A New Future for DNA

As a DNA-based creature myself, I’m always fascinated by DNA’s remarkable capabilities. Not just all the ways that life has found to use it, but our ability to find new ways to take advantage of them. I’ve written about DNA as a storage medium, as a neural network, as a computer, in a robot, even mirror DNA. So when I read about the Synthetic Human Genome (SynHG) project, last week, I was thrilled.   

Welcome to the Synthetic Human Genome Project, Credit: SynHG

The project was announced, and is being funded, by the Wellcome Trust, to the tune of £10 million pounds over five years. Its goal is “to develop the foundational tools, technology and methods to enable researchers to one day synthesise genomes.”

The project’s website elaborates:

Through programmable synthesis of genetic material we will unlock a deeper understanding of life, leading to profound impacts on biotechnology, potentially accelerating the development of safe, targeted, cell-based therapies, and opening entire new fields of research in human health. Achieving reliable genome design and synthesis – i.e. engineering cells to have specific functions – will be a major milestone in modern biology.

The goal of the current project isn’t to build a full synthetic genome, which they believe may take decades, but “to provide proof of concept for large genome synthesis by creating a fully synthetic human chromosome.”

That’s a bigger deal than you might realize.

“Our DNA determines who we are and how our bodies work,” says Michael Dunn, Director of Discovery Research at Wellcome. “With recent technological advances, the SynHG project is at the forefront of one of the most exciting areas of scientific research.” 

The project is led by Professor Jason Chin from the Generative Biology Institute at Ellison Institute of Technology and the University of Oxford, who says: “The ability to synthesize large genomes, including genomes for human cells, may transform our understanding of genome biology and profoundly alter the horizons of biotechnology and medicine.”

He further told The Guardian: “The information gained from synthesising human genomes may be directly useful in generating treatments for almost any disease.”

Project lead Professor Jason Chin. Credit: Magdalen College, Oxford

Professor Patrick Yizhi Cai, Chair of Synthetic Genomics at the University of Manchester boasted: “We are leveraging cutting-edge generative AI and advanced robotic assembly technologies to revolutionize synthetic mammalian chromosome engineering. Our innovative approach aims to develop transformative solutions for the pressing societal challenges of our time, creating a more sustainable and healthier future for all.”

Project member Dr Julian Sale, of the MRC Laboratory of Molecular Biology in Cambridge, told BBC News the research was the next giant leap in biology: "The sky is the limit. We are looking at therapies that will improve people's lives as they age, that will lead to healthier aging with less disease as they get older. We are looking to use this approach to generate disease-resistant cells we can use to repopulate damaged organs, for example in the liver and the heart, even the immune system.”

Consider me impressed.

Professor Matthew Hurles, director of the Wellcome Sanger Institute, explained to BBC News the advantage of synthesizing DNA: “Building DNA from scratch allows us to test out how DNA really works and test out new theories, because currently we can only really do that by tweaking DNA in DNA that already exists in living systems."

It’s mind-blowing to think about the potential benefits that could come of this work, but the potential risks are equally consequential. Designer babies, enhanced humans, hybrids with other animals – synthetic DNA might accommodate all those and more. The sky is the limit indeed.

The project leaders are aware that there are important ethical considerations in such work, and so are including a companion social science program, called Care-full Synthesis, that is being led by Professor Joy Zhang from the Centre for Global Science and Epistemic Justice at the University of Kent. It plans to undertake a “transdisciplinary and transcultural investigation into the socio-ethical, economic, and policy implications of synthesising human genomes,” placing particular emphasis on “fostering inclusivity within and across nation-states, while engaging emerging public–private partnerships and new interest groups.” 

“With Care-full Synthesis, through empirical studies across Europe, Asia-Pacific, Africa, and the Americas, we aim to establish a new paradigm for accountable scientific and innovative practices in the global age,” says Professor Zhang. “One that explores the full potential of synthesising technical possibilities and diverse socio-ethical perspectives with care.”

That may prove to be a harder task that synthesizing a human chromosome.

Working out the socio-ethical perspectives is going to be harder than this, Credit: Microsoft Designer

SynHG is not the only project looking at synthetic DNA; it is a technology whose time is coming. Does anyone think that researchers in China aren’t working on this? Does anyone think they’re equally looking at the ethical considerations? Or maybe the next breakthrough will be some U.S start-up, that is gambling big on a use for synthetic DNA and would be expecting a unicorn-level return.

Professor Bill Earnshaw, a genetic scientist at Edinburgh University, warned BBC News: “The genie is out of the bottle. We could have a set of restrictions now, but if an organisation who has access to appropriate machinery decided to start synthesising anything, I don't think we could stop them."

But Wellcome’s Dr. Tom Collins, who greenlit the funding, told BBC News: “We asked ourselves what was the cost of inaction. This technology is going to be developed one day, so by doing it now we are at least trying to do it in as responsible a way as possible and to confront the ethical and moral questions in as upfront way as possible."

