Risk Savvy: How to Make Good Decisions

A Risk and Statistics book by Gerd Gigerenzer

Risk Savvy book cover image
A risk and statistics guide to making better decisions.

An eye-opening look at the ways we misjudge risk every day and a guide to making better decisions with our money, health, and personal lives

In the age of Big Data we often believe that our predictions about the future are better than ever before. But as risk expert Gerd Gigerenzer shows, the surprising truth is that in the real world, we often get better results by using simple rules and considering less information.

In Risk Savvy, Gerd Gigerenzer reveals that most of us, including doctors, lawyers, financial advisers, and elected officials, misunderstand statistics much more often than we think, leaving us not only misinformed, but vulnerable to exploitation. Yet there is hope. Anyone can learn to make better decisions for their health, finances, family, and business without needing to consult an expert or a super computer, and Gigerenzer shows us how.

Risk Savvy is an insightful and easy-to-understand remedy to our collective information overload and an essential guide to making smart, confident decisions in the face of uncertainty.

On Flickr®

Transgenerational Epigenetic Inheritance : Pesticides linked to Three Generations of Diseases

Ancestral exposure to pesticides may cause adult onset kidney disease, ovarian disease and obesity in future generations

Implications for Obesity, Fertility, Disease

image of Epigenetic mechanisms
Epigenetic mechanisms – ancestral exposure to pesticides may cause adult onset kidney disease, ovarian disease and obesity in future generations.

Washington State University researchers argues that exposure to the pesticide Methoxychlor – also known as Chemform, Methoxo, Metox or Moxie ; introduced in 1948 and widely used during the 1970s as a safer replacement for DDT – could cause diseases three generations later, in offspring who were never exposed to the chemicals themselves.

Most developed nations have banned the pesticide, which can behave like the hormone estrogen and profoundly affects the reproductive system. Methoxychlor was banned in the U.S. in 2003 but it is still widely used in Mexico and South American countries where the U.S. gets a significant portion of its produce.

Biologist Michael Skinner and his team found that if a rat fetus is exposed to the pesticide during the first trimester of pregnancy, the likelihood of kidney disease, ovary disease and obesity in their progeny was elevated for three generations. Multiple diseases were even more prevalent in the third generation – great-grandchildren – than in the second. This is called transgenerational epigenetic inheritance.

Abstract:

A variety of environmental toxicants have been shown to induce the epigenetic transgenerational inheritance of disease and phenotypic variation. The process involves exposure of a gestating female and the developing fetus to environmental factors that promote permanent alterations in the epigenetic programming of the germline. The molecular aspects of the phenomenon involve epigenetic modifications (epimutations) in the germline (e.g. sperm) that are transmitted to subsequent generations. The current study integrates previously described experimental epigenomic transgenerational data and web-based bioinformatic analyses to identify genomic features associated with these transgenerationally transmitted epimutations. A previously identified genomic feature associated with these epimutations is a low CpG density (<12/100bp). The current observations suggest the transgenerational differential DNA methylation regions (DMR) in sperm contain unique consensus DNA sequence motifs, zinc finger motifs and G-quadruplex sequences. Interaction of molecular factors with these sequences could alter chromatin structure and accessibility of proteins with DNA methyltransferases to alter de novo DNA methylation patterns. G-quadruplex regions can promote the opening of the chromatin that may influence the action of DNA methyltransferases, or factors interacting with them, for the establishment of epigenetic marks. Zinc finger binding factors can also promote this chromatin remodeling and influence the expression of non-coding RNA. The current study identified genomic features associated with sperm epimutations that may explain in part how these sites become susceptible for transgenerational programming.

Sources:
  • Pesticide linked to three generations of disease,
    WSU, News, 24-Jul-2014.
  • Identification of Genomic Features in Environmentally Induced Epigenetic Transgenerational Inherited Sperm Epimutations, PLOS one, DOI: 10.1371/journal.pone.0100194, June 17, 2014.
  • Exposure to Pesticides When Pregnant Linked to 3 Generations of Disease, NewsWeek, pesticide-diseases, July 24, 2014.
  • Your Great Grandmother’s Exposure to Pesticides Could Be Making You Obese, Time, 3028766, July 25, 2014.

