnetic resonance imag-

76 Scientific American, September 2023 Illustration by Thomas Fuchs

 Robert Martone is a research scientist with deep expertise
in neurodegeneration, neuro-oncology, biomarkers and
drug discovery. He is currently associate director of the
Lab­-Corp Biomarker Solution Center, supporting research
on neurology biomarkers.

ing to examine the brains of the people in these three sets. Sig- This hypothesis may explain why areas involved in verbal
nificantly, the scans revealed that people with FTD had reduced processing might somehow tamp down activity linked to visual
volume in their left temporal lobe—an area important for speech thinking. The FTD research suggests this evolutionary process
production—compared with that of healthy individuals. The at- is, in a sense, undone in the artists with dementia.
rophy was more pronounced in the artistic group than in those Brain injury and neurodegenerative disease often have
without artistic tendencies. tragic consequences. It is therefore remarkable that these con-
The scientists also found that some brain areas were more ditions can have a seemingly positive effect such as enhanced
active when there was less activity in other areas. In particular, creativity—and this finding can help us understand the origins
healthy people with less activity in the temporal lobe regions af- of innovation. Creativity is part of humanity’s essence and dis-
fected by FTD had more activity in their dorsomedial occipital tinguishes us in some ways from our hominin relatives. Is it pos-
lobe, a region involved in visual association. This finding implies sible that an artist is hidden in each of us, awaiting an acciden-
that impairment of the temporal lobes by FTD could enhance tal emergence?
this visual area. Further, among the visual artists with FTD, the Creativity is a complex behavior that requires several ele-
greater the volume of the dorsomedial occipital lobe, the great- ments, including the capacity for divergent and symbolic
er the volume of the portion of the motor cortex that controls thought, persistence despite uncertainty, skill in execution and
movement in the right hand. the ability to evaluate one’s creations. When considering the
Taking the evidence together, the researchers concluded that burst in artistic activity sometimes seen in people with FTD, all
this disease’s effects on the temporal lobe may result in less con- these factors should be weighed. In general, patients with FTD
trol over the brain region that generates visual associations. In perform poorly on tests of divergent thinking, suggesting either
consequence, the creative drive is unleashed. Meanwhile the in- that the subset of people with the condition who become artists
creased volume of the brain area that controls the right hand is quite distinct from others who have it or that different aspects
might reflect the use of that hand in creating art. of creativity are somehow enhanced in the FTD artists. Other
The researchers tested these ideas by observing brain chang- studies have found that aesthetic judgment is retained in FTD,
es in one person as her FTD progressed and creativity emerged. allowing affected people to evaluate the strength of their fin-
Positron-emission tomography scans measured the amount of ished artwork, although many struggle to recognize emotional
energy being used by different regions of her brain. The scans content in visual art.
revealed that as the woman’s dementia progressed, her frontal Past research has also demonstrated that creativity emerges
and temporal lobes became significantly less active—and the ar- when we limit our self-critical thinking. In those with FTD, a
eas involved in visual association became more active. lack of self-censorship may contribute to socially inappropriate
The study suggests that in a healthy brain, the temporal lobe behavior, for example, but it might also mean an artist’s “inner
directly or indirectly inhibits activity in the dorsomedial occip- critic” is less vocal. Yet another facet of artistic success is prac-
ital lobe, which supports visual association. But why would a tice. FTD is often accompanied by perseverative behavior
part of the brain involved in verbal processing suppress visual in which people repeat the same actions or statements or
regions? From these findings, we can infer a reciprocal or even become mentally stuck in an idea or behavior. Some scientists
competitive relation between our verbal abilities and visual ar- have proposed that the FTD artist benefits from the combina-
tistic creativity. tion of behavioral disinhibition and repetitive practice. Indeed,
This insight is at the heart of a hypothesis regarding how our that could also help explain the literary output of poetic people
brain has changed over the course of human evolution: the su- with FTD, who, unlike visually artistic people with the condi-
perior visual perception hypothesis. Vision demands a lot of our tion, have been spared significant losses to the temporal lobes’
brain’s computational capacity—so much that we often close our language areas.
eyes to concentrate on what we hear, whether it is music, speech, Still, none of these ideas fully explains the flourishing of cre-
birdsong or crashing waves. According to the evolutionary hy- ative behavior in some people with FTD. The authors of the
pothesis, when our species first began to develop language, the JAMA Neurology study emphasize that the FTD artists were only
brain diverted computational capacity from visual processing a small percentage of the total number of people with this de-
to bolster this new activity. mentia in their study group. Other factors, such as an artistic
For example, visual processing helps us comprehend gesture, predisposition and circumstances or an environment conducive
a nonverbal form of communication that probably preceded our to creative pursuits, may be important.
use of verbal language. Computational tasks that supported the The FTD artist may help us understand creativity. Studies of
production and interpretation of gesture were also relevant to such individuals can reveal the subtle interplay among brain re-
speech, and so as we became more adept at language, gesture lost gions that manifests in remarkable behaviors. The complexity
its primacy in communication. The brain regions responsible for of creativity makes it even more incredible that such ability can
gesture could have been taken over by those used in speech be a consequence of neurodegeneration. Ultimately these find-
through an evolutionary process called exaptation, wherein parts ings are a humbling reflection of the human brain’s adaptabili-
of an organism take on different or completely novel roles. ty and seemingly endless capabilities.

