Donating embryos for research is surprisingly complex

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There’s a new film about IVF out on Netflix. And “everyone in the field [of reproductive medicine] has watched it,” according to one embryologist I spoke to recently. Joy is a lovely watch about the birth of the field, thanks to the persistent efforts of Robert Edwards, Jean Purdy, and Patrick Steptoe in the face of significant opposition.

The team performed much of their key research during the 1960s and ’70s. And Louise Brown, the first “test tube baby” (as she was called at the time), was born in 1978. It’s remarkable to think that within 40 years of that milestone, another 8 million babies had been born through IVF. Today, it is estimated that over 12 million babies have resulted from IVF, and that the use of reproductive technology accounts for over 2% of births in the US.

IVF is a success story for embryo research. But today, valuable embryos that could be used for research are being wasted, say researchers who gathered at a conference in central London earlier this week.

The conference was organized by the Progress Educational Trust, a UK-based charity that aims to provide information to the public on genomics and infertility. The event marked 40 years since the publication of the Warnock Report, which followed a governmental inquiry into infertility treatment and embryological research. The report is considered to be the first to guide recognition of the embryo’s “special” status in law and helped establish regulation of the nascent technology in the UK.

The report also endorsed the “14-day rule,” which limits the growth of embryos in a lab to this two-week point. The rule, since adopted around the world, is designed to prevent scientists from growing embryos to the point where they develop a structure called the primitive streak. At this point, the development of tissues and organs begins, and the embryo is no longer able to split to form twins. 

The embryos studied in labs have usually been created for IVF but are no longer needed by the people whose cells created them. Those individuals might have completed their families, or they might not be able to use the embryos because their circumstances have changed. Sometimes the embryos have genetic abnormalities that make them unlikely to survive a pregnancy.

These embryos can be used to learn more about how humans develop before birth, and to discover potential treatments for developmental disorders like spina bifida or heart defects, for example. Research on embryos can help reveal clues about our fundamental biology, and provide insight into pregnancy and miscarriage.

A survey conducted by the Human Fertility and Embryology Authority, which regulates reproductive technology in the UK, found that the majority of patients would rather donate their embryos to research than allow them to “perish,” Geraldine Hartshorne, director of the Coventry Centre for Reproductive Medicine, told the audience.

Despite this, the number of embryos donated for research in the UK has dropped steeply over the last couple of decades, from 17,925 in 2004 to 675 in 2019—a surprising decline considering that the number of IVF cycles performed increased steadily over the same period. 

There are a few reasons why embryos aren’t making it into research labs, says Hartshorne. Part of the problem is that most IVF cycles happen at clinics that don’t have links with academic research centers.

As things stand, embryos tend to be stored at the clinics where they were created. It can be difficult to get them to research centers—clinic staff don’t have the time, energy, or head space to manage the paperwork legally required to get embryos donated to specific research projects, said Hartshorne. It would make more sense to have some large, central embryo bank where people could send embryos to donate for research, she added.

A particular problem is the paperwork. While the UK is rightly praised for its rigorous approach to regulation of reproductive technologies, which embryologists around the globe tend to describe as “world-leading,” there are onerous levels of bureaucracy to contend with, said Hartshorne. “When patients contact me and say ‘I’d like to give my embryos or my eggs to your research project,’ I usually have to turn them away, because it would take me a year to get through the paperwork necessary,” she said.

Perhaps there’s a balance to be struck. Research on embryos has the potential to be hugely valuable. As the film Joy reminds us, it can transform medical practice and change lives.

“Without research, there would be no progress, and there would be no change,” Hartshorne said. “That is definitely not something that I think we should aspire to for IVF and reproductive science.”

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Scientists are working on ways to create embryos from stem cells, without the use of eggs or sperm. How far should we allow these embryo-like structures to develop? 

Researchers have implanted these “synthetic embryos” in monkeys. So far, they’ve been able to generate a short-lived pregnancy-like response … but no fetuses.

Others are trying to get cows pregnant with synthetic embryos. Reproductive biologist Carl Jiang’s first goal is to achieve a cow pregnancy that lasts 30 days. 

Several startups are using robots to fertilize eggs with sperm to create embryos. Two girls are the first people to be born after robot-assisted fertilization, says the team behind the work. 

From around the web

Mexico’s Sinaloa cartel is recruiting young chemistry students from colleges to make fentanyl. Specifically, the students are being tasked with the often dangerous job of trying to synthesize precursor chemicals that must currently be imported. They also try to design stronger versions of the drug that are more likely to get users hooked. (New York Times)

Billionaire Greg Lindberg is running his own “baby project.” Having duped, misled, and paid off a series of egg donors and surrogates, the disgraced insurance tycoon currently has 12 children, nine of whom were born in the last five years or so. He is the sole parent caring for eight of them, despite facing significant jail time since being convicted of bribery and pleading guilty to money laundering and fraud conspiracy charges for crimes unrelated to the baby project. The scale of his project is an indictment of the US fertility industry. (Bloomberg Businessweek)

The UK government has agreed to a contract for more than 5 million doses of a vaccine designed to protect people from the H5 bird flu virus. The vaccine is being procured as part of pandemic preparedness plans and will be used only if the virus starts spreading among humans. (UK Health Security Agency)

Last week, MPs voted in favor of a bill to legalize assisted dying in England and Wales. In the past few months, the debate over the bill has included horror stories of painful deaths. Most deaths are “ordinary,” but we all stand to benefit from talking about, and understanding, what death involves. (New Statesman)

An unknown disease has killed 143 people in southwest Congo, according to local authorities. The number of infections continues to rise, and the situation is extremely worrying. (Reuters)

Brian Thompson, the 50-year-old CEO of US health insurance company UnitedHealthcare, was fatally shot in New York city on Wednesday. The New York Times is reporting that bullet casings found at the scene appear to have been marked with the words “delay” and “deny.” The words may refer to strategies used by insurance companies to avoid covering healthcare costs. (New York Times)

The risk of a bird flu pandemic is rising

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How worried should we be about bird flu? It’s a question that I’ve been asked by friends and colleagues several times over the last couple of weeks. Their concerns have been spurred by some potentially worrisome developments in the US, including the continued spread of the virus among dairy cattle, the detection of the virus in a pig as well as cow’s milk, and—most concerning of all—the growing number of human infections.

I’ll admit that I’m worried. We don’t yet have any evidence that the virus is spreading between people, but the risk of a potential pandemic has increased since I last covered this topic a couple of months ago.

And once you combine that increased risk with an upcoming change in presidential administration that might leave US health agencies in the hands of a vaccine denier who promotes the consumption of raw milk, well … it’s not exactly a comforting thought.

The good news is we are in a much better position to tackle any potential future flu outbreaks than we were to face covid-19 back in 2020, given that we already have vaccines. But, on the whole, it’s not looking great.

The bird flu that is currently spreading in US dairy cattle is caused by the H5N1 virus. The virus is especially lethal to some bird populations and has been wiping out poultry and seabirds for the last couple of years. It has also caused fatal infections in many mammals who came into contact with those birds.

H5N1 was first detected in a dairy cow in Texas in March of this year. As of this week, the virus has been reported in 675 herds across 15 states, according to the US Department of Agriculture’s Animal and Plant Health Inspection Service (also known as APHIS).

Those are just the cases we know about. There may be more. The USDA requires testing of cattle before they are moved between states. And it offers a voluntary testing program for farmers who want to know if the virus is present in their bulk milk tanks. But participation in that program is optional.

States have their own rules. Colorado has required testing of bulk milk tanks in licensed dairy farms since July. The Pennsylvania Department of Agriculture announced plans for a program just last week. But some states have no such requirements.

At the end of October, the USDA reported that the virus had been detected in a pig for the first time. The pig was one of five in a farm in Oregon that had “a mix of poultry and livestock.” All the pigs were slaughtered.

Virologists have been especially worried about the virus making its way into pigs, because these animals are notorious viral incubators. “They can become infected with swine strains, bird strains and human strains,” says Brinkley Bellotti, an infectious disease epidemiologist at Wake Forest University in North Carolina. These strains can swap genes and give rise to new, potentially more infectious or harmful strains.

