Staying Aware: UNOS Proposes Changes to Kidney Allocation System

“The doctor told my parents that I had too many complications which caused my kidneys to fail.  He told them he doesn’t see me living past the age of 3,” said Ahmad Alsardary, 24-year-old student studying occupational therapy at the University of the Sciences in Philadelphia.  Ahmad is one of 118,094 in the United States struggling to carry out vital life functions due to organ failure – a statistic that is constantly updated by the Organ Procurement and Transplantation Network (OPTN).  OPTN advertises “the need is real” with a new patient being added every ten minutes and about eighteen people dying each day waiting for one.  One organ donor can save up to 8 lives or help nearly 50 people. 

http://www.organdonor.gov/about/data.html

MaryClare Cosner, nursing student at the University of Pittsburgh, says her experiences observing organ donation are incomparable to anything else she has experienced in her education.  “Not only did he [a donor] save a woman’s life but his gift also benefited 19 other individuals awaiting organs, corneas, and skin grafts.  The choice of people to benefit others with their bodies after death can, and does, provide the recipients with previously unattainable experiences.  It enables the recipients a new lease on life and the donors a way to leave their mark on this world,” said Cosner.

              
    

Sadly for Ahmad the need is certainly very real as the kidney is the most sought out organ with nearly 94,000 people on the kidney transplant list.  The kidneys are responsible for the filtration of blood in our body.  Blood volume is filtered nearly 60 times per day.  Filtration removes excess salt, water, and waste products, which is necessary for normal maintenance of salt and water balance of the body.  This balance is essential to homeostasis – the relatively stable and constant conditions of the human body for optimal function.  Disruption of homeostasis from kidney disease occurs because chemicals build up in the body, which causes tremendous pain and suffering and could even result in death. 

Ahmad was born with nephrotic syndrome, a disease in which the kidneys are damage.  He was 5 years old when his kidneys both failed and he had to start dialysis.  Dialysis is an artificial treatment for those who have lost kidney function.  It works in the form of temporary mechanical blood filtration.  “I was on dialysis for a few years and then in 1998, I received a kidney transplant from somebody who got in a car accident.  I remember it was like it was yesterday.  I was in class and my teacher told me go to the principal’s office.  As I walked to the principal’s office, I wondered what I had done.  My mom was overwhelmed with joy as she spoke to me in the principal’s office and she told me I got a kidney.  It was a great day that day,” said Ahmad.  Although dialysis is a remarkable scientific development, it is not nearly as effective as a kidney is.  Thus, a more long-term solution is a kidney transplant but the wait for a new kidney is a long one. 

 “I was blessed for 12 years.  I was no longer a slave to a [dialysis] machine.  But in November 2010, in my third year of college, my kidney failed again.  I had to start dialysis again and it was very exhausting to my body,” said Ahmad.  His medical situation didn’t just affect him – it affects the family.  “It was a very emotional time for my parents.  When my little brother was born, he didn’t get much attention because my parents were always worried about me.  I just want to be healthy,” he said. 

According to Scientific American, a study by Johns Hopkins School of Medicine and published in the JAMA The Journal of the American Medical Association, looked at the mortality among 80,000 living kidney donors over the past 15 years, comparing them to people with both kidneys.  The study found no increase in mortality in donors once they recover from the operations.  This suggests living-donation is very low-risk.  And clearly, deceased-donor transplantation have no risks the donor needs to be concerned about.

Kidney donors have the incredible opportunity to give a person one of the few universal things that connects all human beings: health.  In addition to the intrinsic rewards associated with kidney donation, donors contribute greatly to the progress of science.  “I’m not using my organs after I die so if I can help save lives, why not?” said Brenna Rasmussen, sophomore Biology major and organ donor.  With the minimized risk of living-donor transplants and absolutely no risk associated with deceased-donor transplants, everyone should consider being a kidney donor – especially since United Network for Organ Sharing (UNOS) is considering changes to the organ allocation policy that make organ donations more successful.

As the need for organ donations is increasing daily, transplant waiting lists are being greatly scrutinized.  Should the kidney transplant list be on a first-come, first-serve basis or should each individual’s situation be evaluated to determine how valuable a kidney will be to them?  The United Network for Organ Sharing (UNOS) is the private, non-profit organization which manages distribution of organs according to the transplant waiting lists in the United States, under contract of the government.  For the first time in over 20 years, UNOS proposed changes aimed to make better use of the world’s most needed organ – the kidney. 

