Science Friday - Healthcare Ripple Effects, Resilient Flowers, Cancer Detection. April 10, 2020, Part 1

Episode Date: April 10, 2020

Routine Healthcare Is Falling Through The COVID-19 Cracks Our healthcare system is straining under the weight of the coronavirus epidemic, with hospital emergency rooms and ICUs around the country facing shortages of masks, ventilators, hospital beds, and medical staff. But the epidemic is also upsetting parts of the healthcare system that aren’t directly treating COVID patients. How are you supposed to keep up with regular medical care when you’re not supposed to leave the house, or when your primary care doctor’s office is shut down Michael Barnett is an assistant professor at the Harvard T. H. Chan School of Public Health who studies access to healthcare services, as well as a primary care physician at Brigham and Women’s Hospital in Boston. He joins Ira to talk about how patients and clinics are attempting to navigate a healthcare landscape altered by the global pandemic—including telemedicine and virtual health services, the economics of private doctors’ offices, and shortages of regular medications. These Flowers Bounce Back Everywhere, colorful, spirit-lifting flowers are blooming. But if you’ve stepped off a path to avoid an oncoming runner recently, don’t worry. New research, published in the journal New Phytologist, finds some flowers have a unique ability to “bounce back” after injury—say after getting squished by a falling branch or shoe. This gives flowers a second chance at being pollinated, preserving their role in the seasonal ecosystem. One of the authors of this study, Nathan Muchhala, an assistant professor of biology at the University of Missouri in St. Louis, joins Science Friday to discuss the unique properties of flowers. How Dogs Are Helping Scientists Build A Smell Detector For Cancer Scientists are now training dogs to sniff out cancer. A team at UPenn and Monell Chemical Chemical Senses Center are using dogs’ heightened sense of smell to detect the specific chemicals produced by cancer cells. The scientists are using this data to produce a device that could be used in ovarian cancer detection.  Science Friday’s video producer Luke Groskin and digital producer Daniel Peterschmidt talk with Ira about a trip to the cancer laboratory, where they met the scientists—and dogs—behind this unique research. This is part of Science Friday’s Methods, where we bring you into the field alongside the scientists working to answer big questions, by using gorgeous video and pictures. You can read the article and watch the videos about their trip at sciencefriday.com/smellingcancer.  Big Data’s Latest On Tracking The Spread of COVID-19 In an effort to stop the spread of the novel coronavirus, some European countries are collecting information on the movements of residents using cell phone data. This helps determine who is following stay-at-home orders, and who isn’t. Facebook and Google want to use their data about user movements to do the same. But some say this is a big breach of privacy. Amy Nordrum of IEEE Spectrum joins Ira to discuss this story and more of the latest COVID-19 news.  Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flato. Later in the hour, we'll be talking about some of the ripple effects of the COVID-19 pandemic on our health care system. Can you get everyday care, too, during extraordinary times? Just a note, we won't be taking calls during this pre-recorded hour. But first, with most of us in social isolation, self-driving cars are taking to the roads in some communities. Here to update us on that story and more of the latest coronavirus news is Amy Nordrum, editor of the IEEE Spectrum in New York City. Welcome back, Amy. Thank you, I, Ira.

So give us what's the latest on the race for a vaccine? Yes, well, there are more than two dozen companies now around the world working on coronavirus vaccines. Trials have now begun in some areas. Others, companies are expected to start trials soon. They're taking a lot of different approaches to these vaccines. So some are doing a more traditional method where they're taking a weakened snippet or a version of the virus and injecting that into people to be able to build up an immunity to it. Others are taking a newer approach.

So there's a company called Moderna that's created a synthetic version of messenger RNA that persuades the body to produce proteins similar to those that the virus uses to attach and baiting. a human cell so that people can generate an immune response from that. But all of these are still in the pretty early stages. The vaccine is most likely still a year or more away, and work is just beginning across the board. So is there cooperation between countries now to develop this? Well, there has been some cooperation. So Chinese scientists did share this genetic sequence of the virus pretty early on, which allowed all of this work to begin and kick off. There's something called the Coalition for Epidemic Preparedness Innovation that has made a global call for raising $2 billion

that it would put into vaccine development for eight candidates in particular. But most of the work seems to be still happening at the government level. China has done a lot with its government-employed scientists in the military and in the civilian scientific organizations to start work on this. And then at the corporate level here in the U.S. seems to really be driving developments in the area. The corporate level. Yeah, so companies like Johnson & Johnson, NovaVox, Moderna, they're all working on these projects, and they're partnering with federal organizations and certainly trying to do the work faster than they would traditionally and get approvals quicker for this kind of work, but they seem to kind of be driving the bus.

