Mark Pine

Yesterday, the New England Journal of Medicine, one of the nation’s top medical journals, published a perspective on health care supporting a single-payer health care system. Allen S. Brett, M.D., a South Carolina physician, objected to the claim made so often by conservative commentators and corporate interests that our present private-insurance health care system is uniquely fitted to core American values. He wrote:

The notion that American values militate against a single-payer system is advanced not only by advocates of preserving the status quo or making incremental changes but also by some who propose major reforms that nibble around the edges of a single-payer system. For example, Ezekiel Emanuel — now a special adviser on the Obama administration’s health care team … argues that equality of opportunity dictates universal coverage and government funding, but individualism dictates preservation of the private insurance system: “Americans clamor . . . for the chance to choose. . . . We want to choose our insurance plans, our hospitals, our doctors.”

Suppose that “freedom to choose” is indeed the paramount American value relevant to health care. For many people, it would surely imply choice of physician, hospital, or clinic. For such choice, a single-payer system beats the competition hands down. Incremental reforms preserving the private insurance industry and employer-based insurance would probably perpetuate the restricted choice of health care providers that many Americans already encounter: private plans typically limit access to certain physicians or hospitals, and physicians often refuse to accept certain plans. In contrast, single-payer proposals eliminate those restrictions.

Although American’s core values do include freedom to choose, it’s nonsense that our current system, the most expensive in the world, preserves freedom to choose for any but the wealthy.

And who is to say which values are American? Polls have shown that most American’s want to reform the current system, and from half (WSJ-NBC Poll) to two-thirds (NY Times-CBS Poll) favor inclusion of a government-run insurance option in any new system.

Republicans and conservatives are using “American values” talking points to undermine the effort to makes the changes that Americans value. Their real agenda is simple: to keep the insurance companies profiting from our expensive and malfunctioning health care system.

One of the most important reasons for reforms that would include a government-run plan is that more Americans would see how well it could work. Patients using the government-run military and veterans systems like the care they’re getting. And it’s noteworthy that the Gallup Poll found that the age group most skeptical that health care reform would benefit them are the seniors—those who already have nationwide government-run insurance.

It’s down from a high of 72% in June, but the NY Times-CBS News Poll reported today found that 66% of respondents favored the idea of the government offering a health insurance plan like Medicare to compete with private insurers.

So Max Baucus might balk, but the public isn’t. By the usual political standards, two-thirds is a landslide. He’s the chairman of the Senate Finance Committee, and he wants to craft a bipartisan bill. But since Republicans are refusing to vote for any bill including a government option, bipartisan means one without government plan.

Let’s be clear that although Baucus’ intentions may be bipartisan, his plan won’t conform to the wishes of most Americans.

Moreover, 82% of those polled believe our health care system needs either fundamental changes or a complete overhaul. If there’s vacillating support for the health care reform effort, it’s not because the public wants things to stay as they are. The poll suggests Americans are uncertain what kind of legislation we will end up with.

The poll asked a series of questions about concerns people have about the outcome. The questions focused on quality of care, access to treatment, choice of doctors, costs of insurance and possible tax increases, and how reform would affect employers’ ability to offer coverage. In each case, majorities were very concerned or somewhat concerned that things might get worse.

That is no surprise. With negotiations in flux, commentators putting forward all sorts of viewpoints, ads on all the channels, and the rising clamor of argument and criticism, it’s completely natural that Americans might be wary.

But let’s not let our natural caution hold us back from crafting a plan that expresses the overwhelming will of the people for a government offering in health care.

And let’s not let Republicans spouting talking points succeed in weakening the reform effort. The public has tossed aside the Republican’s pitch. The poll asked who had better ideas for reforming the health care system. 55% said Obama, twice as many the 26% who said the Republicans.

Two large studies of doctors and nurses reported this week in JAMA, the Journal of the American Medical Association, demonstrate that healthy lifestyle choices can significantly reduce the risk of heart failure (the heart loses power to pump blood) and hypertension (high blood pressure).