Thankfully, we haven’t seen any other cases in pig farms, and there’s no evidence that the virus can spread between pigs. And while it has been spreading pretty rapidly between cattle, the virus doesn’t seem to have evolved much, says Seema Lakdawala, a virologist at the Emory University School of Medicine in Atlanta, Georgia. That suggests that the virus made the leap into cattle, probably from birds, only once. And it has been spreading through herds since.

Unfortunately, we still don’t really know how it is spreading. There is some evidence to suggest the virus can be spread from cow to cow through shared milking equipment. But it is unclear how the virus is spreading between farms. “It’s hard to form an effective control strategy when you don’t know exactly how it’s spreading,” says Bellotti.

But it is in cows. And it’s in their milk. When scientists analyzed 297 samples of Grade A pasteurized retail milk products, including milk, cream and cheese, they found viral RNA from H5N1 in 20% of them. Those samples were collected from 17 states across the US. And the study was conducted in April, just weeks after the virus was first detected in cattle. “It’s surprising to me that we are totally fine with … our pasteurized milk products containing viral DNA,” says Lakdawala.

Research suggests that, as long as the milk is pasteurized, the virus is not infectious. But Lakdawala is concerned that pasteurization may not inactivate all of the virus, all the time. “We don’t know how much virus we need to ingest [to become infected], and whether any is going to slip through pasteurization,” she says.

And no reassurances can be made for unpasteurized raw milk. When cows are infected with H5N1, their milk can turn thick, yellow and “chunky.” But research has shown that, even when the milk starts to look normal again, it can still contain potentially infectious virus.

The most concerning development, though, is the rise in human cases. So far, 55 such cases of H5N1 bird flu have been reported in the US, according to the US Centers for Disease Control and Prevention (CDC). Twenty-nine of those cases have been detected in California. In almost all those cases, the infected person is thought to have caught the virus from cattle or poultry on farms. But in two of those cases, the source of the infection is unknown.

Health professionals don’t know how a teenager in British Columbia, Canada, got so sick with bird flu, either. The anonymous teenager, who sought medical care for an eye infection on November 2, is still seriously ill in hospital, and continues to rely on a ventilator to breathe. Local health officials have closed their investigation into the teen’s infection.

There may be more, unreported cases out there, too. When researchers tested 115 dairy farm workers in Michigan and Colorado, they found markers of recent infection with the virus in 7% of them.

So far, there is no evidence that the virus can spread between people. But every human infection offers the virus another opportunity to evolve into a form that can do just that. People can act as viral incubators, too. And during flu season, there are more chances for the H5N1 virus to mix with circulating seasonal flu viruses. 

“Just because we [haven’t seen human-to-human spread] now doesn’t mean that it’s not capable of happening, that it won’t happen, or that it hasn’t already happened,” says Lakdawala.

So where do we go from here? Lakdawala thinks we should already have started vaccinating dairy farm workers. After all, the US has already stockpiled vaccines for H5N1, which were designed to protect against previous variants of the virus. “We’re not taking [the human cases] seriously enough,” she says.

We need to get a better handle on exactly how the virus is spreading, too, and implement more effective measures to stop it from doing so. That means more testing of both cows and dairy farm workers at the very least. And we need to be clear that, despite what Robert F. Kennedy Jr., the current lead contender for the role of head of the US Department of Health and Human Services, says, raw milk can be dangerous, and vaccines are a vital tool in the prevention of pandemics.

We still have an opportunity to prevent the outbreak from turning into a global catastrophe. But the situation has worsened since the summer. “This is sort of how the 2009 pandemic started,” says Lakdawala, referring to the H1N1 swine flu pandemic. “We started to have a couple of cases sporadically, and then the next thing you knew, you were seeing it everywhere.”

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The US is planning to stockpile millions of doses of H5N1 vaccines. But our current approach to making flu vaccines is slow and cumbersome. New vaccines that don’t rely on the use of eggs, or make use of mRNA, might offer a better alternative.

Flu season is already underway in the US, where bird flu is spreading among cattle. That has virologists worried that a person infected with both viruses could unwittingly incubate an all-new strain of the virus.

Robert F. Kennedy Jr. has already spread harmful misinformation, pseudoscience and fringe theories about AIDS and covid-19.

Some researchers are exploring new ways to prevent the spread of H5N1 in poultry. The gene editing tool CRISPR could be used to help make chickens more resistant to the virus, according to preliminary research published last year.

From around the web

President-elect Donald Trump has chosen Jay Bhattacharya for his pick to lead the US National Institutes of Health, an agency with a $48 billion budget that oversees the majority of medical research in the country. Bhattacharya was one of three lead authors of the Great Barrington Declaration, a manifesto published in 2020 arguing against lockdowns during the height of the covid-19 pandemic, and supporting a “let it rip” approach instead. (STAT)

An IVF mix up left two families raising each other’s biological babies. They didn’t realize until the children were a couple of months old. What should they do? (Have the tissues ready for this one, which is heartbreaking and heartwarming in equal measure) (New York Times)

Why do we feel the need to surveil our sleeping babies? This beautiful comic explores the various emotional pulls experienced by new parents. (The Verge)

Australia’s parliament has passed a law that bans children under the age of 16 from using social media. Critics are concerned that the law is a “blunt instrument” that might drive young teens to the dark web, or leave them feeling isolated. (The Guardian)

Lab-grown foie gras, anyone? Cultivated meat is going high-end, apparently. (Wired)

Who should get a uterus transplant? Experts aren’t sure.

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

Earlier this year, a boy in Sweden celebrated his 10th birthday. Reproductive scientists and doctors marked the occasion too. This little boy’s birth had been special. He was the first person to be born from a transplanted uterus.

The boy was born in 2014 after his mother, a 35-year-old woman who had been born without a uterus, received a donated uterus from a 61-year-old close family friend. At the time, she was one of only 11 women who had undergone the experimental procedure.

A decade on, over 135 uterus transplants have been performed globally, resulting in the births of over 50 healthy babies. The surgery has had profound consequences for these families—the recipients would not have been able to experience pregnancy any other way.

But legal and ethical questions continue to surround the procedure, which is still considered experimental. Who should be offered a uterus transplant? Could the procedure ever be offered to transgender women? And if so, who should pay for these surgeries?

These issues were raised at a recent virtual event run by Progress Educational Trust, a UK-based charity that aims to provide information to the public on genomics and infertility. One of the speakers was Mats Brännström, who led the team at the University of Gothenburg that performed the first successful transplant.

For Brännström, the story of uterus transplantation begins in 1998. While traveling in Australia, he said, he met a 27-year-old woman called Angela, who longed to be pregnant but lacked a functional uterus. She suggested to Brännström that her mother could donate hers. “I was amazed I hadn’t thought of it before,” he said.

According to Brännström, around 1 in 500 women experience infertility due to what’s known as absolute uterine factor infertility, or AUFI, meaning they do not have a functional uterus. Uterus transplants could offer them a way to get pregnant.

His meeting with Angela kick-started a research project that started in mice and eventually moved on to pigs, sheep, and baboons. Brännström’s team started performing uterus transplants in women as part of a small clinical trial in 2012. In that trial, all the donors were living, and in many cases they were the mothers or aunts of the recipients.

The surgeries ended up being more complicated than he had anticipated, said Brännström. The operation to remove a donor’s uterus was expected to take between three and four hours. It ended up taking between eight and 11 hours.  

In that first trial, Brännström’s team transplanted uteruses into nine women, each of whom had IVF to create and store embryos beforehand. The woman who was the first to give birth had IVF over a 12-month period, which ended six months before her surgery. It took a little over 10 hours to remove the uterus from the donor, and just under five hours to stitch it into the recipient.

The recipient started getting her period 43 days after her transplant. Doctors transferred one of her embryos into the uterus a year after her surgery. Three weeks later, a pregnancy test confirmed she was pregnant.