Let's talk about what's going on with these antibody tests that we keep hearing about. Give us a little explanation of what's going on there and the status. Right, yeah. the hope is that in addition to developing vaccines, we'd also be able to develop potentially treatments for the coronavirus in the short term. So using antibodies that people develop, that help them recover from the virus when they get it. So looking at these antibodies that have been recovered from people who have had coronavirus and gotten better to see if there's possible ways to inject those into people that have the virus to help them recover faster.

There's a number of efforts on this front, and again, different companies are different, taking different approaches. Eli Lilly is working on an antibody treatment, takes a blood sample from a patient and analyzes it for antibodies. It has hundreds of possible candidates that could help against the virus and is trying to kind of figure out which ones to focus on for the coronavirus. A company called Regenerum injects the version of the virus into mice and then uses those mice to produce antibodies that might be then safe to transatlose. or into humans, and it did do this pretty successfully for the Ebola outbreak. Then there's a company in Japan called Takeda that's taking plasma from coronavirus patients and trying to isolate antibodies from that to determine which ones might help them recover faster. Most of these are still, though, in pre-clinical or phase one trials, and results would still be

months or perhaps a year away. You know, getting back to the tests, we have seen stories about these five, minute tests or very fast tests. And yet there is now some question about how accurate they are. Yeah, that would be really great if people didn't have to wait days for results from these tests, which is typically the situation. Now, most hospitals were relying in the U.S. on a version of the test that the CDC had developed early during the outbreak. And there's lots of biotech firms working on these kind of quick, fast turnaround tests. But they're not thought to be as accurate as the traditional tests that are done that do take longer. So it would be great, but I don't think that

it's quite there yet. All right. Let's talk about the CDC putting out new recommendations for wearing masks. They want everybody to wear masks in public. And they recommended everyone, as I say. Tell me the details about this. How about the homemade masks? You know, are they comparable to medical grade? Are we being told to make those two if we can't get the home, the medical grade one? Right. Well, it is important to still save those medical grade masks for doctors and nurses. And the homemade masks are probably not as effective as surgical masks or in 95 respirators, certainly. But there is a feeling that it's better than nothing. And that's why the CDC is recommending it. It may help control the spread of the virus, stop you from spreading it to others, perhaps if you've been asymptomatic and are harboring it yourself. So even though it's not 100% effective, they're hoping that it will have. help reduce community spread. And if you're interested in making one, if you haven't yet and would like to have one, the Centers for Disease Control does have instructions online for how to sew one, or if you prefer a no-so option, they have templates for how to make one out of a T-shirt,

just with a pair of scissors or from a bandana and rubber bands. And there are some best practices to remember. You should wash the mask frequently or boil it in hot water. The fabric that you use should be kind of tightly woven if possible, but still so breathable. And you shouldn't ever touch the front of the mask when you're taking it off or putting it on. You should try to use the ear loops or the strings to put it on and off. And of course, people should not expect that these masks will take the place of other protective measures, right? Right. Yeah, this should be done in concert with things like social distancing and frequent hand washing and just being careful about not touching your face. So this is an additional measure that you can take to try to protect yourself and

others as well as all the things that you've been doing so far. All right. Let's move from do-it-yourself masks to do-it-yourself ventilators. People are 3D printing them, aren't they? Yeah, there's a lot of well-meaning engineers and scientists and just makers who have been trying to kind of come up with faster, cheaper ways to produce ventilators, which we know are in short supply in the U.S. and around the world. And there's been a lot of press for these efforts. There's you know, neat projects out there where people built ventilators just from a couple of things that they bought at the hardware store. But it's, you know, important to keep in mind when you see these that these DIY versions are probably not likely to help make it into any hospital that's

in need anytime soon. A lot of them are more like prototypes that a actual ventilator maker might be able to use as a proof of concept to make a medical grade version. But a lot of these kind of DIY versions, they haven't been tested for reliability or effectiveness. They're not able to provide all the functions that a traditional ventilator would in terms of monitoring a patient or alerting doctors and nurses if something goes wrong. And it's tough to scale things up and make large numbers of them, which is really what's needed right now in terms of ventilators. Yeah, they would have to be tested out and get approval, and it would take a while because

imagine the lawsuits of somebody having a bad outcome with a DIY ventilator. Right. So what I see is more kind of promising is the FDA is now working with ventilator makers to allow them to make modifications to their hardware and software through like a fast approval process where they'd be able to produce perhaps more of these quicker than they were in the past. In your next story with most of us in the social isolation, self-driving cars are playing a role in some communities? Yeah, this is interesting. You know, a lot of self-driving car companies have actually suspended their trials that required a human human. driver in the driver's seat. So while some self-driving cars for passengers are actually on hold right now, and this pandemic might be a setback for those, there's other self-driving vehicles

that are actually in huge demand. And those are the ones making deliveries of food to people that are in quarantine. There's a startup called Unity Drive Innovation that's using an autonomous van to deliver food to people in three cities in China. It's made more than 800 deliveries. and it even outfitted one of its vehicles to spray disinfectant on surfaces outside of a hospital there in Shenzhen. And then in Jacksonville, Florida, the Mayo Clinic is now using autonomous shuttles to move COVID-19 patient tests from one testing site to its facility for processing, supposedly kind of saving staff time in the meantime, bringing them up to do other things. So it's interesting that there's now a lot more demand for actually using autonomous vehicles to transport stuff rather than people. And this might accelerate the development of these autonomous vehicles for delivery.