September 2023, ScientificAmerican.com 77

THE UNIVERSE

Is E.T.
Eavesdropping
on Us?
Cell-phone towers leak radio waves
into space, but the signals will be tough
for aliens to detect
By Phil Plait

Ever worry about shadowy forces t apping your phone calls

and listening in on your private conversations? Well, astrono-
mers have some good news for you: it won’t be aliens with their
ears (or whatever auditory sensory organs they have evolved) to
the speaker getting into your business—unless they’ve done a
lot better than we have at funding radio astronomers. And even
then, they’d have to be really c lose by.
Scientists working on SETI—the search for extraterrestrial
intelligence—have long pondered how to detect life outside
Earth. Assuming there are technologically advanced aliens out
there, they might be trying to communicate with us, or they
might just be leaking radio energy into the cosmos by accident.
Either way, can we pick up that signal? One way to tackle this
question is to turn it around: We know how much energy w  e’re
broadcasting into space. Given our own level of technology, could
we detect such a signal from light-years away? If so, then may-
be we can hear extraterrestrials, too.
SETI scientists have focused their efforts mostly on radio
waves because they’re easy to make; any young technological
civilization will figure that out pretty quickly—after all, we did.
They can be beamed with a lot of power, have lots of informa-
tion encoded in them, and can travel easily through the myriad
dust and gas clouds littering our local space environment. Without going into too much technical detail, cell phones
They’re ideal for cross-galactic communication. emit a weak signal that can be detected by a nearby tower, which
This kind of study has been done in the past; research pub- in turn emits a much stronger signal to send the transmission
lished in the journal S cience i n 1978 looked at our television sig- along. Coverage for a given phone company is divided into small
nals and military radar, the most powerful transmissions we areas called cells, each populated with one or perhaps a few tow-
could send into space. At that time radio telescopes could detect ers that can pick up nearby phone signals.
those emanations out to 25 and 250 light-years away, respective- The signal strength of an individual phone is only a fraction
ly. This is a volume of space that encompasses several hundred of a watt, but a tower emits a couple of hundred watts—about
thousand stars. In the decades since, our broadcast TV signal the same as a bright lightbulb. That’s not much, but there are a
has waned as we’ve turned to cable and the Internet to deliver lot of them. OpenCelliD, an open database of cell locations, has
our shows. The days of wondering whether aliens loved L  ucy as tens of millions of cells listed globally. The total power emitted
much as we did are behind us, I’m afraid. by cell-phone transmissions can be measured in gigawatts.
But other communication methods are on the rise, and they What an alien would detect when pointing a radio telescope
David Wall/Getty Images

could prove more fruitful for any aliens looking for another lone- at Earth depends on more than just the combined signal strength
ly civilization with which to chat. Research by SETI scientists of all those towers, though. The direction the towers transmit in
published in the Monthly Notices of the Royal Astronomical Soci- is also important. Most human cell-phone users are located near
ety looks at how our cell-phone usage might be detectable from Earth’s surface, so the tower antennae are configured to send
other stars. their signals parallel to the ground, covering it like lawn sprin-

78 Scientific American, September 2023

 Phil Plait is a professional astronomer and science communicator
in Colorado. He writes the Bad Astronomy Newsletter. Follow him
on Twitter @BadAstronomer