According to the U.S. Department of Health and Human Services, the current kidney allocation system “cannot keep up with current trends in medicine.  As waiting times for kidney transplant increase throughout the United States, the need for review of the current system and discussion of possible revisions is great.”  With the current policy, kidneys from deceased and living donors are given to candidates primarily based on the length of time the candidate has been on the kidney transplant waiting list.  The country is divided into 58 donation regions.  When donor kidney becomes available, priority is given to the individual who has been waiting the longest in that particular region.  Additional priority is given to children.  Other organ donations, such as for hearts or lungs, follow different protocols, taking into consideration life expectancy and urgency while the kidney allocation system does not at this time.  The proposed changes to the policy attempt to move in such a progressive direction because UNOS recognizes that the current policy does not necessarily maximize the overall potential of the kidney’s success.

The new system seeks to eliminate bad mismatches of donors and recipients.  With the current system, a kidney from a young and healthy individual that might function for decades may be given to an elderly patient with only a few years to live.  The opposite is also possible – a kidney from an elderly individual may be given to a young individual who may outlive the kidney and need another transplant.  These types of complications can lead to unfulfilled potential success of the kidney.  Thus, the most significant part of the proposal is to create a candidate classification index to evaluate both the candidate and the kidney by utilizing a kidney donor profile index (KDPI).  The KDPI better characterizes donor kidneys by using kidney quality to estimate the potential function of a donated kidney if it were transplanted in to the average recipient.  If the index is implemented, the top 20% of kidneys would be given to the candidates with the highest life expectancy post-transplant, maximizing the potential of the kidney and post-transplant survival.  When a resource is scarce, it is important to optimize it. UNOS states, “The proposed changes are estimated to result in an additional 8,380 life years achieved annually from the current pool of deceased donor kidneys while improving access for sensitized candidates and minority candidates.”

Some transplant specialists and bioethicists who are advocating for the policy change emphasize the more specialized matching system to be beneficial because it would be worth the extra years of potential life. Some candidates are difficult to match under the current system due to their health.  For example, it is harder to find a kidney for someone with a rare blood type (such as AB-) and the proposed classification index could allow for better organ matching.  Furthermore, in several cases, kidneys that seemed promising for a transplant were made not viable due to various problems.  Those kidneys could have been transplanted if the allocation system set up a better match.  The proposed change is to distribute lower-quality kidneys, such as older or less optimally functional kidneys, to regions with subpar kidney resources to decrease risk of discard into a medical waste incinerator.  The policy changes could also decrease the need for a repeat transplant and prevent the current problem of returns to the transplants list, in turn making kidneys more available for first-time recipients.  The more effective matching projected outcomes, decreased discard, and overall increased optimization of kidneys could result in more surgeries and procedures for healthcare providers while reducing other expensive hospital visits and dialysis sessions, benefitting both health care providers and patients.

“I agree with the new proposal.  I think that younger people who are more active in the community can get a kidney sooner than later and lead an optimal life,” said Ahmad.

http://theworldaintallsunshineandrainbows.blogspot.com/2013/02/organ-donation-saves-lives-and-i-should.html

Others disagree with the advocates and say the proposal is raising much concern.  There will be the ones who are lucky enough to be put in the top twenty percent of the index.  Conversely, there will be the other eighty percent who will not be as fortunate and could continue spending years on the waiting list.  Age will be a huge factor in deciding who gets a kidney first and this is raising fears of age discrimination.  The index and formulas of how the matched recipients will be determined may not account for everything.  Furthermore, bioethicists against the policy change are posing questions of ethical justification of the allocation. Who’s to say that it is more important for younger person to get a higher ranked kidney versus a middle aged person?  While people are happy UNOS is committed to making a more efficient and fair system, they are wondering about the commitment to increasing supply of the scarce resource.  Either way, UNOS is certainly heading in the right direction in its attempts to optimize kidney allocation.