Kudos to Wellcome for building these considerations into the project. They’d be considered too woke in the U.S. And kudos for acknowledging the costs of inaction, which many policymakers in the U.S. and elsewhere fail to recognize.

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We’ve made remarkable progress on DNA in my lifetime. When I was born, it had just been discovered. The Human Genome Project launched in 1990 and the first sequence of the human genome by 2003. The CRISPR revolution – allowing gene editing -- started in 2012, and we’re now doing personalized gene editing therapy.  “Remarkable” is too mild a word.

But there’s still so much we don’t know. We don’t always know when/why genes turn on/off. We still have a very imperfect understanding of which diseases are genetic and which genes cause them, under what circumstances. And, for heaven’s sake, what is all that “junk DNA” doing? Is it just left over from evolution doing its long kludge towards survival, or does it carry some importance we haven’t learned yet?   

Those are the kinds of things SynHG might help us better understand, and I can’t wait to see what it finds out.

Microplastics Are Here, There, Everywhere

Vaccine experts are going rogue in response to RFK Jr’s attacks on vaccine safety. Health insurers promise – honest…this time – to make prior authorizations less burdensome (although not, of course, to eliminate them). ChatGPT and other LLMs may be making us worse at learning. So many things to write about, but I find myself wanting to return to a now-familiar topic: microplastics.

You may not realize it, but you're eating (and drinking) microplastics. Credit: Microsoft Designer

I first wrote about microplastics in 2020, and subsequent findings caused me to write again about their dangers at least once a year since. Now there are, yet again, new findings, and, nope, the news is still not good.

A new study, from researchers at the Food Packaging Forum, Swiss Federal Institute of Aquatic Science and Technology (Eawag) and the Norwegian University of Science and Technology, and published in npj Science of Food reviewed 103 previous studies about the impact food packaging and “food contact articles (FCAs)” can have on micro- and nanoplastics (MNPs) in our food. They found that even normal use -- such as opening a plastic bottle, steeping a plastic tea bag, or chopping on a plastic cutting board – can contaminate foodstuffs.

“This is the first systematic evidence map to investigate the role of the normal and intended use of food contact articles in the contamination of foodstuffs with MNPs,” explains Dr. Lisa Zimmermann, lead author and Scientific Communication Officer at the Food Packaging Forum. “Food contact articles are a relevant source of MNPs in foodstuffs; however, their contribution to human MNP exposure is underappreciated.” 

Their collected data are freely accessible through the FCMiNo dashboard, which allows users to filter included data by the type of FCA, the main food contact material, the medium analyzed, and whether MNPs were detected, and if so, for their size and polymer type.

Removing the plastic from items you purchase at the grocery store may contaminate it with microplastics, as might steeping a tea bag. Simply opening jars or bottles of milk can as well, and repeated opening and closing of either glass or plastic bottles sheds “untold amounts” of micro- and nanoplastics into the beverage, according to Dr. Zimmerman, who further noted: “The research shows the number of microplastics increases with each bottle opening, so therefore we can say it’s the usage of the food contact article which leads to micro- and nanoplastic release."  

Dr. Zimmerman told The Washington Post: “Plastic is present everywhere. We need to know what we can do.” Examples of what she suggests we can try to do include avoiding storing food in plastic whenever possible and avoiding heating plastic containers. She admitted, though: “We have not really understood all the factors that can lead to the release of micro and nanoplastics.”

One of her co-authors, Dr. Jane Muncke, Managing Director and Chief Scientific Officer at the Food Packaging Forum, warns that ultraprocessed foods carry more risk of contamination: “There’s a higher number of manufacturing steps with ultraprocessed foods, which can increase the contact time with plastic food processing equipment, thus increasing the chance of micro- and nanoplastic migration.”

Dr. Muncke believes their research is a step in the right direction:  

This systematic evidence map helps fill gaps in knowledge on the source of MNPs in foodstuffs. However, it also shows that additional research is needed to better characterize MNP migration related to FCA materials and uses. Importantly, implementing a harmonized testing and reporting framework is key to ensuring reliable and comparable data, which can inform future policy decisions.

David Andrews, acting chief science officer at the Environmental Working Group, told CNN: “This new study highlights food packaging and processing equipment as potentially significant sources of microplastic contamination in the food we eat, and ultimately in our bodies. This study should raise alarm bells.”

It should indeed.

Here’s another study which illustrates that our expectations about microplastics risks aren’t always valid. Researchers from France’s state food agency ANSES found that drinks sold in glass bottles actually have more microplastics in them than do ones in plastic bottles. Glass bottles of cola, lemonade, iced tea and beer had at least five times the amount of particles than plastic bottles or cans.

"We were expecting the opposite result when we compared the level of microplastics in different drinks sold in France," said PhD student Iseline Chaib, who conducted the research. It turns out that the caps on the bottles are the issue. Ms. Chaib explained: “We then noticed that in the glass, the particles emerging from the samples were the same shape, colour and polymer composition – so therefore the same plastic – as the paint on the outside of the caps that seal the glass bottles.”