At 31 weeks, she was admitted to hospital with preeclampsia, a serious medical condition that can develop during pregnancy, and her baby was delivered by C-section 16 hours later. She was discharged from hospital after three days, although the baby spent 16 days in the hospital’s neonatal unit.

Despite those difficulties, her story is considered a success. Other uterus recipients have also experienced pregnancy complications, and some have had surgical complications. And all transplant recipients must adhere to a regimen of immunosuppressant drugs, which can have side effects.

The uteruses aren’t intended to last forever, either. Surgeons remove them once the recipients have completed their families, often after one or two children. The removal is also a significant operation.

Given all that, uterus transplants are not to be taken lightly. And there are other paths to parenthood. Some ethicists are concerned that in pursuing uterus transplantation as a fertility treatment, we might reinforce ideas that define a woman’s value in terms of her reproductive potential, Natasha Hammond-Browning, a legal scholar at Cardiff University in Wales, said at the event. “There is debate around whether we should be giving greater preference to adoption, to surrogacy, and to supporting children who already exist and who need care,” she said.

We also need to consider whether there is a “right to gestate,” and if there is, who has that right, said Hammond-Browning. And these concerns need to be balanced with the importance of reproductive autonomy—the idea that people have the right to decide and control their own reproductive efforts.

Further questions remain over whether uterus transplants might ever be an option for trans women, who not only lack a uterus but also have a different pelvic anatomy. I asked the speakers if the surgery might ever be feasible. They weren’t hugely optimistic that it would, at least in the near future.

“I personally think that the transgender community have been given … false hope for responsible transplantation in the near future,” was the response of J. Richard Smith of Imperial College London, who co-led the first uterus transplant performed in the UK. Even cisgender women who have needed surgery to create “neovaginas” aren’t eligible for the uterus transplants his team are offering as part of a clinical study. They have an altered vaginal microbiome that appears to increase the risk of miscarriage, he said.

“There is a huge amount of work to be done before this work can be translated to the transgender community,” Smith said. Brännström agreed but added that he thinks the surgery will be available at some point—just after a lot more research.

And then there are the legal and ethical questions, none of which have easy answers. Hammond-Browning pointed out that clinical teams would first need to determine what the goal of such an operation would be. Is it about reproduction or gender realignment, for example? And how might that goal influence decisions over who should get a donated uterus, and why?

Considering only 135 human uterus transplants have ever been carried out, we still have a lot to learn about the best way to perform them. (For context, more than 25,000 kidney transplants were carried out in 2023 in the US alone.) Researchers are still figuring out how uteruses from deceased donors differ from those of living ones, and how to minimize complications in young, healthy women. Since that little boy was born 10 years ago, only 50 other children have been born in a similar way. It’s still early days.

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The first birth following the transplantation of a uterus from a dead donor happened in 2017. A team in Brazil transferred the uterus of a 45-year-old donor, who had died from a brain hemorrhage, to a 32-year-old recipient born without a uterus. 

Researchers are working on artificial wombs—“biobags” designed to care for premature babies. They have been tested on lambs and piglets. Now FDA advisors are figuring out how to move the technology into human trials. 

An alternative type of artificial womb is being used to grow mouse embryos. Jacob Hanna at the Weizmann Institute of Science and his colleagues say they’ve been able to grow embryos in this environment for 11 or 12 days—around half the animal’s gestational period. 

Research is underway to develop new fertility options for transgender men. Some of these men are put off by existing approaches, which tend to involve pausing hormone therapy and undergoing potentially distressing procedures. 

From around the web

People on Ozempic, Wegovy, and similar drugs are losing their appetite for sugary, ultraprocessed foods. The food industry will have to adapt. (TIL Nestlé has already started a line of frozen meals targeted at people on these weight-loss drugs.) (The New York Times Magazine)

People who have a history of obesity can find it harder to lose weight. That might be because the fat cells in our bodies seem to “remember” that history and have an altered response to food. (The Guardian)

Robert F. Kennedy Jr. took leave as chairman of Children’s Health Defense, a nonprofit known for spreading doubt about vaccines, to run for US president last year. But he is still involved in legal cases filed by the group. And several of its cases remain open, including ones against the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health—all agencies Kennedy would lead if his nomination for head of Health and Human Services is confirmed. (STAT)

Researchers are among the millions of new users of Bluesky, a social media alternative to X (formerly known as Twitter). “There is this pent-up demand among scientists for what is essentially the old Twitter,” says one researcher who found that the number of influential scientists using the platform doubled between August and November. (Science) 

Since 2016, a team of around 100 scientists have been working to catalogue the 37 trillion or so cells in the human body. This week, the Human Cell Atlas published a collection of studies that represents a significant first step toward that goal—including maps of cells in the nervous system, lungs, heart, gut, and immune system. (Nature)

Why the term “women of childbearing age” is problematic

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

Every journalist has favorite topics. Regular Checkup readers might already know some of mine, which include the quest to delay or reverse human aging, and new technologies for reproductive health and fertility. So when I saw trailers for The Substance, a film centered on one middle-aged woman’s attempt to reexperience youth, I had to watch it.

I won’t spoil the movie for anyone who hasn’t seen it yet (although I should warn that it is not for the squeamish, or anyone with an aversion to gratuitous close-ups of bums and nipples). But a key premise of the film involves harmful attitudes toward female aging.

“Hey, did you know that a woman’s fertility starts to decrease by the age of 25?” a powerful male character asks early in the film. “At 50, it just stops,” he later adds. He never explains what stops, exactly, but to the viewer the message is pretty clear: If you’re a woman, your worth is tied to your fertility. Once your fertile window is over, so are you.

The insidious idea that women’s bodies are, above all else, vessels for growing children has plenty of negative consequences for us all. But it has also set back scientific research and health policy.

Earlier this week, I chatted about this with Alana Cattapan, a political scientist at the University of Waterloo in Ontario, Canada. Cattapan has been exploring the concept of “women of reproductive age”—a descriptor that is ubiquitous in health research and policy.

The idea for the research project came to her when the Zika virus was making headlines around eight years ago. “I was planning on going to the Caribbean for a trip related to my partner’s research, and I kept getting advice that women of reproductive age shouldn’t go,” she told me. At the time, Zika was being linked to microcephaly—unusually small heads—in newborn babies. It was thought that the virus was affecting key stages of fetal development.

Cattapan wasn’t pregnant. And she wasn’t planning on becoming pregnant at the time. So why was she being advised to stay away from areas with the virus?

The experience got her thinking about the ways in which attitudes toward our bodies are governed by the idea of potential pregnancy. Take, for example, biomedical research on the causes and treatment of disease. Women’s health has lagged behind men’s as a focus of such work, for multiple reasons. Male bodies have long been considered the “default” human form, for example. And clinical trials have historically been designed in ways that make them less accessible for women.

Fears about the potential effects of drugs on fetuses have also played a significant role in keeping people who have the potential to become pregnant out of studies. “Scientific research has excluded women of ‘reproductive age,’ or women who might potentially conceive, in a blanket way,” says Cattapan. “The research that we have on many, many drugs does not include women and certainly doesn’t include women in pregnancy.”  

This lack of research goes some way to explaining why women are much more likely to experience side effects from drugs—some of them fatal. Over the last couple of decades, greater effort has been made to include people with ovaries and uteruses in clinical research. But we still have a long way to go.

Women are also often subjected to medical advice designed to protect a potential fetus, whether they are pregnant or not. Official guidelines on how much mercury-containing fish it is safe to eat can be different for “women of childbearing age,” according to the US Environmental Protection Agency, for example.  And in 2021, the World Health Organization used the same language to describe people who should be a focus of policies to reduce alcohol consumption. 

The takeaway message is that it’s women who should be thinking about fetal health, says Cattapan. Not the industries producing these chemicals or the agencies that regulate them. Not even the men who contribute to a pregnancy. Just women who stand a chance of getting pregnant, whether they intend to or not. “It puts the onus of the health of future generations squarely on the shoulders of women,” she says.

