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Q&A: What oncologists can glean from Kate Middleton's cancer announcement

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Q&A: What oncologists can glean from Kate Middleton's cancer announcement

After months of speculation about her recent health challenges, Catherine, Princess of Wales, revealed Friday that she has cancer.

The video announcement was short on specifics, prompting a new set of questions about her condition. She said she was initially told her “condition was non-cancerous.” Learning otherwise after medical tests had been conducted “came as a huge shock,” the former Kate Middleton said.

She said she told the public the same thing she told her young children, Princes George and Louis and Princess Charlotte: “I am well and getting stronger every day.”

Here’s a look at what is known about the princess’ condition:

What kind of cancer does Catherine have?

She didn’t say.

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In Friday’s video statement, she explained that she had “major abdominal surgery” in January and didn’t suspect she had cancer at the time. Only later was it discovered that “cancer had been present,” she said.

With so little information to go on, it’s impossible to know exactly what the princess is up against, experts said. The fact that she had abdominal surgery would seem to rule out breast cancer, which is the most commonly diagnosed cancer for women in the United Kingdom, according to the World Cancer Research Fund.

Other than that, “it can be anything in the abdominal cavity — ovary, colon, appendix, stomach,” said Dr. Beth Karlan, a gynecologic oncologist at UCLA’s Jonsson Comprehensive Cancer Center. “Any of the organs you think of in your tummy could have a malignancy.”

Among women in Britain, the most common types of cancers that affect the abdominal area are those of the bowel, uterus, ovaries, pancreas and kidney, the World Cancer Research Fund says.

If she was initially told she didn’t have cancer, why did her diagnosis change?

Sometimes a cancer patient’s initial symptoms look like something else. For instance, doctors may think a blockage in the ducts of a patient’s gallbladder is caused by a gallstone, but when they perform surgery to remove it, they find cancer, said Dr. Syma Iqbal, gastrointestinal oncologist at USC Norris Comprehensive Cancer Center.

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During surgery, pieces of tissue are removed and sent to a pathology lab, where they are sliced up and examined under a microscope. That close inspection reveals features that are too small to be seen in an operating room.

Discovering that a patient has cancer only after surgical treatment is “not common, but it’s not rare,” Karlan said.

What is Catherine’s prognosis?

Experts said it’s probably good, based on the fact that she said she was now undergoing “preventative chemotherapy.”

What is ‘preventative chemotherapy’?

It’s chemotherapy treatment given after the primary treatment — in Catherine’s case, surgery — that’s intended to reduce the risk that the cancer will come back.

Surgery can remove the bulk of a tumor, and if surgeons know they are operating on a malignancy, they will remove some surrounding tissue and lymph nodes to increase their odds of capturing breakaway cancer cells, Iqbal said. But if there’s a risk that some cells may remain, chemotherapy is a way to kill them off, thus reducing the risk of a recurrence.

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“It can improve the chance of long-term cure and survival,” said Dr. Edward Kim, physician-in-chief for City of Hope Orange County in Irvine.

In the United States, this kind of secondary treatment is called adjuvant chemotherapy. Radiation treatment and hormone therapy are other examples of adjuvant therapies for cancer patients.

“The fact that they think all of the cancer was removed and preventative or adjuvant chemotherapy was given gives us some cause for optimism,” said Dr. Bill Dahut, chief scientific officer with the American Cancer Society.

”If you had found a lot more cancer than you expected, you’d have to go in for another operation. Or if the cancer had already spread, it would be treatment for metastatic or advanced cancer,” Dahut said. “This is chemotherapy given for what’s presumed to be microscopic spread.”

Catherine is 42. Isn’t that kind of young to get cancer?

Generally speaking, the risk of cancer increases with age. But several kinds of cancer have been increasingly seen in younger adults, experts said.

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At 42, the princess is on the younger side of cancer patients. But the incidence of cancer has been rising among people under 50, Kim said.