West Virginia—our overall cell-phone signal is still far too weak

to be detected from any of the three stars. The next-generation
Square Kilometer Array, currently under construction in Aus-
tralia and South Africa, will be more sensitive but still will have
only about 1 percent of the sensitivity needed to detect Earth’s
transmissions from tens of trillions of kilometers away.
If aliens are anything like us, then, we’re safe from eavesdrop-
ping. Judging from my time spent in airports and other public
places, however, a lot of people don’t care at all who overhears
their calls. I wouldn’t go so far as to say I hope aliens abduct
them, but I’m not n  ot s aying that.
What if our galactic neighbors are more advanced technolog-
ically? Telescopes detecting interstellar radiation are like buck-
ets set outside in a rain shower: the bigger the bucket, the more

There’s still a chance that

extraterrestrials could listen in
on our cell-phone conversations,
provided they are close enough and
are in the right part of the sky.

water it collects. It’s technically feasible to build far larger radio

telescopes than we have now. There are even serious proposals
to build huge radio telescopes on the moon. These would be far
more sensitive than what we have today, perhaps capable of pick-
ing up transmissions such as our mobile signals even from inter-
stellar distances.
So there’s still a chance that extraterrestrials could listen in
on our cell-phone conversations, provided they are close enough,
are in the right part of the sky, and have slightly better tech on
hand (or tentacle or pseudopod) than we do now. You can decide
which part of that last sentence is the most far-fetched, but in
any case, that’s a lot of ifs. The longest odds are that they’re suf-
klers spraying water. If you’re on the ground near a tower, ficiently close to us; if their home world is 1,000 light-years away,
you’ll get a strong signal from it, but if you’re above it, you’ll they’ll need a telescope the size of a moon to pick up our trans-
get at best a weak signal. missions. Possible, but a lot of effort.
Tower locations matter as well. There are very few towers in Still, the scientists note that the number of terrestrial cell-
the Pacific Ocean nations, compared with a huge number in the phone towers is increasing, and we get brighter in radio emis-
U.S. And there are more towers in the Northern Hemisphere sions every day. They also plan on expanding their work to
than the Southern, so our alien friends would see a different sig- include more powerful 5G towers, radar, satellite services, and
nal depending on where their home star is located in the sky. more to get a better handle on just how loudly we’re announc-
Putting this together, the scientists modeled what aliens ing our presence in the galaxy. Remember, too, that all of this is
would see from hypothetical planets orbiting three nearby stars: to solve the more pertinent puzzle of whether we can hear them.
HD 95735, Barnard’s Star and Alpha Centauri A. All of these are That remains a maybe, an ambiguous and somewhat madden-
less than nine light-years away, practically in our galactic back- ing conclusion. And of course, everything depends on the answer
yard, maximizing the snooping capabilities of any nosy aliens. to the biggest question of all: Are they even out there?
The stars are also widely spread in declination (the measure of If so, E.T., please phone Earth; we’re eagerly awaiting your call.
latitude on the sky), meaning observers in those spots would see
how Earth appears from different directions.
J O I N T H E C O N V E R S AT I O N O N L I N E
The conclusion? If the alien tech is the same as ours—with a Visit Scientific American on Facebook and Twitter
radio telescope as big as the 100-meter Green Bank Telescope in or send a letter to the editor: [email protected]

September 2023, ScientificAmerican.com 79

REVIEWS
Edited by Amy Brady

NONFIC TION through the story of the voyage, is a much out her prose. A marine geophysicist, for

Nurturing
quieter one: to explore her desire and uncer- instance, details the extensive child care
tainty about becoming a parent. Rush is 35 arrangements that made it possible for her
years old when she joins the expedition and to do the trip. When everyone gathers on