Another problem is the language itself. The term “women of reproductive age” typically includes women between 15 and 44. Women at one end of that spectrum will have very different bodies and a very different set of health risks from those at the other. And the term doesn’t account for people who might be able to get pregnant but don’t necessarily identify as female.

In other cases it is overly broad. In the context of the Zika virus, for example, it was not all women between the ages of 15 and 44 who should have considered taking precautions. The travel advice didn’t apply to people who’d had hysterectomies or did not have sex with men, for example, says Cattapan. “Precision here matters,” she says. 

More nuanced health advice would be helpful in cases like these. Guidelines often read as though they’re written for people assumed to be stupid, she adds. “I don’t think that needs to be the case.”

Another thing

On Thursday, president-elect Donald Trump said that he will nominate Robert F. Kennedy Jr. to lead the US Department of Health and Human Services. The news was not entirely a surprise, given that Trump had told an audience at a campaign rally that he would let Kennedy “go wild” on health, “the foods,” and “the medicines.”

The role would give Kennedy some control over multiple agencies, including the Food and Drug Administration, which regulates medicines in the US, and the Centers for Disease Control and Prevention, which coordinates public health advice and programs.

That’s extremely concerning to scientists, doctors, and health researchers, given Kennedy’s positions on evidence-based medicine, including his antivaccine stance. A few weeks ago, in a post on X, he referred to the FDA’s “aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”  

“If you work for the FDA and are part of this corrupt system, I have two messages for you,” continued the post. “1. Preserve your records, and 2. Pack your bags.”

There’s a lot to unpack here. But briefly, we don’t yet have good evidence that mind-altering psychedelic drugs are the mental-health cure-alls some claim they are. There’s not enough evidence to support the many unapproved stem-cell treatments sold by clinics throughout the US and beyond, either. These “treatments” can be dangerous.

Health agencies are currently warning against the consumption of raw unpasteurized milk, because it might carry the bird flu virus that has been circulating in US dairy farms. And it’s far too simplistic to lump all vitamins together—some might be of benefit to some people, but not everyone needs supplements, and high doses can be harmful.

Kennedy’s 2021 book The Real Anthony Fauci has already helped spread misinformation about AIDS. Here at MIT Technology Review, we’ll continue our work reporting on whatever comes next. Watch this space.

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The tech industry has a gender problem, as the Gamergate and various #MeToo scandals made clear. A new generation of activists is hoping to remedy it. 

Male and female immune systems work differently. Which is another reason why it’s vital to study both women and female animals as well as males. 

Both of the above articles were published in the Gender issue of MIT Technology Review magazine. You can read more from that issue online here.

Women are more likely to receive abuse online. My colleague Charlotte Jee spoke to the technologists working on an alternative way to interact online: a feminist internet.

From around the web 

The scientific community and biopharma investors are reacting to the news of Robert F. Kennedy Jr.’s nomination to lead the Department of Health and Human Services. “It’s hard to see HHS functioning,” said one biotech analyst. (STAT)

Virologist Beata Halassy successfully treated her own breast cancer with viruses she grew in the lab. She has no regrets. (Nature)

Could diet influence the growth of endometriosis lesions? Potentially, according to research in mice fed high-fat, low-fiber “Western” diets. (BMC Medicine)

Last week, 43 female rhesus macaque monkeys escaped from a lab in South Carolina. The animals may have a legal claim to freedom. (Vox)

What’s next for reproductive rights in the US

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

Earlier this week, Americans cast their votes in a seminal presidential election. But it wasn’t just the future president of the US that was on the ballot. Ten states also voted on abortion rights.

Two years ago, the US Supreme Court overturned Roe v. Wade, a legal decision that protected the right to abortion. Since then, abortion bans have been enacted in multiple states, and millions of people in the US have lost access to local clinics.

Now, some states are voting to extend and protect access to abortion. This week, seven states voted in support of such measures. And voters in Missouri, a state that has long restricted access, have voted to overturn its ban.

It’s not all good news for proponents of reproductive rights—some states voted against abortion access. And questions remain over the impact of a second term under former president Donald Trump, who is set to return to the post in January.

Roe v. Wade, the legal decision that enshrined a constitutional right to abortion in the US in 1973, guaranteed the right to an abortion up to the point of fetal viability, which is generally considered to be around 24 weeks of pregnancy. It was overturned by the US Supreme Court in the summer of 2022.

Within 100 days of the decision, 13 states had enacted total bans on abortion from the moment of conception. Clinics in these states could no longer offer abortions. Other states also restricted abortion access. In that 100-day period, 66 of the 79 clinics across 15 states stopped offering abortion services, and 26 closed completely, according to research by the Guttmacher Institute.

The political backlash to the decision was intense. This week, abortion was on the ballot in 10 states: Arizona, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, New York, and South Dakota. And seven of them voted in support of abortion access.

The impact of these votes will vary by state. Abortion was already legal in Maryland, for example. But the new measures should make it more difficult for lawmakers to restrict reproductive rights in the future. In Arizona, abortions after 15 weeks had been banned since 2022. There, voters approved an amendment to the state constitution that will guarantee access to abortion until fetal viability.

Missouri was the first state to enact an abortion ban once Roe v. Wade was overturned. The state’s current Right to Life of the Unborn Child Act prohibits doctors from performing abortions unless there is a medical emergency. It has no exceptions for rape or incest. This week, the state voted to overturn that ban and protect access to abortion up to fetal viability. 

Not all states voted in support of reproductive rights. Amendments to expand access failed to garner enough support in Nebraska, South Dakota, and Florida. In Florida, for example, where abortions after six weeks of pregnancy are banned, an amendment to protect access until fetal viability got 57% of the vote, falling just short of the 60% the state required for it to pass.

It’s hard to predict how reproductive rights will fare over the course of a second Trump term. Trump himself has been inconsistent on the issue. During his first term, he installed members of the Supreme Court who helped overturn Roe v. Wade. During his most recent campaign he said that decisions on reproductive rights should be left to individual states.

Trump, himself a Florida resident, has refused to comment on how he voted in the state’s recent ballot question on abortion rights. When asked, he said that the reporter who posed the question “should just stop talking about that,” according to the Associated Press.

State decisions can affect reproductive rights beyond abortion access. Just look at Alabama. In February, the Alabama Supreme Court ruled that frozen embryos can be considered children under state law. Embryos are routinely cryopreserved in the course of in vitro fertilization treatment, and the ruling was considered likely to significantly restrict access to IVF in the state. (In March, the state passed another law protecting clinics from legal repercussions should they damage or destroy embryos during IVF procedures, but the status of embryos remains unchanged.)

The fertility treatment became a hot topic during this year’s campaign. In October, Trump bizarrely referred to himself as “the father of IVF.” That title is usually reserved for Robert Edwards, the British researcher who won the 2010 Nobel prize in physiology or medicine for developing the technology in the 1970s.

Whatever is in store for reproductive rights in the US in the coming months and years, all we’ve seen so far suggests that it’s likely to be a bumpy ride.

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My colleague Rhiannon Williams reported on the immediate aftermath of the decision that reversed Roe v. Wade when it was announced a couple of years ago. 

The Alabama Supreme Court ruling on embryos could also affect the development of technologies designed to serve as “artificial wombs,” as Antonio Regalado explained at the time.

Other technologies are set to change the way we have babies. Some, which could lead to the creation of children with four parents or none at all, stand to transform our understanding of parenthood.  

We’ve also reported on attempts to create embryo-like structures using stem cells. These structures look like embryos but are created without eggs or sperm. There’s a “wild race” afoot to make these more like the real thing. But both scientific and ethical questions remain over how far we can—and—should go.

My colleagues have been exploring what the US election outcome might mean for climate policies. Senior climate editor James Temple writes that Trump’s victory is “a stunning setback for climate change.” And senior reporter Casey Crownhart explains how efforts including a trio of laws implemented by the Biden administration, which massively increased climate funding, could be undone.