Kidney failure was considered a death sentence not too long ago.  Today, treatments such as dialysis are helping people but are very limited in their treatment capacity.  Kidney transplants offer the most effective long-term improvement in length and quality of life.  The ethics, benefits, detriments, and the public’s consideration of the UNOS kidney allocation proposal revision are now being considered.  You may not have any experience or connection to organ donation presently but could in the future.  It is our duty to ensure that all humans get the best healthcare treatment.  We can do our part by learning about and evaluating organ donation and its associated policies.  After public consideration, the policy will ultimately be voted on by the network of Organ Procurement and Transplantation Network by the Department of Health and Services.  If the final proposal is approved, its affects will be felt immediately.

Let's Get Real

According to a Huffington Post article, 70-year-old Italian scientist Gian Paolo Vanoli claims that vaccinations cause homosexuality. In an interview, Vanoli, an advocated of alternative medicine, claims, "The vaccine is introduced into the child, the child then grows and tries to find its own personality, and if this is inhibited by mercury or other substances present in the vaccine which enter the brain, the child becomes gay. The problem will especially be present in the next generations, because when gays have children, the children will carry along with them the DNA of their parent’s illness. Because homosexuality is a disease, even though the WHO has decided that it is not. Who cares! The reality is that it is so. Each vaccination produces homosexuality, because it prevents the formation of one’s personality. It is a microform of autism, if you will. You will see how many gays there will be in the next generation, it will be a disaster."  Apparently homosexuality became prevalent after the mass administration of vaccines.  He says he doesn't "blame" homosexuals for their illness and that he supports gay marriage - he just wants people to accept that despite the World Health Organization's view, homosexuality is an illness/disease and that it is caused by vaccine. [Insert LOL here] 

For a moment, forget what your views are on homosexuality.  Think about Vanoli's claims from a purely scientific point of view.  They have absolutely no basis or sound evidence.  At least with the vaccine-autism speculation, there were attempts at scientific exploration (albeit unethical and unsuccessful).  Intrigued by the claims of this bold old man, I explored Google far and wide to find the research and basis behind his outrageous claim.  Needless to say, I have found nothing yet.  (I did, however, find one website saying "Vanoli admitted he drinks his own urine daily, “a glass every day,” because he believes it is “great therapy” to reverse the effects of vaccination." I don't know what the accuracy of this is and I am fairly certain urine does not reverse the effects of vaccines.  I'm just putting it out there the same way he put his thoughts out there.) 

It's so unfortunate that this absurd story has gone viral in the matter of just a couple days whereas sound scientific journalism does not peak as much interest.  

In my opinion, based off what I have learned about what is known about vaccines thus far, it is not possible for vaccines to confer psychological changes in an individual.  The effects of the trace amount of mercury containing preservative, thimerosal, in vaccines have not been scientifically associated with medical problems.  This scientific claim settles much better with me than someone who claims to be a scientist.
Now, bring back into play your views on homosexuality.  Vanoli's claims can certainly be a cause for anger, hurt, and mistrust in science.  Despite the findings of their research, scientists must be more sensitive in the way that research is presented. Reading Vanoli's claim trouble me deeply as a scientist, science writer, and hopefully physician.  It's very sad that these claims are published in the media with no evidence and to have the word "scientist", which most people regard with reverence, associated with it. I'm all for freedom of speech but this is just an abuse of it and I hope the scientific community responds to this.

"Fair and Balanced" (Issue Revisited)

Oh boy. I have been struggling with this journalistic idea of fairness vs. balance.  As I suggested in my last blog post, I value fair reporting over balanced reporting.  There are just some issues that don't need a balanced report (ie, global warming or HIV-AIDs association) because of the overwhelming and majority evidence.  The motto Fox News anchors claims to live and report by is "fair and balanced".  However, a study which aimed to "isolate the effects of each type of news source" reports that those who view Fox News regularly are actually less informed on current events than those who do not watch news at all.  A Fox News subscriber would be expected to answer 1.04/5 domestic questions correctly compared to 1.22/5 for those who did not watch news.  Subscribers of media outlets such as NPR (1.51/5 questions answered correctly) and the Daily Show (1.42/5 questioned answered correctly) much out-performed this "fair & balanced" news source.  This makes me wonder what the problem is (beyond the worrisome fact that it is expected most people can only answer less than 2 out of 5 questions current event questions correctly).  Is the problem fair & balanced news or the fact that Fox News does not present fair & balanced news?  Or is it something else?