Uncertainty worried about the closing window of her fer-

tility. Pregnant people are not allowed on the
long and dangerous cruise, and so joining
the deck as the first iceberg comes into
view, Rush likens the ice to “whipped me-
ringue piped into a lopsided point.” For
What can Antarctica’s “doomsday the trip means that she and her husband others, it evokes the geological shapes of
glacier” teach us about community? have delayed trying to start their family by Utah, a ski slope or the movie Happy Feet.
a year. Alongside the dramas on the ship— By collecting and highlighting a multi-
By Rachel Riederer
including treacherous storms and a medical tude of voices, Rush explicitly works against
As writer Elizabeth Rush prepares for her evacuation—she reckons with an interior the classic storylines that dominate Antarc-
two-month expedition to Antarctica, on an question that is increasingly familiar: Is it tic history: “Amundsen’s conquest of the
icebreaker ship staffed with scientists from ethical to bring a child into a world so threat- pole, Scott’s death eleven miles from One
around the globe, she is focused on danger ened by climate collapse? Ton Depot, Shackleton’s miraculous return,
and on scarcity. The researchers are travel- As dozens of climate researchers head Douglas Mawson shooting and eating his
ing to the Thwaites Glacier, a behemoth toward the “doomsday glacier,” this ques- sled dogs.” Those tales center on the hero-
whose potential collapse could dramati- tion is thrown into especially sharp relief. ics of an individual (who is always a man
cally reshape the time line and scale of sea- Resonances arise organically among the and almost always white, Rush notes). The
level rise. “Will Miami even exist in a hun- The potential futures of Antarctica, the chal- Quickening instead offers an exploration
dred years?” Rush muses. “Thwaites will Quickening: lenges of predicting the climate system, story that is also a literature of community,
decide.” The glacier juts out into the Creation and and motherhood. All are uncertain, and as attentive to the cooks and the marine
Amund­sen Sea, which is inaccessibly frozen Community all are attached to unforgiving deadlines. techs as it is to the scientists whose work
over except for a few weeks in January and at the Ends “I know what it feels like to fear that there they support.
February. Rush solicits advice about what may not be many meaningful strategies Rush herself pitches in with the data
of the Earth
to pack for this precious window of data left,” Rush writes. In another instance, collection—sometimes helpfully and once,
by Elizabeth Rush.
gathering—treats for when the ship’s galley “there is a clock, and it is ticking.” She memorably, to disastrous effect—and she
Milkweed,
runs short of fresh produce; work gear that could be talking about her own fertility, comes away with a fresh view of the work
2023 ($30)
will fit her female form better than the the window of time in which humanity of scientific research, something she begins
government-issued versions—and about must move away from fossil fuels or the to understand as “a deeply communal act.”
how to stay safe amid the extreme isolation team’s need to gather what data it can be- Ultimately Rush determines that the work
of the voyage. It seems to be the start of fore the Amundsen Sea freezes it out. of parenting, like the floating village of peo-
a classic adventure tale. Rush’s preoccupations guide the ple studying the glacier, is paving the way
In some ways, it is. Rush structures the course of the inquiry, but her view of both for other, better futures.
journey as a four-act play, complete with the ambivalence of parenthood and the
a cast of characters listed before the first perception of Antarctica is one of many. Rachel Riederer i s a writer and editor
chapter. In act 1, the group members Her shipmates are co-narrators, with snip- focusing on climate and culture. She lives
prepare for departure, savoring their last pets of their interviews peppered through- in New York City.
chances to have a drink or go for a terres-
trial jog. Act 2 brings them to literally
uncharted waters, where they take sonar
readings to map the ocean floor and test
a submarine to see if it can be successfully
launched. They take inflatable boats from
the relative safety of the giant ship onto
a tiny island, where they follow a penguin
trail and scour the beaches for penguin
bones. Throughout, Rush offers keen ob-
servations of the fieldwork and lyrical de-
pictions of the setting, in turn menacing
and ethereal. In a moment of great danger,
“the bergs are many, lavender and faceted,
when the air is full of floating ice crystals.”
But Rush is not at the bottom of the
world to conquer, survive, test her mettle,
compete or plant a flag. Her journey, woven

80 Scientific American, September 2023 Illustration by London Ladd

 Atrocities against people and land
haunt these present-day stories.

FIC TION

Revenge
of the Land
Powerfully unsettling
fiction from
Indigenous writers
Although they are mostly set in the pres-
ent, the past haunts these unsettling dark
fantasies and straight-up horror tales from
Indigenous authors. Mining rich strata
of poisoned history and blood-soaked land,
the writers summon an exhaustive array ferent fathers learns, after blood testing, Ownership of stories, and the way
of ghosts, wolves, Wendigo spirits, human that one qualifies as a tribal member, enti- they change in the telling, is a pressing
eaters, conjure women, and petroglyphs tled to casino money, while the other concern. In Darcie Little Badger’s
willing to exact revenge if you scratch doesn’t. The true terror in both stories “The Scientist’s Horror Story,” a geologist
them with your car keys. Throughout the comes from the protagonists’ desperation regales scientist friends at a convention
26 stories, contemporary American life is to either claim or hide Indigenous lineage. with his own tale of searching a New
a threadbare bandage soaked through In story after story, whether in Mexico ghost town for whatever has
with the gore of the wound it never truly Never Whistle sub­divisions or scrub grass, the protag­­o­­ been transforming victims’ genomes
covers or heals. at Night: nists find the past—“the old ways”; “coun- into “a nonsensical pattern of nucleotides.”
In Rebecca Roanhorse’s standout An Indigenous try nonsense”—seeping into their now. In (One listener takes notes on holes in
“White Hills,” an Instagram influencer’s one, the ghost of General Custer’s widow the plot.)
Dark Fiction
#blessed life is threatened by her casual physically attacks the narrator with “the After building to a classic ghost-story
Anthology
Bijaya Gurung/500px/Getty Images

