Science Friday - Honeybee Health, Assessing COVID Risk, Seeing Numbers. June 26, 2020, Part 2

Episode Date: June 26, 2020

This past year was a strange one for beekeepers. According to a survey from the nonprofit Bee Informed Partnership, U.S. beekeepers lost more than 40% of their honey bee colonies between April of 2019 and April of 2020. That’s significantly more than normal. The Bee Informed Partnership has surveyed professional and amateur beekeepers for the past 14 years to monitor how their colonies are doing. They reach more than 10% of beekeepers in the U.S., so their survey is thought to be a pretty accurate look at what’s going on across the country. That’s why these latest results are so important—and they raise a lot of questions for honey bee researchers. Honey bees are responsible for pollinating a lot of the food grown in the U.S. If they’re in trouble, we’re in trouble. Nathalie Steinhauer, research coordinator for the Bee Informed Partnership in College Park, Maryland, joins producer Kathleen Davis to talk about the report, and what it means for our beloved pollinators. As coronavirus cases spike in re-opened states like Arizona, Texas, and Florida, you may be wondering how to weigh the risks of socializing—whether it’s saying yes to a socially distant barbecue, going on a date, or meeting an old friend for coffee. Many health departments and media outlets have offered guides to being safer while out and about. But when the messages are confusing, or you’re facing a new situation, how can you apply what you know about the virus to make the best choice for you? Ira talks to Oni Blackstock, a primary care physician and an assistant commissioner at the New York City Health Department, and Abraar Karan, a physician at Brigham and Women’s Hospital in Boston, about minimizing risk, and why an all-or-nothing approach to COVID-19 can do more harm than good. Imagine looking at an elementary school poster that shows the alphabet, and the numbers one through 10. The letters make perfect sense to you, as do the numbers zero and one. But instead of a curvy number “2,” or the straight edges of the number “4,” all you see is a messy tangle of lines. That’s the phenomenon experienced by RFS, a man identified only by his initials for privacy reasons. In 2011, RFS was diagnosed with a condition called corticobasal syndrome, a progressive neurodegenerative disorder. Normally, that rare condition primarily affects motor circuitry in the brain. However, RFS had an additional symptom—while he was very skilled at math, he became unable to see the written digits 2 through 9. When RFS looked at one of those numbers, he saw in its place something “very strange” that he could only describe as “visual spaghetti.” Even weirder, other images placed on top of or nearby the digits also became completely distorted. Teresa Schubert and David Rothlein, two scientists who studied RFS’ case as graduate students, discuss what this unusual phenomenon tells us about how the human brain processes incoming visual information. 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 talk about how to think about risk as life under COVID-19 stretches on. And the unusual story of a man who can't see numbers. But first, we're a big fan of pollinators here at Team SciFri. There are even some hobby beekeepers among us. And this year was a strange one for U.S. beekeepers. According to a survey from the nonprofit Be Inforcery. partnership. Beekeepers lost more than 40% of their honeybee colonies since April of last year,

and that's quite a bit more than normal. So what does this mean for our beloved pollinators? Producer Kathleen Davis is going to tell us all about it. The vast majority of beekeepers deal with honeybees, and they're responsible for pollinating a lot of the food that's grown here in the U.S. If honeybees are in trouble, we are in trouble. The bee-informed partnership, has surveyed professional and amateur beekeepers for the past 14 years to find out how their colonies are doing. They reach more than 10% of beekeepers in the U.S., so their survey is thought to be a pretty accurate look at what's going on across the country. That's why these latest results are so important, and they raise a lot of questions for honeybee researchers. Joining me today to shed some light on these

questions is Natalie Steinhower, research coordinator for the Bee Informed Partnership. She's based in College Park, Maryland. Welcome to Science Friday, Natalie. Thank you for having me. So losing more than 40% of honeybee colonies in one year sounds like a really big deal. How does this compare two years past? Yeah, it is a big deal.