The authors of the first article at Harvard Medical School and hospitals in Boston analyzed data from the “Physicians Health Study.” Their cohort of patients included 21,000 men followed for 22 years until 2008. They were assessed in regard to six lifestyle factors related to weight, food consumption, exercise and use of alcohol and tobacco. The men with the healthiest factors cut their risk of heart failure in half.

The investigators’ lifestyle assessments were rigorous.

Each lifestyle risk factor was dichotomized: normal weight (BMI <25) vs. overweight/obese (BMI ≥25); never smoker vs. ever smoker; regular exercise (≥5 times/wk) vs. infrequent/no exercise (<5 times/wk); moderate drinking (≥5 drinks/wk vs. <5 drinks/wk); consumption of breakfast cereal (≥1servings/wk vs. none); and consumption of fruits and vegetables (≥4 servings/d vs. <4 servings/d).

The men’s lifetime risk of heart failure decreased steadily with the number of healthy factors. Those with none had a risk of over 20%; those with two had a risk of 15%, and those with four or more had a risk of 10%. The result held up even when only three factors were considered, obesity, smoking and exercise. The authors found same steady decline in risk, in this case from 18% to 8% in association with 0 to 3 healthy factors.

The second report from doctors at the same institutions analyzed the risk of hypertension, a condition associated with heart failure and other cardiovascular diseases, using data from the “Nurses Health Study.” The statistics came from 84,000 women followed from 1991-2005.

The lifestyle factors assessed included weight (BMI), exercise, diet, folic acid intake and use of nonnarcotic pain relievers, which is known to raise blood pressure. Diet was assessed in comparison to the DASH diet for controlling hypertension. A high score reflected high intake of fruits, vegetables, nuts, legumes, low-fat dairy products and low intake of sodium, sweetened beverages, and red and processed meat.

The risk of developing hypertension was measured by a hazard ratio, which compared groups with different scores on the factors to a reference group, for whom the HR was set at 1. As DASH score rose, HR declined from 1 to 0.82. With increasing exercise, the HR decreased from 1 (<1 day/wk) to 0.87 (7 days/wk). With increasing BMI the HR rose from 1 (BMI < 23) to 4.7 (BMI >= 30). Folic acid intake changed the HR from 1 (none) to 0.88 (>= 800 mg/day).

Alcohol consumption was associated with a U-shaped effect. HR decreased to 0.84 when intake rose from none to one drink per day. Then it rose to 1.61 as intake rose past 2 per day. Intake of acetaminophen and NSAIDs (e.g., ibuprofen) 6 or more days/wk raised the HR to 1.4-1.5. Aspirin used that often raised the HR to 1.22.

Heart failure causes a marked decline in quality of life and increases the risk of death. At the present rate, one in five Americans will eventually develop heart failure. Death due to heart failure occurs in 20%-50% of these patients. Hypertension is a well-known factor in causing heart failure, as well as heart attacks and strokes). The two JAMA reports show that significant reductions in the risk of developing these diseases can come from healthful lifestyle choices.

These findings have particular relevance now, in the midst of the health care debate. Our fee-for-service payment system, which is involved in most medical care, rewards doctors and other providers for doing more and more treatment. In other words, the sicker their patients and the more interventions their patients require, the more money they make.

But these JAMA studies show that real improvements in health can come from interventions that providers would probably not be paid for. In most cases, a doctor would not be remunerated for getting a patient to lose weight, exercise regularly, eat breakfast cereal, or follow the DASH diet. So providers have no motivation at the present time, other than good will, to work to help their patients prevent cardiovascular diseases in these ways. This is the kind of problem in incentives and health care delivery that must change if we our to improve the effectiveness of our health care system and reduce its costs.