mention of Native American ancestry. Per- strength of death.” Spirits take revenge, climax, the speaker somewhat sheepishly
Edited by Shane
haps the collection’s most visceral story, it old truths suddenly get proven again, and agrees that it was all made up, just a
Hawk and Theodore
examines eugenics and phrenology-based professors—in Mathilda Zeller’s “Kush- spooky laugh, letting his audience off the
C. Van Alst, Jr.
racism and builds to scenes of brutal horror. tuka” and in Amber Blaeser-Wardzala’s hook from feeling obliged to think about
Vintage, 2023
Nick Medina’s piercing “Quantum” like- scathing “Collections”—are eager to mount such things—or, by implication, the blood
($17, paperbound)
wise turns on questions of genetics, when Native American tools (and worse) on their that seeps through the bandage.
the mother of two young children from dif- walls, as if their utility has passed. — Alan Scherstuhl

IN BRIEF

Of Time and Turtles: Mending Land of Milk and Honey: A Novel Crossings: How Road Ecology Is
the World, Shell by Shattered Shell by C Pam Zhang. Riverhead Books, 2023 ($28) Shaping the Future of Our Planet
by Sy Montgomery. Illustrated by Matt by Ben Goldfarb. W. W. Norton, 2023 ($30)
Patterson. Mariner Books, 2023 ($28.99) When a thick layer of global smog
causes crop failure, extinctions and Roads may be connective for
The movie portrayals o f turtles as famine, a struggling cook eagerly humans and commerce, but they’re
ultrachill surfers or pizza-ordering elite accepts an offer to work as a private distinctly disruptive to ecosystems
fighters have little in common with the chef for an insular community of and wildlife, writes journalist Ben
richly understated lifestyle Sy Mont- elites perched on a mountaintop high above the Goldfarb in this swift and winding
gomery chronicles during the year choked atmosphere. Though ensconced in envi- ride through the science of road ecology. He cov-
she spends volunteering at a local turtle sanctuary. ronmental privilege and culinary abundance, ers pumas, passages and pavement with equal
There’s abundant drama in the high-stakes field trips: she soon discovers that her new post comes with parts mirth and earnestness, resulting in a surpris-
rescuing the victims of hit-and-runs, unearthing troubling expectations. As her cryptic employer ing reflection on what we owe to nature. Many
freshly laid eggs, releasing rehabilitated “herps” into takes drastic measures to secure the community’s readers came away from Goldfarb’s first book,
the wild. But it’s Montgomery’s heart-tugging con- future, she must choose whether to remain there Eager, as newly minted beaver fans; don’t be sur-
versations with teammates and her commitment to or break free. Writer C Pam Zhang’s lush but prised if you finish Crossings a s an evangelist for
helping an octogenarian named Fire Chief that reveal precise descriptions and inventive premise create road ecology. At the least, the roadkill you spot
turtles to be perfect conduits for meditations on a thought-provoking fusion of the sensory and along the highway will never look the same.
aging, disability and chosen family. —Maddie Bender the speculative.  —Dana Dunham — Tess Joosse