“We are absolutely seeing younger people being diagnosed with cancer,” he said.

In the United States, colorectal cancer is largely to blame. It is now the leading cause of cancer death in men under 50 and is second only to breast cancer among women in that age group, according to the most recent annual report from the American Cancer Society. Both Dahut and Iqbal said the trend is probably similar in the U.K.

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Column: How the GOP — with Democratic Party connivance — has undermined a crucial effort to avert the next pandemic

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Column: How the GOP — with Democratic Party connivance — has undermined a crucial effort to avert the next pandemic

We’ve all come to recognize that committee hearings conducted by the Republican House majority are almost invariably clown shows featuring spittle-flecked posturing by members intent on displaying their ignorance to an appreciative crowd.

Wednesday’s hearing by the Select Subcommittee on the Coronavirus Pandemic was a crystalline example of the genre. It was designed around the grilling of Peter Daszak, the head of EcoHealth Alliance, which oversees international virus research funded by federal agencies.

The members scraped along rock-bottom, but the most telling moment may have been this exchange between Rep. Morgan Griffith (R-Va.) and Daszak. Asked to explain an apparent (but not real) discrepancy in a progress report EcoHealth submitted to the government, Daszak started to answer, but a theatrically fulminating Griffith cut him off.

Our organization, staff, and even my own family were often targeted with false allegations, death threats, break-ins, media harassment, and other damaging acts.

— Peter Daszak, EcoHealth Alliance

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“I can give you the answer to your question,” Daszak said.

“I’m going to answer it for you!” Griffith shot back, then outrageously accused Daszak of lying. Daszak didn’t get a chance to reply.

The whole session, more than three hours, went that way. The members kept peppering Daszak with questions about abstruse matters of science and the grant-making process, only to rudely cut him off when he tried to respond. They misquoted him to his face, misrepresented his work, and spouted cocksure inanities showing with every word that, scientifically speaking, they have no idea what they’re talking about.

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Ideally, congressional hearings should be fact-finding efforts. This was nothing of the kind. It was an opportunity for posturing by politicians intent only on smearing Daszak and EcoHealth on the pretext of getting to the bottom of the pandemic’s cause.

How do we know this? From the fact that hours before the hearing even began, the subcommittee released a report calling on the National Institutes of Health and the Department of Health and Human Services to “immediately commence suspension and debarment proceedings against both EcoHealth and Dr. Daszak” — in other words, permanently cut them off from federal funding.

One more thing about this ludicrious cabaret act: The Democratic committee members, who should have been standing up for science and scientists, did the opposite by throwing Daszak under the bus.

In his opening statement, Ranking Member Raul Ruiz (D-Indio), attacked the GOP majority’s preposterous position that the U.S. government funded research that created the virus responsible for COVID-19. But he accepted its position that Daszak “sought to deliberately mislead” government regulators.

Ruiz’s statement was echoed by other Democrats, including Rep. Debbie Dingell (D-Mich.). Perhaps they hoped that by allowing Daszak to be drawn and quartered, they might persuade the Republicans to climb down from their evidence-free claims about government complicity in the pandemic’s origins.

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Their hearts didn’t seem to be in it, though; they talked as though their main concern was that EcoHealth was spending government funds. They all seemed to be reading from the same ChatGPT script, the key phrase of which was: “poor steward of the taxpayers’ dollars.” Nothing about EcoHealth’s significant achievements in public health.

That makes the Democrats’ performance all the more shameful and cowardly. They’re knowingly participating in a flagrantly fictitious smear campaign.

Let’s examine the background of this display of partisan grandstanding.

Fundamentally, it’s part of a disreputable campaign to demonize responsible scientists such as Anthony Fauci, who retired in 2022 as director of the National Institute of Allergy and Infectious Diseases and was one of the most respected virologists and public health professionals in the world.

Republican leaders and the right wing have tried to turn Fauci into a sinister figure by advancing the absurd proposition that he somehow played a role in creating COVID-19 and spreading it worldwide, and that he masterminded the nation’s anti-pandemic policies, even though he had zero authority to do so.