Unfortunately, it's something that we have got accustomed to. So we have been running the survey for 14 years now. And every year we document the turnover rate of colonies, right? we call it a loss rate. It's really how often do colonies need to be replaced so that the beekeepers can keep their operation size. So it's really similar to a mortality rate. And it's basically meaning that on average in the country, about 40% of the colonies will be lost at some point and will need to be recovered. So it is high and it is higher than what beekeepers themselves consider acceptable. But it is something that we have seen for a number of years now. Now, just to clarify,

Does losing 40% of colonies mean that we lost 40% of honeybees? It does not. So we are really talking about turnover rate. So the population in the U.S. has actually been relatively stable for the last 20 years. And we know this from another survey, which is independent to ours, organized by USDA, which is called the Honey Report. And we estimate that we have about 2.5 million colonies in the country. And that has been relatively stable.

there is always fluctuation from year to year, but relatively stable overall. So that means that beekeeper are able to make up for their lost colonies by making new colonies, right? It's kind of like the similar mortality versus natality for humans. We have the loss rate on one hand, and then beekeepers can recover by making you splits by increasing the size of their apiary on the other hands to maintain the total population relatively stable. So if we're not facing a huge drop-off in the honeybee population, why is it still such a concern that so many colonies are being lost?

So it is a concern that we are losing so many colonies every year because it comes at a high cost for beekeepers. So losing colonies, having to replace them means that you're going to have to invest more time, more effort, more money into making up those loss. Usually colonies that survive or barely survive the winter, it doesn't mean they're healthy. Just we know that this is a good metric of honeybee health.

And we think this is a better metric of honeybee health than the total population size because we actually see how many colonies have been struggling and we can try to keep track of it. So this is the objective of the survey is to really try to keep a pulse on how they're doing and seeing if there are some zones that are at higher risk than others, certain operation types that are at higher risk. And the concern that we have is that this is highlighting issues in honeybee health. And it means it's harder for commercial beekeeper in particular to maintain their operation

in a sustainable way. You mentioned that with the survey, you can look at how this is sort of playing out in different zones. How does this play out geographically? Are there some areas of the country that seem to be hit harder by this colony loss? Or is it pretty even across the nation? Yes. So the estimate that we have at the national level is really an average, right? And like every average, it really hides a lot of the variability behind that one number.

So we actually see everything on the spectrum, right? We see operation that lose 0% of their colonies, other that lose that are a company wiped out, that lose 100% of their operation, and everything in between. So we see variation, as I said, by operation type and by region. We are actually trying to analyze right now the geographical patterns and to see if there are some zones that are constantly at higher risk year after year. Because also, you know, one year out of context is really not terribly meaningful on its own. what we are really interested in is looking at the trends over time. So we've been doing this survey for 14 years now.

And we're basically seeing the cyclical nature of losses. We always see some worse years, some better years. But overall, what we see is that the situation is not getting worse. It's also not getting better. But we're trying to get into some of the more refined region by region risk. And we do see some patterns, but we're at the beginning of that analysis. So generally we say it's typically higher losses in the north than in the south. But all of the state results over the past years are available online. If people want to know the loss rate in their own state, they can look on our website to find past results for their states. Do bee researchers like yourself know why this level of colony loss is happening across the country?

The reason why honeybee colonies can be lost are really multiple. and we usually refer to the drivers of honeybee loss as the four peas of honeybee health. It's pest, pathogen, poor nutrition and pesticides. And unfortunately, it's really hard to identify one single cause of loss for a colony because it can be a combination of factors. We know that there are interaction. So a colony that is nutritionally deprived will resist infection less well. So they might be more susceptible to infection by parasit.

and pathogens. We also know that some pesticides can impact the nutritional status of the bees. So those are all factors that are interacting so that it's very hard to single out one specific cause. It also means that we have to act on all of those factors together to try to improve the situation overall. I would imagine that losing so many colonies would change the experience of being a beekeeper. What are you hearing from? the people behind the bees about this level of colony loss? Yes, so that is a good point. So what we hear from beekeepers is they tell us it's worse than it used to be.

Unfortunately, we don't really have good historical data. So before we started the survey, before that we really do not have a good estimate of mortality rates of colonies. So it's hard to judge because it's only word of mouse in which beekeeper tell us that it used to be better, but we don't know how much worse the situation. is now compared to them. What we know is that this level of acceptable loss seem to be creeping up year to year. So it seems like it's getting more, not accepted, but beekeepers are realizing that the situation is not getting better and that they have to make do with a higher level of loss

in their operation and just try to make the best they can with the situation. Right, right. It's my understanding that some scientists are trying to make tougher bees. that are resistant to certain pests, for example. What's going on with that kind of research right now? Yes. So there are a couple of labs that are actually looking into trying to improve the stocks of honeybees, right? So, for example, certain universities of Minnesota and Baton Rouge USDA Lab are some of the efforts of researchers try to breed more hygienic, more resistant parasites and pathogens. And those efforts are really important because in the long term,

this is what's going to make beekeeping sustainable again, is to try to improve the stocks of the bees. In the meantime, unfortunately, those lines of bees are not yet available to everyone. They're still trying to improve those lines because it's very tricky to improve only certain behaviors while maintaining all of the other aspects of the bees that we want to keep. We want to keep them productive. and good pollinators and non-aggressive.