September 2023, ScientificAmerican.com 81

OBSERVATORY
K E E PIN G A N E Y E O N S C IE N C E

Child Labor Laws what would be in it); existing state laws

had almost always exempted agricultural

Are under Attack

labor; and even the most zealous reform­
ers had no objection to household chores.
Another example came from the
Efforts to weaken labor protections are linked National Association of Manufacturers
(NAM)—at the time the nation’s largest
to the social Darwinist notion that people trade association—which insisted (with­
are inherently unequal out evidence) that “the nature and extent
of the work done by children is grossly
By Naomi Oreskes exaggerated.” The group claimed the
amendment was a power grab to enable
“If there is any matter upon which civi­ The overall trend—in “civilized” na­­ Congress to control the “labor and edu­
lized countries have agreed . . . , it is the tions, as Holmes put it—was toward keep­ cation of all persons under 18 to an
evil of premature and excessive child ing children out of the workplace to extent not now possessed by any State of
labor.” So said U.S. Supreme Court Jus­ enable them to go to school and improve the Union.” Both these claims were false.
tice Oliver Wendell Holmes, Jr., in 1918, their lives through education. In the U.S., The facts of child labor were well docu­
when Americans were waging a fierce this was mostly achieved through state mented, and the amendment said noth­
battle over the employment of young law. But manufacturers criticized these ing about education.
children. More than a century later the laws as creating an unlevel playing field: NAM also made a slippery slope argu­
argument rages again. In recent months to them, any state limit on child labor ment: it claimed that in time the govern­
14 states have introduced or passed laws would disadvantage them relative to ment would use the amendment to
weakening labor protections for minors, competitors in states without such limits. expand its power even more. And it
even in notoriously dangerous indus­ One manufacturer in South Carolina engaged in red-baiting by insisting that
tries, such as meatpacking. Nonenforce­ even stated that a proposed bill prohibit­ the proposed 20th Amendment was
ment of existing laws that limit the ing the employment of children under “socialistic in its origin, philosophy and
hours and types of work that can be per­ age 12 could be called “a bill to discourage associations.” One pamphlet issued by
formed by kids is also on the rise. This manufacturing in South Carolina.” To NAM noted that the 1922 Fourth Con­
past year the number of minors illegally level the playing field, Congress passed gress of the Communist International
employed—including children as young two federal laws. When the Supreme had declared its intent to abolish all wage
as 13—increased by 37 percent. Court overturned these laws on constitu­ labor by children under age 18, suggest­
Holmes’s comments remind us that tional grounds, it was an obvious choice ing that if communists wanted to elimi­
there’s a long and baleful story behind to amend the Constitution. nate child labor, then Americans who
contemporary efforts to bring back child It is a conspicuously forgotten piece of advocated the same must be communists,
labor. Although few, if any, of today’s advo­ American history that in 1924 the U.S. too. Senator William H. King of Utah de­­
cates of weakening child labor protections Congress passed the Child Labor Amend­ clared the proposed amendment to be a
would admit it, the defense of child labor ment, which granted Congress the power “communistic, bolshevistick scheme.”
is historically linked to social Darwinist to “limit, regulate, and prohibit the labor These claims were rooted in noxious
beliefs that people are not equal and do of persons” under age 18. Had it been rat­ ideas about inequality and opportunity.
not deserve an equal chance in life. ified by the states, it would have been the Many defenders of child labor were social
Holmes made his comment in a 1918 20th Amendment to the Constitution. Darwinists who believed people were in­­
dissent to a Supreme Court decision that But business leaders mobilized against it. herently unequal. They associated child
overturned a federal statute meant to The business effort relied heavily on labor laws with socialism because the
limit child labor. Child labor was com­ denying the facts of child labor and prop­ laws enforced assumptions of equality
monplace back then: according to one agating false, misleading and disingenu­ they rejected—such as that all children
estimate, between 1890 and 1910, nearly ous arguments. One example comes from should go to school. They argued that the
20 percent of all American children 10 to the industry newsletter Southern Textile “natural place” of some children (like
15 years old worked in industrial settings. Bulletin, whose editor took out ad­­­ver­ some adults) was in factories. Typically
Some forms of work—such as cleaning tisements claiming that the proposed this referred to children of immigrants,
narrow chimneys or crawling under amendment would hinder boys from particularly Catholic and Jewish immi­
machinery to recover lost objects or bits doing farm work and girls from doing the grants from southern and eastern Europe.
of fabric—were considered particularly dishes. This was misleading because the Child labor was finally brought under
suitable for children as young as five or amendment simply authorized Congress control in 1938, when Congress passed
six because of their small stature. to pass a federal law (but did not stipulate (and the Supreme Court upheld) the Fair

82 Scientific American, September 2023

 Naomi Oreskes i s a professor of the history of science at
Harvard University. She is author of Why Trust Science?
(Princeton University Press, 2019) and co-author of 
The Big Myth (Bloomsbury, 2023).