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This is no innocent game; it has subjected Fauci, who was a top pandemic advisor to Donald Trump until his resistance to Trump’s unhinged takes on the pandemic led to his being sidelined at the White House, to death threats and unending vilification on social media.

Daszak has come in for more than his share of character assassination. Social media posts referring to him have included the image of a guillotine. As the pandemic developed, Daszak told the committee in his opening statement Wednesday, “Our organization, staff, and even my own family were often targeted with false allegations, death threats, break-ins, media harassment, and other damaging acts.”

One recent post on X (formerly Twitter) said “the Daszak family should be shot down.” Daszak says he has asked X to cancel the abusive, anonymous account, without success.

What’s the purpose of this campaign? The attack on the credibility of science and scientists has arisen because validated scientific findings about global warming and the origins of COVID-19 cause economic and political discomfort to Big Business and know-nothings who believe that undermining science will advance their political careers. (I’m looking at you, Robert F. Kennedy Jr.)

An essential tenet of the right-wing position on COVID-19 is that the virus escaped from a Chinese laboratory, specifically the Wuhan Institute of Virology. Superficially this is an alluring theory, since the initial outbreak occurred at a wildlife market in that city. But there is absolutely not a speck of evidence for that theory, and scientific research overwhelmingly indicates that the virus reached humans via a spillover from infected wildlife — the path followed by countless viral outbreaks over human history.

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Lab leak advocates love to point to a statement FBI Director Christopher Wray made in an interview with Fox News in March 2023 — that the bureau had concluded with “moderate confidence” that the virus had escaped from the Chinese lab. But he cited no evidence; the FBI’s assessment, which had been previously disclosed, had been part of a survey of all U.S. intelligence agencies that largely contradicted the FBI’s position. And in June, a report from the Office of the Director of National Intelligence refuted claims that the Chinese lab had played any role in the pandemic.

Anyway, the WIV isn’t exactly near the market — it’s miles away on the far side of the Yangtze River, in a city as densely populated as Los Angeles, with almost three times L.A.’s population, and a huge regional transportation and commercial hub.

That brings us back to EcoHealth, which was founded in 1971 and has long been an essential clearinghouse for funding for research into “emerging disease threats to the U.S.,” as Daszak said in his opening statement.

That has included providing funds for the WIV and other research in China, where viruses capable of jumping into the human population — as did SARS-CoV-2, the virus behind COVID-19 — are commonly found in bats, and where a vigorous, illicit trade in wildlife brings millions of humans into direct contact with potential disease carriers.

EcoHealth’s relationship with Chinese research institutions was open and aboveboard, and its funnelling U.S. grants to those institutions explicitly approved by the NIH and HHS.

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EcoHealth was long considered a gold-plated research organization. “Their grants, when reviewed scientifically, scored at the highest levels in the scientific community,” says Gerald T. Keusch, a former associate director of international research at NIH. “The work they proposed was absolutely stunningly good.”

An internal memo prepared at NIH for a Fauci news conference in January 2020 described EcoHealth as one of “the biggest players in coronavirus work” and Daszak as one of “the world’s experts in … non-human coronaviruses” such as SARS-CoV-2.

As I’ve reported, EcoHealth’s useful and productive role in virological research began to unravel at a news conference April 17, 2020 when a reporter from a right-wing organization mentioned to then-President Trump that NIH had given a $3.7-million grant to the Wuhan Institute of Virology. (Actually, the WIV grant, which was channeled from a larger EcoHealth grant, was only $600,000).

Trump, sensing an opportunity to show a strong hand against China and advance his effort to blame the Chinese for the pandemic, responded: “We will end that grant very quickly.” The NIH terminated the full EcoHealth grant one week later prompting a backlash from the scientific community, including an open letter signed by 77 Nobel laureates who saw the action as a flagrantly partisan interference in government funding of scientific research.