An Open Letter on health care reform to Rep. Chris Van Hollen, Chairman of the Democratic Congressional Campaign Committee:

The NY Times reports this morning that the Senate Finance Committee has nixed the government option in health care reform. And the House is waiting to see what the Senate does to follow suit.

Without a government plan, health care reform is just a giveaway to the insurance industry. It will just give insurers more customers while forcing Americans to hand over more of their hard earned money to the insurance companies and health care providers.

Without the government plan, fee-for-service continues to rule. It’s the real cost problem because it rewards providers for more and more treatment. And it’s also the real health quality problem, because it doesn’t emphasize preventive medicine and lifestyle measures, since they reduce the amount of treatment.

Only a government plan can bring down costs by changing the way health care is managed and paid for.

Obama is a wimp. He sounds strong when he talks, but he tiptoes when he walks. Now is the time to twist arms, to put backsliding senators and representatives in hammerlocks. Does the president have any muscle? Will he come through on this?

Will you come through on this? I’m a loyal Democrat. I vote without fail. I’ve worked for you in all your campaigns. But if there’s no government option in healthcare reform, I’m out of it in the next two elections. I won’t even vote.

Saturday, the NY Times ran a story by science reporter John Markoff titled “Scientists Worry Machines May Outsmart Man.” The article gave examples of a robot that doesn’t need humans to recharge itself, an unstoppable computer virus, autonomous killer drone aircraft, and machines that simulate human conversation and emotions. The reporter wrote:

Impressed and alarmed by advances in artificial intelligence, a group of computer scientists is debating whether there should be limits on research that might lead to loss of human control over computer-based systems.

According to the article, the computer scientists at the conference said there is still a long way to go to create a computer like Hal in “2001: A Space Odyssey.” And they “discounted the possibility of highly centralized superintelligences and the idea that intelligence might spring spontaneously from the Internet.”

Discounted the possibility? I would like to know why. The article doesn’t explain. Do they say this mainly to reassure us? So that those of us not there (at the Asilomar Conference Grounds on Monterey Bay in California, where this conference took place) don’t panic, rise up in fear, and march as Luddites united demanding: No more work on computer intelligence!

The reporter gives no explanation for the “discounting.” On the contrary, to my mind, there’s good reason to think this is precisely what will happen: Supercomputers will become intelligent and the internet will develop intelligence, and both of these things probably are happening now.

After all, what faculties are there in our brains giving us intelligence that do not already reside “out there” in computer systems hooked together by internet cables—just like the functional centers of our brains are hooked together by trunks of axons? There are databases of words, images, and facts (i.e., memory systems); there are systems that receive data from the environment (i.e., sensory systems); there are processors running machines that do tasks and do work (i.e., motor systems); there are computers that delegate and integrate operations (executive and homeostatic systems); there are artificial intelligence systems (such as those learning to speak and interact with humans); and last but not least, there is the internet that connects the computer systems.

Supercomputers are being constructed now, so why should they not be able to execute these functions and become intelligent? And since the internet is connecting the supercomputers, why shouldn’t the internet become intelligent?

This idea is not new. The reporter cites a spectacularly prescient essay, “The Coming Technological Singularity: How to Survive in the Post-Human Era,” written in 1993 by Vernor Vinge of the Department of Mathematical Sciences, San Diego State University. Vinge proposes, “Large computer networks (and their associated users) may ‘wake up’ as a superhumanly intelligent entity.”

The article, therefore, does not break news. Rather, what is eye-catching about the Times piece is, of course, the possibility that these developments may present a danger to humanity and may therefore be cause for “worry.”

According to the article, possible dangers, in addition to those mentioned above, might include criminals controlling superintelligent computers and computers putting people out of work or displacing humans in other ways, including as companions. But I suspect that if the title word “worry” accurately reflects the tenor of the conference, the greatest fear is, in Vernor’s words, “the human era will be ended” and that a post-human world of computer beings will begin. He asks, “just how bad could the Post-Human era be? Well … pretty bad. The physical extinction of the human race is one possibility.”