 vs 

I have a hard time believing actual fair and balanced reporting would lead to the results of the study.  And since I myself am not an advocate for Fox News, the problem probably lies in the fact that Fox News does not present fair and balanced news.  However, I think it may be slightly unfair to say that's the case for only Fox News - no media outlets are completely fair and balanced.  Some do a better job than others, but media outlets are biased and severely affected by political and economic concerns.  They generally report information in a way that appeals the majority of people in that demographic.  Media outlets don't want to report things that the viewers will vehemently disagree with and at the same time, viewers don't want to listen to media sources that are not in line with their ideals.  We must accept the fact that these media outlets' survival is based on their viewership and how much influence they can create.  Essentially, certain media outlets appeal to certain people and that's what you end up supporting.  I don't watch Fox News because I don't agree with a lot of the views Fox News presents whereas I do find myself more inclined to and learning from NPR.  Fox News may be bad at presenting "fair & balanced" news but as far as Fox News viewers' current event literacy goes, it's not completely Fox News' fault - it's partly the viewer's own fault and that's just something we must accept. 

Balance vs. Fairness

I was always of the opinion that a good news article was one that had a point of view but at the same time, showed balance and presented both sides of the story so the reader could truly reflect on the issue at hand.  Chris Mooney, who wrote an article about the decline of science of in the news (which can be found here) said, "“Then there's the problem of "balance"--the idea that reporters must give roughly equal space to two different "sides" of a controversy. When applied to science, especially in politicized areas, this media norm becomes extremely problematic. Should journalists really grant equal time to the small band of scientists who deny the causal relationship between HIV and AIDS when the vast majority of researchers accept the connection between the two? Should they split column space between the few remaining global warming "skeptics" and scientific experts who affirm the phenomenon's human causation? Again, experienced science journalists will know best how to cover such stories and will be aware of the scientific community's very justifiable abhorrence or of unthinking "balance".  His piece and the discussions we've been having in class have made me reevaluate my view of balance as something necessary for scientific writing. 
I'm the type of person who, when presented with two differing views, will go do more research on that subject and try to get to the bottom of what I believe. Now that we know how little people truly spend on scientific literacy, I guess it's a little naive of me to think other people do the same.  Furthermore, if people do do the same, they may only research the side they instinctively connect with or believe which will reinforce misinformation.  It's a very dangerous fine line to tread.  
Dr. Edwards brought up a distinction that has shaped my new view - there is a difference between being balanced and being fair. I no longer believe it is necessary for science writers to present a balanced story when the majority of scientists and overwhelming scientific evidence supports one side; rather, I believe it necessary for science writers to be fair. 
Science writers have a lot to juggle already.  To be effective, their writing has to be novel, interesting, understandable, relevant and have impact in a very little space.  It would make their task even more difficult to present a balance story when one side of the story is largely irrelevant and only supported by a "small band of scientists" or skeptics. That being said, I don't think information that conflicts with the majority science should be completely dismissed.  Retractions in science occur often and there have been times where the majority belief has been replaced for a minority belief (the earth IS a sphere, not flat).  To be fair, it's still important to mention the conflict, no matter how the conflicting thought is.  It doesn't have to take much space or be presented with facts/evidence/data.  It could just be said "Despite overwhelming evidence of the causal relationship between HIV and AIDS, there are still a minority that deny it."  There's a point of view, there's support for the particular point of view, and conflict is presented so there's also something that gets people thinking. People may get curious, wonder why, and learn more about HIV and AIDs leading to an increase in scientific literacy. Boom. That's it. 

Those Scientist People

I google searched "what does a scientist look like" and the first image that came up was this mad scientist type looking guy:

And this is what my friend, Julia Glauberman, a hisotry major drew as what she imagines when she thinks of a scientist:

I would admit that up until recently, I would also picture a similar, less crazy version of the first picture when I thought of a scientist - like the second picture, more Bill Nye the Science Guy. But I'm slowly realizing that I myself am a scientist because science is not bound to a degree. While I do think having a degree or multiple degrees in a scientific field makes a person more qualified, you don't need them to be a scientist.  I started thinking and referring to myself as a scientist after I became a fellow for the Center for Science and the Common Good and other people/my professors started grouping me into the term.  At first it was really odd for me to hear because it's not the first thing I would describe myself as.  The more I thought about it, however, if I'm not a scientist, what am I?