From around the web

Donald Trump has said he’ll let Robert F. Kennedy Jr. “go wild on health.” Here’s where the former environmental lawyer and independent candidate—who has no medical or public health degrees—stands on vaccines, fluoride, and the Affordable Care Act. (New York Times)

Bird flu has been detected in pigs on a farm in Oregon. It’s a worrying development that virologists were dreading. (The Conversation)

And, in case you need it, here’s some lighter reading:

Scientists are sequencing the DNA of tiny marine plankton for the first time. (Come for the story of the scientific expedition; stay for the beautiful images of jellies and sea sapphires.) (The Guardian)

Dolphins are known to communicate with whistles and clicks. But scientists were surprised to find a “highly vocal” solitary dolphin in the Baltic Sea. They think the animal is engaging in “dolphin self-talk.” (Bioacoustics)

How much do you know about baby animals? Test your knowledge in this quiz. (National Geographic)

How exosomes could become more than just an “anti-aging” fad

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

Over the past month or so, I’ve been working on a story about exosomes. You might have seen them advertised—they’re being touted as a hot new beauty treatment, a fountain of youth, and generally a cure-all therapy for a whole host of ailments.

Any cell biologist, though, will tell you what exosomes really are: tiny little blobs that bud off from cells and contain a mixture of proteins and other components. We’re not entirely clear what those components are or what they do, despite the promises made by medspas and cosmetic clinics charging thousands of dollars for exosome “therapies.” As one recipient of an exosome treatment told me, “I feel like it’s a little bit of health marketing bullshit.”

But there is some very exciting scientific research underway to better understand exactly what exosomes do. Scientists are exploring not only how these tiny particles might help cells communicate, but also how they might be used to diagnose or treat diseases. One company is trying to use exosomes to deliver drugs to the brains of people with rare neurological disorders.

It might take longer for these kinds of exosome applications to get to the clinic, but when they do, at least they’ll be evidence based.

Exosomes are a type of extracellular vesicle. This is a scientific way of saying they are basically little packages that bud off from cells. They were once thought to contain cellular garbage, but now scientists believe they convey important signals between cells and tissues.

Exactly what those signals are is still being figured out.  The contents of exosomes from cancer cells will probably be somewhat different to those from healthy cells, for example.

Because of that, many scientists hope that exosomes could one day be used to help us diagnose diseases. In theory, you could isolate exosomes from a blood sample, examine their contents, and figure out what might be going on in a person’s cells. Exosomes might provide clues as to how stressed or close to death a cell is. They might indicate the presence of a tumor.

Raghu Kalluri, a cancer biologist at MD Anderson Cancer Center in Houston, is one of the researchers exploring this possibility. “I believe that exosomes are likely providing a forensic fingerprint of what the cells are undergoing,” he says.

But understanding these signals won’t be straightforward. Exosomes from cancer cells might send signals to surrounding cells in order to “subjugate” them into helping the cancer grow, says Kalluri. Cells around a tumor might also send distress signals, alerting the immune system to fight back against it. “There’s definitely a role for these exosomes in cancer progression and metastasis,” he says. “Precisely what [that role is] is an active area of research right now.”

Exosomes could also be useful for delivering drug treatments. After all, they are essentially little packages of proteins and other matter that can be shuttled between cells. Why not fill them with a medicine and use them to target specific regions of the body?

Because exosomes are made in our bodies, they are less likely to be seen as “foreign” and rejected by our immune systems. And the outer layer of an exosome can serve as a protective coat, shielding the drug from being degraded until it reaches its destination, says James Edgar, who studies exosomes at the University of Cambridge. “It’s a really attractive method for drug delivery,” he says.

Dave Carter is one scientist working on it. Carter and his colleagues at Evox Therapeutics in Oxford, UK, are engineering cells to produce compounds that might help treat rare neurological diseases. These compounds could then be released from the cells in exosomes.

In their research, Carter and his colleagues can change almost everything about the exosomes they study. They can alter their contents, loading them with proteins or viruses or even gene-editing therapies. They can tweak the proteins on their surfaces to make them target different cells and tissues. They can control how long exosomes stay in an animal’s circulation.

“I always used to love playing with Lego,” he adds. “I feel like I’m playing with Lego when I’m working with exosomes.”

Others are hopeful that exosomes themselves hold some kind of therapeutic value. Some hope that exosomes derived from stem cells, for example, might have some regenerative capacity.

Ke Cheng at Columbia University in New York is interested in the idea of using exosomes to treat heart and lung conditions. Several preliminary studies suggest that exosomes from heart and stem cells might help animals like mice and pigs recover from heart injuries, such as those caused by a heart attack.

There are certainly plenty of clinical trials of exosomes underway. When I searched for “exosomes” on clinicaltrials.gov, I got over 400 results. These are early-stage trials, however—and are of variable quality.

Still, it’s an exciting time for exosome research. “It’s a growing field … I think we will see a lot of exciting science in the next five years,” says Cheng. “I’m very optimistic.”

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You can read the piece about the costly exosome treatments being sold in aesthetic clinics and medspas in my longer piece, which was published earlier this week. 

It can be difficult to establish credibility in a medical field when you’re being undercut by clinics selling unapproved treatments and individuals making outlandish claims. Just ask the doctors and scientists trying to legitimize longevity medicine. 

Some treatments can take off culturally without the backing of rigorous evidence, only to go up in flames when the trial results come in. We saw this earlier this year, when FDA advisors rejected the use of MDMA (or ecstasy) for post-traumatic stress disorder (PTSD) owing to “significant confounders” in the trials. 

For some people, unproven treatments might represent a last hope for survival. In those cases, how do we balance access to experimental medicine with the need to protect people who are vulnerable?

Stem cells from human embryos promised to “launch a medical revolution in which ailing organs and tissues might be repaired” when they were isolated just over 25 years ago. So why haven’t they?  

From around the web

Having a disability shouldn’t prevent you from getting married. But that’s exactly the conundrum facing some people in the US, as this heartbreaking short documentary shows. (STAT)

A Neuralink rival says its eye implant restored vision in blind people. Science Corporation’s retinal implant enabled some legally blind individuals to read from a book, play cards, and fill out crossword puzzles. (Wired)

Women in Texas are dying after doctors delay treating them for miscarriages. Doctors treating Josseli Barnica waited 40 hours for the heart of her fetus to stop beating, despite the fact that miscarriage was “inevitable.” Her husband says doctors worried that “it would be a crime to give her an abortion.” She died of a preventable infection three days later. (ProPublica)

Between 30% and 50% of twins share a secret language or mode of communication, a phenomenon known as cryptophasia. The Youlden twins call theirs Umeri. (BBC Future)

Can a machine express fear? Try your hand at creating AI-generated images frightening enough to “spook the machine” as part of a project to explore how machines might express humanlike emotions. It is Halloween, after all. (Spook the Machine)

Oropouche virus is spreading. Here’s what we know.

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

There have been plenty of reports of potentially concerning viruses this last year. Covid is still causing thousands of deaths, and bird flu appears set to make the jump to human-to-human transmission. Now there are new concerns over Oropouche, a virus largely spread by bites from insects called midges (sometimes called no-see-ums in the US).

There have been outbreaks of the Oropouche virus in Latin America for decades. But this one is different. The virus is being detected in all-new environments. It is turning up in countries that have never seen it before. The spread is being described as “unprecedented.”

It may also be causing more severe disease. People with Oropouche fever typically have a sudden fever, aches and pains, and nausea. Most cases are mild, but some people have developed encephalitis and meningitis. And this year, two otherwise healthy young women who caught the virus have died.

Oropouche can be passed from mother to fetus, and it has been linked to stillbirths and birth anomalies. There are no treatments. There are no vaccines, either. This week, let’s take a look at why Oropouche is spreading, and what we can do about it.

Oropouche virus was first identified in 1955, in a person and a pool of mosquitoes from the village of Vega de Oropouche in Trinidad and Tobago. It was found in a sloth in Brazil in 1960. Since then, there have been over 30 outbreaks—in those countries as well as Peru, Panama, Colombia, French Guiana, and Venezuela. At least 500,000 cases have been reported in South America, largely in areas close to forest.