This is a characteristically human worry, I think: That we may need to defend ourselves from extinction from approaching changes and new situations, and that we ought to prepare ourselves to resist them. It’s like the way we view the possibility of Iran developing nuclear weapons or North Korea developing missiles to hurl their weapons at us.

Although Iran and North Korea do present real dangers, I do not think the same considerations apply to the possibility of machines and the internet developing superintelligence. The difference is that Iran and North Korea are different nations from us, with their own interests that may contradict ours, but this difference does not exist between humans and computers or humans and the internet.

Humans are part of the world of computers and internet, which is developing around us so rapidly. We are not separate from it. In the future, the humans will continue to use the computers, and (although we usually don’t speak this way) the computers will continue to use the humans. As the internet grows, humans will use it more and more. If we discover one day evidence of intelligent internet functioning, that internet-being won’t be separate from humans, we humans will be part of it, and we will experience and benefit from the wonderful things that this humans-computers-internet-being is able to see and do.

Vinge’s remarkable essay even considers this possibility. He writes:

Every time our ability to access information and to communicate it to others is improved, in some sense we have achieved an increase over natural intelligence. Even now, the team of a PhD human and good computer workstation (even an off-net workstation!) could probably max any written intelligence test in existence.

Vinge lists some things human-computer combinations might work together on: technological problems, art, games and pastimes, and he writes of the “worldwide Internet as a combination human/machine tool.” Still, I’m not sure Vinge got what he himself was saying.

I’m going to make the claim without justifying it that what really bothers us is that we humans might be excluded from the superconsciousness that emerges in the post-human era. We fear that the huge computer-internet being will have a consciousness all its own, different from ours, vastly larger and more complex, and humans will not be part of it.

We should not fear this. We do not need to worry. We won’t be separate from the consciousness of computers and the internet. We are now communicating through the internet and with the internet (i.e., with the computers on the internet) continually. For example, as I write this, I am communicating with my desktop computer, and when I post, I will be communicating with the internet.

And communication IS consciousness.

My favorite example illustrating how consciousness and communication are the same comes from the split-brain experiments. (I posted about this previously.) Patients back in the 1980s had their brain hemisphere connections (corpus callosum) severed as a treatment for intractable epilepsy. They emerged from the operation with two separate consciousnesses, one in each hemisphere.

The point of the illustration is this: Before the operation the patients had two hemispheres, but they had only one consciousness. That was because their hemispheres were communicating continually via the callosum.

Just as communication via the callosum expands and unifies brain consciousness, internet communication will expand and unify human-computer-internet consciousness. In the future, we humans will continue to communicate through and with the internet and the computers connected to the internet, just as we do now. Because of this, we should not doubt that human consciousness will be expanded and will be unified with that vast network of computers and connections. The vast and complex consciousness of humans, computers, and the internet will be ours. We will be part of it.

However, there is something we should worry about regarding this future: We should make sure that no humans anywhere get left out. Everyone on earth should get an internet connection, and a computer, and the training to use it. There should be no elites in the future—the few who have access to this unified communication and consciousness—and the masses or the minorities who do not. We must make sure everyone gets included!

Have you assumed that the seven-time Tour de France winner, Lance Armstrong, doped his way to victory all those years? His performance this year should go far to canceling your doubts.

Today Armstrong finished third in the Tour, 5 minutes behind his yellow-jersey teammate, Alberto Contador, and 4 minutes behind second place Andy Schleck. Lance is 37, and he returned this year to the Tour after a four-year hiatus. Contador is 26, a superb time-trial rider and fabulous climber. Schleck is 24, also a fabulous climber.

Although Armstrong could not match Contador’s astounding ability to accelerate up the steep climbs of the Pyrenees and the Alps, he displayed solid power to climb and attack on the slopes this year.