Let's go on to your last story. Some countries are looking at digital tools to trace who people have come in contact. Tell us about that. Yeah, there have been a lot of digital tools developed to help public health officials manage this pandemic and figure out who might be at risk. And digital contact tracing is one of them. This can be done in a variety of ways, but mostly it, contact tracing traditionally has been done. It's a very manual process where you interview a patient who's been tested positive for COVID-19 and ask them everybody that they've been into contact with in recent weeks and then contact them to tell them they might be at risk. So there's thoughts about whether, you know, smartphone data might be useful for this or perhaps apps that track your movement throughout a city or town. If so, it could alert you to the fact that, you know, you've been in contact or you've crossed paths with someone who did test positive and you might want to self-quarantine your city or. If so, it could alert you to the fact that, you know, you've been in contact or you've crossed paths with someone who did test positive and you might want to self-quaranty

yourself. And several nations in Europe are taking steps toward this kind of approach. So they've started actually using aggregate smartphone data for many different phones just to see if people are obeying stay-at-home orders. And so this might, you know, this does for some raise privacy issues about tracking the movements of individuals. But when the data is aggregated, at least public health officials have found it quite useful in tracking people's obedience with some of these stay-at-home orders. Do people know they're being tracked? Well, in some a lot of the projects that would be a voluntary participation.

So you would download the app yourself and then you could have some control over how much information you share and what locations you've visited that you perhaps don't want to share. And then there's projects having to do with mobility tracking that Google and Facebook are working on

that rely on location data. And you do have a setting in your phone whether you share that location data or not with these apps. So you do have some measure of control over whether you participate in these kinds of projects. Yeah, because I had heard that Google was already seeing where people congregate in effect saying, hey, look, you guys,

you see there are groups of people not following the rules here. Yeah, and Google and Facebook's projects that they're involved with in terms of mobility tracking don't use individual data at that level. They are relying on aggregated, anonymized data. So those would be less of a concern for individuals. But things like an app that you might download to see if somebody in your neighborhood that you ran across did test positive, that would perhaps be more of a concern. Amy Nordrum, an editor at the I-Tripple-E spectrum here in New York City.

After the break, some of the ripple effects of the COVID-19 pandemic on our health care system. The rise of telemedicine and a physician wonders why he is seeing a decline in heart attack cases. We'll be right back after this short break. Hey there, Ira here. You know, as the world continues to adapt due to COVID-19, getting accurate information is crucial to, protecting ourselves, our loved ones, and our communities. This is where Science Friday comes in. We are here to deliver the facts to combat misinformation,

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Again, that's ScienceFriday.com slash donate. Stay safe, stay healthy, and thanks. This is Science Friday. I'm Ira Flato. Our health care system is straining under the weight of the coronavirus epidemic. shortages of masks, ventilators, hospital beds, medical staff, you know the story.

But the epidemic is also upsetting parts of the health care system that are not directly treating COVID patients. In the coming weeks, we'll be looking at some of these ripple effects. So let's start today with a question about how the pandemic is affecting your access to basic health care. On our Science Friday Voxpop app, we ask for your recent health care experiences, and you gave us a range of responses.

Howdy? I chipped a tooth. The filling that is still in place and the tooth is still holding. So my dentist decided that we should hold off any major repair until after this epidemic. Hope the rest of the tooth doesn't fall out. I'm on antidepressants, and today I've been trying to schedule routine psychiatric appointments so I can keep getting them. My medical practice, however, is so busy that they just took. my number and said they'd call back and I've been literally waiting all day just to make one appointment.

I had to go to the emergency room because I had a couple of puncture wounds in my hand and you can see my adipose tissue. I went to one that was not downtown. It looked like a scene out of I am legend. There was like maybe five cars in the park event. It was all employees. They scanned me as soon as I got in to make sure I didn't have a temperature. I didn't sign any paperwork. I did it all with my phone. everybody stayed pretty far away from me. One person delaying care, one with longer wait times, and one with a strange but relatively streamlined experience. Joining me now to talk about access to care and navigating the medical system in the stay-at-home

times is Michael Barnett. He's assistant professor at the Harvard T.H. Chan School of Public Health. Also a primary care physician at Brigham and Women's Hospital in Massachusetts. Thanks for joining me today, Dr. Barnett. Thank you for having me. You've written about events that are, quote, shock to the health care system, things like natural disasters. How similar is this to a natural disaster? So there are a number of ways from a health care system perspective that this resembles a natural disaster.