The HHS inspector general found the termination to be “improper.” NIH reinstated the grant, but immediately suspended it until EcoHealth met several conditions that were manifestly beyond its capability, as they involved its demanding information from the Chinese government that it had no right to receive.

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The EcoHealth grant was finally restored in May 2023. By then, EcoHealth no longer had a relationship with WIV, which had been barred from receiving any NIH funds. Still, at the time I celebrated the end of a Trump-inspired three-year shutdown of field work to examine how viruses move from rural wildlife to humans. Unfortunately, that was premature.

Since then, Daszak told me, NIH has continued to erect bureaucratic barriers preventing EcoHealth from accessing funds under the grant, in effect freezing its ability to work.

At Wednesday’s hearing, the GOP tried to pretend that the decision to terminate the grant was all NIH’s idea. “This was not ended by the president of the United States,” declared Mitchell Benzine, counsel to the subcommittee’s Republican majority.

Benzine has a suspiciously short memory. According to documents that the subcommittee itself made public, on Jan. 5 this year, Benzine himself elicited closed-door testimony from Lawrence Tabak, a top NIH official, that after that 2020 news conference “[Trump Chief of Staff] Mark Meadows called the Office of General Counsel at HHS, who then called Dr. Tabak, who then called Dr. [Michael] Lauer, who was instructed to cancel the grant.” Can’t get a much more direct line from Trump to NIH than that.

(Lauer is an NIH functionary who has been a key figure placing the bureaucreatic obstacle course before EcoHealth; my request for comment from him and Tabak was met with a no-comment from NIH.)

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Wednesday’s hearing largely recapitulated the attacks on EcoHealth that have been floating in the right-wing fever swamp for four years now. They include a litany of minor bureaucratic snafus, such as a grant progress report that missed a deadline (Daszak said the problem was a glitch in an NIH web portal that prevented it from being submitted on time).

One key assertion is that EcoHealth was funding “gain of function” research at the Wuhan Institute. “Gain of function” is a widely misunderstood term that has become a shibboleth for proponents of the lab-leak hypothesis, who use it as an all-purpose symbol of sinister behavior, like “critical race theory” or “DEI” (diversity, equity and inclusion).

Technically speaking, gain-of-function is a method of modifying a pathogen in the lab to gauge its infectiousness in humans, the better to develop countermeasures such as vaccines. The right-wing claims that such research in China funded by NIH and EcoHealth created SARS-CoV-2, which then escaped into the wild.

There’s no evidence that the Wuhan lab did anything like that, and experienced virologists have questioned whether it’s even technically possible to have created the SARS2 virus given today’s level of knowledge. The U.S. government placed a moratorium on gain-of-function research from 2014 through 2017 to allow for the development of best-practice protocols.

NIH explicitly confirmed to EcoHealth that the studies it was funding didn’t qualify as gain-of-function under its own definition. That didn’t stop the committee members from wasting long swaths of their session accusing Daszak of secretly funding such experiments.

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The attacks on EcoHealth appall scientists and public health experts who know that the organization’s work in identifying potential pandemic sources and crafting responses has never been more important. Agricultural authorities are dealing with the spread of a bird flu virus into cattle herds, another case of species-to-species, or zoonotic, viral transmission.

Given the bipartisan attacks against it, whether EcoHealth can avoid being cut off from all government funding is an open question. But that only underscores the supine irresponsibility with which Democrats have bought into the right wing’s attack on the organization and its crucial work.

“We now have zoonotic threats emerging at an accelerating cadence,” says Peter Hotez, a molecular virologist who is dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.

“This is a time when we need to be doubling down and expanding our global virus surveillance networks,” Hotez told me. “By making up allegations, they’re undermining the work of EcoHealth and other organizations committed to understanding how viruses are jumping from animals to humans. We’re creating incredible vulnerability for ourselves. They’re damaging our national security. That to me is unforgivable — that they’re willing to jeopardize national security for political expedience.”