And so trying to maintain all of that while selecting for hygienic behavior is tricky. So they're doing great efforts, and this is a very interesting area of research. But in the meantime, it means we have to deal with the pest and the pathogens that are attacking the bees now because selecting for bees is not something that you can do on a small scale, so we really really need those large effort to drive the movements.

And in the meantime, the rest of us need to try to keep the environment free of pest as much as possible. Is there a rift in the beekeeping world between people who want to keep these bees natural? I guess for lack of a better term and people who are more in favor of these maybe modified bees. It almost feels to me like kind of an organic versus GMO situation going on for bees right now. Yeah, it's not completely wrong. What is one thing for sure is that beekeepers are usually people with strong opinions one way or another. And there is merit in both aspects.

As I said, we want to go for a better bee that is intrinsically more resistance to pest. But in the meantime, leaving colonies untreated is just spreading the problem to your neighbors. And so that's usually how we convince people that if they don't treat their own colonies, they're just putting more pests in the environment, contaminating their neighbors.

And if they want to collaborate into breeding programs, they should do so. but it's very hard at a very small scale to do that. So we have to have a coordinated effort to do it. And in the meantime, before we have that more resistant bee, we all have to do our part to try to minimize the infections of the bees we have now. Natalie Steinhauer is the research coordinator for the Bee-informed Partnership. She is based in College Park, Maryland.

Thanks so much for joining us, Natalie. Thank you. It was a pleasure. If you're interested in more details about the bee-informed, Informed Partnerships' latest survey, you can find it on their website, beinformed.org. And if you're a beekeeper having trouble with your honeybees, that website has some resources for you as well. For Science Friday, I'm Kathleen Davis. We have to take a short break, but stay with us because coming up, we're going to answer some kind of tricky questions for you. For example, you know the pandemic is far from over. COVID-19 cases are spiking in new odd spots.

but your neighbors want to have a Fourth of July barbecue, and they invite you to come over. How do you decide whether to go or not? We'll talk about living with risk for the foreseeable future. Stay with us. We'll be right back after this short break. This is Science Friday. I'm Ira Flato. If you're in a state that locked down at the beginning of the pandemic, maybe you can relate to our listener, Brenda, who called in from Washington State to our sci-fri-voccur pop app. No, no one's socializing yet.

It's still pretty depressing, boring. Don't get to see our friends, hug people. Get down a lot, but we'll survive it. Yep, it was a long socially distant spring, was it not? And as mask wearing becomes controversial, restaurants reopened to crowds. some states are already seeing big spikes in coronavirus cases, for example, Texas, California, Florida, Arizona. Maybe this is your cue to stay inside until there's, what, a vaccine. But maybe you're trying to find ways to live something like a life outside your home,

and as guides to safe, socially distant barbecues proliferate amid competing political messages about what we should do. We wanted to look to the science, how to make the best choices. for ourselves, regardless of where we are and who's in charge. So that's what we're going to be talking about. Let me introduce my guests. Dr. O'Ne Blackstock, Assistant Commissioner at the Bureau of HIV for New York City Health Department. Welcome, Dr. Blackstock. Thanks so much for having me. You're welcome. And Dr. Obrar Karan, a physician at Harvard Med School and Brigham and Women's Hospital in Boston, Massachusetts. Welcome to Science Friday, Dr. Karan. Thanks so much. Looking forward to it.

Well, you heard one of our listeners talking about how depressing it is. I want to play another listeners who sent us this story. I think I've gone out maybe three times since we've reopened. Every time I go out with friends or with family, we make sure that we are eating outside, not in a restaurant, and that it's not crowded. And so far we've lucked out, it's not crowded. Anytime an area has more than a few people who can't keep a distance, then we don't stay. Is there a right way and a wrong way to make choices like that about seeing friends,

going to restaurants and otherwise existing outside our homes, O'Ne? Yeah, I think that each person is probably going to make the best decision for themselves and their families and their community. But the reality is this is an infectious disease. and individual health and public health are tightly related. People need to really think about not just their families, but their communities as well. So determining whether the place you're going is going to be able to allow for social distancing, whether people will be wearing face coverings, whether it's indoors versus outdoors.