I am a scientist, albeit not the most qualified one, and I'm surrounded by my peers and professors at school who are also scientists with varying qualifications. I no longer imagine the stereotypical traditional and incorrect imagine of a scientist shown above because scientists aren't mysterious, pensive and old white men that are slogging away in a lab.  Scientists can young, old, male, female, ethnically diverse,  and are not bound to a lab full of chemicals.  Scientists are human just like everyone else.  All the scientists I know have families, enjoy watching movies and eating good food, and certainly do not talk about science all the time - it is important for people to know this.  It is time to change the stereotype of what a scientist looks like because this misinformed image of a scientist contributes to the intimidation and mistrust people have.  mistrust is certainly partly due to the fact that science has multiple sides of the story Scientific literacy is more important than ever and it's sad that people would prefer to listen to sweet mom Jenny McCarthy on autism over a much more qualified scientist.  

It is important for people to overcome the misconceptions they have by educating themselves but it is also the responsibility of scientists to make a more positive impact - there needs to be a change in scientific personality.  Scientists need to be accessible, regular people who can communicate effectively in an interesting way. I've never walked about of a complicated science lecture saying, "Wow, that was so impressive because it was so complicated and sounded so important that I had no idea what he/she was saying!"  It impresses me far more when anyone is able to explain their work to someone who does not have any background knowledge on it. 

Science writers play a huge role in this and can help bridge the disconnect between the public and science/scientists. I find it to be important to reflect the personality of what is being written about. The most interesting and effective science articles are the ones that not only identify why the science is important for the public but throw in personal stories or something humorous for scientists to connect with the readers on an easier/more personal level because, after all, scientists actually look like this: http://lookslikescience.tumblr.com/ 

Designer Purses and Truthiness

In 2005, "truthiness" was selected as The American Dialect's society's Word of the year and in 2006, it was Merriam-Webster's Word of the Year.  The word was coined by Stephen Colbert on The Colbert Report's segment The Word.  Apparently I haven't been keeping up with the words of the year because I had never heard of the term before I saw that video.  Truthiness is characterizing a "truth" based on intuition because it feels "right" without regarding facts and evidence.  Essentially, it is following one's "gut feeling".  I've certainly read many accounts of people experiencing "gut feelings" that have lead them to do certain things or make certain decisions.  Spouses accuse their significant other of cheating without any evidence - their gut tells them so and a lot of the time, they are correct!  I've experienced those gut feelings myself but I believe there is an extent to which I can rely on truthiness to make decisions.  For example, my gut give me great vibes when I am looking at (okay, drooling over) designer handbags.  My gut tells me "oh you deserve it, Zeba! What if you never get a chance to buy that gorgeous (and very expensive) purse again?"  And then I have to force myself to remember the facts. I have to remind myself that no, I should not purchase a $500 purse. My brain tells me it is excessive, I still have more essential things to shop for, and I should check the outlet store.  As Colbert says, my brain is "all fact and no heart".
Truthiness can sometimes lead in the right direction and other times, it can lead to destruction.  Is it responsible to think and act in a manner that is truthy? Should truthiness be accepted in science?  In my opinion, there needs to be a balance.  After all, scientific experiments are conducted based on an intuitive hunch and hypothesis.  There is room for good intuition in the scientific world.  However, everyone's perspective are unique - there is bias, emotional reactions, past experiences, and several other factors that influence an individual's decision making and cause us all to see things in different ways.  Truthiness is inevitable.  Due to this, there needs to be a standard to level the playing field.  This is where facts, evidence, and scientifically sound data comes in.  Everyone's truthiness will be different and it should be evaluated against the facts and evidence found by science to determine which course of action to take.
Now, when it comes to science writers, is there a place for truthiness?  If done in a controlled and tasteful manner, I think it is possible to write from both the brain and the heart/gut.  It is, essentially, a writing style and science journalism needs style (as evident by the drastic decline in science writing).  Science writers must report the facts and should also be able to incorporate their perspective.  Reading something full of facts is not as compelling as reading something with a sense of style. However, it is extremely important that the facts and science writer's perspective are distinguished with utmost clarity.  There should be merit, not misinformation - it's a deceivingly fine line.  The reader should be able to grasp the scientific concept of the writing and be stimulated to think about it further.  Science writers are still ultimately writers and opinionated people.  Just like everyone else, they are entitled to their truthiness.  If the science writer wants to write purely from his or her gut without factual evidence, it is no longer science journalism and that type of writing should be presented in opinion blogs/other outlets. Truthiness is certainly spreading.  People become narrow-minded and grounded in their perspective, unfortunately. But, if only truthiness was presented in our media outlets, anybody could make any decision and do anything because they felt it was right.  There would be no standards and society needs standards. There is a place for truthiness in our world, but it will never be a substitute for truth.