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To save Black lives, panel urges regular mammograms for all women ages 40 to 74

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To save Black lives, panel urges regular mammograms for all women ages 40 to 74

To counteract growing rates of breast cancer in younger women and to reduce racial disparities in deaths, an influential panel has changed its advice and is urging most women to begin getting regular mammograms at age 40.

The new recommendations from the U.S. Preventive Services Task Force say women without genetic mutations that make it extremely likely they will develop breast cancer should get their first mammogram to screen for the disease at age 40 and should continue with the exams every other year until they turn 74. The guidelines were published Tuesday in the Journal of the American Medical Assn.

Breast cancer is one of the most common cancers among women in the U.S., as well as one of the deadliest. An estimated 297,790 U.S. women were diagnosed with the disease last year, and 43,170 died of it, according to the American Cancer Society.

The task force, a group of 16 experts convened by the federal government, sparked an uproar 15 years ago when it said women could wait until 50 to begin regular, biennial breast cancer screening — much later and less frequent than what other medical groups were recommending at the time. The group’s rationale was that women in their 40s faced a low risk of breast cancer and that frequent testing of asymptomatic women in this age group caused too many to endure biopsies and other invasive procedures that were unnecessary and potentially dangerous.

The task force reaffirmed its controversial position in 2016. But when the time came to update its guidelines again, two facts stood out.

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First, the incidence of invasive breast cancer in younger women, which had been slowly climbing since at least 2000, began to accelerate around 2015, rising by an average of 2% per year over the following four years.

Second, the task force recognized that among all racial and ethnic groups, Black women are most likely to be diagnosed with breast cancers that have progressed beyond stage 1, including the aggressive “triple negative” tumors that are particularly difficult to treat. Black women also have the highest mortality rate from breast cancer — about 40% higher than that of white women — “even when accounting for differences in age and stage at diagnosis,” the task force wrote in JAMA.

After analyzing data from randomized clinical trials and models based on real-world data, the panel determined that starting biennial mammograms at 40 instead of 50 would prevent an additional 1.3 breast cancer deaths per 1,000 women over the course of their screening lifetimes. For Black women, starting a decade earlier would avert an additional 1.8 deaths per 1,000 women.

“This is a big change, absolutely,” said Dr. Stamatia Destounis, chair of the American College of Radiology Commission on Breast Imaging. “We all realize that if you start to screen a woman at 40, you’re going to find the most cancers.”

Robert Smith, the American Cancer Society’s senior vice president for early cancer detection science, said the task force’s new guidance is more in line with advice from other medical organizations, including his own.

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“We don’t want any woman to have a breast cancer diagnosed late if it can be avoided,” Smith said. “There’s no substitute for finding a breast cancer sooner in its natural history.”

But Ricki Fairley, founder and chief executive of Touch, the Black Breast Cancer Alliance in Annapolis, Md., said that if the goal is to reduce racial disparities, screening starting at age 40 isn’t nearly enough.

“I’m dealing with patients right now that are 24, 23, and are having breast cancer and dying,” said Fairley, a breast cancer survivor who was diagnosed at age 55. “Getting a first mammogram at age 40 is way too late for Black women.”

Reonna Berry, president and co-founder of the African American Breast Cancer Alliance in Minneapolis, criticized the task force for sticking with its advice to screen every other year.

“If we waited every two years to get a mammogram, a lot of Black women would be dead,” said Berry, who was diagnosed with breast cancer at 38 and again a few years ago, in her late 60s.

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A radiologist reviews a mammogram at UCLA.

A radiologist reviews a mammogram at UCLA.

(Jay L. Clendenin / Los Angeles Times)

The American College of Radiology and the Society of Breast Imaging recommend annual screening starting at 40. The American Cancer Society recommends annual screenings for 45- to 54-year-olds, then screening every year or two after that. In addition, the ACR advises Black women to conduct a risk assessment and devise a screening strategy with a doctor when they are 25, Destounis said.