Remember what Dr. Zimmerman warned about the dangers of repeated opening and closing of bottles?

The team suggested manufacturers use a cleaning method of blowing air in the caps, and rising with water and alcohol, which could reduce contamination by 60 percent. Consumers were also advised to rinse caps before putting them back on.   

Variation of average contamination levels (MPs/L) by polymer clusters. Credit: Chaid, et. al.

Last but not least, a paper by West Virginia University biology undergraduate student Isabella Tuzzio tested the presence of microplastics in fish from central Appalachian streams -- and found them in every fish sampled. Each fish averaged 40 pieces of microplastics.

The paper concludes: “Overall, we conclude that microplastic contamination is present and widespread in freshwater ecosystems in North Central and surrounding Appalachian regions throughout three major watersheds (the Monongahela, Cheat, and Ohio watersheds)…Potential sources of microplastic pollution point to agricultural activity, wastewater treatment, and atmospheric deposition.”

"Microplastics are coming from everyday sources like synthetic fibers from laundry and plastic beads in exfoliating face washes," Ms. Tuzzio said. "They're now everywhere, from our streams to remote deserts and even the human body."

She thinks we should be worried:

These plastics are small, but their impact is massive. They carry pollutants, heavy metals and antibiotics. And while the microplastics are spread out in smaller fish, the bigger fish eat those smaller fish. As you work your way up the food chain, there are heavily concentrated levels of these plastics. It's a problem for them and for us, too.

I’m plenty worried. We know that microplastics are everywhere, from the bottom of the ocean to the top of atmosphere, and everywhere in between. We know that they’re throughout our food system, and throughout our bodies. We don’t have enough data yet on exactly what the health risks of all this exposure are, but we have enough evidence that it is not good.  

I’ll grant that microplastics are on RFK Jr’s radar, but I sure wish he’d move it ahead of undermining trust in vaccines or removing food dyes.

How Novel: Novelty Indicators

Humans crave novelty. Our visual cortex is stimulated by changes in our visual field. Even infants show more interest in new sights and sounds. Curiosity doesn’t entirely distinguish homo sapiens from other species, but we certainly would win the prize for maximizing its value. Science, art, and music wouldn’t exist without our drive for novelty. Science in particular thrives on some scientist thinking, “hmm, isn’t that interesting?” then turning it into something that helps us understand the universe we live in better, often with practical applications.

We don't always recognize important novelty when we see it

Depending on what source one believes, there are somewhere between 3 million and 7 million scientific papers published each year; whatever the number, it is growing rapidly, and impossible for a scientist in any particular field to keep up with, much less to look for insights from other fields. Most of these papers, of course, are likely to be incremental work, building on previous research and probably not reflecting true breakthroughs. How then, do researchers, and the people who fund them, spot the truly novel papers that may spark breakthroughs?

Enter the idea of a “novelty indicator” – and welcome to the Metascience Novelty Indicator Challenge.

The need for something to help identify scientific novelty has been recognized for some time. A 2016 paper by Wang, et. al warned that there was, in fact, a bias against such novelty. “Research which explores unchartered waters has a high potential for major impact but also carries a higher uncertainty of having impact,’ the authors warn. “These findings suggest that science policy, in particular funding decisions which rely on traditional bibliometric indicators based on short-term direct citation counts and Journal Impact Factors, may be biased against “high risk/high gain” novel research.”

Similarly, a 2019 paper by Veugelers and Wang emphasizes:

We find that the small proportion of scientific publications which score on novelty, particularly the 1% highly novel scientific publications in their field, are significantly and sizably more likely to have direct technological impact than comparable non-novel publications. In addition to this superior likelihood of direct impact, novel science also has a higher probability for indirect technological impact. being more likely to be cited by other scientific publications which have technological impact.

The issue is, how to best do such a score?

In Nature, Dr. Benjamin Steyn, co-head of the UK Metascience Unit, laments that he has “been stumped by the fact that there are no good ways to measure novelty,” and so: “Without good indicators, researchers can’t assess the prevalence of original papers or their value in scientific progress.”

He mentions work done by DeSci Labs and others on novelty scores, but believes “none of which are foolproof.” There has to be a better way:

That’s why the UK Metascience Unit has partnered with the non-profit organization RAND Europe; the Sussex Science Policy Research Unit; and the publisher Elsevier, to launch MetaNIC (see go.nature.com/3hhsdp3) — a competition to produce and validate indicators for scientific novelty in academic papers. Running until November, MetaNIC is open to researchers all around the world.

Participants will test their algorithm against 50,000 scientific papers that will have been ranked by 10,000 researchers on their novelty. The team whose indicator best matches the humans’ assessments will win £300,000 (US$407, 000). 