A child laborer works at a cotton mill Today we are seeing many old argu­ work that prevailed in the 1920s: an anti­
in South Carolina in 1908. ments being revived to reverse a century government ideology pushed by business
of social progress. Child labor is a case in leaders who resent government regula­
Labor Standards Act, which, among other point. Advocates of weakened protections tion broadly and want the “freedom” to
things, banned child labor in hazardous for children claim that the states—not the pollute the atmosphere, operate danger­
trades, including most jobs in coal min­ federal government—should decide; that ous workplaces and rob immigrant chil­
ing, forest firefighting and meatpacking. attempts to regulate the workplace repre­ dren of their chance to succeed in school
The legislation, combined with improved sent a federal power grab; and that the and beyond.
Gado/Getty Images

adult wages (so families felt less need to defenders of strict limits on child labor
send kids to work) and increased compul­ are socialists trying to (unreasonably)
J O I N T H E C O N V E R S AT I O N O N L I N E
sory school attendance, decreased child level the playing field. Underlying these Visit Scientific American on Facebook and Twitter
labor in industrial settings dramatically. arguments is the same ideological frame­ or send a letter to the editor: [email protected]

September 2023, ScientificAmerican.com 83

50, 100 & 150 YEARS AGO S cienti f ic A m erican O N L I N E
FIND ORIGINAL ARTICLES AND IMAGES
IN N OVATI O N A N D D I S C OV E RY A S C H R O NI C L E D IN S c ientific A meric an IN THE Scientific American ARCHIVES AT
Compiled by Mark Fischetti scientificamerican.com/magazine/sa

S e p t e m b er

1973 Polywater’s
Final Exit
“The long-standing controversy
graphed the animals with a high-
speed camera. As the basilisk picks
up speed, it twists the lower half
ERA was a huge medical hoax. It held
that diseases have a unique vibration
rate that could be sensed from a drop
over the existence of a superdense, of its body from one side to the of blood, or a handwriting sample,
polymeric form of water is appar- other and thrusts each leg back- and treated, all with Abrams’s sealed
ently over. The argument began ward and to the side. The result is electronic boxes.
when Boris V. Derjaguin and col- a rapid waddle, necessary to push
leagues at the Soviet Academy of
Sciences observed that certain sam-
ples condensed in fine capillary
1973 itself ahead with maximum force
and retract each leg from the water
with a minimum of resistance.”
1873 Insects
Superhuman

“M. l’Abbe Plessis, in an article in

tubes represented a new, stable Les Mondes, s ays that he placed a
form of water with a density almost
one and a half times that of ordi-
nary water and a molecular struc-
1923 Sixteen Ohms
of Malaria
“ ‘You have sixteen ohms of malar-
large horned beetle, weighing some
fifty grains, on a smooth plank, then
added weights up to 2.2 pounds. In
ture that could only be described ia,’ exclaimed the man at the rheo- spite of this being 315 times the bee-
as polymeric. Subsequent investiga- stat, to a member of the S cientific tle’s weight, the beetle managed to
tions in the U.S.S.R., Britain, Ger- 1923 American staff who has been in- lift it and move it along. A human is
many and the U.S. argued that the vestigating the much-disputed fully a hundred times feebler in pro-
anomalous properties could be Electronic Reactions of Abrams, portion. Similarly, the flea, scarcely
explained by impurities. Derjaguin a method of diagnosis and treat- 0.03 of an inch in height, manages
has now reported that recent mea- ment developed by Dr. Albert to leap over a barrier 500 times its
surements by his group have re- Abrams of San Francisco. There own altitude. Imagine a human
vealed that their samples invariably are ERA practitioners throughout jumping 3,000 feet in the air!”
contain trace impurities.” the country. Remarkable cures are
said to be effected, including cases Speedy Pigeons
Drunk Intestines 1873 of cancer. But there are many “Carrier pigeons are being thor-
“Alcohol is manufactured in the hu- doubters in and out of medical cir- oughly tested, and some have
man intestine by microorganisms. cles. The public, looking on, re- shown a wonderful speed. The Ari-
The amount of pure ethyl alcohol mains in a quandary.” el, a pigeon that won the $2,000
(the potable kind) produced daily prize in the international con-
is about one ounce. Ethyl alcohol test in Belgium in 1871, accom-
ingested by a human, or produced plished the distance between
in the intestine, is carried to the New York and Stratford, Conn.,
liver. In the liver 80 percent is bro- sixty-four miles, in thirty min-
ken down by alcohol dehydroge- utes. Another bird, known as
nase; the remaining 20 percent is No. 6, made the journey in al-
possibly metabolized by another most as quick a time. The carrier
enzyme, catalase. It is the efficiency pigeon seems to possess a memo-
of the process that so long masked ry for places, coupled with a very
the production of alcohol in the strong attachment for its abode.”
intestine. The microorganisms that
produce it remain unknown.”
1973, Medicinal Plants: “Culpep-
People with auto-brewery syndrome
er’s English Physician and Complete
produce much more alcohol daily and Herbal, written by Nicholas Cul-
may seem intoxicated even though peper (1616–1654), listed hundreds
they haven’t been drinking. of plants that could be ‘applied to
S cientific American, Vol. 229, No. 3; September 1973