You know, all of those factors are going to help you determine how risky that situation is. I know when you're in New York, and I can tell by the ubiquitous car horn that goes off, the car alarms on the streets of New York City, right? There are restaurants that are just now reopening for outdoor service. How do you, at the Health Department, go about crafting the guidelines it takes to keep people safe in these situations? Right. So as a health department, you know, we develop guidance for the public as well as health care providers. and the impetus often is coming from what we're seeing and what we're hearing from community members.

And so I'm fortunate with the Bureau of HIV, we have these very long relationships that we've had with HIV advocates and community members. And for the guidance that we developed on social gatherings, this really actually came from a conversation I had with an HIV advocate on Twitter, as well as with Dr. Julia Marcus, who's an epidemiologist. And we were looking at a posting on Twitter of an indoor party that was taking place during the height of the pandemic's first wave. And people were shaming these individuals.

And so I realized that we needed to develop guidance so that the public knows what may be some lower risk versus higher risk social activities. And so that the public can make the most informed decisions for themselves because the reality is that staying home is not sustainable. and we need to come up with other options that people have that may be more palatable or acceptable. We're in the summer barbecue season. We just went through Memorial Day. We have the 4th of July coming up. Your neighbor is going to have a barbecue. He says, hey, why don't you come on over, bring the family?

And you're saying, oh, how do I tell him no? What do I do? How can I go and still remain safe, Abrar? Yeah, no, you know, that's a great question. question, a question that's going to come up for a lot of people. And when I advise a patient of mine to do something, I think about their individual risk. Are they somebody who is younger? Do they comorbidities? What is the significance of the event that they want to do to their personal life? What does it matter to them in terms of their mental health? And so I think for each person,

it's going to differ. But I think it's okay to say, you know, this situation for me is not ideal right now. If you look at the nature of transmission dynamics, a situation that's, you know, sort of lower risk can turn into a higher risk situation, you know, kind of within the same time course of an event. So you may be outdoors at a barbecue, socially distancing. People may be drinking and socializing. And then before you know it, you may head indoors to use the restroom and there may be some crowding around there. And, you know, just all it takes is a few minutes indoors, without masks face-to-face for transmission to likely occur. I think keeping that in mind is sort of important. And then the other point to Dr. Blackstock's point is that you don't want to

sort of stigmatize or make your neighbor feel like by you not coming, you're sort of judging the situation of, you know, why are you having a barbecue or something like that? And so I think it's really important to have sort of clear communication and, you know, just let people know that if you don't feel comfortable personally, it's sort of, you know, it may be something related to the individual risk within your own household, but to make sure we don't use stigmatizing language or be judgmental because that's not going to help. It's probably going to drive people to do things in a more secluded way, but they'll happen anyways. O'Ne, what about families? I know there's this concept of communal bubbles we keep talking about.

I know I am in one with my family where we have decided we would see each other, but we would stay safe, take the precautions at the same time. Is that a lot of? Is that a something as a policy decision that you would recommend? Yes. So in our social gathering guidance, we do encourage folks to consider social bubble. So having two or three families that you agree to socialize with, but with no one else. And then outside of the bubble, you follow social distancing rules. And, you know, it's really important to find a family that's being as careful as you are. But that you also pick a family that you can learn from and that will enrich your family.

that you can do fun things with, like your kids like each other and you like the parents as well. And it may be an opportunity also to consider a family that may have maybe a different background from you. You know, when we tend to socialize, we tend to socialize along race, ethnicity lines as well as socioeconomic lines. So really thinking about, you know, can you maybe engage with a family maybe who has a different cultural background from you so that you can learn from them and grow as well. Well, Barbara, but to us and my social bubbles that I have, there's a huge amount of trust involved, you know, that people have not violated the social deal that you have made. How do we manage the safety of those bubbles? Absolutely. I think, you know, you really hit the nail on the head here in terms of, in my opinion, trust is really the key to epidemic response in general. The Ebola epidemic, actually, was a great example of where, the loss of trust between communities and sort of international health organizations meant we lost contact tracing and transmission chains because we weren't able to track cases.