Today was effectively the final day of the contest before the ride into Paris tomorrow, when traditionally the riders don’t try to alter the standings. Lance and Contador often climbed in tandem, and sometimes the yellow jersey led the way for his teammate, breaking the stiff headwind, while they ascended 6000-ft. Mt. Ventoux, the giant of Provence.

But Lance had no trouble staying with the leaders. He kept on Contador’s wheel or on that of Frank Schleck, Andy’s brother, who also competed in the Tour. Fifth-place Frank tried several times to break away from Lance to gain time and move into third place—but to no avail. Lance never gave him a chance.

Drug testing this year was extensive. There were 500 doping tests for 180 riders, but the tests weren’t distributed equally. The 50 top riders, including Armstrong, received more testing. Testers had the option of announcing surprise tests as late as 15 minutes before the end of the stage races. And each cyclist carried a biological passport, showing the history of his previous blood test results, so that notable discrepancies could easily be detected.

We can have confidence this year that Armstrong and the other riders who will finish the Tour achieved their places without help of banned substances. For Armstrong the third place finish—at his age and after his years of absence—provides confirmation that he has always had the physical ability and stamina accomplish his victories.

I have always thought the Tour de France the most demanding of all sporting events. Armstrong’s spectacular record earns him a place as one of the greatest athletes of all time. Unlike many, I tended to believe his victories were not accomplished with chemical enhancement. I thought a cancer survivor would probably not use substances—growth factors and anabolic steroids—that could increase the chances of developing another tumor.

It is a wonderful day. The return of this great cyclist to win a place on the Tour de France victory podium is extraordinary, as were his other triumphs. Those who admire prowess and performance in athletics have been given good reason to have renewed faith that greatness can be achieved without secret biological manipulations that cast shadows of doubt and disgrace.

It’s the last week of July. For many children, the school year starts at the end of next month. And some infectious disease researchers are expecting a large upswing in the number of cases of swine flu when school begins. Robert Belshe, MD, director of the Center for Vaccine Development at St. Louis University School of Medicine and a co-investigator on research studies to test vaccines for the flu, said:

It’s looking more and more like we’re going to have a big flu outbreak this fall as soon as the kids get back to school. Influenza is unpredictable, but I believe this pandemic will hit pre-teens, teens and their parents hard, and as many as 60 million Americans could be sick with the flu.

To date, the CDC reports 44,000 cases of flu and 300 deaths (0.7%). Each year, the agency estimates, about 36,000 flu-related deaths occur from seasonal flu. So far most cases of swine flu have been mild.

Swine flu is a new virus, which people haven’t been exposed to and probably have no resistance to. For that reason, governments around the world have mounted crash programs to develop and produce vaccines, which are the most effective way of preventing widespread flu illness. The first clinical trial of a candidate vaccine began this week in Australia. The purpose of the research is to test whether the vaccine is safe to use and stimulates substantial immunity to the illness.

In the US, the NIH has established eight centers around the nation to test swine flu vaccines. Besides testing effectiveness and safety, one of the questions to be investigated is whether the swine flu vaccine can be given along with vaccine to ordinary seasonal flu, which will probably also occur as usual this fall.

The US government is working to have vaccine available for use this fall, but it’s not likely that there will be doses enough for everyone. First to receive the vaccine will probably include children and younger adults, pregnant women, health care personnel, and people who have underlying health conditions. The virus is also susceptible to the antiviral drugs oseltamivir and zanamivir.

Also reported this week, researchers at the University of Alabama have identified a flu virus protein responsible for damaging the lungs. The protein, called M2, injures the cells lining the air passages and sacs in the lung by increasing the amount of oxidants within the cells. The injuries can allow fluid to leak through the lining cells into the air spaces of the lungs and cause difficulty breathing. Since the damage appears to be caused by oxidants, there is the possibility that antioxidants, like vitamin C, might lessen it. This researchers reported that antioxidant treatment worked to prevent damage in a laboratory model.