the cure of all disorders incident to

The Jesus Lizard mankind.’ Fennel was recommend-
“The basilisk lizard of Mexico and ed to ‘break wind and provoke
Central America has a unique abil- urine. . . . The . . . seed, boiled in
water, will stay the hiccough.’ Fern
ity: it can walk on water. In some
roots boiled in mead killed ‘worms
areas this ability has earned it the in the body.’ The foxglove was used
name lagarto Jesus Cristo—the for ‘feebleness of the heart’; today
­Jesus Christ lizard. Joshua Laerm it is the source of digitalis [to treat
of the University of Illinois photo- congestive heart failure].”

84 Scientific American, September 2023

GRAPHIC SCIENCE
Text by Josh Fischman | Graphic by Now Medical Studios

The Brain-Gut Connection

In inflammatory bowel disease, mental stress can produce
two painful types of physical responses
Bouts of disabling pain, bleeding, weight some variety of immunosuppressant such one, for instance—can trigger the release
loss and hospitalization that sometimes as a steroid drug. But even controlled cas- of brain chemicals that cause IBD symp-
require surgery: that’s the lot of about es have periodic flare-ups, and the reasons toms. This doesn’t mean IBD is all in the
three million adults in the U.S. who suffer have been hard to pin down. head, emphasizes Christoph A. Thaiss of
from inflammatory bowel disease, or IBD. Now scientists have traced two detailed the University of Pennsylvania, one of the
(The illness has two main forms, Crohn’s molecular pathways from the brain to the researchers. But it does mean psychother-
disease and ulcerative colitis. It is fre- gut that produce IBD flares. And in three apy and targeted stress-management tech-
quently associated with an overactive different groups of IBD patients, they niques have important—and until now
immune system and may have a genetic found that psychological stress—a death underappreciated—roles to play in pre-
component.) Treatments often involve in the family or a bad fight with a loved venting and treating agonizing flares.

Psychological Stress Can Cause an Inflammatory Response and Impaired Food Movement in the Gut

Glucocorticoids travel Glucocorticoids travel

In response to
from the adrenal from the adrenal
chronic stress, the brain
glands into the gut. glands into the gut.
releases a stress hormone called
CRH. CRH causes the pituitary gland
to stimulate the adrenal glands on the Pituitary Enteric
kidneys to release another class of gland neuron
hormones (glucocorticoids). In response to
The two pathways stress signals,
shown in yellow TGFß2 is
outline what released from
In response to stress
happens next. enteric neurons.
signals, enteric
TGFß2 reduces
glial cells turn Enteric neuronal activity.
into eGAPS cells. glial cell
TGFß2

eGAPS cell
eGAPS cells send The population
out signals (CSF1) of mature healthy
to recruit immune neurons goes
cells (monocytes) down, and
CSF1 Kidney
to the intestine. Adrenal the number of
gland

 ol. 186; June 22, 2023 (reference)

immature neurons
goes up.
Monocyte Source: “The Enteric Nervous System Relays Psychological Stress to Intestinal

Immature Reduced numbers

Monocytes neuron of healthy neurons
ACh cause a reduction
release signals
(TNF) that can in acetylcholine
Inflammation,” by Kai Markus Schneider et al., in C ell, V

TNF
lead to intestinal (ACh). This disrupts
cell damage, the signaling
inflammation pathways that
and pain. control food
Intestine
movement
(light and
through the gut
dark pink)
(dysmotility).

Inflammatory Response Impaired Food Movement

86 Scientific American, September 2023