#FullMoonEngageMe Social Media Event N°4 – The Sturgeon Moon #EmpireAvenue #SocialNetworking

Friday 8th of August : join our free social media event taking place at each Full Moon – via #EAv – and give a boost to your social networking!

The Sturgeon Moon

sturgeon moon image
The Sturgeon Moon – Photo credit Maharani Rutan. Friday 8th of August : join our free social media event taking place at each Full Moon – via #EmpireAvenue – and give a boost to your social networking!

There are native American names for the full moons that you can find here, here or here.
August month full moon is called Sturgeon Moon because some native American tribes knew that the sturgeon of the Great Lakes and Lake Champlain were most readily caught during this full Moon.
Other full moon names include the Red Moon, Green Corn Moon, Grain Moon, Wheat Cut Moon or Blueberry Moon.

#FullMoonEngageMe Social Media Event N°4 Schedule

The event will start on Friday 8th of August at 12:00 noon UTC and last until Monday the 11th in HERE.

What is this about?

A great opportunity for you to super charge your social networking, to meet Empire Avenue Leaders, to connect with top social media engagers and more… Last May initial SoMe event was followed by the strawberry moon and by the buck moon.  In Empire Avenue EAv Gangstas community, you can still access May’s thread, June’s thread and July’s thread. And there is our FAQs.

Questions?
  • Please use the comment section to ask any question about the event.
  • You can join – for FREE – Empire Avenue at anytime – before and after any FullMoon EngageMe Social Media Event.
    You can use this link – with no strings attached – to get some extra “eaves” at start !
    See you soon 😉

How well do Exposure Protocols in Experimental EDCs Studies mimic Human Exposures?

Gavage should be abandoned as the default route of administration for hazard assessments of EDCs

Should oral gavage be abandoned in toxicity testing of endocrine disruptors?

Abstract

image of Oral Gavage in Mice
Gavage should be abandoned as the default route of administration for hazard assessments of EDCs.

For decades, hazard assessments for environmental chemicals have used intra-gastric gavage to assess the effects of ‘oral’ exposures. It is now widely used – and in some cases required – by US federal agencies to assess potential toxicity of endocrine disrupting chemicals (EDCs). In this review we enumerate several reasons why gavage is not appropriate for the assessment of EDCs using Bisphenol-A (BPA) as a main example.

  • First, whereas human dietary exposures interact with the oral mucosa, gavage exposures avoid these interactions, leading to dramatic differences in absorption, bioavailability and metabolism with implications for toxicokinetic assumptions and models.
  • Additionally, there are well acknowledged complications associated with gavage, such as perforation of the esophagus that diminish its value in toxicological experiments.
  • Finally, the gavage protocol itself can induce stress responses by the endocrine system and confound the assessment of EDCs.

These serious flaws have not been taken into account in interpreting results of EDC research. We propose the exploration of alternatives to mimic human exposures when there are multiple exposure routes/sources and when exposures are chronic. We conclude that gavage may be preferred over other routes for some environmental chemicals in some circumstances, but it does not appropriately model human dietary exposures for many chemicals. Because it avoids exposure pathways, is stressful, and thus interferes with endocrine responses, gavage should be abandoned as the default route of administration for hazard assessments of EDCs.

Sources
  • One more reason not to trust #EPA chemical tests: They often use gavage, which underestimates human exposure, Pete Myers, @petemyers status/492397493154742272, 24 Jul 2014.
  • Should oral gavage be abandoned in toxicity testing of endocrine disruptors?, BioMed Central, Environmental Health 2014, 13:46 doi:10.1186/1476-069X-13-46, 25 June 2014.
  • Oral Argument: Sublingual Findings Challenge Key Assumptions about BPA Exposure, Environ Health Perspect; DOI:10.1289/ehp.121-A257, Aug 2013.