The news media haven’t highlighted the expenses Americans individually pay out for health care now, without reform. But Tuesday, David Leonhardt, the NY Times financial columnist, gave us specific information.

Since one-sixth of our nation’s GDP is expended for health care, the typical household spends $15,000 per year on health. That’s $6,500 more than the household average of other wealthy nations. Yet, in 2000, the World Health Organization used life expectancy to assess health care effectiveness in 191 nations. The U.S. ranked 37th.

One of our nation’s leading providers of high quality health care at low cost is the Cleveland Clinic. Physicians at the clinic receive salaries rather than fees for service. As a result, they practice and prescribe without considering their own income, since it doesn’t change with the number of patients they see or the number of procedures they perform (unlike most American doctors). Leonhardt quotes Delos Cosgrove, one of the clinic’s heart surgeons:

I came here 30-some years ago. And I have never received any additional pay for anything I did. It never made a difference if I did five heart operations or four — I got paid the same amount of money. So I had no incentive to do any extra tests or anything.

For 25 years, I’ve received medical care at Kaiser-Permanente of the Mid-Atlantic States. Like the Cleveland Clinic, Kaiser puts physicians on salary. As a doctor and sophisticated medical consumer, I’ve always felt that the care I received has been first rate. Occasionally, I’ve had to wait for an appointment with a specialist but not with my primary doctor. When I’ve had an acute condition, I’ve always gotten seen in a day or two.

Despite the good care, on several occasions, I’ve temporarily left Kaiser for the world of fee-for-service care. The most recent time, about 2-1/2 years ago, I wanted insurance to cover me in Maryland, the location of my Kaiser clinic, which provides service only within its territory. But I also needed coverage in Massachusetts, where I have my summer home. I selected Blue Cross, which provides coverage nationwide. I ended up very unhappy with the Blue coverage. The problems included finding doctors, getting lab tests, and paying copay after copay.

The last problem was the worst. I had a routine colonoscopy in the spring. The copay bills didn’t stop coming all year: for the gastroenterologist, the pathologist, the clinical lab, etc. etc. There was a copay for each provider, most of whom I didn’t select or visit personally. I didn’t add up all the bills, and I never knew whether they were correct. Indeed, I called Blue Cross about one bill and learned that it had been sent in error, and I didn’t have to pay it. But I wouldn’t have known if I hadn’t checked.

I can say this to Americans: If you want fee-for-service, with all its uncertainties and expenses, you can have it. The president’s plan gives you the ability to keep the insurance you have. I’ll always choose to get care where the doctors are on salary, and the copays are low frequency and low cost.

Diabetes was a big subject in my family. It’s what killed my mother’s mother, who lived until I was 12. But for all the time I remember her, she suffered from the disease and looked scrawny and weak. I remember how my mother, who was a dietician, worried about her. Back then, we understood that diabetes was caused by too much sugar. The disease, after all, is diagnosed by high blood glucose levels. Mom told me I should not eat a lot of candy, or I would get the disease, too.

So recent ideas about the causation of diabetes seem radically different to me. This is the subject of an article on insulin resistance this month in Science. The report explained that all the evidence points to a problem with the body’s ability to handle and store fat. If that’s the case, perhaps it’s why diabetes has increased in parallel with obesity in the last 40 years. Among Americans, the prevalence of both conditions has doubled during that time span.

Central to diabetes are the actions of insulin, which promotes the storage of glucose as glycogen, fatty acids as fat, and amino acids as protein. To stimulate glucose storage, the hormone triggers the uptake of the sugar from the blood into liver and muscle cells, and in so doing lowers the glucose level in the blood. Diabetics become insensitive to this action of insulin and high blood glucose levels result. Called insulin resistance, it’s the diagnostic and fundamental condition at the core of diabetes.

But diabetes has many deleterious effects besides raising blood sugar. High glucose levels appear to injure blood vessels, and since all organs depend on their blood supply, many organ systems get damaged, including the heart, eyes, kidneys, brain and nerves, skin and others.