What we know from experience with hurricanes, like say Hurricane Sandy or Hurricane Maria, is that when a natural disaster comes in, there's, of course, the, effect on population health from the disaster itself for people's homes being flooded and being exposed to natural elements that can harm them, of course. But also, natural disasters shut down the health care system. Hospitals can't work. Power is out. Doctors offices are closed. And with the coronavirus, there isn't the physical damage of a natural disaster like a hurricane, but in many ways the health care system is shutting down, both because they may be too busy in some situations like some of your listeners explained around the emergency room.

But also we have healthcare systems that are shutting down because they don't want to expose their staff or patients to the coronavirus. And they're trying to postpone basically anything that's not an absolute emergency for several weeks or months until the coast is more clear and they feel safer having patients come to their facility. But sometimes they have a very difficult problem like this woman was saying she had a puncture wound in her hand. if you have a toothache and you need to go see your dentist, you need to go. That's something you can't put off. Are doctors offices or emergency rooms, you know, prepared for this kind of walk-in or semi-emergency that has nothing to do with the virus? It's a tough question.

You know, I think part of what's a challenge is it's really a cliche almost now to talk about how unprecedented the current situation is. And the truth is that a lot of doctors and health care facilities are really figuring this out as we go. You know, one challenge is the idea of what is and isn't a quote-unquote elective problem or non-emergent problem is not so cut and dry necessarily. You know, sometimes a toothache is a toothache that maybe can be nursed along for a month or two. And sometimes a toothache could turn into an abscess, which, if not treated, could actually result in somebody getting very sick or losing more teeth or having damage to their mouth that actually could be reversible. There's a big fuzzy boundary between

what needs to be treated in the next two weeks versus what can wait three months. And both doctors and patients, I think, are kind of roping around to figure out how can we balance the competing interests of getting people care they need soon versus trying to limit the exposure of health care personnel and people as much as we can because that is also, you know, health care facilities are going to be such a nexus to spread coronavirus throughout a community if we're not careful. How much of a standard checkup, let's say it's your time to have a standard checkup or an appointment, can be delivered over telemedicine? Telemedicine is one of the saving graces, I think, of the situation right now. Telemedicine was really not embraced in a broad way prior to coronavirus epidemic.

And now the entire healthcare system is basically having a crash course in how to deliver telemedicine because we have no other option. The good news is that for routine health care issues, such as just a routine checkup to the extent that people are still doing those, or maybe more importantly, managing common chronic illnesses like diabetes or high blood pressure or, say, weight loss, I'd say most medical care can be delivered just as effectively over telemedicine, even over just a telephone, as you could get through an in-person visit. Because so much of what we do in medicine is really just communication. It's talking with patients. It's checking in on how they feel what they've done.

We do need some biological information, physiological information, like weight or blood pressure or, say, blood sugar for people who have diabetes. And many people have the devices at home they can use, many of which are available just at the pharmacy to buy over the counter to measure a lot of that information. But even without it, we can do a lot by cell. I've seen this going through the internet now of doctors telling patients to buy a little fingertip, blood pressure, and oxygen level meter. Are you familiar with that?

Yes, and they're actually quite cheap. They're those oxygen meters that will also tell you your heart rate. Sometimes they could be 20 bucks, 30 bucks, and at least in my experience, they seem to be relatively reliable, though I think it's when it depends, of course, on the device. They're impossible to get, I'll tell you why I try to buy one. Yeah, I'm not surprised. Yeah. But we are all going to have to, I guess, adapt to this new telemedicine, I guess,

idea and learn as we go along with it. You know, I think that's what everyone is doing, including doctors, because the medical system in the U.S. has been very cozy with the idea of delivering basically almost every ounce of health care through an in-person visit where a patient and a physician are in the same room at the same time. And there have been calls for years, including by folks like myself, to try to transition or healthcare system away from one which is based fundamentally in having an office with it as the way that we deliver all health care.

When we have so many other technologies and so many other ways that we can interact with patients and connect the people who have a hard time coming to the office or for whom it's extremely inconvenient. And now we're all thrust into it and doctors need to learn a new way of communicating and a new way of being proactive with their patients to help manage illness even if people aren't, even when people are outside the routine of walking into the physician office, once, twice, three times a year. Can you actually show a doctor something on your body through telemedicine? You can. And I think there are situations where actually seeing the patient

in person or maybe seeing a rash on somebody's leg, a doctor might be able to get a sense of what's going on through video. It's, of course, going to be somewhat limited because the resolution is not back rate. So if you need to, for instance, look at something on the skin, it may not really be possible to tell for certain whether it's one kind of rash versus another. On the other hand, there are things that are probably easier to assess by video, like for instance, how somebody's breathing doing. You can get a sense by hearing someone talk on the phone. But if you're trying to clinically assess, does someone who potentially have coronavirus, are they getting sick enough that they might need to go to the emergency room? Sometimes it can be a chance.