That’s probably because of the way the virus is transmitted. Oropouche virus is thought to be carried by some populations of sloths, and potentially some nonhuman primates. These animals can host the virus, which can then spread to people via insect bites, usually from midges or some types of mosquitoes.

Since late 2023, outbreaks have been reported in a number of countries in South America, Central America, and the Caribbean, including Cuba, a first for the country. 

There has been an especially large surge of cases in Brazil. Since the beginning of this year, 10,275 cases of Oropouche have been confirmed in the Americas, according to a situation summary report published by the Pan American Health Organization (PAHO) earlier this week. And 8,258 of them were in Brazil. Travelers have also imported cases to the US and Europe for the first time—90 such cases have been reported in the US, and 30 in Europe.

Another change is that this time around, the virus has been infecting people in urban settings far from forests. It is not entirely clear why, but there are probably a few reasons. Climate change, for a start, has led to increased temperatures and rainfall, both of which can help create breeding grounds for the insects that transmit the virus. And deforestation and urbanization, both of which have caused people to encroach on the habitats of wild animals, have also raised the risk of transmission to people, says Ana Pereiro do Vale, a veterinarian and microbiologist at University College Dublin in Ireland.

The virus itself also appears to have changed, according to new research published this week. William de Souza at the University of Kentucky and his colleagues analyzed blood samples taken from people with an Oropouche diagnosis between 2015 and 2024, enabling them to compare the form of the virus that is currently circulating with a historical strain.

The team found evidence that the virus has swapped genetic material with a related one, creating a new “virus reassortment.” It is this new form of the virus that has spread since the end of 2023, the team says.

That’s not all. The genetic changes have endowed the virus with new features. The current reassortment appears to be better at replicating in mammalian cells. That might mean that infected people—and sloths—have more of the virus in their blood, making it easier for biting insects to pick it up and pass it on.

The new form of the virus also seems to be more virulent. The team’s lab tests suggest that compared with the historical strain, it appears to cause more damage to the cells it infects.

We are still getting to grips with how the virus can spread, too. We know midges and mosquitoes are responsible for spreading Oropouche, but the virus can also pass to a fetus during pregnancy, with potentially harmful consequences. According to the PAHO report, Brazil has reported “13 fetal deaths, three spontaneous miscarriages, and four cases of birth anomalies” linked to Oropouche infections.

In a separate study published earlier this week, Raimunda do Socorro da Silva Azevedo at the Evandro Chagas Institute in Ananindeua, Brazil, and her colleagues assessed 65 unexplained cases of microcephaly—a birth anomaly in which babies have an unexpectedly small head—that had been recorded in Brazil between 2015 and 2024. The team found evidence of an Oropouche infection in six of the babies—and in all three that had been born in 2024.

It’s still not clear whether or how the virus might affect fetuses and babies, and research is ongoing. But the US Centers for Disease Control and Prevention (CDC) recommends that pregnant travelers “reconsider non-essential travel” to Cuba. 

Some scientists worry that the virus might also spread via sex. In August, a 42-year-old Italian man who fell ill after returning from a trip to Cuba was found to have Oropouche virus in his semen. And it was still there 58 days later. The CDC currently recommends that men diagnosed with Oropouche should use condoms or not have sex for at least six weeks from the start of their symptoms. They should avoid donating semen, too, according to the organization.

There are a lot of unanswered questions when it comes to Oropouche. Some scientists have suggested that this is because outbreaks have historically been seen in poorer countries in the Global South.

“There is sufficient colonialism in disease research—if it doesn’t affect the industrial world and Western business interests, it’s not important,” Shahid Jameel, a virologist at the University of Oxford, told Gavi, an organization focused on global vaccination efforts. “Now that the virus has been found in Cuba—not far from Miami—the wheels of public health will turn.”

Let’s hope they get in gear quickly. As Vale says: “We don’t know what will happen with the virus, the mutation rate of the virus, or if the virus will jump to another host. We need to be careful and pay attention.”

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Oropouche infections can look similar to dengue—another viral disease, also spread by mosquitoes, that affects people in Brazil. The country is attempting to tackle the problem with bacteria-infected mosquitoes, Cassandra Willyard reported in March.

The spread of bird flu in dairy cattle in the US has virologists worried. The virus could stick around on US farms forever and is raising the risk of outbreaks in mammals—including humans—around the world.

Flu season is officially upon those of us in the Northern Hemisphere. This year, it could enable the creation of an all-new bird flu, too. 

Could gene editing help curb the spread of bird flu? Abdullahi Tsanni explored the possibility of using CRISPR to make chickens resistant to the virus.

Another option, of course, is vaccines. Most flu vaccines are made, ironically, in chicken eggs. mRNA vaccines could provide an alternative, egg-free approach.

From around the web

A fertility clinic in London has helped two transgender individuals have a baby in a process that involved egg freezing, donated sperm, IVF, embryo storage, and surrogacy. “To our knowledge this is the first report of family building by a transgender couple in which both partners had successfully achieved gender reassignment and the creation of a family through surrogacy,” write the team. (Reproductive BioMedicine Online)

“They showed me them in a mirror … and I looked like a witch,” says one woman who has experienced the horror of dental veneers gone wrong. Veneers have become as routine as Botox and lip filler. But what can people do when their dream of a perfect smile turns into a nightmare? (The Guardian)

Thinking about deleting your 23andMe data? The company will hold on to some of it regardless, to comply with legal regulations. Some of your genetic information, your date of birth and your sex, and data linked to your account deletion request will all be retained. (MIT Technology Review)

Pet dogs are spending more time indoors, in environments they aren’t suited to. Service dogs, on the other hand, are uniquely well adapted to life in the 21st century, say two researchers at the Duke Canine Cognition Center. Humans need to breed and train more puppies like service animals, they argue. (The Atlantic)

These are the best ways to measure your body fat

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

This week, an office conversation turned to body weight. We all know that being overweight is not great for your health—it’s linked to metabolic diseases like diabetes and cardiovascular problems. But weighing yourself won’t tell you all you need to know about your disease risk.

A friend of mine is a super-fit marathon runner. She’s all lean muscle. And yet according to her body mass index (BMI), which is a measure of weight relative to height, she’s overweight. Which is frankly ridiculous.

I, on the other hand, have never been all that muscular. I like to think I’m a healthy weight—but nurses in the past have advised me, on the basis of my BMI, to eat more butter and doughnuts. This is advice I never expected to receive from a health professional. (I should add here that my friend and I are roughly the same height and wear the same size in clothes.)

The BMI is flawed. So what should we be using instead? There are several high-tech alternatives, but a simple measure that involves lying on your back could also tell you about how your body size might influence your health.

First, let’s talk about fat—the most demonized of all body components. Fat is stored in adipose tissue, which has some really important functions. It stores energy, keeps us warm, and provides protective cushioning for our organs. It also produces a whole host of important substances, from hormones that control our appetite to chemicals that influence the way our immune systems work.

Not all fat is equal, either. Our bodies contain white fat, brown fat, and beige fat. While white fat stores energy, brown fat helps burn calories. Beige fat tissue contains a mixture of the two. And white fat can also be broken down into two additional categories: the type under your skin is different from that which covers your internal organs.

It’s the visceral fat—the type surrounding your organs—that is thought to be more harmful to your health, if there’s too much of it. Having more visceral fat has been linked to an increased risk of diabetes and cardiovascular disease. (That relationship isn’t straightforward either, though; studies have shown that removing this “excess” fat doesn’t improve metabolic health.)

Either way, having a good idea of how much fat is in your body, and where it is, would be valuable. It might at least give us some idea of our risk of metabolic disorders. There are quite a few different ways of measuring this.

BMI is the most widely adopted. It’s the official measure the World Health Organization uses to define overweight and obesity. On the plus side, it’s very easy to calculate your BMI. Unfortunately, it doesn’t tell you very much about the fat in your body or how it corresponds to your health. After all, your body weight includes your bones, muscles, blood, and everything else, not just your fat. (And as we’ve seen, it can lead well-meaning health practitioners to recommend weight loss or weight gain when it’s really not appropriate.)