The Challenge website explains the importance:

If the global science system had responsibly used better and more timely indicators of research excellence, this could have a profound impact on the incentives of researchers, our understanding of the factors which make excellence more likely, and in turn, the pace of research progress. Better metascience indicators can help funders, governments, academic institutions, and individuals get more high-quality research out of limited resources.

As Dr. Steyn says: “Better indicators could improve our understanding of the factors that make research excellence more likely, the incentives of scientists and so the pace of scientific progress. That is worth exploring.”

Credit: MetaNIC

It’s worth pointing out exactly what the Metascience Unit that he is co-head of is for. It is a branch of the UK government, and the website explains: “Metascience typically examines the institutional structures, practices and incentives explaining how researchers spend their time and the speed, direction, nature and impact of their outputs.”

To put that in practice:

All our work starts from a simple idea: that the scientific method, so powerful in so many areas of life, should be systematically and routinely applied to how we practice, fund and support science itself.

Investing in research, development and innovation is vital to UK and international economic growth and prosperity. However, it is not just the quantity of that investment that matters, but also the quality. How research is funded and practiced is critical to accelerating scientific breakthroughs and innovations, nurturing talent, and shaping research culture.”

It makes me wish the U.S. had a Metascience Unit. Instead, we have DOGE, which is slashing federal scientific funding in the name of curbing “waste, fraud, and abuse,” crushing anything that can even remotely be considered “DEI,” and, while they are at it, punishing universities that President Trump is mad at. That’s no way to invest in science, to discover innovation, or to prepare for the future. If anything, it scorns novelty.

In JAMA Network, David Cutler and Edward Glaeser warn that the proposed NIH cuts are “the $8 trillion health care catastrophe.” In Forbes, John Drake, a professor at the University of Georgia, points out: “New macro-empirical research finds that every dollar invested in non-defense public R&D yields $1.40–$2.10 in economic output, and since World War II, government funding has driven roughly 20% of U.S. productivity.”  A paper from American University researchers concludes: “…budget cuts to public R&D would significantly hurt the economy in the long run, with large negative effects on GDP, investment, and government revenue. A 25 percent cut to public R&D spending would reduce GDP by an amount comparable to the decline in GDP during the Great Recession.”

So, yeah, how one cuts research, and which research gets cut, makes a difference, not just to researchers and their institutions but to all of us and the future of our country. 

I understand that federal funding isn’t unlimited and perhaps could be spent more judiciously, but arbitrary cuts are perhaps the worst way to do it. It sure seems like focusing on novelty, with its bigger potential for large impacts, could be a much better way to direct funding.

Maybe you, or a researcher you know, should sign up for the Metascience Novelty Indicators Challenge! 

The Long Game Should Have Already Started

Two books I recently read reminded me that, when it comes to playing the long game, conservatives have it all over, well, let’s not call them liberals, since the conservatives have managed to make that a pejorative term. Let’s just say left/center-left/center or even -- dare I say it? – progressives. Whatever we call them, they better get in that game.

Andrew C. McKevitt’s Gun Country: Gun Capitalism, Culture, and Control in Cold War America details how over the past sixty years conservatives successfully fought against efforts to regulate the sale, ownership, and use of guns, with the Heller decision opening up the doors and gun advocates flooding through them ever since.

Cara Fitzpatrick’s The Death of Public School: How Conservatives Won the War Over Education in America shows how conservatives sought to divert funds from public schools to private schools, even religious ones, for over seventy years. Conservatives recently “lost” a Supreme Court ruling (St. Isidore of Seville Catholic Virtual School v. Drummond) that would have allowed the nation’s first religious charter school, but no one should think the war is over or that advocates of public education are even holding their own, much less winning. Voucher programs are in place in most states and are on their way in most others.  

And, of course, conservatives spent forty years trying to overturn Roe v. Wade (see The Fall of Roe: The Rise of a New America by Elizabeth Dias and Lisa Lerer), succeeding with Dobbs. That was the long game played masterfully.

Credit: Jacquelyn Martin/AP

Most Americans support some form of gun control, public schools, and abortion rights, so the conservatives’ long game required shrewd planning and unrelenting persistence. What I don’t see -- what I’m worried is not happening -- are the long games on issues that people who aren’t hard right conservatives care about. Maybe they’re happening and are too subtle for me to be aware of, but I fear conservatives are just better at the long game.

Here are some of the key issues I mean:

Campaign finance:  It is appalling that the world’s richest man – who is not even a U.S. citizen – can essentially buy a Presidential election and several other races (along with fellow billionaires). It’s appalling that Citizens United held that corporations had the same rights as citizens to political donations and allowed them to flood campaigns with money. It's appalling that there was over $1b in “dark money” contributed in the 2024 election.  

This is not a way to run a democracy. In fact, it is a way to ensure we don’t have a democracy. We need real, meaningful campaign finance reform that returns power to the voters.

Voting Rights: The 1960’s saw some apparent victories in achieving voting rights, but sixty years later those rights are under attack again – in more pernicious ways. The Supreme Court is considering a case that would “gut” the Voting Rights Act, and states continue to chip away. Gerrymandering is widespread, in both red and blue states. Our vote is being neutered.