Smith said that although Black women under 40 are more likely than their white counterparts to be diagnosed with breast cancer, the difference isn’t large enough to warrant widespread screening.

According to data gathered by the National Cancer Institute, there are 38 breast cancer cases per 100,000 Black women between the ages of 30 and 34, compared with 32.3 cases per 100,000 white women in the same age group. For women ages 35 to 39, the respective figures are 74.8 and 69.2. In both age groups, that amounts to fewer than 6 additional breast cancers per 100,000 women.

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Smith and others criticized the task force for failing to endorse screening mammograms for women over 74. As in years past, the panel determined there wasn’t enough evidence to make a recommendation one way or another.

“At the age of 75, the risk of breast cancer is very high,” Smith said.

There are 473.2 cases per 100,000 women of all racial and ethnic backgrounds between the ages of 75 and 79, and 425.8 cases for ages 80 to 84, the National Cancer Institute reports.

“There’s no reason, at least in our judgment, that women should stop screening as long as they’re in good health and expect to live another 10 years,” Smith said.

Dr. John B. Wong, a vice chair of the task force, said the lack of evidence regarding mammograms for older women is “totally frustrating.”

There are no randomized clinical trials with women in this age group, but the panel did consider a cohort study of more than 1 million Medicare patients that found no benefit to screening women ages 75 to 84, Wong said.

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The situation was similar regarding the use of ultrasound or MRI as supplemental screening tools for women with dense breasts, he said.

“We know that they’re at increased risk, and we know mammography doesn’t work as well for them,” Wong said. “We would love to have some evidence to help us decide what to recommend about what they should do.”

On the question of screening frequency, the task force had enough data to act. With biennial screening between the ages of 40 and 74, there will be about 1,376 false-positive results per 1,000 women over their lifetimes, along with 14 instances of doctors finding and treating early-stage tumors that might never have become dangerous if left alone. Both would increase by about 50% if women were screened annually, Wong said.

The panel concluded that screening every other year prevents more deaths and results in more years of life gained per mammogram, producing a better balance of benefits and harms.

Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology, said she would weigh those trade-offs differently.

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“As a breast cancer doctor, I’m on the receiving end of everybody who’s diagnosed, and I think they way overplayed the harms versus the benefits,” she said, particularly the anxiety that would stem from being asked to come in for follow-up imaging. “I know for some women that’s very scary and all, but it’s almost a paternalistic kind of view.”

That notion was echoed by Karen Eubanks Jackson, founder and CEO of Sisters Network, a national breast cancer organization for Black women.

“We understand that having too many mammograms can sometimes not be in your favor,” said Jackson, a breast cancer survivor. “But as a Black woman having had it four times, I’d rather be false positive than be positive and not know it. Give me my choice.”

Gralow emphasized that the task force recommendations do not apply to women with any kind of breast abnormality.

“If you have any symptom, then you should go straight to diagnostics, and that should be done at any age,” she said.

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In Smith’s ideal world, precision medicine would allow doctors to replace broad guidelines with individualized screening recommendations based on the information in each woman’s health records.

“They might say, ‘Start screening at an earlier age’ or ‘Screen every year’ or ‘You can go every other year, and that’s just as safe,’ ” Smith said. “The sooner we move in that direction, the better.”

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Canny as a crocodile but dumber than a baboon — new research ponders T. rex's brain power

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Canny as a crocodile but dumber than a baboon — new research ponders T. rex's brain power

In December 2022, Vanderbilt University neuroscientist Suzana Herculano-Houzel published a paper that caused an uproar in the dinosaur world.

After analyzing previous research on fossilized dinosaur brain cavities and the neuron counts of birds and other related living animals, Herculano-Houzel extrapolated that the fearsome Tyrannosaurus rex may have had more than 3 billion neurons — more than a baboon.