Scanners that can specifically measure fat are more useful here. Typically, doctors can use a DEXA scan, which relies on x-rays, to give an idea of where and how much body fat a person has. CT scanners (which also makes use of x-rays) and MRI scanners (which use magnets) can give similar information. The problem is that these are not all that convenient—they’re expensive and require a hospital visit. Not only that, but standard equipment can’t accommodate people with severe obesity, and people with some medical implants can’t use MRI scanners. We need simpler and easier measures, too.

Measuring the circumference of a person’s waist seems to yield more useful information than BMI. Both waist-to-hip and waist-to-height ratios can give a better idea of a person’s risk of developing diseases associated with excess weight. But this isn’t all that easy either—measuring tapes can stretch or slip, and it can be difficult to measure the exact same part of a person’s waist multiple times. And the measure seems to be a better indicator of health in men than in women.

Instead, Emma Börgeson, who studies cardiometabolic disease at Aarhus University in Denmark, and her colleagues recommend the SAD measure. SAD stands for sagittal abdominal diameter, and it’s a measure of the size of a person’s belly from back to front.

To measure your SAD, you need to lie on your back. Bend your knees at a 90-degree angle to make sure your back is not arching and is flush with the floor. Then measure how much your belly protrudes from the ground when you exhale. (The best way to do this is with a sliding-beam caliper.)

In this position, the fat under the skin will slide to the sides of your body, while the visceral fat will be held in place. Because of this, the SAD can give you a good idea of how much of the more “dangerous” kind of fat you have. The fat can be trimmed down with diet and exercise.

This measure was first proposed in the 1980s but never took off. That needs to change, Börgeson and her colleagues argue in a paper published in Nature Reviews Endocrinology a few months ago. “SAD is simple, affordable, and easier to implement than waist-to-hip based measurements,” the team writes. “We would argue for its extended use.”

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Weight-loss drugs like Ozempic, Wegovy, and Mounjaro are wildly popular and effective; they were named one of MIT Technology Review’s 10 Breakthrough Technologies of 2024. Abdullahi Tsanni explored what we know—and don’t know—about their long-term effects.

Over the last couple of years, those weight-loss drugs have taken over the internet, with users sharing stories of their miraculous results on social media. But the day-to-day reality of weight-loss injections isn’t always pleasant—and some side effects are particularly nasty, Amelia Tait reported last year.

A future alternative could be vibrating pills that trick you into feeling full. For now, it seems to work in pigs, as Cassandra Willyard reported last year.

When you lose weight, where does it go? It kind of depends on your metabolism, as Bonnie Tsui explains.

We don’t fully understand how weight-loss drugs like Ozempic work. That’s partly because we don’t fully understand how hunger works. Adam Piore reported on the painstaking hunt for the neurons that control the primitive urge to eat.

From around the web

Hospitals in the US are facing shortages of IV fluids in the wake of Hurricane Helene. Some are having patients drink Gatorade instead. (STAT) 

Marcella Townsend’s face became unrecognizable after a propane explosion left her with second- and third-degree burns over most of her body. In an attempt to help her recover, surgeons applied a thin layer of donated placenta to her face. It was “the best thing they could have done, ever,” says Townsend, who says her face now “looks exactly like it did before.” (The New York Times)

Intermittent fasting can help mice live longer—but genes have a bigger effect on lifespan than diet does. (Nature)

This one-millimeter-long, doughnut-shaped robot can swim through snot. (Popular Science)

A new law in California protects consumers’ brain data. Some think it doesn’t go far enough.

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

On September 28, California became the second US state to officially recognize the importance of mental privacy in state law. That pink, jelly-like, throbbing mass under your skull—a.k.a. your brain—contains all your thoughts, memories, and ideas. It controls your feelings and actions. Measuring brain activity can reveal a lot about a person—and that’s why neural data needs to be protected.

Regular Checkup readers will be familiar with some of the burgeoning uses of “mind-reading” technologies. We can track brain activity with all sorts of devices, some of which measure brain waves while others track electrical activity or blood flow. Scientists have been able to translate this data into signals to help paralyzed people move their limbs or even communicate by thought alone.

But this data also has uses beyond health care. Today, consumers can buy headsets that allow them to learn more about how their brains work and help them feel calm. Employers use devices to monitor how alert their employees are, and schools use them to check if students are paying attention.

Brain data is precious. It’s not the same as thought, but it can be used to work out how we’re thinking and feeling, and reveal our innermost preferences and desires. So let’s look at how California’s law might protect mental privacy—and how far we still have to go.

The new bill amends the California Consumer Privacy Act of 2018, which grants consumers rights over personal information that is collected by businesses. The term “personal information” already included biometric data (such as your face, voice, or fingerprints). Now it also explicitly includes neural data.

The bill defines neural data as “information that is generated by measuring the activity of a consumer’s central or peripheral nervous system, and that is not inferred from nonneural information.” In other words, data collected from a person’s brain or nerves.

The law prevents companies from selling or sharing a person’s data and requires them to make efforts to deidentify the data. It also gives consumers the right to know what information is collected and the right to delete it.

“This new law in California will make the lives of consumers safer while sending a clear signal to the fast-growing neurotechnology industry there are high expectations that companies will provide robust protections for mental privacy of consumers,” Jared Genser, general counsel to the Neurorights Foundation, which cosponsored the bill, said in a statement. “That said, there is much more work ahead.”

Genser hopes the California law will pave the way for national and international legislation that protects the mental privacy of individuals all over the world. California is a good place to start—the state is home to plenty of neurotechnology companies, so there’s a good chance we’ll see the effects of the bill ripple out from there.

But some proponents of mental privacy aren’t satisfied that the law does enough to protect neural data. “While it introduces important safeguards, significant ambiguities leave room for loopholes that could undermine privacy protections, especially regarding inferences from neural data,” Marcello Ienca, an ethicist at the Technical University of Munich, posted on X.

One such ambiguity concerns the meaning of “nonneural information,” according to Nita Farahany, a futurist and legal ethicist at Duke University in Durham, North Carolina. “The bill’s language suggests that raw data [collected from a person’s brain] may be protected, but inferences or conclusions—where privacy risks are most profound—might not be,” Farahany wrote in a post on LinkedIn.

Ienca and Farahany are coauthors of a recent paper on mental privacy. In it, they and Patrick Magee, also at Duke University, argue for broadening the definition of neural data to what they call “cognitive biometrics.” This category could include physiological and behavioral information along with brain data—in other words, pretty much anything that could be picked up by biosensors and used to infer a person’s mental state.

After all, it’s not just your brain activity that gives away how you’re feeling. An uptick in heart rate might indicate excitement or stress, for example. Eye-tracking devices might help give away your intentions, such as a choice you’re likely to make or a product you might opt to buy. These kinds of data are already being used to reveal information that might otherwise be extremely private. Recent research has used EEG data to predict volunteers’ sexual orientation or whether they use recreational drugs. And others have used eye-tracking devices to infer personality traits.

Given all that, it’s vital we get it right when it comes to protecting mental privacy. As Farahany, Ienca, and Magee put it: “By choosing whether, when, and how to share their cognitive biometric data, individuals can contribute to advancements in technology and medicine while maintaining control over their personal information.”

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Nita Farahany detailed her thoughts on tech that aims to read our minds and probe our memories in a fascinating Q&A last year. Targeted dream incubation, anyone? 

There are lots of ways that your brain data could be used against you (or potentially exonerate you). Law enforcement officials have already started asking neurotech companies for data from people’s brain implants. In one case, a person had been accused of assaulting a police officer but, as brain data proved, was just having a seizure at the time.

EEG, the technology that allows us to measure brain waves, has been around for 100 years. Neuroscientists are wondering how it might be used to read thoughts, memories, and dreams within the next 100 years.

Electrodes implanted in or on the brain can provide us with the most detailed insights into how our minds work. They can also provide us with amazing imagery, like this video that essentially shows what a thought looks like as it is being formed.