extremely valuable just to watch at somebody's breathing and just to see how much they, how hard they have to work just to have a conversation with you on the phone. That's very interesting. Let's talk a bit about drug shortages. Are there ripple effects of the crisis on the availability of medications you'd need for regular care? Yeah, there are increasing reports of drug shortages. There isn't a lot of systematic data that I'm aware of at the moment to really report on them. Part of what's interesting about this pandemic is that information and the situation is moving so quickly that basically the only way to keep up to date on what's going on sometimes is to follow reputable sources on social media and to get a feeling of what reports are circulating out there. What I am seeing that it seems like some basic medications are starting to become in short supply, and these are things that we actually need in the hospital and potentially in the ICU as well. So, for instance, drugs that you need to sedate patients or keep their muscles paralyzed from moving if they're on a ventilator.

Also, there are reports of shortages of antibiotics. In particular, an antibiotic called azithromycin, which has been widely promoted despite the lack of evidence as effective for potentially treating or preventing coronavirus in combination with hydroxychloroquine. Hydroxychloroquine is another drug that is in short supply. There's been a lot of discussion about how there's a lot of. There's actually very little evidence to support whether hydroxychloroquine is effective, but it's been widely promoted by a variety of people, including the president, and that has prompted a surge of interest in acquiring that medication, often by doctors themselves, prescribing it for themselves.

Unfortunately, these are medications that people with other diseases need to treat their ailments like lupus or rheumatoid arthritis, and there are reports of them being in short supply and worrying about running out of those and risking a disease flare. Another set of medications that I also worry about that are in short supply are inhaled medications to help breathing. So one of these medications is called albuterol, and it's a very basic inhaled mist, basically, that is essential to treat folks with asthma or with smoking-related lung disease like emphysema. And hospitals are using it quite a bit in treating patients with coronavirus as well.

And so if that becomes in short supply, it's also good. going to be a major problem. I thought it was interesting from hearing of the Voxpop app from one of our listeners who said that basically she went to an emergency room and the parking lot was empty and no one was in it and she got service very quickly and efficiently. Is that common now, do you think? Well, it's interesting because I guess the emergency rooms, there I'm a little bit surprised, but there's a complex mix of changes. in the healthcare system. On the one hand, you have places like New York City

where the emergency room and the hospitals are overflowing. They're completely packed with people who are sick, with coronavirus, as well as every other reason why people would be sick. And let's not forget that before the coronavirus showed up on the scene, most American hospitals run very close to capacity. And we have a lot of folks who are sick in the US.

And it's not like the healthcare system had a ton of empty capacity at baseline just to treat people who need to be treated on any given day. Now, double or triple that volume with coronavirus patients, and we run into a really significant problem. Now, one way that the healthcare system has made capacity is by basically canceling as many, quote-unquote, elective procedures or not purely emergency-based procedures and other admissions that they can. And this includes things that folks in the public might not think of as necessarily elective or non-emergent. So, for instance,

sometimes people are admitted to the hospital to get chemotherapy for cancer. No one thinks of chemotherapy is something that should wait around for a few months, but it's not strictly an emergency. And sometimes that might be able to safely wait for a little time, particularly if you're in an extremely unprecedented situation like now. And of course, there are lots of other surgeries that can easily wait a few months. So that's opened up a bunch of hospital beds. And also clinics like mine have canceled practically every appointment that they can,

and every routine or prior schedule appointments because we want to avoid exposing patients to health care settings and having people come in who don't otherwise, you know, absolutely require care. What this means is that while emergency rooms and hospitals are filled to the brim and overflowing, you have surgical centers and physician offices and maybe some community emergency rooms, which are ghost town. They're empty because physicians have canceled their schedules and cleared out as much as possible. They're transitioning everything to hell medicine. And also, patients are scared. They don't want to

come into a health care setting. And a lot of health care, I think, is not happening right now, which probably should be happening on some kind of timely manner. But people are basically sheltering at home and health care issues are very likely to accumulate over this period. And there could be a second wave of basically undertreated illness, not related to COVID, that we're going to have to manage in the next few months. Flato, and this is Science Friday from WNYC Studios. People are basically fearful of coming in. Correct. Well, I think the fear combined with the deliberate canceling and people getting

the message from their physician, we're canceling your appointment because of COVID, and we're going to wait until we can see you. And that's a powerful message for patients. No one's being told, we don't like you. We don't want you to come in, but they're being told, we're canceling your appointment for now because it's not safe for you to come in. And I think patients get the message that I need to wait. One unnerving set of reports that I have also been reading about is that a lot of cardiologists, for example, are reporting that volumes of heart attacks in their hospitals are way down. And this is really concerning and a bit mysterious because they're even reporting decreased volumes of the most serious kind of heart attack, which physicians call a stemming for