Conservatives talk about ID and other requirements, but let’s remind ourselves: in many other countries, if you are a citizen, you’re eligible to vote. In some countries, you are expected to vote. In the U.S., less than 75% of eligible voters were registered to vote in 2024, and that was for a hotly contested Presidential race.  Citizens should have both a right and a duty to vote. “States rights” to oversee elections don’t supersede our right to vote.

Privacy: We say we value our privacy, but we don’t act as though it actually is important. We’ve given it away to Big Tech and other corporations, and that is only going to get worse. Roe was based on an inferred right to privacy, and we saw how easily the Supreme Court swept that away.

The founders did not foresee Facebook, Google, surveillance cameras, or big data, and so the Bill of Rights doesn’t mention a right to privacy. If there is one thing that conservatives, liberals, and everyone in between should be able to agree on, it is that we deserve a constitutionally guaranteed right to privacy.

Credit: Tor Project

Living Wage: the federal minimum wage hasn’t been increased since 2009. Take that in: 2009. Meanwhile, most workers have seen wage stagnation, our income and wealth inequalities are at record levels, and intergenerational social mobility – e.g., the American Dream that your kids will do better than you did – has crashed.

We cannot have a democracy where the vast majority of our wealth goes to a tiny minority. We cannot have a stable country that is clearly split into the have and have-nots. Workers need to be paid a living wage -- one that doesn’t require them to work multiple jobs, that gives their children the upbringing and opportunities they should have, and that lets them have suitable housing.

Health care: I am so sick of conservatives saying people on Medicaid who don’t work don’t deserve coverage.  I’m disgusted that ten states, including two of our largest, never felt that their poor deserved Medicaid expansion at all. I’m dismayed that it is considered a victory that, due to ACA, we “only” have 30 million people without insurance (not to mention the tens of millions who are underinsured).  

People in America should have a right to health care (just as they should have a right to clean air and water, safe and sufficient food, and adequate housing). These should not have to be “earned” or given on the whims of the legislators. And don’t talk to me about “Medicare for All,” a meaningless phrase; if we ever get universal coverage, it shouldn’t look, or be financed, anything like Medicare. We can do much, much better.

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You may have your own list of priorities. I could probably come up with a few more. But that’s the thing about priorities: if too many things are a priority, then nothing is.  Those five are big, big asks, but I’m hard pressed to see what I’d take away.

So, where’s the long game for these? Not just looking ahead to the next election cycle or the next Presidential race, but knowing what the end game is and plotting out the gritty detail about how to get there, no matter how long it takes or what setbacks are encountered. Who is doing that work, what are they doing – and how can we help?

There’s famous saying that applies here: the best time to plant a tree is twenty years ago. The second best is now. Let’s start planting. 

The Future Is Here - and We're Not Ready

The war in Ukraine started out pretty much like you’d expect a 20^th century war might: aerial and artillery bombardment, followed by massed troops behind tanks and armed vehicles. It devolved into an early 20^th century war, complete with trenches and suicidal frontal attacks. Somewhere along the line, though, it turned into an actual 21^st century war, with cyberattacks and, most of all, drones dictating the battles.

That's the future knocking. Credit: Microsoft Designer

The latest surprise was Ukraine hitting Russian airbases as far as 3,000 miles away, using trucks with camouflaged drones to get near the bases, deployed remotely to great effect. Russia didn’t see it coming; neither did NATO or the U.S.

We think about the future, we try to prepare for it, but somehow it still manages to surprise us.

W.J. Hennigan writes in The New York Times:

The mission, called Operation Spider’s Web, was a fresh reminder to leaders of the world’s most advanced militaries that the toughest threats they face today are not limited to their regular rivals with expensive gear. Instead, swarms of small, off-the-shelf drones that can evade ground defenses can also knock out billions of dollars of military hardware in an instant.

What happened in Russia can happen in the United States — or anywhere else. The risk facing military bases, ports and command headquarters peppered across the globe is now undeniably clear.

The Editorial Board of The Wall Street Journal (with whom I seldom agree!) felt similarly: “ One urgent lesson beyond that conflict is that the U.S. homeland is far more vulnerable than most Americans realize.” 

“The Pentagon should be very worried about this,” Stacie Pettyjohn, a senior fellow at the Center for a New American Security who focuses on drone warfare and nuclear deterrence, told The Washington Post. Jason Matheny, CEO of the Rand Corporation, added: “Any country that has strategic bombers, strategic missiles and silos, or strategic nuclear submarines at port is looking at the attack and thinking the risk to our arsenal from a containerized set of drones disguised as a semitrailer poses a real risk.”

“If I think asymmetrically, if you’re Russia or China or another actor, what they’d likely do is try to infiltrate the United States and build their weapon from within the country,” retired General Glen VanHerck told WaPo. “Or if they put a container ship carrying drones into the Port of Long Beach or somewhere in close proximity to our critical infrastructure, including nuclear ports, that would be really hard to detect.”