Same thing here. You're talking about trust in the context of families and interacting. It takes a lot of trust to join a social bubble where in which you're going to socialize and say, I trust you to not expose me, you trust me to not expose you. And so I think it's critically important, as Dr. Blackstock mentioned, that it's a you know, with families who you can really count on. And I noticed that your department puts out guidelines, very interesting guidelines. And, of course, the one I could not resist looking at, and that was the guideline for dating

and having safer sex on dating. Yes. So that was probably one of our guidance that went like the most viral. So as the Bureau of HIV, we do many sexual health marketing campaigns and we're known for being very sex positive. So we got a lot of questions early on about whether having sex during a pandemic was safe. We know sex is a normal part of life for so many people, and people will and should have sex during the pandemic. And so what we emphasized were harm reduction strategies, so ways to enjoy pleasurable sexual activity while minimizing your risk.

Dr. Karan, why is harm reduction better than completely eliminating our risks of gas? getting sick? Well, I think if you take a step back, so anytime I treat a patient clinically, or even when I think of my own life, every decision that I make is not to optimize my health at the disregard of everything else that matters to me as a human being. So I could avoid every single item of food that is deemed unhealthy, or I could avoid ever having an alcoholic beverage, or I could avoid doing anything that would cause me some kind of risk. that's not the way that we live as human beings in general. And so when we think about it applied

to this situation as well, we can only stay completely locked down for a certain period of time, right? After that, all of these other effects sort of weigh in. And so I think we approach it both pragmatically and also think of it as avoiding stigma and judgment, which is completely harmful. Then risk mitigation is what makes the most sense. And as we understand, more about transmission dynamics, we are able to use science to help guide what is safe and what is not safe. So I tell people a lot of the time, if you're walking around outside by yourself, that's a great time to get some fresh air without a mascot and if there's no one around you. And when you're indoors, that's where it's most important to wear a mask. Let's say masking

is an example where people may not mask the entire day. And so I think it's important to remember. It's not just the advice we give. It's what people are actually going to do with that advice that really matters. And I know because you work in HIV a couple of weeks ago, Dr. Fauci was on our show and said he saw a lot of parallels between this pandemic and the HIV AIDS epidemic. What do you see as lessons we can apply from HIV to this disease? So we were talking earlier about the harm reduction approach. And that actually originated during the early stages of the HIV AIDS epidemic. So Michael Callan and Richard Berkowitz, who were both gay men and both had been diagnosed with AIDS, they wrote this pamphlet. It was called How to Have Sex during an Epidemic. And it really pioneered the

strategy of harm reduction in the context of safer sex, because what they did is they recognized that many gay men are going to have sex. So let's support them in making the most informed choices for themselves. And I think that whole harm reduction approach is something that we definitely need to implement and use as part of our response to the COVID pandemic. And Brar, you've worked on Ebola. Are there lessons there for us also? Absolutely. I think the most important lesson, as you mentioned before, was maintaining trust within the communities, because I really do think that as much as we've got a pandemic, we also have within that multiple local community level epidemics ongoing and how communities

interact is so different. So if I go out in the street in Boston, in here without a mask on, people are going to look at me very, very strangely and may say something to me, especially if I was indoors, they would, I think, undoubtedly say something to me. But if you're in Arizona or in Florida, that might be very different. And the way that people interact with their healthcare leaders or with their government leaders in a community in Florida or in Arizona versus a community in Massachusetts may be very different. And so establishing trust with your community and leveraging that trust to promote scientifically

backed public health guidance, like wearing masks, is so critical. Just a quick note that I'm Iroflato, and this is Science Friday from WNYC Studios. Dr. Blackstock, a lot of states are putting out a lot of messages, some of them conflicting or confusing. If I live in a state with less clear messaging or want to do something and can't find guidelines, if I want to think like an epidemiologist, how do I assess situations that I can't find guidance for? Right. So the CDC actually has a really great website with lots of helpful information that can help with assessing your risks. So I think the first thing, the first question you want to answer is, is COVID-19 spreading in your community. And you can usually find this information on your state or local health department website. And if you have

trouble finding that, you can go through the CDC website. And what I would do is like look at trends in, you the percentage of tests that are positive or trends in newly diagnosed cases, hospitalizations, and deaths. And if you see all of those increasing, that would suggest worsening community spread. And so definitely would take greater precautions. And Abra, do you think that most people have accurate information about their personal level of risk? You know, that is an interesting question. A number of patients that I have who are from very challenging socioeconomic backgrounds, have lower access to health care services, may not know if they have uncontrolled hypertension or