short. These are emergencies that really shouldn't be elective. If you have one of these heart attacks called a semi, most people will be in extreme pain or discomfort, and it's obvious that something very terrible is happening. And to see a greatly decreased volume of those heart attacks makes me extremely worried that maybe people are actually suffering with quite severe symptoms at home and aren't showing up because they think that basically nothing is going to be as important as a coronavirus patient in the hospital right now. It's possible there's something else going on that may be somehow social distancing and people basically staying at home are suppressing these kinds of emergencies. But there are a number of reports like this that concern me.

What do patients need to be thinking now beyond staying healthy? I think it's really important right now to recognize that your health. concerns are not less important now than they were before and that it can be really hard for someone without medical training to assess whether or not a medical worry you have right now that may or may not be related to coronavirus needs attention in the next few days or if it can wait a few weeks. Because that's actually a very tough call to make, but I worry that patients are trying to make the call themselves because they don't want to inconvenience their doctors or they don't wants to try to make the busyness and the current situation worse.

But actually, that's a very difficult call to make. And, you know, doctors like myself, we are here for patients. In fact, many of us, our offices are quieter and emptier than they have ever been before. And so we have the capacity and time to take care of concerns that come up. And I want to encourage people to reach out to their doctors if they have concerns beyond standard, you know, beyond their standard keeping up with health. and routine checkup. Dr. Barnett, we have run out of time.

This has been very, very informative. I want to thank you very much for taking time to be with us today. Thank you very much. Pleasure. Michael Barnett is an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women's Hospital in Boston. When we come back, we're going to explore how flowers bounce back after injury.

Stay with us. This is Science Friday. I'm Ira Flato. It's been a hard few weeks. We are practicing social isolation, probably spending a lot more time inside. Maybe feeling a little down in the dumps, but outside spring is in the air. And with spring come colorful spirit-lifting flowers. Even better. New research says some flowers have a unique ability to bounce back after injury, say by getting squished by a a falling branch or a shoe. This gives flowers a second chance at getting pollinated, serving their role in the spring ecosystem. Producer Kathleen Davis spoke with Nathan Muchawa, one of the authors of this study published in the journal New Phytologist. He's a biology professor at the University of Missouri in St. Louis. Thank you, Nathan, for being on Science Friday. Sure. Thanks for the invitation. So you found that some flowers have the ability to bounce back after injury. What is a flower injury? What does this look like? That's just saying that some things

can knock a flower off of its proper orientation, say a heavy wind or branches falling or the whole plant kind of fall sideways. This could cause a flower to be misoriented. So how did you actually test this out? I mean, I'm imagining stomping through a flower field with some heavy duty boots on. Is what you did or did you do something else? I was actually working in rainforest and my collaborator, Scott Armbruster, he was also working in forest. We were working with flowers that were higher up. And well, first we just noticed that this was happening. We would notice that flowers would reorient really quickly. So then we decided to experimentally test this. And that involved actually taking the flowers and twisting them and putting them off their normal position.

and testing whether they could actually reorient or not. And in your research, you found that not every flower can bounce back. So what kinds of flowers have this ability? Yeah, so there's an important distinction between flowers. There's two types. There's bilaterally symmetrical or radially symmetrical flowers. And the majority of flowers, probably what you're used to, are these radially symmetric sort of star-shaped flowers, like daisies or sunflowers.

and for them, orientation isn't as important. And then the other set, about a quarter of flowers are bilaterally symmetrical, meaning they have the left and right sides are mirror images of each other, just like us, just like humans or most mammals are like this. And for those, the orientation is really important. So do you know why flowers that are symmetrical down the middle can do this, but not other types? Basically, evolution favors it. So the main goal of a flower is to try to get its pollen to another flower of the same species. This is how plants reproduce and they need the pollinator to do this. Well, radially symmetric flowers are much more generalist. Any sort of pollinator can enter the flower and they often enter from any direction. While these bilaterally symmetric flowers, these tend to be very specialized to specific to, say hummingbirds or bumblebees or bat, and they're trying to put their pollen on a very

precise spot on the bodies of pollinated. And if this spot is off, then the flower is going to fail. The pollinator is not going to pass on that pollen to a female of the same species. So for them, the orientation relative to gravity is really important. Do you have any idea what's going on mechanically in the flower that lets it prop back up after it's been bent or injured? We didn't study this directly, but you can see this. You can actually sort of think of this as plant behavior, and you can see this in the way that leaves will reorient towards light,

or a whole plant will try to avoid shade and move more towards light through time. So we assume it's the same mechanisms, and it probably has to do with cell growth in the stem and, say, the side that needs to elongate to properly twist the stem on those cells, are probably growing longer than cells on the other side of the stem. Do we know how flowers are able to sense that they are injured?