Fertility in Men exposed prenatally to DiEthylStilbestrol

DiEthylStilbestrol usage review buttress the need for adequate and rigorous research into the use of drugs in pregnancy and ensure that they do more good than harm before being introduced

Abstract

image of PubMed NCBI The Endocrine Society logo
In that 1995 study, DES sons with genital malformations were nonetheless as fertile as other men.

BACKGROUND:
Prenatal exposure to diethylstilbestrol causes infertility in male mice and has been associated with malformations of the genital tract in men. However, little is known about the fertility of men who have been exposed prenatally to diethylstilbestrol.
METHODS:
In 1950 through 1952, 1646 pregnant women were enrolled in a randomized, placebo-controlled clinical trial of diethylstilbestrol at Chicago Lying-in Hospital. We interviewed men who were born to the women during that study about their fertility.
RESULTS:
Four decades after their birth, we were able to trace 548 of the surviving sons (68 percent). Ninety percent consented to be interviewed (253 who had been exposed to diethylstilbestrol in utero and 241 who had not been exposed). Congenital malformations of the genitalia were reported three times as often by the diethylstilbestrol-exposed men as by the sons of the women in the placebo group. Within the exposed group, malformations were reported twice as often among those exposed to diethylstilbestrol before the 11th week of gestation as among those exposed later (P = 0.05). Men with genital malformations were nonetheless as fertile as other men. The diethylstilbestrol-exposed men (with or without genital malformations) had no impairment of fertility by any measure, including whether they had ever impregnated a women, age at the birth of their first child, average number of children, medical diagnosis of a fertility problem, or length of time to conception in the most recent pregnancy of the female partner. Finally, diethylstilbestrol-exposed men had no impairment of sexual function, as indicated, for example, by the frequency of intercourse or reported episodes of decreased libido.
CONCLUSIONS:
High doses of diethylstilbestrol did not lead to impairment of fertility or sexual function in adult men who had been exposed to the drug in utero.

Sources

  • Fertility in men exposed prenatally to diethylstilbestrol, NCBI, PMID: 7723797, ;332(21):1411-6, 1995 May 25.
  • Full text – New England Journal of Medicine 1995; 332:1411-1416, DOI: 10.1056/NEJM199505253322104, May 25, 1995.
More DES DiEthylStilbestrol Resources

Three-Person IVF UK Plans are going Forward…

Government Decision on Mitochondria Replacement Regulations

The creation of babies using sperm and eggs from three genetic parents, well considered by the UK government, which raised ethical concerns,  has moved another step closer in the UK…

Government Decision on Mitochondria Replacement Regulations

image of human cloning
The UK fertility regulator said there was no evidence that it would be unsafe, but called for extra checks. Should Parliament pass the regulations, the HFEA will need to consider how any mitochondria replacement therapies could be licensed.

The Government has today announced its intention to put regulations relating to mitochondria replacement before Parliament.

Earlier this year, the Department of Health commissioned the HFEA to reconvene its expert panel of scientists to conduct a review into the safety and efficacy of techniques relating to mitochondria replacement.The panel was clear that it had seen no evidence which suggested that mitochondrial replacement is unsafe and that good progress was being made on the science.

Dr Andy Greenfield, chair of the HFEA’s expert panel of scientists, said:

Our understanding of mitochondria has developed significantly over recent years, and scientists in the UK and the US are now close to providing new treatment options for a range of serious conditions that are inherited through the mothers’ mitochondria. In three years study the expert panel has seen no evidence which suggests that these new mitochondrial replacement therapies are unsafe. The scientific direction of travel is clear; and although we have recommended further experiments before treatment should be offered we understand that good progress on these is being made and we expect them to support the conclusions we have reached to date.”