if they've got poorly controlled diabetes to what extent that is. And there's a lot of overlap here because a lot of my patients who are most vulnerable are also part of families where there's a lot of indoor crowding in the house, where other family members might have been frontline workers who are really carrying our society through some of the toughest times during the pandemic. And so that's why I think we see a lot of the overlapping factors. And that plays into many complex social dynamics, including systemic racism and others, which I think make it hard for everybody to totally know their individual risk. And how do we, let's say that this virus, there's a virus that we have now, let's say that

it just keeps going on. I mean, how do we deal with it? And as a long-term issue, it gets worse, it gets better, it gets worse again. And what if it never, never? goes away, Arbor. How do we deal with that long time? What I would say is this is where these first six months, year, we're figuring out a lot of things, transmission dynamics, we're figuring out therapeutics that may work, we're figuring out how much children transmit. We're waiting to see what the long-term effects of this are going to be if there's viral latency, if this represents later. I think that we have to play it extremely conservatively initially as we figure all of these things out. And by next year, if we have a lot more understanding, our way of life may be very different

then, and we may have adjusted to a new normal at that point, that maybe was better than our old way of life. So that's my thoughts. I'm sure Dr. Blackstock has some thoughts too on that. Yeah, I think about sort of like a continuum of risks in terms of like, obviously the lowest risk is staying indoors and sheltering in place. And then like the highest risk is, you know, you're moving through going outdoors, maybe by yourself, then outdoor gatherings and then being indoors with other people you don't live with.

And I think we will kind of shift back and forth along that continuum in terms of, you know, depending on what the level of new cases is in our area, the level of spread, you know, we may shift to, you know, the extreme end and everyone's sheltering in place again. And then, you know, as things get better, moving along that continuum. But I anticipate we'll be figuring out sort of what is the level of risk we're most comfortable with and sort of shifting along that continuum and modifying our activities accordingly. Well, I hope everybody stays tuned because we will. We'll be talking about this for months, years.

Who knows how long to come? I want to thank my guests, Dr. O'Ne Blackstock, Assistant Commissioner at the New York City Department of Health. And Dr. Abraar Karan, a physician at Harvard Mid School and Brigham and Women's Hospital in Boston. Thank you both for taking time to be with us today. Thanks so much, Ira. Thanks so much. When we come back, an unusual story about how the human brain sees the world, stay with us. We'll be right back after this break.

I'm Ira Plato. This is Science Friday from WNYC Studios. This is Science Friday. I'm Ira Flato. All of us have things that our brains are not good at. For instance, I forget names or mangle them all the time. Sorry, if I've done it to you, it's not personal, I promise. But this week, researchers are telling the story of one man with an unusual deficit.

He cannot see numbers. Science Fridays Charles Burquist has more. Imagine visiting an elementary school classroom, and along the bulletin board there's that colorful poster showing all the letters and numbers. A through Z make perfect sense to you, and zero and one are no problem. But instead of seeing a curvy number two or the straight lines of a number four, all you see is a tangle of lines. That's the phenomenon experienced by one man, RFS.

Those are his initials for privacy reasons. This week in the proceedings of the National Academy of Sciences, researchers try to explore what's going on in his brain. How can your brain have some specific shape that is something it cannot see? Joining me now to talk about it are two scientists who both studied RFS during their doctoral work at Johns Hopkins, and are both now working on postdocs in the Boston area. Teresa Schubert is in the Department of Psychology at Harvard, and David Rothline is at the Veterans Affairs Boston Healthcare System.

Welcome to Science Friday. Hi, thank you. Hello. So, Teresa, tell us about this gentleman, RFS. What was his specific deficit here? What was going wrong for RFS? So RFS has been diagnosed with a condition called corticobasal degeneration. which is a very rare brain disease somewhat similar to Alzheimer's,

and that slowly over time it kind of eats away at your neural tissue. Normally corticobasal degeneration causes difficulty controlling your muscles and your motor movements, so difficulty walking and chewing. RFS has those symptoms also that have been progressing over time, but then this very strange symptom that we've never seen before of when he looks at a digit, it appears to him like spaghetti is the best way he can explain it. It's just this tangled mess, and he knows it's a digit because digits are the only things that appear that way, but he has no idea what digit it is. He says it looks truly bizarre. How did you come to be

working with him? What's the backstory here? RFS was seen by a neurologist and neuropsychologist initially at Johns Hopkins Hospital. And the neurologist has a close connection with our advisor and the senior author on this paper, Michael McCloskey. The neurologist knew that Michael McCloskey was really interested in number processing, letter processing, and so referred RFS to Mike to investigate a little bit further when we saw him trace a B perfectly normal, but an 8, as a bunch of what he described spaghetti, we knew it was something more than just a problem with

digit processing. Now, David, it's not that he can't do math. He was an engineer, apparently. Correct. He's actually quite good at math. And he remained as an engineer even after his digit deficit began. So even though he couldn't do math using the digits two through nine, zero and one were spared. So before we saw him, he was doing some of his math in binary. He was doing math using Roman numerals. He was doing math using number words, basically anything that didn't involve those particular forms or characters. And in fact, we taught him a new set of digits.