What exactly is going on in our brains, anyway? When neuroscientists used electrodes implanted deep in the brains of people being treated for epilepsy, they found order and chaos. 

From around the web

Infections are responsible for 13% of cancers. Here’s how to protect against four of them. (New York Times)

Scientists have created the first map of the neurons in a fruit fly’s brain. All 139,225 of them. (Nature)

Oropouche fever is surging in South America. Disturbingly, there are increasing reports of the virus harming pregnant women and their babies. (Viruses)

Women in heterosexual relationships already do more housework and household organization than their partners. Is technology making things worse? (BBC Future)

Do you sigh during your sleep? It could be a sign of something serious. (Nature)

Space travel is dangerous. Could genetic testing and gene editing make it safer?

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

Recently, global news has been pretty bleak. So this week, I’ve decided to focus my thoughts beyond Earth’s stratosphere and well into space. A couple of weeks ago, SpaceX launched four private astronauts into orbit, where they performed the first ever spacewalk undertaken by private citizens (as opposed to astronauts trained by national agencies).

The company has more ambitious plans for space travel, and it’s not alone. Elon Musk, the founder of SpaceX, claimed on Sunday that he would launch uncrewed missions to Mars within two years, and crewed missions four years after that if the uncrewed missions were successful. (Other SpaceX timelines for reaching the Red Planet haven’t panned out.) NASA refers to Mars as its “​​horizon goal for human exploration.” China previously announced plans for a human mission as early as 2033 and recently moved up its timeline for an uncrewed sample return mission by two years. And the UAE has a 100-year plan to construct a habitable community on Mars by 2117.

None of this will be straightforward. Long-distance space travel can wreak havoc on human health. There’s radiation and microgravity to contend with, as well as the psychological toll of isolation and confinement. Research on identical twin astronauts has also revealed a slew of genetic changes that happen when a person spends a year in space.

That’s why some bioethicists are exploring the idea of radical treatments for future astronauts. Once we’ve figured out all the health impacts of space travel, they argue, we should edit the genomes of astronauts ahead of launch to offer them the best protection. Some have even suggested this might result in the creation of an all-new species: Homo spatialis. If this is starting to sound a bit like sci-fi, that’s because—for now, at least—it is. But there are biotechnologies we can use to help space travelers now, too.

Space travel is risky. When it comes down to it, a space launch essentially involves strapping humans into a capsule and exploding a bomb beneath them, says Paul Root Wolpe, who served as NASA’s senior bioethicist for 15 years.

Once you’re in space, you’re subject to far higher levels of radiation than you’d encounter on Earth. Too much radiation can increase a person’s risk of cancer and neurological disorders. It can also harm body tissues, resulting in cataracts or digestive diseases, for example. That’s why agencies like the US Department of Labor’s Occupational Safety and Health Administration set limits on radiation exposure. (NASA also sets limits on the amount of radiation astronauts can be exposed to.)

Then there’s microgravity. Our bodies have adapted to Earth’s gravity. Without that gravitational pull, strange things can happen. For one thing, internal fluids can start to pool at the top of the body. Muscles don’t need to work as hard when there’s no gravity, and astronauts tend to experience loss of muscle mass as well as bone.

Five years ago, scientists working with NASA published the results of a groundbreaking study comparing two identical twins—one of whom spent a year in space while the other remained on Earth. The twins, Mark and Scott Kelly, were both trained astronauts. And because they have the same set of genes, researchers were able to compare them to assess the impact of long-term space travel on how genes work.

The researchers found that both twins experienced some changes to the way their genes worked over that period, but they changed in different ways. Some of the effects in the space-faring brother lasted for more than six months. These changes are thought to be a response to the stress of space travel and perhaps a reaction to the DNA damage caused by space radiation.

Space travel comes with other risks, including weight loss, permanent eye damage caused by what is known as “spaceflight-associated neuro-ocular syndrome,” and psychological distress as a result of being far from friends and loved ones.

And if all that weren’t enough, injuries are also common on space missions, says Wolpe, who is now founding director of the Center for Peace Building and Conflict Transformation at Emory University. Tools and equipment can float around, knocking into people. Bungee cords snap. “Astronauts are supposed to wear safety goggles at all times, but they didn’t,” says Wolpe. “The injury list is lengthy … it’s really surprising how many injuries were [sustained] by astronauts on the space station.”

Commercial space travel brings a new set of dangers. Until very recently, the only people who traveled to space went through rigorous health tests and training programs overseen by national agencies. That isn’t the case for private space travel, where the rules are determined by the individual company, says Wolpe.

Astronauts are screened for common conditions like high blood pressure and diabetes. Space tourists might not be. We’re still learning the basics when it comes to the impact of space travel on health. We have no idea how it might affect a person who has various disorders and takes multiple medications.

Could gene editing protect astronauts from these potential problems? People who have adapted to high altitudes on Earth have genetic factors that allow them to thrive in low-oxygen environments—what if we could confer these factors to astronauts? And while we’re at it, why not throw in some more genetic changes—ones that might protect them from bone or muscle loss, for example?

Here’s where we get into Homo spatialis territory—the idea of a new species better suited to a life in space, or on a planet other than Earth. For the time being, this approach is not an option—there are currently no gene therapies that have been designed for people undertaking space travel. But one day “it might be in the best interests of the astronauts to undergo some genetic intervention, like gene editing, to safeguard them,” says Rosario Isasi, a bioethicist at the University of Miami. “It might be more than a duty, but a condition for an astronaut going on these missions.”

Wolpe is not keen on the idea. “There is some integrity to being human, and to the human body, that should not be breached,” he says. “These kinds of modifications are going to … end up with a number of disasters.” Isasi also hopes that advances in precision medicine, which will make possible bespoke treatments for individuals, might sidestep the need for genetic modifications.

In the meantime, genetic testing could be helpful for both astronauts and space tourists, says Wolpe. Some body tissues are more vulnerable to radiation damage, including the thyroid gland. Genetic tests that reveal a person’s risk of thyroid cancer might be useful for those considering space travel, he says.

Whether people are going into space as tourists, employees, scientists, or research subjects, figuring out how to send them safely is vitally important. After all, space tourism is nothing like regular tourism. “You’re putting [people] in a situation the human body was never designed to be in,” says Wolpe.

Now read the rest of The Checkup

Read more from MIT Technology Review’s archive

Scientists can test-drive space missions in extreme and remote environments here on Earth. “Analogue astronaut facilities,” which have been set up in deserts and in the Antarctic, simulate the isolating experience of real space travel, Sarah Scoles reports.

Astronaut meals could be set for a slightly weird overhaul. The prepackaged food currently used has a shelf life of around a year and a half. Making food from astronauts’ breath could one day be an alternative solution for longer space missions, writes Jonathan O’Callaghan.

Only 11 people can fit on the International Space Station at once. Perhaps a self-assembling space habitat—complete with a sea-anemone-inspired sofa—could provide alternative living quarters, writes Sarah Ward.

More than a dozen robotic vehicles are scheduled to land on the moon in the 2020s, and there are plans in the works for “lunar economies” and “permanent settlements,” reports Jonathan O’Callaghan in this piece that explores what’s next for the moon.

The International Space Station is getting old, and there are plans to destroy it by 2030. Now NASA is partnering with private companies to develop new commercial space stations for research, manufacturing, and tourism, reports David W. Brown.

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The team that earned the Nobel Prize for developing CRISPR is asking to cancel two of their own seminal patents. My colleague Antonio Regalado has the scoop. (MIT Technology Review)

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Only 6% of the plastic produced in the US in 2021 ended up getting recycled, according to a Greenpeace report. It’s one of the reasons why microplastics are so ubiquitous. (National Geographic)

Axolotls age slowly, and no one really knows what they die. It now appears they pause at least one aspect of the aging process partway through their lives. (New Scientist)

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Being a living kidney donor today is less risky than it was a couple of decades ago. Data collected between 1994 and 2009 estimated 3.1 deaths within 90 days per 10,000 donations. This figure declined in the years between 2013 and 2022, to less than 1 death per 10,000 donations. (JAMA Network)