Moving from research into clinical practice always involves a degree of uncertainty. If Parliament does change the law the regulatory processes required by the HFEA before treatment can be offered will ensure, to the extent that assurance can ever be offered, that mitochondrial replacement works and is sufficiently safe to be offered to people with serious mitochondrial disease.”

Sally Cheshire, Chair of the HFEA, said :

The HFEA was first asked by the Government to provide expert advice on this important issue in 2011. Since then we have produced three separate reports on the science and one on public attitudes. Our advice shows that the science is moving rapidly in the right direction and that a majority of the public support these new treatment options for what are serious, and sometimes fatal, inherited conditions. Taken together, these reports provide an evidence base which is a model for public policy making, especially when considering the introduction of new techniques at the cutting edge of biology and ethics.”

The decision to change the law is, quite properly, for Parliament and today the Government has signalled its intention to introduce Regulations. But even if the law is changed that doesn’t mean that treatments will be offered overnight. As the regulator, the HFEA will need to design and implement a process to ensure that clinics are licensed against rigorous standards – the public would expect nothing less.”

Should Parliament pass the regulations, the HFEA will need to consider how any mitochondria replacement therapies could be licensed. We look forward to working with the Department of Health to develop a rigorous approval process.

Sources and Six Years of BBC Press Releases:

  • Government decision on mitochondria replacement regulations,
    HFEA, press release, 22 July 2014.
  • Three person IVF plans ‘progress’ in UK,
    BBC News Health, health-28417860, 22 July 2014.
  • Three-person babies ‘in two years’ – says science review,
    BBC News Health, health-27678464, 03 June 2014.
  • Why make babies from three people?,
    BBC News Health, health-27682884, 03 June 2014.
  • Three-person baby details announced,
    BBC News Health, health-26367220, 27 February 2014.
  • UK government backs three-person IVF,
    BBC News Health, health-23079276, 28 June 2013.
  • A bold step for science and society,
    BBC News Health, health-23086162, 28 June 2013.
  • Three-person IVF: Your stories,
    BBC News Health, health-23096105, 28 June 2013.
  • Three-person IVF moves closer in UK,
    BBC News Health, health-21806911, 20 March 2013.
  • The woman who lost all seven children,
    BBC News Health, magazine-19648992, 20 September 2012.
  • Lisa Jardine: We need public opinion on 3-person IVF,
    BBC Today, newsid_9752000/9752373, 17 September 2012.
  • Ethics of using three people’s DNA to create one baby,
    BBC News Health, health-19604004, 17 September 2012.
  • ‘Three people, one baby’ public consultation begins,
    BBC News Health, health-19597856, 17 September 2012.
  • Three-person IVF ‘is ethical’ to treat mitochondrial disease,
    BBC News Health, health-18393682, 12 June 2012.
  • Three-person IVF’ technique moves closer,
    BBC News Health, health-16627043, 19 January 2012.
  • New fertility technique to be assessed by regulator,
    BBC News Health, health-12708858, 11 March 2011.
  • Three-person IVF ‘may prevent inherited disease’,
    BBC News Health, health/8619533, 14 April 2010.
  • Genetic advance raises IVF hopes,
    BBC News Health, health/8220553, 26 August 2009.
  • Three-parent embryo formed in lab,
    BBC News Health, health/7227861, 5 February 2008.

Etude Nationale sur le suivi des femmes porteuses d’implants mammaires

Toute personne porteuse de prothèse(s) mammaire(s) est invitée à participer à cette étude nationale même si elle n’a pas eu de problèmes de santé

poster sur les implants PIP retirés en France
L’étude LUCIE est une cohorte épidémiologique nationale réalisée auprès des personnes porteuses ou ayant porté des prothèses mammaires et opérées en France (France métropolitaine et territoires d’outre-mer).

En 2013 en France, on estimait à 346 000 le nombre de femmes porteuses d’implants mammaires. On évalue à environ 30 000 celles qui ont porté une prothèse fabriquée par la société PIP (dont une partie a été retirée depuis). Au-delà du caractère défectueux de ces prothèses mammaires, seule une vaste étude épidémiologique permettrait de documenter leurs effets indésirables potentiels.