He was able to learn them very quickly and integrate them in his life. And he continued working as an engineer for a few more years longer than you probably could have, if not for those digits. So it's something about the visual form of the digit itself. How is seeing a seven different from flipping it over and seeing an uppercase L? Yeah. So we know that there is some specialized processing in your brain for processing letters and numbers, also other things like faces, for example. And it seems like for RFS, whenever he's looking at a shape that gets interpreted as a digit, that's what causes this weirdness, this warping and distortion so that he can no longer see it.

So, for example, if you imagine an eight, it's just two circles stacked on top of each other. And if you separate those circles quite a bit, RFS is able to see it as, oh, there's a circle, there's some blank space, there's another circle. But as soon as you bring those circles closer and closer together to where it starts looking like an eight to you, it disappears for him and it becomes this tangled mess. So it's really about his brain interpreting the shape as a digit that leads it to have this trouble. So would it be correct to say that the number sensor in his brain is working, but there's some kind of noise or interference on the lines leading away from the number sensor? Yes, I think that's a very good way to put it.

So the number sensor is, it's looking around the earlier areas of the brain to try to find, am I seeing a digit or am I seeing something else? And when like a digit appears, it's a number two. The number two sensor will raise its hand and say, ah, I see a number two. And then it sends that signal to other parts of the brain. So you know that the name of it is two. You know that it represents the quantity to. But it seems like the output of that is just a bunch of nonsense or,

crazy distortion that he perceives. And so he can't interpret what's being output, even though the input is being recognized but not being sent out correctly. And in your research, you found that this distortion spaghetti effect extended to other images that were either on top of the digit or placed too closely to the digit? Yeah, because the distortion was so overwhelming, as he describes, we want to see if it affected other objects that were placed on top of it. Would they just shine through or would they also get distorted with the mess that he perceives with digits? And what we found is, yeah, when we put faces embedded in digits or nearby digits or other objects, he can't even see that there's an object there.

And you can't certainly interpret that it's a face or other object. I'm unclear on how the number presence blocks awareness of the face. So the way that we have thought about this and the way that it's led us into thinking about how your awareness is constructed is you're always aware of something in a particular place in space. So if you see the number two, you don't see it floating around, you see a number two in a particular place, you know, 18 inches in front of your face just to the left of the edge of the screen or whatever. And so we think that the reason that RFS can't see these faces, for example, when they're embedded. within a digit is the part of his brain that's constructing this awareness of what he's seeing has to take information of everything in that place. And because one of the things in that place is this digit, which is giving these distorted signals, that's distorting everything in that

same location. And that's why if you present a digit, you know, on one side of the screen and face on the far other side of the screen or somewhere else entirely, he can still see that face, fine. It's only when they're in the same location. And his awareness is trying to assign to that location face, but also this weird distorted thing that that distortion basically wins out. And that's all he sees in that location. When we see something, is there some kind of dispatcher in the brain that says, this thing that you're seeing is a face. We'll send it to the face processing part. Or does the visual information sort of? of wash over the entire brain at once and only the correct parts are keyed to respond to the

input. I think that second explanation is probably closest to the way we think of the visual parts of the brain as working. So all of this visual input is coming in through your eyes and there are specialized areas of the brain for processing and recognizing faces and digits and letters. And so when there happens to be a digit in what you're looking at, that digit area becomes active, and then that area, as David was just saying, is going to pass that information. Oh, I've detected a two, or the face area saying, oh, I've detected a face is going to pass that

information on. And in order for you to actually become aware of seeing the two or seeing the face, that information has to get passed on correctly. So if you do an MRI or some other kind of brain scan on him, can you point to a specific part of the brain and say, ah, I see this physical flaw, that is where things are breaking down for RFS? No, we cannot because he has, Giaz, it's a degenerative condition. It affects lots of areas of the brain. So basically his brain, if you look at his skin, it's the spaces between, you know, there's the folds and hills of the brain.