As a result, she argued, the predators could have been smart enough to make and use tools and to form social cultures akin to those seen in present-day primates.

The original “Jurassic Park” film spooked audiences by imagining velociraptors smart enough to open doors. Herculano-Houzel’s paper described T. rex as essentially wily enough to sharpen their own shivs. The bold claims made headlines, and almost immediately attracted scrutiny and skepticism from paleontologists.

In a paper published Monday in “The Anatomical Record,” an international team of paleontologists, neuroscientists and behavioral scientists argue that Herculano-Houzel’s assumptions about brain cavity size and corresponding neuron counts were off-base.

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True T. rex intelligence, the scientists say, was probably much closer to that of modern-day crocodiles than primates — a perfectly respectable amount of smarts for a therapod to have.

“What needs to be emphasized is that reptiles are certainly not as dim-witted as is commonly believed,” said Kai Caspar, a biologist at Heinrich Heine University Düsseldorf and co-author of the paper. “So whereas there is no reason to assume that T. rex had primate-like habits, it was certainly a behaviorally sophisticated animal.”

Brain tissue doesn’t fossilize, and so researchers examine the shape and size of the brain cavity in fossilized dinosaur skulls to deduce what their brains may have been like.

In their analysis, the authors took issue with Herculano-Houzel’s assumption that dinosaur brains filled their skull cavities in a proportion similar to bird brains. Herculano-Houzel’s analysis posited that T. rex brains occupied most of their brain cavity, analogous to that of the modern-day ostrich.

But dinosaur brain cases more closely resemble those of modern-day reptiles like crocodiles, Caspar said. For animals like crocodiles, brain matter occupies only 30% to 50% of the brain cavity. Though brain size isn’t a perfect predictor of neuron numbers, a much smaller organ would have far fewer than the 3 billion neurons Herculano-Houzel projected.

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“T. rex does come out as the biggest-brained big dinosaur we studied, and the biggest one not closely related to modern birds, but we couldn’t find the 2 to 3 billion neurons she found, even under our most generous estimates,” said co-author Thomas R. Holtz, Jr., a vertebrate paleontologist at University of Maryland, College Park.

What’s more, the research team argued, neuron counts aren’t an ideal indicator of an animal’s intelligence.

Giraffes have roughly the same number of neurons that crows and baboons have, Holtz pointed out, but they don’t use tools or display complex social behavior in the way those species do.

“Obviously in broad strokes you need more neurons to create more thoughts and memories and to solve problems,” Holtz said, but the sheer number of neurons an animal has can’t tell us how the animal will use them.

“Neuronal counts really are comparable to the storage capacity and active memory on your laptop, but cognition and behavior is more like the operating system,” he said. “Not all animal brains are running the same software.”

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Based on CT scan reconstructions, the T. rex brain was probably “ a long tube that has very little in terms of the cortical expansion that you see in a primate or a modern bird,” said paleontologist Luis Chiappe, director of the Dinosaur Institute at the Natural History Museum of Los Angeles County.

“The argument that a T. Rex would have been as intelligent as a primate — no. That makes no sense to me,” said Chiappe, who was not involved in the study.

Like many paleontologists, Chiappe and his colleagues at the Dinosaur Institute were skeptical of Herculano-Houzel’s original conclusions. The new paper is more consistent with previous understandings of dinosaur anatomy and intelligence, he said.

“I am delighted to see that my simple study using solid data published by paleontologists opened the way for new studies,” Herculano-Houzel said in an email. “Readers should analyze the evidence and draw their own conclusions. That’s what science is about!”

When thinking about the inner life of T. rex, the most important takeaway is that reptilian intelligence is in fact more sophisticated than our species often assumes, scientists said.

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“These animals engage in play, are capable of being trained, and even show excitement when they see their owners,” Holtz said. “What we found doesn’t mean that T. rex was a mindless automaton; but neither was it going to organize a Triceratops rodeo or pass down stories of the duckbill that was THAT BIG but got away.”

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