A la demande de l’Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM), un groupe de chercheurs dirigé par Florent de Vathaire au sein de l’Unité l’Inserm 1018 “Centre de recherche en épidémiologie et santé des populations” lance une étude baptisée LUCIE.

Cette enquête qui se déroulera sur 10 ans a pour objectif de suivre près de 100 000 femmes portant ou ayant porté des implants mammaires de toutes marques. Les résultats permettront ainsi de conclure quant à la potentielle survenue d’effets indésirables à moyen et long terme chez les femmes porteuses de prothèses PIP.

Ensemble, l’Inserm et l’ANSM se mobilisent pour améliorer la connaissance scientifique sur les problématiques associées aux prothèses mammaires et permettre ainsi de veiller à la sécurité d’emploi de ces produits.

Communiqués de presse:

  • L’Inserm soutenu par l’ANSM lance l’étude LUCIE sur le suivi des femmes porteuses d’implants mammaires, ANSM, communiqué, 11/07/2014.
  • 100 000 femmes porteuses d’implants mammaires suivies pendant 10 ans, Inserm, espace journalistes, 11 juillet 2014.
  • Prothèses mammaires : 100 000 femmes suivies pendant 10 ans, Pourquoi Docteur, Question d’actu 11 Juillet 2014.
  • Implants mammaires en silicone : rapport d’évaluation de l’ANSM sur leur utilisation en France de 2010 à 2013, Vidal, actualites/13754, 07 Mai 2014.

Uterine Cancers among Women undergoing a Minimally Invasive Hysterectomy using Electric Power Morcellation

Evaluating the Risks of Electric Uterine Morcellation

JAMA Network logo
Presence of uterine cancers at time of hysterectomy studied using morcellation.

Even though minimally invasive surgery has improved outcomes for hysterectomy, the procedure requires removal of the uterus through small incisions. Morcellation, or fragmentation of the uterus into smaller pieces, is one method to remove the uterus. Recently, concern has been raised that morcellation may result in the spread of undetected malignancies.

Despite the commercial availability of electric power morcellators for 2 decades, accurate estimates of the prevalence of malignancy at the time of electric power morcellation (herein referred to as morcellation) are lacking.

Among women undergoing a minimally invasive hysterectomy using electric power morcellation, uterine cancers were present in 27 per 10,000 women at the time of the procedure, according to a new study. There has been concern that this procedure, in which the uterus is fragmented into smaller pieces, may result in the spread of undetected malignancies.

Sources and More Information:

  • Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation, JAMA, articleid=1890400,  doi:10.1001/jama.2014.9005, July 22, 2014.
  • Presence of uterine cancers at time of hysterectomy studied using morcellation, ScienceDaily, 140722164353, July 22, 2014.
  • Patient safety must be a priority in all aspects of care, The Lancet Oncology, Volume 15, Issue 2, Page 123,  doi:10.1016/S1470-2045(14)70042-7, February 2014.
  • Evaluating the Risks of Electric Uterine Morcellation, JAMA. 2014;311(9):905-906. articleid=1828692, doi:10.1001/jama.2014.1093, March 5, 2014.
  • Peritoneal Dissemination Complicating Morcellation of Uterine Mesenchymal Neoplasms, PLOS one, DOI: 10.1371/journal.pone.0050058, November 26, 2012.
  • Risk of occult malignancy in morcellated hysterectomy: a case series, NCBI, PMID: 21804400, 30(5):476-83. doi: 10.1097/PGP.0b013e3182107ecf, 2011 Sep.
  • Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease, JAMA, articleid=1653522, 2013;309(7):689-698. doi:10.1001/jama.2013.186, February 20, 2013.
  • The value of re-exploration in patients with inadvertently morcellated uterine sarcoma, GynecologicOncology, Volume 132, Issue 2 , Pages 360-365, article/S0090-8258(13)01351-6, February 2014

Early-Life BPA-Exposure tied to Behavior Problems, Emotional Difficulties in Young Girls

Prenatal Bisphenol A Exposure and Child Behavior in an Inner-City Cohort

Harvard Public Health logo
Prenatal Bisphenol A Exposure and Child Behavior in an Inner-City Cohort, 2012 study – Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children, 2011 study.