The spaces between the different hills are much larger. And that's because there's atrophy of the gray matter that comes with degenerative conditions. And so while his whole brain looks a little more atrophied as a whole, we can't point to a single location and say, oh, there is a lesion there or there's a hole there. That is at least the source of his dysfunction. People talk about how marvelously adaptable the brain is. And there are these stories of somebody who lost one form of perception makes up for it in another area. Why isn't his brain able to shift this number sensing capability off onto another area of the brain or adapt to deal with this degeneration? So I think in cases of degeneration, unfortunately, plasticity is a lot

more limited. So certainly after someone has had a stroke, especially if that's relatively early in their life. But even adults, people in their 60s and 70s who have a stroke can often recover an incredible amount of function and their brain undergoes some reorganization. With degenerative conditions, it's much harder because any place that the brain may try and reorganize or send functions to a new area might be the next place that's knocked out by the degeneration. But also for RFS in one way, he was able to overcome the deficit. So Mike developed for him this set of surrogate digit symbols, which are just other ways of drawing the digits. They look nothing like the normal digits. They're made completely of straight lines. And they have a very systematic relationship.

If it has two horizontal lines, it's a six. If it has three horizontal lines, it's an eight. I don't quite remember the system. But RFS was able to learn those, and he actually uses those every day as his new digits. So this new way of representing the digits has given him a way to continue jotting down notes and doing math problems, but also indicates that those are preserved in his brain, and his brain isn't kind of distorting those as well as the original digit. Right. Are there other people with this deficit selectively unable to see specific things? There's certainly plenty of cases where there's individuals who cannot see certain categories of objects. So there's people who, after a lesion to the brain, might have trouble seeing or

identifying faces, identifying words. So these sort of what we call agnosias or difficulty recognizing things exist. However, what makes RFS's case unique is that he sees something, but it doesn't look anything like what is hitting his eyes, essentially. It's getting to his brain and then distorting, so it looks very different. So what we call that is a metamorphopsya. and there's only other case of category-specific metamorphopsias occur actually with faces, where some people after a stroke or during seizures might report that faces or half of a face will appear like it's melting, for example. So this is not just, oh, I have trouble with faces.

I have trouble recognizing people. It's whatever that person has on top of their shoulders does not look like a face to me. That's right. or it looks like a highly distorted face. Interesting. I'm Charles Berkwist. You're listening to Science Friday from WNYC Studios. In case you're just joining us, I'm talking with Teresa Schubert and David Rothwein

about the case of RFS, a gentleman who was unable to see the digits two through nine. There are tons of theories about how the brain works. Does this study point to any one of the ones? those sets of theories more or less than another? Or does it exclude things of, okay, well, that's clearly not how the brain works? It certainly excludes a sort of theory that you might have, just as someone living with a brain, about the way your brain works, which is the idea that when you open your eyes, they function like a video camera or they're taking snapshots of the world and everything that comes in through your eyes you're going to see. That's clearly not

the case for RFS. This digit information is coming in through his eyes, and it's being detected as a digit, which we know, because otherwise everything would be distorted. It wouldn't be selective just to digits, but that information isn't becoming something that he can see. So there has to be at least two, possibly many more stages that allow you to first detect something, but that on its own is not enough for you to see it, for you to actually become aware of eyes. there's a two there. There have to be stages after that that process that information into a way that it actually becomes part of your conscious awareness of what you're seeing in the world. So a lot of medical research is based on these huge studies of thousands or hundreds of thousands of

people to get some big data trend. And here you're looking at one man. How much can you tell about the wider world from just looking at one guy? So I think that's a really good question. question. The trend tends to be we want to have larger samples of studies. We want to have more people because we want to generalize these findings. And for many kinds of findings and questions, this is true. If we're giving a medicine to people who have the cold, we want to make sure that it works, not just for one person, but works for everybody. However, when you're addressing sort of theories about how the mind and brain work, I think looking at a single individual could be the most informative because the kinds of statements that are theories, which is, for example,

consciousness works this way. If you find one case where it doesn't work that way, then that theory needs to be expanded or at least reconcile with, you know, your single case. And so I think they could, in fact, be very informative. Teresa Schubert is a postdoctoral fellow in psychology at Harvard University in Cambridge, Massachusetts. And David Rothwein is a postdoctoral researcher at the Veterans Affairs Boston Health Care System in Boston. Thanks to both of you for talking to me today. Thank you.

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