The WaPo article also quotes Army Gen. Bryan Fenton, commander of U.S. Special Operations Command, in an April Congressional hearing: The “character of warfare is changing at a ratio faster than we’ve ever seen. Our adversaries use $10,000 one-way drones that we shoot down with $2 million missiles. That cost-benefit curve is upside down.”

Mr. Hennigan warns: “The U.S. military has globe-spanning technology to detect, track and shoot down ballistic missiles, but — so far — its multimillion-dollar systems remain helpless against the drone threat. The Pentagon has tried to develop technologies and defensive tactics, but results have been spotty at best.” 

One only also has to think about how Ukraine had previously used cheap drones to sink expensive Russian ships last year, how the ragtag Houthis have rattled the mighty U.S. Navy in the Red Sea using drone attacks, or how the Israelis snuck explosives in the pagers and cell phones using by Hezbollah in a devastating “red button” attack last fall. This is war in a new age.

Rep. Jason Crow (D-Colorado) told WaPo: “This conflict has already fundamentally changed the nature of warfare,” with the Pentagon still spending “exorbitant amounts of money” on military programs for conflicts “that would be relevant decades ago.”

Billion dollar warships are impressive, multi-million dollar warplanes are the norm, pricy ballistic missiles are assumed, and who doesn’t like a fancy tank? But we’re learning that enough drones in the right places handled by the right people (or an AI) can negate all those investments in the past.

We’re seeing the future of war right now, and our slow moving military-industrial complex is too focused on what it has been doing -- and the trillions of dollars it brings them -- to react quickly enough. And guess what: its evolution won’t stop with drones.

All this came home to me in a New York Times opinion piece by Thomas Friedman:

[Trump’s] ridiculous right-wing woke obsession with destroying the U.S. electric vehicle industry that President Joe Biden was trying to build up undermines U.S. efforts to compete with China in electric batteries. Batteries are the new oil; they will power the new industrial ecosystem of A.I.-infused self-driving cars, robots, drones and clean tech.

The consequence of this, the economics writer Noah Smith observed, is the weakening of America’s capacity to build the kind of cheap, battery-powered drones that Ukraine just used to destroy part of Russia’s air fleet — and that China could use the same way against our aircraft carriers. “Trump and the G.O.P.,” Smith noted, “have decided to think of batteries as a culture-war issue instead of one of national security. They think they’re attacking hippie-dippy green energy, sticking it to the socialist environmentalist kids and standing up for good old red-blooded American oil and gas. Instead, what they’re actually doing is unilaterally disarming America’s future drone force and ceding the key weapon of the modern battlefield to China.

Add to that Trump’s war on science, especially on health care, makes this all so much worse. Mr. Friedman continued:

What has distinguished and enriched the United States for so many years — and kept it the dominant global economic and military power — has been the ability to consistently attract that extra scientist or ambitious immigrant, that extra dollar of investment and that extra dollop of trust from allies. As the biggest economy in the world, we benefited disproportionately from a stable, global free market.

“Any conventional understanding of U.S. power would say that we would be crazy to put all three at risk, but that is exactly what we are doing today,” Nader Mousavizadeh, a founder of the geopolitical consulting firm Macro Advisory Partners, told me.

The lowest level in 35 years. Source: NYT/NSF

The future is happening now. All the money we’ve been spending, on so many things in so many ways, are sunk costs. They may or may not be the best things to be spending money on in the 21^st century. Chances are, many of them are not. Where’s our UBI? Where is our 21^st century healthcare financing and delivery system? Where is our robotics industry, our EV industry, our alternative energy industries? Where is our AI strategy?

Meanwhile, we’re driving away the people who are inventing the future, and that future is happening now. We have a geriatric President bent on personal vengeance and a geriatric Congress busy fighting pointless cultural wars. They are not equipped to lead us into the future. But it is coming nonetheless.

Waste, Fraud and Abuse - Oh, My!

So the House has passed their “big, beautiful bill,” by the narrowest of margins. Crucial to the bill are large savings from Medicaid, which in past years Republicans would have taken some glee from but now they are careful to explain away as just cutting “waste, fraud and abuse,” having finally realized that many MAGA voters depend on Medicaid.

Much of those savings come from proposed work requirements for Medicaid recipients, long a favored Republican tactic that the Biden Administration kept rejecting. Speaker Mike Johnson is very vocal about their importance. The people impacted by the work requirements, he insisted on Face the Nation:

If you are able to work and you refuse to do so, you are defrauding the system. You're cheating the system. And no one in the country believes that that's right. So there's a moral component to what we're doing. And when you make young men work, it's good for them, it's good for their dignity, it's good for their self-worth, and it's good for the community that they live in.