In a 2001 study of Cincinnati-area children, young girls exposed to higher levels of Bisphenol-A  (BPA) in utero had more behavioral problems and were more anxious and over-active than those only exposed to small amounts of the chemical.

In 2002, a study of New-York-area children followed African-American and Dominican women and their children from pregnancy to child’s age 5 years, collecting spot urine samples from the mothers during pregnancy (34 weeks on average) and from children between 3 and 4 years of age to estimate BPA exposure. The results suggested that prenatal exposure to BPA may affect child behavior, and differently among boys and girls.

Sources:

  • Prenatal Bisphenol A Exposure and Child Behavior in an Inner-City Cohort, NCBI, PMCID: PMC3440080, Apr 27, 2012. doi: 10.1289/ehp.1104492
  • Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children, pediatrics, peds.2011-1335, August 8, 2011.
  • Exposure to BPA, chemical used to make plastics, before birth linked to behavioral, emotional difficulties in young girls, Harvard School of Public Health, Press Releases, October 24, 2011
  • BPA tied to behavior problems in girls: study, Reuters, idUSTRE79N0X220111024, Oct 24, 2011

Kisspeptin-54 Triggers Egg Maturation in Women undergoing IVF Treatment

New trigger for ovulation could make IVF safer

This Imperial College London video describes the results of research carried out by Professor Dhillo’s team which has shown for the first time in women with infertility that the novel hormone kisspeptin can be used safely and effectively to stimulate ovulation and mature eggs in IVF treatment.

BACKGROUND

Patients with mutations that inactivate kisspeptin signaling are infertile. Kisspeptin-54, the major circulating isoform of kisspeptin in humans, potently stimulates reproductive hormone secretion in humans. Animal studies suggest that kisspeptin is involved in generation of the luteinizing hormone surge, which is required for ovulation; therefore, we hypothesized that kisspeptin-54 could be used to trigger egg maturation in women undergoing in vitro fertilization therapy.

METHODS

Following superovulation with recombinant follicle-stimulating hormone and administration of gonadotropin-releasing hormone antagonist to prevent premature ovulation, 53 women were administered a single subcutaneous injection of kisspeptin-54 (1.6 nmol/kg, n = 2; 3.2 nmol/kg, n = 3; 6.4 nmol/kg, n = 24; 12.8 nmol/kg, n = 24) to induce a luteinizing hormone surge and egg maturation. Eggs were retrieved transvaginally 36 hours after kisspeptin injection, assessed for maturation (primary outcome), and fertilized by intracytoplasmic sperm injection with subsequent transfer of one or two embryos.

RESULTS

Egg maturation was observed in response to each tested dose of kisspeptin-54, and the mean number of mature eggs per patient generally increased in a dose-dependent manner. Fertilization of eggs and transfer of embryos to the uterus occurred in 92% (49/53) of kisspeptin-54–treated patients. Biochemical and clinical pregnancy rates were 40% (21/53) and 23% (12/53), respectively.

CONCLUSION

This study demonstrates that a single injection of kisspeptin-54 can induce egg maturation in women with subfertility undergoing in vitro fertilization therapy. Subsequent fertilization of eggs matured following kisspeptin-54 administration and transfer of resulting embryos can lead to successful human pregnancy.

Sources:

  • New trigger for ovulation could make IVF safer, Imperial College London, news_18-7-2014-11-49-26, 18 July 2014.
  • Full Study – Kisspeptin-54 triggers egg maturation in women undergoing in vitro fertilization, J Clin Invest. doi:10.1172/JCI75730, view/75730, July 18, 2014.