The Science paper describes two competing theories of the cause of diabetes: inflammation and fat over load, and it reports the evidence for each one. But it turns out that both disease mechanisms may be involved in diabetes, and both also involve a defect in the handling of fat and fatty acids. One researcher quoted in the article, Gerald Shulman, an endocrinologist at Yale, said:

One likely possibility is that people simply eat too much for their level of physical activity. The excess nutrients, in this scenario, then overwhelm the fat tissue, causing the fat cells to expand and secrete inflammatory molecules, or they spill out of the fat tissue and instead accumulate where they don’t belong. But that doesn’t explain why some obese individuals—often very obese—remain resolutely insulin sensitive. This suggests that something about the fat tissue itself, and maybe its ability to absorb and retain fatty acids and do so in a manner that doesn’t induce inflammation, is the fundamental defect….

The article concludes by noting that “when individuals lose weight, they become more insulin sensitive. If nothing else, this has given researchers the confidence to assume that excess body fat—particularly in the abdomen and around the internal organs—is a fundamental cause of insulin resistance.

I inherit a family history of diabetes though my mother, as noted. But my dad also died while suffering from type II diabetes, although he never required insulin. So the disease comes at me from both sides. For many years of my life, I was obese; all my life my weight yo-yoed up and down. When I passed 60, I finally decided I could spend no more years ignoring the risks. As a result, I lost 40 lbs. about three years ago, and I’ve kept it off since. Thankfully.

A Science Magazine article on learning in early childhood reveals with remarkable clarity the processes whereby an infant discovers how to behave, talk, and comprehend. The review paper by researchers at the Universities of Washington and California points to capacities and mechanisms that work together in the learning infant—statistical computation, social interaction, and imitation.

Scientists have discovered that babies, even neonates, have computational capabilities for estimating the statistical frequencies of events and the probabilities of association of events, which allows them to infer causal relationships. And babies use similar statistical capacities to determine the frequencies and association probabilities of sounds in verbal utterances, which allows them to parse words, infer grammar, and learn language.

But this learning is motivated and guided by social contact. Babies do not direct their computational abilities randomly. Parents and significant others focus their attention. Babies observe and calculate the frequencies and probabilities of events and language sounds in interactions involving these important other people.

This statistical learning is closely connected to capacities for imitation. “Newborns as young as 42 min old match gestures shown to them, including tongue protrusion and mouth opening,” according to the authors. Areas of the brain for sensory observation and motor expression get connected in this learning process. Magneto- encephalographic studies have revealed “nascent neural links between speech perception and production. At 6 months of age, listening to speech activates higher auditory brain areas (superior temporal), as expected, but also simultaneously activates Broca’s area, which controls speech production, although listening to nonspeech sounds does not.”

Thus, in recent years, research has shown learning to involve astonishing innate computational abilities and capacities for social interaction and imitation. The authors describe “a convergence of discoveries in psychology, neuroscience, and machine learning [that] has resulted in principles of human learning.” They express hope that a “new science of learning” will arise to transform educational practices.

In reading this remarkable article, I felt hopeful that a new science of learning might soon get integrated into efforts to improve education in our nation, particularly in underperforming schools. For example, the article shows how educational performance may be connected to the effectiveness and quality of teachers.

The Department of Education has stressed that “Research shows that the most important factor in determining student performance is a highly skilled, highly effective teacher in the classroom.” And President Obama has declared, “It’s time to start rewarding good teachers, stop making excuses for bad ones.”

The science reported in the article supports this emphasis on the role of teacher. It has shown that social interactions are vital for learning. It explains that learning is intimately involved with interpersonal contacts between the teacher and the pupil.

Learning occurs when the learner pays close attention to and shares observations with important other people, who by their example can motivate and guide the neurological processes and developments activated in the learner’s brain. The dependence on others and the social nature of learning begins with birth, and in all likelihood it continues throughout childhood.