He's convinced that, instead of working, too many of them – especially young men – “playing video games all day.” He and other Republicans want to return Medicaid to what they see as its original purpose: “It’s intended for young, you know, single, pregnant women and the disabled and the elderly,” Speaker Johnson said. “But what’s happening right now is you have a lot of people, for example, young men, able-bodied workers, who are on Medicaid. They’re not working when they can.”

Maybe he should be working, but does this mean he shouldn't have Medicaid? Credit: Microsoft Designer

He’s generally right that, for most of its existence, Medicaid was not truly a program for the poor so much as for certain kinds of poor people, especially low income pregnant women and children, and the medically impoverished. It took Obamacare to widen coverage to all people under the poverty line, although the Supreme Court allowed states to decide if they wanted to do so, and ten states still have not.

It is, indeed, a moral question, just not the kind that Speaker Johnson likes, about whether there is a moral imperative to give more people, especially poor people, health coverage.  

The issue of these non-working Medicaid recipients is something of a shibboleth. Kaiser Family Foundation, for example, found “that 92% of Medicaid adults are either working (64%) or have circumstances that may qualify them for an exemption.” A 2023 CBO analysis cast doubt that such work requirements wouldn’t have much impact on the number of Medicaid recipients working. Work requirements are a solution in search of a problem.

Credit: Kaiser Family Foundation

What we do know about work requirements, from waiver programs in Arkansas and Georgia, is that they do, indeed, reduce the number of people on Medicaid, but largely by making it more difficult to verify eligibility. The requirements are confusing, the processes the recipients/potential recipients have to follow are cumbersome, and the mechanisms required to oversee them are expensive (or, depending on your perspective, lucrative for some vendors).

It's not about getting able-bodied people on Medicaid to work, and it is not about “waste, fraud and abuse;” it’s about getting fewer people enrolled in Medicaid.

The calls to return Medicaid to its original purpose seem very self-serving. Medicare, for example, did not original cover people with ESRD or disabled people under 65. Social Security did not originally cover farm workers or self-employed workers, and didn’t include benefits for disabled people or survivors of retired persons (spouses and children). We could save lots of money by returning those programs to their original purposes, but those are bridges that Republicans are not ready to cross…yet.

If we think Medicaid is not the right program for many poor people, well, that’s a fair discussion. Medicaid has more than its share of problems, not the least of which are low reimbursement rates in most states and a resulting lack of participating health care providers. Many poor people might, indeed, be better served by just letting them enroll in an ACA plan.

Unfortunately, though, ACA wasn’t designed for poor people, Its premium subsidies and cost sharing reductions do not apply to people with incomes under the federal poverty level. It was assumed that such people would all be covered by Medicaid expansion. Sure, low income people could get an ACA plan, but it is hard to see how they could afford the premiums or to pay deductibles/coinsurance amounts for care they might receive.

Maybe those low income, videogame playing young men could get jobs, but there’s a good chance their employers wouldn’t offer health insurance, or, even if they did, the required employee premium contribution would be unaffordable, or they could try to get an even more unaffordable ACA plan. For better or for worse, in the convoluted system we have Medicaid is the best place for them.

The moral component that Speaker Johnson and others – many of whom profess to be devout Christians – seem to miss is that in the richest country in the world no one should not get the health care they should have due to its cost. The best way the U.S. has found to try to achieve that – and it is a wildly imperfect solution -- is to get more people covered by some form of health insurance. ACA cut the number of those without insurance almost in half, but that still leaves almost 30 million people without coverage.  

The ”big, beautiful bill” is estimated to add another 10+ million people to the ranks of the uninsured, most but not all of whom would come from people losing Medicaid coverage. It could also, oh-by-the-way, further cripple safety net hospitals and professionals, further exacerbating the impact.

So when you hear Republicans talk about “waste, fraud and abuse” in Medicaid, what they’re saying is that some people do not deserve to get health care (similar SNAP cuts mean some people don’t deserve to eat). I have a hard time with that, and I don’t even need to check my Bible to be pretty sure it’s morally wrong.

Whether or not those people are playing videogames.

If they want to go after fraudulent billing, overtreatment, kickbacks, and so on, yeah, I’m all onboard for targeting those kinds of waste, fraud and abuse. But kicking poor people when they’re already down, no.

I'm Sensing Some Future

One of my frequent laments is that here we are, a quarter of the way into the 21^st century, yet too much of our health care system still looks like the 20^th century, and not enough like the 22^nd century. It’s too slow, too reactive, too imprecise, and uses too much brute force. I want a health care system that seems more futuristic, that does things more elegantly.

We're not there yet - but we're getting closer. Credit: Microsoft Designer

So here are three examples of the kinds of things that give me hope, in rough order of when they might be ready for prime time:

Floss sensor: You know you’re supposed to floss every day, right? And you know that your oral health is connected to your overall health, in a number of ways, right? So some smart people at Tufts University thought, hmm, perhaps we can help connect those dots.