It is shown that plants have gravitropism. They can sense gravity. So for these flowers, that's probably the main component is they're trying to figure out where gravity is pulling on them and then orient vertically to that. Hmm, that's really interesting. For what other reasons would a flower need to have a sense of gravity? Well, this would be the main reason, and you want to orient vertically with these specialized flowers, maybe partly to protect your flowers from rain.

Sometimes petals are covering over the pollen, and you want to keep that rain cover above the flower. But the main reason, again, you could think of, say, in a lot of bat-pollinated flowers, the pollen will be put on a real precise spot on the tops of forehead. If you instead hit the side of the bat's head, the next type of bat visits a flower where the female parts touch the top of the bat's head, that pollen is not going to be successfully transferred. So does being able to spring back up give these flowers an advantage when it comes to attracting pollinators? Pollinators will sense misoriented flowers. They'll tend to avoid any sort of flower that looks incorrect. But the main advantage is not so much attraction, but it's making sure that your pollen is making it to females of the same species. So this is in a way giving these flowers a second chance, right?

Yeah, yeah, exactly. You can think of flowers as being such a large investment for plants that if something knocks it off, rather than just kind of giving up on those flowers, something knocks them out of orientation, the better solution would be to just reorient those flowers. So because of coronavirus, a lot of us are staying inside more. Do you think flowers and pollinators are having a better spring because of this? I do think so. And I think the main reason has to do with pollution levels.

You've probably seen these news stories of pollution levels in cities decreasing. And pollinators tend to be pretty sensitive to pollution, especially insect pollinators. For instance, there's studies showing that pollution will alter the scent of flowers and kind of throw off pollinators in trying to locate their flowers. And just in general, all animal and plant populations do better with less pollution. So I do think that this will be at least a short-term

boon for plants and pollinators. Well, Nathan, thank you so much for joining us. Yeah, thank you very much. Science Friday producer Kathleen Davis, speaking with Nathan Muchala, biology professor at the University of Missouri in St. Louis. Dogs have aided people for centuries.

Search and rescue dogs save human lives and disasters, and they are certainly helping many of us stay calm at home. Of course, there are bomb-sniffing dogs and drug-sniffing dogs, and now there is a cancer-sniffing dog, yeah? Dogs can sniff and detect deadly hidden ovarian cancer. A team at UPenn and Manel Chemical Census Center is using data from dogs to build a device to make previously undetectable cancers a thing of the past.

Scivry video producer Luke Roskin and digital producer Daniel Petershmit visited this dog research lab, and they tell the tale in our methods project, which, using video and pictures, brings you into the field alongside the people working to answer big questions. You can watch the videos and read about their trip at ScienceFriday.com slash smelling cancer, and now they're here with us. Hi, Luke and Daniel. Hi, Ira, how's it going? Pretty good.

Let's talk about it. This research takes place in a few labs. What does the dog lab look like? Well, it doesn't exactly look like a lab. Certainly not the dog type of lab. No pun intended. But it looks a little bit more like a kennel than anything else. You have a whole bunch of dogs that have, you know, very well-tended cages,

as well as a workout room and several rooms where they can sniff out different sort of chemicals or substances. And then there's, of course, you know, an obstacle course, a rubble pit where they can go digging and looking for, you know, hidden things, you know, for the rescue dogs. I've heard stories, all kinds of stories, about dogs being able to detect epileptic seizures or panic attacks and alerting their owners. how did these researchers know that the dogs would be able to pick up the cancer? Yeah, the head of the Penn Working Dog Center, Dr. Cynthia Otto, she told us that she always suspected dogs could do this type of work. You know, as you were just saying, you've probably heard stories of people whose dogs

who, you know, would like keep whining at them or continually nudging their stomach or something as if there was something wrong. And then they would get it checked out and a tumor would end up being there. And then all these research papers kept popping up that different cancers had specific odors. And dogs are amazing smellers. So Otto had a pretty good hunch that they could be taught how to smell ovarian cancer. So could my daughter's pug smell cancer? Technically, biologically, yes.

The structure of its nose and its brain is able to pick up on all the vivid colors and smells of the world, as it were. but in terms of its training, probably not. Most dogs aren't trained the way that these dogs are trained. These dogs are incredibly well trained. They are elite Olympian class dogs. They are bred and raised from being puppies just for these sorts of tasks. So the working dog group at Penn Vet, this is all they do. They work with their dogs day in, day out.

They have these huge blackboards all over the place that show what the dog's schedules looks like, and they are kept to a very rigorous schedule. So could your daughter's pug do it? Probably not. They probably couldn't tell you that there's cancer there, although they probably could actually smell it. They wouldn't know what it is. Yeah, yeah.