The Time Has Come To Think

The weight of words blows me away. There is both a sense of power and a sense of weakness behind them - something truly challenging for me as an aspiring physician and science writer. This power and weakness can readily be exemplified by the vaccine and autism controversy.  No scientific study, done ethically, shows a correlation between vaccines and autism.  Furthermore, the risks associated with being unvaccinated is far grearter than the potential risks of vaccination.  Just take a look at this to put things in perspective:

However, the 1998 Wakefield et al study incorrectly claimed there was a connection between the MMR vaccine and autism.  It was later retracted/discredited for unethical research.  But, the misinformation was already out, the damage already done.  The rate of vaccinations in children fell fairly significantly after the Wakefield paper.  This leads me to so many questions!
Do people who chose not to vaccinate their children after hearing the findings of the "study" know that it was a fraudulent claim? Unlikely. I read several scientific papers and not once did I think to check if the study was still credited or not. I just assume it's data and findings were and are still valid. Furthermore, even if parents have become aware that the claims in the Wakefield study are incorrect, I think it's unlikely to change their mindset on vaccines. Once someone believes in something very strongly, it's hard to change that. 
Are new parents who attempt to increase their scientific literacy by researching vaccine information on the internet and later becoming vaccine-autism advocates necessarily scientifically ignorant? It is profoundly hard to say. People go online and read a study or a news article or a blog about how vaccines are linked to autism but they had the right intention of learning. As a scientist, I'm so pleased that people aren't just blindly doing whatever the scientists or doctors tell them to without at least trying understand it. It is important for people to find out what vaccines are, why children need them, if there are risks, what the associated risks are, etc, in order to make an informed decision regarding their child's health. On the flip side, still as a scientist, it's troubling to me that people don't know what scientifically sound evidence is and how to go about finding it to make the right decisions.  People usually fail to question what they are reading and rarely find all sides of the story. Once people believe in something, they tend to ignore evidence against their belief. This closed-mindedness, in my opinion, is a form of ignorance in itself and can lead to misinformation. 
As a science writer in support of vaccines, I want to help the average Joe get correct information in an understandable way - but with opposing and influential views (like star Jenny McCarthy's), how can this be done?   How do science writers overcome misinformation? How did a former playboy playmate with no background in science become more reliable than a scientist?! It disheartens me to say that the source through which people get information has a huge impact. Who am I? Just good ol' Ursinus pre-med student, Zeba Hussaini. That name doesn't ring a bell [- yet :)] Who are all those scientists "et al"? Dunno. Who is Jenny McCarthy? ding ding ding! That Playmate of the Year turned mother of an autistic child turned activist and author on parenting! 
Parents have autistic children and it breaks their hearts. They need to know why and they need to know the cure and they need to know it now.  Unfortunately, the science world doesn't know yet but a quick search on Google leads the parents to Jenny McCarthy claiming her son's autism had been "cured". The emotional parents cling on to the heart-wrenching words by Jenny McCarthy and other vaccine-autism advocates.  Suddenly, they have found others who are in the same position. There is power in numbers. The parents find support, something to blame, and reinforcement. There's no longer a need for sound scientific back-up because there's emotional bias, source-confirmation bias, herd-mentality bias and that, however unfortunate, is enough for people to put their children and others at risk by refusing vaccinations. This concept is so deeply ingrained in some vaccine-autism advocates that there mind is never going to change (the "gone cases"). But there are those who are a little bit more open minded and who scientists and science writers, can lead in the right direction, if done correctly. Informative and pleasant dialogue can be just what a person needs to be persuaded. Nobody wants to hear "You're wrong, this is the complicated scientific evidence why: blah blah blah blah blah." If scientists and science writers can find the source of misinformation, find evidence to back up the right information, and present it in an appealing, respectful, and most importantly, understandable dialogue, I think it would do wonders. At the very least, cause people to rethink, re-research, and reevaluate their position. And isn't thinking one of the things scientists and science writers want the general public to do?