 “It started in a collaboration with several departments across Tufts, examining how stress and other cognitive states affect problem solving and learning,” said Sameer Sonkusale, professor of electrical and computer engineering. “We didn’t want measurement to create an additional source of stress, so we thought, can we make a sensing device that becomes part of your day-to-day routine? Cortisol is a stress marker found in saliva, so flossing seemed like a natural fit to take a daily sample.”

The result: “a saliva-sensing dental floss looks just like a common floss pick, with the string stretched across two prongs extending from a flat plastic handle, all about the size of your index finger.”

The floss sensor that can assess your stress level. Photo: Atul Sharma and Nafize Ishtiaque Hossain

It uses a technology called electropolymerized molecularly imprinted polymers (eMIPs) to detect the cortisol. “The eMIP approach is a game changer,” said Professor Sonkusale. “Biosensors have typically been developed using antibodies or other receptors that pick up the molecule of interest. Once a marker is found, a lot of work has to go into bioengineering the receiving molecule attached to the sensor. eMIP does not rely on a lot of investment in making antibodies or receptors. If you discover a new marker for stress or any other disease or condition, you can just create a polymer cast in a very short period of time.”

The sensor is designed to track rather to diagnose, but the scientists are optimistic that the approach can be used to track other conditions, such as oestrogen for fertility tracking, glucose for diabetes monitoring, or markers for cancer. They also hope to have a sensor that can track multiple conditions, “for more accurate monitoring of stress, cardiovascular disease, cancer, and other conditions.” 

They believe that their sensor has comparable accuracy to the best performing sensors currently available, and are working n a start-up to commercialize their approach.

Nano-scale biosensor: Flossing is all well and good, but many of us are not as diligent about it as we should be, so, hey, what about sensors inside us that do the tracking without us having to do anything? That’s what a team at Stanford are suggesting in A biochemical sensor with continuous extended stability in vivo, published in Nature.

The researchers say:

The development of biosensors that can detect specific analytes continuously, in vivo, in real time has proven difficult due to biofouling, probe degradation and signal drift that often occur in vivo. By drawing inspiration from intestinal mucosa that can protect host cell receptors in the presence of the gut microbiome, we develop a synthetic biosensor that can continuously detect specific target molecules in vivo.

“We needed a material system that could sense the target while protecting the molecular switches, and that’s when I thought, wait, how does biology solve this problem?” said Yihang Chen, the first author of the paper. Their modular biosensor, called the Stable Electrochemical Nanostructured Sensor for Blood In situ Tracking (SENSBIT) system, can survive more than a week in live rats and a month in human serum.

A figure showing how SENSBIT mimics intestinal mucosa. Credit: Yihang Chen using BioRender

“This work began more than a dozen years ago and we have been steadily advancing this technology,” said Tom Soh, senior author of the paper. “This order-of-magnitude improvement in whole-blood sensor longevity over existing technologies is a huge advancement toward next-generation biosensors.”

The researchers believe their approach can lead to a new medical paradigm – “one where we can not only detect disease earlier but also potentially tailor treatments in real time.” Amen to that!

In vivo CAR-T therapies: If you follow cancer treatments, you’re familiar with CAR-T therapies, which engineer immune cells to fight cancer cells. They’re very promising, but very expensive, and time-consuming to make. “This whole process, it’s just inefficient,” Saar Gill, a haematologist and oncologist also at the Perelman School of Medicine, told Cassandra Willyard in Nature. “If I’ve got a patient with cancer, I can prescribe chemotherapy and they’ll get it tomorrow.”

Ms. Willyard profiles the approach of engineering the CAR-T cells in vivo. The potential, she reports, is enormous: “Treatments that deliver a gene for the CAR protein to cells in the blood could be mass produced and available on demand — theoretically, at a much lower price than current CAR-T therapies. A single dose of commercial CAR-T therapy costs around $500,000. A vial of in vivo treatment might cost an order of magnitude less.”

“If it’s efficacious and safe, it could really challenge the current paradigm,” Joseph McGuirk, a haematologist and oncologist who studies cellular therapies at the University of Kansas Medical Center, told her. And “we need to challenge the current paradigm”.

Obviously, this is not simple. “The stumbling block is, how do you get it to the right cell, the right place, right time?” said Michel Sadelain, a genetic engineer and director of the Columbia Initiative in Cell Engineering and Therapy at Columbia University. Ms. Willard describes different approaches that different companies are trying to accomplish this. Some companies, for example, are using viral vectors, while others use nanoparticles to deliver RNA into T cells. Other companies are skipping T cells and inserting the RNA into macrophages and other immune cells.

Human trials are underway, although with small numbers of participants. “I think 2025 and 2026 are going to be two very busy years in this area,” one CEO told Ms. Willyard.  Let’s hope so.

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Each of these is promising, and certainly in the right direction. Add these to, say, 3D printing in vivo using sound or programming smart cells, and forgive me if I get excited. We’re seeing glimpses of the future.

So next time someone wants to stick a needle in you for a blood test, put you through a colonoscopy, or start you on a grueling chemotherapy regime, ask yourself: would I be doing this in the 22^nd century?