Speaking of what it is, that's my next question. What exactly does a dog detect when they're smelling cancer? Oh, that's a great question. So when you think of what's going on inside your body and what gets kind of exuded out of your body in the form of smell, it's a very rich tapestry, especially in the nose of a dog. So the cancer cells, if you had cancer inside your body, would be producing all sorts of chemicals, just like any other cell in your body would be producing chemicals. The only difference is that in cancer, they're producing a specific amount of those chemicals. and they're getting released into your bloodstream, and then eventually some of them are you going to get it released out of your body,

you know, through either your urine or your sweat. And in this case, the dogs actually aren't smelling people. They're actually smelling blood plasma samples from cancer patients, and these are all collected from patients at a hospital. Some have benign growths, some have more malignant growths. And they also take samples, you know, a control sample, where the people are healthy. They place those samples in jars around what looks like kind of the little spokes

that come out of a wheel. And they put them in these little containers. And the dog goes into this room and it walks around this wheel, sniffing at each of the different samples. And when it spots one that it thinks, it believes, has the cancer sample, it kind of puts its nose right up against it and stays there and just kind of like focuses heavily on that sample. it gets a little bridge click,

and then it comes back, and it gets a little reward if it got the right answer. And once the animals are trained to identify the specific cancer, they can do this very quickly. I mean, we watch them, and they do it like that. It's very quick. They go around, and they immediately can spot these sorts of cancer samples. I'm Ira Flato, and this is Science Friday from WNYC Studios.

But the point is not to have to create a whole bunch of dogs, service dogs that would go into doctors' offices and sniff patients. No. That's not what they're doing here. No, these dogs are never, I mean, they made a very explicit point about this. These dogs are never going to see a patient. That is not a very reliable way to diagnose somebody because the patient could be queuing them. The doctor could be queuing them.

These dogs don't get any cues when they do these tests. So they have no intention of bringing the dogs into a clinical setting. They're a diagnostic tools. They are the gold standard of cancer detection. They are far better than any sort of equipment. There's another lab that's working with them at Monell Chemical Census Center. And what they do is they're trying to isolate the specific odors that the dogs are picking up that represent cancer. Is it all of the different chemicals from the blood sample that represents cancer when there's cancer in there?

Or are there very specific odors in there? And then what they then can do is they can build a sensor equipment, a apparatus, a device that actually can detect those specific chemicals in the very specific quantities for different types of samples. The team is starting with ovarian cancer. Why start with this type of cancer? Yeah, yeah. So the oncologist on this research, Dr. Yanos-Tani, he called ovarian cancer a mean, mean disease. it's the fifth most deadly cancer in women. It has close to 14,000 deaths per year. And partly why that is is that it has no noticeable symptoms until it gets to stage three or four. And at that point, the chemotherapy doesn't have a lot of effect. And those symptoms are just incredibly normal. It's like a little bit of bloating or discomfort, which happens to everybody. And even if you suspect you have

something up and you go to the doctor, often they can't find anything. that's wrong. So there's no way to detect it early. And that's why the team is building this device. They know ovarian cancer has a smell. They're pretty sure the dogs can smell it at early stages. And if dogs can smell it, as one of the researchers put it, you know, they can definitely smell it through instrumentation if there's something chemical going on. And hopefully what they learned from making this device is that they can build these odor profiles for other hidden cancers and apply the same methodology to them. Daniel, you and Luke visited these smell research labs?

Yeah, yeah. So we traveled down to Philadelphia last year. We interviewed and filmed these researchers in their labs. And from that trip and some other reporting, we put together a documentary video and a long-form article that takes a deep dive into the people and the dogs behind the project. And in that article, we have those videos sprinkled throughout it. and, you know, there's dogs in it.

Well, I got a sneak preview of it. I started reading the article. It's terrific. You can see the piece. Watch the videos. You want to do that. Both of those at ScienceFriiday.com slash smelling cancer. Thank you, guys.

Thanks, Luke. Thank, Daniel. Thank you, Ira. You're welcome. SciFri video producer Luke Groskin and digital producer Daniel Petersmith. And that's about all the time we have for today. Charles Berquist is our director.

Our producers are our, Alexa Lim, Christy Taylor, Katie Feather, and Kathleen Davis. BJ Leaterman, composed our theme music. And if you missed any part of the program, we'd like to hear it again. Subscribe to our podcasts, yeah, or ask your smart speaker to play Science Friday. And on the Science Friday Vox Pop app, we have a question for you this week. Have you or someone you know been affected by Valley Fever? We're working on a project about the fungal disease, and we want to hear your story.

So chime in on the Science Friday Voxpop. wherever you get your apps. You can also email us. Our address is SciFri at ScienceFriaday.com. Have a safe and peaceful weekend. I'm Ira Flater.